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BACKGROUND: Functional impairment is the main consideration when it comes to choosing therapy for infantile hemangiomas (IH). However, since most hemangiomas are treated for cosmetic reasons, it is important to know the cosmetic outcome assessed by the parents. OBJECTIVE: To evaluate the aesthetic outcomes of IH, considering the characteristics of the lesions and the treatments used. PATIENTS AND METHODS: The Spanish Infantile Hemangioma Nationwide Prospective Cohort (2016-2022) recruited all consecutive patients diagnosed with IH in 12 Spanish hospitals. The children included had two photos of the IH lesion (at both baseline and at the end of the study). A panel of parents blindly assessed all available photos using a scale from 0 (worst cosmetic outcomes) to 10 (best cosmetic outcomes). The different scores - both before and after treatment - as well as the outcomes percent considered excellent (>9) were described and compared. We analyzed the effect of receiving different therapies and performed causal model analyses estimating the mean treatment effect of parents' assessments. RESULTS: The median follow-up was 3.1 years. A total of 824 photos were evaluated. Baseline aesthetic impact was higher in the propranolol group vs the topical timolol and observation treatment groups (1.85 vs 3.14 vs 3.66 respectively; p<0.001). After treatment, the aesthetic impact was similar between both treatment groups (7.59 vs 7.93 vs 7.90; p>0.2). The causal model could only be applied to the comparison between topical timolol and observation, revealing no differences whatsoever. CONCLUSION: This is the first prospective cohort to analyze the aesthetic outcome of IH. The final aesthetic results of the three therapies were similar, with nearly 40% of patients achieving excellent aesthetic outcomes.
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Introducción Existen diversas opciones terapéuticas para los hemangiomas infantiles (HI). El propranolol se utiliza con base en un ensayo pivotal. Nuestro objetivo fue describir las características del HI en la práctica clínica, incluyendo las terapias utilizadas, así como comparar las características de los pacientes tratados con propranolol y las de los pacientes del ensayo, para valorar su validez externa. Métodos Se incluyó consecutivamente a los pacientes que acudieron a doce hospitales españoles desde junio de 2016 a octubre de 2019 (n=601). Resultados La edad media fue de 3,9 (DE:1,9) meses, con una ratio mujer-varón de 2:1. La mayoría de los HI fueron de tipo localizado (82%, 495), superficial (64%, 383) y ubicados en cara (25%, 157) y tronco (31%, 188). El tamaño mediano fue de 17 (RI: 10-30) x 12 (RI: 7-20) mm. Se encontraron complicaciones en 16 (3%) pacientes. Se inició tratamiento en el 52% (311) de los casos. La mayoría de los pacientes recibió timolol (76%, 237), reservándose propranolol para las complicaciones o los HI de alto riesgo. El compromiso estético fue el principal motivo de iniciar la terapia (64%, 199). Las diversas características de los pacientes y de los HI tratados con propranolol fueron similares a las del ensayo clínico pivotal, aunque 1/3 de los HI no alcanzó el diámetro mínimo para cumplir los criterios de inclusión, y no se comunicó información pronóstica importante. Conclusiones Dado que muchos pacientes reciben tratamiento debido al compromiso estético, existe una necesidad de conocer mejor los resultados estéticos de las terapias e incrementar la evidencia sobre el uso de timolol, que actualmente es la terapia más común. El propranolol está siendo utilizado en una población generalmente similar a la del ensayo; sin embargo, esta afirmación no puede confirmarse de manera definitiva (AU)
Background There are several therapeutic options for infantile haemangiomas (IH). Propranolol is used according to a pivotal trial. We aimed to describe the characteristics of IH in clinical practice, including the therapies used, and to compare the characteristics of patients treated with propranolol with those of the trial to assess its external validity. Methods Consecutive patients attending 12 Spanish hospitals from June 2016 to October 2019 were included (n=601). Results The mean age was 3.9 (SD:1.9) months, with a 2:1 female-to-male ratio. Most IHs were localized (82%, 495), superficial (64%, 383) and located in the face (25%, 157) and trunk (31%, 188). Median size was 17 (IR: 10-30) x 12 (IR: 7-20) mm. Complications were found in 16 (3%) patients. Treatment was initiated for 52% (311). Most patients received timolol (76%, 237); propranolol was reserved for complications or high-risk IHs. Aesthetic impairment was the main reason for starting therapy (64%, 199). Several characteristics of the patients and IHs treated with propranolol are similar to those of the pivotal clinical trial, but 1/3 of IHs did not reach the minimum diameter to meet the inclusion criteria, and important prognostic information was not reported. Conclusions As most patients receive treatment for aesthetic impairment, there is a need to better understand the aesthetic results of therapies and to increase evidence on the use of timolol, which is currently the most common therapy. Propranolol is being used in a population generally similar to that of the trial; however, this statement cannot be definitely confirmed (AU)
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Humanos , Masculino , Femenino , Lactante , Hemangioma/tratamiento farmacológico , Hemangioma/epidemiología , Propranolol/uso terapéutico , Vasodilatadores/uso terapéutico , Estudios de Cohortes , Estudios Prospectivos , Academias e Institutos , España , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
BACKGROUND: There are several therapeutic options for infantile haemangiomas (IH). Propranolol is used according to a pivotal trial. We aimed to describe the characteristics of IH in clinical practice, including the therapies used, and to compare the characteristics of patients treated with propranolol with those of the trial to assess its external validity. METHODS: Consecutive patients attending 12 Spanish hospitals from June 2016 to October 2019 were included (n=601). RESULTS: The mean age was 3.9 (SD:1.9) months, with a 2:1 female-to-male ratio. Most IHs were localized (82%, 495), superficial (64%, 383) and located in the face (25%, 157) and trunk (31%, 188). Median size was 17 (IR: 10-30) x 12 (IR: 7-20) mm. Complications were found in 16 (3%) patients. Treatment was initiated for 52% (311). Most patients received timolol (76%, 237); propranolol was reserved for complications or high-risk IHs. Aesthetic impairment was the main reason for starting therapy (64%, 199). Several characteristics of the patients and IHs treated with propranolol are similar to those of the pivotal clinical trial, but 1/3 of IHs did not reach the minimum diameter to meet the inclusion criteria, and important prognostic information was not reported. CONCLUSIONS: As most patients receive treatment for aesthetic impairment, there is a need to better understand the aesthetic results of therapies and to increase evidence on the use of timolol, which is currently the most common therapy. Propranolol is being used in a population generally similar to that of the trial; however, this statement cannot be definitely confirmed.
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Liquen Plano/diagnóstico , Piel/patología , Adolescente , Biopsia , Niño , Preescolar , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Adulto JovenRESUMEN
We report a case of primary cutaneous infection by the emerging fungus Aspergillus ustus in an immunosuppressed patient after a domestic accident. The patient failed to respond to itraconazole and died before receiving a new treatment with amphotericin B. There have been eight other cases reported since 1973, and only two patients survived the infection. In vitro susceptibility testing of seven antifungal drugs showed that terbinafine and the new azole derivative UR-9825 were the most active against this fungus.
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Aspergilosis/microbiología , Aspergillus/aislamiento & purificación , Dermatomicosis/microbiología , Anciano , Femenino , Humanos , Huésped InmunocomprometidoRESUMEN
We describe a case of Ofuji's papuloerythroderma (PE) in a 72-year-old man with biliary sepsis induced by choledocholithiasis. The PE disappeared completely after surgery with no relapse. This aetiology for PE does not appear to have been described previously, while its resolution after treatment of the primary process supports the idea that it may be a reactive disorder of multifactorial origin.
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Dermatitis Exfoliativa/etiología , Cálculos Biliares/complicaciones , Sepsis/complicaciones , Anciano , Dermatitis Exfoliativa/patología , Cálculos Biliares/cirugía , Humanos , MasculinoRESUMEN
We report a 4 year-old boy affected with hypohidrotic ectodermal dysplasia in whom loose anagen hair syndrome (LAHS) was suspected clinically. The diagnosis was confirmed by examination of hair by optic and scanning electron microscopy. Loose anagen hairs have not been previously described in the ectodermal dysplasias. It is possible that our patient had real LAHS or an ectodermal dysplasia with loose anagen hair as an epiphenomenon.
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Displasia Ectodérmica/complicaciones , Folículo Piloso/patología , Preescolar , Diagnóstico Diferencial , Displasia Ectodérmica/diagnóstico , Displasia Ectodérmica/fisiopatología , Enfermedades del Cabello/complicaciones , Enfermedades del Cabello/diagnóstico , Enfermedades del Cabello/patología , Humanos , Masculino , Microscopía ElectrónicaRESUMEN
Papuloerythroderma (PE) is a rare type of erythroderma of the elderly which results from the coalescence of sheets of papules that spare skin folds, with peripheral eosinophilia in most cases. Skin biopsy shows a nonspecific eczematous pattern with a mature T cell lymphocytic and eosinophilic infiltrate with Langerhans cells in the dermis. We report 2 cases of PE. The 1st case, in which no underlying malignancy could be found, responded partially to oral etretinate, topical steroid creams and tar derivates. The 2nd case did not respond to high-dose oral steroids and was associated with adenocarcinoma of the colon, with a fatal outcome. PE has been associated with lymphoma and carcinoma. We report the first European case of PE associated with visceral carcinoma and review the cases reported in the western literature.
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Adenocarcinoma/complicaciones , Dermatitis Exfoliativa/complicaciones , Neoplasias del Recto/complicaciones , Enfermedades Cutáneas Vesiculoampollosas/complicaciones , Administración Tópica , Anciano , Anciano de 80 o más Años , Antiinflamatorios/uso terapéutico , Dermatitis Exfoliativa/tratamiento farmacológico , Dermatitis Exfoliativa/patología , Eccema/patología , Eosinofilia/complicaciones , Eosinofilia/tratamiento farmacológico , Eosinofilia/patología , Etretinato/uso terapéutico , Europa (Continente) , Resultado Fatal , Femenino , Glucocorticoides , Humanos , Queratolíticos/uso terapéutico , Células de Langerhans/patología , Masculino , Piel/patología , Enfermedades Cutáneas Vesiculoampollosas/tratamiento farmacológico , Enfermedades Cutáneas Vesiculoampollosas/patología , Linfocitos T/patología , Breas/uso terapéuticoRESUMEN
Alternaria longipes was reported as the agent of a cutaneous infection in a patient with a neoplastic disease. The fungus has not been reported previously as causing disease in humans. It was distinguished by its rather small conidia with smooth or slightly verruculose walls and a pale brown beak which rarely extended into a secondary conidiophore. In vitro inhibitory activities of amphotericin B, ketoconazole, itraconazole, and miconazole were shown.
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Alternaria/aislamiento & purificación , Dermatomicosis/microbiología , Huésped Inmunocomprometido , Alternaria/citología , Alternaria/efectos de los fármacos , Antifúngicos/farmacología , Carcinoma de Células Escamosas/complicaciones , Carcinoma de Células Escamosas/tratamiento farmacológico , Dermatomicosis/complicaciones , Dermatomicosis/patología , Pie/patología , Antebrazo/patología , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Neoplasias de los Senos Paranasales/complicaciones , Neoplasias de los Senos Paranasales/tratamiento farmacológico , Reacción del Ácido Peryódico de SchiffRESUMEN
Patients with human immunodeficiency virus (HIV) infection are prone to severe drug reactions, mainly from sulfonamides. We report the case of a 33-year-old male patient with HIV infection (group IV C-2 of CDC staging system) that developed a toxic epidermal necrolysis (TEN) affecting more than 70% of the body surface area and severe mucosal involvement after starting fluconazole for a recurrent oral thrush with dysphagia. This is to our knowledge the first reported case of TEN due to fluconazole.
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Fluconazol/efectos adversos , Infecciones por VIH/complicaciones , Síndrome de Stevens-Johnson/etiología , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Adulto , Candidiasis Bucal/tratamiento farmacológico , Fluconazol/uso terapéutico , Humanos , MasculinoAsunto(s)
Sarcoma de Kaposi/epidemiología , Neoplasias Cutáneas/epidemiología , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Europa (Continente)/epidemiología , Femenino , Homosexualidad , Humanos , Masculino , Sarcoma de Kaposi/etiología , Sarcoma de Kaposi/terapia , Neoplasias Cutáneas/etiología , Neoplasias Cutáneas/terapia , España/epidemiología , Estados Unidos/epidemiologíaRESUMEN
The features and prognostic factors of 67 cases of Kaposi's sarcoma (KS) associated to the acquired immunodeficiency syndrome (AIDS) diagnosed at the Hospital Clinic, Barcelona, are analyzed. All the patients were male; mean age was 39.7 years, ranging from 22 and 62 years. 64 were homosexuals (95.5%), two were homosexual-drug addicts (3%) and one was drug addict (1.5%). Prevalence of cytomegalovirus and herpes virus infections were 91.1% and 89.5% respectively. In 42 cases (62.7%) KS was the initial AIDS presentation. The most common localization was the skin (89.5%), followed by the digestive tract (52.2%) and the lymph nodes (22.4%). Staging distribution was: 20 patients (29.8%) were in stage I, 11 patients (16.4%) in stage II, 7 patients (10.4%) in stage III, and 29 patients (43.2%) in stage IV. Constitutional symptoms associated to KS were found in 37 patients (55%). Overall 39 patients have already died, and the actuarial survival possibility of these 67 cases was 55% after 12 months. Univariant statistical analysis showed the presence of six variables with prognostic significance (p less than 0.05): staging, symptomatology, total white blood count, total lymphocyte count, T helper lymphocyte count and hemoglobin. Multivariant statistical analysis only chose the staging and symptomatology variables as independent (p less than 0.01 and p less than 0.001, respectively).