RESUMEN
La prevalencia global de la onicomicosis pedis es de 4,3%, y en hospitalizados puede llegar hasta 8,9%. Aun así, se propone que está ampliamente subdiagnosticada. Personas añosas con comorbilidades presentan mayor riesgo de onicomicosis pedis y de sus complicaciones. Se examinaron aleatoriamente a 64 pacientes hospitalizados en el Servicio de Medicina del Hospital San José. A aquellos con signos clínicos de onicomicosis pedis se les realizó un examen micológico directo (MD) y estudio histopatológico de un corte de uña teñido con PAS (Bp/PAS). Muestra de 64 pacientes, un 78,1% presentó onicomicosis pedis clínica y en un 70,3% se confirmó el diagnóstico con MD y/o Bp/PAS positivo. De los pacientes con onicomicosis confirmada, el promedio de edad fue de 67,8 +/- 12,3 años. Un 44% correspondió al sexo femenino y un 56% al sexo masculino. La onicomicosis pedis en el servicio de medicina interna del Hospital San José es una condición frecuente. El conjunto de MD y Bp/PAS podría ser considerado como una buena alternativa diagnóstica. (AU)
Onychomycosis of the toenails has a global prevalence of 4,3% and can reach up to 8,9% in hospitalized patients. It has been hypothesized that it is widely under diagnosed. Aged patients with multiple diseases have an increased risk of Onychomycosis and its complications. 64 patients of the internal medicine ward were randomly selected. Those who had clinical signs of onychomycosis of the toenails were tested with direct microscopy and histological study of the nail plate with PAS staining. Of the 64 patients, 78,1% (50) had clinical signs of onychomycosis of the toenails and in 70,3% (45) the diagnosis was confirmed either by direct microscopy and/or by histological study of the nail plate with PAS staining. The mean age for the group with onychomycosis was 67,8 +/- 12,3 ages. 44% were female and 56% were male. Onychomycosis of the toenails is a frequent condition at the internal medicine ward of the San José Hospital. The direct microscopy together with the histological study of the nail plate with PAS staining seem to be a good diagnosis alternative. (AU)
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Onicomicosis/epidemiología , Centros de Atención Terciaria/estadística & datos numéricos , Dermatosis del Pie/epidemiología , Chile/epidemiología , Prevalencia , Onicomicosis/diagnóstico , Onicomicosis/microbiología , Onicomicosis/patología , Dermatosis del Pie/diagnóstico , Dermatosis del Pie/microbiología , Dermatosis del Pie/patología , Hospitalización/estadística & datos numéricosRESUMEN
Onychomycosis is estimated at a prevalence of 10% worldwide with the infecting organism most commonly Trichophyton rubrum (T. rubrum). Traditional culture identification of causative organisms has inherent risks of overestimating dermatophytes, like T. rubrum, by inhibiting the growth of possible nondermatophyte mould (NDM) environmental contaminants which could be causative agents. Recently, molecular methods have revealed that a proportion of onychomycosis cases in North America may be caused by mixed infections of T. rubrum as an agent co-infecting with one or more NDM. Determining the global burden of mixed infections is a necessary step to evaluating the best therapies for this difficult-to-treat disease. To determine the prevalence of mixed infections in a global population, nail samples from onychomycosis patients in Brazil, Canada, and Israel (n = 216) were analyzed by molecular methods for the presence of dermatophytes and five NDMs. If an NDM was detected, repeat sampling was performed to confirm the NDM. T. rubrum was detected in 98% (211/216) of infections with 39% mixed (84/216). The infection type was more likely to be mixed in samples from Brazil, but more likely to be a dermatophyte in samples from Canada and Israel (Χ2 = 16.92, df = 2, P<0.001). The most common cause of onychomycosis was T. rubrum. In all countries (Brazil, Canada and Israel combined) the prevalence of dermatophyte (Χ2 = 211.15, df = 3, P<0.001) and mixed (dermatophyte and NDM; Χ2 = 166.38, df = 3, P<0.001) infection increased with patient age. Our data suggest that mixed infection onychomycosis is more prevalent than previously reported with the aging population being at increased risk for mixed infections.
Asunto(s)
Coinfección/diagnóstico , Onicomicosis/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Arthrodermataceae/genética , Arthrodermataceae/aislamiento & purificación , Brasil/epidemiología , Canadá/epidemiología , Niño , Coinfección/epidemiología , Coinfección/microbiología , ADN de Hongos/aislamiento & purificación , ADN de Hongos/metabolismo , Femenino , Dermatosis del Pie/diagnóstico , Dermatosis del Pie/epidemiología , Dermatosis del Pie/microbiología , Carga Global de Enfermedades , Humanos , Israel/epidemiología , Masculino , Persona de Mediana Edad , Onicomicosis/epidemiología , Onicomicosis/microbiología , Prevalencia , Adulto JovenRESUMEN
INTRODUCTION: Idiopathic Palmoplantar Eccrine Hidradenitis (IPPH) is a rare neutrophilic derma tosis, with painful erythematous nodules of sudden onset in the plantar or palmoplantar region, in children without other underlying diseases. OBJECTIVE: To present a case that shows the main clinical and histological characteristics of this entity. CLINICAL CASE: 11-year-old girl with a 48-hours history of painful erythematous-violaceous nodules on the right foot plant associated with fever of up to 38.2 °C, with no history of interest except hyperhidrosis and intense exercising on previous days. Given the clinical suspicion of IPPH, a skin biopsy was performed, which showed inflammatory neutrophil infiltration around eccrine sweat glands and neutrophilic abscesses, confirming the diagnosis. Oral NSAIDs and rest were prescribed, with resolution of the lesions in 7 days. CONCLUSIONS: This case demonstrates the most important aspects of this entity, in many cases underdiagnosed, since it can be confused with other pathologies that occur with painful acral nodules, but have different pathogenic and therapeutic implications. To properly identify the IPPH allows preventing an unnecessary alarm, both patients and their parents, as in dermatologists and pediatricians themselves.
Asunto(s)
Dermatosis del Pie/diagnóstico , Hidradenitis/diagnóstico , Dolor Agudo/etiología , Niño , Femenino , Dermatosis del Pie/complicaciones , Dermatosis del Pie/patología , Hidradenitis/complicaciones , Hidradenitis/patología , HumanosAsunto(s)
Dermatosis del Pie/patología , Queratitis/diagnóstico , Queratitis/patología , Adolescente , Conexina 26/genética , Dermatosis del Pie/diagnóstico , Dermatosis del Pie/tratamiento farmacológico , Humanos , Queratitis/genética , Masculino , Onicomicosis/diagnóstico , Onicomicosis/tratamiento farmacológicoRESUMEN
Resumen: Introducción: La Hidradenitis palmoplantar ecrina idiopática (HPPI) es una dermatosis neutrofílica infrecuente, que cursa con nódulos eritematosos dolorosos de comienzo brusco en regiones plantares o palmoplantares, en niños que no tienen otra enfermedad subyacente. Objetivo: Presentar un caso que ilustra las principales características clínicas e histológicas de la HPPI. Caso Clínico: Niña de 11 años evaluada por nódulos eritematovioláceos dolorosos en planta de pie derecho de 48 horas de evo lución y fiebre de hasta 38,2 °C, sin antecedentes de interés salvo hiperhidrosis y práctica intensa de ejercicio en los días previos. Ante la sospecha clínica de HPPI se realizó biopsia cutánea, que mostró infiltrado inflamatorio neutrofílico alrededor de glándulas sudoríparas ecrinas y abscesos de neutrófilos, confirmando el diagnóstico. Se indicaron antiinflamatorios no esteroidales orales y reposo, con resolución de las lesiones en 7 días. Conclusiones: Este caso demuestra los aspectos más importantes de la HPPI. Esta entidad en muchos casos es infradiagnosticada, dado que puede confundirse con otras patologías que también cursan con nódulos acrales dolorosos, pero tienen distintas implicacio nes patogénicas y terapéuticas. Identificar apropiadamente la HPPI permite evitar la alarma innece saria, tanto en pacientes y sus padres, como en los propios dermatólogos y pediatras.
Abstract: Introduction: Idiopathic Palmoplantar Eccrine Hidradenitis (IPPH) is a rare neutrophilic derma tosis, with painful erythematous nodules of sudden onset in the plantar or palmoplantar region, in children without other underlying diseases. Objective: To present a case that shows the main clinical and histological characteristics of this entity. Clinical Case: 11-year-old girl with a 48-hours history of painful erythematous-violaceous nodules on the right foot plant associated with fever of up to 38.2 °C, with no history of interest except hyperhidrosis and intense exercising on previous days. Given the clinical suspicion of IPPH, a skin biopsy was performed, which showed inflammatory neutrophil infiltration around eccrine sweat glands and neutrophilic abscesses, confirming the diagnosis. Oral NSAIDs and rest were prescribed, with resolution of the lesions in 7 days. Conclusions: This case demonstrates the most important aspects of this entity, in many cases underdiagnosed, since it can be confused with other pathologies that occur with painful acral nodules, but have different pathogenic and therapeutic implications. To properly identify the IPPH allows preventing an unnecessary alarm, both patients and their parents, as in dermatologists and pediatricians themselves.
Asunto(s)
Humanos , Femenino , Niño , Hidradenitis/diagnóstico , Dermatosis del Pie/diagnóstico , Hidradenitis/complicaciones , Hidradenitis/patología , Dolor Agudo/etiología , Dermatosis del Pie/complicaciones , Dermatosis del Pie/patologíaRESUMEN
Mycetoma is a chronic infection that is slow to develop and heal. It can be caused by fungi (eumycetoma) or bacteria (actinomycetoma). We describe a case of actinomycetoma caused by Actinomadura mexicana in the Caribbean region.
Asunto(s)
Actinomadura/aislamiento & purificación , Dermatosis del Pie/diagnóstico , Micetoma/diagnóstico , Actinomadura/genética , Adulto , Región del Caribe , Diagnóstico Diferencial , Femenino , Dermatosis del Pie/microbiología , Humanos , Micetoma/microbiologíaAsunto(s)
Humanos , Masculino , Preescolar , Enfermedades de la Piel/congénito , Hamartoma/congénito , Enfermedades de la Piel/diagnóstico , Enfermedades de la Piel/patología , Nalgas , Proliferación Celular , Torso , Dermatosis del Pie/congénito , Dermatosis del Pie/diagnóstico , Dermatosis del Pie/patología , Hamartoma/diagnóstico , Hamartoma/patologíaAsunto(s)
Artrópodos , Dermatosis del Pie/etiología , Animales , Niño , Dermatosis del Pie/diagnóstico , Humanos , MasculinoRESUMEN
We report a case of amelanotic acral melanoma in a 42-year-old Chinese woman. Ten months previously the patient found a 2-cm asymmetric erythematous macular plaque on her left sole. The lesion was diagnosed as verruca plantaris by every physician the patient consulted. One month ago, an enlarged lymph node was detected in the left groin, which biopsy reported as metastatic melanoma. Dermoscopy suggested verruca plantaris, and positron emission tomography (PET) revealed increased glucose metabolism in the macular plaque. Finally, biopsy of the plaque revealed amelanotic melanoma. Misdiagnosis and diagnostic delay are usually associated with poorer patient outcomes. Awareness of atypical presentations of acral melanoma is thus important for decreasing misdiagnosis rates and improving patient outcomes.
Asunto(s)
Dermatosis del Pie/patología , Melanoma Amelanótico/patología , Neoplasias Cutáneas/patología , Verrugas/patología , Adulto , Biopsia , Diagnóstico Tardío , Dermoscopía , Diagnóstico Diferencial , Errores Diagnósticos , Femenino , Dermatosis del Pie/diagnóstico , Humanos , Metástasis Linfática , Melanoma Amelanótico/diagnóstico , Neoplasias Cutáneas/diagnóstico , Verrugas/diagnósticoRESUMEN
Abstract: We report a case of amelanotic acral melanoma in a 42-year-old Chinese woman. Ten months previously the patient found a 2-cm asymmetric erythematous macular plaque on her left sole. The lesion was diagnosed as verruca plantaris by every physician the patient consulted. One month ago, an enlarged lymph node was detected in the left groin, which biopsy reported as metastatic melanoma. Dermoscopy suggested verruca plantaris, and positron emission tomography (PET) revealed increased glucose metabolism in the macular plaque. Finally, biopsy of the plaque revealed amelanotic melanoma. Misdiagnosis and diagnostic delay are usually associated with poorer patient outcomes. Awareness of atypical presentations of acral melanoma is thus important for decreasing misdiagnosis rates and improving patient outcomes.
Asunto(s)
Humanos , Femenino , Adulto , Neoplasias Cutáneas/patología , Verrugas/patología , Melanoma Amelanótico/patología , Dermatosis del Pie/patología , Neoplasias Cutáneas/diagnóstico , Biopsia , Verrugas/diagnóstico , Melanoma Amelanótico/diagnóstico , Dermoscopía , Diagnóstico Diferencial , Errores Diagnósticos , Diagnóstico Tardío , Dermatosis del Pie/diagnóstico , Metástasis LinfáticaRESUMEN
Abstract: Background: In our country, the Brazilian Standard Series is the most used for the etiological diagnosis of allergic contact dermatitis to shoes. However, there is no assessment of the usefulness of specific allergens for shoes. Objectives: To measure the improvement in diagnostic accuracy of allergic contact dermatitis to shoes with the use of a specific complementary series in patch testing and describe the characteristics of the affected population, such as gender, location of lesions, time of evolution, and the most common allergens. Methods: This retrospective study evaluated the results of 52 patients with suspected shoe dermatitis subjected to patch tests with the standard and specific series to quantify the gain in diagnostic accuracy. Results: Among the 52 suspected cases, 29 cases (56%) were confirmed. In 13 (45%) cases the diagnosis was determined through the specific series, which results in an 81% increase in the number of diagnoses. Study limitation: Small sample size. Conclusions: Women were more commonly affected, with a mean time for the final diagnosis of 45 months, and the most common localization was the dorsum of the feet. There was an increase in diagnostic accuracy with the introduction of new haptens in the patch test of patients with suspected shoes dermatitis.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Zapatos/efectos adversos , Alérgenos/análisis , Dermatitis Alérgica por Contacto/diagnóstico , Dermatosis del Pie/diagnóstico , Brasil , Pruebas del Parche , Alérgenos/efectos adversos , Estudios Retrospectivos , Dermatitis Alérgica por Contacto/etiología , Dermatosis del Pie/etiologíaRESUMEN
Mycetoma cases are predominantly found in tropical regions and are a rare finding in the United States. These masses that are fungal or bacterial in origin can result in significant destruction of soft tissue and bone. We present a case of a patient who emigrated from Mexico to Indianapolis. He presented with a soft-tissue mass that was excised and ultimately found to be a eumycetoma of the hallux of his left foot. Successful treatment included surgical resection in combination with postoperative terbinafine, which was pulse dosed to decrease its impact on hepatic function.
Asunto(s)
Dermatosis del Pie/diagnóstico , Micetoma/diagnóstico , Adulto , Antifúngicos/uso terapéutico , Terapia Combinada , Emigrantes e Inmigrantes , Dermatosis del Pie/tratamiento farmacológico , Dermatosis del Pie/microbiología , Dermatosis del Pie/cirugía , Hallux/patología , Humanos , Indiana , Masculino , México/etnología , Micetoma/tratamiento farmacológico , Micetoma/cirugía , Terbinafina/uso terapéuticoRESUMEN
BACKGROUND: In our country, the Brazilian Standard Series is the most used for the etiological diagnosis of allergic contact dermatitis to shoes. However, there is no assessment of the usefulness of specific allergens for shoes. OBJECTIVES: To measure the improvement in diagnostic accuracy of allergic contact dermatitis to shoes with the use of a specific complementary series in patch testing and describe the characteristics of the affected population, such as gender, location of lesions, time of evolution, and the most common allergens. METHODS: This retrospective study evaluated the results of 52 patients with suspected shoe dermatitis subjected to patch tests with the standard and specific series to quantify the gain in diagnostic accuracy. RESULTS: Among the 52 suspected cases, 29 cases (56%) were confirmed. In 13 (45%) cases the diagnosis was determined through the specific series, which results in an 81% increase in the number of diagnoses. STUDY LIMITATION: Small sample size. CONCLUSIONS: Women were more commonly affected, with a mean time for the final diagnosis of 45 months, and the most common localization was the dorsum of the feet. There was an increase in diagnostic accuracy with the introduction of new haptens in the patch test of patients with suspected shoes dermatitis.
Asunto(s)
Alérgenos/análisis , Dermatitis Alérgica por Contacto/diagnóstico , Dermatosis del Pie/diagnóstico , Zapatos/efectos adversos , Alérgenos/efectos adversos , Brasil , Dermatitis Alérgica por Contacto/etiología , Femenino , Dermatosis del Pie/etiología , Humanos , Masculino , Persona de Mediana Edad , Pruebas del Parche , Estudios RetrospectivosRESUMEN
Reticulohistiocytomas represent a group of benign histiocytic dermal proliferations, which occur either sporadically as solitary cutaneous nodules or, when multiple, in association with systemic disease. Due to its nonspecific clinical presentation, reticulohistiocytoma may mimic other benign or malignant skin neoplasms; therefore, in most cases, a biopsy is needed in order to establish the correct diagnosis. The histology is typically characterized by the presence of large histiocytes with abundant eosinophilic cytoplasm with immunohistochemical profile positive for CD68, CD163, and vimentin. The authors report the case of a patient with solitary reticulohistiocytoma with illustrative clinical, dermoscopic, and histologic features.
Asunto(s)
Dermatosis del Pie/diagnóstico , Histiocitosis de Células no Langerhans/diagnóstico , Dedos del Pie , Dermoscopía , Diagnóstico Diferencial , Femenino , Dermatosis del Pie/patología , Histiocitosis de Células no Langerhans/patología , Humanos , Inmunohistoquímica , Persona de Mediana Edad , Dedos del Pie/patologíaRESUMEN
Syphilis is a worldwide sexually transmitted infection caused by Treponema pallidum subspecies pallidum. Its association with other STIs, including HIV, demands early diagnosis and immediate treatment of patients. We herein report an unusual serpiginous form of secondary syphilis.
Asunto(s)
Dermatosis del Pie/etiología , Dermatosis de la Mano/etiología , Sífilis/complicaciones , Adulto , Antibacterianos/administración & dosificación , Dermatosis del Pie/diagnóstico , Dermatosis del Pie/tratamiento farmacológico , Dermatosis de la Mano/diagnóstico , Dermatosis de la Mano/tratamiento farmacológico , Humanos , Inyecciones Intramusculares , Masculino , Penicilina G Benzatina/administración & dosificación , Sífilis/diagnóstico , Sífilis/tratamiento farmacológicoRESUMEN
Abstract: Syphilis is a worldwide sexually transmitted infection caused by Treponema pallidum subspecies pallidum. Its association with other STIs, including HIV, demands early diagnosis and immediate treatment of patients. We herein report an unusual serpiginous form of secondary syphilis.
Asunto(s)
Humanos , Masculino , Adulto , Sífilis/complicaciones , Dermatosis del Pie/etiología , Dermatosis de la Mano/etiología , Penicilina G Benzatina/administración & dosificación , Sífilis/diagnóstico , Sífilis/tratamiento farmacológico , Dermatosis del Pie/diagnóstico , Dermatosis del Pie/tratamiento farmacológico , Dermatosis de la Mano/diagnóstico , Dermatosis de la Mano/tratamiento farmacológico , Inyecciones Intramusculares , Antibacterianos/administración & dosificaciónRESUMEN
Abstract: Reticulohistiocytomas represent a group of benign histiocytic dermal proliferations, which occur either sporadically as solitary cutaneous nodules or, when multiple, in association with systemic disease. Due to its nonspecific clinical presentation, reticulohistiocytoma may mimic other benign or malignant skin neoplasms; therefore, in most cases, a biopsy is needed in order to establish the correct diagnosis. The histology is typically characterized by the presence of large histiocytes with abundant eosinophilic cytoplasm with immunohistochemical profile positive for CD68, CD163, and vimentin. The authors report the case of a patient with solitary reticulohistiocytoma with illustrative clinical, dermoscopic, and histologic features.