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INTRODUCTION: Dermatoporosis is a chronic cutaneous fragility syndrome, characterized by skin atrophy, purpura and pseudo-cicatrices. OBJECTIVE: To determine factors associated with dermatoporosis in a sample of subjects aged ≥ 60 years. METHODS: Observational, cross-sectional, descriptive, analytical study of subjects aged ≥ 60 years who underwent history taking, physical examination and application of a self-administered dermatoporosis diagnostic questionnaire. To determine the associated factors, a multivariate logistic regression analysis was used. RESULTS: In 315 evaluated subjects, the prevalence of dermatoporosis was 29%; 70% were females. Associated risk factors were age > 75 years (p = 0.001), prolonged sun exposure (p = 0.002), use of anticoagulants/antiplatelet medications (p = 0.004), oral steroids (p = 0.03) and chronic kidney disease (p = 0.03), as well as maternal age > 40 years at last pregnancy (p = 0.02), breastfeeding for > 7 months per pregnancy and > 18 cumulative months (p = 0.01). Age < 20 years at first pregnancy and menopause after 45 years were related to dermatoporosis absence. The correlation between self-assessment and clinical diagnosis was considerably high (0.95, p < 0.001). CONCLUSIONS: The risk factors associated with dermatoporosis were similar to those previously reported.
INTRODUCCIÓN: La dermatoporosis es un síndrome crónico de fragilidad cutánea, caracterizado por atrofia, púrpura y pseudocicatrices en piel. OBJETIVO: Determinar los factores asociados a dermatoporosis en una muestra de sujetos ≥ 60 años. MÉTODOS: Estudio observacional, transversal, descriptivo y analítico de sujetos ≥ 60 años a quienes se realizó historia clínica, exploración física y aplicación de un autocuestionario diagnóstico de dermatoporosis. Para determinar los factores asociados se realizó análisis de regresión logística multivariado. RESULTADOS: En 315 sujetos, la prevalencia de dermatoporosis fue de 29 %; 70 % fue del sexo femenino. Los factores asociados fueron edad > 75 años (p = 0.001), exposición solar prolongada (p = 0.002), ingesta de anticoagulantes/antiplaquetarios (p = 0.004), esteroides orales (p = 0.03) y enfermedad renal crónica (p = 0.03); así como, edad materna > 40 años en el último parto (p = 0.02), lactancia > 7 meses por embarazo y lactancia acumulada > 18 meses (p = 0.01). Se relacionaron con su ausencia, edad < 20 años en el primer embarazo y menopausia después de los 45 años. La correlación entre la autovaloración y el diagnóstico clínico fue muy alta (0.95, p < 0.001). . CONCLUSIONES: Los factores de riesgo asociados a dermatoporosis fueron similares a los previamente reportados.
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Envelhecimento da Pele , Dermatopatias , Idoso , Feminino , Humanos , Masculino , Estudos Transversais , México/epidemiologia , Fatores de Risco , Pele , Dermatopatias/diagnóstico , Dermatopatias/epidemiologiaRESUMO
Resumen Introducción: La dermatoporosis es un síndrome crónico de fragilidad cutánea, caracterizado por atrofia, púrpura y pseudocicatrices en piel. Objetivo: Determinar los factores asociados a dermatoporosis en una muestra de sujetos ≥ 60 años. Métodos: Estudio observacional, transversal, descriptivo y analítico de sujetos ≥ 60 años a quienes se realizó historia clínica, exploración física y aplicación de un autocuestionario diagnóstico de dermatoporosis. Para determinar los factores asociados se realizó análisis de regresión logística multivariado. Resultados: En 315 sujetos, la prevalencia de dermatoporosis fue de 29 %; 70 % fue del sexo femenino. Los factores asociados fueron edad > 75 años (p = 0.001), exposición solar prolongada (p = 0.002), ingesta de anticoagulantes/antiplaquetarios (p = 0.004), esteroides orales (p = 0.03) y enfermedad renal crónica (p = 0.03); así como, edad materna > 40 años en el último parto (p = 0.02), lactancia > 7 meses por embarazo y lactancia acumulada > 18 meses (p = 0.01). Se relacionaron con su ausencia, edad < 20 años en el primer embarazo y menopausia después de los 45 años. La correlación entre la autovaloración y el diagnóstico clínico fue muy alta (0.95, p < 0.001). Conclusiones: Los factores de riesgo asociados a dermatoporosis fueron similares a los previamente reportados.
Abstract Introduction: Dermatoporosis is a chronic cutaneous fragility syndrome, characterized by skin atrophy, purpura and pseudo-cicatrices. Objective: To determine factors associated with dermatoporosis in a sample of subjects aged ≥ 60 years. Methods: Observational, cross-sectional, descriptive, analytical study of subjects aged ≥ 60 years who underwent history taking, physical examination and application of a self-administered dermatoporosis diagnostic questionnaire. To determine the associated factors, a multivariate logistic regression analysis was used. Results: In 315 evaluated subjects, the prevalence of dermatoporosis was 29%; 70% were females. Associated risk factors were age > 75 years (p = 0.001), prolonged sun exposure (p = 0.002), use of anticoagulants/antiplatelet medications (p = 0.004), oral steroids (p = 0.03) and chronic kidney disease (p = 0.03); as well maternal age > 40 years at last pregnancy (p = 0.02), breastfeeding for > 7 months per pregnancy and > 18 cumulative months (p = 0.01). Age < 20 years at first pregnancy and menopause after 45 years were related to dermatoporosis absence. The correlation between self-assessment and clinical diagnosis was considerably high (0.95, p < 0.001). Conclusions: The risk factors associated with dermatoporosis were similar to those previously reported.
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BACKGROUND: The use of soap for skin cleansing is common among the population. However, it is possible that it causes damage to skin cells and disrupts the skin barrier. OBJECTIVE: To determine the cytotoxic effect of soaps on in vitro-cultured keratinocytes and to correlate it with clinical irritation. METHOD: A survey was conducted to find out the most widely used commercial soaps and their number. Subsequently, their cytotoxicity was evaluated in human keratinocyte cultures using the resazurin assay. The soaps with the highest and lowest cytotoxicity were applied to the skin of healthy volunteers to assess their effect on the skin barrier using colorimetry and transepidermal water loss (TEWL) assays. RESULTS: Of the analyzed soaps, 37 % were shown to be toxic to keratinocytes in vitro. The soap with the highest toxicity induced the highest rate of erythema and TEWL, in comparison with the least toxic soap and the vehicle used as the control solution. CONCLUSION: Soaps marketed for skin cleansing can contain chemical ingredients that damage human keratinocytes and cause skin barrier subclinical irritation. Their use can worsen preexisting dermatoses, generate xerotic or irritant contact dermatitis, and cause atrophy and dermatoporosis.
INTRODUCCIÓN: El jabón para el aseo cutáneo es de empleo común entre la población, sin embargo, es posible que cause daño a las células de la piel y modifique la barrera cutánea. OBJETIVO: Determinar el efecto citotóxico de los jabones en queratinocitos cultivados in vitro y correlacionarlo con la irritación clínica. MÉTODO: Se realizó una encuesta para conocer los jabones comerciales más utilizados y su cantidad; posteriormente, se evaluó su citotoxicidad en cultivos de queratinocitos humanos mediante el método de resazurina. Los jabones con mayor y menor citotoxicidad se aplicaron en piel de voluntarios sanos para evaluar su efecto en la barrera cutánea mediante ensayos de colorimetría y pérdida transepidérmica de agua. RESULTADOS: De los jabones analizados, 37 % demostró ser tóxico para los queratinocitos in vitro. El jabón con mayor toxicidad indujo el mayor índice de eritema y pérdida transepidérmica de agua, en comparación con el jabón menos tóxico y el vehículo empleado como solución control. CONCLUSIÓN: Los jabones comercializados para el aseo cutáneo pueden incluir ingredientes químicos que dañan los queratinocitos humanos y causan irritación subclínica de la barrera cutánea. Su utilización puede agravar dermatosis preexistentes, generar dermatitis xerósica o de contacto irritativa y causar atrofia y dermatoporosis.
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Irritantes/efeitos adversos , Queratinócitos/efeitos dos fármacos , Testes de Irritação da Pele , Sabões/efeitos adversos , Água Corporal , Células Cultivadas , Colorimetria , Dermatite Irritante/etiologia , Eritema/induzido quimicamente , Voluntários Saudáveis , Humanos , Concentração de Íons de Hidrogênio , Pele/efeitos dos fármacos , Sabões/químicaRESUMO
Resumen Introducción: El jabón para el aseo cutáneo es de empleo común entre la población, sin embargo, es posible que cause daño a las células de la piel y modifique la barrera cutánea. Objetivo: Determinar el efecto citotóxico de los jabones en queratinocitos cultivados in vitro y correlacionarlo con la irritación clínica. Método: Se realizó una encuesta para conocer los jabones comerciales más utilizados y su cantidad; posteriormente, se evaluó su citotoxicidad en cultivos de queratinocitos humanos mediante el método de resazurina. Los jabones con mayor y menor citotoxicidad se aplicaron en piel de voluntarios sanos para evaluar su efecto en la barrera cutánea mediante ensayos de colorimetría y pérdida transepidérmica de agua. Resultados: De los jabones analizados, 37 % demostró ser tóxico para los queratinocitos in vitro. El jabón con mayor toxicidad indujo el mayor índice de eritema y pérdida transepidérmica de agua, en comparación con el jabón menos tóxico y el vehículo empleado como solución control. Conclusión: Los jabones comercializados para el aseo cutáneo pueden incluir ingredientes químicos que dañan los queratinocitos humanos y causan irritación subclínica de la barrera cutánea. Su utilización puede agravar dermatosis preexistentes, generar dermatitis xerósica o de contacto irritativa y causar atrofia y dermatoporosis.
Abstract Introduction: The use of soap for skin cleansing is common among the population. However, it is possible that it causes damage to skin cells and disrupts the skin barrier. Objective: To determine the cytotoxic effect of soaps on in vitro-cultured keratinocytes and to correlate it with clinical irritation. Method: A survey was conducted to find out the most widely used commercial soaps and their number. Subsequently, their cytotoxicity was evaluated in human keratinocyte cultures using the resazurin assay. The soaps with the highest and lowest cytotoxicity were applied to the skin of healthy volunteers to assess their effect on the skin barrier using colorimetry and transepidermal water loss (TEWL) assays. Results: Of the analyzed soaps, 37 % were shown to be toxic to keratinocytes in vitro. The soap with the highest toxicity induced the highest rate of erythema and TEWL, in comparison with the least toxic soap and the vehicle used as the control solution. Conclusion: Soaps marketed for skin cleansing can contain chemical ingredients that damage human keratinocytes and cause skin barrier subclinical irritation. Their use can worsen preexisting dermatoses, generate xerotic or irritant contact dermatitis, and cause atrophy and dermatoporosis.
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Humanos , Sabões/efeitos adversos , Queratinócitos/efeitos dos fármacos , Testes de Irritação da Pele , Irritantes/efeitos adversos , Pele/efeitos dos fármacos , Sabões/química , Água Corporal , Células Cultivadas , Dermatite Irritante/etiologia , Colorimetria , Eritema/induzido quimicamente , Voluntários Saudáveis , Concentração de Íons de HidrogênioRESUMO
BACKGROUND: Malar melasma has a chronic and recurrent character that may be related to epigenetic changes. OBJECTIVE: To recognize the expression and DNA methylation of DNA methyltransferases (DNMTs) in malar melasma and perilesional skin, as well as the changes in DNMTs after their treatment with sunscreen in combination with 4% niacinamide, 0.05% retinoic acid, or placebo. METHODS: Thirty female patients were clinically evaluated for the expression of DNMT1 and DNMT3b using real-time PCR and immunofluorescence. These initial results were compared to results after eight weeks of treatment with sunscreen in combination with niacinamide, retinoic acid, or placebo. RESULTS: The relative expression of DNMT1 was significantly elevated in melasma compared with unaffected skin in all subjects, indicating DNA hypermethylation. After treatment, it was decreased in all groups: niacinamide (7 versus 1; p<0.01), retinoic acid (7 versus 2; p<0.05), and placebo (7 versus 3; p<0.05), which correlates with clinical improvement. DNMT3b was not overexpressed in lesional skin but reduced in all groups. CONCLUSIONS: We found DNA hypermethylation in melasma lesions. Environmental factors such as solar radiation may induce cellular changes that trigger hyperpigmentation through the activation of pathways regulated by epigenetic modifications. However, limiting or decreasing DNA methylation through sunscreen, niacinamide, and retinoic acid treatments that provide photoprotection and genetic transcription can counteract this.
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Metilases de Modificação do DNA/metabolismo , Melanose/tratamento farmacológico , Melanose/enzimologia , Niacinamida/uso terapêutico , Protetores Solares/uso terapêutico , Tretinoína/uso terapêutico , 5-Metilcitosina/metabolismo , Adulto , Metilação de DNA , Metilases de Modificação do DNA/genética , Epiderme/efeitos dos fármacos , Epiderme/patologia , Feminino , Fluorescência , Regulação Enzimológica da Expressão Gênica/efeitos dos fármacos , Humanos , Placebos , Protetores Solares/farmacologiaRESUMO
Prostate cancer is the second most frequently diagnosed cancer worldwide and the fifth most common cause of cancer deaths among men. Cutaneous metastasis is an uncommon phenomenon in prostatic cancer, occurring in 0.06-0.3% of cases. Case Presentation. A 56-year-old man presented to our outpatient clinic with a one-month history of a 1.5 cm in diameter, solitary, asymptomatic, purple nodule located on his upper right cheek. After biopsy, prostatic cancer metastasis was diagnosed. Discussion. A literature review revealed 59 articles documenting 71 cases of this diagnosis. The review recorded epidemiological data, including age, duration, morphology, location, and outcome of patients. Conclusions. The skin is an uncommon site for metastasis of prostate cancer, and the review showed that its presence is associated with a poor prognosis (approximately 10 months from diagnosis).
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Background: The blend of hemoglobin, carotenes, and melanin defines the skin color. Constitutive pigmentation is genetically determined, facultative color is induced when skin is exposed to environment. The objective was to quantify both pigmentations in a sample of Mexican population and to analyze its relationship with sex, age, and phototype. Methods: We evaluated 259 individuals during the winter. Skin colorimetry was obtained by diffuse reflectance spectrometry, using the International Commission of Illumination coordenates. L*a*b* parameters were measured and the individual typological angle (ITA) was estimated from forehead, thorax, neck, forearms, and buttocks areas. Results: Facultative pigmentation differed from constitutive in L*, a*, and ITA° values. In men, L* and ITA° parameters were lower. Constitutive pigmentation was similar between sexes. Phototypes III, IV, and V showed differences in L*, b*, and ITA°. Facultative values such as L*, a*, ATI°, and the constitutive a* reduce as age increases. Conclusions: The cutaneous tones of a sample of population were quantified recognizing their values for white, light brown, and dark brown skin. A reference frame for research related to cutaneous pigmentation in Mexico is presented.
Antecedentes: La mezcla de melanina, hemoglobina y carotenos definen el color cutáneo. La pigmentación constitutiva está determinada genéticamente, la facultativa se induce cuando la piel se expone al ambiente. El objetivo fue cuantificar ambas pigmentaciones en una muestra de población mexicana, y analizar su relación con el género, edad y fototipo. Métodos: Se evaluaron 259 personas durante un periodo invernal. La colorimetría cutánea se obtuvo mediante espectrometría de reflectancia difusa utilizando las coordenadas de la Comisión Internacional de Iluminación. Se registraron los valores L*a*b* y se estimó el ángulo tipológico individual (ATI°) en frente, tórax, cuello, antebrazos y glúteos. Resultados: La pigmentación facultativa difirió de la constitutiva en los parámetros L*, a*, y ATIº. En hombres, los valores facultativos de L* y ATI° fueron menores. La pigmentación constitutiva fue similar entre sexos. Los fototipos III, IV y V muestran diferencias en L*, b* y ATI°. Los valores facultativos L*, a*, ATI° y el constitutivo a* se reducen al incrementarse la edad. Conclusiones: Se cuantificaron los tonos cutáneos de una muestra de población reconociéndose los valores para la piel blanca, morena clara y morena oscura. Se presenta un marco de referencia para estudios relacionados con la pigmentación cutánea en México.
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Pigmentação da Pele , Pele/química , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Espectral , Adulto JovemRESUMO
OBJECTIVE: The aim of this study was to obtain autologous dermal-epidermal skin substitutes from oral mucosa from diabetic subjects as a first step towards a possible clinical application for cases of diabetic foot. MATERIAL AND METHODS: Oral mucosa was obtained from diabetic and healthy subjects (n=20 per group). Epidermal cells were isolated and cultured using autologous fibrin to develop dermal-epidermal in vitro substitutes by the air-liquid technique with autologous human serum as a supplement media. Substitutes were immunocharacterized with collagen IV and cytokeratin 5-14 as specific markers. A Student´s t- test was performed to assess the differences between both groups. RESULTS: It was possible to isolate epidermal cells from the oral mucosa of diabetic and healthy subjects and develop autologous dermal-epidermal skin substitutes using autologous serum as a supplement. Differences in the expression of specific markers were observed and the cytokeratin 5-14 expression was lower in the diabetic substitutes, and the collagen IV expression was higher in the diabetic substitutes when compared with the healthy group, showing a significant difference. CONCLUSION: Cells from oral mucosa could be an alternative and less invasive source for skin substitutes and wound healing. A difference in collagen production of diabetic cells suggests diabetic substitutes could improve diabetic wound healing. More research is needed to determine the crosstalk between components of these skin substitutes and damaged tissues.
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Transplante de Células/métodos , Diabetes Mellitus Tipo 2 , Células Epidérmicas , Células Epiteliais/transplante , Mucosa Bucal/citologia , Pele Artificial , Adulto , Idoso , Materiais Biocompatíveis , Estudos de Casos e Controles , Técnicas de Cultura de Células , Proliferação de Células , Células Cultivadas , Colágeno/análise , Diabetes Mellitus Tipo 2/terapia , Feminino , Fibroblastos , Humanos , Queratinócitos/citologia , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Úlcera Cutânea/terapia , Fatores de Tempo , Transplante Autólogo , CicatrizaçãoRESUMO
Abstract Oral mucosa has been highlighted as a suitable source of epidermal cells due to its intrinsic characteristics such as its higher proliferation rate and its obtainability. Diabetic ulcers have a worldwide prevalence that is variable (1%-11%), meanwhile treatment of this has been proven ineffective. Tissue-engineered skin plays an important role in wound care focusing on strategies such autologous dermal-epidermal substitutes. Objective The aim of this study was to obtain autologous dermal-epidermal skin substitutes from oral mucosa from diabetic subjects as a first step towards a possible clinical application for cases of diabetic foot. Material and Methods Oral mucosa was obtained from diabetic and healthy subjects (n=20 per group). Epidermal cells were isolated and cultured using autologous fibrin to develop dermal-epidermal in vitro substitutes by the air-liquid technique with autologous human serum as a supplement media. Substitutes were immunocharacterized with collagen IV and cytokeratin 5-14 as specific markers. A Student´s t- test was performed to assess the differences between both groups. Results It was possible to isolate epidermal cells from the oral mucosa of diabetic and healthy subjects and develop autologous dermal-epidermal skin substitutes using autologous serum as a supplement. Differences in the expression of specific markers were observed and the cytokeratin 5-14 expression was lower in the diabetic substitutes, and the collagen IV expression was higher in the diabetic substitutes when compared with the healthy group, showing a significant difference. Conclusion Cells from oral mucosa could be an alternative and less invasive source for skin substitutes and wound healing. A difference in collagen production of diabetic cells suggests diabetic substitutes could improve diabetic wound healing. More research is needed to determine the crosstalk between components of these skin substitutes and damaged tissues.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Pele Artificial , Transplante de Células/métodos , Diabetes Mellitus Tipo 2 , Epiderme/citologia , Células Epiteliais/transplante , Mucosa Bucal/citologia , Úlcera Cutânea/terapia , Fatores de Tempo , Transplante Autólogo , Cicatrização , Materiais Biocompatíveis , Estudos de Casos e Controles , Queratinócitos/citologia , Células Cultivadas , Reprodutibilidade dos Testes , Colágeno/análise , Técnicas de Cultura de Células , Proliferação de Células , Diabetes Mellitus Tipo 2/terapia , FibroblastosRESUMO
Patients in treatment with allopurinol are in risk of having life threatening adverse reactions particularly at the beginning of the treatment. Two percent of the patients prescribed with this drug have associated severe cutaneous adverse reactions. We present two cases of allopurinol hypersensitivity syndrome in mexican patients in which asymptomatic hyperuricemia was the indication to its use. The general physician and the specialist must be alert of this syndrome that causes elevate morbidity and mortality.
Los pacientes bajo tratamiento con alopurinol pueden presentar reacciones adversas potencialmente mortales, particularmente al inicio del tratamiento. Las reacciones cutáneas adversas por alopurinol tienen una prevalencia aproximada del 2 %. Presentamos dos casos de síndrome de hipersensibilidad por alopurinol en pacientes mexicanos en quienes la hiperuricemia asintomática fue la indicación para su uso. El médico general y el especialista deben estar alerta ante este síndrome que ocasiona alta morbilidad y mortalidad.
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Alopurinol/efeitos adversos , Síndrome de Hipersensibilidade a Medicamentos/etiologia , Supressores da Gota/efeitos adversos , Adolescente , Alopurinol/uso terapêutico , Síndrome de Hipersensibilidade a Medicamentos/diagnóstico , Feminino , Supressores da Gota/uso terapêutico , Humanos , Hiperuricemia/tratamento farmacológico , Masculino , Adulto JovemRESUMO
BACKGROUND: The incidence of skin cancer has increased in Mexico in recent years. Ultraviolet radiation is the main risk factor associated. Due to the need to develop strategies to prevent skin cancer, the aim of the study was to estimate the UV intensity in several representative regions of Mexico, the average annual UV dose of these populations, and the potential benefit of applying sunscreen at different ages. METHODS: The intensity of UV radiation was quantified by remote and terrestrial radiometry. The dose of UV exposure was measured in minimal erythema doses using validated models for face and arms. The benefit of using a sunscreen was calculated with the use of a sunscreen with SPF 15 from birth to age 70. RESULTS: The UV radiation is lower in December and greater in the period from May to July. The region with a lower annual dose is Tijuana; and the higher annual dose is in the Mexico City area. The annual difference between these regions was 58 %. Through life, a low SPF sunscreen can reduce up to 66 % of the received UV dose. CONCLUSIONS: The geographical location is a risk factor for accumulation of UV radiation in Mexico. Since childhood, people receive high amounts of it; however, most of this dose can be reduced using any commercially available sunscreen, if applied strategically.
Introducción: La incidencia del cáncer de piel en México se ha incrementado en los últimos años. La radiación UV es el principal factor de riesgo asociado. Debido a la necesidad de desarrollar estrategias para evitarla, el objetivo del estudio fue estimar la intensidad UV en diversas regiones representativas del país, la dosis UV promedio anual de esas poblaciones y el beneficio potencial de la aplicación de un filtro solar a diferentes edades. Métodos: se cuantificó la intensidad de la radiación UV mediante radiometría terrestre y remota. La dosis de exposición UV se midió en dosis mínimas eritematógenas utilizando modelos validados para cara y brazos. El beneficio de realizar fotoprotección se calculó para el uso de un filtro con FPS 15 desde el nacimiento hasta los 70 años. Resultados: la radiación UV es menor en diciembre y máxima de mayo a julio. La localidad con menor dosis anual es Tijuana y la máxima el Distrito Federal. La diferencia anual entre estas regiones es de 58 %. Durante la vida, un filtro solar de baja potencia puede reducir hasta 66 % la dosis recibida. Conclusiones: la localización geográfica es un factor de riesgo para la acumulación de radiación UV en México. Desde la infancia, la población recibe dosis elevadas de radiación UV. La mayoría de esas dosis puede reducirse mediante cualquier filtro solar disponible en el comercio, si es aplicado de forma estratégica.
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Exposição Ambiental/estatística & dados numéricos , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/prevenção & controle , Protetores Solares/uso terapêutico , Raios Ultravioleta/efeitos adversos , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Pré-Escolar , Exposição Ambiental/efeitos adversos , Exposição Ambiental/prevenção & controle , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , México , Pessoa de Meia-Idade , Radiometria , Fatores de Risco , Estações do Ano , Adulto JovemRESUMO
Hypercalcemia in children with malignancy is an uncommon condition. It has been described in leukemia patients with impaired renal excretion of calcium or osteolytic lesions. Metastatic calcinosis cutis (MCC) may develop if hypercalcemia persists. We report the case of a 5-year-old girl with an atypical dermatosis and unspecific gastrointestinal symptoms. Considered clinical diagnoses were xanthomas, histiocytosis, molluscum contagiosum, and nongenital warts. Cutaneous histological analysis showed amorphous basophilic deposits in the dermis suggestive of calcium deposits. Laboratory tests confirmed serum hypercalcemia. Extensive investigations such as bone marrow biopsy established the diagnosis of an acute pre-B cell lymphoblastic leukemia. Hypercalcemia in hematopoietic malignancies is unusual, especially as initial manifestation of the disease. Careful review of the literature fails to reveal previous reports of these peculiar cutaneous lesions of MCC in children with leukemia.
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The pathogenesis of melasma, a common, photo-induced hyperpigmentary disorder, is not clearly understood. Significant factors linked to melasma are ultraviolet radiation exposure and genetic predisposition. Histological analysis has demonstrated that melasma is caused by a network of cellular interactions among melanocytes, keratinocytes, mast cells, fibroblasts, and dermal vasculature exhibits, features similar to chronic sun damage. Dermal inflammation caused by ultraviolet radiation might play an important role in the hyperpigmentation and reactivation of melasma lesions through the production of melanogenic cytokines and growth factors. Because the role of inflammation in this disorder is unknown, we used histochemistry, immunohistochemistry, and quantitative real-time polymerase chain reaction to evaluate melasma lesions from healthy female patients (n = 20) with malar melasma. Lesional skin without specific solar exposure or photoprotection measures within the previous 4 weeks was compared with nonlesional skin. The increased lymphocytic infiltrate in lesional skin was mainly composed of CD4 T cells, mast cells, and macrophages. Levels of the cytokine interleukin (IL)-17 and the proinflammatory mediator cyclooxygenase (COX)-2 were significantly elevated in affected skin compared with healthy skin. In addition, the Melasma Activity and Severity Index score, fraction of solar elastosis, and epidermal melanin were positively associated with COX-2 expression. There was no statistically significant difference in IL-1α, IL-1ß, R-IL1, IL-6, IL-8, vascular endothelial growth factor, and tumor necrosis factor alpha expression levels. Together, these data indicated that melasma under unchallenged conditions is characterized by chronic inflammatory cells and mediators, which may explain its recurrent nature.
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Antígenos CD4/análise , Ciclo-Oxigenase 2/análise , Dermatite/imunologia , Mediadores da Inflamação/análise , Interleucina-17/análise , Melanose/imunologia , Pele/imunologia , Imunidade Adaptativa , Adulto , Doenças Assintomáticas , Biomarcadores/análise , Estudos de Casos e Controles , Ciclo-Oxigenase 2/genética , Dermatite/enzimologia , Dermatite/genética , Dermatite/patologia , Feminino , Humanos , Imunidade Inata , Imuno-Histoquímica , Interleucina-17/genética , Melanose/enzimologia , Melanose/genética , Melanose/patologia , RNA Mensageiro/genética , Reação em Cadeia da Polimerase em Tempo Real , Pele/enzimologia , Pele/patologia , Regulação para CimaRESUMO
Cryosurgery is a common therapeutic modality used in dermatology; therefore we must be aware of its possible adverse effects. We report a case of a patient with subcutaneous emphysema which occurred following the application of cryotherapy after multiple punctures of local anesthetic and intralesional steroids in a chest keloid scar. Despite the fact that this condition was gradually resolved after expectant observation, we warn about this complication when sprayed cryotherapy is preceded by multiple punctures on cutaneous lesions above bony surfaces. In similar settings, cryotherapy must be first administered or a cotton-tip applicator should be used.
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Eczema herpeticum is an acute dermatoses caused by herpes simplex virus type 1 in atopic dermatitis patients, and is considered a dermatology emergency. Eczema herpeticum occurs in less than 3% of atopic patients. We report a patient with a history of atopic dermatitis who presented to an emergency department with eczema herpeticum. He was admitted and treated with antiviral medications with good outcome. We investigated filaggrin null mutations in the patient and his family and correlate them with the severity of the disease. We present the first Mexican patient with eczema herpeticum, atopic dermatitis and the presence of R501 X and 2282del4 filaggrin null mutations.
Assuntos
Dermatite Atópica/complicações , Dermatite Atópica/genética , Proteínas de Filamentos Intermediários/genética , Erupção Variceliforme de Kaposi/complicações , Mutação , Adolescente , Proteínas Filagrinas , Humanos , Masculino , LinhagemRESUMO
BACKGROUND: Sporotrichosis is a subacute or chronic mycosis acquired by traumatic inoculation or inhalation of fungal conidia. It is caused by the dimorphic fungus Sporothrix, which causes different clinical presentations, being the cutaneous and lymphocutaneous variants being the most frequent. The disseminated cutaneous form is a rare presentation occurring in a minority of cases in Mexico. CASE REPORT: We report an atypical case of disseminated sporotrichosis in an alcoholic and iatrogenically immunosuppressed patient, whose clinical lesions resembled tumoral-stage mycosis fungoides. Histological examination and culture revealed the presence of Sporothrix schenckii. CONCLUSIONS: The patient was treated with itraconazole 200mg per day for 4 months with clinical resolution. To the best of our knowledge, this is the first report of this type of clinical manifestation.
Assuntos
Micose Fungoide/patologia , Neoplasias Cutâneas/patologia , Esporotricose/patologia , Idoso , Diagnóstico Diferencial , Humanos , MasculinoRESUMO
A cross-sectional study of geriatric patients was performed to provide a comprehensive description of the prevalence and clinical characteristics of chronic itch affecting Hispanic geriatric subjects in Mexico. Participants were recruited from both nursing homes and geriatric ambulatory care centers. Patients without dementia were evaluated using an itch intensity and characteristic questionnaire and were assessed for itch-related dermatoses (n = 302). Data on medications and underlying systemic diseases were obtained from medical records. The prevalence of chronic itch was 25% in this population. Of those with chronic itch, 69% had xerosis, 28% had itch-related dermatoses, and 96% had documented comorbidities. The most common comorbidities were diabetes mellitus (OR = 2.3, 95% CI 1.3-3.9, p = 0.003) and chronic venous insufficiency (OR = 4.4, 95% CI 1.6-12.2, p = 0.002). The most common areas where patients experienced itch were legs (54%), back (45%), scalp (28%) and arms (27%). Patients experienced the greatest amount of itch in the winter (77%) and during the night (65%). Chronic itch is a common problem in the studied Hispanic geriatric population, and its presence significantly correlates with xerosis, diabetes, and venous insufficiency.
Assuntos
Prurido/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Estudos Transversais , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Estações do Ano , Dermatopatias/epidemiologia , Inquéritos e Questionários , Insuficiência Venosa/epidemiologia , Escala Visual AnalógicaRESUMO
In Latin America, people have largely abandoned the practice of wearing hats and traditional clothing that provided skin protection. Sunscreen application has therefore become essential to protect against the increased sun exposure. The physician-prescribed medical-grade sunscreens provide sufficient sun protection but the requirement for regular use puts a financial burden on the patient that is often not sustainable. An appropriate sunscreen should provide a high and broad ultraviolet (UV) protection against UVB and UVA. Several over-the-counter (OTC) sunscreens have been developed for sale at affordable prices and are available for purchase in convenient locations, such as local grocery stores. The aim of this study was to assess the in vitro UV protection of 34 popular OTC sunscreens found in the Latin American market. UV absorbance/transmittance was quantified by diffusion transmission spectroscopy using coarse silica plaques. Photostability was tested by irradiating them with simulated solar light and calculating the sun protection factor (SPF), critical length of absorption (C lambda ), UVA/UVB ratio, and the spectral uniformity index (SUI). The results indicated that the in vitro SPFs were significantly lower than the value declared on the labels, particularly for those claiming high SPF values; however, the majority of these sunscreens offered high levels of UV protection. Considering the advantages of low cost and ample accessibility, we concluded that this sample of OTC sunscreens can be beneficial to the general public by providing some level of skin protection from solar radiation, and may be promoted to improve compliance with recommended photoprotection behavior.