Dermatología

20 Mayo 2011

Comite editorial

Archivado en: Acerca, Acerca de comite editorial — dermatologia @ 5:18

Editor Principal
Dr. Rubén José Larrondo Muguercia

Editor de Honor
Dr. Alfredo Abreu Daniel

Comité Editorial
Dra. Fernanda Pastrana Fundora.
Dra. Olaine Gray Lovio.
Dr. Ernesto Miyares Diaz.
Dra. Edelisa Moredo Romo.
Msc. Yanitza Ricardi Sabatier.
Dra. Justa Yolanda Columbié Cumbá.
Dr. Camilo Hernández Derivet.

18 Mayo 2011

Vitamina D en queloides

Archivado en: Actualidad dermatologica — dermatologia @ 16:48

From The British Journal of Dermatology
Vitamin D: A Novel Therapeutic Approach for Keloid, an in vitro Analysis
G.Y. Zhang; T. Cheng; Q. Luan; T. Liao; C.L. Nie; X. Zheng; X.G. Xie; W.Y. Gao

Keloids are distinguished by substantial deposition of collagen in the dermis, resulting in an imbalanced production and aggregation of extracellular matrix (ECM). The precise molecular and biochemical dysfunctions are still unknown, but tissue fibrosis after injury is known to be a reactive process, in which several different factors modulate the relevant pathways.[1,2] Data reported with respect to differences between keloid fibroblasts and normal skin fibroblasts in the context of cellular functions such as collagen production, degradation, and expression and activity of collagenases, have been diverse. Collagen synthesis and degradation, including collagenase activity, are known to be significantly higher in keloid tissues.[3–5]

Vitamin D, specifically its most active metabolite 1,25-dihydroxyvitamin D3 (1,25D), or calcitriol, plays an important role in a variety of biological processes such as calcium homeostasis, hormone secretion, cell proliferation and differentiation.[6–9] Most, if not all, pleiotropic actions of vitamin D and its analogues are mediated by the specific vitamin D receptor (VDR), a ligand-dependent transcription factor that belongs to the steroid nuclear receptor gene family.[6,10] Vitamin D has been shown to inhibit collagen synthesis in interstitial fibrosis and in the rat glomerulonephritis model and heart fibrosis, by inhibiting the production and accumulation of interstitial matrix components or suppressing transforming growth factor (TGF)-β1 gene expression.[7,11,12] Furthermore, it has been found that in NIH/3T3 fibroblastic cells and primary lung fibroblasts, the expressed functional VDRs and vitamin D opposed the effects of TGF-β1, a well-studied profibrotic factor in these cells.[13] Moreover, several studies have demonstrated the effectiveness of orally administered 1,25-dihydroxycholecalciferol (calcitriol), the biologically active form of vitamin D, as a treatment for scleroderma, a skin fibrosis disease.[14–16] However, relatively little is known about the potential role of vitamin D in this dermal fibrosis formation.

Based on the above studies, we postulated that vitamin D may function as a countervailing influence to attenuate collagen formation during keloid pathogenesis, and that unregulated collagen expression in keloid fibroblasts both at baseline and after TGF-β1 stimulation induced by vitamin D might be one of the mechanisms by which this occurs. To test this hypothesis, we examined the effects of vitamin D on keloid fibroblasts and TGF-β1-induced collagen expression in the present study.

Ver más 

Adalimumab en psoriasis

Archivado en: Actualidad dermatologica — dermatologia @ 15:42

From Medscape Dermatology > Viewpoints
Adalimumab for Psoriasis: Making the Switch
Graeme M. Lipper, MD

Psoriasis is a chronic, potentially debilitating inflammatory skin disorder associated with erosive arthritis and an increased risk for cardiovascular disease.[1] Management strategies are tailored to disease severity, with milder psoriasis typically responding to topical therapy and moderate to severe disease requiring the addition of phototherapy and/or systemic immunosuppressive drugs.

Over the past decade, tumor necrosis factor alpha (TNF-alpha) antagonists (infliximab, etanercept, adalimumab) have become the “go-to” drugs for controlling moderate to severe psoriasis. This drug class offers impressive, durable efficacy while minimizing the side effects seen with less selective immunosuppressive agents, such as methotrexate and cyclosporine.

How should patients be transitioned to TNF-alpha blockers such as the monoclonal antibody adalimumab? Is it better to overlap treatments or simply stop current treatment, allow for a brief “washout” period, and then initiate the TNF-alpha blocker? If a patient is flaring on one TNF-alpha blocker (etanercept), would that patient potentially benefit from trying another drug in the same class, such as adalimumab?

Ver más 

Anticonvulsivante en neuralgia postherpética

Archivado en: Actualidad dermatologica — dermatologia @ 12:19

From Medscape Education Clinical Briefs
Anticonvulsant May Help Prevent Postherpetic Neuralgia CME
News Author: Megan Brooks
CME Author: Désirée Lie, MD, MSEd

April 15, 2011 — Treating patients with acute herpes zoster with the anticonvulsant gabapentin may help prevent postherpetic neuralgia (PHN), according to results of an uncontrolled, open-label study conducted at a private dermatology clinic in Texas.

Whitney Lapolla, MD, of the Center for Clinical Studies in Houston, Texas, and colleagues report their findings online April 11 in the Archives of Dermatology.

Based on her experience, Dr. Lapolla told Medscape Medical News, she would advise clinicians to “consider prescribing gabapentin in addition to standard antiviral therapy and analgesics for patients with moderate to severe shingles pain on presentation.”

ver más

22 Abril 2011

Sarcoidosis

Archivado en: Clinica y Terapeutica — dermatologia @ 13:13

Sarcoidosis: Presentación clínica, inmunopatogénesis y tratamiento
En 1899, Boeck acuñó el término sarcoidosis para dar nombre a las “células epitelioides con grandes núcleos pálidos y también algunas células gigantes” que se encuentran en la biopsia de piel. La sarcoidosis puede afectar a las personas de todas las edades pero afecta más comúnmente a los sujetos entre la tercera y cuarta décadas de la vida. En Estados Unidos, la tasa de incidencia anual ajustada en las personas de raza negra es casi 3 veces más elevada que la de las personas de raza blanca (35,5 casos por 100.000 habitantes vs. 10,9 por 100.000 habitantes, respectivamente). En la raza negra, la sarcoidosis tiene probablemente un carácter crónico y fatal. ver más en la dirección que sigue, antes debe registrarse
http://www.intramed.net/contenidover.asp?contenidoID=69685&uid=555307

Pulsos de itraconazol en esporotricosis cutánea

Archivado en: Actualidad dermatologica — dermatologia @ 12:16

Eficacia y seguridad de itraconazol en pulsos vs regimen continuo en esporotricosis cutanea
Dres. Y Song, S-X Zhong, L Yao y col
JEADV 2011, 25, 302-305.
El itraconazol, un agente triazol antifúngico, ha mostrado buena eficacia, seguridad y tolerabilidad en el tratamiento de la esporotricosis en varios ensayos clínicos bien designados.  En el año 2007 la Sociedad de Enfermedades Infecciosas de América (IDSA) recomendó al itraconazol 200 mg/d en régimen continuo como primera elección para tratar la esporotricosis cutánea.  El curso de tratamiento generalmente varía entre 3-6 meses.  El itraconazol en pulsos (200 mg 2 veces por día por 1 semana y 3 semanas sin tratamiento) se utilizó convencionalmente para onocomicosis y para otras micosis.  Esta terapia se basa en la propiedad del itraconazol de concentrarse en los tejidos especialmente la piel y puede mantener altos niveles durante el periodo de descanso.  La principal ventaja del régimen en pulsos es la mejor seguridad hepática y la conveniencia al reducir la dosis total de la droga. ver más previo registro en IntraMed

20 Abril 2011

Dermatoscopía de nevo y melanoma en la infancia

Archivado en: Actualidad dermatologica — dermatologia @ 16:21

From Medscapedermatology Education
Dermoscopy of Nevi and Melanoma in Childhood CME
Christine Brooks, DO; Alon Scope, MD; Ralph Braun, MD; Ashfaq A. Marghoob, MD

CME Released: 02/07/2011; Valid for credit through 02/07/2012
Melanocytic neoplasms of childhood belong to three distinct classes, including congenital nevi, acquired nevi and melanoma. Congenital melanocytic nevi (CMN) consist of nevi that are clinically evident at birth, as well as nevi manifesting congenital features that become clinically apparent shortly after birth (i.e., tardive CMN).[1] In addition, nevus spilus and segmental speckled-lentiginous nevus are also considered to be CMN. Melanocytic nevi that develop many months to years after birth are termed acquired melanocytic nevi (AMN) and include junctional nevi, compound nevi, dermal nevi, blue nevi (BN) and Spitz nevi (SN). Although rare, the incidence of melanoma in the pediatric population appears to be rising, and as such, it has become imperative that clinicians include melanoma in the differential diagnosis of atypical pigmented or amelanotic lesions in children.[2–4] It is important to acknowledge that melanoma can develop in healthy children, as well as those with underlying genetic or immunologic disorders, such as xeroderma pigmentosum. Approximately half of all pediatric melanomas arise in a de novo fashion, while the other 50% emerge in association with pre-existing cutaneous lesions. Nearly 30% of childhood melanomas arise within giant CMN, and approximately 20% develop in association with AMN.[5] Thus, any suspicious or evolving lesion in a child should not be dismissed as a benign entity, and a diagnosis of melanoma ought to enter the differential.

The clinical features of melanoma in children can be quite subtle, and can mimic SN and angiomas, often resulting in missed opportunities to perform a diagnostic biopsy in a timely fashion. Interestingly, retrospective studies suggest that at the time of diagnosis, up to 60% of pediatric melanomas are of intermediate thickness, which may in part be due to a delay in the clinical diagnosis and hesitation on the part of the clinician to perform a biopsy.[6,7] On the other hand, many benign CMN and AMN can manifest clinical features resembling melanoma, prompting unnecessary biopsies. It goes without saying that any technique that increases the sensitivity for detecting melanoma, while at the same time improving specificity, would be highly valued by clinicians. One technique that can improve a physician’s ability to detect melanoma and avoid superfluous biopsies in both children and adults is dermoscopy.

más

Actualidad en el tratamiento del acné

Archivado en: Actualidad dermatologica — dermatologia @ 15:48

From Medscape Dermatology News
Current State of Acne Treatment
Highlighting Lasers, Photodynamic Therapy, and Chemical Peels
Randie H Kim PhD; April W Armstrong MD

Posted: 04/14/2011; Dermatology Online Journal. 2011;17(3) © 2011 Arthur C. Huntley, MD

Acne vulgaris continues to be a challenge to dermatologists and primary care physicians alike. The available treatments reflect the complex and multifactorial contributors to acne pathogenesis, with topical retinoids as first-line therapy for mild acne, topical retinoids in combination with anti-microbials for moderate acne, and isotretinoin for severe nodular acne. Unfortunately, these conventional therapies may not be effective against refractory acne, can lead to antibiotic resistance, and is associated with adverse effects. With the rise of new technologies and in-office procedures, light and laser therapy, photodynamic therapy, chemical peels, and comedo extraction are growing in popularity as adjunctive treatments and may offer alternatives to those who desire better efficacy, quicker onset of action, improved safety profile, reduced risk of antibiotic resistance, and non-systemic administration. Whereas adjunctive therapies are generally well-tolerated, the number of randomized controlled trials are few and limited by small sample sizes. Furthermore, results demonstrating efficacy of certain light therapies are mixed and studies involving photodynamic therapy and chemical peels have yet to standardize and optimize application, formulation, and exposure times. Nevertheless, adjunctive therapies, particularly blue light and photodynamic therapy, show promise as these treatments also target factors of acne pathogenesis and may potentially complement current conventional therapy.

más

Actualidad en el diagnóstico de escabiosis

Archivado en: Actualidad dermatologica — dermatologia @ 15:40

From Medscape Dermatology news
From Reuters Health Information
Screen for Scabies With Tape, Confirm With Dermoscopy: Study
NEW YORK (Reuters Health) Apr 13 - In resource-poor settings, the adhesive tape test is an ideal way to screen for scabies, say the authors of a new study. And dermoscopy - but not skin scraping - is good for diagnosis.

“If a trained dermatoscopist is not available, then the adhesive tape test is the method of choice,” they add.

Scabies, a mite infestation of the upper layer of the epidermis, affects up to half of children and 10% of adults in resource-poor rural and urban areas, said Dr. Birke Walter of Charite Universite Berlin and colleagues in the April issue of the Archives of Dermatology.

Microscopic examination of skin scrapings has long been the standard means of diagnoses. More recently it’s become possible to make an in vivo diagnosis using epiluminescence microscopy and dermoscopy.

To compare techniques in a resource-poor setting, Dr. Walter and colleagues recruited 125 Brazilian slum dwellers with a presumptive diagnosis of scabies.

Results were available for analysis on 113 individuals, 55% of whom were children. Forty-one people, or 36%, were diagnosed with scabies. Most had moderate infestations.

Sensitivity and specificity, respectively, were 0.83 and 0.46 for dermoscopy and 0.46 and 1.00 for skin scraping. For the tape test - which involves applying clear packing tape to a lesion, pulling it off, and examining it under a microscope within three hours - sensitivity and specificity were 0.68 and 1.00, respectively.

Dermoscopy was more sensitive for more severe disease, while disease severity didn’t influence the sensitivity of the adhesive tape test.

ver más

Imiquimod crema en verrugas genitales

Archivado en: Actualidad dermatologica — dermatologia @ 15:28

From Medscape Dermatology education
Short-Acting Imiquimod Cream Approved for Genital Warts CME/CE
News Author: Norra MacReady
CME Author: Laurie Barclay, MD
CME/CE Released: 04/06/2011; Valid for credit through 04/06/2012
April 6, 2011 — The US Food and Drug Administration (FDA) has approved the use of 3.75% imiquimod cream (Zyclara Cream) for the treatment of external anogenital warts in people aged 12 years and older, according to an announcement released by Graceway Pharmaceuticals, which manufactures the cream.

The new preparation works in about half the time of older imiquimod preparations, which should enhance patient compliance, the company stated in a press release.

In an intent-to-treat analysis of all patients participating in 2 large, phase 3, double-blind, placebo-controlled trials, application of imiquimod once a day for up to 8 weeks was associated with complete clearance of the warts in 28.3% of patients compared with 9.4% of the patients using the placebo cream. The investigators defined complete clearance as clearance of baseline and emergent warts. Among the patients who experienced complete wart clearance, only 15% experienced a recurrence within 12 weeks.

ver más

« Entradas anterioresEntradas siguientes »

Autor: dermatologia | Contáctenos
Otro blog más de Art