Dermatología

18 Mayo 2011

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.”

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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.

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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.

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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.

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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.

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Esteroides sistémicos frente a alergia por contacto

Archivado en: Actualidad dermatologica — dermatologia @ 15:21

From Medscape Dermatology News
How Do Systemic Steroids Suppress Contact Allergies?
Craig A. Elmets, MD

Posted: 03/28/2011; Journal Watch © 2011 Massachusetts Medical Society

Abstract
Systemic steroids increase TGF-β, thereby inducing a chain of actions that eventually improve contact allergies.

Introduction
Systemic corticosteroids are among the most widely used medications in dermatology. Although many effects of these potent immunosuppressive agents are known, understanding of the mechanism by which they benefit allergic contact dermatitis is incomplete. To characterize the effects of oral glucocorticosteroids on the cutaneous immune response, investigators examined biopsied specimens from 24 participants from an earlier study of anti-inflammatory compounds in nickel-allergic patients who were randomized to 10 mg prednisone daily or placebo. After the 10-day study period, all were patch-tested to nickel sulfate.

The prednisone recipients had significantly reduced patch-test reactions. Specimens from the prednisone recipients showed fewer CD4+ and CD8+ T-cells, neutrophils, macrophages, and non-Langerhans cell dendritic cells but many more CD25+FOXP3+ regulatory T cells and epidermal Langerhans cells, as well as a dramatic increase in transforming growth factor-β (TGF-β) mRNA. In vitro studies showed that the prednisone treatment resulted in Langerhans cells that were much better than untreated Langerhans cells at stimulating the proliferation of regulatory T cells. Regulatory T cells required both interleukin-10 and TGF-β to mediate their suppressive effects.

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14 Abril 2011

Galería de imágenes en pediatría

Archivado en: sitios relacionados — dermatologia @ 17:22

Galería de imágenes en pediatría

 

8 Abril 2011

Dermatosis lineales

Archivado en: Clinica y Terapeutica — dermatologia @ 14:29

Las Dermatosis lineales son un grupo de enfermedades de la piel, congénitas o adquiridas, cuyas lesiones se disponen linealmente, algunas de ellas siguen las líneas de Blaschko por ejemplo la Incontinencia pigmenti, otras se disponen a lo largo de un dermatoma, por lo que adoptan un patrón metamérico como el Herpes zóster, y el resto aparecen linealmente pero sin seguir las formas anteriormente mencionadas como es el caso de la Larva migrans cutánea.

Nos motivamos a hacer una revisión del tema con reportes de la literatura médica y casos de la consulta con el objetivo de que constituya una guía práctica para facilitar el diagnostico, ya que estas entidades se presentan con relativa
frecuencia.

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