RESUMO
Las dermatosis autoinfligidas representan un motivo habitual de consulta, así como un desafío diagnóstico y terapéutico. Se caracterizan por la autoprovocación de lesiones cutáneas de manera consciente o inconsciente en el contexto de trastornos psiquiátricos complejos. Comunicamos el caso de una paciente que consultó al Servicio de Dermatología por úlceras irregulares y sobreinfectadas localizadas en rostro, de 2 meses de evolución. El caso representó una dificultad diagnóstica ya que solo a partir del interrogatorio exhaustivo y los exámenes complementarios, que descartaron otras patologías, se arribó al diagnóstico de úlceras autoprovocadas en contexto de patología psiquiátrica que requirió manejo interdisciplinario. (AU)
Self-inflicted dermatoses are a frequent cause for consultation and represent a diagnostic and therapeutic challenge. They are characterized by the conscious or unconscious self-generation of cutaneous lesions in the context of complex psychiatric disorders. We report the case of a patient who consulted at the dermatology department with two months history of irregular and superinfected ulcers located on the face. This case represented a diagnostic difficulty since only from an exhaustive interrogation and complementary examinations, which ruled out other pathologies, we arrived at the diagnosis of self-inflicted ulcers in the context of psychiatric pathology that required interdisciplinary management. (AU)
Assuntos
Humanos , Úlcera Cutânea/psicologia , Transtornos Mentais/complicações , Sinais e Sintomas , Dermatopatias/diagnóstico , Dermatopatias/etiologia , Dermatopatias/patologia , Dermatopatias/psicologia , Dermatopatias/terapia , Úlcera Cutânea/patologia , Úlcera Cutânea/terapia , Traumatismos Faciais/patologia , Traumatismos Faciais/terapia , Avulsões Cutâneas/etiologia , Avulsões Cutâneas/terapiaRESUMO
La enfermedad injerto contra huésped es una entidad en la cual las células inmunológicas competentes de un tejido injertado reconocen y dañan antígenos presentes en el receptor del trasplante, que es incapaz de defenderse de ellas. Es una complicación frecuente del trasplante alogénico de médula ósea, y con menor frecuencia se produce luego de trasplantes de órganos sólidos o transfusiones de hemoderivados no irradiados. Se comunica el caso de una paciente de sexo femenino de 23 años, con leucemia linfoblástica aguda.y trasplante alogénico de médula ósea, que presentó una enfermedad injerto contra huésped con compromiso cutáneo y gastrointestinal dependiente de corticoides, con mejoría de los signos y síntomas cutáneos luego del tratamiento con infliximab y fotoféresis extracorpórea. (AU)
Graft versus host disease is an entity in which competent grafted immune cells recognize and damage tissue antigens present in the transplant recipient, who is unable to defend from them. It is one of the most serious complications in patients undergoing allogeneic bone marrow transplantation, although less frequently it may be associated with solid organ transplants or transfusions of not irradiated blood products. We report the case of a 23 year-old patient with acute lymphoblastic leukemia and allogeneic bone marrow transplantation, that presented graft versus host disease with skin and gastrointestinal involvement, dependent on corticosteroids, that showed improvement in signs and skin symptoms after treatment with infliximab and extracorporeal photopheresis. (AU)
Assuntos
Humanos , Feminino , Adulto , Adulto Jovem , Fotoferese , Doença Enxerto-Hospedeiro/tratamento farmacológico , Doença Enxerto-Hospedeiro/terapia , Sinais e Sintomas , Transplante Homólogo/efeitos adversos , Transfusão de Sangue , Metilprednisolona/administração & dosagem , Prednisona/administração & dosagem , Dor Abdominal , Ganciclovir/administração & dosagem , Fatores de Risco , Transplante de Órgãos/efeitos adversos , Transplante de Medula Óssea/efeitos adversos , Tacrolimo/administração & dosagem , Corticosteroides/efeitos adversos , Corticosteroides/uso terapêutico , Infecções por Citomegalovirus/diagnóstico por imagem , Diarreia , Mucosite , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Leucemia-Linfoma Linfoblástico de Células Precursoras/radioterapia , Neutropenia Febril , Infliximab/uso terapêutico , Avulsões Cutâneas/tratamento farmacológico , Avulsões Cutâneas/sangue , Doença Enxerto-Hospedeiro/etiologia , Doença Enxerto-Hospedeiro/mortalidade , Imunossupressores/efeitos adversos , Ácido Micofenólico/administração & dosagemRESUMO
La miasis es una infestación por larvas en desarrollo de una gran variedad de moscas del orden Díptera. Según el sitio de invasión, se clasifica en miasis cavitarias, que pueden deberse a invasión de cavidades naturales o de heridas, y miasis forunculoide, cuando atraviesa piel indemne. Esta infestación presenta una distribución mundial, con variaciones estacionales en relación con la latitud geográfica y el ciclo de vida de distintas especies de moscas. Presentamos una serie de tres casos de pacientes con distintas formas clínicas de manifestación de miasis. (AU)
Myiasis is the tissue infestation by a variety of Diptera order larvae flies. According to the invasion site, they are classified in myiasis of cavities, which can be because of an invasion of natural cavities or wounds, and furuncular myiasis, when they invade through intact skin. This infestation has a worldwide distribution, with seasonal variations in relation to the geographic latitude and the life cycle of different species of flies. We present three cases of patients with different clinical forms of presentation of myiasis. (AU)
Assuntos
Humanos , Masculino , Adulto , Idoso de 80 Anos ou mais , Carcinoma Basocelular/prevenção & controle , Diabetes Mellitus Tipo 2/complicações , Eritema Nodoso , Miíase/diagnóstico , Prurigo , Meato Acústico Externo/lesões , Miíase/classificação , Miíase/etiologia , Miíase/tratamento farmacológicoRESUMO
El melanoma ha experimentado un aumento constante en su tasa de incidencia en las últimas cinco décadas a nivel mundial. El pronóstico del paciente con melanoma se relaciona con el estadio de la enfermedad al momento del diagnóstico, con una sobrevida global media de 6,2 meses en pacientes con melanoma metastásico. El avance en las investigaciones sobre la biología y el comportamiento tumoral permitió el desarrollo de nuevas terapias con distintos mecanismos de acción y mayor eficacia. En esta revisión se abordan las terapias biológicas en melanoma metastásico, su mecanismo de acción y principales resultados en ensayos clínicos. (AU)
Melanoma has experienced a consistent increase in incidence over the past five decades worldwide. The prognosis of patients with melanoma is related to the stage of disease at diagnosis, with a median overall survival of 6.2 months in metastatic melanoma. Progress in research on tumor biology allowed the development of new therapies with different mechanisms of action and greater efficiency. In this review, biologic therapies in metastatic melanoma, its mechanism of action and main results in clinical trials are discussed. (AU)
Assuntos
Humanos , Terapia Biológica , Melanoma/terapia , Metástase Neoplásica/terapia , Incidência , Proteína Quinase 1 Ativada por Mitógeno/antagonistas & inibidores , Dacarbazina/efeitos adversos , Dacarbazina/uso terapêutico , Inibidores de Proteínas Quinases/efeitos adversos , Inibidores de Proteínas Quinases/uso terapêutico , Ipilimumab/efeitos adversos , Ipilimumab/uso terapêutico , Antineoplásicos Imunológicos/efeitos adversos , Antineoplásicos Imunológicos/uso terapêutico , Vemurafenib/efeitos adversos , Vemurafenib/uso terapêutico , Nivolumabe/efeitos adversos , Nivolumabe/uso terapêutico , ImunoterapiaRESUMO
El síndrome de Laugier-Hunziker es un trastorno pigmentario adquirido poco frecuente, caracterizado por presentar lesiones hiperpigmentadas cutaneomucosas idiopáticas que pueden asociarse a melanoniquia longitudinal. A pesar de ser considerado una enfermedad benigna sin manifestaciones sistémicas ni potencial maligno, es clave realizar el diagnóstico diferencial con otros trastornos pigmentarios, en especial con el síndrome de Peutz-Jeghers. Se presenta aquí el caso de un paciente con este síndrome poco frecuente. (AU)
Laugier-Hunziker syndrome is a rare acquired pigmentary disorder that is characterized by idiopathic mucocutaneous pigmentation that may be associated with longitudinal melanonychia. Although this syndrome is considered a benign disease with no systemic manifestations or malignant potential, it is important to rule out other mucocutaneous pigmentary disorders, especially Peutz-Jeghers syndrome. We report the case of a patient with this unusual syndrome. (AU)
Assuntos
Humanos , Masculino , Idoso , Hiperpigmentação/diagnóstico , Doenças Labiais/diagnóstico , Dermatopatias/diagnóstico , Dermatopatias/patologia , Síndrome de Peutz-Jeghers/diagnóstico , Hiperpigmentação/patologia , Diagnóstico Diferencial , Doenças Labiais/patologia , Doenças da Boca/diagnóstico , Doenças da Boca/patologiaRESUMO
La escabiosis es una ectoparasitosis pruriginosa producida por el ácaro Sarcoptes scabiei, variedad hominis, específica del ser humano. Si bien su distribución es universal, con frecuencia es subdiagnosticada por asociarla únicamente a hacinamiento y malos hábitos de higiene. Se transmite por contacto directo con una persona afectada o a través de fómites, por lo que es muy común el contagio de los convivientes. Presentamos un caso de escabiosis en una paciente anciana evaluada por prurito generalizado. (AU)
Scabies is a human specific pruritic ectoparasitosis produced by the mite Sarcoptes scabiei var. hominis. Although it has a worldwide distribution, it is often underdiagnosed because it is only associated with overcrowding and poor hygiene. It is transmitted by a direct contact with an affected person or through fomites. The transmission to cohabitants is very common. We present a case of scabies in an elderly patient with generalized pruritus. (AU)
Assuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Prurido/etiologia , Escabiose/diagnóstico , Prurido/tratamento farmacológico , Sarcoptes scabiei/patogenicidade , Escabiose/etiologia , Escabiose/parasitologia , Escabiose/tratamento farmacológico , Escabiose/transmissão , Ivermectina/administração & dosagemRESUMO
BACKGROUND: Dermatofibrosarcoma protuberans (DFSP) is an uncommon intermediate-grade fibrohistiocytic sarcoma. It occurs most often in adults aged 20-50 years and is associated with local invasion and a high recurrence rate. Uncontrolled local disease or metastases may result in death. Treatment has involved wide excision, Mohs micrographic surgery (MMS) and other approaches. The purpose of the current study was to review our experience with MMS in the treatment of patients with DFSP over the past six years. METHODS: We carried out a retrospective chart review for all patients treated with MMS at the Hospital Italiano de Buenos Aires during a six-year period to October 2009. Patient data included age and sex, site, and prior surgical treatment (if any) of the tumor and details of the Mohs procedure. RESULTS: Eleven patients were treated for DFSP. Four (36.4%) patients had been previously treated with a standard wide excision. Three (27.3%) of the 11 tumors were located on the back, four (36.4%) on the upper extremity, one (9.1%) on the lower extremity, and three (27.3%) on the trunk. Mean lesion size at presentation was 5.16 cm(2), and mean defect size was 12.65 cm(2), yielding a difference of 7.49 cm(2) and a ratio (defect size/lesion size) of 2.45. No tumors recurred after MMS. CONCLUSIONS: The recurrence potential of DFSP is directly related to the extent of resection. Mohs micrographic surgery with continuous histological margin control allows for maximum tissue preservation and low recurrence rates and is rapidly emerging as a first-line treatment modality for this condition.