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BACKGROUND: Erythroderma, characterized by erythema and scaling that affects at least 90% of the body, has diverse causes. Most of the clinical manifestations and laboratory findings are nonspecific, making diagnosis challenging. MATERIAL AND METHODS: Retrospective study of patients treated between January 1, 2010, and June 1, 2020. We reviewed the records to identify all patients with erythroderma who were hospitalized in Hospital Italiano de Buenos Aires and followed for at least 6 months. We extracted information on clinical histories, the characteristics of the episodes, laboratory and histopathologic findings, and clinical course. RESULTS: Seventy patients were studied. The mean age at onset was 63 years, and the ratio of men to women was 1.2:1. Adverse drug reactions caused the largest proportion of the rashes (48%), and vancomycin was the most common culprit (involved in 30% of the cases). The next most frequent cause was a preexisting skin disease, psoriasis being the most common (in 42%). The clinicopathologic correlation was adequate for diagnosis after the first biopsy in 40% of patients, but the diagnostic yield increased to 76% with the second biopsy. The largest number of biopsies required was 8, in 2 patients. The outcome was favorable in 92% of the cases. CONCLUSION: Adverse reactions to medications accounted for the largest proportion of erythroderma cases in this series, and vancomycin was the main culprit. We found no statistically significant associations among the variables studied. Nor did we identify potential predictors of causes, poor outcomes, or mortality.
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Dermatite Esfoliativa , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Feminino , Hospitais de Ensino , Humanos , Masculino , Estudos Retrospectivos , VancomicinaRESUMO
BACKGROUND: Extracorporeal photopheresis (ECP) is an immunomodulatory therapy used to treat graft-vs-host disease (GVHD) in adults and children. Few studies have examined its use in children. OBJECTIVE: To describe demographic characteristics, clinical response, adverse effects, and outcomes in a series of pediatric patients with acute or chronic GVHD treated with ECP. MATERIAL AND METHODS: We included all pediatric patients with acute or chronic GVHD treated with ECP by the dermatology department of Hospital Italiano de Buenos Aires between January 2012 and December 2018. We used the UVAR-XTS™ system (2 patients) and the CELLEX system (7 patients). Patients with acute GVHD received 2 sessions a week and were reassessed at 1 month, while those with chronic GVHD received 2 sessions every 2 weeks and were reassessed at 3 months. Treatment duration in both scenarios varied according to response. RESULTS: We evaluated 9 pediatric patients with corticosteroid-refractory, -dependent, and/or -resistant GVHD treated with ECP. Seven responded to treatment and 2 did not. Response was complete in 1 of the 9 patients with skin involvement and partial in 7. Complete response rates for the other sites of involvement were 60% (3/5) for the liver, 50% (1/2) for the gastrointestinal system, and 80% (4/5) for mucous membranes. Two patients died during the study period. CONCLUSION: ECP is a good treatment option for pediatric patients with acute or chronic GVHD.
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BACKGROUND: Extracorporeal photopheresis (ECP) is an immunomodulatory therapy used to treat graft-vs-host disease (GVHD) in adults and children. Few studies have examined its use in children. OBJECTIVE: To describe demographic characteristics, clinical response, adverse effects, and outcomes in a series of pediatric patients with acute or chronic GVHD treated with ECP. MATERIAL AND METHODS: We included all pediatric patients with acute or chronic GVHD treated with ECP by the Dermatology Department of Hospital Italiano de Buenos Aires between January 2012 and December 2018. We used the UVAR-XTS™ system (2 patients) and the CELLEX system (7 patients). Patients with acute GVHD received 2 sessions a week and were reassessed at 1 month, while those with chronic GVHD received 2 sessions every 2 weeks and were reassessed at 3 months. Treatment duration in both scenarios varied according to response. RESULTS: We evaluated 9 pediatric patients with corticosteroid-refractory, -dependent, and/or -resistant GVHD treated with ECP. Seven responded to treatment and 2 did not. Response was complete in 1 of the 9 patients with skin involvement and partial in 7. Complete response rates for the other sites of involvement were 60% (3/5) for the liver, 50% (1/2) for the gastrointestinal system, and 80% (4/5) for mucous membranes. Two patients died during the study period. CONCLUSION: ECP is a good treatment option for pediatric patients with acute or chronic GVHD.
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Resumen La doxiciclina, una tetraciclina semisintética de segunda generación, ampliamente usada para el tratamiento de patologías dermatológicas por sus propiedades antimicrobianas, ha demostrado en varios estudios experimentales sus acciones como un potente fármaco antiinflamatorio, aprobado por estas características por la FDA como una terapia complementaria en la periodontitis del adulto, así como en el tratamiento de la forma papulopustulosa de la rosácea. Se describen además en la literatura otras indicaciones para procesos inflamatorios, tales como, calcinosis cutis, vasculitis livedoide, patologías ampollares, entre otras. Se presenta una serie de 10 pacientes con lipodermatoesclerosis que presentaron una respuesta eficaz a su patología al recibir tratamiento con doxiciclina durante 3 meses, destacando de esta forma su eficacia terapéutica, accesibilidad y baja asociación a efectos adversos.
Abstract Doxycycline, a second generation semi-synthetic tetracycline, widely used for the treatment of dermatological diseases for its antimicrobial effects, has shown in many clinical studies its actions as a powerful anti-inflammatory drug. Approved by the FDA as a complementary therapy in adult periodontitis, and of the papulopustular form of rosacea. In addition, other indications for inflammatory processes are described in the literature, such as calcinosis cutis, livedoid vasculitis, blistering pathologies, among others. We present a series of 10 patients with lipodermatosclerosis who presented an effective response to their pathology when receiving treatment with doxycycline for 3 months. Its therapeutic efficacy, accessibility and low association with adverse effects are highlighted.
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Atitude do Pessoal de Saúde , COVID-19/epidemiologia , Dermatologia , Terapia de Imunossupressão , Imunossupressores/uso terapêutico , SARS-CoV-2 , Acesso à Informação , Adolescente , Adulto , Argentina/epidemiologia , COVID-19/prevenção & controle , Estudos Transversais , Dermatite Atópica/tratamento farmacológico , Dermatite Atópica/epidemiologia , Dermatologia/estatística & dados numéricos , Pesquisas sobre Atenção à Saúde/estatística & dados numéricos , Hidradenite Supurativa/tratamento farmacológico , Hidradenite Supurativa/epidemiologia , Humanos , Pessoa de Meia-Idade , Distanciamento Físico , Psoríase/tratamento farmacológico , Psoríase/epidemiologia , Sociedades Médicas/estatística & dados numéricos , Adulto JovemRESUMO
BACKGROUND: Hidradenitis suppurativa is a chronic recurrent systemic inflammatory disease that mainly involves large skin folds. It develops when pilosebaceous units become blocked, leading to the formation of painful nodules, abscesses, fistulas, and scarring. The impact of this disease on quality of life is great. OBJECTIVES: To describe the prevalence and clinical features of hidradenitis suppurativa in patients treated at Hospital Italiano de Buenos Aires and determine the frequency of comorbidities and time to diagnosis in this population. MATERIAL AND METHODS: Retrospective descriptive cross-sectional study. Information was extracted from the computerized clinical records of all patients with a diagnosis of hidradenitis suppurativa managed in Hospital Italiano de Buenos Aires between July 2012 and October 2017. RESULTS: Our initial search of the records yielded 180 cases; the diagnosis was confirmed in 66 cases. Sixty-five percent of the patients were women, and the mean age was 37 years. The prevalence of this diagnosis was 0.02%. The armpits, vulva, and groin were the locations most frequently affected. Smoking, overweight, and obesity were the most commonly recorded concomitant conditions. Male sex and perianal and gluteal locations were associated with severity. Time until diagnosis varied widely, ranging from diagnosis at the first visit in some cases to as long as 142 months and 21 visits. CONCLUSIONS: Our findings are consistent with the literature on hidradenitis suppurativa. This is the first Argentinian study to describe the prevalence of this disease as well as the concomitant conditions found and the rate of diagnostic error.
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Hidradenite Supurativa/epidemiologia , Adolescente , Adulto , Idoso , Argentina/epidemiologia , Doenças Autoimunes/epidemiologia , Comorbidade , Estudos Transversais , Diagnóstico Tardio , Feminino , Hidradenite Supurativa/diagnóstico , Hidradenite Supurativa/patologia , Hospitais de Ensino/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Hospitais Urbanos/estatística & dados numéricos , Humanos , Inflamação/epidemiologia , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Prevalência , Estudos Retrospectivos , Fumar/epidemiologia , Adulto JovemRESUMO
Primary cutaneous mantle cell lymphoma (MCL) is a rare cutaneous proliferation of naive pregerminal CD-5 positive B cells in the skin with no extracutaneous involvement. Overexpression of cyclin D1 is pathognomonic of this condition, and surgery and radiation therapy are the most common therapeutic options. In this case, we describe the clinical, histopathological, immunohistochemical, and molecular characteristics of a new case of primary cutaneous MCL.
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Previa una revision de antecedentes de la literatura mundial sobre el tema, se describe la sintomatologia mas frecuente y las caracteristicas psicosociales y se pasa revista a la legislacion vigente en la materia. Dado el desconocimiento general del cuadro en nuestro medio, sobre la base de las experiencias recogidas en la practica y en los datos bibliograficos, hemos desarrollado un "Plan Integral de Ayuda al Nino Abandonado y Maltratado (PIANAM)", implementando en el Partido de General San Martin un sistema para su prevencion, deteccion, notificacion, tratamiento y rehabilitacion de los afectados. Los componentes seran: El Centro Coordinador que funcionara las 24 horas en el Hospital Dr. Diego E. Thompson. Medicos privados y de otros servicios asistenciales zonales, que derivan los casos sospechosos al Centro Coordinador.Si el nino se encontrara internado en otros Centros Hospitalarios del Partido, se solicitaran los datos para Archivo, Estadistica y eventuales acciones. El Equipo Interdisciplinario de especialistas, reunidos todos los antecedentes, evaluara las condiciones bio-psico-sociales familiares, aconsejando la conducta a seguir. Se procurara la asignacion de recursos para que el sistema funcione
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Lactente , Pré-Escolar , Humanos , Masculino , Feminino , Criança Abandonada , Síndrome da Criança Espancada , Família , LegislaçãoRESUMO
Previa una revision de antecedentes de la literatura mundial sobre el tema, se describe la sintomatologia mas frecuente y las caracteristicas psicosociales y se pasa revista a la legislacion vigente en la materia. Dado el desconocimiento general del cuadro en nuestro medio, sobre la base de las experiencias recogidas en la practica y en los datos bibliograficos, hemos desarrollado un "Plan Integral de Ayuda al Nino Abandonado y Maltratado (PIANAM)", implementando en el Partido de General San Martin un sistema para su prevencion, deteccion, notificacion, tratamiento y rehabilitacion de los afectados. Los componentes seran: El Centro Coordinador que funcionara las 24 horas en el Hospital Dr. Diego E. Thompson. Medicos privados y de otros servicios asistenciales zonales, que derivan los casos sospechosos al Centro Coordinador.Si el nino se encontrara internado en otros Centros Hospitalarios del Partido, se solicitaran los datos para Archivo, Estadistica y eventuales acciones. El Equipo Interdisciplinario de especialistas, reunidos todos los antecedentes, evaluara las condiciones bio-psico-sociales familiares, aconsejando la conducta a seguir. Se procurara la asignacion de recursos para que el sistema funcione