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Interleukin-17 (IL-17) and tumor necrosis factor (TNF) regulate the remodeling of the extracellular matrix by endopeptidases. However, it is not yet clear whether these cytokines have a functional hierarchy. This study aimed to assess whether IL-17 and TNF are hierarchically structured in psoriasis. Monocytes from 60 patients with plaque psoriasis and 60 non-psoriatic controls were stimulated in vitro with IL-17 or TNF, and the production of matrix metalloproteinases (MMPs) and their inhibitor (TIMP-1) were measured. Serum levels of inflammatory mediators also were measured. Serum levels of TNF, IL-17, MMP-1, and MMP-9 were higher in psoriasis than in control subjects. Basal productions of MMP-1, MMP-2, and MMP-9 by monocytes were higher in psoriasis than in controls, while TIMP-1 production was lower. TNF stimulation increased all MMPs in psoriasis and controls; TIMP-1 production was unchanged. IL-17 stimulation increased all MMPs in psoriasis and controls and decreased TIMP-1 production only in psoriasis. MMP-9 production was higher in monocytes stimulated with IL-17 compared to TNF in psoriasis and controls. TIMP-1 production decreased more with IL-17 than with TNF, but only in cells from psoriasis patients. MMP-1/TIMP-1, MMP-2/TIMP-1, and MMP-9/TIMP-1 ratios were higher after IL-17 stimulation (compared to TNF stimulation) in psoriasis; this occurred in monocytes from controls only for the MMP-2/TIMP-1 ratio. In conclusion, IL-17 has a greater capacity than TNF to dysregulate the balance between MMPs and their tissue inhibitor. This hierarchical supremacy supports the blockade of IL-17 as the first line of treatment in plaque psoriasis over TNF inhibitors.

Cutaneous vasculities (CV) represents a diagnostic challenge, occurs as primary cutaneous disorder or as a manifestation of other entities.To search the cause of CV. Methods: Patients with CV were prospectively evaluated. In all patients, skin biopsies were drawn, and direct immunofluorescence was done in most of the patients. American College of Rheumatology (ACR) and Chapel Hill Consensus Conference Criteria (CHCC) were used for classification.32 patients were studied. There was female predominance (71.8%). Children presented drug-associated CV or Schönlein-Henoch púrpura (SHP). Adults presented more frequently SHP, systemic lupus erythematosus or paraneoplastic vasculitis, other diagnosis as polyarteritis nodosa, microscopic polyangiitis, thrombotic vasculitis (post-puerperal), antiphospholipid syndrome, Churg-Strauss syndrome, and drug-associated CV were presented. Using the ACR and CHCC criteria, 50% of cases were classified.In our institution, during this work the etiologic diagnostic of CV increased more than twice. However, in the case of HSV or LA and SHP none of the proposed criteria had high specificity; other parameters were used to discern between both. Six patients remained as not classified. In our view, cryoglobulins and hepatitis serology do not seem useful unless patient’s history supports they need to be done. Unclassified patients were followed-up closely for 2 years.Las vasculitis cutáneas (VC), primarias o como manifestación de enfermedades sistémicas, constituyen un reto diagnóstico.Determinar las causas de VC.Se incluyeron pacientes con diagnóstico de CV, a los cuales se les realizó valoración clínica, biopsia cutánea y exámenes de laboratorio. En la mayoría de los casos se realizó inmunofluorescencia directa. Los casos se clasificaron con los criterios del American College of Rheumatology (ACR) y la Chapel Hill Consensus Conference (CHCC).Se incluyeron 32 pacientes; la frecuencia fue mayor en mujeres (71.8%). Los niños presentaron VC asociadas a medicamentos o púrpura de Schönlein-Henoch (PSH). En adultos se reportó con más frecuencia PSH, vasculitis asociada a lupus eritematoso sistémico y vasculitis paraneoplásicas; otros diagnósticos etiológicos incluyeron poliarteritis nodosa (PAN), poliangeítis microscópica (PAM), vasculitis trombótica (pospuerperal), síndrome antifosfolípidos (SAF), síndrome de Churg-Strauss (SCS) y VC asociada a medicamentos. Utilizando los criterios del ACR y la CHCC para vasculitis se clasificó el 50% de los casos.En el Hospital Gea, durante este trabajo, el diagnóstico etiológico de las CV se incrementó más del doble. Sin embargo, en relación a los diagnósticos vasculitis por hipersensibilidad (VHS) y PSH ninguna de las clasificaciones utilizadas contaba con criterios específicos. Seis pacientes permanecieron sin clasificar. Observamos que los estudios de crioglobulinas y serología para hepatitis no son útiles como estudios iniciales, salvo que la historia clínica del paciente lo sugiera. Los pacientes sin clasificar se siguieron por dos años.

Introduction: Spitz nevus is an uncommon, benign melanocytic proliferation that primarily appears on face, trunk or lower extremities of children. This lesion may share clinical and microscopical characteristics with melanoma, making it a diagnostic and management challenge. Case Report: A 13-year old male presented with an asymptomatic chronic dermatosis located on the third left-hand nail. Cutaneous examination revealed a homogeneous dark brown melanonychia which extended up to the cuticle. Upon dermoscopy, longitudinal bands measuring less than 3 mm wide of heterogeneous colors ranging from light to dark brown, and positive Hutchinson’s sign were observed. Discussion/Conclusion: We report the second case of a Spitz nevus ungually localized which strongly resembled an ungual melanoma with a positive Hutchinson’s sign upon dermoscopy. Describing the infrequent presentation and location of the Spitz nevus poses an opportunity to establish diagnostic and management criteria in the near future.

Disseminated and recurrent infundibulofolliculitis is an uncommon non-infectious skin eruption characterized by recurrent, sometimes pruritic, follicular papules commonly seen on the trunk and proximal extremities. We describe the clinical, dermoscopic, and histopathologic characteristics of disseminated and recurrent infundibulofolliculitis in three young pediatric patients from the tropical regions of Mexico, Guerrero, and Chiapas.

Pyoderma gangrenosum is a rare, neutrophil-mediated, auto-inflammatory dermatosis that wound care specialists must be prepared to recognise. This condition has clinical features analogous to infectious processes. There is no specific diagnostic test and the diagnosis is usually obtained from exclusion. Its early recognition and proper management with prompt initiation of immunosuppressive therapy are essential to improve the quality of life and the prognosis of patients.

INTRODUCCIÓN: El lupus eritematoso (LE) es una enfermedad autoinmune poco frecuente en el sexo masculino, que presenta manifestaciones clínicas múltiples relacionadas al pronóstico de la enfermedad. La etiología es desconocida, sin embargo, se relaciona a la exposición de radiación ultravioleta y alteración en la función linfocítica. El lupus eritematoso profundo (LEP) es una variante clínica de LE cutáneo que se presenta entre el 1% al 3% de los pacientes y únicamente el 10% de los casos reportados en la literatura pertenecen al sexo masculino. Hasta el 50% de los pacientes con LEP presentan progresión a lupus eritematoso sistémico (LES) durante su evolución.PRESENTACIÓN DEL CASO: Adolescente 16 años, previamente sano, que presentó una placa eritematosas, induradas y asintomáticas en mejilla izquierda de evolución crónica. Se realizó biopsia incisional con diagnóstico de LEP. El resto del abordaje para descartar lupus eritematoso sistémico resultó negativo. El paciente recibió tratamiento con corticosteroide tópico por 4 semanas en esquema de reducción así como fotoprotección estricta con mejoría del eritema y disminución del área indurada. Actualmente el paciente continúa en seguimiento con atención a signos y síntomas sugerentes de lupus eritematoso sistémico.CONCLUSIÓN: El LEP es una dermatosis multifactorial poco frecuente en el sexo masculino, por lo que la literatura actual podría no ser representativa en este sexo. Es necesario realizar un abordaje amplio al momento del diagnóstico con pruebas de laboratorio séricas y reumatológicas. Es de suma importancia ser capaces de identificar de manera temprana signos y síntomas que sugieran progresión a LES o linfoma.

Actinic prurigo (AP) is a type of photodermatosis that primarily affects the Latin American mestizo population. Histologically, AP cheilitis exhibits acanthosis with spongiosis and vacuolation of the basal cell layer overlying a dense lymphocytic inflammatory infiltrate that forms well-defined lymphoid follicles. Toluidine blue is a thiazide, acidophilic, and metachromatic dye used in vivo to selectively stain the acidic components of tissues such as sulfates, carboxylates, and phosphate radicals that are incorporated into DNA and RNA. It is necessary to develop a method that allows detecting, on clinical grounds the area of the lesion in which it is more feasible to find such structures. Thus to increase the sensitivity of the biopsy, in AP cheilitis to accurately identify where the lymphoid follicles reside, based on the higher concentration of DNA in such structures and thus confirm the diagnosis. In this study, staining was positive in 85% of patients with AP cheilitis, in 14 of whom 82% lymphoid follicles were observed by histopathology. One of the pathologist’s problems in establishing the diagnosis of AP is that the main histopathological characteristics are not always identified in the submitted samples because it is not easy to clinically identify the most representative site of the lesion selected for performing a biopsy. Based on our results, we propose using toluidine blue as an auxiliary method to choose a tissue sample to facilitate the diagnosis and allow clinicians to make clinical correlations between the histopathological and therapeutic findings.

China officially recognized atypical pneumonia outbreak in December 2019; on 11 March 2020, the World Health Organization declared COVID-19 as a pandemic that is produced by a new coronavirus, named SARS-CoV-2, of rapid transmissibility, which can be asymptomatic, with mild to severe respiratory symptoms, and with cardiovascular, neurological, gastrointestinal, and cutaneous complications. Considering that the pandemic prolonged more than initially expected was prognostic, it is essential for the medical community to identify the signs and symptoms of COVID-19. Thus, this work’s objectives were to present cases of cutaneous lesions observed in COVID-19 Mexican patients. We register cutaneous lesions in COVID-19 patients referred from internal medicine and otorhinolaryngology services to dermatology. We presented four interesting cases with cutaneous lesions, including exanthema morbilliform, urticaria, chilblains, ecchymosis, and facial edema, and review the available literature. The most frequent cutaneous markers are rash, chilblains, and urticaria. Skin lesions may be the first manifestation of COVID-19, accompany initial respiratory symptoms, or appear during the disease course. Symptoms associated with vascular changes (livedo reticularis and vasculitis) are considered of poor prognosis.

Introduction: Onychomycosis is a frequent chronic nail infection, with a worldwide prevalence of 5.5% making it the most common nail disease, and its incidence increases with age. Clinically, it causes discoloration and thickening of the nail plate and may be accompanied by onycholysis. However, little is known of the subclinical infection. Methods: We studied adult male and female outpatients auto-referred as healthy and that had healthy appearing toenails. Nail distal clippings were obtained from the right first toenail. This sample was stained with PAS and observed by an expert dermatopathologist searching for fungal structures. Results: A total of 32 samples were included: 8 from men (25%) and 24 from women (75%), with ages ranging from 27 to 66 years (mean age of 43 years). Twenty-four patients did not present any histopathological finding suggestive of infection (75%), while 7 patients had a single finding (spores or hyphae) (21.8%), and 1 patient had both findings (3.12%). Discussion/Conclusion: We found 4 patients with yeasts, 3 with hyphae, and 1 patient with a combined infection with both yeasts and hyphae (3.1%). These add up to 25% of the clinically apparent healthy nails. Our results show that we still have much to learn from the initial stages of onychomycosis and that our population probably has higher incidence of this nail disease, so we must be alert to subtle nail changes. As our participants signed an informed consent, we will contact those that resulted positive for follow up consultations.

RESUMEN El termino carcinoma verrugoso (epitelioma cuniculatum [EC]) se atribuye a Ackerman, y corresponde a una de las tres formas inusuales de carcinoma espinocelular o de celulas escamosas, el cual se caracteriza por ser una neoformacion bien diferenciada, de bajo grado de malignidad y con poco potencial metastasico. Las otras dos formas corresponden al tumor de Buschke-Lowenstein y en la cavidad oral, al tumor de Ackerman. Se presenta el caso de un hombre de 61 anos de edad con una neoformacion exofitica de aspecto verrugoso en planta del pie derecho, de 20 anos de evolucion, la cual fue traumatizada durante ese tiempo, de manera constante y repetitiva mediante medios mecanicos y quimicos. Palabras Clave: Epitelioma Cuniculatum, Carcinoma Verrugoso plantar, Carcinoma Espinocelular. ABSTRACT The Epithelioma Cuniculatum (EC), is one of three rare forms of low grade squamous cells carcinoma, where the topography in which it is presented is the foot, which is characterized for being a well differentiated carcinoma, it has a slow growth and a low metastasis potential. We present a 61 year old man with an exophytic lesion with a warty appearance on right foot sole, 20 years of evolution, which during that time was diagnosed as a plantar wart and it was treated and traumatized with mechanical and chemical means with de purpose of eliminate it, without success. Key Words: Cuniculatum Epithelioma, Verrucous Plantar Carcinoma, Squamous Cells Carcinoma.

Dermatobia hominis is a fly endemic to and widely distributed throughout the Americas; it is found from the southern regions of Mexico to Argentina. However, because of widespread travel, myiasis has become common in countries where neither the disease nor the species that cause this infection are endemic. Central Mexico, for instance, is not a region where myiasis is endemic. We, thus, describe three cases of D. hominis myiasis: two autochthonous cases from the southern part of Mexico and one imported from Costa Rica. In addition, morphological and genetic identification was performed on the maggots extracted from the patients.

Antecedentes: La foliculitis por Malassezia spp. (fm) es una infección del folículo piloso causada principalmente por M. furfur. Afecta a adolescentes y adultos y se caracteriza por la presencia de pápulas y pústulas foliculares pruriginosas localizadas en el tronco.Objetivo: Describir las características epidemiológicas y clínicas de los pacientes con fm diagnosticados por examen directo (emd) en el Centro Dermatológico de Yucatán (cdy).Métodos: Se realizó un estudio transversal, descriptivo y retrospectivo en el que se revisaron los registros de los Emds realizados en el Laboratorio de Micología del cdy durante enero 2009 - diciembre 2015.Resultados y conclusiones: Se documentaron 56 casos, el 78.6% fueron hombres. La edad promedio fue de 21.4 años. La topografía más frecuente fue el tronco (94.6%), seguido de cara (16.1%), cuello (12.5%), extremidades superiores (10.7%) e inferiores (3.6%). Durante el 2015 se documentaron 22 casos (39.3%) de los cuales el 86.3% se presentaron en junio-septiembre. Seis casos (27.7%) utilizaron previamente esteroides tópicos y 3 casos (13.6%) antibióticos sistémicos. Todos los casos fueron diagnosticados mediante EMD con azul de metileno, el cual es una técnica rápida y no invasiva que permite iniciar un tratamiento temprano.

Background Connective tissue autoimmune diseases (CTADs) constitute a group of conditions, including rheumatoid arthritis; systemic lupus erythematosus; mixed connective tissue disease; calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia (CREST) syndrome; scleroderma; dermatomyositis; and Sjogren syndrome. There are few studies on the alterations in filiform papillae in CTAD. Thus, the objective of this work was to determine whether there are changes in the macroscopic and dermoscopic patterns of filiform papillae. Methods This case-control study included patients who were diagnosed with CTAD. The dependent variable was the dermoscopic pattern of filiform papillae of the tongue, and the independent variables were age, gender, time of evolution, and current treatment. A photograph of the back of the tongue was taken, and subsequently, the same site was examined by dermatoscopy. The microscopic and dermoscopic patterns of filiform papillae were classified (Maeda). Results We included 50 cases and 50 controls, 94% of whom were female. The mean age was 43.96 ± 14.65 years. Of the cases with CTAD, 25% presented with a normal macroscopic pattern, versus 36% (18) with pattern II, 12% (6) with pattern III, and 20% (10) with pattern IV. The dermoscopic pattern was type I in 23 cases (46%), type II in 16 (32%), type III in 10 (20%), and type IV in one patient (2%). Conclusions We have noted alterations in filiform papillae in CTADs, which emphasizes the importance of a detailed intraoral exploration and the macroscopic and dermoscopic evaluation of the dorsum of the tongue, specifically the filiform papillae.

Background: Actinic prurigo (AP) is an idiopathic photodermatosis. Although its initial manifestations can appear in 6 to 8-year-old children, cases are diagnosed later, between the second and fourth decades of life, when the injuries are exacerbated. Objective: To identify risk factors associated with clinical manifestations of AP such as skin and mucosal lesions. Methods: Thirty patients with AP and 60 controls were included in the study, the dependent variable was the presence of skin or labial mucosal lesions, the independent variables were age, sex, solar exposure, living with pets or farm animals, exposure to wood smoke, smoking habit, years smoking, and hours spent per day and per week in contact with people who smoke. Results: Of the 30 diagnosed AP patients, 66.7% were female. Patients age ranged from 7 to 71 years and the mean age was 35.77 ± 14.55 years. We found significant differences with the age and cohabitation with farm animals. Those who lived with farm animals presented 14.31 times higher probability of developing AP (95% CI 3-78.06). Study limitations: This is a case-control study; therefore, a causal relationship cannot be proven, and these results cannot be generalized to every population. Conclusions: The identification of factors related to the development of AP increases our knowledge of its physiopathology. Moreover, identifying antigens that possibly trigger the allergic reaction will have preventive and therapeutic applications in populations at risk of AP.

Perinevoid alopecia has been described as an associated alopecia surrounding a pigmented nevus due to an inflammatory response against nevus structures. It is described as a part of other nevocentric phenomena in which a cellular inflammatory response against nevus antigens develops. A 35-year-old male presented with a unique area of non-scarring alopecia surrounding an asymptomatic, pigmented nevus with a 1-month evolution. Trichoscopic and histologic findings were compatible with alopecia areata (AA). One month after excision, hair regrowth was reported by the patient. We concluded that perinevoid alopecia is an extremely rare clinical presentation of AA associated with a central, pigmented nevus where a cellular inflammatory response is triggered against hair follicles, nevoid cells, and melanocytic structures.

Background Chagas disease (CD) is caused by the protozoan parasite Trypanosoma cruzi and is transmitted by triatomine insects. Clinical manifestations vary according to the phase of the disease. Cutaneous manifestations are usually observed in the acute phase (chagoma and Romaña’s sign) or after reactivation of the chronic phase by immunosuppression; however, a disseminated infection in the acute phase without immunosuppression has not been reported for CD. Here, we report an unusual case of disseminated cutaneous infection during the acute phase of CD in a Mexican woman. Methods Evaluation of the patient included a complete clinical history, a physical exam, and an exhaustive evaluation by laboratory tests, including ELISA, Western blot and PCR. Results Skin biopsies of a 50-year-old female revealed intracellular parasites affecting the lower extremities with lymphangitic spread in both legs. The PCR tests evaluated biopsy samples obtained from the lesions and blood samples, which showed a positive diagnosis for T. cruzi. Partial sequencing of the small subunit ribosomal DNA correlated with the genetic variant DTU II; however, serological tests were negative. Conclusions We present a case of CD with disseminated skin lesions that was detected by PCR and showed negative serological results. In Mexico, an endemic CD area, there are no records of this type of manifestation, which demonstrates the ability of the parasite to initiate and maintain infections in atypical tissues.

Fillers are frequently used in aesthetic medicine and, although usually safe, complications can occur. Vascular occlusion leading to tissue necrosis is a rare but severe complication. Alopecia after hyaluronic acid injection has been recently reported, being a vascular compromise the most probable physiopathological mechanism. The trichoscopic findings in this entity have not been described yet. A case report of a 30-year-old female who developed this complication following a hyaluronic acid injection as well as the description of the trichoscopic findings are presented in this report.

La toxina Pet (plasmid-encoded toxin) producida por Escherichia coli (EAEC) es uno de los autotransportadores más estudiados en la familia Enterobacteriaceae.Es responsable de cambios morfológicos enenterocitos durante la infección por EAEC. Recientemente, Pet fue encontrada en el genoma de una cepa de Proteus mirabilis RTX339 [P. mirabilis (Pet+)]. P. mirabilis causa infección en el tracto urinario (ITU) en pacientes que usan catéteres o que presentan anomalías estructurales o funcionales. En este estudio una ITU con P. mirabilis (Pet+) fue inducida en ratones hembras BALB/c. Los ratones infectados con P. mirabilis (Pet+) muestran una colonización bacteriana en vejiga y riñón desde el segundo hasta el día decimo de la infección. Los cambios morfológicos fueron evidenciados por histología. Se observaron múltiples células exfoliadas del epitelio de transición de la vejiga, así como alteraciones morfológicas en la corteza renal. Se confirmó la presencia de Pet en las células exfoliadas y en las del parénquima por microscopíaconfocal. Las alteraciones del citoesqueleto fueron observadas en los sitios donde se detectó Pet. La toxina Pet expresada por la cepa de P. mirabilis (Pet+) contribuye a la patogenicidad y afecta tejidos urinarios durante el curso de la infección.

Background: Pemphigus is part of a group of blistering diseases that affect the skin and mucous membranes. Based on its autoimmune origin, autoantibodies develop in pemphigus that are directed toward cell surface components of keratinocytes. However, some data cannot be explained, such as the lack of a relationship between autoantibody levels and the severity of clinical manifestations, treatment resistance, the presence of inflammatory infiltrates and the potential occurrence of apoptosis as determinants of vesicle formation. Objective: To examine the presence of apoptosis in pemphigus vulgaris by TUNEL technique. Methods: In this cross-sectional study, we selected 15 paraffin-embedded tissues from subjects who were diagnosed with pemphigus vulgaris by hematoxylin and eosin staining. The samples were subjected to TUNEL assay and examined under an Olympus BX61 fluorescence microscope. Positivity was categorized dichotomously, and the statistical analysis was performed using the X2 test. Results: Positivity was observed in basal layer cells in 14 (93.3%) cases. In 13 (86.7%) of the positive cases, we noted espinosum and granular layers that formed the blister roof, and in 12 cases (80%), positive acantholytic cells were observed. Conclusions: TUNEL positivity was observed in pemphigus vulgaris, implicating apoptosis in the pathophysiology of this condition, which can help guide the development of apoptotic blockers as therapeutics.

Actinic prurigo (AP) is an idiopathic photodermatosis; the initial manifestations usually occur during the first decades of life but can appear at any age. Cases are usually diagnosed late once the lesions have exacerbated; due to the extensive involvement of the vermilion border and the etiology, it has been confused with and related to a potentially malignant process. Syndecan-1 and E-cadherin were positive in the epidermis, with moderate-to-intense staining in 100% of samples. Ki67 and MCM3 were expressed in the lower third of the epidermis and showed greater immunolabeling in samples that contained lymphoid follicles (Ki 67: epidermis [17.7% ± 6.79%] and dermis [7.73% ± 6.69%]; MCM3: epidermis [22.92% ± 10.12%] and dermis [6.13% ± 6.27%]). In conclusion AP is a disease in which there is no evidence that the lesions are potentially cancerous. AP cheilitis should not be confused with actinic cheilitis because they are separate entities.

Myiasis caused by Dermatobia hominis , the human botfly, is frequent in the Americas, however, scarce morphological and molecular information exist regarding this dipteran. We describe three cases in urban areas of Mexico were D. hominis is not endemic. Morphological and genetic identification were performed using the cytochrome oxidase I as a molecular marker. The mitochondrial cytochrome oxidase I gene is useful for inferring the genetic divergence of D. hominis .

e21544 Background: A relationship between EGFR signaling pathway expression in skin and the use of targeted cancer therapies has been consistently demonstrated. Nonetheless, consistent evidence to support the use of skin biopsies as a surrogate for therapeutic evaluation. Methods: The present study is a prospective single-blind analysis of skin biopsies of patients with confirmed advanced EGFR mutated lung adenocarcinoma. Immunohistochemistry was performed with EGFR, p27, Ki67, STAT3, and MAPK, as well as an H&E histopathological analysis, looking for their relationship with the response to treatment with tyrosine kinase inhibitors. ROC curve analysis was used to determine the cutoff value for each biomarker selected dichotomizing the response to treatment as mentioned in the tissue samples section (adequate response or no response). Kaplan Meier analysis for progression-free survival was performed. Results: From the 35 biopsies obtained, 21 (60%) of the patients were women and 14 (40%) men; the mean age of participants was 60.6±11.7 years. Twelve patients (34.3%) were at the pre-treatment group, 12 (34.3%) had an adequate response to treatment and 11 (31.4%) were at the no response to treatment group. The median progression-free survival was 9 months. The next biomarkers were significantly related to an adequate response to treatment by using a bivariate correlation test: EGFR (p = 0.025), Ki67 (p = 0.015), STAT3 (p = 0.017), stratum corneum thickness (p = 0.039) and the number of layers of the stratum corneum(p = 0.041). A better median of progression-free survival was obtained on those with a value above of the cutoff preestablished of EGFR (21 months versus 7 months, 95% CI 0-46 versus 4.23-9.77, p = 0.025) and number of layers of the stratum corneum (21 months versus 8 months, 95% CI 0-43.81 versus 6.72-9.28, p = 0.030), however, for p27 a better median of progression-free survival was shown in those with a value below the cutoff before mentioned (21 months versus 8 months, 95% CI 8.17-33.83 versus 6.87-9.13, p = 0.031). Conclusions: We found a relationship between EGFR, Ki67, STAT3, stratum corneum, number of layers of stratum corneum, with the response to treatment, and better progression-free survival for high expression EGFR, number of layers of the stratum corneum and low expression for p27. The present study should incite to perform a further investigation to validate these markers as potential prognostic and predictive factors.

espanolIntroduccion: El linfoma anaplasico de celulas T grandes CD30+ es un linfoma primario cutaneo en el cual no hay evidencia de enfermedad sistemica; para su diagnostico es necesario el estudio histopatologico. Objetivo: Presentar los casos diagnosticados en el Departamento de Dermatologia del Hospital General “Dr. Manuel Gea Gonzalez” con linfomas anaplasicos de celulas T grandes primarios cutaneos CD30+ durante un periodo de 24 anos. Metodo: Estudio retrospectivo en el que realizo estadistica descriptiva. Se recopilo informacion de sexo, edad, caracteristicas clinicas, resultados de pruebas complementarias, tratamientos previos y actuales, reportes de los estudios histopatologicos y de inmunohistoquimica. Resultados: Entre 29 309 expedientes, se encontraron nueve casos (0.000034 %) con diagnostico de linfoma anaplasico de celulas T CD30+. Se hizo la confirmacion del diagnostico histopatologico e inmunohistoquimico por dos dermatopatologos certificados. La edad promedio fue de 61.2 anos, hubo predominio del sexo femenino y de lesion papular o nodular y topografia variada como presentacion clinica inicial. Conclusiones: El pronostico del linfoma anaplasico de celulas T grandes CD30+ en la poblacion estudiada fue dependiente del estadio clinico. El tratamiento en etapas tempranas tiene resultados favorables. EnglishIntroduction: CD30+ anaplastic large T cell lymphoma is a cutaneous primary lymphoma in which there is no evidence of systemic disease; histopathological study is required for its diagnosis. Objective: To present the cases diagnosed with primary cutaneous CD30+ anaplastic large T-cell lymphoma over a 24-year period in Hospital General “Dr. Manuel Gea Gonzalez” Department of Dermatology. Method: Retrospective study. Descriptive statistics was carried out. Information was collected on gender, age, clinical characteristics, complementary test results, previous and current treatments, histopathological studies reports and immunohistochemistry test results. Results: Of 29 309 records, nine patients (0.000034%) with a diagnosis of CD30+ anaplastic T cell lymphoma were found. Histopathological and immunohistochemical diagnosis was confirmed by two certified dermatopathologists. Average age was 61.2 years, and there was a predominance of the female gender, with initial clinical presentation as a papular or nodular lesion and varied topography. Conclusions: The prognosis of CD30+ anaplastic large T cell lymphoma in the studied population was dependent on clinical stage. The treatment at early stages has favorable results.

Background Hypopigmented dermatoses, more evident in dark-skinned people, are a frequent cause of consultation. Their etiology includes a wide range of dermatoses, from benign to malignant diseases. The clinical presentation appears very similar between them, making the correct diagnoses and management a challenge. Methodology Clinical records and histopathological biopsies were identified and compared in patients of the "Dr. Manuel Gea Gonzalez" General Hospital throughout a 16-year period with the presumptive diagnosis of hypopigmented epitheliotropic T-cell dyscrasia (HTCD) or hypopigmented mycosis fungoides (HMF). Immunostaining analysis was performed in each specimen, the panel of antibodies used was: CD3, CD4, CD7, CD8, CD20, and CD62L. Results Thirty cases of 81 patients found in the registries were included in this study. The main age group was formed by children younger than 15 years old. The main clinical differences between both entities were gender, presence of plaques, and neck lesions. The most significant histopathological parameters used to differentiate both diagnoses were: severity of lymphocytic infiltration, the extent of epidermotropism, folliculotropism, presence of Pautrier's microabscesses, lymphocytes with cerebriform nuclei, and dermal fibroplasia. No immunohistochemical differences were found between them. Conclusion The clinical distinction between HTCD and HMF continues to be a challenge, therefore an extensive clinicopathological correlation must be performed. AbCD7 and AbCD62L were not useful to differentiate both dermatoses. This paper suggests that HTCD and HMF should be considered as the beginning and the end of the same clinical spectrum.

Introducción: el dar a conocer las principales características clínicas de la afectación de algunos virus del papiloma humano en cavidad bucal, permite al profesional de la salud identificar factores de riesgo y las principales lesiones asociadas con el mismo, con el fin de brindar atención oportuna, evitando de esta manera el pasar por alto este tipo de lesiones.Características: el virus del papiloma humano (VPH) pertenece a la familia de los Papillomaviridae que mide entre 50-55 nm de diámetro, son virus pequeños de ADN no envueltos, epiteliotrópicos cuyo genoma está formado por cadenas dobles de cADN, este virus se puede llegar a encontrar de forma latente en el organismo durante años sin evidenciar cambios histológicos o clínicos, o bien puede formar papilomas benignos o verrugas cuyas lesiones consisten en tejido hiperplásico con engrosamiento de la capa espinosa del epitelio y un aumento de la proliferación capilar.Resultados: al tratarse de un virus exclusivamente epiteliotrópico la vía de entrada ocurre a través de micro-rupturas del epitelio que expone a las células de la superficie basal al virus, lo cual explica la alta frecuencia con la que se presenta en las poblaciones.Conclusiones: el odontólogo de práctica general debe conocer las generalidades de los virus VPH, de tal manera que cuando identifiquen alguna lesión relacionada con algunos de los subtipos, pueda orientar al paciente y ofrecer un tratamiento acertado cuando así se requiera

BACKGROUND: Actinic prurigo is an idiopathic photodermatosis, the pathophysiology of which has been hypothesized to involve subtype IV type b (Th2) hypersensitive response, whereby IL4, IL5, and IL13 are secreted and mediate the production of B cells, IgE, and IgG4. OBJECTIVES: To examine the association of serum IgE levels and the clinical severity of injuries. METHODS: This case-control study comprised patients with a clinical and histopathological diagnosis of actinic prurigo, as well as clinically healthy subjects, from whom 3cc of peripheral blood was taken for immunoassay. Cases were classified by lesion severity as mild, moderate, and severe. Descriptive statistics were analyzed, and chi-square test was performed. RESULTS: We included 21 actinic prurigo patients and 21 subjects without disease; 11 patients with actinic prurigo had elevated serum IgE levels, and 10 had low serum levels. Six actinic prurigo (AP) patients with elevated serum levels of IgE had moderate injuries, 4 had severe injuries, and 1 had minor injuries. Eight out of 10 patients with normal IgE levels presented with minor injuries in the clinical evaluation. The 21 controls did not have increased serum IgE levels. CONCLUSIONS: Elevated IgE levels are associated with moderate to severe clinical lesions, suggesting that actinic prurigo entails a type IV subtype b hypersensitivity response in which Th2 cells predominate.

El virus del papiloma humano (VPH) forma parte de un grupo de virus ADN heterogéneo llamados papillomaviridae; este virus es causante de múltiples lesiones hiperplásicas, verrucosas y papilomatosas de las células epiteliales de piel y mucosas, existen más de 120 tipos de VPH, de solo 100 se conoce su secuencia genómica completa. Los dos géneros más importantes son los papilomavirus alpha (ð) y los beta (ß), la mayoría de los virus que infectan el área genital pertenecen al género alpha; según sus características clínicas, se pueden subdividir en cutáneos y de mucosa. Si bien las infecciones por este virus son frecuentes en cavidad oral, este campo de la medicina se encuentra en estudio, debido a que la información sobre el tema no es concluyente, es prioritario para el estomatólogo conocer las generalidades acerca del VPH y tratar las lesiones de una manera informada, este virus se asocia a un 35% de los casos de cáncer de cavidad oral, de los cuales el 70% de ellos son de alto riesgo. En México, se tiene estimado que cerca del 43% de los hombres y del 17,5% de las mujeres, todos ellos sanos y sexualmente activos tienen alguna infección por VPH.

Actinomycetoma syndrome by Actinomadura (A.) madurae is characterized by a subcutaneous chronic lesion that affects fascia, muscle and bone. A. madurae produces colonies that form grains of less than 1 mm in diameter. Grains are surrounded and infiltrated by neutrophils involved in the grain disruption by enzymes like β-glucuronidase released after the neutrophil degranulation. The aim of this work was to evaluate the polysaccharide degradation of grains treated with β-glucuronidase and to detect the presence and activity of β-glucuronidase within the A. madurae grains. Actinomadura madura grains from patients infected were processed to quantify the total content of polysaccharide with the phenol-sulfuric acid reaction. Grains were treated with β-glucuronidase at different conditions to evaluate the optimal polysaccharide degradation. Grains were analyzed to detect the enzyme by using anti-human β-glucuronidase antibody while enzymatic activity was assessed by evaluating the release of reduced sugars and by in situ enzymatic activity. Optimal degradation of polysaccharide in the grains treated with β-glucuronidase was found with 300 units/ml of enzyme and 24 hr of incubation at 37°C. Presence and activity of β-glucuronidase enzyme within the grains were detected. Results suggested that β-glucuronidase present within A. madurae grain resulted from degranulated neutrophils surrounding and/or infiltrated within the grain.

El miofibroma es una neoplasia benigna compuesta por celulas mioides contractiles localizadas alrededor de la pared de vasos sanguineos delgados, es un tumor que se presenta sobre todo en la infancia aunque puede ocurrir a cualquier edad, tiene predileccion en cabeza y cuello, sin embargo en cavidad oral es raro y aun mas si es intraoseo, puede estar asociado a miofibromatosis o bien presentarse de manera solitaria. Los diagnosticos diferenciales dependen de la localizacion y de las caracteristicas radiograficas y de primera instancia es muy dificil incluir al miofibroma entre las lesiones intraoseas. Histologicamente presenta patron bifasico conformado por celulas fusiformes dispuestas en fasciculos y haces asi como nucleos fusiformes con citoplasma eosinofilo dentro de un estroma hialinizado. Es necesario recurrir al panel de inmunohistoquimica en neoplasias de celulas fusiformes, positivo a Acs Actina, Actina musculo liso y Vimentina. Reportamos el caso de una mujer de 45 ano con un miofibroma en la mandibula.

Background Actinic prurigo (AP) is an idiopathic photodermatosis that usually onsets during childhood and predominates in women. It is characterized by the symmetrical involvement of sun-exposed areas of the skin, lips, and conjunctiva. Objectives This study aimed to analyze the risk factors associated with AP using a case–control design. Methods All patients diagnosed with AP during 1990–2006 at Dr. Manuel Gea Gonzalez General Hospital in Mexico City were included. Respective controls were recruited. Race, demographic, geographic, socioeconomic, environmental, clinical, and nutritional risk factors were assessed. Results A total of 132 persons were enrolled. These included 44 cases and two control groups comprising, respectively, dermatology and non-dermatology outpatients without AP or any autoimmune disease. Distribution by gender, age, place of birth, place of residence, and economic status did not differ significantly among the three groups. A total of 256 variables were analyzed. Only 19 variables were found to be statistically significant (P