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Introduction Lupus erythematosus (LE) is an autoimmune disease often treated with antimalarial drugs. The prolonged use of chloroquine and hydroxychloroquine can cause hyperpigmentation in the skin, oral mucosa and retinal pigment epithelium, which in turn can trigger toxicity in this epithelium, which in some cases causes vision loss. The objective of the present work was to establish the association between the presence of oral pigmented macules by antimalarial and secondary retinal toxicity. Methods A total of 105 patients diagnosed with LE being treated with chloroquine/hydroxychloroquine were evaluated. All patients were ophthalmologically evaluated for retinopathy screening. When the patient showed oral hyperpigmented maculae, an incisional biopsy was performed with the corresponding histopathological study with informed consent. The variables were compared using the chi-square test for quantitative variables and the non-parametric Mann–Whitney U-test for categorical variables. The confidence level was established at 95%, and p-values of ≤0.005 were considered statistically significant. Results Only 9.5% of the patients showed oral brown spots. Histopathologically, 100% of the oral macules showed characteristics of oral pigmentation by drug and 100% ophthalmological parameters of normality. Two patients presented with a diagnosis of pre-retinopathy, but none showed oral lesions. Conclusion Hyperpigmented macules in the buccal mucosa in lupus patients receiving antimalarial treatment are not frequent and do not represent a predictive finding of toxicity of the drug.

BACKGROUND: The infection by coronavirus disease 2019 (COVID-19) has been associated with multiple cutaneous manifestations, although characterization of them in Hispanic patients with darker skin phototypes is lacking. The objective of this study is to characterize the clinical dermatological manifestations associated with COVID-19 infection in cases with few or without general symptoms in patients from Latin America. METHODS: Cross-sectional study using a questionnaire that was made for health professionals (physicians with a specialty in dermatology) to investigate dermatological lesions associated with COVID-19 infection in patients from 25 countries of Latin America. The survey was active from June 9 to July 30, 2020. RESULTS: In this study, information was collected from a total of 347 patients. We found a female gender predominance: 179/347 (51.6%). The mean age at presentation was 40.87 years. The most frequent dermatological manifestations were maculopapular rash and urticarial lesions, followed by papulovesicular lesions, vesicular lesions, chilblain-like lesions, papular lesions, ecchymosis, petechial purpura, pityriasis rosea-like lesions, pruritus, palmoplantar dysesthesias, transient livedo, acral necrosis, palpable purpura, livedo racemosa, and retiform purpura. As far as we know, there are no previous reports of pruritus and palmoplantar dysesthesias. CONCLUSIONS: This registry emphasizes skin manifestations as an important criterion for establishing the diagnosis of COVID-19 infection in Latin American countries. This information will be useful for the early identification of suspected cases by health professionals (dermatologists and nondermatologists) and will allow contact tracing to mitigate the impact on health systems at different levels

More than 50% of the world population live in the tropics mostly in developing countries, with great poverty and poor essential goods, services, and access. These conditions and environmental factors make the population high risk for a group of fungal, bacterial, and parasitic diseases, many of which affect the oral mucosa.

The Ibero Latin American College of Dermatology, CILAD, the largest dermatologic organization in the region, was established in 1948 during the course of the V International Congress of Leprosy held in Havana, Cuba. Constituted in its beginning with fewer than 100 dermatologists from nine countries, its growth has been exponential, reaching now around 4000 members spread throughout Latin America, the Iberian Peninsula, and other regions of the world. In recent years, academic activity has been intense, such as the development of several institutional programs, like its community health care program, designed for geographic areas lacking dermatologic care in the Latin American region. This contribution presents a review of its history, noting the dermatologists and personalities who ennoble the institution. The multiple areas of interest of this growing dermatologic organization are described, and the projections toward the future are discussed.

Background Mycobacterium haemophilum was first recovered from subcutaneous lesions of a patient with Hodgkin's disease. Because of its special growth requirements (it grows at 30–32 °C and requires iron-supplemented medium), the organism cannot be isolated using routine culture techniques for other mycobacteria. Only a few developed countries have reported infection with this mycobacterium. We report the first two cases diagnosed in Venezuela. Methods The diagnosis of the first case was established using polymerase chain reaction (PCR)-restriction endonuclease analysis of the gene encoding the 65-kDa heat shock protein (hsp65) for the direct identification of M. haemophilum in a clinical specimen in which bacilli were observed on acid-fast smear, but growth was not detected by standard culture procedures. Results After recognizing this bacterium as a possible cause of infection in our setting, clinical samples of cutaneous lesions were routinely cultured on blood agar at 30 °C for at least 6 weeks, which resulted in the diagnosis of the second case. Conclusions Dermatologists should consider this bacterium in immunocompromised patients with cutaneous ulcerating lesions. Material from the lesions can be screened for mycobacteria using an acid-fast stain and, if acid-fast bacilli are seen, PCR analysis of mycobacterial hsp65 can be an effective tool for early diagnosis. Appropriate culture methods are required for bacteriologic confirmation of infection with M. haemophilum.

SUMMARYOutbreaks of soft tissue or skin infection due to non-tuberculous mycobacteria are reported frequently in scientific journals but in general the infection source in these outbreaks remains unknown. In Venezuela, in two distinct outbreaks, one after breast augmentation surgery and another after hydrolipoclasy therapy, 16 patients contracted a soft tissue infection due toMycobacterium abscessussubsp.abscessus.Searching for the possible environmental infection sources in these outbreaks, initially the tap water (in the hydrolipoclasy therapy outbreak) and a surgical skin marker (in the breast implant surgery outbreak), were identified as the infection sources. Molecular typing of the strains with a variable number tandem repeat typing assay confirmed the tap water as the infection source but the molecular typing technique excluded the skin marker. We discuss the results and make a call for the implementation of stringent hygiene and disinfection guidelines for cosmetic procedures in Venezuela.

Introduccion La mesoterapia se utiliza mucho en Latinoamerica con fines cosmeticos, especialmente en pacientes con obesidad. En este estudio se describen las caracteristicas clinicas y epidemiologicas, el diagnostico microbiologico, el tratamiento y el seguimiento de infecciones por micobacterias no tuberculosas en un grupo de pacientes en Caracas (Venezuela) con antecedentes de mesoterapia. Metodologia Entre marzo de 2002 y diciembre de 2003 se evaluaron 49 pacientes con infeccion en la piel y tejidos blandos secundaria a mesoterapia. Se tomaron muestras de las lesiones para el aislamiento de micobacterias y se elaboro una ficha clinica. Ademas, se analizaron 15 productos utilizados en mesoterapia. Las micobacterias aisladas fueron identificadas a traves del polimorfismo de fragmentos de restriccion del gen hsp65 . Resultados De los 49 pacientes evaluados, en el 81,6% se confirmo una infeccion por micobacterias no tuberculosas. Las especies mas comunes fueron Mycobacterium abscessus y M. fortuitum pero tambien se aislaron M. chelonae , M. peregrinum , M. simiae y una nueva especie que fue designada M. cosmeticum. Los pacientes recibieron tratamiento especifico para cada especie durante un periodo de 3 hasta 18 meses. La investigacion de la fuente de infeccion revelo que 21 pacientes estaban agrupados en tres brotes y se encontraron dos productos contaminados, uno con M. fortuitum y otro con M. abscessus . Conclusiones Los medicos deben estar atentos ante aquellos pacientes con antecedentes de mesoterapia que desarrollen tardiamente lesiones en piel y tejidos blandos, que no respondan al tratamiento antimicrobiano convencional, ya que estas podrian ser causadas por micobacterias no tuberculosas.

We have studied 75 patients ( 72 female and 3 male). Average age was 36 years old, ranging from 21 to 65 yo, who were subjected to modelling substances (filling). About 75% of patients had responded to use of Deflazacort + Colchicine, however, 92% have suffered a relapse five months after. These patients have received an immunosuppressant as Azathioprine despite the most frequent clinical manifestations were: Erythema 90%, Skin Pigmentation 58%, Edema 70% and Keloids 25%. There were autoimmune manifestations as Raynaud's Phenomenon, Livedo Reticularis, Psoriasis and Arthritis. We have designed a flow chart for treatment based on clinical and imaginologic improvement (using Ultrasound and MRI). Criteria for severity and lack of treatment response were increased acute phase reactants, poor response to deflazacort, personal and/or family history of Autoimmune Disease.

Mesotherapy is widely used In Latin America for cosmetic purposes, particularly in obese individuals. We describe the clinical and epidemiological characteristics, microbiological diagnosis, treatment and follow-up of patients from Caracas (Venezuela) with soft tissue infection caused by non-tuberculous mycobacteria following mesotherapy.Between March 2002 and December 2003, we evaluated 49 cases of skin and soft tissue infection following mesotherapy. Specimens obtained from the lesions and 15 products used in the mesotherapy procedure were cultured for the presence of non-tuberculous mycobacteria. Isolated mycobacteria were identified by PCR restriction fragment length polymorphism analysis of the hsp65 gene.Infection by non-tuberculous mycobacteria was confirmed in 81.6% of the 49 cases. Mycobacterium abscessus and M. fortuitum were the most common species, but M. chelonae, M. peregrinum, M. simiae and a new species that was designated "M. cosmeticum" were also isolated. Patients were treated with species-specific antibiotic agents for 3 to 18 months. Investigation into the source of the infection revealed that 21 patients were clustered within 3 different outbreaks and two products were found to be contaminated with M. fortuitum and M. abscessus, respectively.Physicians should be alerted to the possibility of infection by non-tuberculous mycobacteria in patients with a history of mesotherapy who develop late-onset skin and soft tissue infection, particularly if they do not respond to conventional antibiotic treatment.