Guillermo Romero

La agammaglobulinemia ligada al cromosoma X o de Bruton es una inmunodeficiencia primaria caracterizada por una incapacidad para el desarrollo y maduración de linfocitos B desde células pre-B. Se traduce en una ausencia de linfocitos B y de células plasmáticas con el ...

: Melanomas with complete histological regression have been seen very infrequently. On the other hand, the diagnosis of metastatic melanoma is based on the histopathology and positivity of markers such as S100, Melan-A, and HMB-45 whose sensitivity is 99%, 82%, and 76%, respectively. It is very rare that metastatic melanomas and even more primary melanoma are negative for all of these markers. In these rare cases, there is usually a known primary. We present the case of a 82-year-old woman with a erythematous mass in the left groin and a 1-cm black–bluish irregular nodule on the skin of the ipsilateral foot. This lesion was clinical and dermoscopically compatible with primary melanoma. In the histological evaluation of the skin, a dermis full of melanophages and hemosiderophages were found in a background of fibrosis, scarce lymphocytic infiltrate, and neovascularization. Any cells expressing melanocytic markers were observed. It was diagnosed as tumoral melanosis. Lymph nodes showed a proliferation of atypical epithelioid cells with eosinophilic cytoplasm. Mitosis was conspicuous. Tumoral cells were vimentin and CD99 positive, and S100, CD34, HMB-45, Melan-A, SOX 10, tyrosinase, C-KIT, CD45, and CKAE1/AE3 negative, and BRAF-V600 mutated was detected. During follow-up, atypical vitiligo-like lesions were discovered, suggesting the diagnosis of metastatic melanoma totally regressed in our patient.

Telemedicine refers to the use of telecommunications technology to provide health care and medical information. The practice of medicine--and dermatology in particular--is undergoing a great upheaval due to advances in information technology. This article briefly reviews the origin, development, applications, benefits, methodology, and components of telemedicine. Specifically, we will analyze the types and applications of teledermatology, paying particular attention to technical, organizational, and legal aspects.

There is considerable variability in the results of studies that evaluate diagnostic reliability in teledermatology. There are only two studies that compare the synchronous and asynchronous modalities of teleconsult in the same sample. We present the results of the pilot project DERMATEL, a study of diagnostic concordance that aims to increase the evidence of these aspects. One-hundred-fifty.nine patients referred by the general practitioner in the first consult were randomized (algorithm 3:2:1) in three arms: asyncronous teledermatology (store-and-forward or SAF), synchronous teldermatology (real-time or VTC), and conventional consult (CC). We used high-quality, fixed digital images in all cases. The patients on the VTC teledermatology arm were also evaluated by videoconference. Finally all patients attended a face-to-face consult, considered the gold standard of patient care. A second dermatologist evaluated the diagnostic and management concordance between the teleconsults and th...

A 34-year-old woman, after 2 weeks of treatment with phenytoin and amitriptyline, developed fever and cutaneous lesions consisting of a generalized maculopapular rash and eosinophilia. Her biochemical data showed abnormal liver functions with increased levels of SGOT, SGPT, LDH, gamma-glutamyl transpeptidase and alkaline phosphatase. The skin biopsy pattern was compatible with phenytoin drug eruption of the erythemamultiforme-like type (lymphocytic exocytosis, isolated dyskeratotic cells, vacuolation of basal cells and incontinence of pigment). The patch tests were positive with phenytoin (patch test biopsy showed a typical eczematous pattern). The patch test with amitriptyline was negative. An oral challenge with amitriptyline showed an erythematous maculopapular rash. The challenge with phenytoin was not carried out because the previously abnormal liver function tests contraindicated the challenge. Although there are a few cases reported, the patch tests could be useful for diagno...

Although many studies have evaluated the diagnostic reliability of store-and-forward (SF) teledermatology, the reliability of the technique for the diagnosis of general skin conditions in a clinical practice setting has never been demonstrated. We evaluated the reliability of SF teledermatology in clinical practice by analyzing the diagnostic agreement achieved in a subgroup of patients from the DERMATEL-2 study. Patients referred from primary care settings were randomized to 3 groups: SF, a combination of videoconferencing and SF technology (VC-SF), and a control group. This article focuses on the SF group. Clinical data were recorded and photographs taken by primary care physicians, who forwarded the data electronically. Each SF consultation package was assessed by 3 dermatologists (D1,D2,D3). Subsequently all the patients were assessed by a single dermatologist (D1) in a face-to-face consultation. Finally, 2 other dermatologists (D4,D5) assessed the agreement between the diagnoses obtained by SF and FF. In total, 457 patients (200 males and 257 females) aged between 2 months and 86 years were randomized (192 to SF, 176 to VC-SF, and 89 to the control group). The diagnostic categories were as follows: tumors (49.4%), inflammatory (25.7%), adnexal (11%), infectious (9.4%) and other processes (4.4%) Since 170 patients had consultations deemed valid for analysis, the study included a total of 510 SF assessments. Most of the images and clinical records were of high quality (71.2% and 91.2% respectively), and diagnostic confidence was high in 81.4% of the cases studied. In 58.4% of cases the condition was managed exclusively by teledermatology. Levels of complete and aggregate interobserver agreement between SF and face-to-face evaluators were 0,72 and 0.90, respectively, for diagnosis and 0.61 and 0.80 for treatment. Diagnostic agreement correlated with the image quality (P < .001), diagnostic confidence (P<.001), felt need for conventional consultation (P<.001), and the quality of the clinical record (P=.013). The interobserver reliability of SF diagnosis in clinical practice is good. Dermatologists are able to predict errors in diagnosis by analyzing their own diagnostic confidence and evaluating the quality of the images.

Cutaneous adverse reactions are frequently described with anticonvulsant drugs, especially with aromatic drugs such as carbamazepine, phenytoin, and phenobarbital. Patch tests could be useful for diagnosing this clinical picture. Hypersensitivity to several anticonvulsant drugs is common but unpredictable. 15 patients from our allergy section, suffering from anticonvulsant skin allergy, were included. We describe their analitic alterations, responsible drugs, and anticonvulsants tolerated, the results of patch tests with anticonvulsant drugs (5% pet. and aq.), and skin biopsies wherever carried out. 23 adverse skin reactions with different anticonvulsant drugs occurred in the 15 patients: 13 resulted in fever and generalized cutaneous rash, 7 patients suffered only from cutaneous rash. There was one case of palpable purpura, one of erythema multiforme (target lesions), and another one suffered only cutaneous pruritus. Eosinophilia was found in 5 cases. Liver enzymes were elevated in...

The rapid increase in the use of telemedicine makes a critical appraisal of these services essential. This article reviews the current evidence from studies of teledermatology with sufficiently rigorous methodology to allow reasonable conclusions to be drawn. The review is organized according to areas of research in teledermatology: reliability of diagnosis and management, accuracy, outcomes, costs, and satisfaction. The conclusion of this review is that teledermatology has been shown to be feasible and reliable but that it has a long way to go before maturing as a medical technology in daily practice. The largest body of evidence relates to the reliability of diagnosis and management, but although numerous studies have been performed, many have marked methodological shortcomings. Accuracy studies have been conducted in skin oncology with appropriate methodology that show an accuracy comparable to that of face-to-face consultations. Studies of health outcomes should be designed such that a faithful assessment of the final outcomes, costs, and satisfaction with teledermatology systems can be carried out.

Cutaneous metastases are infrequent and in some cases represent the first manifestation of an unknown neoplasm. Acrally located metastases are particularly rare, and the prognosis is very poor, with a survival time of only a few months. Although the clinical presentation varies, they are generally confused with an infectious or inflammatory process, which delays diagnosis. When they are located on

IntroductionThere is considerable variability in the results of studies that evaluate diagnostic reliability in teledermatology. There are only two studies that compare the synchronous and asynchronous modalities of teleconsult in the same sample. We present the results of the pilot project DERMATEL, a study of diagnostic concordance that aims to increase the evidence of these aspects.

Résumé/Abstract Introduction. Molluscum contagiosum is a common viral infection for which there is no specific antiviral therapy. Curettage or cryotherapy treatments are very effective, but the pain and emotional trauma involved limit their use. In 1998, the Food and Drug ...

ABSTRACT The rapid increase in the use of telemedicine makes a critical appraisal of these services essential. This article reviews the current evidence from studies of teledermatology with sufficiently rigorous methodology to allow reasonable conclusions to be drawn. The review is organized according to areas of research in teledermatology: reliability of diagnosis and management, accuracy, outcomes, costs, and satisfaction. The conclusion of this review is that teledermatology has been shown to be feasible and reliable but that it has a long way to go before maturing as a medical technology in daily practice. The largest body of evidence relates to the reliability of diagnosis and management, but although numerous studies have been performed, many have marked methodological shortcomings. Accuracy studies have been conducted in skin oncology with appropriate methodology that show an accuracy comparable to that of face-to-face consultations. Studies of health outcomes should be designed such that a faithful assessment of the final outcomes, costs, and satisfaction with teledermatology systems can be carried out.