Alopecia en conectivopatías

Varias conectivopatías tienen hallazgos importantes al examen cutáneo, muchas de ellas pueden tener compromiso concomitante o exclusivo del cuero cabelludo. Los tricólogos debemos conocer los hallazgos clave en la clínica, tricoscopía e histología para realizar el diagnóstico correcto oportunamente y sin retrasos. En esta revisión presentamos estos hallazgos en lupus eritematoso, dermatomiositis y morfea. También discutimos las claves diagnósticas y el diagnóstico diferencial a considerar. Finalmente, enfocamos de forma práctica el tratamiento y el pronóstico de estos pacientes

Toxicidad por colistina: hiperpigmentación cutánea, neurotoxicidad y nefrotoxicidad. Reporte de caso

La colistina o polimixina E es un antibiótico cuyo uso fue descontinuado por la toxicidad renal y neurológica relacionadas al uso de colistina sulfato. Estos efectos adversos han disminuido con el uso del profármaco colistimetato sódico. Actualmente el uso de colistina es más frecuente debido al incremento de infecciones ocasionadas por bacilos Gram negativos multirresistentes, sobre todo en las unidades de cuidados intensivos. Presentamos el caso de una mujer de 50 años de edad con antecedente de consumo de anti-inflamatorios no esteroideos y corticoides, pos- operada de perforación gástrica que evolucionó con colecciones abdominales por Acinetobacter sp. multirresistente. Recibió 34 días de colistina endovenosa y desarrolló hiperpigmentación cutánea, ataxia (neurotoxicidad) y falla renal (nefrotoxicidad) de forma secuencial secundaria a la administración de colistina, los efectos adversos desaparecieron con la suspensión del antibiótico

Acne Keloidalis Nuchae: A Multicenter Retrospective Study of 142 Hispanic Patients

Introduction: Acne keloidalis nuchae (AKN) is a primary cicatricial alopecia with mixed infiltrate. It is more common in African or persons of African descent. Objectives: Our objective was to describe the epidemiology and clinical and trichoscopic presentations of AKN in a large series of Hispanic patients. Methods: This was a retrospective study from 10 different dermatological centers in Argentina, Colombia, Mexico, and Peru. Patients with a clinical diagnosis of AKN treated by 12 dermatologists experienced in trichology from 2018 to 2022 were included. The Umar classification system was used to determine severity. Results: We identified 142 patients with AKN: 98% were male (n=140) with a mean age of 32 years; 108 patients had a previous history of trauma to the nuchal area (76%, p50 months of evolution were mainly classified in classes III and IV compared to patients with an evolution of <50 months (30%, n=9 vs. 14%, n=15; p=0.019; respectively). Conclusion: AKN should be considered in the differential diagnosis in the Hispanic population. Advanced stages of the disease are correlated with chronic evolution

Compromising between European and US allergen immunotherapy schools: Discussions from GUIMIT, the Mexican immunotherapy guidelines

Background: Allergen immunotherapy (AIT) has a longstanding history and still remains the only disease-changing treatment for allergic rhinitis and asthma. Over the years 2 different schools have developed their strategies: the United States (US) and the European. Allergen extracts available in these regions are adapted to local practice. In other parts of the world, extracts from both regions and local ones are commercialized, as in Mexico. Here, local experts developed a national AIT guideline (GUIMIT 2019) searching for compromises between both schools. Methods: Using ADAPTE methodology for transculturizing guidelines and AGREE-II for evaluating guideline quality, GUIMIT selected 3 high-quality Main Reference Guidelines (MRGs): the European Academy of Allergy, Asthma and Immunology (EAACI) guideines, the S2k guideline of various German-speaking medical societies (2014), and the US Practice Parameters on Allergen Immunotherapy 2011. We formulated clinical questions and based responses on the fused evidence available in the MRGs, combined with local possibilities, patient's preference, and costs. We came across several issues on which the MRGs disagreed. These are presented here along with arguments of GUIMIT members to resolve them. GUIMIT (for a complete English version, see Supplementary data) concluded the following: Results: Related to the diagnosis of IgE-mediated respiratory allergy, apart from skin prick testing complementary tests (challenges, in vitro testing and molecular such as species-specific allergens) might be useful in selected cases to inform AIT composition. AIT is indicated in allergic rhinitis and suggested in allergic asthma (once controlled) and IgE-mediated atopic dermatitis. Concerning the correct subcutaneous AIT dose for compounding vials according to the US school: dosing tables and formula are given; up to 4 non-related allergens can be mixed, refraining from mixing high with low protease extracts. When using European extracts: the manufacturer's indications should be followed; in multi-allergic patients 2 simultaneous injections can be given (100% consensus); mixing is discouraged. In Mexico only allergoid tablets are available; based on doses used in all sublingual immunotherapy (SLIT) publications referenced in MRGs, GUIMIT suggests a probable effective dose related to subcutaneous immunotherapy (SCIT) might be: 50–200% of the monthly SCIT dose given daily, maximum mixing 4 allergens. Also, a table with practical suggestions on non-evidence-existing issues, developed with a simplified Delphi method, is added. Finally, dissemination and implementation of guidelines is briefly discussed, explaining how we used online tools for this in Mexico. Conclusions: Countries where European and American AIT extracts are available should adjust AIT according to which school is followed