Two-Step Digital Follow-up of Patients at High Risk for Melanoma: a Retrospective Analysis of 152 Patients

Data de publicació electrónica: 13-11-2020Antecedentes: La dermatoscopia digitalizada (DD) ha demostrado mejorar la precisión en el diagnóstico del melanoma (MM) en pacientes de alto riesgo. La combinación de DD y fotografía corporal total (FCT) puede facilitar la detección de nuevas lesiones o la aparición de cambios macroscópicos precoces en lesiones previamente registradas. Objetivos: El objetivo del presente estudio fue determinar el número de biopsias necesarias para diagnosticar un MM y, las características clínicas y dermatoscópicas asociadas al diagnóstico de melanoma en pacientes en seguimiento, mediante DD y FCT, de lesiones pigmentadas. Pacientes y métodos: Se realizó un estudio retrospectivo de 152 pacientes con elevado riesgo de sufrir MM, en seguimiento digitalizado entre el 2002 y el 2016, en el Hospital del Mar de Barcelona. Se estudiaron y analizaron las lesiones pigmentadas extirpadas a partir de los cambios observados tras controles periódicos con DD y FCT. Resultados: Se analizaron un total de 99 biopsias (84 nevus displásicos, 13 MM y dos nevus melanocíticos junturales/compuestos) con una ratio lesión melanocítica benigna: MM de 6,6. El índice Breslow promedio fue de 0,19 mm. Las lesiones malignas presentaron, con mayor frecuencia, cambios macroscópicos respecto a los nevus melanocíticos (p = 0,018). En el análisis dermatoscópico, el crecimiento asimétrico y los cambios focales en estructuras se asociaron con MM (p < 0,001). Los parámetros de dermatoscopia individuales relacionados con el diagnóstico de MM fueron la asimetría (p < 0,001), retículo pigmentado invertido (p = 0,011), glóbulos atípicos (p = 0,011) y vasos polimorfos (p = 0,045). Conclusiones: El seguimiento mediante FCT resulta una herramienta útil en el diagnóstico precoz de MM. Un 50% de los melanomas detectados mediante el seguimiento digitalizado se diagnosticaron por la aparición de una lesión nueva en los mapas corporales o por la detección de cambios macroscópicos de una lesión preexistente. El seguimiento dermatoscópico resulta fundamental, ya que un elevado número de hallazgos dermatoscópicos individuales pueden observarse tanto en nevus melanocíticos como en un melanoma maligno, y el diagnóstico de malignidad solo se puede establecer a partir de los cambios en el registro de dermatoscopia durante el seguimiento

Mini pulse corticosteroid therapy with oral dexamethasone for moderate to severe alopecia areata: A multicentric study.

Extensive subtypes of alopecia areata (AA) (totalis, universalis, or multifocal) still have no approved and effective treatments in Europe, although Janus kinase inhibitors, such as baricitinib, are promising treatments that have been recently approved by the FDA. Nowadays, the higher costs and the lower experience with Janus kinase inhibitors, provide more difficulties in its accessibility. On the other hand, different corticosteroids regimens have been evaluated with conflicting results from decades. In 2016, a new regimen of mini pulse corticosteroid therapy with oral dexamethasone (MPCT-OD) 0.1mg/kg/day twice per week for adult patients with alopecia areata totalis or universalis, was reported to be effective with a lower rate of adverse effects. We performed a retrospective and multicentric study to collect data from patients with extensive forms of alopecia areata who had received MPCTOD (0.1 mg/kg/day twice weekly of dexamethasone) for at least 24 weeks. We included adult patients (≥18 years) with extensive forms of AA (SALT index ≥ 10) that did not respond to previous treatments. Variables including epidemiological and clinical data were recorded. Therapeutic response was assessed through the % change in SALT score (from 0 to 100%) and the changes in eyebrow and eyelash alopecia index (EBA, ELA) from baseline to 24 weeks after the beginning of the treatment. Dexamethasone dosage, duration of the treatment, time until response, time to relapse, adverse effects, and discontinuation were also recorded

Bikini textile contact dermatitis: a sherlockian approach revealing 2,4-dichlorophenol as a potential textile contact allergen

Background: Different textile constituents may act as allergens and/or irritants and provoke textile contact dermatitis (TCD). Objectives: To report a case of TCD caused by ethylene glycol monododecyl ether and 2,4-dichlorophenol, present in a bikini. Methods: A woman presented with an eczematous, pruritic rash in the area of the bikini straps and back. Patch testing was performed with the European baseline, textile, sunscreen, and photo-patch series, the bikini "as is", and ethanol and acetone extracts of the bikini. Thin-layer chromatography (TLC) of the extracts and gas chromatography-mass spectrometry (GC-MS) analysis were used to elucidate the culprit agents. Results: Positive reactions were found to the bikini "as is" and to the ethanol and acetone extracts. Patch testing with TLC strips showed a strong reaction to spots-fractions 3 and 4. GC-MS was performed to identify substances in each fraction and those suspected to be skin sensitisers were patch tested. On day (D) 4 positive reactions to ethylene glycol monododecyl ether (irritant reaction) and 2,4-dichlorophenol (++) were observed. Conclusion: A myriad of chemical compounds can be found in clothing. Ethylene glycol monododecyl ether and 2,4-dichlorophenol were identified as the potential culprits of this bikini TCD

Relevance of the basophil high-affinity IgE receptor in chronic urticaria: clinical experience from a tertiary care institutio

BACKGROUND: The high-affinity IgE receptor (FcεRI) expression on effector cells has been poorly characterized in patients with chronic urticaria (CU) to date. OBJECTIVES: To investigate the FcεRI expression on blood basophils in a large cohort of patients with CU and its potential relationship with relevant features of the disease. METHODS: Basophil FcεRI expression was measured by flow cytometry in 287 patients with CU (192 with chronic spontaneous urticaria and 95 with chronic inducible urticaria) at their initial evaluation in our department. A control group of healthy nonatopic individuals was included to provide reference data, and the effect of antihistamine and anti-IgE therapy on the basophil FcεRI expression was also evaluated in a cohort of patients with CU. RESULTS: The median FcεRI expression was found significantly higher in patients with CU compared with healthy controls (P < .0001). A positive correlation was found between serum IgE levels and basophil FcεRI expression (R = 0.422; P < .001). Significantly higher FcεRI levels on basophils were detected in patients with CU who presented with concomitant atopic features (P = .003), negative autologous serum skin test (P = .002), negative autologous plasma skin test (P = .009), or undetected levels of antithyroid antibodies (P = 0.01). Baseline FcεRI expression was not related to the activity and duration of the disease, and was not significantly modified during antihistamine therapy; however, it correlated with the clinical response to omalizumab (P = .003). CONCLUSIONS: Although further multicenter studies are needed to corroborate these findings, the assessment of basophil FcεRI levels might be relevant in daily clinical practice supporting an autoimmune pathogenesis and predicting response to anti-IgE treatment

Fulvalene cyclopentadienyl titanium and zirconium(III) and -(IV) complexes. X-Ray crystal structure of [{Ti(η5-C5H5) Cl}2 (μ-O)(μ-η5-η5-C10H8)]

The reaction of the fulvalene titanium(III) hydride [{Ti(η5-C5H5)(μ-H)}2(μ-η5-η5-C10H8)] (1) with chlorine leads to [{Ti(η5-C5H5)(μ-Cl)}2(μ-η5-η5-C10H8)] (3) and [{Ti(η5-C5H5)Cl2}2(μ-η5-η5-C10H8)] (4). The reaction of 3 with azobenzene, in wet toluene, gives [{Ti(η5-C5H5)Cl}2(μ-O)(μ-η5-η5-C10H8)] (5) and 1,2-diphenyl hydrazine. The alkylation of 4 and the analogous zirconium complex [{Zr(η5-C5H55)Cl2}2(μ-η5-η5-C10H8)] (2) with LiCH2SiMe3 or LiCH3 permits isolation of the tetraalkyl derivatives [{M(η5-C5H5)(CH2SiMe3)2}2(μ-η5-η5-C10H8)] (M Ti (6); Zr (8)) and [{Ti(η5-C5H5)(CH3)2}2(μ-η5-η5C10H8)] (7). All the new fulvalene compounds were characterized by IR, and 1H and 13C NMR spectroscope, and mass spectra and 5 by X-ray diffraction. The structure of 5 is very similar to that of the comparable TiIV compound [{Ti(η5-C5H5)2Cl}2(μ-O)] except for the smaller TiOTi angle (159.4° against 173.81°) and a significant deviation from linearity

Fulvalene titanium and zirconium complexes: synthesis and NMR study of phosphanido-, alkyl-, and alkynyl-derivatives. X-ray crystal structures of [{Ti(η5−C5H5)(μ−PPH2)}2{μ−(η5−C5H4−η5−C5H4)}] and [{Zr(η5−C5H5)(μ−C≡CSiMe3)}2{μ−(η5−C5H4−η5−C5H4)}]

Reaction of with one or two equivalents of LiPPh2 afforded the new phosphanidometal(III) complexes . Reaction of 2 with LiC≡CSiMe3 led to the diamagnetic zirconium(III) alkynyl derivative [{Zr(C5H5)(μ−C≡CSiMe3)}2(μ−η5−C5H4−η5−C5H4], 7. Alkylation of 6 with LiCH2CMe2Ph gave [{Zr(η5−C5H5)(CH2CMe2Ph)2}2{μ−(η5−C5H4)}], 8. A detailed NMR study of complexes 3 and 4 allowed the observation of the spectral behaviour of the eight different fulvalene protons through their coupling to the 31P nucleus. The fluxional behaviour of complex 7 was studied by dynamic DNMR, and kinetic parameters for the σ-π-conversion of the alkynyl ligand were determined. The molecular structures of complexes 3 and 7 were determined by X-ray diffraction methods