Clinical utility of intralesional methotrexate to distinguish crateriform keratinocytic tumors before surgery

Clinical utility of intralesional methotrexate to distinguish crateriform keratinocytic tumors before surgeryDear Editors,Keratoacanthoma (KA) and cutaneous squamous cell carci-noma (CSCC) may adopt an identical crateriform morpho-logy. Nowadays, the debate about whether KA is a distinct entity, or a low-grade variant of cutaneous squamous cell carcinoma (CSCC) still persists. Since CSCC is a more ag-gressive neoplasm, misdiagnosing crateriform lesions may have a negative impact on the patient's prognosis. Evaluating a partial biopsy is extremely challenging to confidently dis-tinguish KA from CSCC [1]. No distinctive gene expression profiles have been identified and no pathognomonic criteria to unequivocally differentiate between KA and CSCC exist [2]. Consequently, the surgical approach remains the gold standard in the management of crateriform tumors, especi-ally those arising on the face

Neoadjuvant intralesional methotrexate for juvenile xanthogranuloma in an adult

Juvenile xanthogranuloma (JXG) is a non-Langerhans cell histiocytosis usually occurring in infants and typically located in the head or neck.1 Clinically, solitary skin lesions are found in 60%–82% of patients and the most common variant is characterized by one yellowish nodule. Adult onset is rare, and although JXG is usually self-limiting in children, spontaneous resolution is uncommon at older ages. In addition, up to 50% of patients with spontaneous regression develop an atrophy or anetodermal area.2 Thus, complete excision is frequently performed in this population subgroup to achieve better cosmetic results. In disseminated forms, different chemotherapy regimens, corticosteroids and other systemic therapies are used. Herein, we report a case of adult JXG treated with intralesional methotrexate (MTX) resulting in a rapid reduction in size

Refractory facial Darier's disease treated with daylight photodynamic therapy

Darier’s disease (DD) is an infrequent autosomal dominant skin disorder caused by a mutation of the ATP2A2 gene on chromosome 12 [1]. Mutations in this gene result in abnorma-lities in keratinocyte cell-cell adhesion producing an alterati-on of the keratinization of the skin, which clinically presents with dyskeratotic papules mostly affecting seborrheic and in-tertriginous areas. Palmoplantar and nail involvement is often present [1–3]. As a wide range of treatments have been propo-sed for this skin disorder with different results, the manage-ment of this disease is still a challenge for the dermatologist

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

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Clinical utility of intralesional methotrexate to distinguish crateriform keratinocytic tumors before surgery

Mendeley supplemental figure 1. Crateriform tumors with similar size and location before and after intralesional methotrexate administration. Keratoacanthoma tumors (A and C) underwent a marked reduction in size compared with cutaneous squamous cell carcinoma (B and D)

Ingenol mebutate for the treatment of actinic keratosis: effectiveness and safety in 246 patients treated in real-life clinical practice.

Introduction: The aim of the study was to evaluate the results on effectiveness and safety of topical treatment for actinic keratosis (AK) with ingenol mebutate gel (IMG) in real-life conditions and to perform an analysis of the factors that may influence the treatment outcomes. Materials and methods: Retrospective study of patients with non-hyperkeratotic AK lesions prescribed with IMG in Spain according to clinical practice. Dermatologists reported the characteristics of patients and AK at baseline, and the findings observed up to 60 d after treatment. Results and conclusions: A total of 260 treatments in 246 patients with a mean (SD) age 70.6 (10.4) years were reviewed. The number of clinically visible AK in the treated area decreased from 6.16 (3.02) to 1.22 (2.02) (p < .001) lesions with an average reduction of 84%. Univariate analysis showed higher reduction rates when IMG was applied in the face/scalp (p = .026), in women (p = .041), and in patients under 70 years of age (p = .033). According to multivariate analysis, advanced age was associated with worse clearance rates (p = .038). However, besides statistical significance, we can conclude that gender (female) and age (under 70 years-old) show a tendency to have better efficacy outcomes but without clinical relevance. Topical IMG was generally well tolerated and had positive cosmetic results after 60 d. Age influences on IMG effectiveness for AK and LSRs were correlated with higher effectiveness ratios

Simplified lower eyelid reconstruction algorithm after basal cell carcinoma surgery: A retrospective series of patients

The lower eyelid is a frequent location for basal cell carcinoma (BCC), and oncoplastic reconstruction usually represents a challenge for the dermatologic surgeon. To create a useful and practical algorithm for lower eyelid reconstruction, a retrospective chart review of patients with lower eyelid BCC treated with surgery between 2015 and 2020 at the dermatology department of University Clinic of Navarra in Spain was performed. Defects were classified into three categories based on the vertical component: pretarsal, preseptal and complex (pretarsal + preseptal)1 (Table 1). Patients with BCC on the eyelid-cheek junction (n = 4), patients with BCC extended to both eyelids (n = 3) and patients with extensive posterior lamella defects that required a particular reconstruction of the lamella (n = 5) were excluded

Apremilast in combination with botulinum toxin-A injection for recalcitrant Hailey-Hailey disease

Hailey–Hailey disease (HHD) is a rare genodermatosis caused by a mutation in the ATP2C1 gene, which codes for a calcium channel. This ionic alteration leads to a defective keratinocyte adhesion. Hailey–Hailey disease is characterized by recurrent flare-ups of vesicles and flaccid blisters in folds that have an impact on patients’ quality of life. The recurrent and refractory nature of this condition makes its treatment a challenge. Isolated cases have been reported describing controversial results after treatment with apremilast. Here we present a case of refractory HHD who experienced an excellent response after treatment with apremilast and botulinum toxin-A (BoNT) infiltrations

Apremilast in combination with botulinum toxin-A injection for recalcitrant Hailey-Hailey disease

Hailey–Hailey disease (HHD) is a rare genodermatosis caused by a mutation in the ATP2C1 gene, which codes for a calcium channel. This ionic alteration leads to a defective keratinocyte adhesion. Hailey–Hailey disease is characterized by recurrent flare-ups of vesicles and flaccid blisters in folds that have an impact on patients’ quality of life. The recurrent and refractory nature of this condition makes its treatment a challenge. Isolated cases have been reported describing controversial results after treatment with apremilast. Here we present a case of refractory HHD who experienced an excellent response after treatment with apremilast and botulinum toxin-A (BoNT) infiltrations