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.
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.
During the last few decades, management of psoriasis has changed worldwide, owing to a better understanding of its pathophysiology and the introduction of new treatments. As experts in the field of dermatology, specialists from Latin America collaborated to develop this review and further provide an update on the current state of psoriasis management in Latin America. With the goal of summarizing the latest information on psoriasis in most countries in Latin America, we conducted a literature search to obtain relevant articles published in the medical/scientific literature in Latin American countries over the last 10 years; in addition, we completed a questionnaire comprised of 20 questions on important issues related to psoriasis. The aim of this final document is to help improve understanding and management of the disease and to help patients gain better access to new approaches and medical solutions.
Background: anal intraepithelial neoplasia (AIN) is frequent in HIV-1-infected men-who-have-sex-with-men (MSM). High-grade AIN is considered the precursor of invasive anal squamous cell cancer. Anal condylomata, high-grade AIN, and anal squamous cell cancer are more common in MSM, particularly those with HIV. This study investigates the prevalence of histologically and molecularly confirmed highgrade AIN within anal lesions of MSM.Methods: we studied 188 MSM evaluated at Hospital de Clinicas, one of main private Venezuelan medical centers. Coloproctological exam was performed and anal samples were collected for cytological, histological analyses, HPV-DNA-PCR and hibridization detection methods. Anal biopsy was performed with abnormal coloproctological exam. Cytology results were reported using two main categories: low-grade (LG-AIN) and high-grade (HG-AIN) anal intraepithelial neoplasia. Anal squamous cells of unknown significance (ASCUS) were reported. CD4+ T-cell counting and HIV-1-RNA viral level were evaluated. Low-risk HPV (6 and 11) and high-risk HPV (16/18/31/33/35) probes were used for HPV DNA amplification. Variables were analyzed with SPSS Results: main patient age was 40.5 ± 1.5 y-old, main CD4 counts 354.7 ± 28.8 cells/mm3, geometric mean viral load 3.21 ± 0.16 log HIV-RNA copies. From the total, 41.6% presented HG-AIN at cytology, 41.6% were normal, 0.5% LG-AIN(p < 0.05). HPV DNA presence was detected in 56.3% of patients, in 75% of patients with SIL (p0.05), 13.7% classified as high-risk HPV, 15.8% low-risk, 5.8% mixed, 20% negative. Anal condylomata were found in 1.6% of patients, 2.6% presented ASCUS Conclusions: high-risk and low-risk HPV were detected. There was no relationship between specific HPV types identified and variables tested. Anal HPV was nearly universal in men infected with HIV and often caused by multiple types. High-grade AIN contained a HPV types greater burden. These data demonstrate high prevalence of HPV in HIV-infected MSM and suggest the need to develop HPV screening protocols for males.
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