Experience in visceral cutaneous and cutaneous loxoscelism of hospital management: clinical, evolution and therapeutic proposal Background: Loxoscelism is a common pathology in our environment with a broad spectrum of differential diagnoses and presentations, with potentially serious complications, even to the point of death. To date, there is no standard treatment for these patients. Aim: To describe the clinical manifestations, main complications, therapeutic management, and evolution of loxoscelism in an inpatient setting from a tertiary hospital in Chile. Methods: All patients consulting and hospitalized in the hospital of the Pontificia Universidad Católica de Chile with diagnosis of loxoscelism between 2014 to 2017 and evaluated by dermatologist were included. Review of clinical files, including symptoms, images, laboratory parameters and treatment. Results: We evaluated seventeen inpatient with loxoscelism, whose presentation responds to the national epidemiological pattern. Most cases were managed with antibiotics, systemic corticosteroids, antihistamines, and dapsone. From these, 11.8% corresponded to viscerocutaneous loxoscelism, successfully managed with supportive measures, systemic corticosteroids and antihistamines. Fifty-nine percent healed their cutaneous lesions after one month of treatment, with slight residual scarring or post inflammatory hyperpigmentation, without associated mortality in our series. Discussion: Most cases of cutaneous loxoscelism presented excellent response and rapid resolution of the disease after combined therapy with systemic corticosteroids, antibiotics and dapsone, suggesting that the use of these therapies could stop the progression of cutaneous necrosis and prevent complications associated with loxoscelism.
a b s t r a c tThe bibliometric characteristics of systematic reviews (SRs) in dermatology are unknown. We analyzed a group of 309 SRs using Scopus and the ISI Web of Science. These 309 SRs were published between 2008 and 2012 in journals with a median journal impact factor of 3.63; 48.2% (n ¼ 149) included metaanalysis, 11.6% (n ¼ 36) were Cochrane reviews, and 76.7% (n ¼ 237) summarized enough evidence to inform clinical decisions. The most common country of origin was the USA (n ¼ 66, 21.4%), and the most frequently studied disease was psoriasis (n ¼ 50, 16.2%).
CaseA 50-year-old healthy male was seen for a 6-week history of right leg pain, occasional dyspnea and extensive non-pruritic skin rash in trunk and extremities (Fig. 1A). Physical examination revealed tachypnea with normal breath sounds and a non-confluent maculo-papular rash in the trunk and extremities. No adenopathies, mucosal or palmo-plantar lesions were evident.A contrast-enhanced CT scan showed presence of multiple axillary, hilar, and mediastinal lymphadenopathy (Fig. 1B), and bilateral and diffusely distributed pulmonary nodules with ground-glass density (Fig. 1C). Bone scintigraphy showed increased uptake of isotope on the right tibia (Fig. 1D). The Rapid Plasma Reagin test (RPR) was positive in 128 dilutions, with a positive Treponema pallidum microhemagglutination assay. Human immunodeficiency virus and serology of other * (J. Manríquez). sexually transmitted diseases were negative. Additional laboratory investigation revealed negative antinuclear antibodies, as well as negative anti-double-stranded DNA, anti-Smith, anti-Ro, anti-La, and anti-neutrophil cytoplasmic antibodies. Complement C3 and C4 levels were within normal ranges. Skin biopsy revealed epidermal orthokeratosis and dermis with perivascular and periadnexal infiltrate composed by lymphocytes, neutrophils and plasma cells. Immunohistochemistry was positive for T. pallidum using monoclonal antibodies.Considering the above mentioned data a diagnosis of secondary syphilis affecting skin, bone (periostitis), and pulmonary was established. The patient was successfully treated with three-weekly doses of 2.4 million units of intramuscular benzathine-penicillin. Secondary syphilis is characterized by multisystem involvement: skin rash, mucosal lesions, and generalized lymphadenopathy. Simultaneous skin, lung, and skeletal involvement are extremely infrequent, with no cases reported until now.http://dx.
In hospitalised patients assessed for exanthematous macules and papules, the evaluation of these clinical features may aid in the early identification of SCAR cases.
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