Guillermo Romero | University of Castilla-La Mancha (original) (raw)
Papers by Guillermo Romero
Revista de la Sociedad Española del Dolor
Objetivo: Conocer la prevalencia real del síndrome de boca ardiente (SBA) y los posibles factores... more Objetivo: Conocer la prevalencia real del síndrome de boca ardiente (SBA) y los posibles factores de riesgo asociados. Material y métodos: Estudio observacional descriptivo transversal, de base poblacional con selección aleatoria simple en mayores de 24 años. Tras muestreo aleatorio, el año 2015 se contactó telefónicamente identificando pacientes que cumplían criterios de inclusión. A estos se les realizó entrevista presencial, descartando presencia de lesiones orales, se realizó test de ansiedad, depresión y analítica. Se agregó una cohorte de pacientes ya diagnosticados de base de datos del Hospital de Ciudad Real de Dermatología, para analizar los posibles factores de riesgo asociados comparando con un grupo control. Las características de los pacientes con SBA y los controles sin SBA se analizaron estadísticamente con el SPSS v 21 y se utilizaron la prueba de Chi cuadrado y el Odds Ratio (OR) para evaluar las diferencias en las características de los grupos. La significación estadística se fijó en p < 0,05. Resultados: La prevalencia fue de 0,84 % (IC 95 %: 0,28-1,4). Los factores que alcanzaron significación estadística en el desarrollo de SBA fueron los siguientes: el sexo femenino p < 0,05 (IC 1,43-2,20), antecedentes de ansiedad p < 0,05 (IC 6,4-72,47), depresión p < 0,05 (IC 3,59-34,40), de candidiasis oral p < 0,05 (IC 1,44-16,27), de déficit nutricional p < 0,05 (IC 4,1-100,05), miedo al cáncer p < 0,05 (IC 2,53-64,56) y uso de prótesis dentales p < 0,05 (IC 2,53-64,56). La toma de antidepresivos p < 0,05 (IC 7,28-177,86) y ansiolíticos p < 0,05 (IC 7,56-99,67). La presencia de sequedad bucal subjetiva p < 0,05 (IC 1,81-14,93) y objetiva p < 0,05 (IC 1,47-14,57). Tener alterados los cuestionario de ansiedad p < 0,05 (IC 10,64-183,29) y depresión p < 0,05 (IC: 5,48-132,92). Conclusiones: La prevalencia de SBA en el área de Ciudad Real es de 0,84 por cien habitantes. Aunque puede tener un origen multifactorial, podría existir asociación con el género femenino, antecedente de ansiedad, de depresión, de uso de prótesis dentales, de infección por candidiasis oral, el uso de antidepresivos, de ansiolíticos, miedo al cáncer, la sequedad bucal subjetiva y estados actuales de ansiedad y de depresión.
Dermatology Online Journal, 2018
Revista Colombiana de Reumatología, 2018
Objetivo: Determinar el riesgo cardiovascular y la prevalencia de factores de riesgo cardiovascul... more Objetivo: Determinar el riesgo cardiovascular y la prevalencia de factores de riesgo cardiovascular (RCV) en los pacientes con artritis reumatoide. Materiales y métodos: Estudio observacional, descriptivo y transversal, realizado en el Hospital General de Ciudad Real, entre junio de 2013 y mayo de 2014. Se realizó una analítica completa, se elaboró un perfil clínico, se calculó el SCOREm y se estratificó el RCV. Finalmente, se determinó la presencia de aterosclerosis subclínica mediante la realización de una ecografía carotídea. Resultados: 119 pacientes aceptaron participar en el estudio. Hubo una prevalencia del 73,1% de los factores de riesgo tradicionales, 6,72% había presentado un evento cardiovascular al momento del estudio, 22,68% poseía un infradiagnóstico de diabetes mellitus o nefropatía.
Acta pediátrica española, 2004
Actas Dermo-Sifiliográficas, 2020
Colgajos quirúrgicos; Cirugía del cáncer de piel; Cirugía del cáncer de la oreja; Cirugía oído ex... more Colgajos quirúrgicos; Cirugía del cáncer de piel; Cirugía del cáncer de la oreja; Cirugía oído externo Resumen Introducción y objetivos: Los defectos de la zona anterior del pabellón auricular (PA) son un desafío reconstructivo debido a la compleja topografía y el difícil acceso. Describimos nuestra experiencia con el uso del colgajo en isla en puerta giratoria (CIPG) para la reconstrucción de defectos auriculares y se presentan los resultados quirúrgicos. Material y métodos: Estudio descriptivo retrospectivo de pacientes tratados mediante reconstrucción de oreja, de diversas localizaciones de la zona anterior, mediante el CIPG, tras la resección de tumores malignos. Resultados: Entre 2011 y 2019 se operó a 17 pacientes: 7 carcinomas epidermoides y 10 basocelulares. El estudio histológico convencional mostró bordes quirúrgicos libres en todas las piezas de resección. El tiempo medio de seguimiento fue de 40 meses. Hubo una recidiva local en un carcinoma epidermoide, con buena respuesta a radioterapia, de forma que todos los pacientes estaban libres de enfermedad al completar el seguimiento. Solo 3 pacientes presentaron complicaciones menores (depresión de la superficie del colgajo en un caso y retracción del oído hacia la mastoides en 2 casos). Mediante escalas de valoración subjetiva, se determinó el resultado postoperatorio estético y funcional, tanto por parte del dermatólogo como del paciente. En todos los pacientes se conservó el contorno normal del PA reconstruido y ningún paciente requirió cirugía correctiva adicional. Conclusiones: La reconstrucción auricular mediante CIPG permitió la reparación satisfactoria tras la resección completa de los tumores, preservando la estructura y funcionalidad. Está descrito que el CIPG es una muy buena opción reconstructiva de la concha auricular; es una técnica sencilla que permite reparar grandes defectos con mínimos riesgos de necrosis. En la serie presentada, el resultado cosmético fue excelente, con muy bajo índice de recurrencias. Los resultados son óptimos en la reparación de lesiones conchales pero también de otras zonas, como el antihélix y las fosas triangular y escafoidea.
Medicina Cutanea Ibero Latino Americana, 1999
Actas Dermo-Sifiliográficas, 2003
Actas Dermo-Sifiliográficas, 2004
La agammaglobulinemia ligada al cromosoma X o de Bruton es una inmunodeficiencia primaria caracte... more La agammaglobulinemia ligada al cromosoma X o de Bruton es una inmunodeficiencia primaria caracterizada por una incapacidad para el desarrollo y maduración de linfocitos B desde células pre-B. Se traduce en una ausencia de linfocitos B y de células plasmáticas con el ...
Actas Dermo-Sifiliográficas, 2004
Se h an descrito pan iculitis en el curso de enfermedades del tejido conjuntivo, principalmente e... more Se h an descrito pan iculitis en el curso de enfermedades del tejido conjuntivo, principalmente en el lupus y en la esclerodermia 1. Por otra parte, se h an documen tado pocos casos de pan iculitis en relación con la dermatomiositis, y n in gun o en el contexto de la forma amiopática 2. Se presen ta el caso de un a pacien te con dermatomiositis amiopática que en el curso de su enfermedad desarrolló lesiones clínicas de paniculitis. CASO CLÍNICO Una mujer de 61 años fue diagnosticada en 1996 de dermatomiositis amiopática por la presencia de lesiones eritematovioláceas en zona periorbitaria, lesiones poiquilodérmicas en la «V» del escote (fig. 1) , pápulas eritematosas firmes en articulaciones CASOS BREVES Paniculitis asociada a derm atom iositis am iopática M ar ía Rodr íguez-Vázquez a , Guiller mo Romer o-Aguiler a a , M ónica Gar cía-Ar pa a , Fr ancisco M ar tín-Dávila b y Pilar Cor tina de la Calle a
Acta Dermato-Venereologica, 2005
The American Journal of Dermatopathology, 2020
: Melanomas with complete histological regression have been seen very infrequently. On the other ... more : Melanomas with complete histological regression have been seen very infrequently. On the other hand, the diagnosis of metastatic melanoma is based on the histopathology and positivity of markers such as S100, Melan-A, and HMB-45 whose sensitivity is 99%, 82%, and 76%, respectively. It is very rare that metastatic melanomas and even more primary melanoma are negative for all of these markers. In these rare cases, there is usually a known primary. We present the case of a 82-year-old woman with a erythematous mass in the left groin and a 1-cm black–bluish irregular nodule on the skin of the ipsilateral foot. This lesion was clinical and dermoscopically compatible with primary melanoma. In the histological evaluation of the skin, a dermis full of melanophages and hemosiderophages were found in a background of fibrosis, scarce lymphocytic infiltrate, and neovascularization. Any cells expressing melanocytic markers were observed. It was diagnosed as tumoral melanosis. Lymph nodes showed a proliferation of atypical epithelioid cells with eosinophilic cytoplasm. Mitosis was conspicuous. Tumoral cells were vimentin and CD99 positive, and S100, CD34, HMB-45, Melan-A, SOX 10, tyrosinase, C-KIT, CD45, and CKAE1/AE3 negative, and BRAF-V600 mutated was detected. During follow-up, atypical vitiligo-like lesions were discovered, suggesting the diagnosis of metastatic melanoma totally regressed in our patient.
El ombligo es una estructura anatómica en la que pueden aparecer lesiones de naturaleza muy diver... more El ombligo es una estructura anatómica en la que pueden aparecer lesiones de naturaleza muy diversa tanto benignas como malignas. La aparición de un epitelioma basocelular en el ombligo es muy poco frecuente. Por otro lado, clínicamente puede ser indistinguible de un nódulo umbilical metastásico.
![Research paper thumbnail of [Telemedicine and teledermatology (I): concepts and applications]](https://attachments.academia-assets.com/41467040/thumbnails/1.jpg)
](Actas dermo-sifiliográficas, 2008
Telemedicine refers to the use of telecommunications technology to provide health care and medica... more Telemedicine refers to the use of telecommunications technology to provide health care and medical information. The practice of medicine--and dermatology in particular--is undergoing a great upheaval due to advances in information technology. This article briefly reviews the origin, development, applications, benefits, methodology, and components of telemedicine. Specifically, we will analyze the types and applications of teledermatology, paying particular attention to technical, organizational, and legal aspects.
Actas dermo-sifiliográficas, 2006
There is considerable variability in the results of studies that evaluate diagnostic reliability ... more There is considerable variability in the results of studies that evaluate diagnostic reliability in teledermatology. There are only two studies that compare the synchronous and asynchronous modalities of teleconsult in the same sample. We present the results of the pilot project DERMATEL, a study of diagnostic concordance that aims to increase the evidence of these aspects. One-hundred-fifty.nine patients referred by the general practitioner in the first consult were randomized (algorithm 3:2:1) in three arms: asyncronous teledermatology (store-and-forward or SAF), synchronous teldermatology (real-time or VTC), and conventional consult (CC). We used high-quality, fixed digital images in all cases. The patients on the VTC teledermatology arm were also evaluated by videoconference. Finally all patients attended a face-to-face consult, considered the gold standard of patient care. A second dermatologist evaluated the diagnostic and management concordance between the teleconsults and th...
Journal of investigational allergology & clinical immunology
A 34-year-old woman, after 2 weeks of treatment with phenytoin and amitriptyline, developed fever... more A 34-year-old woman, after 2 weeks of treatment with phenytoin and amitriptyline, developed fever and cutaneous lesions consisting of a generalized maculopapular rash and eosinophilia. Her biochemical data showed abnormal liver functions with increased levels of SGOT, SGPT, LDH, gamma-glutamyl transpeptidase and alkaline phosphatase. The skin biopsy pattern was compatible with phenytoin drug eruption of the erythemamultiforme-like type (lymphocytic exocytosis, isolated dyskeratotic cells, vacuolation of basal cells and incontinence of pigment). The patch tests were positive with phenytoin (patch test biopsy showed a typical eczematous pattern). The patch test with amitriptyline was negative. An oral challenge with amitriptyline showed an erythematous maculopapular rash. The challenge with phenytoin was not carried out because the previously abnormal liver function tests contraindicated the challenge. Although there are a few cases reported, the patch tests could be useful for diagno...
Panniculitic T-cell lymphoma is a rare, aggressive variant of cutaneous T-cell lymphoma, with few... more Panniculitic T-cell lymphoma is a rare, aggressive variant of cutaneous T-cell lymphoma, with fewer than 100 cases described. The main problem is its diagnosis, as both the clinical and the histological features may simulate benign panniculitis. We present the case of a 34-year-old male patient, who had presented with an indurated plaque, sclerodermiform in appearance, on the front of the right thigh for 4 months, later accompanied by fever and constitutional symptoms. The initial diagnosis was cellulitis, but no clinical improvement was seen despite systemic antibiotic therapy. After two skin biopsies, the patient was diagnosed with panniculitic cutaneous T-cell lymphoma. The patient was treated with 8 cycles of CHOP chemotherapy, with resolution of the symptoms.
Actas Dermo-Sifiliográficas (English Edition), 2012
Actas Dermo-Sifiliográficas (English Edition), 2014
Although many studies have evaluated the diagnostic reliability of store-and-forward (SF) teleder... more Although many studies have evaluated the diagnostic reliability of store-and-forward (SF) teledermatology, the reliability of the technique for the diagnosis of general skin conditions in a clinical practice setting has never been demonstrated. We evaluated the reliability of SF teledermatology in clinical practice by analyzing the diagnostic agreement achieved in a subgroup of patients from the DERMATEL-2 study. Patients referred from primary care settings were randomized to 3 groups: SF, a combination of videoconferencing and SF technology (VC-SF), and a control group. This article focuses on the SF group. Clinical data were recorded and photographs taken by primary care physicians, who forwarded the data electronically. Each SF consultation package was assessed by 3 dermatologists (D1,D2,D3). Subsequently all the patients were assessed by a single dermatologist (D1) in a face-to-face consultation. Finally, 2 other dermatologists (D4,D5) assessed the agreement between the diagnoses obtained by SF and FF. In total, 457 patients (200 males and 257 females) aged between 2 months and 86 years were randomized (192 to SF, 176 to VC-SF, and 89 to the control group). The diagnostic categories were as follows: tumors (49.4%), inflammatory (25.7%), adnexal (11%), infectious (9.4%) and other processes (4.4%) Since 170 patients had consultations deemed valid for analysis, the study included a total of 510 SF assessments. Most of the images and clinical records were of high quality (71.2% and 91.2% respectively), and diagnostic confidence was high in 81.4% of the cases studied. In 58.4% of cases the condition was managed exclusively by teledermatology. Levels of complete and aggregate interobserver agreement between SF and face-to-face evaluators were 0,72 and 0.90, respectively, for diagnosis and 0.61 and 0.80 for treatment. Diagnostic agreement correlated with the image quality (P < .001), diagnostic confidence (P<.001), felt need for conventional consultation (P<.001), and the quality of the clinical record (P=.013). The interobserver reliability of SF diagnosis in clinical practice is good. Dermatologists are able to predict errors in diagnosis by analyzing their own diagnostic confidence and evaluating the quality of the images.
Journal of investigational allergology & clinical immunology, 2002
Cutaneous adverse reactions are frequently described with anticonvulsant drugs, especially with a... more Cutaneous adverse reactions are frequently described with anticonvulsant drugs, especially with aromatic drugs such as carbamazepine, phenytoin, and phenobarbital. Patch tests could be useful for diagnosing this clinical picture. Hypersensitivity to several anticonvulsant drugs is common but unpredictable. 15 patients from our allergy section, suffering from anticonvulsant skin allergy, were included. We describe their analitic alterations, responsible drugs, and anticonvulsants tolerated, the results of patch tests with anticonvulsant drugs (5% pet. and aq.), and skin biopsies wherever carried out. 23 adverse skin reactions with different anticonvulsant drugs occurred in the 15 patients: 13 resulted in fever and generalized cutaneous rash, 7 patients suffered only from cutaneous rash. There was one case of palpable purpura, one of erythema multiforme (target lesions), and another one suffered only cutaneous pruritus. Eosinophilia was found in 5 cases. Liver enzymes were elevated in...
Revista de la Sociedad Española del Dolor
Objetivo: Conocer la prevalencia real del síndrome de boca ardiente (SBA) y los posibles factores... more Objetivo: Conocer la prevalencia real del síndrome de boca ardiente (SBA) y los posibles factores de riesgo asociados. Material y métodos: Estudio observacional descriptivo transversal, de base poblacional con selección aleatoria simple en mayores de 24 años. Tras muestreo aleatorio, el año 2015 se contactó telefónicamente identificando pacientes que cumplían criterios de inclusión. A estos se les realizó entrevista presencial, descartando presencia de lesiones orales, se realizó test de ansiedad, depresión y analítica. Se agregó una cohorte de pacientes ya diagnosticados de base de datos del Hospital de Ciudad Real de Dermatología, para analizar los posibles factores de riesgo asociados comparando con un grupo control. Las características de los pacientes con SBA y los controles sin SBA se analizaron estadísticamente con el SPSS v 21 y se utilizaron la prueba de Chi cuadrado y el Odds Ratio (OR) para evaluar las diferencias en las características de los grupos. La significación estadística se fijó en p < 0,05. Resultados: La prevalencia fue de 0,84 % (IC 95 %: 0,28-1,4). Los factores que alcanzaron significación estadística en el desarrollo de SBA fueron los siguientes: el sexo femenino p < 0,05 (IC 1,43-2,20), antecedentes de ansiedad p < 0,05 (IC 6,4-72,47), depresión p < 0,05 (IC 3,59-34,40), de candidiasis oral p < 0,05 (IC 1,44-16,27), de déficit nutricional p < 0,05 (IC 4,1-100,05), miedo al cáncer p < 0,05 (IC 2,53-64,56) y uso de prótesis dentales p < 0,05 (IC 2,53-64,56). La toma de antidepresivos p < 0,05 (IC 7,28-177,86) y ansiolíticos p < 0,05 (IC 7,56-99,67). La presencia de sequedad bucal subjetiva p < 0,05 (IC 1,81-14,93) y objetiva p < 0,05 (IC 1,47-14,57). Tener alterados los cuestionario de ansiedad p < 0,05 (IC 10,64-183,29) y depresión p < 0,05 (IC: 5,48-132,92). Conclusiones: La prevalencia de SBA en el área de Ciudad Real es de 0,84 por cien habitantes. Aunque puede tener un origen multifactorial, podría existir asociación con el género femenino, antecedente de ansiedad, de depresión, de uso de prótesis dentales, de infección por candidiasis oral, el uso de antidepresivos, de ansiolíticos, miedo al cáncer, la sequedad bucal subjetiva y estados actuales de ansiedad y de depresión.
Dermatology Online Journal, 2018
Revista Colombiana de Reumatología, 2018
Objetivo: Determinar el riesgo cardiovascular y la prevalencia de factores de riesgo cardiovascul... more Objetivo: Determinar el riesgo cardiovascular y la prevalencia de factores de riesgo cardiovascular (RCV) en los pacientes con artritis reumatoide. Materiales y métodos: Estudio observacional, descriptivo y transversal, realizado en el Hospital General de Ciudad Real, entre junio de 2013 y mayo de 2014. Se realizó una analítica completa, se elaboró un perfil clínico, se calculó el SCOREm y se estratificó el RCV. Finalmente, se determinó la presencia de aterosclerosis subclínica mediante la realización de una ecografía carotídea. Resultados: 119 pacientes aceptaron participar en el estudio. Hubo una prevalencia del 73,1% de los factores de riesgo tradicionales, 6,72% había presentado un evento cardiovascular al momento del estudio, 22,68% poseía un infradiagnóstico de diabetes mellitus o nefropatía.
Acta pediátrica española, 2004
Actas Dermo-Sifiliográficas, 2020
Colgajos quirúrgicos; Cirugía del cáncer de piel; Cirugía del cáncer de la oreja; Cirugía oído ex... more Colgajos quirúrgicos; Cirugía del cáncer de piel; Cirugía del cáncer de la oreja; Cirugía oído externo Resumen Introducción y objetivos: Los defectos de la zona anterior del pabellón auricular (PA) son un desafío reconstructivo debido a la compleja topografía y el difícil acceso. Describimos nuestra experiencia con el uso del colgajo en isla en puerta giratoria (CIPG) para la reconstrucción de defectos auriculares y se presentan los resultados quirúrgicos. Material y métodos: Estudio descriptivo retrospectivo de pacientes tratados mediante reconstrucción de oreja, de diversas localizaciones de la zona anterior, mediante el CIPG, tras la resección de tumores malignos. Resultados: Entre 2011 y 2019 se operó a 17 pacientes: 7 carcinomas epidermoides y 10 basocelulares. El estudio histológico convencional mostró bordes quirúrgicos libres en todas las piezas de resección. El tiempo medio de seguimiento fue de 40 meses. Hubo una recidiva local en un carcinoma epidermoide, con buena respuesta a radioterapia, de forma que todos los pacientes estaban libres de enfermedad al completar el seguimiento. Solo 3 pacientes presentaron complicaciones menores (depresión de la superficie del colgajo en un caso y retracción del oído hacia la mastoides en 2 casos). Mediante escalas de valoración subjetiva, se determinó el resultado postoperatorio estético y funcional, tanto por parte del dermatólogo como del paciente. En todos los pacientes se conservó el contorno normal del PA reconstruido y ningún paciente requirió cirugía correctiva adicional. Conclusiones: La reconstrucción auricular mediante CIPG permitió la reparación satisfactoria tras la resección completa de los tumores, preservando la estructura y funcionalidad. Está descrito que el CIPG es una muy buena opción reconstructiva de la concha auricular; es una técnica sencilla que permite reparar grandes defectos con mínimos riesgos de necrosis. En la serie presentada, el resultado cosmético fue excelente, con muy bajo índice de recurrencias. Los resultados son óptimos en la reparación de lesiones conchales pero también de otras zonas, como el antihélix y las fosas triangular y escafoidea.
Medicina Cutanea Ibero Latino Americana, 1999
Actas Dermo-Sifiliográficas, 2003
Actas Dermo-Sifiliográficas, 2004
La agammaglobulinemia ligada al cromosoma X o de Bruton es una inmunodeficiencia primaria caracte... more La agammaglobulinemia ligada al cromosoma X o de Bruton es una inmunodeficiencia primaria caracterizada por una incapacidad para el desarrollo y maduración de linfocitos B desde células pre-B. Se traduce en una ausencia de linfocitos B y de células plasmáticas con el ...
Actas Dermo-Sifiliográficas, 2004
Se h an descrito pan iculitis en el curso de enfermedades del tejido conjuntivo, principalmente e... more Se h an descrito pan iculitis en el curso de enfermedades del tejido conjuntivo, principalmente en el lupus y en la esclerodermia 1. Por otra parte, se h an documen tado pocos casos de pan iculitis en relación con la dermatomiositis, y n in gun o en el contexto de la forma amiopática 2. Se presen ta el caso de un a pacien te con dermatomiositis amiopática que en el curso de su enfermedad desarrolló lesiones clínicas de paniculitis. CASO CLÍNICO Una mujer de 61 años fue diagnosticada en 1996 de dermatomiositis amiopática por la presencia de lesiones eritematovioláceas en zona periorbitaria, lesiones poiquilodérmicas en la «V» del escote (fig. 1) , pápulas eritematosas firmes en articulaciones CASOS BREVES Paniculitis asociada a derm atom iositis am iopática M ar ía Rodr íguez-Vázquez a , Guiller mo Romer o-Aguiler a a , M ónica Gar cía-Ar pa a , Fr ancisco M ar tín-Dávila b y Pilar Cor tina de la Calle a
Acta Dermato-Venereologica, 2005
The American Journal of Dermatopathology, 2020
: Melanomas with complete histological regression have been seen very infrequently. On the other ... more : Melanomas with complete histological regression have been seen very infrequently. On the other hand, the diagnosis of metastatic melanoma is based on the histopathology and positivity of markers such as S100, Melan-A, and HMB-45 whose sensitivity is 99%, 82%, and 76%, respectively. It is very rare that metastatic melanomas and even more primary melanoma are negative for all of these markers. In these rare cases, there is usually a known primary. We present the case of a 82-year-old woman with a erythematous mass in the left groin and a 1-cm black–bluish irregular nodule on the skin of the ipsilateral foot. This lesion was clinical and dermoscopically compatible with primary melanoma. In the histological evaluation of the skin, a dermis full of melanophages and hemosiderophages were found in a background of fibrosis, scarce lymphocytic infiltrate, and neovascularization. Any cells expressing melanocytic markers were observed. It was diagnosed as tumoral melanosis. Lymph nodes showed a proliferation of atypical epithelioid cells with eosinophilic cytoplasm. Mitosis was conspicuous. Tumoral cells were vimentin and CD99 positive, and S100, CD34, HMB-45, Melan-A, SOX 10, tyrosinase, C-KIT, CD45, and CKAE1/AE3 negative, and BRAF-V600 mutated was detected. During follow-up, atypical vitiligo-like lesions were discovered, suggesting the diagnosis of metastatic melanoma totally regressed in our patient.
El ombligo es una estructura anatómica en la que pueden aparecer lesiones de naturaleza muy diver... more El ombligo es una estructura anatómica en la que pueden aparecer lesiones de naturaleza muy diversa tanto benignas como malignas. La aparición de un epitelioma basocelular en el ombligo es muy poco frecuente. Por otro lado, clínicamente puede ser indistinguible de un nódulo umbilical metastásico.
Actas dermo-sifiliográficas, 2008
Telemedicine refers to the use of telecommunications technology to provide health care and medica... more Telemedicine refers to the use of telecommunications technology to provide health care and medical information. The practice of medicine--and dermatology in particular--is undergoing a great upheaval due to advances in information technology. This article briefly reviews the origin, development, applications, benefits, methodology, and components of telemedicine. Specifically, we will analyze the types and applications of teledermatology, paying particular attention to technical, organizational, and legal aspects.
Actas dermo-sifiliográficas, 2006
There is considerable variability in the results of studies that evaluate diagnostic reliability ... more There is considerable variability in the results of studies that evaluate diagnostic reliability in teledermatology. There are only two studies that compare the synchronous and asynchronous modalities of teleconsult in the same sample. We present the results of the pilot project DERMATEL, a study of diagnostic concordance that aims to increase the evidence of these aspects. One-hundred-fifty.nine patients referred by the general practitioner in the first consult were randomized (algorithm 3:2:1) in three arms: asyncronous teledermatology (store-and-forward or SAF), synchronous teldermatology (real-time or VTC), and conventional consult (CC). We used high-quality, fixed digital images in all cases. The patients on the VTC teledermatology arm were also evaluated by videoconference. Finally all patients attended a face-to-face consult, considered the gold standard of patient care. A second dermatologist evaluated the diagnostic and management concordance between the teleconsults and th...
Journal of investigational allergology & clinical immunology
A 34-year-old woman, after 2 weeks of treatment with phenytoin and amitriptyline, developed fever... more A 34-year-old woman, after 2 weeks of treatment with phenytoin and amitriptyline, developed fever and cutaneous lesions consisting of a generalized maculopapular rash and eosinophilia. Her biochemical data showed abnormal liver functions with increased levels of SGOT, SGPT, LDH, gamma-glutamyl transpeptidase and alkaline phosphatase. The skin biopsy pattern was compatible with phenytoin drug eruption of the erythemamultiforme-like type (lymphocytic exocytosis, isolated dyskeratotic cells, vacuolation of basal cells and incontinence of pigment). The patch tests were positive with phenytoin (patch test biopsy showed a typical eczematous pattern). The patch test with amitriptyline was negative. An oral challenge with amitriptyline showed an erythematous maculopapular rash. The challenge with phenytoin was not carried out because the previously abnormal liver function tests contraindicated the challenge. Although there are a few cases reported, the patch tests could be useful for diagno...
Panniculitic T-cell lymphoma is a rare, aggressive variant of cutaneous T-cell lymphoma, with few... more Panniculitic T-cell lymphoma is a rare, aggressive variant of cutaneous T-cell lymphoma, with fewer than 100 cases described. The main problem is its diagnosis, as both the clinical and the histological features may simulate benign panniculitis. We present the case of a 34-year-old male patient, who had presented with an indurated plaque, sclerodermiform in appearance, on the front of the right thigh for 4 months, later accompanied by fever and constitutional symptoms. The initial diagnosis was cellulitis, but no clinical improvement was seen despite systemic antibiotic therapy. After two skin biopsies, the patient was diagnosed with panniculitic cutaneous T-cell lymphoma. The patient was treated with 8 cycles of CHOP chemotherapy, with resolution of the symptoms.
Actas Dermo-Sifiliográficas (English Edition), 2012
Actas Dermo-Sifiliográficas (English Edition), 2014
Although many studies have evaluated the diagnostic reliability of store-and-forward (SF) teleder... more Although many studies have evaluated the diagnostic reliability of store-and-forward (SF) teledermatology, the reliability of the technique for the diagnosis of general skin conditions in a clinical practice setting has never been demonstrated. We evaluated the reliability of SF teledermatology in clinical practice by analyzing the diagnostic agreement achieved in a subgroup of patients from the DERMATEL-2 study. Patients referred from primary care settings were randomized to 3 groups: SF, a combination of videoconferencing and SF technology (VC-SF), and a control group. This article focuses on the SF group. Clinical data were recorded and photographs taken by primary care physicians, who forwarded the data electronically. Each SF consultation package was assessed by 3 dermatologists (D1,D2,D3). Subsequently all the patients were assessed by a single dermatologist (D1) in a face-to-face consultation. Finally, 2 other dermatologists (D4,D5) assessed the agreement between the diagnoses obtained by SF and FF. In total, 457 patients (200 males and 257 females) aged between 2 months and 86 years were randomized (192 to SF, 176 to VC-SF, and 89 to the control group). The diagnostic categories were as follows: tumors (49.4%), inflammatory (25.7%), adnexal (11%), infectious (9.4%) and other processes (4.4%) Since 170 patients had consultations deemed valid for analysis, the study included a total of 510 SF assessments. Most of the images and clinical records were of high quality (71.2% and 91.2% respectively), and diagnostic confidence was high in 81.4% of the cases studied. In 58.4% of cases the condition was managed exclusively by teledermatology. Levels of complete and aggregate interobserver agreement between SF and face-to-face evaluators were 0,72 and 0.90, respectively, for diagnosis and 0.61 and 0.80 for treatment. Diagnostic agreement correlated with the image quality (P < .001), diagnostic confidence (P<.001), felt need for conventional consultation (P<.001), and the quality of the clinical record (P=.013). The interobserver reliability of SF diagnosis in clinical practice is good. Dermatologists are able to predict errors in diagnosis by analyzing their own diagnostic confidence and evaluating the quality of the images.
Journal of investigational allergology & clinical immunology, 2002
Cutaneous adverse reactions are frequently described with anticonvulsant drugs, especially with a... more Cutaneous adverse reactions are frequently described with anticonvulsant drugs, especially with aromatic drugs such as carbamazepine, phenytoin, and phenobarbital. Patch tests could be useful for diagnosing this clinical picture. Hypersensitivity to several anticonvulsant drugs is common but unpredictable. 15 patients from our allergy section, suffering from anticonvulsant skin allergy, were included. We describe their analitic alterations, responsible drugs, and anticonvulsants tolerated, the results of patch tests with anticonvulsant drugs (5% pet. and aq.), and skin biopsies wherever carried out. 23 adverse skin reactions with different anticonvulsant drugs occurred in the 15 patients: 13 resulted in fever and generalized cutaneous rash, 7 patients suffered only from cutaneous rash. There was one case of palpable purpura, one of erythema multiforme (target lesions), and another one suffered only cutaneous pruritus. Eosinophilia was found in 5 cases. Liver enzymes were elevated in...