Browsing by Author "Wortsman, Ximena"

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    Acrokeratoelastoidosis of the Foot with Clinical, Dermoscopic, Ultrasonographic, and Histopathologic Correlation
    (2018) Uribe González, Pablo Francisco; Ortiz, Elena; Wortsman, Ximena; González Bombardiere, Sergio
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    Can Ultrasound Examinations Generate Pain in Hidradenitis Suppurativa Patients? Results from a Multicentric Cross-Sectional Study
    (2023) Wortsman, Ximena; Reyes-Baraona, Francisco; Ramirez-Cornejo, Cristian; Ferreira-Wortsman, Camila; Caposiena Caro, Raffaele Dante; Molina-Leyva, Alejandro; Arias-Santiago, Salvador; Giavedoni, Priscila; Martorell, Antonio; Romani, Jorge; Gonzalez, Claudia; Alfageme, Fernando
    Background: Pain is not a trivial issue for hidradenitis suppurativa (HS) patients and has been considered a domain in the Core Outcome Set. To date, there is no evidence about pain caused by the ultrasound examinations. Objective: The aim of the study was to assess the presence of pain generated by the ultrasound examinations of HS patients. Methods: A multicentric cross-sectional study for detecting pain during the ultrasound examinations of HS patients using a validated verbal questionnaire immediately after the imaging studies. Statistical analysis included demographic data and possible associations with sex, age, location, clinical (Hurley), and ultrasonographic scoring (SOS-HS). The statistical tests were two proportions Z test, chi(2) test, Student's t test, and ANOVA. A p < 0.05 was considered significant. Results: 317 patients met the criteria. 77.3% of them did not present pain. Of cases with pain, 59.8% were mild, 16.7% moderate, and 23.6% severe. No significant association was found with sex, age, staging, location, or the number of affected regions. Although nonsignificant, severe pain cases were more frequent in the clinical Hurley III and ultrasonographic SOS-HS III stages. Conclusion: Pain generated by the ultrasound examination of HS patients is infrequent.
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    Comparison of clinical marking and ultrasound-guided injection of Botulinum type A toxin into the masseter muscles for treating bruxism and its cosmetic effects
    (2016) Quezada-Gaon, Natacha; Wortsman, Ximena; Penaloza, Osvaldo; Eduardo Carrasco, Juan
    Background Botulinum toxin type A has been used for treating the hypertrophy of the masseter muscles and its cosmetic effects. Ultrasound is increasingly used in dermatology, along with the guidance of mini-invasive procedures.
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    Concepts, Role, and Advances on Nail Imaging
    (2021) Wortsman, Ximena
    ? There are several imaging techniques for studying the nail, and all of them require proper devices and trained operators. ? Currently, among imaging techniques, the better axial spatial resolution and the more extensive range of applications are provided by ultrasound, which currently is the first-choice imaging technique for evaluating nail conditions. ? A correlation of state-of-the-art clinical and imaging figures supports the review of this topic.
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    Dissecting cellulitis of the scalp early diagnosed by color doppler ultrasound
    (2017) Cataldo Cerda, Karina; Wortsman, Ximena
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    Evaluation of Ultrasound Changes With the Use of Microneedling Versus Fractional CO2 Laser in Atrophic Acne Scars
    (2024) Nanco-Melendez, Claudio; Yagnam-Diaz, Mathias; Munoz-Caceres, Marco; Contador-Gonzalez, Javier; Gubelin-Harcha, Walter; Chicao-Carmona, Fernando; Tan, Jerry; Wortsman, Ximena
    Introduction: Atrophic acne scarring, a common sequela of acne, can be treated by different interventions, including microneedling and laser resurfacing. Objectives: We sought to evaluate the comparative efficacy of microneedling versus fractional CO2 laser in treating atrophic acne facial scars using imaging with high and ultra-high frequency ultrasound. Methods: Participants received 2 sessions, separated by 1 month, of microneedling on the left side of the face and fractional CO2 laser on the right. Color Doppler ultrasound evaluations (24 and 70 MHz) were conducted at baseline and 3 months after treatment. Each patient completed questionnaires on satisfaction, pain, and adverse effects. Results: Nine subjects were enrolled. The frequency order of scar types was boxcar, ice-pick, and rolling. At 3 months, using the acne scar clinical evaluation scale, a decrease in scar scores of both methods was observed for total scars (P = 0.0005), ice-pick scars (P = 0.0128), and rolling scars (P = 0.0007). Twenty-two scars analyzed by ultrasound demonstrated a trend to decrease in size; however, no significant changes were observed for either microneedling or CO2 laser treatments. Moreover, there were no significant differences between these methods. Both treatments were rated as good or very good by patient assessments. There was a low frequency of pain and hyperpigmentation reported with both modalities, albeit somewhat higher with microneedling. Conclusions: Both microneedling and CO2 laser improved atrophic acne scars. Ultrasound did not show significant differences between these modalities.
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    Frequent applications of color Doppler ultrasound in dermatology that support diagnosis and management
    (2023) Wortsman, Ximena
    The use of color Doppler ultrasound in dermatology is a new field of ultrasound that has been exponentially growing in the last decades. It has multiple applications, such as the detection of the morphology and extent of benign cutaneous tumors and skin cancer, the study of vascular anomalies, the diagnosis of inflammatory conditions of the skin, the discrimination of the most common cosmetic fillers, as well as the diagnosis of aesthetic complications, among other uses.This utilization of ultrasound requires special devices that work with high-frequency probes, standardized protocols, as well as an operator trained in these pathologies.Nowadays, color Doppler ultrasound in dermatology has become an essential part of the dermatologic toolkit, providing critical anatomical information that helps patient management.
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    Granulomatous Reaction Secondary to Fractional Radiofrequency Microneedling with Clinical, Ultrasonographic, and Histologic Correlation
    (2024) Gatica, Jose Luis; Ortega, Rinna; Aragon-Caqueo, Diego; Wortsman, Ximena; Sazunic, Ivo; Loubies, Rodrigo
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    High-Resolution Ultrasound of Odontogenic Cutaneous Sinus Tract
    (2024) Corvino, Antonio; Catalano, Orlando; Wortsman, Ximena; Roldan, Fernando Alfageme; Cavallieri, Fernanda; Gonzalez, Claudia; Tafuri, Domenico; Corvino, Fabio; Cocco, Giulio; Caruso, Martina
    ObjectivesTo investigate the role of high-resolution ultrasound (HR-US) in the initial and differential diagnosis of the Odontogenic Cutaneous Sinus Tract (OCST) in a multicentric setting.MethodsSkin HR-US examinations of OCSTs performed between January 2019 and June 2023 at different Institutions were retrospectively reviewed. Epidemiological and clinical data (age, gender, location of the skin lesion, causative tooth, and the clinical suspicion) as well as HR-US imaging findings (morphology and length of the sinus tract, Doppler signal, and cortical bone interruption of maxilla or mandible) were collected. US examinations were performed by expert radiologists using a high-performance US scanner, employing a high-frequency linear probe (15 MHz or higher frequencies). In only one patient the HR-US exam was integrated with strain elastography (SE).ResultsSixteen patients were enrolled with a median age of 37.6 years (range 16-70 years). The most frequent clinical suspicion was epidermal cyst, while OCST was suspected in only two cases. In all cases, HR-US depicted the sinus tract as a nodular, triangular or "champignon-shaped" lesion in the subcutaneous layer, which continued with a slightly tortuous band structure, up to the focally interrupted cortical bone plate. Furthermore, color Doppler evaluation showed color signals around and/or within the lesion, expression of inflammation. On SE, the sinus tract showed a hard pattern, due to fibrous and granulomatous tissue.ConclusionsHR-US, thanks to its high spatial resolution, allows the evaluation of OCST, and play a crucial diagnostic role, mainly when the clinical suspicious is different.
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    How to Start on Dermatologic Ultrasound: Basic Anatomical Concepts, Guidelines, Technical Considerations, and Best Tips
    (2024) Gonzalez, Claudia; Wortsman, Ximena
    Dermatologic ultrasound has grown exponentially during the last decades and has passed from the experimental phase to the routine daily practice in multiple countries. The performance of this imaging technique requires color Doppler ultrasound devices working with high-frequency probes, a trained operator on imaging and dermatologic conditions, and the performance of standardized protocols for obtaining the anatomical data properly. In this review, we analyze the ultrasonographic anatomy of the skin, hair, and nails, the technical requirements and considerations, the guidelines, and the recommended protocols, and provide the best tips for practicing this type of examination confidently. Semin Ultrasound CT MRI 45: 180-191 (c) 2023 Elsevier Inc. All rights reserved.
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    Inter- and Intra-rater Agreement of Dermatologic Ultrasound for the Diagnosis of Lobular and Septal Panniculitis
    (2020) Romani, Jorge; Giavedoni, Priscila; Roe, Esther; Vidal, David; Luelmo, Jesus; Wortsman, Ximena
    Objectives-Dermatologic ultrasound (US) may aid in the diagnosis and classification of panniculitis. The purpose of this study was to assess the capability of dermatologic US for subtyping mainly septal/lobular panniculitis.
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    Lingual Epidermal Choristoma: Ultrasonography as a Diagnostic Tool
    (2024) del Puerto, Constanza; Wortsman, Ximena; Downey, Camila
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    Low effectiveness of methotrexate in the management of localised scleroderma (morphea) based on an ultrasound activity score
    (2021) Vera-Kellet, Cristian; Meza-Romero, Rodrigo; Moll-Manzur, Catherina; Ramirez-Cornejo, Cristian; Wortsman, Ximena
    Background: The effectiveness of methotrexate (MTX), a first-line treatment for localised scleroderma (morphea), has not been assessed using colour Doppler ultrasonography (CDU). Objectives: We aimed to ultrasonographically monitor disease activity in patients with morphea treated with MTX, assessing its effectiveness using an Ultrasound Morphea Activity Score (US-MAS). Materials& Methods: Aretrospective cohort of 22 patients was studied between July 2014 and July 2019. The morphea of each patient, treated with MTX, was confirmed by histology and all patients had at least two CDU examinations. The US-MAS is based on published ultrasound signs of disease activity validated by histology. A weight-adjusted average MTX dose (mg/kg/wk) was used to standardize dosage, weight, and time between CDU examinations. The difference in US-MAS between two CDU examinations was determined. Statistical analyses includedWilcoxon and Fisher exact tests, the Spearman correlation coefficient, and risk ratios with 95% confidence intervals. To create two groups, we determined the median of the sample as the cut-off point for MTX dose (0.265 mg/kg/week). Significance was set at p <= 0.05; Results: In all cases, CDU examinations showed subclinical signs of activity beyond the visible lesional borders, either in the same or adjacent corporal segments. A negative correlation was found between the change in US-MAS andMTXdose (Spearman coefficient, -0.45; p = 0.035). The group dosed at >= 0.265 mg/kg/wk showed a non-significant change in US-MAS (2-point decrease). No case became inactive. Conclusion: MTX is a treatment with a low effectiveness for morphea, causing only slight decreases in ultrasound activity at higher doses.
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    Morphea After Liposuction Ultrasonography
    (2022) Araneda-Ortega, Paulina; Jose Poblete-Villacorta, Maria; Munoz-Lopez, Camila; Vera-Kellet, Cristian; Wortsman, Ximena
    Liposuction is a common aesthetic procedure; however, to date, liposuction has not been linked to morphea. The aim was to review cases with a history of liposuction that presented active morphea lesions in the same surgery regions and were confirmed by ultrasound and histology. A retrospective descriptive analysis of the clinical, ultrasonographic, and pathology database took place (2014-2020). Eleven patients met the criteria. Ultrasound supported the diagnosis, and the ultrasonographic signs of activity in these cases matched the features described in the literature in 100% of cases. In summary, morphea may appear after liposuction and ultrasound can support its early detection.
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    Multicentric Study on High-Frequency Ultrasound Characterization of Calcium Deposits in Dermal and Subcutaneous Calciphylaxis and Calcinosis
    (2022) Gamissans, Marta; Giavedoni, Priscila; Roe, Esther; Sanchez, Julia; Quintana-Codina, Monica; Garbayo-Salmons, Patricia; Vidal, David; Riera-Marti, Nuria; Lopez-Llunell, Cristina; Romani, Jorge; Wortsman, Ximena
    Objectives Calcium depositions are frequent in multiple inflammatory dermatosis, they can be explored by ultrasound (US) but the patterns of these depositions have not yet been described. The aim of this study is to describe different patterns of calcium deposition in inflammatory dermatoses. Methods The clinical and US data of 58 patients from 7 different centers with inflammatory dermatosis showing ultrasonography-detected calcium depositions was retrospectively reviewed. Results Dystrophic calcinosis represented 86.2%, calciphylaxis 8.6%, and metastatic calcinosis 5.2%. Three different sonographic patterns of calcium deposition were found: 1) thin hyperechoic bands, parallel to the surface of the epidermis, generating a strong and wide posterior acoustic shadow; 2) hyperechoic spots or lumps with a narrow acoustic shadow; and 3) a linear hyperechoic band parallel to the walls of a blood vessel with also a narrow acoustic shadow. The predominant pattern in metastatic calcifications was type 1, in dystrophic calcifications type 2, and in calciphylaxis type 3. In dystrophic calcinosis, cutis deposits were longer and wider than in calciphylaxis (P < .05). Conclusion New data on inflammatory dermatoses with calcium deposition may be useful for the diagnosis and monitoring of calcium deposits and could avoid the performance of more invasive tests, such as a skin biopsy.
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    Nifedipine cream versus sildenafil cream for patients with secondary Raynaud phenomenon : a randomized, double-blind, controlled pilot study
    (2018) Wortsman, Ximena; Del Barrio-Díaz, Pablo; Meza-Romero, Rodrigo; Poehls-Risco, Christine; Vera Kellet, Cristián Andrés
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    Polyacrylamide for the Face
    (Springer Cham, 2020) Quezada Gaón, Natacha; Vera Kellet, Cristián Andrés; Wortsman, Ximena
    Polyacrylamide is a good nonabsorbable volumizing gel not approved by the FDA. It is considered a gel whose application is similar to hyaluronic acid, giving an excellent aesthetic result. It is preferably used in HIV-positive patients, because of their immunosuppression state, due to the risk of producing granulomas. Aquamid® from the European Company Contura is a polyacrylamide gel that can be applied to the face and the body, with the most frequent side effects occurring when it is used in glabella and lips. In spite of having good cosmetic results, it is avoided in immunocompetent individuals or patients with autoimmune diseases. We only use this treatment in patients with HIV.
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    Practical applications of ultrasound in dermatology
    (2021) Wortsman, Ximena
    Ultrasound has evolved in dermatology from an experimental phase to a daily practice imaging technique. Its several advantages include its safety, good balance between penetration and resolution, high definition, and the detection of blood flow in real time. Its applications are growing and include the support of the diagnosis and extent in all axes, including depth, vascularity patterns, staging, and follow up of multiple cutaneous diseases-benign cutaneous tumors, vascular anomalies, nail lesions, skin cancer, inflammatory cutaneous diseases, and aesthetics complications. Published by Elsevier Inc.
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    Präoperativer Hochfrequenzultraschall: Ein zuverlässiges Managementinstrument bei nichtmelanozytärem Hautkrebs der Ohrmuschel und der Nase
    (2024) Crisan, Diana; Wortsman, Ximena; Catalano, Orlando; Badea, Radu; Kastler, Sabine; Badea, Alexandru; Manea, Avram; Scharffetter-Kochanek, Karin; Strilciuc, Stefan; Crisan, Maria; Schneider, Lars Alexander
    Hintergrund und ZielsetzungDas Wissen & uuml;ber die Tiefeninfiltration bei nichtmelanozyt & auml;rem Hautkrebs (NMSC) mithilfe pr & auml;operativer Sonographie k & ouml;nnte den & Auml;rzten erm & ouml;glichen, den am besten geeigneten therapeutischen Ansatz zu w & auml;hlen, unn & ouml;tige Operationen und teure bildgebende Verfahren zu vermeiden und die Diagnose und Behandlung nicht zu verz & ouml;gern. In unserer retrospektiven, monozentrischen Studie haben wir die N & uuml;tzlichkeit des Hochfrequenzultraschalls (HFUS) zur Beurteilung der Tiefeninfiltration bei aurikul & auml;ren und nasalen NMSC-F & auml;llen untersucht und die darauffolgende & Auml;nderung des therapeutischen Ansatzes bewertet.Patienten und MethodikIn 60 NMSC-F & auml;llen haben wir die Genauigkeit des HFUS bei der Erkennung von Knorpel- und Knocheninfiltration sowie die Korrelation sonographischer und histologischer Parameter beurteilt.ErgebnisseIn 16,6% der F & auml;lle wurde pr & auml;operativ eine tiefe Knorpel-/Knochenbeteiligung oder eine lokoregionale Erkrankung identifiziert, was zu einer ge & auml;nderten therapeutischen Strategie mit radioimmunologischer Behandlung anstelle von Operation f & uuml;hrte. In zwei F & auml;llen identifizierte der pr & auml;operative HFUS eine lokale Knorpelinfiltration, was die Anzahl der chirurgischen Eingriffe reduzierte. Bei den verbleibenden 48 L & auml;sionen ohne Tiefeninfiltration wurde eine Korrelation von > 99% zwischen der histologischen und sonographischen Tumoreindringtiefe gefunden (p <0.001).SchlussfolgerungenPr & auml;operativer HFUS beeinflusst das therapeutische Vorgehen bei NMSC, indem es eine subklinische Beteiligung tieferer Strukturen erkennt, umfangreichere diagnostische Ma ss nahmen vermeidet, Kosten reduziert und die Qualit & auml;t der Gesundheitsversorgung verbessert. HFUS sollte in der Dermatochirurgie vor der Tumorentfernung zur optimierten Therapie und zur verbesserten Patientenberatung eingesetzt werden.