Karla Leslie Martínez Hernández

Introducción: El carcinoma cutáneo no melanoma (CCNM), que incluye el carcinoma basocelular y el carcinoma espinocelular cutáneo, constituye la neoplasia maligna más frecuente a nivel mundial y su incidencia continúa en aumento. La prevención secundaria y terciaria en pacientes de alto riesgo se ha basado en la fotoprotección, la vigilancia dermatológica periódica y, en casos seleccionados, la quimioprevención farmacológica. La nicotinamida (vitamina B3) y los retinoides sistémicos (acitretina, isotretinoína y etretinato) son los agentes con mayor respaldo clínico, aunque presentan perfiles diferenciados de eficacia y seguridad. Objetivo: Evaluar la eficacia y seguridad de la nicotinamida y los retinoides sistémicos para la quimioprevención del carcinoma cutáneo no melanoma en adultos inmunocompetentes y poblaciones de alto riesgo mediante una revisión sistemática basada en la metodología PRISMA. Metodología: Se realizó una búsqueda sistemática en MEDLINE, Embase, Cochrane Library y Web of Science desde el inicio de cada base de datos hasta septiembre de 2025. Dos revisores independientes seleccionaron los estudios y resolvieron las discrepancias por consenso. Se incluyeron ensayos clínicos aleatorizados, estudios cuasiexperimentales y cohortes comparativas que evaluaran nicotinamida oral o retinoides sistémicos para la prevención de nuevos CCNM o queratosis actínicas (QA). El riesgo de sesgo se evaluó mediante la herramienta RoB 2 y la calidad metodológica de las revisiones sistemáticas mediante AMSTAR 2. Resultados: Se incluyeron 12 estudios (6 sobre nicotinamida y 6 sobre retinoides), que comprendieron un total de 2.134 pacientes. La administración de nicotinamida a dosis de 500 mg cada 12 horas redujo la incidencia de nuevos CCNM en pacientes inmunocompetentes de alto riesgo, evidenciando en el ensayo ONTRAC una reducción relativa aproximada del 23 % a los 12 meses, con un perfil de seguridad favorable; sin embargo, el beneficio desapareció tras la suspensión del tratamiento. Los metaanálisis recientes muestran un efecto protector modesto y heterogéneo, más consistente para el carcinoma espinocelular que para el carcinoma basocelular, con incertidumbre persistente en receptores de trasplante. Por su parte, los retinoides sistémicos demostraron una reducción consistente de carcinoma espinocelular cutáneo y queratosis actínicas en receptores de trasplante de órgano sólido, con un efecto dependiente de la dosis, aunque limitado por eventos adversos mucocutáneos, dislipidemia, hepatotoxicidad y teratogenicidad. Conclusiones: La nicotinamida constituye una alternativa segura, bien tolerada y costo-efectiva para la quimioprevención en pacientes inmunocompetentes con antecedentes de CCNM o múltiples queratosis actínicas. Los retinoides sistémicos son eficaces en receptores de trasplante y pacientes con riesgo muy elevado, pero requieren una cuidadosa selección de candidatos, monitorización clínica y bioquímica periódica, así como consejería reproductiva. Se necesitan ensayos pragmáticos con seguimientos superiores a dos años para establecer la duración óptima del tratamiento y su impacto sobre la mortalidad, la calidad de vida y los resultados a largo plazo

El acné vulgar es una dermatosis inflamatoria crónica altamente prevalente. Los antibióticos tópicos y sistémicos han sido un pilar terapéutico durante décadas; sin embargo, su uso prolongado o inadecuado se asocia con un incremento de la resistencia antimicrobiana en Cutibacterium acnes y bacterias comensales, así como con alteraciones del microbioma cutáneo. Esta revisión sistemática sintetiza la evidencia contemporánea sobre el impacto del uso de antibióticos en la resistencia, las estrategias de uso racional y las alternativas terapéuticas no antibióticas Se realizó una revisión sistemática conforme a PRISMA 2020 (Page et al., 2021), incluyendo estudios clínicos, observacionales y revisiones sistemáticas sobre resistencia antimicrobiana, duración del tratamiento y opciones terapéuticas. La selección y extracción de datos fueron realizadas por dos revisores independientes Los resultados evidencian que la resistencia de C. acnes a macrólidos y lincosamidas es elevada y variable según la región, con tendencia creciente cuando se emplean como monoterapia tópica o en tratamientos prolongados (Beig et al., 2024; Zhu et al., 2025; Walsh et al., 2016). Las guías recomiendan evitar antibióticos tópicos aislados, limitar la duración sistémica (≤3–4 meses) y combinarlos con peróxido de benzoilo o retinoides (Reynolds et al., 2024; Nast et al., 2016). Alternativas eficaces incluyen retinoides, ácido azelaico, terapias hormonales, isotretinoína, clascoterona y dapsona tópica En conclusión, el uso racional de antibióticos requiere indicación precisa, duración limitada y combinación con agentes no antibióticos. Las alternativas permiten reducir la exposición sin comprometer la eficacia

The skin microbiome has emerged as a key regulator of immune function with significant implications for systemic disease. This review aims to analyze the role of cutaneous microbial communities in immune modulation and their contribution to the development, diagnosis, and treatment of systemic conditions. A structured narrative review was conducted using a scientific methodological framework, integrating evidence from dermatology, immunology, and microbiology. The findings indicate that microbial dysbiosis is consistently associated with immune imbalance, barrier dysfunction, and systemic inflammation. Key mechanisms include Toll-like receptor activation, cytokine modulation, and T-cell differentiation, which collectively influence disease progression. Additionally, the study highlights the growing relevance of the gut-skin axis as a pathway connecting local microbial changes with systemic outcomes. Diagnostic applications, particularly microbiome-based biomarkers, demonstrate potential for disease prediction and monitoring, while therapeutic strategies such as probiotics, bacteriotherapy, and antimicrobial peptides represent emerging approaches in personalized medicine. However, variability across populations and methodological heterogeneity remain significant challenges. This review underscores the importance of the skin microbiome as a central component in human health and supports its integration into future clinical and research frameworks, particularly in diverse international contexts..

Cutaneous oncology has entered a new phase defined by the integration of early detection strategies, molecular risk stratification, and biologically guided systemic therapies. Melanoma, although less frequent than keratinocyte cancers, remains the most lethal form of skin cancer, while basal cell carcinoma and Merkel-cell carcinoma contribute significantly to global oncologic burden. This review analyzes the contemporary transformation of cutaneous oncology within the precision medicine framework, focusing on three core domains: stage-based prognosis, genomic characterization, and targeted and immune-based therapeutic interventions. Evidence from landmark clinical trials demonstrates that BRAF-mutated melanoma benefits from combined BRAF/MEK inhibition, while immune checkpoint blockade—particularly PD-1–based regimens—achieves durable survival in advanced disease. Long-term survival data confirm sustained benefit in a subset of patients, redefining expectations for metastatic melanoma outcomes. In addition, immunotherapy has shown meaningful activity in other aggressive cutaneous malignancies such as Merkel-cell carcinoma. The integration of staging systems, molecular diagnostics, and systemic therapies illustrates a dual therapeutic paradigm in which tumor genotype and immune context guide treatment selection. From an international perspective, including healthcare systems in Mexico, Colombia, and Ecuador, the implementation of precision oncology requires structured integration of early detection, standardized pathology, essential genomic testing, and multidisciplinary therapeutic access. Cutaneous oncology in the precision era is therefore characterized by coordinated biological insight and clinical application, forming the basis for advanced academic instruction and evidence-based oncologic practice.

The skin has increasingly been recognized as a clinically significant interface reflecting systemic disease. This review analyzes recent international evidence (2020–2025) on the relationship between cutaneous manifestations and underlying systemic conditions, emphasizing their diagnostic value in modern clinical practice. A structured narrative review was conducted using high-impact literature indexed in major databases, focusing on autoimmune, inflammatory, infectious, vascular, and neoplastic diseases. The findings demonstrate that dermatologic manifestations frequently serve as early indicators of systemic pathology, often preceding or complementing internal clinical findings. Immune dysregulation, chronic inflammation, endothelial injury, and autoantibody-mediated mechanisms were identified as the primary pathophysiological links between skin and systemic disease. Additionally, the analysis highlights the importance of clinicopathologic correlation, lesion pattern recognition, and interdisciplinary collaboration in improving diagnostic accuracy. The results also underscore the relevance of dermatologic evaluation across different levels of care, particularly in primary care and internal medicine settings, where early recognition can significantly influence clinical outcomes. This is especially important in regions such as Mexico, Colombia, and Ecuador, where clinical examination remains a fundamental component of patient assessment.

Immunologic and inflammatory skin disorders have undergone a profound conceptual transformation over the past two decades. Conditions such as psoriasis, atopic dermatitis, autoimmune blistering diseases, and cutaneous lupus erythematosus are now understood as immune-mediated entities driven by specific pathogenic pathways rather than solely morphologic diagnoses. This review synthesizes contemporary high-impact literature to analyze emerging diagnostic and therapeutic paradigms, emphasizing the transition from broad immunosuppression to mechanism-informed precision targeting. Particular attention is given to the IL-23/Th17 axis in psoriasis, type 2 inflammation in atopic dermatitis, and autoantibody-mediated mechanisms in blistering disorders. The review further compares cytokine-specific biologics with intracellular pathway modulators such as JAK inhibitors, highlighting distinctions in monitoring requirements, breadth of immunologic impact, and practical considerations. A structured therapeutic sequencing model is proposed, integrating clinical severity, immunologic alignment, safety monitoring, and healthcare feasibility. Special consideration is given to implementation in diverse international contexts, including Mexico, Colombia, and Ecuador. The findings support a unified framework in which diagnosis remains clinically grounded but conceptually reinforced by immunopathogenesis, and treatment selection is increasingly guided by targeted immune modulation. This paradigm reflects the broader evolution of translational medicine and underscores the necessity of adaptable, evidence-based strategies in inflammatory dermatology.

Chronic inflammatory skin disorders have traditionally been regarded as localized dermatologic entities; however, increasing evidence from cutaneous immunology supports their interpretation as visible manifestations of underlying immune dysregulation. Across a broad spectrum of inflammatory, autoimmune, and autoinflammatory dermatoses, reproducible immune pathways have been shown to drive stable clinical phenotypes, positioning the skin as a sentinel organ of systemic immune imbalance. This review synthesizes current immunopathological evidence linking major chronic inflammatory skin disorders with dominant immune-dysregulation domains, including polarized cytokine-driven inflammation, cytotoxic T-cell–mediated autoimmunity, innate immune hyperreactivity, autoantibody-mediated tissue injury, and immune-driven fibrosis. By comparatively analyzing mechanistic, clinical, and therapeutic literature, the review identifies shared and disease-specific immune signatures that explain phenotypic diversity while supporting a unified conceptual framework. The findings highlight that conditions such as psoriasis, atopic dermatitis, vitiligo, alopecia areata, hidradenitis suppurativa, chronic urticaria, autoimmune bullous diseases, cutaneous lupus erythematosus, rosacea, and systemic sclerosis can be systematically interpreted through their immunological architecture rather than solely by morphology. Framing chronic inflammatory dermatoses as markers of immune dysregulation enhances diagnostic reasoning, strengthens medical education, and reinforces the clinical relevance of dermatologic findings in recognizing broader immune-mediated disease, particularly in diverse international healthcare settings.

The skin frequently reflects internal pathological processes, making cutaneous manifestations valuable indicators of systemic disease. This narrative integrative review analyzes current scientific evidence on dermatologic findings that function as early or concurrent markers of underlying systemic disorders. The study synthesizes peer-reviewed literature addressing renal–metabolic, inflammatory–immune, malignancy-related, and vascular–calcific conditions, emphasizing recognizable cutaneous patterns and their clinical context. Results demonstrate that paraneoplastic dermatoses are commonly described as early indicators that may precede the diagnosis of internal malignancy, whereas renal–metabolic and vascular–calcific manifestations are more frequently reported as concurrent expressions of established systemic disease. Inflammatory and immune-mediated dermatoses exhibit variable timing, reflecting heterogeneous triggers and systemic associations. Across categories, cutaneous findings consistently mirror immune dysregulation, metabolic imbalance, vascular injury, or neoplastic activity. This review highlights the diagnostic and educational relevance of dermatologic examination in general medical practice, particularly in settings where access to advanced diagnostic resources may be limited. Integrating systematic skin assessment into routine clinical evaluation can strengthen diagnostic reasoning, support earlier recognition of systemic illness, and promote a more holistic approach to patient care.

Amelanotic melanoma represents a diagnostically challenging subtype of melanoma due to the absence or minimal presence of pigmentation, which often leads to delayed recognition and poorer clinical outcomes. Early detection is therefore critical, yet traditional visual and dermoscopic criteria demonstrate limited sensitivity for non-pigmented lesions. In recent years, advanced image-based diagnostic approaches have shown promising performance in melanoma detection; however, their applicability to amelanotic melanoma and their validation across diverse clinical contexts remain insufficiently explored. This review analyzes current evidence on image-based strategies for the early detection of amelanotic melanoma, focusing on diagnostic performance, clinical validation, and integration into real-world practice. A structured narrative review methodology was employed, synthesizing findings from comparative performance studies, clinical validation trials, benchmarking initiatives, and meta-analyses. The results indicate that while image-based approaches can enhance diagnostic sensitivity and support clinician decision-making, their effectiveness is strongly influenced by dataset representation, lesion subtype complexity, and clinician–system interaction. Evidence further supports the value of multimodal diagnostic pathways that integrate clinical evaluation, dermoscopy, image-based analysis, and adjunctive imaging in diagnostically ambiguous cases.

Chronic inflammatory skin diseases have increasingly been recognized as systemic disorders with clinically significant extracutaneous manifestations. Among these, the association between chronic cutaneous inflammation and metabolic syndrome has emerged as a relevant and reproducible pattern across epidemiological, clinical, and mechanistic studies. This review synthesizes current evidence examining the bidirectional relationship between chronic inflammatory dermatoses—primarily psoriasis and moderate-to-severe atopic dermatitis—and metabolic syndrome, including its key components: obesity, insulin resistance, dyslipidemia, hypertension, and type 2 diabetes mellitus. Population-based studies and meta-analyses consistently demonstrate a higher prevalence of metabolic syndrome and related metabolic abnormalities in patients with chronic inflammatory skin disease, with stronger associations observed in more severe disease phenotypes. Mechanistic data support these observations, highlighting shared inflammatory pathways, cytokine signaling, adipokine imbalance, and immunometabolic interactions as common underlying processes. The findings discussed in this review reinforce the concept of systemic inflammation as a unifying framework linking skin and metabolic disease. Recognizing chronic inflammatory dermatoses as markers of increased metabolic risk has important implications for clinical practice, preventive strategies, and medical education. An integrated, multidisciplinary approach may facilitate earlier identification of cardiometabolic risk and improve long-term outcomes, particularly in regions experiencing a rising burden of metabolic disease, such as Latin America.