The Impact of Shared Assistance between Dermatology and Internal Medicine on Patients with Psoriasis.

Background: The care of psoriatic patients requires a multidisciplinary approach that addresses not only skin involvement but also cardiovascular risk factors. Coordination between dermatology and internal medicine departments, with a specific focus on treatment and long-term follow-up, can substantially improve the course of a disease and its associated complications. Objective: to evaluate the effects of the holistic management of patients with psoriasis by a multidisciplinary team consisting of dermatology and internal medicine specialists. Methods: We conducted an observational, prospective, single-center case-control study between October 2016 and December 2019 in San Jorge University Hospital (Huesca, Spain). Cases included patients undergoing follow-up in the combined dermatology and internal medicine clinic. The control group consisted of an equivalent number of randomly selected, age- and sex-matched patients with moderate-to-severe psoriasis who were seen in the general dermatology department of the same hospital during the same time period. Main outcomes and measures: The primary outcome was the control of psoriatic disease and cardiovascular risk factors such as weight, blood pressure, waist circumference, body mass index (BMI), SCORE index (Systematic Coronary Risk Evaluation), and blood test parameters, as well as diet, physical exercise, and habits such as tobacco and alcohol consumption. To compare data collected over time, data were grouped into three time periods: baseline (t1), intermediate (t2), and final (t3). Results: The case group consisted of 27 patients, and the control group consisted of 25 patients. Multivariate analysis was used to evaluate the relationship between the 10-year risk of experiencing a cardiovascular event (SCORE) and the clinical characteristics and analytical variables of patients with psoriasis and controls (n = 52). The variables that were significantly associated with a higher 10-year risk of experiencing a cardiovascular event were age (OR, 1.33; CI95% 1.21-1.50; p < 0.001); smoking (OR, 5.05, CI95% 1.07-27.37; p = 0.047); PASI (OR, 7.98, CI95% 2.32-35.86; p = 0.003); BSA (OR, 1.22, CI95% 1.01-1.49; p = 0.044); and being a control patient (OR, 3.26; CI95% 0.84-13.56; p = 0.029). Conclusions: Pharmacological and behavioral interventions carried out as part of the procedure of the multidisciplinary clinic resulted in improvements in the following variables relative to the control group: PASI, BSA, DLQI, PSOLIFE, lipid profile, insulin and HOMA-IR GGT levels, vitamin D levels, and SCORE. These findings indicate the beneficial effect of the multidisciplinary clinic, which reduced the risk of cardiovascular events in psoriatic patients with metabolic comorbidities.

Impact of UV-based self-assessed photoaging on sun protection intentions: validation based on trail runners and their companions

Background: Appearance-based interventions emphasize how UV exposure contributes to the premature aging of skin. Objectives: The current study was aimed at evaluating the impact of self-assessed skin damage based on UV imaging on the intention to modify photoprotection habits. Materials & Methods: A prospective observational study was performed. Mountain runners and their companions participating in the GAP Trail were invited to participate. Participants were asked to complete a validated questionnaire about sun exposure habits, and were invited to see an image of their faces using SkinScope. Results: In total, 116 people participated in the study. The degree of photoaging established by the dermatologist using the Glogau score significantly correlated with that based on self-assessment by the participants using the UV system (p < 0.001). Almost all UV fluorescence image colours significantly correlated with the grade of photoaging. After seeing their image with the UV system, 65.5% stated that they would improve photoprotection measures. Conclusion: UV imaging is a reliable way to self-evaluate photoaging and may reinforce photoprotection habits.

Skin cancer prevalence in farm workers in Spain

Background: Solar ultraviolet radiation (UVR) is one of the main risk factors for non-melanoma skin cancer. In Spain, 11% of the population are outdoor workers. Farmers are among the outdoor workers with the highest levels of chronic sun exposure. Objectives: To study the prevalence of skin cancer in farmers and evaluate their photoprotection habits. Materials & Methods: We performed an observational cross-sectional prospective study of farmers who completed a validated questionnaire on UVR exposure and protective behaviour and underwent a skin examination and skin colorimetry overseen by a dermatologist. Results: The study population consisted of 215 farm workers (84.4% male; mean age: 65.8 ± 14 years; mean years working: 45 ± 18). Actinic keratosis (AK) was detected in 41.4%, basal cell carcinoma (BCC) in 9.8%, and squamous cell carcinoma (SCC) in 1.4%. The most frequent photoprotection measure was the shade (69.3%). Photoaging type was significantly associated with the presence of AK and BCC, and Olson Grade II and III AK lesions correlated with SCC. The number of nevi on the lower extremities was the only predictor of the appearance of BCC. Conclusion: Photoprotection measures were not regularly used by most farm workers and the prevalence of skin cancer lesions was high. The findings underscore the need to improve photoprotection habits and early detection of skin cancer in this population.

Sun Protection Behaviors and Knowledge in Mountain Marathon Runners and Risk Factors for Sunburn. / Hábitos y conocimientos sobre fotoprotección y factores de riesgo para quemadura solar en corredores de maratones de montaña.

BACKGROUND AND OBJECTIVES: The incidence of skin cancer in our society is growing at an alarming rate due to overexposure to solar UV radiation in recreational and occupational settings. The aim of this study was to evaluate sun exposure and protection attitudes, behaviors, and knowledge among mountain ultramarathon runners and to assess risk factors for sunburn in this population. MATERIAL AND METHODS: Cross-sectional survey of runners who participated in the «Gran Trail Aneto-Posets¼ race in Aragon, Spain. Using a validated questionnaire, we collected data on sociodemographic characteristics, running experience, sunburn in the previous summer, and sun exposure and protection behaviors. We calculated descriptive statistics and performed bivariate and multivariate analyses of associations using history of sunburn as the primary outcome. Statistical significance was set at a p level of less than 0.05. RESULTS: We surveyed 657 runners (72.1% men) with a mean age of 39.71 years; 45.1% reported sunburn in the past year. The most common protective measures used were sunglasses (74.7%), sunscreen (sun protection factor ≥ 15) (61.9%), a hat (52.2%), and other protective clothing (7.4%). Risk factors for sunburn were younger age, low Fitzpatrick skin type (I and II), running for three or more hours a day, and staying in the shade as a protective measure. By contrast, protective factors were use of sunscreen and seeking shade rather than sun at midday (p < 0.001). CONCLUSIONS: Sunburn is common among long-distance mountain runners, despite what appears to be adequate sun protection knowledge and behaviors. Targeted strategies are needed to improve sun protection behaviors among mountain runners.

Skin Cancer Prevalence in Outdoor Workers of Ski Resorts.

BACKGROUND: Snow reflectivity and altitude increase the exposure of ski resort workers to solar ultraviolet radiation. The aim was to assess the presence of skin cancer in ski resorts workers and compare it with other groups of outdoor workers reviewing published studies. METHODS: An observational cross-sectional prospective study was conducted in the three largest ski resorts in Spain: Baqueira Beret, Lleida; Formigal, Huesca and Sierra Nevada, Granada. All outdoor workers including ski instructors were invited to participate in the study. The participants completed a validated questionnaire about sun exposure and underwent a skin examination. RESULTS: 219 workers were included in the study (80% male; mean age 43.8 (SD 11.31) years). Actinic keratosis (AK) but no other skin cancers were detected in 32 participants (14.62%). Those with AK worked in the Southernmost ski resort, were more likely to have light colour hair, and were older and with higher photoaging grade than those without them. CONCLUSION: Compared to other studies, outdoor workers on ski resorts show a higher prevalence of AK than general population but a lower prevalence than other groups of outdoor workers.

The association between atopic dermatitis and serum 25-hydroxyvitamin D in children: Influence of sun exposure, diet, and atopy features-A cross-sectional study.

BACKGROUND: Previous studies have linked low serum vitamin D (VD) or 25-hydroxyvitamin D (25(OH)D) levels with increased severity of atopic dermatitis (AD) in children. OBJECTIVE: To investigate the association between serum VD (25(OH)D) levels and AD and AD severity, considering the influence of diet and sun exposure. METHODS: We performed a prospective cross-sectional study of healthy controls and children diagnosed with AD. Participants were recruited between January 2011 and December 2012, and the following parameters were assessed: age, sex, body mass index (BMI), AD severity, Fitzpatrick skin type, asthma and rhinitis history, dietary VD intake, daily potential sun-induced VD production, sunscreen use, 25(OH)D and IgE serum levels, and results of the ImmunoCAP Phadiatop Infant test. RESULTS: The study population consisted of 105 healthy controls and 134 AD patients. Serum 25(OH)D levels were significantly lower in moderate and severe AD than in mild AD, although this association was only significant for patients with light Fitzpatrick skin type (mean(SD) 36.7 (11.9) ng/mL; moderate 28.8 [11.5] ng/mL; and severe 27.6 [12.1] ng/mL, P = .045). Logistic regression analysis revealed a positive association between severe AD and both positive ImmunoCAP Phadiatop test and BMI. CONCLUSION: Our data support an association between VD deficiency and AD severity only in patients with light complexion.

Body mass index and serum lipid profile: Association with atopic dermatitis in a paediatric population.

BACKGROUND/OBJECTIVES: The association between atopic dermatitis, body weight and serum lipid levels is not well known, and very few studies have examined this relationship in children. METHODS: Children (n = 239) under 14 years old participated in this prospective cross-sectional study. The following variables were recorded: age, gender, weight, height, atopic dermatitis severity, serum levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides. RESULTS: Mean body mass index was slightly higher in atopic dermatitis patients than healthy controls and significantly higher in atopic dermatitis patients aged 0-2 years (atopic dermatitis, 16.7 ± 4.6; controls, 15.7 ± 1.3; P = 0.04) and 12-14 years (atopic dermatitis, 24.9 ± 5.3; controls, 20.6 ± 3.4; P = 0.03). Among atopic dermatitis patients, body mass index was significantly higher in those with severe atopic dermatitis in the 9-12 (P = 0.03) and 12-14 (P = 0.01) years groups. Mean serum lipid levels were higher in patients with severe atopic dermatitis than in the atopic dermatitis group as a whole. These differences reached statistical significance for total cholesterol (P = 0.04) and triglycerides (P = 0.02). CONCLUSION: The prevalence of overweight, obesity and dyslipidemia is greater in children with atopic dermatitis than in age-matched healthy counterparts.

Observational study of chondrodermatitis nodularis helicis treated with methyl aminolevulinate photodynamic therapy.

BACKGROUND: Therapies used to treat chondrodermatitis nodularis helicis (CNH), such as surgical excision, pressure relief, or topical steroids report varying degrees of success. OBJECTIVE: We evaluated the response and safety of methyl aminolevulinate (MAL) photodynamic therapy (PDT) in CNH. METHODS: This retrospective, observational study performed at the University Hospital Ramon y Cajal (Madrid, Spain) and Hospital San Jorge (Huesca, Spain) included all patients diagnosed with CNH and treated with MAL-PDT from 2008 to 2015. Treatment sites were prepared and irradiated as per the conventional MAL-PDT procedure. RESULTS: Patients underwent a mean of 2.3 sessions with between-session intervals ranging from 15 days to 1 month. A complete response to PDT was observed in 33 patients (76.7%), who experienced pain relief and resolution of the inflammatory nodule. Lesion recurrence was recorded in 10 patients (23.3%) during the mean follow-up period of 20 months. Receiving ≥2 PDT sessions was significantly associated with a good response (26/28, 93% success rate, P = .003). LIMITATIONS: Some limitations of the study are the lack of an established between-session interval, the absence of evaluation of curettage effectiveness and the limited sample size. DISCUSSION: The results support the view that PDT is a promising treatment approach for CNH.