[Diagnostic agreement between primary care physicians and dermatologists in the health area of a referral hospital]. / Estudio de concordancia diagnóstica en Dermatología entre Atención Primaria y Especializada en el área de salud de un hospital de referencia.

INTRODUCTION: Skin diseases account for a high proportion of presenting complaints in primary health care. In Spain, the growing demand for consultations and the resulting longer waiting lists make it necessary to establish criteria for appropriate referrals to a specialist. This study aimed to investigate the characteristics of referrals from primary care centers to dermatology specialists as well as the correlation between the presenting complaint and the final dermatologic diagnosis. PATIENTS AND METHODS: We collected data from 3164 patients seen for the first time by dermatologists in our specialist service during 1998. Patients were stratified according to the referring primary health care center and the reason for referral. The agreement between the presenting complaint and the final dermatologic diagnosis was studied. For each dermatologic condition, the positive predictive value, diagnostic sensitivity, and k statistic were calculated. RESULTS: The overall diagnostic agreement was 65.52 %. Primary care physicians were found to over diagnose diseases caused by papillomavirus and the diagnostic sensitivity was very low for diseases such as basal cell carcinoma and seborrheic keratosis. CONCLUSIONS: It is necessary to insist on training primary care physicians, ensuring appropriate referral from primary health care clinics, and promoting an effective dialogue with the specialist.

[Analysis of the demand for dermatological care in the immigrant population served by hospital Miguel Servet in Saragossa, Spain]. / Análisis de la demanda asistencial de Dermatología en la población inmigrante del área de salud del Hospital Miguel Servet de Zaragoza.

INTRODUCTION: In recent years there has been an increase in the size of the immigrant population consulting dermatology services in Spain. The aim of this study was to describe the epidemiological characteristics of this sector of the population in the health care area served by Miguel Servet Hospital in Saragossa, Spain. MATERIAL AND METHODS: Data were collected on immigrant patients seen in the dermatology department of our hospital during 2004. Dermatological diagnoses were classified according to the International Classification of Diseases, Ninth Revision, Clinical Modification. Statistical analysis was undertaken using the SPSS statistical package, Access database management software, and Excel spreadsheets. RESULTS: A total of 706 patients were seen, corresponding to approximately 4 % of all first appointments, and more women were seen than men, a difference that was statistically significant. The mean age of the patients was 31 years and there were no statistically significant differences in age between the sexes. In order of frequency, the most common countries of origin of the patients were Ecuador, Colombia, Romania, Morocco, Gambia, Guinea, and Senegal. The most common skin diseases in this population group were infectious diseases, in particular mycoses, followed by viral diseases and pyodermatitis, as well as sexually transmitted diseases. In all cases, the incidence of the disease was higher than in the Spanish population. CONCLUSIONS: An appropriate knowledge of dermatological diseases in this population group is necessary both to obtain correct diagnosis and to develop preventative measures for imported diseases.

[Dermatophytes isolated in our clinics. 5-year-study in Zaragoza]. / Dermatófitos aislados en muestras clínicas. Estudio de 5 años en Zaragoza.

BACKGROUND: This review summarizes the different species of dermatophytes isolates in our laboratory between 1991 and 1995. We describe the clinical forms and establish the distribution over this period of time. METHODS: Retrospective survey of samples from outpatients of the Dermatology Service in Miguel Servet Hospital where mycologic cultures are required. The extraction of samples is made by scrapes with a carpet or scalpel and they are cultured on Saboureaud agar with chloramphenicol and dermatophytes agar for 3 weeks. All plates were incubated at 28 degrees C. The identification of isolated strains is made by means of morphologic and physiologic criteria; the doubtful strains were identified in national referral center of Majadahonda CNMVISS. RESULTS: 4004 samples were analyzed from 3934 patients and 543 strains of dermatophytes were isolated. The frequencies were as follow: Microsporum canis (44%), Trichophyton mentagrophytes (31.4%), Trichophyton rubrum (18.6%), Epidermophyton floccosum (2.6%), Microsporum gypseum (1.4%), Trichophyton tonsurans (0.7%), Trichophyton verrucosum (0.7%), Trichophyton violaceum (0.2%) y Microsporum audouinii (0.2%). The most frequently observed dermatophytoses were Tinea corporis (54.8%), followed by Tinea unguium (12.6%), Tinea capitis (12.5%), Tinea pedis (8.3%), Tinea manuum (6.3%), Tinea cruris (4.7%) and Tinea barbae (0.7%). CONCLUSIONS: The zoophylic species are the most prevalent in our area and we have observed a raise of Microsporum canis in recent years. It is important to perform mycologic survey in every suspected lesion in older to determinate the true incidence of human dermatophytoses.

[Fixed cutaneous sporotrichosis localized on the face, with an infrequently seen clinical picture]. / Esporotricosis cutánea fija de localización facial, con morfología clínica poco frecuente.

A case of fixed cutaneous sporotrichosis in an urban patient in whom the contagious trauma could not be proved is commented on. Remarkable is the location of the lesions involving the face, which is extremely rare, as well as the morphology of the lesions, adopting the pattern of congestive erythema on which there were crusty-erythematous papules causing an intense itching which also preceded their onset.

[Diffuse normolipemic xanthoma planum]. / Xantoma plano difuso normolipémico.

We comment on the case of a 75-year-old woman whose dermatologic process had started 15 years before with the onset of xanthelasma on the lower eyelids which were surgically removed, recurring on the scar areas two months later. At the same time new lesions involved the forehead as well as the periorbital and malar regions. Some months later new yellow papular lesions appeared involving the neck, thorax, pelvis and extremities which grew eccentrically covering large areas. Five years later the lesions localized on the face and showed a progressive tendency to atrophy in their centers while those localized on the trunk showed an evolution to sclerosis of their central area. There was no mucosal involvement or ulceration in any of the xanthomatous lesions. The microscopic study revealed the existence of a dermal infiltrate formed by histiocyte foamy frothy cells and Touton cells, among which there were some lymphocytes, which occasionally adopted a perianexial, perineural and perivascular pattern but there were no signs of thrombosis or degenerative changes in the perilesional connective tissue. The study by chromatography of the lipid composition of the pathologic skin revealed an increase in cholesterol esters. The laboratory exams as well as the general physical examination performed every six months for a period of 15 years' time were always normal except for a moderate elevation of ESR which persisted throughout the process.(ABSTRACT TRUNCATED AT 250 WORDS)

[Generalized urticaria due to food allergy (codfish)]. / Urticaria generalizada por contacto a alimentos (bacalao).

A case of generalized urticaria after ingesta of raw cod in a patient who had any previous episodes of atopy or other findings of interest is presented. One month after the manipulation of this same food she presented another episode of generalized urticaria, this time more severe and persistent. Skin patches to cod provoked a contact urticaria probably produced by an immunologic mechanism. A sensitization via the digestive tract is presumed on the basis of the clinical course and the symptoms of the patient.