Photocarcinogenic Risk Associated With Narrowband UV-B Phototherapy: An Epidemiologic Study in a Tertiary Care Hospital. / Riesgo de fotocarcinogénesis asociado a la fototerapia UVB-BE. Estudio epidemiológico de un hospital terciario.

BACKGROUND: The risk of skin cancer in patients treated with narrowband (NB) UV-B phototherapy is not well understood. Although experimental studies have shown that there is a risk, clinical studies have not detected an increased incidence of cancer following treatment. The aim of this study was to determine the incidence of nonmelanoma skin cancer (NMSC) in patients treated with NB UV-B phototherapy at a tertiary care hospital in the Mediterranean area. MATERIAL AND METHODS: We conducted a retrospective chart review of 474 patients who received whole-body NB UV-B phototherapy at our hospital between 2002 and 2016 and identified those diagnosed with NMSC during follow-up. We calculated the corresponding crude and standardized incidence rates and compared these with rates in the general population in a similar geographic area. RESULTS: Of the 474 patients, 193 (40.7%) were men and 281 (59.3%) were women. The mean (SD) follow-up period was 5.8 (3) years. The prevalence of NMSC at the end of the study period was 1.9% and the standardized incidence was 108.3 cases per 100 000 patient-years. The SIR of 1.9 in the study group was not significantly different from that of the general population. The number of patients who needed to be treated with NB UV-B phototherapy for 1 case of NMSC to occur was 1900. CONCLUSION: NB UV-B phototherapy does not appear to be associated with an increased risk of NMSC.

Allergic contact dermatitis due to cosmetics: A clinical and epidemiological study in a tertiary hospital. / Dermatitis alérgica de contacto a cosméticos, estudio clínico-epidemiológico en un hospital terciario.

The incidence of allergic contact dermatitis (ACD) to cosmetics in the general population is rising with the increasing use of cosmetic products and their proliferation and diversification. The aims of this study were to determine the prevalence of ACD to cosmetics in our setting, analyze changes over time, describe the clinical and epidemiological features of this allergic reaction, and identify the allergens and cosmetics involved. We performed a prospective study at the skin allergy unit in Hospital General Universitario de Valencia in Spain between 2005 and 2013 and compared our findings with data collected retrospectively for the period 1996 to 2004. The 5419 patients who underwent patch testing during these 2 periods were included in the study. The mean prevalence of ACD to cosmetics increased from 9.8% in the first period (1996-2004) to 13.9% in the second period (2005-2013). A significant correlation was found between ACD to cosmetics and female sex but not atopy. Kathon CG (blend of methylchloroisothiazolinone and methylisothiazolinone), fragrances, and paraphenylenediamine were the most common causes of ACD to cosmetics during both study periods, and acrylates and sunscreens were identified as emerging allergens during the second period.

The role of new immunosuppressive drugs in nonmelanoma skin cancer in renal transplant recipients.

INTRODUCTION: Nonmelanoma skin cancer (NMSC) is the most common malignancy in patients who have received a solid organ transplant. Multiple factors are involved in the onset of posttransplant NMSC. OBJECTIVES: To analyze the relationship between new immunosuppressive drugs and the onset of NMSC in renal transplant recipients. METHOD: This was a combined retrospective and prospective observational study in which we studied 289 patients who received a kidney transplant between January 1996 and December 2010 at Hospital Universitario Doctor Peset in Valencia, Spain. RESULTS: Seventy-three patients (25.2%) developed 162 NMSCs over a median follow-up of 72 months. There were no statistically significant differences in the onset of NMSC on comparing different induction therapy strategies involving monoclonal and polyclonal antibodies. NMSCs occurred less frequently in patients treated with mammalian target of rapamycin (mTOR) inhibitors than in those treated with other immunosuppressive regimens, although the differences were not statistically significant. Three of 5 patients with recurrent NMSC who were switched from calcineurin inhibitors to mTOR inhibitors developed additional NMSCs despite the change. CONCLUSIONS: Induction therapy with monoclonal and polyclonal antibodies in renal transplant recipients is not associated with an increased risk of NMSC. While mTOR inhibitors are associated with a lower risk of posttransplant NMSC, it remains to be determined whether a switch to these drugs is useful in the management of patients who develop multiple NMSCs.

Detection of human papillomavirus in nonmelanoma skin cancer lesions and healthy perilesional skin in kidney transplant recipients and immunocompetent patients.

BACKGROUND: The influence of human papillomavirus (HPV) on the development of nonmelanoma skin cancer (NMSC) is a topic of debate. HPV types from the beta genus (HPV-ß) have been most frequently associated with the development of skin cancer. OBJECTIVES: To analyze the prevalence and range of HPV types in NMSC lesions and healthy perilesional skin in immunodepressed and immunocompetent patients and to evaluate the influence of various clinical factors on the prevalence of HPV in skin cancer. METHODS: Nested polymerase chain reaction and sequencing were used to detect HPV in 120 NMSC samples obtained by biopsy from 30 kidney transplant recipients and 30 immunocompetent patients. In all cases, a sample was taken from the tumor site and the surrounding healthy skin. Potential confounders were assessed and the data analyzed by multivariate logistic regression. RESULTS: HPV DNA was detected in 44 (73.3%) of the 60 samples from immunodepressed patients and in 32 (53.3%) of the 60 samples from immunocompetent patients (adjusted odds ratio, 3.4; 95% CI, 1.2-9.6). In both groups of patients, HPV was more common in healthy perilesional skin than in lesional skin. HPV-ß was the most common type isolated. CONCLUSION: We found a wide range of HPV types (mostly HPV-ß) in the skin of kidney transplant recipients and immunocompetent patients with skin cancer.

Vitamin D and cutaneous lupus erythematosus: effect of vitamin D replacement on disease severity.

BACKGROUND: The main vitamin D source is exposure to ultraviolet radiation, which aggravates cutaneous lupus erythematosus (CLE). OBJECTIVES: The aims of this study were to identify variables associated with lower serum 25-hydroxyvitamin D [25(OH)D] levels in CLE patients and assess the effect of vitamin D restoration on disease severity. METHODS: Vitamin D status in 60 CLE patients and 117 apparently healthy subjects was compared. We recommended oral vitamin D3 to 27 CLE patients. After one year of treatment, changes in disease severity were assessed and compared to 25 untreated CLE patients. Disease severity was measured by the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI), number of exacerbations, duration of active lesions and patient assessment. RESULTS: Presence of CLE raised the odds of having vitamin D deficiency (OR 3.47, 95% CI 1.79-6.69). Increasing age and disease duration were associated with higher odds of having vitamin D deficiency. After a one-year follow-up, disease activity improved in the treatment group (CLASI A 2.7 ± 2.9 vs. 0.9 ± 1.4) (p = 0.003), as confirmed by the patient assessment (p = 0.01). CONCLUSIONS: Vitamin D inadequacy is more prevalent in CLE participants than in healthy controls. Treating vitamin D insufficiency is associated with improved disease severity according to physician and patient assessments.

[Use of psoralen plus UV-A therapy in the autonomous community of Valencia, Spain]. / Estudio epidemiológico de la PUVAterapia en la comunidad valenciana.

BACKGROUND: Photochemotherapy with 8-methoxypsoralen and long-wavelength UV-A (PUVA) has been extensively used for the treatment of various skin diseases since its approval in 1982 by the US Food and Drug Administration. METHODS: A retrospective study was performed of patients treated with PUVA, including topical and systemic treatment, over a period of 14 years. All patients were treated using a standard PUVA therapy regimen. RESULTS: A total of 877 patients were analyzed for the period 1982 to 1996. Forty-one skin diseases were treated, including 341 cases of psoriasis and 71 cutaneous T-cell lymphomas. The aim of the study was to describe the characteristics of the patients treated with PUVA therapy during that period and compare the results with those observed in other regions. CONCLUSIONS: Although PUVA therapy is widely used in a large number of countries for the treatment of various skin diseases, few studies have described the characteristics of the patients and the differences in the parameters of PUVA according to the disease.

Phacomatosis pigmentokeratotica: a 20-year follow-up with malignant degeneration of both nevus components.

Phacomatosis pigmentokeratotica is a rare syndrome defined by the association of an organoid nevus occasionally with sebaceous differentiation, a speckled lentiginous nevus, and other extracutaneous anomalies. The disorder is a consequence of the so-called twin spot genetic mechanism. We describe the first occurrence involving malignant degeneration of both nevus components, giving rise to three basal cell carcinomas over the sebaceous nevus and a malignant melanoma of the superficial spreading type over the speckled lentiginous nevus. This observation, in concert with the other instances reported in the literature, points to the need for adequate patient follow-up to ensure early detection and treatment of any possible associated malignant degeneration.

Treatment of widespread segmental nevus spilus by Q-switched alexandrite laser (755 nm, 100 nsec).

BACKGROUND: Widespread unilateral nevus spilus causes important cosmetic and psychological disturbances, and only a few therapeutic options can guarantee good functional and cosmetic results. OBJECTIVE: To evaluate the clinical response of a patient with widespread segmental nevus spilus to Q-switched (QS) alexandrite laser. METHODS: The treatment was QS alexandrite laser (755 nm, 100 nsec) with a mean fluence of 7.28 +/- 0.37 J/cm2 using a single-impact technique at 10 +/- 8.47-week intervals. RESULTS: Fifty percent clearance of the facial portion of the lesion was observed after 16 treatment sessions with QS alexandrite laser. CONCLUSION: QS alexandrite laser is suitable for removal of widespread segmental nevus spilus.

[Disseminated inflammatory tinea: An unusual presentation.]. / Tiña inflamatoria diseminada: presentación inusual.

Tinea incognito represents a new entity caused basically by the careless application of corticosteroidal creams. We present a 71-year-old man with disseminated erythematous and squamous lesions treated with corticosteroid creams for seven months; the clinical aspect worsened and new pustular lesions appeared. The diagnosis of disseminated inflammatory tinea was confirmed by culture, with the growth of Trichophyton mentagrophytes. We comment on the clinical findings and the factors that contribute to spread the process.

[Lupus-pemphigus]. / Penfigo-lupus.

A case of a woman of 23 years old with lesions in the exposed areas of the skin (face and lower neck) is presented. The histological study was compatible with pemphigus (subcorneal acantholysis and acantholytic cells). The direct immunofluorescence revealed the presence of IgG in intercellular spaces on all the surfaces of the epidermis. In the indirect immunofluorescence ANA (1/800), anti-DNA (1/200) and anti-ICS (1/200) was found. The rest of the analysis clearly showed thrombocytopenia and C4 consumption. The interesting aspect of this case rests in the coexistence of clinical and analytical findings of each of these of autoimmune diseases.

[Reiter-Fiessinger-Leroy syndrome]. / Síndrome de Reiter-Fiessinger-Leroy.

A patient with Reiter- Fiessinger - Leroy disease is described. He presented all the symptoms: urethritis , conjunctivitis , arthritis, balanitis circinata and keratodermia. The antigen reward HLA-B27 lean up on the diagnostic. The treatment with methotrexate disappeared the clinical manifestations.

[Benign late syphilis: 2 cases, gummatous syphilis and nodular syphilis]. / Sífilis tardía benigna: dos casos, sífilis gomosa y sífilis nodular.

Two mild syphilis cases are hereby described. Their clinical and morphological characteristics differ. The first case showed syphilitic gums on the right eyebrow rim and tuberous lesions, some of which ulcerated. They made up plaques like archs on limbs. The second case showed nodular lesions distribute on practically all the cutaneous tegument. The specific and non-specific syphilitic tests were positive. The CRL study on the cellular and serological aspects was normal. The histopathologic pieces were compatible with the clinical diagnosis. Lesions evolved to a quick disappearance with the penicillin G benzatine treatment established. Attention is drawn to the possibility of noticing new cases of mild syphilis due to the present high incidence of the sexually transmitted diseases.