Comparative epidemiologic study of skin diseases in foreign children and children of Spanish origin in Alicante, Spain.

INTRODUCTION: Previous studies in Spain have shown that the foreign and immigrant populations can have different diseases to Spanish-born individuals. However, no comparative study has specifically investigated foreign children in Spain. MATERIAL AND METHODS: The objective of the study was to compare skin diseases in foreign children with those in children born in Spain of Spanish parents. We included all patients under 15 years of age who were seen in our dermatology department between January 2007 and December 2007. RESULTS: During the study period, 3108 pediatric patients were seen in the dermatology department. Of these, 2661 (85.6%) were Spanish and 447 (14.3%) were foreigners. Foreign children sought medical care more often (11.4%) than Spanish children (6%) (P<.001) and made less use of the specialist outpatient clinic (59.6% vs 68.8% [P<.001]) and more use of emergency care. Complaints observed more frequently in the foreign children were scabies (adjusted odds ratio [aOR], 10.6; 95% CI, 4.71-24.10), arthropod bites (aOR, 2.80; 95% CI, 1.14-6.87), hypopigmentation (aOR, 2.61; 95% CI, 1.06-6.44), and atopic dermatitis (aOR, 1.65; 95% CI, 1.19-2.31). Melanocytic nevus was observed more frequently in Spanish children (aOR, .50; 95% CI, .30-.83). CONCLUSIONS: Differences between children born in Spain of Spanish parents and foreign children were found for type of visit and frequency of skin diseases.

Outpatient treatment of infantile hemangiomas with propranolol: a prospective study.

OBJECTIVE: To assess the safety and effectiveness of oral propranolol (OP) in the treatment of infantile hemangiomas. MATERIAL AND METHOD: We conducted a prospective study of infantile hemangiomas (IHs) treated with oral propranolol between October 2008 and March 2011. We included fast-growing IHs in the proliferative phase, IHs affecting vital structures, ulcerated IHs, and IHs that could cause functional or aesthetic problems after the proliferative phase. The patients received oral propranolol 2mg/kg/d and were monitored on an outpatient basis. Response to treatment was assessed by volume reduction, lightening of color, improvement of symptoms, and parent satisfaction. Time of initial and peak response, as well as side effects and sequelae, were recorded. RESULTS: We analyzed 20 IHs, corresponding to 17 girls and 3 boys. The main sites of involvement were around the eyes (20%), the nose (15%), the neck (15%), and the trunk (15%). Ninety percent of the hemangiomas were focal and in the proliferative phase. Treatment was started between the ages of 2 and 19 months and the main reason for starting treatment was rapid growth (50% of cases). Initial response was observed in 70% of cases and only in 2 of them it took over a month. Peak response occurred at 3 months. All the IHs responded to treatment; response was excellent in 55% of cases, good in 35%, and minimal in 10%. The following factors were predictive of response: focal IH, proliferative phase, periorbital location, and ulceration. No serious side effects were observed. CONCLUSION: Oral propranolol was clinically effective in reducing the volume and color of infantile hemangiomas, although the reduction was not complete and telangiectasia and scarring persisted after treatment. Oral propranolol also proved to be safe for use in outpatients.

[Annular erythema of infancy]. / Eritemas anulares en la infancia.

Many skin diseases appear as annular lesions. Some are more typical of adults or older children, whereas others usually appear in young children. Annular or figurate erythema of infancy comprises a group of dermatoses in which the primary lesion adopts an annular, oval circinate, or polycyclic pattern. Similarities in clinical presentation, age at onset, and duration of lesions mean that these conditions are difficult to diagnose; sometimes, they can only be identified by subtle differences in their clinicopathologic features. Clinical pictures enable us to distinguish one member of this group of diseases from another and also to differentiate them from other annular eruptions. For ease of description, we classify annular erythema of infancy into 2 types: conditions with a known etiology and conditions with characteristic reaction patterns but uncertain etiology.

Quality Indicators in Care of Patients With Atopic Dermatitis: Consensus Document of the Spanish Academy of Dermatology and Venereology. / Indicadores de calidad en la atención dermatológica a pacientes con dermatitis atópica. Documento de consenso de la Academia Española de Dermatología y Venereología.

No information is currently available on whether the available clinical practice guidelines on the management of atopic dermatitis are known or being applied in Spain. The aim of this study was to improve the care of patients with atopic dermatitis by developing a set of quality indicators based on existing clinical practice guidelines. Relevant clinical practice guidelines identified through a literature search were submitted to a panel of 11 specialists, who selected the highest quality guidelines using the AGREE (Appraisal of Guidelines for Research & Evaluation) II instrument. The panel then defined a subset of the recommendations supported by a high level of evidence and proposed a health care quality indicator for each one together with a standard for measuring degree of adherence. Consensus was achieved on 21 of the 150 proposed indicators using the modified Delphi method. The aim of implementing the indicators that achieved consensus in this study is to standardize the actions of health professionals providing care for patients with atopic dermatitis and ultimately to improve the quality of the care delivered.

Implementation and Operation of an Integrated Quality Management System in Accordance With ISO 9001:2015 in a Dermatology Department. / Implantación y desarrollo de un sistema integrado de gestión de calidad según la norma ISO 9001:2015 en un Servicio de Dermatología.

Quality management systems (QMS) are tools that serve to structure, control and improve the usual activities that take place in an organization or service. The ISO 9001:2015 is an internationally recognized standard, which provides the necessary resources to help an organization to improve its performance, based on the principle of plan-do-control-act, in order to obtain continuous improvement. In the field of health, it is an essential tool for the management of the services offered to patients. The ISO quality certification allows to demonstrate compliance, according to established quality standards. The process of implementing a QMS follows several phases that culminate with the completion of an external audit, which once passed, allows obtaining the quality certification ISO 9001:2015. This article describes the steps to follow to obtain this certification in a Dermatology Service.

[Anogenital warts: a clinical, pathological and virological study]. / Verrugas anogenitales: estudio clínico-patológico y virológico.

The objective of this study was to investigate the possible relationship between the presence of anogenital warts (AGW) in children and the sexual abuse as mode of transmission. Our series includes 8 patients with AGW who were treated in our hospital during the year 2007. A complete physical examination was carried out, including colposcopy or anoscopy, and samples were taken for histopathological examination and human papiloma virus (HPV) subtyping. We considered perinatal transmission as a possible route in two cases. Although sexual abuse was definitively confirmed in only one case, we observed some findings in four cases that led us to consider the possibility of sexual abuse. We did not consider the possibility of heteroinoculation or autoinoculation from common warts in any case. Our results have demonstrated the difficulty in assessing with certainty the source of HPV contamination in children with AGW.

Persistent Desquamation of the Scalp as a Manifestation of Tinea Capitis in Sub-Saharan Children.

Scalp hyperkeratosis of childhood is most often associated with atopic or seborrheic dermatitis. However, in black children can be associated with tinea capitis. We undertook a retrospective study in all Sub-Saharan children presenting with chronic scalp scaling between June 2010 and June 2013, to determine whether chronic desquamation of the scalp is a clinical manifestation of tinea capitis. The criterion used to diagnose tinea capitis was a positive mycolological culture. Of the 23 Sub-Saharan African children attended, 12 (43.4%) presented with chronic scalp flaking. Mycological culture was performed in 9 of the 12 cases. The culture was positive in 6 out of 9, so 26% of the Sub-Saharan African children attended were diagnosed with tinea capitis. In 52.1% of the cases with persistent scalp scaling the culture was positive. In conclusion, chronic scaling of the scalp may well be the sole form of presentation of tinea capitis in Sub-Saharan children.

[Immunohistochemical study of the distribution of carcinoembryonic antigen and keratin in tumors of epidermal origin. II: Keratoacanthoma and premalignant lesions]. / Estudio inmunohistoquímico de distribución de antígeno carcinoembrionario y queratina en tumores de origen epidérmico. Parte II: Queratoacantoma y lesiones premalignas.

Carcinoembryonic antigen (CEA) has been studied extensively, in association with visceral tumors and normal tissues. Although CEA has been demonstrated in sweat gland cutaneous tumors, little is known about its presence in skin and epithelial related tumors. We studied the presence of CEA and keratin in keratoacanthomas and precancerous skin lesions using immunohistochemical techniques. Its distribution related with differentiation, proliferation and malignant potential is observed. The expression of both antigens is correlated.

[Immunohistochemical study of the distribution of carcinoembryonic antigen and keratin in 2 cases of extramammary Paget disease]. / Estudio inmunohistoquímico de distribución de antígeno carcinoembrinario y queratina en dos casos de enfermedad de Paget extramamario.

Sweat gland origin of Paget disease is demonstrated by the presence of carcinoembryonic antigen (CEA). We studied the expression of CEA and keratin in two cases of extramammary Paget disease. Our results are commented.

[Immunohistochemical study of the distribution of carcinoembryonic antigen and keratin in tumors of epidermal origin. I: Squamous and basal cell epitheliomas]. / Estudio inmunohistoquímico de distribución de antígeno carcinoembrionario y queratina en tumores de origen epidérmico. Parte I: Epiteliomas espinocelulares y basocelulares.

Carcinoembryonic antigen (CEA) has been studied extensively, in association with visceral tumors and normal tissues. Although CEA has been demonstrated in sweat gland cutaneous tumors, little is known about its presence in skin and epithelial related tumors. We studied the presence of CEA and keratin in squamous cell and basal cell carcinoma using immunohistochemical techniques. Its distribution related with differentiation, proliferation and malignant potential is observed. The expression of both antigens is correlated.

[Kaposi's sarcoma as the first manifestation of AIDS]. / Sarcoma de Kaposi como primera manifestación de un SIDA.

We report herein a case of Acquired Immunodeficiency Syndrome in a 38 years old man with Kaposi's sarcoma, which evolution was fulminant in some months. The clinical, pathological and pathogenic characteristics of Kaposi's sarcoma in this syndrome are discussed.

[Eosinophilic fasciitis. Response to treatment with cimetidine]. / Fasceitis eosinofílica. Respuesta al tratamiento con cimetidina.

Eosinophilic fasciitis is a syndrome of imprecise classification which usually responds well to corticosteroids. We report a patient who did not respond to such treatment but he improved with cimetidine therapy. The pathogenesis of this syndrome and the possible action mechanism of cimetidine are discussed.

[Kawasaki syndrome]. / Síndrome de Kawasaki.

Kawasaki syndrome is not usual in our country. We report this case to stress the clinical importance of this syndrome in which dermatological signs predominate.