Body dysmorphic disorder in patients with acne: a multicentre study.

BACKGROUND AND OBJECTIVE: Body dysmorphic disorder (BDD) is a mental disorder that is difficult to diagnose, causes a lot of suffering and is more prevalent in dermatology patients than in the general population. Our objective was to screen for possible cases of BDD in patients with acne and to determine the prevalence according to DSM-IV and DSM-5 criteria, as well as to analyse the relationship between dermatological and sociodemographic variables. METHODS: A total of 245 patients diagnosed with acne in 11 dermatological centres in Spain were included in the study by members of the Aragon Psychodermatology Research Group and Spanish Research Group of Psychiatric Dermatology. We used the Body Dysmorphic Disorder Questionnaire (BDDQ) as a screening tool. RESULTS: In our sample, we obtained a prevalence for BDD of 10.6% (95% CI: 7.6-13.6%). The prevalence was the same with DSM-IV or DSM-5 criteria. Possible cases of BDD were predominantly women (P = 0.021), and 56% had non-inflammatory lesions vs. 30% of negative patients (P = 0.002). Positive patients as possible cases of BDD spent more than two hours on average a day worrying about their appearance. Most people only worried about one part of their body (86%), and in 95% of the cases, the part of their body that worried them was the face. The three most frequent compulsive behaviours in patients who screened positive for BDD were mirror checking (90.7%), camouflaging (79.1%) and using make-up (72.1%). CONCLUSIONS: As a consequence of the high prevalence of possible cases of BDD in patients with acne observed in our study, there is a need for dermatologists to screen for BDD so that they can be referred to a mental health unit to confirm the diagnosis and be offered treatment to reduce the progression of psychosocial deterioration and the development of comorbid disorders.

High-frequency ultrasound features in a case of gouty panniculitis.

Gouty panniculitis is caused by the deposition of urate crystals in the subcutaneous tissue, accompanied by a lobular panniculitis. It presents as subcutaneous nodules, most commonly located on the lower extremities. Being an unusual clinical presentation of gout, the sonographic findings of gouty panniculitis have been scarcely described in the literature. Our report describes the ultrasound features we found in a case of gouty panniculitis and the usefulness of this technique for diagnosis and monitoring of this disease.

Advertising in Actas Dermosifiliográficas, 1909-1939.

We review advertisements published in the journal Actas Dermosifiliográficas between 1909 and 1939. Treatments for sexually transmitted diseases were advertised with particular frequency, and they offer a case in point that exemplifies the close relationship between the pharmaceutical industry and medical journals.

The elements of dermatology: the legacy of Covisa and Bejarano.

In 1936, Covisa and Bejarano published a treatise entitled Elementos de Dermatología (The Elements of Dermatology). In this surprisingly modern book they abandoned the nosological debates characteristic of the 19th century and instead classified diseases according to their etiology and pathogenesis based on the scientific and technical advances of the time. Moreover, unlike other books available at the time, which were essentially adaptations of foreign texts, this was the first medical work to reflect the reality of Spanish medicine. However, the future of both the book and its authors was to be determined by the start of the Spanish Civil War in the same year. Covisa and Bejarano, who were both extremely active in the public health system and medical education during the Second Republic, were obliged to seek exile in America. Due to the difficulties of the time, very few copies of the book reached the public and no new editions were ever printed. We will never know what would have happened if the war had not started, but we believe that this important work should be remembered.

Informed consent in dermatology: an update.

Spanish legislation recognizes patients' right to be informed about various aspects of their illness and to make autonomous decisions regarding diagnosis and treatment. As dermatologists, we need to become familiar with this legislation, heed its stipulations, and implement them in our practice.

How to understand sports and traditional games and how to apply it to physical education. On the "Goal of Game".

Introduction: Does philosopher's stone exist in physical education? It could be said that teaching games for understanding approach (TGfU) keeps turning everything it touches into gold: its presence in the educational centers, its volume of publications, the way of teaching games and sports, its connections with other approaches, its game categories, learning transferable principles of play. But… no, all that glitters is not gold. There are TGfU issues that should be improved. For example, these categories are disconnected from each other because TGfU lacks classification criteria. The "goal of game" is a concept that has been studied, but it has not been applied to physical education. The aim of the article is to show how to deepen the understanding sports and traditional games from the "goal of game", and to propose its applicability to physical education. Methods: The traits of "goal of game" will be identified by investigating two close concepts, "prelusory goal" (formalist philosophy of sport) and "motor-goal" (motor praxeology). Results: The traits of "goal of game" concept: main-motor-problem, described in the game rules and that the players will try to solve during the game dynamics. The "goal of game" chances: (1) It allows us to understand sports and traditional games based on their internal logic (2) It allows us to classify traditional games and sports based on classification criteria and that can be useful to organize the physical education program; (3) It allows us to deepen the understanding of sporting games and their applicability to physical education: on the one hand, proposing progressively more specific goal of game options and, on the other hand, proposing a network model of intentions of play to understand the game dynamics and to design learning tasks. Conclusions: The conclusions collect some properties of the "goal of game" concept in order to propose its applicability in physical education students learning: identify and compare the main-motor-problems of the games; solve these problems during the game dynamics; transfer the procedures used to solve other games. The goal(d) of game amazes us; maybe physical education teachers are curious to continue discovering this wonderful treasure.

Frontal Fibrosing Alopecia: A Retrospective Study of 75 Patients. / Alopecia frontal fibrosante: estudio retrospectivo de 75 pacientes.

BACKGROUND AND OBJECTIVE: Frontal fibrosing alopecia is an increasingly common form of scarring alopecia. The aim of this study was to describe the demographic and clinical characteristics of patients with FFA seen at the trichology unit of a medium-sized regional hospital and to report on treatments used. MATERIAL AND METHOD: We reviewed the medical records of all patients with FFA seen at the trichology unit of Hospital Universitario Infanta Sofía in Madrid, Spain between May 2016 and May 2018. We analyzed associations between disease severity, clinical patterns, need for oral medications, and other characteristics. RESULTS: Seventy-five patients (73 women and 2 men) were studied. Diagnosis was clinical in most cases and 13 cases (17.3%) were confirmed histologically. Median (interquartile range) age at reported onset of symptoms was 61 (12) years. Involvement of the eyebrows was recorded in 70 patients (93.3%) and signs of oral and genital lichen planus in 7 (9.6%). Eleven patients (14.7%) had hypothyroidism and 15 (20.0%) had signs of rosacea. Only 5 of the patients who presented a linear pattern (21.7%) had severe hairline recession. Patients with unstable and/or symptomatic disease (n=24) were treated with oral medications (5-alpha reductase inhibitors, hydroxychloroquine, corticosteroids, and isotretinoin) or intralesional corticosteroids. Eighteen patients (75.0%) achieved disease stability. Ten of the 15 patients with signs of rosacea and 10 of those with facial papules required systemic treatment. CONCLUSION: Most of the patients in this series of FFA were postmenopausal women. The prevalence of oral and genital lichen planus was higher than that observed in the general population. Patients with a linear pattern had less severe disease. Facial papules were more common in younger patients and both facial papules and rosacea were associated with a greater need for oral treatment.

Development and Preliminary Validation of the HSQoL-24 Tool to Assess Quality of Life in Patients With Hidradenitis Suppurativa. / Desarrollo y validación preliminar del instrumento HSQoL-24 para evaluar calidad de vida en pacientes con hidradenitis supurativa.

INTRODUCTION AND OBJECTIVES: Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the skin with a negative impact on quality of life. Up to now, there are no disease specific instruments in Spanish to assess quality of life in HS. The objective of this study was to develop and validate a questionnaire to evaluate the quality of life in patients with HS. MATERIAL AND METHODS: A multicentre study was carried out in Spain between 2016 and 2017 to develop the questionnaire. Both the conceptual framework and understanding of the patient's situation were considered through a review of the literature, consensus of professionals from different related health areas, and in-depth interviews with patients. The resulting questionnaire was passed to a group of 30 patients with 30±10 days of interval between both assessments. RESULTS: The reliability analysis shows a good internal consistency and reproducibility with Cronbach's alpha score of 0.920 (test) and 0.917 (retest) and intraclass correlation coefficient with DLQI and Skindex-29 of 0.698 IC 95% (0.456-0.844) and 0.900 IC 95% (0.801-0.951) respectively. Cut-off points were established for its use and the instrument was found to be sensitive to change. CONCLUSIONS: The HSQoL-24 is the first disease-specific self-administered instrument to assess quality of life in patients with HS in Spanish. It is user friendly, and easy to score. This study shows that the instrument is reliable, valid and sensitive to change, pending confirmatory study with a larger sample of 100 patients with HS.

[Risks of black henna tattoos]. / Riesgos de los tatuajes de henna negra.

Temporary henna tattoos have become increasingly popular in the last few years, because of their apparent harmlessness and disappearance in few weeks. Black henna contains paraphenylenediamine (PPD), a synthetic colorant which is used in hair dyes and can cause sensitization. Many cases of allergic contact dermatitis occurring after tattooing have been reported, especially in children and teenagers during the summer time, since there are many tattoo-painters at holiday places and the parents are unaware of the risks of these tattoos. Clinicians, particularly pediatricians, primary care physicians and dermatologists should seek to remedy this misinformation. We can be the first person to be consulted before the tattoo painting and we will treat patients with lesions. We present our experience of eight cases of allergic contact dermatitis after tattooing and briefly review the literature on the risks of black henna tattoos.