Accuracy of clinical diagnosis and videodermoscopy in female pattern hair loss.

BACKGROUND: Female pattern hair loss (FPHL) is a non-scarring hair disease characterized by progressive hair diminishment and decrease of its density. Although typical cases of FPHL are usually straightforward to diagnose, its initial forms can be unrecognized and often need the use of other diagnostic methods. OBJECTIVE: To describe the accuracy of a diagnosis of FPHL based on clinical grounds and videodermoscopy compared with scalp biopsy. METHODS: An observational diagnostic test study was performed. Scalp biopsies were read by the same dermatopathologist and processed horizontally to allow follicle's number and size evaluation. Digital videodermoscopy was also performed. RESULTS: A total of 202 patients were enrolled, but only 35 women were assessed with digital videodermoscopy. When clinical diagnosis was compared to scalp biopsy, a sensitivity, specificity, positive predictive value (PPV), and a negative predictive value (NPV), of 77% %, 72.4%, 82.2%; and 65.5%, were respectively obtained. Videodermoscopy showed a sensitivity, specificity, PPV and NPV of 88.9%, 100%, 100%, and 72.7%, respectively. CONCLUSIONS: This study provided valuable information on the accuracy of clinical examination of FPHL, showed the usefulness of videodermoscopy as a method that in the future may replace scalp biopsy for its diagnosis, or also could aid patient´s follow-up.

Interventions for chronic pruritus of unknown origin.

BACKGROUND: Pruritus is a sensation that leads to the desire to scratch; its origin is unknown in 8% to 15% of affected patients. The prevalence of chronic pruritus of unknown origin (CPUO) in individuals with generalised pruritus ranges from 3.6% to 44.5%, with highest prevalence among the elderly. When the origin of pruritus is known, its management may be straightforward if an effective treatment for the causal disease is available. Treatment of CPUO is particularly difficult due to its unknown pathophysiology. OBJECTIVES: To assess the effects of interventions for CPUO in adults and children. SEARCH METHODS: We searched the following up to July 2019: Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, and trials registries. We checked the reference lists of included studies for additional references to relevant trials. SELECTION CRITERIA: We sought to include randomised controlled trials and quasi-randomised controlled trials that assessed interventions for CPUO, as defined in category VI ('Other pruritus of undetermined origin, or chronic pruritus of unknown origin') of the International Forum for the Study of Itch (IFSI) classification, in children and adults. Eligible interventions were non-pharmacological or topical or systemic pharmacological interventions, and eligible comparators were another active treatment, placebo, sham procedures, or no treatment or equivalent (e.g. waiting list). DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Our primary outcomes were 'Patient- or parent-reported pruritus intensity' and 'Adverse events'. Our secondary outcomes were 'Health-related quality of life', 'Sleep disturbances', 'Depression', and 'Patient satisfaction'. We used GRADE to assess the certainty of evidence. MAIN RESULTS: We found there was an absence of evidence for the main interventions of interest: emollient creams, cooling lotions, topical corticosteroids, topical antidepressants, systemic antihistamines, systemic antidepressants, systemic anticonvulsants, and phototherapy. We included one study with 257 randomised (253 analysed) participants, aged 18 to 65 years; 60.6% were female. This study investigated the safety and efficacy of three different doses of oral serlopitant (5 mg, 1 mg, and 0.25 mg, once daily for six weeks) compared to placebo for severe chronic pruritus; 25 US centres participated (clinical research centres and universities). All outcomes were measured at the end of treatment (six weeks from baseline), except adverse events, which were monitored throughout. A pharmaceutical company funded this study. Fifty-five per cent of participants suffered from CPUO, and approximately 45% presented a dermatological diagnosis (atopic dermatitis/eczema 37.3%, psoriasis 6.7%, acne 3.6%, among other diagnoses). We unsuccessfully attempted to retrieve outcome data from study authors for the subgroup of participants with CPUO. Participants had pruritus for six weeks or longer. Total study duration was 10 weeks. Participants who received serlopitant 5 mg may have a greater rate of relief of patient-reported pruritus intensity as measured by the visual analogue scale (VAS; a reduction in VAS score indicates improvement) compared to placebo (126 participants, risk ratio (RR) 2.06, 95% confidence interval (CI) 1.27 to 3.35; low-certainty evidence). We are uncertain of the effects of serlopitant 5 mg compared to placebo on the following outcomes due to very low-certainty evidence: adverse events (127 participants; RR 1.48, 95% CI 0.87 to 2.50); health-related quality of life (as measured by the Dermatology Life Quality Index (DLQI); a higher score indicates greater impairment; 127 participants; mean difference (MD) -4.20, 95% CI -11.68 to 3.28); and sleep disturbances (people with insomnia measured by the Pittsburgh Sleep Symptom Questionnaire-Insomnia (PSSQ-I), a dichotomous measure; 128 participants; RR 0.49, 95% CI 0.24 to 1.01). Participants who received serlopitant 1 mg may have a greater rate of relief of patient-reported pruritus intensity as measured by VAS compared to placebo; however, the 95% CI indicates that there may also be little to no difference between groups (126 participants; RR 1.50, 95% CI 0.89 to 2.54; low-certainty evidence). We are uncertain of the effects of serlopitant 1 mg compared to placebo on the following outcomes due to very low-certainty evidence: adverse events (128 participants; RR 1.45, 95% CI 0.86 to 2.47); health-related quality of life (DLQI; 128 participants; MD -6.90, 95% CI -14.38 to 0.58); and sleep disturbances (PSSQ-I; 128 participants; RR 0.38, 95% CI 0.17 to 0.84). Participants who received serlopitant 0.25 mg may have a greater rate of relief of patient-reported pruritus intensity as measured by VAS compared to placebo; however, the 95% CI indicates that there may also be little to no difference between groups (127 participants; RR 1.66, 95% CI 1.00 to 2.77; low-certainty evidence). We are uncertain of the effects of serlopitant 0.25 mg compared to placebo on the following outcomes due to very low-certainty evidence: adverse events (127 participants; RR 1.29, 95% CI 0.75 to 2.24); health-related quality of life (DLQI; 127 participants; MD -5.70, 95% CI -13.18 to 1.78); and sleep disturbances (PSSQ-I; 127 participants; RR 0.60, 95% CI 0.31 to 1.17). The most commonly reported adverse events were somnolence, diarrhoea, headache, and nasopharyngitis, among others. Our included study did not measure depression or patient satisfaction. We downgraded the certainty of evidence for all outcomes due to indirectness (only 55% of study participants had CPUO) and imprecision. We downgraded outcomes other than patient-reported pruritus intensity a further level due to concerns regarding risk of bias in selection of the reported result and some concerns with risk of bias due to missing outcome data (sleep disturbances only). We deemed risk of bias to be generally low. AUTHORS' CONCLUSIONS: We found lack of evidence to address our review question: for most of our interventions of interest, we found no eligible studies. The neurokinin 1 receptor (NK1R) antagonist serlopitant was the only intervention that we could assess. One study provided low-certainty evidence suggesting that serlopitant may reduce pruritus intensity when compared with placebo. We are uncertain of the effects of serlopitant on other outcomes, as certainty of the evidence is very low. More studies with larger sample sizes, focused on patients with CPUO, are needed. Healthcare professionals, patients, and other stakeholders may have to rely on indirect evidence related to other forms of chronic pruritus when deciding between the main interventions currently used for this condition.

Daylight-mediated photodynamic therapy for actinic damage in Latin America: consensus recommendations.

Although conventional photodynamic therapy (c-PDT) using methyl aminolevulinate cream (MAL) is effective for the treatment of grade I-II facial and scalp actinic keratosis (AK), it is associated with treatment-related pain for some patients. Daylight-mediated PDT (DL-PDT) has shown similar efficacy to c-PDT, was nearly painless, and was well tolerated. Overall, DL-PDT effectively treats AK and offers a simpler and better tolerated treatment option than c-PDT. This consensus panel provided recommendations on the use of DL-PDT in Latin America (LATAM) for the treatment of actinic damage associated with few or multiple AKs. The panel was comprised of eight dermatologists from different LATAM countries who have experience using PDT for the treatment of actinic damage. The panel reviewed the relevant literature and provided personal expertise with regard to using DL-PDT for the treatment of photodamage with or without AK. The recommendations formulated by the expert panel provide evidence-based guidelines on all aspects of DL-PDT for the treatment of actinic damage associated with AK in different regions of LATAM. These recommendations provide guidance for dermatologists to ensure maintenance of efficacy and safety of DL-PDT when treating actinic damage, associated with few or multiple AKs in sun-exposed skin.

Anti-TNF agents for paediatric psoriasis.

BACKGROUND: Psoriasis is a chronic skin disease that may develop at any age. Estimates for the United States and Europe suggest that psoriasis accounts for 4% of skin diseases in children. In most cases, the condition is mild and can be treated with creams. However, a small percentage of children have moderate to severe disease that requires drugs, such as ciclosporin or methotrexate, and some will require injections with newer biological agents, such as anti-TNF (tumour necrosis factor) drugs. Anti-TNF drugs (among them etanercept, infliximab, and adalimumab) are designed to reduce inflammation in the body caused by tumour necrosis factor. Evidence for the safety and efficacy of these biological agents in paediatric psoriasis is lacking. OBJECTIVES: To assess the efficacy and safety of anti-TNF agents for the treatment of paediatric psoriasis. SEARCH METHODS: We searched the following databases up to July 2015: the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 6), MEDLINE (from 1946), Embase (from 1974), and LILACS (from 1982). We also searched 13 trials registers and checked the reference lists of included studies and key review articles for further references to relevant randomised controlled trials (RCTs). We handsearched conference proceedings and attempted to contact trial authors and relevant pharmaceutical manufacturers. We searched the US Food and Drug Administration's and European Medicines Agency's adverse effects databases. SELECTION CRITERIA: All relevant RCTs that evaluated the efficacy and safety of anti-TNF agents for the treatment of chronic plaque psoriasis in individuals less than 18 years of age. DATA COLLECTION AND ANALYSIS: Two review authors independently checked titles and abstracts and performed data extraction and 'Risk of bias' assessment of the included studies. One review author entered data into Review Manager (RevMan), and a second review author checked the data. We also attempted to obtain unclear data from the trial authors where possible.Our primary outcomes were investigator-assessed number of participants achieving a 75% improvement in Psoriasis Area and Severity Index-75 (PASI 75) compared to baseline, improvement in quality of life using an instrument such as Children's Dermatology Life Quality Index (CDLQI), and adverse effects. Our secondary outcomes included the proportion of participants achieving PASI 50 and the Physician's Global Assessment (PGA). MAIN RESULTS: We included one study with 211 participants (median age 13 years), in which etanercept (dosage ranged from 0.8 to 50 mg per kilogram of body weight) was compared to placebo. Follow-up was over a 48-week period.At week 12, 57% versus 11% who received etanercept or placebo, respectively, achieved the PASI 75 (risk ratio 4.95, 95% confidence interval (CI) 2.83 to 8.65; high-quality evidence). Absolute risk reduction and the number needed to treat to obtain a benefit with etanercept was 45% (95% CI 33.95 to 56.40) and 2 (95% CI 1.77 to 2.95), respectively.The percentage improvement from baseline of the CDLQI scores at week 12 was better in the etanercept group than the placebo group (52.3% versus 17.5%, respectively (P = 0.0001)). Analysis between the groups showed an effect size that was clinically important (mean difference 2.30, 95% CI 0.85 to 3.75; high-quality evidence). However, means, medians, and minimal important difference results and results of the Pediatric Quality of Life Inventory, Stein Impact on Family Scale, and Harter Self-Perception Profile for Children scores must be interpreted with caution, as they were not prespecified outcomes.Three serious adverse events were reported, but they were resolved without sequelae. Deaths or other events such as malignant tumours, opportunistic infections, tuberculosis, or demyelination were not reported in the included study.Also, 13% of participants in the placebo group and 53% in the etanercept group had a PGA of clear or almost clear (risk ratio 3.96, 95% CI 2.36 to 6.66; high-quality evidence) at week 12. AUTHORS' CONCLUSIONS: This review found only one RCT evaluating the use of this type of biological therapy. Although the risk of publication bias was high, as we included only one industry-sponsored RCT, the risk of allocation, selection, performance, attrition, and selective reporting biases for all outcomes (except for CDLQI) was low, and no short-term serious adverse events were found.We can conclude, based on this single included study, that etanercept seems to be efficacious and safe (at least in the short term) for the treatment of paediatric psoriasis. However, as the GRADE approach refers not to individual studies but to a body of evidence, we shall wait for the results of the ongoing studies in a future update of this review. In addition, future studies should evaluate quality-of-life endpoints established a priori and standardise primary outcome measures such as PASI 75, and should include the PGA as a secondary endpoint. Also, collating and reporting adverse events uniformly is required to better evaluate safety.

Epidemiology of adult patients with atopic dermatitis in AWARE 1: A second international survey.

Background: There are gaps in our understanding of the epidemiology of atopic dermatitis (AD) in adults. Objective: To evaluate the prevalence and severity of AD in adults from countries/regions within Asia, Eurasia, Latin America, Middle East, and Russia. Methods: This international, web-based survey was performed in Argentina, Brazil, China, Colombia, Egypt, Hong Kong, Israel, Malaysia, Mexico, Russia, Kingdom of Saudi Arabia (KSA), Singapore, Taiwan, Thailand, Turkey, and United Arab Emirates. Questionnaires were sent to adult members of online respondent panels for determination of AD and assessment of severity. A diagnosis of AD required respondents to meet the modified United Kingdom (UK) Working Party criteria and to self-report they had a physician diagnosis of AD. Severity of AD was determined using Patient-Oriented Scoring of Atopic Dermatitis (PO-SCORAD), Patient-Oriented Eczema Measure (POEM), and Patient Global Assessment (PGA). Results: Among respondents by country/region the prevalence of AD ranged from 3.4% in Israel to 33.7% in Thailand. The prevalence was generally higher in females versus males. Severity varied by scale, although regardless of scale the proportion of respondents with mild and moderate disease was higher than severe disease. PGA consistently resulted in the lowest proportion of severe AD (range 2.4% China - 10.8% Turkey) relative to PO-SCORAD (range 13.4% China - 41.6% KSA) and POEM (range 5.1% China - 16.6% Israel). Conclusions: This survey highlights the importance of AD in adults, with high prevalence and high morbidity among respondents and emphasizes that AD is not just a disease of childhood-there is disease persistence and chronicity in adults.

Epidemiologic characteristics and burden of psoriasis: A multicenter, cross-sectional study.

Background: Although psoriasis burden and treatment have been well characterized in developed countries, there are scarce in-depth epidemiological studies in Latin American countries. Objectives: To describe the sociodemographic and clinical features and the economic burden of psoriasis among children and adult patients from Colombia. Methods: This cross-sectional study included patients from dermatology private practice offices, health provider institutions and hospitals in seven Colombian cities. We collected data on disease distribution, weight, height, body mass index, waist-hip ratio, disease severity, therapy, personal history of comorbidities, and direct costs. Multiple logistic regression analyses were conducted to assess the associations between severity scales and sociodemographic and clinical variables. Results: Two-hundred-three patients (43.8% women, 56.2% men) with an age range between 7 to 89 years old were included. The main subtype was psoriasis vulgaris and mean age of diagnosis was 37.1 years. The most common comorbidities were obesity, hypertension, psoriatic arthritis, dyslipidemia and diabetes. Women had a significant increased odds of presenting with psoriatic arthritis. Body-mass-index and hypertension were significantly associated with a higher psoriasis severity, whereas being female and non-obese was associated with a lower risk. A third of the patients had a family history of psoriasis and sleeping disorders. Forty-one percent of participants either had no income or had an income below 224 US dollars per month and >20% of their income was spent on their disease. Conclusions: This study is supported by robust scientific data and contributes to understanding the burden of psoriasis in Latin America. This study adds well-supported data through an in-depth clinical and economical characterization of Colombian children and adult patients with psoriasis and shows the high impact and burden of the disease on patients and their families.

Clinical and sociodemographic features and quality of life in patients with atopic dermatitis who attended dermatology teaching clinics in Medellín, Antioquia and its metropolitan area / Caracterización clínica, sociodemográfica y determinación del impacto en la calidad de vida de pacientes con dermatitis atópica de la ciudad de Medellín y su área metropolitana

Introduction: Atopic dermatitis is a cutaneous, inflammatory, chronic disease, very frequent in the world and it imposes a high clinical and quality of life impact in patients. To date there are no local studies describing the general features in our population. Objective: To evaluate the socio demographic, clinical and life quality features in patients with atopic dermatitis from Medellín city and its metropolitan area. Materials and methods: cross sectional, descriptive study, that included patients who attended some teaching dermatological clinics. Data collection included sociodemographic and clinical features in addition to clinical issues and quality of life measurements. Results: A total of 13 patients were included. 36,3% manifested a sleeping disturbance, 38,1% attention deficit; 44,2% reported asthma in the childhood. EASI and SCORAD scores were 6,9 and 32,4, respectively, which indicates a mild-moderate compromise. Regarding quality of Life, Skindex-29 showed average scores for the symptomatic, emotional and functional dominions of 37,7, 25,09 and 16,9, respectively, and a total score of 24,78. In EQ-5D scores, the most altered component was the presence of pain or discomfort (17,6%) and the presence of anxiety or depression (12,1%), which enhances the symptomatic and emotional impact of the disease. Conclusion: These results confirm that patients with atopic dermatitis present similar features to those reported in other studies from different countries, highlighting the burden of the disease in adults and its impact in neuropsychiatric and emotional domains.

Introducción. La dermatitis atópica es una enfermedad cutánea crónica e intermitente muy frecuente, con un impacto clínico evidente en la calidad de vida de los pacientes. No hay estudios locales que describan las características generales de esta condición en nuestra población. Objetivo. Evaluar las características sociodemográficas, clínicas y de calidad de vida en pacientes con dermatitis atópica residentes en Medellín y su área metropolitana. Materiales y métodos. Se hizo un estudio transversal descriptivo de pacientes que consultaron en algunos centros de referencia de la ciudad de Medellín, a quienes se les hizo una encuesta sobre variables sociodemográficas y clínicas. Además, se evaluó la seriedad clínica de la enfermedad y su impacto en la calidad de vida. Resultados. Se incluyeron 113 pacientes, de los cuales 36,3 % manifestó tener algún trastorno del sueño, 38,1 % reportó déficit de atención y 44,2 % informó haber sufrido asma en la infancia. Se registró un puntaje promedio de 6,9 en el índice EASI (Eczema Area and Severity Index) y de 32,4 en el SCORAD (Scoring Atopic Dermatitis), es decir, el compromiso clínico era de leve a moderado. Con el cuestionario Skindex-29, se encontraron promedios de 37,7, 25,09 y 16,9 para los dominios sintomático, emocional y funcional, respectivamente, con un promedio total de 24,78. En el cuestionario EuroQol 5 Dimensions (EQ-5D), el componente más importante fue la presencia de dolor o malestar (17,6 %) y de ansiedad o depresión (12,1 %). Conclusión. Los resultados obtenidos confirmaron que la población analizada con dermatitis atópica presentaba características similares a las reportadas en otras partes del mundo, con un impacto neuropsiquiátrico y emocional en aspectos como el sueño.

Atopic dermatitis in the COVID-19 era: Results from a web-based survey.

Given that the COVID-19 era has changed the behavior of all individuals, and since previous reports about its possible impact on atopic dermatitis (AD) patients remained speculative, in this survey we aimed to explore the real impact of COVID-19 among AD patients. All participants provided verbal consent prior to completing the survey. A 37-question web-based survey with no personal identifiers was sent to 212 previously identified AD patients. Itching, sleep disturbances, SARS-CoV-2, illness cost, economic dependence, monthly income, and monthly investment in AD before and during the pandemic, were all included in the analysis. A response rate of 73.1% was obtained. The mean age of participants was 30 years-old, and 57% were women. Around 75% reported AD worsening, and 59.4% of the patients reported sleep problems. Uncertainty, anxiety, and pessimism were frequent during the pandemic. Only 1.3% tested positive for SARS-CoV-2, and it was only significantly associated with comorbidities (p=0.03; Chi2 Test). A significant difference was found in economic dependence and monthly income when compared between before and during the pandemic. This study provides probably the best possible assessment of the clinical, social, and economic effects of the pandemic on patients with an already proven diagnosis of AD.

Epidemiologic features and burden of atopic dermatitis in adolescent and adult patients: A cross-sectional multicenter study.

BACKGROUND: Atopic dermatitis (AD) is considered as one of the most frequent chronic skin conditions. Previous AD epidemiologic studies have been mainly retrospective and/or have been performed through surveys instead of in-person visits. Epidemiological studies concerning AD in Latin American countries are scarce. OBJECTIVE: To describe sociodemographic and clinical features and the economic burden of AD on children and adult patients in Colombia through in-person visits. METHODS: This was a cross-sectional study of 212 patients that included sociodemographic and clinimetric data. The diagnostic criteria of Hanifin and Rajka was used and data relating to disease distribution, disease severity (through the BSA: Body surface area; EASI: Eczema Area and Severity Index; SCORAD: Scoring Atopic Dermatitis), Fitzpatrick's skin phototypes, personal and familiar history of allergic diseases, previous treatments, and personal history of comorbidities, was collected. RESULTS: Patient age range was 12-76, and 52.8% were female. Disease distribution was mainly flexural (19.6%). Early age start, Denni-Morgan fold, and infections tendency were more frequent in adolescents compared to adults. Mean age of diagnosis was 12 years old, AD diagnosis was made mostly by a dermatologist, 48.1% (102 patients) reported alcohol consumption, and 59% of consumers were heavy drinkers. Comorbidities found were: chronic rhinitis (68.9%) food allergy (32.5%), allergic conjunctivitis (29.7%), and asthma (28.8%). Around 81% earned less than $896 US dollars and 59% invested 6-30% of their monthly budget yearly, and 40% had work or school absenteeism. Mean scores of BSA, EASI, and SCORAD involvement were 32.6, 13.7, and 42.4, respectively. CONCLUSIONS: This study adds well-supported data through an in-depth clinical and economical characterization of Colombian adolescents and adult patients with atopic dermatitis and shows its high impact and burden on patients and their families. It also contributes to understand the burden of AD in Latin America.

Protective association exhibited by a single nucleotide polymorphism of the IFIH1 gene in patients with psoriasis: A case-control study. / Asociación protectora del polimorfismo de nucleótido único en IFIH1 en pacientes con psoriasis: estudio de casos y controles.

INTRODUCTION: Psoriasis is a chronic inflammatory dermatosis, a with variable clinical presentation and whose multifactorial etiology carries an essential genetic component. Multiple genetic variations associated with psoriasis have been described around the world. However, these variants are unknown among the Colombian population. This study aimed to evaluate the single nucleotide polymorphism rs10930046 (His460Arg) in the IFIH1 gene and its ssociation with the development of psoriasis in a Colombian population. METHODS: An observational, unmatched, case-control study was performed, including 51 patients with psoriasis and 151 population controls, all with self-reported Paisa ancestry (from the Antioquia region). All individuals were genotyped for the single nucleotide polymorphism rs10930046 (His460Arg) in the IFIH1 gene, and its association with psoriasis was pursued. Both groups were demographically characterized, and cases were also assessed for clinical variables. RESULTS: Through the allelic association analysis, cases were found to have a lower frequency of the single nucleotide polymorphism rs10930046 (His460Arg) in the IFIH1 gene than controls; 5% versus 22.67%, respectively. There were no significant differences in age or sex. We also found that psoriasis vulgaris was the most common variant (78%), that about half of the cases had nail psoriasis (56%), 19.6% had psoriatic arthritis, and that 45% had some comorbidity. CONCLUSIONS: The results obtained from this study confirm that carriers of the single nucleotide polymorphism rs10930046 (His460Arg) in the IFIH1 gene have a decreased risk of developing psoriasis.

INTRODUCCIÓN: La psoriasis es una dermatosis inflamatoria crónica, con presentación clínica variable y cuya etiología involucra un componente genético importante. Alrededor del mundo se han descrito múltiples variaciones genéticas asociadas a la enfermedad. Sin embargo, en población colombiana se desconocen estas variantes. En este estudio se evalúa el polimorfismo de nucleótido único rs10930046 (His460Arg) en el gen IFIH1 y su asociación con el desarrollo de psoriasis en población colombiana. Además, se caracteriza a los individuos demográfica y clínicamente. MÉTODOS: Se realizó un estudio observacional de casos y controles, no pareado, que incluyó 51 individuos con psoriasis y 151 controles poblacionales, todos de ancestría paisa (proveniente de la región de Antioquia) auto reportada. A todos los individuos se les realizó genotipificación del polimorfismo de nucleótido único rs10930046 (His460Arg) en el gen IFIH1 y se les determinó la asociación con la enfermedad. Se caracterizaron demográficamente ambos grupos y los casos clínicamente. RESULTADOS: Se encontró que los casos presentaron una menor frecuencia del polimorfismo de nucleótido único rs10930046 (His460Arg) en el gen IFIH1 en relación a los controles, 5 versus 22,67% respectivamente, con un análisis de asociación alélico. No hubo diferencias significativas en edad ni en sexo. La psoriasis vulgar fue la variante de presentación más común (78%). Alrededor de la mitad de los casos presentaron psoriasis ungular (56%), en menor frecuencia artritis psoriásica (19,6%) y el 45% de los casos tuvo alguna comorbilidad. CONCLUSIONES: Los resultados obtenidos confirman que los portadores del polimorfismo de nucleótido único rs10930046 (His460Arg) en el gen IFIH1, presentan un riesgo disminuido de desarrollar psoriasis.

Effectiveness and adverse events of topical and allergen immunotherapy for atopic dermatitis: a systematic review and network meta-analysis protocol.

BACKGROUND: Atopic dermatitis (AD) is an inflammatory chronic condition that affects the skin of children and adults and has an important impact on the quality of life. Treatments for AD are based on environmental controls, topical and systemic therapies, and allergen-specific immunotherapy (AIT). However, it remains unclear the effectiveness and adverse events of AIT and all conventional topical treatments compared with placebo and each other for AD. METHODS: We will search five electronic databases [Central Cochrane register of controlled trials (CENTRAL), MEDLINE, EMBASE, CINAHL, and LILACS] from inception until November 2019 with no language restriction, and we will include experimental studies [randomized controlled trials (RCTs), and quasi-RCTs]. The primary outcome is global and specific skin symptoms assessment. Secondary outcomes are hospital length of stay, quality of life, and adverse events. Reviewers independently will extract data from the studies that meet our inclusion criteria and will assess the risk of bias of individual primary studies. We will conduct random effects pairwise meta-analyses for the observed pairwise comparisons with at least two trials. Then, we will perform random-effects Bayesian network meta-analysis (NMA) to obtain treatment effects for all possible comparisons and to provide a hierarchy of all interventions for each outcome. Possible incoherence between direct and indirect sources of evidence will be investigated locally (if possible) and globally. To investigate sources of statistical heterogeneity, we will perform a series of meta-regression analyses based on pre-specified important effect modifiers. Two authors will appraise the certainty of the evidence for each outcome applying the GRADE's framework for NMA. DISCUSSION: The findings of this systematic review will shed the light on the effectiveness and adverse events of all possible comparisons for treating AD and on the quality of the collated evidence for recommendations. It will also provide critical information to health care professionals to comprehend and manage this disease at different age stages, treatment type, duration, and severity of atopic dermatitis. SYSTEMATIC REVIEW REGISTRATION: PROSPERO Protocol ID CRD42019147106.

Lack of correlation between minimal erythema dose and skin phototype in a Colombian scholar population.

BACKGROUND: Sun exposure and skin phototype are the most relevant risk factors for skin cancer. Colombia has high levels of ultraviolet radiation during the whole year, therefore, both, high UVI's and outdoor worker's daily activities, in our country are very important risk factors for the development of cutaneous cancer. To date no study has evaluated the usefulness of Fitzpatrick's skin phototype classification in Colombians and its correlation with the minimal erythema dose (MED) and constitutional skin color. Such information is gaining importance in other nations due to the fact that several country's population is becoming more ethnically diverse. OBJECTIVES: To determine the skin phototype, accumulated sun exposure, sun protection behavior, MED and phenotype in a Colombian school population. METHODS: Last year high school students from the western Antioquia were invited to participate by phone and letter through their respective school directors. A self-questionnaire was handled to each student. A representative sample of the universe was selected for a medical examination by a dermatologist in order to validate the results of the self-questionnaire. The constitutional skin color was determined with the chromameter CR 300 Minolta. The MED was defined as the minimal dose of UVB being able to induce erythema 24 h later. RESULTS: Eight schools of the area agreed to participate in the study, and a total of 911 students (58% girls and 42% boys) filled-out the self-questionnaire. Sun exposure in the majority of individuals was in a level between moderate and very high. Ninety percent of students do not use any sun protection device or cream. Only a 50% of concordance between self-assessed skin phototype vs. medical skin phototype was found, and the highest concordance corresponded to skin phototype II (82%). There was a marked difference in skin photosensitivity of Colombians compared with reports in Caucasians. We observed a marked overlapping in MED's and L* values in phototypes II and III. CONCLUSIONS: The Fitzpatrick's classification was not useful in Hispanic populations such as ours. Therefore, a new skin-phototype classification system is required. In our population the constitutional color was a good predictor of the MED but it did not correlate with skin phototype. The self-assessed questionnaire method was not useful to determine skin cancer risk in our population. The majority of this population has light skin phototypes and is highly exposed to solar UV radiation without proper protection.

Quality assessment of atopic dermatitis clinical practice guidelines in ≤ 18 years.

Atopic dermatitis (AD) is a chronic inflammatory skin disease that affects the patients' quality of life greatly often from a very young age. Its worldwide incidence in children and adults varies, but it is usually among the first ten causes of dermatological consultation worldwide. There is a wide variety of treatment options for this condition including topical and systemic regimes. The decision to choose a treatment option in dermatological diseases is greatly influenced by the personal experience of each specialist, which increases variability in the selection of available therapies. Clinical practice guidelines (CPGs) not only offer recommendations supported on the available scientific evidence, but also are intended to assist in making appropriate decisions in clinical scenarios. To standardize the way in which CPGs should be developed, an instrument called AGREE II (Appraisal of Guidelines for Research and Evaluation) is used. In this study, ten clinical practice guidelines in ≤ 18 years were evaluated. Six domains (scope and purpose, stakeholder involvement, rigor of development, clarity and presentation, applicability, and editorial independence) were assessed for each guideline, by three reviewers. Most of the domains obtained high scores except in the applicability domain. It is suggested that future atopic dermatitis CPGs should emphasize in the facilitating factors and barriers that may influence the application of guideline recommendations.

Effect of imiquimod in anogenital warts from HIV-positive men.

BACKGROUND: HIV-positive patients have unpredictable local immune responses even with severe systemic immunosuppression and data reported to date is insufficient to predict the effect of imiquimod in HIV-positive patients. OBJECTIVE: To evaluate the efficacy of 5% topical imiquimod in HIV-positive male patients with anogenital warts (AGW) and to elucidate its effect on recurrence. STUDY DESIGN: Open-label clinical trial. RESULTS: Of the 43 patients enrolled, 86% completed treatment. Patients' mean age was 34 years (range: 19-50). Thirty-one patients were receiving highly active antiretroviral therapy (HAART) therapy. At week 16, 10 patients completely cleared lesions and 21 patients had a wart size reduction > or =50%. At 20 weeks of therapy, 17 patients achieved total clearance whereas 14 patients had a >50% wart reduction. Clearance was not influenced by CD4-counts, HIV-viral load, previous therapy, or wart localization. Of the patients who experienced a complete clearance, five (29%) had a recurrence. Mean time of recurrence was 14.4 weeks. Erythema, pruritus, and burning sensation were the most frequent local skin reactions. CONCLUSIONS: Topical 5% imiquimod is safe and may benefit HIV-positive patients with anogenital warts particularly when it is used for up to 20 weeks. It is also useful to decrease wart recurrence.

Epidemiologic characteristics and burden of psoriasis: A multicenter, cross-sectional study

Antecedentes La carga de enfermedad y el tratamiento de la psoriasis han sido bien caracterizados en los países desarrollados, pero los estudios epidemiológicos realizados en America Latina son escasos. Objetivos Describir las características sociodemográficas, clínicas y económicas de la psoriasis en pacientes pediátricos y adultos de Colombia. Métodos Este fue un estudio observacional transversal que incluyó pacientes recolectados en consultorios privados de dermatología, instituciones prestadoras de salud y hospitales de siete ciudades de Colombia. Se incluyeron datos relacionados con la distribución de la enfermedad, peso, altura, índice de masa corporal, medición de la cintura/cadera, severidad de la enfermedad, tratamiento, antecedentes de comorbilidades y costos directos para el paciente o la familia. Se realizó un análisis de regresión logística múltiple para evaluar las asociaciones entre la severidad de la psoriasis y las variables sociodemográficas y clínicas. Resultados Se incluyeron 203 pacientes (43.8% mujeres y 56.2% hombres) con un rango de edad entre 7 a 89 años. El subtipo principal fue la psoriasis vulgar y la edad media de diagnóstico fue de 37,1 años. Las comorbilidades más frecuentes fueron la obesidad, la hipertensión arterial, la artritis psoriásica, la dislipidemia y la diabetes. Las mujeres tuvieron un mayor riesgo de presentar artritis psoriásica. El índice de masa corporal y la hipertensión se asociaron significativamente con la severidad de la psoriasis, mientras que ser mujer y no obeso se relacionó con un menor riesgo, respectivamente. Un tercio de los pacientes tenía antecedentes familiares de psoriasis y trastornos del sueño. Cuarenta y uno por ciento de los participantes no tenían ingresos o tenían ingresos inferiores a 224 dólares estadounidenses por mes y >20% de sus ingresos los gastaron en la enfermedad. Conclusiones Este estudio muestra un gran impacto de la psoriasis en los pacientes afectados y contribuye a comprender la carga de la psoriasis en América Latina aportando datos científicos sólidos a la comunidad dermatológica y a las autoridades sanitarias colombianas con respecto a los estándares de atención médica. También crea conciencia sobre la carga económica de la enfermedad y también enfatiza la necesidad de un seguimiento estrecho de los pacientes con psoriasis para prevenir, identificar y manejar sus comorbilidades.

Background Although psoriasis burden and treatment have been well characterized in developed countries, there are scarce in-depth epidemiological studies in Latin American countries. Objectives To describe the sociodemographic and clinical features and the economic burden of psoriasis among children and adult patients from Colombia. Methods This cross-sectional study included patients from dermatology private practice offices, health provider institutions and hospitals in seven Colombian cities. We collected data on disease distribution, weight, height, body mass index, waist-hip ratio, disease severity, therapy, personal history of comorbidities, and direct costs. Multiple logistic regression analyses were conducted to assess the associations between severity scales and sociodemographic and clinical variables. Results Two-hundred-three patients (43.8% women, 56.2% men) with an age range between 7 to 89 years old were included. The main subtype was psoriasis vulgaris and mean age of diagnosis was 37.1 years. The most common comorbidities were obesity, hypertension, psoriatic arthritis, dyslipidemia and diabetes. Women had a significant increased odds of presenting with psoriatic arthritis. Body-mass-index and hypertension were significantly associated with a higher psoriasis severity, whereas being female and non-obese was associated with a lower risk. A third of the patients had a family history of psoriasis and sleeping disorders. Forty-one percent of participants either had no income or had an income below 224 US dollars per month and >20% of their income was spent on their disease. Conclusions This study is supported by robust scientific data and contributes to understanding the burden of psoriasis in Latin America. This study adds well-supported data through an in-depth clinical and economical characterization of Colombian children and adult patients with psoriasis and shows the high impact and burden of the disease on patients and their families.

Molecular and serological evidence of the epidemiological association of HPV 13 with focal epithelial hyperplasia: a case-control study.

BACKGROUND: Focal epithelial hyperplasia is a benign proliferative condition that is more frequently found in children of certain ethnic groups. Human papillomavirus 13 and 32 DNA has been consistently detected in these lesions. OBJECTIVE: To demonstrate the epidemiological association of HPV 13 with FEH in the Emberá-Chamí community of Antioquia, Colombia. METHODS: A population-based, case-control study was conducted. One hundred and thirty-eight children were screened and 17 clinical and histologically-confirmed cases were sex and age-matched with 27 controls. Biopsies from FEH lesions and mouth washes from controls were obtained for DNA analysis. HPV 13 DNA was identified using a previously described type-specific PCR test. HPV 13 VLPs were produced by cloning of L1 from the HPV 13 cloned genome and seroreactivity against HPV 13 VLPs of sera from cases and controls were evaluated by ELISA. RESULTS: Among the whole population the prevalence of FEH was 13%. One-hundred-percent of the cases and 29.6% of the controls were HPV 13 positive. There was a significant difference in HPV DNA status between cases and controls (one-tailed Fisher exact test: P<0.0001). Antibodies against HPV 13 VLPs were found in 58.8% of cases and in 33.3% of controls, this difference was not statistically significant (P=0.089 Fisher exact test). However, the median of the ODs of the ELISA positive sera of the cases was 0.596 (interquartile range: 0.5075-0.8245) versus 0.452 (interquartile range: 0.337-0.479) in the controls and this was significantly different (P=0.0041 Man-Whitney test). CONCLUSIONS: We demonstrated a risk for association of FEH with infection with HPV 13. The higher level of antibodies against HPV 13 VLPs in cases may suggest the requirement of higher viral load or viral persistence for disease development.

Caracterización clínica, sociodemográfica y determinación del impacto en la calidad de vida de pacientes con dermatitis atópica de la ciudad de Medellín y su área metropolitana / Clinical and sociodemographic features and quality of life in patients with atopic dermatitis who attended dermatology teaching clinics in Medellín, Antioquia and its metropolitan area

Resumen | Introducción. La dermatitis atópica es una enfermedad cutánea crónica e intermitente muy frecuente, con un impacto clínico evidente en la calidad de vida de los pacientes. No hay estudios locales que describan las características generales de esta condición en nuestra población. Objetivo. Evaluar las características sociodemográficas, clínicas y de calidad de vida en pacientes con dermatitis atópica residentes en Medellín y su área metropolitana. Materiales y métodos. Se hizo un estudio transversal descriptivo de pacientes que consultaron en algunos centros de referencia de la ciudad de Medellín, a quienes se les hizo una encuesta sobre variables sociodemográficas y clínicas. Además, se evaluó la seriedad clínica de la enfermedad y su impacto en la calidad de vida. Resultados. Se incluyeron 113 pacientes, de los cuales 36,3 % manifestó tener algún trastorno del sueño, 38,1 % reportó déficit de atención y 44,2 % informó haber sufrido asma en la infancia. Se registró un puntaje promedio de 6,9 en el índice EASI (Eczema Area and Severity Index) y de 32,4 en el SCORAD (Scoring Atopic Dermatitis), es decir, el compromiso clínico era de leve a moderado. Con el cuestionario Skindex-29, se encontraron promedios de 37,7, 25,09 y 16,9 para los dominios sintomático, emocional y funcional, respectivamente, con un promedio total de 24,78. En el cuestionario EuroQol 5 Dimensions (EQ-5D), el componente más importante fue la presencia de dolor o malestar (17,6 %) y de ansiedad o depresión (12,1 %). Conclusión. Los resultados obtenidos confirmaron que la población analizada con dermatitis atópica presentaba características similares a las reportadas en otras partes del mundo, con un impacto neuropsiquiátrico y emocional en aspectos como el sueño.

Abstract | Introduction: Atopic dermatitis is a cutaneous, inflammatory, chronic disease, very frequent in the world and it imposes a high clinical and quality of life impact in patients. To date there are no local studies describing the general features in our population. Objective: To evaluate the socio demographic, clinical and life quality features in patients with atopic dermatitis from Medellín city and its metropolitan area. Materials and methods: cross sectional, descriptive study, that included patients who attended some teaching dermatological clinics. Data collection included sociodemographic and clinical features in addition to clinical issues and quality of life measurements. Results: A total of 13 patients were included. 36,3% manifested a sleeping disturbance, 38,1% attention deficit; 44,2% reported asthma in the childhood. EASI and SCORAD scores were 6,9 and 32,4, respectively, which indicates a mild-moderate compromise. Regarding quality of Life, Skindex-29 showed average scores for the symptomatic, emotional and functional dominions of 37,7, 25,09 and 16,9, respectively, and a total score of 24,78. In EQ-5D scores, the most altered component was the presence of pain or discomfort (17,6%) and the presence of anxiety or depression (12,1%), which enhances the symptomatic and emotional impact of the disease. Conclusion: These results confirm that patients with atopic dermatitis present similar features to those reported in other studies from different countries, highlighting the burden of the disease in adults and its impact in neuropsychiatric and emotional domains.

Feasibility of daylight-mediated photodynamic therapy for actinic keratosis throughout the year in Central and South America: a meteorological study.

BACKGROUND: Daylight-mediated photodynamic therapy (DL-PDT) is an efficacious treatment option for thin actinic keratosis (AK) that offers advantages over conventional PDT in terms of tolerability, treatment duration, and cost. A clinical study conducted in Australia determined the mean irradiance during a 2-hour exposure to be 305.8 W/m(2) (range: 40-585 W/m(2) ). The protoporphyrin IX light dose is influenced by latitude, weather conditions, and time of year. A recent study of meteorological data concluded that DL-PDT can be performed effectively throughout the year in Australia. OBJECTIVES: Based on the same hypothesis and applying the same methodology, the present study investigated the suitability of daylight to perform DL-PDT in Central and South America. METHODS: Solar radiation and weather data were gathered and analyzed to assess daylight irradiance (light intensity) throughout a full year across 32 geographical locations in Central and South America. RESULTS: The minimum average daily solar irradiance reported was above 305.8 W/m(2) in all locations investigated throughout the year. Annual averages of daily irradiance ranged from 578 W/m(2) in Chihuahua, Mexico, to 321 W/m(2) in Puerto Montt, Chile. CONCLUSIONS: Daylight-mediated PDT for AK can be performed effectively throughout the year in Central and South America given that weather conditions permit a comfortable 2-hour direct exposure to daylight.

[What clinicians should know about human papilloma virus vaccines]. / Lo que los clínicos deben saber acerca de las vacunas contra el virus del papiloma humano.

Human papillomaviruses (HPVs) are epitheliotropic viruses that infect the basal layer of mucosal and keratinizing epithelia. HPV viral genome is made up of an early transcription region (E) and a late region composed of genes L1, L2, and a long control region (LCR). Despite the benign character of most lesions, HPV oncogenicity has been demonstrated in anal cancer, epidermodysplasia verruciformis, and cervical cancer. Nearly 12% of worldwide cancer incidence is due to HPV infection and HPV-16 is the most prevalent genotype found. Therefore, efforts in vaccines against HPVs have been directed mainly toward this genotype to dramatically diminish worldwide anogenital cancer incidence. Therapeutic vaccines are based on induction of an immunologic response against infected cells that express modified viral antigens E6 and E7. Prophylactic vaccines are based on prevention of infection by means of induction of humoral immunity against capsid viral proteins L1 and L2. This article reviews basics of the design of HPV vaccines and the type of vaccines currently being evaluated in clinical studies.