Phototherapy in atopic dermatitis: a systematic review of the literature.

BACKGROUND: Phototherapy is a treatment option for atopic dermatitis recommended by several guidelines. OBJECTIVE: To perform a systematic review of the efficacy of different modalities of phototherapy and photochemotherapy in moderate to severe atopic dermatitis. MATERIAL AND METHODS: We considered all randomized clinical trials (RCTs) performed in patients with atopic dermatitis, and accepted all outcome measures. Articles were identified via an online search of the MEDLINE (via Ovid) and Embase databases and the Cochrane Central Register of Controlled Trials. We also searched for clinical trials registered in Current Controlled Trials and in the World Health Organization's International Clinical Trials Registry Platform. RESULTS: Twenty-one RCTs (961 patients) were included in the qualitative analysis. Two of the trials included children and adolescents (32 patients). The efficacy of narrow-band UV-B and UV-A1 phototherapy was similar for the different outcome measures contemplated. Two RCTs assessed the efficacy of psoralen plus UV-A therapy (PUVA). No serious adverse events were described. In general, the publications reviewed were characterized by a high risk of bias and poor reporting of methodology and results. CONCLUSIONS: There is evidence for the use of narrow-band UV-B and UV-A1 phototherapy in moderate to severe atopic dermatitis. Evidence supporting the use of PUVA in atopic dermatitis is scarce and there is little information on the use of phototherapy in childhood. For the purpose of future studies, it would be advisable to use comparable criteria and scales for the evaluation of disease severity and patients, to standardize radiation methods, and to establish a minimum follow-up time.

The use of systematic reviews in clinical trials and narrative reviews in dermatology: is the best evidence being used?

INTRODUCTION AND OBJECTIVES: Systematic reviews -the most comprehensive type of literature review-should be taken into account before a clinical trial or a narrative review on a topic is undertaken. The objective of this study was to describe the use of systematic reviews in clinical trials and narrative reviews in dermatology. MATERIAL AND METHODS: This was a descriptive cross-sectional study. We selected randomized clinical trials and narrative reviews from the dermatological clinical research journals identified as most important (according to impact factor) and from Actas Dermosifiliográficas, and studied the bibliographies to ascertain whether the authors made reference to existing systematic reviews and Cochrane reviews. RESULTS: Of the 72 clinical trials for which a systematic review was available, 24 (33.3%) cited at least 1 review; reference was made to relevant Cochrane reviews in 15.6% of cases and to non-Cochrane reviews in 32%. In the case of the 24 narrative reviews for which a review was available, 10 (41.7%) cited at least 1 review; Cochrane reviews were cited in 20% and non-Cochrane reviews in 35.3%.In the case of Actas Dermosifiliográficas, very few clinical trials were found and the findings for narrative review articles were similar to those observed for the other journals. CONCLUSIONS: Systematic reviews are not often taken into account by the authors of clinical trials and narrative reviews and this may lead to redundant studies and publications. Authors appear to use Cochrane reviews even less than non-Cochrane reviews and are therefore ignoring one of the main sources of available evidence.

Prevalence of dystrophic epidermolysis bullosa in Spain: a population-based study using the 3-source capture-recapture method. Evidence of a need for improvement in care.

BACKGROUND: Dystrophic epidermolysis bullosa (DEB) is a rare disease that represents a heavy burden for both the patient and the health care system. There are currently no data on the prevalence of DEB in Spain. OBJECTIVE: To determine the prevalence of DEB in Spain. METHODS: We used data from 3 incomplete population-based sources (hospital dermatology departments, diagnostic laboratories performing antigenic mapping, genetic testing or both, and the Spanish Association of Epidermolysis Bullosa Patients [DEBRA]) and combined them using the 3-source capture-recapture methodology. RESULTS: We identified 152 living DEB patients. The estimated prevalence of DEB was 6.0 cases per million (95% CI, 4.2-11.8) in adults and 15.3 (95% CI, 10.4-40.8) in children under 18 years of age. The data indicated that 77% of the patients were not being followed up in specialized centers of reference; 65% had not had a genetic diagnosis, and 76% were not members of DEBRA. CONCLUSIONS: The prevalence of DEB in Spain is 6.0 patients per million (95% CI, 4.2-11.8), a figure higher than previous estimates in many areas, but similar to those found in other southern Europe countries. The north-south difference may represent real geographic differences in prevalence, but it might be due to the fact that most of the data come from registries with a lower than expected catchment. Many patients are not being followed up in centers of reference, do not have genetic diagnosis, and are not members of patients' associations, suggesting that there is room for considerable improvement in their care.

[Who funds research by Spanish dermatologists? Comparative analysis of articles published in 2008]. / ¿Quién financia la investigación de los dermatólogos españoles? Análisis del año 2008 y comparación con otros grupos.

BACKGROUND: References have been made in the literature to the funding of clinical trials by the pharmaceutical industry. Other types of funding, however, have been less well studied. OBJECTIVE: To describe the sources of funding for research by Spanish dermatology departments published in 2008. MATERIAL AND METHODS: A bibliometric study was performed of the research articles published by Spanish, French, and British dermatology departments and by Spanish rheumatology departments in 2008 according to MEDLINE records. RESULTS: Articles published by Spanish dermatology departments received funding in 36.4% of cases. This percentage is lower than that found for the other groups studied and remained low for all different types of funding. Statistically significant relationships were found between a higher percentage of funding and a higher level of evidence, as well as between a higher level of funding by the pharmaceutical industry and the publication of research into quality of life and pharmacological treatment. Inadequate declaration of funding was observed in 57.1% of articles from Spanish dermatology departments and the role of the sponsor was not declared in any article. Similar findings were obtained for the other groups studied. CONCLUSIONS: The proportion of research articles published by Spanish dermatology departments that receive external funding is low, and this is associated with a lower level of scientific evidence. In order to obtain more external funding, we must improve our competitiveness.

[Clinical research publication by Spanish dermatologists over time and in comparison with other research groups in 2008]. / Evolución de la investigación clínica publicada por los dermatólogos españoles y comparación con otros grupos en 2008.

INTRODUCTION: Clinical research is the form of research nearest to clinical practice. MATERIAL AND METHODS: For the years 1992, 1996, 2000, 2004, and 2008, we identified all indexed articles published by Spanish dermatologists and calculated the percentages corresponding to clinical research according to a previously validated definition; we then calculated the proportion of clinical research articles offering higher levels of evidence. For 2008, we compared these percentages to those of French and British dermatologists and Spanish rheumatologists. We also compared these groups' rates of productivity in 2008 in relation to articles providing higher levels of evidence. RESULTS: In 2008, 36% of Spanish dermatologists' publications reported clinical research; 7% were studies offering higher levels of evidence. The proportions did not change significantly over the period studied. Clinical research publications accounted for 35% and 43% of the articles by French and British dermatologists in 2008 and 54% of articles by Spanish rheumatologists in that year. The proportion of publications reporting clinical research was significantly higher for Spanish rheumatologists than for Spanish dermatologists. The proportions of publications offering higher levels of evidence were significantly different in 2008 only for the comparison between Spanish dermatologists and rheumatologists. Other differences were not statistically significant. In the comparison of rates of productivity in clinical research offering higher levels of evidence, British dermatologists were significantly more productive than Spanish dermatologists. CONCLUSIONS: Differences were observed in relation to specialty (Spanish dermatologists vs rheumatologists) and nationality (Spanish vs British dermatologists). The reasons for the differences identified need to be studied in order to improve this situation.

Morphea in Childhood: An Update. / Morfea en la infancia: actualización.

Morphea is an inflammatory, fibrosing skin disorder. When it occurs in childhood, it is also known as localized juvenile scleroderma. It is more common in girls and typically appears around the age of 5 to 7 years. According to a recent classification system, morphea is divided into 5 types: circumscribed (plaque), linear, generalized, pansclerotic, and mixed. Approximately 40% of patients present extracutaneous manifestations. Childhood morphea is treated with phototherapy, oral or topical calcitriol, topical tacrolimus 0.1%, methotrexate, topical or systemic corticosteroids, mycophenolate mofetil, bosentán, and topical imiquimod 5%. A variety of measuring tools are used to monitor response to treatment. Few prognostic studies have been conducted, but findings to date suggest that the disease tends to run a chronic or intermittent-recurrent course and frequently causes sequelae.