Recommendations on the Clinical Management of Androgenetic Alopecia: A Consensus Statement From the Spanish Trichology Group of the Spanish Academy of Dermatology and Venererology (AEDV). / Recomendaciones sobre el manejo clínico de la alopecia androgénica: un documento de consenso del Grupo Español de Tricología de la Academia Española de Dermatología y Venereología.

Androgenetic alopecia can be challenging to treat due to the wide range of available treatments, most of which are not based on evidence from clinical trials. In addition many of the options do not include androgenetic alopecia among the approved indications according to their summaries of product characteristics. A panel of 34 dermatologists from the Spanish Trichology Society of the Spanish Academy of Dermatology and Venereology (AEDV) used the Delphi method to develop a consensus statement on the management of androgenetic alopecia. Over a 2-round process the experts agreed on 138 (86%) of the 160 proposed items, which were structured into 4 blocks of recommendations: general considerations, pharmacologic treatment, procedures and hair transplant, and special cases. The resulting consensus statement based on expert opinion of the scientific evidence can guide professionals in the routine management of androgenetic alopecia.

Necrosis grasa subcutánea múltiple: correlación ecográficohistopatológica. Multiple encapsulated fat necrosis: histopathological relation to ultrasound findings.

Encapsulated fat necrosis is a benign entity that has multiple possible conditions in the differential diagnosis. Because of this, the ultrasound and histological studies become highly relevant. We present a 14-year-old boy with this condition who exhibited numerous nodules that were detected after an intentional weight loss of 20kg. The ultrasound and histopathological examinations were necessary to confirm the diagnosis. Even though there is not a clear traumatic record in all cases, trauma constitutes the main hypothesis for its development, by decreasing the blood supply to the adipose tissue lobules and causing subsequent ischemic necrosis. Similar lesions have been described in the omentum and in the breast after surgical procedures or invasive diagnostic tests. In the ultrasound study, at least three presentation patterns have been described, which might match the three histological states, from early fat tissue degeneration to ultimate necrosis and even calcification. It is important to know the clinical characteristics, the ultrasound patterns, and the histological findings of this condition for an accurate diagnosis.

[Dermatological emergencies: a cross-sectional study of a hospital of intermediate complexity]. / Urgencias dermatológicas: estudio transversal de un hospital de complejidad intermedia.

OBJECTIVE: To determine if the introduction of some referral criteria in the dermatology emergency department has changed the number of patients referred from the emergency department, as well as the type of diseases, and the profile of the patient who uses this service. MATERIAL AND METHODS: A cross-sectional study was conducted on all consecutive patients attended in the emergency department of the Hospital Príncipe de Asturias during a 31-day period from March 2015 to May 2015 and in the same period in 2016. Variables collected were: gender, age, days from the onset, day of the week, complementary diagnostic tests, referral, reason for consultation, diagnosis and group, whether or not they met the criteria, destination, and whether or not they had a previous appointment. RESULTS: A total of 525 patients were seen in dermatology emergency department in 2015, and 371 in 2016 (P<.001). Of the 896 patients seen 55.7% were women and 44.3% men (14.45 patients per day). A total of 121 diagnoses were made, with the most common being: other dermatitis, drug reactions, and atopic dermatitis. Only 32 pathologies made up 70% of the diagnoses. More than half (51.6%) did not meet the referral criteria. CONCLUSIONS: The introduction of referral criteria has led to a reduction of 30% in the number of patients in 2016. The main diagnoses in both groups were other dermatitis and drug reactions. The profile of the patient is in accordance with the description in the literature.

Tratamiento de la alopecia areata, un recorrido desde las opciones terapéuticas clásicas hasta los nuevos fármacos aparecidos en los últimos años.

La alopecia areata constituye un reto terapéutico, sobre todo en sus formas extensas. Antes de iniciar cualquier tratamiento es necesario tener en cuenta algunas consideraciones. Se trata de una enfermedad que no afecta de forma directa a la salud del paciente y que puede presentar resolución espontánea. Las formas extensas, las que se inician en la infancia y las de larga evolución son muy rebeldes a los tratamientos y asocian recaídas. Todos los tratamientos tienen efectos secundarios. Ningún tratamiento ha demostrado alterar el curso de la enfermedad, muy pocos han demostrado eficacia en ensayos clínicos aleatorizados y no existen guías terapéuticas salvo la publicada en 2003 y actualizada en 2012 en el British Journal of Dermatology. Por todo ello, es necesario elaborar un plan de tratamiento individualizado en cada paciente. Se debe comenzar con los fármacos más seguros e inocuos, y pasar al siguiente escalón terapéutico cuando el actual haya demostrado su ineficacia durante un periodo de 6 meses. Se revisan las principales propuestas farmacológicas para alopecia areata, aportando datos sobre su mecanismo de acción, efectos secundarios y posicionamiento terapéutico en función de los estudios disponibles. Finalmente, se propone un algoritmo terapéutico como guía en el manejo de esta patología.

Eccrine Porocarcinoma: Patient Characteristics, Clinical and Histopathologic Features, and Treatment in 7 Cases. / Porocarcinoma ecrino: aspectos demográficos, clínicos, histopatológicos y terapéuticos en una serie de 7 pacientes.

Eccrine porocarcinoma is a rare, malignant cutaneous adnexal tumor that arises from the ducts of sweat glands. Found mainly in patients of advanced age, this tumor has diverse clinical presentations. Histology confirms the diagnosis, detects features relevant to prognosis, and guides treatment. Growth is slow, but the prognosis is poor if the tumor metastasizes to lymph nodes or visceral organs. We report 7 cases of eccrine porocarcinoma, describing patient characteristics, the clinical and histopathologic features of the tumors, and treatments used. Our observations were similar to those of other published case series. Given the lack of therapeutic algorithms or protocols for this carcinoma, we propose a decision-making schema based on our review of the literature and our experience with this case series. The algorithm centers on sentinel lymph node biopsy and histologic features.