Moderate to Severe Psoriasis in Older Adults: Recommendations on Management from the Psoriasis Working Group of the Spanish Academy of Dermatology and Venereology (AEDV). / Recomendaciones del Grupo de Psoriasis de la Academia Española de Dermatología y Venereología sobre el manejo del paciente de edad avanzada con psoriasis en placas moderada-grave.

Managing moderate to severe psoriasis in older adults is complex due to factors characteristic of the later years of life, such as associated comorbidity, polypharmacy, and immunosenescence. This consensus statement discusses 17 recommendations for managing treatment for moderate to severe psoriasis in patients older than 65 years. The recommendations were proposed by a committee of 6 dermatologists who reviewed the literature. Fifty-one members of the Psoriasis Working Group of the Spanish Academy of Dermatology and Venereology (AEDV) then applied the Delphi process in 2 rounds to reach consensus on which principles to adopt. The recommendations can help to improve management, outcomes, and prognosis for older adults with moderate to severe psoriasis.

Markerless monocular tracking system for guided external eye surgery.

This paper presents a novel markerless monocular tracking system aimed at guiding ophthalmologists during external eye surgery. This new tracking system performs a very accurate tracking of the eye by detecting invariant points using only textures that are present in the sclera, i.e., without using traditional features like the pupil and/or cornea reflections, which remain partially or totally occluded in most surgeries. Two known algorithms that compute invariant points and correspondences between pairs of images were implemented in our system: Scalable Invariant Feature Transforms (SIFT) and Speed Up Robust Features (SURF). The results of experiments performed on phantom eyes show that, with either algorithm, the developed system tracks a sphere at a 360° rotation angle with an error that is lower than 0.5%. Some experiments have also been carried out on images of real eyes showing promising behavior of the system in the presence of blood or surgical instruments during real eye surgery.

[Cutaneous adverse reactions to tattoos and piercings]. / Reacciones cutáneas adversas por tatuajes y piercings.

Piercings and tattoos have become very popular in western society in recent decades, particularly among younger generations. Reports of medical complications associated with these decorative techniques have increased in parallel with the rise in their popularity. Due to their high frequency, adverse cutaneous reactions are particularly important among these potential complications. Tattoo-related complications include a number of cutaneous and systemic infections secondary to breach of the epidermal barrier, acute and delayed inflammatory reactions with different histopathological patterns, the appearance of benign and malignant tumors on tattooed areas of skin, and certain dermatoses triggered by isomorphic phenomena. Piercing-related complications are similar, though some, such as pyogenic skin infections, are much more common due to the delayed wound healing after piercing in certain sites. We must differentiate between complications that are independent of the site of piercing, and specific complications, which are closely related to the body area pierced. The rate of complications after performing piercings or tattoos depends on the experience of the artist, the hygiene techniques applied, and the postprocedural care by the customer. However, some of these complications are unpredictable and depend on factors intrinsic to the patient. In this article, we review the most common decorative techniques of body art, with particular focus on the potential cutaneous complications and their management.

[Allergic contact dermatitis due to corticosteroids: a 3-year retrospective study in a hospital skin allergy unit]. / Dermatitis de contacto por corticoides: estudio retrospectivo de 3 años en una unidad de alergia cutánea hospitalaria.

BACKGROUND: Corticosteroid contact dermatitis and its patch testing are subject to certain peculiarities that we should be aware of. MATERIALS AND METHODS: We performed a retrospective study of all patients who underwent patch tests with a corticosteroid battery in the Skin Allergy Unit of the Dermatology Department of Hospital General Universitario, Alicante, Spain, between October 2004 and June 2007. RESULTS: During the study period, patch tests were performed on 1065 patients in our allergy unit. A corticosteroid battery was used in 34 patients (3.1 %). Fourteen patients were positive for budesonide or tixocortol in the standard battery; 20 were negative for these allergens but there was a clinical suspicion of steroid allergy. At least one positive reaction in the corticosteroid battery was observed in 15 patients (44.1 %). The substance most commonly implicated was budesonide (13 patients sensitized). The corticosteroid battery revealed sensitization to other groups of corticosteroids in 4 of the 15 patients with corticosteroid sensitization. Seventeen patients brought drugs that were also tested, obtaining positive results for 10 substances. CONCLUSIONS: Allergens for contact dermatitis due to corticosteroids included in the standard battery (budesonide and tixocortol) detected 93 % of patients who are sensitized to steroids; there would appear to be little benefit in performing a corticosteroid battery if those markers are negative. The battery of corticosteroids and the drugs provided by patients were useful to define more exactly the corticosteroid classes that the patient should avoid.

Localized acquired cutis laxa secondary to interstitial granulomatous dermatitis.

We report the case of a 68-year-old woman who had interstitial granulomatous dermatitis associated with seronegative polyarthritis. Two years later, this had evolved to become localized acquired cutis laxa.

Langerhans cell histiocytosis: an update.

The histiocytoses represent a heterogeneous group of disorders that are characterized by the proliferation and accumulation of reactive or neoplastic histiocytes within various tissues. Langerhans cell histiocytosis (LCH) is the commonest of these disorders and it is associated with high morbidity and mortality, especially in children. LCH is a poorly understood disease with features suggestive of a neoplastic, reactive, or immune dysregulation process. The clinical spectrum of LCH is considered to be broad and includes from self-resolving involvement of a single organ to a potentially fatal multisystem disease. The purpose of this review is to undertake an update of LCH with emphasis on the current recommendations regarding the classification, evaluation and treatment of this enigmatic disease.

[Brachioradial pruritus as a symptom of cervical radiculopathy]. / Prurito braquiorradial como síntoma de radiculopatía cervical.

Brachioradial pruritus is characterized by the presence of pruritus on the lateral aspect of the arms. The etiology of this enigmatic entity is the subject of some debate some authors claim that brachioradial pruritus is a photodermatosis whereas others attribute it to the presence of underlying cervical radiculopathy. In these case reports, we present our experience with brachioradial pruritus and discuss the role of underlying neuropathy in its etiology and that of other types of localized pruritus such as notalgia paresthetica, anogenital pruritus, and burning mouth syndrome.

[Perifollicular xanthomatosis as a key histological finding in Fox-Fordyce disease]. / Xantomatosis perifolicular: hallazgo histológico clave en la enfermedad de Fox-Fordyce.

Fox-Fordyce disease is a rare skin condition characterized by the presence of multiple pruritic follicular papules in areas rich in apocrine glands, such as the axillae, mammary areolae, or genital regions. There is a high degree of variability in the histological findings seen in Fox-Fordyce disease. In addition to those described as typical of this entity, such as dilation of the infundibulum and hyperkeratosis and spongiosis of the infundibular epithelium, many other histological changes can be observed. We report the case of a 21-year-old woman with Fox-Fordyce disease and highlight the importance of perifollicular xanthomatosis as a key histological finding in the diagnosis of the disease.

Periodontal Ehlers-Danlos syndrome associated with type III and I collagen deficiencies.

In 1997, Ehlers-Danlos syndrome type VIII (EDS-VIII) was excluded from the diagnostic categories as there were insufficient data regarding the clinical features and the precise underlying molecular basis. However, a recent review of published cases shows that EDS-VIII has distinctive clinical features, which would suggest that it should be considered as a separate entity in future nosological classifications. The underlying molecular defect in EDS-VIII is unknown. A reduction of collagen type III was reported in a single case, but no consistent biochemical or structural changes are detectable. We report a patient with EDS-VIII who showed a reduction in the collagen type I and type III synthesis rates. Type I and type III procollagen and collagen synthesis and secretion rates were investigated in cultured fibroblasts and compared with five healthy controls and three patients with EDS type IV whose fibroblasts were cultured in parallel.

[Vitamin B complex and homocysteine in chronic renal failure]. / Vitaminas B y homocisteína en la insuficiencia renal crónica.

Metabolic, biochemical, and hormonal changes occur in chronic renal failure usually associated with hyponutrition states. In predialysis patients, knowing the nutritional state about water-soluble vitamins such as thiamine, riboflavin, pyridoxine, cianocobalamine, and folic acid is becoming more and more important since some of the manifestations of chronic renal failure may be due to the deficiency of some of these water-soluble vitamins. The metabolic pathways in which most of these vitamins participate are interrelated and it is difficult to understand how the individual deficits of each vitamin affect renal pathology. This work aims at reviewing not only this issue but also the status of these water-soluble vitamins that different authors have found in groups of predialysis patients. On the other hand, the issue on the high prevalence of hyperhomocysteinemia in chronic renal failure as the main mortality risk factor due to cardiovascular pathologies as well as the implication of these vitamins in the metabolism of homocysteine, and consequently in plasma levels of this metabolite in predialysis patients is reviewed.

[Brooke-Spiegler syndrome: an heterogeneous entity]. / Síndrome de Brooke-Spiegler: una entidad heterogénea.

The Brooke-Spiegler syndrome is a rare, autosomally dominant disease with a predisposition to develop different adnexal tumors. Clinically it is characterized by the presence of multiple cylindromas, trichoepitheliomas, and occasionally, spiradenomas. Although Brooke-Spiegler syndrome, familial cylindromatosis and multiple familial trichoepithelioma were initially described as separate entities, the recently identified identical mutations in the gene of cylindromatosis suggest that they represent fenotypic variations of the same entity. In this article we present the case of a woman and her daughter, both affected by this rare genodermatosis.