Guidelines for the Diagnosis, Treatment, and Prevention of Hand Eczema. / Guía para el diagnóstico, el tratamiento y la prevención del eccema de manos.

Hand eczema is a common condition associated with significantly impaired quality of life and high social and occupational costs. Managing hand eczema is particularly challenging for primary care and occupational health physicians as the condition has varying causes and both disease progression and response to treatment are difficult to predict. Early diagnosis and appropriate protective measures are essential to prevent progression to chronic eczema, which is much more difficult to treat. Appropriate referral to a specialist and opportune evaluation of the need for sick leave are crucial to the good management of these patients. These guidelines cover the diagnosis, prevention, and treatment of chronic hand eczema and highlight the role that primary care and occupational health physicians can play in the early management of this disease.

[Recommendations on the management of urticaria in Primary Care]. / Recomendaciones para el manejo de la urticaria en Atención Primaria.

Urticaria is a common cause for patient consultations in Primary Care (PC). However, the optimal approach to managing urticaria in PC is controversial and not well-established. For this reason, there is a clear need to clarify the causes of urticaria and to develop treatment protocols to improve urticaria management in the PC setting. The present work has been developed with this objective. A group of experts in PC and dermatology, with specific expertise in treating urticaria, have reviewed the main clinical guidelines and publications on urticaria in order to develop clear, interdisciplinary recommendations on managing urticaria. In this article, consensus-based recommendations are presented that include simple, practical diagnostic, and treatment algorithms. These guidelines will help to optimise the management of patients with urticaria, increasing their quality of life and reducing the socioeconomic costs associated with this illness.

[Vitamin D for daily practice]. / Vitamina D para la práctica diaria.

Vitamin D is a fat-soluble vitamin which has the regulation of calcium-phosphorus metabolism in the body as its main function. Vitamin D receptor is present in most of the nucleated cells of the body, and its role in multiple body processes is being discovered. The 3 main sources of vitamin D are ultraviolet sun radiation, diet, and supplementation. The skin, through solar radiation, provides 90% of the bodýs vitamin D needs. In cases of low vitamin D, sun exposure habits and diet must be reviewed, and pharmacological supplementation must be assessed. Measurement in the body is performed by determining 25-hydroxycholecalciferol with values below 20ng/ml being considered insufficient. Universal screening of vitamin D is not currently recommended, only in situations where a deficiency is suspected.

[Dermoscopy for beginners (ii): Dermoscopic structures and diagnostic methods]. / Dermatoscopia para principiantes (ii): estructuras dermatoscópicas y métodos diagnósticos.

Dermoscopy (DS) is an in vivo non-invasive diagnostic technique developed to study skin lesions. It improves the diagnostic accuracy of hyperpigmented lesions and early diagnosis of potentially malignant lesions, especially melanoma. It uses a device called a dermoscope to display deeper skin structures not visible to the naked eye, called dermoscopic structures. Only some of them have histological significance, basing them on DS. Many, more or less complex, dermoscopic methods have been developed to aid in the differential diagnosis of skin cancer. The most widespread is 2-step algorithm dermoscopy. But there are some more simple methods, designed to be operated by non-medical experts in DS. Two of them are useful in primary care: the 3-point checklist of DS, and the BLINCK algorithm. This paper focuses on describing the dermoscopic parameters needed to implement these algorithms, as well as their interpretation.

[Dermoscopy for beginners (i): General information]. / Dermatoscopia para principiantes (i): características generales.

The incidence of skin cancer has been gradually increasing worldwide since the 1960s. It is currently a health and economic problem for the different health systems. Dermoscopy is a non-invasive in vivo diagnostic technique, developed to study skin lesions. It improves the diagnostic accuracy of hyperpigmented lesions, as well as an early diagnosis of potentially malignant lesions, especially melanoma. The time spent on physical examination is not significantly increased. New applications have currently been discovered for this technique. Dermoscopy requires a learning process. Due to the complexity of the topic, the text has been divided into 2 parts to try to simplify its presentation. This first part will focus on the more technical aspects and the characteristics of the device called dermoscope. In the second part, 2 diagnostical methods will be presented along with their easy interpretation and usefulness in Primary Care.

[Chikungunya, an emerging viral disease. Proposal of an algorithm for its clinical management]. / Chikungunya, una enfermedad vírica emergente. Propuesta de un algoritmo de manejo clínico.

Chikungunya fever (CHIK) is an emerging viral disease. It is caused by the Chikungunya virus, an alphavirus from the Togaviridae family. It is transmitted to humans by the bite of infected mosquitoes, mainly Aedes aegypti and Aedes albopictus. They are also involved in the transmission of dengue, malaria, etc. CHIK is now endemic in any region of Africa and Southeast-Asia. Cases of CHIK have been reported in America, the Caribbean, and Europe (France, Italy and Spain). There are reservoirs of these mosquitoes in some regions of Spain (Catalonia, Alicante, Murcia and Balearic islands). CHIK is characterized by a sudden high and debilitating fever, and severe or disabling symmetrical arthralgia. It tends to improve in days or weeks. There are severe and chronic forms of CHIK. There is no specific treatment or prophylaxis for CHIK. An algorithm is proposed for the clinical management of CHIK based in the latest guidelines.

[Klippel-Feil syndrome, a rare cervicalgia]. / Síndrome de Klippel-Feil, una cervicalgia poco frecuente.

Cervicalgia is defined as the presence of pain in the neck region, and can radiate to the shoulders, upper limbs or back. It is a source of frequent visits to Primary Care, and more than half of the general population will suffer neck pain at some point in their life. Klippel-Feil syndrome is an exceptional cause of cervicalgia. It belongs to the group of so-called malformations of the hold-down skull-cervical congenital disease. Klippel-Feil syndrome is a complex disease entity characterized by the fusion of two or more vertebrae, and may also be associated with other bone and visceral disorders. The characteristic clinical triad consists of short-neck, implantation below the hair in the occipital region, and limitation of cervical mobility. However, this clinical picture is present in less than 50% of these patients.

[Candida esophagitis in an immunocompetent women. A case report]. / Esofagitis candidiásica en una paciente inmunocompetente. A propósito de un caso.

Candida esophagitis (CE) is one of the invasive infections caused by Candida albicans (CA). Its prevalence diagnosed by upper endoscopy ranges between 0.77-2.4%. Its main cause is CA. CE more often affects immunocompromised people, however it may affect healthy people too. CE requires systemic antifungal therapy. We report a case of a CE in a healthy woman who presented good response to prescribed treatment. Omeprazole might be involved in the development of her CE.