Nuevas perspectivas en el tratamiento de la alopecia androgenética / New Perspectives on the Treatment of Androgenetic Alopecia

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Encuesta a dermatólogos sobre terapia biológica en pacientes con psoriasis moderada-grave en España / Opinion of Spanish Dermatologists Regarding the Use of Biologic Therapy in Patients With Moderate to Severe Psoriasis

Introducción y objetivos: La terapia biológica ha supuesto un importante avance en el tratamiento de la psoriasis moderada-grave, pero su manejo depende de las características del paciente y del criterio del dermatólogo. El objetivo de esta encuesta fue conocer los criterios utilizados por los dermatólogos para la elección de estos tratamientos. Método: Estudio transversal mediante encuesta a dermatólogos con experiencia en psoriasis moderada-grave en España. La encuesta constó de 31 ítems distribuidos en 5 secciones: perfil del investigador, manejo de la enfermedad, tratamiento de la psoriasis moderada-grave, uso de fármacos biológicos y valoración de estos. Resultados: Participaron 190 dermatólogos con experiencia en el manejo de fármacos biológicos en psoriasis. En opinión de los participantes, el 31% de los pacientes con psoriasis moderada-grave que está en tratamiento activo utiliza algún fármaco biológico. De estos el 28% en algún momento del tratamiento necesita un cambio de principio activo, motivado principalmente por falta de actividad o aparición de alguna reacción adversa. La administración de los fármacos biológicos sería en monoterapia en el 73% de los casos. Un 53-59% de los dermatólogos administra estos fármacos en tratamiento continuo. Las propiedades farmacológicas mejor valoradas por los dermatólogos fueron: seguridad (4,8 puntos; IC 95%: 4,7-4,9), eficacia a largo plazo (4,6; IC 95% 4,5-4,7) y tolerabilidad (4,5; IC 95%: 4,4-4,6). Conclusiones: Los dermatólogos con experiencia en fármacos biológicos utilizan esta opción terapéutica en algo más de la cuarta parte de los pacientes con psoriasis moderada-grave. En su opinión, el biológico de elección debería ser, por este orden: seguro, eficaz a largo plazo y bien tolerado (AU)

Background and objectives: Biologic therapy has represented a major advance in the treatment of moderate to severe psoriasis but its use depends upon the characteristics of the patient and the criteria applied by the dermatologist. The aim of this survey was to determine the criteria employed by dermatologists in the decision to use these drugs. Methods: A cross-sectional survey was undertaken among Spanish dermatologists with experience in the treatment of moderate to severe psoriasis. The survey comprised 31 items distributed in 5 sections: investigator profile, disease management, treatment of moderate to severe psoriasis, use of biologic drugs, and evaluation of the use of biologic drugs for the treatment of moderate to severe psoriasis. Results: One hundred-ninety dermatologists were included in the study. The study participants reported that 31% of patients receiving treatment for moderate to severe psoriasis are treated with biologic drugs. Of those, 28% require a change in treatment at some point due either to lack of activity or the appearance of side effects. Biologic drugs would be administered as monotherapy in 73% of cases. In between 53% and 59% of cases, biologic drugs would be prescribed as continuous treatments. On a scale of 1 to 5, the most valued pharmacological properties by dermatologists were safety (4.8 points; 95% confidence interval [CI], 4.7-4.9), long-term efficacy (4.6 points [4.5-4.7]), and tolerance (4.5 [4.4-4.6]). Conclusions: Dermatologists with experience in the use of biologic drugs employ this treatment option in slightly more than a quarter of cases of moderate to severe psoriasis. In their opinion, the choice of biologic drug should be based on, in order of importance, safety, long-term efficacy, and tolerance (AU)

[Opinion of Spanish dermatologists regarding the use of biologic therapy in patients with moderate to severe psoriasis]. / Encuesta a dermatólogos sobre terapia biológica en pacientes con psoriasis moderada-grave en España.

BACKGROUND AND OBJECTIVES: Biologic therapy has represented a major advance in the treatment of moderate to severe psoriasis but its use depends upon the characteristics of the patient and the criteria applied by the dermatologist. The aim of this survey was to determine the criteria employed by dermatologists in the decision to use these drugs. METHODS: A cross-sectional survey was undertaken among Spanish dermatologists with experience in the treatment of moderate to severe psoriasis. The survey comprised 31 items distributed in 5 sections: investigator profile, disease management, treatment of moderate to severe psoriasis, use of biologic drugs, and evaluation of the use of biologic drugs for the treatment of moderate to severe psoriasis. RESULTS: One hundred-ninety dermatologists were included in the study. The study participants reported that 31% of patients receiving treatment for moderate to severe psoriasis are treated with biologic drugs. Of those, 28% require a change in treatment at some point due either to lack of activity or the appearance of side effects. Biologic drugs would be administered as monotherapy in 73% of cases. In between 53% and 59% of cases, biologic drugs would be prescribed as continuous treatments. On a scale of 1 to 5, the most valued pharmacological properties by dermatologists were safety (4.8 points; 95% confidence interval [CI], 4.7-4.9), long-term efficacy (4.6 points [4.5-4.7]), and tolerance (4.5 [4.4-4.6]). CONCLUSIONS: Dermatologists with experience in the use of biologic drugs employ this treatment option in slightly more than a quarter of cases of moderate to severe psoriasis. In their opinion, the choice of biologic drug should be based on, in order of importance, safety, long-term efficacy, and tolerance.

Erupción vesiculosa intermitente en un niño / Intermittent vesiculous eruption in a child

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Noncoherent-intense-pulsed light for the treatment of relapsing hairy intradermal melanocytic nevus after shave excision.

BACKGROUND AND OBJECTIVE: Few reports about melanocytic lesions treatment by means of noncoherent-intense-pulsed light (NCIPL) have been published. Here we evaluate the clinical results of a relapsing hairy intradermal melanocytic nevus treated with a noncoherent-intense-pulsed light source. STUDY DESIGN/MATERIALS AND METHODS: A facial repigmented hairy intradermal melanocytic nevus that relapsed after shave excision, received four treatment sessions of a noncoherent-intense-pulsed light source (EpiLight, ESC Medical Systems Ltd, Israel) with the following parameters: 755 nm, a fluence energy of 40-42.5 J/cm(2), triple mode, a pulse width of 3.8 ms, and a delay of 20 ms, at 4-week intervals. RESULTS: Complete pigment clearance and hair removal was obtained. We have neither observed repigmentation nor hair regrowth after a 6 month-follow-up. No side effects were documented. CONCLUSIONS: Noncoherent-intense-pulse light is an effective treatment for hairy-pigmented melanocytic nevus.

Intense pulsed light for melanocytic lesions.

BACKGROUND: Few reports about melanocytic lesion treatment using intense pulsed light have been published. OBJECTIVES: To evaluate the clinical results of diverse melanocytic lesions after treatment with an intense pulsed light source. METHODS: Superficial and deep melanocytic lesions were treated by an intense pulsed light source with the following parameters: filters of 590, 615, and 755 nm, a fluence energy of 34-38 J/cm2, double mode, a pulse width of 3.8-4.5 msec, and a delay of 20 msec, at 4- to 8-week intervals. Two treatment sessions were applied to superficial lesions, while deep ones received four. RESULTS: A clearance of 76-100% (excellent) was obtained for superficial lesions such as ephelides, epidermal melasma, and café au lait macules. Nevus spilus showed good clinical clearance (51-75%); however, deep lesions such as nevus of Becker, epidermal nevus, and mixed melasma showed an average clearance of less than 25%. Postinflammatory hyperpigmentation was observed in melasma. CONCLUSION: Intense pulsed light is an effective treatment for superficial melanocytic lesions; however, those with a deep component improve only if repetitive treatment sessions are applied.

Early effects of exogenous arginine after the implantation of prosthetic material into the rat abdominal wall.

We have investigated the effects of high arginine (Arg) levels (7.5 mg/100 g body weight per hour) on the early integration of biocompatible mesh grafts into the rat abdominal wall. Studies were performed over implantation intervals of 6, 12, 24 or 48 hours (n=12, each). Arginine and related compounds were quantified in plasma, wound fluids and multiple tissues. Plasma nitric oxide (NO) production was studied. Strips were taken from the polypropylene fiber-host tissue interfaces (PTIs) for optical microscopic analysis and for immunohistochemical analysis using rat-specific antibodies against type I and type III collagens. Exogenous Arg was metabolized at the peripheral tissues but reliably reached the wound space. High amounts of Arg and ornithine (Orn) were detected in the specimens considered. No changes on citrulline (Ctr) or NO concentrations were observed, overall suggesting that, during the period studied, the arginase pathway predominated. The acute scarring response differed significantly in the two placements considered. The P-SS interface evidenced more extensive new tissue growth than the P-DS interface. Forty-eight hours after mesh implantation cellular infiltration, fibroblast proliferation, and mesh-surrounding angiogenesis were higher in the arginine-treated rats. Type III collagen staining was related to arginine treatment, being higher (++) in the study group. In conclusion, and independently of the site of mesh placement, supplemental Arg seemed to favorably affect early local collagen deposition. This could be potentially helpful to ameliorate the integration of biomaterials into the tissues and, consequently, to allow for the design of more selective therapeutic strategies to prevent hernia recurrence rates.

Corrective photoepilation for improper hairline placement after hair transplantation.

BACKGROUND: Noncoherent filtered flashlamp pulsed light has not been used for correction of surgical problems after hair transplantation. OBJECTIVE: To evaluate the clinical results of photoepilation in a patient with improper hairline placement after hair transplantation. METHODS: A noncoherent filtered flashlamp pulsed light source was used to photoepilate the misplaced frontal hairline in a 37-year-old Caucasian man, skin phototype IV (Fitzpatrick scale), who suffered from common baldness grade IV (Ebling scale) and had undergone a hair transplant 6 years before. The frontal hairline received three treatment sessions at 2-month intervals with the following treatment parameters: 695 nm cutoff filter, fluence 38 J/cm2, 3.5-msec pulse duration, triple-pulse mode, and 30-msec delay. The gulfs received two treatment sessions with the same protocol. RESULTS: Final clinical aspect was good and no hair regrowth in the frontal hairline has been observed after 1.5 years of follow-up. CONCLUSION: Noncoherent filtered flashlamp pulsed light is a novel therapeutic choice that offers a nonsurgical solution to unnatural hairline after hair transplantation.

Small bowel enema in non-responsive coeliac disease.

A small bowel enema was performed in patients with non-responsive coeliac disease, in coeliac patients on a normal diet (untreated) and those who had shown a good response to a gluten free diet, and in control subjects to determine whether there were any specific radiological features of the non-responsive state. A significant reduction in the average number of jejunal folds and an increase in the number of ileal folds (reversal of the jejunoileal fold pattern) was found in eight of nine non-responsive coeliac patients, one of seven untreated coeliac patients, and in none of the good responders or control subjects. This pattern identifies coeliac patients with a poor response to a gluten free diet who are likely to suffer major complications.

[Clinical trial of a topical preparation containing urea, sunflower oil, evening primrose oil, wheat germ oil and sodium pyruvate, in several hyperkeratotic skin conditions]. / Ensayo clínico de un preparado tópico conteniendo: urea, aceite de Helianthus annuus, aceite de Oenothera biennis, aceite de germen de trigo y piruvato sódico, sobre diversos procesos cutáneos hiperqueratósicos.

A topical clinical trial with preparations containing urea and sodium pyruvate has been made. It was used for diverse hyperkeratotic skin conditions (psoriasis, xerosis, pityriasis rubra pilaris, stuccokeratosis, seborrheic dermatitis, stasis dermatitis, pityriasis lichenoides chronica). A month later a clinical improvement was evident in all cases except in pityriasis lichenoides.

Variables in the preparation of the large intestine for double contrast barium enema examination.

This study examines which methods are most appropriate for preparation of the large bowel for double contrast barium enema. Two proprietary laxatives, X-Prep and Picolax, mechanical colonic lavage, and dietary restriction were evaluated in a randomised study of 160 patients. Four alternative preparations were compared with or without dietary restriction. The four preparations were X-Prep alone, X-Prep plus lavage, Picolax alone, and Picolax plus lavage. Scoring of the radiographs was carried out on a double blind basis. Picolax proved superior to X-Prep overall (p less than 0.01) but this was almost entirely because of its greater effect in the right colon and transverse colon. Cleansing in the left colon and rectosigmoid was similar with both laxatives. Restriction of solid food improved bowel cleansing and gave better results than mechanical lavage. The addition of a colonic lavage in starved patients did not significantly improve the quality of bowel preparation with either laxative.