Sensitive Scalp: Diagnosis and Practical Management. / Cuero cabelludo sensible: diagnóstico y manejo práctico.

Sensitive scalp is sensitive skin located on the scalp. Sensitivity is considered primary in the absence of an associated scalp disorder and secondary when caused by conditions such as psoriasis, seborrheic dermatitis, and atopic dermatitis. The clinical manifestations of primary sensitive scalp are subjective. Common presenting symptoms are burning, itching, trichodynia, and dysesthesia, often coinciding with hair loss. Clinically, the skin appears normal or red. An objective diagnosis based on laboratory or histologic findings is not possible. Triggers may be endogenous (e.g., stress and emotional or psychopathological disturbances) or exogeneous (e.g., topical products and cosmetics). Treatment must be individualized. Options include pimecrolimus, hydration with hyaluronic acid, and mesotherapy with plasma rich in growth factors.

Alopecia femenina y sistemas de integración capilar: estudio de la repercusión psicológica / Alopecia female hair integration system: a study of the psychological impact

Fundamento: Es sabido que la alopecia femenina provoca una intensa repercusión en el psiquismo. Sin embargo, no existen estudios que calibren los cambios que puedan producirse en el mismo, cuando el aspecto de la paciente mejora gracias a la implantación de un Sistema de Integración Capilar. Un Sistema de Integración Capilar (SIC) es una prótesis parcial de cabello, de carácter semipermanente, personalizada, hecha a mano con pelos naturales de iguales características de color, grosor y textura al cabello del paciente, que se ajusta a la porción del cuero cabelludo carente de pelo y que se integra, sin intervención quirúrgica, cabello a cabello ocultando las zonas afectadas y creando una apariencia homogénea. El objetivo de este trabajo es conocer en qué medida la implantación del SIC mejora el estado psicológico de las pacientes que sufren alopecia de diferentes tipos. Material y método: Se estudió en 24 mujeres con alopecia moderada-grave de diferentes tipos que acudieron de forma sucesiva al Instituto Médico Dermatológico (IMD) de Madrid (España) entre febrero y julio de 2011 para ser tratadas con SIC. Se completó el cuestionario Hospital Anxiety and Depression Scale (HADS) antes y 3 meses después de la implantación del SIC. Se comparó la evolución en el tiempo de los cuadros de ansiedad y depresión a través del test de McNemar como herramienta estadística. Resultados: Ansiedad: al inicio del estudio el 83,33% de las pacientes mostraban diferentes niveles de ansiedad. A los 3 meses de la (AU)

Rationale: It is well know that female alopecia has a severe psychological impact. However, there are no studies assessing the psychological changes that may occur when the patient’s image improves due to the implementation of a Hair Integration System (HIS). A HIS is a partial, personalized, semipermanent hair prosthesis made of natural hair with the same characteristics of color, thickness, and texture than the patient’s hair and that is adjusted to the portion of the scalp lacking the hair and that is integrated hair by hair without any surgical intervention, covering the areas affected and yielding a homogenous appearance. The aim of this work was to know to what extent the implantation of HIS improves the psychological status of patients suffering from different types of alopecia. Material and methods: We studied 24 women with severe to moderate alopecia of different types consecutively consulting to the Instituto Médico Dermatológico (IMD) of Madrid (Spain) between February and July of 2011 to be treated by HIS. The patients completed the Hospital Anxiety and Depression Scale (HADS) before and 3 months after the implantation of HIS. The time course of anxiety and depression disorders was compared by using the McNemar test. Results: Anxiety: at the study beginning, 83.33% of the patients showed different anxiety levels. Three months after the implantation of HIS, 74.99%of the patients showed a statistically significant improvement (p value < 0.01) in the anxiety status. Depression: at the study beginning, 66.67% of the patients showed depression signs. Three months after, the signs of depression were no longer existent in 100% of the patients. Conclusions: this study confirms that alopecia disorders have a negative psychological impact (anxiety, depression) in women. HIS is an efficacious tool for the cosmetic treatment of alopecia, with almost immediate positive psychological effects (AU)

Ustekinumab dentro de las terapéuticas hospitalarias / Ustekinumab within the hospital terapeutic

La incorporación de medicamentos a la práctica asistencial tiene repercusiones clínicas, organizativas y económicas. Es por tanto necesaria una evaluación previa basada en criterios de evidencia. En este artículo se analizará el caso de ustekinumab, fármaco biológico indicado para el tratamiento de lapsoriasis en placa de moderada a grave. En algunos hospitales está admitido como tratamiento de segunda línea en caso de falta de respuesta a agentes anti TNF, para lo que no existe ni se aporta ninguna justificación. La evaluación final acerca de la inclusión de ustekinumab en la farmacia del hospital es responsabilidad de la Comisión de Farmacia y Terapéutica del mismo, pero la puesta a disposición de los datos pertinentes a la Comisión, es responsabilidad del médico peticionario, que es quien mejor conoce el fármaco en cuestión. Ustekinumab es un anticuerpo monoclonal que actúa sobre una nueva diana terapéutica, las interleucinas 12 y 23, con un rápido inicio de acción, eficaz a corto plazo, que además se mantiene al cabo de tres años y con unas tasas de efectos adversos similar a la esperada en los pacientes tratados con placebo. No está contraindicado en la insuficiencia cardiaca congestiva moderada o grave (NYHA III/IV) ni en enfermedad desmielinizante, a diferencia de los fármacos antiTNF indicados en el tratamiento de la psoriasis. Destaca como principal ventaja de este medicamento la comodidad posológica en comparación con cualquier otro tratamiento. Todo esto sugiere que ustekinumab es un agente terapéutico importante en el tratamiento de los pacientes con psoriasis. Por razones éticas y de equidad, todos los agentes biológicos aprobados para el tratamiento de la psoriasis deben estar disponibles para todos los pacientes candidatos a tratamiento, sin limitaciones de cualquier tipo que puedan implicar una desigualdad para el paciente, lo que justifica la elaboración de este trabajo (AU)

The incorporation of drugs to clinical practice has numerous economic, clinical and administration consequences. Thus, before starting any treatment it is necessary a preliminary evaluation of the drug according to evidence-based medicine criteria. The present article discusses the main characteristics of ustekinumab, a biologic drug prescribed for the treatment of moderate to severe plaque psoriasis. Although there is no justification for this strategy a number of hospitals use this agent as second-line treatment in anti-TNF monoclonal antibody unresponsive patients. The responsibility to include ustekinumab in the hospital pharmacy belongs to the Pharmacy and Therapeutics Committee. However, the person who knows best the drug is the referring clinician and in turn he is the responsible of making the relevant data available to the committee. Ustekinumab is a monoclonal antibody that specifically targets the cytokines interleukin 12 (IL-12) and interleukin 23 (IL-23). The main advantages of ustekinumab are its rapid onset of action and short-term clinical effectiveness. The effect of ustekinumab can be found three years after the end of treatment and the rates of adverse effects of ustekinumab are similar to placebo. Compared to other prescribed medications to treat psoriasis, as antiTNF, it is not contraindicated in patients with moderate or severe congestive heart failure (NYHA III/IV) neither in demyelinating diseases. The main advantage of ustekinumab is its easy administration and dosage in comparison with other treatments. For all this reasons, ustekinumab is a usefull therapeutic agent for the treatment of patients with chronic plaque psoriasis. Due to ethical and equity reasons, all biologic agents that have been approved for the treatment of psoriasis must be available for all patients who are candidates for the treatment, without limitations that may involve inequality for the patient. This is the primary objective of this paper (AU)

[Sensitive skin: a complex syndrome]. / La piel sensible: un síndrome complejo.

Epidemiologic studies indicate that ever larger numbers of people report having sensitive skin, for which a European prevalence of 50% is estimated. Sensitive skin is characterized by hyperreactivity, with manifestations varying in relation to many factors. The pathogenesis of this disorder is poorly understood, although studies point to a biophysical mechanism. Objective diagnosis of sensitive skin is difficult, as information comes mainly from the patient's report of symptoms in the absence of effective, strongly predictive tests because of great interindividual variability in skin sensitivity. Substances that trigger a reaction in hypersensitive skin also vary greatly. The impact of this syndrome on quality of life is considerable and patients often present psychiatric symptoms; therefore, dermatologists should explore this possibility when taking a patient's history. Patient cooperation and physician persistence are both essential for treating sensitive skin.