Efficacy of photobiomodulation therapy combined with mobile health education in patients with head and neck cancer suffering from chronic xerostomia after radiotherapy: protocol for a three-arm, randomised, placebo-controlled, double-blinded study.

INTRODUCTION: The role of photobiomodulation (PBM) therapy for oral tissue damage induced by cancer treatment is currently unclear, and there is low-quality to moderate-quality evidence supporting the use of this approach for treating xerostomia and/or hyposalivation. Consequently, patients with head and neck cancer increasingly turn to basic oral hygiene to alleviate salivary gland dysfunction, and their adherence can be improved by mobile health (mHealth) education. The primary objective of this study will be to analyse the effects of different doses of PBM therapy (7.5 J/cm2 vs 3 J/cm2) plus mHealth education on quality of life (QoL), oral health, salivary secretion and salivary gland ultrasound assessment at postintervention and at the 6-month follow-up in patients with head and neck cancer after radiotherapy compared with those in control group. METHODS AND ANALYSIS: A prospective, three-arm, randomised, placebo-controlled, double-blinded study will be conducted among patients with head and neck cancer suffering from chronic xerostomia. A total of 20 patients per arm will be included and randomly assigned to receive 7.5 J/cm2 of PBM, 3 J/cm2 of PBM or placebo therapy. PBM therapy will be applied during 24 sessions at 22 points extra and intraorally two times per week for 3 months, combined with a mobile application (https://www.laxer.es). The assessments will be recorded at the beginning of the study, at postintervention and at the 6-month follow-up. The primary outcomes will be QoL, oral health, salivary secretion and salivary gland ultrasound. The pain pressure threshold, functional performance, mood and sleep quality will be secondary indicators. ETHICS AND DISSEMINATION: This study received ethics approval from the Andalusian Biomedical Research Ethics Portal (2402-N-21 CEIM/CEI Provincial de Granada) according to the Declaration of Helsinki for Biomedical Research. The results of this study will be presented at national and international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT05106608.

Histological Changes Related to Symptomatic Improvement of Spontaneous Keloids Treated with a Low-Dosage Regimen of UVA-1 Phototherapy.

Keloids are a difficult-to-treat disease characterized by an imbalance in mechanisms of tissue reparation. We present the case of a middle-aged woman with spontaneous keloids which histologically and clinically improved after UVA-1 phototherapy treatment. There are few reported cases of keloids treated with high doses of UVA-1 phototherapy. We used a low-dosage regimen with a good response in only one cycle, which could diminish the risk of skin cancer development.

Successful treatment of erythematous-squamous disorders of the external auditory canal with tacrolimus and clotrimazole in otic oil: Our experience in 25 patients.

The external auditory canal (EAC) comprises a special area where erythematous-scaly diseases are located. Among the main dermatoses that can affect EAC seborrheic dermatitis, psoriasis, irritant or allergic contact dermatitis, chronic external otitis (atrial eczematoid dermatitis) and cutaneous lupus should be considered. In this study, 25 consecutive patients were recruited on our dermatological outpatient clinic, 9 men and 16 women, with a clinical diagnosis of localized erythematous-squamous dermatoses in EAC. The mean age was 48.8 years (16-83). The mean time of evolution of the dermatoses was 11.44 months (2-36). Regarding the diagnosis, 14 patients were diagnosed with seborrheic dermatitis (56%), 9 patients with psoriasis (36%), 1 patient with subacute cutaneous lupus (4%), and 1 patient with allergic contact dermatitis to corticosteroids (4%). The indicated treatment was tacrolimus 0.1% and clotrimazole 1% in otic oil, twice a day, for 1 month. The EAC had to be cleaned initially with saline solution impregnated on a swab from the ears. The IGA score and pruritus showed a high results, with important improvement of almost all patients. The satisfaction of the patients obtained with the TSQM-9 questionnaire was 95.2. Retreatment showed an equal efficacy observed during the first treatment period. The efficacy and the absence of side effects with the treatment make this magistral formula an adequate therapeutic option for these dermatoses.

PDT and BF-200 ALA: The therapy option for the treatment of Poikiloderma of Civatte.

Poikiloderma is a chronic skin condition affecting middle-age men and women that comprises cutaneous atrophy, telangiectasias, and changes in the pigmentation of the skin usually of mottled appearance (both hyper- and hypopigmentation). There is no specific medical treatment for Poikiloderma of Civatte (PC), but the use of photoprotector/sunscreen + SPF 50 to avoid prolonged sun exposure is highly recommended in these patients. Some authors recommend the use of topical corticoids in early stages; however, the results have not been satisfactory. Multiple topical (retinoids, dimethyl sulfoxide, or calcineurin inhibitors), systemic (cyclophosphamide), and physical (dermabrasion, phototherapy, and fractional photothermolysis) treatments have been described with unequal and inconsistent responses or unsatisfactory. This report underlies the combination of BF-200 ALA and photodynamic therapy (PDT) with positive results at the clinical level: significant improvement of pigmentary changes and telangiectasias after two PDT sessions.

Apremilast, más allá de la psoriasis como diana terapéutica / Apremilast, beyond psoriasis as a therapeutic target

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Efficacy and cost of etanercept in long-term psoriasis: Rational use in clinical practice.

INTRODUCTION: The advent of the biological therapies has led health expenditure in dermatology units. This study aims to evaluate, in our regular clinical practice, the patterns of use of etanercept and its influence on efficacy and safety outcomes, as well as the real costs associated with continuous and intermittent treatment regimens. METHODS: Observational, retrospective, non-interventionist, and multicenter study to analyze the experience of the treatment with etanercept in the management of moderate-to-severe plaque psoriasis, given according to the daily clinical practice of the Dermatology Departments of the Complejo Hospitalario de Jaén and the Hospital Universitario Virgen del Rocío (Seville). RESULTS: 83.3% (n = 45) of the 54 patients included in our study received the continuous regimen of Etanercept, whereas 16.7% (n = 9) were given the intermittent regimen. 94.4% (n = 51) of the patients studied began the Etanercept treatment at a dose of 50 mg/week. The mean patient/year cost of the study population is €11 298.80 (95%CI €10 551.40-€12 046.20). Breaking down the first and the second year of treatment by regimen, in the continuous regimen the mean cost would be €12 294.15 and €12 327.05 in the first and the second year, respectively, and €10 302.07 and €4986.51 in the intermittent regimen. DISCUSSION: Etanercept is a biologic that had demonstrated its versatility over the years and permits the individualization of treatment in our patients, thus having a direct impact on drug-related costs. This is well demonstrated in our series, where 94.4% of our patients begin with the dose of 50 mg/d. Our study yields relatively higher figures in patients on continuous therapy, with 77.1% of them maintaining PASI75 at week 24. CONCLUSIONS: We present our experience in regular clinical practice with etanercept, showing it to be an effective, safe, and versatile drug that permits patient-tailored treatment, delivering a frankly satisfactory control of our psoriasis patients.

Resultados del uso de etanercept en pacientes con psoriasis / Results from the use of etanercept in psoriatic patients

La psoriasis es una enfermedad crónica, inflamatoria, mediada inmunológicamente, con una considerable repercusión en la calidad de vida de los pacientes. Su importancia, además, está dada, entre otros factores, por su elevada prevalencia en la población. Los avances en el conocimiento de la inmunopatología de esta enfermedad y de la biología molecular han permitido el desarrollo de nuevos fármacos que representan una nueva forma de abordar la situación de estos pacientes, y que se encuadran en la denominada terapia biológica. El etanercept se empleó por primera vez en estudios clínicos con seres humanos en 1992 y ya son varios cientos de miles los enfermos tratados en todo el mundo por diferentes afecciones. Actualmente, la Agencia Europea de Evaluación de Medicamentos tiene aprobada la indicación de etanercept en las siguientes enfermedades: 1. Psoriasis en placa en adultos (“adultos con psoriasis en placa, de moderada a grave, que no han respondido o que tienen contraindicada, o no toleran, otra terapia sistémica incluyendo ciclosporina, metotrexato o PUVA”); 2. Psoriasis pediátrica grave en placa. 3. Artritis psoriásica; 4. Artritis reumatoidea; 5. Artritis idiopática juvenil poliarticular; 6. Espondilitis anquilosante. Su utilización en la psoriasis, ya bien conocida, ha hecho que poco a poco empiecen a surgir cuestiones sobre su manejo en situaciones especiales que requieren tener en cuenta las particularidades de su aplicación (lactancia, vacunaciones, infecciones) que abordaremos en este trabajo...

Leishmaniasis cutánea crónica: respuesta a n-metil glucamina intralesional tras fracaso con paramomicina tópica / Chronic cutaneous leishmaniasis: response to intralesional n-metil glucamine after failure with topical paramomycin

La leishmaniasis cutánea es una de las causas más importantes de úlcera cutánea crónica en el litoral mediterráneo. Presentamos el caso de una mujer de 87 años que consulta por la aparición de una lesión en frente de 8 meses de evolución clínicamente sugerente de eccema que en el estudio histológico demostró que se trataba de una leishmaniasis. Se trató sin éxito primero con rifampicina y posteriormente con paramomicina tópica al 15%, por lo que se aplicó n-metil glucamina intralesional, obteniéndose la curación a los 2 meses. El tratamiento de elección de la leishmaniasis cutánea son los antimoniales pentavalentes (vía parenteral o intralesional). Se discute la eficacia del tratamiento tópico con paromomicina al 15% (AU)