Percepción del médico y paciente de la gravedad de la psoriasis, su impacto en la calidad de vida y satisfacción con la atención y el tratamiento recibido. Estudio observacional en España / Physician and Patient Perception of Disease Severity, Quality of Life, and Treatment Satisfaction in Psoriasis: An Observational Study in Spain

Introducción: El objetivo de este estudio fue evaluar el impacto de la psoriasis en la calidad de vida del paciente, las diferencias entre médicos y pacientes en las percepciones sobre la calidad de vida, los tratamientos y las necesidades de los pacientes y la relación médico-paciente. Material y métodos: Estudio observacional, multicéntrico, de corte transversal, en el cual un grupo de dermatólogos representativos de toda la geografía española, con ejercicio tanto en el ámbito hospitalario como ambulatorio, y de pacientes con diagnóstico de psoriasis, cumplimentaron una encuesta especialmente diseñada para el estudio. La encuesta incluía preguntas sobre datos demográficos del paciente, características de la enfermedad, impacto de esta sobre la calidad de vida, manejo terapéutico de la psoriasis y relación paciente-dermatólogo. Resultados: Un total de 151 dermatólogos de toda España incluyeron una media de 5 pacientes cada uno. Se incluyeron en el análisis un total de 771 encuestas cumplimentadas por los dermatólogos y 732 encuestas cumplimentadas por los pacientes. Dos terceras partes de los pacientes presentaban una enfermedad moderada a grave con una importante repercusión en la calidad de vida, en especial sobre el estado emocional. No obstante, la calidad de vida sóloe ra evaluada de forma sistemática y rutinaria por el 19,9% de los dermatólogos. El 47% de los pacientes estaba muy satisfecho o bastante satisfecho con el tratamiento que recibía. No se encontraron diferencias relevantes entre las percepciones del paciente y del médico sobre los aspectos evaluados. Conclusiones: Nuestros resultados señalan el importante impacto que tiene la psoriasis sobre la calidad de vida del paciente y la necesidad de evaluar este parámetro de forma sistemática. Los pacientes refieren un buen grado de satisfacción con la atención recibida por los dermatólogos y los tratamientos administrados. Existe bastante concordancia entre los pacientes y los dermatólogos en la valoración de los parámetros evaluados (AU)

Objectives: The aims of this study were to determine the impact of psoriasis on patient quality of life, to analyze differences in perception between patients and physicians regarding quality of life, treatment satisfaction, and patient needs, and to assess the physician—patient relationship. Material and methods: A multicenter, observational, cross-sectional study was undertaken in which a representative group of dermatologists—–working in hospitals and outpatient clinics throughout Spain—–and their patients with a diagnosis of psoriasis completed specifically designed questionnaires. The questionnaires covered patient demographics, disease characteristics, impact of the disease on quality of life, treatment of psoriasis, and the relationship between patient and dermatologist. Results: A total of 151 dermatologists from throughout Spain included a mean of 5 patients each. The analysis included 771 questionnaires completed by dermatologists and 732 completed by patients. Two-thirds of patients had moderate-to-severe psoriasis with a major impact on quality of life, particularly in relation to emotional wellbeing. Nevertheless, quality of life was only assessed routinely and systematically by 19.9% of dermatologists. Overall, 47% of patients reported being quite satisfied or very satisfied with the treatment they received. No significant differences were observed between patients and dermatologists on the aspects analyzed. Conclusions: Our results highlight the substantial impact of psoriasis on patient quality of life and the consequent need for systematic quality-of-life assessment in affected patients. Patients reported a high level of satisfaction with the care provided by dermatologists and the treatment received. There was good agreement between patients and dermatologists in their assessment of the variables analyzed (AU)

[Pulsed dye laser treatment for Jessner's lymphocytic infiltration of the skin]. / Infiltrat lymphocytaire de Jessner et Kanof traité par laser à colorant pulsé

BACKGROUND: Jessner's lymphocytic infiltration of the skin (LIS) is a chronic, benign T-cell infiltrative disorder, usually manifesting as erythematous papules or plaques on the face, neck and back. PATIENTS AND METHODS: five patients presented LIS with numerous skin lesions on the face and back characteristic of this disease. Histological examination showed a lymphocytic infiltrate in the dermis without any modification of the epidermis. Direct immunofluorescent study was negative in all cases. Response to dermocorticoids proved inconsistent or negative in all patients. An excellent outcome was achieved in all five patients with pulsed dye laser. In one case, further skin lesions appeared at 1 year and responded to the same treatment. Following a single treatment session with 6-8 J/cm(2), three of five patients showed normal skin. Regression occurred in the other two cases after two to three sessions. Pulsed dye laser appeared to be the best treatment for Jessner-Kanof disease for three patients at 4-8 years of follow-up. DISCUSSION: only one case of Jessner-Kanof disease treated by pulsed dye laser has been reported. Pulsed dye laser has been used in cutaneous lupus and annular granuloma. Selective photothermolysis allows photocoagulation of dilated vessels. CONCLUSION: pulsed dye laser at 595nm could offer a valuable therapeutic alternative, and even a first-line treatment with no side effects.

Narrowband UVB treatment of pigmented purpuric lichenoid dermatitis (Gougerot-Blum).

Pigmented purpuric dermatoses are a group of dermatoses characterized clinically by pinpoint petechia and purpura on a brown, red or yellow base. Five diseases are included in the group of pigmented purpuric eruptions which significantly overlap clinically and histologically. Phototherapy in various forms of purpuric dermatoses has been reported in literature previously. Here we present a case of pigmented purpuric lichenoid dermatitis which rapidly cleared with narrowband UVB therapy.

Grover's disease: 34 years on.

Grover's disease is an entity reported worldwide and recognized as a common disease since Grover first described it in 1970. Its cause remains obscure, but hospitalized, febrile and sun-damaged patients are particularly prone. It is frequently associated with some other skin diseases, including eczemas, psoriasis and solar keratoses. Acantholysis is the universal histological finding in all the varying clinical presentations. Treatment in the past has been ad hoc, but topical therapy, acitretin and phototherapy can suppress symptoms.

Mycosis fungoides presenting as Ofuji's papuloerythroderma.

We report three patients presented with clinical features of Ofuji's papuloerythroderma (pruritic erythematous papules and extensive erythema sparing all skin folds), however, showing histopathological findings of mycosis fungoides (Pautrier's microabscess, haloed lymphocytes, disproportionate epidermotropism, and wiry collagen bundles). One case was associated with plaque stage of mycosis fungoides and follicular mucinosis. T-cell receptor (TCR) gene rearrangement analysis in the lesional skin tissue demonstrated rearrangement of the gamma chain in all cases. HTLV-1 serology was negative for two patients who conducted HTLV-1 test. We think that Ofuji's papuloerythroderma might be a variant of early mycosis fungoides rather than secondary skin manifestations to certain cutaneous inflammatory diseases.

Generalized eruptive keratoacanthoma (Grzybowski variant).

We describe a patient with generalized eruptive keratoacanthoma (KA) of Grzybowski showing the characteristic features of this extremely rare condition. Since the first description by Grzybowski in 1950, only 28 additional cases (including the present one) have been reported. This variety of KA most commonly affects patients during the fifth to seventh decade of life and appears as a generalized eruption of hundreds to thousands of follicular papules. The small pruriginous papules often have a keratotic centre and show microscopic features of KA. Marked facial involvement is characteristic and can lead to masked facies with ectropion, as in our patient. The course of the disease is chronic and the response to therapy is poor.

Lichen amyloidosis presenting as a papular pruritus syndrome in a human-immunodeficiency-virus-infected man.

A human-immunodeficiency-virus (HIV)-positive man presented with pruritic erythematous and flesh-colored papules on his arms and trunk of 1 year's duration. The lesions had previously been treated with oral ketoconazole and topical emollients with no improvement. Microscopic evaluation of lesional skin from his left forearm showed lichen amyloidosis. The patient was started on ultraviolet B phototherapy which he received for 2 weeks without improvement. Lichen amyloidosis should be added to the differential diagnosis of papular pruritus syndrome in HIV-positive individuals.

Satisfactory remission achieved by PUVA therapy in Langerhans cell hisiocytosis in an elderly patient.

Langerhans cell histiocytosis is currently regarded as a reactive proliferative process of Langerhans cells rather than a malignancy. The disease is characterized by Langerhans cell infiltration of skin, lung, bone and other organs. We report a 74-year-old man with Langerhans cell histiocytosis who had generalized hemorrhagic and crusted papules. He also had diabetes insipidus. Because he did not have any severe constitutional symptoms or failure of vital organs, we applied topical PUVA treatment to his skin lesions, which responded well to the therapy. Diabetes insipidus, however, remained, in spite of X ray radiotherapy for the pituitary lesion.

Papuloerythroderma and cutaneous T cell lymphoma.

An 83-year-old man had the typical cutaneous features of papuloerythroderma of Ofuji. There were reduced numbers of lymphocytes and platelets in his peripheral blood but the eosinophil count was normal. Skin biopsy showed a nondiagnostic infiltrate of T lymphocytes in the dermis. Treatment with topical steroids and UVB phototherapy was ineffective. Twelve months after presentation, a further skin biopsy revealed atypical lymphoid cells invading the epidermis and the skin adnexae. A diagnosis of malignant lymphoma was made; no evidence of extracutaneous spread was found. Photochemotherapy produced rapid resolution of the skin eruption and clearance of the cutaneous infiltrate. Papuloerythroderma may be a manifestation of a cutaneous lymphoma.