A retrospective, observational multicenter study of 141 patients treated with ustekinumab 90 mg.

A change of pricing policy in Spain have made both doses of ustekinumab (UST), 45 and 90 mg, recently available at the same price. Our primary objective was to evaluate effectiveness of UST 90 mg at 52 and 104 weeks in psoriasis patients in clinical practice; secondary objectives were to study the reasons for using this dose and to delineate its efficacy in patients previously treated with anti-IL17 drugs. 91.8% of the 141 patients treated with UST 90 started with 45 mg and later increased their dose. Clinicians changed dose due to weight over 100 kg in 20.6% of the cases and all the other dose changes were off-label to improve partial cutaneous or articular response or due to a previous failure of anti-IL17 therapy. After 12 months of UST 90 treatment, absolute PASI was lower than 3 in 87.5% of patients and lower than 1 in 72.2%. Efficacy data were even better for patients with body mass index (BMI) <25. UST 90 can be effective in patients with previous use of anti-IL17 drugs. It appears to be an alternative treatment option not only for high BMI patients, but also to increase the cutaneous or articular efficacy of the drug in patients with normal BMI.

Nevus-associated melanoma: An observational retrospective study of 22 patients evaluated with dermoscopy and reflectance confocal microscopy.

BACKGROUND: The frequency of nevus-associated melanoma (NAM) has been estimated to be 29% of diagnosed melanomas. MATERIALS AND METHODS: This is an observational retrospective study of 22 cases of NAM diagnosed in the Universitary Hospital Alcorcón between September 2011 and 2018. The main objective was to analyze dermoscopic and RCM features of NAM. We also studied if there was an association between any dermoscopic or RCM parameter and Breslow depth. RESULTS: The most frequent dermoscopic characteristics were multicomponent pattern (50%), multifocal pigmentation (45.5%), atypical network (59.1%), and blue-gray regression structures (77.3%). RCM evidenced pagetoid cells in 95.5% melanomas (abundant in 59.1%), non-edged dermal papillae in 86.4%, atypical cells at the dermal-epidermal junction in 90.9%, and atypical junctional nesting in 81.8%. Deeper Breslow index was associated with red color (mean Breslow 0.65 vs 0.37 in melanomas without red, P = 0.035), shiny white streaks (0.85 vs 0.38, P = 0.041), abundant pagetoid cells (0.68 vs 0.26, P = 0.017), and non-edged papillae (0.59 vs 0.00, P = 0.014). CONCLUSION: RCM is a valuable tool for diagnosing NAM. Even it is very difficult to differentiate NAM from DNM both with dermoscopy and RCM, RCM can help us to detect remnants of a preexisting nevus and estimate Breslow depth.

Laser therapy for hair removal on grafts and flaps.

The diversity and utility of laser procedures have increased over the recent years and nowadays, applications for medical and cosmetic reasons have increased considerably. Problematic intraoral and cutaneous hirsutisms have been described as a consequence of complex reconstruction usually after oncology surgery. We present three patients in whom hair removal laser was performed on grafts and flaps in different compromised anatomical areas: oral cavity, penis, and auricular pavilion. All three patients were men; in two of them the hairy graft was a consequence after oncologic surgery reconstruction whereas the third patient presented hair in his auricular pavilion after cochlear implant due to a congenital ear malformation. In all the patients, neodymium:yttrium, aluminum, garnet laser (Nd:YAG) (1,064 nm) laser was performed with excellent aesthetic and functional outcomes with only three sessions. Hair removal laser is a well-accepted and effective method of achieving permanent decrease in hair density. Several lasers have been used successfully, including the long-pulse Alexandrite (755 nm), the long-pulse diode (810 nm), and the Nd:YAG laser (1,064 nm). There is currently no standard protocol for laser use on hairy grafts or flaps and there is limited published data regarding skin graft revision to enhance aesthetics and function.

Key dermoscopic signs in the diagnosis and progression of extrafacial lentigo maligna: Evaluation of a series of 41 cases.

BACKGROUND/OBJECTIVES: Lentigo maligna is usually located on the face. Extrafacial lentigo maligna is less common, and diagnosis of early forms is very difficult. Confocal microscopy of facial and extrafacial lentigo maligna shares the same features (abundant dendritic cells and generalised atypical junctional thickenings) and helps us to identify the dermoscopic features of extrafacial lentigo maligna. METHODS: We analysed dermoscopic and clinical features of 41 lesions diagnosed by confocal microscopy of extrafacial lentigo maligna confirmed on histology to identify dermoscopic signs of early lesions. RESULTS: Erased areas on dermoscopy were the clue to diagnose early lesions. At the borders of these areas, very small, round or triangular structures were found. At the lesion periphery, dermoscopy revealed a fine reticular pattern that helped to identify them as a melanocytic lesion. A progressive increase of the number and size of erased areas was accompanied by the appearance of various angulated structures around them (angulated lines, zig-zag structures or polygonal structures). Analysis of invasive lesions revealed very large erased areas containing white lines and atypical vascularisation. CONCLUSIONS: We have identified the dermoscopic early features and signs of progression by examining the dermoscopic and reflectance confocal microscopy findings of early and invasive extrafacial lentigo maligna.

Reaccion acneiforme noduloquistica secundaria a vemurafenib con buena respuesta a isotretinoina oralSevere acneiform eruption associated with vemurafenib with response to isotretinoin.

Vemurafenib, a kinase inhibitor that targets tumors with the BRAF V600E mutation, is a promising option for unresectable or metastatic melanoma. Cutaneous side-effects have been reported including alopecia, photosensitivity, squamous cell carcinoma, keratoacanthomas, keratosis pilaris-like eruption, and palmoplantar hyperkeratosis. Acneiform eruptions have been reported in 3%-6% of the patients treated with BRAF inhibitors,and 5 cases are described in the literature. Although they responded well to topical therapies, oral antibiotics, or observation, one case required oral etretinate and the withdrawal of vemurafenib because the adverse event reached grade 3. We report one case of a severe acneiform eruption associated with vemurafenib with a good response to isotretinoin allowing continuation of the BRAF inhibitor.

Cutaneous infection due to Mycobacterium immunogenum: an European case report and review of the literature.

(no more than 200 words): In the last few years, the incidence of cutaneous infections caused by nontuberculous mycobacteria is increasing. Since Mycobacterium immunogenum was first described in 2001, few case reports have been described, all of them in the American continent. We report a case with cutaneous infection caused by this newly discovered NTB in Europe.A 65-year-old woman presented with a 3-months history of pruritic lesions on abdomen. Examination revealed erythematous inflammatory papules, pustules, and crusts. Three weeks later, mycobacteria were cultured from the biopsy specimen. Mycobacterium immunogenum was identified based on susceptibility test results and polymerase chain reaction (PCR) restriction enzyme analysis. Treatment with clarithromycin was started. M. immunogenum is a nontuberculous mycobacterium that was first described by Wilson et al. in 2001 as a rapidly growing variety and new species in the Mycobacterium chelonae-Mycobacterium abscessus group. PCR-restriction analysis of a 439-bp segment of the hsp65 gene and/or sequencing the species-specific region of the 16S rDNA can confirm this new species. Since the description of M. immunogenum, 8 clinical case reports have been published, most involving cutaneous infections and all of them in the American continent. We present a case of cutaneous infection caused by M. immunogenum in a Spanish woman.

A case of de novo palmoplantar psoriasis with psoriatic arthritis and autoimmune hypothyroidism after receiving nivolumab therapy.

Nivolumab, a monoclonal antibody against the programmed cell death protein 1 (PD-1), has shown promising results in patients with advanced malignancies, including melanoma, lung cancer, and renal cancer. Immune-related adverse events (irAEs) have been reported, including both organ-specific toxicities and skin toxicities. Herein, we report a case of predominantly palmoplantar psoriasis with severe nail involvement, psoriatic arthritis, and autoimmune hypothyroidism after receiving nivolumab treatment for lung cancer. We also summarize the case reports that have been published previously. The knowledge of these irAEs in patients undergoing anti-PD1 therapy is important since it will enable earlier recognition and appropriate management, with the aim of maintaining effective dose without disruption.

Trends in orthopaedic surgery for spondyloarthritis: outcomes from a National Hospitalised Patient Registry (MBDS) over a 17-year period (1999-2015).TREND-EspA study.

OBJECTIVE: To assess the incidence of orthopaedic surgery (OS) (including total hip arthroplasty (THA), total knee arthroplasty, upper limb arthroplasty, arthrodesis and spinal surgery) and associated trends in patients with spondyloarthritis (SpA) over a long period (17 years). METHODS: An observational, retrospective, population-based, serial cross-sectional study was conducted. All hospital admissions of patients with SpA reported between 1999 and 2015 were analysed, and a control group was selected and matched by age, sex and year of admission. Incidence rates for OS (and subtypes) were calculated. Generalised linear models were used to analyse trends; unconditional logistic regression models were used to calculate crude and adjusted ORs (aORs) with the aim of evaluating the association between OS and SpA. RESULTS: The study database contained data on 214 280 hospital admissions (SpA/non-SpA 1:1 ratio). In the SpA cohort, 5 382 admissions (5.02%) had undergone OS compared with 3 533 in the non-SpA cohort (3.29%) (AOR 1.64; 95% CI 1.57 to 1.72). OS rates increased for both cohorts (+4.92% per year vs +8.41%). The trend in OS, THA, arthrodesis and spinal surgery decreased or stabilised in patients under age 60 in the SpA cohort, while the non-SpA cohort remained stable. In the SpA cohort, the mean age was 53.68 years (SD 13.65) in 1999, increasing to 62.76 years (SD 12.74) in 2015. In the non-SpA cohort, the mean age remained stable at around 63 years. CONCLUSIONS: A 9-year difference in the age of patients undergoing OS was observed in patients with SpA. The incidence of OS, THA and arthrodesis decreased in patients under age 60, and the incidence of spinal surgery decreased in patients under age 40. Our findings suggest that these patients are increasingly able to defer surgical interventions.

Trends in amyloidosis in spondyloarthritis: results from the Spanish National Inpatient Registry over a 17-year period (1999-2015)-TREND-EspA study.

OBJECTIVE: To assess the incidence of amyloidosis and trends therein in patients with spondyloarthritis (SpA) over a long period (17 years). METHODS: An observational retrospective population-based matched cohort study was conducted. All the admissions of patients with SpA, including ankylosing spondylitis (AS), psoriatic arthritis (PsA), arthritis associated with inflammatory bowel disease (SpA-IBD) and reactive arthritis (ReA), reported between 1999 and 2015, were analysed and a control group matched by age, sex and year of admission was selected. Incidence rates for amyloidosis were calculated. Generalised linear models were used for trend analysis and unconditional logistic regression for calculating crude and adjusted ORs (AOR) to assess the association between amyloidosis and SpA. RESULTS: The study database contained data on 107 140 admissions in each group. Between 1999 and 2015, 792 patients in the SpA cohort (0.7% of all admissions) had a diagnosis of amyloidosis versus 68 in the non-SpA cohort (0.1%) (p<0.001). From 1999 to 2015, incidence rates of amyloidosis tended to decrease in the SpA cohort (-4.63%/year overall), while they increased in the Non-SpA cohort (+10.25%/year overall). We found strong associations of amyloidosis with all SpAs (AOR 10.4; 95% CI 8.2 to 13.3) and with each type studied (AORs 10.05 (7.84 to 12. 88) for AS, 9.5 (7.3 to 12.4) for PsA, 22.9 (16.6 to 31.7) for SpA-IBD and 10.1 (6.1 to 16.7) for ReA). CONCLUSIONS: Incidence of amyloidosis among patients with SpA has strongly decreased in Spain. Amyloidosis is most strongly associated with SpA-IBD while the strength of association with PsA and ReA is similar to that with AS.

Lengua en pradera segada: una manifestación de la sífilis secundaria / Mowed-meadow pattern of the tongue: A sign of secondary syphilis

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Fat necrosis and subcutaneous abscesses due to apomorphine / Necrosis grasa y abscesos subcutáneos por apomorfina

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Kaposi sarcoma in an immunosuppressed young woman / Sarcoma de Kaposi en una mujer joven inmunocomprometida

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