Sequential use with imiquimod and surgery in extramammary Paget's disease.

Extramammary Paget's disease is an uncommon intraepithelial adenocarcinoma which occurs in areas rich in apocrine glands. Although surgery is the treatment of choice, numerous noninvasive treatments have been tried. There are studies that have demonstrated the efficacy of imiquimod to treat Extramammary Paget's disease, but we found no mention in the literature of its use as neoadjuvant therapy previous to surgery excision. We present a case of a large plaque of extramammary Paget's disease successfully treated with imiquimod and minor surgery of the residual disease.

Multicenter case-control study of risk factors for cutaneous melanoma in Valencia, Spain.

INTRODUCTION: It is important to identify subgroups within the general population that have an elevated risk of developing cutaneous melanoma because preventive and early-detection measures are useful in this setting. The findings of most studies that have evaluated risk factors for cutaneous melanoma are of limited application in Spain because the populations studied have different pigmentary traits and are subject to different environmental factors. OBJECTIVE: To identify the phenotypic characteristics and amount of exposure to sunlight that constitute risk factors for cutaneous melanoma in the population of the Autonomous Community of Valencia, Spain. METHODS: We performed a multicenter observational case-control study. In total, the study included 242 patients with melanoma undergoing treatment in 5 hospitals and 173 controls enrolled from among the companions of the patients between January 2007 and June 2008. The information was collected by means of a standardized, validated questionnaire. The odds ratio (OR) was calculated for each variable and adjusted using a multiple logistic regression model. RESULTS: The risk factors found to be statistically significant were skin phototypes I and II, blond or red hair, light eye color, abundant melanocytic nevi, and a personal history of actinic keratosis or nonmelanoma skin cancer. After the multivariate analysis, only blond or red hair (OR=1.9), multiple melanocytic nevi (OR=3.1), skin phototypes i and ii (OR=2.1), and a personal history of actinic keratosis (OR=3.5) or nonmelanoma skin cancer (OR=8.1) maintained significance in the model as independent predictive variables for melanoma. CONCLUSIONS: Our study supports the importance of certain factors that indicate genetic predisposition (hair color and skin phototype) and environmental factors associated with exposure to sunlight. Patients with multiple acquired melanocytic nevi and patients with markers of chronic skin sun damage (actinic keratosis and nonmelanoma cancer) presented a significant increase in risk.

Effects of flavonoids and other polyphenols on inflammation.

Flavonoids are a family of polyphenolic compounds which are widespread in nature (vegetables) and are consumed as part of the human diet in significant amounts. There are other types of polyphenols, including, for example, tannins and resveratrol. Flavonoids and related polyphenolic compounds have significant antiinflammatory activity, among others. This short review summarizes the current knowledge on the effects of flavonoids and related polyphenolic compounds on inflammation, with a focus on structural requirements, the mechanisms involved, and pharmacokinetic considerations. Different molecular (cyclooxygenase, lipoxygenase) and cellular targets (macrophages, lymphocytes, epithelial cells, endothelium) have been identified. In addition, many flavonoids display significant antioxidant/radical scavenging properties. There is substantial structural variation in these compounds, which is bound to have an impact on their biological profile, and specifically on their effects on inflammatory conditions. However, in general terms there is substantial consistency in the effects of these compounds despite considerable structural variations. The mechanisms have been studied mainly in myeloid cells, where the predominant effect is an inhibition of NF-κB signaling and the downregulation of the expression of proinflammatory markers. At present there is a gap in knowledge of in vitro and in vivo effects, although the pharmacokinetics of flavonoids has advanced considerably in the last decade. Many flavonoids have been studied for their intestinal antiinflammatory activity which is only logical, since the gastrointestinal tract is naturally exposed to them. However, their potential therapeutic application in inflammation is not restricted to this organ and extends to other sites and conditions, including arthritis, asthma, encephalomyelitis, and atherosclerosis, among others.

[Combined therapy with etanercept and systemic drugs or phototherapy]. / Terapia combinada con etanercept y fármacos sistémicos o fototerapia.

Biological therapy has been shown to have a very satisfactory antipsoriasic effect. However, this response is not always achieved in all the patients and may be insufficient for others. Thus, strategies have recently been designed, among which the use of combined therapies with biological and systemic drugs or phototherapy have been designed. In this work, we have reviewed the combined therapy with etanercept, systemic drugs and phototherapy and present the case of a patient with psoriasis treated with etanercept and narrow band UVB.

Prevalencia de lactancia materna y factores asociados a su abandono en un área del centro-norte de España / Prevalence of breastfeeding and factors associated with cessation in an area of north-central Spain

Introducción. La lactancia materna (LM) es el alimento idóneo para el recién nacido y el lactante. El objetivo del estudio fue estimar la prevalencia y duración de la LM e identificar los factores relacionados con su abandono. Pacientes y métodos. Estudio observacional prospectivo, realizado en el Área de Salud Valladolid-Este, situada en el norte de España, que incluyó recién nacidos atendidos en la maternidad de un hospital de tercer nivel entre octubre de 2015 y febrero de 2016. Se excluyeron aquellos recién nacidos que precisaron ingreso hospitalario. Se llevaron a cabo encuestas a las madres al alta de maternidad y seguimiento mediante entrevistas telefónicas durante 2 años, realizadas a los 6, 12, 18 y 24 meses postparto, recogiéndose información sobre el tipo de alimentación de los recién nacidos, datos sociodemográficos, gestacionales y perinatales. Se realizó análisis de regresión de Cox, univariante y multivariante. Resultados. Se incluyeron 223 recién nacidos, 201 (90,1%) recibían LM al alta de maternidad (71,3% LM exclusiva y 18,8% lactancia mixta). La prevalencia de LM fue del 51,7% a los 6 meses, del 21,4% a los 12 meses y del 3% a los 24 meses. Los factores de riesgo relacionados con el abandono de la LM fueron: no haber amamantado previamente (HR 1,65; IC95% 1,13-2,42) o haber amamantado menos de 3 meses (HR 4,81; IC95% 2,32-9,25), tabaquismo materno gestacional (HR 2,57; IC95% 1,59-4,1), cesárea programada (HR 1,79; IC95% 1,08-2,98) y peso del recién nacido menor de 2.800 g (HR 1,57; IC95% 1,02-2,43). Conclusiones. La tasa de LM al alta de maternidad es similar a la de otros estudios nacionales. Se identificaron varios factores implicados en su abandono, hallazgos relevantes para diseñar estrategias de apoyo que permitan incentivar su continuidad (AU)

Background. Breastfeeding (BF) is the optimal way to nourish newborns and infants, due to the multiple benefits it offers. The aim of this study was to estimate the prevalence and incidence of breastfeeding and identify the risk factors related with breastfeeding weaning. Methods. A prospective, observational study was performed on healthy newborns in the area of Valladolid-East, Spain, between October 2015 and February 2016. Questionnaires were completed by mothers at discharge from maternity and and follow-up through telephone interviews for 2 years, carried out at 6, 12, 18 and 24 months postpartum. Sociodemographic variables, gestational, perinatal and breastfeeding data were collected. Univariate and multivariate Cox regression analysis were performed. Results. A total of 223 newborns were included. At hospital discharge, 201 newborns (90.1%) received breastfeeding (71.3% exclusive breastfeeding and 18.8% partial breastfeeding). At 6 months, prevalence of breastfeeding was 51.7%, 21.4% at 12 months and 3% at 24 months. Risk factors for stopping breastfeeding were: not having previously breastfed (HR 1.65; IC95% 1.13-2.42) or previous breastfeeding less than 3 months (HR 4.81; IC95% 2.32-9.25), tobacco consumption during gestation (HR 2.57; IC95% 1.59-4.1), C-section without delivery work (HR 1.79; IC95% 1.08-2.98) and birthweight below 2,800 g (HR 1.57; IC95% 1.02-2.43). Conclusions. The rate of initiation of breastfeeding is similar to that of other national studies. Several risk factors related to the cessation of breastfeeding were identified. This is an important finding so as to design support strategies that will promote the maintenance of breastfeeding (AU)

The bisphosphonate alendronate improves the damage associated with trinitrobenzenesulfonic acid-induced colitis in rats.

BACKGROUND AND PURPOSE: The nitrogen-containing bisphosphonates are drugs used successfully in the treatment of osteoporosis. They act inhibiting farnesyl diphosphate synthase. This mechanism may also produce anti-inflammatory effects. The therapeutic activity of alendronate was tested in vivo using a model of inflammatory bowel disease. EXPERIMENTAL APPROACH: The trinitrobenzenesulfonic acid model of colitis in the rat was used. Rats were treated orally with alendronate and its efficacy compared with that of oral sulphasalazine or vehicle, starting 2 h after colitis induction. The status of the animals was assessed 5 days later. KEY RESULTS: Alendronate treatment (25 or 75 mg kg(-1) day(-1)) resulted in a decrease in the colonic damage score and loss of body weight (at 25 mg kg(-1) day(-1) only). This was associated to a dramatic reduction in the mRNA levels of interleukin 1 beta (IL-1 beta), monocyte chemoattractant protein 1 (MCP-1) and interleukin 1 receptor antagonist (IL-1 ra). The magnitude of the beneficial effect was comparable to that of sulphasalazine (at a 6-20 fold higher dose). Thus sulphasalazine post-treatment reduced the mRNA levels of IL-1 beta/IL-1 ra and MCP-1 to the same extent as alendronate and additionally lowered colonic alkaline phosphatase activity, but failed to affect body weight loss or colonic damage score. Alendronate failed to exert beneficial effects when administered intraperitoneally. CONCLUSIONS AND IMPLICATIONS: Oral but not intraperitoneal alendronate significantly protected the colon in experimental rat colitis. Inflammatory bowel disease patients might benefit from exposure to oral alendronate.

Experimental inflammation of the rat distal colon inhibits ion secretion in the proximal colon by affecting the enteric nervous system.

Intestinal inflammation causes hyporesponsiveness of the inflamed tissue to secretagogues but little is known about the behaviour of the areas proximal to the site of inflammation. We studied the responses of the proximal segment of the colon to carbachol, histamine, isobutylmethylxanthine (IBMX) and vasoactive intestinal peptide (VIP) in rats with trinitrobenzenesulphonic acid (TNBS)-induced, chronic inflammation of the distal colon. Macroscopic and biochemical analysis ruled out the presence of inflammation in the proximal colon. When mounted in Ussing chambers under voltage-clamp conditions, basal transport and conductance were not affected. However, the maximum response in the concentration/response curves (short-circuit current) for carbachol and histamine was reduced in TNBS-treated rats, without changes in the EC(50). This effect corresponded to reduced chloride secretion, as demonstrated by ion substitution experiments. The responses to IBMX and VIP were virtually unaffected. The inhibitory effect was abolished by pretreatment with the neural blockers tetrodotoxin and lidocaine but not indomethacin, suggesting that the enteric nervous system is responsible for the inhibition. In conclusion, chronic distal inflammation of the distal colon results in inhibition of calcium-dependent secretion in the proximal colon via a reduction of the contribution of the enteric nervous system.

Mortalidad e ingresos hospitalarios por violencia de los menores de 15 años en la Comunidad Valenciana (2007-2011) / Mortality and hospital admissions by violence among children under 15 years in the Valencian Autonomous Community (2007-2011)

Introducción: la violencia contra la infancia jamás es justificable y puede prevenirse actuando sobre los desencadenantes de comportamientos violentos. Conocer su magnitud y características posibilita emprender cambios que contribuyan a reducir su frecuencia y gravedad. Métodos: se analiza la mortalidad y los ingresos hospitalarios por violencia en menores de 15 años en el periodo 2007-2011 en la Comunitat Valenciana. Resultados: se contabilizaron 12 defunciones y 156 ingresos. Murieron tres veces más niños que niñas. Los fallecimientos fueron más frecuentes en los menores de un año, seguido del grupo de 10-14 años. Los seis casos de suicidio ocurrieron en el grupo de 10-14 años y los métodos utilizados fueron: ahorcamiento, estrangulamiento o sofocación y saltar desde lugar elevado. Los homicidios fueron el doble en niños y niñas de 0-9 años. Ingresaron por violencia dos veces más las niñas, siete veces más en el grupo de 10-14 años, tres veces más los extranjeros, dos veces más los residentes en medio rural y dos veces más si tenían riesgo de exclusión social, siendo estas diferencias estadísticamente significativas. Los ingresos por violencia autoinfligida fueron el doble (intento de suicidio) que por agresiones. Conclusiones: el número de casos es de gran importancia epidemiológica y de salud pública. En la violencia contra la infancia se manifiestan los ejes de desigualdad en salud y la necesidad de mejorar la declaración y la coordinación de todos los ámbitos de la atención a los menores. Es relevante relacionar las distintas fuentes de información, devolverla a los profesionales y formarlos (AU)

Introduction: violence against children is never justifiable and can be prevented by acting on the factors that trigger violent behaviors. Knowing the magnitude and nature of violence against children allows us to undertake the changes that will contribute to reduce their frequency and severity. Methods: in this paper, mortality and hospital admissions due to violence among children under 15 years from 2007 to 2011 in the Valencian Autonomous Community is analysed. Results: 12 deaths and 156 hospital admissions were registered. Boys' deaths were three times as frequent as those of girls. The deaths were more frequent in children under one year, followed by 10-14 years. The six cases of suicide occurred in the group of 10-14 years and the methods used were: hanging, strangulation or suffocation; and jumping from a high place. There were twice as many killings in children of 0-9 years. Girls were hospitalized due to violence twice as often as boys. Hospital admissions were 7 times as high in the group of 10-14 years, 3 times as high in foreigners, twice as high in residents in rural areas and twice as high if there was a risk of social exclusion, with these differences being statistically significant. Hospital admissions from self-inflicted violence were twice as high (attempted suicide with drugs) as those caused by assault (beating, stabbing and rape). Conclusions: the number of cases found is numerically small but of great epidemiological and public health significance. Axes of inequality in health due to violence in childhood are highlighted as well as the need of improving the notification of cases and the coordination in all areas related to childcare. Linking information sources and returning the information to professionals is relevant as well as training them (AU)

Flavonoids exert distinct modulatory actions on cyclooxygenase 2 and NF-kappaB in an intestinal epithelial cell line (IEC18).

BACKGROUND AND PURPOSE: Cyclooxygenase 2 (COX-2) is involved in inflammatory bowel disease, but the effect of flavonoids at the intestinal epithelial level is unknown. We aimed to characterize the effect and structure-activity relationship of nine selected flavonoids on COX-2 expression in intestinal epithelial cell (IEC)18 cells. We also investigated the signal transduction pathway(s) responsible for the effects observed. EXPERIMENTAL APPROACH: Intestinal epithelial cell 18, a non-tumour cell line with intestinal epithelial phenotype, was used. COX-2 was measured by Western blot and the involvement of the NF-kappaB pathway assessed by Western blot, pharmacological inhibition, luciferase reporter assays and nuclear translocation experiments. KEY RESULTS: The effect of flavonoids on COX-2 expression depended on the experimental conditions tested [non-stimulated and lipopolysaccharide (LPS)-stimulated]. Flavonoids caused an increase in COX-2 expression and NF-kappaB-dependent gene transcription under basal conditions. Conversely, under LPS stimulation flavonoids increased, decreased or did not affect COX-2 levels depending on the specific type. Variable effects were observed on extracellular signal regulated kinase/p38/c-Jun N-terminal kinase phosphorylation and p50/65 nuclear translocation. CONCLUSION AND IMPLICATIONS: The effect of flavonoids on COX-2 expression depended on the balance of the interference with IkappaB-alpha phosphorylation and other signalling targets, and therefore depends on the experimental conditions and on the type of flavonoids. This is expected to result in different effects in inflammatory conditions. In general, flavonoids may limit epithelial COX-2 expression in inflammatory conditions while favouring it when inflammation is not present.

[Severe adult atopic dermatitis: treatment with mycophenolate mofetil in 8 patients]. / Tratamiento de la dermatitis atópica grave del adulto con mofetil micofenolato en 8 pacientes.

BACKGROUND: Atopic dermatitis (AD) includes severe forms that can be refractory to various systemic treatments. Mycophenolate mofetil (MMF) has been found to be useful in patients with severe forms of AD and to have fewer side effects than long-term treatment with oral corticosteroids or cyclosporine. OBJECTIVES: To evaluate the efficacy and adverse effects of MMF in patients seen in our skin allergy unit with severe adult AD refractory to other systemic treatments. METHODS: We performed a retrospective study of 8 patients with severe adult AD treated with MMF, analyzing the baseline characteristics, previous treatments used by the patients, and the outcome and adverse effects of treatment with MMF. RESULTS: Five patients treated with MMF showed improvement in the fourth week of treatment. In addition, 5 of the 8 patients presented a clear, long-term improvement in their disease. Remission of AD occurred in 1 patient, making it possible to discontinue MMF; this patient remains stable with no relapses after 4 months without treatment. The other 4 patients continue on maintenance therapy. Three patients continued to have frequent acute outbreaks of AD despite treatment with MMF for 16 to 72 weeks. All patients tolerated the treatment and there were few adverse effects. CONCLUSIONS: MMF can be an effective option in selected patients with severe forms of atopic dermatitis. Although the response is not as rapid as with oral corticosteroids or cyclosporine, it can be used for maintenance treatment with good clinical control and few adverse effects.

[Allergic contact dermatitis due to corticosteroids: a 3-year retrospective study in a hospital skin allergy unit]. / Dermatitis de contacto por corticoides: estudio retrospectivo de 3 años en una unidad de alergia cutánea hospitalaria.

BACKGROUND: Corticosteroid contact dermatitis and its patch testing are subject to certain peculiarities that we should be aware of. MATERIALS AND METHODS: We performed a retrospective study of all patients who underwent patch tests with a corticosteroid battery in the Skin Allergy Unit of the Dermatology Department of Hospital General Universitario, Alicante, Spain, between October 2004 and June 2007. RESULTS: During the study period, patch tests were performed on 1065 patients in our allergy unit. A corticosteroid battery was used in 34 patients (3.1 %). Fourteen patients were positive for budesonide or tixocortol in the standard battery; 20 were negative for these allergens but there was a clinical suspicion of steroid allergy. At least one positive reaction in the corticosteroid battery was observed in 15 patients (44.1 %). The substance most commonly implicated was budesonide (13 patients sensitized). The corticosteroid battery revealed sensitization to other groups of corticosteroids in 4 of the 15 patients with corticosteroid sensitization. Seventeen patients brought drugs that were also tested, obtaining positive results for 10 substances. CONCLUSIONS: Allergens for contact dermatitis due to corticosteroids included in the standard battery (budesonide and tixocortol) detected 93 % of patients who are sensitized to steroids; there would appear to be little benefit in performing a corticosteroid battery if those markers are negative. The battery of corticosteroids and the drugs provided by patients were useful to define more exactly the corticosteroid classes that the patient should avoid.

Revisión bibliográfica de Implantología Bucofacial delaño 2008. Primera parte / Bibliographic review of the Oral Implantology of 2008 year. First part

La actividad asistencial de los profesionales de la Odontología tiene como consecuencia una baja disponibilidad de tiempo para dedicarse a la lectura de artículos científicos. Ante la dificultad de mantener un buen nivel de información en el campo de la Implantología Bucofacial, nuestro intereses exponer de forma sintética una revisión de la literatura científica publicada en las revistas más relevantes de la especialidad durante el año 2008. El lector interesado encontrará en este artículo algunos de los diferentes temas que integran esta disciplina, expuestos por apartados (plan de tratamiento, pacientes especiales, diseño y superficies, regeneración ósea, regeneración tisular guiada, carga inmediata, pacientes irradiados, implantes extraorales) (AU)

The lack of the available time of professionals involved in the Odontologic field and the difficulty to maintain a good level of information about Oral Implantology, arouse the interest of these authors to expose a synthetic review of 2008 publications in the most relevant dental journals. Inside this article there are different aspects related to treatment planning, special patients, design and surfaces, immediate load, guided bone regeneration, guided tissue regeneration, radiotherapy and extraoral implants (AU)

Improved method for quantifying vitamin D in proprietary infants' formulas and in breast milk.

In this new method for quantifying vitamin D in infants' formulas and breast milk, after repeated lipid extraction, samples are further purified by passage through Sep-Pak cartridges, followed by liquid chromatography, then quantified by competitive protein-binding assay. Analytical recovery is estimated by use of added 3H-labeled vitamin D. For repeated assays of a reconstituted proprietary powdered milk formula in two runs, the intra-assay vitamin D values were 9.0 (SD 1.4) (n = 6) and 8.9 (SD 1.6) micrograms/L (n = 7) (t = 0.07). Assay of a proprietary liquid formula yielded values of 14.9 (SD 0.9) micrograms/L (n = 6). For each, the results agreed with the vitamin D content shown on the label. Vitamin D concentrations in breast milk from two groups of lactating mothers of different social class and nutritional status were 2.3 (SD 1.4) (n = 7) and 2.0 (SD 1.7) micrograms/L (n = 7). Overall recoveries ranged from 65 to 75%. Only 2 mL of milk is required, which facilitates sample collection, and the assay is less time-consuming than other current methods.

Enfermedad de Fox-Fordyce con presentación clínica atípica / Fox-Fordyce Disease With an Atypical Clinical Presentation

No disponible

Estudio multicéntrico de casos y controles sobre factores de riesgo de desarrollar un melanoma cutáneo en la Comunidad Valenciana / Multicenter Case-Control Study of Risk Factors for Cutaneous Melanoma in Valencia, Spain

Introducción: En la población general es importante identificar aquellos subgrupos con un riesgo elevado de padecer un melanoma cutáneo, por la posibilidad de aplicar medidas preventivas y de detección temprana de la enfermedad. La mayoría de los estudios realizados que evalúan estos factores de riesgo tienen una aplicabilidad limitada en nuestro medio, debido a que las poblaciones estudiadas están sometidas a distintos factores ambientales y los rasgos pigmentarios son diferentes. Objetivos: Identificar qué características fenotípicas individuales y relacionadas con la exposición solar son factores de riesgo para desarrollar un melanoma cutáneo en la población de la Comunidad Valenciana. Métodos: Realizamos un estudio multiinstitucional observacional de casos y controles. Fueron incluidos 242 casos de melanoma incidentes tratados en 5 hospitales, y 173 controles recogidos entre los acompañantes de los pacientes entre enero de 2007 y junio de 2008. La información fue recogida mediante un cuestionario estandarizado y validado. Fue calculada la odds ratio (OR) para cada variable y ajustada mediante regresión logística múltiple. Resultados: Los fototipos I-II, el color de pelo rubio o pelirrojo, el color de ojos claro, la presencia de abundantes nevos melanocíticos y los antecedentes personales de queratosis actínicas o de cáncer cutáneo no melanoma fueron los factores de riesgo estadísticamente significativos. Tras el estudio multivariado solo el color de pelo rubio o pelirrojo (OR=1,9), la presencia de múltiples nevos melanocíticos (OR=3,1), los fototipos I-II (OR=2,1) y los antecedentes personales de queratosis actínicas (OR=3,5) o de cáncer cutáneo no melanoma (OR=8,1) se mantuvieron en el modelo como las variables predictivas independientes relacionadas con el desarrollo de melanoma. Conclusiones: Nuestro estudio apoya la importancia de una serie de factores que indican predisposición genética (color de pelo y fototipo) y ambientales relacionados con la exposición solar. Los pacientes con múltiples nevos melanocíticos adquiridos, y también aquellos con marcadores de daño solar crónico (queratosis actínicas y cáncer cutáneo no melanoma), presentaron un significativo aumento del riesgo (AU)

Introduction: It is important to identify subgroups within the general population that have an elevated risk of developing cutaneous melanoma because preventive and early-detection measures are useful in this setting. The findings of most studies that have evaluated risk factors for cutaneous melanoma are of limited application in Spain because the populations studied have different pigmentary traits and are subject to different environmental factors. Objective: To identify the phenotypic characteristics and amount of exposure to sunlight that constitute risk factors for cutaneous melanoma in the population of the Autonomous Community of Valencia, Spain. Methods: We performed a multicenter observational case-control study. In total, the study included 242 patients with melanoma undergoing treatment in 5 hospitals and 173 controls enrolled from among the companions of the patients between January 2007 and June 2008.The information was collected by means of a standardized, validated questionnaire. The odds ratio (OR) was calculated for each variable and adjusted using a multiple logistic regressionmodel. Results: The risk factors found to be statistically significant were skin phototypes I and II, blondor red hair, light eye color, abundant melanocytic nevi, and a personal history of actinic keratosisor nonmelanoma skin cancer. After the multivariate analysis, only blond or red hair (OR = 1.9), multiple melanocytic nevi (OR = 3.1), skin phototypes I and II (OR = 2.1), and a personal history of actinic keratosis (OR = 3.5) or nonmelanoma skin cancer (OR = 8.1) maintained significance in the model as independent predictive variables for melanoma. Conclusions: Our study supports the importance of certain factors that indicate genetic predisposition(hair color and skin phototype) and environmental factors associated with exposure to sunlight. Patients with multiple acquired melanocytic nevi and patients with markers of chronic skin sun damage (actinic keratosis and nonmelanoma cancer) presented a significant increase in risk (AU)

Terapia combinada con etanercept y fármacos sistémicos o fototerapia / Combined therapy with etanercept and systemic drugs or phototherapy

La terapia biológica ha mostrado un efecto antipsoriásico muy satisfactorio; sin embargo, dicha respuesta no siempre se alcanza en todos los pacientes y además puede no resultar suficiente para otros. Por ello, recientemente se han diseñado estrategias entre las que destaca el uso de terapias combinadas con fármacos biológicos y sistémicos o la fototerapia. En este trabajo revisamos la terapia combinada con etanercept, fármacos sistémicos y fototerapia, y presentamos un paciente con psoriasis tratado con etanercept y UVB-BE (AU)

Biological therapy has been shown to have a very satisfactory antipsoriasic effect. However, this response is not always achieved in all the patients and may be insufficient for others. Thus, strategies have recently been designed, among which the use of combined therapies with biological and systemic drugs or phototherapy have been designed. In this work, we have reviewed the combined therapy with etanercept, systemic drugs and phototherapy and present the case of a patient with psoriasis treated with etanercept and narrow band UVB (AU)