Microbe-Dependent Induction of IL-9 by CLA+ T Cells in Psoriasis and Relationship with IL-17A.

IL-9 is present in psoriatic lesions and is produced by lymphocytes. However, it is not known whether this cytokine is induced by relevant pathogenic triggers of psoriasis, such as Streptococcus pyogenes. Here we addressed the production of IL-9 in response to various pathogens in a psoriatic ex vivo model. Extracts of S. pyogenes and Candida albicans triggered the production of IL-9 and also IL-17A and IFN-γ. This induction was dependent on the interaction between CLA+ T cells and epidermal cells. Neutralization of IL-9 reduced S. pyogenes-induced IL-17A production by CLA+ T cells but had no effect on IFN-γ production. Also, IL-9 increased the survival of circulating psoriatic CLA+ T cells. Co-cultures from patients with guttate or plaque psoriasis with S. pyogenes produced similar amounts of IL-9. High cytokine responses in streptococcal-driven guttate patients paralleled peaks in Psoriasis Area Severity Index and anti-streptolysin O levels. Our results confirm that IL-9 promotes inflammation in psoriasis by up-regulating IL-17A production and support the clinical association of the immune response by streptococcal-sensitized CLA+ T cells with this cytokine, especially in guttate psoriasis.

Vulvar Basal Cell Carcinoma: Four Case Reports With Immunohistochemical Study.

Basal cell carcinomas (BCC) are the most frequent tumours in humans and normally appear in photoexposed areas of the skin. It is widely accepted that BCCs originate at follicular stem cells and consequently are very rare in nonhairy areas. Here, we report 4 cases of vulvar BCC, 3 of which were located in a vulvar semimucous area, a nonphotoexposed area, and a nonhairy area. We have determined the CK7 and CK19 profile of all cases; both are markers of simple epithelium with glandular differentiation. Interestingly, all cases were positively stained for CK7 and CK19. Considering that the vulvar region is rich in sebaceous and apocrine units, we hypothesise a glandular origin of BCCs situated in the vulvar region.

Core Content for Undergraduate Medical Education in Spain: Recommendations of the Instructors' Group of the Spanish Academy of Dermatology and Venereology (AEDV).

BACKGROUND: Skin problems are among the most frequent reasons for seeking medical attention in primary care. In recent years, as a result of the process of adapting medical curricula to the requirements of the European Higher Education Area, the amount of time students spend learning the concepts of dermatology has been reduced in many universities. MATERIAL AND METHODS: In order to reach a consensus on core content for undergraduate education in dermatology, we sent a survey to the 57 members of the instructors' group of the Spanish Academy of Dermatology and Venereology (AEDV), asking their opinions on what objectives should be set for a dermatology course in Spain. A total of 131 previously selected objectives were listed. We then applied the Delphi method to achieve consensus on which ones the respondents considered important or very important (score≥4 on a Likert scale). RESULTS: Nineteen responses (33%) were received. On the second round of the Delphi process, 68 objectives achieved average scores of at least 4. The respondents emphasized that graduates should understand the structure and functions of the skin and know about bacterial, viral, and fungal skin infections, the most common sexually transmitted diseases (STDs), and the 4 main inflammatory dermatoses. Students should also learn about common complaints, such as itching and bald patches; the management of dermatologic emergencies; purpura and erythema nodosum as signs of internal disease; and the prevention of STDs and skin cancer. During clinical clerkships students should acquire the communication skills they will need to interview patients, write up a patient's medical history, and refer the patient to a specialist. CONCLUSIONS: The AEDV's group of instructors have defined their recommendations on the core content that medical faculties should adopt for the undergraduate subject of dermatology in Spain.

Evaluating clinical dermatology practice in medical undergraduates.

The acquisition of competences (the set of knowledge, skills and attitudes required to perform a job to a professional level) is considered a fundamental part of medical training. Dermatology competences should include, in addition to effective clinical interviewing and detailed descriptions of skin lesions, appropriate management (diagnosis, differentiation, and treatment) of common skin disorders and tumors. Such competences can only be acquired during hospital clerkships. As a way of certifying these competences, we propose evaluating the different components as follows: knowledge, via clinical examinations or critical incident discussions; communication and certain instrumental skills, via structured workplace observation and scoring using a set of indicators; and attitudes, via joint evaluation by staff familiar with the student.

Unilateral milia-type intradermal tophi associated with underlying urate subcutaneous deposition: an uncommon cutaneous presentation of gout.

Tophi develop during the most advanced clinical stage of gout, and are usually located on or around the joints. However, unusual skin features caused by intradermal and/or subcutaneous deposition of tophaceous material at locations other than articular regions have been reported. We present the case of a patient with a condition that has been recently termed 'miliarial gout'. which is only the second such case, to our knowledge. A 51-year-old woman, who had a chronic joint disease that had been diagnosed and treated as psoriatic arthritis, presented with multiple asymptomatic, yellowish-white, firm papules (1-3 mm in size) on erythematous areas on the outside of her left leg. On histological examination of a skin biopsy, uric acid crystals were seen in the dermis and subcutis. The patient also had a raised level of serum urate, consistent with a diagnosis of gout. Treatment with allopurinol led to rapid improvement. Intake of corticosteroids and diuretics was a possible triggering factor for the development of cutaneous tophi in this patient.

Guía para la compra de una cámara fotográfica para Dermatología / Guide to buying a camera for dermatological photography

La elección de una cámara fotográfica para su uso en Dermatología suele resultar un proceso difícil, tanto más si esta es digital, ya que el mercado evoluciona constantemente. En el presente artículo se enuncian y describen los parámetros en los que debemos basar nuestra elección y que incluyen el tipo de cámara, el sensor, el objetivo y su capacidad macro, el modo prioridad a la apertura, la pantalla, el visor, la velocidad de funcionamiento, el flash, la batería, la tarjeta y el formato de imagen. Se apuntan los últimos avances en el terreno de la fotografía digital que pueden tener utilidad en las cámaras de uso dermatológico (AU)

Choosing a camera for use in the dermatology office is difficult, particularly in the case of a digital camera because the market is constantly evolving. This article explains the features that should be taken into account, including camera type, sensor, lens and macro capability, aperture priority mode, screen, viewfinder, operating speed, flash, battery, memory card, and image format. The most recent advances in the field of digital photography relevant to the dermatologist are discussed (AU)

[Guide to buying a camera for dermatological photography]. / Guía para la compra de una cámara fotográfica para Dermatología.

Choosing a camera for use in the dermatology office is difficult, particularly in the case of a digital camera because the market is constantly evolving. This article explains the features that should be taken into account, including camera type, sensor, lens and macro capability, aperture priority mode, screen, viewfinder, operating speed, flash, battery, memory card, and image format. The most recent advances in the field of digital photography relevant to the dermatologist are discussed.

Tratamiento neoadyuvante con acitretino oral e imiquimod tópico en el carcinoma basocelular gigante / Oral Acitretin and Topical Imiquimod as Neoadjuvant Treatment for Giant Basal Cell Carcinoma

El carcinoma basocelular (CBC) gigante se define como aquel que mide 5cm o más. Aunque la cirugía se considera el tratamiento de elección para cualquier tipo de CBC, en los de gran tamaño, puede ser altamente destructiva. Así, utilizamos la combinación de acitretino oral e imiquimod 5% tópico como tratamiento neoadyuvante en dos pacientes afectos de un CBC gigante. El acitretino es un retinoide sistémico que se utiliza en la prevención primaria del cáncer cutáneo no melanoma. El imiquimod es un inmunomodulador aprobado para el tratamiento, entre otros, de CBC superficiales no faciales menores de 2cm. Estudios previos han demostrado una acción sinérgica anticarcinogénica de ambos fármacos, tanto in vivo como in vitro. Dicha combinación produjo en nuestros pacientes una gran reducción de la masa tumoral, lo que nos permitió aplicar posteriormente un tratamiento definitivo con la remisión completa de los CBC (AU)

Giant basal cell carcinoma (BCC) is defined as a tumor with a diameter of 5cm or more. Surgery, the treatment of choice for any type of BCC, can cause considerable anatomical damage in large tumors. In 2 patients with giant BCC we therefore provided neoadjuvant treatment with a combination of oral acitretin and topical 5% imiquimod. Acitretin is a systemic retinoid used for primary prevention of nonmelanoma skin cancer. Imiquimod is an immunomodulator whose approved indications include treatment of non facial superficial BCC less than 2cm in diameter. Previous studies have demonstrated a synergic anticancer effect of both drugs in vitro and in vivo. This combination produced a marked reduction in tumor mass in our patients. Later we were able to provide definitive treatment, which achieved complete remission of the tumors (AU)

[Oral acitretin and topical imiquimod as neoadjuvant treatment for giant basal cell carcinoma]. / Tratamiento neoadyuvante con acitretino oral e imiquimod tópico en el carcinoma basocelular gigante.

Giant basal cell carcinoma (BCC) is defined as a tumor with a diameter of 5 cm or more. Surgery, the treatment of choice for any type of BCC, can cause considerable anatomical damage in large tumors. In 2 patients with giant BCC we therefore provided neoadjuvant treatment with a combination of oral acitretin and topical 5% imiquimod. Acitretin is a systemic retinoid used for primary prevention of nonmelanoma skin cancer. Imiquimod is an immunomodulator whose approved indications include treatment of nonfacial superficial BCC less than 2 cm in diameter. Previous studies have demonstrated a synergic anticancer effect of both drugs in vitro and in vivo. This combination produced a marked reduction in tumor mass in our patients. Later we were able to provide definitive treatment, which achieved complete remission of the tumors.

[Portfolios: a tool for the training and assessment of residents in dermatology, part 2]. / El portafolio como herramienta de formación y evaluación de los residentes de dermatología (II).

A portfolio is a collection of material documenting reflection about practice. It contains documents (eg, case histories and questionnaires the resident has used), images, and video recordings that reveal that an individual has acquired the competencies needed for professional practice. This assessment tool simultaneously supports learning and provides evidence for certifying competence. The adoption of portfolio use by a dermatology department requires the support of both the training supervisor and the chief of department. The learning objectives defined by the National Board for Medical-Surgical Dermatology and Venereology must be taken into consideration so that ways to assess each objective can be included; this approach supports holistic ongoing education as well as the certification of competencies the resident finally achieves. Use of portfolios in medical residency training can improve on current assessment methods, which we believe lack precision. We propose that portfolios gradually begin to replace the resident's training log. We are currently developing an online software application that will facilitate the use of portfolios.

El portafolio como herramienta de formación y evaluación de los residentes de Dermatología (I) / Portfolios: A Tool for the Training and Assessment of Residents in Dermatology, Part 1

El portafolio del residente es un cuaderno de aprendizaje basado en la reflexión sobre la práctica diaria. Consiste en una recopilación de documentos (historias e informes clínicos), encuestas, fotografías y videograbaciones que permiten certificar la adquisición de las competencias necesarias para ejercer la profesión. Sirve al mismo tiempo como instrumento de evaluación, tanto formativa como sumativa. Favorece el autoaprendizaje continuo y progresivo alrededor de las preguntas: ¿qué he aprendido?, ¿qué aplicación ha tenido?, ¿qué me falta por aprender? y ¿qué he de hacer para alcanzarlo? Estas preguntas evidencian las competencias adquiridas y las deficiencias de formación, lo que permite la elaboración de un plan de mejora individual y su reevaluación posterior. Para su diseño se necesita en primer lugar hacer una lista de las competencias a adquirir y las actividades a realizar en cada año de residencia, con el fin de definir el perfil del profesional. Presentamos aquí un modelo de portafolio para la formación y evaluación de los residentes de Dermatología (AU)

The medical resident’s portfolio is a collection of materials that show reflective learning in the context of clinical practice. A portfolio contains documents (such as case histories and questionnaires the resident has used), images, and video recordings that reveal that an individual has acquired the competencies needed for professional practice. A portfolio is an assessment tool that simultaneously supports learning and gives evidence for certifying competence. It encourages independent continuing professional development that is incremental and centered on answering questions about what one has learned, how it might be applied, what still needs to be learned, and what must be done to reach one’s goal. Answering such questions provides evidence of competencies that have been acquired and what is still lacking, allowing the trainee to develop a plan for personal improvement and evaluate subsequent achievements. The first step in creating a portfolio is to list required skills and abilities, along with the actions that will allow the resident to acquire them during each year of residency training. The ultimate goal is to define the resident’s professional competence. We describe a model on which to base a training and assessment portfolio for residents in dermatology ( AU)

[Portfolios: a tool for the training and assessment of residents in dermatology, part 1]. / El portafolio como herramienta de formación y evaluación de los residentes de Dermatología (I).

The medical resident's portfolio is a collection of materials that show reflective learning in the context of clinical practice. A portfolio contains documents (such as case histories and questionnaires the resident has used), images, and video recordings that reveal that an individual has acquired the competencies needed for professional practice. A portfolio is an assessment tool that simultaneously supports learning and gives evidence for certifying competence. It encourages independent continuing professional development that is incremental and centered on answering questions about what one has learned, how it might be applied, what still needs to be learned, and what must be done to reach one's goal. Answering such questions provides evidence of competencies that have been acquired and what is still lacking, allowing the trainee to develop a plan for personal improvement and evaluate subsequent achievements. The first step in creating a portfolio is to list required skills and abilities, along with the actions that will allow the resident to acquire them during each year of residency training. The ultimate goal is to define the resident's professional competence. We describe a model on which to base a training and assessment portfolio for residents in dermatology.

[Use of www.dermatoweb.net to support undergraduate teaching of dermatology]. / www.dermatoweb.net. Una web docente para el aprendizaje de la Dermatología en el pregrado.

Dermatoweb is a website to aid undergraduate dermatology training. It includes the dermatology program of the Lerida Faculty of Medicine, and is based principally on clinical presentations, tables with the differential diagnosis of the 20 most common reasons for dermatologic consultation, about 200 clinical test cases to stimulate self-training, and a subject list with the 32 topics that make up the dermatology syllabus in many faculties of medicine. Thanks to this website, some of our students achieve high marks in dermatology despite hardly coming to classes. In addition, therapeutic guidelines for the common dermatoses can be found on the site, and an atlas with more than 5,300 photographs and almost 100 videos on the more common dermatological procedures; these can serve as a visual aid for family doctors, residents in dermatology in the initial years, and practicing dermatologists.

Expression of somatostatin receptors in human melanoma cell lines: effect of two different somatostatin analogues, octreotide and SOM230, on cell proliferation.

Somatostatin analogues (SAs) are potential anticancer agents. This study was designed to investigate the expression of somatostatin receptors (SSTRs) in melanoma cells and the effect of two SAs on cell proliferation and viability. Eighteen primary and metastatic human cutaneous melanoma cell lines were treated with octreotide and SOM230. Expression of SSTR1, SSTR2, SSTR3 and SSTR5 was assessed by real-time polymerase chain reaction. Proliferation, viability and cell death were assessed using standard assays. Inhibition was modelled by mixed-effect regression. Melanoma cells expressed one or more SSTR. Both SAs inhibited proliferation of most melanoma cell lines, but inhibition was < 50%. Neither SA affected cell viability or induced cell death. The results suggest that melanoma cell lines express SSTRs. The SAs investigated, under the conditions used in this study, did not, however, significantly inhibit melanoma growth or induce cell death. Novel SAs, combination therapy with SAs and their anti-angiogenic properties should be further investigated.

Difusión por resonancia magnética en el diagnóstico precoz de la embolia grasa cerebral / Diffusion-weighted MRI in early diagnosis of cerebral fat embolism syndrome

Introducción. El síndrome de embolia grasa (SEG) es una entidad de difícil diagnóstico y una causa importantede morbimortalidad en pacientes con politraumatismos. Caso clínico. Hombre de 19 años que ingresa con fracturaabierta de tibia y peroné sin traumatismo craneal niclínica neurológica. La fractura se reduce quirúrgicamentemediante osteosíntesis, presentando a las pocas horas, deforma brusca, un cuadro confusional y mioclonías en miembrossuperiores, sin otras manifestaciones. Se practica tomografíacomputarizada craneal y punción lumbar con resultados normales. El electroencefalograma demuestraactividad punta-onda frontotemporal con generalización. Con el diagnóstico de estatus epiléptico es tratado con valproato intravenoso con mejoría del nivel de conciencia y desaparición de las mioclonías. La imagen por resonanciamagnética (RM) cerebral practicada 68 h después muestra múltiples lesiones isquémicas agudas en coronas radiadas.La ecocardiografía no evidencia foramen oval permeable. El paciente es dado de alta sin secuelas con el diagnóstico deSEG. En la RM de control a las 5 semanas persisten las lesionessin restricción en secuencia de difusión.Conclusiones. El SEG es una complicación frecuente, infradiagnosticada y potencialmente grave que se debe considerar en pacientes politraumatizados. La manipulación llevada a cabo en la reducción ortopédica parece tener unpapel importante en su patogenia. La RM permite el diagnóstico y la caracterización de las lesiones agudas en el sistema nervioso central, descartando otras etiologías (AU)

Introduction. Fat embolism syndrome (FES) is a potentially serious, but poorly diagnosed, complication inpolytraumatized patients. Case report. A 19 year-old male was admitted inour hospital with tibia and fibula fracture and no evidence of cranial traumatism or neurological symptoms.He underwent surgical reduction and internal fixation of the fractures. A few hours later, his consciousnesssuddenly deteriorated and he developed myoclonic jerks in his upper limbs. A computed tomography scan of thebrain and lumbar puncture showed no abnormalities.The electroencephalograph demonstrated frontotemporalspike-wave activity with tendency to generalization.Diagnosed of epileptic status, he was treated with intravenous valproic acid. The myoclonia disappeared andthe patient regained consciousness. A magnetic resonance imaging (MRI) scan of the head performed 68 hlater showed multiple high intensity signals throughout the white matter which were seen on the diffusionweighted images as bright spots. Echocardiography did not demonstrate patent oval foramen. The patient wasdischarged from hospital without sequels and with the diagnosis of FES. The control MRI at 5 weeks showedthe persistence of the lesions without restriction in diffusionsequence. Conclusions. FES is a frequent complication that is underdiagnosed and potentially serious. It should beconsidered in polytraumatized patients. The manipulation performed in the orthopedic reduction seems to haveplayed an important role in the patient’s condition. MRI allows for the diagnosis and characterization of acute lesions in the central nervous system, ruling outother etiologies (AU)

[Diffusion-weighted MRI in early diagnosis of cerebral fat embolism syndrome]. / Difusión por resonancia magnética en el diagnóstico precoz de la embolia grasa cerebral.

INTRODUCTION: Fat embolism syndrome (FES) is a potentially serious, but poorly diagnosed, complication in polytraumatized patients. CASE REPORT: A 19 year-old male was admitted in our hospital with tibia and fibula fracture and no evidence of cranial traumatism or neurological symptoms. He underwent surgical reduction and internal fixation of the fractures. A few hours later, his consciousness suddenly deteriorated and he developed myoclonic jerks in his upper limbs. A computed tomography scan of the brain and lumbar puncture showed no abnormalities. The electroencephalograph demonstrated frontotemporal spike-wave activity with tendency to generalization. Diagnosed of epileptic status, he was treated with intravenous valproic acid. The myoclonia disappeared and the patient regained consciousness. A magnetic resonance imaging (MRI) scan of the head performed 68 h later showed multiple high intensity signals throughout the white matter which were seen on the diffusion weighted images as bright spots. Echocardiography did not demonstrate patent oval foramen. The patient was discharged from hospital without sequels and with the diagnosis of FES. The control MRI at 5 weeks showed the persistence of the lesions without restriction in diffusion sequence. CONCLUSIONS: FES is a frequent complication that is underdiagnosed and potentially serious. It should be considered in polytraumatized patients. The manipulation performed in the orthopedic reduction seems to have played an important role in the patient's condition. MRI allows for the diagnosis and characterization of acute lesions in the central nervous system, ruling out other etiologies.

[Childhood dermatosis in a dermatology clinic of a general university hospital in Spain]. / Dermatosis infantiles en la consulta de Dermatología de un hospital general universitario en España.

BACKGROUND AND OBJECTIVES: Pediatric dermatology is a relatively new subspecialty for which few epidemiological studies are available. We aimed to determine the work load associated with this subspecialty and the most common presenting complaints among pediatric patients in the general dermatology clinic of our hospital. METHODS: A descriptive study was performed based on hospital records to analyze patients aged 16 years or under seen in our department in 2005 and their diagnoses. RESULTS: Pediatric dermatology accounts for 12.1 % of the work load in our department (1,329/10,998 patients were

Effect of proteasome inhibitors on proliferation and apoptosis of human cutaneous melanoma-derived cell lines.

BACKGROUND: Cutaneous malignant melanoma is an aggressive type of skin cancer which causes disproportionate mortality in young and middle-aged adults. Once disseminated, melanoma can be considered an incurable disease, highly resistant to standard antineoplastic treatment, such as chemotherapy or radiation therapy. The proteasome represents a novel target for cancer therapy that can potentially be used in melanoma. OBJECTIVES: To assess the effect of four structurally different proteasome inhibitors on human cutaneous melanoma-derived cell lines. METHODS: Sixteen human cutaneous melanoma-derived cell lines which are original were obtained from patients who were treated by two of the authors. Cells were cultured, exposed to proteasome inhibitors (bortezomib, ALLN, MG-132 and epoxomicin) and then assayed for cell cycle and cell death analyses. RESULTS: Proteasome inhibitors inhibited the in vitro growth of melanoma cells, and this effect was due to a reduction in cell proliferation rate and an induction of both caspase-dependent and caspase-independent cell death. Moreover, release of apoptosis-inducing factor was observed in the presence of the broad-specificity caspase inhibitor BAF (Boc-D-fmk). In addition, the four different proteasome inhibitors induced caspase 2 processing. CONCLUSIONS: This study provides information regarding the in vitro effects of proteasome inhibitors on melanoma cell lines, and the molecular mechanisms involved. It also gives support to the future use of such inhibitors in the treatment of patients with melanoma, either administered alone or in combination with other drugs.