Moderate to Severe Psoriasis in Older Adults: Recommendations on Management from the Psoriasis Working Group of the Spanish Academy of Dermatology and Venereology (AEDV). / Recomendaciones del Grupo de Psoriasis de la Academia Española de Dermatología y Venereología sobre el manejo del paciente de edad avanzada con psoriasis en placas moderada-grave.

Managing moderate to severe psoriasis in older adults is complex due to factors characteristic of the later years of life, such as associated comorbidity, polypharmacy, and immunosenescence. This consensus statement discusses 17 recommendations for managing treatment for moderate to severe psoriasis in patients older than 65 years. The recommendations were proposed by a committee of 6 dermatologists who reviewed the literature. Fifty-one members of the Psoriasis Working Group of the Spanish Academy of Dermatology and Venereology (AEDV) then applied the Delphi process in 2 rounds to reach consensus on which principles to adopt. The recommendations can help to improve management, outcomes, and prognosis for older adults with moderate to severe psoriasis.

Markerless monocular tracking system for guided external eye surgery.

This paper presents a novel markerless monocular tracking system aimed at guiding ophthalmologists during external eye surgery. This new tracking system performs a very accurate tracking of the eye by detecting invariant points using only textures that are present in the sclera, i.e., without using traditional features like the pupil and/or cornea reflections, which remain partially or totally occluded in most surgeries. Two known algorithms that compute invariant points and correspondences between pairs of images were implemented in our system: Scalable Invariant Feature Transforms (SIFT) and Speed Up Robust Features (SURF). The results of experiments performed on phantom eyes show that, with either algorithm, the developed system tracks a sphere at a 360° rotation angle with an error that is lower than 0.5%. Some experiments have also been carried out on images of real eyes showing promising behavior of the system in the presence of blood or surgical instruments during real eye surgery.

Reacciones cutáneas adversas por tatuajes y piercings / Cutaneous Adverse Reactions to Tattoos and Piercings

En las últimas décadas, la realización de piercings y tatuajes se ha convertido en una práctica muy popular en los países occidentales, especialmente entre los más jóvenes. Paralelamente al auge de estas técnicas decorativas corporales, las comunicaciones acerca de complicaciones médicas asociadas han aumentado. De todas estas complicaciones potenciales destacan por su frecuencia las que afectan a la piel y mucosas. Las complicaciones asociadas a los tatuajes incluyen múltiples procesos infecciosos, cutáneos o sistémicos, debido a la ruptura de la barrera epidérmica, reacciones inflamatorias agudas y crónicas con diferentes patrones histológicos, la aparición de tumores benignos y malignos sobre áreas tatuadas o el brote de ciertas dermatosis por el fenómeno isomórfico. Las complicaciones asociadas a los piercings son similares, aunque algunas de ellas, como las piodermitis, son mucho más comunes debido al lento proceso de cicatrización de la perforación en determinadas localizaciones. Hemos de diferenciar entre las complicaciones que son independientes de la localización del piercing y de las complicaciones específicas, las cuales están estrechamente relacionadas con el área perforada. La tasa de complicaciones tras la realización de tatuajes y perforaciones depende de la experiencia del artista, de las condiciones higiénicas en las que tiene lugar y de los cuidados posteriores tras la realización de la técnica por parte del propio cliente. Sin embargo, algunas de estas complicaciones son impredecibles y dependen de factores intrínsecos del propio paciente. En este artículo revisamos las técnicas decorativas más frecuentes que abarca el body art, con especial interés en sus posibles complicaciones cutáneas y en el manejo de éstas (AU)

Piercings and tattoos have become very popular in western society in recent decades, particularly among younger generations. Reports of medical complications associated with these decorative techniques have increased in parallel with the rise in their popularity. Due to their high frequency, adverse cutaneous reactions are particularly important among these potential complications. Tattoo-related complications include a number of cutaneous and systemic infections secondary to breach of the epidermal barrier, acute and delayed inflammatory reactions with different histopathological patterns, the appearance of benign and malignant tumors on tattooed areas of skin, and certain dermatoses triggered by isomorphic phenomena. Piercing-related complications are similar, though some, such as pyogenic skin infections, are much more common due to the delayed wound healing after piercing in certain sites. We must differentiate between complications that are independent of the site of piercing, and specific complications, which are closely related to the body area pierced. The rate of complications after performing piercings or tattoos depends on the experience of the artist, the hygiene techniques applied, and the post procedural care by the customer. However, some of these complications are unpredictable and depend on factors intrinsic to the patient. In this article, we review the most common decorative techniques of body art, with particular focus on the potential cutaneous complications and their management (AU)

[Cutaneous adverse reactions to tattoos and piercings]. / Reacciones cutáneas adversas por tatuajes y piercings.

Piercings and tattoos have become very popular in western society in recent decades, particularly among younger generations. Reports of medical complications associated with these decorative techniques have increased in parallel with the rise in their popularity. Due to their high frequency, adverse cutaneous reactions are particularly important among these potential complications. Tattoo-related complications include a number of cutaneous and systemic infections secondary to breach of the epidermal barrier, acute and delayed inflammatory reactions with different histopathological patterns, the appearance of benign and malignant tumors on tattooed areas of skin, and certain dermatoses triggered by isomorphic phenomena. Piercing-related complications are similar, though some, such as pyogenic skin infections, are much more common due to the delayed wound healing after piercing in certain sites. We must differentiate between complications that are independent of the site of piercing, and specific complications, which are closely related to the body area pierced. The rate of complications after performing piercings or tattoos depends on the experience of the artist, the hygiene techniques applied, and the postprocedural care by the customer. However, some of these complications are unpredictable and depend on factors intrinsic to the patient. In this article, we review the most common decorative techniques of body art, with particular focus on the potential cutaneous complications and their management.

[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.

Localized acquired cutis laxa secondary to interstitial granulomatous dermatitis.

We report the case of a 68-year-old woman who had interstitial granulomatous dermatitis associated with seronegative polyarthritis. Two years later, this had evolved to become localized acquired cutis laxa.

Dermatitis de contacto por corticoides. Estudio retrospectivo de 3 años en una Unidad de Alergia Cutánea hospitalaria / Allergic Contact Dermatitis due to Corticosteroids: A 3-Year Retrospective Study in a Hospital Skin Allergy Unit

Introducción. La dermatitis de contacto por corticoides y la realización de las pruebas epicutáneas con estas sustancias presentan peculiaridades que hay que conocer. Material y métodos. Realizamos un estudio retrospectivo de todos los pacientes en los que se aplicó la batería de corticoides en la Unidad de Alergia Cutánea de la Sección de Dermatología del Hospital General Universitario de Alicante, durante el período comprendido entre octubre de 2004 y junio de 2007. Resultados. Durante el período de estudio se atendieron 1.065 pacientes, a 34 de ellos (3,1 %) se les aplicó la batería de corticoides, 14 pacientes con budesonida o tixocortol positivos en la batería estándar y 20 con estos marcadores negativos pero con sospecha clínica de alergia a corticoides. Quince pacientes (44,1 %) obtuvieron algún positivo en la batería de corticoides. La sustancia que más positivos obtuvo fue budesonida (13 pacientes sensibilizados). En 4 de 15 pacientes el uso de la batería de corticoides informó de sensibilización a otros grupos de corticoides. A 17 pacientes se les aplicaron los medicamentos aportados por ellos, obteniéndose 10 sustancias positivas. Conclusiones. Los marcadores para la dermatitis de contacto por corticoides presentes en la batería estándar (budesonida y tixocortol) detectaron el 93 % de pacientes sensibilizados a corticoides, por lo que no parece rentable aplicar la batería de corticoides si dichos marcadores son negativos. La batería de corticoides y los propios fármacos aportados por los pacientes fueron útiles para definir mejor los grupos de corticoides que estos no pueden utilizar (AU)

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 (AU)

Langerhans cell histiocytosis: an update.

The histiocytoses represent a heterogeneous group of disorders that are characterized by the proliferation and accumulation of reactive or neoplastic histiocytes within various tissues. Langerhans cell histiocytosis (LCH) is the commonest of these disorders and it is associated with high morbidity and mortality, especially in children. LCH is a poorly understood disease with features suggestive of a neoplastic, reactive, or immune dysregulation process. The clinical spectrum of LCH is considered to be broad and includes from self-resolving involvement of a single organ to a potentially fatal multisystem disease. The purpose of this review is to undertake an update of LCH with emphasis on the current recommendations regarding the classification, evaluation and treatment of this enigmatic disease.

[Brachioradial pruritus as a symptom of cervical radiculopathy]. / Prurito braquiorradial como síntoma de radiculopatía cervical.

Brachioradial pruritus is characterized by the presence of pruritus on the lateral aspect of the arms. The etiology of this enigmatic entity is the subject of some debate some authors claim that brachioradial pruritus is a photodermatosis whereas others attribute it to the presence of underlying cervical radiculopathy. In these case reports, we present our experience with brachioradial pruritus and discuss the role of underlying neuropathy in its etiology and that of other types of localized pruritus such as notalgia paresthetica, anogenital pruritus, and burning mouth syndrome.

Prurito braquiorradial como síntoma de radiculopatía cervical / Brachioradial pruritus as a symptom of cervical radiculopathy

El prurito braquiorradial (PBR) se caracteriza por la presencia de prurito localizado en la cara lateralde los brazos. Se trata de una entidad enigmática con una etiología controvertida; mientras que algunos autoresconsideran el PBR como una fotodermatosis, otros atribuyen su aparición a la presencia de una radiculopatíacervical subyacente. En este artículo se presenta nuestra experiencia con esta entidad y se discute el papel de una neuropatía subyacente en la etiología de este y otros pruritos localizados como la notalgia parestésica, el prurito anogenital o el síndrome de la boca ardiente (AU)

Brachioradial pruritus is characterized by the presence of pruritus on the lateral aspect of the arms. The etiology of this enigmatic entity is the subject of some debate -some authors claim that brachioradial pruritus is a photodermatosis whereas others attribute it to the presence of underlying cervical radiculopathy. In these case reports, we present our experience with brachioradial pruritus and discuss the role of underlyingneuropathy in its etiology and that of other types of localized pruritus such as notalgia paresthetica, anogenital pruritus, and burning mouth syndrome (AU)

Isotretinoína a dosis bajas en el tratamiento del lupus crónico discoide en mujeres fértiles / Low-Dose Isotretinoin For Treatment of Chronic Discoid Lupus in Women of Childbearing Age

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[Perifollicular xanthomatosis as a key histological finding in Fox-Fordyce disease]. / Xantomatosis perifolicular: hallazgo histológico clave en la enfermedad de Fox-Fordyce.

Fox-Fordyce disease is a rare skin condition characterized by the presence of multiple pruritic follicular papules in areas rich in apocrine glands, such as the axillae, mammary areolae, or genital regions. There is a high degree of variability in the histological findings seen in Fox-Fordyce disease. In addition to those described as typical of this entity, such as dilation of the infundibulum and hyperkeratosis and spongiosis of the infundibular epithelium, many other histological changes can be observed. We report the case of a 21-year-old woman with Fox-Fordyce disease and highlight the importance of perifollicular xanthomatosis as a key histological finding in the diagnosis of the disease.

Xantomatosis perifolicular: hallazgo histológico clave en la enfermedad de Fox-Fordyce / Perifollicular xanthomatosis as a key histological finding in Fox-Fordyce disease

La enfermedad de Fox-Fordyce es una rara dermatosis caracterizada por la presencia de múltiples pápulas foliculares pruriginosas en áreas corporales con riqueza de glándulas apocrinas como axilas, areolas mamarias o región genital. Los hallazgos histopatológicos que definen la enfermedad de Fox-Fordyce son muy variados. Además de los hallazgos descritos como típicos de esta entidad, como la dilatación del infundíbulo y la hiperqueratosis y espongiosis del epitelio infundibular, se pueden observar otros muchos hallazgos histológicos. Presentamos el caso de una mujer de 21 años de edad afectada por esta enfermedad y recalcamos la importancia de la xantomatosis perinfundibular como hallazgo histológico clave en el diagnóstico de esta entidad (AU)

Fox-Fordyce disease is a rare skin condition characterized by the presence of multiple pruritic follicular papules in areas rich in apocrine glands, such as the axillae, mammary areolae, or genital regions. There is a high degree of variability in the histological findings seen in Fox-Fordyce disease. In addition to those described as typical of this entity, such as dilation of the infundibulum and hyperkeratosis and spongiosis of the infundibular epithelium, many other histological changes can be observed. We report the case of a 21-year-old woman with Fox-Fordyce disease and highlight the importance of perifollicular xanthomatosis as a key histological finding in the diagnosis of the disease (AU)