Pioderma gangrenoso y dermatosis pustulosa subcórnea refractarios tratados con éxito mediante adalimumab / Recalcitrant Pyoderma Gangrenosum and Subcorneal Pustular Dermatosis Successfully Treated With Adalimumab

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Eccrine sweat glands associate with the human hair follicle within a defined compartment of dermal white adipose tissue.

BACKGROUND: Eccrine sweat glands (ESGs) are critical for thermoregulation and are involved in wound healing. ESGs have traditionally been considered as separate skin appendages without connection to the pilosebaceous unit (PSU). However, recent preliminary evidence has encouraged the hypothesis that the PSU and ESG are more interconnected than previously thought. OBJECTIVES: To re-evaluate the morphology of human skin adnexa with an integrated three-dimensional (3D) perspective in order to explore the possible interconnections that the PSU and the ESG may form. METHODS: A systematic 3D reconstruction method of skin sections, direct visualization of human scalp follicular unit transplant grafts and a scalp strip ex vivo were used to validate and further explore the hypothesis. RESULTS: We demonstrate that the coiled portion of most ESGs is morphologically integrated into the PSU of human scalp skin and forms a structural unit that is embedded into a specific, hair follicle-associated region of dermal white adipose tissue (dWAT). This newly recognized unit is easily accessible and experimentally tractable by organ culture of follicular units and can be visualized intravitally. CONCLUSIONS: We propose a model of functional human skin anatomy in which ESGs are closely associated with the PSU and the dWAT to form a common homeostatic tissue environment, which may best be encapsulated in the term 'adnexal skin unit'. The challenge now is to dissect how each component of this superstructure of human skin functionally cooperates with and influences the other under physiological conditions, during regeneration and repair and in selected skin diseases.

Dermatitis flagelada por setas shiitake / Flagellate dermatitis due to shiitake mushrooms

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Trasplante de folículos pilosos en úlceras crónicas: un nuevo concepto de injerto / Hair-follicle Transplant Into Chronic Ulcers: A New Graft Concept

Las úlceras venosas crónicas de los miembros inferiores representan un reto terapéutico importante en la práctica clínica diaria, resultando primordial la búsqueda de nuevas alternativas que mejoren la curación de estas heridas. Pese al tratamiento habitual con compresión, desbridamiento y uso de apósitos, muchas úlceras permanecen sin cicatrizar. En estas úlceras que no curan uno de los tratamientos más empleados es el trasplante de injertos cutáneos en sus diversas variantes: pinch grafts, punch grafts, injertos de piel de espesor parcial, injertos de piel de grosor total e injertos elaborados a partir de células cultivadas en laboratorio. En los últimos años numerosos estudios han destacado el importante papel del folículo piloso en el proceso de cicatrización de las heridas cutáneas. Trasladando a la práctica estos conocimientos se han utilizado folículos pilosos del cuero cabelludo en injertos tipo punch que son trasplantados al lecho de las úlceras crónicas para estimular su curación. Los resultados parecen ser mejores que el trasplante tradicional de injertos tipo punch sin pelo, lo cual proporciona nuevas líneas de tratamiento para las úlceras venosas crónicas recalcitrantes (AU)

Chronic venous leg ulcers are a major therapeutic challenge in clinical practice, and the search for new approaches to improve wound healing is essential. Many ulcers do not heal with traditional treatment using compression, debridement, and dressings. Skin-grafts variants, such as pinch grafts, punch grafts, split- or full-thickness skin grafts, and grafts derived from cells cultured in the laboratory, are among the most widely used options in ulcers that do not heal. In recent years, numerous studies have brought to our attention the important role of the hair follicle in the healing process of cutaneous wounds. Putting knowledge into practice, hair follicles from the scalp have been used in punch-type grafts transplanted to the base of chronic ulcers to stimulate healing. Results appear to be better than those with traditional hairless punch grafts, opening new lines of treatment for recalcitrant chronic venous ulcers (AU)

Hair-follicle Transplant Into Chronic Ulcers: A New Graft Concept. / Trasplante de folículos pilosos en úlceras crónicas: un nuevo concepto de injerto.

Chronic venous leg ulcers are a major therapeutic challenge in clinical practice, and the search for new approaches to improve wound healing is essential. Many ulcers do not heal with traditional treatment using compression, debridement, and dressings. Skin-grafts variants, such as pinch grafts, punch grafts, split- or full-thickness skin grafts, and grafts derived from cells cultured in the laboratory, are among the most widely used options in ulcers that do not heal. In recent years, numerous studies have brought to our attention the important role of the hair follicle in the healing process of cutaneous wounds. Putting knowledge into practice, hair follicles from the scalp have been used in punch-type grafts transplanted to the base of chronic ulcers to stimulate healing. Results appear to be better than those with traditional hairless punch grafts, opening new lines of treatment for recalcitrant chronic venous ulcers.

Absorción sistémica de tacrolimus tópico en enfermedad de Crohn metastásica con úlceras cutáneas / Systemic absorption of topical tacrolimus in metastatic Crohn disease with skin ulcers

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Demanda derivada a Dermatología: peso de la patología banal / Referrals to Dermatology: Proportion of Banal Disorders

Introducción: Las enfermedades dermatológicas ocupan un lugar importante en las consultas de Atención Primaria (AP). Nuestro objetivo fue conocer las características y costes de la demanda derivada a Dermatología desde AP. Material y método: Estudio descriptivo transversal de los pacientes remitidos a Dermatología por un centro de salud de AP, realizado en una consulta de Dermatología ubicada en el propio centro de salud y atendida por un dermatólogo del Complejo Hospitalario Universitario de Albacete durante 10 días aleatorios desde el 21 de abril de 2009 al 26 de junio de 2009. Se recogieron los datos de edad, sexo, aplicación o no de crioterapia y grupo diagnóstico. En función de esta última variable se dividieron los pacientes en 4 categorías: A) patología degenerativa benigna o entidades banales, cuyo tratamiento podría no ser apropiado en el Sistema Nacional de Salud ;B) enfermedades resueltas en una visita única realizada por el dermatólogo en el centro de AP;C) enfermedades derivadas a la consulta externa de Dermatología; y D) Entidades que precisan tratamiento quirúrgico y son derivadas a quirófano. Resultados: Se recogieron los datos de 257 pacientes, con una media de edad de 41,18 años y ligero predominio femenino. El grupo diagnóstico más frecuente fue el B (53,7%), seguido del grupo A (19,1%), C (19,1%) y D (8,2%). El coste total estimado de las 257 consultas fue de 29.750,32 euros, de los que 5.672,24 euros representarían el gasto en entidades cutáneas banales. Conclusiones: La actual saturación de las consultas de Dermatología por motivos banales hace necesario un mayor control de la demanda derivada desde AP (AU)

Background and objective: Skin diseases account for a large number of consultations in primary care. The objective of this study was to determine the characteristics and cost of referrals from primary care to a dermatology clinic. Material and methods: Descriptive cross-sectional study of referrals from a primary care health center to a dermatology clinic. The dermatology clinic was situated in the same health center and was attended by a dermatologist from Complejo Hospitalario Universitario in Albacete, Spain. The study was performed on 10 days selected at random between April 21, 2009, and June 26, 2009. The data gathered included age, sex, use of cryotherapy, and diagnostic group. Patients were divided into 4 diagnostic groups: A) benign degenerative disease or trivial disorders whose treatment may not merit involvement of the national health service, B) diseases resolved with a single dermatology consultation at the health center, C) diseases requiring evaluation in hospital-based dermatology outpatients, and D) diseases referred for surgical treatment. Results: Data were gathered on 257 patients with a mean age was 41.18 years and there was a slight female predominance. The majority of patients were in diagnostic group B (53.7%),followed by groups A (19.1%), C (19.1%), and D (8.2%). The total estimated cost of these257 visits was D 29 750.32, of which D 5672.24 was for trivial disorders. Conclusions: The current high prevalence of trivial disorders in the caseload of dermatology clinics by trivial disorders makes it necessary to control referrals from primary care more strictly (AU)

[Referrals to dermatology: proportion of banal disorders]. / Demanda derivada a Dermatología: peso de la patología banal.

BACKGROUND AND OBJECTIVE: Skin diseases account for a large number of consultations in primary care. The objective of this study was to determine the characteristics and cost of referrals from primary care to a dermatology clinic. MATERIAL AND METHODS: Descriptive cross-sectional study of referrals from a primary care health center to a dermatology clinic. The dermatology clinic was situated in the same health center and was attended by a dermatologist from Complejo Hospitalario Universitario in Albacete, Spain. The study was performed on 10 days selected at random between April 21, 2009, and June 26, 2009. The data gathered included age, sex, use of cryotherapy, and diagnostic group. Patients were divided into 4 diagnostic groups: A) benign degenerative disease or trivial disorders whose treatment may not merit involvement of the national health service, B) diseases resolved with a single dermatology consultation at the health center, C) diseases requiring evaluation in hospital-based dermatology outpatients, and D) diseases referred for surgical treatment. RESULTS: Data were gathered on 257 patients with a mean age was 41.18 years and there was a slight female predominance. The majority of patients were in diagnostic group B (53.7%), followed by groups A (19.1%), C (19.1%), and D (8.2%). The total estimated cost of these 257 visits was €29 750.32, of which €5672.24 was for trivial disorders. CONCLUSIONS: The current high prevalence of trivial disorders in the caseload of dermatology clinics by trivial disorders makes it necessary to control referrals from primary care more strictly.

[Dermatology consultations in an emergency department prior to establishment of emergency dermatology cover]. / Consultas dermatológicas en el Servicio de Urgencias: situación previa a la instauración de guardias de la especialidad.

BACKGROUND AND OBJECTIVE: an increasing number of patients seek emergency treatment for dermatologic complaints. The aim of this study was to assess the characteristics of skin complaints seen in an emergency department prior to establishment of specialist dermatology cover. MATERIALS AND METHODS: a retrospective, descriptive study was undertaken using data on urgent dermatology cases seen by nonspecialist physicians in the emergency department of Hospital General Universitario de Albacete, Spain, in 2008. RESULTS: a total of 3662 patients with skin diseases were seen (2.59% of all emergency cases; approximately 10 patients per day). The mean age was 27.73 years and there was a slight predominance of female patients. Children and adolescents accounted for 5.85% of cases. A total of 96 different conditions were diagnosed and 84% of cases corresponded to one of 21 different diagnostic entities, urticaria being the most frequent (19.27%). The 96 diagnoses were grouped into 16 categories to facilitate analysis. According to this classification, most patients had infectious diseases (47.49%), followed by urticaria and angioedema (20.13%), "nonspecific diagnosis" (11.93%), and "descriptive diagnosis" (6.49%). In 4.8% of cases, the patient was admitted, most frequently for cellulitis. CONCLUSIONS: in nonspecialist emergency services, the number of different diagnoses is small in relation to the number of patients seen and the proportion of nonspecific and descriptive diagnoses is relatively large. In our opinion, an on-call dermatologist should be made available within emergency departments in order to offer a higher quality of care to patients with skin conditions.

Consultas dermatológicas en el Servicio de Urgencias: situación previa a la instauración de guardias de la especialidad / Dermatology Consultations in an Emergency Department Prior to Establishment of Emergency Dermatology Cover

Introducción: los pacientes que solicitan atención urgente por problemas dermatológicos suponen una demanda asistencial creciente y numerosa. El objetivo de nuestro trabajo fue evaluar las características de la patología dermatológica en el Servicio de Urgencias antes de la implantación de las guardias de la especialidad. Material y métodos: estudio descriptivo y retrospectivo que recoge los datos referidos a la patología dermatológica urgente atendida, por médicos no especialistas, en el Servicio de Urgencias del Hospital General Universitario de Albacete durante el año 2008. Resultados: se atendió a un total de 3.662 pacientes con enfermedades dermatológicas (2,59% de urgencias dermatológicas, 10 pacientes/día). La edad media fue de 27,73 años, con un ligero predominio femenino. La población pediátrica supuso el 44,12%. Fueron diagnosticados 96 procesos diferentes, correspondiendo un 84% de toda la patología atendida a 21 entidades diagnósticas, siendo el diagnóstico más frecuente el de urticaria (19,27%). Los 96 procesos diagnósticos se agruparon en 15 patologías para su análisis, destacando en primer lugar la patología infecciosa (47,49%), seguida de urticaria y angioedema (20,13%), “diagnóstico inespecífico” (11,93%) y “diagnóstico descriptivo” (6,49%). Se realizaron 4,8% de ingresos, siendo la celulitis la causa más frecuente. Conclusiones: el número de diagnósticos diferentes se reduce en las consultas de urgencias generales, aumentando los diagnósticos inespecíficos y descriptivos. Consideramos necesaria la presencia de un dermatólogo de guardia para intentar ofrecer mayor calidad asistencial al paciente dermatológico (AU)

Background and objective: an increasing number of patients seek emergency treatment for dermatologic complaints. The aim of this study was to assess the characteristics of skin complaints seen in an emergency department prior to establishment of specialist dermatology cover. Materials and methods: a retrospective, descriptive study was undertaken using data on urgent dermatology cases seen by non specialist physicians in the emergency department of Hospital General Universitario de Albacete, Spain, in 2008. Results: atotal of 3662 patients with skin diseases were seen (2.59% of all emergency cases; approximately 10 patients per day). The mean age was 27.73 years and there was a slight predominance of female patients. Children and adolescents accounted for 5.85% of cases. A total of 96 different conditions were diagnosed and 84% of cases corresponded to one of 21 different diagnostic entities, urticaria being the most frequent (19.27%). The 96 diagnoses were grouped into 16 categories to facilitate analysis. According to this classification, most patients had infectious diseases (47.49%), followed by urticaria and angioedema (20.13%), “nonspecific diagnosis” (11.93%), and “descriptive diagnosis” (6.49%). In 4.8% of cases, the patient was admitted, most frequently for cellulitis. Conclusions: in nonspecialist emergency services, the number of different diagnoses is small in relation to the number of patients seen and the proportion of nonspecific and descriptive diagnoses is relatively large. In our opinion, an on-call dermatologist should be made available within emergency departments in order to offer a higher quality of care to patients with skin conditions (AU)