Recommendations from the Spanish Academy of Dermatology and Venereology Psoriasis Working Group on the Management of Patients with Cancer and Psoriasis. / Recomendaciones del Grupo de Psoriasis de la Academia Española de Dermatología y Venereología sobre el manejo de la psoriasis en pacientes oncológicos.

Several studies suggest that patients with psoriasis have a higher incidence of neoplasms, especially of the skin, which could be associated with the use of therapies to treat psoriasis. Furthermore, the evidence available on the safety profile of some treatments in this context, and the management of these patients is scarce, which is why clinical practice guidelines with recommendations on the management of psoriasis in cancer patients are ambiguous. This study provides recommendations on the management and use of the therapies currently available for these patients. They are the result of a Delphi consensus reached by 45 dermatologists of the Spanish Academy of Dermatology and Venereology Psoriasis Working Group, whose goal is to help specialists in the field in their decision-making processes.

Merkel cell carcinoma and Merkel cell polyomavirus: a systematic review and meta-analysis.

Several observational studies have assessed the correlation between Merkel cell carcinoma and Merkel cell polyomavirus with variable results. The objective of this systematic review was to determine whether there is a correlation between Merkel cell carcinoma and Merkel cell polyomavirus. Studies assessing the relationship between Merkel cell carcinoma and Merkel cell polyomavirus from January 2008 to August 2014 were pooled from Medline, Embase, PubMed, Cochrane Database of Systemic Reviews and Google Scholar. From each study we collected the first author's last name, publication year, country of origin, type of study design, characteristics of participants, possible variables incorporated into the multivariable analyses and the risk ratio (RR) for Merkel cell carcinoma associated with Merkel cell polyomavirus combined with the corresponding 95% confidence interval (CI). Methodological assessment of the study was evaluated using the Newcastle-Ottawa scale. Crude RR was calculated from the data provided in each article. Meta-analyses for the global RR and for the proportion of positives in both case and control samples were performed. In addition, in order to explore the sources of heterogeneity among the studies, meta-regression and sensitivity analyses are also provided. A total of 22 studies were identified for the analysis. The pooled RR from random-effects analysis was determined to be 6.32 (95% CI, 4.02-9.93). Global proportions of positive samples were 0.79 (95% CI, 0.72-0.84) and 0.12 (95% CI, 0.08-0.19) in the case and control groups, respectively. The findings support the association between Merkel cell carcinoma and Merkel cell polyomavirus. However, a non-negligible percentage of positive results have been identified in controls. Some caution must be taken in the interpretation of these results because heterogeneity between studies was found.

Ustekinumab. Neoplasias y otros aspectos de seguridad / Ustekinumab. Neoplasms and Other Safety Aspects

La reciente aparición de nuevos tratamientos biológicos ha permitido un importante avance en el control de la psoriasis. Las interleucinas 12 y 23 desempeñan un papel importante en el control de neoplasias e infecciones. La aparición de nuevas moléculas que bloquean su acción ha reavivado el debate sobre el riesgo de desarrollar neoplasias en los pacientes con psoriasis que reciben este tipo de medicaciones. En este artículo, realizamos una revisión de los estudios de seguridad a tres y cuatro años disponibles hasta la fecha y una revisión de la literatura. Con los datos actuales, se puede concluir que los pacientes expuestos a ustekinumab no presentan mayor riesgo de padecer neoplasias que la población general (AU)

The recent introduction of a new class of biologic agents in psoriasis has led to important advances in the management of this disease. IL-12 and IL-23 play a key role in the control of malignancies and infections. The development of novel molecules capable of blocking the action of these cytokines has rekindled the debate on whether biologic agents increase the risk of malignancy in patients with psoriasis. In this chapter, we review the safety data for patients who have been treated for 3 or 4 years and the literature on the use of ustekinumab. Based on the available evidence, it can be concluded that patients treated with stekinumab do not have a higher risk of malignancy than the general population (AU)

Psoriasis ungueal: estudio en 661 pacientes con psoriasis vulgar / Nail Psoriasis in Individuals With Psoriasis Vulgaris: A Study of 661 Patients

Introducción y objetivos: La psoriasis ungueal afecta a un número importante de pacientes con psoriasis. No obstante, son raros los estudios epidemiológicos que recojan las características de estos individuos. Describimos la epidemiología y principales características de los pacientes con psoriasis ungueal. Material y método: Se trata de un estudio prospectivo de casos y controles realizado en el Hospital Universitario Marqués de Valdecilla y Hospital Universitario Central de Asturias entre enero de 2007 y diciembre de 2009.ResultadosDe un total de 661 pacientes la psoriasis ungueal fue diagnosticada en el 47,4% de los pacientes. La prevalencia fue 13,5 puntos mayor en hombres que en mujeres. Los pacientes con afectación ungueal presentan mayor severidad de la enfermedad (PASI 12,82 vs 8,22), mayor duración de la misma (20,30 vs 13,94 años), incidencia superior de artropatía psoriática (29,7% vs 11,5%), mayor frecuencia de antecedentes familiares positivos (53,7% vs 42,8%) y mayor proporción de obesidad IMC > 30 (31,6vs 23,9%). La psoriasis en el grupo con afectación ungueal se inicia de forma precoz (74,1 vs 65,5%) y se asocia con menor frecuencia a Cw*0602 (33 vs 50,3%). Conclusiones: La afectación ungueal es una manifestación frecuente en los pacientes con psoriasis y se asocia a mayor gravedad de la enfermedad y mayor número de comorbilidades (AU)

Background and objectives: The nails are affected in a substantial number of patients with psoriasis. Nevertheless, few epidemiological studies have reported the characteristics of patients with nail psoriasis. Here we describe the epidemiology of nail psoriasis and the main characteristics of affected patients. Patients and methods: We undertook a prospective case–control study at Hospital Universitario Marqués de Valdecilla and Hospital Universitario Central de Asturias in Spain between January 2007 and December 2009. Results: Of a total of 661 patients included, 47.4% were diagnosed with nail psoriasis, which was 13.5% more prevalent in men. The group of patients with nail disease had more severe psoriasis (12.82 vs 8.22 points on the psoriasis area and severity index) and a longer disease duration (20.30 vs 13.94years), and included a larger percentage of patients with psoriatic arthritis (29.7% vs 11.5%), a positive family history of the disease (53.7% vs 42.8%), and a body mass index greater than 30 (31.6% vs 23.9%). A larger percentage of the patients with nail disease had early-onset psoriasis (74.1% vs 65.5%) and fewer were carriers of the human lymphocyte antigen Cw*0602 allele (33% vs 50.3%). Conclusions: Nail disease is frequent in psoriasis and is associated with greater severity of psoriasis and a larger number of comorbidities (AU)

[Nail psoriasis in individuals with psoriasis vulgaris: a study of 661 patients]. / Psoriasis ungueal: estudio en 661 pacientes con psoriasis vulgar.

BACKGROUND AND OBJECTIVES: The nails are affected in a substantial number of patients with psoriasis. Nevertheless, few epidemiological studies have reported the characteristics of patients with nail psoriasis. Here we describe the epidemiology of nail psoriasis and the main characteristics of affected patients. PATIENTS AND METHODS: We undertook a prospective case-control study at Hospital Universitario Marqués de Valdecilla and Hospital Universitario Central de Asturias in Spain between January 2007 and December 2009. RESULTS: Of a total of 661 patients included, 47.4% were diagnosed with nail psoriasis, which was 13.5% more prevalent in men. The group of patients with nail disease had more severe psoriasis (12.82 vs 8.22 points on the psoriasis area and severity index) and a longer disease duration (20.30 vs 13.94years), and included a larger percentage of patients with psoriatic arthritis (29.7% vs 11.5%), a positive family history of the disease (53.7% vs 42.8%), and a body mass index greater than 30 (31.6% vs 23.9%). A larger percentage of the patients with nail disease had early-onset psoriasis (74.1% vs 65.5%) and fewer were carriers of the human lymphocyte antigen Cw*0602 allele (33% vs 50.3%). CONCLUSIONS: Nail disease is frequent in psoriasis and is associated with greater severity of psoriasis and a larger number of comorbidities.

[Psoriasiform skin reactions during treatment with etanercept]. / Reacciones cutáneas psoriasiformes durante el tratamiento con etanercept.

Anti-TNFs have a wide spectrum of skin lesions, psoriasis being found among them paradoxically. A 42-year old woman with a history of rheumatoid arthritis since 19 years of age was referred to the Dermatology service due to pustular psoriasis on both soles during treatment with etanercept. Due to her incapacity to walk and the pain reported by the patient, etanercept was replaced with adalimumab with clinical improvement and total disappearance of the lesions at six weeks of switching the anti-TNF. Tumor necrosis factor inhibitors are drugs that act in T cell mediated diseases. The appearance of psoriasiform rashes is more frequent than reported in the literature. They appear in all the indications and with all the anti-TNFs. Adalimumab is the most frequent. Three types of reactions are produced, the pustular one being the most frequent. It predominates in women and may appear chronologically at any time during the treatment. Regarding the treatment, it is recommendable to continue with the anti-TNFs.

Reacciones cutáneas psoriasiformes durante el tratamiento con etanercept / Psoriasiform skin reactions during treatment with etanercept

Los anti-factor de necrosis tumoral (TNF) presentan un amplio espectro de lesiones cutáneas, entre las que se encuentra paradójicamente la psoriasis. Una mujer de 42 años, con una historia de artritis reumatoidea desde los 19 años, fue remitida al servicio de Dermatología por presentar una psoriasis pustulosa en ambas plantas de los pies durante un tratamiento con etanercept. Ante la presencia de este cuadro se instauró tratamiento corticoideo tópico oclusivo, con mejoría clínica a las 4 semanas y desaparición total de las lesiones a las 6 semanas. Los anti-TNF son fármacos que actúan en enfermedades mediadas por células T. La aparición de erupciones psoriasiformes es más frecuente de lo comunicado en la literatura, ya que aparecen en todas las indicaciones y con todos los anti-TNF, con mayor frecuencia con adalimumab. Se producen tres tipos de reacciones, siendo la pustulosa la más común; predomina en mujeres y puede aparecer cronológicamente en cualquier momento durante el tratamiento. Respecto al tratamiento es aconsejable continuar con los anti-TNF (AU)

Anti-TNFs have a wide spectrum of skin lesions, psoriasis being found among them paradoxically. A 42-year old woman with a history of rheumatoid arthritis since 19 years of age was referred to the Dermatology service due to pustular psoriasis on both soles during treatment with etanercept. Due to her incapacity to walk and the pain reported by the patient, etanercept was replaced with adalimumab with clinical improvement and total disappearance of the lesions at six weeks of switching the anti-TNF. Tumor necrosis factor inhibitors are drugs that act in T cell mediated diseases. The appearance of psoriasiform rashes is more frequent than reported in the literature. They appear in all the indications and with all the anti-TNFs. Adalimumab is the most frequent. Three types of reactions are produced, the pustular one being the most frequent. It predominates in women and may appear chronologically at any time during the treatment. Regarding the treatment, it is recommendable to continue with the anti-TNFs (AU)

Trombocitopenia temporal probablemente inducida por isotretinoína / Temporary Thrombocytopenia Probably Induced by Isotretinoin

No disponible

No disponible

Primary cutaneous extraskeletal osteosarcoma under a previous electrodessicated actinic keratosis.

Extraskeletal osteosarcoma represents approximately 1% of soft tissue sarcomas and approximately 4% of all osteosarcomas. It is therefore much rarer than osteosarcoma arising primarily in bone. Skin as a primary site has seldom been reported. This report describes an extraskeletal osteosarcoma of the skin under a previously electrodessicated actinic keratosis.

Q fever: a new cause of 'doughnut' granulomatous lobular panniculitis.

Q fever is an uncommon zoonotic rickettsial disease with no exanthem or specific cutaneous lesions. Only nonspecific cutaneous involvement has been reported to date. A 69-year-old Spanish woman with chronic myelogenous leukaemia developed fever and two subcutaneous nodules. The patient complained of extreme pain. Biopsy revealed a granulomatous lobular panniculitis with a characteristic 'fibrin ring' or 'doughnut' appearance: fibrin and inflammatory cells arranged around a central clear space. Changes of membranous lipodystrophy were also found. Q fever serological studies were positive. Our patient had panniculitis with singular histopathological features. These histopathological changes have been described in liver and bone marrow of patients with Q fever. To the best of our knowledge, this cutaneous involvement due to Q fever has not previously been described in the literature.

Squamous cell carcinoma arising in long-standing necrobiosis lipoidica.

Necrobiosis lipoidica (NL) is a disease of collagen. Squamous cell carcinomas developing in areas of chronic ulceration and scarring have been well documented in a variety of skin diseases but rarely in areas of necrobiosis lipoidica. The case history of a 76-year-old female is presented, whose squamous cell carcinoma appeared 30 years after the diagnosis of necrobiosis lipoidica. The clinical and histopathological picture is described, stressing the importance of the unusual association of the two pathologies in the prognostic.

Varicella complicated by group A streptococcal facial cellulitis.

An increase has been recently noted in the incidence of life-threatening group A beta-hemolytic streptococcal (GABHS) infections in children recovering from varicella. We report our experience with a patient who required pediatric intensive care unit admission because of a serious GABHS infection 1 week after the onset of varicella. Emergency physicians must look for this complication in patients with varicella remaining abnormally febrile and presenting unusual manifestations.