Penfigoide ampolloso e inhibidores de la DPP4 / Bullous pemphigoid and DPP4 inhibitors

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Nuevas poblaciones con riesgo cardiovascular aumentado: enfermedad cardiovascular en las enfermedades dermatológicas / New populations at increased cardiovascular risk: Cardiovascular disease in dermatological diseases

La implicación de un mayor riesgo cardiovascular en algunas enfermedades dermatológicas ha sido evidenciada en las últimas décadas. Enfermedades como la psoriasis y el lupus eritematoso sistémico se encuentran actualmente incluidas en las guías de prevención de la enfermedad cardiovascular. Otras enfermedades como la alopecia androgénica, el síndrome del ovario poliquístico, la hidrosadenitis supurativa o el liquen plano disponen de numerosos estudios que apuntan a un mayor riesgo en estos pacientes, aunque todavía no han sido incluidas en estas guías. En el presente artículo se realiza una revisión de las evidencias que avalan esta asociación, con el objeto de advertir al clínico sobre la necesidad de un mayor control de los factores de riesgo cardiovascular en estos pacientes

The increased cardiovascular risk in some dermatological diseases has been demonstrated in recent decades. Diseases such as psoriasis and systemic lupus erythematosus are currently included in the guidelines for prevention of cardiovascular disease. Other diseases such as androgenic alopecia, polycystic ovary syndrome, hidradenitis suppurativa or lichen planus have numerous studies that point to an increased risk, however, they have not been included in these guidelines. In this article we review the evidence supporting this association, in order to alert the clinician to the need for greater control in cardiovascular risk factors in these patients

[New populations at increased cardiovascular risk: Cardiovascular disease in dermatological diseases]. / Nuevas poblaciones con riesgo cardiovascular aumentado: enfermedad cardiovascular en las enfermedades dermatológicas.

The increased cardiovascular risk in some dermatological diseases has been demonstrated in recent decades. Diseases such as psoriasis and systemic lupus erythematosus are currently included in the guidelines for prevention of cardiovascular disease. Other diseases such as androgenic alopecia, polycystic ovary syndrome, hidradenitis suppurativa or lichen planus have numerous studies that point to an increased risk, however, they have not been included in these guidelines. In this article we review the evidence supporting this association, in order to alert the clinician to the need for greater control in cardiovascular risk factors in these patients.

Cellular basis of secondary infections and impaired desquamation in certain inherited ichthyoses.

IMPORTANCE: Secondary infections and impaired desquamation complicate certain inherited ichthyoses, but their cellular basis remains unknown. In healthy human epidermis, the antimicrobial peptides cathelicidin (LL-37) and human ß-defensin 2 (HBD2), as well as the desquamatory protease kallikrein-related peptidase 7 (KLK7), are delivered to the stratum corneum (SC) interstices by lamellar body (LB) exocytosis. OBJECTIVE: To assess whether abnormalities in the LB secretory system could account for increased risk of infections and impaired desquamation in inherited ichthyoses with known abnormalities in LB assembly (Harlequin ichthyosis [HI]), secretion (epidermolytic ichthyosis [EI]), or postsecretory proteolysis (Netherton syndrome [NS]). DESIGN, SETTING, AND PARTICIPANTS: Samples from library material were taken from patients with HI, EI, NS, and other ichthyoses, but with a normal LB secretory system, and in healthy controls and were evaluated by electron microscopy and immunohistochemical analysis from July 1, 2010, through March 31, 2013. MAIN OUTCOME AND MEASURES: Changes in LB secretion and in the fate of LB-derived enzymes and antimicrobial peptides in ichthyotic patients vs healthy controls. RESULTS: In healthy controls and patients with X-linked ichthyosis, neutral lipid storage disease with ichthyosis, and Gaucher disease, LB secretion is normal, and delivery of LB-derived proteins and LL-37 immunostaining persists high into the SC. In contrast, proteins loaded into nascent LBs and their delivery to the SC interstices decrease markedly in patients with HI, paralleled by reduced immunostaining for LL-37, HBD2, and KLK7 in the SC. In patients with EI, the cytoskeletal abnormality impairs the exocytosis of LB contents and thus results in decreased LL-37, HBD2, and KLK7 secretion, causing substantial entombment of these proteins within the corneocyte cytosol. Finally, in patients with NS, although abundant enzyme proteins loaded in parallel with accelerated LB production, LL-37 disappears, whereas KLK7 levels increase markedly in the SC. CONCLUSIONS AND RELEVANCE: Together, these results suggest that diverse abnormalities in the LB secretory system account for the increased risk of secondary infections and impaired desquamation in patients with HI, EI, and NS.

[Bacterial lip abscess in an immunocompetent patient]. / Absceso bacteriano labial en paciente inmunocompetente.

Lip abscesses are a potentially serious condition rarely reported in the medical literature. This disease requires prompt diagnosis and treatment with hospitalization, intravenous antibiotics, and urgent surgical drainage. Clinical knowledge of this condition is essential to guide the differential diagnosis and correctly adapt the etiological treatment. The presence of necrotic and cavitated lesions requires ruling out immunosupression or methicillin-resistant agent. We report a necrotic and cavitated bacterial lip abscess caused by methicillin-sensitive Staphylococcus aureus in an immunocompetent male.

Asociaciones de la concentración de adiponectina sérica con parámetros antropométricos, bioquímicos y presión arterial en población de alto riesgo cardiovascular / Serum adiponectin concentration association with anthropometric, biochemical and blood pressure measures in a population with high cardiovascular risk

Introducción. La adiponectinemia se ha asociado inversamente con obesidad abdominal, un perfil lipídico más favorable y menor resistencia a la insulina. Sin embargo, recientes estudios en población de alto riesgo cardiovascular, especialmente con función renal alterada, muestran que concentraciones elevadas son un indicador desfavorable. Nuestro objetivo ha sido estudiar la asociación entre adiponectinemia y parámetros antropométricos, bioquímicos y presión arterial (PA) en pacientes de alto riesgo cardiovascular. Pacientes y métodos. Se estudió a 185 pacientes (133 mujeres y 52 varones), participantes del estudio PREDIMED (edad media de 65,5 ± 4,3 años). Se obtuvieron datos clínicos, antropométricos, bioquímicos y de PA, así como adiponectinemia. Resultados. El índice de masa corporal (IMC) fue ligeramente superior en mujeres que en varones (31,1 ± 4,3 frente a 29,4 ± 4,0 kg/m2; p = 0,01). La prevalencia de diabetes fue del 42,2%, y era superior en los varones (61,5%) que en las mujeres (34,6%). La adiponectinemia fue superior en las mujeres que en los varones (11,0 ± 5,2 frente a 6,9 ± 3,3 µg/ml; p < 0,001). Tras ajustar por sexo, las concentraciones medias de adiponectina fueron más elevadas en no diabéticos que en diabéticos (10,3 ± 0,5 frente a 7,5 ± 0,5; p < 0,001). Se obtuvieron correlaciones positivas entre adiponectina y colesterol unido a lipoproteínas de alta densidad (cHDL) (r = 0,36; p < 0,001), y correlaciones negativas con triglicéridos plasmáticos (r = ­0,28; p < 0,001), glucemia (r = ­0,28; p < 0,001) y creatinina plasmática (r = ­0,28; p = 0,007). Ni la PA sistólica ni la diastólica se asociaron con la adiponectinemia. Conclusiones. La adiponectinemia en esta población de alto riesgo cardiovascular no presenta correlaciones tan claras con parámetros antropométricos y PA como en población general. Sí que se ha mostrado más baja en diabéticos y correlacionada inversamente con la creatinina (AU)

Introduction. Serum adiponectin concentrations have been inversely associated with abdominal obesity, a more favorable lipid profile, and less insulin resistance. Nevertheless, recent studies in the population at high cardiovascular risk, especially that with altered renal function, show that high adiponectin concentrations are an unfavorable indicator. The aim of this study was to analyze the association of adiponectinemia with anthropometric, biochemical and blood pressure parameters in patients with high cardiovascular risk. Patients and methods. We studied 185 patients (133 women and 52 men), participating in the PREDIMED study (mean age 65.5 ± 4.3 years). Clinical, anthropometric, biochemical and blood pressure data, as well as adiponectinemia, were analyzed. Results. The body mass index was slightly higher in women than in men (31.1 ± 4.3 kg/m2 versus 29.4 ± 4.0 kg/m2; p = 0.01). The prevalence of diabetes was 42.2% and was higher in men (61.5%) than in women (34.6%). Adiponectin concentrations were higher in women than in men (11.0 ± 5.2 versus 6.9 ± 3.3 µg/mL; p < 0.001). After adjustment for sex, mean adiponectin concentrations were higher in nondiabetic than in diabetic participants (10.3 ± 0.5 versus 7.5 ± 0.5; p < 0.001). Positive correlations between adiponectin and high-density lipoprotein cholesterol were obtained (r = 0.36; p < 0.001). Negative correlations with plasma triglycerides (r = ­0.28; p < 0.001), glycemia (r = ­0,28; p < 0.001) and plasma creatinine (r = ­0.28; p = 0.007) were found. No association was found between adiponectinemia and systolic or diastolic blood pressure. Conclusions. In the population studied with high cardiovascular risk, the correlations between adiponectinemia and anthropometric parameters and blood pressure were less clear than those in the general population. However, adiponectin concentrations were lower in diabetics and were inversely correlated with creatinine levels (AU)