Evidence-based guidelines of the spanish psoriasis group on the use of biologic therapy in patients with psoriasis in difficult-to-treat sites (nails, scalp, palms, and soles).

Psoriatic lesions affecting the scalp, nails, palms, and the soles of the feet are described as difficult-to-treat psoriasis and require specific management. Involvement of these sites often has a significant physical and emotional impact on the patient and the lesions are difficult to control with topical treatments owing to inadequate penetration of active ingredients and the poor cosmetic characteristics of the vehicles used. Consequently, when difficult-to-treat sites are involved, psoriasis can be considered severe even though the lesions are not extensive. Scant information is available about the use of biologic therapy in this setting, and published data generally comes from clinical trials of patients who also had moderate to severe extensive lesions or from small case series and isolated case reports. In this article we review the quality of the scientific evidence for the 4 biologic agents currently available in Spain (infliximab, etanercept, adalimumab, and ustekinumab) and report level i evidence for the use of biologics to treat nail psoriasis (level of recommendation A) and a somewhat lower level of evidence in the case of scalp involvement and palmoplantar psoriasis.

Directrices españolas basadas en la evidencia para el tratamiento de la psoriasis con agentes biológicos, 2013. I. Consideraciones de eficacia y selección del tratamiento / Spanish Evidence-Based Guidelines on the Treatment of Psoriasis With Biologic Agents, 2013. Part 1: On Efficacy and Choice of Treatment

La terapia biológica representa una alternativa bien establecida en el manejo de la psoriasis moderada y grave. Sin embargo, su elevado coste, la experiencia relativamente limitada en su empleo clínico y la abundancia de publicaciones existentes hacen necesario el desarrollo de unas directrices basadas en la evidencia científica disponible y en el consenso de un grupo de expertos. El objetivo ideal del tratamiento de la psoriasis es conseguir y mantener a largo plazo un blanqueamiento completo o prácticamente completo o, en su defecto, una mínima afectación localizada y controlable con tratamientos tópicos. Aunque la evidencia disponible permite comparar de forma directa o indirecta la eficacia y las posibilidades de fracaso terapéutico primario o secundario de los diferentes fármacos según parámetros objetivos, las limitaciones en la extrapolación de los ensayos clínicos a la clínica diaria condicionan que la elección del fármaco y de la pauta de administración se realicen de forma individualizada en función de las características de cada paciente. La presente actualización de las directrices para el tratamiento de la psoriasis con agentes biológicos de la Academia Española de Dermatología y Venereología (AEDV) incorpora la información más reciente disponible a este respecto (AU)

Biologic therapy is a well-established strategy for managing moderate and severe psoriasis. Nevertheless, the high cost of such therapy, the relatively short span of clinical experience with biologics, and the abundance of literature now available on these agents have made evidence-based and consensus-based clinical guidelines necessary. The ideal goal of psoriasis treatment is to achieve complete or nearly complete clearing of lesions and to maintain it over time. Failing that ideal, the goal would be to reduce involvement to localized lesions that can be controlled with topical therapy. Although current evidence allows us to directly or indirectly compare the efficacy or risk of primary or secondary failure of available biologics based on objective outcomes, clinical trial findings cannot be directly translated to routine practice. As a result, the prescribing physician must tailor the treatment regimen to the individual patient. This update of the clinical practice guidelines issued by the Spanish Academy of Dermatology and Venereology (AEDV) on biologic therapy for psoriasis incorporates information from the most recent publications on this topic (AU)

Spanish evidence-based guidelines on the treatment of psoriasis with biologic agents, 2013. Part 1: on efficacy and choice of treatment. Spanish Psoriasis Group of the Spanish Academy of Dermatology and Venereology.

Biologic therapy is a well-established strategy for managing moderate and severe psoriasis. Nevertheless, the high cost of such therapy, the relatively short span of clinical experience with biologics, and the abundance of literature now available on these agents have made evidence-based and consensus-based clinical guidelines necessary. The ideal goal of psoriasis treatment is to achieve complete or nearly complete clearing of lesions and to maintain it over time. Failing that ideal, the goal would be to reduce involvement to localized lesions that can be controlled with topical therapy. Although current evidence allows us to directly or indirectly compare the efficacy or risk of primary or secondary failure of available biologics based on objective outcomes, clinical trial findings cannot be directly translated to routine practice. As a result, the prescribing physician must tailor the treatment regimen to the individual patient. This update of the clinical practice guidelines issued by the Spanish Academy of Dermatology and Venereology (AEDV) on biologic therapy for psoriasis incorporates information from the most recent publications on this topic.

Lesiones nodulares en extremidades inferiores delarga evolución. Eritema indurado de Bazin / Long evolution of nodular lessions in low extremities. Erythema induratum of Bazin

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Epitelioma espinocelular sobre queratosis seborreica. Aportación de un caso / Squamous carcinoma arising in seborrheic keratosis. Report of a case

Se presenta un caso de epitelioma espinocelular que apareció sobre una queratosis seborreica (QS) en una paciente de 94 años de edad, que presentaba una placa hiperpigmentada en el abdomen. La lesión revelaba una masa ulcerada que, clínicamente, sugería malignidad. El examen histopatológico de la lesión puso de manifiesto la presencia de un carcinoma espinocelular sobre una QS. Por tanto, la coexistencia de carcinoma espinocelular y QS es posible y debería ser considerada cuando se aprecia un cambio maligno sobre una QS (AU)