Perceived quality of life in patients with psoriasis treated with interleukin 17 and 23 inhibitors. / Calidad de vida percibida por los pacientes con psoriasis tratados con inhibidores de interleucina 17 y 23.

OBJECTIVE: To determine the effectiveness in terms of quality of life perceived by adult patients with moderate/severe plaque psoriasis treated with interleukin 17 or 23 inhibitors and to identify associated factors. METHOD: Cross-sectional observational study including adult patients diagnosed with moderate/severe plaque psoriasis treated with interleukin 17 or 23 inhibitors for at least 12 or 16 weeks in follow-up, respectively. RESULTS: Forty-one patients were included: 65% male, median age 54 years (SD=13). The included patients were treated with ixekizumab 35%, guselkumab 25%, secukinumab 17.5%, brodalumab 15% and risankizumab 7.5%. Psoariasis area severity index (PASI) reduction was 94.6% (RIC 76.8-100%), DLQI of 1 (RIC 0-2.75), DLQI ≤ 1, 60%. The most affected health dimensions were symptoms and perceptions (57.5%), activities of daily living (27.5%) and discomfort caused with treatment (17.5%). No association was found between DLQI score < 1 and demographic, comorbidities and treatment-related variables. The median PASI reduction in patients with DLQI<1 was superior to patients with DLQI > 1 (100% vs 90.2%, p=0.025). CONCLUSIONS: Patients with moderate/severe plaque psoriasis treated with interleukin 17 or 23 inhibitors achieve adequate therapeutic targets achieving the target set according to clinical practice guideline recommendations (score ≤1 on the DLQI questionnaire and 90-100% reduction in the PASI index) and in accordance with the results of recent meta-analyses and real-life studies. A greater reduction of the PASI index is observed in the group reaching the quality of life target, there being the possibility of using patient-reported outcomes in the evaluation of treatment effectiveness.

Lupus miliaris disseminatus faciei with complete response to isotretinoin.

Lupus miliaris disseminatus faciei is an uncommon type of granulomatous rosacea characterized by a papular eruption in the central regions of the face. A 43-year-old woman presented with an asymptomatic papular eruption on the face that had developed over a period of five months. Physical examination revealed multiple, small, reddish-brown papules, distributed symmetrically on the central area of the face. A biopsy was taken, showing dermal epithelioid cell granulomas with central necrosis and surrounding lymphocytic infiltrate with multinucleate giant cells. No foreign bodies were found in granulomas and no mycobacterial or fungal components were detected. On the basis of these findings, the diagnosis of lupus miliaris disseminatus faciei was made. The patient was given oral isotretinoin 20mg/day with initial slow response. After 6 months' treatment the lesions completely disappeared. Many authors consider this entity to be a variant of granulomatous rosacea. It is a chronic condition that primarily affects young adults. Treatment is usually unsatisfactory. Therapies with corticosterois, tetracyclines, retinoids, clofazimine or topical tacrolimus have been described but there is a lack of controlled studies and convincing results. Our success with a 6-month course of low dose isotretinoin suggests consideration of a longer trial prior to abandoning this as treatment.

Distrofia simpática refleja: descripción de un caso con lesiones cutáneas / Reflex sympathetic dystrophy: description of a case with skin lesions

La algodistrofia simpática refleja es un síndrome mal definido en el que el paciente desarrolla un dolor desproporcionado a la causa. Se incluye dentro de los síndromes dolorosos regionales complejos. Los síntomas comienzan ante un traumatismo previo, en ocasiones trivial, y consisten en dolor urente, edema, cambios en el color de la piel, alteraciones en la vascularización, cambios de temperatura, hiperhidrosis y alteraciones cutáneas que consisten principalmente en cambios atróficos. Se han descrito otras manifestaciones cutáneas menos frecuentes en pacientes con este síndrome consistentes en pápulas, ampollas, lesiones inflamatorias e hiperpigmentación de aspecto reticulado. Presentamos el caso de un paciente con algodistrofia simpática refleja que tenía úlceras superficiales en la extremidad afectada que parecía una dermatitis artefacta

Reflex sympathetic dystrophy or algodystrophy is a poorly defined syndrome in which the patient develops pain disproportionate to the cause. It is included among the complex regional pain syndromes. The symptoms are triggered by some type of trauma, at times trivial, and consist of burning pain, edema, changes in skin color, alterations in vascularization, temperature changes, hyperhidrosis and skin disorders, which primarily consist of atrophic changes. Other less frequent cutaneous manifestations have been described in patients with this syndrome. These include papules, blisters, inflammatory lesions and reticulated hyperpigmentation. We discuss the case of a patient with reflex sympathetic dystrophy who presented with superficial ulcers on the affected limb, which mimicked dermatitis artefacta