Body dysmorphic disorder in patients with acne: a multicentre study.

BACKGROUND AND OBJECTIVE: Body dysmorphic disorder (BDD) is a mental disorder that is difficult to diagnose, causes a lot of suffering and is more prevalent in dermatology patients than in the general population. Our objective was to screen for possible cases of BDD in patients with acne and to determine the prevalence according to DSM-IV and DSM-5 criteria, as well as to analyse the relationship between dermatological and sociodemographic variables. METHODS: A total of 245 patients diagnosed with acne in 11 dermatological centres in Spain were included in the study by members of the Aragon Psychodermatology Research Group and Spanish Research Group of Psychiatric Dermatology. We used the Body Dysmorphic Disorder Questionnaire (BDDQ) as a screening tool. RESULTS: In our sample, we obtained a prevalence for BDD of 10.6% (95% CI: 7.6-13.6%). The prevalence was the same with DSM-IV or DSM-5 criteria. Possible cases of BDD were predominantly women (P = 0.021), and 56% had non-inflammatory lesions vs. 30% of negative patients (P = 0.002). Positive patients as possible cases of BDD spent more than two hours on average a day worrying about their appearance. Most people only worried about one part of their body (86%), and in 95% of the cases, the part of their body that worried them was the face. The three most frequent compulsive behaviours in patients who screened positive for BDD were mirror checking (90.7%), camouflaging (79.1%) and using make-up (72.1%). CONCLUSIONS: As a consequence of the high prevalence of possible cases of BDD in patients with acne observed in our study, there is a need for dermatologists to screen for BDD so that they can be referred to a mental health unit to confirm the diagnosis and be offered treatment to reduce the progression of psychosocial deterioration and the development of comorbid disorders.

Mácula eritematosa dolorosa en el tobillo de una mujer joven / Painful erythematous macular lesion in the ankle of a young woman

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Differences Between Men and Women in Chronic Scratching: A Psychodermatologic Study in Lichen Simplex Chronicus / Diferencias de personalidad entre hombres y mujeres con liquen simple crónico. Implicaciones para la conducta de rascado crónico

Introduction: Chronic scratching is common to many skin disorders. Being a female and presenting a high level of psychopathology are risk factors for chronic scratching. Yet, it is unclear why. Certain personality characteristics that are more prevalent in women are also known to influence emotional states (i.e. emotional tension). Objective: The present study aims to explore whether these personality styles might help understand why gender and emotional distress are associated with scratching. Material and methods: We compared the personality patterns of 103 patients (69.9% women) diagnosed with Lichen Simplex Chronicus, against a sample of healthy individuals. Results: Significant differences were found in the personality styles of men and women with LSC. Women were more pessimistic, oriented to fulfil the needs of others, traditional, insecure, submissive, and reserved, with moderate (d= .43) to strong (d= .96) size effects ranges. Some of these differences, such as in traditionalism, dutifulness, other-orientation, and pessimism, were also observed when compared with healthy men and women, with small (d= .03) to moderate (d= .47) size effects ranges. Conclusions: These psychological factors may help explain the mechanisms underlying gender differences in chronic scratching, at least in Lichen Simplex Chronicus. The findings might open new avenues for research and treatment (AU)

Introducción: El rascado crónico es común a varias enfermedades dermatológicas. Ser mujer y presentar niveles elevados de psicopatología son factores de riesgo para el rascado crónico. Sin embargo, aún se desconoce la causa de esta relación. Ciertas características de personalidad relacionadas con el estrés son más prevalentes en mujeres. Objetivo: Explorar si los estilos de personalidad pueden explicar las diferencias entre hombres y mujeres en las variables psicológicas asociadas con el rascado crónico. Material y métodos: Comparamos los perfiles de personalidad de 103 pacientes (69,9% mujeres) diagnosticados de liquen simple crónico y una muestra de sujetos sanos. Resultados: Se encontraron diferencias estadísticamente significativas entre hombres y mujeres con liquen simple crónico, siendo las mujeres más pesimistas, orientadas a los demás, tradicionales, inseguras, sumisas y reservadas en cuanto a sus emociones negativas, con rangos del tamaño del efecto entre moderados (d = 0,43) y altos (d = 0,96). También se encontraron entre la muestra de liquen simple crónico y los controles, como por ejemplo en tradicionalismo, sumisión, orientación al otro y pesimismo, con rangos del tamaño del efecto entre bajos (d = 0,03) y moderados (d = 0,47). Conclusiones: Estos hallazgos podrían ayudar a explicar los mecanismos subyacentes a las diferencias de sexo en rascado crónico, al menos en el liquen simple crónico (AU)

Differences Between Men and Women in Chronic Scratching: A Psychodermatologic Study in Lichen Simplex Chronicus.

INTRODUCTION: Chronic scratching is common to many skin disorders. Being a female and presenting a high level of psychopathology are risk factors for chronic scratching. Yet, it is unclear why. Certain personality characteristics that are more prevalent in women are also known to influence emotional states (i.e. emotional tension). OBJECTIVE: The present study aims to explore whether these personality styles might help understand why gender and emotional distress are associated with scratching. MATERIAL AND METHODS: We compared the personality patterns of 103 patients (69.9% women) diagnosed with Lichen Simplex Chronicus, against a sample of healthy individuals. RESULTS: Significant differences were found in the personality styles of men and women with LSC. Women were more pessimistic, oriented to fulfil the needs of others, traditional, insecure, submissive, and reserved, with moderate (d=.43) to strong (d=.96) size effects ranges. Some of these differences, such as in traditionalism, dutifulness, other-orientation, and pessimism, were also observed when compared with healthy men and women, with small (d=.03) to moderate (d=.47) size effects ranges. CONCLUSIONS: These psychological factors may help explain the mechanisms underlying gender differences in chronic scratching, at least in Lichen Simplex Chronicus. The findings might open new avenues for research and treatment.

Tinción inmunohistoquímica p16 en carcinomas epidermoides del área genital y extragenital / Immunohistochemical Staining of p16 in Squamous Cell Carcinomas of the Genital and Extragenital Area

Introducción: La proteína p16 es una proteína supresora tumoral. El objetivo del estudio era comprobar si la tinción p16 se relaciona con la presencia de papilomavirus (subtipos mucosos o α, VPH-mc) en carcinomas epidermoides (CE) extragenitales (como ocurre en el cérvix y en CE genitales). Material y método: Se realizó tinción inmunohistoquímica con p16 a diversas lesiones incluidas en parafina del área genital (8 condilomas, tres CE intraepidérmicos y 7 CE invasores) y del área extragenital (20 CE intraepidérmicos tipo enfermedad de Bowen [EB] y 10 CE invasores). La detección de VPH-mc se realizó mediante reacción en cadena de la polimerasa (PCR). Resultados: En el área genital la tinción p16 fue negativa en los condilomas y positiva en los tres CE intraepidérmicos y en dos CE invasores (29%). Se detectó VPH-mc en 6 condilomas y dos CE intraepidérmicos (100%, excluyendo tres lesiones que no se pudieron estudiar con PCR) y en los dos CE invasores positivos para p16. En el área extragenital la tinción p16 fue positiva en 19 EB (95%) y en dos CE invasores (20%). Se detectó VPH-mc en 4 EB (tinción p16 positiva) y en un CE invasor (p16 negativa). En los CE intraepidérmicos la tinción p16 fue útil para objetivar si existían focos de microinfiltración dérmica o invasión de estructuras anexiales normales. Conclusiones: Según nuestros resultados la positividad de p16 es independiente de la detección de VPH en los CE extragenitales, al contrario de lo observado en CE genitales. En el área extragenital la pérdida de proteína p16 en los CE invasores respecto a los CE intraepidérmicos indicaría progresión tumoral (AU)

Background and objectives: Positive immunostaining for the tumor suppressor protein p16 is associated with the presence of mucosal or alfa subtypes of human papillomavirus (HPV) in cervical and genital squamous cell carcinoma (SCC). The aim of this study was to determine whether p16 immunostaining is also associated with mucosal HPV in extragenital SCC. Material and methods: Paraffin sections of lesions located in the genital region (8 genital warts, 3 intraepidermal SCCs, and 7 invasive SCCs) and extragenital area (29 intraepidermal SCCs corresponding to Bowen disease and 10 invasive SCCs) were stained for p16 by immunohistochemistry. Mucosal HPV was detected by polymerase chain reaction (PCR). Results: In the genital area, p16 immunostaining was negative in genital warts and positive in all 3 intraepidermal SCCs and 2 invasive SCCs (29%). Mucosal HPV was detected in 6 genital warts and 2 intraepidermal SCCs (100% after exclusion of 3 lesions that could not be analyzed by PCR) and in the 2 invasive SCCs that were positive for p16. In the extragenital area, 19 intraepidermal SCCs (95%) and 2 invasive SCCs (20%) were immunopositive for p16. Mucosal HPV was detected in 4 intraepidermal SCCs (p16 immunopositive) and 1 invasive SCC (p16 immunonegative). In intraepidermal SCCs, p16 immunostaining facilitated the identification of dermal microinfiltration or invasion of normal skin appendages. Conclusions: According to our results, unlike in genital SCCs, p16 immunopositivity is independent of the presence of HPV in extragenital SCCs. Compared with intraepidermal SCCs, the absence of p16 protein in invasive SCCs in the extragenital area would indicate progression of the disease (AU)

[Immunohistochemical staining of p16 in squamous cell carcinomas of the genital and extragenital area]. / Tinción inmunohistoquímica p16 en carcinomas epidermoides del área genital y extragenital.

BACKGROUND AND OBJECTIVES: Positive immunostaining for the tumor suppressor protein p16 is associated with the presence of mucosal or αsubtypes of human papillomavirus (HPV) in cervical and genital squamous cell carcinoma (SCC). The aim of this study was to determine whether p16 immunostaining is also associated with mucosal HPV in extragenital SCC. MATERIAL AND METHODS: Paraffin sections of lesions located in the genital region (8 genital warts, 3 intraepidermal SCCs, and 7 invasive SCCs) and extragenital area (29 intraepidermal SCCs corresponding to Bowen disease and 10 invasive SCCs) were stained for p16 by immunohistochemistry. Mucosal HPV was detected by polymerase chain reaction (PCR). RESULTS: In the genital area, p16 immunostaining was negative in genital warts and positive in all 3 intraepidermal SCCs and 2 invasive SCCs (29%). Mucosal HPV was detected in 6 genital warts and 2 intraepidermal SCCs (100% after exclusion of 3 lesions that could not be analyzed by PCR) and in the 2 invasive SCCs that were positive for p16. In the extragenital area, 19 intraepidermal SCCs (95%) and 2 invasive SCCs (20%) were immunopositive for p16. Mucosal HPV was detected in 4 intraepidermal SCCs (p16 immunopositive) and 1 invasive SCC (p16 immunonegative). In intraepidermal SCCs, p16 immunostaining facilitated the identification of dermal microinfiltration or invasion of normal skin appendages. CONCLUSIONS: According to our results, unlike in genital SCCs, p16 immunopositivity is independent of the presence of HPV in extragenital SCCs. Compared with intraepidermal SCCs, the absence of p16 protein in invasive SCCs in the extragenital area would indicate progression of the disease.

[Burning mouth syndrome]. / Síndrome de la boca urente.

Burning mouth syndrome is characterized by a painful burning or stinging sensation affecting the tongue or other areas of the mouth without obvious signs of an organic cause on physical examination. A burning mouth sensation can occur in several cutaneous or systemic diseases that must be ruled out prior to making a diagnosis of burning mouth syndrome, since this term is used exclusively to refer to idiopathic forms and is included within the cutaneous sensory disorders. In most cases, patients with burning mouth syndrome have accompanying psychologic or psychiatric conditions. Consequently, the syndrome has traditionally been included among the psychogenic dermatoses. However, it is currently unclear whether psychologic factors are a cause or a consequence of the syndrome, or whether each exacerbates the other. Recent studies propose the etiology to be neurologic, either neuropathic or related to taste.