AEDV Expert Document on the Management of Ulcerative Venereal Infections. / Documento de expertos de la AEDV sobre el manejo de infecciones venéreas ulcerativas.

Currently, ulcerative sexually transmitted infections, including syphilis, herpes simplex virus (HSV), lymphogranuloma venereum (LGV), chancroid, donovanosis and, more recently, monkeypox (MPOX), represent a growing challenge for health care professionals. The incidence of syphilis and LGV has increased in recent years in Spain. Additionally, HSV, syphilis and chancroid can also increase the risk of HIV acquisition and transmission. The population groups most vulnerable to these infections are young people, men who have sex with men (MSM) and commercial sex workers. It is important to make a timely differential diagnosis since genital, anal, perianal, and oral ulcerative lesions may pose differential diagnosis with other infectious and non-infectious conditions such as candidiasis vulvovaginitis, traumatic lesions, carcinoma, aphthous ulcers, Behçet's disease, fixed drug eruption, or psoriasis. For this reason, the dermatologist plays a crucial role in the diagnosis and management of sexually transmitted infections. This chapter presents the main epidemiological, clinical and therapeutic features associated with these infections.

Estudio piloto de la teledermatología directa durante el estado de alarma por la pandemia COVID-19 en un área sanitaria de Madrid (Estudio EVIDE-19) / Direct-to-Patient Teledermatology During COVID-19 Lockdown in a Health District in Madrid, Spain: The EVIDE-19 Pilot Study

ANTECEDENTES: Como consecuencia de la pandemia por la COVID-19 cesó la actividad dermatológica asistencial, por lo que iniciamos un estudio para evaluar la utilidad de la teledermatología (TD) directa entre paciente y dermatólogo a través de una App. El objetivo fue evaluar el impacto de esta herramienta para evitar consultas presenciales, así como describir los principales diagnósticos y la satisfacción de pacientes y médicos. MATERIAL Y MÉTODO: Estudio descriptivo prospectivo. Se incluyen pacientes nuevos que cumplen criterios de inclusión. Se realizó un análisis descriptivo de todas las variables mediante el programa estadístico SPSS. RESULTADOS: De los 1.497 pacientes que aceptaron participar el 25% (n = 374) enviaron una consulta virtual con imagen. De entre ellos el 17% (n = 64) fueron dados de alta de forma directa para control por atención primaria. En un 85% (n=318) de los pacientes se logra evitar la consulta presencial durante al menos 3 meses. Se emitió un diagnóstico en el 87,1% (n = 325) de los pacientes, siendo la confianza en el diagnóstico ≥ 7/10 en el 77,5% (n = 290). La calidad de la imagen fue suficiente en el 52,1%. La satisfacción del paciente fue de 4,5/5. Once de 16 dermatólogos consideraron la TD útil globalmente. La afección más frecuente fue la inflamatoria y melanocítica, siendo los diagnósticos más habituales nevus, acné y eccema. DISCUSIÓN:La TD directa asíncrona es una herramienta eficaz para valorar pacientes nuevos, con un alto grado de satisfacción para médicos y pacientes. El desarrollo de un sistema de TD eficiente implica la integración de la imagen digital en los sistemas de información médicos

BACKGROUND: Dermatologic care was halted because of the coronavirus disease 2019 pandemic, prompting us to study the usefulness of direct-to-patient teledermatology via a mobile application. We aimed to evaluate the service as a tool for avoiding face-to-face consultations, describe the main conditions diagnosed, and assess levels of patient and physician satisfaction. MATERIAL AND METHOD: Prospective descriptive study of new patients who met the inclusion criteria. Descriptive statistics for all variables were analyzed with SPSS. RESULTS: Of the 1,497 patients who agreed to participate in the study, 25% (n = 374) sent an image to a consultant dermatologist through the mobile application. Sixty-four patients (17%) were discharged directly and referred to primary care for follow-up. A face-to-face consultation was avoided for at least 3 months in 85% of patients (n = 318); 87.1% (n = 325) received a diagnosis and the dermatologist's level of confidence in this diagnosis was 7 or higher in 77.5% of cases (n = 290). The quality of the images sent was considered sufficient in 52.1% of cases. Patients rated their satisfaction with a score of 4.5 out of 5. Eleven of the 16 dermatologists rated their satisfaction as good overall. The most common conditions were inflammatory and melanocytic lesions. The main diagnoses were nevi, acne, and eczema. DISCUSSION: Direct-to-patient store-and-forward teledermatology is an effective means of evaluating new patients. Both clinicians and patients expressed high levels of satisfaction with the service. Systems enabling the addition of digital images to patient records are necessary to ensure the efficiency of teledermatology

Direct-to-Patient Teledermatology During COVID-19 Lockdown in a Health District in Madrid, Spain: The EVIDE-19 Pilot Study. / Estudio piloto de la teledermatología directa durante el estado de alarma por la pandemia COVID-19 en un área sanitaria de Madrid (Estudio EVIDE-19).

BACKGROUND: Dermatologic care was halted because of the coronavirus disease 2019 pandemic, prompting us to study the usefulness of direct-to-patient teledermatology via a mobile application. We aimed to evaluate the service as a tool for avoiding face-to-face consultations, describe the main conditions diagnosed, and assess levels of patient and physician satisfaction. MATERIAL AND METHOD: Prospective descriptive study of new patients who met the inclusion criteria. Descriptive statistics for all variables were analyzed with SPSS. RESULTS: Of the 1,497 patients who agreed to participate in the study, 25% (n=374) sent an image to a consultant dermatologist through the mobile application. Sixty-four patients (17%) were discharged directly and referred to primary care for follow-up. A face-to-face consultation was avoided for at least 3 months in 85% of patients (n=318); 87.1% (n=325) received a diagnosis and the dermatologist's level of confidence in this diagnosis was 7 or higher in 77.5% of cases (n=290). The quality of the images sent was considered sufficient in 52.1% of cases. Patients rated their satisfaction with a score of 4.5 out of 5. Eleven of the 16 dermatologists rated their satisfaction as good overall. The most common conditions were inflammatory and melanocytic lesions. The main diagnoses were nevi, acne, and eczema. DISCUSSION: Direct-to-patient store-and-forward teledermatology is an effective means of evaluating new patients. Both clinicians and patients expressed high levels of satisfaction with the service. Systems enabling the addition of digital images to patient records are necessary to ensure the efficiency of teledermatology.

Spanish Guidelines for Diagnosis, Management, Treatment, and Prevention of DRESS Syndrome.

BACKGROUND AND OBJECTIVE: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a complex multisystemic severe drug hypersensitivity reaction whose diagnosis and management are troublesome. DRESS syndrome requires management by various specialists. The correct identification of the culprit drug is essential to ensure safe future therapeutic options for the patient. There are no previous Spanish guidelines or consensus statements on DRESS syndrome. Objective: To draft a review and guidelines on the clinical diagnosis, allergy work-up, management, treatment, and prevention of DRESS syndrome in light of currently available scientific evidence and the experience of experts from multiple disciplines. METHODS: These guidelines were drafted by a panel of allergy specialists from the Drug Allergy Committee of the Spanish Society of Allergy and Clinical Immunology (SEAIC), together with other medical specialists involved in the management of DRESS syndrome and researchers from the PIELenRed consortium. A review was conducted of scientific papers on DRESS syndrome, and the expert panel evaluated the quality of the evidence of the literature and provided grades of recommendation. Whenever evidence was lacking, a consensus was reached among the experts. RESULTS: The first Spanish guidelines on DRESS syndrome are now being published. Important aspects have been addressed, including practical recommendations about clinical diagnosis, identification of the culprit drug through the Spanish pharmacovigilance system algorithm, and the allergy work-up. Recommendations are provided on management, treatment, and prevention. Algorithms for the management of DRESS in the acute and recovery phases have been drawn up. Expert consensus-based stepwise guidelines for the management and treatment of DRESS syndrome are provided.

Spanish guidelines for diagnosis, management, treatment, and prevention of DRESS syndrome

BACKGROUND: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a complex multisystemic severe drug hypersensitivity reaction whose diagnosis and management are troublesome. DRESS syndrome requires management by various specialists. The correct identification of the culprit drug is essential to ensure safe future therapeutic options for the patient. There are no previous Spanish guidelines or consensus statements on DRESS syndrome. OBJECTIVE: To draft a review and guidelines on the clinical diagnosis, allergy work-up, management, treatment, and prevention of DRESS syndrome in light of currently available scientific evidence and the experience of experts from multiple disciplines. METHODS: These guidelines were drafted by a panel of allergy specialists from the Drug Allergy Committee of the Spanish Society of Allergy and Clinical Immunology (SEAIC), together with other medical specialists involved in the management of DRESS syndrome and researchers from the PIELenRed consortium. A review was conducted of scientific papers on DRESS syndrome, and the expert panel evaluated the quality of the evidence of the literature and provided grades of recommendation. Whenever evidence was lacking, a consensus was reached among the experts. RESULTS: The first Spanish guidelines on DRESS syndrome are now being published. Important aspects have been addressed, including practical recommendations about clinical diagnosis, identification of the culprit drug through the Spanish pharmacovigilance system algorithm, and the allergy work-up. Recommendations are provided on management, treatment, and prevention. Algorithms for the management of DRESS in the acute and recovery phases have been drawn up. Expert consensus-based stepwise guidelines for the management and treatment of DRESS syndrome are provided

ANTECEDENTES: El síndrome DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) es una reacción cutánea grave inducida por hipersensibilidad a fármacos, compleja y multisistémica. Su diagnóstico y manejo es difícil e implica a diferentes especialistas. Es muy importante una correcta identificación del fármaco responsable para que el paciente disponga de opciones terapéuticas seguras en el futuro. No hay guías ni documentos de consenso españoles previos sobre el síndrome DRESS. OBJETIVO: Realizar una revisión y guía sobre el diagnóstico clínico y alergológico, manejo, tratamiento y prevención del DRESS según la evidencia científica disponible y la experiencia de expertos de diferentes especialidades médicas. MÉTODOS: Esta guía ha sido elaborada por un grupo de alergólogos del Comité de Alergia a Fármacos de la SEAIC, junto a otros especialistas involucrados en el manejo del DRESS e investigadores del Consorcio PIELenRed. Se realizó una búsqueda de publicaciones científicas sobre DRESS y el grupo de expertos evaluó la evidencia científica de la literatura y aportaron grados de recomendación. Cuando no existía evidencia se alcanzó un consenso entre expertos. RESULTADOS: Se publica la guía española sobre DRESS. Incluye aspectos prácticos importantes sobre el diagnóstico clínico, la identificación de fármacos causales a través del algoritmo del Sistema Español de Farmacovigilancia y guía para el diagnóstico alergológico. Se realizan recomendaciones sobre el manejo, tratamiento y prevención del DRESS. Se aportan algoritmos sobre el manejo en la fase aguda y en la de recuperación. Se ha elaborado una guía terapéutica escalonada consensuada por expertos especialistas implicados en el tratamiento del DRESS

Ustekinumab. Análisis de efectos adversos infecciosos / Ustekinumab. Analysis of Rates of Infection

Ustekinumab es el primer representante de un nuevo grupo de fármacos biológicos, cuyo mecanismo de acción principal es la inhibición selectiva de la actividad de las interleucinas 12 y 23. A pesar de ser la terapia de uso más reciente en dermatología, es el fármaco que mayor número de pacientes ha aportado en su desarrollo clínico en psoriasis. Gracias a esta experiencia acumulada, se ha confirmado que el perfil de seguridad de ustekinumab frente a eventos infecciosos demuestra un riesgo similar a placebo y equiparable a la población general en cuanto a incidencia absoluta, infecciones severas y requerimientos de antibioterapia adicional. Este comportamiento inicial se confirma durante el seguimiento a 3 y 4 años en pacientes con psoriasis moderada a severa. A pesar de este perfil favorable de seguridad, el carácter inmunosupresor selectivo de ustekinumab aconseja mantener un seguimiento estricto de los pacientes en tratamiento, como el despistaje de infecciones activas o latentes, similar a los aplicados en el caso de los fármacos anti factor de necrosis tumoral (AU)

Ustekinumab is the first of a new class of biologic agents whose main mechanism of action involves the selective inhibition of IL-12 and IL-23. Although ustekinumab is the latest biologic to be approved for use in dermatology, its approval was based on the largest clinical development program conducted to date in psoriasis. Safety data accumulated during the clinical development phase showed the risk of infection to be similar in patients in the ustekinumab and placebo groups. The use of additional antibiotics and the rates of overall infection and serious infection in patients on ustekinumab and the general population were also comparable. Subsequent studies confirmed the safety of this drug in patients with moderate to severe psoriasis treated for 3 or 4 years. Despite its favorable safety profile, ustekinumab is a selective immunosuppressant. Clinicians should therefore closely monitor patients and apply screening measures similar to those used during anti-TNF therapy to detect de novo infections or the reactivation of latent infections (AU)

Placa hiperpigmentada en el pie de un paciente keniata / Hyperpigmented Plaque on the Foot of a Kenyan Patient

No disponible

Detección precoz de la neoplasia intraepitelial anal en pacientes de alto riesgo / Early Detection of Anal Intraepithelial Neoplasia in High-Risk Patients

La incidencia de carcinoma epidermoide anal ha aumentado de forma alarmante, especialmente en grupos de riesgo como son los pacientes homosexuales y los inmunosuprimidos. La infección por un genotipo oncogénico del virus del papiloma humano (VPH) en el canal anal o en la piel perianal, desencadena una progresión de lesiones displásicas intraepiteliales (neoplasia intraepitelial anal o NIA), que son las precursoras del carcinoma epidermoide anal. La NIA puede diagnosticarse a través del cribado mediante citología y biopsia guiada por anoscopia de alta resolución, y puede tratarse mediante diferentes procedimientos, con el fin de evitar la progresión a carcinoma anal invasivo. En vista de los recientes avances en el conocimiento de esta patología, y de que cada vez son más los expertos que recomiendan la puesta en marcha de programas de cribado de la NIA, revisamos el concepto actual de la misma, su diagnóstico y tratamiento desde una perspectiva dermatológica (AU)

The incidence of anal squamous cell carcinoma has increased alarmingly, particularly in high-risk groups such as men who have sex with men and immunosuppressed patients. Infection with an oncogenic strain of the human papillomavirus in the anal canal or perianal skin leads to anal intraepithelial neoplasias (AIN), progressive dysplastic intraepithelial lesions that are the precursors of anal squamous cell carcinoma. AIN can be diagnosed through cytological screening and biopsy guided by high-resolution anoscopy and can be treated using a range of procedures in an effort to prevent progression to invasive anal carcinoma. Given the recent advances in the understanding of this disease, and the increasing calls from experts for the establishment of screening programs to identify AIN, we review current knowledge on the condition, its diagnosis, and treatment from the point of view of dermatology (AU)

[Early detection of anal intraepithelial neoplasia in high-risk patients]. / Detección precoz de la neoplasia intraepitelial anal en pacientes de alto riesgo.

The incidence of anal squamous cell carcinoma has increased alarmingly, particularly in high-risk groups such as men who have sex with men and immunosuppressed patients. Infection with an oncogenic strain of the human papillomavirus in the anal canal or perianal skin leads to anal intraepithelial neoplasias (AIN), progressive dysplastic intraepithelial lesions that are the precursors of anal squamous cell carcinoma. AIN can be diagnosed through cytological screening and biopsy guided by high-resolution anoscopy and can be treated using a range of procedures in an effort to prevent progression to invasive anal carcinoma. Given the recent advances in the understanding of this disease, and the increasing calls from experts for the establishment of screening programs to identify AIN, we review current knowledge on the condition, its diagnosis, and treatment from the point of view of dermatology.

Successful treatment of three cases of primary extramammary Paget's disease of the vulva with Imiquimod--proposal of a therapeutic schedule.

BACKGROUND/AIM: Extramammary Paget's disease (EMPD) is an intraepidermal adenocarcinoma of apocrine gland-bearing skin. Although surgery remains the mainstay of treatment, loss of tissue function and high recurrence rates have been reported. Recently, topical Imiquimod has been shown as a safe and effective treatment option for extramammary Paget's disease. METHODS: Three patients diagnosed of EMPD of the vulva were treated with a daily application of 5% Imiquimod cream for three weeks, followed by an every other day application for an additional three weeks. RESULTS: Complete clinical and histological remission of the disease was achieved in the three patients. Mild irritation and tenderness were observed as the only side effects. CONCLUSION: Based on our results, we consider that Imiquimod cream is a safe and effective therapeutic option for the treatment of vulvar EMPD. These promising results warrant further studies to determine the real efficacy and safety of Imiquimod 5% cream for the treatment of this uncommon disease.