Iberia Consensus on Strategies to Prevent and Manage Irritation by Topical Retinoids in Facial and Trunk Acne. / Consenso Iberia sobre estrategias de prevención y manejo de la irritación por retinoides tópicos en acné localizado en cara y tronco.

OBJECTIVE: To assess the level of agreement on various prevention and management strategies for irritation caused by topical retinoids in facial and trunk acne in an attempt to alleviate it and minimize treatment discontinuations as much as possible. METHOD: After reviewing the scientific medical literatura currently available, 4 different areas of uncertainty in the management of irritation caused by topical retinoids in acne were identified. A questionnaire with 34 recommendations was created and evaluated by a group of 133 dermatologists (Delphi methodology). RESULTS: In 82.3% of the recommendations (28 out of 34), some level of agreement was reached (≥ 85% agreement in 22 recommendations and ≥ 70% agreement in 6). The results with the highest level of agreement focused on specific patient education strategies (explaining that irritation is an expected reaction at the beginning of treatment and tends to decrease over time), gradual and/or spaced application of topical retinoids (at night time to prevent and/or reduce skin irritation), and the importance of using adjuvant products, specific for acne-prone skin, hydration, photoprotection, and skin cleansing. These recommendations reflect a comprehensive approach to managing irritation associated with topical retinoids and promoting long-term adherence. CONCLUSIONS: Skin irritation caused by topical retinoids in facial and trunk acne is an expected, mild, and controllable reaction if proper prevention and management guidelines are followed, meaning that it should not be a reason for treatment discontinuation.

Iberia Consensus on Strategies to Prevent and Manage Irritation by Topical Retinoids in Facial and Trunk Acne. / Consenso Iberia sobre estrategias de prevención y manejo de la irritación por retinoides tópicos en acné localizado en cara y tronco.

OBJECTIVE: To assess the level of agreement on various prevention and management strategies for irritation caused by topical retinoids in facial and trunk acne in an attempt to alleviate it and minimize treatment discontinuations as much as possible. METHOD: After reviewing the scientific medical literatura currently available, 4 different areas of uncertainty in the management of irritation caused by topical retinoids in acne were identified. A questionnaire with 34 recommendations was created and evaluated by a group of 133 dermatologists (Delphi methodology). RESULTS: In 82.3% of the recommendations (28 out of 34), some level of agreement was reached (≥85% agreement in 22 recommendations and≥70% agreement in 6). The results with the highest level of agreement focused on specific patient education strategies (explaining that irritation is an expected reaction at the beginning of treatment and tends to decrease over time), gradual and/or spaced application of topical retinoids (at night time to prevent and/or reduce skin irritation), and the importance of using adjuvant products, specific for acne-prone skin, hydration, photoprotection, and skin cleansing. These recommendations reflect a comprehensive approach to managing irritation associated with topical retinoids and promoting long-term adherence. CONCLUSIONS: Skin irritation caused by topical retinoids in facial and trunk acne is an expected, mild, and controllable reaction if proper prevention and management guidelines are followed, meaning that it should not be a reason for treatment discontinuation.

Lesión tuberosa en la rodilla de un año de evolución / Tuberous Lesion of 1-Year Duration on the Knee

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Pitiriasis «rubra pilaris» localizada / Pityriasis rubra pilaris localized

Incluimos la pitiriasis rubra pilaris (PRP) dentro del grupo de las dermatosis papuloescamosas hiperqueratósicas de origen desconocido. Aunque poco frecuente, se han constatado dos picos de incidencia en la primera y en la quinta década de la vida, lo cual determina su clasificación en cinco grandes grupos, los dos primeros típicos en la edad adulta y los tres restantes en la edad juvenil. En los últimos años se ha incluido un sexto grupo, asociado al virus de la inmunodeficiencia humana (VIH), independientemente de la edad. No existe un tratamiento estandarizado para la PRP, pero por lo general en casos localizados suelen emplearse tratamientos tópicos, entre los que incluimos los corticoides, los derivados de la vitamina D o los retinoides; en casos más extensos podría recurrirse a tratamientos sistémicos, y como primera elección los retinoides orales(AU)

Pityriasis rubra pilaris (PRP) is an uncommon papulosquamous keratotic dermatosis of unknown origin. It has a bimodal distribution of age onset concentrating in the first and fifth decades. Classification of PRP includes 5 types: types I and II represent the forms of adult PRP, respectively, whereas types III, IV, and V are seen in juveniles. In recent years, a type VI PRP associated with HIV infection has been proposed. A universal standard treatment for PRP is lacking. Topical therapy is the treatment of choice for patients with mild type III and type IV PRP, including corticoids, vitamin D analogue ortopical retinoids. Systemic therapy is reserved for patients with severe type III and type V. Acitretin and isotretinoin are the treatment of choice(AU)

Síndrome de Peutz-Jeghers / Peutz-Jeghers syndrome

Presentamos el caso de un niño de 6 años de edad con lesioneshiperpigmentadas en la región perioral. El padre del pacientehabía sido diagnosticado de síndrome de Peutz-Jeghers (SPJ)mediante un estudio genético. Las lesiones cutáneas, junto conlos antecedentes familiares, fueron la clave para el diagnósticotemprano de la enfermedad. El SPJ es una entidad rara, caracterizadapor la aparición de lentigos periorificiales y póliposgastrointestinales. Histológicamente, estos pólipos son hamartomasque pueden llegar a malignizarse. Además, el SPJ seasocia al desarrollo de tumores extraintestinales (mama, endometrio,ovario, testículo, páncreas...). Por ello, es necesariorealizar un diagnóstico precoz y un control periódico de laspersonas que padecen este síndrome y sus familiares(AU)

We report the case of a 6-year-old child with hyperpigmentedlesions in perioral region. His father had been diagnosed ofPeutz-Jeghers syndrome (PJS) by genetic testing. PJS is a rareentity characterized by the presence of hyperpigmented periorificiallesions and gastrointestinal polyps. Histologically, thesepolyps are hamartomas that can become malignant. Moreover,PJS is associated with the development of nongastrointestinalcancer (breast, endometrium, ovary, testicle, pancreas...). It istherefore necessary to make an early diagnosis and periodicmonitoring of the patients with this syndrome and their families(AU)

Actitud expectante como tratamiento eficaz en un caso de múltiples lesiones por «Molluscum contagiosum» / Attitude expectant as effective treatment in Molluscum contagiosum

El molusco contagioso es una infección cutánea frecuente causada por un virus de la familia de los poxvirus, que afecta principalmente a los niños. La enfermedad puede transmitirse por contacto directo a través de la piel, por fómites contaminados o por autoinoculación. La infección se resuelve habitualmente de forma espontánea en pacientes inmunocompetentes, en un tiempo que puede oscilar entre meses y años. Existe un debate continuo sobre si se debe tratar activamente o mantener una actitud expectante(AU)

Molluscum contagiosum is a common skin infection, caused by a poxvirus, that affect mainly children. The disease can be transmitted by direct contact, fomites, or auto-inoculation. The infection will usually resolve within months or years in people with normal immunity. There has been a continous discussion about whether physicians should treat Molluscum contagiosum actively or not(AU)

Síndrome del pelo impeinable / Uncombable hair syndrome

El síndrome del pelo impeinable es una anomalía infrecuente del tallo piloso, que determina la presencia de un pelo desorganizado y difícil de peinar. Esta entidad se caracteriza por la presencia de un surco longitudinal a lo largo del tallo piloso y una forma triangular en la sección transversal(AU)

Uncombable hair syndrome is a rare anomaly of the hair shaft that results in a disorganized, unruly hair pattern that it is impossible to comb flat. This condition has a characteristic longitudinal groove along the hair shaft and a triangular cross-section(AU)

Erupción acneiforme inducida por erlotinib que respeta el área de piel previamente irradiada / Erlotinib-induced Acneiform Rash Not Affecting Previously Irradiated Skin

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Calcinosis cutis and Sjögren's syndrome.

Cutaneous calcinosis can be classified into four types: dystrophic, metastatic, idiopathic and iatrogenic. Dystrophic calcification constitutes the most frequent variant and is associated with a large number of illnesses, among which are included some collagen diseases such as CREST syndrome, scleroderma, dermatomyositis and lupus erythematosus. We present a case of dystrophic calcinosis cutis, affecting the fingertip of a woman with a 10-year history of primary Sjögren's syndrome (SS). She has been receiving diltiazem as a treatment for the last 15 months, resulting in the partial resolution of the lesions. We emphasize the fact that the presence of calcinosis cutis has not been described previously in patients with SS, and that diltiazem has partially improved our patient's cutaneous lesions.

Nódulos eritematosos agrupados en el tronco / Cluster oferyt hematous nodules on the trunk

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