[Translated article] Requirements for Accessing New Dermatology Drugs in Spain: Results of the EQUIDAD Study.

BACKGROUND: Although the Spanish Ministry of Health prepares national therapeutic positioning reports (TPRs) and drug reimbursement policies, each of the country's 17 autonomous communities (ACs) is responsible for health care services and prescription requirements in its territory. The aim of the EQUIDAD study was to describe and explore potential differences in prescription requirements for new dermatology drugs across the autonomous communities. MATERIAL AND METHODS: Cross-sectional study conducted in April and May, 2023. Two dermatologists with management responsibilities from each autonomous community reported on territorial and more local prescription requirements for drugs covered by national TPRs issued between 2016 and 2022. RESULTS: Thirty-three researchers from 17 autonomous communities participated. The data submitted revealed between-community inequities in access to new drugs. Overall, 64.7% of the regions imposed additional prescription requirements to those mentioned in the TPRs for psoriasis. This percentage was lower for atopic dermatitis (35.3%) and melanoma (11.8%). The most common requirement for accessing a new drug was a previous prescription for another drug. Differences and additional requirements were also detected at the local level (i.e., differences between hospitals within the same autonomous community). CONCLUSIONS: Spain's autonomous communities have multiple regional and local prescription requirements that are not aligned with national TPR recommendations. These differences result in inequitable access to new drugs for both patients and practitioners across Spain.

Requirements for Accessing New Dermatology Drugs in Spain: Results of the EQUIDAD Study. / Condicionantes de acceso a nuevos medicamentos dermatológicos en España: resultados del proyecto EQUIDAD.

BACKGROUND: Although the Spanish Ministry of Health prepares national therapeutic positioning reports (TPRs) and drug reimbursement policies, each of the country's 17 autonomous communities (ACs) is responsible for health care services and prescription requirements in its territory. The aim of the EQUIDAD study was to describe and explore potential differences in prescription requirements for new dermatology drugs across the autonomous communities. MATERIAL AND METHODS: Cross-sectional study conducted in April and May, 2023. Two dermatologists with management responsibilities from each autonomous community reported on territorial and more local prescription requirements for drugs covered by national TPRs issued between 2016 and 2022. RESULTS: Thirty-three researchers from 17 autonomous communities participated. The data submitted revealed between-community inequities in access to new drugs. Overall, 64.7% of the regions imposed additional prescription requirements to those mentioned in the TPRs for psoriasis. This percentage was lower for atopic dermatitis (35.3%) and melanoma (11.8%). The most common requirement for accessing a new drug was a previous prescription for another drug. Differences and additional requirements were also detected at the local level (i.e., differences between hospitals within the same autonomous community). CONCLUSIONS: Spain's autonomous communities have multiple regional and local prescription requirements that are not aligned with national TPR recommendations. These differences result in inequitable access to new drugs for both patients and practitioners across Spain.

Enfermedades autoinflamatorias en dermatología pediátrica. Parte 1: síndromes urticariformes, síndromes pustulosos y síndromes con ulceraciones cutáneo-mucosas / Autoinflammatory diseases in pediatric dermatology-part 1: urticaria-like syndromes, pustular syndromes, and mucocutaneous ulceration syndromes

Las enfermedades monogénicas autoinflamatorias son un grupo de enfermedades emergentes y heterogéneas en continuo estudio y desarrollo en la actualidad. Nuestro objetivo es revisar estas enfermedades desde el punto de vista de su etiopatogenia y principales manifestaciones, con el fin de proponer una clasificación, basada en las características clinicopatológicas de las lesiones cutáneas típicas, que resulte de utilidad en la práctica clínica habitual de los dermatólogos. El texto está enfocado en el diagnóstico de estos síndromes durante la edad pediátrica, ya que es el periodo habitual de aparición de los primeros síntomas y signos. La primera parte de la revisión se centrará en el desarrollo de los síndromes urticariformes, que incluyen a su vez las criopirinopatías y los síndromes hereditarios asociados a fiebres periódicas, y de los síndromes pustulosos, resumiendo al final del texto las alternativas terapéuticas de estos síndromes autoinflamatorios y sus mutaciones genéticas (AU)

Monogenic autoinflammatory diseases are a heterogeneous emergent group of conditions that are currently under intensive study. We review the etiopathogenesis of these syndromes and their principal manifestations. Our aim is to propose a classification system based on the clinicopathologic features of typical skin lesions for routine clinical use in dermatology. Our focus is on diagnosis in pediatric practice given that this is the period when the signs and symptoms of these syndromes first appear. In Part 1 we discuss the course of urticaria-like syndromes, which include cryopyrin-associated periodic conditions and hereditary periodic fever syndromes. Pustular syndromes are also covered in this part. Finally, we review the range of therapies available as well as the genetic mutations associated with these autoinflammatory diseases (AU)

Enfermedades autoinflamatorias en dermatología pediátrica. Parte 2: síndromes histiocítico-macrofágicos y síndromes vasculopáticos / Autoinflammatory diseases in pediatric dermatology-part 2: histiocytic, macrophage activation, and vasculitis syndromes

El descubrimiento de nuevos síndromes autoinflamatorios y nuevas mutaciones está avanzando a una velocidad vertiginosa en los últimos años. La segunda parte de la revisión está centrada en el estudio de los síndromes histiocítico-macrofágicos y de los síndromes vasculopáticos, incluyendo al final del texto una tabla con las alternativas terapéuticas de estos síndromes autoinflamatorios y sus mutaciones genéticas (AU)

The discovery of new autoinflammatory syndromes and novel mutations has advanced at breakneck speed in recent years. Part 2 of this review focuses on vasculitis syndromes and the group of histiocytic and macrophage activation syndromes. We also include a table showing the mutations associated with these autoinflammatory syndromes and treatment alternatives (AU)

Onicomicosis subungueal proximal por Aspergillus niger: un simulador de melanoma maligno subungueal / Proximal Subungual Onychomycosis Due to Aspergillus niger: A Simulator of Subungual Malignant Melanoma

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Autoinflammatory Diseases in Pediatric Dermatology-Part 2: Histiocytic, Macrophage Activation, and Vasculitis Syndromes. / Enfermedades autoinflamatorias en dermatología pediátrica. Parte 2: síndromes histiocítico-macrofágicos y síndromes vasculopáticos.

The discovery of new autoinflammatory syndromes and novel mutations has advanced at breakneck speed in recent years. Part 2 of this review focuses on vasculitis syndromes and the group of histiocytic and macrophage activation syndromes. We also include a table showing the mutations associated with these autoinflammatory syndromes and treatment alternatives.

Autoinflammatory Diseases in Pediatric Dermatology-Part 1: Urticaria-like Syndromes, Pustular Syndromes, and Mucocutaneous Ulceration Syndromes. / Enfermedades autoinflamatorias en dermatología pediátrica. Parte 1: síndromes urticariformes, síndromes pustulosos y síndromes con ulceraciones cutáneo-mucosas.

Monogenic autoinflammatory diseases are a heterogeneous emergent group of conditions that are currently under intensive study. We review the etiopathogenesis of these syndromes and their principal manifestations. Our aim is to propose a classification system based on the clinicopathologic features of typical skin lesions for routine clinical use in dermatology. Our focus is on diagnosis in pediatric practice given that this is the period when the signs and symptoms of these syndromes first appear. In Part 1 we discuss the course of urticaria-like syndromes, which include cryopyrin-associated periodic conditions and hereditary periodic fever syndromes. Pustular syndromes are also covered in this part. Finally, we review the range of therapies available as well as the genetic mutations associated with these autoinflammatory diseases.

Lesión dianiforme ampollosa en la mano de un ganadero: una entidad relevante para un médico rural / Targetoid bullous lesion in a farmer's hand: a relevant entity to a country doctor

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Niveles de 25-hidroxivitamina D en pacientes con melanoma y factores asociados con su insuficiencia / 25-hydroxyvitamin D in patients with melanoma and factors associated with inadequate levels

INTRODUCCIÓN Y OBJETIVOS: Los pacientes con melanoma parecen llevar al extremo las medidas de protección, lo que puede influir en los niveles de 25-hidroxivitamina D-25(OH)D-. El objetivo del estudio fue evaluar los niveles de 25(OH)D en pacientes con melanoma cutáneo e identificar factores relacionados con niveles inadecuados. MATERIAL Y MÉTODOS: Se midieron prospectivamente los niveles séricos de 25(OH)D en pacientes diagnosticados de melanoma cutáneo durante un periodo de seguimiento de un año. Se evaluaron qué factores ambientales, fenotípicos y genotípicos se relacionaban con niveles insuficientes y deficientes mediante regresión logística. RESULTADOS: De un total de 215 pacientes solo un 24,7% tenían valores normales de 25(OH)D y un 8,8% tenían valores deficientes (< 10 ng/ml). La obesidad (OR: 4,2; IC 95% OR: 1,3-13,3) y la extracción de sangre realizada en otoño/invierno (OR: 2,1; IC 95% OR: 1,1-4) se asociaron a niveles insuficientes (< 30 ng/ml). Los niveles deficitarios (< 10 ng/m) se asociaron a la obesidad (OR: 7,1; IC 95% OR: 1,1-46,9), la extracción de sangre realizada en otoño/invierno (OR: 9,0; IC 95% OR: 1,7-47,0), la ausencia de efélides (OR: 5,4; IC 95% OR: 1,2-23,4) y, marginalmente, a la presencia de tener < 2 polimorfismos no sinónimos en el receptor 1 de la melanocortina (MC1R) (OR: 5,0; IC 95% OR: 0,9-28,9). Limitaciones: No se han incluido en el análisis algunos factores, como la alimentación, relacionados con los niveles de 25(OH)D. CONCLUSIONES: Se deberían monitorizar los niveles de 25(OH)D en los pacientes con melanoma y valorar dar suplementos orales en los casos que lo precisen

INTRODUCTION AND OBJECTIVES: Patients with melanoma appear to take extreme sun-protection measures, which could influence 25-hydroxyvitamin D [25(OH)D] levels. The aim of this study was to measure 25(OH)D levels in patients with cutaneous melanoma and identify factors associated with inadequate levels. MATERIAL AND METHODS: Over a period of 1 year, we prospectively measured serum 25(OH)D in patients with cutaneous melanoma and used logistic regression analysis to identify environmental, phenotypic, and genotypic factors that were associated with insufficient and deficient levels. RESULTS: Of 215 patients analyzed, 8.8% had deficient 25(OH)D levels (< 10 ng/mL) and just 24.7% had normal levels. Insufficient levels (< 30 ng/mL) were associated with obesity (odds ratio [OR], 4.2; 95% confidence interval [CI], 1.3-13.3) and blood sampling in autumn/winter (OR, 2.1; 95% CI, 1.1-4). Deficient levels (< 10 ng/mL) were associated with obesity (OR, 7.1; 95% CI, 1.1-46.9), blood sampling in autumn/winter (OR, 9.0; 95% CI, 1.7-47.0), absence of freckles (OR, 5.4; 95% CI, 1.2-23.4), and, with marginal significance, the presence of fewer than 2 nonsynonymous melanocortin-1 receptor (MC1R) polymorphisms (OR, 5.0; 95% CI, 0.9-28.9). Limitations: Some factors related to 25(OH)D levels, such as food, were not included in the analyses. CONCLUSIONS: 25(OH)D levels should be monitored in patients with melanoma and the need for oral supplements should be contemplated where appropriate

25-Hydroxyvitamin D in Patients With Melanoma and Factors Associated With Inadequate Levels. / Niveles de 25-hidroxivitamina D en pacientes con melanoma y factores asociados con su insuficiencia.

INTRODUCTION AND OBJECTIVES: Patients with melanoma appear to take extreme sun-protection measures, which could influence 25-hydroxyvitamin D [25(OH)D] levels. The aim of this study was to measure 25(OH)D levels in patients with cutaneous melanoma and identify factors associated with inadequate levels. MATERIAL AND METHODS: Over a period of 1 year, we prospectively measured serum 25(OH)D in patients with cutaneous melanoma and used logistic regression analysis to identify environmental, phenotypic, and genotypic factors that were associated with insufficient and deficient levels. RESULTS: Of 215 patients analyzed, 8.8% had deficient 25(OH)D levels (<10ng/mL) and just 24.7% had normal levels. Insufficient levels (<30ng/mL) were associated with obesity (odds ratio [OR], 4.2; 95% confidence interval [CI], 1.3-13.3) and blood sampling in autumn/winter (OR, 2.1; 95% CI, 1.1-4). Deficient levels (<10ng/mL) were associated with obesity (OR, 7.1; 95% CI, 1.1-46.9), blood sampling in autumn/winter (OR, 9.0; 95% CI, 1.7-47.0), absence of freckles (OR, 5.4; 95% CI, 1.2-23.4), and, with marginal significance, the presence of fewer than 2 nonsynonymous melanocortin-1 receptor (MC1R) polymorphisms (OR, 5.0; 95% CI, 0.9-28.9). LIMITATIONS: Some factors related to 25(OH)D levels, such as food, were not included in the analyses. CONCLUSIONS: 25(OH)D levels should be monitored in patients with melanoma and the need for oral supplements should be contemplated where appropriate.

FR - El papel de las células madre epidérmicas en el desarrollo del carcinoma basocelular / The Role of Epidermal Stem Cells in the Origin of Basal Cell Carcinoma

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Fístula colecistocólica: una causa poco frecuente de hemorragia digestiva baja / Cholecistocolic fistula: an uncommon cause of lower gastrointestinal bleeding

La fístula colecistocólica es un tipo poco común de fístula bilioentérica que tiene una presentación clínica variable y que generalmente aparece como complicación de la enfermedad litiásica biliar. Puede manifestarse en forma de dolor abdominal, náuseas, pérdida de peso, diarrea con o sin esteatorrea asociada, clínica dispéptica y más raramente como hemorragia digestiva baja, colangitis de repetición o incluso como un ileobiliar. Las técnicas más útiles para el diagnóstico son el TC abdominal, los estudios baritados y la colangiopancreatografía retrógrada endoscópica (CPRE).Describimos el caso de una mujer de edad avanzada, pluripatológica, con fístula colecistocólica, que se presentó en forma de hemorragia digestiva baja. Fue estudiada mediante colonoscopia, TC abdominal y enema de bario. Durante el ingreso requirió transfusión de 4 concentrados de hematíes, desestimándose el tratamiento invasivo debido a su comorbilidad de base. Evolucionó favorablemente, con resolución espontanea del cuadro. Dos meses después permanecía asintomática(AU)

Cholecystocolic fistula is an uncommon biliary enteric fistula with a variable clinical presentation that usually appears as a rare complication of gallstone disease. It can present with abdominal pain, nausea, weight loss, diarrhoea with or without associated steatorrhea, and dyspeptic symptoms. Rare cases have been reported with lower gastrointestinal haemorrhage and even with a gallstone ileous. The most useful techniques for diagnosis are CT, barium studies, and ERCP. We report a case of a cholecistocolic fistula in an eldery woman with multiple medical comorbidities that presented as lower gastrointestinal bleeding. She was explored with colonoscopy, abdominal CT and barium enema. She required a total of 4 units of whole blood and because of her comorbidities a decision was made not to proceed with invasive treatment. She had a good evolution and was asymptomatic two months later(AU)

[Cholecistocolic fistula: an uncommon cause of lower gastrointestinal bleeding]. / Fístula colecistocólica: una causa poco frecuente de hemorragia digestiva baja.

Cholecystocolic fistula is an uncommon biliary-enteric fistula with a variable clinical presentation that usually appears as a rare complication of gallstone disease. It can present with abdominal pain, nausea, weight loss, diarrhoea with or without associated steatorrhea, and dyspeptic symptoms. Rare cases have been reported with lower gastrointestinal haemorrhage and even with a gallstone ileous. The most useful techniques for diagnosis are CT, barium studies, and ERCP. We report a case of a cholecistocolic fistula in an elderly woman with multiple medical comorbidities that presented as lower gastrointestinal bleeding. She was explored with colonoscopy, abdominal CT and barium enema. She required a total of 4 units of whole blood and because of her comorbidities a decision was made not to proceed with invasive treatment. She had a good evolution and was asymptomatic two months later.

Manejo multidisciplinar del cáncer epitelial de ovario. Diagnóstico radiológico / Multidisciplinary management of ovarian epithelial cancer. Radiological diagnosis

En el contexto del abordaje multidisciplinar parael diagnóstico y tratamiento del cáncer de ovario, laaportación del radiólogo incluye cuatro puntos fundamentalesque son: identificación de la lesión, caracterización,estudio de extensión y valoración evolutiva.En el presente trabajo se describen los hallazgos y clavesdiagnósticas en TCMD (Tomografía Computarizadamultidetector) y RM (Resonancia Magnética), la aportacióne indicación de otras tecnologías como el PET(Tomografía por Emisión de Positrones) y se esbozanlas técnicas emergentes basadas en imagen funcional(estudios dinámicos con contraste en RM y estudios dedifusión por RM)(AU)

In the context of a multidisciplinary approach forthe diagnosis and treatment of ovarian cancer, the contributionof radiology includes the following four fundamentalpoints: identification of the lesion, its characterization,study of its extension and evaluation of itsevolution. This article describes the findings and keydiagnostic elements in MDCT (Multidetector ComputedTomography) and MR (Magnetic Resonance), thecontribution and indication of other technologies likePET (Positron Emission Tomography), and outlines theemergent techniques based on functional image analysis(dynamic contrast-enhanced MRI studies and MRIdiffusion studies)(AU)

Nefropatía por litio / no disponible

No disponible