Development and validation of the Frontal Fibrosing Alopecia Severity Score.

BACKGROUND: Frontal fibrosing alopecia (FFA) is a scarring alopecia characterized by recession of the frontotemporal hairline and loss of the eyebrows. OBJECTIVE: To design and validate a scoring system to assess the severity of FFA. METHODS: The Frontal Fibrosing Alopecia Severity Score (FFASS) was developed; criterion validity was assessed by the Investigator's Global Assessment, and construct validity was evaluated by the convergence of other measures of severity (the Patient's Global Assessment], the rest of the clinical features, the Lichen Planopilaris Activity Index, and quality of life measures (Dermatology Life Quality Index and Hospital Anxiety Depression Scale). Intraobserver and interobserver reliability were determined. RESULTS: In total, 103 female patients were included. The FFASS showed significant correlation to the Patient's Global Assessment, occipital involvement, and the Lichen Planopilaris Activity Index. Intraobserver reliability was completed for 31 subjects and showed good correlation (intraclass correlation coefficient, 0.86; 95% confidence interval, 0.7-0.95; P < .001). Interobserver reliability showed excellent correlation (intraclass correlation coefficient, 0.97; 95% confidence interval, 0.95-0.99; P < .001). LIMITATIONS: The study was performed at a single institution, and only female patients were assessed. CONCLUSIONS: The FFASS is a statistically validated scale and a reliable measure of FFA severity, and it can be used in clinical practice and future research studies as an assessment tool.

Undesirable effects after treatment with dermal fillers.

BACKGROUND: Soft tissue augmentation is one of the most frequent techniques in cosmetic dermatology. Nowadays, there are a high number of available materials. Nonanimal hyaluronic acid (HA) is one of most useful fillers for lip augmentation and for treating nasolabial folds, marionette lines, and the dynamic wrinkles of the upper face. OBJECTIVE: To evaluate the type and management of undesirable effects of nonanimal reticulated or stabilized HA observed in our cosmetic unit in the past 3 years. MATERIALS AND METHODS: The consecutive patients using HA attending to our clinic in the past 3 years were divided into 3 categories, according to the time of presentation of the adverse reactions: immediate, early, and late-onset complications. All patients were treated. RESULTS: Twenty-three patients presented to our clinic complaining of complications after soft tissue augmentation with HA. Ten patients presented immediate-onset complications, 8 showed early-onset complications, and 5 cases complaint of late-onset complications. Treatment of the first group consisted of hyaluronidase injection, massage, and topical antibiotics. Early- and late-onset complications were treated with intralesional triamcinolone acetonide. All patients improved, with the exception of a woman with recurrent granulomas. CONCLUSION: Generally, undesirable effects of HA (immediate, early, or late onset) are not frequent, and when present, they improve if treated properly. Physicians need to be aware of these possible adverse events in order to establish proper treatment and prevent scarring or other sequelae.

Las pruebas epicutáneas de contacto en medicina laboral / Patch testing in occupational medicine

Dentro de la Medicina Laboral las dermatosis ocupacionales suponen entre el 30-60% del total de enfermedades profesionales y, dentro de ellas el 80-90% son dermatitis de contacto. Este alto número no se ve reflejado en datos oficiales debido a que en muchas ocasiones, al ser condiciones de rápida resolución o de escasa repercusión sistémica, no son declaradas. En relación a las dermatitis de contacto, la forma más frecuente en el entorno laboral es la forma alérgica y la que preferentemente se declara, al ser un proceso que en muchas ocasiones constituye motivo de incapacidad. Para el abordaje diagnóstico y correspondiente asociación con el entorno de trabajo es imprescindible realizar una historia clínica laboral completa junto con la descripción de las lesiones, y la utilización de métodos diagnósticos distintos a los de otros procesos no cutáneos, como son las pruebas de parche (patch test) o pruebas epicutáneas. Constituyen un método simple, accesible y seguro para llegar al diagnóstico de las dermatitis alérgicas de contacto. Incluyen una batería estándar, propia de un país donde se trabaja, ampliada de baterías específicas en relación con el perfil, las tareas y los productos manipulados por el trabajador. La prevención en el trabajo es el único tratamiento etiológico para la sustitución y control de los riesgos laborales relacionados con las dermatosis profesionales (AU)

In occupational medicine, occupational dermatoses account for 30 to 60% of the total amount of occupational diseases and, within 80 to 90% of them correspond to contact dermatitis. This high number is not reflected in official data because in most cases, as conditions of rapid resolution or low systemic impact, they are not declared. Regarding contact dermatitis, the most common type in the workplace is the allergic type, which preferably is declared, because often results in disability. For the correct diagnosis and association with the work environment is essential to make a full history of the patient’ occupational background, correct description of the skin lesions, and the use of diagnostic methods other than those of non-cutaneous processes, such as patch testing. They provide a simple, accessible and safe method for the diagnosis of allergic contact dermatitis. They include a standard national baseline series, proper of the country where the patient works, and additional extended series, specific to the occupation performed by the worker. Prevention at work is the only etiological treatment for replacement and control of occupational hazards associated with occupational skin diseases (AU)

Afectación ungueal de origen ocupacional / Nail involvement of occupational origin

Desde el siglo V a.C. Hipócrates ya describía las afectaciones ungueales, las cuales luego se relacionaban con enfermedades sistémicas o adquiridas. Los médicos de medicina del trabajo se deben preparar para detectar las afectaciones por factores externos. Sin embargo son pocos los casos publicados sobre patología ungueal de origen ocupacional. Nuestra revisión consiste en brindar conocimientos básicos sobre esta asignatura. Desde su definición, función y la descripción de su anatomía. La patología ungueal la clasificaremos según: a) anomalías de: la forma, de la adhesión, de la coloración, superficie, infección; b) según el mecanismo de acción que se producen o c) según el tipo de ocupación. Al adquirir estos conocimientos podremos establecer posteriores pautas de prevención eficaces (AU)

From the V century B.C. Hippocrates described the damages in the nails, which then were related to systemic diseases or acquired. As physicians we must prepare work to detect the effects caused by external factors. However, few published cases of occupational origin nail pathology. Our review is to provide basic knowledge on this subject. From its definition, function and description of the anatomy. The nail pathology classify as: a) anomalies: the way of accession, coloration, surface, infection, b) according to the mechanism of action that occur oc) by type of occupation. By acquiring this knowledge we can establish effective prevention guidelines later (AU)

N-acetylcysteine in the Treatment of Trichotillomania.

Trichotillomania is as medical condition caused by the patient himself by pulling out of is own hair, resulting in a perceptible hair loss pattern that frequently is associated with other psychiatric processes. Generally has a chronic course in most patients, and a challenging therapeutical management. There are several available options for is treatment, but the clinical response is not satisfactory in many patients. Recently, N-acetylcisteine, a glutamate modulator, has shown efficacy in the treatment of trichotillomania and other compulsive behaviors, and is considered a new alternative in the management of this condition. We describe two patients with trichotillomania successfully treated with N-acetylcysteine. Nevertheless, further studies need to be conducted to establish the appropriate treatment regimen and to evaluate it long-term efficacy in improving this chronic condition.

Kathon CG y Dermatología Laboral. Actualización / Kathon CG and Occupational Dermatology. An update

El Kathon CG constituye el nombre comercial de una mezcla de isotiazolinas: Metilcloroisotiazolinona y Metilisotiazolinona. Es un conservante muy utilizado, sobre todo en la industria cosmética, aunque en los últimos años también se ha impuesto su presencia en productos de limpieza de uso doméstico y actualmente a concentraciones más altas en preparados de uso industrial como aceites de corte, emulsiones de látex, pinturas al temple, aceites para motores Diesel, etc. Por su alto poder sensibilizante y amplia utilización, constituye actualmente una de las causas más frecuentes de alergia de contacto por preservativos, tanto en nuestra vida privada, como en el ámbito profesional. Objetivos: Estudiar la capacidad sensibilizante del Kathon CG y su relación con el desarrollo de eczema de contacto alérgico de origen profesional. Métodos: Estudio observacional descriptivo, a través de la revisión de las historias clínicas de los pacientes vistos en el Servicio de Dermatología Laboral del Instituto Nacional de Medicina y Seguridad en el Trabajo durante los años 2008-2012; 1520 pacientes fueron evaluados y estudiados mediante pruebas epicutáneas para descartar una posible dermatosis profesional. Se registraron los casos de sensibilización al Kathon CG y se analizaron las siguientes variables: genero, edad, grupo profesional, localización de las lesiones cutáneas, relevancia y relación profesional. El análisis estadístico se realizó con el programa SPSS 15.0. Resultados: Se observó sensibilización al Kathon CG en 88 pacientes (5,8%), correspondiendo un 42% a sensibilizaciones de origen profesional. Conclusiones: La alergia de contacto profesional por Kathon CG constituye actualmente es un problema de alta prevalencia. Ante un paciente con positividad a este alérgeno hay que interrogar siempre por su profesión (AU)

Kathon CG is the tradename for a mixture of isothiazolines: methylchloroisothiazolinone and methylisothiazolinone. It is a widely used preservative, especially in the cosmetic industry, although in recent years is presence have also been imposed in cleaning products for household use and, at higher concentrations in industrial preparations such as cutting oils, latex emulsions, paints, oils for diesel engines, etc. Because of its high sensitizing power and widespread use, is currently one of the most common causes of allergic contact dermatitis, both in our private lives, as in the occupational field.Objectives: To study the sensitizing capacity of Kathon CG and its relation to the development of allergic contact dermatitis of occupational origin.Methods: We performed a retrospective study by reviewing the medical records of patients seen at the Department of Occupationsal Dermatology at the Instituto Nacional de Medicina y Seguridad en el Trabajo, during the years 2008-2012. In that period, 1520 patients were evaluated and studied by patch testing, to rule out an occupational skin condition. We recorded cases of sensitization to Kathon CG and analyzed the following data: gender, age, occupational group, location of skin lesions, relevance and occupational origin. Statistical analysis was performed using SPSS 15.0.Results: We observed sensitization to Kathon CG in 88 patients (5.8%), and 42% were of occupational origin.Conclusions: Occupational contact allergy to Kathon CG is currently a problem of high prevalence. In patients with sensitization to this allergen, we should always ask about their occupation (AU)