Phototherapy with Narrow-Band UVB in Adult Guttate Psoriasis: Results and Patient Assessment.

BACKGROUND: Acute guttate psoriasis (AGP) is a distinctive clinical entity with good response to treatment with narrow-band ultraviolet B (NB-UVB). OBJECTIVE: To investigate the results of NB-UVB phototherapy in adult patients with adult guttate psoriasis. MATERIAL AND METHODS: We carried out a prospective, open, and observational study. Patients over 18 years with more than 5% of body surface area affected were included. The PASI was assessed prior to and after treatment. The follow-up period was 18 months. After treatment, patients completed a simple questionnaire to assess their overall impression of the treatment. RESULTS: The 67 adult patients with AGP included in this study had an initial PASI of 8.55 (SD 5.03). Patients were treated with a mean of 19.9 sessions (SD 13.5) and mean doses of 14 mJ/cm2 (SD 10.5). Of the 67 patients, 52 achieved PASI90 with 96.15% of PASI reduction, and of these, 46 (88%) maintained PASI90 during the 18 months of follow-up. Patients were very satisfied with the treatment. DISCUSSION: AGP is a defined clinical entity with a variable course. Phototherapy with NB-UVB appears to be a very good option for treatment of AGP because of the good results obtained and patient satisfaction.

Treatment of moderate and severe adult chronic atopic dermatitis with narrow-band UVB and the combination of narrow-band UVB/UVA phototherapy.

The phototherapy is a safe and effective technique for the treatment of adult patients with atopic dermatitis (AD). The treatment of chronic forms of the disease is most often done with narrow-band UVB (NB-UVB). There also exist effective phototherapy options against the AD. The aim of this study was to asses if the combination of NB-UVB with UVA was more effective than the treatment with only NB-UVB against adult chronic AD. We carried out a prospective and observational study. Adult patients with chronic AD with more than 50% of the total body surface area affected (TBSA) were included. The affected TBSA was calculated using the so-called "rule of nines." Patients with a clearance rate >75% of the initial affected TBSA or complete clearance rate were considered as complete response (CR). An analogue scale from 0 to 10 was used to measure the improvement grade of the pruritus. The treatments were repeated three times a week. The initial doses of NB-UVB and UVA were determined by patient's phototype. The treatments were performed using a phototherapy booth (UV7002, Walmann, Villingen-Schwenningen, Germany(®) ) with TL01 and UVA fluorescent lamps. Statistical analysis was performed with SPSS(®) (IBM, New York, NY) for Windows 21.0. A total of 26 patients with adult chronic AD were included in the study, 16 patients were treated with UVB-BE and 10 patients with the combined treatment option NB-UVB/UVA. The mean value of cumulative doses and the mean number of performed treatments were similar between both groups of patients (p > 0.05). The mean value of duration of response was significantly higher in the patients treated only with NB-UVB, 101 versus 6.8 months (p ≥ 0.05). No differences were observed for the patients that showed complete response (p = 0.42) and in the analogue scale of pruritus (p > 0.005). In our study, the patients treated with the combination of NB-UVB and UVA were similar to the patient that were only treated with NB-UVB e. Further prospective and controlled studies have to be performed in order to determine the dosing regimens of phototherapy in adult patients with AD.

Dermatosis neutrofílica del dorso de la mano / Neutrophilic dermatosis of the dorsal hands

La Dermatosis Neutrofílica del dorso de la mano (DNDM) es una entidad descrita recientemente. Se presenta con placas eritematosas, pústulas y ampollas limitadas al dorso de las manos, y la anatomía patológica se caracteriza por un denso infiltrado de neutrófilos. Desde hace unos años existe un debate para clasificar esta patología dentro de las dermatosis neutrófilicas o de las vasculitis pustulosas. Presentamos un nuevo caso de DNDM en la que no se objetiva vasculitis en la anatomía patológica

Neutrophilic dermatosis of the dorsal hands (NDDH) is a recently described disorder. This condition presented with erythematous plaques, pustules and bullae limited to the dorsal hands, and it is characterized histologically by a dense neutrophilic infiltrate. Controversy remains to categorize this entity as a neutrophilic dermatosis or a pustular vasculitis. We described a new case of NDDH that lack vasculitis in the biopsy findings

Exploración física en dermatología laboral / No disponible

La exploración física tiene como finalidad la obtención de datos objetivos (signos clínicos) que el médico recoge directamente del paciente. La exploración del enfermo con una probable dermatosis profesional debe tener en cuenta tres aspectos fundamentales, como son la localización de las lesiones, su morfología y si existen estigmas físicos de alguna enfermedad dermatológica en otras áreas de la piel. La principal localización de una dermatosis profesional son las manos. El hecho de que el cuadro sea unilateral orienta hacia una dermatitis de contacto, pudiéndose sospechar la sustancia causante según la zona de afectación de la mano. La afectación bilateral nos orienta, en general, a que la causa principal sea una enfermedad endógena. Son bilaterales, aunque de causa exógena, las dermatitis de contacto aerotransportadas y lumínicas, afectando ambas a regiones no protegidas por la vestimenta. Una localización en las áreas protegidas por las prendas de vestir puede deberse a la retención del antígeno o irritante en la ropa. La descripción minuciosa de la morfología de las lesiones suele conducir al diagnóstico al dermatólogo que atiende al paciente, a pesar de que ya se hayan resuelto sus lesiones. Se debe tener en cuenta, además, que en otras zonas de la piel pueden existir estigmas de una enfermedad, como la psoriasis o la dermatitis atópica, que expliquen el cuadro por el que acude el trabajador. La exploración física debe corroborar el diagnóstico de sospecha, obtenido previamente con la anamnesis. Si esto no es así, debemos replantearnos nuestro interrogatorio antes de llevar a cabo las pruebas complementarias que sean necesarias

With the physical examination physicians obtain objective data (clinical signs) directly from the patient. During the examination of a patient who suffers an occupational dermatitis, we have to bear in mind three essential aspects: The location of the lesions, its morphology and the presence of physical stigmas of a dermatologic disease in other areas of the skin. The hands are the main location of an occupational dermatitis. Unilateral lesions orientate towards a contact dermatitis as origin. In addition, we can suspect the causing agent according to the affected zone of the hand. Bilateral locations signal, generally, towards an endogenous disease. Anyhow, airborne and photocontact dermatitis are bilateral, and its lesions are over areas not protected by clothes. Locations in areas under the dress can be explained by an allergen or an irritant retained on the clothes. To describe thoroughly the morphology of the lesions commonly can guide to the diagnostic to a dermatologist, even if he/she does not see the patient when the lesions are present. In addition, we must have in mind that in other areas of the skin can exist stigmas of a disease, like lesions of psoriasis or atopic dermatitis, that might explain the lesions that hastened the visit of the patient. With the physical examination we must corroborate the diagnostic of suspicion previously obtained with the anamnesis. If this is not like that, we must restate our interrogatory before carrying out the complementary tests that could be necessary