Paniculitis por micobacterias atípicas tras mesoterapia / Panniculitis Due to Atypical Mycobacteria After Mesothera

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Utilidad de la ecografía cutánea en la clasificación de subtipos de los carcinomas basocelulares primarios / Usefulness of high-frequency ultrasound in the classification of histologic subtypes of primary basal cell carcinoma

INTRODUCCIÓN: La biopsia incisional puede fallar en la correcta catalogación de subtipos histológicos de carcinoma basocelular (CBC). La ecografía (ECO) cutánea es una herramienta diagnóstica útil en el diagnóstico y manejo de este tumor. OBJETIVOS: El objetivo principal fue evaluar la utilidad diagnóstica de la ECO frente a la biopsia punch en la correcta clasificación del patrón histológico de infiltración de los CBC primarios. Los objetivos secundarios fueron: evaluar si el rendimiento diagnóstico de la ECO frente a la biopsia incisional guardaba relación con el tamaño tumoral y con formas de CBC simples frente a formas mixtas. MÉTODOS: Estudio observacional prospectivo de los casos de CBC primarios atendidos en el Servicio de Dermatología del Hospital Costa del Sol (Marbella) entre octubre de 2013 y mayo de 2014. Previamente a la extirpación quirúrgica se realizó una ECO cutánea (Dermascan C©, sonda lineal, 20 Mhz) y una biopsia punch. Se valoró el porcentaje de acuerdo absoluto y rendimiento diagnóstico (sensibilidad, especificidad, valor predictivo positivo [VPP] y valor predictivo negativo [VPN]) para resultados globales y parciales entre ECO y punch frente al gold estándar (biopsia escisional por cortes seriados). RESULTADOS: Se incluyeron 156 casos. La tasa de concordancia diagnóstica global de la ECO fue del 73,7% (sensibilidad: 74,5%, especificidad: 73%) vs. 79,9% (sensibilidad: 76%, especificidad: 82%) para el punch. En el análisis individual destaca para el CBC superficial un VPP para la ECO del 93,3% frente al 92% para el punch. En el análisis por tamaño tumoral la ECO incrementó el porcentaje de acuerdo absoluto del 70,4 al 77,3% (área 40 mm2 vs. área > 40 mm2) manteniendo el VPN constante para ambos subgrupos (82%). Para la biopsia punch, el porcentaje de acuerdo absoluto pasó del 86,4 al 72,6%. CONCLUSIONES: La ECO cutánea muestra una especial utilidad para descartar la presencia de invasividad, para el diagnóstico de formas superficiales simples y para la correcta catalogación de CBC de área mayor a 40 mm2

INTRODUCTION: Incisional biopsy may not always provide a correct classification of histologic subtypes of basal cell carcinoma (BCC). High-frequency ultrasound (HFUS) imaging of the skin is useful for the diagnosis and management of this tumor. OBJECTIVES: The main aim of this study was to compare the diagnostic value of HFUS compared with punch biopsy for the correct classification of histologic subtypes of primary BCC. We also analyzed the influence of tumor size and histologic subtype (single subtype vs. mixed) on the diagnostic yield of HFUS and punch biopsy. METHODS: Retrospective observational study of primary BCCs treated by the Dermatology Department of Hospital Costa del Sol in Marbella, Spain, between october 2013 and may 2014. Surgical excision was preceded by HFUS imaging (Dermascan C©, 20-MHz linear probe) and a punch biopsy in all cases. We compared the overall diagnostic yield and accuracy (sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV]) of HFUS and punch biopsy against the gold standard (excisional biopsy with serial sections) for overall and subgroup results. RESULTS: We studied 156 cases. The overall diagnostic yield was 73.7% for HFUS (sensitivity, 74.5%; specificity, 73%) and 79.9% for punch biopsy (sensitivity, 76%; specificity, 82%). In the subgroup analyses, HFUS had a PPV of 93.3% for superficial BCC (vs. 92% for punch biopsy). In the analysis by tumor size, HFUS achieved an overall diagnostic yield of 70.4% for tumors measuring 40 mm2 or less and 77.3% for larger tumors; the NPV was 82% in both size groups. Punch biopsy performed better in the diagnosis of small lesions (overall diagnostic yield of 86.4% for lesions 40 mm2 vs. 72.6% for lesions > 40 mm2). CONCLUSIONS: HFUS imaging was particularly useful for ruling out infiltrating BCCs, diagnosing simple, superficial BCCs, and correctly classifying BCCs larger than 40 mm2

Usefulness of High-Frequency Ultrasound in the Classification of Histologic Subtypes of Primary Basal Cell Carcinoma. / Utilidad de la ecografía cutánea en la clasificación de subtipos de los carcinomas basocelulares primarios.

INTRODUCTION: Incisional biopsy may not always provide a correct classification of histologic subtypes of basal cell carcinoma (BCC). High-frequency ultrasound (HFUS) imaging of the skin is useful for the diagnosis and management of this tumor. OBJECTIVES: The main aim of this study was to compare the diagnostic value of HFUS compared with punch biopsy for the correct classification of histologic subtypes of primary BCC. We also analyzed the influence of tumor size and histologic subtype (single subtype vs. mixed) on the diagnostic yield of HFUS and punch biopsy. METHODS: Retrospective observational study of primary BCCs treated by the Dermatology Department of Hospital Costa del Sol in Marbella, Spain, between october 2013 and may 2014. Surgical excision was preceded by HFUS imaging (Dermascan C©, 20-MHz linear probe) and a punch biopsy in all cases. We compared the overall diagnostic yield and accuracy (sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV]) of HFUS and punch biopsy against the gold standard (excisional biopsy with serial sections) for overall and subgroup results. RESULTS: We studied 156 cases. The overall diagnostic yield was 73.7% for HFUS (sensitivity, 74.5%; specificity, 73%) and 79.9% for punch biopsy (sensitivity, 76%; specificity, 82%). In the subgroup analyses, HFUS had a PPV of 93.3% for superficial BCC (vs. 92% for punch biopsy). In the analysis by tumor size, HFUS achieved an overall diagnostic yield of 70.4% for tumors measuring 40mm2 or less and 77.3% for larger tumors; the NPV was 82% in both size groups. Punch biopsy performed better in the diagnosis of small lesions (overall diagnostic yield of 86.4% for lesions ≤40mm2 vs. 72.6% for lesions >40mm2). CONCLUSIONS: HFUS imaging was particularly useful for ruling out infiltrating BCCs, diagnosing simple, superficial BCCs, and correctly classifying BCCs larger than 40mm2.

Responsiveness of the Spanish Version of the "Skin Cancer Index".

Background. Skin Cancer Index (SCI) is a specific questionnaire measuring health related quality of life (HRQL) in patients with cervicofacial non-melanoma skin cancer (CFNMSC). The original scale has recently been adapted and validated into Spanish. Objectives. Evaluate the responsiveness of the Spanish version of SCI. Methods. Patients with CFNMSC candidate for surgical treatment were administered the questionnaire at time of diagnostic (t0), 7 days after surgery (t1), and 5 months after surgery (t2). The scale and subscales scores (C1: social/appearance, C2: emotional) were then evaluated. Differences between t0-t1, t1-t2, and t0-t2 were determined and a gender-and-age segmented analysis was performed. Results. 88 patients, 54.8% male, mean age 62.5 years, completed the study. Differences between t0-t1 and t1-t2 scores were statistically significant (p < 0.05). The lowest values were found at time of diagnosis and postsurgery. Women and patients under 65 years showed the lowest values at the three times. Limitations. Concrete geographic and cultural area. Clinical and histological variables are not analysed. Conclusions. Our results confirm responsiveness of the Spanish version of the SCI. Further development of the instrument in Spanish-speaking countries and populations will make it possible to extend worldwide research and knowledge horizons on skin cancer.

Ecografía aplicada al manejo del cáncer cutáneo no melanoma / Ultrasound in the management of non-melanoma skin cancer

La ecografía cutánea ha mostrado un papel relevante en el estudio y manejo del cáncer cutáneo no melanoma permitiendo, entre otros, ayudar en el diagnóstico y diagnóstico diferencial de estos tumores, establecer su tamaño y relaciones con estructuras vecinas, así como en la delimitación de márgenes quirúrgicos y en la detección de lesiones subclínicas y recidivas. En el presente artículo se analiza el papel de la ecografía cutánea en el campo del cáncer cutáneo no melanoma (carcinomas basocelular y escamocelular, linfomas y dermatofibrosarcoma) mediante una revisión de la literatura

Cutaneous ultrasound plays an important role in the study and management of non-melanoma skin cancer. Among other factors, this technique contributes to the diagnosis and differential diagnosis of these tumours, the establishment of their size and relation to neighbouring structures, the delimitation of surgical margins, and the detection of subclinical and recurrent lesions. The present article analyses the role of cutaneous ultrasound in the field of non-melanoma skin cancer (basal and squamous cell carcinomas, lymphomas and dermatofibrosarcoma) through a literature review

Campaña de prevención y detección de cáncer cutáneo en campos de golf de la Costa del Sol / Skin cancer prevention and detection campaign at golf courses on Spain’s Costa del Sol

Introducción y objetivos: El desarrollo de programas de prevención y detección de cáncer cutáneo específicamente dirigidos a grupos diana -de mayor rentabilidad que aquellos desarrollados sobre la población general- es necesario. Intervenciones en enclaves turísticos al aire libre ya demostraron eficacia, aunque no existen campanas específicas en campos de golf. Nuestros objetivos fueron describir el perfil de riesgo de los trabajadores y jugadores de golf y evaluar el impacto de una intervención. Material y métodos: Estudio transversal descriptivo desarrollado en 6 campos de golf, realizándose cuestionarios sobre datos demográficos, factores de riesgo y hábitos de exposición solar y fotoprotección, examen cutáneo. Se impartió consejo sanitario en fotoprotección, autoexamen y cremas fotoprotectoras, y finalmente se completaron encuestas de satisfacción e intención de cambio. Se midió el efecto en términos de: diagnósticos realizados, satisfacción con la intervención e intención expresada de cambio y efecto potencial en términos de factores de riesgo presentes. Resultados: De 351 participantes (el 57% golfistas, el resto trabajadores) el 70,4% tenían piel clara, el 11,7% tenían antecedentes familiares y el 8,5% personales de cáncer de piel. Entre los golfistas se diagnosticó cáncer cutáneo en el 10,7% y queratosis actínicas en el 40%. El 99,4% de los participantes valoró las jornadas positivamente, el 93,9% refirió intención de mejorar sus hábitos de fotoexposición y el 93,4% intención de examinarse la piel más frecuentemente. Conclusiones: Trabajadores de campos de golf y especialmente golfistas se confirman como una importante diana para la prevención del cáncer cutáneo. Esta es la primera campaña dirigida a estos grupos, resultando factible y útil el desarrollo de las mismas; su éxito parece relacionado con el desarrollo en el propio escenario, la intervención multicomponente y su estrategia publicitaria motivacional (AU)

Background and objectives: Skin cancer prevention and detection campaigns targeting specific groups are necessary and have proven to be more effective than those aimed at the general population. Interventions in outdoor tourist spots have proven successful, although none have specifically targeted golf courses. The aims of this study were to describe the risk profile of golfers and golf course workers and evaluate the impact of a skin cancer prevention and early detection intervention. Material and methods: This was a cross-sectional descriptive study conducted at 6 golf courses. The intervention included a skin examination and completion of a questionnaire about demographic details, risk factors, and sun exposure and sun protection habits. Participants were also given advice on sun protection measures, self-examination, and use of sunscreens, and were asked about their satisfaction with the intervention and their intention to change their current behaviors. The effect was measured in terms of the diagnoses made, satisfaction with the intervention, reported intention to change, and potential effect in terms of existing risk factors. Results: Of the 351 participants (57% golfers and 43% golf course workers), 70.4% had fair skin, 11.7% had a family history of skin cancer, and 8.5% had a personal history of skin cancer. Skin cancer and actinic keratoses were diagnosed in 10.7% and 40% of the golfers, respectively. The session was rated positively by 99.4% of the participants; 93.9% stated that they intended to improve their sun exposure habits and 93.4% said that they planned to examine their skin more frequently. Conclusions: Our findings confirm that golf course workers and, in particular, golfers are an important target for skin cancer prevention campaigns. This is the first intervention to specifically target golf courses, and it proved to be both feasible and useful. Its success appears to be attributable to numerous factors: it was conducted at golf courses, had multiple components, and was preceded by a motivational campaign (AU)

Skin cancer prevention and detection campaign at golf courses on Spain's Costa del Sol.

BACKGROUND AND OBJECTIVES: Skin cancer prevention and detection campaigns targeting specific groups are necessary and have proven to be more effective than those aimed at the general population. Interventions in outdoor tourist spots have proven successful, although none have specifically targeted golf courses. The aims of this study were to describe the risk profile of golfers and golf course workers and evaluate the impact of a skin cancer prevention and early detection intervention. MATERIAL AND METHODS: This was a cross-sectional descriptive study conducted at 6 golf courses. The intervention included a skin examination and completion of a questionnaire about demographic details, risk factors, and sun exposure and sun protection habits. Participants were also given advice on sun protection measures, self-examination, and use of sunscreens, and were asked about their satisfaction with the intervention and their intention to change their current behaviors. The effect was measured in terms of the diagnoses made, satisfaction with the intervention, reported intention to change, and potential effect in terms of existing risk factors. RESULTS: Of the 351 participants (57% golfers and 43% golf course workers), 70.4% had fair skin, 11.7% had a family history of skin cancer, and 8.5% had a personal history of skin cancer. Skin cancer and actinic keratoses were diagnosed in 10.7% and 40% of the golfers, respectively. The session was rated positively by 99.4% of the participants; 93.9% stated that they intended to improve their sun exposure habits and 93.4% said that they planned to examine their skin more frequently. CONCLUSIONS: Our findings confirm that golf course workers and, in particular, golfers are an important target for skin cancer prevention campaigns. This is the first intervention to specifically target golf courses, and it proved to be both feasible and useful. Its success appears to be attributable to numerous factors: it was conducted at golf courses, had multiple components, and was preceded by a motivational campaign.

A Spanish version of the Skin Cancer Index: a questionnaire for measuring quality of life in patients with cervicofacial nonmelanoma skin cancer.

INTRODUCTION: The Skin Cancer Index (SCI) is the first specific patient-reported outcome measure for patients with cervicofacial nonmelanoma skin cancer. To date, only the original English version has been published. OBJECTIVES: To develop a Spanish version of the SCI that is semantically and linguistically equivalent to the original, and to evaluate its measurement properties in this different cultural environment. MATERIAL AND METHODS: A cross-sectional study was conducted of the cultural adaptation and empirical validation of the questionnaire, analysing the psychometric properties of the new index at different stages. RESULTS: Of 440 patients recruited to the study, 431 (95%) completed the Spanish version of the SCI questionnaire, in a mean time of 6·3 min (SD 2·9). Factor analysis of the scale revealed commonality and loading values of < 0·5 for three of the 15 items. The remaining 12 items converged into two components: appearance/social aspects (seven items) and emotional aspects (five items). Both domains presented a high level of internal consistency, with Cronbach's alpha values above 0·8. The convergent-discriminant validity analysis produced correlations higher than 0·3 for the mental component of the Short Form Health Survey-12v2 Health Questionnaire (correlation coefficient 0·39) and the Dermatology Quality of Life Index (correlation coefficient -0·30). In the test-retest, nine of the 12 items produced a weighted kappa value exceeding 0·4, and for the remaining three items, the absolute agreement percentage exceeded 60%. CONCLUSIONS: The Spanish version of the SCI quality of life scale has been satisfactorily adapted and validated for use in Spanish-speaking countries and populations.

[Ultrasound in the management of non-melanoma skin cancer]. / Ecografía aplicada al manejo del cáncer cutáneo no melanoma.

Cutaneous ultrasound plays an important role in the study and management of non-melanoma skin cancer. Among other factors, this technique contributes to the diagnosis and differential diagnosis of these tumours, the establishment of their size and relation to neighbouring structures, the delimitation of surgical margins, and the detection of subclinical and recurrent lesions. The present article analyses the role of cutaneous ultrasound in the field of non-melanoma skin cancer (basal and squamous cell carcinomas, lymphomas and dermatofibrosarcoma) through a literature review.

Utilidad de la ecografía cutánea en el diagnóstico de invasividad del carcinoma basocelular recurrente tras tratamiento no quirúrgico / The Usefulness of High-Resolution Ultrasound in Detecting Invasive Disease in Recurrent Basal Cell Carcinoma After Nonsurgical Treatment

INTRODUCCIÓN Y OBJETIVOS: La determinación del subtipo histológico de carcinoma basocelular (CBC) es crucial en el adecuado abordaje del mismo (sobre todo diferenciar variantes agresivas de no agresivas). En ocasiones la biopsia falla en la correcta catalogación del mismo con sus conocidas consecuencias. La ecografía cutánea de alta frecuencia (ECAF) es una técnica reciente que ha mostrado potencialidad en la distinción de variantes de CBC. El objetivo del estudio fue mostrar la posible utilidad de la ECAF en la identificación de la invasividad del CBC recurrente tras tratamientos no quirúrgicos diagnosticados mediante biopsia como no invasivos. MATERIAL Y MÉTODOS: Estudio observacional, prospectivo de casos consecutivos de CBC con sospecha clínica de recurrencia tras tratamiento no quirúrgico y que previamente a dicho tratamiento habían sido diagnosticados por biopsia-punch como variantes superficiales. Previamente a la extirpación quirúrgica de los mismos se realizó una ecografía de la lesión y posteriormente un punch de la zona sospechosa de persistencia. Finalmente se estudió la tasa de concordancia entre los resultados diagnósticos de cada una de las pruebas (ECAF, biopsia-punch y biopsia escisional). RESULTADOS: Se incluyeron 8 casos. De entre los 4 casos en los que la biopsia-punch realizó una mala clasificación de invasividad (eran realmente subtipos invasivos pero la biopsia-punch determinó subtipos superficiales), la ECAF fue capaz de detectar dicha invasividad en 3 de ellos. CONCLUSIÓN: La ECAF podría ser de utilidad en la detección de persistencias tumorales de CBC tras tratamientos no quirúrgicos, permitiendo guiar la biopsia-punch en la detección del área más sospechosa de infiltración

INTRODUCTION AND OBJECTIVES: Accurate subtyping of basal cell carcinoma (BCC) is crucial for the effective management of this disease and it is particularly important to distinguish between aggressive and nonaggressive histologic variants. Histologic subtype is not always accurately identified by biopsy and this can have serious implications. High-resolution ultrasound (HRUS) is a recent technique that has proven to be of value in differentiating between variants of BCC. The aim of this study was to investigate the potential usefulness of HRUS for detecting invasive disease in recurrent BCC treated nonsurgically following an initial diagnosis of noninvasive BCC by biopsy. MATERIAL AND METHODS: This was a prospective observational study of consecutive cases of BCC with clinical suspicion of recurrence following nonsurgical treatment and a pretreatment diagnosis of superficial BCC by punch biopsy. Before surgical excision, the recurrent lesions were evaluated by HRUS followed by a punch biopsy of the site of suspected recurrence. The diagnostic agreement between HRUS, punch biopsy, and excisional biopsy was then evaluated. RESULTS: Eight lesions were studied. HRUS identified invasive disease in 3 of the 4 cases that were incorrectly classified as superficial subtypes by punch biopsy. CONCLUSION: HRUS could be useful for detecting persistent tumor after nonsurgical treatment and for choosing the site most likely to harbor invasive disease for punch biopsy

The usefulness of high-resolution ultrasound in detecting invasive disease in recurrent basal cell carcinoma after nonsurgical treatment.

INTRODUCTION AND OBJECTIVES: Accurate subtyping of basal cell carcinoma (BCC) is crucial for the effective management of this disease and it is particularly important to distinguish between aggressive and nonaggressive histologic variants. Histologic subtype is not always accurately identified by biopsy and this can have serious implications. High-resolution ultrasound (HRUS) is a recent technique that has proven to be of value in differentiating between variants of BCC. The aim of this study was to investigate the potential usefulness of HRUS for detecting invasive disease in recurrent BCC treated nonsurgically following an initial diagnosis of noninvasive BCC by biopsy. MATERIAL AND METHODS: This was a prospective observational study of consecutive cases of BCC with clinical suspicion of recurrence following nonsurgical treatment and a pretreatment diagnosis of superficial BCC by punch biopsy. Before surgical excision, the recurrent lesions were evaluated by HRUS followed by a punch biopsy of the site of suspected recurrence. The diagnostic agreement between HRUS, punch biopsy, and excisional biopsy was then evaluated. RESULTS: Eight lesions were studied. HRUS identified invasive disease in 3 of the 4 cases that were incorrectly classified as superficial subtypes by punch biopsy. CONCLUSION: HRUS could be useful for detecting persistent tumor after nonsurgical treatment and for choosing the site most likely to harbor invasive disease for punch biopsy.

Five-year economic evaluation of non-melanoma skin cancer surgery at the Costa del Sol Hospital (2006-2010).

BACKGROUND: The cost associated with treatment of non-melanoma skin cancer is expected to rise considerably over the coming decades. This important public health problem is therefore expected to have an enormous economic impact for the various public health services. OBJECTIVES: To estimate the cost of the surgical-care process of non-melanoma skin cancer at the Costa del Sol Hospital and seek areas to improve its efficiency, using the activity-based costing (ABC) method and the tools designed for decision analysis. SECONDARY OBJECTIVE: To compare the costs for hospitalized patients obtained using the ABC method with the data published by the Spanish Ministry of Health, using the diagnosis-related groups (DRG) classification system. MATERIAL AND METHODS: Retrospective analysis of the cost of non-melanoma skin cancer surgery at the Costa del Sol Hospital. RESULTS: The total estimated cost from 2006 to 2010 was 3 398 540€. Most of the episodes (47.3%) corresponded to minor outpatient surgery. The costs of the episodes varied greatly according to the type of admission: 423€ (minor outpatient surgery), 1267€ (major outpatient surgery), and 1832€ (inpatient surgery). The average cost of an inpatient episode varied significantly depending on the calculation system used (ABC: 2328€ vs. DRG: 5674€). CONCLUSIONS: The ABC cost analysis system favours standardization of the care process for these tumours and the detection of areas to improve efficiency. This would enable more reliable economic studies than those obtained using traditional methods, such as the DRG.

Infiltración cutánea por linfocitos T CD8+ asociada a virus de la inmunodeficiencia humana / Cutaneous CD8+ T-cell Infiltrates Associated With Human Immunodeficiency Virus

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Sensibilización de contacto a alérgenos de la serie estándar en el Hospital Costa del Sol: Estudio retrospectivo (2005-2010) / Contact Sensitization to Allergens in the Spanish Standard Series at Hospital Costa del Sol in Marbella, Spain: a Retrospective Study (2005-2010)

La prevalencia de la alergia de contacto a los diferentes compuestos puede variar dependiendo de la población estudiada, de la técnica y del material empleado en las pruebas epicutáneas. En España el Grupo Español de Investigación en Dermatitis de Contacto y Alergia Cutánea (GEIDAC) ha propuesto una batería de 29 alérgenos para estudiar a los pacientes con sospecha de dermatitis de contacto alérgica. Material y métodos: Análisis retrospectivo de 839 pacientes con sospecha de dermatitis de contacto, realizado en el Hospital Costa del Sol desde el 1 de enero de 2005 hasta el 31 de diciembre de 2010. Para ello se utilizaron pruebas epicutáneas estándar de 34 alérgenos en las que estuvieron incluidos los 29 compuestos de la batería estándar española propuesta por el GEIDAC. Objetivo: Valorar la prevalencia de la sensibilización de contacto entre los pacientes estudiados y estudiar su asociación con factores sociodemográficos (sexo, edad, localización, ocupación) y clínicos (dermatitis atópica). Resultados: El 48% de los pacientes presentó sensibilización al menos a uno de los alérgenos testados. Las mujeres presentaron una frecuencia de sensibilización más elevada que los hombres (56,9 vs. 33,1%). La localización afectada con mayor frecuencia fue la mano (36,1%). Los alérgenos más frecuentes fueron sulfato de níquel (25,9%), dicromato potásico (7,6%), tiomersal (5,1%), cloruro de cobalto (4,5%) y mezcla de fragancias I (3,8%). Por el contrario, se detectó una baja frecuencia de sensibilización a conservantes como mezcla de parabenos (0,1%), imidazolidinil urea (0,1%), diazolidinil urea (0,2%) y mezcla de quinoleínas (0,2%). No se registraron sensibilizaciones para lactonas sesquiterpénicas y metildibromoglutaronitrilo (euxyl K400). Conclusiones: Nuestros resultados son similares a los previamente publicados a nivel nacional. La baja sensibilización a ciertos alérgenos, como la mayoría de conservantes y las lactonas sesquiterpénicas, podría hacer necesario reconsiderar su utilidad como alérgenos en futuras series estándar (AU)

Background: The prevalence of contact allergy to different compounds can vary according to the population studied, the technique used, and the materials employed in patch tests. The Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) has proposed a panel of 29 allergens for use in patients with suspected allergic contact dermatitis. Objective: To determine the prevalence of contact sensitization in a group of Spanish patients and to analyze potential associations with sociodemographic and clinical variables (sex, age, site of lesions, occupation, and diagnosis of atopic dermatitis). Material and methods: A retrospective study of patients with suspected contact dermatitis was undertaken at Hospital Costa del Sol in Marbella, Spain, for the period between January 1, 2005 and December 31, 2010; 839 patients were included in the analysis. Patch tests were carried out with 34 allergens, including the 29 compounds that comprise the Spanish standard panel proposed by the GEIDAC. Results: Sensitization to at least 1 allergen in the panel was observed in 48% of patients. Women had a higher frequency of sensitization than men (56.9% vs 33.1%). The hands were the most commonly affected site (36.1%). The most frequently involved allergens were nickel sulfate (25.9%), potassium dichromate (7.6%), thiomersal (5.1%), cobalt chloride (4.5%), and fragrance mix I (3.8%). In contrast, preservatives such as paraben mix (0.1%), imidazolidinyl urea (0.1%), diazolidinyl urea (0.2%), and quinoline mix (0.2%) had low rates of sensitization. Sensitization to sesquiterpene lactones and methyldibromo glutaronitrile (euxyl K 400) were not observed. Conclusions: Our results are similar to those previously reported for Spanish patients. The low level of sensitization to certain allergens such as most preservatives and sesquiterpene lactones may suggest that their use in standard patch test series should be reconsidered(AU)

Comparative epidemiological study of non-melanoma skin cancer between Spanish and north and central European residents on the Costa del Sol.

BACKGROUND: Non-melanoma skin cancer (NMSC) is the most common tumour in white people. The progressive increase of these malignancies in such populations as those found in Europe represents an important public health concern which it is presumed will have a great impact on healthcare costs. However, the lack of comparable epidemiological information between countries hinders the development of a common health policy. OBJECTIVES: The aim of this study was to describe the epidemiological, clinical and therapeutic aspects of NMSC in the public health area of the western part of the Costa del Sol, in southern Spain, and study the differences between the Spanish (S) population and that originally between the north and centre of Europe (N). METHODS: We undertook a retrospective analysis of all patients with histologically confirmed tumours in both populations during the period 1 January 2006 to 30 June 2009. RESULTS: In comparison with the Spanish, the patients from the north and centre of Europe were more likely to have phototype I/II (S: 56.9%; N: 85.8%), recreational photoexposure (S: 48.4%; N: 83.8%), multiple carcinomas (S: 16.8%; N: 28.2%) and more carcinomas per patient (S: 1.7 ± 1.3; N: 2.3 ± 2.3). The tumours were more often located on the trunk and limbs (S: 28.3%; N: 50.2%) with a predominance of the less aggressive histological types (S: 34.7%; N: 42.6%) and non-invasive treatments in patients from the north and centre of Europe (S: 25.6%; N: 35.3%) when compared with the Spanish population. CONCLUSION: Persons from the north and centre of Europe living on the Costa del Sol present a different pattern of NMSC to the local Spanish population and usually require a less invasive therapeutic approach. These findings highlight the need to define prevention and treatment policies for NMSC according to the characteristics of each particular population. This would help reduce not only the frequency but also the associated morbimortality of this disease, particularly in high-risk populations.

[Contact sensitization to allergens in the Spanish standard series at Hospital Costa del Sol in Marbella, Spain: a retrospective study (2005-2010)]. / Sensibilización de contacto a alérgenos de la serie estándar en el Hospital Costa del Sol: Estudio retrospectivo (2005-2010).

BACKGROUND: The prevalence of contact allergy to different compounds can vary according to the population studied, the technique used, and the materials employed in patch tests. The Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) has proposed a panel of 29 allergens for use in patients with suspected allergic contact dermatitis. OBJECTIVE: To determine the prevalence of contact sensitization in a group of Spanish patients and to analyze potential associations with sociodemographic and clinical variables (sex, age, site of lesions, occupation, and diagnosis of atopic dermatitis). MATERIAL AND METHODS: A retrospective study of patients with suspected contact dermatitis was undertaken at Hospital Costa del Sol in Marbella, Spain, for the period between January 1, 2005 and December 31, 2010; 839 patients were included in the analysis. Patch tests were carried out with 34 allergens, including the 29 compounds that comprise the Spanish standard panel proposed by the GEIDAC. RESULTS: Sensitization to at least 1 allergen in the panel was observed in 48% of patients. Women had a higher frequency of sensitization than men (56.9% vs 33.1%). The hands were the most commonly affected site (36.1%). The most frequently involved allergens were nickel sulfate (25.9%), potassium dichromate (7.6%), thiomersal (5.1%), cobalt chloride (4.5%), and fragrance mix I (3.8%). In contrast, preservatives such as paraben mix (0.1%), imidazolidinyl urea (0.1%), diazolidinyl urea (0.2%), and quinoline mix (0.2%) had low rates of sensitization. Sensitization to sesquiterpene lactones and methyldibromo glutaronitrile (euxyl K 400) were not observed. CONCLUSIONS: Our results are similar to those previously reported for Spanish patients. The low level of sensitization to certain allergens such as most preservatives and sesquiterpene lactones may suggest that their use in standard patch test series should be reconsidered.

Botriomicosis cutánea / Cutaneous botryomycosis

La botriomicosis es una infección granulomatosa crónica supurativa, poco frecuente, caracterizada por la presencia en el estudio histológico de gránulosbasófilos que contienen los microorganismos causantes. Esta entidad puede afectar la piel, y mucosas solamente o asociarse afectación visceral.Traumatismos, cuerpos extraños y deficiencias en los mecanismos de defensa son factores predisponentes de esta enfermedad, pero también puededesarrollarse en individuos aparentemente sanos.Presentamos un caso de botriomicosis cutánea afectando la región patelar de paciente inmunocompetente, con un traumatismo local previo que precisósutura años antes como único factor predisponente. Se intenta ilustrar la dificultad que existe en ocasiones para realizar el diagnóstico de estaentidad clínica y la pobre respuesta a diversas opciones terapéuticas siendo frecuentes las recidivas (AU)

Botryomycosis is an uncommon, chronic, granulomatous, suppurative disease characterized by the presence of abscess containing granules with thecausative bacterias. This infection can involve skin alone or in association with visceral organs. Trauma, foreign bodies and immunodeficiency predisposefor the disease, but botryomycosis may develop in apparently helathy individuals.We report a woman with lesions in the patellar area following local trauma with no immunodeficiency, as a predisposing factor. We emphasize the difficultyfor the diagnosis of this entity and the limited response to different treatments (AU)