Evaluation of 25 years of phototherapy for treating psoriasis at a teaching hospital in southern Spain.

BACKGROUND: For years, phototherapy has been used in a wide range of skin diseases, which is unsurprising as skin is the anatomical feature most directly exposed to light, especially in psoriasis. Although the role of light therapy has been replaced by different therapeutic modalities in recent years, this treatment is now an established option for many skin diseases. OBJECTIVES: The aim was to characterize the patient population that had received the aforementioned treatment in the Virgen Macarena Health Area in Seville (Spain) between June 1985 and October 2011. METHODS: We have designed a descriptive study with a univariate analysis covering 443 treatments with light therapy, all administered to the same number of patients suffering from psoriasis. RESULTS: 79.15% of patients were discharged due to improvement or healing, while the 20.85% were discharged due to other reasons. The average total accumulative dose was 131.53 J/cm2. We do not detected an increase in proportion in patients for develop NMSK after light therapy treatment. CONCLUSIONS: We consider that phototherapy is still an effective and efficient treatment that will have to be reconsidered in the current macroeconomic context.

Evaluation of 25 years of phototherapy for treating psoriasis at a teaching hospital in southern Spain

AbstractBACKGROUND:For years, phototherapy has been used in a wide range of skin diseases, which is unsurprising as skin is the anatomical feature most directly exposed to light, especially in psoriasis. Although the role of light therapy has been replaced by different therapeutic modalities in recent years, this treatment is now an established option for many skin diseases.OBJECTIVES:The aim was to characterize the patient population thathad received the aforementioned treatment in the Virgen Macarena Health Area in Seville (Spain) between June 1985 and October 2011.METHODS:We have designed a descriptive study with a univariate analysis covering 443 treatments with light therapy, all administered to the same number of patients suffering from psoriasis.RESULTS:79.15% of patients were discharged due to improvement or healing, while the 20.85% were discharged due to other reasons. The average total accumulative dose was 131.53 J/cm2. We do not detected an increase in proportion in patients for develop NMSK after light therapy treatment.CONCLUSIONS:We consider that phototherapy is still an effective and efficient treatment that will have to be reconsidered in the current macroeconomic context.

Results of a combination of bleomycin and triamcinolone acetonide in the treatment of keloids and hypertrophic scars.

While treatment of keloids and hypertrophic scars normally shows modest results, we found that treatment with bleomycin was more promising. The present study was divided into two parts. In the first part the aim was to show the results using a combination of bleomycin and triamcinolone acetonide per cm2 (BTA). In the second part the objective was to determine the response to both drugs in large keloids that were divided into 1 cm2 squares, treating each square with the dose previously used. In the first part of the study, the clinical response of 37 keloids ranging from 0.3 to 1.8 cm2 treated with BTA were followed up over a period of 1- 2 years. 0.375 IU bleomycin and 4 mg triamcinolone acetonide were injected every 3 months. In the second part of the study we reviewed the clinical response in six patients with large keloids. The monthly dose administered never exceeded 3 IU of bleomycin. The first study showed 36 keloids (97.29%) softening after the first dose. In the second study, 5 showed different responses (the response was complete in the four smaller keloids). The largest keloid needed 9 doses to achieve an improvement of 70%. In conclusion, combined treatment with 0.375 IU of bleomycin and 4mg of triamcinolone acetonide to 1 cm2 was considered to be an acceptable procedure for the treatment of keloids. The best results were obtained in keloids over 1 cm2 or when divided into 1 cm2 square areas. Larger series need to be performed in order to confirm these results..

Results of a combination of bleomycin and triamcinolone acetonide in the treatment of keloids and hypertrophic scars / Resultados de uma combinação de bleomicina e triamcinolone acetonide no tratamento de quelóides e cicatrizes hipertróficas

While treatment of keloids and hypertrophic scars normally shows modest results, we found that treatment with bleomycin was more promising. The present study was divided into two parts. In the first part the aim was to show the results using a combination of bleomycin and triamcinolone acetonide per cm2 (BTA). In the second part the objective was to determine the response to both drugs in large keloids that were divided into 1 cm2 squares, treating each square with the dose previously used. In the first part of the study, the clinical response of 37 keloids ranging from 0.3 to 1.8 cm2 treated with BTA were followed up over a period of 1- 2 years. 0.375 IU bleomycin and 4 mg triamcinolone acetonide were injected every 3 months. In the second part of the study we reviewed the clinical response in six patients with large keloids. The monthly dose administered never exceeded 3 IU of bleomycin. The first study showed 36 keloids (97.29%) softening after the first dose. In the second study, 5 showed different responses (the response was complete in the four smaller keloids). The largest keloid needed 9 doses to achieve an improvement of 70%. In conclusion, combined treatment with 0.375 IU of bleomycin and 4mg of triamcinolone acetonide to 1 cm2 was considered to be an acceptable procedure for the treatment of keloids. The best results were obtained in keloids over 1 cm2 or when divided into 1 cm2 square areas. Larger series need to be performed in order to confirm these results..

Enquanto normalmente o tratamento de queloides e cicatrizes hipertróficas mostra resultados moderados, o tratamento com bleomicina revelou resultados mais promissores. Este estudo foi dividido em duas partes. Na primeira parte, o objetivo foi mostrar os resultados da utilização de uma combinação de bleomicina e acetonido de triancinolona por cm2 (BAT). Na segunda parte, o objetivo foi determinar a resposta aos dois medicamentos em queloides grandes, que foram divididos em quadrados de 1 cm2, tratando cada quadrado com a dose utilizada anteriormente. Na primeira parte do estudo, a resposta clínica de 37 queloides de 0,3 to 1,8 cm2 tratados com BAT foi monitorada por um período de 1 a 2 anos. Injeções de 0,375 UI de bleomicina e 4 mg de acetonido de triancinolona foram aplicadas a cada 3 meses. Na segunda parte do estudo, revisamos a resposta clínica em 6 pacientes com queloides grandes. A dose mensal administrada nunca excedeu 3 UI de bleomicina. O primeiro estudo mostrou que 36 queloides (97,29%) amoleceram após a primeira dose. No segundo estudo, 5 mostraram diferentes respostas (a resposta foi completa nos quatro queloides menores). O queloide maior necessitou de 9 doses para apresentar melhora de 70%. Concluindo, o tratamento combinado com 0,375 UI de bleomicina e 4 mg de acetonido de triancinolona por cm2foi considerado um procedimento aceitável para o tratamento de queloides. Os melhores resultados foram obtidos em queloides com mais de 1 cm2 ou divididos em áreas de 1cm2. Estudos mais amplos deveriam ser realizados, para confirmar esses resultados.

Efficacy and safety of clinical use of etanercept for the treatment of moderate-to-severe psoriasis in Spain: results of a multicentric prospective study at 12 months follow-up.

BACKGROUND: The efficacy of etanercept in the treatment of psoriasis has been demonstrated in several clinical trials, but information regarding results derived from prospective observational studies in clinical practice is scarce. OBJECTIVES: To evaluate the efficacy and safety of etanercept administration according to routine clinical use in moderate-to-severe plaque psoriasis. MATERIALS AND METHODS: Postauthorization, prospective study, carried out at 59 dermatology units in Spain. Patients diagnosed with moderate-to-severe plaque psoriasis received etanercept during a 12-month period. RESULTS: Altogether, 444 patients were enrolled. Overall, 325 patients (73.2%) initiated etanercept treatment at a dose of 50 mg twice weekly; 96 patients (21.6%) received etanercept as a continuous regimen for the entire study period, and 348 patients (79.4%) an intermittent regimen. Among these, 185 patients (41.6% overall) received one course of treatment, stopped at various study points and did not restart etanercept treatment, whereas the remaining 163 patients (36.7% overall) stopped etanercept treatment, lost response, relapsed and were retreated. Most patients who interrupted etanercept treatment did so at month 6. Altogether, 79.7% of patients completed the study period. Etanercept treatment resulted in significant improvement in disease activity. A Psoriasis Area and Severity Index (PASI) 75 response was achieved by 76.1% of patients at month 6. Out of 252 adverse events reported, 31 were considered severe. Three possibly treatment-related malignancies were detected during the study. No opportunistic infections, tuberculosis or demyelinating events were reported. CONCLUSION: The PASI 75 response rate at month 6 in this observational, naturalistic study is similar to those observed in recent published trials with etanercept, and within the range of those reported for other marketed biologicals.

Free flaps in Surgical Dermatology: comparison between fasciocutaneous and myocutaneous free flaps in facial reconstructions / Retalhos livres em dermatologia cirúrgica: comparação entre os retalhos livres fasciocutâneos e miocutâneos nas reconstruções faciais

BACKGROUND: Dermatologic surgeons routinely harvest pedicled flaps at distance with an axial or random pattern to repair facial defects. These types of skin flaps are time-consuming and have high economic, social and personal costs. These drawbacks could be avoided with the introduction of a single-step transfer of free flaps to the recipient site, with microvascular anastomosis. OBJECTIVE: To demonstrate that better results are obtained with myocutaneous or fasciocutaneous free flaps and which one is more suitable in surgical dermatology. MATERIAL AND METHODS: We selected two patients of opposite sexes and similar ages who had undergone Mohs surgery to remove recurrent malignant tumors that were located in the upper cheek bordering the zygomatic zone. The woman was treated with a fasciocutaneous radial free flap and the man with a rectus abdominis free flap. RESULTS: Both patients had excellent immediate postoperative outcomes. Complications observed in the male patient were related to a previous pulmonary alteration. The fasciocutaneous radial free flap reconstruction was easier to perform than the rectus abdominis free flap; nevertheless, the radial free flap is very thin and, although the palmaris longus tendon is used, it does not yield enough volume, requiring later use of implants. In contrast, the rectus abdominis free flap transfers a wide flap with enough fat tissue to expand in the future. As for the cosmetic results regarding the donor site, the rectus abdominis free flap produces better-looking scars, since secondary defects of the palmar surface cannot be directly closed and usually require grafting - a situation that some patients do not accept. CONCLUSIONS: In surgical dermatology, each case, once the tumor has been extirpated, requires its own reconstructive technique. The radial free flap is suitable for thin patients who are willing to cover their arm with a shirt. The rectus abdominis free flap is best suited for obese ...

FUNDAMENTOS: Os cirurgiões dermatológicos habitualmente realizam retalhos pediculados cutâneos à distância, de padrão axial ou ao acaso, para reparar os defeitos faciais. Estes tipos de retalhos cutâneos requerem muito tempo para realizar-se e têm elevadas despesas econômicas, sociais e pessoais. Com a introdução da transferência em uma única etapa de retalhos livres ao local receptor, com anastomose microvascular, estes inconvenientes poderiam ser evitados. OBJETIVO: Demonstrar que se obtêm melhores resultados com retalhos livres fasciocutâneos ou miocutâneos e qual deles é mais adequado em Dermatologia cirúrgica. MATERIAL E MÉTODOS: Selecionamos dois pacientes, de sexos diferentes e idades similares, que haviam sido tratados com cirurgia de Mohs, para eliminar os tumores malignos recidivantes que se localizavam na parte superior das bochechas contatando com a zona zigomática. A mulher foi tratada com um retalho livre fasciocutâneo radial e o homem com um retalho livre do músculo reto do abdômen. RESULTADOS: Ambos os pacientes tiveram excelentes períodos pós-operatórios imediatos. As complicações observadas no homem foram relacionadas a uma alteração pulmonar prévia. O retalho fasciocutâneo radial livre foi mais fácil de realizar do que o do reto do abdômen; não obstante, o retalho livre radial é muito fino e, embora lhe seja incluído tendão do palmar, não proporciona suficiente volume razão pela qual requer a introdução posterior de implantes. Em contrapartida, o retalho livre do reto do abdômen transfere um largo retalho que tem suficiente tecido grasso para poder engordar no futuro. Quanto aos resultados estéticos da zona doadora, o retalho do reto do abdômen produz melhores cicatrizes, já que os defeitos secundários da superfície palmar do antebraço não podem ser fechados diretamente e requerem habitualmente a aplicação de um enxerto; situação que alguns pacientes não aceitam. CONCLUSÕES: Como sempre em Dermatologia cirúrgica, cada ...

Free flaps in surgical dermatology. Comparison between fasciocutaneous and myocutaneous free flaps in facial reconstructions.

BACKGROUND: Dermatologic surgeons routinely harvest pedicled flaps at distance with an axial or random pattern to repair facial defects. These types of skin flaps are time-consuming and have high economic, social and personal costs. These drawbacks could be avoided with the introduction of a single-step transfer of free flaps to the recipient site, with microvascular anastomosis. OBJECTIVE: To demonstrate that better results are obtained with myocutaneous or fasciocutaneous free flaps and which one is more suitable in surgical dermatology. MATERIAL AND METHODS: We selected two patients of opposite sexes and similar ages who had undergone Mohs surgery to remove recurrent malignant tumors that were located in the upper cheek bordering the zygomatic zone. The woman was treated with a fasciocutaneous radial free flap and the man with a rectus abdominis free flap. RESULTS: Both patients had excellent immediate postoperative outcomes. Complications observed in the male patient were related to a previous pulmonary alteration. The fasciocutaneous radial free flap reconstruction was easier to perform than the rectus abdominis free flap; nevertheless, the radial free flap is very thin and, although the palmaris longus tendon is used, it does not yield enough volume, requiring later use of implants. In contrast, the rectus abdominis free flap transfers a wide flap with enough fat tissue to expand in the future. As for the cosmetic results regarding the donor site, the rectus abdominis free flap produces better-looking scars, since secondary defects of the palmar surface cannot be directly closed and usually require grafting - a situation that some patients do not accept. CONCLUSIONS: In surgical dermatology, each case, once the tumor has been extirpated, requires its own reconstructive technique. The radial free flap is suitable for thin patients who are willing to cover their arm with a shirt. The rectus abdominis free flap is best suited for obese patients with deep and voluminous defects, although it is necessary to dislocate the navel from its original position.