Tratamiento de la enfermedad de Hailey-Hailey con láser de dióxido de carbono: tratamiento en 8 pacientes / Carbon Dioxide Laser Treatment in Hailey-Hailey Disease: A Series of 8 Patients

Introducción y objetivos: La enfermedad de Hailey-Hailey (EHH) o pénfigo familiar benigno es un rara genodermatosis ampollosa con herencia autosómica dominante. Cursa con erosiones cutáneas, localizadas principalmente en los grandes pliegues, que se sobreinfectan y pueden ser muy dolorosas e incapacitantes para los pacientes. Es una afección difícil de tratar, y aunque se han usado múltiples tratamientos tópicos y sistémicos para controlar los brotes de la enfermedad, ninguno de ellos consigue remisiones a medio-largo plazo. Pacientes y método: Realizamos un estudio retrospectivo de una serie de 8 casos de EHH tratados con láser CO2 en nuestro centro desde 1999 a 2011. Los pacientes tratados tenían una media de edad de 50,7 años, siendo 4 de ellos hombres y 4 mujeres. El seguimiento de los pacientes osciló entre uno y 12 años. Resultados: De los 8 pacientes tratados 6 obtuvieron unos resultados satisfactorios (4 pacientes con mejoría clínica>75% y 2 pacientes entre 50-75%). Esta eficacia se mantuvo a lo largo del tiempo. Los peores resultados se observaron en los pacientes tratados con potencias más bajas. Las zonas con recidiva de la enfermedad después del tratamiento se trataron con una segunda sesión de láser con buena respuesta. No observamos efectos adversos, salvo ligeros cambios texturales y de la pigmentación. Conclusiones: El láser de CO2 es un tratamiento eficaz y seguro a medio-largo plazo en los casos de EHH sintomáticos y refractarios a tratamientos convencionales (AU)

Introduction and objectives: Hailey-Hailey disease (HHD), or benign familial pemphigus, is arare autosomal dominant genodermatosis characterized by the formation of blisters. Eruptionsare usually located in large skin folds, and when blisters become infected the condition can bevery painful and disabling. HHD is difficult to treat. Many topical and systemic treatments have been used to bring exacerbations under control, but none have achieved medium- to long-term remission. Patients and methods: Retrospective study of 8 patients with HHD treated with carbon dioxide laser therapy in our hospital between 1999 and 2011. The patients’ mean age was 50.7 years. The 4 men and 4 women were followed for between 1 and 12 years. Results: Satisfactory outcomes were achieved for 6 of the patients. Clinical improvement was observed in more than 75% of the affected area in 4 patients and in 50% to 75% of the area in 2 patients. The effect of treatments was maintained over time. The poorest outcomes were observed in patients treated at lower potencies. When blistering recurred after treatment, a second laser session achieved a good response. We observed no adverse events other than slight changes in skin texture and pigmentation. Conclusions: Carbon dioxide laser therapy was safe and effective in producing medium- to long-term improvement in HHD symptoms that were refractory to conventional treatments (AU)

Carbon dioxide laser treatment in Hailey-Hailey disease: a series of 8 patients.

BACKGROUND: Hailey-Hailey disease (HHD), or benign familial pemphigus, is a rare autosomal dominant genodermatosis characterized by the formation of blisters. Eruptions are usually located in large skin folds, and when blisters become infected the condition can be very painful and disabling. HHD is difficult to treat. Many topical and systemic treatments have been used to bring exacerbations under control, but none have achieved medium- to long-term remission. PATIENTS AND METHODS: Retrospective study of 8 patients with HHD treated with carbon dioxide laser therapy in our hospital between 1999 and 2011. The patients' mean age was 50.7 years. The 4 men and 4 women were followed for between 1 and 12 years. RESULTS: Satisfactory outcomes were achieved for 6 of the patients. Clinical improvement was observed in more than 75% of the affected area in 4 patients and in 50% to 75% of the area in 2 patients. The effect of treatments was maintained over time. The poorest outcomes were observed in patients treated at lower potencies. When blistering recurred after treatment, a second laser session achieved a good response. We observed no adverse events other than slight changes in skin texture and pigmentation. CONCLUSIONS: Carbon dioxide laser therapy was safe and effective in producing medium- to long-term improvement in HHD symptoms that were refractory to conventional treatments.

Manejo práctico de las enfermedades ampollosas autoinmunes más frecuentes / Practical management of the most common autoimmune bullous diseases

Las enfermedades ampollosas autoinmunes constituyen un grupo de entidades relativamente infrecuentes cuyo tratamiento, aunque semejante, varía en función de las escuelas dermatológicas. Dentro de este grupo las más frecuentes son el pénfigo vulgar y foliáceo, el penfigoide ampolloso y de mucosas, la enfermedad IgA lineal y la dermatitis herpetiforme. En los últimos años se han incluido en el arsenal terapéutico fármacos que han cambiado en ocasiones el pronóstico de las mismas. Recogemos en este artículo los protocolos de actuación actuales en estos procesos basados en la literatura y en la experiencia de consultas monográficas de enfermedades ampollosas. Así mismo, hemos recogido los datos de una encuesta vía internet sobre los métodos terapéuticos en pénfigo vulgar de más de 40 dermatólogos con experiencia habitualmente hospitalaria en España (AU)

Autoimmune bullous diseases are relatively uncommon and their treatment-although generally similar-may vary depending on the dermatologist. Within this group of diseases, the most common are pemphigus vulgaris and pemphigus foliaceus, bullous and mucosal pemphigoid, linear immunoglobulin A disease, and dermatitis herpetiformis. In recent years, the therapeutic arsenal has been extended by new drugs, some of which have changed the prognosis of these diseases. This article describes current management protocols for these processes as indicated in the literature and derived from the experience of specialized clinics for bullous diseases. We also present the findings from an Internet survey on therapeutic approaches in pemphigus vulgaris answered by more than 40 dermatologists who work primarily in Spanish hospital clinics (AU)

[Practical management of the most common autoimmune bullous diseases]. / Manejo práctico de las enfermedades ampollosas autoinmunes más frecuentes.

Autoimmune bullous diseases are relatively uncommon and their treatment -- although generally similar -- may vary depending on the dermatologist. Within this group of diseases, the most common are pemphigus vulgaris and pemphigus foliaceus, bullous and mucosal pemphigoid, linear immunoglobulin A disease, and dermatitis herpetiformis. In recent years, the therapeutic arsenal has been extended by new drugs, some of which have changed the prognosis of these diseases. This article describes current management protocols for these processes as indicated in the literature and derived from the experience of specialized clinics for bullous diseases. We also present the findings from an Internet survey on therapeutic approaches in pemphigus vulgaris answered by more than 40 dermatologists who work primarily in Spanish hospital clinics.

Psoriasis en relación con ansiedad, mejoría marcada tras tratamiento ansiolítico / Psoriasis and anxiety: marked improvement after anxiolytic therapy

No disponible

[Role of neuropeptides in dermatology]. / Papel de los neuropéptidos en dermatología.

Neuropeptides (NP) are a heterogeneous group of proteins functioning as neurotransmitters, neuromodulators and neurohormones. More than fifty of these molecules have been described, and some have been detected in human skin through immunochemistry and radioimmunoassay. In this article we attempt to study the role played by some of these substances such as substance P (SP), calcitonin gene related peptide (CGRP), neuropeptide Y (NPY), vasoactive intestinal peptide (VIP), somatostatin (S), and neurotensin (N). Several NP induce inflammatory response with edema and erythema. They can also induce the release of histamine by mastocytes, regulate cutaneous blood flow, and participate in sweat regulation and nociception. They also exert their action over several cells that participate in immunity, acting as mitotic, and chemotactic factors, inhibiting or stimulating inflammatory mechanisms. Specific NP have their receptors on epidermal cells. We will also try to study certain diseases in which NP play an important role in inducing or alleviating lesions, such as psoriasis, atopic eczema, alopecia areata, vitiligo, nodular prurigo, aquagenic pruritus, hypertrophic scars and other entities.