Seguridad en los procedimientos dermatológicos: oclusión vascular por materiales de relleno / Safety in Dermatologic Procedures: Vascular Occlusion by Filling Materials

Las complicaciones más graves del tratamiento con los rellenos dérmicos para el rejuvenecimiento facial son las isquémicas, que pueden provocar un síndrome de Nicolau, una ceguera o, incluso, un ictus. Se describen las medidas preventivas que es conveniente aplicar cuando se realizan estos procedimientos y, en caso de que aparezcan, se proponen los pasos a seguir ante esta urgencia dermatológica. Es importante tener un amplio conocimiento de la anatomía facial. Son preferibles el uso de cánulas y las técnicas de infiltración retrógradas. Cuando aparece un evento isquémico cutáneo, usaremos hialuronidasa infiltrada preferiblemente con cánula. Si el evento isquémico ocurre a nivel ocular se trasladará al paciente a un medio hospitalario con código ictus (AU)

Ischemic events are the most serious complications of facial antiaging treatment with dermal fillers. Ischemia can cause Nicolau syndrome, blindness, or even stroke. This article discusses how to prevent ischemic complications and what steps to take should a dermatologic emergency develop. A thorough understanding of facial anatomy is important. Preferred procedural techniques involve the use of cannulas and retrograde injection. When ischemia is detected in the skin, hyaluronidase should be injected, preferably through a cannula. If ocular ischemia occurs, the patient should be transferred to a hospital with stroke code activation (AU)

Safety in Dermatologic Procedures: Vascular Occlusion by Filling Materials. / Seguridad en los procedimientos dermatológicos: oclusión vascular por materiales de relleno.

Ischemic events are the most serious complications of facial antiaging treatment with dermal fillers. Ischemia can cause Nicolau syndrome, blindness, or even stroke. This article discusses how to prevent ischemic complications and what steps to take should a dermatologic emergency develop. A thorough understanding of facial anatomy is important. Preferred procedural techniques involve the use of cannulas and retrograde injection. When ischemia is detected in the skin, hyaluronidase should be injected, preferably through a cannula. If ocular ischemia occurs, the patient should be transferred to a hospital with stroke code activation.

Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases.

BACKGROUND: The cutaneous manifestations of COVID-19 disease are poorly characterized. OBJECTIVES: To describe the cutaneous manifestations of COVID-19 disease and to relate them to other clinical findings. METHODS: We carried out a nationwide case collection survey of images and clinical data. Using a consensus we described five clinical patterns. We later described the association of these patterns with patient demographics, the timing in relation to symptoms of the disease, the severity and the prognosis. RESULTS: The lesions may be classified as acral areas of erythema with vesicles or pustules (pseudo-chilblain) (19%), other vesicular eruptions (9%), urticarial lesions (19%), maculopapular eruptions (47%) and livedo or necrosis (6%). Vesicular eruptions appear early in the course of the disease (15% before other symptoms). The pseudo-chilblain pattern frequently appears late in the evolution of the COVID-19 disease (59% after other symptoms), while the rest tend to appear with other symptoms of COVID-19. The severity of COVID-19 shows a gradient from less severe disease in acral lesions to more severe in the latter groups. The results are similar for confirmed and suspected cases, in terms of both clinical and epidemiological findings. Alternative diagnoses are discussed but seem unlikely for the most specific patterns (pseudo-chilblain and vesicular). CONCLUSIONS: We provide a description of the cutaneous manifestations associated with COVID-19 infection. These may help clinicians approach patients with the disease and recognize cases presenting with few symptoms. What is already known about this topic? Previous descriptions of cutaneous manifestations of COVID-19 were case reports and mostly lacked illustrations. What does this study add? We describe a large, representative sample of patients with unexplained skin manifestations and a diagnosis of COVID-19, using a consensus method to define morphological patterns associated with COVID-19. We describe five clinical patterns associated with different patient demographics, timing and prognosis, and provide illustrations of these patterns to allow for easy recognition.

¿Sigue siendo la parafenilendiamina un alérgeno de contacto prevalente en España? / Is p-Phenylenediamine Still a Prevalent Contact Allergen in Spain?

OBJETIVOS: El objetivo del trabajo es mostrar la tendencia de la sensibilización de contacto entre los años 2004 y 2014 tras la regulación de su concentración en cosméticos en el año 2009 e investigar los factores de riesgo de la alergia de contacto a la parafenilendiamina. MATERIAL Y MÉTODOS: El diseño del estudio fue observacional retrospectivo e incluyó a pacientes con sospecha de alergia de contacto parcheados con la serie estándar del Grupo Español de Investigación en Dermatitis de Contacto y Alergia Cutánea durante los años 2004 a 2014, en 8 hospitales terciarios españoles. En las pruebas epicutáneas estaba incluida la parafenilendiamina al 1% en vaselina o 0,073 mg/cm2 en el TRUE-test(R). El estudio estadístico se realizó siguiendo las recomendaciones internacionales del análisis de los datos en alergia de contacto. RESULTADOS: Un total de 386 (4,1%) pacientes de los 9.341 incluidos fueron positivos a la parafenilendiamina, cuya tendencia empezó a decrecer en los primeros años (2004-2007) y a partir de ahí se mantuvo en torno al 4%. Los factores de riesgo para el desarrollo de una alergia de contacto a la parafenilendiamina fueron el sexo, la edad por encima de los 40 años, la polisensibilización y la profesión, entre las que destacan los trabajadores de la peluquería, los trabajadores de la goma y el plástico CONCLUSIONES: La alergia de contacto a la parafenilendiamina sigue siendo elevada en pacientes con eccema de contacto. Los factores de riesgo que predisponen a la alergia de contacto a la PPD coinciden con los que han sido publicados previamente

OBJECTIVES: To analyze trends in the prevalence of contact sensitization to p-phenylenediamine between 2004 and 2014, taking into consideration that the concentration of this product in cosmetics was regulated in 2009. To explore risk factors for contact allergy to p-phenylenediamine. MATERIAL AND METHODS: Retrospective observational study of patients suspected of having contact dermatitis from allergy to p-phenylenediamine during the years between 2004 and 2015 in 8 tertiary level hospitals. The patients underwent patch testing (TRUE-test) with the standard series of the Spanish Research Group on Contact Dermatitis and Skin Allergies. This series included p-phenylenediamine 1%. We followed international recommendations for the statistical analysis of data related to contact allergies. RESULTS: Three hundred eighty-six out of 9341 patients (4.1%) had positive reactions to p-phenylenediamine. The prevalence tended to decrease in the early years (2004-2007) and then leveled off at around 4%. Risk factors for developing contact dermatitis from p-phenylenediamine were sex, age over 40 years, multiple sensitivities, and profession, notably workers in hair salons and those who handle rubber and plastics. CONCLUSIONS: The prevalence of p-phenylenediamine allergy remains high among patients with contact eczema. Risk factors for p-phenylenediamine contact allergy are consistent with previous reports

Is p-Phenylenediamine Still a Prevalent Contact Allergen in Spain? / ¿Sigue siendo la parafenilendiamina un alérgeno de contacto prevalente en España?

OBJECTIVES: To analyze trends in the prevalence of contact sensitization to p-phenylenediamine between 2004 and 2014, taking into consideration that the concentration of this product in cosmetics was regulated in 2009. To explore risk factors for contact allergy to p-phenylenediamine. MATERIAL AND METHODS: Retrospective observational study of patients suspected of having contact dermatitis from allergy to p-phenylenediamine during the years between 2004 and 2015 in 8 tertiary level hospitals. The patients underwent patch testing (TRUE-test) with the standard series of the Spanish Research Group on Contact Dermatitis and Skin Allergies. This series included p-phenylenediamine 1%. We followed international recommendations for the statistical analysis of data related to contact allergies. RESULTS: Three hundred eighty-six out of 9341 patients (4.1%) had positive reactions to p-phenylenediamine. The prevalence tended to decrease in the early years (2004-2007) and then leveled off at around 4%. Risk factors for developing contact dermatitis from p-phenylenediamine were sex, age over 40 years, multiple sensitivities, and profession, notably workers in hair salons and those who handle rubber and plastics. CONCLUSIONS: The prevalence of p-phenylenediamine allergy remains high among patients with contact eczema. Risk factors for p-phenylenediamine contact allergy are consistent with previous reports.

Dermatitis alérgica de contacto al ácido kójico / Allergic Contact Dermatitis to Kojic Acid

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Adaptación cultural al español del cuestionario Early Arthritis for Psoriatic Patients / Spanish Cultural Adaptation of the Questionnaire Early Arthritis for Psoriatic Patients

INTRODUCCIÓN Y OBJETIVOS: El cuestionario Early Arthritis for Psoriatic patients (EARP) es una herramienta de screening para artritis psoriásica con buenas propiedades de medición en su versión original en italiano que no ha sido todavía adaptado culturalmente al español. Este artículo expone la adaptación para población española como paso previo a su validación. MATERIAL Y MÉTODO: Aplicación de la metodología recomendada por la International Society for Pharmacoeconomics and Outcomes Research para adaptaciones culturales de medidas centradas en el paciente y que consta de las siguientes fases: preparación, traducción, reconciliación, retrotraducción y su revisión, armonización, test de comprensión y su revisión y corrección de pruebas. En la preparación se obtuvo el permiso de los autores del cuestionario original para su adaptación cultural y colaboraron durante el proceso como asesores. RESULTADOS: La traducción del cuestionario original al español la realizaron traductores nativos que realizaron pequeñas modificaciones aceptadas por los autores de la versión original. Se realizó la retrotraducción al italiano, obteniendo una versión equivalente al EARP original. La versión española después de la retrotraducción se aplicó en el test de comprensión a 35 pacientes. Todos ellos contestaron a todos los ítems sin hacer aportaciones adicionales. CONCLUSIÓN: La adaptación cultural del cuestionario EARP para población española constituye la primera etapa para su posterior uso en práctica clínica habitual. La aplicación de una metodología estandarizada garantiza la equivalencia entre el EARP en español y el original. En una segunda etapa se realizará la validación en población española

INTRODUCTION AND OBJECTIVES: The Early Arthritis for Psoriatic patients (EARP) questionnaire is a screening tool for psoriatic arthritis. The original Italian version has good measurement properties but the EARP required translation and adaptation for use in Spain. This article describes the cultural adaptation process as a step prior to validation. MATERIAL AND METHODS: We used the principles of good practice for the cross-cultural adaptation of patient-reported outcomes measurement established by the International Society Pharmacoeconomics and Outcome Research. The steps in this process were preparation, forward translation, reconciliation, back-translation and review, harmonization, cognitive debriefing and review, and proofreading. During preparation the developers of the original questionnaire were asked for their permission to adapt the EARP for use in Spain and to act as consultants during the process. RESULTS: The original questionnaire was translated into Spanish by native Spanish translators, who made slight changes that were approved by the questionnaire's developers. The Spanish version was then back-translated into Italian; that version was reviewed to confirm equivalence with the original Italian text. The reconciled Spanish EARP was then tested for comprehensibility and interpretation in a group of 35 patients. All the patients answered all items without making additional comments. CONCLUSION: This cultural adaptation of the EARP questionnaire for Spanish populations is the first step towards its later use in routine clinical practice. The application of a cross-cultural adaptation method ensured equivalence between the original and Spanish versions of the EARP. The Spanish questionnaire will be validated in a second stage

Spanish Cultural Adaptation of the Questionnaire Early Arthritis for Psoriatic Patients. / Adaptación cultural al español del cuestionario Early Arthritis for Psoriatic Patients.

INTRODUCTION AND OBJECTIVES: The Early Arthritis for Psoriatic patients (EARP) questionnaire is a screening tool for psoriatic arthritis. The original Italian version has good measurement properties but the EARP required translation and adaptation for use in Spain. This article describes the cultural adaptation process as a step prior to validation. MATERIAL AND METHODS: We used the principles of good practice for the cross-cultural adaptation of patient-reported outcomes measurement established by the International Society Pharmacoeconomics and Outcome Research. The steps in this process were preparation, forward translation, reconciliation, back-translation and review, harmonization, cognitive debriefing and review, and proofreading. During preparation the developers of the original questionnaire were asked for their permission to adapt the EARP for use in Spain and to act as consultants during the process. RESULTS: The original questionnaire was translated into Spanish by native Spanish translators, who made slight changes that were approved by the questionnaire's developers. The Spanish version was then back-translated into Italian; that version was reviewed to confirm equivalence with the original Italian text. The reconciled Spanish EARP was then tested for comprehensibility and interpretation in a group of 35 patients. All the patients answered all items without making additional comments. CONCLUSION: This cultural adaptation of the EARP questionnaire for Spanish populations is the first step towards its later use in routine clinical practice. The application of a cross-cultural adaptation method ensured equivalence between the original and Spanish versions of the EARP. The Spanish questionnaire will be validated in a second stage.

La serie estándar en las pruebas alérgicas de contacto / The Spanish Standard Patch Test Series

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Actualización de la serie estándar española de pruebas alérgicas de contacto por el Grupo Español de Investigación en Dermatitis de Contacto y Alergia Cutánea (GEIDAC) para 2016 / The Spanish standard patch test series: 2016 update by the Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC)

La serie estándar española de pruebas alérgicas de contacto recomendada por el Grupo Español de Investigación en Dermatitis de Contacto (GEIDAC) ha sido actualizada para 2016. La nueva serie sustituye a la que estaba vigente desde 2012, y el Grupo la recomienda utilizar a partir de ahora como herramienta básica de la consulta de eccema de contacto. La nueva serie estándar elimina, por la falta de frecuencia de positividades relevantes, 4 haptenos: clioquinol, tiomersal, mercurio y primina, y añade 3 nuevos: metilisotiazolinona, diazolidinil urea e imidazolidinil urea. Modifica además la concentración en agua de 2 haptenos clásicos muy importantes: la mezcla metilcloroisotiazolinona/metilisotiazolinona, que pasa a 200ppm aq, y el formaldehído, que se parcheará a partir de ahora al 2% aq. La actualización de la serie estándar española es una de las funciones del GEIDAC, que vela por su adecuación a la epidemiología y la casuística de nuestro entorno

The Spanish standard patch test series, as recommended by the Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC), has been updated for 2016. The new series replaces the 2012 version and contains the minimum set of allergens recommended for routine investigation of contact allergy in Spain from 2016 onwards. Four haptens —clioquinol, thimerosal, mercury, and primin— have been eliminated owing to a low frequency of relevant allergic reactions, while 3 new allergens -methylisothiazolinone, diazolidinyl urea, and imidazolidinyl urea- have been added. GEIDAC has also modified the recommended aqueous solution concentrations for the 2 classic, major haptens methylchloroisothiazolinone and methylisothiazolinone, which are now to be tested at 200ppm in aqueous solution, and formaldehyde, which is now to be tested in a 2% aqueous solution. Updating the Spanish standard series is one of the functions of GEIDAC, which is responsible for ensuring that the standard series is suited to the country's epidemiological profile and pattern of contact sensitization

Necrobiosis lipoídica sarcoidea en paciente no diabético. Utilidad de la ecografía cutánea / Sarcoidal Necrobiosis Lipoidica in a Nondiabetic Patient: Usefulness of Skin Ultrasound

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The Spanish standard patch test series: 2016 update by the Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC). / Actualización de la serie estándar española de pruebas alérgicas de contacto por el Grupo Español de Investigación en Dermatitis de Contacto y Alergia Cutánea (GEIDAC) para 2016.

The Spanish standard patch test series, as recommended by the Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC), has been updated for 2016. The new series replaces the 2012 version and contains the minimum set of allergens recommended for routine investigation of contact allergy in Spain from 2016 onwards. Four haptens -clioquinol, thimerosal, mercury, and primin- have been eliminated owing to a low frequency of relevant allergic reactions, while 3 new allergens -methylisothiazolinone, diazolidinyl urea, and imidazolidinyl urea- have been added. GEIDAC has also modified the recommended aqueous solution concentrations for the 2 classic, major haptens methylchloroisothiazolinone and methylisothiazolinone, which are now to be tested at 200ppm in aqueous solution, and formaldehyde, which is now to be tested in a 2% aqueous solution. Updating the Spanish standard series is one of the functions of GEIDAC, which is responsible for ensuring that the standard series is suited to the country's epidemiological profile and pattern of contact sensitization.

Un puente frente a la brecha digital / Bridging the Digital Divide

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