Challenges and Solutions in Oral Isotretinoin in Acne: Reflections on 35 Years of Experience.

Acne vulgaris affects more than 80% of adolescents and young adults and forms a substantial proportion of the dermatologist's and general practitioner's caseload. Severity of symptoms varies but may result in facial scarring and psychological repercussions. Oral isotretinoin is highly effective but can only be prescribed by specialists. Side effects are recognized and mostly predictable, ranging from cosmetic effects to teratogenicity. These can affect patients' quality of life and treatment adherence. This article provides a commentary on 4 key areas: the use of oral isotretinoin vs oral antibiotics, including the importance of early recognition of nonresponse to treatment, the psychological effects of acne and isotretinoin treatment, the side effects of isotretinoin therapy, and cosmetic treatment options that can help alleviate predictable side effects. The authors, who have all participated in various international expert groups, draw on relevant literature and their extensive professional experience with oral isotretinoin in the treatment of acne. The aim of this article is to provide an informative and practical approach to managing oral isotretinoin treatment in patients with acne, to help optimize treatment of this skin disease.

Esthetic dermatology and emotional well-being according to gender.

INTRODUCTION: There has been an increase in the demand for esthetic dermatology treatments within the general population. The purpose of this study was to analyze, within the scope of general population, the relationship between people's perception of esthetic dermatology treatments and emotional well-being, as well as for differences in gender. METHODS: The Aesthetic Dermatology and Emotional Well-Being (DEBIE) Scale, [Journal of Cosmetic Dermatology vol. 13 (2014) 336-345] was applied to 770 Spanish people over 18 years old. The scale is structured according to six factors and classified into two dimensions: (1) Emotional Well-Being and (2) Perception of Aesthetic Dermatology. Cronbach alpha for the total scale was very high (0.90). Data analysis includes the following: (1) bivariate correlations with Pearson's coefficient; (2) gender differences through Student's t test, and (3) the effect size through R2 and Cohen's d. RESULTS: A statistically significant relationship which is directly proportional has been identified between the degree of emotional well-being of people (self-esteem and assertiveness, optimism, and motivation) and the knowledge and attitude toward Aesthetic Dermatology. There are statistically significant differences according to gender: Women have a lower level of emotional well-being than men, as well as greater knowledge and more positive attitude toward Aesthetic Dermatology. CONCLUSIONS: People who are familiar with Aesthetic Dermatology and have a better attitude toward it, are also more self-confident, more optimistic and more motivated; with emotional strength. Regarding gender, it is expected that women may seek more consultation and esthetic dermatology treatments than men do.

Aesthetic dermatology and emotional well-being questionnaire.

BACKGROUND: In recent years, there has been a great development of esthetic dermatology as a subspecialty of dermatology. It is important to know to which extent the general population regard this branch of medical surgical specialty as being of interest and contributing to emotional well-being. OBJECTIVE: To analyze the technical features of a questionnaire which has been designed to reflect such perception of the general population about esthetic dermatology and its contribution to emotional well-being. MATERIAL AND METHOD: Production and psychometric analysis of a self-filled in questionnaire in relation to esthetic dermatology and emotional well-being (DEBIE). This questionnaire is made of 57 items and has been applied to a sample of 770 people within the general population. The drawing-up process of the questionnaire is described to provide content validity. Items analysis was carried out together with exploratory and confirmatory factor analysis to assess the structure and construct validity of the tool. The extent of internal consistency (reliability) and concurrent validity has also been verified. RESULTS: DEBIE questionnaire (Spanish acronym for Aesthetic Dermatology and Emotional Well-being) revolves around six factors explaining 53.91% of the variance; there is a high level of internal consistency (Cronbach's α 0.90) and reasonable criterion validity. CONCLUSIONS: DEBIE questionnaire brings together adequate psychometric properties that can be applied to assess the perception that the general population have in relation to esthetic dermatology and its contribution to their emotional well-being.

Validation of the Spanish Acne Severity Scale (Escala de Gravedad del Acné Española--EGAE).

BACKGROUND: Several acne grading systems have been described, but consensus is lacking on which shows superiority. A standardized system would facilitate therapeutic decisions and the analysis of clinical trial data. OBJECTIVE: To assess the feasibility, reliability, validity and sensitivity to change of the Spanish Acne Severity Scale (EGAE). MATERIALS & METHODS: A Spanish, multicentre, prospective, observational study was performed in patients with facial, back or chest acne assessed using EGAE, Leeds Revised Acne Grading system (LRAG) and lesion count. Clinicians answered 4 questions regarding EGAE use and time employed. Patients were evaluated at baseline and after 5±1 weeks. Four additional blinded observers, all dermatologists, evaluated patients' pictures using EGAE and LRAG. RESULTS: In total, 349 acne locations were assessed in 328 patients. Of the dermatologists, 95.6% (CI: 92.9-97.5%) reported that EGAE was easy to use, and 75% used it in <3 minutes. Interobserver reliability of the EGAE scale was shown by a Kendall's W of 0.773 (p<0.001). EGAE and LRAG scales showed a high correlation (Spearman's correlation>0.85; p<0.001). EGAE mean score in treatment-compliant patients was significantly lower at follow-up than at baseline (2.14 vs. 1.57, p<0.001, Cohen's d=0.35).The pre-post-treatment difference in EGAE mean score in non-compliant patients was not significant (1.44 vs. 1.32, p<0.102) and Cohen's d was lower (0.19) than in compliant patients. CONCLUSION: The use of EGAE to evaluate acne grade in daily clinical dermatological practice in Spanish centres has shown feasibility, high interobserver reliability, concurrent validity and sensitivity to detect treatment effects.

Effects of benzoyl peroxide 5% clindamycin combination gel versus adapalene 0.1% on quality of life in patients with mild to moderate acne vulgaris: a randomized single-blind study.

BACKGROUND: Patients with acne vulgaris often have impaired quality of life (QOL). The fixed-dose combination of benzoyl peroxide 5%/clindamycin 1% gel (BPO/C) topical gel provides an earlier onset of action and is more effective against inflammatory and total facial lesions than adapalene (AP) 0.1% gel. OBJECTIVE: To compare BPO/C and AP with regard to the early effect on QOL, efficacy, and tolerability in patients with mild to moderate acne vulgaris. METHODS: Patients were randomized to BPO/C or AP once nightly for 12 weeks in a multicentre, single-blind trial. The primary efficacy endpoint was QOL at week 2, assessed using the Skindex-29 questionnaire. Secondary endpoints included grading and counting of acne lesions; investigator assessments of peeling, erythema, and dryness, and patient-reported burning or itching. Adverse events were monitored during the study and during the 14-day minimum follow-up period. RESULTS: A total of 168 patients were enrolled, and 114 patients completed the study. In the intent-to-treat population, after 2 weeks of treatment, BPO/C was associated with a small but noticeably better improvement in global QOL compared with AP (-4.9 versus -1.1; P<0.001). A greater reduction in both total and inflammatory lesions was noted from week 1 onward (P<0.05) with BPO/C versus AP. At all time points, BPO/C was better tolerated than AP for all investigator-rated (dryness, peeling, erythema) and patient-rated (burning, itching) events (P<0.036). CONCLUSIONS: BPO/C is associated with early improvements in QOL compared with AP. These QOL improvements are likely to be the result of better efficacy and tolerability outcomes observed with BPO/C.

Ethinylestradiol/Chlormadinone acetate: dermatological benefits.

Acne vulgaris, hirsutism, seborrhea and female pattern hair loss (FPHL) are common disorders of the pilosebaceous unit (PSU). In some women with hyperandrogenemia, an excess of androgens at the PSU can lead to the development of these dermatological manifestations. These manifestations can cause many psychiatric and psychological implications, such as social fears and anxiety, and can adversely affect quality of life. High androgen levels at the PSU as a possible underlying cause of acne vulgaris, hirsutism, seborrhea and FPHL supports the rationale for using combined oral contraceptives for the management of these conditions in women. The purpose of this review is to describe these dermatological manifestations of the PSU and the management of these conditions through the use of the oral contraceptive ethinylestradiol/chlormadinone acetate (EE/CMA). EE/CMA 0.03/2 mg is a combined monophasic contraceptive pill with anti-androgenic properties. It is approved in Europe for contraception and has been investigated in phase III trials for the treatment of acne. EE/CMA was better than placebo and similar to another low-dose oral contraceptive (ethinylestradiol/levonorgestrel) in improving symptoms of acne in two phase III randomized controlled trials in patients with mild to moderate papulopustular acne. In addition, in trials investigating the contraceptive efficacy of EE/CMA, limited data suggest that there were also improvements in hirsutism, FPHL and seborrhea in small subgroups of patients. EE/CMA has a good safety profile. The most commonly reported adverse events are breast tenderness/pain, headache/migraine and nausea. Evidence in the literature indicates that the use of EE/CMA for the treatment of dermatological disorders under the control of androgens may be a valid treatment option. Further investigation is warranted.

Metástasis en mama de melanoma maligno cutáneo / Breast metastases from cutaneous malignant melanoma

Las metástasis en mama desde tumores primarios extramamarios suponen el 2% de todos los tumores malignos de la mama (linfomas y melanomas malignos son los más frecuentes), y pueden simular tumores primarios tanto clínica como radiológicamente. El pronóstico de pacientes con metástasis de mama de tumores sólidos en general es malo (el 80% mueren antes de un año). El tratamiento más aceptado es la escisión simple, por lo que conocer, previamente a la cirugía, la procedencia metastásica del nódulo impedirá una cirugía demasiado agresiva que no va a mejorar el pronóstico. Presentamos un caso de metástasis de mama de un melanoma maligno cutáneo diagnosticado en piel de costado derecho (extirpado 3 años antes) (AU)

Breast metastases from extramammary primary tumors account for 2% of all malignant breast tumors (the most common being lymphoma and malignant melanoma) and can mimic primary breast carcinoma clinically and radiologically. The prognosis of patients with metastases to the breast from solid tumors is generally poor, with 80% dying in the first year. The most widely accepted treatment is simple excision. Consequently, determining the source of metastases prior to surgery avoids further surgical procedures that will not improve prognosis. We present a case of metastases from malignant cutaneous melanoma to the breast diagnosed in the right thoracic wall and surgically excised 3 years previously (AU)

Alopecia de patrón femenino / Female pattern hair loss

La alopecia androgénetica femenina, o alopecia de patrón femenino, es una de las causas más frecuentes de caída de pelo. Su aparición origina importante estrés y problemas psicológicos; de ahí la importancia de un manejo adecuado. Hay casos que se asocian a hiperandrogenismo. En este trabajo revisamos las distintas formas clínicas, discutimos las pruebas de laboratorio más indicadas y los distintos tratamientos, entre ellos, la finasterida.

Female androgenetic alopecia or female pattern hair loss is one of the most frequent causes of hair loss. It can originate high stress and psychological problems, and a correct approach is therefore important. Certain cases are associated with hyperandrogenism. In this report we review the different clinical patterns, the most indicated laboratory tests and the different treatments, including finasteride.

Ayer y hoy de la publicidad en la dermatología española / Yesterday and today of advertisments in Spanish dermatology

La publicidad dermatológica es una actividad de comunicación humana que tiene como fin convencer al cliente de la bondad de un producto científico dermatológico o relacionado con la Dermatología. A lo largo de su historia, la publicidad dermatológica ha evolucionado de forma paralela a la de la sociedad: El cliente se ha universalizado; las técnicas de mercadotecnia se han profesional izado; aparece el aval científico; la rigurosidad de contenidos ha aumentado y han disminuido los productos milagro; la forma de presentación es más atractiva. Finalmente, el dermatólogo participa cada vez más activamente en la divulgación de las enfermedades cutáneas y en la orientación y asesoría a los técnicos de la mercadotecnia acerca de la publicidad dermatológica

The dermatological advertising is a human communication activity, that try to persuade to customer about the goodness of scientific product of the dermatology. Throughout history, the dermatological publicity develop in parallel to the society. The customer has become universal; the techniques of marketing have be come professional/; it appears the guarantee scientific; the presentation is more attractive. During the last years, dermatologists have increased their participation in the activities to divulgation of cutaneous diseases, and in the orientation to marketing workers about dermatological advertising

Tratamiento y prevención del herpes zoster / Treatment and prevention in herpes zoster

No disponible

Detección y tipado de Papillomavirus humano en raspados de pacientes infectados por el virus de la inmunodeficiencia humana / HPV detection and typing in scrapes from HIV- infected patients

La infección por Papillomavirus humano (VPH) es más frecuente en pacientes inmunodeprimidos, incluyendo la infección por el virus de la inmunodeficiencia humana (VIH), donde se ha estudiado particularmente la infección cervical por cepas genitales oncogénicas de VPH. Hemos estudiado las características de la infección por VPH en una consulta dermatológica de pacientes infectados por el VIH, con una muestra predominante de hombres jóvenes adictos a drogas por vía parenteral (ADVP), con lesiones verrucosas anogenitales. Las 120 tomas de 61 pacientes correspondían a 98 muestras mucosas y 22 no mucosas. La detección en raspados con torunda, principalmente de semimucosas anal y/o genital (también en casos sin lesión), se realizó tras extracción de ADN y amplificación mediante reacción en cadena de la polimerasa (PCR). La tipificación posterior se llevó a cabo mediante digestión por enzimas de restricción e hibridación con sondas específicas. Se detectaron uno o varios tipos de VPH en un 74% de las tomas mucosas de lesiones y en un 31% de las tomas mucosas sin lesión. Los tipos de VPH más encontrados han sido VPH 6 y 11 (33 muestras), frente al VPH 16 (11 muestras) o el VPH 18 (ningún caso). Encontramos tipos de alto riesgo oncogénico asociados a cifras de CD4 inferiores a 150 /mm3. Destacamos, en conclusión, la rentabilidad de la técnica del raspado de mucosas para el clínico como cribaje de infección por VPH, la elevada incidencia de VPH incluso oncogénico en localizaciones sin lesión clínica, la frecuencia de coinfecciones por varios tipos de VPH y el predominio del VPH 6 en nuestro medio (AU)

Sarcoidosis subcutánea / Subcutaneous sarcoidosis

La sarcoidosis subcutánea está caracterizada por lesiones nodulares, móviles, no dolorosas, sin componente epidérmico, localizadas fundamentalmente en extremidades, que presentan histológicamente granulomas sarcoideos en el tejido celular subcutáneo. Aunque existe afectación cutánea en aproximadamente un cuarto de los pacientes con sarcoidosis, los nódulos subcutáneos, que pueden coexistir con otras lesiones cutáneas, son raros. Se han referido en la literatura menos de 40 casos de sarcoidosis subcutánea. Presentamos el caso de una mujer de 63 años de edad que presentaba nódulos profundos en las extremidades de 15 días de evolución. El estudio histopatológico de las lesiones cutáneas mostró granulomas no caseificantes en el tejido celular subcutáneo, compatibles con sarcoidosis subcutánea. Las tinciones especiales realizadas descartaron la existencia de materiales extraños, hongos o bacilos ácido-alcohol resistentes. Una radiografía de tórax reveló adenopatías torácicas. Se realizó tratamiento con corticoides orales durante dos meses, obteniendo una respuesta excelente (AU)

Necrobiosis lipoídica nodular: a propósito de un caso / Nodular necrobiosis lipoidica: a case report

Presentamos el caso de una mujer de 30 años, diagnosticada hacía 2 años de necrobiosis lipoídica por la presencia de lesiones típicas en su pierna izquierda. Consultó en nuestro servicio por la aparición durante el último mes de lesiones nodulares eritematosas muy similares al eritema nodoso en ambos muslos y pierna izquierda. La biopsia cutánea reveló una paniculitis por necrobiosis lipoídica.No se encontró ninguna patología asociada y la respuesta al tratamiento fue favorable (AU)