Hiperpigmentación de las falanges distales del lactante / Hyperpigmentation of an Infant's Fingers and Toes

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¿Es útil la determinación de la dosis eritematógena mínima previa a la fototerapia ultravioleta B de banda estrecha? / Is it Useful to Calculate Minimal Erythema Dose Before Narrowband UV-B Phototherapy?

Introducción y objetivos: La dosis de inicio en la fototerapia UVB de banda estrecha (UVBBE) viene determinada por el fototipo o por la determinación de la dosis eritematógena mínima (DEM). El cálculo de la DEM identifica pacientes con fotosensibilidad no sospechada. El objetivo de nuestro estudio es conocer la influencia que puedan tener en una DEM disminuida los fármacos fotosensibilizantes concomitantes, el diagnóstico, la asociación con acitretina en pacientes con psoriasis y evidenciar si la DEM alterada provoca más reacciones adversas y más graves. Material y métodos: Se trata de un estudio observacional de una cohorte retrospectiva desde el período comprendido entre el 1 de febrero de 2009 al 31 de marzo de 2015. La determinación de la DEM se categorizó en DEM normal o patológica. Resultados: Trescientos dos pacientes con distintas dermatosis inician UVBBE en función de la DEM. No se han encontrado diferencias entre el grupo con DEM patológica respecto al normal, ni en el número de fármacos consumidos (p = 0,071), ni en el potencial fotosensibilizante (p = 0,806). El análisis multivariante ajustado por edad, sexo y fototipo reveló que la psoriasis es un factor protector de DEM patológica (OR = 0,31 [IC 95%: 0,16-0,58]). No se encontró riesgo significativo de eritema ni prurito en los pacientes con DEM alterada OR = 1,68 (IC 95%: 0,91-3,29) y OR = 2,04 (IC 95%: 0,99-4,22), respectivamente. Conclusiones: La psoriasis protege de tener una DEM patológica. Si bien el eritema y el prurito fueron más frecuentes en los pacientes con DEM patológica, las diferencias no fueron estadísticamente significativas (AU)

Introduction and objectives: The starting dose for narrowband UV-B phototherapy is determined by a patient's skin phototype or minimal erythema dose (MED). Calculation of MED identifies patients with unsuspected photosensitivity. The aim of this study was to investigate the influence of factors such as concomitant use of photosensitizing agents, diagnosis, and combination with acitretin in patients with psoriasis on the frequency and severity of adverse effects in patients with a low MED to narrowband UV-B phototherapy. Material and methods: We undertook a retrospective observational cohort study between February 1, 2009 and March 31, 2015. MED values were classified as normal or low. Results: In total, 302 patients with different skin conditions started narrowband UV-B phototherapy at a dose determined by their MED. No differences were found between patients with a low MED and those with a normal MED for number of drugs taken (P = .071) or use of photosensitizing agents (P = 0.806). Following adjustment for age, sex, and phototype, the multivariate analysis showed that psoriasis exerted a protective effect against a low MED (OR = 0.31 [95% CI, 0.16-0.58]). No significant risk of erythema or pruritus was detected in patients with a low MED (OR = 1.68; 95% CI, 0.91-3.29 and OR = 2.04; 95% CI, 0.99-4.22, respectively). Conclusions: Psoriasis protects against a low MED. Although erythema and pruritus were more common in patients with a low MED, the differences were not significant (AU)

Is it Useful to Calculate Minimal Erythema Dose Before Narrowband UV-B Phototherapy? / ¿Es útil la determinación de la dosis eritematógena mínima previa a la fototerapia ultravioleta B de banda estrecha?

INTRODUCTION AND OBJECTIVES: The starting dose for narrowband UV-B phototherapy is determined by a patient's skin phototype or minimal erythema dose (MED). Calculation of MED identifies patients with unsuspected photosensitivity. The aim of this study was to investigate the influence of factors such as concomitant use of photosensitizing agents, diagnosis, and combination with acitretin in patients with psoriasis on the frequency and severity of adverse effects in patients with a low MED to narrowband UV-B phototherapy. MATERIAL AND METHODS: We undertook a retrospective observational cohort study between February 1, 2009 and March 31, 2015. MED values were classified as normal or low. RESULTS: In total, 302 patients with different skin conditions started narrowband UV-B phototherapy at a dose determined by their MED. No differences were found between patients with a low MED and those with a normal MED for number of drugs taken (P=.071) or use of photosensitizing agents (P=0.806). Following adjustment for age, sex, and phototype, the multivariate analysis showed that psoriasis exerted a protective effect against a low MED (OR=0.31 [95% CI, 0.16-0.58]). No significant risk of erythema or pruritus was detected in patients with a low MED (OR=1.68; 95% CI, 0.91-3.29 and OR=2.04; 95% CI, 0.99-4.22, respectively). CONCLUSIONS: Psoriasis protects against a low MED. Although erythema and pruritus were more common in patients with a low MED, the differences were not significant.

Perception of psoriasis treatment in the outpatient setting: survey of patients and their prescribing physicians.

BACKGROUND: Patients' perception of disease management can influence compliance to treatment and thus affect outcome. OBJECTIVE: To survey patients and physicians on their perceptions of biologic therapy for treating psoriasis in an outpatient setting. METHODS: The subjective impact of intravenous treatment of severe psoriasis on patients and physicians in the outpatient setting was determined via two surveys. RESULTS: Between September and November 2014, 24 dermatologists and 90 patients were surveyed. Treatment with biologic agents in the outpatient setting was associated with a high level of patient satisfaction: 93.3% of patients considered their psoriasis well controlled and 46.1% reported complete control. Patients highly valued the feeling of greater disease control (72.2%), regular follow-up (66.7%) and rapid improvement of psoriasis (58.9%) when attending an outpatient setting. Other positive aspects of outpatient treatment were control of other health issues and perceived improvements in quality of life (QoL). Outpatient attendance was high; with 90% of patients keeping scheduled appointments and 79.2% of physicians acknowledged that they were able to monitor their patients' condition more closely. CONCLUSION: Administration of treatment in an outpatient setting may provide a feeling of improved QoL and disease control.

Metabolic syndrome in Spanish patients with psoriasis needing systemic therapy: Prevalence and association with cardiovascular disease in PSO-RISK, a cross-sectional study.

BACKGROUND: Increasing evidence indicates a relationship between psoriasis and metabolic syndrome (MS). We evaluated the prevalence of MS in patients receiving systemic treatment for psoriasis in Spain, and its relationship to cardiovascular disease (CVD). METHODS: This cross-sectional, multicenter, non-interventional study enrolled 368 patients with moderate-to-severe psoriasis requiring systemic treatment. Clinical parameters for psoriasis, CV risk factors, MS and CVD were assessed. Descriptive and logistic regression analyses were performed. RESULTS: 352 patients were included (median psoriasis duration: 18 years, plaque psoriasis [95.7%], psoriatic arthritis [22.8%]). Overall, 132 patients (37.5%) fulfilled diagnostic criteria for MS; the most prevalent MS components were high blood pressure and increased waist circumference. Patients with MS were older, more likely to be obese and to have a sedentary lifestyle and hypercholesterolemia than those without MS. CVD was more prevalent in patients with MS than in those without (29.5% versus 15.9%, p = 0.002), particularly coronary heart disease (CHD), myocardial infarction and heart failure. MS was independently associated with CVD (OR 1.98, p = 0.018) and CHD (OR 2.02, p = 0.044). CONCLUSION: The prevalence of MS was high among patients with moderate-to-severe psoriasis requiring systemic treatment, and was associated with a higher prevalence of CVD. Dermatologists should consider implementing simple screening protocols.

Estudio prospectivo de la hiperpigmentación del área genital en recién nacidos españoles: frecuencia y factores predisponentes / Prospective study of hyperpigmentation of the genital area in Spanish newborns: frequency and predisposing factors

Realizamos un estudio prospectivo de 1.000 recién nacidos vistos en las primeras 72 horas de vida en el Área Sanitaria de Ferrol (noroeste de España)con el objetivo de conocer la prevalencia de la hiperpigmentación del área genital y ver como influyen, en su aparición, los factores neonatales y maternos, el momento de exploración y la modalidad de parto. La frecuencia de la hiperpigmentación genital fue del 15,3%. Encontramos una prevalencia superior en los neonatos no caucásicos (p = 0,000) de sexo masculino (p = 0,000), con mancha mongólica (p = 0,000), nacidos por vía vaginal (p =0,030) y con madre menor de 30 años (p = 0,006) y con al menos 2 gestaciones previas (p = 0,015) (AU)

We performed a prospective study of 1,000 neonates investigated in the first 72 hours of life in the Health Area of Ferrol (northwest of Spain), in order to assess the prevalence of hyperpigmentation of the genital area, the influence of different maternal and neonatal parameters, day of neonatalexploration and type of delivery. Overall frequency of hyperpigmentation was 15.3%. We found a higher prevalence of this dermatosis in non-Caucasian infants (p = 0.000) of male sex (p = 0.000), with Mongolian spot (p = 0.000), vaginal delivery (p = 0.030), maternal age below 30 years (p =0.006) and at least two previous pregnancies (p = 0.015) (AU)

Syringeable Pluronic-α-cyclodextrin supramolecular gels for sustained delivery of vancomycin.

The ability of Pluronic® F127 to form supramolecular gels in the presence of αCD has been explored as a way to design syringeable gel formulations able to sustain drug release while using the lowest proportion of both components. The effects of αCD concentration range (0-9.7% w/v) in copolymer (6.5%, 13% and 20%) gel features were evaluated at 4, 20 and 37°C. An effective complexation of Pluronic and αCD was evidenced as a change in the surface pressure of the π-A isotherm of Pluronic on a subphase of CD solution and the apparition of new peaks in the X-ray spectra. Once the Pluronic and αCD solutions were mixed, the systems became progressively turbid solutions or white gels. The greater the αCD concentration was, the faster the gel formation. The supramolecular hydrogels were thixotropic and those containing 5% or more αCD had G' values above G″ at room temperature, but they were still easily syringeable. The values of both moduli increased as temperature raised; the effect being more evident for 13% and 20% w/v copolymer. The gels prepared with low proportions of αCD exhibited phase separation in few days, particularly when stored at 4 or 37 °C. By contrast, those prepared with 6.5% copolymer were stable for at least two months when stored at 20 °C. The gels were able to sustain vancomycin release for several days; the higher the αCD proportion, the slower the release was. Furthermore, the drug-loaded gels showed activity against Staphylococcus aureus. The results obtained highlight the role of the αCD concentration on the tuning of the rheological features and drug release profiles from Pluronic gels.

Influencia de los factores neonatales y maternos en la prevalencia de vérnix caseosa / Influence of Neonatal and Maternal Factors on the Prevalence of Vernix Caseosa

Al nacimiento la vérnix caseosa puede cubrir toda la superficie corporal o acumularse sólo en la espalda y los pliegues. En los últimos años ha aumentado el interés por su composición, funciones y aplicaciones en la edad adulta. Nuestro objetivo fue conocer la prevalencia de la vérnix caseosa en los recién nacidos del Área Sanitaria de Ferrol, y ver cómo repercutían los parámetros neonatales y maternos en su desarrollo. Realizamos un estudio prospectivo de 1.000 recién nacidos vistos en los primeros tres días de vida en nuestro hospital. Encontramos vérnix caseosa en el 49,2% de los neonatos. El perfil clínico de presencia de vérnix caseosa sería: recién nacido de sexo femenino, sano, a término, con peso elevado producto de una gestante no primigesta, con ingesta de fármacos y suplementos dietéticos durante el embarazo sometida a un parto eutócico. Existe relación entre ausencia de vérnix caseosa y la presencia de descamación fisiológica y de eritema tóxico neonatal (AU)

At birth, vernix caseosa can cover the whole body surface or accumulate only on the back and in the skin folds. Interest in its composition and function and its possible applications in adults has increased in recent years. The objective of this study was to determine the prevalence of vernix caseosa in newborn infants in the health care area of Ferrol, Spain, and to assess its relationship with neonatal and maternal factors. We performed a prospective study of 1000 newborns seen within the first 3days of life in our hospital. Vernix caseosa was observed in 42.9% of cases. The clinical profile associated with the presence of vernix caseosa was the following: healthy newborn girl with a high birth weight, born at term by normal vaginal delivery to a multiparous mother who had received medication and dietary supplements during pregnancy. The absence of vernix caseosa was associated with the presence of physiological scaling of the newborn and erythema toxicum neonatorum (AU)

Prevalencia de marcas de nacimiento y lesiones cutáneas transitorias en 1.000 recién nacidos españoles / Prevalence of Birthmarks and Transient Skin Lesions in 1.000 Spanish Newborns

Introducción: Prácticamente la totalidad de los neonatos presenta alguna marca de nacimiento o lesión cutánea benigna transitoria. Hay pocos estudios, especialmente en nuestro país, que analicen la frecuencia de estos trastornos. Nuestro objetivo es conocer su prevalencia en1.000 recién nacidos del área sanitaria de Ferrol y compararla con los hallazgos de otras 9series de similares características. Pacientes y métodos: Realizamos un estudio descriptivo de 1.000 recién nacidos vistos en los3 primeros días de vida en la consulta de Perinatología del Servicio de Pediatría del Hospital Arquitecto Marcide. En cada caso se investigó la presencia o ausencia de 19 lesiones cutáneas benignas transitorias y 11 marcas de nacimiento. Resultados: 994 neonatos, el 99,4%, presentaban alguna lesión cutánea. El 99,2% y el 72% tenían lesiones cutáneas transitorias y marcas de nacimiento respectivamente. Las 5 más prevalentes fueron la hiperplasia sebácea en el 75% de los neonatos, la mancha salmón en el 64,2%, la hipertricosis en el 59%, el callo de succión labial en el 54% y el quiste palatino en el 53,7%. Conclusiones: En el presente estudio se demuestra la presencia de lesiones cutáneas benignas en la mayor parte de los neonatos. En su desarrollo y detección influyen no solo las características propias del país donde se realiza el estudio (climáticas, sociosanitarias o ‘‘grupos raciales’’), sino también variaciones en el período de exploración, en los criterios de inclusión de neonatos y en la terminología empleada (AU)

Background and objectives: Almost all newborn children have some sort of birthmark or transient benign skin lesion. Few studies, however, have analyzed their frequency, particularly in Spain. The aims of this study were to determine their prevalence in 1000 newborn children in the health care area of Ferrol in northwest Spain and to compare the results with those of 9other studies with similar characteristics. Patients and methods: We undertook a descriptive study of 1000 newborn infants seen in the first 3 days of life at the neonatal clinic in the Department of Pediatrics, Hospital Arquitecto Marcide, Ferrol, Spain. Each infant was examined for the presence of 19 different transient benign skin lesions and 11 birthmarks. Results: Birthmarks or benign skin lesions were present in 994 neonates (99.4%). Transient skin lesions were present in 99.2% and birthmarks in 72%. The 5 most prevalent lesions were sebaceous hyperplasia (75%), salmon patch (64.2%), hypertrichosis (59%), sucking calluses (54%), and palatine cysts (53.7%). Conclusions: The results of this study show that most neonates have benign skin lesions. The findings of studies to assess their frequency are influenced not only by geographic location (affecting variables such as climate, social and health care conditions, and ethnic group) but also by the timing of examination, the inclusion criteria applied, and the terminology used (AU)

[Influence of neonatal and maternal factors on the prevalence of vernix caseosa]. / Influencia de los factores neonatales y maternos en la prevalencia de vérnix caseosa.

At birth, vernix caseosa can cover the whole body surface or accumulate only on the back and in the skin folds. Interest in its composition and function and its possible applications in adults has increased in recent years. The objective of this study was to determine the prevalence of vernix caseosa in newborn infants in the health care area of Ferrol, Spain, and to assess its relationship with neonatal and maternal factors. We performed a prospective study of 1000 newborns seen within the first 3 days of life in our hospital. Vernix caseosa was observed in 42.9% of cases. The clinical profile associated with the presence of vernix caseosa was the following: healthy newborn girl with a high birth weight, born at term by normal vaginal delivery to a multiparous mother who had received medication and dietary supplements during pregnancy. The absence of vernix caseosa was associated with the presence of physiological scaling of the newborn and erythema toxicum neonatorum.

Queratosis seborreicas eruptivas y transitorias desencadenadas por una dermatitis seborreica / Transient eruptive seborrheic keratoses triggered by seborrheic dermatitis

Los acantomas posteczema, también llamados queratosis seborreicas eruptivas transitorias, fueron descritos por Williams en 1956. Son lesiones similares a queratosis seborreicas que aparecen en áreas afectas por dermatosis inflamatorias y que se resuelven espontáneamente en los seis primeros meses tras la curación del proceso cutáneo de base. Con frecuencia se confunde esta entidad con el signo de Leser-Trélat. Presentamos los casos dedos pacientes con acantomas posteczema que aparecieron tras un brote de dermatitis seborreica (AU)

Posteczema acanthomas, also called transient eruptive seborrheic keratoses, were first described by Williams in 1956. They are seborrheic keratoseslikelesions, usually involving areas affected by inflammatory dermatoses, and they tend to regress spontaneously in the following six months after thehealing of the primary cutaneous condition. They are often misdiagnosed as the Leser-Trélat sign. We report two cases of eruptive posteczema acanthomasfollowing an exacerbation of seborrheic dermatitis (AU)

Prevalencia y características clínicas de los nevos melanocíticos congénitos en 1.000 recién nacidos españoles / Prevalence and Clinical Features of Congenital Melanocytic Nevi in 1, 000 Spanish Newborns

Introducción: El nevo melanocítico congénito es una proliferación melanocítica benigna presente al nacimiento o en los primeros meses de vida. Aunque es una lesión común, hay pocos estudios en nuestro entorno que analicen su frecuencia. El objetivo de nuestro estudio es conocer su prevalencia y las localizaciones más frecuentes en los recién nacidos de nuestra área sanitaria, y analizar la influencia de los factores neonatales y maternos en el desarrollo de estas lesiones. Pacientes y métodos: Realizamos un estudio prospectivo de 1.000 neonatos consecutivos vistos en las primeras 72 horas de vida en la consulta de Perinatología del Servicio de Pediatría de nuestro hospital (Hospital Arquitecto Marcide, Ferrol, España). En cada caso se recogieron datos referentes a diferentes parámetros maternos y neonatales, y la presencia, el tamaño y la localización de los nevos melanocíticos congénitos. Resultados: Catorce neonatos (el 1,4% de los neonatos incluidos) presentaban al menos un nevo melanocítico congénito. Doce eran caucasianos y 2 árabes. Respecto al sexo, 10 recién nacidos eran de sexo femenino y 4 de sexo masculino. En todos los casos presentaba solo un nevo melanocítico. Ocho se localizaban en el tronco, 2 en el área facial, 2 en las extremidades superiores y 2 en las inferiores. El 50% de los nevos melanocíticos congénitos tenían un diámetro inferior a 1,5cm y la otra mitad entre 1,5 y 3,5cm. Conclusiones: Existe una mayor prevalencia de nevos melanocíticos en los recién nacidos pretérmino, de sexo femenino y no caucasianos. La edad materna, el número de gestaciones previas y el peso al nacimiento no parecen influir en su aparición (AU)

Background: Congenital melanocytic nevus is a benign proliferation of melanocytes that is present at birth or develops in the first months of life. Although such lesions are common, few studies have analyzed their prevalence in Spain. Objectives: The aim of this study was to define the prevalence and most frequent anatomical areas affected by congenital melanocytic nevi in our health service area. We also analyzed the influence of maternal and neonatal factors in the development of these lesions. Patients and methods: We performed a prospective study of 1000 consecutive neonates seen in the first 72hours of life in the perinatology clinic of the Pediatrics Department of Hospital Arquitecto Marcide in Ferrol, Spain, recording specific maternal and neonatal variables and the size and site of congenital melanocytic nevi if present. Results: Fourteen infants (10 girls and 4 boys; 12 white European, 2 North African; 1.4% of the study population) presented at least 1 melanocytic nevus. None had more than 1 lesion. Eight of the nevi were located on the trunk, 2 on the face, 2 on the upper limbs, and 2 on the lower limbs. The diameter of the lesions was less than 1.5cm in half of cases and between 1.5 and 3.5cm in the remainder. Conclusions: There was a higher prevalence of congenital melanocytic nevi in preterm infants, females, and nonwhite infants. Maternal age, number of previous pregnancies, and birth weight do not appear to influence the prevalence of these lesions (AU)