Description of Patients Treated with Biologic Drugs as First-Line Systemic Therapy in the BIOBADADERM Registry Between 2008 and 2016. / Descripción de los pacientes que reciben biológicos como primer tratamiento sistémico en el registro BIOBADADERM durante el periodo 2008-2016.

INTRODUCTION AND OBJECTIVES: Biologic drugs are usually prescribed as second-line treatment for psoriasis, that is, after the patient has first been treated with a conventional psoriasis drug. There are, however, cases where, depending on the characteristics of the patient or the judgement of the physician, biologics may be chosen as first-line therapy. No studies to date have analyzed the demographics or clinical characteristics of patients in this setting or the safety profile of the agents used. The main aim of this study was to characterize these aspects of first-line biologic therapy and compare them to those observed for patients receiving biologics as second-line therapy. MATERIAL AND METHOD: We conducted an observational study of 181 patients treated in various centers with a systemic biologic drug as first-line treatment for moderate to severe psoriasis between January 2008 and November 2016. All the patients were registered in the Spanish Registry of Adverse Events Associated with Biologic Drugs in Dermatology. RESULTS: The characteristics of the first- and second-line groups were very similar, although the patients receiving a biologic as first-line treatment for their psoriasis were older. No differences were observed for disease severity (assessed using the PASI) or time to diagnosis. Hypertension, diabetes, and liver disease were all more common in the first-line group. There were no differences between the groups in terms of reasons for drug withdrawal or occurrence of adverse effects. CONCLUSIONS: No major differences were found between patients with psoriasis receiving biologic drugs as first- or second-line therapy, a finding that provides further evidence of the safety of biologic therapy in patients with psoriasis.

Reacción cutánea granulomatosa a tinte rojo de tatuaje / Granulomatous skin reaction to a red pigment tattoo

Presentamos un varón de 46 años de edad que a los 4 meses de aplicarse un tatuaje en la pierna derecha presentó prurito, escozor y sobreelevación en el área de aplicación del tinte rojo. La biopsia realizada muestra granulomas formados por histiocitos y células plasmáticas alrededor con depósito de pigmento rojo. Las pruebas percutáneas fueron negativas, así como el parcheado a los diferentes componentes de la tinta roja aportada por el paciente (AU)

A 46 year old man presented to our clinic with a 4 months history of stinging, itching and raising of a red tattoo in his right leg. Histopathology showed granulomata composed by histiocytes, surrounded by red pigment-laden plasma cells. Patch tests were negative (AU)

[Epidemiologic study of 20 cases of pemphigus at Hospital Clínico Universitario Virgen de la Victoria de Málaga, Spain]. / Estudio epidemiológico de 20 casos de pénfigo en el Hospital Clínico Universitario Virgen de la Victoria de Málaga.

INTRODUCTION: Pemphigus comprises a group of autoimmune blistering diseases that affect the skin and mucous membranes. Its clinical and epidemiologic features vary according to geographic location and ethnic background. OBJECTIVE: An exhaustive search of the literature reveals very few reports of the epidemiology of pemphigus in setting. Our aim, thus, was to conduct a retrospective study of the clinical and epidemiologic features of pemphigus at a secondary care hospital in Málaga, Spain. MATERIAL AND METHODS: We studied 20 patients diagnosed with pemphigus in our department over a period of 13 years (January 1995 to January 2008). RESULTS: We analyzed a large variety of clinical and epidemiologic parameters including sex; age; type of pemphigus; time since onset; associated symptoms; type, morphology, and location of lesions at the time of diagnosis; extent of skin and mucosal involvement; treatment received; treatment-related adverse effects and complications; number of hospital admissions; and patient outcome. CONCLUSIONS: Except for minor differences, our results are in agreement with published data on pemphigus regarding sex, age, and clinical presentation. According to our results, male sex is a predictor of poor prognosis as it is associated with poorer response to treatment and a higher rate of adverse effects and hospital admission.

Estudio epidemiológico de 20 casos de pénfigo en el Hospital Clínico Universitario Virgen de la Victoria de Málaga / Epidemiologic Study of 20 Cases of Pemphigus at Hospital Clínico Universitario Virgen de la Victoria de Málaga, Spain

Introducción: Los pénfigos son un grupo de enfermedades ampollosas autoinmunes que afectan a la piel y a las membranas mucosas. Sus características clínicas y epidemiológicas son variables en función de factores geográficos y étnicos. Objetivo: Si hacemos una búsqueda bibliográfica exhaustiva encontramos escasos trabajos sobre epidemiología del pénfigo en nuestro medio. El objetivo de nuestro estudio es determinar las características clínicas y epidemiológicas del pénfigo en un hospital de segundo nivel de Málaga (España), de una manera retrospectiva. Material y métodos: El estudio incluyó 20 pacientes diagnosticados de pénfigo en nuestro Servicio en un periodo de 13 años, comprendido entre enero de 1995 y enero de 2008. Resultados: Se analizaron un extenso número de parámetros clínicos y epidemiológicos, incluyendo sexo, edad, tipo de pénfigo, tiempo de evolución de la enfermedad hasta el momento del diagnóstico, sintomatología asociada, tipo, morfología y localización de las lesiones en el momento del diagnóstico, afectación de piel y mucosas, tipo de tratamiento realizado, efectos adversos y complicaciones debidas a la terapia, número de ingresos hospitalarios y evolución final de los pacientes. Conclusiones: Aunque con pequeñas diferencias, nuestros resultados están en buena consonancia con los ya existentes en la literatura en lo relativo al sexo, la edad y el perfil clínico de la enfermedad. Según nuestros datos ser varón es un factor de mal pronóstico, puesto que se asocia a una peor respuesta de la enfermedad al tratamiento y a mayor tasa de efectos secundarios y frecuencia de ingresos hospitalarios (AU)

Introduction: Pemphigus comprises a group of autoimmune blistering diseases that affect the skin and mucous membranes. Its clinical and epidemiologic features vary according to geographic location and ethnic background. Objective: An exhaustive search of the literature reveals very few reports of the epidemiology of pemphigus in setting. Our aim, thus, was to conduct a retrospective study of the clinical and epidemiologic features of pemphigus at a secondary care hospital in Málaga, Spain. Material and methods: We studied 20 patients diagnosed with pemphigus in our department over a period of 13 years (January 1995 to January 2008). Results: We analyzed a large variety of clinical and epidemiologic parameters including sex; age; type of pemphigus; time since onset; associated symptoms; type, morphology, and location of lesions at the time of diagnosis; extent of skin and mucosal involvement; treatment received; treatment-related adverse effects and complications; number of hospital admissions; and patient outcome. Conclusions: Except for minor differences, our results are in agreement with published data on pemphigus regarding sex, age, and clinical presentation. According to our results, male sex is a predictor of poor prognosis as it is associated with poorer response to treatment and a higher rate of adverse effects and hospital admission (AU)

[Diagnostic utility of nail biopsy: a study of 15 cases]. / La biopsia ungueal: un método diagnóstico de gran utilidad. Estudio de 15 casos.

INTRODUCTION: Nail biopsy is thought to be a useful technique for the diagnosis of diseases affecting the nail apparatus and may help avoid delays in the diagnosis of important mucocutaneous diseases. Furthermore, it has therapeutic value in its own right. It is not a difficult technique to perform but it requires an in-depth knowledge of the anatomy and physiology of the nail unit, as well as surgical experience and patient collaboration. In order to assess the diagnostic utility of this technique, we reviewed the nail biopsies performed in our department between June 2005 and May 2006. PATIENTS AND METHODS: We identified 15 patients in whom nail biopsy had been performed. The clinical findings, type of biopsy performed, and histopathologic diagnosis were assessed. RESULTS: Nail biopsy allowed diagnosis of a variety of skin disease in 13 out of 15 patients (psoriasis in 5, onychomycosis in 4, melanonychia in 2, melanoma in 1, and subungual hematoma in 1). None of the patients presented sequelae as a result of the intervention after several months of follow-up. CONCLUSION: Nail biopsy is a useful tool in cases in which the patient history, clinical presentation, and additional tests have not led to a definitive diagnosis. In our experience, it can be performed safely and with minimal scarring.

Thick melanoma: the problem continues.

BACKGROUND: The incidence of melanoma and its associated mortality has stabilized over the recent years, due in part to efforts directed at better prevention and detection of these lesions. We analysed the trends in the distribution of melanomas, mainly according to their thickness. METHODS: Data from the Dermatology Service of 'Virgen de la Victoria' University Hospital in Malaga (Spain) showed a total of 459 cases of melanoma between 1990 and 2005, both inclusive. The lesions were stratified according to year of diagnosis (1990-96 and 1997-2005), sex, age (0-49, > or = 50), thickness (0-0.99, 1.00-1.99, and > or = 2 mm) and the histological subtype [lentigo maligna melanoma (LMM), superficial spreading melanoma (SSM), nodular melanoma (NM) and acral lentiginous melanoma (ALM)]. Particular attention was given to the distribution of the groups according to thickness. RESULTS: The number of new cases rose by 92% between the two study periods (1990-1996 and 1997-2005). However, the number of new cases of thick melanoma remained almost constant over the two periods, being associated with persons over 50 years of age (65.1% vs. 64.3%), with men having half the cases (48.4% vs. 47%). The proportion of nodular melanomas within the group of thick melanomas was high in both periods (36.5% and 39.3%, respectively). CONCLUSIONS: This study shows that despite the large increase in new melanomas, the diagnosis of thick melanomas has remained constant, mainly in persons over the age 50 years, with a relative increase in men. New strategies and education programmes are, therefore, required for the early detection of this type of tumour to reduce its incidence in these patients.

[Longitudinal study of different metastatic patterns in the progression of cutaneous melanoma]. / Estudio temporal de los diferentes patrones metastásicos en la progresión del melanoma cutáneo.

INTRODUCTION: Compared with other tumors, melanoma has displayed one of the largest increases in incidence in recent years, and it is known to have a high metastatic potential. In cases of metastasis, approximately two-thirds of patients have lymph-node metastases and one-third develop systemic metastases. However, few studies have been reported that analyzed different metastatic patterns according to the natural history of melanoma. The main aim of this study was to analyze the different metastatic pathways and patterns and to assess the time course of development of metastases from cutaneous melanoma. MATERIAL AND METHODS: A retrospective study was performed in 575 patients with onset of primary melanoma between 1990 and 2004. During follow-up, 67 patients developed metastases. Different pathways for metastasis were established and evaluated. We identified 4 metastatic pathways according to the metastatic pattern during progression of the melanoma. The time course of metastases was also evaluated. Finally, we analyzed melanomas with local recurrence in terms of whether or not systemic progression occurred. RESULTS: Melanoma metastases first occurred in local lymph nodes in 55.2 % of the patients. Initial metastasis was systemic in 14.9 % of the patients. The anatomical location and tumor thickness influenced which metastatic pathway was followed. Distant metastases occurred after a mean of 25 months regardless of the pathway followed CONCLUSIONS: The development of distant metastases displays a constant time course and the time to onset is independent of the metastatic pathway. This observation may explain why sentinel lymph node biopsy has a limited impact on overall survival of melanoma patients.

Estudio temporal de los diferentes patrones metastásicos en la progresión del melanoma cutáneo / Longitudinal study of different metastatic patterns in the progression of cutaneous melanoma

Introducción. El melanoma es uno de los tumores que más ha aumentado en las últimas décadas y posee un elevado potencial de diseminación. Cuando metastatiza, hasta en dos tercios de las ocasiones lo hace a los ganglios linfáticos regionales y aproximadamente en un tercio de los casos a nivel sistémico. Existen, sin embargo, pocos estudios en la literatura que hayan analizado los diferentes patrones metastásicos en el contexto de la historia natural del melanoma. El objetivo principal del presente estudio es analizar las diferentes vías y patrones metastásicos y el tiempo de evolución en el desarrollo de metástasis en el melanoma cutáneo. Material y métodos. Se realizó un estudio retrospectivo en una serie de 575 pacientes con melanoma primario como primera presentación entre los años 1990 y 2004. En el seguimiento, 67 pacientes desarrollaron metástasis. Se establecieron y evaluaron diferentes vías de diseminación. También se establecieron cuatro rutas de diseminación dependiendo del patrón de diseminación en la progresión del melanoma. Se evaluó el curso temporal de las metástasis. Por último, se analizaron aquellos melanomas con recurrencia locorregional comparando los melanomas con y sin progresión sistémica. Resultados. Las metástasis linfáticas regionales constituyen la primera vía de diseminación de los melanomas (55,2 %). Las metástasis sistémicas aparecieron como primera vía metastásica en el 14,9 % de los casos. La localización anatómica y el grosor tumoral influyen en las diferentes vías metastásicas. Las metástasis a distancia aparecieron con una media de 25 meses, independientemente de la ruta de diseminación. Conclusiones. La aparición de metástasis a distancia es un evento con un curso temporal constante. Surgen al mismo tiempo independientemente de la ruta metastásica del melanoma. Esto podría explicar el beneficio limitado de la biopsia del ganglio centinela sobre la supervivencia global de los pacientes con melanoma

Introduction. Compared with other tumors, melanoma has displayed one of the largest increases in incidence in recent years, and it is known to have a high metastatic potential. In cases of metastasis, approximately two-thirds of patients have lymph-node metastases and one-third develop systemic metastases. However, few studies have been reported that analyzed different metastatic patterns according to the natural history of melanoma. The main aim of this study was to analyze the different metastatic pathways and patterns and to assess the time course of development of metastases from cutaneous melanoma. Material and methods. A retrospective study was performed in 575 patients with onset of primary melanoma between 1990 and 2004. During follow-up, 67 patients developed metastases. Different pathways for metastasis were established and evaluated. We identified 4 metastatic pathways according to the metastatic pattern during progression of the melanoma. The time course of metastases was also evaluated. Finally, we analyzed melanomas with local recurrence in terms of whether or not systemic progression occurred. Results. Melanoma metastases first occurred in local lymph nodes in 55.2 % of the patients. Initial metastasis was systemic in 14.9 % of the patients. The anatomical location and tumor thickness influenced which metastatic pathway was followed. Distant metastases occurred after a mean of 25 months regardless of the pathway followed Conclusions. The development of distant metastases displays a constant time course and the time to onset is independent of the metastatic pathway. This observation may explain why sentinel lymph node biopsy has a limited impact on overall survival of melanoma patients