Neoadjuvant intralesional methotrexate in cutaneous squamous cell carcinoma: a comparative cohort study.

BACKGROUND: Intralesional methotrexate (MTX-il) has been used as neoadjuvant therapy for keratoacanthoma but has only been utilized in a few isolated cases of cutaneous squamous cell carcinoma as neoadjuvant therapy (cSCC). OBJECTIVES: The objective of this study was to evaluate the effectiveness in clinical practice of presurgical MTX-il infiltration to reduce the size of the cSCC. Safety and the impact on subsequent reconstructive surgical techniques was also assessment. METHODS: Single, retrospective, observational study of two historical cohorts differentiated in time. Subjects included were diagnosed with infiltrating cSCC. Patients included in group-A received neoadjuvant MTX-il and patients included in group-B underwent scheduled surgery without prior infiltration. Univariate and multivariate analyses were performed. RESULTS: Group-A patients (n = 43) showed an average reduction in the tumour area of 0.52 cm(2) , while in group-B (n = 43), the area increased by 0.49 cm(2) . A multivariate linear regression analysis demonstrated that MTX-il was the only independent variable that significantly reduced the tumour size [mean 42.6% (95% CI: 31.17-54.03)]. Tumours ≥2 cm in size required significantly a lower percentage of complex reconstructions (P = 0.026). Lower lip tumours showed a higher reduction in group treated with MTX-il (P = 0.045). The only complication observed was discomfort during methotrexate infiltration (60.47%). CONCLUSIONS: Neoadjuvant MTX-il reduced the presurgical size of cSCC lesions and could simplify their subsequent surgery.

Facial Angiofibroma Severity Index (FASI): reliability assessment of a new tool developed to measure severity and responsiveness to therapy in tuberous sclerosis-associated facial angiofibroma.

BACKGROUND: Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous disorder characterized by the development of multisystem hamartomatous tumours. Topical sirolimus has recently been suggested as a potential treatment for TSC-associated facial angiofibroma (FA). AIM: To validate a reproducible scale created for the assessment of clinical severity and treatment response in these patients. METHODS: We developed a new tool, the Facial Angiofibroma Severity Index (FASI) to evaluate the grade of erythema and the size and extent of FAs. In total, 30 different photographs of patients with TSC were shown to 56 dermatologists at each evaluation. Three evaluations using the same photographs but in a different random order were performed 1 week apart. Test and retest reliability and interobserver reproducibility were determined. RESULTS: There was good agreement between the investigators. Inter-rater reliability showed strong correlations (> 0.98; range 0.97-0.99) with inter-rater correlation coefficients (ICCs) for the FASI. The global estimated kappa coefficient for the degree of intra-rater agreement (test-retest) was 0.94 (range 0.91-0.97). CONCLUSIONS: The FASI is a valid and reliable tool for measuring the clinical severity of TSC-associated FAs, which can be applied in clinical practice to evaluate the response to treatment in these patients.

Association between bullous pemphigoid and neurologic diseases: a case-control study.

INTRODUCTION: In the past 10 years, bullous pemphigoid has been associated with other comorbidities and neurologic and psychiatric conditions in particular. Case series, small case-control studies, and large population-based studies in different Asian populations, mainland Europe, and the United Kingdom have confirmed this association. However, no data are available for the Spanish population. MATERIAL AND METHODS: This was an observational, retrospective, case-control study with 1:2 matching. Fifty-four patients with bullous pemphigoid were selected. We compared the percentage of patients in each group with concurrent neurologic conditions, ischemic heart disease, diabetes, chronic obstructive pulmonary disease, and solid tumors using univariate logistic regression. An association model was constructed with conditional multiple logistic regression. RESULTS: The case group had a significantly higher percentage of patients with cerebrovascular accident and/or transient ischemic attack (odds ratio [OR], 3.06; 95% CI, 1.19-7.87], dementia (OR, 5.52; 95% CI, 2.19-13.93), and Parkinson disease (OR, 5; 95% CI, 1.57-15.94). A significantly higher percentage of cases had neurologic conditions (OR, 6.34; 95% CI, 2.89-13.91). Dementia and Parkinson disease were independently associated with bullous pemphigoid in the multivariate analysis. CONCLUSIONS: Patients with bullous pemphigoid have a higher frequency of neurologic conditions.

Spanish adaptation of the European guidelines for the evaluation and treatment of actinic keratosis.

Current trends in our setting indicate that the prevalence of actinic keratosis and similar diseases will increase in coming years and impose a greater burden on health care resources. A long list of clinical features must be taken into account when approaching the treatment of actinic keratosis. Until recently, therapeutic approaches focused solely on ablative procedures and the treatment of individual lesions and did not take into account areas of field cancerization. Now that the therapeutic arsenal has grown, standardized criteria are needed to guide the optimal choice of treatment for each patient. The elaboration of evidence-based consensus recommendations for the diagnosis and treatment of actinic keratosis generates knowledge that will help clinicians to deliver the highest level of care possible, standardizing decision-making processes and enhancing awareness among all the health professionals involved in the care pathway.

Current options for the treatment of facial angiofibromas.

Facial angiofibromas are hamartomatous growths that are closely associated with tuberous sclerosis complex and, in fact, they constitute one of the main diagnostic criteria for that disease. These lesions composed of blood vessels and fibrous tissue appear on the face at an early age. Since they have important physical and psychological repercussions for patients, several treatment options have been used to remove them or improve their appearance. However, the lack of treatment guidelines prevents us from developing a common protocol for patients with this condition. The present article aims to review the treatments for facial angiofibromas used to date and to propose a new evidence-based treatment protocol.

Tratamiento de las alopecias de patrón masculino y femenino. Eficacia clínica del aminexil y SP94 en dos series de 180 pacientes, hombres y mujeres / Treatment of alopecias of male and female patterns. Clinical efficacy of aminexil and SP94 in two surveys of 180 patients, men and women

El efecto del aminexil combinado con SP.94 fue evaluado como positivo en un grupo de pacientes de ambos sexos. Para poder confirmar estos positivos efectos se ha realizado un estudio en 180 pacientes de cada sexo en las Unidades de Tricología de dos Hospitales. Los pacientes se aplicaron sobre cuero cabelludo y cabellos húmedos 6 ml. de la loción todas las noches. A los pacientes se les realizó controles al comienzo del tratamiento y a los 45,90 y 180 días. Se efectuó en todos tipificación de la alopecia según las escalas de Ebling y Ludwig, y se les preguntó por su edad separándolos en grupos de menores de 17 años, entre 18 y 34 años, entre 35 y 49 años, y 50 o más años. También se interrogó por enfermedades y medicación concomitantes, presencia de dermatitis seborreica, cantidad de cabellos caídos en un lavado de 48 horas antes, deficiencias nutricionales o errores congénitos. A las mujeres con signos clínicos de síndrome SAHA se les realizó una analítica hormonal. La exploración del paciente en cada visita incluyó la realización de un tricograma con estudio del diámetro de los cabellos, signo de arrancamiento, sebometrías, corneometría, control iconográfico, graduación de la alopecia, y una valoración de la evolución de la dermatitis seborreica según una escala cuantitativa. En las visitas también se les pidió a los pacientes una valoración de la cosmeticidad y eficacia del producto, que de (..) (AU)

Effect of aminexil combined with SP94 was evaluated as positive in a group of patients of both genders. To confirm these positive effects a survey in 180patients of each gender has been performed in two Trichology Units of two Hospitals. Patients applied 6 ml. of the lotion in humid scalp all the nights. Controls to the start of treatment and at 45, 90, and 180 days was realized. Graduation of alopecia in accordance with the Ebling’s and Ludwig’s scales, and differentiation on four group of age (less than 17 year, between 18 and 34 years, between 35 and 49 years, and more than 50 year) was performed. All the patients were asked about their clinical background or treatments realized, seborrhoeic dermatitis, number of hairs shedding in a wash 48 hour before, nutritional deficiencies or congenital errors. Women with clinical signs of SAHA syndrome an hormonal analysis was performed Exploration of patients at each visit included trichogram and study of the hair diameter, pull sign, sebometry, corneometry, photographic control, graduation of alopecia, and a valoration of seborrhoeic dermatitis evolution in a quantitative scale. In each visit was also asked to patients for a evaluation about cosmeticity and efficacy of the lotion, by which of a subjecitive manner was divided in worst, similar, acceptable-better, and excellent, that was contrasted with the opinion of two physicians that had their evaluation based on the signs and photograph of each visit. Patient’s compliment was study with the Morisky-Green’s questionnaire. Patients that do not follow the protocol of application or that did not attend to some visit were substituted. Results permit to assure aminexil associated with SP.94 stop or delay loss of hair and favored its wide, although regroth of new hair lost in the evolutive process of androgenetic alopecia was not demonstrated, neither its actuation in seborrhorea and soborrhoeic dermatitis (AU)

Actualización en dermatitis atópica. Propuesta de algoritmo de actuación / Atopic Dermatitis: Update and Proposed Management Algorithm

La dermatitis atópica es una enfermedad inflamatoria crónica que afecta al 20% de los niños y casi al 3% de los adultos, produciendo un deterioro importante de la calidad de vida de los pacientes y sus familias. En más del 75% de los casos es autorresolutiva y mejora después de la pubertad. No obstante, hay casos que no consiguen esta mejoría o que en los primeros años de la vida alcanza niveles de severidad que afectan de forma importante la salud y el desarrollo social de los pacientes. Actualmente no contamos con guías terapéuticas adecuadas para solucionar estas situaciones que se escapan del manejo habitual. En el siguiente artículo repasamos las opciones terapéuticas de las que disponemos actualmente para afrontar casos de dermatitis atópica moderada-severa, aportamos nuestra experiencia y planteamos un posible algoritmo terapéutico (AU)

Atopic dermatitis is a chronic inflammatory disease that affects 20% of children and almost 3% of adults and is associated with considerable impairment of quality of life for both patients and their families. While the condition resolves spontaneously after puberty in over 75%of cases, it can persist into adulthood. Furthermore, in young children severe forms can have serious health consequences and affect social development. There are no appropriate guidelines on how to handle cases that do not respond to routine treatment. In this article, we review the current treatments for moderate to severe atopic dermatitis, describe our experience with this disease, and propose a management algorithm (AU)

Atopic dermatitis: update and proposed management algorithm.

Atopic dermatitis is a chronic inflammatory disease that affects 20% of children and almost 3% of adults and is associated with considerable impairment of quality of life for both patients and their families. While the condition resolves spontaneously after puberty in over 75% of cases, it can persist into adulthood. Furthermore, in young children severe forms can have serious health consequences and affect social development. There are no appropriate guidelines on how to handle cases that do not respond to routine treatment. In this article, we review the current treatments for moderate to severe atopic dermatitis, describe our experience with this disease, and propose a management algorithm.

An Internet-based programme to promote adequate UV exposure behaviour in adolescents in Spain.

BACKGROUND: The exponential rise in the incidence of cutaneous cancers underscores the need to promote primary prevention. Adolescents are highly familiar with the use of Internet, and new technologies and Internet systems have proven especially useful to educate this age group in other health problems. To date, there have been no reports of Internet-based primary prevention campaigns for adolescents against skin cancer. OBJECTIVES: To determine the knowledge and behaviour of a Spanish adolescent population in relation to sun exposure through an Internet-based system and to describe the use of an Internet-based school intervention programme to improve the sun exposure knowledge and behaviour in adolescents. METHODS: The cross-sectional study included 2170 school pupils aged between 12 and 16 years from public secondary schools. Pupils in the participating centres completed the survey via the website, which contained a total of 35 questions and three information blocks. For the intervention programme, a sub-sample of 12 secondary schools (total of 1290 pupils) was randomly selected. RESULTS: About 56.7% of the female pupils and 52.6% of the male pupils reported having suffered from sunburn in the previous summer. Sunburn risk increased with the frequency of sun exposure between 12 and 6 pm (OR of 3.59), null knowledge of the negative effects of sun exposure (OR of 2.102), the use of sun protection cream (OR of 0.695 for non-use) and physical sun protection measures (OR of 2.21 for 0-1 physical measures). A significant reduction in self-reported sunburns was observed in the quasi-experimental group in comparison with controls after adjusting for sex and inland or coastal location of the centre (OR = 0.45, 95% CI = 0.23-0.87, P = 0.018). Adjusted OR showed that there was a significant improvement in the use of physical measures, use of sun cream, frequency of sun cream application every 2 h and use of protection on cloudy days. CONCLUSIONS: This is the first study to demonstrate that a programme entirely conducted via Internet significantly reduces by half self-reported sunburn risk in an adolescent population achieving very high satisfaction rates.

Sustained clinical effectiveness and favorable safety profile of topical sirolimus for tuberous sclerosis - associated facial angiofibroma.

BACKGROUND: Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous disorder characterized by the development of multisystem hamartomatous tumours. Facial angiofibroma appears in up to 80% of patients and has a considerable psychological impact. Various invasive procedures have been used, although they show limited effectiveness and potential adverse effects. OBJECTIVES: To evaluate the sustained clinical benefits and safety profile of topical sirolimus applied to treat facial angiofibromas. METHODS: This study was a non-blinded, uncontrolled case-series comprising 10 patients with TSC-associated facial angiofibroma that was treated with 0.4% sirolimus ointment 3 times a week for 9 months. Patients were clinically evaluated at baseline and at 6, 12, 24 and 36 weeks. Plasma levels of sirolimus were determined. RESULTS: A sustained improvement was observed in erythema and in the size and extension of the lesions as early as the first weeks of treatment. Sirolimus plasma levels remained below detection limits (0.3 ng/mL) in all cases. The formula was well-tolerated with no local or systemic adverse effects. CONCLUSIONS: Topical sirolimus seems to be an effective and safe medical alternative to surgery or laser-based treatments in patients with TSC-associated facial angiofibromas.

Tratamiento del acné en la práctica clínica habitual: encuesta de opinión entre los dermatólogos españoles / Treatment of Acne in Daily Clinical Practice: an Opinion Poll Among Spanish Dermatologists

Introducción y objetivos: el objetivo del estudio fue conocer los hábitos de tratamiento del acné de los dermatólogos españoles. El objetivo secundario fue comparar dichos hábitos con el algoritmo de la Global Alliance y elaborar un algoritmo español de tratamiento del acné. Pacientes y métodos: se diseñó un estudio tipo encuesta, transversal y multicéntrico en el que participaron 872 dermatólogos españoles. El estudio constaba de cuatro encuestas, distribuidas aleatoriamente, con los tres casos clínicos siguientes: acné grave en el seno de un síndrome de androgenización (caso 1), acné comedoniano de intensidad leve (caso 2) y acné moderado papulopustuloso (caso 3). La cuarta encuesta presentaba cinco fotografías de diferentes tipos de acné y un esquema con varias opciones terapéuticas para elegir las más adecuadas. Resultados: para el caso 1 un 55% de los dermatólogos eligieron la opción de antiandrógenos/anticonceptivos orales más retinoides tópicos o más peróxido de benzoilo/antibióticos tópicos. En el caso 2 un 62% escogieron retinoides tópicos, y en el caso 3 un 68% seleccionaron la opción de antibióticos sistémicos más peróxido de benzoilo. La terapia combinada fue considerada de elección en todos los tipos de acné, siendo los retinoides tópicos el tratamiento inicial para las formas leves y moderadas, así como la opción preferida como tratamiento de mantenimiento. Conclusiones: en general, los dermatólogos españoles tratan el acné de acuerdo con el algoritmo de la Global Alliance, pero las numerosas opiniones recogidas en las preguntas abiertas de las encuestas confirman la necesidad de unificar criterios en el tratamiento del acné (AU)

Background and objectives: the aim of this study was to determine the approaches used to treat acne in clinical practice by Spanish dermatologists. A secondary objective of the study was to compare the practices of Spanish dermatologists with the Acne Global Alliance treatment algorithm and develop a Spanish treatment algorithm for acne. Patients and methods: a multicenter, cross-sectional survey was undertaken among 872 Spanish dermatologists. The study comprised 4 randomly distributed questionnaires. The first 3 contained the following case descriptions: severe acne associated with masculinization (case 1), mild comedonal acne (case 2), and moderate papulopustular acne (case 3). The fourth questionnaire contained 5 photographs of different types of acne and an algorithm containing various treatment options, from which dermatologists were asked to choose the most appropriate. Results: for case 1, 55% of dermatologists chose oral antiandrogens/contraceptive drugs plus topical retinoids or topical benzoyl peroxide/antibiotics. In case 2, 62% chose topical retinoids and, in case 3, 68% chose systemic antibiotics plus benzoyl peroxide. Combination therapy was considered the treatment of choice in all types of acne, with topical retinoids as the initial treatment option for mild and moderate forms and the preferred option for maintenance therapy. Conclusions: in general, Spanish dermatologists treat acne in accordance with the Acne Global Alliance treatment algorithm. The varying opinions reported in response to open questions, however, confirm the need to unify criteria for the treatment of acne (AU)

[Treatment of acne in daily clinical practice: an opinion poll among Spanish dermatologists]. / Tratamiento del acné en la práctica clínica habitual: encuesta de opinión entre los dermatólogos españoles.

BACKGROUND AND OBJECTIVES: the aim of this study was to determine the approaches used to treat acne in clinical practice by Spanish dermatologists. A secondary objective of the study was to compare the practices of Spanish dermatologists with the Acne Global Alliance treatment algorithm and develop a Spanish treatment algorithm for acne. PATIENTS AND METHODS: a multicenter, cross-sectional survey was undertaken among 872 Spanish dermatologists. The study comprised 4 randomly distributed questionnaires. The first 3 contained the following case descriptions: severe acne associated with masculinization (case 1), mild comedonal acne (case 2), and moderate papulopustular acne (case 3). The fourth questionnaire contained 5 photographs of different types of acne and an algorithm containing various treatment options, from which dermatologists were asked to choose the most appropriate. RESULTS: for case 1, 55% of dermatologists chose oral antiandrogens/contraceptive drugs plus topical retinoids or topical benzoyl peroxide/antibiotics. In case 2, 62% chose topical retinoids and, in case 3, 68% chose systemic antibiotics plus benzoyl peroxide. Combination therapy was considered the treatment of choice in all types of acne, with topical retinoids as the initial treatment option for mild and moderate forms and the preferred option for maintenance therapy. CONCLUSIONS: in general, Spanish dermatologists treat acne in accordance with the Acne Global Alliance treatment algorithm. The varying opinions reported in response to open questions, however, confirm the need to unify criteria for the treatment of acne.

[Comorbidities in psoriasis]. / Comorbilidades en psoriasis.

Although in most majority the psoriasis presents/displays a clinical cutaneous today fundamentally we know that it can be associated to other diseases extracutaneous, as much you will articular, digestive, metabolic, cardiovascular and even psychic. We reviewed in this article the atiopathogenics bases and the risks that the psoriáasics patients must to suffer these comorbidities.

Comorbilidades en psoriasis / Comorbidities in psoriasis

Aunque en la mayoría de las ocasiones la psoriasis presenta una clínica fundamentalmente cutánea, hoy sabemos que puede asociarse a otras enfermedades extracutáneas, tanto articulares como digestivas, metabólicas, cardiovasculares e incluso psíquicas. Revisamos en este artículo las bases etiopatogénicas y los riesgos que los pacientes psoriásicos tienen para padecer estas llamadas comorbilidades (AU)

Although in most majority the psoriasis presents/displays a clinical cutaneous today fundamentally we know that it can be associated to other diseases extracutaneous, as much you will articular, digestive, metabolic, cardiovascular and even psychic. We reviewed in this article the atiopathogenics bases and the risks that the psoriáasics patients must to suffer these comorbidities (AU)

[Complications in dermatologic surgery]. / Complicaciones en Dermatología Quirúrgica.

Surgical complications are any deviation from the expected course of the surgical procedure. They occur as a consequence of one or more unexpected events, which can be avoided in the majority of cases through careful planning, a precise surgical technique, and correct postoperative care. Some complications, such as cardiac arrhythmias, anaphylaxis, and cardiorespiratory arrest, are life-threatening whereas others, occurring as a direct result of surgery, can affect the healing process and the final cosmetic appearance of the scar. We must therefore have not only the relevant training in dermatologic surgery, but also in basic and advanced cardiopulmonary resuscitation. In this review we discuss the perioperative measures necessary to avoid the onset of complications in dermatologic surgery and we define the various complications that can develop.