[Translated article] Requirements for Accessing New Dermatology Drugs in Spain: Results of the EQUIDAD Study.

BACKGROUND: Although the Spanish Ministry of Health prepares national therapeutic positioning reports (TPRs) and drug reimbursement policies, each of the country's 17 autonomous communities (ACs) is responsible for health care services and prescription requirements in its territory. The aim of the EQUIDAD study was to describe and explore potential differences in prescription requirements for new dermatology drugs across the autonomous communities. MATERIAL AND METHODS: Cross-sectional study conducted in April and May, 2023. Two dermatologists with management responsibilities from each autonomous community reported on territorial and more local prescription requirements for drugs covered by national TPRs issued between 2016 and 2022. RESULTS: Thirty-three researchers from 17 autonomous communities participated. The data submitted revealed between-community inequities in access to new drugs. Overall, 64.7% of the regions imposed additional prescription requirements to those mentioned in the TPRs for psoriasis. This percentage was lower for atopic dermatitis (35.3%) and melanoma (11.8%). The most common requirement for accessing a new drug was a previous prescription for another drug. Differences and additional requirements were also detected at the local level (i.e., differences between hospitals within the same autonomous community). CONCLUSIONS: Spain's autonomous communities have multiple regional and local prescription requirements that are not aligned with national TPR recommendations. These differences result in inequitable access to new drugs for both patients and practitioners across Spain.

Requirements for Accessing New Dermatology Drugs in Spain: Results of the EQUIDAD Study. / Condicionantes de acceso a nuevos medicamentos dermatológicos en España: resultados del proyecto EQUIDAD.

BACKGROUND: Although the Spanish Ministry of Health prepares national therapeutic positioning reports (TPRs) and drug reimbursement policies, each of the country's 17 autonomous communities (ACs) is responsible for health care services and prescription requirements in its territory. The aim of the EQUIDAD study was to describe and explore potential differences in prescription requirements for new dermatology drugs across the autonomous communities. MATERIAL AND METHODS: Cross-sectional study conducted in April and May, 2023. Two dermatologists with management responsibilities from each autonomous community reported on territorial and more local prescription requirements for drugs covered by national TPRs issued between 2016 and 2022. RESULTS: Thirty-three researchers from 17 autonomous communities participated. The data submitted revealed between-community inequities in access to new drugs. Overall, 64.7% of the regions imposed additional prescription requirements to those mentioned in the TPRs for psoriasis. This percentage was lower for atopic dermatitis (35.3%) and melanoma (11.8%). The most common requirement for accessing a new drug was a previous prescription for another drug. Differences and additional requirements were also detected at the local level (i.e., differences between hospitals within the same autonomous community). CONCLUSIONS: Spain's autonomous communities have multiple regional and local prescription requirements that are not aligned with national TPR recommendations. These differences result in inequitable access to new drugs for both patients and practitioners across Spain.

Necrosis grasa subcutánea múltiple: correlación ecográficohistopatológica. Multiple encapsulated fat necrosis: histopathological relation to ultrasound findings.

Encapsulated fat necrosis is a benign entity that has multiple possible conditions in the differential diagnosis. Because of this, the ultrasound and histological studies become highly relevant. We present a 14-year-old boy with this condition who exhibited numerous nodules that were detected after an intentional weight loss of 20kg. The ultrasound and histopathological examinations were necessary to confirm the diagnosis. Even though there is not a clear traumatic record in all cases, trauma constitutes the main hypothesis for its development, by decreasing the blood supply to the adipose tissue lobules and causing subsequent ischemic necrosis. Similar lesions have been described in the omentum and in the breast after surgical procedures or invasive diagnostic tests. In the ultrasound study, at least three presentation patterns have been described, which might match the three histological states, from early fat tissue degeneration to ultimate necrosis and even calcification. It is important to know the clinical characteristics, the ultrasound patterns, and the histological findings of this condition for an accurate diagnosis.

Síndrome de Klippel-Trénaunay: manifestaciones cutáneas / Klippel-Trénaunay syndrome: cutaneous manifestations

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Urgencias dermatológicas: estudio transversal de un hospital de complejidad intermedia / Dermatological emergencies: a cross-sectional study of a hospital of intermediate complexity

OBJETIVO: Conocer si la introducción de criterios de derivación en la urgencia dermatológica modifica el número de pacientes y las patologías derivadas desde el servicio de Urgencias generales, así como el perfil del paciente que hace uso de este servicio. MATERIAL Y MÉTODOS: Estudio observacional que incluyó de forma consecutiva a los pacientes vistos en Urgencias de Dermatología del Hospital Príncipe de Asturias en un periodo de 31 días de 2015, de marzo a mayo, y en el mismo periodo en 2016. Como variables se recogieron sexo, edad, tiempo de evolución, día de la semana, pruebas complementarias, procedencia, motivo de consulta, diagnóstico y grupo, así como el cumplimiento de los criterios, el destino y si tenía cita previa. RESULTADOS: En 2015 acudieron 525 pacientes y 371 en 2016 (p < 0,001). Fueron atendidos 896 pacientes en total (14,45 pacientes/día); el 55,7% eran mujeres y el 44,3% varones. Se realizaron 121 diagnósticos diferentes, siendo los más frecuentes: otras dermatitis, toxicodermias y dermatitis atópica. Tan solo 32 enfermedades suponen el 70% de los diagnósticos. El 51,6% no cumplió los criterios de derivación urgente. CONCLUSIONES: La introducción de criterios de derivación ha permitido reducir el volumen de pacientes en un 30% en el año 2016. Otras dermatitis y las toxicodermias fueron los principales diagnósticos en ambos grupos. El perfil del paciente coincide con el descrito en la literatura

OBJECTIVE: To determine if the introduction of some referral criteria in the dermatology emergency department has changed the number of patients referred from the emergency department, as well as the type of diseases, and the profile of the patient who uses this service. MATERIAL AND METHODS: A cross-sectional study was conducted on all consecutive patients attended in the emergency department of the Hospital Príncipe de Asturias during a 31-day period from March 2015 to May 2015 and in the same period in 2016. Variables collected were: gender, age, days from the onset, day of the week, complementary diagnostic tests, referral, reason for consultation, diagnosis and group, whether or not they met the criteria, destination, and whether or not they had a previous appointment. RESULTS: A total of 525 patients were seen in dermatology emergency department in 2015, and 371 in 2016 (P < .001). Of the 896 patients seen 55.7% were women and 44.3% men (14.45 patients per day). A total of 121 diagnoses were made, with the most common being: other dermatitis, drug reactions, and atopic dermatitis. Only 32 pathologies made up 70% of the diagnoses. More than half (51.6%) did not meet the referral criteria. CONCLUSIONS: The introduction of referral criteria has led to a reduction of 30% in the number of patients in 2016. The main diagnoses in both groups were other dermatitis and drug reactions. The profile of the patient is in accordance with the description in the literature

[Dermatological emergencies: a cross-sectional study of a hospital of intermediate complexity]. / Urgencias dermatológicas: estudio transversal de un hospital de complejidad intermedia.

OBJECTIVE: To determine if the introduction of some referral criteria in the dermatology emergency department has changed the number of patients referred from the emergency department, as well as the type of diseases, and the profile of the patient who uses this service. MATERIAL AND METHODS: A cross-sectional study was conducted on all consecutive patients attended in the emergency department of the Hospital Príncipe de Asturias during a 31-day period from March 2015 to May 2015 and in the same period in 2016. Variables collected were: gender, age, days from the onset, day of the week, complementary diagnostic tests, referral, reason for consultation, diagnosis and group, whether or not they met the criteria, destination, and whether or not they had a previous appointment. RESULTS: A total of 525 patients were seen in dermatology emergency department in 2015, and 371 in 2016 (P<.001). Of the 896 patients seen 55.7% were women and 44.3% men (14.45 patients per day). A total of 121 diagnoses were made, with the most common being: other dermatitis, drug reactions, and atopic dermatitis. Only 32 pathologies made up 70% of the diagnoses. More than half (51.6%) did not meet the referral criteria. CONCLUSIONS: The introduction of referral criteria has led to a reduction of 30% in the number of patients in 2016. The main diagnoses in both groups were other dermatitis and drug reactions. The profile of the patient is in accordance with the description in the literature.

Linfangitis esclerosante no venérea del pene: la importancia del diagnóstico clínico / Nonvenereal Sclerosing Lymphangitis of the Penis: Importance of the Clinical Diagnosis

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Eritema periorbitario en «ojos de mapache»: clave diagnóstica de lupus neonatal / Periorbital "raccoon-eye" erythema: diagnostic key for neonatal lupus

El lupus eritematoso neonatal es una dermatosis mediada por anticuerpos que se adquiere por vía transplacentaria. Puede afectar a la piel o al corazón, y en el 10% de los casos afecta a ambos órganos. Las lesiones cutáneas remiten espontáneamente, mientras que las cardiacas persisten y pueden llegar a ser mortales (10% de los casos). El eritema periocular en «ojos de mapache» es una forma de presentación característica cuando existe afectación cutánea. Exponemos el caso de un varón de 2 meses de edad con lesiones muy representativas de esta entidad, a fin de facilitar su reconocimiento y que su diagnóstico no pase inadvertido. Gracias a la sospecha clínica, se podrá orientar la anamnesis tanto en la madre como en el lactante y se realizarán los estudios complementarios pertinentes de autoinmunidad y electrocardiografía, que confirmarán el diagnóstico y descartarán una posible afectación cardiaca (AU)

Neonatal lupus erythematosus is an antibody-mediated dermatosis that is acquired transplacentally. Skin and heart are the most frequently affected organs; in 10% of cases, both are involved. Cutaneous lesions disappear spontaneously whereas heart involvement persists without improvement and is lethal (in 10% of cases). Periorbital "raccoon-eye" erythema is a characteristic form of presentation when skin involvement is present. We report the case of a 2-month-old male with very representative le-sions of this entity, in order to facilitate its recognition. Due to clinical suspect, the anamnesis can be oriented in both the mother and the infant and the pertinent complementary studies of autoimmunity and electrocardiography will be carried out, which will confirm the diagnosis and rule out a possible cardiac involvement (AU)

Tumefacción labial en varón inmunocompetente / Lip Swelling in an Immunocompetent Man

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