Randomized double-blind placebo-controlled clinical trial to evaluate the effect of a mixture of probiotic strains on symptom severity and use of corticosteroids in children and adolescents with atopic dermatitis.

BACKGROUND: The intestinal microbiota is altered in patients with atopic dermatitis (AD) when compared with those of the healthy population. Some interventions with specific probiotic preparations already demonstrate a change in composition of this microbiota accompanied by improvement in the disease. OBJECTIVES: This research work was designed to evaluate clinical efficacy of the probiotic preparation, and to measure the effect of the intervention on the total dose of corticosteroids administered to subjects. METHODS: This double-blind, randomized, placebo-controlled clinical trial including 70 participants with AD aged 4-17 years was designed to evaluate the clinical effect, compared with placebo, of a probiotic mixture of Bifidobacterium lactis, Bifidobacterium longum and Lactobacillus casei at a total daily consumption of 1 × 109 colony-forming units per capsule, over 12 weeks. After randomization and exclusion, 35 patients were allocated to probiotic and 35 to placebo. Clinical variables analysed were SCORAD (SCORing of Atopic Dermatitis) and Investigator Global Assessment (IGA) indices; effect on the amount of topical corticosteroids used; and assessment of safety. RESULTS: Mean SCORAD index at 12 weeks showed a statistically significant difference of -5.43 (95% confidence interval -10.65 to -0.21) between probiotic (SCORAD 13.52) and placebo groups (SCORAD 18.96); P = 0.04. Comparison between groups showed a statistically significant difference in the number of patients with IGA score improvement over the 12-week intervention: 29 of 32 (90.5%) in the probiotic group vs. 17 of 30 (56.7%) in the placebo group (P < 0.002). A comparison between groups of the proportions of days using corticosteroids and the total dose (g) of corticosteroids between baseline and end of study showed no significant difference, but between weeks 6 and 12 there was a statistically significant reduction in the probiotic group when compared with the placebo group in both variables. Numbers of adverse events were similar in both groups of treatment. CONCLUSIONS: The probiotic mix used in this clinical trial demonstrated efficacy on the change in activity index of AD compared with placebo. Furthermore, the total number of days and total amount of topical corticosteroids required by participants in the probiotic group showed a significant reduction compared with placebo between 6 and 12 weeks.

Analysis and evaluation of the operational characteristics of a new photodynamic therapy device.

One of the key aspects of photodynamic therapy is the light source that is used to irradiate the lesion to be treated. The devices used must ensure that their emission spectrum matches the absorption spectrum of the photosensitizer, so that treatment radiation is delivered only on the target area, without irradiating healthy tissue at superficial or deep levels. Irradiance values must be adequate in order to avoid thermal damage, exceed the oxygen replenishment rate and avoid long treatment times. Furthermore, the device should be user-friendly, inexpensive, and able to be adapted to different photosensitizers. We have developed an easy-to-use and highly customizable device based on LED technology. Its innovative geometric design allows radiation to be delivered to a small treatment surface, since the LEDs are arranged in three arms, the configuration of which directs their radiation on the treatment point. Different high-power color LEDs are disposed on the arms, and can be independently selected based on the most effective wavelengths for exciting the different photodynamic therapy photosensitizers. We have tested the prototype in 5 different patients (1 actinic keratose, 1 actinic cheilitis, 1 superficial basal cell carcinoma and 2 Bowen's disease) and after 1-2 sessions of total cumulative dose of 25-50 J / cm2, 100% clearance of lesions were obtained. Our device can be used by any professional in the field, whether for medical or research purposes. It facilitates the development of treatment protocols and trials with different photosensitizers.

Carcinoma basocelular de la vulva. Descripción de dos casos y revisión de la literatura / Basal cell carcinoma of the vulva. A report of two cases and literature review

Aunque el carcinoma basocelular es el tumor maligno más frecuente de la piel, representa menos del 5% de los tumores de la vulva. Presentamos dos casos en mujeres de 43 y 66 años que presentaban en región vulvar ulceración, picor y sangrado. Ambas pacientes fueron tratadas mediante biopsia escisional; una de ellas precisó una amplia escisión posterior por recidiva local. El carcinoma basocelular de la vulva, a pesar de su rareza, debe considerarse en el diagnóstico diferencial de las lesiones cutáneas vulvares. Su precisión diagnóstica depende de un alto índice de sospecha, biopsia de la lesión y estudio histopatológico de la misma. La escisión local completa es curativa, aunque el índice de recurrencias es elevado y se han descrito casos de metástasis (AU)

Tratamiento de verrugas plantares con bleomicina intralesional / Treatment of plantar warts with intralesional bleomycin

Las verrugas vulgares son tumores cutaneomucosos benignos debido a la infección por el virus del papiloma humano, siendo una de sus localizaciones electivas las plantas de los pies. Hemos realizado un estudio con bleomicina intralesional en pacientes con verrugas plantares. Material y método: se han tratado 24 verrugas plantares en pacientes sanos de todas las edades y ambos sexos. Se infiltró bleomicina intralesional a una concentración de 1 U/ml a razón de 0,1 ml en verrugas de diámetro igual o menor de 3 mm y 0,2 ml en verrugas de diámetro mayor de 3 mm, reevaluando al paciente 1 mes después del tratamiento y aplicando una segunda infiltración en aquellas lesiones que no respondieron a la primera. Resultado: el 95% de las verrugas (24 de 25) desaparecieron completamente tras uno o dos tratamientos. Sólo una verruga (4 por ciento) fue resistente al tratamiento. Conclusiones: la bleomicina intralesional es una técnica de elección en el tratamiento de las verrugas plantares (AU)