Drug Survival in Cyclosporine Treatment for Moderate to Severe Atopic Dermatitis: Analysis of the Spanish Atopic Dermatitis Registry (BIOBADATOP). / Supervivencia de la ciclosporina en el tratamiento de la dermatitis atópica moderada-grave: Registro Español de Dermatitis Atópica (BIOBADATOP).

BACKGROUND: The past 5 years have seen a proliferation of new treatments for atopic dermatitis (AD). We analyzed recent drug survival data for cyclosporine in this setting. Because the Spanish National Healthcare system requires patients with AD to be treated with cyclosporine before they can be prescribed other systemic treatments, drug survival for cyclosporine may be shorter than in other diseases. MATERIAL AND METHOD: Multicenter, observational, prospective cohort study using data from the Spanish Atopic Dermatitis Registry (BIOBADATOP). Data from the Spanish Registry of Systemic Treatments in Psoriasis (BIOBADADERM) were used to create a comparison cohort. RESULTS: We analyzed data for 130 patients with AD treated with cyclosporine (median drug survival, 1 year). Median cyclosporine survival in the psoriasis comparison group (150 patients) was 0.37 years. Drug survival was significantly longer in AD than in psoriasis (P<.001). CONCLUSION: Drug survival of cyclosporine in the BIOBADATOP registry is similar to that described in other series of patients with AD and longer than that observed in the BIOBADADERM psoriasis registry.

BIOBADATOP Spanish Atopic Dermatitis Registry: Description and Early Findings. / BIOBADATOP: Registro Español de Dermatitis Atópica. Descripción y primeros resultados.

BACKGROUND: In recent years, remarkable improvements in our understanding of atopic dermatitis (AD) have revolutionized treatment perspectives, but access to reliable data from clinical practice is essential. MATERIALS AND METHOD: The Spanish Atopic Dermatitis Registry, BIOBADATOP, is a prospective, multicenter database that collects information on patients of all ages with AD requiring systemic therapy with conventional or novel drugs. We analyzed the registry to describe patient characteristics, diagnoses, treatments, and adverse events (AEs). RESULTS: We studied data entries for 258 patients who had received 347 systemic treatments for AD. Treatment was discontinued in 29.4% of cases, mostly due to a lack of effectiveness (in 10.7% of cases). A total of 132 AEs were described during follow-up. Eighty-six AEs (65%) were linked to a systemic treatment, most commonly dupilumab (39AEs) and cyclosporine (38AEs). The most common AEs were conjunctivitis (11patients), headache (6), hypertrichosis (5), and nausea (4). There was 1severe AE (acute mastoiditis) associated with cyclosporine. CONCLUSIONS: Initial findings on AEs from the Spanish BIOBADATOP registry are limited by short follow-up times precluding comparisons or calculation of crude and adjusted incidence rates. At the time of our analysis, no severe AEs had been reported for novel systemic therapies. BIOBADATOP will help answer questions on the effectiveness and safety of conventional and novel systemic therapies in AD.

Core Content for Undergraduate Medical Education in Spain: Recommendations of the Instructors' Group of the Spanish Academy of Dermatology and Venereology (AEDV).

BACKGROUND: Skin problems are among the most frequent reasons for seeking medical attention in primary care. In recent years, as a result of the process of adapting medical curricula to the requirements of the European Higher Education Area, the amount of time students spend learning the concepts of dermatology has been reduced in many universities. MATERIAL AND METHODS: In order to reach a consensus on core content for undergraduate education in dermatology, we sent a survey to the 57 members of the instructors' group of the Spanish Academy of Dermatology and Venereology (AEDV), asking their opinions on what objectives should be set for a dermatology course in Spain. A total of 131 previously selected objectives were listed. We then applied the Delphi method to achieve consensus on which ones the respondents considered important or very important (score≥4 on a Likert scale). RESULTS: Nineteen responses (33%) were received. On the second round of the Delphi process, 68 objectives achieved average scores of at least 4. The respondents emphasized that graduates should understand the structure and functions of the skin and know about bacterial, viral, and fungal skin infections, the most common sexually transmitted diseases (STDs), and the 4 main inflammatory dermatoses. Students should also learn about common complaints, such as itching and bald patches; the management of dermatologic emergencies; purpura and erythema nodosum as signs of internal disease; and the prevention of STDs and skin cancer. During clinical clerkships students should acquire the communication skills they will need to interview patients, write up a patient's medical history, and refer the patient to a specialist. CONCLUSIONS: The AEDV's group of instructors have defined their recommendations on the core content that medical faculties should adopt for the undergraduate subject of dermatology in Spain.

[Epidemiologic study of skin diseases among immigrants in Alicante, Spain]. / Estudio epidemiológico de la patología cutánea en la población inmigrante de Alicante.

BACKGROUND: The influx of a large number of immigrants has altered the sociodemographic profile in Spain. To date, few studies of the skin diseases of immigrants to Spain have been done. OBJECTIVE: To determine the frequency of visits by immigrants to our dermatology clinic, to describe their skin complaints, and to compare them to those of the autochthonous Spanish population. PATIENTS AND METHODS: Prospective, descriptive, analytic study, with an observational substudy of cases and controls from a cross-section of the population. We included all immigrant patients seen at the dermatology clinic between February 2005 and February 2006. RESULTS: Visits by immigrants to the dermatology clinic accounted for 4.1% of the caseload. Their most frequent complaints were eczematous dermatitis (18.4%), viral warts (6.4%), and acne (6.3%). Comparison between the immigrant and autochthonous patient populations showed that eczematous dermatitis, alopecia, melasma, ringworm, scabies, Herpes simplex infection, keratosis pilaris, and xerosis were significantly more frequent among immigrant patients, whereas viral warts, actinic keratosis, hidradenitis suppurativa, lupus, melanoma, and squamous cell carcinoma were significantly less frequent (P < .05). CONCLUSIONS: The immigrant population consults the dermatologist about skin conditions that are already well represented in our routine practice. As the infectious skin diseases of immigrants are also common in our environment, these patients are unlikely to transmit serious tropical skin diseases to the local population.

Polypodium leucotomos extract in atopic dermatitis: a randomized, double-blind, placebo-controlled, multicenter trial.

INTRODUCTION: Topical corticosteroids are used to treat inflammation and relieve itching in atopic dermatitis, but their use is limited by adverse reactions. OBJECTIVES: The main aim of this study was to investigate whether daily treatment with Polypodium leucotomos extract would reduce the use of topical corticosteroids in children and adolescents with atopic dermatitis. We also analyzed oral antihistamine use and changes in disease severity. PATIENTS AND METHODS: We performed a phase IV randomized, double-blind, placebo-controlled, multicenter trial involving 105 patients aged between 2 and 17 years who were receiving topical corticosteroids to treat moderate atopic dermatitis. The patients were randomized to receive, in addition to their standard treatment, Polypodium leucotomos extract or placebo (both in capsule form) for 6 months. The percentage of days on which topical corticosteroids and other atopic dermatitis treatments were used was calculated. RESULTS: Use of Polypodium leucotomos extract did not significantly reduce the mean (SD) percentage of days on which topical corticosteroids were used (11% [12%] vs 12% [11%] for placebo). A significant reduction was, however, observed for oral histamine use (median percentage of days, 4.5% in the Polypodium leucotomos group and 13.6% in the placebo group [P= .038]). The percentage of patients who used oral antihistamines was also lower in the Polypodium leucotomos group. CONCLUSION: Long-term treatment with Polypodium leucotomos extract has benefits for children and adolescents with atopic dermatitis who require pharmacologic treatment to reduce inflammation and relieve itching.

Severe sorafenib-induced hand-foot skin reaction.

Sorafenib is a new drug, multikinase inhibitor, which has been recently approved for the treatment of metastatic renal cell carcinoma and hepatocellular carcinoma. Up to 90 percent of patients receiving this drug have been reported to develop dermatological symptoms. Recently, it has been suggested that the appearance of skin toxicity during therapy may indicate antitumor activity. We report a new case of sorafenib-induced severe hand-foot skin reaction, which hindered the patient's normal life. The reaction was successfully treated with topical costicosteroids and discontinuation of sorafenib. However, the patient died one month later.

[Attitude of the adult patient with atopic dermatitis to the disease and its treatment: the ACTIDA Study]. / Actitud del paciente adulto con dermatitis atópica frente a su patología y tratamiento. Estudio ACTIDA.

OBJECTIVE: To determine the attitude of adult patients with atopic dermatitis (AD) to their disease and its treatment. MATERIAL AND METHODS: A multicenter, cross-sectional study was performed in patients with at least 2 outbreaks of AD in the previous year. RESULTS: Two hundred twenty-seven dermatologists recruited 1441 analyzable patients, the majority women, with a mean of 3.6 outbreaks per year. Most of the patients (97.2%) indicated that they always or sometimes requested medical evaluation of a new outbreak. In the most recent outbreak, 72.2% had used combined therapy, regardless of the severity of the episode; 2-drug combinations were the most common. The majority of dermatologists prescribed combined therapy, most commonly a 2-drug combination for mild or minimal disease, and 3 or more drugs for moderate to very severe outbreaks. CONCLUSIONS: Treatments used by patients for an outbreak of AD are similar to those prescribed by dermatologists in recent outbreaks.

[Current prevalence and characteristics of dermatoses associated with human immunodeficiency virus infection]. / Prevalencia y características de las dermatosis relacionadas con la infección por VIH en la actualidad.

INTRODUCTION: The introduction of highly active antiretroviral therapy has produced a substantial change in the natural history of human immunodeficiency virus (HIV) infection. The frequency of opportunistic infections and AIDS-related cancers has fallen, though new health problems have developed. Likewise, there has been a change in the spectrum of skin diseases now observed in these patients. OBJECTIVE: To analyze the prevalence and characteristics of skin disease in a group of HIV-infected outpatients. METHODS: A cross-sectional, observational study was performed. All patients who attended the day care unit of the infectious diseases department over a 6-month period (May-October, 2003) were offered the possibility of complete dermatologic examination. Epidemiologic and clinical variables were recorded in all participants, together with the findings on examination of the skin. A comparative study was performed, grouping the patients according to CD4-lymphocyte count and antiretroviral treatment. RESULTS: The prevalence of dermatoses in the study patients was 98.3%. The most common conditions were xerosis (114 patients, 37.6%), seborrheic dermatitis (94 patients, 31%), distal subungual onychomycosis (80 patients, 26.4%), and viral warts (65 patients, 21.4%). Grouped by etiology, infectious diseases were the most common (68.6%), followed by inflammatory diseases (47.5%). CONCLUSION: Mucocutaneous lesions continue to be very common in HIV-infected patients, although there has been a qualitative change in the conditions that these patients present.

Localized acquired cutis laxa secondary to interstitial granulomatous dermatitis.

We report the case of a 68-year-old woman who had interstitial granulomatous dermatitis associated with seronegative polyarthritis. Two years later, this had evolved to become localized acquired cutis laxa.

Langerhans cell histiocytosis: an update.

The histiocytoses represent a heterogeneous group of disorders that are characterized by the proliferation and accumulation of reactive or neoplastic histiocytes within various tissues. Langerhans cell histiocytosis (LCH) is the commonest of these disorders and it is associated with high morbidity and mortality, especially in children. LCH is a poorly understood disease with features suggestive of a neoplastic, reactive, or immune dysregulation process. The clinical spectrum of LCH is considered to be broad and includes from self-resolving involvement of a single organ to a potentially fatal multisystem disease. The purpose of this review is to undertake an update of LCH with emphasis on the current recommendations regarding the classification, evaluation and treatment of this enigmatic disease.

Tuberculous empyema necessitatis. A rare cause of cutaneous abscess in the XXI century.

A 24-year-old Moroccan man was admitted to the hospital because of a tumor of the abdominal wall, fever, and purulent sputum. Imaging tests showed the presence of a pleural effusion and tumor in the right abdominal wall. The organized collection of liquid in the mass was contiguous with the thoracic collection and that of the subphrenic space. Thoracocentesis removed purulent material suggestive of empyema. Cultures and polymerase chain reaction (PCR) tests confirmed the diagnosis of tuberculous empyema. Empyema necessitatis refers to empyema that extends into the extrapleural space through a defect in the pleural surface. Various infectious etiologies may be responsible. Tuberculous empyema necessitatis is a rare complication of tuberculosis (TB); our case is even more unusual because this condition presented as an abdominal wall abcess and the patient was immunocompetent. His only predisposing factors were his country of origin, where there is a high prevalence of TB and the delay in diagnosis due to a lack of access to health care.

Merkel cell tumor presenting as a painful patch lesion on the right arm.

Primary small cell cutaneous neuroendocrine carcinoma (Merkel cell carcinoma) is an uncommon, highly malignant, primary cutaneous neuroendocrine carcinoma. Clinically it is seen as a 0.5- to 5.0-cm pinkish purple papule or nodule, usually not ulcerated, on the head, neck, or, less frequently, the roots of the limbs. We present the case of a woman with an atypical clinical presentation of a Merkel cell tumor.

[Gianotti-Crosti syndrome in an adult]. / Síndrome de Gianotti-Crosti en un adulto.

A 31 years old woman had an exanthematic eruption of small and acral distributed papules. At the same time she suffered a clinical and biological hepatitis B. This case is described attending to the clinic, histopathology and direct immunofluorescence. By the way the Gianotti-Crosti syndrome is reviewed.

Pruritus in HIV-infected patients in the era of combination antiretroviral therapy: a study of its prevalence and causes.

Pruritus is a common symptom in HIV-infected patients. However, there is a lack of studies examining this symptom. We investigated the prevalence of pruritus and its causes in this population by offering the possibility of participating in a skin health programme to all HIV-infected patients who attended our service in Alicante, Spain. Those who accepted (n = 303) underwent an interview and a detailed physical examination by specialists from the Dermatology Department. Between May 2003 and October 2003, 94 patients (31%) reported pruritus: xerosis, seborrhoeic eczema and interdigital tinea pedis were the most frequent dermatological entities responsible for this symptom. Patients with pruritus had higher viral loads (P = 0.006). We conclude that pruritus is still a frequent symptom in HIV-infected patients. To the best of our knowledge this is the first prevalence study of pruritus in an HIV population in the combination antiretroviral therapy (cART) era.

¿Tenemos algo más que aportar en el tratamiento de la tricotilomanía? / What else could we add to the treatment of trichotillomania?

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