[Response to treatment with oral alitretinoin in patients with chronic hand eczema that is refractory to treatment with potent topical corticosteroids: experience in 15 patients]. / Respuesta al tratamiento con alitretinoína oral en ECM refractario con eczema crónico de manos refractario al tratamiento con corticoides tópicos potentes: nuestra experiencia en 15 pacientes.

BACKGROUND: Alitretinoin (9-cis-retinoic acid) is an endogenous derivative of vitamin A and functions as an agonist of both families of nuclear receptors (retinoic acid receptor-α, -ß, -γ; retinoid X receptor-α, -ß, -γ). It has been investigated in the treatment of chronic hand eczema in many studies in recent years and the results have been promising. OBJECTIVES: To evaluate the efficacy and safety of oral alitretinoin in the treatment of chronic hand eczema that is refractory to treatment with potent topical corticosteroids and to analyze the long-term response to treatment. MATERIALS AND METHODS: A prospective, observational, descriptive study was undertaken in 15 patients with chronic hand eczema that was refractory to treatment with potent topical corticosteroids. Patients were administered oral alitretinoin 30 mg/d for 3 months followed by 6 months of follow-up. RESULTS: A complete response, with "clear" hands was obtained in 7 patients (47%), 5 patients (33%) achieved a partial response (almost clear hands), 1 patient (7%) showed substantial improvement, 1 (7%) showed moderate improvement, and 1 patient (7%) did not respond to treatment. Relapse occurred within 6 months of treatment suspension in 54% of cases. The treatment was well tolerated. Side effects, observed in 50% of cases, were mild (headache, elevated lipid levels, slightly elevated transaminase levels, and epigastric pain), except in 1 patient, who had a substantial reduction in thyroid stimulating hormone levels. CONCLUSIONS: The results of our study support the proposal of alitretinoin as an effective and safe short-term and medium-term treatment for chronic hand eczema in patients whose disease is refractory to treatment with potent topical corticosteroids.

[Store-and-forward teledermatology: assessment of validity in a series of 2000 observations]. / Teledermatología diferida: análisis de validez en una serie de 2.000 observaciones.

BACKGROUND AND OBJECTIVES: The aim of this study was to assess the validity of store-and-forward teledermatology as a tool to support physicians in primary care and hospital emergency services and reduce the requirement for face-to-face appointments. Diagnostic validity and the approach chosen for patient management (face-to-face vs teledermatology) were compared according to patient origin and diagnostic group. MATERIAL AND METHODS: Digital images from 100 patients were assessed by 20 different dermatologists and the diagnoses offered were compared with those provided in face-to-face appointments (gold standard). The proposed management of the different groups of patients was also compared. RESULTS: The percentage complete agreement was 69.05% (95% confidence interval [CI], 66.9%-71.0%). The aggregate agreement was 87.80% (95% CI, 86.1%-89.0%). When questioned about appropriate management of the patients, observers elected face-to-face consultation in 60% of patients (95% CI, 58%-61%) and teledermatology in 40% (95% CI, 38%-41%). Diagnostic validity was higher in patients from primary care (76.1% complete agreement and 91.8% aggregate agreement) than those from hospital emergency services (61.8% complete agreement, 83.4% aggregate agreement) (p < 0.001) and teledermatology was also chosen more often in patients from primary care compared with those from emergency services (42% vs 38%; p=0.003). In terms of diagnostic group, higher validity was observed for patients with infectious diseases (73.3% complete agreement and 91.3% aggregate agreement) compared to those with inflammatory disease (70.8% complete agreement and 86.4% aggregate agreement) or tumors (63.0% complete agreement and 87.2% aggregate agreement) (p <0.001). Teledermatology was also chosen more often in patients with infectious diseases (52%) than in those with inflammatory disease (40%) or tumors (28%) (p <0.001). CONCLUSIONS: Store-and-forward teledermatology has a high level of diagnostic validity, particularly in those cases referred from primary care and in infectious diseases. It can be considered useful for the diagnosis and management of patients at a distance and would reduce the requirement for face-to-face consultation by 40%.

[Surgical vs nonsurgical treatment of basal cell carcinoma]. / Tratamiento quirúrgico vs. no quirúrgico en el carcinoma basocelular.

Numerous therapeutic options are now available for the treatment of basal cell carcinoma. However, few randomized controlled trials with 5-year follow-up have compared the effectiveness of the different treatments. Such a comparison is difficult, probably because efficacy depends on several factors: those related to the tumor, the patient, the technique, and the dermatologist's experience. We first describe the available therapeutic options, including certain innovative treatments. We have divided them into 2 main groups-surgical and nonsurgical-and focus on the indications, advantages, and disadvantages of each one, as well as on the cure and recurrence rates. Then, based on the evidence reviewed, we attempt to provide an outline of the therapeutic strategies recommended in basal cell carcinoma, and the approach to be used in specific situations. We also describe our own experience.

Respuesta al tratamiento con alitretinoína oral en ECM refractario con eczema crónico de manos refractario al tratamiento con corticoides tópicos potentes: nuestra experiencia en 15 pacientes / Response to Treatment With Oral Alitretinoin in Patients With Chronic Hand Eczema That Is Refractory to Treatment With Potent Topical Corticosteroids: Experience in 15 Patients

Introducción: alitretinoína (ácido 9-cis-retinoico) es un derivado endógeno de la vitamina A, panagonista de ambas familias de receptores nucleares (RAR-α, -β, -γ, RXR-α, -β, -γ) estudiado en el eczema crónico de manos en diversos trabajos durante los últimos años con resultados prometedores. Objetivos: evaluar la eficacia y seguridad de alitretinoína oral en el tratamiento del eczema crónico de manos refractario al tratamiento con corticoides tópicos potentes, y su respuesta mantenida a largo plazo. Material y métodos: llevamos a cabo un estudio prospectivo, descriptivo y observacional. Se reclutaron un total de 15 pacientes con eczema crónico de manos refractarios al tratamiento con corticoides tópicos potentes, a los que se les administró una dosis de alitretinoína oral de 30mg/día durante tres meses, con un seguimiento posterior de 6 meses. Resultados: un total de 7 pacientes (47%) obtuvo respuesta completa con «manos limpias» al finalizar el tratamiento, 5 pacientes (33%) alcanzaron una respuesta parcial «manos casi limpias», un paciente (7%) obtuvo mejoría importante, otro paciente (7%) evidenció mejoría moderada y sólo un paciente (7%) no respondió al tratamiento. El porcentaje de recaída durante los 6 meses después de haber terminado el tratamiento fue del 54%. El tratamiento fue bien tolerado con efectos colaterales en el 50% de los pacientes, considerados leves (cefalea, hiperlipidemias, aumento leve de transaminasas, epigastralgias), excepto un paciente, que presentó una disminución importante de la hormona estimulante del tiroides. Conclusiones: los resultados presentados son coherentes con la propuesta de alitretinoína como un medicamento eficaz y seguro para el tratamiento a corto y medio plazo del eczema crónico de manos en pacientes refractarios a tratamiento con corticoides tópicos potentes (AU)

Background: Alitretinoin (9-cis-retinoic acid) is an endogenous derivative of vitamin A and functions as an agonist of both families of nuclear receptors (retinoic acid receptor-α, -β, -γ; retinoid X receptor-α, -β, -γ). It has been investigated in the treatment of chronic hand eczema in many studies in recent years and the results have been promising. Objectives: To evaluate the efficacy and safety of oral alitretinoin in the treatment of chronic hand eczema that is refractory to treatment with potent topical corticosteroids and to analyze the long-term response to treatment. Materials and methods: A prospective, observational, descriptive study was undertaken in 15 patients with chronic hand eczema that was refractory to treatment with potent topical corticosteroids. Patients were administered oral alitretinoin 30mg/d for 3 months followed by 6 months of follow-up. Results: A complete response, with “clear” hands was obtained in 7 patients (47%), 5 patients (33%) achieved a partial response (almost clear hands), 1 patient (7%) showed substantial improvement, 1 (7%) showed moderate improvement, and 1 patient (7%) did not respond to treatment. Relapse occurred within 6 months of treatment suspension in 54% of cases. The treatment was well tolerated. Side effects, observed in 50% of cases, were mild (headache, elevated lipid levels, slightly elevated transaminase levels, and epigastric pain), except in 1 patient, who had a substantial reduction in thyroid stimulating hormone levels. Conclusions: The results of our study support the proposal of alitretinoin as an effective and safe short-term and medium-term treatment for chronic hand eczema in patients whose disease is refractory to treatment with potent topical corticosteroids (AU)

Teledermatología diferida: análisis de validez en una serie de 2.000 observaciones / Store-and-Forward Teledermatology: Assessment of Validity in a Series of 2000 Observations

Introducción y objetivos: Objetivo: evaluar la validez de la teledermatología diferida y su aplicación como herramienta de apoyo a Atención Primaria y servicios de Urgencias hospitalarias (consultas presenciales evitadas). Comparar validez y manejo del paciente (presencial vs teledermatología) según el origen del paciente y el grupo diagnóstico. Material y métodos: se compararon los diagnósticos emitidos sobre 100 pacientes por 20 dermatólogos observadores con el emitido en la consulta presencial (patrón oro) y se comparó el manejo entre los grupos de pacientes. Resultados: porcentaje de acuerdo completo (AC): 69,05 (IC 95%: 66,9-71,0). Porcentaje de acuerdo agregado (AG): 87,80 (IC 95%: 86,1-89,0). Pacientes manejados de manera presencial: 60% (58-61). Pacientes manejados por teledermatología: 40% (38-41). Los pacientes provenientes de Atención Primaria y el grupo de patología infecciosa presentó mayor validez diagnóstica (76,1 AC y 91,8 AG; p < 0,001 para Atención Primaria y 73,3 AC y 91,3 AG; p < 0,001 parapatología infecciosa) y fueron manejados vía teledermatológica (42%; p = 0,003 para Atención Primaria y 52%; p < 0,001 para patología infecciosa) en mayor medida que los provenientes de Urgencias (61,8 AC y 83,4 AG; 38% manejo teledermatológico) y aquéllos con patología inflamatoria(70,8 AC y 86,4 AG; 40% manejo teledermatológico) o tumoral (63,0 AC y 87,2 AG; 28%manejo teledermatológico). Conclusiones: la teledermatología diferida presenta una elevada validez diagnóstica, especialmente en casos remitidos de Atención Primaria y para patología infecciosa, y es útil en el manejo y diagnóstico a distancia de pacientes, ya que evitaría el 40% de las consultas presenciales (AU)

Background and objectives: The aim of this study was to assess the validity of store-and forward teledermatology as a tool to support physicians in primary care and hospital emergency services and reduce the requirement for face-to-face appointments. Diagnostic validity and the approach chosen for patient management (face-to-face vs teledermatology) were compared according to patient origin and diagnostic group. Material and methods: Digital images from 100 patients were assessed by 20 different dermatologists and the diagnoses offered were compared with those provided in face-to-face appointments (gold standard). The proposed management of the different groups of patients was also compared. Results: The percentage complete agreement was 69.05% (95% confidence interval [CI], 66.9%—71.0%). The aggregate agreement was 87.80% (95% CI, 86.1%—89.0%). When questioned about appropriate management of the patients, observers elected face-to-face consultation in60% of patients (95% CI, 58%—61%) and teledermatology in 40% (95% CI, 38%—41%). Diagnostic validity was higher in patients from primary care (76.1% complete agreement and 91.8% aggregate agreement) than those from hospital emergency services (61.8% complete agreement, 83.4% aggregate agreement) (p < 0.001) and teledermatology was also chosen more often in patients from primary care compared with those from emergency services (42% vs 38%; p = 0.003). In terms of diagnostic group, higher validity was observed for patients with infectious diseases (73.3% complete agreement and 91.3% aggregate agreement) compared to those with inflammatory disease (70.8% complete agreement and 86.4% aggregate agreement) or tumors (63.0% complete agreement and 87.2% aggregate agreement) (p <0.001). Teledermatology was also chosen more often in patients with infectious diseases (52%) than in those with inflammatory disease (40%) or tumors (28%) (p <0.001). Conclusions: Store-and-forward teledermatology has a high level of diagnostic validity, particularly in those cases referred from primary care and in infectious diseases. It can be considered useful for the diagnosis and management of patients at a distance and would reduce the requirement for face-to-face consultation by 40% (AU)

Tratamiento quirúrgico vs. no quirúrgico en el carcinoma basocelular / Surgical vs Nonsurgical Treatment of Basal Cell Carcinoma

El arsenal terapéutico para el tratamiento de los carcinomas basocelulares hoy en día es muy amplio. No obstante, existen pocos estudios controlados, aleatorizados con seguimiento a 5 años que comparen la eficacia de los diferentes tratamientos. Esto es difícil, debido probablemente a que la eficacia de los mismos depende de varios factores: los derivados del propio tumor, del paciente, de la técnica y del manejo de ella hecha por el dermatólogo. Describiremos en primer lugar las opciones terapéuticas con las que contamos, incluyendo además algunos tratamientos innovadores, dividiéndolas en dos grupos principales: quirúrgicos y no quirúrgicos, enfatizando en las indicaciones, ventajas y desventajas de cada tipo, así como las tasas de curación y recurrencia de los mismos. Posteriormente con las evidencias presentadas intentaremos, de manera esquemática, exponer las estrategias terapéuticas recomendadas en cada caso, las actitudes a adoptar en determinadas situaciones así como nuestra propia experiencia (AU)

Numerous therapeutic options are now available for the treatment of basal cell carcinoma. However, few randomized controlled trials with 5-year follow-up have compared the effectiveness of the different treatments. Such a comparison is difficult, probably because efficacy depends on several factors: those related to the tumor, the patient, the technique, and the dermatologist's experience. We first describe the available therapeutic options, including certain innovative treatments. We have divided them into 2 main groups—surgical and nonsurgical—and focus on the indications, advantages, and disadvantages of each one, as well as on the cure and recurrence rates. Then, based on the evidence reviewed, we attempt to provide an outline of the therapeutic strategies recommended in basal cell carcinoma, and the approach to be used in specific situations. We also describe our own experience (AU)