AEDV Expert Consensus Document on the Organization of a Multidisciplinary Unit for Patients With or at Risk of Venereal Infections. / Documento de expertos de la Academia Española de Dermatología y Venereología sobre la organización de una unidad multidisciplinar de atención a pacientes con o en riesgo de infecciones venéreas.

Over the past few years, venereal or sexually transmitted infections (STIs) have been on the rise worldwide requiring additional specialized monographic consultations to specifically treat STIs. Therefore, the Spanish Academy of Dermatology and Venereology (AEDV) Research Working Group on STIs and HIV has drafted this document with the necessary requirements in terms of infrastructure, personnel, technology, specific materials for sample collection, and needs for current therapeutic options. Strict emphasis is placed on the protection of patient privacy. A health care circuit model is outlined too. Additionally, a section has been included on contact tracking and reporting, key elements for the effective prevention and control of STIs. These clinical practice guidelines seek to establish a clinical action framework adapted to the current challenges posed by STIs and HIV in the dermatology, venereology, and multidisciplinary settings.

Clinical and Epidemiological Characteristics of Patients Being Treated for Scabies in Spain: Opportunities for Improvement - A Multicenter Cross-Sectional CLINI-AEDV Study. / Características clínicas y epidemiológicas de pacientes diagnosticados de escabiosis en España: oportunidades de mejora. Estudio transversal multicéntrico CLINI-AEDV.

BACKGROUND: Several studies support the hypothesis that scabies is on the rise in Spain. There are also concerns about the possible development of resistance to treatment and an increase in atypical presentations. The aims of this study were to describe the demographic and clinical characteristics of patients with scabies seen by dermatologists in Spain, to identify the possible emergence of atypical forms of scabies, and to explore the frequency of treatment failures and associated risk factors. METHODS: We conducted an observational, cross-sectional, multicenter study of data collected prospectively in April and May 2023 using the CLINI-AEDVp platform created by the Spanish Academy of Dermatology and Venereology (AEDV). RESULTS: Participating dermatologists from 31 hospitals in 15 of Spain's autonomous communities recorded 186 cases of active scabies (51% in women) during the study period. A diagnostic certainty level of A, B or C as per the International Alliance for the Control of Scabies Consensus Criteria was required for diagnosis. Overall, 92% of patients had typical scabies and 66% had already been treated with a scabicide for the current episode. Of the treated patients, only 36% had received and completed adequate treatment (including the simultaneous treatment of all household members) and 50% had not received clear written recommendations. CONCLUSIONS: In a high proportion of the cases of scabies studied, the patient had already received treatment. In those cases, we observed several remediable shortcomings that could explain why some of these treatments had failed. Remedying these deficiencies should lead to better control of scabies and an improved assessment of the actual effectiveness of currently available scabicides.

[Translated article] Clinical and Epidemiological Characteristics of Patients Being Treated for Scabies in Spain: Opportunities for Improvement - A Multicenter Cross-Sectional CLINI-AEDV Study.

BACKGROUND: Several studies support the hypothesis that scabies is on the rise in Spain. There are also concerns about the possible development of resistance to treatment and an increase in atypical presentations. The aims of this study were to describe the demographic and clinical characteristics of patients with scabies seen by dermatologists in Spain, to identify the possible emergence of atypical forms of scabies, and to explore the frequency of treatment failures and associated risk factors. METHODS: We conducted an observational, cross-sectional, multicenter study of data collected prospectively in April and May 2023 using the CLINI-AEDVp platform created by the Spanish Academy of Dermatology and Venereology (AEDV). RESULTS: Participating dermatologists from 31 hospitals in 15 of Spain's autonomous communities recorded 186 cases of active scabies (51% in women) during the study period. A diagnostic certainty level of A, B or C as per the International Alliance for the Control of Scabies Consensus Criteria was required for diagnosis. Overall, 92% of patients had clinical features of classic scabies and 66% had already been treated with a scabicide for the current episode. Of the treated patients, only 36% had received and completed adequate treatment (including the simultaneous treatment of all household members) and 50% had not received clear written recommendations. CONCLUSIONS: In a high proportion of scabies cases, the patient has already received treatment. In those cases, we observe several remediable shortcomings that could explain why some of these treatments fail. Remedying these deficiencies should lead to better control of scabies and an improved assessment of the actual effectiveness of currently available scabicides.

Analysis of Undergraduate Dermatology Syllabi at Spanish Universities: Does the Weight of Theoretical Content Match the Skin Conditions Seen in Primary Care and General Dermatology Practices? / Análisis de las características de la docencia de pregrado de Dermatología en las universidades españolas. ¿Los contenidos teóricos se aproximan a la casuística de los médicos de Atención Primaria y dermatólogos generales?

INTRODUCTION: Undergraduate dermatology courses vary in the nearly 50 Spanish medical faculties that teach the subject. This study aimed to describe the characteristics of these courses and to analyze whether the weight assigned to dermatology topics reflect the caseloads of primary care physicians and general dermatologists in the Spanish national health system. MATERIAL AND METHODS: Cross-sectional study of syllabi used in Spanish medical faculties during the 2021-2022 academic year. We determined the number of teaching hours in public and private university curricula and compared the weight of dermatology topics covered to the dermatology caseloads of primary care physicians and general dermatologists as reported in published studies. RESULTS: Most medical faculties taught dermatology for one semester. The median number of credits offered was 4.5. On average, lectures covered 24 theoretical topics, and seminars and workshops covered 9 topics. We identified a clear disparity between the percentage of time devoted to dermatology topics in course lectures and the skin conditions usually managed in primary care and general dermatology practices. DISCUSSION: The skin diseases most commonly treated by primary care physicians and general dermatologists are underrepresented in the curricula of Spanish medical faculties. The topics that should be given more weight in syllabi, or recovered for inclusion in dermatology courses, should be re-examined. Our findings show that the topics that ideally should be emphasized more are types of dermatitis, infectious skin diseases, acne, psoriasis, rashes, and the differential diagnosis of benign and malignant neoplasms. There should be additional support for the theoretical teaching of these topics.

Survey on Private Dermatology Practice Characteristics and Fees in Spain in 2023. Update and Changes From 2018. / Encuesta sobre las características y honorarios de la práctica dermatológica privada española en 2023. Actualización y cambios con respecto a 2018.

The present work includes the analysis of the data obtained through a survey conducted in January 2023 to 235 dermatologists practicing private healthcare activity in Spain. A subsequent frame is added to the study with similar methodology carried out in 2018, while analyzing the changes and adaptations that the practice has with the new times and emerging challenges. Compared to 2018, in 2023 the following findings stand out: increases in dedication to private activity, teleconsultations, advance payment for techniques, acceptance of payments by bank card and electronic banking; changes in the periodicity of price adjustment; the fact that 60% of respondents state that they have adjusted prices upwards in the year; a rise in prices that is approximately in line with that of the CPI, and the observation that male dermatologists more frequently state higher extreme prices.

Safety in Dermatologic Procedures: Accidental Injury to Major Blood Vessels and Nerve Structures. / Seguridad en procedimientos dermatológicos: sección de grandes vasos sanguíneos y estructuras nerviosas.

This article in the series «Safety in Dermatologic Procedures¼ deals with the accidental laceration of major blood vessels and nerve structures during surgery. We first look at the anatomic location and course of the blood vessels and nerve structures that are most at risk of injury and then describe the possible outcomes in each case. We finally offer some recommendations on how to avoid damage to structures in danger zones and how to repair them if they are accidentally compromised.

SARS-CoV-2 infection in patients with or at risk for venereal infections: Incidence and associated factors in a sexual health clinic. / Infección por SARS-CoV-2 en pacientes con o en riesgo de infecciones venéreas: estudio de su incidencia y factores asociados en un centro monográfico de infecciones de transmisión sexual.

BACKGROUND AND OBJECTIVE: SARS-CoV-2 is more easily spread by close contact, which is inherent to sexual intercourse. People with, or at risk for, sexually transmitted infections (STIs) may therefore have higher rates of COVID-19. The aim of this study was to estimate SARS-CoV-2 antibody seroprevalence in people seen at a dedicated STI clinic, compare our findings to the estimated seroprevalence in the local general population, and study factors associated with SARS-CoV-2 infection in this setting. MATERIAL AND METHODS: Cross-sectional observational study including consecutive patients older than 18 years of age who had not yet been vaccinated against COVID-19 and who underwent examination or screening at a dedicated municipal STI clinic in March and April 2021. We ordered rapid SARS-CoV-2 serology and collected information on demographic, social, and sexual variables, STI diagnoses, and history of symptoms compatible with SARS-CoV-2 infection. RESULTS: We studied 512 patients (37% women). Fourteen (24.2%) had a positive SARS-CoV-2 test. Variables associated with positivity were use of FFP2 masks (odds ratio 0.50) and a higher-than-average number of sexual partners (odds ratio 1.80). Use of FFP2 masks was not randomly distributed in this sample. CONCLUSIONS: Sexually active members of the population in this study had a higher incidence of SARS-CoV-2 infection than the general population. The main route of infection in this group appears to be respiratory, linked to close contact during sexual encounters; sexual transmission of the virus is probably limited.

What Proportion of the Spanish Dermatology Caseload Corresponds to Pediatric Dermatoses? Results From the DIADERM National Random Sampling Survey. / ¿Cuánta carga asistencial suponen las dermatosis pediátricas en la actividad ambulatoria en la dermatología española? Resultados del muestreo aleatorio nacional DIADERM.

BACKGROUND: Visits for skin conditions are very common in pediatric primary care, and many of the patients seen in outpatient dermatology clinics are children or adolescents. Little, however, has been published about the true prevalence of these visits or about their characteristics. MATERIAL AND METHODS: Observational cross-sectional study of diagnoses made in outpatient dermatology clinics during 2 data-collection periods in the anonymous DIADERM National Random Survey of dermatologists across Spain. All entries with an International Classification of Diseases, Tenth Revision code related to dermatology in the 2 periods (84 diagnoses) were collected for patients younger than 18 years and classified into 14 categories to facilitate analysis and comparison. RESULTS: In total, the search found 20 097 diagnoses made in patients younger than 18 years (12% of all coded diagnoses in the DIADERM database). Viral infections, acne, and atopic dermatitis were the most common, accounting for 43.9% of all diagnoses. No significant differences were observed in the proportions of diagnoses in the respective caseloads of specialist vs. general dermatology clinics or public vs. private clinics. Seasonal differences in diagnoses (January vs. May) were also nonsignificant. CONCLUSIONS: Pediatric care accounts for a significant proportion of the dermatologist's caseload in Spain. Our findings are useful for identifying opportunities for improving communication and training in pediatric primary care and for designing training focused on the optimal treatment of acne and pigmented lesions (with instruction on basic dermoscopy use) in these settings.

Safety in Dermatologic Procedures: Basic and Advanced Cardiopulmonary Resuscitation. / Seguridad en procedimientos dermatológicos: Reanimación cardiopulmonar básica e instrumental.

This article in the series on safety in dermatologic procedures covers the delivery of basic cardiopulmonary resuscitation (using no devices), instrumental resuscitation (using an automated external defibrillator), and pharmacological resuscitation (using adrenaline). We provide a brief overview of the updated 2021 European Resuscitation Council guidelines and offer an algorithm and visual aids to support recommended practices.

Lipoatrophia semicircularis: Clinical study and follow-up of 76 cases in Madrid, Spain. Classification proposal. / Lipoatrofia semicircular: estudio y seguimiento clínico de 76 casos en Madrid, España. Propuesta de clasificación.

INTRODUCTION: The clinical presentations of Lipoatrophia semicircularis (LS) vary, and diagnostic criteria are unclear. Several etiopathogenic factors, including occupational environmental ones, have been suggested. We aimed to describe a cluster of cases of suspected LS that started to appear in May 2008 among employees of the city council of Madrid, Spain. We report the actions taken by the council's Occupational Health Service and propose clinical categories with prognostic implications. MATERIAL AND METHOD: Retrospective observational case series study including prospectively collected data from patients evaluated between 2008 and 2021 at the Madrid City Council STI/Dermatology Department. Information on measures taken by the Occupational Health Service is detailed. The recording of clinical variables for statistical analysis and the proposal of defined clinical patterns were carried out. RESULTS: We studied the cases of 75 women and one man, most of whom attended follow-up visits for a median of 37 months. Local symptoms were observed in just 14.5% of patients. The cases were classified into 4 groups: typical LS, unilateral LS, band-like lipoatrophy in the lower limbs, and nonspecific LS. Clinical outcomes were more often favorable in the first 2 groups, in which 76% of patients achieved total or partial improvement of lesions (vs. 25.8% in the last 2 groups). LS was negatively associated with the presence of hypertrophic subcutaneous adipose tissue (P<.001). DISCUSSION: Typical LS, which can often be unilateral, generally has a satisfactory outcome. The clinical characteristics of this form distinguish it from other types of lipoatrophy. Measures taken by the Occupational Health Service contributed to favorable outcomes. In this series, LS was not associated with marked subcutaneous adipose tissue hypertrophy in the thighs. Our proposed categories may help distinguish between cases of LS with a favorable prognosis and other cases presenting with skin surface depressions, which are often persistent.

Artificial Intelligence in Dermatology: A Threat or an Opportunity? / Inteligencia artificial en dermatología: ¿amenaza u oportunidad?

The worldwide explosion of interest in artificial intelligence (AI) has created a before-and-after moment in our lives by generating great improvements in such sectors as the automotive and food production industries. AI has even been called the fourth industrial revolution. Machine learning through AI is helping to improve professional processes and promises to transform the health care sector as we know it in various ways: 1) through applications able to promote health in the general population by providing high-quality information and offering advice for different segments of the population based on prediction models; 2) by developing prediction models based on anonymized clinical data, for preventive purposes in primary care; 3) by analyzing images to provide additional decision-making support for health care providers, for improving specialist care at the secondary level; and 4) through robotics applied to processes that promote health and well-being. However, the medical profession harbors doubts about whether this revolution is a threat or an opportunity owing to a lack of understanding of AI technology and the methods used to validate its applications. This article outlines basic aspects of AI as it is applied in dermatology and reviews the main advances achieved in the last 5 years.

[Sexually Transmitted Infections During the First Wave of the COVID-19 Pandemic in Spain]. / Infecciones de transmisión sexual (ITS) durante el estado de alarma por la pandemia de COVID-19 en España.

OBJECTIVE: To describe changes in sexually transmitted infection (STI) diagnoses during the first wave of the COVID-19 pandemic in Spain. MATERIAL AND METHODS: We collected demographic, chronological, and clinical data for all patients seen for a possible STI at Hospital La Paz, Centro Sanitario Sandoval, and Centro de Diagnóstico Médico in Madrid and Hospital Costa del Sol in Malaga between March 14, 2020 and June 30, 2020. RESULTS: We identified 674 STI diagnoses. The median age of the patients was 33 years. Most cases were observed among people aged 30 to 40 years and among men who have sex with men. The most common diagnoses were proctitis (36.5%), syphilis (16%), nongonococcal (13.3%) and gonococcal (11.3%) urethritis, genital herpes (8.8%), vulvovaginitis/cervicitis (8.3%), and genital warts (4.2%). A microbiologically confirmed diagnosis was on record for 77% of cases. The main microorganisms identified were Chlamydia trachomatis (35.7%), Neisseria gonorrhoeae (31.4%) and Treponema pallidum (17.2%). The number of STI diagnoses increased after the easing of lockdown restrictions, which resulted in greater freedom of movement and more consultations. On comparing the 2019 and 2020 STI registries from Centro Sanitario Sandoval and Hospital La Paz for the period March to June, we observed reductions (of up to 81%) in all STI diagnoses. CONCLUSIONS: Physical distancing and movement restrictions appear to have resulted in a reduction in the incidence of STIs, although these measures did not completely eliminate sexual risk behaviors.

What Proportion of the Spanish Dermatology Caseload Corresponds to Primarily Sexually Transmitted Infections and Other Anogenital Dermatoses? Results From the DIADERM National Random Survey. / ¿Cuánta carga asistencial suponen las infecciones de transmisión predominantemente sexual y otras dermatosis anogenitales en las consultas de Dermatología en España? Resultados del muestreo aleatorio nacional DIADERM.

BACKGROUND AND OBJECTIVE: Predominantly sexually transmitted infections (STIs) and infestations and other anogenital dermatoses are covered in the training of specialists in dermatology and venereology in Spain. This study aimed to analyze the proportion of the dermatology caseload these diseases account for within the public and private dermatological activity of the Spanish health system. MATERIAL AND METHODS: Observational cross-sectional study of time periods describing the diagnoses made in outpatient dermatology clinics, obtained through the anonymous DIADERM survey of a representative random sample of dermatologists. Based on diagnostic codes of the International Classification of Diseases, Tenth Revision, 36 related diagnoses were selected, and classified into 12 groups. RESULTS: Only 3.16% of diagnoses corresponded to STIs and other anogenital dermatoses. The most common diagnostic group was anogenital human papillomavirus infection, followed by molluscum contagiosum, and inflammatory anogenital dermatoses. Lesions with these diagnoses were usually the main reasons for first visits in the National Health Service. In private practice, the diagnoses usually came after referrals from other physicians. CONCLUSIONS: STIs and other anogenital dermatoses account for a very small proportion of the dermatology caseload in Spain, although the inclusion of molluscum contagiosum diagnoses overestimates these conditions. The fact that no STI centers or monographic STI consultations were included in the random sample of dermatology partly explains the under-representation of these areas of the specialty. A determined effort to support and promote monographic STI centres and clinics should be made.

Sexually Transmitted Infections During the First Wave of the COVID-19 Pandemic in Spain.

OBJECTIVE: To describe changes in sexually transmitted infection (STI) diagnoses during the first wave of the COVID-19 pandemic in Spain. MATERIAL AND METHODS: We collected demographic, chronological, and clinical data for all patients seen for a possible STI at Hospital La Paz, Centro Sanitario Sandaval, and Centro de Diagnóstico Médico in Madrid and Hospital Costa del Sol in Malaga between March 14, 2020 and June 30, 2020. RESULTS: We identified 674 STI diagnoses. The median age of the patients was 33 years. Most cases were observed among people aged 30 to 40 years and among men who have sex with men. The most common diagnoses were proctitis (36.5%), syphilis (16%), nongonococcal (13.3%) and gonococcal (11.3%) urethritis, genital herpes (8.8%), vulvovaginitis/cervicitis (8.3%), and genital warts (4.2%). A microbiologically confirmed diagnosis was on record for 77% of cases. The main microorganisms identified wereChlamydia trachomatis (35.7%), Neisseria gonorrhoeae (31.4%), and Treponema pallidum (17.2%). The number of STI diagnoses increased after the easing of lockdown restrictions, which resulted in greater freedom of movement and more consultations. On comparing the 2019 and 2020 STI registries from Centro Sanitario Sandoval and Hospital La Paz for the period March to June, we observed reductions (of up to 81%) in all STI diagnoses. CONCLUSIONS: Physical distancing and movement restrictions appear to have resulted in a reduction in the incidence of STIs, although these measures did not completely eliminate sexual risk behaviors.

OBJETIVO: Describir los cambios en el comportamiento de las ITS durante la situación de alerta sanitaria por la pandemia SARS-CoV-2. MATERIAL Y MÉTODOS: Se recogieron datos demográficos, cronológicos y clínicos de todos los pacientes que solicitaron atención médica por ITS en los hospitales La Paz y Costa del Sol, y los Centros Sandoval y de Diagnóstico Médico entre el 14/03/2020 y el 30/06/2020. RESULTADOS: Documentamos 674 casos de ITS. La mediana de edad fue de 33 años. El mayor porcentaje de casos se dio en el rango de 30-40 años y en hombres que tenían sexo con hombres. Los diagnósticos más frecuentes fueron: proctitis (36,5%), sífilis (16%), uretritis no gonocócica (13,3%) y gonocócica (11,3%), herpes genital (8,8%), vulvovaginitis/cervicitis (8,3%) y condilomas (4,2%).En 77% de los casos hubo confirmación microbiológica, siendo los microorganismos más frecuentes Chlamydia trachomatis (35,7%), Neisseria gonorrhoeae (31,4%) y Treponema pallidum (17,2%).Se constató un incremento del número de casos de ITS tras el desconfinamiento, explicable por las mayores libertades y el aumento de consultas. Comparando los registros de ITS del Centro Sandoval y el Hospital La Paz en los cuatrimestres de marzo a junio de 2019 frente a 2020, se observó una disminución en 2020 de todos los diagnósticos, de hasta un 81% menos que en 2019. CONCLUSIONES: Las medidas de distanciamiento y limitación de movilidad aparentemente generaron una disminución de la incidencia de ITS, pero sin llegar a una inhibición completa de las conductas sexuales de riesgo.