Clinicopathological characteristics of cutaneous and mucocutaneous leishmaniasis in patients treated with TNF-α inhibitors.

BACKGROUND AND OBJECTIVES: The increasing use of biologics in the treatment of inflammatory diseases has led to more cases of leishmaniasis in patients subjected to iatrogenic immunosuppression. The main objective was to describe the characteristics of the patients with cutaneous (CL) or mucocutaneous (MCL) leishmaniasis who were receiving a biological therapy at the time of diagnosis. PATIENTS AND METHODS: A multicenter retrospective study was design based on a cohort of patients diagnosed with CL or MCL. All patients who were being treated with biologicals were included. For each case, two matched non-exposed patients were included for comparison. RESULTS: 38 patients were diagnosed with CL or MCL while being treated with tumor necrosis factor alpha (TNF-α) inhibitors. Leishmaniasis presented more frequently as a plaque (58.3%) with a larger median lesion size (2.5 cm), ulceration (92.1%), and required a greater median number of intralesional meglumine antimoniate infiltrations (3 doses) (P < 0.05) than in non-exposed patients. We found no systemic involvement in patients being treated with anti-TNF-α. We did not find differences regarding the treatment characteristics whether biologic therapy was modified or not. CONCLUSIONS: Although management should be individualized, maintenance of biologic therapy does not seem to interfere with treatment of CL or MCL.

Dolor e inflamación del pabellón auricular / Pain and inflammation of the pinna

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Síndrome de Sweet asociado a colitis ulcerosa / Sweet syndrome inapatient with ulcerouscolitis

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Fiabilidad diagnóstica de una consulta de teledermatología asíncrona / Diagnostic reliability of an asynchronous teledermatology consultation

Objetivo: Analizar el índice de concordancia diagnóstica entre atención primaria, una consulta de teledermatología asíncrona y una consulta de dermatología convencional.Diseño: Estudio prospectivo de concordancia no aleatorizado.Emplazamiento: Servicio de Dermatología del Hospital Son Llàtzer(Palma de Mallorca) ycentros de salud de Sóller y Arenal(Mallorca).Participantes: Se ha incluido a 158 pacientes entre diciembre de 2005 y julio de 2008 remitidos mediante teleconsulta.Mediciones principales: Análisis de los diagnósticos de atención primaria, de la consulta de teledermatología y de la consulta presencial en el periodo establecido. Cálculo delíndice kappa de concordancia.Resultados: Desde diciembre de 2005 hasta julio de 2008 se realizaron 158 teleconsultas: 94 (59,5%) mujeres y 64(40,5%) varones, de edades comprendidas entre 9 y 96 (media, 55)años. Agrupando los diagnósticos en categorías, la distribución fue: 48(37,2%) tumoresbenignos, 39 (30,2%)afecciones inflamatorias y de anejos, 15 (11,6%)enfermedades infecciosas, 14 (10,9%)tumores malignos y 13 (10,1%)tumores premalignos. En losdiagnósticos agrupados, la concordancia fue del 59,8% (intervalo de confianza[IC] del 95%, 50–70%) (p<0,0001) para atención primaria y del 94,7%(IC del 95%, 90–99%) (p<0,0001)para teledermatología.Conclusiones: La principal ventaja de la teledermatología asíncrona es la mejora en la calidad del cribado, que detecta lesiones malignas o sospechosas. Sin embargo, precisamos estudios metodológicamente comparables a mayor escala para evaluar tambiéninconvenientes (limitación de la técnica fotográfica, valoración de otras lesiones, aspectos legales, motivación de los profesionales, etc.)(AU)

Objective: To analyze the diagnostic agreement rate between primary care,anasynchronous teledermatology consultation, and a conventional dermatology consultation.Design: Prospective non-randomized concordance study.Setting: Dermatology Service in Hospital Son Llàtzer (Palma de Mallorca)and primary care centers of Sóller and Arenal(Mallorca).Participants: Patients have been included from December 2005 to July 2008, sent byteleconsultation (n = 158).Main measurements: Analysis of primary care, teledermatology consultation and face-to-face consultation diagnosis, in mentioned period of time. Calculation of kappa index of concordance.Results: 158 teleconsultations have been made from December 2005 to July 2008, 94 (59,5%) women, and 64(40,5%) men, aged from 9 to 96 years old (average, 55 year sold). After grouping the diagnosis in categories, the distribution was: 48 (37,2%) benigntumours, 39 (30,2%)inflammatory and appendages diseases, 15 (11,6%)infectious diseases, 14 (10,9%)malignant tumours, and 13 (10,1%)premalignant tumours. In grouped diagnosis, concordance was 59,8%(CI 95%, 50–70%) (P<0001) for general practitioner and 94,7% (CI 95%, 90–99%) (P<0001) forteledermatologist.Conclusions: The main advantage of asynchronous teledermatology is the improvement of the quality triage, allowing the detection of malignantor suspicious lesions. However, we need more comparable studies on a larger scale to evaluate the disadvantages(photographic technique limitation, evaluation of other lesions, legal aspects, professional motivation...)(AU)