RESUMO
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.
Assuntos
Acne Vulgar , Dermatologia , Dermatopatias , Adolescente , Criança , Humanos , Dermatopatias/diagnóstico , Dermatopatias/epidemiologia , Estudos Transversais , Espanha/epidemiologiaRESUMO
INTRODUCTION: In recent years, increasing use has been made of oral anticholinergics such as oxybutynin for the management of hyperhidrosis. The primary aim of this study is to determine the variables associated with adherence to this treatment, and secondarily to obtain data on its effectiveness, safety and adverse effects. MATERIAL AND METHODS: This is a prospective study of patients with hyperhidrosis, at any location, receiving treatment with oral oxybutynin in the period 2007-2016. Epidemiological variables, treatment details, effectiveness and adverse effects were recorded. Effectiveness was determined according to the Hyperhidrosis Disease Severity Scale (HDSS) at baseline, at 3 and 12 months and in successive visits. A descriptive analysis was performed, and Cox's bivariate and multivariate regressions were calculated to determine the variables associated with treatment adherence. RESULTS: A total of 201 patients (140 women) with a mean age of 34 years were included. The mean initial HDSS score was 3.8, and the median follow-up period was 29 months. At 3 months, 84.57% of the patients had responded to treatment (excellent response: 72.94%), but adverse effects were reported by 68.2%. At 12 months, 54.23% had responded (excellent response: 79.82%), with adverse effects in 75.2%. The main variable associated with greater adherence was affected areas: palms of the hands and soles of the feet. The following variables were associated with poorer adherence: onset of hyperhidrosis in adolescence, failure to provide an incrementally increasing, individualized dose, initial HDSS score of 3 and partial initial response. The multivariate analysis confirmed the association between the onset of hyperhidrosis during adolescence, the failure to provide a progressively increasing dose and palmar affectation. DISCUSSION: This study was conducted to identify the variables associated with adherence to treatment by hyperhidrosis patients treated with oral oxybutynin. This information would facilitate selection of patients for this treatment and enhance our understanding of the biological behaviour of such anticholinergics when used to treat hyperhidrosis.
Assuntos
Hiperidrose/tratamento farmacológico , Ácidos Mandélicos/uso terapêutico , Parassimpatolíticos/uso terapêutico , Cooperação do Paciente , Administração Oral , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Ácidos Mandélicos/administração & dosagem , Ácidos Mandélicos/efeitos adversos , Pessoa de Meia-Idade , Parassimpatolíticos/efeitos adversos , Estudos Prospectivos , Adulto JovemRESUMO
Until quite recently, clinical guidelines and reviews on the treatment of hyperhidrosis advised against the use of systemic therapies based on their unacceptable adverse effects and a lack of evidence of usefulness. Numerous studies published over the past few years, however, have shown that, when used appropriately, these treatments are effective and in general have a favorable tolerability profile, making them an additional option for the treatment of hyperhidrosis, particularly for disease that is widespread, multifocal, or resistant to other treatments. In this review, the first of its kind, we examine the systemic therapies available for hyperhidrosis, including antihypertensives, psychoactive agents, and in particular oral anticholinergics, although none of these drugs are currently approved for this indication.
Assuntos
Hiperidrose/tratamento farmacológico , Anti-Hipertensivos/uso terapêutico , Antagonistas Colinérgicos/uso terapêutico , Ensaios Clínicos como Assunto , Gerenciamento Clínico , Medicina Baseada em Evidências , Glicopirrolato/uso terapêutico , Humanos , Metanálise como Assunto , Uso Off-Label , Psicotrópicos/uso terapêuticoRESUMO
BACKGROUND AND OBJECTIVES: Skin cancer prevention and detection campaigns targeting specific groups are necessary and have proven to be more effective than those aimed at the general population. Interventions in outdoor tourist spots have proven successful, although none have specifically targeted golf courses. The aims of this study were to describe the risk profile of golfers and golf course workers and evaluate the impact of a skin cancer prevention and early detection intervention. MATERIAL AND METHODS: This was a cross-sectional descriptive study conducted at 6 golf courses. The intervention included a skin examination and completion of a questionnaire about demographic details, risk factors, and sun exposure and sun protection habits. Participants were also given advice on sun protection measures, self-examination, and use of sunscreens, and were asked about their satisfaction with the intervention and their intention to change their current behaviors. The effect was measured in terms of the diagnoses made, satisfaction with the intervention, reported intention to change, and potential effect in terms of existing risk factors. RESULTS: Of the 351 participants (57% golfers and 43% golf course workers), 70.4% had fair skin, 11.7% had a family history of skin cancer, and 8.5% had a personal history of skin cancer. Skin cancer and actinic keratoses were diagnosed in 10.7% and 40% of the golfers, respectively. The session was rated positively by 99.4% of the participants; 93.9% stated that they intended to improve their sun exposure habits and 93.4% said that they planned to examine their skin more frequently. CONCLUSIONS: Our findings confirm that golf course workers and, in particular, golfers are an important target for skin cancer prevention campaigns. This is the first intervention to specifically target golf courses, and it proved to be both feasible and useful. Its success appears to be attributable to numerous factors: it was conducted at golf courses, had multiple components, and was preceded by a motivational campaign.
Assuntos
Detecção Precoce de Câncer , Golfe , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/prevenção & controle , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Cutâneas/etiologia , Espanha , Luz Solar/efeitos adversosRESUMO
Certain skin conditions, such as vitiligo, acne, vascular malformations, and surgical scars, can impair the quality of life of pediatric patients, especially adolescents-even to the point of hindering psychosocial development. We review the cases of 6 patients with discoloration or scarring, predominantly of the face, who attended our cosmetic camouflage workshops from January through December 2012. The quality-of-life impact of their skin disorder was assessed before and after workshop attendance. Cosmetic camouflage is an easily replicated, cheap, and noninvasive adjunctive treatment of great potential value in managing skin conditions that impair the physical and emotional well-being of pediatric patients.
Assuntos
Cosméticos , Educação de Pacientes como Assunto , Qualidade de Vida , Acne Vulgar/terapia , Adolescente , Criança , Cicatriz/terapia , Feminino , Humanos , Hipopigmentação/terapia , Masculino , Nevo de Ota/terapia , Neoplasias Cutâneas/terapia , Vitiligo/terapiaRESUMO
INTRODUCTION AND OBJECTIVES: Accurate subtyping of basal cell carcinoma (BCC) is crucial for the effective management of this disease and it is particularly important to distinguish between aggressive and nonaggressive histologic variants. Histologic subtype is not always accurately identified by biopsy and this can have serious implications. High-resolution ultrasound (HRUS) is a recent technique that has proven to be of value in differentiating between variants of BCC. The aim of this study was to investigate the potential usefulness of HRUS for detecting invasive disease in recurrent BCC treated nonsurgically following an initial diagnosis of noninvasive BCC by biopsy. MATERIAL AND METHODS: This was a prospective observational study of consecutive cases of BCC with clinical suspicion of recurrence following nonsurgical treatment and a pretreatment diagnosis of superficial BCC by punch biopsy. Before surgical excision, the recurrent lesions were evaluated by HRUS followed by a punch biopsy of the site of suspected recurrence. The diagnostic agreement between HRUS, punch biopsy, and excisional biopsy was then evaluated. RESULTS: Eight lesions were studied. HRUS identified invasive disease in 3 of the 4 cases that were incorrectly classified as superficial subtypes by punch biopsy. CONCLUSION: HRUS could be useful for detecting persistent tumor after nonsurgical treatment and for choosing the site most likely to harbor invasive disease for punch biopsy.
Assuntos
Carcinoma Basocelular/diagnóstico por imagem , Recidiva Local de Neoplasia/diagnóstico por imagem , Neoplasias Cutâneas/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basocelular/patologia , Carcinoma Basocelular/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia/patologia , Estudos Prospectivos , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/terapia , UltrassonografiaAssuntos
Glicopirrolato/administração & dosagem , Hiperidrose/tratamento farmacológico , Antagonistas Muscarínicos/administração & dosagem , Administração Oral , Adolescente , Adulto , Idoso , Criança , Esquema de Medicação , Feminino , Glicopirrolato/efeitos adversos , Humanos , Masculino , Ácidos Mandélicos/administração & dosagem , Pessoa de Meia-Idade , Antagonistas Muscarínicos/efeitos adversos , Estudos Prospectivos , Resultado do Tratamento , Adulto JovemRESUMO
The incidence of tinea incognito (TI) appears to have increased over recent years, although no large series of cases has been reported in children. The aim of this study was to analyse the main epidemiological, clinical and microbiological characteristics of TI diagnosed in children in comparison with other tineas. We undertook a retrospective study of 818 tineas diagnosed in children in a referral hospital between 1977 and 2006, concentrating on TI. Of the 54 TI diagnosed, 85% were in the last 15 years. Most children were older than 9 years of age. The most usual clinical forms were tinea corporis (46.3%) and tinea faciei (38.9%). Topical steroids alone had been used to treat 68.5% of the cases. Direct examination was positive in 91.5% of the cases examined. Culture was positive in 85.2% of cases. The most frequently isolated dermatophyte was Trichophyton mentagrophytes (44.4%). This is the largest case series of childhood TI reported to date. TI has increased over recent years and important differences were found between these TI and the other tineas in children over the same period.
Assuntos
Arthrodermataceae/isolamento & purificação , Tinha/epidemiologia , Tinha/patologia , Adolescente , Arthrodermataceae/classificação , Criança , Pré-Escolar , Feminino , Hospitais , Humanos , Incidência , Lactente , Masculino , Estudos Retrospectivos , Espanha/epidemiologia , Tinha/microbiologiaRESUMO
BACKGROUND: Tinea capitis (TC) is the most common mycological infection in childhood. The epidemiology of TC varies depending on the geographical area and the time of study, and although it is an important public health problem in our area, only a few long-term studies have focused on children. OBJECTIVES: The aim of this study was to analyse the main epidemiological, clinical and microbiological features of TC in children over 30 years and compare these features with those of other tineas. METHODS: We undertook a retrospective study of 818 tineas in children at a referral hospital in southern Spain diagnosed between 1977 and 2006, concentrating on TC. RESULTS: Of the 444 TC diagnosed, 61.5% were in boys. Most children (66.9%) were aged 4-9 years. Twelve patients were immigrants. Inflammatory clinical forms were present in 18.2% of cases. At the time of diagnosis, 10.4% of the cases had been treated with antifungal agents. The most frequently isolated dermatophyte was Microsporum canis (63.5%). CONCLUSIONS: We report the largest study of TC in Spain. Our results were very similar to those in other national studies, noting a predominance of non-inflammatory cases of TC caused by zoophilic dermatophytes. Although the species of the causal dermatophytes have not varied substantially in this period, the increasing number of immigrants may lead to a change in the aetiology of TC in the future. The number of cases referred to the dermatology department who have already been treated shows a lack of communication between primary care and dermatology.