RESUMO
Attention has been focused on new ways to understand and manage urticaria ever since the recent addition of novel drugs to the therapeutic arsenal, the updating of clinical practice guidelines, and the publication of pathophysiologic insights. The Andalusian Section of the Spanish Academy of Dermatology and Venereology (AEDV) has developed a clinical pathway that defines quality-of-care characteristics and makes recommendations on decision-making affecting patients with urticaria. We present a patient-centered approach to care, in which the patient's clinical pathway through the health care system includes links between primary and hospital care to ensure continuity-a key feature of quality.
Assuntos
Procedimentos Clínicos , Urticária/diagnóstico , Urticária/terapia , Doença Aguda , Doença Crônica , HumanosRESUMO
Benign skin lesions are a common reason for visits to primary care physicians and dermatologists. However, access to diagnosis and treatment for these lesions varies considerably between users, primarily because no explicit or standardized criteria for dealing with these patients have been defined. Principally with a view to reducing this variability in the care of patients with benign cysts or tumors, the Andalusian Regional Section of the Spanish Academy of Dermatology and Venereology (AEDV) has created a Process of Care document that describes a clinical pathway and quality-of-care characteristics for each action. This report also makes recommendations for decision-making with respect to lesions of this type.
Assuntos
Procedimentos Clínicos , Cistos/diagnóstico , Cistos/terapia , Dermatopatias/diagnóstico , Dermatopatias/terapia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/terapia , HumanosRESUMO
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 , UltrassonografiaRESUMO
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.
Assuntos
Tinha do Couro Cabeludo/epidemiologia , Tinha do Couro Cabeludo/microbiologia , Criança , Pré-Escolar , Epidermophyton/isolamento & purificação , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Microsporum/isolamento & purificação , Estudos Retrospectivos , Espanha/epidemiologia , Trichophyton/isolamento & purificaçãoAssuntos
Citosina/análogos & derivados , Organofosfonatos/uso terapêutico , Verrugas/tratamento farmacológico , Administração Tópica , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Cidofovir , Citosina/administração & dosagem , Citosina/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Organofosfonatos/administração & dosagem , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Superficial basal cell carcinoma (sBCC) and Bowen's disease (BD) are usually slow-growing, low-grade malignancies that mainly affect older persons. Surgery is often the first choice of treatment and the modality with the lowest failure rate. However, non-invasive procedures, such as topical methyl aminolevulinate photodynamic therapy (MAL-PDT) and imiquimod, are increasingly demanded by dermatologists and patients, because of their generally favourable efficacy and adverse effects profile and their excellent cosmetic outcome. OBJECTIVE: To assess the cost of MAL-PDT and of treatment with imiquimod for primary non-melanoma superficial cutaneous carcinomas compared with conventional surgery, thereby calculating the total medical cost, and the direct and indirect costs. SETTING: We collected data on 67 patients with 86 tumours (32 sBCC, 54 BD). Patients were treated between May 2006 and April 2007 at the Dermatology Department of the Costa del Sol Hospital in Marbella, Spain. The mean cost and mean cost per complete clinical response were calculated for each therapeutic option. RESULTS: After 2 years of follow-up, a complete response was observed in 89.5% of the MAL-PDT group, 87.5% of the imiquimod group and 97.5% of the surgery group. The difference in costs when compared with the surgery group was a mean saving per lesion treated of 307 euros for the imiquimod group, and 322 euros for the MAL-PDT group. CONCLUSIONS: Although surgery proved to be more effective treatment, our results suggest that its average cost is greater than that of non-invasive therapy for the treatment of non-melanoma superficial cutaneous carcinomas on the lower limbs, at least after the first 2 years of follow-up.
Assuntos
Ácido Aminolevulínico/análogos & derivados , Aminoquinolinas/uso terapêutico , Doença de Bowen/tratamento farmacológico , Carcinoma Basocelular/tratamento farmacológico , Fotoquimioterapia/economia , Neoplasias Cutâneas/tratamento farmacológico , Ácido Aminolevulínico/economia , Ácido Aminolevulínico/uso terapêutico , Aminoquinolinas/economia , Doença de Bowen/cirurgia , Carcinoma Basocelular/cirurgia , Análise Custo-Benefício , Humanos , Imiquimode , Neoplasias Cutâneas/cirurgiaAssuntos
Etanercepte/efeitos adversos , Psoríase/tratamento farmacológico , Sarcoidose/induzido quimicamente , Adulto , Citocinas/fisiologia , Etanercepte/uso terapêutico , Humanos , Doenças Linfáticas/induzido quimicamente , Doenças Linfáticas/diagnóstico por imagem , Masculino , Modelos Imunológicos , Psoríase/complicações , Psoríase/imunologia , Sarcoidose/diagnóstico por imagem , Sarcoidose/imunologia , Sarcoidose Pulmonar/induzido quimicamente , Sarcoidose Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Fator de Necrose Tumoral alfa/antagonistas & inibidoresRESUMO
BACKGROUND AND OBJECTIVES: Recent years have seen a resurgence of syphilis in Spain due to changes in sexual behavior. Here we describe the incidence of the disease in our clinic and investigate its relationship with the sexual habits of men who have sex with men (MSM). PATIENTS AND METHODS: A cross-sectional descriptive study of incident cases of syphilis in 2007 and 2008 was performed, followed by a case-control study of sexual behavior in the previous year to compare MSM with and without syphilis. RESULTS: We recorded 26 new cases of syphilis, 19 of which were diagnosed at early stages. Eight patients were infected with human immunodeficiency virus and 15 were classed as MSM. Sixty-five MSM without syphilis were selected as a control group. MSM with syphilis had a larger number of sexual partners: odds ratio (OR), 3.98 (95% confidence interval [CI], 0.90-17.46) for the category "2 to 5 sexual partners"; OR, 3.22 (95% CI, 0.84-12.43) for the category "more than 5 sexual partners". The inconsistent use of condoms was significantly more common among MSM with syphilis than among those without syphilis (OR, 3.96; 95% CI, 1.15-13.61; p=0.02). CONCLUSIONS: Syphilis continues to be a public health problem in our setting, particularly among homosexual and bisexual men. In this study, inconsistent use of condoms and a greater number of sexual partners were risk factors for syphilis in MSM. The development of prevention programs targeting this at-risk population should be considered a priority.