Morfea en la infancia: actualización / Morphea in Childhood: An Update

La morfea es una enfermedad de la piel que se manifiesta en forma de inflamación y fibrosis. En niños y jóvenes, también se conoce como esclerodermia juvenil localizada. En edad infantil, afecta con mayor frecuencia al sexo femenino y la edad de comienzo se ha establecido en torno a los 5-7 años. Una clasificación reciente divide la morfea en: circunscrita (en placas), lineal, generalizada, panesclerótica y mixta. Alrededor de un 40% de los pacientes presentan manifestaciones extracutáneas. Los tratamientos empleados en morfea infantil son: fototerapia, calcitriol oral, calcipotriol tópico, tacrolimus 0,1% tópico, metotrexato, glucocorticoides tópicos y sistémicos, mofetil micofenolato, bosentán e imiquimod 5% tópico. Diversas medidas de resultado pueden ayudar a monitorizar el tratamiento. Los estudios pronósticos son escasos, pero apuntan hacia una enfermedad con tendencia a un curso crónico o intermitente-recurrente y una frecuencia considerable de secuelas

Morphea is an inflammatory, fibrosing skin disorder. When it occurs in childhood, it is also known as localized juvenile scleroderma. It is more common in girls and typically appears around the age of 5 to 7 years. According to a recent classification system, morphea is divided into 5 types: circumscribed (plaque), linear, generalized, pansclerotic, and mixed. Approximately 40% of patients present extracutaneous manifestations. Childhood morphea is treated with phototherapy, oral or topical calcitriol, topical tacrolimus 0.1%, methotrexate, topical or systemic corticosteroids, mycophenolate mofetil, bosentán, and topical imiquimod 5%. A variety of measuring tools are used to monitor response to treatment. Few prognostic studies have been conducted, but findings to date suggest that the disease tends to run a chronic or intermittent-recurrent course and frequently causes sequelae

Morphea in Childhood: An Update. / Morfea en la infancia: actualización.

Morphea is an inflammatory, fibrosing skin disorder. When it occurs in childhood, it is also known as localized juvenile scleroderma. It is more common in girls and typically appears around the age of 5 to 7 years. According to a recent classification system, morphea is divided into 5 types: circumscribed (plaque), linear, generalized, pansclerotic, and mixed. Approximately 40% of patients present extracutaneous manifestations. Childhood morphea is treated with phototherapy, oral or topical calcitriol, topical tacrolimus 0.1%, methotrexate, topical or systemic corticosteroids, mycophenolate mofetil, bosentán, and topical imiquimod 5%. A variety of measuring tools are used to monitor response to treatment. Few prognostic studies have been conducted, but findings to date suggest that the disease tends to run a chronic or intermittent-recurrent course and frequently causes sequelae.

Modalidades de fototerapia para el tratamiento de la dermatitis atópica: revisión sistemática de la literatura / Phototherapy in Atopic Dermatitis: A Systematic Review of the Literature

Antecedentes: La fototerapia es una opción terapéutica empleada en dermatitis atópica (DA) y recomendada en múltiples guías. Objetivos: Evaluar la eficacia de las distintas modalidades de fototerapia y fotoquimioterapia en el tratamiento de pacientes con DA moderada-grave, mediante una revisión sistemática. Material y métodos: Consideramos los ensayos clínicos aleatorizados (ECA) realizados en pacientes con DA, aceptando cualquier medida de desenlace. Localizamos los artículos mediante una búsqueda electrónica, utilizando Medline (vía Ovid), Embase y Cochrane Central Register of Controlled Trials. Adicionalmente, buscamos los ensayos clínicos registrados en Current Controlled Trials y en la WHO International Clinical Trials Registry Platform. Resultados: Incluimos 21 ECA en el análisis cualitativo (961 pacientes). Dos ECA incluyeron niños y adolescentes (32 pacientes). Las modalidades UVBBE y UVA1 mostraron resultados de eficacia similares en diversas medidas de desenlace. Dos ECA incluyeron la terapia PUVA. No se describieron efectos secundarios graves. En general, el riesgo de sesgos fue elevado y la calidad de las publicaciones baja, en cuanto a comunicación de la metodología empleada y los resultados obtenidos. Conclusiones: Existe evidencia para el uso de UVBBE y UVA1 en DA moderada-grave. La evidencia para el uso de PUVA en DA es mínima, así como los datos del uso de la fototerapia en la infancia. En futuros estudios sería recomendable estandarizar los criterios de gravedad de la DA y las escalas de valoración de los pacientes, homogeneizar las técnicas de irradiación y establecer un periodo de seguimiento mínimo (AU)

Background: Phototherapy is a treatment option for atopic dermatitis recommended by several guidelines. Objective: To perform a systematic review of the efficacy of different modalities of phototherapy and photochemotherapy in moderate to severe atopic dermatitis. Material and methods: We considered all randomized clinical trials (RCTs) performed in patients with atopic dermatitis, and accepted all outcome measures. Articles were identified via an online search of the MEDLINE (via Ovid) and Embase databases and the Cochrane Central Register of Controlled Trials. We also searched for clinical trials registered in Current Controlled Trials and in the World Health Organization’s International Clinical Trials Registry Platform. Results: Twenty-one RCTs (961 patients) were included in the qualitative analysis. Two of the trials included children and adolescents (32 patients). The efficacy of narrow-band UV-B and UV-A1 phototherapy was similar for the different outcome measures contemplated. Two RCTs assessed the efficacy of psoralen plus UV-A therapy (PUVA). No serious adverse events were described. In general, the publications reviewed were characterized by a high risk of bias and poor reporting of methodology and results. Conclusions: There is evidence for the use of narrow-band UV-B and UV-A1 phototherapy in moderate to severe atopic dermatitis. Evidence supporting the use of PUVA in atopic dermatitis is scarce and there is little information on the use of phototherapy in childhood. For the purpose of future studies, it would be advisable to use comparable criteria and scales for the evaluation of disease severity and patients, to standardize radiation methods, and to establish a minimum follow-up time (AU)

Phototherapy in atopic dermatitis: a systematic review of the literature.

BACKGROUND: Phototherapy is a treatment option for atopic dermatitis recommended by several guidelines. OBJECTIVE: To perform a systematic review of the efficacy of different modalities of phototherapy and photochemotherapy in moderate to severe atopic dermatitis. MATERIAL AND METHODS: We considered all randomized clinical trials (RCTs) performed in patients with atopic dermatitis, and accepted all outcome measures. Articles were identified via an online search of the MEDLINE (via Ovid) and Embase databases and the Cochrane Central Register of Controlled Trials. We also searched for clinical trials registered in Current Controlled Trials and in the World Health Organization's International Clinical Trials Registry Platform. RESULTS: Twenty-one RCTs (961 patients) were included in the qualitative analysis. Two of the trials included children and adolescents (32 patients). The efficacy of narrow-band UV-B and UV-A1 phototherapy was similar for the different outcome measures contemplated. Two RCTs assessed the efficacy of psoralen plus UV-A therapy (PUVA). No serious adverse events were described. In general, the publications reviewed were characterized by a high risk of bias and poor reporting of methodology and results. CONCLUSIONS: There is evidence for the use of narrow-band UV-B and UV-A1 phototherapy in moderate to severe atopic dermatitis. Evidence supporting the use of PUVA in atopic dermatitis is scarce and there is little information on the use of phototherapy in childhood. For the purpose of future studies, it would be advisable to use comparable criteria and scales for the evaluation of disease severity and patients, to standardize radiation methods, and to establish a minimum follow-up time.

Empleo de las revisiones sistemáticas en ensayos clínicos y revisiones narrativas en dermatología: ¿se usa la mejor evidencia disponible? / The Use of Systematic Reviews in Clinical Trials and Narrative Reviews in Dermatology: Is the Best Evidence Being Used?

INTRODUCCIÓN Y OBJETIVOS: Las revisiones sistemáticas son la forma de revisión más exhaustiva y deberían ser consideradas antes de realizar un ensayo clínico o revisión sobre un tema. El objetivo de este estudio es describir la utilización de revisiones sistemáticas en los ensayos clínicos y revisiones narrativas publicadas en dermatología. MATERIAL Y MÉTODOS: Se diseñó un estudio descriptivo transversal. Se seleccionaron ensayos clínicos aleatorizados y revisiones narrativas de las revistas más relevantes (por factor de impacto) de investigación clínica de dermatología y de Actas Dermosifiliográficas y se evaluó si hacían referencia a revisiones sistemáticas y Cochrane (en caso de existir) en la bibliografía. RESULTADOS: En el grupo de ensayos clínicos se hacía referencia a alguna de las revisiones sistemáticas existentes en el 33,3% de los artículos (15,6% de las revisiones Cochrane que existían y 32,2% de las no Cochrane sobre el tema). En el grupo de revisiones narrativas alguna de las revisiones sistemáticas existentes eran referenciadas en el 41,7% de los trabajos (20% Cochrane y 35,3% no Cochrane). En Actas Dermosifiliográficas existían muy pocos ensayos clínicos publicados; las revisiones narrativas reproducían lo que se observaba en el resto de revistas. CONCLUSIONES: Las revisiones sistemáticas son poco tenidas en cuenta en la realización de ensayos clínicos y revisiones narrativas, lo que puede llevar a estudios y publicaciones redundantes. Además las revisiones Cochrane parecen ser incluso menos empleadas, obviando así los autores una de las principales fuentes de evidencia existentes

INTRODUCTION AND OBJECTIVES: Systematic reviews -the most comprehensive type of literature review-should be taken into account before a clinical trial or a narrative review on a topic is undertaken. The objective of this study was to describe the use of systematic reviews in clinical trials and narrative reviews in dermatology. MATERIAL AND METHODS: This was a descriptive cross-sectional study. We selected randomized clinical trials and narrative reviews from the dermatological clinical research journals identified as most important (according to impact factor) and from Actas Dermosifiliográficas , and studied the bibliographies to ascertain whether the authors made reference to existing systematic reviews and Cochrane reviews. RESULTS: Of the 72 clinical trials for which a systematic review was available, 24 (33.3%) cited at least 1 review; reference was made to relevant Cochrane reviews in 15.6% of cases and to non-Cochrane reviews in 32%. In the case of the 24 narrative reviews for which a review was available, 10 (41.7%) cited at least 1 review; Cochrane reviews were cited in 20% and non-Cochrane reviews in 35.3%.In the case of Actas Dermosifiliográficas , very few clinical trials were found and the findings for narrative review articles were similar to those observed for the other journals. CONCLUSIONS: Systematic reviews are not often taken into account by the authors of clinical trials and narrative reviews and this may lead to redundant studies and publications. Authors appear to use Cochrane reviews even less than non-Cochrane reviews and are therefore ignoring one of the main sources of available evidence

The use of systematic reviews in clinical trials and narrative reviews in dermatology: is the best evidence being used?

INTRODUCTION AND OBJECTIVES: Systematic reviews -the most comprehensive type of literature review-should be taken into account before a clinical trial or a narrative review on a topic is undertaken. The objective of this study was to describe the use of systematic reviews in clinical trials and narrative reviews in dermatology. MATERIAL AND METHODS: This was a descriptive cross-sectional study. We selected randomized clinical trials and narrative reviews from the dermatological clinical research journals identified as most important (according to impact factor) and from Actas Dermosifiliográficas, and studied the bibliographies to ascertain whether the authors made reference to existing systematic reviews and Cochrane reviews. RESULTS: Of the 72 clinical trials for which a systematic review was available, 24 (33.3%) cited at least 1 review; reference was made to relevant Cochrane reviews in 15.6% of cases and to non-Cochrane reviews in 32%. In the case of the 24 narrative reviews for which a review was available, 10 (41.7%) cited at least 1 review; Cochrane reviews were cited in 20% and non-Cochrane reviews in 35.3%.In the case of Actas Dermosifiliográficas, very few clinical trials were found and the findings for narrative review articles were similar to those observed for the other journals. CONCLUSIONS: Systematic reviews are not often taken into account by the authors of clinical trials and narrative reviews and this may lead to redundant studies and publications. Authors appear to use Cochrane reviews even less than non-Cochrane reviews and are therefore ignoring one of the main sources of available evidence.

Prevalencia de la epidermólisis ampollosa distrófica en España: estudio poblacional usando el método de captura-recaptura con 3 fuentes de datos. Evidencia de la necesidad de mejora en la atención sociosanitaria / Prevalence of Dystrophic Epidermolysis Bullosa in Spain: A Population-Based Study Using the 3-Source Capture-Recapture Method. Evidence of a Need for Improvement in Care

Antecedentes: No existen datos sobre la prevalencia de la epidermólisis ampollosa distrófica en España (EAD). La EAD es una enfermedad rara que conlleva una gran carga para el paciente que la sufre y para el sistema de salud que le atiende. Objetivo: Describir la prevalencia de la EAD en España. Métodos: Hemos empleado datos procedentes de 3 fuentes incompletas de pacientes: departamentos de Dermatología, 2 laboratorios de diagnóstico y la Asociación española de pacientes con epidermólisis ampollosa, DEBRA España, y los hemos combinado usando el método de captura-recaptura. Resultados: Hemos identificado 152 pacientes vivos. La prevalencia estimada de EAD fue de 6,0 casos por millón de habitantes (IC 95%: 4,2-11,8). La prevalencia en niños menores de 18 años fue de 15,3 por millón (IC 95%: 10,4-40,8). De acuerdo con el modelo de captura-recaptura el 77% no son seguidos en unidades de referencia, el 65% no tienen diagnóstico genético y el 76% no pertenecen a DEBRA. Conclusiones: La prevalencia de EAD en España es de 6,0 pacientes por millón de habitantes (IC 95%: 4,2 a 11,8), un número mayor que el estimado en otras zonas del mundo, pero similar a otros encontrados en otros países del Sur de Europa. Este resultado puede ser debido a auténticas variaciones geográficas, o a que los otros registros recogen un número incompleto de casos. La mayoría de los pacientes no son seguidos en unidades de referencia, no tienen diagnóstico genético y no son miembros de la asociación de pacientes, lo cual quiere decir que su situación sociosanitaria es muy mejorable (AU)

Background: Dystrophic epidermolysis bullosa (DEB) is a rare disease that represents a heavy burden for both the patient and the health care system. There are currently no data on the prevalence of DEB in Spain. Objective: To determine the prevalence of DEB in Spain. Methods: We used data from 3 incomplete population-based sources (hospital dermatology departments, diagnostic laboratories performing antigenic mapping, genetic testing or both, and the Spanish Association of Epidermolysis Bullosa Patients [DEBRA]) and combined them using the 3-source capture–recapture methodology. Results: We identified 152 living DEB patients. The estimated prevalence of DEB was 6.0 cases per million (95% CI, 4.2–11.8) in adults and 15.3 (95% CI, 10.4–40.8) in children under 18 years of age. The data indicated that 77% of the patients were not being followed up in specialized centers of reference; 65% had not had a genetic diagnosis, and 76% were not members of DEBRA. Conclusions: The prevalence of DEB in Spain is 6.0 patients per million (95% CI, 4.2–11.8), a figure higher than previous estimates in many areas, but similar to those found in other southern Europe countries. The north–south difference may represent real geographic differences in prevalence, but it might be due to the fact that most of the data come from registries with a lower than expected catchment. Many patients are not being followed up in centers of reference, do not have genetic diagnosis, and are not members of patients’ associations, suggesting that there is room for considerable improvement in their care (AU)

Prevalence of dystrophic epidermolysis bullosa in Spain: a population-based study using the 3-source capture-recapture method. Evidence of a need for improvement in care.

BACKGROUND: Dystrophic epidermolysis bullosa (DEB) is a rare disease that represents a heavy burden for both the patient and the health care system. There are currently no data on the prevalence of DEB in Spain. OBJECTIVE: To determine the prevalence of DEB in Spain. METHODS: We used data from 3 incomplete population-based sources (hospital dermatology departments, diagnostic laboratories performing antigenic mapping, genetic testing or both, and the Spanish Association of Epidermolysis Bullosa Patients [DEBRA]) and combined them using the 3-source capture-recapture methodology. RESULTS: We identified 152 living DEB patients. The estimated prevalence of DEB was 6.0 cases per million (95% CI, 4.2-11.8) in adults and 15.3 (95% CI, 10.4-40.8) in children under 18 years of age. The data indicated that 77% of the patients were not being followed up in specialized centers of reference; 65% had not had a genetic diagnosis, and 76% were not members of DEBRA. CONCLUSIONS: The prevalence of DEB in Spain is 6.0 patients per million (95% CI, 4.2-11.8), a figure higher than previous estimates in many areas, but similar to those found in other southern Europe countries. The north-south difference may represent real geographic differences in prevalence, but it might be due to the fact that most of the data come from registries with a lower than expected catchment. Many patients are not being followed up in centers of reference, do not have genetic diagnosis, and are not members of patients' associations, suggesting that there is room for considerable improvement in their care.

Metástasis cutáneas en el cáncer de pulmón: revisión de la literatura a propósito de dos casos / Cutaneous metastasis of lung cancer: two case reports and review of the literature

Las metástasis cutáneas son la manifestación dermatológica más frecuente del cáncer de pulmón. Son indicativas de progresión de la neoplasia primaria y de un pronóstico ominoso. Comunicamos dos casos de metástasis cutáneas de adenocarcinoma pulmonar con diferente modo de presentación. Se pretende remarcar la clínica heterogénea de estas lesiones y la necesidad de conocer este fenómeno que, aunque infrecuente, debe descartarse siempre en un paciente con una lesión sospechosa y una historia de tabaquismo o de cáncer de pulmón (AU)

Cutaneous metastases are the most frequent dermatologic manifestation of lung cancer. They are indicative of neoplasm progression and bad prognosis. We report two cases of cutaneous metastases from lung adenocarcinoma. We emphasize the different clinical presentation of these lesions, and the need to keep in mind this phenomenon, which we must rule out in a patient with a suspected lesion and a medical history of nicotine poisoning or lung cancer (AU)

¿Quién financia la investigación de los dermatólogos españoles? Análisis del año 2008 y comparación con otros grupos / Who Funds Research by Spanish Dermatologists? Comparative Analysis of Articles Published in 2008

Introducción: Existen referencias en la literatura acerca de la financiación de los ensayos clínicos por la industria farmacéutica. Otros tipos de financiación han sido menos evaluados. Objetivos: Describir la presencia de financiación y su tipo en la investigación realizada por los Servicios de Dermatología españoles en el año 2008. Material y métodos: Estudio bibliométrico de los artículos de investigación publicados por Servicios de Dermatología españoles, franceses y británicos y Servicios de Reumatología españoles en el año 2008, indexados en Medline. Resultados: El porcentaje de financiación de los artículos de investigación publicados por Servicios de Dermatología españoles fue del 36,4%, siendo este porcentaje menor en comparación con los restantes grupos estudiados, y manteniéndose bajo para los distintos tipos de financiación. Existen relaciones significativas entre un mayor porcentaje de financiación y un mayor nivel de evidencia, así como entre un mayor porcentaje de financiación por la industria y los temas de calidad de vida y de tratamiento farmacológico. En un 57,1% de los artículos de investigación dermatológica española no se declara la financiación de modo adecuado y en ninguno se indicó el papel del financiador. Estos últimos hallazgos fueron similares para los restantes grupos estudiados. Conclusión: El porcentaje de financiación externa en los artículos de investigación publicados por Servicios de Dermatología españoles es bajo, y se relaciona con menor nivel de evidencia científica que los restantes grupos estudiados. Se propone la necesidad de aumentar nuestra competitividad para obtener mayor financiación externa (AU)

Background: References have been made in the literature to the funding of clinical trials by the pharmaceutical industry. Other types of funding, however, have been less well studied. Objective: To describe the sources of funding for research by Spanish dermatology departments published in 2008. Material and methods: A bibliometric study was performed of the research articles published by Spanish, French, and British dermatology departments and by Spanish rheumatology departments in 2008 according to MEDLINE records. Results: Articles published by Spanish dermatology departments received funding in 36.4% of cases. This percentage is lower than that found for the other groups studied and remained low for all different types of funding. Statistically significant relationships were found between a higher percentage of funding and a higher level of evidence, as well as between a higher level of funding by the pharmaceutical industry and the publication of research into quality of life and pharmacological treatment. Inadequate declaration of funding was observed in 57.1% of articles from Spanish dermatology departments and the role of the sponsor was not declared in any article. Similar findings were obtained for the other groups studied. Conclusions: The proportion of research articles published by Spanish dermatology departments that receive external funding is low, and this is associated with a lower level of scientific evidence. In order to obtain more external funding, we must improve our competitiveness (AU)

[Who funds research by Spanish dermatologists? Comparative analysis of articles published in 2008]. / ¿Quién financia la investigación de los dermatólogos españoles? Análisis del año 2008 y comparación con otros grupos.

BACKGROUND: References have been made in the literature to the funding of clinical trials by the pharmaceutical industry. Other types of funding, however, have been less well studied. OBJECTIVE: To describe the sources of funding for research by Spanish dermatology departments published in 2008. MATERIAL AND METHODS: A bibliometric study was performed of the research articles published by Spanish, French, and British dermatology departments and by Spanish rheumatology departments in 2008 according to MEDLINE records. RESULTS: Articles published by Spanish dermatology departments received funding in 36.4% of cases. This percentage is lower than that found for the other groups studied and remained low for all different types of funding. Statistically significant relationships were found between a higher percentage of funding and a higher level of evidence, as well as between a higher level of funding by the pharmaceutical industry and the publication of research into quality of life and pharmacological treatment. Inadequate declaration of funding was observed in 57.1% of articles from Spanish dermatology departments and the role of the sponsor was not declared in any article. Similar findings were obtained for the other groups studied. CONCLUSIONS: The proportion of research articles published by Spanish dermatology departments that receive external funding is low, and this is associated with a lower level of scientific evidence. In order to obtain more external funding, we must improve our competitiveness.

[Clinical research publication by Spanish dermatologists over time and in comparison with other research groups in 2008]. / Evolución de la investigación clínica publicada por los dermatólogos españoles y comparación con otros grupos en 2008.

INTRODUCTION: Clinical research is the form of research nearest to clinical practice. MATERIAL AND METHODS: For the years 1992, 1996, 2000, 2004, and 2008, we identified all indexed articles published by Spanish dermatologists and calculated the percentages corresponding to clinical research according to a previously validated definition; we then calculated the proportion of clinical research articles offering higher levels of evidence. For 2008, we compared these percentages to those of French and British dermatologists and Spanish rheumatologists. We also compared these groups' rates of productivity in 2008 in relation to articles providing higher levels of evidence. RESULTS: In 2008, 36% of Spanish dermatologists' publications reported clinical research; 7% were studies offering higher levels of evidence. The proportions did not change significantly over the period studied. Clinical research publications accounted for 35% and 43% of the articles by French and British dermatologists in 2008 and 54% of articles by Spanish rheumatologists in that year. The proportion of publications reporting clinical research was significantly higher for Spanish rheumatologists than for Spanish dermatologists. The proportions of publications offering higher levels of evidence were significantly different in 2008 only for the comparison between Spanish dermatologists and rheumatologists. Other differences were not statistically significant. In the comparison of rates of productivity in clinical research offering higher levels of evidence, British dermatologists were significantly more productive than Spanish dermatologists. CONCLUSIONS: Differences were observed in relation to specialty (Spanish dermatologists vs rheumatologists) and nationality (Spanish vs British dermatologists). The reasons for the differences identified need to be studied in order to improve this situation.

Evolución de la investigación clínica publicada por los dermatólogos españoles y comparación con otros grupos en 2008 / Clinical Research Publication by Spanish Dermatologists Over Time and in Comparison With Other Research Groups in 2008

Introducción: La investigación clínica es la forma de investigación más próxima a la actividad asistencial. Material y métodos: Utilizando una definición de investigación clínica previamente validada, comparamos los porcentajes de investigación clínica e investigación clínica con alto nivel de evidencia publicados por los dermatólogos españoles en 1992, 1996, 2000, 2004 y 2008; y de los dermatólogos españoles, franceses, británicos y los reumatólogos españoles en 2008. Comparamos también la productividad científica de alto nivel de evidencia en 2008. Resultados: El porcentaje de investigación clínica de los dermatólogos españoles en 2008 fue del 36% (un 7% fueron artículos de alto nivel de evidencia). En los años estudiados estos porcentajes no cambiaron. En 2008 los porcentajes de artículos de investigación clínica en los dermatólogos franceses, los dermatólogos británicos y los reumatólogos españoles fueron, respectivamente: 35, 43 y 54%, observándose una diferencia significativa entre estos últimos y los dermatólogos españoles. También existieron diferencias en el porcentaje de investigación clínica de alto nivel de evidencia. A excepción de las observadas en la comparación con los reumatólogos españoles, las diferencias en 2008 podrían deberse al azar, dada la ausencia de significación estadística. Nuestra productividad científica de alto nivel de evidencia es superada significativamente por la de los dermatólogos británicos. Discusión: Las diferencias con los reumatólogos españoles sugieren la existencia de factores propios de la especialidad, y con los dermatólogos ingleses de factores propios del país. Conclusiones: Sería importante analizar las causas de estos resultados e intentar mejorar esta situación (AU)

Introduction: Clinical research is the form of research nearest to clinical practice. Material and methods: For the years 1992, 1996, 2000, 2004, and 2008, we identified all indexed articles published by Spanish dermatologists and calculated the percentages corresponding to clinical research according to a previously validated definition; we then calculated the proportion of clinical research articles offering higher levels of evidence. For 2008, we compared these percentages to those of French and British dermatologists and Spanish rheumatologists. We also compared these groups’ rates of productivity in 2008 in relation to articles providing higher levels of evidence. Results: In 2008, 36% of Spanish dermatologists’ publications reported clinical research; 7% were studies offering higher levels of evidence. The proportions did not change significantly over the period studied. Clinical research publications accounted for 35% and 43% of the articles by French and British dermatologists in 2008 and 54% of articles by Spanish rheumatologists in that year. The proportion of publications reporting clinical research was significantly higher for Spanish rheumatologists than for Spanish dermatologists. The proportions of publications offering higher levels of evidence were significantly different in 2008 only for the comparison between Spanish dermatologists and rheumatologists. Other differences were not statistically significant. In the comparison of rates of productivity in clinical research offering higher levels of evidence, British dermatologists were significantly more productive than Spanish dermatologists. Conclusions: Differences were observed in relation to specialty (Spanish dermatologists vs rheumatologists) and nationality (Spanish vs British dermatologists). The reasons for the differences identified need to be studied in order to improve this situation (AU)

Ulceración nasal / Nasal Ulceration

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