ABSTRACT
BACKGROUND: Alopecia areata (AA) is a skin disease that produces hair loss in patches of skin. The underlying mechanism of AA is a loss of immune privilege of hair follicles, which are then attacked by natural killer (NK) cells. A previous genome-wide association study linked single nucleotide polymorphisms of the protein MHC class I chain-related A (MICA) to this disease. MICA is the ligand for the activating receptor NKG2D, expressed mainly by NK cells and CD8+ cytotoxic T cells. As the aforementioned study did not include short tandem repeats (STRs) of MICA, we decided to study these in relation to AA. AIM: To study the association of STRs with AA, alongside that of human leucocyte antigen (HLA) locus B, which is closely linked to MICA. METHODS: DNA amplicon size analysis was carried out, and HLA-B locus genomic typing was performed by PCR-sequence-specific oligonucleotide analysis. RESULTS: We observed an association between AA and both MICA*009 and HLA-B14; associations were also observed between HLA-B alleles and MICA alleles, which have both been previously found to be connected with AA, but never studied together. CONCLUSIONS: We conclude that it is important to study HLA-B and MICA together to avoid the influence of their association in experiments in which they are investigated separately.
Subject(s)
Alopecia Areata/genetics , HLA-B14 Antigen/genetics , Histocompatibility Antigens Class I/genetics , Microsatellite Repeats , Genetic Predisposition to Disease , Genotype , HLA-B Antigens/genetics , Humans , Polymorphism, Single Nucleotide , Sequence Analysis, DNAABSTRACT
BACKGROUND: Alopecia areata totalis (AAT) and universalis (AAU) pose a therapeutic challenge. OBJECTIVE: To describe the clinical and epidemiological features, therapeutic response and prognostic factors in a large series of patients diagnosed with AAT and AAU. METHODS: This retrospective multicenter study included patients diagnosed with AAT/AAU with a minimum follow-up of 12 months. Response was assessed based on the regrowth of scalp hair. RESULTS: In all, 132 patients (92 women and 40 men) - 80 (61%) diagnosed with AAU and 52 (39%) diagnosed with AAT - were included. The median time between the presentation of alopecia areata (AA) and the development of extensive AA was 1 year and it was less than 4 years in 121 patients (91%). There was an initial response to treatment in 64% of patients, although only 14% presented a persistent response. Adverse side effects from the medications used were detected in 33% of patients. The prognostic factors associated with poor response were the presence of AAU and a positive family history of AA. CONCLUSIONS: Treatment of AAT and AAU is challenging. Although an initial regrowth may be achieved, the duration of response is usually short. There were no significant differences on the effectiveness or duration of response between the various systemic therapies.
Subject(s)
Alopecia Areata/therapy , Alopecia/therapy , Adolescent , Adult , Age of Onset , Aged , Alopecia/diagnosis , Alopecia Areata/diagnosis , Alopecia Areata/genetics , Child , Child, Preschool , Comorbidity , Disease Progression , Female , Humans , Infant , Male , Middle Aged , Prognosis , Retrospective Studies , Time Factors , Treatment Outcome , Young AdultABSTRACT
BACKGROUND: Alopecia areata on the beard area (BAA) is a common clinical manifestation, but there are no studies about its characteristics. OBJECTIVE: To describe the epidemiology, comorbidities, clinical presentation, evolution, diagnostic findings and therapeutic choices in a series of patients with BAA. METHODS: This retrospective multicentre review included patients diagnosed with BAA as the first and unique clinical manifestation with at least 12 months of follow-up. Diagnosis was performed based on the typical clinical features. Extra-beard involvement was monitored in all cases. RESULTS: Overall, 55 male patients with a mean age of 39.1 years (range 20-74) were included. Twenty-five patients (45.5%) developed alopecia of the scalp during follow-up and more than 80% of cases appeared in the first 12.4 months. Clinical presentation of AA on the scalp was patchy AA (less than 5 patches) (52%), multifocal AA (28%), AA totalis (12%) and AA universalis (8%). Multivariate analysis revealed a trend of association between scalp involvement and family history of AA without statistical significance. CONCLUSIONS: According to this study, BAA may progress to scalp AA in a significant number of patients (45.5% of the patients with a follow-up interval of at least 12 months). In the group of patients who developed scalp AA, 80% of them did it within the first 12 months, so follow-up of patients with BAA is highly encouraged.
Subject(s)
Alopecia Areata/epidemiology , Adult , Aged , Alopecia Areata/diagnosis , Humans , Male , Middle Aged , Retrospective Studies , Young AdultABSTRACT
La incorporación de nuevos fármacos al arsenal terapéutico, la actualización de las guías de práctica clínica y los hallazgos fisiopatológicos recientemente comunicados hacen que el manejo y conocimiento de la urticaria sea un tema de candente actualidad. La Sección territorial andaluza de la AEDV ha desarrollado un proceso de atención en el que se describen el recorrido del paciente, las características de calidad de las actuaciones y las recomendaciones para la toma de decisiones en los pacientes con urticaria. Presentamos un enfoque centrado en el paciente, y en el que se muestra su devenir en el sistema sanitario y la interrelación entre la atención primaria y hospitalaria, garantizando un punto clave, su continuidad asistencial
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
Subject(s)
Humans , Urticaria/epidemiology , Patient-Centered Care/organization & administration , Continuity of Patient Care/organization & administration , Patient Care Planning , Practice Patterns, Physicians'ABSTRACT
Las lesiones cutáneas benignas representan un motivo de consulta frecuente, tanto en atención primaria como en las consultas de dermatología. Sin embargo, existe una amplia variabilidad en el acceso de los usuarios al diagnóstico y tratamiento de las lesiones cutáneas benignas, debido principalmente a que no se establecieron criterios explícitos y homogéneos para el abordaje de los pacientes con lesiones benignas. Con el objetivo principal de reducir la variabilidad en la atención a las personas con lesiones quísticas o tumorales benignas la Sección Territorial Andaluza de la AEDV ha desarrollado un proceso de atención en el que se describen el recorrido del paciente, las características de calidad de las actuaciones y las recomendaciones para la toma de decisiones en este tipo de lesiones
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
Subject(s)
Humans , Male , Female , Skin Neoplasms/diagnosis , Skin Neoplasms/surgery , Skin Neoplasms/therapy , Primary Health Care/methods , Primary Health Care , Diagnosis , Therapeutics/instrumentation , Therapeutics/methods , Therapeutics , Keratosis, Seborrheic/pathology , Keratosis, Seborrheic/surgery , Keratosis, Seborrheic/therapy , Dermatologic Surgical Procedures/instrumentation , Dermatologic Surgical Procedures/methods , Dermatologic Surgical Procedures , Dermatology/instrumentation , Dermatology/methods , Health Systems , Consensus , SpainABSTRACT
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.
Subject(s)
Critical Pathways , Cysts/diagnosis , Cysts/therapy , Skin Diseases/diagnosis , Skin Diseases/therapy , Skin Neoplasms/diagnosis , Skin Neoplasms/therapy , HumansABSTRACT
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.
Subject(s)
Critical Pathways , Urticaria/diagnosis , Urticaria/therapy , Acute Disease , Chronic Disease , HumansSubject(s)
Antimalarials/adverse effects , Antimalarials/therapeutic use , Lupus Erythematosus, Systemic/drug therapy , Pruritus/chemically induced , Water/adverse effects , Adult , Antimalarials/administration & dosage , Chloroquine/administration & dosage , Chloroquine/adverse effects , Chloroquine/therapeutic use , Data Collection , Female , Humans , Hydroxychloroquine/administration & dosage , Hydroxychloroquine/adverse effects , Hydroxychloroquine/therapeutic use , Lupus Erythematosus, Systemic/complications , Male , Middle AgedABSTRACT
Sinus histiocytosis with massive lymphadenopathy is an entity that exceptionally appears as a purely cutaneous disease. We described 2 cases of this form with spontaneous involution. Histology showed a polymorphic infiltrate in the dermis and hypodermis composed of large histiocytes with lymphophagocytosis, neutrophils and plasma cells. Immunohistochemical stains demonstrated the positivity of histiocytes for protein S-100 and MAC 387.
