Consensus document on the evaluation and treatment of moderate-to-severe psoriasis: Psoriasis Group of the Spanish Academy of Dermatology and Venereology.

Psoriasis is a highly prevalent disease with a major impact on quality of life; therefore, appropriate patient management is mandatory. Given that many issues in psoriasis are controversial and not clearly defined by evidence-based medicine, management of psoriasis is very variable. Expert consensus can generate practical guidelines for optimization of patient care. Much has changed since 2009, when the Consensus Document on the Evaluation and Treatment of Moderate to Severe Psoriasis was published by the Spanish Psoriasis Group (GEP) of the Spanish Academy of Dermatology and Venereology (AEDV). The objective of the present consensus document is to provide the dermatologist with updated recommendations for the evaluation and treatment of patients with moderate-to-severe plaque psoriasis. All active members of the GEP of the AEDV were invited to participate in the survey. The final group comprised 46 members from various areas of Spain and with substantial experience in managing psoriasis. A 3-round Delphi process was used to reach consensus. Consistent agreement and consistent disagreement (consensus) required the achievement of at least two of the following three criteria: Criterion 1, which was based on the position occupied by the mean on a scale of 1-9 and an SD <2; Criterion 2, which was based on the median and interquartile range (IQR) on a scale of 1-9; Criterion 3, which considered the percentage of the voting experts on a scale of 1-9. The items studied were definition of severity, therapeutic objectives, indications for systemic treatment and biologic therapy, induction and maintenance periods, therapeutic failure, loss of response, relapse and rebound, continuous and intermittent therapy, screening of patients before treatment, adherence to therapy, follow-up of treatment outcome, combination of drugs, transitioning and associated comorbidities. Consistent agreement or disagreement (consensus) was achieved for 198 items (agreement, 3 criteria 146 items, 2 criteria 43 items; disagreement, 3 criteria 9 items, 2 criteria 0 items) based on the criteria described above. Completion of the Delphi consensus process enabled a broad and experienced group of Spanish psoriasis experts to provide useful and practical guidelines for the management and treatment of patients with moderate-to-severe psoriasis, particularly in areas where evidence is lacking.

A prospective evaluation of the cost of psoriasis in Spain (EPIDERMA project: phase II).

OBJECTIVE: To estimate the direct and indirect costs related to psoriasis in Spain. METHODS: We performed a 12-month, multicentre, prospective longitudinal and observational study. Overall expense of care was assessed as the sum of direct and indirect costs. RESULTS: A total of 797 patients with varying demographics and different degrees of severity of psoriasis were included in the study. The mean total cost of psoriasis, including direct and indirect items, was 1,079 euro per patient and year. The major sources of expenditure were prescription drugs (46.6%), followed by medical activities (34.5%). Mean costs in patients with moderate and severe psoriasis were approximately 1.5 and 2.5 times higher than in those with mild psoriasis, respectively. CONCLUSIONS: In Spain, psoriasis is associated with substantial costs both to the National Health System and to the patients.

Bilateral localized lipoatrophy secondary to a single intramuscular corticosteroid injection.

A 15-year-old boy developed two, almost symmetric, asymptomatic, depressed plaques, localized to both buttocks after receiving a single intramuscular corticosteroid injection in his right buttock for treatment of lumbar pain. He suffered from asthma since early childhood, and had been repeatedly treated with corticosteroid injections for many years as a young child. A skin biopsy from both lesions was performed, showing a decrease in the number and size of adipocytes. We describe a case of acquired localized lipoatrophy with a particular bilateral distribution secondary to a single intramuscular corticosteroid injection.

[Prolonged and severe photodermatitis, an early manifestation of ataxia telangiectasia]. / Fotodermatitis prolongada y severa, una manifestación precoz de la ataxia-telangiectasia.

We report two new cases of ataxia-telangiectasia (A-T) in two child brothers. The first symptom of the disease was a serious and prolonged pellagra-like photodermatitis. This rare manifestation of the has not be reported before and it could be explain by a defect in DNA repair.