ABSTRACT
El grado de conocimiento y aplicación de las guías de práctica clínica sobre el manejo de la dermatitis atópica son desconocidos en nuestro entorno. El objetivo de este estudio es elaborar indicadores de calidad basados en las guías de práctica clínica existentes, para mejorar la atención de los pacientes. Tras una búsqueda bibliográfica de guías de práctica clínica, un grupo de 11 panelistas seleccionó las de mayor calidad mediante el instrumento AGREE II. Posteriormente se extrajeron recomendaciones con alto nivel de evidencia y propusieron un indicador de calidad asistencial asociado a un estándar para medir el grado de cumplimiento de cada recomendación. De los 150 indicadores propuestos, se obtuvo consenso en 21 de ellos tras la realización del método Delphi modificado. La implementación de los indicadores consensuados en este estudio pretende estandarizar las actuaciones de los profesionales sanitarios para mejorar la calidad asistencial de los pacientes con dermatitis atópica
No information is currently available on whether the available clinical practice guidelines on the management of atopic dermatitis are known or being applied in Spain. The aim of this study was to improve the care of patients with atopic dermatitis by developing a set of quality indicators based on existing clinical practice guidelines. Relevant clinical practice guidelines identified through a literature search were submitted to a panel of 11 specialists, who selected the highest quality guidelines using the AGREE (Appraisal of Guidelines for Research & Evaluation) II instrument. The panel then defined a subset of the recommendations supported by a high level of evidence and proposed a health care quality indicator for each one together with a standard for measuring degree of adherence. Consensus was achieved on 21 of the 150 proposed indicators using the modified Delphi method. The aim of implementing the indicators that achieved consensus in this study is to standardize the actions of health professionals providing care for patients with atopic dermatitis and ultimately to improve the quality of the care delivered
Subject(s)
Humans , Consensus Development Conferences as Topic , Dermatitis, Atopic/diagnosis , Dermatitis, Atopic/therapy , Quality Assurance, Health Care , Societies, MedicalABSTRACT
No information is currently available on whether the available clinical practice guidelines on the management of atopic dermatitis are known or being applied in Spain. The aim of this study was to improve the care of patients with atopic dermatitis by developing a set of quality indicators based on existing clinical practice guidelines. Relevant clinical practice guidelines identified through a literature search were submitted to a panel of 11 specialists, who selected the highest quality guidelines using the AGREE (Appraisal of Guidelines for Research & Evaluation) II instrument. The panel then defined a subset of the recommendations supported by a high level of evidence and proposed a health care quality indicator for each one together with a standard for measuring degree of adherence. Consensus was achieved on 21 of the 150 proposed indicators using the modified Delphi method. The aim of implementing the indicators that achieved consensus in this study is to standardize the actions of health professionals providing care for patients with atopic dermatitis and ultimately to improve the quality of the care delivered.
Subject(s)
Dermatitis, Atopic , Dermatology , Venereology , Consensus , Dermatitis, Atopic/therapy , Humans , Quality Indicators, Health Care , SpainABSTRACT
BACKGROUND: Alitretinoin is a systemic retinoid licensed for use in adult patients suffering from chronic hand eczema recalcitrant to potent topical steroids. Experience with its use in childhood is lacking. OBJECTIVES: To report on the efficacy and safety of alitretinoin treatment in a cohort of children and adolescents with chronic hand eczema (CHE) and other inflammatory skin diseases. METHODS: We performed a retrospective chart review of all consecutive patients under the age of 18 years treated with alitretinoin at our paediatric skin centre. Physician's Global Assessment (PGA) was used as the primary outcome measure. RESULTS: Thirteen children (9 girls and 4 boys) were enrolled in this study. The median age at start of treatment with alitretinoin was 11.5 years (range 5.8-15.8 years). Nine children were diagnosed with CHE, two with severe atopic dermatitis (AD), and two with inherited ichthyosis [netherton syndrome (NS), autosomal recessive congenital ichthyosis (ARCI)]. Moderate to excellent response (PGA decrease of ≥1 point) was observed in 7 (78%) of the nine patients with CHE, one of the two patients with extensive AD and in the one patient with ARCI. In the remaining four subjects, no convincing effect was documented. Tolerability was overall very good. The most common adverse event was headache in 10 patients (77%) during the initiation of treatment, leading to interruption of therapy in one subject. CONCLUSIONS: Alitretinoin seems to be highly effective and safe for the treatment of paediatric CHE and should thus be considered in children with refractory disease under topical therapy. Larger studies are required to corroborate these findings.
Subject(s)
Dermatologic Agents , Eczema , Hand Dermatoses , Adolescent , Adult , Alitretinoin , Child , Child, Preschool , Chronic Disease , Eczema/drug therapy , Female , Hand Dermatoses/drug therapy , Humans , Male , Retrospective Studies , Treatment Outcome , TretinoinABSTRACT
Antecedentes; La dermatitis atópica (DA) es una enfermedad inflamatoria crónica de la piel típicamente infantil cuyas formas graves pueden afectar intensamente la calidad de vida del paciente. Existen formas refractarias al tratamiento convencional en las que es preciso emplear inmunosupresores sistémicos como la azatioprina (AZA) para alcanzar un buen control de la enfermedad. Objetivo: Evaluar la eficacia y la tolerancia de la AZA en niños con DA grave. Pacientes y métodos: Se realizó una revisión retrospectiva de niños con DA grave tratados con AZA entre enero de 2007 y mayo de 2017. Resultados: Se revisaron 11 pacientes (6 varones, 5 mujeres) con una edad promedio de 13 años (rango 8-18 años). La edad media ± DE al inicio del tratamiento fue de 10,9 ± 2,2 años (IC 95% 8,6-13,1). La media de la dosis inicial de AZA fue de 1,8 ± 0,2 mg/kg/d. Evaluamos la respuesta al tratamiento de nuestros pacientes a las 4 semanas, entre la semana 12 y la 16, y a partir de los 6 meses. La media del tratamiento fue de 10,8 ± 5,7 meses. Dos pacientes tuvieron que suspender el tratamiento por efectos adversos. Siete de los 9 pacientes restantes presentaron un aclaramiento completo o casi completo de la DA a los 6 meses de tratamiento. Conclusión: En nuestra experiencia, la AZA es bien tolerada y puede ser considerada como una opción terapéutica en los niños con DA grave refractaria a tratamientos convencionales
Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease that typically affects children. Severe forms may have a profound effect on patients quality of life. Some forms are resistant to conventional treatment and require the use of systemic immunosuppressants such as azathioprine (AZA) to adequately manage the disease. Objective: To evaluate the effectiveness and tolerance of AZA in children with severe AD. Patients and methods: We performed a retrospective study of children with severe AD treated with AZA between January 2007 and May 2017. Results: We reviewed the cases of 11 patients (6 boys and 5 girls) with a mean age of 13 years (range, 8-18 years). The mean (SD) age at start of treatment was 10.9 (2.2) years (95% CI 8.6-13.1). The mean initial dosage of AZA was 1.8 (0.2) mg/kg/d. We evaluated treatment response after 4 weeks, 12 to 16 weeks, and 6 months. Mean treatment duration was 10.8 (5.7) months. Treatment had to be suspended in 2 patients because of adverse effects. Seven of the 9 remaining patients presented complete or almost complete clearance of the AD after 6 months of treatment. Conclusion: In our experience, AZA is well tolerated and may be considered as a treatment option in children with severe AD resistant to conventional treatment
Subject(s)
Humans , Male , Female , Child , Adolescent , Dermatitis, Atopic/drug therapy , Azathioprine/adverse effects , Evaluation of the Efficacy-Effectiveness of Interventions , Azathioprine/therapeutic use , Retrospective Studies , Treatment Outcome , Steroids/administration & dosageABSTRACT
BACKGROUND: Atopic dermatitis (AD) is a chronic inflammatory skin disease that typically affects children. Severe forms may have a profound effect on patients' quality of life. Some forms are resistant to conventional treatment and require the use of systemic immunosuppressants such as azathioprine (AZA) to adequately manage the disease. OBJECTIVE: To evaluate the effectiveness and tolerance of AZA in children with severe AD. PATIENTS AND METHODS: We performed a retrospective study of children with severe AD treated with AZA between January 2007 and May 2017. RESULTS: We reviewed the cases of 11 patients (6 boys and 5 girls) with a mean age of 13 years (range, 8-18 years). The mean (SD) age at start of treatment was 10.9 (2.2) years (95% CI 8.6-13.1). The mean initial dosage of AZA was 1.8 (0.2) mg/kg/d. We evaluated treatment response after 4 weeks, 12 to 16 weeks, and 6 months. Mean treatment duration was 10.8 (5.7) months. Treatment had to be suspended in 2 patients because of adverse effects. Seven of the 9 remaining patients presented complete or almost complete clearance of the AD after 6 months of treatment. CONCLUSION: In our experience, AZA is well tolerated and may be considered as a treatment option in children with severe AD resistant to conventional treatment.
Subject(s)
Azathioprine/therapeutic use , Dermatitis, Atopic/drug therapy , Immunosuppressive Agents/therapeutic use , Adolescent , Azathioprine/adverse effects , Child , Female , Humans , Immunosuppressive Agents/adverse effects , Male , Retrospective Studies , Severity of Illness Index , Time Factors , Treatment OutcomeSubject(s)
Antineoplastic Agents/therapeutic use , Carcinoma, Basal Cell/drug therapy , Eyelid Neoplasms/drug therapy , Imiquimod/therapeutic use , Nose Neoplasms/drug therapy , Skin Neoplasms/drug therapy , Xeroderma Pigmentosum/drug therapy , Administration, Cutaneous , Antineoplastic Agents/administration & dosage , Child, Preschool , Humans , Imiquimod/administration & dosage , MaleSubject(s)
Amphotericin B/therapeutic use , Antiprotozoal Agents/therapeutic use , Leishmaniasis, Cutaneous/drug therapy , Leishmaniasis, Cutaneous/parasitology , Child, Preschool , Communicable Diseases, Imported/drug therapy , Communicable Diseases, Imported/parasitology , Female , Humans , Leishmania tropica , Male , Travel-Related IllnessABSTRACT
La aparición tardía de telangiectasias cutáneas extensas de forma simétrica y ascendente, sin manifestación sistémica asociada, constituye la forma de presentación típica de la telangiectasia esencial generalizada (TEG). Estudios recientes sugieren que la vasculopatía colágena cutánea (VCC) tiene una presentación clínica idéntica pero los hallazgos histopatológicos son distintivos y permiten diferenciarla de la TEG. Presentamos 2 pacientes con múltiples telangiectasias cutáneas con hallazgos histopatológicos diagnósticos de TEG y de VCC. La dermatoscopia de las telangiectasias en ambos casos fue similar, excepto en las lesiones más antiguas de VCC que presentaba vasos de color violáceo y con una morfología tortuosa en serpentina. Durante el seguimiento de ambas pacientes de 12 y 42 años (TEG y VCC, respectivamente) hemos comprobado que en la TEG las telangiectasias mantienen su aspecto inicial mientras que en la VCC se observó un oscurecimiento progresivo de las lesiones y cambios en la morfología resultando en varicosidades superficiales
The late development of symmetrical, ascending telangiectasias over an extensive area of the skin with no associated systemic manifestations is a common presentation of generalized essential telangiectasia (GET). It was recently suggested that cutaneous collagenous vasculopathy (CCV) is clinically identical to GET but that the 2 conditions can be distinguished by their distinctive histopathologic findings. We present 2 patients, both women, with multiple telangiectasias and describe the histopathologic findings that led to the diagnoses of GET and CCV. Dermoscopic findings in both cases were similar, except that the older telangiectasias in the patient with CCV were violaceous and distributed in a tortuous, serpentine pattern. During follow-up 12 years for the woman with GET and 42 years for the woman with CCV we saw that in GET the lesions remained stable in appearance whereas in CCV there was progressive darkening and morphological changes eventually resulting in superficial varicose veins
Subject(s)
Humans , Female , Middle Aged , Aged, 80 and over , Vascular Diseases/complications , Cardiovascular Diseases/complications , Dermoscopy , Immunohistochemistry/methods , Biopsy/methods , Glycogen Storage Disease/complications , Glycogen Storage Disease/diagnosis , Pruritus/complications , Basement Membrane/pathology , Glycogen Storage Disease/pathologySubject(s)
Collagen/biosynthesis , Skin Diseases/chemically induced , Tattooing/adverse effects , Adult , Humans , Male , Young AdultABSTRACT
The late development of symmetrical, ascending telangiectasias over an extensive area of the skin with no associated systemic manifestations is a common presentation of generalized essential telangiectasia (GET). It was recently suggested that cutaneous collagenous vasculopathy (CCV) is clinically identical to GET but that the 2 conditions can be distinguished by their distinctive histopathologic findings. We present 2 patients, both women, with multiple telangiectasias and describe the histopathologic findings that led to the diagnoses of GET and CCV. Dermoscopic findings in both cases were similar, except that the older telangiectasias in the patient with CCV were violaceous and distributed in a tortuous, serpentine pattern. During follow-up 12 years for the woman with GET and 42 years for the woman with CCV we saw that in GET the lesions remained stable in appearance whereas in CCV there was progressive darkening and morphological changes eventually resulting in superficial varicose veins.
Subject(s)
Skin Diseases, Vascular/pathology , Telangiectasis/pathology , Aged, 80 and over , Collagen , Female , Humans , Middle AgedABSTRACT
Melanoma in individuals with oculocutaneous albinism has been reported in the literature to be rare compared with the more common occurrence of squamous cell carcinoma and basal cell carcinoma. We present a singular case of amelanotic naevoid melanoma arising from a small congenital naevus in a 16-month old albino boy, the youngest reported to date.
Subject(s)
Albinism, Oculocutaneous/complications , Melanoma, Amelanotic/complications , Nevus/complications , Skin/pathology , Albinism, Oculocutaneous/diagnosis , Dermatologic Surgical Procedures/methods , Humans , Infant , Male , Melanoma, Amelanotic/diagnosis , Melanoma, Amelanotic/surgery , Nevus/congenital , Nevus/surgeryABSTRACT
BACKGROUND AND OBJECTIVES: Jellyfish are free-living members of the phylum Cnidaria who share a specialized stinging cell, the cnidocyte. Pelagia noctiluca is the most frequent and toxic jellyfish species found in the Balearic beaches and cnidocytes are arranged in pigmented clusters called 'warts'. Dermoscopy continues to expand its use much beyond the pigmentary lesions and to date, there is no data regarding dermoscopic findings in jellyfish stings. The aim of the present work was to study the dermoscopic findings of jellyfish stings in the island of Mallorca. PATIENTS AND METHODS: We retrospectively reviewed the clinical and dermoscopic images of 25 episodes of jellyfish stings caused by P. noctiluca that occurred between 2009 and 2015. RESULTS: Overall, the following dermoscopic features were found: brown dots (84%), pinkish hue (56%), pinpoint brown crusts (44%), scale-crust (40%), brown 'Chinese characters pattern' (32%), 'serpentine' ulceration (28%), linear purpura (20%), and whitish-yellow crusts (15%). Vessels were mainly dotted (36%) or reticular (16%). Scale-crust, serpentine ulceration and pinkish hue were significantly more frequent in lesions older than 2 days. Conclusions and limitations: Our study identifies 4 dermoscopic features that may represent the contact with P. noctilucacnidocytes: brown dots, brown 'Chinese characters pattern', pinpoint brown crusts and whitish-yellow crusts. A peculiar finding of 'serpentine ulceration' with brown dots would be very suggestive of P. noctiluca sting. We believe dermoscopy is a valuable tool in the diagnosis of jellyfish stings when a clear history of contact is lacking. Further studies are needed to validate our findings in other jellyfish species
INTRODUCCIÓN Y OBJETIVOS: Las medusas son miembros del phylum Cnidaria que comparten una célula urticante especializada, el cnidiocito. En Baleares, Pelagia noctiluca es la medusa más frecuente y tóxica. En ella los cnidiocitos se encuentran en agrupaciones pigmentadas llamadas 'verrugas'. La dermatoscopia continúa ampliando su uso más allá de las lesiones pigmentadas, pero hasta la fecha no se ha utilizado en el diagnóstico de las picaduras de medusa. El objetivo del presente trabajo es estudiar los hallazgos dermatoscópicos en esta patología en la isla de Mallorca. PACIENTES Y MÉTODOS: Revisamos retrospectivamente las imágenes clínicas y dermatoscópicas de 25 episodios de picaduras de medusa por P. noctiluca entre 2009 y 2015. RESULTADOS: Se encontraron las siguientes imágenes: puntos marrones (84%), tono rosado (56%), costras marrones puntiformes (44%), escamocostra (40%), patrón en 'letras chinas' marrones (32%), ulceración 'en serpentina' (28%), púrpura lineal (20%) y costras blancoamarillentas (15%). Los vasos fueron puntiformes (36%) o reticulares (16%). La escamocostra, la ulceración en serpentina y el tono rosado fueron significativamente más frecuentes en las lesiones de más de 2días de duración. Conclusiones y limitaciones: Nuestro estudio identificó 4 imágenes dermatoscópicas debidas al contacto con los cnidiocitos: puntos marrones, patrón en 'letras chinas' marrones, costras marrones puntiformes y costras blancoamarillentas. La combinación de ulceración 'en serpentina' y puntos marrones sería muy sugestiva de picadura por P. noctiluca. La dermatoscopia es una herramienta útil en el diagnóstico de las picaduras de medusas, en ausencia del antecedente de contacto con ellas. Se necesitan más estudios para validar estos hallazgos en picaduras por otras especies de medusa
Subject(s)
Humans , Cnidarian Venoms/adverse effects , Endoscopy/methods , Bites and Stings/diagnosis , Retrospective StudiesABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Hemangioma/classification , Hemangioma/diagnosis , Hemangioma/genetics , Vascular Malformations/diagnosis , Vascular Malformations/genetics , Vascular Malformations/pathology , Mutation/genetics , Mutation/physiology , Receptor, TIE-2 , Carcinoma, Verrucous/diagnosis , Carcinoma, Verrucous/pathology , Carcinoma, Verrucous/therapy , Vascular Diseases/congenital , Vascular Diseases/genetics , Vascular Diseases/pathologyABSTRACT
BACKGROUND AND OBJECTIVES: Jellyfish are free-living members of the phylum Cnidaria who share a specialized stinging cell, the cnidocyte. Pelagia noctiluca is the most frequent and toxic jellyfish species found in the Balearic beaches and cnidocytes are arranged in pigmented clusters called "warts". Dermoscopy continues to expand its use much beyond the pigmentary lesions and to date, there is no data regarding dermoscopic findings in jellyfish stings. The aim of the present work was to study the dermoscopic findings of jellyfish stings in the island of Mallorca. PATIENTS AND METHODS: We retrospectively reviewed the clinical and dermoscopic images of 25 episodes of jellyfish stings caused by P. noctiluca that occurred between 2009 and 2015. RESULTS: Overall, the following dermoscopic features were found: brown dots (84%), pinkish hue (56%), pinpoint brown crusts (44%), scale-crust (40%), brown "Chinese characters pattern" (32%), "serpentine" ulceration (28%), linear purpura (20%), and whitish-yellow crusts (15%). Vessels were mainly dotted (36%) or reticular (16%). Scale-crust, serpentine ulceration and pinkish hue were significantly more frequent in lesions older than 2 days. CONCLUSIONS AND LIMITATIONS: Our study identifies 4 dermoscopic features that may represent the contact with P. noctiluca cnidocytes: brown dots, brown "Chinese characters pattern", pinpoint brown crusts and whitish-yellow crusts. A peculiar finding of "serpentine ulceration" with brown dots would be very suggestive of P. noctiluca sting. We believe dermoscopy is a valuable tool in the diagnosis of jellyfish stings when a clear history of contact is lacking. Further studies are needed to validate our findings in other jellyfish species.
Subject(s)
Bites and Stings/pathology , Dermoscopy , Scyphozoa , Adolescent , Adult , Aged , Animals , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Retrospective Studies , Young AdultABSTRACT
No disponible
Subject(s)
Humans , Female , Child, Preschool , Hypotrichosis/complications , Hypotrichosis , Erythema/complications , Erythema , Hyperkeratosis, Epidermolytic/complications , Hyperkeratosis, Epidermolytic/diagnosis , Ectodermal Dysplasia/complications , Ectodermal Dysplasia/diagnosis , Alopecia/congenital , Alopecia/pathology , Medical History Taking/methods , Medical History Taking/standards , Alopecia/complications , Alopecia/diagnosis , Microscopy, Electron, Scanning/instrumentation , Microscopy, Electron, Scanning/methods , Scalp/pathology , ScalpABSTRACT
No disponible
Subject(s)
Humans , Female , Child, Preschool , Hyperpigmentation/complications , Hyperpigmentation/diagnosisSubject(s)
Face/pathology , Pigmentation Disorders/diagnosis , Child, Preschool , Female , Humans , InfantSubject(s)
Hemangioma/classification , Hemangioma/genetics , Skin Diseases, Vascular/classification , Skin Diseases, Vascular/genetics , Skin Neoplasms/classification , Skin Neoplasms/genetics , Vascular Malformations/classification , Vascular Malformations/genetics , Genetic Testing , Hemangioma/pathology , Humans , Skin Diseases, Vascular/pathology , Skin Neoplasms/pathology , Vascular Malformations/pathologyABSTRACT
INTRODUCCIÓN: Las complicaciones otológicas asociadas a las ictiosis congénitas autosómicas recesivas (ICAR) no sindrómicas, apenas han sido estudiadas en la literatura. OBJETIVO: Conocer la frecuencia y el tipo de manifestaciones otológicas de los pacientes diagnosticados de ICAR, actualmente en seguimiento en la unidad de dermatología pediátrica de nuestro hospital. MATERIAL Y MÉTODO: Se estudió de forma prospectiva la presencia de los siguientes parámetros: dolor, prurito ótico, acúfenos, otitis, tapón de cerumen, acúmulo de restos epiteliales y sordera. Se recogió en la anamnesis las medidas de higiene diaria, tratamientos tópicos o intervenciones médico-quirúrgicas requeridas y la periodicidad con la que los pacientes habían consultado a un especialista de otorrinolaringología (ORL). En todos los casos se realizaron otoscopia y pruebas auditivas. RESULTADOS: Se estudiaron 10 pacientes, 2 con fenotipo de bebé colodión autorresolutivo y 8 con ictiosis. Un 100% (8/8) de los pacientes con ictiosis referían algún síntoma o signo en la anamnesis, en el 75% (6/8) se observaron anomalías en la exploración del conducto auditivo externo y en el 25% (2/8) se objetivó sordera de conducción, que en un caso se consiguió revertir. Nuestro trabajo está limitado por el escaso número de pacientes, todos menores de 19 años. CONCLUSIONES: Es fundamental la participación conjunta del dermatólogo y del especialista de ORL en el manejo de los pacientes con ictiosis para establecer las mejores medidas terapéuticas y preventivas. Se precisan más estudios que determinen la frecuencia de la afectación otológica, su repercusión en la calidad de vida y la periodicidad mínima idónea de visitas al especialista de ORL
BACKGROUND: Few studies have investigated ear involvement in nonsyndromic autosomal recessive congenital ichthyosis (ARCI). OBJECTIVES: To assess the type and frequency of otologic manifestations of ARCI in patients under follow-up at the pediatric dermatology department of our hospital. MATERIALS AND METHODS: We prospectively studied the presence of ear pain, ear itching, tinnitus, otitis, cerumen impaction, accumulation of epithelial debris, and hearing loss. Daily hygiene measures, topical treatments, medical-surgical interventions, and frequency of visits to an ear, nose, and throat (ENT) specialist were noted in the patients' medical records. Ear examination and hearing tests were performed in all cases. RESULTS: Ten patients were studied: 2 had a self-healing collodion baby phenotype and 8 had ichthyosis. There was mention of otologic manifestations in the records of all 8 patients with ichthyosis (100%); 6 of these patients (75%) had abnormalities in the external auditory canal examination and 2 (25%) had conductive hearing loss. Our findings are limited by the small number of patients studied, all of whom were younger than 19 years. CONCLUSIONS: The involvement of both dermatologists and ENT specialists in the management of patients with ichthyosis is crucial to ensure the application of the best therapeutic and preventive measures. More studies are needed to assess the prevalence and impact on quality of life of ear involvement in patients with ichthyosis and to determine the optimal interval between ENT visits for these patients