Atypical Kaposi's sarcoma in young inmunocompetent patient.

Kaposi´s sarcoma is a rare tumor associated with human herpes virus 8 (HHV-8) infection. Four main clinical subtypes have been described. This study reports on a form of KS in an HIV negative and immunocompetent middle-aged man. The only remarkable factor is that he has sex with other men. This form of Kaposi´s sarcoma is rare. It occurs more in younger patients than in the classic form, is limited to the skin, and is associated with a good prognosis. The means of transmission of the virus is through saliva in oroanal or orogenital sexual practices. Mechanisms of tumor development are still not well known. Given the possible increased number of this variant, it would be interesting to extend this study.

Basal cell carcinoma arising in outdoor workers versus indoor workers: a retrospective study.

Basal cell carcinoma (BCC) is the most prevalent malignancy in white individuals and continues to be a serious health problem. Individuals who have sustained exposure to UV radiation are at the highest risk for developing BCC. The aim of this study was to compare the features of BCC in outdoor workers (OWs) with a history of occupational exposure to UV radiation versus indoor workers (IWs). We found that OWs are more likely to develop nodular BCC with no increased risk for superficial BCC. The age of onset of BCC was older in OWs than in IWs. Truncal BCC was more common in IWs, which may suggest other etiological factors are involved in BCC such as genetic predisposition.

Atypical Kaposi's sarcoma in young inmunocompetent patient

Abstract: Kaposi´s sarcoma is a rare tumor associated with human herpes virus 8 (HHV-8) infection. Four main clinical subtypes have been described. This study reports on a form of KS in an HIV negative and immunocompetent middle-aged man. The only remarkable factor is that he has sex with other men. This form of Kaposi´s sarcoma is rare. It occurs more in younger patients than in the classic form, is limited to the skin, and is associated with a good prognosis. The means of transmission of the virus is through saliva in oroanal or orogenital sexual practices. Mechanisms of tumor development are still not well known. Given the possible increased number of this variant, it would be interesting to extend this study.

Prevalence and Associated Factors of Erectile Dysfunction in Patients With Moderate to Severe Psoriasis and Healthy Population: A Comparative Study Considering Physical and Psychological Factors.

Recent studies have shown that psoriasis is associated with an increased prevalence of erectile dysfunction. To our knowledge, no comparative study has considered simultaneously the role of organic factors and psychological factors in this process. We performed a prospective case series study matched by age to explore the prevalence of erectile dysfunction in psoriasis patients compared to a healthy population and to investigate the role of anxiety, depression, and cardiovascular risk factors in the relationship between psoriasis and erectile dysfunction. The healthy group was matched by frequency to cases by age. Seventy-nine patients with moderate to severe psoriasis and 79 healthy controls participated in the study. Participants completed the Massachusetts General Hospital Sexual Functioning Questionnaire and the Hospital Anxiety and Depression Scale. Psoriasis patients had an increased prevalence of erectile dysfunction in comparison to controls, 34.2 vs. 17.7 % (p < .05). Multivariate analysis showed a significant association between erectile dysfunction and age, smoking and anxiety/depression, but not with psoriasis per se. In conclusion, the higher prevalence of smoking and anxiety/depression among patients with moderate to severe psoriasis probably explains the higher prevalence of erectile dysfunction in this population.

Distribution pattern of psoriasis, anxiety and depression as possible causes of sexual dysfunction in patients with moderate to severe psoriasis.

BACKGROUND: Psoriasis may significantly impair sexual function. Depression and organic factors appear to play a key role in this relation. However, beyond genital psoriasis, the importance of the disease's distribution patterns has not been considered. OBJECTIVES: To research sexual function in psoriasis patients and investigate the roles of anxiety, depression and psoriasis' distribution patterns in sexual dysfunction. METHODS: A comparative study matched for sex and age was performed. Eighty patients with moderate to severe psoriasis and 80 healthy controls were included. The participants completed the Massachusetts General Hospital-Sexual Functioning Questionnaire, the Hospital Anxiety and Depression Scale, and the Self-Administered Psoriasis Area and Severity Index. RESULTS: Psoriasis was associated with sexual dysfunction, odds ratio=5.5 (CI 95% 2.6-11.3; p<0.001). Certain distribution patterns of psoriasis, involving specific body regions, were associated with an increase in sexual dysfunction in the group presenting the disease, odds ratio 7.9 (CI 95% 2.3-33.4; p<0.001). Multivariate logistic regression analysis identified anxiety and depression, and the involvement of these specific areas, as possible independent risk factors for sexual dysfunction in patients with moderate to severe psoriasis. CONCLUSION: This study identifies body areas potentially related to sexual dysfunction, independently of anxiety and depression, in psoriasis patients. The results suggest that the assessment of sexual dysfunction and the involvement of these body areas should be considered as disease severity criteria when choosing the treatment for psoriasis patients.

Distribution pattern of psoriasis, anxiety and depression as possible causes of sexual dysfunction in patients with moderate to severe psoriasis

Abstract BACKGROUND: Psoriasis may significantly impair sexual function. Depression and organic factors appear to play a key role in this relation. However, beyond genital psoriasis, the importance of the disease's distribution patterns has not been considered. OBJECTIVES: To research sexual function in psoriasis patients and investigate the roles of anxiety, depression and psoriasis' distribution patterns in sexual dysfunction. METHODS: A comparative study matched for sex and age was performed. Eighty patients with moderate to severe psoriasis and 80 healthy controls were included. The participants completed the Massachusetts General Hospital-Sexual Functioning Questionnaire, the Hospital Anxiety and Depression Scale, and the Self-Administered Psoriasis Area and Severity Index. RESULTS: Psoriasis was associated with sexual dysfunction, odds ratio=5.5 (CI 95% 2.6-11.3; p<0.001). Certain distribution patterns of psoriasis, involving specific body regions, were associated with an increase in sexual dysfunction in the group presenting the disease, odds ratio 7.9 (CI 95% 2.3-33.4; p<0.001). Multivariate logistic regression analysis identified anxiety and depression, and the involvement of these specific areas, as possible independent risk factors for sexual dysfunction in patients with moderate to severe psoriasis. CONCLUSION: This study identifies body areas potentially related to sexual dysfunction, independently of anxiety and depression, in psoriasis patients. The results suggest that the assessment of sexual dysfunction and the involvement of these body areas should be considered as disease severity criteria when choosing the treatment for psoriasis patients. .

Defining the dermoscopic characteristics of fast-growing cutaneous melanomas.

A high growth rate in melanomas has been associated with a more aggressive phenotype and worse survival. The aim of this study was to define the dermoscopic characteristics associated with this type of cutaneous melanoma. We carried out a retrospective study of 132 cutaneous melanomas, analyzing certain clinical characteristics and the most important dermoscopic variables related to the melanomas. Fast-growing melanomas were considered to be those with a growth rate of more than 0.5 mm per month. Fast-growing melanomas more often lacked an atypical network, were symmetrical, presented ulceration, and were hypopigmented. The dermoscopic vascular pattern often showed atypical irregular vessels and milky-red areas. The association of these two is a specific characteristic. Fast-growing melanomas have a characteristic phenotype and dermoscopy can be useful for their identification.

Distribution pattern of psoriasis affects sexual function in moderate to severe psoriasis: a prospective case series study.

INTRODUCTION: Psoriasis may significantly impair sexual function. Depression and organic factors appear to play a key role in this relationship. However, beyond genital psoriasis, the importance of the distribution pattern of the disease has not been considered. AIM: To investigate the role of the distribution pattern of psoriasis in sexual dysfunction. METHODS: A prospective case series study was carried out on 133 patients with moderate to severe psoriasis. MAIN OUTCOME MEASURES: The participants completed the Massachusetts General Hospital-Sexual Functioning Questionnaire, the Hospital Anxiety and Depression Scale, and the Self-Administered Psoriasis Area and Severity Index. RESULTS: Forty-four women (mean age 42.0 ± 14.1) and 79 men (mean age 47 ± 11.7) were included in the study. Psoriasis lesions on abdomen, genitals, lumbar region, and buttocks in women and chest, genitals, and buttocks in men were associated with an increase in sexual dysfunction. Multivariate logistic regression analysis showed that the involvement of these specific areas may be independent risk factors for sexual dysfunction in patients with moderate to severe psoriasis. CONCLUSIONS: This is the first study identifying body areas other than genitals as potentially related to sexual dysfunction in psoriasis patients. The results suggest that the assessment of sexual dysfunction and the involvement of these body areas should be considered as disease severity criteria when deciding on treatment for psoriasis patients.

Ulcerated upper lip tumour: diagnostic procedure.

A Mediterranean Spanish woman, aged 56 years and in good health, presented with a nodule above her upper lip, which had rapidly evolved to central ulceration with crusting. As part of the work-up, samples were taken for microbiological and histopathological investigation. At the follow-up appointment the lesion had almost disappeared and a small fibrotic area of scarring remained. The diagnostic procedure to distinguish between localised cutaneous leishmaniasis and keratoacanthoma, both characterised by rapidly growing nodules on the face, is presented in this case-based article.

Safety and effectiveness of ustekinumab for treatment of moderate to severe psoriasis: a prospective study in a clinical setting.

BACKGROUND: There are few studies analyzing the behavior of ustekinumab in the complex management of psoriasis within diary clinical practice setting. OBJECTIVE: To assess the utility of ustekinumab in a psoriasis unit. METHODS: Analysis of the prospective data gathered during the follow-up of 30 consecutive psoriasis patients treated with ustekinumab at a single referral centre. Three effectiveness endpoints were defined 12 weeks, 28 and "long-term treatment". The main outcome measure was improvement from baseline PASI at week 28 and at a point of adjustment of prolonged treatment signed as "long-term treatment". RESULTS: Overall 82.1% and 42.8% patients achieved respectively PASI75 and PASI90 response rates at week 28. Long-term treatment maintained efficacy outcomes 81.5% and 40.7% PASI75 and PASI90, respectively were observed. At week 28, patients naïve to TNFα- blockers agents and patients with a baseline PASI >10 had better PASI75 and PASI90 response rates than previously treated patients. CONCLUSIONS: In clinical practice, the efficacy and patient adherence to ustekinumab are excellent and even better to the data obtained in clinical trials. Clinical indicators of psoriasis severity: previous treatments with tumor necrosis factor α blockers agents and active treatment beside small increases in PASI determine a delayed maximal response.

The role of accessibility policies and other determinants of health care provision in the initial prognosis of malignant melanoma: a cross-sectional study.

BACKGROUND: The prognostic benefit of health care service provision and delivery policies for patients with malignant melanoma (MM) is not yet clear. OBJECTIVE: To analyze the role of health care provision determinants in the initial prognosis of MM. METHODS: A multicenter cross-sectional study was conducted at 14 public hospitals and recruited 3550 patients with MM between 2000 and 2009. The study variables were analyzed using univariate and multivariate models to identify their role in the variations observed. RESULTS: In a 10-year period, the number of patients with MM increased by 78.54%, with primary in situ MM (Tis) or MMs with a Breslow thickness <1 mm (T1) representing 51.72% of the total number of MMs in 2000, increasing to 62.23% by the end of the study period (P = .005). Among the variables that explained the variation in MM frequency the year of diagnosis after 2004 (univariate odds ratio [OR], 1.43 [P < .001]; multivariate OR, 1.36 [P = .005]) and diagnosis in centers with specific fast-track referral systems (univariate OR, 1.24 [P = .01]; multivariate OR, 1.59 [P = .025]) were shown to explain the increasing frequency of Tis-T1 MM. LIMITATIONS: The primary potential limitation of this study is its retrospective nature. CONCLUSION: Health care provision policies and interventions aimed at improving accessibility to specialized care appear to explain the increasing frequency of Tis-T1 MM.

Basal cell carcinoma: analysis of factors associated with incomplete excision at a referral hospital in southern Spain.

Basal cell carcinoma (BCC) is the most prevalent malignancy, with excision as the best therapeutic approach. Incomplete excision of nonmelanoma skin cancer is a clinical indicator of the surgical technique performed. This retrospective study of 292 patients with BCC assessed the rate of incomplete excision in a tertiary referral hospital in southern Spain and its relationship with tumor location as well as histologic and surgical features.

[A case of lichenoid sarcoidosis with characteristic clinical and histopathological findings]. / Descripción de un caso de sarcoidosis liquenoide con hallazgos clínicos e histopatológicos característicos.

Sarcoidosis is a multisystem inflammatory disease characterized by the formation of noncaseating granulomas in various organs and tissues. The majority of patients with systemic sarcoidosis will present with lung and lymph node involvement. In addition, 20% have skin involvement that may be the only manifestation of the disease or may be an important prognostic marker for involvement of other organs. There are multiple forms of presentation of cutaneous sarcoidosis, which may be a true challenge.We report a patient with a one month history of an eruption of skin colored papules. Some were grouped in a symmetrical distribution on the trunk, inner arms, and lumbar region. Pathologic examination revealed an infiltrate in the papillary dermis showing a band of noncaseating granulomas along with disruption of the basal lamina and lichenoid changes. The clinicopathological correlation confirmed the diagnosis of lichenoid sarcoidosis. We consider our case interesting owing to the clinical presentation and the lichenoid distribution of granulomas.

Widespread eosinophilic pustular folliculitis in a nonimmunocompromised patient.

OBJECTIVE: We present a case of eosinophilic pustular folliculitis, a rare dermatosis which is often associated with HIV infection or internal malignancies. CLINICAL PRESENTATION AND INTERVENTION: We report the case of a 66-year-old man with a medical history of hypertension. Histopathological examination showed a dense follicular inflammatory infiltrate with abundant eosinophils. The clinical response to indomethacin was excellent with no recurrence during the follow-up. CONCLUSION: The patient responded well to indomethacin treatment.

Psoriasis comprehensive care: an evaluation of a web site.

Psoriasis is a disease that affects many facets of life. Psoriasis patients have needs that cannot be addressed within the traditional consultation structure. Although the Internet provides a number of health resources, the quality of the information is variable, and many sites are not editorially independent. After reviewing the contents available on the Internet related to psoriasis, the staff of the psoriasis unit at San Cecilio University Hospital (Granada, Spain) developed a Web site to meet the needs of psoriasis patients. A group of 241 patients who attended a follow-up visit to our psoriasis unit evaluated the Web site and provided feedback through an online survey. The result of the Web development process was the creation of "Psoriasis365" (https://sites.google.com/site/psoriasis365/). Overall, the Web site achieved high scores, the most popular section being "research." These results suggest that the Web site can complement the healthcare of psoriasis patients and is potentially useful for research purposes.