ABSTRACT
BACKGROUND: It has been reported that clinical evaluation consistently underestimates the severity of hidradenitis suppurativa (HS). OBJECTIVE: To determine the usefulness of ultrasound as a diagnostic tool in HS compared with clinical examination and to assess the subsequent modification of disease management. METHODS: Cross-sectional multicentre study. Severity classification and therapeutic approach according to clinical vs. ultrasound examination were compared. RESULTS: Of 143 HS patients were included. Clinical examination scored 38, 70 and 35 patients as Hurley stage I, II and III, respectively; with ultrasound examination, 21, 80 and 42 patients were staged with Hurley stage I, II and III disease, respectively (P < 0.01). In patients with stage I classification as determined by clinical examination, 44.7% changed to a more severe stage. Clinical examination indicated that 44.1%, 54.5% and 1.4% of patients would maintain, increase or decrease treatment, respectively. For ultrasound examination, these percentages were 31.5%, 67.1% and 1.4% (P < 0.01). Concordance between clinical and ultrasound intra-rater examination was 22.8% (P < 0.01); intra-rater and inter-rater (radiologist) ultrasound agreement was 94.9% and 81.7%, respectively (P < 0.01). LIMITATIONS: The inability to detect lesions that measure ≤0.1 mm or with only epidermal location. CONCLUSION: Ultrasound can modify the clinical staging and therapeutic management in HS by detecting subclinical disease.
Subject(s)
Hidradenitis Suppurativa/diagnostic imaging , Hidradenitis Suppurativa/therapy , Adult , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Severity of Illness Index , UltrasonographyABSTRACT
La medicina evolutiva o darwiniana entiende algunos procesos patológicos como intentos del organismo por solucionar un problema o generar mecanismos de defensa. Algunas enfermedades pueden haber representado una ventaja en ciertos estadios de la evolución humana. La psoriasis es una enfermedad poligénica con alta penetrancia y una prevalencia de hasta el 3% en las poblaciones de origen caucásico. Se ha descrito que las lesiones de psoriasis generan una mayor capacidad para la curación de las heridas, y de lucha contra la infección. Se ha postulado que, en ciertas poblaciones, los genes promotores de psoriasis han sido seleccionados ante la presión ambiental de ciertas infecciones como la lepra, el sida y la tuberculosis. La tendencia de los enfermos con psoriasis grave al desarrollo de síndrome metabólico puede representar un intento de reacción ante presiones ambientales y señales de alarma que desencadenan resistencia insulínica y ahorro de grasa
Darwinian medicine, or evolutionary medicine, regards some pathological conditions as attempts by the organism to solve a problem or develop defense mechanisms. At certain stages of human evolution, some diseases may have conferred a selective advantage. Psoriasis is a high-penetrance multigenic disorder with prevalence among whites of up to 3%. Psoriatic lesions have been linked with enhanced wound-healing qualities and greater capacity to fight infection. Leprosy, tuberculosis, and infections caused by viruses similar to human immunodeficiency virus have been postulated as environmental stressors that may have selected for psoriasis-promoting genes in some human populations. The tendency of patients with severe psoriasis to develop metabolic syndrome may reflect the bodys attempt to react to environmental stresses and warning signs by triggering insulin resistance and fat storage
Subject(s)
Humans , Psoriasis/chemically induced , Psoriasis/metabolism , Skin Diseases, Infectious , Skin Diseases, Metabolic/metabolism , Adaptation, Biological , Birth Weight , Psoriasis/classification , Biological Evolution , Selection, Genetic , Skin Diseases, Metabolic/chemically induced , Skin Diseases, Metabolic/complications , Genetic Predisposition to Disease , Genetic FitnessABSTRACT
Darwinian medicine, or evolutionary medicine, regards some pathological conditions as attempts by the organism to solve a problem or develop defense mechanisms. At certain stages of human evolution, some diseases may have conferred a selective advantage. Psoriasis is a high-penetrance multigenic disorder with prevalence among whites of up to 3%. Psoriatic lesions have been linked with enhanced wound-healing qualities and greater capacity to fight infection. Leprosy, tuberculosis, and infections caused by viruses similar to human immunodeficiency virus have been postulated as environmental stressors that may have selected for psoriasis-promoting genes in some human populations. The tendency of patients with severe psoriasis to develop metabolic syndrome may reflect the body's attempt to react to environmental stresses and warning signs by triggering insulin resistance and fat storage.
Subject(s)
Biological Evolution , Genetic Fitness , Psoriasis/genetics , Adaptation, Biological , Birth Weight , Energy Metabolism , Ethnicity/genetics , Gene-Environment Interaction , Genetic Predisposition to Disease , Humans , Metabolic Syndrome/etiology , Penetrance , Psoriasis/complications , Psoriasis/epidemiology , Psoriasis/physiopathology , Selection, Genetic , Skin Diseases, Infectious/genetics , Skin Diseases, Infectious/prevention & control , Wound HealingABSTRACT
La vitamina D aumenta la salud musculoesquelética y reduce la mortalidad asociada a problemas óseos en algunos grupos de población, especialmente en los ancianos y otros grupos de riesgo. Existen evidencias de que la vitamina D influye en el desarrollo del cáncer, la enfermedad cardiovascular, los procesos autoinmunes y las infecciones. Por otro lado, distintos estudios epidemiológicos avalan un estado de deficiencia o insuficiencia de vitamina D en la población de casi todo el mundo. Ante todas estas evidencias surgen diferentes controversias, en parte relacionadas con las medidas de fotoprotección impulsadas para prevenir el cáncer cutáneo. Las últimas recomendaciones del Instituto de Medicina Americano (IOM) consideran que niveles séricos de 20ng/ml (50nmol/l) parecen suficientes y alcanzables para la población general, incluso en condiciones de mínima exposición solar. Si atendemos a estas cifras, quizás la prevalencia de esa hipovitaminosis casi pandémica comunicada en los últimos años esté sobreestimada. El presente artículo recoge todas estas evidencias y controversias, además de profundizar en el papel de la radiación ultravioleta en la síntesis cutánea de la vitamina D. La conclusión es que no se debe tomar el sol como fuente primordial de vitamina D, puesto que se tiene certeza de que la radiación ultravioleta es un carcinógeno cutáneo. Lo saludable es combinar una exposición solar limitada junto a una adecuada alimentación y la administración de suplementos cuando sean necesarios (AU)
Vitamin D enhances musculoskeletal health and reduces mortality related to bone disease in some populations, particularly the elderly and other high-risk groups. Evidence suggests that vitamin D has an impact in cancer, cardiovascular disease, autoimmune processes, and infections. Epidemiologic studies have also detected vitamin D deficits or insufficiency in nearly all the world's populations. Such evidence has led to debate related, to a certain degree, to photoprotective measures that aim at protecting against skin cancer. The latest recommendations of the American Institute of Medicine consider that serum levels of 20 ng/mL (50 nmol/L) appear to be adequate in the general population and achievable even with minimal sun exposure. If these figures are reliable, the apparent pandemic of vitamin D deficiency reported in recent years may be exaggerated. This article reviews the evidence and issues under discussion, looking especially at the role ultraviolet radiation plays in synthesizing vitamin D in the skin. The conclusion is that sun exposure should not be used as the only source of vitamin D given that it is also clearly carcinogenic for the skin. A healthful approach combines moderate sun exposure, adequate food sources of the vitamin, and supplements whenever required (AU)
Subject(s)
Humans , Male , Female , Vitamin D/biosynthesis , Vitamin D/physiology , Vitamin D/therapeutic use , Vitamin D Deficiency/complications , Ultraviolet Rays , Multiple Sclerosis/epidemiology , Cathelicidins/physiology , Heart Failure/etiology , Neoplasms/epidemiology , Receptors, Calcitriol/genetics , Calcifediol/blood , Hypertension , Vitamin D Deficiency/drug therapy , Calcium, Dietary , PsoriasisABSTRACT
Vitamin D enhances musculoskeletal health and reduces mortality related to bone disease in some populations, particularly the elderly and other high-risk groups. Evidence suggests that vitamin D has an impact in cancer, cardiovascular disease, autoimmune processes, and infections. Epidemiologic studies have also detected vitamin D deficits or insufficiency in nearly all the world's populations. Such evidence has led to debate related, to a certain degree, to photoprotective measures that aim at protecting against skin cancer. The latest recommendations of the American Institute of Medicine consider that serum levels of 20 ng/mL (50 nmol/L) appear to be adequate in the general population and achievable even with minimal sun exposure. If these figures are reliable, the apparent pandemic of vitamin D deficiency reported in recent years may be exaggerated. This article reviews the evidence and issues under discussion, looking especially at the role ultraviolet radiation plays in synthesizing vitamin D in the skin. The conclusion is that sun exposure should not be used as the only source of vitamin D given that it is also clearly carcinogenic for the skin. A healthful approach combines moderate sun exposure, adequate food sources of the vitamin, and supplements whenever required.
Subject(s)
Vitamin D/therapeutic use , Autoimmune Diseases/drug therapy , Autoimmune Diseases/epidemiology , Autoimmune Diseases/etiology , Bone and Bones/metabolism , Cardiovascular Diseases/drug therapy , Cardiovascular Diseases/etiology , Cardiovascular Diseases/prevention & control , Clinical Trials as Topic , Diabetes Mellitus, Type 1/etiology , Diabetes Mellitus, Type 1/prevention & control , Diet , Habits , Humans , Immunity, Innate , Infections/immunology , Neoplasms/drug therapy , Neoplasms/etiology , Neoplasms, Radiation-Induced/etiology , Neoplasms, Radiation-Induced/prevention & control , Psoriasis/drug therapy , Psoriasis/etiology , Skin/immunology , Skin/metabolism , Skin/radiation effects , Skin Neoplasms/etiology , Skin Neoplasms/prevention & control , Spain , Sunlight/adverse effects , Ultraviolet Rays/adverse effects , Vitamin D/biosynthesis , Vitamin D/blood , Vitamin D/physiology , Vitamin D Deficiency/complications , Vitamin D Deficiency/epidemiology , Vitamin D Deficiency/prevention & controlSubject(s)
Vitamin D/physiology , Animals , Biological Evolution , Bone and Bones/metabolism , Calcium/metabolism , Climate , Diet , Female , Homeostasis , Humans , Male , Neoplasms/etiology , Nutritional Requirements , Osteoporosis/etiology , Psoriasis/etiology , Psoriasis/therapy , Racial Groups , Skin Pigmentation/physiology , Species Specificity , Sunlight , Vitamin D/therapeutic use , Vitamin D Deficiency/complications , Vitamin D Deficiency/drug therapy , Vitamin D Deficiency/epidemiology , Vitamin D Deficiency/prevention & controlABSTRACT
No disponible
No disponible
