ABSTRACT
El tratamiento de la alopecia androgénica (AGA) puede ser complejo para el clínico debido a la amplia gama de terapias disponibles, en muchos casos con escasos ensayos clínicos disponibles, y con muchas de las opciones de tratamiento sin aprobación de uso en la AGA según su ficha técnica. Este documento de consenso sobre el manejo de la AGA se ha elaborado siguiendo un método Delphi, en el que han participado 34 dermatólogos miembros del Grupo Español de Tricología de la Academia Española de Dermatología y Venereología. Tras 2 rondas de votaciones, se consensuaron 138 de los 160 ítems propuestos (86%), estructurados en 4 bloques de recomendaciones: generalidades, tratamiento farmacológico, procedimientos y trasplante capilar, y casos especiales. Este documento de consenso se apoya en la evidencia científica disponible y en la opinión de expertos para ayudar a los profesionales en el manejo de la AGA en la práctica clínica diaria.(AU)
Androgenetic alopecia can be challenging to treat due to the wide range of available treatments, most of which are not based on evidence from clinical trials. In addition many of the options do not include androgenetic alopecia among the approved indications according to their summaries of product characteristics. A panel of 34 dermatologists from the Spanish Trichology Society of the Spanish Academy of Dermatology and Venereology (AEDV) used the Delphi method to develop a consensus statement on the management of androgenetic alopecia. Over a 2-round process the experts agreed on 138 (86%) of the 160 proposed items, which were structured into 4 blocks of recommendations: general considerations, pharmacologic treatment, procedures and hair transplant, and special cases. The resulting consensus statement based on expert opinion of the scientific evidence can guide professionals in the routine management of androgenetic alopecia.(AU)
Subject(s)
Humans , Male , Female , Consensus , Complementary Therapies , Alopecia/drug therapy , Alopecia/therapy , Spain , DermatologyABSTRACT
El tratamiento de la alopecia androgénica (AGA) puede ser complejo para el clínico debido a la amplia gama de terapias disponibles, en muchos casos con escasos ensayos clínicos disponibles, y con muchas de las opciones de tratamiento sin aprobación de uso en la AGA según su ficha técnica. Este documento de consenso sobre el manejo de la AGA se ha elaborado siguiendo un método Delphi, en el que han participado 34 dermatólogos miembros del Grupo Español de Tricología de la Academia Española de Dermatología y Venereología. Tras 2 rondas de votaciones, se consensuaron 138 de los 160 ítems propuestos (86%), estructurados en 4 bloques de recomendaciones: generalidades, tratamiento farmacológico, procedimientos y trasplante capilar, y casos especiales. Este documento de consenso se apoya en la evidencia científica disponible y en la opinión de expertos para ayudar a los profesionales en el manejo de la AGA en la práctica clínica diaria.(AU)
Androgenetic alopecia can be challenging to treat due to the wide range of available treatments, most of which are not based on evidence from clinical trials. In addition many of the options do not include androgenetic alopecia among the approved indications according to their summaries of product characteristics. A panel of 34 dermatologists from the Spanish Trichology Society of the Spanish Academy of Dermatology and Venereology (AEDV) used the Delphi method to develop a consensus statement on the management of androgenetic alopecia. Over a 2-round process the experts agreed on 138 (86%) of the 160 proposed items, which were structured into 4 blocks of recommendations: general considerations, pharmacologic treatment, procedures and hair transplant, and special cases. The resulting consensus statement based on expert opinion of the scientific evidence can guide professionals in the routine management of androgenetic alopecia.(AU)
Subject(s)
Humans , Male , Female , Spain , DermatologyABSTRACT
Androgenetic alopecia can be challenging to treat due to the wide range of available treatments, most of which are not based on evidence from clinical trials. In addition many of the options do not include androgenetic alopecia among the approved indications according to their summaries of product characteristics. A panel of 34 dermatologists from the Spanish Trichology Society of the Spanish Academy of Dermatology and Venereology (AEDV) used the Delphi method to develop a consensus statement on the management of androgenetic alopecia. Over a 2-round process the experts agreed on 138 (86%) of the 160 proposed items, which were structured into 4 blocks of recommendations: general considerations, pharmacologic treatment, procedures and hair transplant, and special cases. The resulting consensus statement based on expert opinion of the scientific evidence can guide professionals in the routine management of androgenetic alopecia.
Subject(s)
Dermatology , Venereology , Humans , Alopecia/drug therapy , Academies and Institutes , ConsensusABSTRACT
Female pattern hair loss (FPHL) is an important hair disorder, especially when young women are affected. However, pharmacological treatments are not successful in all women. Androgens, especially dihydrotestosterone (DHT), may play a role in FPHL, but many women with this disorder have normal serum androgen levels. It therefore appears that hair follicle levels of DHT depend on in situ testosterone (T) metabolism. Because T can be converted to DHT or estradiol (E2) by 5α-reductase (5α-R) and aromatase, respectively, these enzymes would determine DHT and E2 concentrations and their ratio. We propose and apply a low-invasive, sensitive and precise method for the absolute quantification of mRNA levels of aromatase and 5α-R isozymes (type 1, type 2 and type 3) in plucked hair from young women with FPHL. Normoandrogenic women with FPHL and controls were studied. Plucked hair samples were obtained by trichogram from vertex scalp and mRNA levels quantified by real-time RT-PCR. We revealed for the first time the presence of 5α-R3 mRNA in human hair. Interestingly, one, two, or even three 5α-R isozymes were increased in some women with FPHL but not in others, which may explain the lack of response to 5α-R inhibitors in some FPHL cases. Aromatase mRNA levels were significantly lower in women with FPHL than in controls. It may therefore produce a reduction in oestrogen levels and an increase in the androgen/oestrogen ratio in hair. The proposed low-invasive technique offers a molecular aetiologic diagnosis of FPHL for the selection of more appropriate pharmacological treatments with early predicted effectiveness.
Subject(s)
3-Oxo-5-alpha-Steroid 4-Dehydrogenase/analysis , Alopecia/diagnosis , Aromatase/metabolism , Hair Follicle/pathology , Membrane Proteins/analysis , Scalp Dermatoses/pathology , 3-Oxo-5-alpha-Steroid 4-Dehydrogenase/metabolism , 5-alpha Reductase Inhibitors/therapeutic use , Adult , Alopecia/blood , Alopecia/drug therapy , Alopecia/pathology , Dihydrotestosterone/blood , Dihydrotestosterone/metabolism , Female , Humans , Isoenzymes/metabolism , Membrane Proteins/metabolism , RNA, Messenger/analysis , RNA, Messenger/metabolism , Sensitivity and Specificity , Testosterone/blood , Testosterone/metabolism , Young AdultABSTRACT
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 AdultSubject(s)
Cellulitis , Isotretinoin/therapeutic use , Scalp Dermatoses , Skin Diseases, Genetic , Adolescent , Adult , Biopsy , Cellulitis/diagnosis , Cellulitis/epidemiology , Cellulitis/therapy , Dermatologic Agents/therapeutic use , Female , Global Health , Humans , Male , Middle Aged , Morbidity/trends , Multicenter Studies as Topic , Retrospective Studies , Scalp , Scalp Dermatoses/diagnosis , Scalp Dermatoses/epidemiology , Scalp Dermatoses/therapy , Skin Diseases, Genetic/diagnosis , Skin Diseases, Genetic/epidemiology , Skin Diseases, Genetic/therapy , Spain/epidemiology , Young AdultABSTRACT
BACKGROUND: Folliculitis decalvans (FD) is a rare neutrophilic scarring alopecia that represents a therapeutic challenge for dermatologists. OBJECTIVE: To describe the epidemiology, comorbidities, clinical presentation, diagnostic findings and therapeutic options in a large series of patients with FD. METHODS: This retrospective multicentre review includes patients diagnosed with FD based on clinical and histopathologic findings. The clinical severity was determined by the maximum diameter of the largest alopecic patch (slight: <2 cm, moderate: 2-4.99 cm, severe: 5 cm or more). Response to therapy was assessed as improvement, worsening or stabilization depending on the clinical symptoms (pruritus and trichodynia), inflammatory signs (erythema, pustules and crusts) and the extension of the alopecic patch. RESULTS: Overall, 82 patients (52 males and 30 females) with a mean age of 35 years were included. No significant comorbidities were present. A family history was present in three males. Severe FD was observed in 17 patients (21%). The independent factors associated with severe FD after multivariate analysis were: onset of FD before 25 years of age and presence of pustules. Oral antibiotics (tetracyclines and the combination of clindamycin and rifampicin) improved 90% and 100% of the patients, with a mean duration of response of 4.6 and 7.2 months respectively. CONCLUSIONS: The onset of FD before 25 years of age and the presence of pustules within the alopecic patch were associated with severe FD. Tetracyclines and the combination of clindamycin and rifampicin were the most useful treatments.
Subject(s)
Alopecia Areata/etiology , Folliculitis/diagnosis , Scalp Dermatoses/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Alopecia Areata/diagnosis , Alopecia Areata/epidemiology , Dermoscopy , Female , Folliculitis/complications , Folliculitis/epidemiology , Humans , Incidence , Male , Middle Aged , Retrospective Studies , Scalp Dermatoses/complications , Scalp Dermatoses/epidemiology , Severity of Illness Index , Spain/epidemiology , Young AdultABSTRACT
El melanoma cutáneo supone el 5% de todas las neoplasias malignas cutáneas, con una incidencia que va en aumento. En su evolución natural el melanoma tiene un crecimiento local, posibilidad de diseminación por vía linfática y hemática. El diagnóstico precoz (prevención secundaria) determina el pronóstico de la enfermedad, ya que la supervivencia está en relación directa con el estadio al diagnóstico. La tomografía por emisión de positrones (PET) es una técnica de medicina nuclear que utiliza moléculas marcadas con isótopos emisores de positrones para la obtención de imágenes. El más utilizado es la 18 flúor-fluorodeoxiglucosa (18F-FDG). En la célula tumoral el aumento de la tasa glucolítica principalmente determina una mayor entrada de FDG en la célula y un mayor atrapamiento, permitiendo su detección externa. Actualmente la mayoría de equipos PET son equipos multimodalidad PET/TAC que dan una información más completa, incorporando información morfológica a los hallazgos funcionales de la PET. La posible utilidad de la PET/TAC en pacientes con melanoma maligno es un tema controvertido que plantea varios interrogantes; en qué momento hay que realizar esta prueba, si supone una ventaja sobre los métodos de diagnóstico convencional y si proporciona un beneficio real sobre los pacientes. A través de una revisión de la literatura iremos analizando cada uno de estos aspecto (AU)
Malignant melanoma accounts for 5% of all malignant skin tumors and its incidence is increasing. In the natural course of melanoma, tumors grow locally and can spread via the lymph system or the blood. Because survival is directly related to the stage of the disease at diagnosis, early detection (secondary prevention) has an impact on prognosis. Positron emission tomography (PET) is a nuclear medicine technique that generates images using molecules labeled with positron-emitting isotopes. The most widely used molecule is fluorodeoxyglucose (FDG). Because of the elevated glycolytic rate in tumor cells, which results in increased FDG uptake, greater quantities of FDG become trapped in tumor cells, enabling external detection. Today, most PET scanners are multimodal PET---computed tomography (CT) scanners, which provide more detailed information by combining morphological information with functional PET findings. The possible utility of PET-CT in patients with malignant melanoma is a subject of debate. Various questions have been raised: when the scan should be performed, whether PET-CT has advantages over conventional diagnostic methods, and whether PET-CT provides a real benefit to patients. In this review of the literature, we will analyze each of these questions (AU)
Subject(s)
Humans , Melanoma/diagnosis , Skin Neoplasms/diagnosis , Positron-Emission Tomography/methods , Fluorodeoxyglucose F18 , Neoplasm Staging/methods , Lymphatic Metastasis/diagnosis , Neoplasm Recurrence, Local/diagnosisABSTRACT
No disponible
Subject(s)
Humans , Skin Neoplasms/surgery , Suture Techniques , Dermatologic Surgical Procedures/methodsABSTRACT
Malignant melanoma accounts for 5% of all malignant skin tumors and its incidence is increasing. In the natural course of melanoma, tumors grow locally and can spread via the lymph system or the blood. Because survival is directly related to the stage of the disease at diagnosis, early detection (secondary prevention) has an impact on prognosis. Positron emission tomography (PET) is a nuclear medicine technique that generates images using molecules labeled with positron-emitting isotopes. The most widely used molecule is fluorodeoxyglucose (FDG). Because of the elevated glycolytic rate in tumor cells, which results in increased FDG uptake, greater quantities of FDG become trapped in tumor cells, enabling external detection. Today, most PET scanners are multimodal PET-computed tomography (CT) scanners, which provide more detailed information by combining morphological information with functional PET findings. The possible utility of PET-CT in patients with malignant melanoma is a subject of debate. Various questions have been raised: when the scan should be performed, whether PET-CT has advantages over conventional diagnostic methods, and whether PET-CT provides a real benefit to patients. In this review of the literature, we will analyze each of these questions.
Subject(s)
Melanoma/diagnostic imaging , Positron Emission Tomography Computed Tomography , Skin Neoplasms/diagnostic imaging , Humans , Melanoma/pathology , Neoplasm Staging , Skin Neoplasms/pathology , Melanoma, Cutaneous MalignantABSTRACT
Los métodos de exploración en tricología se pueden clasificar en 3 categorías: métodos no invasivos (historia clínica, exploración general, inspección y palpación del cabello y cuero cabelludo, fotografía, dermoscopia, etc.), métodos semi-invasivos (tricograma) e invasivos (biopsia). En este artículo se repasa de forma práctica el abordaje de los motivos de consulta en tricología en la consulta del dermatólogo (AU)
Hair and scalp evaluation techniques can be classified into 3 categories: noninvasive methods (clinical history, general examination, inspection and palpation of the hair and scalp, photography, dermoscopy, etc.); semi-invasive methods (the trichogram); and invasive methods (biopsy). In this article, we provide a practical guide on how to evaluate hair and scalp conditions in the dermatology office (AU)
Subject(s)
Humans , Hair Diseases/diagnosis , Scalp/physiopathology , Medical History Taking/methods , Physical Examination/methodsABSTRACT
La dermoscopia es un procedimiento diagnóstico que ha demostrado su utilidad en tumores pigmentados. En la actualidad sus aplicaciones se han extendido a otras enfermedades de la piel y de los anejos como el pelo (tricoscopia) y uñas (onicoscopia).La aplicación de la dermoscopia en la exploración de las alteraciones ungueales es una técnica no invasiva que nos permite valorar diferentes características de las uñas: anomalías en la lámina ungueal (pigmentaciones de origen melanocítico y no melanocítico), y el lecho ungueal y nos ayuda adetectar anomalías en el patrón vascular del hiponiquio y del pliegue proximal (en las enfermedades del tejido conectivo).A continuación se exponen los signos más característicos de la exploración con esta técnica y se establecen los patrones de las pigmentacione sungueales de origen melanocítico y no melanocítico, enfermedades ungueales como el psoriasis ungueal y afectación de enfermedades del tejidoconectivo (AU)
Dermoscopy has proven to be a useful diagnostic procedure in pigmented tumours. More recently its application has been extended to other skin diseases, and diseases of the cutaneous annexes such as the hair (trichoscopy) and nails (onichoscopy).The application of dermoscopy in the evaluation of nails disorders is a noninvasive technique that enables the assessment of specific characteristics ofthe nails: dermoscopy permits better visualization of abnormalities in the nail plate (pigmentation produced by melanocytic and non melanocyticlesions) and bed, and aids detection of the vascular abnormalities in the hyponychium and proximal nail fold (in connective tissue diseases).The most characteristic signs observed with this technique are reported below, describing the patterns of nail pigment of melanocytic and nonmelanocycit origin, nail diseases like ungueal psoriasis and connective tissue diseases (AU)
Subject(s)
Humans , Nail Diseases/diagnosis , Endoscopy/methods , Connective Tissue Diseases/diagnosis , Pigmentation Disorders/diagnosis , Diagnosis, DifferentialABSTRACT
Hair and scalp evaluation techniques can be classified into 3 categories: noninvasive methods (clinical history, general examination, inspection and palpation of the hair and scalp, photography, dermoscopy, etc.); semi-invasive methods (the trichogram); and invasive methods (biopsy). In this article, we provide a practical guide on how to evaluate hair and scalp conditions in the dermatology office.
Subject(s)
Dermoscopy , Hair Diseases/pathology , Scalp Dermatoses/pathology , HumansABSTRACT
La dermoscopia es un procedimiento diagnóstico que ha demostrado su utilidad en tumores pigmentados y otras enfermedades cutáneas. En la actualidad sus aplicaciones se han extendido más allá y han invadido el campo de la tricología. En tricología disponemos de métodos no invasivos para el diagnóstico y seguimiento del paciente como el tricograma y el fototricograma a los que se añade la tricoscopia como una técnica más de exploración tricológica que mejora el diagnóstico de diferentes patologías del pelo. Mediante esta técnica es más fácil observar algunas características del pelo y del cuero cabelludo y aporta unos signos diagnósticos sencillos de obtener con videodermoscopia o con dermatoscopio manual, que ya forman parte del instrumental habitual en la consulta del dermatólogo. A continuación se exponen los signos más característicos de la exploración con esta técnica y se establecen los patrones característicos de la alopecia androgenética (AGA), la alopecia areata (AA) y la alopecia cicatricial (AC (AU)
Dermoscopy has proven to be a useful diagnostic procedure in pigmented tumours and other skin diseases, and its application has been extended to other fields, including trichology. Thus, trichoscopy has now been added to available non-invasive diagnostic and follow-up techniques in trichology, such as the trichogram and phototrichogram, as a further trichological examination to improve the diagnosis of different hair diseases. Trichoscopy facilitates the observation of certain hair and scalp features and contributes diagnostic signs that are readily detected with video or manual dermatoscopes, which already form part of the usual equipment in the dermatology office. The most characteristic signs observed with this technique are reported below, describing the patterns of androgenetic alopecia (AGA), alopecia areata (AA) and cicatricial alopecia (CA) (AU)
Subject(s)
Humans , Endoscopy , Hair Diseases/diagnosis , Hypotrichosis/diagnosis , Alopecia/diagnosis , Cicatrix/complicationsSubject(s)
Pregnancy Complications/diagnosis , Sweet Syndrome/diagnosis , Adult , Female , Humans , PregnancyABSTRACT
El granuloma de Majocchi es una dermatofitosis bien conocida, aunque infrecuente, generalmente causada por especies de Trichophyton. Presentamosel caso de un varón de 56 años que consultó por una placa en antebrazo de tres años de evolución, asintomática, de crecimiento progresivo. Eneste tiempo le habían realizado dos biopsias sin llegar a un diagnóstico y había sido tratado con clobetasol tópico sin ninguna mejoría. Con la sospechade una tiña incógnito se le practicó una nueva biopsia, se tomaron muestras para cultivo y se inició tratamiento con griseofulvina oral con resolucióncompleta del cuadro a las seis semanas. El diagnóstico histológico fue de granuloma de Majocchi y el cultivo demostró Trichophyton verrucosum.Aunque la mayoría de los casos de granuloma de Majocchi se han descrito en piernas de mujeres de edad media con antecedente de algún traumalocal, cada vez se están comunicando más casos de presentación atípica, como el nuestro, y es muy frecuente verlos enmascarados como una tiñaincógnita por la aplicación previa de corticoides (AU)
Majocchi´s granuloma is a rare but well known dermatophytosis, usually caused by Trichophyton species. We report a case of a 56-year-old man whohad a 3-year-evolution plaque in his forearm, asympthomatic, which had been growing up progressively. During this time he had been treated withtopical clobetasol, with no resolution, and two skin biopsies were performed, with no histopathological diagnosis. With clinical diagnosis of tineaincognito, local cultures and a new skin biopsy were performed, and we started treatment with oral griseofulvine, with complete remission of the diseasein 6 weeks time. Majocchi´s granuloma was the histopathologic diagnosis and cultures proved the infection with Trichophyton verrucosum.Althoug most cases of Majocchi´s granuloma have been reported in lower legs of young women with local trauma such us depilation, nowadays moreand more cases are being reported with unusual clinical presentations, and it is more common to see such cases showing as a tinea incognito becauseof previous use of topical corticosteroids (AU)
Subject(s)
Humans , Male , Middle Aged , Dermatomycoses/diagnosis , Trichophyton/isolation & purification , Granuloma/diagnosis , Tinea/diagnosis , Diagnosis, DifferentialABSTRACT
No disponible
No disponible
