ABSTRACT
Apremilast is an oral small molecule approved for the treatment of psoriasis, psoriatic arthritis and oral ulcers associated with Behçet's disease. This research was conducted to describe the characteristics of patients who received treatment with apremilast for a skin disorder, either before, during, or after a biological treatment, with the aim of analyze the reasons that lead to start this drug in real clinical practice or suspend it for another. A total of 41 patients were enrolled: nine (22.0%) had received biological treatment prior to apremilast, seven (17.0%) both before and after apremilast and 25 (61.0%) after apremilast. One patient received concomitant treatment with adalimumab and apremilast. Most patients (85.4%) received apremilast as treatment for psoriasis. Reasons for starting apremilast were lack of efficacy with previous treatments (85.4%) and adverse effects or contraindication to previous treatments (14.6%), without statistically significant differences between patients who had received a previous biologic and those who had not. Drug survival was not influenced by previous biological treatment, but we found an increased risk of drug discontinuation in patients with chronic kidney disease (log-rank p = 0.028). The main reason of apremilast withdrawal was lack of adequate disease control (60.0%), most of whom required treatment with biologics. Therefore, despite the extensive development of new therapies for psoriasis and other dermatological conditions, apremilast is a widely used drug even in patients who are candidates for biologic treatment. Its initiation is more frequent due to poor disease control than because of other therapies contraindications.
Subject(s)
Arthritis, Psoriatic , Biological Products , Psoriasis , Humans , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Thalidomide/adverse effects , Arthritis, Psoriatic/drug therapy , Psoriasis/drug therapy , Psoriasis/chemically induced , Biological Products/adverse effectsABSTRACT
Porokeratosis (PK) is an epidermal disorder of keratinization, caused by a clone expansion of a mutated keratinocyte that generates a thin parakeratotic column: the cornoid lamella (CL). Depending on the clinical presentation, we differentiate up to 6 different types of PK. Most frequent locations for the lesions are limbs and trunk, while scalp is rarely affected. The possible origin of the CL in the epidermal appendages has been proposed (ostia of the eccrine glands and infundibulum of the follicle). The first case of PK limited to the scalp with exclusive involvement of the hair follicles is presented in this manuscript. It helps identify the clinical description and especially the trichoscopy as a diagnostic key in follicular PK and also to elucidate if it is an incidental histological finding or a new different clinical variant of PK.
ABSTRACT
Eccrine mucinous nevus is an uncommon hamartoma whose histological diagnosis is simple because of its peculiar morphological features, which include an increase in the number and/or size of the glands and eccrine ducts accompanied by abundant mucin deposits. When it presents with the typical symptom, focal hyperhidrosis, clinical suspicion is possible. El nevus mucinoso ecrino (NME) es un hamartoma escasamente reportado en la literatura cuyo diagnóstico histológico es sencillo debido a sus peculiares rasgos morfológicos, que incluye un aumento del número y/o tamaño de las glándulas ductos ecrinos acompañado de abundante depósito de mucina. Cuando presenta los hallazgos típicos, como la hiperhidrosis focal, es posible su sospecha clínica.
Subject(s)
Nevus/pathology , Sweat Gland Neoplasms/pathology , Humans , Hyperhidrosis/etiology , Male , Middle Aged , Nevus/complications , Sweat Gland Neoplasms/complicationsABSTRACT
Central centrifugal cicatricial alopecia (CCCA) is included among the primary lymphocytic cicatricial alopecias. The current nomenclature of CCCA suggested by the North American Hair Research Society refers to the traditional clinical presentation pattern of this type of alopecia, which begins in the central area of the scalp and has a progressive and symmetric centrifuge evolution. However, some exceptions should be highlighted, and a new clinical variety of CCCA presenting with patches of hair loss affecting the lateral and posterior scalp has been recently described. Here, we report a new case of CCCA presenting with a patchy pattern. In addition to the fact that this new patchy presentation of CCCA is not contemplated in the current terminology, it has a difficult differential diagnosis with other alopecias that have patches as their presentation. In these cases, both the trichoscopy and the histopathology are indispensable for diagnosis that will allow a targeted treatment and avoid an unfortunate prognosis.
Subject(s)
B-Lymphocytes/pathology , Dermatitis, Allergic Contact/etiology , Eye Diseases/etiology , Eyelids/surgery , Gold/adverse effects , Prostheses and Implants/adverse effects , Pseudolymphoma/etiology , Adult , Betamethasone/therapeutic use , Biopsy , Dermatitis, Allergic Contact/prevention & control , Eye Diseases/drug therapy , Eye Diseases/pathology , Glucocorticoids/therapeutic use , Humans , Male , Patch Tests , Pseudolymphoma/drug therapy , Pseudolymphoma/pathology , Treatment OutcomeABSTRACT
El desarrollo de las nuevas tecnologías está modificando nuestra vida en muchos aspectos, incluyendo la aparición de nuevas patologías y el cambio en las causas de otras ya conocidas. El eritema "ab igne" es un tipo de hipermelanosis producida por la exposición crónica al calor moderado, que clásicamente se ha relacionado con el uso de braseros, bolsas de agua caliente o mantas eléctricas, actualmente las podemos ver relacionadas con el empleo de ordenadores portátiles. El diagnóstico es eminentemente clínico y la sospecha diagnóstica junto con la anamnesis dirigida revelarán la exposición crónica a la radiación térmica. Es necesario tener presentes estos nuevos agentes etiológicos para evitar retrasos diagnósticos y el consiguiente empeoramiento del cuadro clínico. El conocimiento de esta entidad clínica es importante dado que se encuentra dentro del diagnóstico diferencial de la patología con lesiones reticuladas cutáneas, presente de forma habitual en ciertas enfermedades reumatológicas. Los facultativos debemos conocer esta entidad para sospecharla y advertir a nuestros pacientes del riesgo que supone el apoyo directo y continuado de una fuente de calor(AU)
El desarrollo de las nuevas tecnologías está modificando nuestra vida en muchos aspectos, incluyendo la aparición de nuevas patologías y el cambio en las causas de otras ya conocidas. El eritema "ab igne" es un tipo de hipermelanosis producida por la exposición crónica al calor moderado, que clásicamente se ha relacionado con el uso de braseros, bolsas de agua caliente o mantas eléctricas, actualmente las podemos ver relacionadas con el empleo de ordenadores portátiles. El diagnóstico es eminentemente clínico y la sospecha diagnóstica junto con la anamnesis dirigida revelarán la exposición crónica a la radiación térmica. Es necesario tener presentes estos nuevos agentes etiológicos para evitar retrasos diagnósticos y el consiguiente empeoramiento del cuadro clínico. El conocimiento de esta entidad clínica es importante dado que se encuentra dentro del diagnóstico diferencial de la patología con lesiones reticuladas cutáneas, presente de forma habitual en ciertas enfermedades reumatológicas. Los facultativos debemos conocer esta entidad para sospecharla y advertir a nuestros pacientes del riesgo que supone el apoyo directo y continuado de una fuente de calor(AU)
Subject(s)
Humans , Male , Middle Aged , Medical History Taking , Low Back Pain/complications , Diagnosis, Differential , Erythema Ab Igne/diagnostic imaging , Lumbosacral Region/injuriesABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Genital Diseases, Male/diagnosis , Skin Ulcer/chemically induced , Ibuprofen/adverse effects , Drug Eruptions/diagnosisSubject(s)
Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Drug Eruptions/diagnosis , Ibuprofen/adverse effects , Penile Diseases/chemically induced , Ulcer/chemically induced , Adult , Drug Eruptions/etiology , Humans , Male , Medical History Taking , Penile Diseases/diagnosis , Ulcer/diagnosisABSTRACT
Fibro-osseous pseudotumor of the digits is a benign neoplasm that originates in the soft tissue adjacent to the short bones of the hands and feet. We present a case in a 13-year-old girl that was initially misdiagnosed as pyogenic granuloma. Familiarity with this entity and imaging and histologic studies are necessary to avoid incorrect diagnoses and aggressive surgical interventions.
Subject(s)
Fibroma/pathology , Granuloma, Plasma Cell/pathology , Granuloma, Pyogenic/pathology , Osteoma/pathology , Soft Tissue Neoplasms/pathology , Adolescent , Biopsy, Needle , Diagnosis, Differential , Female , Fibroma/diagnosis , Fibroma/surgery , Fingers , Granuloma, Plasma Cell/diagnosis , Granuloma, Pyogenic/diagnosis , Humans , Immunohistochemistry , Osteoma/diagnosis , Osteoma/surgery , Rare Diseases , Soft Tissue Neoplasms/diagnosis , Soft Tissue Neoplasms/surgery , Treatment OutcomeABSTRACT
No disponible
Subject(s)
Humans , Female , Aged, 80 and over , Erythema/complications , Erythema/diagnosis , Osteoarthritis/complications , Osteoarthritis/drug therapy , Calcium/therapeutic use , Vitamin D/therapeutic use , Alendronate/therapeutic use , Tramadol/therapeutic use , Hot Temperature/adverse effects , Hemosiderin/adverse effects , Vasodilation/radiation effectsSubject(s)
Erythema/etiology , Hot Temperature/adverse effects , Aged, 80 and over , Erythema/diagnosis , Female , HumansABSTRACT
Herpes gestationis es una enfermedad pruriginosa del embarazo, poco frecuente, que en algunas ocasiones puede producir prematuridad y bajo peso del recién nacido. Presentamos el caso de una mujer de 25 años, embarazada, que en la semana 20 desarrolló un herpes gestationis difícilmente controlable con 50 mg/día de prednisona, por lo que se trató con ciclosporina (3 mg/kg/día) asociada al corticosteroide, con lo que mejoró rápidamente. Revisamos las características de esta enfermedad y la posibilidad de tratamiento con ese inmunosupresor en los casos rebeldes (AU)