Application of the Simplified Psoriasis Index in the Routine Clinical Practice: A Pilot Study. / Aplicación del Simplified Psoriasis Index en la práctica clínica habitual: estudio piloto.

BACKGROUND AND OBJECTIVE: The Simplified Psoriasis Index (SPI) is a recently validated tool in Spanish that measures psoriasis severity by integrating 3 different spheres: clinical severity (SPI-s), psychosocial impact (SPI-p), and natural history (SPI-i). Our objective was to study the validity and equivalence of this new scale compared to routinely used scales such as the Psoriasis Area and Severity Index, PASI, and the Dermatology Life Quality Index (DLQI). MATERIALS AND METHODS: This was a cross-sectional and observational study that included 45 patients aged 18 to 74 years. Demographic data and information associated with psoriasis severity and the patients' quality of life were collected, using PASI, DLQI, and SPI simultaneously. The correlation of reference scales (PASI and DLQI) with SPI was examined. The degree of agreement between the 2 versions of SPI completed by the physician (proSPI-s) and self-administered by the patient (saSPI-s), was also studied. RESULTS: The mean age of the study population was 51 years, with a mean psoriasis history of 14.05 years. A strong correlation was found between PASI and proSPI-s (r=0.89), as well as between DLQI and SPI-p (r=0.89), with a moderate correlation being reported between PASI and saSPI-s (r=0.52). The degree of agreement between proSPI-s and saSPI-s was moderate. CONCLUSIONS: These findings represent the initial results of real clinical practice using the validated Spanish version of SPI, making its use truly promising in the routine clinical practice.

[Sequential histological and immunohistochemical assessment of proliferation and apoptotic markers during treatment of psoriasis with antitumor necrosis factor alpha (infliximab)]. / Evaluación histológica e inmunohistoquímica secuencial de marcadores de proliferación y apoptosis durante el tratamiento de la psoriasis con anti-factor de necrosis tumoral alpha (infliximab).

BACKGROUND AND OBJECTIVES: Psoriasis is an inflammatory skin disease of immunologic nature that is mediated by T-helper-1 cytokines. Clinical response to treatment with antitumor necrosis factor (TNF) alpha antibodies (infliximab) has been significant; however, the mechanisms for clearance of lesions have not been elucidated. The aim of the present study was to assess variations in the histology and expression of proliferation and apoptotic markers in sequential skin biopsies of patients with psoriasis treated with infliximab. MATERIAL AND METHODS: We studied skin biopsies (of lesioned and healthy skin) from 3 patients with extensive moderate-to-severe psoriasis (mean psoriasis area and severity index [PASI] score, 35) treated with intravenous infliximab infusions (5 mg/kg) at weeks 0, 2, and 6. Biopsies were taken on days 0, 14, and 28, and were processed for conventional histological and immunohistochemical study. The apoptotic markers used were TP53, B-cell lymphoma 2 protein, anticaspase 3, and anticaspase 8. The cell proliferation marker used was Ki67. RESULTS: Treatment with infliximab was associated with a significant clinical improvement in 3 patients (mean PASI score, 21.6 at 14 days and 13.9 at 6 weeks), which correlated with the progressive disappearance of histological lesions with a decrease in epidermal proliferation. However, apoptosis was not observed, and the samples tested negative for anticaspase antibodies. Expression of TP53 decreased 2 weeks after starting treatment, and was similar to that in normal skin at 28 days. CONCLUSIONS: Clinical and histological response of psoriasis to infliximab was not associated with a significant increase in the apoptotic markers assessed.

[Narrow band UVB therapy in early stage mycosis fungoides. A study of 23 patients]. / Tratamiento con UVB de banda estrecha de los estadios iniciales de la micosis fungoide. Estudio de 23 pacientes.

INTRODUCTION: Phototherapy is effective for mycosis fungoides. Narrow band UVB (UVB1) therapy is being used as an alternative to PUVA therapy for its efficacy and less adverse events. The objective of the study was to determine the efficacy of narrow band UVB therapy in early stage mycosis fungoides. METHODS: It is a retrospective study of 23 patients with stage IB mycosis fungoides that have received UVB1 therapy following the phototherapy protocol of the Spanish Photobiology Group. RESULTS: Thirteen patients (57 %) had a complete response, eight patients (35 %) had a partial response and two patients (8 %) did not respond. Half of the patients with complete response (n = 6) relapsed after one year of follow-up. CONCLUSIONS: We consider that UVB1 therapy is a good alternative for treatment of early stage mycosis fungoides, although the disease-free period is short.

Tratamiento con UVB de banda estrecha de los estadios iniciales de la micosis fungoide. Estudio de 23 pacientes / Narrow band UVB therapy in early stage mycosis fungoides. A study of 23 patients

Introducción. La fototerapia ha demostrado ser de utilidad en la micosis fungoide. La radiación UVB de banda estrecha (UVB1) está siendo utilizada como alternativa a la radiación UVA por su eficacia y menores efectos secundarios. El objetivo del estudio fue determinar la eficacia del tratamiento de la fototerapia con UVB1 en los estadios iniciales de la micosis fungoide. Métodos. Estudio retrospectivo sobre 23 pacientes con micosis fungoide en estadio IB que habían recibido fototerapia con UVB, según el protocolo de fototerapia del Grupo Español de Fotobiología. Resultados. Se obtuvo respuesta completa en 13 pacientes (57 %), respuesta parcial en 8 (35 %) y no respondieron 2 (8 %). La mitad de los pacientes con respuesta completa que finalizaron el año de seguimiento (n = 6) presentaron recidivas. Conclusiones. Consideramos que la fototerapia con UVB1 es una buena opción en el tratamiento de las fases iniciales de la micosis fungoide, aunque el intervalo libre de enfermedad no es prolongado

Introduction. Phototherapy is effective for mycosis fungoides. Narrow band UVB (UVB1) therapy is being used as an alternative to PUVA therapy for its efficacy and less adverse events. The objective of the study was to determine the efficacy of narrow band UVB therapy in early stage mycosis fungoides. Methods. It is a retrospective study of 23 patients with stage IB mycosis fungoides that have received UVB1 therapy following the phototherapy protocol of the Spanish Photobiology Group. Results. Thirteen patients (57 %) had a complete response, eight patients (35 %) had a partial response and two patients (8 %) did not respond. Half of the patients with complete response (n = 6) relapsed after one year of follow-up. Conclusions. We consider that UVB1 therapy is a good alternative for treatment of early stage mycosis fungoides, although the disease-free period is short

Sézary syndrome associated with granulomatous lesions during treatment with bexarotene.

Sézary syndrome (SS) is a leukaemic variant of cutaneous T-cell lymphoma (CTCL). We report a patient with SS who developed granulomatous lesions. These lesions broke out during treatment with bexarotene when the disease had appeared to stabilize. After a partial clinical remission the disease showed rapid progression and finally led to the patient's death. This contradicts the initial assessment, which considered the granulomatous inflammation as a good prognostic factor in CTCL.

[Rapidly metastasizing renal carcinoma with intense expression of p53 and P-glycoprotein]. / Carcinoma renal rápidamente metastatizante con intensa expresión de p53 y glicoproteína P.

OBJECTIVE: A case of rapidly metastasizing renal carcinoma is presented. METHODS: A 62-year-old man complained of fever for the past 6 weeks and weight loss. An abdominal CT disclosed two cystic hepatic lesions compatible with hydatid cysts and a mass in the upper pole of the left kidney suggestive of a carcinoma. The patient underwent resection of the kidney. RESULTS: Histopathological analysis demonstrated renal adenocarcinoma with pleomorphic areas. Immunohistochemical analysis showed a high cellular proliferation rate (Ki67) and intense expression of p53 and glycoprotein P. The patient developed metastasis to the brain four months later and pulmonary and cutaneous metastases shortly thereafter. CONCLUSIONS: Clear cell renal carcinoma can have a rapidly progressive course. Histological studies and determination of adverse immunohistological markers can be useful in these cases.