Alopecia areata totalis and universalis: a multicenter review of 132 patients in Spain.

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.

Beard alopecia areata: a multicentre review of 55 patients.

BACKGROUND: Alopecia areata on the beard area (BAA) is a common clinical manifestation, but there are no studies about its characteristics. OBJECTIVE: To describe the epidemiology, comorbidities, clinical presentation, evolution, diagnostic findings and therapeutic choices in a series of patients with BAA. METHODS: This retrospective multicentre review included patients diagnosed with BAA as the first and unique clinical manifestation with at least 12 months of follow-up. Diagnosis was performed based on the typical clinical features. Extra-beard involvement was monitored in all cases. RESULTS: Overall, 55 male patients with a mean age of 39.1 years (range 20-74) were included. Twenty-five patients (45.5%) developed alopecia of the scalp during follow-up and more than 80% of cases appeared in the first 12.4 months. Clinical presentation of AA on the scalp was patchy AA (less than 5 patches) (52%), multifocal AA (28%), AA totalis (12%) and AA universalis (8%). Multivariate analysis revealed a trend of association between scalp involvement and family history of AA without statistical significance. CONCLUSIONS: According to this study, BAA may progress to scalp AA in a significant number of patients (45.5% of the patients with a follow-up interval of at least 12 months). In the group of patients who developed scalp AA, 80% of them did it within the first 12 months, so follow-up of patients with BAA is highly encouraged.

Ultrasonic monitoring of malolactic fermentation in red wines.

The progress of malolactic fermentation in red wines has been monitored by using ultrasonic techniques. The evolution of ultrasonic velocity of a tone burst 1MHz longitudinal wave was measured, analyzed and compared to those parameters of oenological interest obtained simultaneously by analytical methods. Semi-industrial tanks were used during measurements pretending to be in real industrial conditions. Results showed that the ultrasonic velocity mainly changes as a result of the conversion by lactic acid bacteria of malic acid into lactic acid and CO2. Overall, the present study has demonstrated the potential of the ultrasonic technique in monitoring the malolactic fermentation process.

Study of frontal hairline patterns in Spanish Caucasian women.

BACKGROUND: Anterior hairline measurements and their possible relationship with androgen levels, sebum production, and skin hydration have not been reported in white Spanish women. MATERIAL AND METHODS: This was a prospective descriptive and analytical observational study conducted on 103 healthy premenopausal white Spanish women recruited from the health staff of Hospital Universitario Virgen Macarena in Seville, Spain. Measurements were made of anterior hairline implantation, sebum levels, and the degree of hydration of the stratum corneum. Androgen levels were also determined in 50 volunteers from this group 3 to 5 days after the end of the menstrual cycle. RESULTS: The mean age of the women was 29.7 years. A widow's peak was observed in 94.17% of the group. The mean dimensions of the widow's peak were a height of 1.01 cm and width of 2.13 cm. The mean hormone levels were within normal limits for our hospital's laboratory with the exception of 17-hydroxyprogesterone, with a mean level of 1.39 ng/mL (range, 0.6-5.9ng/mL; normal limits, 0.15-1.10 ng/mL). The mean prostate specific antigen level was 0.04ng/mL (range 0.02-0.08ng/mL; normal limits, 0.00-0.02ng/mL). CONCLUSIONS: The hairline measurements of the white Spanish women in this study differ from those reported in American women. Knowledge of this normal pattern of anterior hairline implantation can be important in the evaluation of women with female androgenetic alopecia with male pattern, frontal fibrosing alopecia, or other established scarring alopecia seeking a surgical solution by hair transplantation.

Value of hormonal levels in patients with male androgenetic alopecia treated with finasteride: better response in patients under 26 years old.

BACKGROUND: Finasteride is a 5alpha-reductase inhibitor that has proved to be an effective treatment for men with androgenetic alopecia. OBJECTIVES: To investigate the hormonal influence of finasteride 1 mg daily on hormonal levels and hair growth in men of different ages and with different degrees of alopecia according to the Hamilton-Norwood scale. METHODS: Two hundred and seventy men aged 14-58 years with male androgenetic alopecia III-VI Hamilton-Norwood score (II-III Ebling score) were treated with finasteride 1 mg daily. Steroid hormone (free testosterone, 5alpha-dihydrotestosterone, dehydroepiandrosterone-sulphate, delta4-androstenedione, 17-hydroxyprogesterone), prostate-specific antigen (PSA) and sebum levels, and trichogram changes were determined at baseline, and at 6 and 12 months of treatment. RESULTS: According to significant hormonal statistical analysis, the patients were divided by age (up to or over 26 years). In the group of patients26 years. No variations in sebum levels were observed. CONCLUSIONS: High levels of 5alpha-dihydrotestosterone in patients

Lamb waves beam deviation due to small inclination of the test structure in air-coupled ultrasonic NDT.

In Lamb waves inspection, an air-coupled transmitter transducer is oriented at a specific angle such that it generates a pure Lamb mode which propagates along the structure and interacts with any existing defects. For this inspection system, amplitude losses appears when small inclinations of the tested structure occurs. An important factor which affects directly these losses has been observed, it consists of the Lamb waves beam (LWB) deviation due to this bad alignment. In this work, a simple expression of LWB deviation has been deduced. This expression includes the test structure angle, phase velocity of generated Lamb mode, and the phase velocity of waves propagating in the coupled medium. A(0) Lamb mode is generated and detected in 1 mm thick aluminium plate sample using 1 MHz PZ27 piezoelectric transducers of 20 mm of diameter. Experimental LWB deviation angles are measured for different inclination angles of the test sample. A comparative study is released with theoretical results. For 1 degree of misalignment in the aluminium plate inclination, and transducers separation distance of 35 mm, LWB deviation angle is around 7 degrees and the amplitude is reduced by around 11%. Then, for a large separation distance, we must move the receiver transducer to detect the deviated LWB. It is shown that, for both theoretical and experimental studies, the LWB deviation and its measured amplitude are very sensitive to the alignment of the tested structure with respect to the transmitter-receiver transducers plane. In metal plates it is most satisfactory to use A(0) mode compared with S(0) mode since it is easy to excite and has a large amplitude and small deviation beam angles.

Diffraction aperture non-ideal behaviour of air coupled transducers array elements designed for NDT.

Air coupled piezoelectric ultrasonic array transducers are a novel tool that could lead to interesting advances in the area of non-contact laminar material testing using Lamb wave's propagation techniques. A key issue on the development of such transducers is their efficient coupling to air media (impedance mismatch between the piezoelectric material and air is 90 dB or more). Adaptation layers are used in order to attain good matching and avoid possible serious signal degradation. However, the introduction of these matching layers modify the transducer surface behaviour and, consequently, radiation characteristics are altered, making the usual idealization criteria (of uniform surface movement) adopted for field simulation purposes inaccurate. In our system, we have a concave linear-array transducer of 64 elements (electrically coupled by pairs) working at 0.8 MHz made of PZ27 rectangular piezoceramics (15 mm x 0.3 mm) with two matching layers made of polyurethane and porous cellulose bonded on them. Experimental measurements of the acoustic aperture of single excited array elements have shown an increment on the geometrical dimensions of its active surface. A sub-millimeter vibrometer laser scan has revealed an extension of the aperture beyond the supposed physical single array element dimensions. Non-uniform symmetric apodized velocity surface vibration amplitude profile with a concave delay contour indicates the presumed existence of travelling wave phenomena over the surface of the outer array matching layer. Also, asymptotic propagation velocities around 2500 m/s and attenuation coefficient between 15 and 20 dB/mm has been determined for the travelling waves showing clear tendencies. Further comparisons between the experimental measurements of single array element field radiation diagram and simulated equivalent aperture counterpart reveal good agreement versus the ideal (uniform displaced) rectangular aperture. For this purpose an Impulse Response Method (IRM) has been used.

Sebaceus naevi: a clinicopathologic study.

OBJECTIVE: To analyse sebaceus naevus (SN) incidence, associated malignancies, and developmental defects in a retrospective study. METHODS: We retrospectively analysed all cases of SN excised in our Department over a 20-year period. All cases of epidermal naevus syndrome (Schimmelpenning syndrome) associated with SN were recorded, as well as all patients with histological changes suggesting degeneration of the initial SN. RESULT: A total 226 patients with SN were included in the study. Stage II was the most common (65%), and the parietal area was the most common location of SN (42%), with only 7% located in non-scalp areas. Syringocystadenoma papilliferum and trichoblastoma were the most common tumours arising on SN. We only found five patients with basal cell carcinoma arising on previous SN. Epidermal naevus syndrome associated with SN was diagnosed in 16 patients, and this was the most common neurocutaneous association. CONCLUSION: The incidence of malignancy arising on SN was very low, indicating that prophylactic surgery of NS in children is not recommendable. Developmental defects should be investigated in order to evidence possible epidermal naevus syndrome associated with SN.

Primary multifocal localized hypertrichosis.

We describe a new variant of congenital hypertrichosis, primary multifocal localized hypertrichosis in a mother and her son. They presented with long vellus hair on the trunk and arms in foci from birth. They also associated some forms of hair dysplasia.

Psicodermatología: de la emoción a la lesión (iii): enfermedades dermatológicas con alta comorbilidad psiquiátrica / Psychodermatology: from emotion to lesion (III): Skin diseases with high psychiatric comorbidity

Acné, psoriasis, dermatitis atópica, alopecia areata y urticaria crónica son las enfermedades dermatológicas en las que se ha descrito mayor comorbilidad psiquiátrica. Los diagnósticos más frecuentes recogidos en las series publicadas son el trastorno adaptativo, trastorno de ansiedad generalizada, depresión mayor, fobia social y paranoia. El estrés psicosocial puede también actuar como desencadenante de reagudizaciones en la rosácea, líquen plano, eczema dishidrosiforme, eczema numular y dermatitis seborreica, además de las dermatosis anteriormente citadas. En la génesis de patología psiquiátrica en las enfermedades dermatológicas intervienen múltiples factores: severidad de la dermatosis, cronicidad, repercusiones estéticas, acontecimientos vitales, autoimagen corporal y autoconcepto, ansiedad social, atractivo interpersonal percibido, etc. En un elevado porcentaje de casos de urticaria crónica se desconocen los factores precipitantes, jugando la ansiedad y el estrés un papel importante. Se ha descrito mejoría tras tratamiento con tricíclicos (amitriptilina, doxepina).En la dermatitis atópica también se ha descrito una elevada ansiedad-rasgo. Las formas severas de psoriasis presentan, por su parte, una elevada prevalencia de depresión mayor, siendo frecuentes asimismo el abuso de sustancias y la i d eación suicida. El estrés puede actuar como desencadenante en un 40-50 por ciento de los brotes, o actuar como mantenedor de los mismos. El acné compromete la imagen corporal en un periodo vital especialmente significativo (adolescencia), aunque parece que un tratamiento precoz de las formas severas con isotretinoína podría disminuir significativamente las tasas de ansiedad y depresión asociadas. La alopecia areata presenta con frecuencia p s i c opatología asociada (60-70 por ciento de los casos), por lo que es probable que la comorbilidad psiquiátrica en esta enfermedad se encuentre infradiagnosticada e infratratada (AU)

Psicodermatología: de la emoción a la lesión (iv): psicofarmacología, psicoterapia y dermatología / Psychodermatology: from emotion to lesion (IV): Psychopharmacology, psycotherapy and dermatology

Diversos tipos de psicoterapia han sido utilizados en dermatología. Muchos pacientes con dermatosis crónicas, invalidantes o inestéticas se benefician de un apoyo psicoterapeútico básico, que puede realizar el propio dermatólogo: mantener una actitud empática, favorecer la expresión emocional, mantener la esperanza de mejoría clínica con otros tratamientos o las expectativas en la investigación futura, reforzar las redes de cuidado social y familiar de los pacientes, mantener un vínculo afectivo estable del paciente dermatológico crónico con el personal médico y de enfermería, etc. También se han utilizado técnicas más especializadas con buen resultado: modificación de conducta (tricotilomanía, trastorno dismórfico corporal), grupos de autoayuda (acné, alopecia areata, psoriasis), técnicas cognitivas, dinámicas, etc.En cuanto a los tratamientos psicofarmacológicos, las benzodiacepinas pueden ser útiles en los trastornos adaptativos que acompañan y/o preceden a las reagudizaciones de algunas dermatosis, y pueden ser también fácilmente manejadas por el propio dermatólogo. Los antidepresivos tricíclicos están bien documentados en los trastornos dermatológicos, consiguiendo una acción sedativa y antipruriginosa por sus efectos anticolinérgicos, antiH1 y antiH2. Los Inhibidores Selectivos de la Recaptación de Serotonina (ISRS), menos documentados, son sin embargo de más fácil manejo para el dermatólogo. Su eficacia ha sido contrastada en la tricotilomanía, trastorno dismórfico corporal y alopecia areata.Los nuevos antipsicóticos (risperidona, olanzapina, quetiapina) son útiles en el delirio de parasitación, aunque deben mantenerse a largo plazo, ya que la recaída es la norma tras la retirada. Por último, los reguladores del humor presentan con frecuencia efectos indeseables en la piel: erupciones acneiformes, exacerbación del psoriasis y alopecia con las sales de litio; lesiones maculopapulosas, que pueden progresar hasta un síndrome de StevensJohnson, con carbamacepina; alopecia con valproico (AU)

Psicodermatología: de la emoción a la lesión (I): concepto. Bases biológicas, psicológicas y sociales. Psiconeuroinmunología / Psychodermatology: from emotion to lesion (I): concept, biological, psychological and social basis. Psychoneuroinmunology

La Psicodermatología, una disciplina de transición entre ambas especialidades médicas, sienta sus bases en: a) interacciones entre el SNC, Sistema Nervioso Vegetativo y Sistema Inmune (bases etiopatogénicas y fisiopatológicas, en relación con la psiconeuroinmunología); b) afectación de la piel en las enfermedades psiquiátricas primarias y afectación del funcionamiento psicológico en algunas dermatosis (bases clínicas); c) papel de la piel en la expresión de las emociones, relaciones sociales e interacción con el medio externo (bases psicológicas y socioculturales), y d) papel de la psicoterapia y los psicofármacos en las enfermedades dermatológicas (bases terapéuticas).Por su parte, la Psiconeuroinmunología es la ciencia básica que estudia cómo elevados niveles de ansiedad pueden inhibir la proliferación linfocitaria inducida por mitógenos en sangre periférica, bloquear la actividad de las células n a t u r a l - k i l l e r o la producción de interferón y de interleucina, condicionando así la evolución de algunas enfermedades dermatológicas. Los tratamientos psicológicos (psicoterapias de diversa orientación que persiguen, en esencia, un mejor afrontamiento del estrés) y psicofarmacológicos pueden utilizarse, de esta forma, para potenciar la respuesta inmunológica. El modelo de Psiquiatría de Enlace puede servir, desde el ángulo clínico, como método de aproximación al enfermo dermatológico crónico, mejorando la psicopatología existente, la adaptación a la enfermedad y, en suma, la calidad de vida del paciente (AU)

Psicodermatología: de la emoción a la lesión (II): trastornos psiquiátricos primarios con manifestaciones dermatológicas / Psychodermatology: from emotion to lesion (I): Concept. Biological, psychological and social basis. Psychoneuroinmunology

Las dermatosis autoprovocadas, las alucinaciones táctiles, el delirio de parasitación, la tricotilomanía, el trastorno dismórfico corporal y los síntomas dermatológicos en las obsesiones y en las fobias son, básicamente, los trastornos psiquiátricos primarios con clínica dermatológica más representativos. Las dermatosis autoinducidas, conocidas clásicamente en dermatología como patomimias, son un grupo heterogéneo de lesiones dermatológicas polimorfas, de aspecto lineal y variado, localizadas en lugares accesibles y habitualmente en idéntico estadio evolutivo. Suelen corresponder a un trastorno facticio tipo Munchausen, una simulación pura o un estado disociativo histérico. Por su parte, las alucinaciones táctiles sugieren psicosis toxicoinducida (cocaína, anfetaminas, alucinógenos, drogas de diseño), estado confusional agudo o esquizofrenia, aunque han sido también descritas en carcinomas de pulmón y mediastino. El delirio de parasitación, delusio parasitorum o síndrome de Eckbom es un trastorno delirante crónico de tipo somático, en el que el paciente tiene la certeza de que es colonizado por parásitos cutáneos, que se mueven e incluso creen ver. La tricotilomanía, una de las clásicas representantes de la Psicodermatología, consiste en el arrancamiento autoprovocado del pelo con pérdida perceptible del mismo. Se considera en la actualidad como un trastorno del control de los impulsos y se encuadra en el denominado espectro obsesivo-compulsivo. En el adulto suele ser tributaria de tratamiento psiquiátrico, a diferencia de las formas benignas infantiles, de curso transitorio y habitualmente autolimitadas. EI trastorno dismórfico corporal (TDC) dermatológico (rubeosis facial excesiva, cicatrices sobrevaloradas, acné sobrevalorado, mínimos nevus o telangiectasias, exceso de vello facial, etc.) es un diagnóstico cada día más frecuente, y debería ser sospechado por dermatólogos y cirujanos plásticos ante las quejas inconsistentes y repetitivas sobre el aspecto físico. La "adicción a la cirugía" es una complicación del TDC y puede derivar en problemas legales (AU)

Trastorno dismórfico dermatológico, hipocondría de la belleza o el espejo de la bruja de blancanieves (i) / Dermatologic dysmorphic disorder, beauty hypochondriasis or the mirror of Snow-White's witch (I)

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