The role of accessibility policies and other determinants of health care provision in the initial prognosis of malignant melanoma: a cross-sectional study.

BACKGROUND: The prognostic benefit of health care service provision and delivery policies for patients with malignant melanoma (MM) is not yet clear. OBJECTIVE: To analyze the role of health care provision determinants in the initial prognosis of MM. METHODS: A multicenter cross-sectional study was conducted at 14 public hospitals and recruited 3550 patients with MM between 2000 and 2009. The study variables were analyzed using univariate and multivariate models to identify their role in the variations observed. RESULTS: In a 10-year period, the number of patients with MM increased by 78.54%, with primary in situ MM (Tis) or MMs with a Breslow thickness <1 mm (T1) representing 51.72% of the total number of MMs in 2000, increasing to 62.23% by the end of the study period (P = .005). Among the variables that explained the variation in MM frequency the year of diagnosis after 2004 (univariate odds ratio [OR], 1.43 [P < .001]; multivariate OR, 1.36 [P = .005]) and diagnosis in centers with specific fast-track referral systems (univariate OR, 1.24 [P = .01]; multivariate OR, 1.59 [P = .025]) were shown to explain the increasing frequency of Tis-T1 MM. LIMITATIONS: The primary potential limitation of this study is its retrospective nature. CONCLUSION: Health care provision policies and interventions aimed at improving accessibility to specialized care appear to explain the increasing frequency of Tis-T1 MM.

Quality of life in persons living with psoriasis patients.

BACKGROUND: Numerous studies have analyzed the influence of psoriasis on the quality of life and psychosocial health of patients. However, few studies have addressed the effect of this disease on individuals living with these patients (cohabitants). OBJECTIVE: To analyze the influence of psoriasis on the levels of anxiety, depression, and quality of life of the cohabitants of psoriatic patients. METHODS: The study included patients, cohabitants, and controls, a total of 130 participants. Their quality of life was measured with the Dermatology Life Quality Index (DLQI) and Family Dermatology Life Quality Index (FDLQI), and their psychological state with the Hospital Anxiety and Depression Scale (HADS). Demographic data of participants and clinical characteristics of patients were also gathered. RESULTS: The presence of psoriasis impaired the quality of life of 87.8% of the cohabitants. FDLQI scores of cohabitants were significantly associated with the DLQI scores of the patients (rs = 0.554; P < .001). Anxiety and depression levels did not differ between patients and cohabitants, but were significantly higher than in the controls (P < .001). LIMITATIONS: Additional studies with larger numbers of patients and cohabitants are required to analyze differences between groups according to psoriasis severity. CONCLUSION: Psoriasis markedly worsens the global well-being of patients and their cohabitants, who experienced an impairment of their quality of life and higher levels of anxiety and depression.

Placas eritematosas escamosas faciales / Erythematous scaly facial plaques

No disponible

Presentación cutánea anetodérmica de un trastorno linfoproliferativo postrasplante / Cutaneos anetodermal presentation of posttransplant lymphoproliferative disorder

Los trastornos linfoproliferativos postrasplante son un grupo heterogéneo de proliferaciones linfocitarias, generalmente de fenotipo B y con frecuencia asociadas al virus de Epstein-Barr (VEB), que ocurren durante el transcurso del tratamiento inmunosupresor postrasplante y comprometen la vida del paciente. La piel es una localización potencial de estos trastornos linfoproliferativos postrasplante, aunque son muy pocos los casos de afectación cutánea descritos hasta la fecha. Un varón de 41 años, trasplantado renal 11 años antes, y en tratamiento con ciclosporina A y prednisona, consultó por un nódulo eritematovioláceo anetodérmico de un año de evolución en la espalda, donde presentaba otras lesiones de anetodermia. Las biopsias mostraron una proliferación linfocitaria B, con restricción para cadenas kappa, positividad para LMP-1 (latent membrane protein 1 del VEB), y elastólisis peritumoral. El nódulo tumoral involucionó en un mes tras disminuir la dosis de ciclosporina A, realizándose radioterapia adicional de la región. Se presenta un nuevo caso de trastorno linfoproliferativo postrasplante cutáneo de fenotipo B y asociado al VEB, peculiar por presentar elastolisis peritumoral y lesiones de anetodermia previas (AU)

Telangiectasia nevoide unilateral / Unilateral nevoid telangiectasia

Una paciente de 22 años consultó por lesiones vasculares telangiectásicas en hemicara izquierda de 3 años de evolución con características clínicas e histológicas de telangiectasia nevoide unilateral. Se caracteriza por una agrupación de telangiectasias de distribución segmentaria que clásicamente se ha relacionado con estados de hiperestrogenismo. En nuestro caso, y en concordancia con otros autores, la distribución de las lesiones sigue un patrón según las líneas de Blaschko y no metamérico (AU)

Evolución inusual de un nódulo de los ordeñadores en un trasplantado renal / Unusual evolution of milker's nodule in a kidney trasplant recipient

Un varón de 47 años desarrolló a los 7 meses de un segundo trasplante renal un nódulo de los ordeñadores que tardó 6 meses en involucionar espontáneamente en lugar de las 4 a 6 semanas habituales (AU)