Aesthetic dermatology and emotional well-being questionnaire.

BACKGROUND: In recent years, there has been a great development of esthetic dermatology as a subspecialty of dermatology. It is important to know to which extent the general population regard this branch of medical surgical specialty as being of interest and contributing to emotional well-being. OBJECTIVE: To analyze the technical features of a questionnaire which has been designed to reflect such perception of the general population about esthetic dermatology and its contribution to emotional well-being. MATERIAL AND METHOD: Production and psychometric analysis of a self-filled in questionnaire in relation to esthetic dermatology and emotional well-being (DEBIE). This questionnaire is made of 57 items and has been applied to a sample of 770 people within the general population. The drawing-up process of the questionnaire is described to provide content validity. Items analysis was carried out together with exploratory and confirmatory factor analysis to assess the structure and construct validity of the tool. The extent of internal consistency (reliability) and concurrent validity has also been verified. RESULTS: DEBIE questionnaire (Spanish acronym for Aesthetic Dermatology and Emotional Well-being) revolves around six factors explaining 53.91% of the variance; there is a high level of internal consistency (Cronbach's α 0.90) and reasonable criterion validity. CONCLUSIONS: DEBIE questionnaire brings together adequate psychometric properties that can be applied to assess the perception that the general population have in relation to esthetic dermatology and its contribution to their emotional well-being.

Three cases of cutaneous phaeohyphomycosis by Exophiala jeanselmei.

Cutaneous phaeohyphomycosis is a rare opportunistic fungal disease, knowledge of which is important because of the increase in organ transplantation, aggressive treatments for malignancies, and chronic use of corticosteroids. We report 3 cases of cutaneous phaeohyphomycosis: two patients treated with oral corticosteroids and one elderly woman with multiple hospitalizations. They showed several different clinical appearances. Histopathologically, the fungal infection affected the dermis and subcutis in all cases and in one of them, also the epidermis. Exophiala jeanselmei was isolated from the purulent exudate in the three cases. Good response was obtained with surgical and antifungal treatment.

Imiquimod in mycosis fungoides.

Imiquimod is a topically active imidazoquinoline immunomodulator agent. It works as an indirect antiviral and antitumoral and stimulates the production of INF-alpha and various other cytokines. We assayed topical imiquimod in treating early stages of mycosis fungoides. We applied imiquimod 5% cream in four patients with multi-treatment resistant plaques of MF (stages IA and IIB). We applied it on one patient in association with systemic INFalpha-2a. We observed a complete clinical clearance of the lesions in all four patients. In three cases we achieved a complete histopathological clearance and in one case a partial histopathological clearance. The patient treated with imiquimod and systemic INFalpha-2a showed the most spectacular improvement with a rapid total response. We ascribe this improvement to a synergic effect of imiquimod and systemic INFalpha-2a treatment. Before the introduction of imiquimod, this patient had been treated for 2 years with systemic INFalpha-2a alone, without any evidence of clinical response. Imiquimod could be an effective therapy for early-stage disease of CTCL, used alone or in combination with systemic immunomodulatory therapy.

Livedoid skin reaction probably due to imatinib therapy.

OBJECTIVE: To report 3 cases of skin rash with a peculiar livedoid pattern that were probably associated with imatinib therapy. CASE SUMMARY: In the first case, a 74-year-old male diagnosed with Philadelphia chromosome-positive (Ph+) chronic myeloid leukemia (CML), treated with imatinib 400 mg/day, developed a skin eruption with a livedoid pattern. Systemic corticosteroids were started, and skin lesions improved. The second case involved a 66-year-old male with Ph+ CML who was treated with imatinib 600 mg/day. After initiation of this treatment, he developed a skin rash with a livedoid pattern. The drug treatment was discontinued and then reintroduced. Topical corticosteroid treatment was started, resulting in total remission of the skin lesions. When the imatinib dose was progressively reintroduced, the skin lesions recurred. The patient died as a result of the progression of his disease. In the third case, a 43-year-old male with Ph+ acute lymphoblastic leukemia was treated with imatinib 600 mg/day. After a few days of treatment, the patient developed a skin rash with a livedoid pattern. He died as a result of probable septic shock. DISCUSSION: Imatinib is a tyrosine kinase receptor inhibitor that inhibits BCR/ABL tyrosine kinase. There have been several published articles on cutaneous adverse reactions related to imatinib therapy. The most common cutaneous adverse event of imatinib is a rash with variable clinical presentation. The Naranjo probability scale indicated a probable relationship between imatinib and the rash in all 3 cases reported here. CONCLUSIONS: Adverse reactions to imatinib that affect the skin occur frequently. They are strongly dose dependent, self-limiting, or easily managed by lowering the dose of imatinib and, if necessary, prescribing short-term therapy with a systemic corticosteroid. Clinicians should monitor patients taking imatinib and institute treatment quickly if a rash develops.