¿Sigue siendo la parafenilendiamina un alérgeno de contacto prevalente en España? / Is p-Phenylenediamine Still a Prevalent Contact Allergen in Spain?

OBJETIVOS: El objetivo del trabajo es mostrar la tendencia de la sensibilización de contacto entre los años 2004 y 2014 tras la regulación de su concentración en cosméticos en el año 2009 e investigar los factores de riesgo de la alergia de contacto a la parafenilendiamina. MATERIAL Y MÉTODOS: El diseño del estudio fue observacional retrospectivo e incluyó a pacientes con sospecha de alergia de contacto parcheados con la serie estándar del Grupo Español de Investigación en Dermatitis de Contacto y Alergia Cutánea durante los años 2004 a 2014, en 8 hospitales terciarios españoles. En las pruebas epicutáneas estaba incluida la parafenilendiamina al 1% en vaselina o 0,073 mg/cm2 en el TRUE-test(R). El estudio estadístico se realizó siguiendo las recomendaciones internacionales del análisis de los datos en alergia de contacto. RESULTADOS: Un total de 386 (4,1%) pacientes de los 9.341 incluidos fueron positivos a la parafenilendiamina, cuya tendencia empezó a decrecer en los primeros años (2004-2007) y a partir de ahí se mantuvo en torno al 4%. Los factores de riesgo para el desarrollo de una alergia de contacto a la parafenilendiamina fueron el sexo, la edad por encima de los 40 años, la polisensibilización y la profesión, entre las que destacan los trabajadores de la peluquería, los trabajadores de la goma y el plástico CONCLUSIONES: La alergia de contacto a la parafenilendiamina sigue siendo elevada en pacientes con eccema de contacto. Los factores de riesgo que predisponen a la alergia de contacto a la PPD coinciden con los que han sido publicados previamente

OBJECTIVES: To analyze trends in the prevalence of contact sensitization to p-phenylenediamine between 2004 and 2014, taking into consideration that the concentration of this product in cosmetics was regulated in 2009. To explore risk factors for contact allergy to p-phenylenediamine. MATERIAL AND METHODS: Retrospective observational study of patients suspected of having contact dermatitis from allergy to p-phenylenediamine during the years between 2004 and 2015 in 8 tertiary level hospitals. The patients underwent patch testing (TRUE-test) with the standard series of the Spanish Research Group on Contact Dermatitis and Skin Allergies. This series included p-phenylenediamine 1%. We followed international recommendations for the statistical analysis of data related to contact allergies. RESULTS: Three hundred eighty-six out of 9341 patients (4.1%) had positive reactions to p-phenylenediamine. The prevalence tended to decrease in the early years (2004-2007) and then leveled off at around 4%. Risk factors for developing contact dermatitis from p-phenylenediamine were sex, age over 40 years, multiple sensitivities, and profession, notably workers in hair salons and those who handle rubber and plastics. CONCLUSIONS: The prevalence of p-phenylenediamine allergy remains high among patients with contact eczema. Risk factors for p-phenylenediamine contact allergy are consistent with previous reports

Is p-Phenylenediamine Still a Prevalent Contact Allergen in Spain? / ¿Sigue siendo la parafenilendiamina un alérgeno de contacto prevalente en España?

OBJECTIVES: To analyze trends in the prevalence of contact sensitization to p-phenylenediamine between 2004 and 2014, taking into consideration that the concentration of this product in cosmetics was regulated in 2009. To explore risk factors for contact allergy to p-phenylenediamine. MATERIAL AND METHODS: Retrospective observational study of patients suspected of having contact dermatitis from allergy to p-phenylenediamine during the years between 2004 and 2015 in 8 tertiary level hospitals. The patients underwent patch testing (TRUE-test) with the standard series of the Spanish Research Group on Contact Dermatitis and Skin Allergies. This series included p-phenylenediamine 1%. We followed international recommendations for the statistical analysis of data related to contact allergies. RESULTS: Three hundred eighty-six out of 9341 patients (4.1%) had positive reactions to p-phenylenediamine. The prevalence tended to decrease in the early years (2004-2007) and then leveled off at around 4%. Risk factors for developing contact dermatitis from p-phenylenediamine were sex, age over 40 years, multiple sensitivities, and profession, notably workers in hair salons and those who handle rubber and plastics. CONCLUSIONS: The prevalence of p-phenylenediamine allergy remains high among patients with contact eczema. Risk factors for p-phenylenediamine contact allergy are consistent with previous reports.

Pronóstico de las infecciones urinarias con tratamiento antibiótico discordante / Prognosis of urinary tract infections with discordant antibiotic treatment

Introducción. Este estudio se propone evaluar el pronóstico de las infecciones del tracto urinario (ITU) tratadas empíricamente con tratamiento antibiótico inadecuado. Material y método. Estudio de cohortes prospectivo, de pacientes mayores de 18 años de edad, atendidos en un servicio de urgencias hospitalario entre el 01/02 y el 31/05 de 2007 por síntomas miccionales, acompañados de piuria (>10leucocitos/mm3 de orina no centrifugada) o tira reactiva positiva para nitritos-leucocitos y urocultivo con >103 unidades formadoras de colonias. Se consideró que el tratamiento antibiótico prescrito empíricamente era adecuado si la bacteria aislada era sensible y se había prescrito por un tiempo correcto. Se consideró que hubo fracaso terapéutico cuando persistía la sintomatología tras 5 días de tratamiento. Se registraron la edad, el sexo, la presencia de sonda vesical permanente, el tipo de ITU, hospitalización en los 3 meses previos, la procedencia del paciente y las enfermedades asociadas. Resultados. Se aislaron 177 bacterias en 168 pacientes. En 29 casos (17,3%) el microorganismo aislado era resistente al antibiótico prescrito. En tan solo 6 pacientes hubo fracaso terapéutico, aunque no precisaron ingreso hospitalario. Los pacientes que vivían en una residencia de ancianos (13,7 vs 2,2%, p=0,015) o que habían sido ingresados durante los 3 meses previos (20,6 vs 4,3%, p=0,039) presentaron un mayor riesgo de recibir tratamiento inadecuado. Conclusiones. El pronóstico de los pacientes atendidos en Servicios de Urgencias Hospitalarios por ITU con tratamiento antibiótico discordante es favorable en la mayoría de los casos. Sería recomendable la realización de urocultivo en pacientes con mayor riesgo de padecer ITU por un microorganismo resistente(AU)

Introduction. This study aims to evaluate the prognosis of urinary tract infections (UTI) treated empirically with inadequate antibiotic treatment. Material and Methods. Prospective cohort study of patients over 18 years of age, attended in the hospital emergency service between 01/02 and 31/05 of 2007, due to micturation symptoms, accompanied by pyuria (>10leukocytes/mm3 of uncentrifuged urine) or positive reactive strip for nitrites-leukocytes and urine culture with >103 colony forming units. It was considered that the antibiotic treatment prescribed empirically was adequate if the bacteria isolated was sensitive and had been prescribed for the correct time. It was considered that there was therapeutic failure when the symptoms persisted after 5 days of treatment. Age, gender, presence of indwelling bladder catheter, type of UTI, hospitalization in the previous 3 months, origin of the patient and associated diseases were recorded. Results. A total of 177 bacteria were isolated in 168 patients. In 29 cases (17.3%), the microorganism isolated was resistant to the antibiotic prescribed. There was thereaputic failure in only 6 patients, although they did not required hospital admission. The patients who lived in a residential home for the elderly (13.7% vs 2.2%, P=0.015) or who had been hospitalized during the previous 3 months (20.6% vs 4.3%, p=0.039) had a greater risk of receiving inadequate treatment. Conclusions. The prognosis of the patients attended in the emergency hospital service due to UTI with discordant antibiotic treatment is favorable in most of the cases. Performing urine culture in patients with greater risk of suffering UTI due to a resistant microorganism would be recommendable(AU)

[Prognosis of urinary tract infections with discordant antibiotic treatment]. / Pronóstico de las infecciones urinarias con tratamiento antibiótico discordante.

INTRODUCTION: This study aims to evaluate the prognosis of urinary tract infections (UTI) treated empirically with inadequate antibiotic treatment. MATERIAL AND METHODS: Prospective cohort study of patients over 18 years of age, attended in the hospital emergency service between 01/02 and 31/05 of 2007, due to micturation symptoms, accompanied by pyuria (>10 leukocytes/mm(3) of uncentrifuged urine) or positive reactive strip for nitrites-leukocytes and urine culture with >10(3) colony forming units. It was considered that the antibiotic treatment prescribed empirically was adequate if the bacteria isolated was sensitive and had been prescribed for the correct time. It was considered that there was therapeutic failure when the symptoms persisted after 5 days of treatment. Age, gender, presence of indwelling bladder catheter, type of UTI, hospitalization in the previous 3 months, origin of the patient and associated diseases were recorded. RESULTS: A total of 177 bacteria were isolated in 168 patients. In 29 cases (17.3%), the microorganism isolated was resistant to the antibiotic prescribed. There was thereaputic failure in only 6 patients, although they did not required hospital admission. The patients who lived in a residential home for the elderly (13.7% vs 2.2%, P = 0.015) or who had been hospitalized during the previous 3 months (20.6% vs 4.3%, p = 0.039) had a greater risk of receiving inadequate treatment. CONCLUSIONS: The prognosis of the patients attended in the emergency hospital service due to UTI with discordant antibiotic treatment is favorable in most of the cases. Performing urine culture in patients with greater risk of suffering UTI due to a resistant microorganism would be recommendable.

[Contact dermatitis due to dimethyl fumarate]. / Dermatitis de contacto por dimetilfumarato.

Dimethyl fumarate is a fumaric acid ester. It been used for some years to treat psoriasis and also as a preservative in desiccant sachets in the transport of furniture and footwear. Its irritant properties and sensitizing potential in contact with the skin were recently highlighted when it was implicated as the causative agent in 2 epidemics of severe acute eczema: sofa dermatitis in northern Europe and shoe dermatitis in Spain. The present article aims to guide dermatologists in the diagnosis and management of patients allergic to dimethyl fumarate. We review the clinical manifestations, results of patch tests, possible cross-reactions, and sources of exposure to dimethyl fumarate responsible for these skin reactions.

Dermatitis de contacto por dimetilfumarato / Contact dermatitis due to dimethyl fumarate

El dimetilfumarato es un éster del ácido fumárico que se utiliza desde hace años para el tratamiento de la psoriasis; además se emplea como conservante en bolsitas antihumedad para garantizar el transporte de muebles y calzado. Su capacidad irritante en contacto con la piel y su alta capacidad sensibilizante han quedado demostradas recientemente tras haber sido implicado como agente causal en dos epidemias de eccema agudo grave: por un lado, la «dermatitis del sofá» en el norte de Europa, y por otro lado, una epidemia de dermatitis por calzado en España. El presente artículo pretende orientar a los dermatólogos en el diagnóstico y tratamiento de los pacientes alérgicos al dimetilfumarato. Repasamos las manifestaciones clínicas, los resultados de las pruebas epicutáneas, las reacciones cruzadas existentes y las fuentes de exposición de dimetilfumarato que inducen estas dermatitis (AU)

Dimethyl fumarate is a fumaric acid ester. It been used for some years to treat psoriasis and also as a preservative in desiccant sachets in the transport of furniture and footwear. Its irritant properties and sensitizing potential in contact with the skin were recently highlighted when it was implicated as the causative agent in 2 epidemics of severe acute eczema: sofa dermatitis in northern Europe and shoe dermatitis in Spain. The present article aims to guide dermatologists in the diagnosis and management of patients allergic to dimethyl fumarate. We review the clinical manifestations, results of patch tests, possible cross-reactions, and sources of exposure to dimethyl fumarate responsible for these skin reactions (AU)

Tumores sebáceos: seguimiento clínico y presencia de neoplasias en una serie de 12 pacientes / Clinical follow-up and presence of visceral tumors in 12 patients with sebaceous gland tumors

Introducción. Los tumores sebáceos son un grupo infrecuente de neoplasias. En algunos casos se han relacionado con neoplasias viscerales en pacientes con el síndrome de Muir-Torre; una variante clínica del síndrome de cáncer de colon hereditario no polipósico. El objetivo de este trabajo es revisar el diagnóstico y el seguimiento de una serie de pacientes con tumores sebáceos para comprobar cuántos de ellos cumplían criterios de síndrome de Muir-Torre. Pacientes y métodos. Se realizó una búsqueda en la base de datos del Servicio de Dermatología del Consorcio Hospital General Universitario de Valencia entre 1990 y 2005, buscando pacientes con tumores sebáceos. Se revisaron las biopsias para confirmar el diagnóstico. También buscamos datos en las historias clínicas que sugiriesen un diagnóstico de síndrome de Muir-Torre, cuando las historias estaban incompletas nos pusimos en contacto por teléfono con los pacientes. Resultados. Encontramos 20 pacientes diagnosticados de tumores sebáceos, pero después de revisar la biopsia sólo confirmamos este diagnóstico en 12 pacientes. Dos pacientes pertenecían a una familia con antecedentes de neoplasias viscerales, que cumplía los criterios clínicos de síndrome de cáncer de colon hereditario no polipósico. No hubo un seguimiento uniforme de los pacientes ni se realizaron las mismas pruebas en todos ellos. Conclusiones. Es fundamental descartar la presencia de un síndrome de Muir-Torre en pacientes con tumores sebáceos. El uso de nuevas técnicas como la detección de la inestabilidad de micro satélites o la inmunohistoquímica pueden ayudar a detectar a las familias que tienen un mayor riesgo de padecer el síndrome de Muir-Torre (AU)

Background. Sebaceous gland tumors are a rare type of neoplasm. In some cases they have been associated with visceral tumors in patients with Muir-Torre syndrome, a hereditary form of non polyposis colorectal cancer. The aim of this study was to review the diagnosis and follow-up of a series of patients with sebaceous gland tumors to assess how many met the criteria for Muir-Torre syndrome. Patients and methods. A search was performed of records from 1990 to 2005 in the database of the Department of Dermatology of the Consorcio Hospital General Universitario de Valencia in Valencia, Spain, to identify patients with sebaceous gland tumors. The biopsy material was reviewed to confirm the diagnosis. We also searched the patient histories for information suggestive of a diagnosis of Muir-Torre syndrome; when the histories were incomplete, we contacted the patients by telephone. Results. We identified 20 patients diagnosed with sebaceous gland tumors, but after reviewing the biopsy material diagnosis was only confirmed in 12. Two patients belonged to a family with a history of visceral tumors that met the clinical criteria for hereditary nonpolyposis colorectal cancer syndrome. Follow-up was not uniform in all patients and not all underwent the same tests. Conclusions. It is essential to rule out the presence of Muir-Torre syndrome in patients with sebaceous gland tumors. The use of new techniques such as immunohistochemistry or detection of microsatellite instability may help to identify families at increased risk of Muir-Torre syndrome (AU)

[Clinical follow-up and presence of visceral tumors in 12 patients with sebaceous gland tumors]. / Tumores sebáceos: seguimiento clínico y presencia de neoplasias en una serie de 12 pacientes.

BACKGROUND: Sebaceous gland tumors are a rare type of neoplasm. In some cases they have been associated with visceral tumors in patients with Muir-Torre syndrome, a hereditary form of nonpolyposis colorectal cancer. The aim of this study was to review the diagnosis and follow-up of a series of patients with sebaceous gland tumors to assess how many met the criteria for Muir-Torre syndrome. PATIENTS AND METHODS: A search was performed of records from 1990 to 2005 in the database of the Department of Dermatology of the Consorcio Hospital General Universitario de Valencia in Valencia, Spain, to identify patients with sebaceous gland tumors. The biopsy material was reviewed to confirm the diagnosis. We also searched the patient histories for information suggestive of a diagnosis of Muir-Torre syndrome; when the histories were incomplete, we contacted the patients by telephone. RESULTS: We identified 20 patients diagnosed with sebaceous gland tumors, but after reviewing the biopsy material diagnosis was only confirmed in 12. Two patients belonged to a family with a history of visceral tumors that met the clinical criteria for hereditary nonpolyposis colorectal cancer syndrome. Follow-up was not uniform in all patients and not all underwent the same tests. CONCLUSIONS: It is essential to rule out the presence of Muir-Torre syndrome in patients with sebaceous gland tumors. The use of new techniques such as immunohistochemistry or detection of microsatellite instability may help to identify families at increased risk of Muir-Torre syndrome.

Genetic studies in variegate porphyria in Spain. Identification of gene mutations and family study for carrier detection.

BACKGROUND: First, to establish the mutations of the protoporphyrinogen-oxidase (PPOX) gene in four Spanish patients with variegate porphyria (VP). Second, study of carrier status detection in the families, including a four-generation Balearic family. Third, evaluation of the results of carrier detection screening methods. DESIGN: Blood samples of four patients and of 139 members belonging to four families, including four generations of a Balearic family were processed for mutation analysis of the 13 exons of PPOX gene. Biochemical studies were performed together (blood and faecal porphyrin analysis) and plasma fluorescence scanning for 626 nm peak emission detection. A questionnaire regarding clinical manifestations was submitted to all family members studied. RESULTS: Single strand conformational analysis (SSCP) of DNA allowed the detection of the following mutations: W224R, 746delT: exon 7, 1077-1082insC: exon 10, and IVS6+2T-->A. Mutation was present in 19 of the 139 members of the families studied. Clinical manifestations or biochemical alterations were checked in the carriers detected and found as not relevant or not present. Only 11 members of the 19 mutation-bearing individuals showed plasma fluorescence PV peak positivity. CONCLUSION: Demonstration of gene mutation is the most reliable means of detecting carriers in studies of variegate porphyria families. DNA analysis is the most sensitive carrier detection method and also allows transmission behaviour of the genetic defect to be established in successive generations of the affected families.

Kaposi's varicelliform eruption in an HIV-positive patient after laser resurfacing.

Kaposi's varicelliform eruption (KVE) is an infection produced by the cutaneous dissemination of herpes virus type 1 or 2. Usually this disease has been described in atopic patients. In this report we present an HIV-positive woman with a Kaposi's varicelliform eruption that started after skin resurfacing with a laser. This is the first report, to the best of our knowledge, of Kaposi's varicelliform eruption after laser resurfacing. The immunodepressed status of the patient may have played a role in her infection.

Síndrome de Parry-Romberg. Presentación de un caso y revisión de la bibliografía / Parry-Romberg syndrome. Case report and literature review

El síndrome de Parry-Romberg, también conocido como hemiatrofia facial progresiva, es una entidad clínica infrecuente donde hay atrofia de la piel, tejido celular subcutáneo y hueso en una mitad de la cara. Este síndrome se ha asociado con procesos autoinmunes, sobre todo con la esclerodermia, pero su etiología no está clara. Presentamos el caso de una mujer de 20 años con hemiatrofia labial y enoftalmos ipsilateral, asociada con una placa lineal de esclerosis cutánea compatible con una esclerodermia lineal en golpe de sable. No se encontraron alteraciones significativas en la analítica, excepto una leve elevación del factor reumatoide y la proteína C reactiva, ni tampoco se objetivaron alteraciones cerebrales en la resonancia magnética. En este artículo revisamos las complicaciones y los diferentes tratamientos usados en el síndrome de Parry-Romberg, además de las diferentes hipótesis sobre su etiología (AU)

Parry-Romberg syndrome, also known as progressive facial hemiatrophy, is a rare clinical entity, in which there is unilateral atrophy of the skin, subcutaneous tissue and bone in one half of the face. This syndrome has been associated with autoimmune disorders, especially scleroderma, but its etiology remains unclear. We present the case of a 20-year-old woman with labial hemiatrophy and ipsilateral enophthalmos, associated with a linear plaque of cutaneous selerosis in the scalp, compatible with linear scleroderma in coup de sabre. Laboratory investigations revealed no significant alterations except a slight elevation of rheumatoid factor and C reactive protein. Cerebral magnetic resonance imaging was also normal. We review the complications and different treatments used in Parry-Romberg syndrome, as well as the various hypotheses on its etiology (AU)

[Serratia marcescens and neonatal sepsis]. / Serratia marcescens y sepsis neonatal.

Authors review infections produced by Serratia marcescens which arose in our neonatal unit from 1982 to 1984, both inclusive. From a total of 4.353 newborns admitted, Serratia marcescens was isolated in 51 newborns; 26 of them exhibited a clinical picture of sepsis, remaining 25 being considered as contaminated. By comparing various characteristics of the contaminated and septic newborns, no difference was found related to sex, gestational age, prenatal pathology, type of delivery, Apgar score, birth-weight or time of diagnosis. Only difference between both groups was severity of intercurrent process and consequently, whether or not were they subject to previous antibiotic treatment and invasive therapeutic maneuvers. Authors conclude that perinatal factors seem to be not so important, as far as supporting a disseminated infection by this organism in concerned, in contrast to former observation by the others authors.