Perfil clínico, terapéutico y calidad de vida de los pacientes con dermatitis seborreica / Clinical and therapeutic profile and quality of life of patients with seborrheic dermatitis

Introducción. Se describen las características clínicas de la dermatitis seborreica (DS), las estrategias terapéuticas empleadas en la práctica clínica habitual y el impacto en la calidad de vida de la población afectada en España. Métodos. Estudio epidemiológico, multicéntrico, transversal en pacientes mayores de 16 años con DS. Se evaluaron la intensidad de los síntomas (escala 0-4) y el impacto en la calidad de vida mediante el cuestionario Skindex-29 (escala 0-100). Resultados. Participaron 2.159 pacientes, con una edad media de 43,6 años, el 55 % hombres y el 42 % con antecedentes familiares de DS. El diagnóstico se realizó como media a los 33,7 años. La mediana de brotes en el último año es de 3. La duración mediana de cada brote es de 14 días. Las zonas más afectadas son la facial (88 %) y el cuero cabelludo (70 %). Las medias de las intensidades son: descamación 1,9, eritema 1,89, prurito 1,73, piel grasa 1,52, infiltración 0,87. El 98 % de los pacientes refiere un factor desencadenante de los brotes, estrés/depresión/fatiga (76 %) y estacionalidad (44 %). La patología concomitante más común es el acné (35 %). Los tratamientos más frecuentes son corticoides tópicos (60 %), antimicóticos imidazólicos (35 %) e hidratantes/nutritivos (31 %). La puntuación global media del Skindex-29 es de 20,5. Conclusiones. El perfil clínico mayoritario de la DS es un paciente de 40 años, con afectación facial/cuero cabelludo, intensidad leve-moderada, padeciendo un episodio de estrés/depresión/fatiga previo al brote. Los tratamientos más frecuentes, en la práctica clínica habitual, son corticoides tópicos y antimicóticos imidazólicos. El impacto de la DS sobre la calidad de vida es bajo

Introduction. The clinical characteristics of seborrheic dermatitis (SD), therapeutic strategies employed in current clinical practice and impact on the quality of life in the Spanish population are described. Methods. An epidemiological, multicenter, transversal study in patients older than 16 years with seborrheic dermatitis. We evaluated the intensity of symptoms (scale 0-4), and impact on the quality of life by the Skindex-29 questionnaire (scale 0-100). Results. Two thousand one hundred and fifty nine patients participated, the mean age was 43,6 years, 55 % were men and 42 % had a family history of seborrheic dermatitis. Diagnosis is usually carried out at a mean age of 33,7 years. The median number of outbreaks in the last year is three. The median duration of each outbreak is 14 days. The most involved areas are the face (88 %) and scalp (70 %). The mean intensities are as follows: scaling 1.9, erythema 1.89, pruritus 1.73, oily skin 1.52, and induration 0.87. Ninety-eight percent of patients report a trigger factor for outbreaks, namely stress/depression/fatigue (76 %) and seasonal variation (44 %). Acne is the most common concomitant disease (35 %). The most common treatments are topical steroids (60 %), imidazole antifungals (35 %) and hydratating/nutritive products (31 %). The mean Skindex-29 global score is 20.5. Conclusions. The most common clinical profile of seborrheic dermatitis is a 40-year-old patient with facial/scalp involvement of mild to moderate intensity with a history of stress/depression/fatigue prior to the outbreak. The most common treatments in the daily clinical practice are topical steroids and imidazole antifungals. The impact of seborrheic dermatitis in the quality of life is low

[Clinical and therapeutic profile and quality of life of patients with seborrheic dermatitis]. / Perfil clínico, terapéutico y calidad de vida de los pacientes con dermatitis seborreica.

INTRODUCTION: The clinical characteristics of seborrheic dermatitis (SD), therapeutic strategies employed in current clinical practice and impact on the quality of life in the Spanish population are described. METHODS: An epidemiological, multicenter, transversal study in patients older than 16 years with seborrheic dermatitis. We evaluated the intensity of symptoms (scale 0-4), and impact on the quality of life by the Skindex-29 questionnaire (scale 0-100). RESULTS: Two thousand one hundred and fifty nine patients participated, the mean age was 43,6 years, 55 % were men and 42 % had a family history of seborrheic dermatitis. Diagnosis is usually carried out at a mean age of 33,7 years. The median number of outbreaks in the last year is three. The median duration of each outbreak is 14 days. The most involved areas are the face (88 %) and scalp (70 %). The mean intensities are as follows: scaling 1.9, erythema 1.89, pruritus 1.73, oily skin 1.52, and induration 0.87. Ninety-eight percent of patients report a trigger factor for outbreaks, namely stress/depression/fatigue (76 %) and seasonal variation (44 %). Acne is the most common concomitant disease (35 %). The most common treatments are topical steroids (60 %), imidazole antifungals (35 %) and hydratating/nutritive products (31 %). The mean Skindex-29 global score is 20.5. CONCLUSIONS: The most common clinical profile of seborrheic dermatitis is a 40-year-old patient with facial/scalp involvement of mild to moderate intensity with a history of stress/depression/fatigue prior to the outbreak. The most common treatments in the daily clinical practice are topical steroids and imidazole antifungals. The impact of seborrheic dermatitis in the quality of life is low.

Histoplasmosis clásica diseminada con afectación cutánea / Classic disseminated histoplasmosis with cutaneous involvement

No disponible

No disponible

Recommendations for the use of etanercept in psoriasis: a European dermatology expert group consensus.

BACKGROUND: Psoriasis is a chronic, inflammatory skin disorder that has a significant impact on quality of life and, particularly in moderate to severe cases, adversely affects the patient's overall health and well-being. Biological treatments, such as etanercept, are being widely adopted across Europe for treatment of moderate to severe psoriasis due to favourable safety and efficacy profiles. The increase in usage, combined with a growing body of clinical evidence, has identified a need to clarify the best use of etanercept within its current treatment label. OBJECTIVE: To prepare a series of recommendations agreed by an expert group of dermatologists, relating to the most effective use of etanercept for psoriasis in Europe, within the product license. METHODS: An expert panel of dermatologists from across Europe completed a Delphi survey to address the current use of etanercept in psoriasis in Europe. In June 2005 the results were presented to the expert panel at their nominal group meeting, and a consensus was agreed. RESULTS: It was recommended that, where possible, patients are initiated on the 50 mg twice-weekly (BIW) dose. Etanercept should be given until remission is achieved (maximum 24 weeks) and retreatment should be initiated according to the physician's judgement. Before commencing treatment, contraindications, such as infection or previous malignancy (within 5 years), should be ruled out. CONCLUSIONS: The consensus presented herein provides valuable clarification of use of etanercept according to the label, which may have wider implications relating to the use of all biological therapies in psoriasis.

A 52-week randomized safety study of a calcipotriol/betamethasone dipropionate two-compound product (Dovobet/Daivobet/Taclonex) in the treatment of psoriasis vulgaris.

BACKGROUND: The calcipotriol/betamethasone dipropionate two-compound product Dovobet/Daivobet/Taclonex(LEO Pharma A/S, Ballerup, Denmark) has been shown to be safe and effective in the treatment of psoriasis for up to 8 weeks. As psoriasis is a chronic disease, long-term treatment may be required, so there is a need to investigate the safety of its use over a longer period of time. OBJECTIVES: To investigate the safety of two treatment regimens involving use of the two-compound product over 52 weeks in the treatment of patients with psoriasis. METHODS: Patients (n = 634) were randomized double-blind to treatment with: (i) 52 weeks of the two-compound product (two-compound group); (ii) 52 weeks of alternating 4-week periods of the two-compound product and calcipotriol (alternating group); or (iii) 4 weeks of the two-compound product followed by 48 weeks of calcipotriol (calcipotriol group). Treatments in all groups were used once daily when required. RESULTS: Adverse drug reactions (ADRs) occurred in 45 (21.7%) patients in the two-compound group, 63 (29.6%) in the alternating group and 78 (37.9%) in the calcipotriol group. The odds ratio for an ADR in the two-compound group relative to the calcipotriol group was 0.46 (95% confidence interval 0.30-0.70; P < 0.001). ADRs of concern associated with long-term topical corticosteroid use occurred in 10 (4.8%) patients in the two-compound group, six (2.8%) in the alternating group and six (2.9%) in the calcipotriol group; those with the highest incidence were skin atrophy, occurring in four (1.9%), one (0.5%) and two (1.0%) patients, respectively, and folliculitis, in three (1.4%), one (0.5%) and no patients, respectively. CONCLUSIONS: Treatment with the two-compound product for up to 52 weeks appears to be safe and well tolerated whether used on its own or alternating every 4 weeks with calcipotriol treatment.

Calciphylaxis associated with alcoholic cirrhosis.

Calciphylaxis is an uncommon disease characterized by calcification of dermal vessels that determines skin necrosis. Calciphylaxis has been almost exclusively reported in association with renal failure and altered phosphor-calcium metabolism. Only a few cases have been described in hyperparathyroidism, malignancies, and, recently, cirrhosis. We report a patient that developed calciphylaxis related to end-stage alcoholic cirrhosis, without any alteration in the phosphocalcic and parathyroid hormone metabolisms. Possible contributing factors were repeated albumin infusions and low levels of protein C and S.

Subcutaneous sarcoidosis--clinicopathological study of 10 cases.

BACKGROUND: Subcutaneous sarcoidosis is a specific cutaneous lesion of sarcoidosis that is rarely reported. OBJECTIVE: Our purpose was to analyse the clinicopathological features of 10 patients with subcutaneous sarcoidosis and its relationship with the systemic features of the disease. PATIENTS AND METHODS: The patients with systemic sarcoidosis, diagnosed from 1974 to 2002 at a university hospital in Barcelona, Spain, who developed subcutaneous involvement, were included in the study. The diagnosis of systemic sarcoidosis was made according to conventional criteria. All the patients were monitored prospectively at the sarcoidosis clinic of the hospital. Skin biopsies were performed when granulomatous cutaneous involvement was suspected clinically. RESULTS: Granulomatous cutaneous involvement was demonstrated in 85 of 480 patients with systemic sarcoidosis. In 10 of these 85 patients subcutaneous sarcoidosis was diagnosed (11.8%). The lesions were most frequently located in the extremities, involving the forearms in nine patients. Indurated linear bands from the elbow to the hand were observed in five patients. In all of our patients the subcutaneous nodules appeared at the beginning of the disease. In six patients, the nodules remitted spontaneously in less than 2 years. In two cases foreign particles were detected under polarized light. CONCLUSIONS: Subcutaneous sarcoidosis is a quite uniform clinicopathological entity usually appearing at the beginning of the disease. It usually heralds forms of sarcoidosis with nonsevere systemic involvement and is not associated with chronic fibrotic disease.

Coumarin necrosis induced by renal insufficiency.

Cutaneous necrosis is an infrequent complication of coumarin therapy. Skin necrosis has usually been reported in patients with congenital protein C deficiency or, less commonly, protein S deficiency. However, this complication may also occur with acquired and transient protein C and/or S deficiency. In coumarin therapy there is a relatively hypercoagulable state at the start of treatment, and most lesions appear between the third and sixth days. We describe a 75-year-old man receiving coumarin therapy (acenocumarol) for 7 years who was given a nonsteroidal anti-inflammatory agent (diclofenac) for a pain in his knee. Two days later, his renal function deteriorated and skin necrosis became evident. Biopsy showed histological changes consistent with coumarin-induced necrosis. Protein C and S levels were normal. We concluded that in our patient acute renal insufficiency aggravated by diclofenac treatment probably associated with an inadvertent withdrawal could have been the precipitating factor for transient protein C deficiency.

Cutaneous granulomas as the first manifestation of Hodgkin's disease.

We report the case of a 64-year-old male in whom fever, cutaneous rash and hepatomegaly were the first manifestations of Hodgkin disease (HD). Histologically a dense lymphohistiocytic infiltrate with a granulomatous pattern was found in the skin infiltrate. A computed tomography scan revealed hepatosplenomegaly and a small retroperitoneal lymphadenopathy. An hepatic percutaneous biopsy showed a granulomatous infiltration with typical Reed-Sternberg cells. Cutaneous manifestations of HD are briefly reviewed. The authors underline that granulomatous infiltration of the skin as the first manifestation of lymphoma is a very rare feature. We also discuss the possible pathogenic mechanisms of skin granulomas.

Primary cutaneous marginal zone B-cell lymphoma: a clinical, histopathological, immunophenotypic and molecular genetic study of 22 cases.

BACKGROUND: Primary cutaneous marginal zone B-cell lymphoma (MZCL) has recently been described. Differentiation from follicular centre cell lymphomas and lymphocytomas is often difficult due to insufficient experience and a lack of large series of patients. OBJECTIVES: To characterize primary cutaneous MZCL better, we report clinical, histopathological, immunophenotypic and molecular genetics features in a series of 22 patients. METHODS: All patients were treated and followed up at the same institution. Diagnosis of MZCL was based on the World Health Organization classification criteria. All samples were routinely tested with a wide panel of monoclonal antibodies. DNA was extracted from every sample following standard methods. IgH rearrangement and t(14;18)(q32;q21) studies were performed in all samples. RESULTS: Twenty-two patients (20 men, two women; mean age 50 years, range 24-77) were included. The mean follow-up was 43 months. Seventy per cent of patients presented with characteristic skin lesions on the trunk or extremities, consisting of deep red to violaceous infiltrated plaques, nodules or tumours frequently surrounded by diffuse or annular erythema. Four patients presented with lesions on the head and neck area. Two patients had disseminated skin lesions. The main histopathological features were non-epidermotropic, dense lymphocytic infiltrates mainly distributed in a nodular pattern. Adnexal involvement was usually present, with eventual formation of lymphoepithelial complexes. Cytologically, the infiltrate was polymorphous with marginal zone B cells and B-monocytoid cells. Blastoid CD30+ cells were often observed. Colonized reactive germinal centres and lymphoplasmocytoid differentiation were frequently present. Neoplastic cells were CD20+, CD79a+, CD5- and CD10-. Monotypic expression of light chains was observed in 18 cases (13 kappa; five lambda). Clonal IgH rearrangements were detected in 14 cases. The bcl-2 mutation t(14;18)(q32;q21) was demonstrated in two cases. Most patients were treated with local radiotherapy. Complete response rate with this approach was 100%. Six patients (27%) had skin recurrences from 6 months to 8 years after first treatment. Five patients (23%) had extracutaneous involvement. Two of them had a large cell transformation and one died of lymphoma. Three of four patients with head and neck presentation developed extracutaneous disease. CONCLUSIONS: MZCL appears to be a well recognizable entity, clinically, histologically and immunophenotypically. Although prognosis is generally good, the disease has potential for skin as well as extracutaneous recurrences. Large cell transformation and head and neck presentation may be associated with a worse prognosis.

Foreign bodies in granulomatous cutaneous lesions of patients with systemic sarcoidosis.

OBJECTIVE: To assess the presence of foreign material in the granulomatous cutaneous lesions of patients with systemic sarcoidosis. DESIGN AND SETTING: Observational study reevaluating histological specimens at a university referral hospital. PATIENTS: Sixty-five patients diagnosed as having sarcoidosis who developed granulomatous cutaneous involvement. MAIN OUTCOME MEASURES: To detect the presence of polarizable foreign particles in cutaneous biopsy specimens and to evaluate the association with clinical features of the patients. RESULTS: Granulomatous cutaneous involvement was demonstrated in 65 (15.3%) of 425 patients with systemic sarcoidosis. In 14 (22%) of the 65 patients, the cutaneous biopsy specimen showed foreign particles in polarized light. The skin lesions corresponded to 3 different clinical patterns: an admixture of papules and infiltration of previously undetected minute scars (n = 6); scar sarcoidosis (n = 4); and subcutaneous nodules (n = 4). The lesions were located most frequently in the extremities, involving the knees in 10 patients. CONCLUSIONS: The presence of polarizable foreign body material in granulomatous cutaneous lesions is not infrequent in patients with systemic sarcoidosis. Inoculation of foreign matter from a previous inapparent minor trauma may induce granuloma formation in individuals with sarcoidosis.

Simpatectomía torácica endoscópica para el tratamiento de la hiperhidrosis palmar primaria. a propósito de 28 casos / Thoracic endoscopic sympathectomy for the treatment of the primary palmar hyperhidrosis. A report of 28 cases

La hiperhidrosis primaria es una disfunción consistente en sudoración profusa de predominio palmoplantar y axilar. Esta disfunción del control vegetativo conlleva importantes inconvenientes sociales y laborales. Debido a la limitada eficacia de los tratamientos tópicos y quirúrgicos se presenta la experiencia en la práctica de simpatectomía torácica por vía toracoscópica. Un total de 28 simpatectomías torácicas endoscópicas de extremidades superiores se realizaron en 21 pacientes afectos de hiperhidrosis primaria (siete operados de ambas extremidades superiores y 14 de forma unilateral).En el 100 % de las intervenciones realizadas se obtuvo la desaparición completa de la sudoración del miembro superior, axila y parte de la hemicara homolateral. Los efectos secundarios fueron mínimos y en los controles a 2-28 meses no aparecieron recidivas (AU)

Cardiac involvement and molecular staging in a fatal case of mycosis fungoides.

Polymerase chain reaction (PCR) amplification of T-cell receptor-gamma gene rearrangement was used for molecular staging in a case of primary cutaneous T-cell lymphoma (CTCL) with fatal evolution. Although initial evaluation was negative for systemic involvement, the patient died due to heart failure. Autopsy findings revealed lymphomatous myocardial infiltration, but other tissues and organs examined, including lymph nodes, liver, spleen, lung and bone marrow, appeared to be free of disease. Molecular analysis from frozen samples obtained during the initial evaluation, as well as paraffin-embedded material obtained during autopsy, revealed the presence of clonal rearranged bands in all tissues examined except the bone marrow. Subsequent hybridization of PCR products with a tumour-specific oligoprobe confirmed the PCR results, suggesting widespread dissemination of the lymphomatous process. The use of molecular analysis can add significant information about the extent of disease in patients with CTCL and may be helpful in the establishment of therapeutic options.

[Skin reactions to interferon alpha in a series of 92 patients with multiple sclerosis]. / Reacciones cutáneas por interferón beta en una serie de 92 pacientes con esclerosis múltiple.

BACKGROUND: A significant proportion of multiple sclerosis patients develop cutaneous reactions by interferon beta 1b (IFN-beta). The am of this study was to describe clinically and histologically the cutaneous reactions by IFN-beta. PATIENTS AND METHODS: A series of 92 patients with multiple sclerosis in treatment with IFN-beta was followed. Cutaneous biopsy was performed in cases with persistent lesions. RESULTS: 9 out of 92 patients presented eritematous plaques, 4 cutaneous ulcers and 1 sclerodermiform plaques. Vascular thrombosis was demonstrated in 2 cases. CONCLUSIONS: In patients with multiple sclerosis treated with IFN-beta the persistent skin lesions are more frequent in female patients. Generally is not necessary to stop the treatment.