Safety and Effectiveness of Percutaneous Ultrasound-Guided Galvanic Current in Tunnels of Patients with Hidradenitis Suppurativa: A Pilot Study.

INTRODUCTION: The recurrent nature of hidradenitis suppurativa (HS), even under maintained systemic treatment, makes it necessary to have effective local treatments; however, the response to these therapies is variable (44-81%). The application of galvanic current (GC) has demonstrated its utility in humans in treating lesions structurally similar to those of HS. With this background, the main objective of this study was to evaluate the efficacy and safety of ultrasound-guided percutaneous GC in inflamed and/or draining tunnels of HS. METHODS: This was an open study (one-way repeated measures design over time). Patients were evaluated at 4 and 12 weeks after receiving GC. A combined clinical response at week 12 (absence of suppuration/inflammation on examination and clinical interview) was considered the principal variable of efficacy. Adverse effects potentially associated with GC were reported by telephone and at each visit. RESULTS: Twenty-six patients were included, with a male/female ratio of 5:8. The mean age was 35.84 (13.14) years. At 12 weeks after the administration of GC, a complete response was achieved in 77% (20/26) of the treated lesions. No serious adverse effects were observed, and the mean procedural pain assessed by the numeric rating scale was 0.03 (0.2). CONCLUSION: GC has proven to be effective and well tolerated in inflamed and draining tunnels of patients with HS.

Anxiety, depression, and alcohol use disorder in dermatologists: relationship with burnout and associated risk factors.

Burnout syndrome is a mental health condition related to chronic occupational stress; its prevalence, as well as its relationship with other mental health disorders in physicians, has become a topic of growing interest. However, no studies with large sample sizes evaluate this association in dermatologists. With this background, a cross-sectional study was designed, which included 420 Spanish dermatologists; the mean age was 44.5 years (12.39), and 62% (260/420) were women. Eleven percent (45/420) of the participants presented a moderate risk of burnout, more than half of the sample had at least one of the burnout symptoms, 47% (198/420) had some degree of anxiety, and 20.3% (85/420) presented some degree of depression. Less than 1% (4/420) demonstrated a high risk of alcohol use disorder. Being female was associated with a higher risk of depression and anxiety. Meanwhile, men and residents showed an increasedrisk of alcohol use disorder. Burnout and its domains showed a significative association with depression and anxiety, while no relationship with alcohol abuse was observed.

The impact of photodynamic therapy on skin homeostasis in patients with actinic keratosis: A prospective observational study.

BACKGROUND: Photodynamic therapy (PDT) is an effective treatment for actinic keratosis (AKs), but there is little information on how PDT affects skin barrier function. The objectives of this study are: To compare skin barrier function between skin with AKs and healthy skin and to evaluate the impact of PDT on skin homeostasis in patients with AKs. METHODS: A prospective observational study was conducted in patients with AKs to evaluate epidermal barrier function and skin homeostasis before and 1 ek after receiving PDT. RESULTS: A total of 21 subjects were included in the study, male/female ratio was 17:4, mean age was 75.86 years. The number of AKS observed before starting treatment was reduced with respect to those diagnosed 1 month after starting PDT (14.83 vs. 1.91, p < 0.0001). Application of PDT for treating AKs modifies epidermal barrier function. Immediately after the first session temperature, transepidermal water loss (TEWL), stratum corneum hydration (SCH) and total antioxidant capacity (TAC) increased while pH decreased on lesional skin. After 1-month follow-up, the only remained change was the increased in SCH. Higher increases in temperature were observed when using occlusive PDT compared to mixed modality. 5-ALA and M-ALA seem to have a similar impact on skin barrier. CONCLUSIONS: PDT can improve skin barrier function in patients with AKs. Skin homeostasis parameters can be used to assess efficacy and optimize dosing.

Factors Influencing Major Life-Changing Decisions in Patients with Psoriasis: A Cross-sectional Study.

Psoriasis is a chronic inflammatory disease associated with significant impairment in quality of life. Although quality of life in patients with psoriasis has been widely studied, there is little evidence regarding the impact of psoriasis on major life-changing decisions (MLCD). The aims of this study are to describe the impact of psoriasis on MLCD and to explore the potential clinical factors associated with MLCD. This cross-sectional study included 113 patients with psoriasis, regardless of disease severity, duration, or current treatment. The impact of the disease on different MLCD, including those related to professional career, decision of having children, choice of clothing, and leisure activities, was explored using Likert scales. Mean age was 51 years old and female to male ratio was 1.08 (54/50). The mean Psoriasis Area Severity Index was 3.75, and 30% (35/113) of the patients had psoriatic arthropathy. The most affected MLCD were career choice (median (interquartile range) score 3 (2-4)), social relationships (2 (1-3)), choice of clothing (2 (1-3)), job performance, absenteeism, and choice of holiday destination (1 (0-2)). Female sex, early age of onset and psoriatic arthropathy were associated with a greater impact of the disease on MLCD (p < 0.05). The results showed that a range of MLCD are affected in patients with psoriasis, such as career choice, job performance, absenteeism, or choice of clothing. Female sex,  psoriatic arthritis and early age of onset are factors associated with a greater impact on MLCD. In order to limit the long-term negative effects of psoriasis on patients, special attention should be paid to detection of psoriatic arthritis, and to patients with early disease onset.

Perceptions of medical students toward teledermatology as an educational tool: a cross-sectional study.

Introduction: Teledermatology consultations have recently been on the rise, especially due to the SARS-CoV-2 pandemic. The role of teledermatology has been extensively discussed as a mean for the education of dermatology residents. Nevertheless, little has been explored on its use as a pedagogical tool for medical students. The objectives of this study were to assess the level of satisfaction of medical students with teledermatology and to evaluate their opinion about its use as an educational tool. Methods: A cross-sectional study was carried out at the Dermatology Department, Hospital Universitario Virgen de las Nieves, Granada (Spain). Participants were fourth-year medical students. Every student would spend half of their internship in face-to-face consultations and the other half in teledermatology consultations. Data was collected via self-administered questionnaires. Results: Eighty one students were finally surveyed, being 66.67% (73/81) female. A majority of students considered a mixed clinical internship model (face-to-face consultations combined with teledermatology) more suitable for obtaining higher marks in the subject of dermatology and in the Medical Intern Resident exam (p = 0.04). Nevertheless, face-to-face practice was considered more useful for their training as general practitioners (p = 0.04). Conclusion: Despite the fact that students highly value doctor-patient relationship, teledermatology is considered a powerful educational tool.

Improvement of Sexual Function and Sleep Quality in Patients with Atopic Dermatitis Treated with Dupilumab: A Single-Centre Prospective Observational Study.

Atopic dermatitis (AD) is a chronic inflammatory skin disease presenting as xerosis, eczema and intense pruritus. These symptoms negatively impact patients' quality of life. However, the effect of AD on sexual function and sleep quality and how treatment with dupilumab could modify them have not been explored in depth. The aim of this study is to assess the effects of dupilumab on sexual and sleep quality in patients with AD. For that purpose, an observational prospective study was designed. Patients were evaluated at baseline and after 16 weeks of dupilumab treatment. Disease severity was assessed by Eczema Area and Severity (EASI) and SCORing Atopic Dermatitis index (SCORAD). Sexual function was evaluated using validated questionnaires, for men via the International Index of Erectile Dysfunction 5 (IIEF-5) and for women via the Female Sexual Function Index (FSFI). Sleep impairment was recorded through Pittsburgh Sleep Quality Index (PSQI). Thirty-two patients, with a mean age of 30.53 ± 14.48 years old, were included. Regarding sex, 59.8% (20) were female. Most patients had a severe disease reflected in a mean basal EASI of 23.24 ± 6.74 and a SCORAD of 54.07 ± 13.89. Clinical scores improved after dupilumab treatment. At baseline, 47.37% women presented sexual dysfunction and 66.67% men had erectile dysfunction. FSFI improved from 23.51 to 27.93 points (p = 0.008) after dupilumab. Desire, arousal, satisfaction and pain were the components with great improvement. Women with a great improvement in FSFI showed greater clinical results and increased quality of life. At first, 96.9% (31/32) of participants presented with poor sleep quality. After treatment with dupilumab, sleep quality was enhanced and PSQI scores decreased from 12.8 points at baseline to 7.73 points (p < 0.001). In conclusion, dupilumab is associated with reduced sexual dysfunction, mainly in women, and sleep quality.

The Impact of Sleep Quality on Mood Status and Quality of Life in Patients with Alopecia Areata: A Comparative Study.

Alopecia Areata (AA) is a chronic condition which has been associated with poor quality of life and mood status disturbances. The aim of this study is to compare the sleep quality between AA patients and controls, and to analyze the impact of poor sleep quality on patients with AA regarding mood status disturbances, quality of life and sexuality. A cross-sectional study including patients suffering from mild-to-severe AA and sex- and age-matched healthy controls was performed. Socio-demographic and clinical variables, sleep quality, quality of life, sexual disfunction, anxiety, depression and personality were collected using validated questionnaires. A total of 120 participants (60 patients and 60 controls) were included. Patients with AA showed worse sleep scores than controls (p = 0.003), as well as higher rates of anxiety and depression (p < 0.05). After a multivariate analysis, a worse sleep quality was found to be linked to anxiety, depression, a poorer quality of life and a type D personality score independently of the disease severity. In light of the results, patients with AA have a worse sleep quality than healthy controls. A poor sleep quality is associated with anxiety, depression and a worse quality of life, therefore being a general marker of a poor quality of life. Screening for sleep disturbances in specialized units could be useful to detect patients who could benefit from additional psychological support.