Management of Moderate to Severe Psoriasis in Routine Clinical Practice in Spanish Hospitals. / Manejo de la psoriasis moderada-grave en condiciones de práctica habitual en el ámbito hospitalario español.

BACKGROUND: There is currently little information available on the management of patients with psoriasis in the daily clinical practice of dermatologists in Spain. OBJECTIVE: The aim of this study was to survey a group of Spanish dermatologists with particular expertise in the management of psoriasis to determine their opinions on the protocols used in routine clinical practice. MATERIAL AND METHODS: A cross-sectional study based on an online survey about the management of psoriasis sent to 75 dermatologists. The survey, which was specifically designed for the study, included 12questions on different aspects of clinical practice in the treatment of moderate to severe psoriasis. RESULTS: The response rate was 96% (n=72). Biologics were the most widely used monotherapy option. In total, 64.3% of respondents reported that their patients used conventional systemic therapies for 1 to 2years before switching to a biologic drug and that the main reason for the switch was unstable control of disease activity. Overall, 85.7% assigned a "high" or "very high" importance to the use of a Psoriasis Area Severity Index score of <3 as a treatment goal. The drugs of choice among the respondents were etanercept for pediatric patients (78.6%), adalimumab and etanercept for patients with psoriatic arthritis (64.3%), and ustekinumab in patients frequently away from home (78.6%) and patients with a history of multiple sclerosis, demyelinating diseases (64.3%), or poor adherence to treatment (71.4%). CONCLUSION: This study provides a unique overview of the opinions of a representative sample of expert dermatologists on the current use of biologics for the treatment of psoriasis in Spain.

[Infections with cutaneous and nervous system alterations]. / Infecciones con afectación cutánea y del sistema nervioso.

OBJECTIVE: We review and update the clinical and diagnostic aspects in the most representative neurocutaneous infections, emphasizing the features of interdisciplinary interest. METHODS: Human skin is the primary host barrier against infection and his importance is critical in the immunocompromised population. The genetic hability of pathogen micro-organisms to bind the adhesion molecules of cellular membranes defines the anatomic affinity of each species. Cutaneous involvement can be crucial for diagnosis in infectious diseases. The characteristics of the elemental lesions and the accessible cytology, bacteriology and histopathology procedures, usually leads to a specific diagnosis. We highlight the cutaneous manifestations of the acute and subacute bacterial meningitides. We review the clinico-pathologic characteristics of the meningoencephalitidis associated to the viral exanthems. We describe the chronic bacterial entities with prominent cutaneous and neural affectation as lepra, syphilis and borreliosis, as well as the numerous clinical forms of presentation of herpesvirus hominis and varicellazoster. Finally, we stand out the transcendency of cutaneous findings in the HIV set. CONCLUSIONS: The appropriate interpretation of the infectious cutaneous semiology, supplemented with exams of direct samples, allow frequently to reach an ethiologic or orientated diagnosis, in a rapid, economic and non-invasive way. This information must be carefully incorporated to the study of high-morbidity infections, as there that concerns to the nervous system.

Milia en plaque.

A 59-year-old woman presented with milia grouped in plaques, in the preauricular areas, bilaterally. Follicle-damaging dermatoses, tumours and external agents, can lead to this peculiar clinical pattern. We outline the clinical and histological features which allow accurate diagnosis of this condition.

[Gangrenous juvenile vasculitis of the scrotum. Report of 2 cases]. / Vasculitis gangrenosa juvenil del escroto. Aportación de dos casos.

Among the various necrotic-ulcerous processes that may become established in the genitalia, one peculiar form of scrotal gangrene was described in 1973 by Piñol et al. under the name of juvenile gangrenous vasculitis of the scrotum. The clinical and pathological features of this entity, of undetermined etiology, allows it to be singled out and differentiated from other pictures of genital ulceration. With the contribution of two new cases, which we have had the opportunity to see recently, we want to call attention towards this distinctive though uncommonly diagnosed entity. Also, to emphasize the good response of the process to appropriate antibiotic and topical treatment in a picture which, due to its initial evolutive nature, to our judgement deserves to be considered within the acute symptomatic complex of the scrotum.

[Gougerot's lupus erythematosus tumidus]. / Lupus eritematoso tumidus de Gougerot.

A case of LEDC is reported, with clinic, histopathological and immune-fluorescence studies. The injuries start suddenly on the face and neck with a capricious evolution, reaching a complete disappearance without leaving neither scar nor atrophy, returning in few time in zones normally not exposed to the sun, as subchin region, low neck zone and lateral aspects of the neck continuing on the level of the skin of the head. The clinic study of the injuries call to mind the form described by Gougerot in 1930 of his túmidus and by the evolution of the same, the forma described by Gougerot and Carteaud, denominating it "à eclipse".