Pedro Herranz Pinto

Dupilumab (an anti-interleukin-4-receptor-α monoclonal antibody) blocks signalling of interleukin 4 and interleukin 13, type 2/Th2 cytokines implicated in numerous allergic diseases ranging from asthma to atopic dermatitis. Previous 16-week monotherapy studies showed that dupilumab substantially improved signs and symptoms of moderate-to-severe atopic dermatitis with acceptable safety, validating the crucial role of interleukin 4 and interleukin 13 in atopic dermatitis pathogenesis. We aimed to evaluate the long-term efficacy and safety of dupilumab with medium-potency topical corticosteroids versus placebo with topical corticosteroids in adults with moderate-to-severe atopic dermatitis.In this 1-year, randomised, double-blinded, placebo-controlled, phase 3 study (LIBERTY AD CHRONOS), adults with moderate-to-severe atopic dermatitis and inadequate response to topical corticosteroids were enrolled at 161 hospitals, clinics, and academic institutions in 14 countries in Europe, Asia-Pacific, and North America. Patients were randomly assigned (3:1:3) to subcutaneous dupilumab 300 mg once weekly (qw), dupilumab 300 mg every 2 weeks (q2w), or placebo via a central interactive voice/web response system, stratified by severity and global region. All three groups were given concomitant topical corticosteroids with or without topical calcineurin inhibitors where inadvisable for topical corticosteroids. Topical corticosteroids could be tapered, stopped, or restarted on the basis of disease activity. Coprimary endpoints were patients (%) achieving Investigator's Global Assessment (IGA) 0/1 and 2-point or higher improvement from baseline, and Eczema Area and Severity Index 75% improvement from baseline (EASI-75) at week 16. Week 16 efficacy and week 52 safety analyses included all randomised patients; week 52 efficacy included patients who completed treatment by US regulatory submission cutoff. This study is registered with ClinicalTrials.gov, NCT02260986.Between Oct 3, 2014, and July 31, 2015, 740 patients were enrolled: 319 were randomly assigned to dupilumab qw plus topical corticosteroids, 106 to dupilumab q2w plus topical corticosteroids, and 315 to placebo plus topical corticosteroids. 623 (270, 89, and 264, respectively) were evaluable for week 52 efficacy. At week 16, more patients who received dupilumab plus topical corticosteroids achieved the coprimary endpoints of IGA 0/1 (39% [125 patients] who received dupilumab plus topical corticosteroids qw and 39% [41 patients] who received dupilumab q2w plus topical corticosteroids vs 12% [39 patients] who received placebo plus topical corticosteroids; p<0·0001) and EASI-75 (64% [204] and 69% [73] vs 23% [73]; p<0·0001). Week 52 results were similar. Adverse events were reported in 261 (83%) patients who received dupilumab qw plus topical corticosteroids, 97 (88%) patients who received dupilumab q2w, and 266 (84%) patients who received placebo, and serious adverse events in nine (3%), four (4%), and 16 (5%) patients, respectively. No significant dupilumab-induced laboratory abnormalities were noted. Injection-site reactions and conjunctivitis were more common in patients treated with dupilumab plus topical corticosteroids-treated patients than in patients treated with placebo plus topical corticosteroids.Dupilumab added to standard topical corticosteroid treatment for 1 year improved atopic dermatitis signs and symptoms, with acceptable safety.Sanofi and Regeneron Pharmaceuticals Inc.

Background Tralokinumab, a fully human monoclonal antibody, specifically neutralizes interleukin-13, a key cytokine driving peripheral inflammation in atopic dermatitis (AD). In phase II studies, tralokinumab combined with topical corticosteroids provided early and sustained improvements in AD signs and symptoms. Objectives To evaluate the efficacy and safety of tralokinumab monotherapy in adults with moderate-to-severe AD who had an inadequate response to topical treatments. Methods In two 52-week, randomized, double-blind, placebo-controlled, phase III trials, ECZTRA 1 and ECZTRA 2, adults with moderate-to-severe AD were randomized (3 : 1) to subcutaneous tralokinumab 300 mg every 2 weeks (Q2W) or placebo. Primary endpoints were Investigator’s Global Assessment (IGA) score of 0 or 1 at week 16 and ≥ 75% improvement in Eczema Area and Severity Index (EASI 75) at week 16. Patients achieving an IGA score of 0 or 1 and/or EASI 75 with tralokinumab at week 16 were rerandomized to tralokinumab Q2W or every 4 weeks or placebo, for 36 weeks. The trials were registered with ClinicalTrials.gov: NCT03131648 and NCT03160885. Results At week 16, more patients who received tralokinumab vs. placebo achieved an IGA score of 0 or 1: 15·8% vs. 7·1% in ECZTRA 1 [difference 8·6%, 95% confidence interval (CI) 4·1–13·1; P = 0·002] and 22·2% vs. 10·9% in ECZTRA 2 (11·1%, 95% CI 5·8–16·4; P < 0·001) and EASI 75: 25·0% vs. 12·7% (12·1%, 95% CI 6·5–17·7; P < 0·001) and 33·2% vs. 11·4% (21·6%, 95% CI 15·8–27·3; P < 0·001). Early improvements in pruritus, sleep interference, Dermatology Life Quality Index, SCORing Atopic Dermatitis and Patient-Oriented Eczema Measure were observed from the first postbaseline measurements. The majority of week 16 tralokinumab responders maintained response at week 52 with continued tralokinumab treatment without any rescue medication (including topical corticosteroids). Adverse events were reported in 76·4% and 61·5% of patients receiving tralokinumab in ECZTRA 1 and ECZTRA 2, respectively, and in 77·0% and 66·0% of patients receiving placebo in ECZTRA 1 and ECZTRA 2, respectively, in the 16-week initial period. Conclusions Tralokinumab monotherapy was superior to placebo at 16 weeks of treatment and was well tolerated up to 52 weeks of treatment.

Several immunomodulatory agents are used in the treatment of epidermal necrolysis, but evidence of their efficacy is limited. The Autonomous Community of Madrid has two reference burn units to which all patients with epidermal necrolysis are referred. One burn unit has mostly used cyclosporine (CsA), and the other has used non-CsA therapies (mainly high-dose intravenous immunoglobulin). The allocation of patients to one or the other burn unit was mainly based on proximity, resembling a random assignment. Thus, we took advantage of this "natural experiment" to estimate the mortality risk ratio (MRR) of CsA (n = 26) compared with non-CsA (n = 16) treatment using hospital as an instrumental variable over the period from 2001 to 2015. We also computed the observed versus expected (O/E) MRR in a case series of 49 CsA-treated patients (including 23 patients from other regions treated in Madrid), and using the Score for Toxic Epidermal Necrolysis (i.e., SCORTEN) scale to estimate the expected values. The instrumental variable-based MRR of CsA versus non-CsA was 0.09 (95% confidence interval = 0.00-0.49). The O/E analysis also showed a reduction in mortality risk (MRROE = 0.42; 95% confidence interval = 0.14-0.99). We identified five other case series of CsA-treated patients providing MRROE and meta-analyzed their results. The pooled MRROE (including from this study) was 0.41 (95% confidence interval = 0.21-0.80). All three approaches consistently show that CsA reduces the mortality in epidermal necrolysis patients.

Journal of the European Academy of Dermatology and VenereologyVolume 34, Issue 10 p. e541-e542 Letter To The Editor Cutaneous small vessel vasculitis secondary to COVID-19 infection: a case report A. Mayor-Ibarguren, Corresponding Author A. Mayor-Ibarguren [email protected] orcid.org/0000-0003-1585-5995 Dermatology Department, Hospital Universitario La Paz, Madrid, Spain Correspondence: A. Mayor-Ibarguren. E-mail: [email protected]Search for more papers by this authorM. Feito-Rodriguez, M. Feito-Rodriguez Dermatology Department, Hospital Universitario La Paz, Madrid, SpainSearch for more papers by this authorL. Quintana Castanedo, L. Quintana Castanedo orcid.org/0000-0001-5136-841X Dermatology Department, Hospital Universitario La Paz, Madrid, SpainSearch for more papers by this authorE. Ruiz-Bravo, E. Ruiz-Bravo Anatomopathology Department, Hospital Universitario La Paz, Madrid, SpainSearch for more papers by this authorD. Montero Vega, D. Montero Vega Microbiology Department, Hospital Universitario La Paz, Madrid, SpainSearch for more papers by this authorP. Herranz-Pinto, P. Herranz-Pinto Dermatology Department, Hospital Universitario La Paz, Madrid, SpainSearch for more papers by this author A. Mayor-Ibarguren, Corresponding Author A. Mayor-Ibarguren [email protected] orcid.org/0000-0003-1585-5995 Dermatology Department, Hospital Universitario La Paz, Madrid, Spain Correspondence: A. Mayor-Ibarguren. E-mail: [email protected]Search for more papers by this authorM. Feito-Rodriguez, M. Feito-Rodriguez Dermatology Department, Hospital Universitario La Paz, Madrid, SpainSearch for more papers by this authorL. Quintana Castanedo, L. Quintana Castanedo orcid.org/0000-0001-5136-841X Dermatology Department, Hospital Universitario La Paz, Madrid, SpainSearch for more papers by this authorE. Ruiz-Bravo, E. Ruiz-Bravo Anatomopathology Department, Hospital Universitario La Paz, Madrid, SpainSearch for more papers by this authorD. Montero Vega, D. Montero Vega Microbiology Department, Hospital Universitario La Paz, Madrid, SpainSearch for more papers by this authorP. Herranz-Pinto, P. Herranz-Pinto Dermatology Department, Hospital Universitario La Paz, Madrid, SpainSearch for more papers by this author First published: 22 May 2020 https://doi.org/10.1111/jdv.16670Citations: 51Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1WuZ, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the chinese center for disease control and prevention. JAMA 2020; 323: 1239. 10.1001/jama.2020.2648 CASPubMedWeb of Science®Google Scholar 2HenryD, Ackerman M, Sancelme E et al. Urticarial eruption in COVID-19 infection. J Eur Acad Dermatol Venereol 2020. https://doi.org/10.1111/jdv.16472 10.1111/jdv.16472 PubMedWeb of Science®Google Scholar 3BouazizJD, Duong T, Jachiet M et al. Vascular skin symptoms in COVID-19: a french observational study. J Eur Acad Dermatol Venereol 2020. https://doi.org/10.1111/jdv.16544 10.1111/jdv.16544 Web of Science®Google Scholar 4PiccoloV, Neri I, Filippeschi C et al. Chilblain-like lesions during COVID-19 epidemic: a preliminary study on 63 patients. J Eur Acad Dermatol Venereol 2020. https://doi.org/10.1111/jdv.16526 10.1111/jdv.16526 Web of Science®Google Scholar 5MarzanoAV, Genovese G, Fabbrocini G et al. Varicella-like exanthem as a specific COVID-19-associated skin manifestation: multicenter case series of 22 patients. J Am Acad Dermatol 2020; 83: 280–285. https://doi.org/10.1016/j.jaad.2020.04.044 10.1016/j.jaad.2020.04.044 CASPubMedWeb of Science®Google Scholar 6JennetteJC, Falk RJ, Bacon PA et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum 2013; 65: 1. 10.1002/art.37715 CASPubMedWeb of Science®Google Scholar 7CarlsonJA. The histological assessment of cutaneous vasculitis. Histopathology 2010; 56: 3–23. 10.1111/j.1365-2559.2009.03443.x PubMedWeb of Science®Google Scholar 8NalbantS, Koc B, Top C et al. Hypersensitivity vasculitis and cytokines. Rheumatol Int 2002; 22: 244–248. 10.1007/s00296-002-0235-6 CASPubMedWeb of Science®Google Scholar 9ChenX, Zhao B, Qu Y et al. Detectable serum SARS-CoV-2 viral load (RNAaemia) is closely correlated with drastically elevated interleukin 6 (IL-6) level in critically ill COVID-19 patients. Clin Infect Dis 2020. https://doi.org/10.1093/cid/ciaa449 Web of Science®Google Scholar 10McNeilHP, Chesterman CN, Krilis SA. Immunology and clinical importance of antiphospholipid antibodies. Adv Immunol 1991; 49: 193–280. 10.1016/S0065-2776(08)60777-4 CASPubMedWeb of Science®Google Scholar Citing Literature Volume34, Issue10October 2020Pages e541-e542 This article also appears in:JEADV COVID-19 articles ReferencesRelatedInformation

Coronavirus disease 2019 (Covid-2019) has been associated with several cutaneous manifestations(1-3). A temporary field hospital was implemented during the pandemic peak in Madrid, Spain, to attend COVID-19 patients with mild to moderate pneumonia.

Human monkeypox has become increasingly frequent worldwide since the outbreak was first reported in May 2022.As cidofovir is effective against vaccinia and other Orthopoxvirus diseases, we hypothesize that its topical use could be an effective treatment for monkeypox skin lesions, avoiding the adverse effects of systemic administration.We conducted a prospective study to collect data on the clinical and virologic course of patients with monkeypox. All patients were offered symptomatic treatment. They were also offered treatment with topical cidofovir on a compassionate use basis. Twelve patients received treatment with topical cidofovir 1%, while the others received only symptomatic treatment. Prospective visits were scheduled for the collection of clinical and virological data.Lesions cleared quicker in the cidofovir-treated group (hazard ratio, 4.572; P = .0039). The median time to resolution was 12 (11.5-15) and 18 (16-21) days, respectively. On day 14, polymerase chain reaction-positive skin lesions were detected in 10% of the cidofovir sample, compared with 62.5% of the non-treated group (P = .019). Local adverse effects were frequent (50%), especially in the anogenital region. No systemic adverse effects were reported.The study is not a clinical trial and lacks a placebo-controlled arm.Topical cidofovir is a potentially relevant therapy in patients with skin lesions but mild systemic involvement. Reducing time to resolution could shorten isolation time and improve the cosmetic impact in areas such as the face.

Journal Article Safety and effectiveness of ustekinumab and antitumour necrosis factor therapy in patients with psoriasis and chronic viral hepatitis B or C: a retrospective, multicentre study in a clinical setting Get access R. Navarro, R. Navarro Department of Dermatology, Hospital Universitario de la Princesa, Madrid, Spain Raquel Navarro. E‐mail: nat_eraa@hotmail.com Search for other works by this author on: Oxford Academic Google Scholar E. Vilarrasa, E. Vilarrasa Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain Search for other works by this author on: Oxford Academic Google Scholar P. Herranz, P. Herranz Department of Dermatology, Hospital Universitario la Paz, Madrid, Spain Search for other works by this author on: Oxford Academic Google Scholar L. Puig, L. Puig Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain Search for other works by this author on: Oxford Academic Google Scholar X. Bordas, X. Bordas Department of Dermatology, Hospital de Bellvitge, Barcelona, Spain Search for other works by this author on: Oxford Academic Google Scholar J.M. Carrascosa, J.M. Carrascosa Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain Search for other works by this author on: Oxford Academic Google Scholar R. Taberner, R. Taberner Department of Dermatology, Hospital Son Llátzer, Mallorca, Spain Search for other works by this author on: Oxford Academic Google Scholar M. Ferrán, M. Ferrán Department of Dermatology, Hospital del Mar, Barcelona, Spain Search for other works by this author on: Oxford Academic Google Scholar M. García‐Bustinduy, M. García‐Bustinduy Department of Dermatology, Hospital Universitario de Canarias, La Laguna, Spain Search for other works by this author on: Oxford Academic Google Scholar A. Romero‐Maté, A. Romero‐Maté Department of Dermatology, Hospital de Fuenlabrada, Madrid, Spain Search for other works by this author on: Oxford Academic Google Scholar ... Show more R. Pedragosa, R. Pedragosa Department of Dermatology, Hospital Plató, Barcelona, Spain Search for other works by this author on: Oxford Academic Google Scholar A. García‐Diez, A. García‐Diez Department of Dermatology, Hospital Universitario de la Princesa, Madrid, Spain Search for other works by this author on: Oxford Academic Google Scholar E. Daudén E. Daudén Department of Dermatology, Hospital Universitario de la Princesa, Madrid, Spain Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 168, Issue 3, 1 March 2013, Pages 609–616, https://doi.org/10.1111/bjd.12045 Published: 01 March 2013 Article history Accepted: 07 September 2012 Published: 01 March 2013

Aromatic antiepileptic drugs (AEDs) are among the drugs most frequently involved in severe cutaneous adverse reactions (SCARs), such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reactions with eosinophilia and systemic symptoms (DRESS). This study investigated the associations between the genetic polymorphisms of HLA class-I and AED-induced SCARs in the Spanish population. HLA class-I genotypes were determined in AED (phenytoin[PHT],lamotrigine[LTG],carbamazepine[CBZ],phenobarbital[PB])-induced SJS/TEN (n = 15) or DRESS (n = 12) cases included in the Spanish SCAR registry, PIELenRed. There were 3 control groups: (A)tolerant to a single AED, (B)tolerant to any AED, and (C)Spanish population controls. For SJS/TEN, concomitant HLA-A*02:01/Cw15:02 alleles were significantly associated with PHT-cases compared to control groups B and C [(B)odds ratio(OR):14.75, p = 0.009;(C)OR:27.50, p < 0.001], and were close to significance with respect to control group A (p = 0.060). The genotype frequency of the HLA-B*38:01 was significantly associated with PHT-LTG-cases compared with the 3 groups of controls [(A)OR:12.86, p = 0.012;(B)OR:13.81; p = 0.002;(C)OR:14.35, p < 0.001], and with LTG-cases [(A)OR:147.00, p = 0.001;(B)OR:115.00, p < 0.001;(C)OR:124.70, p < 0.001]. We found the HLA-B*15:02 allele in a Spanish Romani patient with a CBZ-case. The HLA-A*11:01 was significantly associated with CBZ-cases [(A)OR:63.89, p = 0.002;(B)OR:36.33, p = 0.005;(C)OR:28.29, p = 0.007]. For DRESS, the HLA-A*24:02 genotype frequency was statistically significant in the PHT-LTG-cases [(A)OR:22.56, p = 0.003;(B)OR:23.50. p = 0.001; (C)OR:33.25, p < 0.001], and in the LTG-cases [(A),OR:49.00, p = 0.015;(B)OR:27.77, p = 0.005; (C)OR:34.53, p = 0.002]. HLA-A*31:01 was significantly associated with the CBZ-cases [(A)OR:22.00, p = 0.047;(B)OR:29.50, p = 0.033;(C)OR:35.14, p = 0.006]. In conclusion, we identified several significant genetic risk factors for the first time in the Spanish Caucasian population: HLA-A*02:01/Cw*15:02 combination as a risk factor for PHT-induced SJS/TEN, HLA-B*38:01 for LTG- and PHT- induced SJS/TEN, HLA-A*11:01 for CBZ-induced SJS/TEN, and HLA-A*24:02 for LTG- and PHT- induced DRESS. The strong association between HLA*31:01 and CBZ-DRESS in Europeans was confirmed in this study.

Summary Background Drug reaction with eosinophilia and systemic symptoms ( DRESS ) is a severe delayed hypersensitivity reaction. The determination of drug causality is complex. The lymphocyte transformation test ( LTT ) has been reported positive in more than 50% of DRESS cases. Nevertheless, the sensitivity and specificity of LTT specifically in DRESS have not yet been established. Rechallenge with the culprit drug is contraindicated and cannot be used as gold standard for sensitivity and specificity determination. Objective To estimate the sensitivity and specificity of LTT in a clinically defined series of patients with DRESS . Methods Some 41 patients diagnosed with DRESS were included in the study. The results of the algorithm of the Spanish Pharmacovigilance System were used as the standard for a correct diagnosis of drug causality. A standard LTT was performed with involved drugs in acute or recovery samples. A stimulation index ( SI ) ≥2 in at least one concentration except for beta‐lactams ( SI ≥3) and contrast media ( SI ≥4) was considered positive. Contingency tables and ROC curves were used for analysis. Results Sensitivity and specificity of LTT in the recovery phase of DRESS were 73% and 82%, respectively, whereas in the acute phase, they were only 40% and 30%, respectively. Comparison of skin tests and LTT confirmed a higher sensitivity and specificity of LTT in DRESS . LTT showed high sensitivity (S) and specificity (Sp) for anticonvulsants (S 100%, Sp 100%; P = .008), anti‐ TB drugs (S 87.5%, Sp 100%; P = .004), and beta‐lactams (S 73%, Sp 100%; P = .001). ROC curves revealed that the best criteria for LTT positivity for all drugs are SI ≥2 in at least one concentration, increasing overall sensitivity to 80%, and for beta‐lactams from 73% to 92%. Conclusions and clinical relevance LTT is a good diagnostic tool for drug causality in DRESS , mainly when performed in the recovery phase.

During the coronavirus disease 2019 (COVID-19) epidemic, dermatologists and other physicians have been treating patients with cutaneous manifestations related to this infection. Because of the high risk of taking photographs of these patients, there are few clinical images reported in the literature.

Journal of the European Academy of Dermatology and VenereologyVolume 35, Issue 8 p. e489-e491 Letter to the Editor Pityriasis rosea, COVID-19 and vaccination: new keys to understand an old acquaintance J.M. Busto-Leis, Corresponding Author J.M. Busto-Leis [email protected] orcid.org/0000-0003-2719-9550 Department of Dermatology, La Paz University Hospital, Madrid, Spain *Correspondence: J.M. Busto Leis. E-mail: [email protected]Search for more papers by this authorG. Servera-Negre, G. Servera-Negre orcid.org/0000-0002-8439-0872 Department of Dermatology, La Paz University Hospital, Madrid, SpainSearch for more papers by this authorA. Mayor-Ibarguren, A. Mayor-Ibarguren orcid.org/0000-0003-1585-5995 Department of Dermatology, La Paz University Hospital, Madrid, SpainSearch for more papers by this authorE. Sendagorta-Cudós, E. Sendagorta-Cudós orcid.org/0000-0002-6255-7037 Department of Dermatology, La Paz University Hospital, Madrid, SpainSearch for more papers by this authorM. Feito-Rodríguez, M. Feito-Rodríguez orcid.org/0000-0002-2645-8904 Department of Dermatology, La Paz University Hospital, Madrid, SpainSearch for more papers by this authorA. Nuño-González, A. Nuño-González orcid.org/0000-0001-7252-1647 Department of Dermatology, La Paz University Hospital, Madrid, SpainSearch for more papers by this authorM.D. Montero-Vega, M.D. Montero-Vega Department of Microbiology, La Paz University Hospital, Madrid, SpainSearch for more papers by this authorP. Herranz-Pinto, P. Herranz-Pinto orcid.org/0000-0002-9840-6628 Department of Dermatology, La Paz University Hospital, Madrid, SpainSearch for more papers by this author J.M. Busto-Leis, Corresponding Author J.M. Busto-Leis [email protected] orcid.org/0000-0003-2719-9550 Department of Dermatology, La Paz University Hospital, Madrid, Spain *Correspondence: J.M. Busto Leis. E-mail: [email protected]Search for more papers by this authorG. Servera-Negre, G. Servera-Negre orcid.org/0000-0002-8439-0872 Department of Dermatology, La Paz University Hospital, Madrid, SpainSearch for more papers by this authorA. Mayor-Ibarguren, A. Mayor-Ibarguren orcid.org/0000-0003-1585-5995 Department of Dermatology, La Paz University Hospital, Madrid, SpainSearch for more papers by this authorE. Sendagorta-Cudós, E. Sendagorta-Cudós orcid.org/0000-0002-6255-7037 Department of Dermatology, La Paz University Hospital, Madrid, SpainSearch for more papers by this authorM. Feito-Rodríguez, M. Feito-Rodríguez orcid.org/0000-0002-2645-8904 Department of Dermatology, La Paz University Hospital, Madrid, SpainSearch for more papers by this authorA. Nuño-González, A. Nuño-González orcid.org/0000-0001-7252-1647 Department of Dermatology, La Paz University Hospital, Madrid, SpainSearch for more papers by this authorM.D. Montero-Vega, M.D. Montero-Vega Department of Microbiology, La Paz University Hospital, Madrid, SpainSearch for more papers by this authorP. Herranz-Pinto, P. Herranz-Pinto orcid.org/0000-0002-9840-6628 Department of Dermatology, La Paz University Hospital, Madrid, SpainSearch for more papers by this author First published: 26 April 2021 https://doi.org/10.1111/jdv.17301Citations: 21Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Conflict of interest Nothing to disclose. References 1Ehsani AH, Nasimi M, Bigdelo Z. Pityriasis rosea as a cutaneous manifestation of COVID-19 infection. J Eur Acad Dermatol Venereol 2020; 34: 436–437. 10.1111/jdv.16579 CASPubMedWeb of Science®Google Scholar 2Drago F, Ciccarese G, Broccolo F et al. The role of cytokines, chemokines, and growth factors in the pathogenesis of Pityriasis Rosea. Mediators Inflamm 2015; 2015: 438963. 10.1155/2015/438963 CASPubMedWeb of Science®Google Scholar 3Watanabe T, Kawamura T, Jacob SE et al. Pityriasis rosea is associated with systemic active infection with both human herpesvirus-7 and human herpesvirus-6. J Invest Dermatol 2002; 119: 793–797. 10.1046/j.1523-1747.2002.00200.x CASPubMedWeb of Science®Google Scholar 4Rodriguez-Zuniga M, Torres N, Garcia-Perdomo H. Effectiveness of acyclovir in the treatment of pityriasis rosea. A systematic review and meta-analysis. An Bras Dermatol 2018; 93: 686–695. 10.1590/abd1806-4841.20187252 PubMedWeb of Science®Google Scholar 5Drago F, Ciccarese G, Rebora A, Parodi A. Human herpesvirus-6, -7, and Epstein-Barr virus reactivation in pityriasis rosea during COVID-19. J Med Virol 2021; 93: 1850–1851. 10.1002/jmv.26549 CASPubMedWeb of Science®Google Scholar 6Cho YT, Yang CW, Chu CY. Drug reaction with eosinophilia and systemic symptoms (DRESS): an interplay among drugs, viruses, and immune system. Int J Mol Sci 2017; 18: 1243. 10.3390/ijms18061243 CASPubMedWeb of Science®Google Scholar 7Le Balc'h P, Pinceaux K, Pronier C, Seguin P, Tadié JM, Reizine F. Herpes simplex virus and cytomegalovirus reactivations among severe COVID-19 patients. Crit Care 2020; 24: 530. 10.1186/s13054-020-03252-3 PubMedWeb of Science®Google Scholar 8Drago F, Ciccarese G, Javor S, Parodi A. Vaccine-induced pityriasis rosea and pityriasis rosea-like eruptions: a review of the literature. J Eur Acad Dermatol Venereol 2016; 30: 544–545. 10.1111/jdv.12942 CASPubMedWeb of Science®Google Scholar 9Papakostas D, Stavropoulos PG, Papafragkaki D, Grigoraki E, Avgerinou G, Antoniou C. An atypical case of pityriasis rosea gigantea after influenza vaccination. Case Rep Dermatol 2014; 6: 119–123. 10.1159/000362640 PubMedGoogle Scholar 10Drago F, Ciccarese G, Rebora A, Parodi A. Pityriasis rosea following human papillomavirus vaccination. Braz J Infect Dis 2015; 19: 224–225. 10.1016/j.bjid.2014.10.006 PubMedWeb of Science®Google Scholar Citing Literature Volume35, Issue8August 2021Pages e489-e491 This article also appears in:JEADV COVID-19 articles ReferencesRelatedInformation

Wet wrap therapy (WWT) consists of topical steroids administered under a layer of wet cotton bandages or garments. Several trials with WWT have reported promising results in atopic dermatitis (AD). However, no systematic review and meta‐analysis on its efficacy and safety has been published. Our objective was to conduct a systematic review of the literature on WWT in AD to assess its efficacy and safety. We included randomized controlled trials among patients of all ages with a diagnosis of AD based on predefined criteria or made by a dermatologist. Electronic searches were performed from 1970 to 30 March 2016 in the Cochrane Central Register of Controlled Trials, MEDLINE, Embase and the World Health Organization International Clinical Trials Registry. Selection of studies and data extraction were performed independently by two researchers, and discrepancies were resolved by consensus. Six trials comparing WWT with topical steroids in children or adults with AD were included. Sample sizes ranged from 19 to 51 patients. Results on clinical severity and quality of life were reported incompletely and proved heterogeneous across studies. A nonsignificant tendency to increased risk of mild skin infections was observed in those treated with WWT (pooled relative risk 6·35, 95% confidence interval 0·83–48·55). The overall grade of quality of evidence for the efficacy and safety outcomes was low. In conclusion, the evidence that WWT is more effective than conventional treatment with topical steroids in AD is of low quality. Further clinical trials should establish the efficacy of WWT in AD.

Guselkumab is a drug used to treat moderate to severe plaque psoriasis. However, real-life clinical data on its off-label use are limited, especially regarding the optimal drug dosage regimen for different patient profiles. The main objective of this real-world, single-centre, retrospective study was to identify the off-label guselkumab dosing regimen used in clinical practice. The study also aimed to evaluate the drug's efficacy, safety, and survival, as well as the proportion of super-responders (SR) based on a newly proposed definition. The study included 69 patients who started treatment with guselkumab between March 2019 and July 2021. Patients were followed up until April 2022, during which time their efficacy, safety, persistence, and use of guselkumab were recorded. Patients were aged ≥ 18 years and had moderate to severe plaque psoriasis. The mean disease duration was 18.6 years, and 59% of patients had received at least one biologic treatment before guselkumab with a mean of 1.3 biologics per patient. The initial absolute Psoriasis Area and Severity Index (PASI) was 10.1 and decreased to 2.1 between Week 11–20 without significant changes in the PASI value throughout the 90 weeks of follow-up. The cumulative probability of drug survival was 93.5% at Week 52. No differences were found in terms of efficacy and survival associated with the off-label drug dosage regimens compared to the doses described in the Summary of Product Characteristics (SmPC). The greatest adjustments in the drug administration regimen were achieved in the subgroups of bio-naïve and SR patients, with a reduction in the number of administrations by 40% and 47% compared to the regimen described in the SmPC. Super-response to guselkumab was mainly associated with patients naïve to previous biologic treatment. The study demonstrated that off-label use of guselkumab was safe and effective in real-life clinical practice. The findings suggest that adjustments to the drug administration regimen may be necessary to optimise its use in different patient profiles, especially in SR and bio-naïve patients. Further studies are needed to confirm these findings.

Tildrakizumab is a humanized, IgG1/κ antibody that interacts with the p19 subunit of interleukin 23. It is approved for the treatment of moderate-to-severe plaque psoriasis. Real-world evidence on the effectiveness and safety of tildrakizumab is limited.To assess the effectiveness and safety of tildrakizumab at 24 weeks in patients with moderate-to-severe plaque psoriasis in routine clinical practice.Retrospective, observational, multicentre study including adult patients with moderate-to-severe plaque psoriasis treated with tildrakizumab under real-life conditions. Patient data were extracted from anonymized electronic medical records. Statistical analysis was performed using SPSS22.A total of 190 patients were included. About 53.9% were men with a mean age of 51.45 (SD 3.9) and a mean BMI of 29.13 (SD 6.21). About 79.8% (132 out of 190) of patients had previously received biological therapy (BT) and 17.3% (33 out of 191) had psoriatic arthritis. Baseline PASI was 10.7 (SD 6.53). Up to 109 patients reached Week 24 and at this point mean baseline PASI decreased to 1.7 (SD 4.8), representing an 88.79% mean PASI reduction. At 6 months, 87.1% and 40.3% of the treated patients achieved PASI ≤3 and ≤1, respectively. At Week 24 mean BSA decreased from 13.2 (SD 10.07) to 1.6 (SD 4.40) and mean DLQI went from 12.5 (SD 7.12) to 1.2 (SD 3.27). Multivariate analysis showed no differences when effectiveness was correlated with gender, obesity, psoriatic arthritis or prior exposure to BT. The rate of adverse events (AE) was 5.9% (11 out of 190), where infections were the most frequent AE (4 out of 11). One patient suffered a haemorrhagic ictus and one patient died due to causes unrelated to the study.Tildrakizumab was effective and safe in a large cohort of patients with moderate-to-severe plaque psoriasis treated in a routine clinical setting.

Extramammary Paget's disease (EMPD) is an intraepidermal adenocarcinoma of apocrine gland-bearing skin. Although surgery remains the mainstay of treatment, loss of tissue function and high recurrence rates have been reported. Recently, topical Imiquimod has been shown as a safe and effective treatment option for extramammary Paget's disease.Three patients diagnosed of EMPD of the vulva were treated with a daily application of 5% Imiquimod cream for three weeks, followed by an every other day application for an additional three weeks.Complete clinical and histological remission of the disease was achieved in the three patients. Mild irritation and tenderness were observed as the only side effects.Based on our results, we consider that Imiquimod cream is a safe and effective therapeutic option for the treatment of vulvar EMPD. These promising results warrant further studies to determine the real efficacy and safety of Imiquimod 5% cream for the treatment of this uncommon disease.

Methotrexate (MTX) is the most frequently used conventional systemic drug in the treatment of psoriasis. Despite over 50years of experience in this setting, certain aspects of the use of this drug in clinical practice are still little standardized and poorly understood. For this reason, a group of 15 experts took part in a consensus development conference to achieve consensus on a series of recommendations on the use of MTX in psoriasis. The guidelines, which were developed on the basis of a systematic review of the literature, were validated by 2 rounds of voting and categorized by level of evidence and grade of recommendation. Before MTX can be used to treat moderate to severe psoriasis, the patient must be evaluated to assess the suitability of the treatment, including consideration of vaccination status and screening for tuberculosis and pregnancy. The recommended starting dose for a patient with no risk factors is 10 to 20mg/wk, the therapeutic dose for most patients is 15mg/wk, and the maximum dose is 20mg/wk. Most patients who respond to treatment will show improvement within 8weeks. Parenteral administration of MTX is desirable when there is a risk of erroroneous dosing, nonadherence, gastrointestinal intolerance, or inadequate response to the therapeutic dose taken orally. Noninvasive methods are preferred for monitoring hepatotoxicity. MTX is a good treatment option for patients with a history of cancer, but is not recommended in patients with chronic hepatitisB infection or individuals who are seropositive for human immunodeficiency virus.

Recently a new entity, postmenopausal frontal fibrosing alopecia, was added to the established subtypes of scarring alopecias affecting postmenopausal women. This condition is characterized by a progressive frontal hairline recession associated with scarring. We studied the clinical and histopathologic features in four women with this disorder. Of note, a history of bilateral oophorectomy in two of them appears to be a new association. All four cases had frontoparietal recession of the hairline and two of them also had loss of their eyebrows. None of our four patients had any mucous membrane or other skin lesions. Histological examination showed perifollicular fibrosis and lymphocytic inflammation around the isthmus and infundibular areas of the follicles. No effective treatments have emerged for this type of postmenopausal alopecia, but progression of the hair loss and scarring appears to be self-limiting. We believe that this condition is a distinct clinicopathological variant of lichen planopilaris.

The incidence of anal cancer among HIV-infected patients is higher than that in other populations. Anal high-grade squamous intraepithelial lesions are considered precursors to invasive squamous-cell carcinomas and are strongly associated to high-risk human papillomavirus infection.The aim of this study is to determine the prevalence of anal high-grade squamous intraepithelial lesions through screening based on cytology and high-resolution anoscopy with biopsy in a cohort of HIV-infected men who have sex with men.This investigation is an observational cross-sectional cohort study.The study was conducted in the HIV unit of a tertiary hospital in Spain.Three hundred HIV-infected men who have sex with men participated. Physical examination led to a diagnosis of perianal squamous-cell carcinoma and high-grade squamous intraepithelial lesions in 2 patients who were then excluded.Anal liquid cytology was performed. Patients with cytological abnormalities underwent high-resolution anoscopy and biopsy.The primary outcome measured was biopsy-proven high-grade squamous intraepithelial lesions.The median age was 41 ± 10.5 years. The mean and nadir CD4 cell counts were 651 ± 205 cells/mm(3) (interquartile range, 438-800) and 273 ± 205 cells/mm(3) (interquartile range, 131-362). High-risk human papillomavirus was detected in 80.9% of patients, and human papillomavirus 16 was detected in 35.9% of patients. The mean number of human papillomavirus genotypes was 4.6 ± 2.9 (CI, 2-6). Anal cytology was abnormal in 40.9% of patients (n = 122/298; interquartile range, 35.4%-46.6%). High-resolution anoscopy and biopsies were performed in 119 patients. The results of histological analyses were as follows: normal, 7.7% (n = 23); condyloma, 4.3% (n = 13); anal intraepithelial neoplasia 1, 5.7% (n = 17); anal intraepithelial neoplasia 2, 14% (n = 42); and anal intraepithelial neoplasia 3, 8% (n = 24). The overall prevalence of high-grade squamous intraepithelial lesions among patients with abnormal cytology was 54% (95% CI, 45.1%-62.8%). A diagnosis of high-grade squamous intraepithelial lesions was associated with human papillomavirus 16 and human papillomavirus 51 infection, and with detection of a higher number of human papillomavirus genotypes.High-resolution anoscopy was only performed in patients with abnormal cytology.The prevalence of high-risk human papillomavirus infection and high-grade squamous intraepithelial lesions is high in our cohort. Physical examination enabled straightforward diagnosis of perianal high-grade squamous intraepithelial lesions and squamous-cell carcinoma in 2 patients.

Aim We conducted a prospective evaluation of all eosinophilic drug reactions (EDRs) through the Prospective Pharmacovigilance Program from Laboratory Signals at Hospital to find out the incidence and distribution of these entities in our hospital, their causative drugs, and predictors. Methods All peripheral eosinophilia &gt;700 × 10 6 cells l −1 detected at admission or during hospitalisation, were prospectively monitored over 42 months. The spectrum of the localised or systemic manifestation of EDR, the incidence, the distribution of causative drugs, and the predictors were analysed. Results The incidence of EDR was 16.67 (95% Poisson confidence interval [CI]: 9.90–25.98) per 10 000 admissions. Of 274 cases of EDR, 154 (56.2%) cases in 148 patients were asymptomatic hypereosinophilia. In the remaining 120 (43.8%) cases, there was other involvement. Skin and soft tissue reactions were detected in 36 (13.1%) cases; visceral EDRs in 19(7.0%) cases; and drug‐induced eosinophilic cutaneous and visceral manifestations were detected in the remaining 65 (23.7%) cases, 64 of which were potential drug reaction with eosinophilia and systemic symptoms (DRESS). After adjusting for age, sex, and hospitalisation wards, predictors of symptomatic eosinophilia were earlier onset of eosinophilia (hazard ratio [HR], 10.49; 95%CI: 3.13–35.16) higher eosinophil count (HR, 8.51; 95%CI: 3.28–22.08), and a delayed onset of corticosteroids (HR, 1.34; 95%CI: 1.01–1.73). A higher eosinophil count in patients with DRESS was significantly associated with greater impairment of liver function, prolonged hospitalisation, higher cumulative doses of corticosteroids, and if hypogammaglobinaemia was detected, a reactivation of human‐herpesvirus 6 was subsequently detected. Conclusions Half (53.3%, 64/120 cases) of symptomatic EDRs were potential DRESS. The main predictor of severity of EDR was an early severe eosinophilia.

Abstract Background Little has been published on the real‐world effectiveness and safety of apremilast in psoriasis. Objectives To evaluate the effectiveness, safety and drug survival of apremilast at 52 weeks in patients with moderate to severe plaque psoriasis or palmoplantar psoriasis in routine clinical practice. Methods Retrospective, multicentre study of adult patients with moderate to severe plaque psoriasis or palmoplantar psoriasis treated with apremilast from March 2016 to March 2018. Results We studied 292 patients with plaque psoriasis and 85 patients with palmoplantar psoriasis. The mean (SD) Psoriasis Area and Severity Index (PASI) score was 10.7 (7.0) at baseline and 3.0 (4.2) at 52 weeks. After 12 months of treatment, 73.6% of patients had a PASI score of 3 or less. In terms of relative improvement by week 52, 49.7% of patients achieved PASI‐75 (≥75% reduction in PASI score) and 26.5% achieved PASI‐90. The mean physician global assessment score for palmoplantar psoriasis fell from 4.2 (5.2) at baseline to 1.3 (1.3) at week 52. Overall drug survival after 1 year of treatment with apremilast was 54.9 %. The main reasons for treatment discontinuation were loss of efficacy (23.9%) and adverse events (15.9%). Almost half of the patients in our series (47%) experienced at least one adverse event. The most common events were gastrointestinal problems. Conclusions Apremilast may be a suitable alternative for the treatment of moderate to severe psoriasis and palmoplantar psoriasis. Although the drug has a good safety profile, adverse gastrointestinal effects are common.

La enfermedad por coronavirus-19 (COVID-19) se ha relacionado con múltiples síntomas: respiratorios, trombóticos, neurológicos, digestivos o cutáneos. Estos últimos se han clasificado en 5 tipos: lesiones acroisquémicas, lesiones vesiculares, erupción urticarial, exantema maculopapular o lesiones livedoides. Sin embargo, se han descrito mucho menos las alteraciones orales asociadas a la COVID-19. Presentamos un estudio transversal realizado durante abril del 2020 en el Hospital de Campaña de IFEMA examinando la mucosa oral de 666 pacientes con COVID-19. En total, 78 pacientes (11,7%) presentaron alteraciones en la mucosa oral. La más frecuente fue papilitis lingual transitoria anterior en forma de U (11,5%) asociada o no a edema lingual (6,6%); estomatitis aftosa (6,9%), mucositis (3,9%) glositis con depapilación en parches (3,9%), boca urente (5,3%), lengua saburral (1,6%) y enantema (0,5%). La mayoría refería disgeusia asociada. La cavidad oral se puede alterar por la enfermedad COVID-19, el edema lingual con papilitis lingual transitoria en forma de U o la glositis con depapilación en parches son los signos encontrados con mayor frecuencia, al igual que la sensación de ardor en la cavidad oral o boca urente. Otras manifestaciones orales que se pueden asociar a la COVID-19 son mucositis con o sin aftas o el enantema. Todos pueden ser signos clave para un diagnóstico de esta enfermedad. Coronavirus disease 19 (COVID-19) has many manifestations, including respiratory, thrombotic, neurologic, digestive, and cutaneous ones. Cutaneous manifestations have been classified into 5 clinical patterns: acro-ischemic (pseudo-chilblain), vesicular, urticarial, maculopapular, and livedoid. Oral manifestations have also been reported, but much less frequently. We performed a cross-sectional study in which we examined the oral mucosa of 666 patients with COVID-19 at the IFEMA field hospital in Madrid in April 2020. Seventy-eight patients (11.7%) had changes involving the oral mucosa. The most common were transient anterior U-shaped lingual papillitis (11.5%) accompanied or not by tongue swelling (6.6%), aphthous stomatitis (6.9%), a burning sensation in the mouth (5.3%), mucositis (3.9%), glossitis with patchy depapillation (3.9%), white tongue (1.6%), and enanthema (0.5%). Most of the patients also reported taste disturbances. COVID-19 also manifests in the oral cavity. The most common manifestations are transient U-shaped lingual papillitis, glossitis with patchy depapillation, and burning mouth syndrome. Mucositis with or without aphthous ulcers or enanthema may also be observed. Any these findings may be key clues to a diagnosis of COVID-19.

Como consecuencia de la pandemia por la COVID-19 cesó la actividad dermatológica asistencial, por lo que iniciamos un estudio para evaluar la utilidad de la teledermatología (TD) directa entre paciente y dermatólogo a través de una App. El objetivo fue evaluar el impacto de esta herramienta para evitar consultas presenciales, así como describir los principales diagnósticos y la satisfacción de pacientes y médicos. Estudio descriptivo prospectivo. Se incluyen pacientes nuevos que cumplen criterios de inclusión. Se realizó un análisis descriptivo de todas las variables mediante el programa estadístico SPSS. De los 1.497 pacientes que aceptaron participar el 25% (n = 374) enviaron una consulta virtual con imagen. De entre ellos el 17% (n = 64) fueron dados de alta de forma directa para control por atención primaria. En un 85% (n = 318) de los pacientes se logra evitar la consulta presencial durante al menos 3 meses. Se emitió un diagnóstico en el 87,1% (n = 325) de los pacientes, siendo la confianza en el diagnóstico ≥ 7/10 en el 77,5% (n = 290). La calidad de la imagen fue suficiente en el 52,1%. La satisfacción del paciente fue de 4,5/5. Once de 16 dermatólogos consideraron la TD útil globalmente. La afección más frecuente fue la inflamatoria y melanocítica, siendo los diagnósticos más habituales nevus, acné y eccema. La TD directa asíncrona es una herramienta eficaz para valorar pacientes nuevos, con un alto grado de satisfacción para médicos y pacientes. El desarrollo de un sistema de TD eficiente implica la integración de la imagen digital en los sistemas de información médicos. Dermatologic care was halted because of the coronavirus disease 2019 pandemic, prompting us to study the usefulness of direct-to-patient teledermatology via a mobile application. We aimed to evaluate the service as a tool for avoiding face-to-face consultations, describe the main conditions diagnosed, and assess levels of patient and physician satisfaction. Prospective descriptive study of new patients who met the inclusion criteria. Descriptive statistics for all variables were analyzed with SPSS. Of the 1,497 patients who agreed to participate in the study, 25% (n = 374) sent an image to a consultant dermatologist through the mobile application. Sixty-four patients (17%) were discharged directly and referred to primary care for follow-up. A face-to-face consultation was avoided for at least 3 months in 85% of patients (n = 318); 87.1% (n = 325) received a diagnosis and the dermatologist's level of confidence in this diagnosis was 7 or higher in 77.5% of cases (n = 290). The quality of the images sent was considered sufficient in 52.1% of cases. Patients rated their satisfaction with a score of 4.5 out of 5. Eleven of the 16 dermatologists rated their satisfaction as good overall. The most common conditions were inflammatory and melanocytic lesions. The main diagnoses were nevi, acne, and eczema. Direct-to-patient store-and-forward teledermatology is an effective means of evaluating new patients. Both clinicians and patients expressed high levels of satisfaction with the service. Systems enabling the addition of digital images to patient records are necessary to ensure the efficiency of teledermatology.

Coronavirus disease 19 (COVID-19) has many manifestations, including respiratory, thrombotic, neurologic, digestive, and cutaneous ones. Cutaneous manifestations have been classified into 5 clinical patterns: acro-ischemic (pseudo-chilblain), vesicular, urticarial, maculopapular, and livedoid. Oral manifestations have also been reported, but much less frequently. We performed a cross-sectional study in which we examined the oral mucosa of 666 patients with COVID-19 at the IFEMA field hospital in Madrid in April 2020. Seventy-eight patients (11.7%) had changes involving the oral mucosa. The most common were transient anterior U-shaped lingual papillitis (11.5%) accompanied or not by tongue swelling (6.6%), aphthous stomatitis (6.9%), a burning sensation in the mouth (5.3%), mucositis (3.9%), glossitis with patchy depapillation (3.9%), white tongue (1.6%), and enanthema (0.5%). Most of the patients also reported taste disturbances. COVID-19 also manifests in the oral cavity. The most common manifestations are transient U-shaped lingual papillitis, glossitis with patchy depapillation, and burning mouth syndrome. Mucositis with or without aphthous ulcers or enanthema may also be observed. Any these findings may be key clues to a diagnosis of COVID-19. La enfermedad por coronavirus-19 (COVID-19) se ha relacionado con múltiples síntomas: respiratorios, trombóticos, neurológicos, digestivos o cutáneos. Estos últimos se han clasificado en 5 tipos: lesiones acroisquémicas, lesiones vesiculares, erupción urticarial, exantema maculopapular o lesiones livedoides. Sin embargo, se han descrito mucho menos las alteraciones orales asociadas a COVID-19. Presentamos un estudio transversal realizado durante abril de 2020 en el Hospital de Campaña de IFEMA examinando la mucosa oral de 666 pacientes con COVID-19. En total, 78 pacientes (11.7%) presentaron alteraciones en la mucosa oral. La más frecuente fue papilitis lingual transitoria anterior en forma de U (11.5%) asociada o no a edema lingual (6,6%); estomatitis aftosa (6.9%), mucositis (3.9%) glositis con depapilación en parches (3.9%), boca urente (5.3%), lengua saburral (1,6%) y enantema (0.5%). La mayoría refería disgeusia asociada. La cavidad oral se puede alterar por la enfermedad COVID-19, el edema lingual con papilitis lingual transitoria en forma de U o la glositis con depapilación en parches son los signos encontrados con mayor frecuencia, al igual que la sensación de ardor en la cavidad oral o boca urente. Otras manifestaciones orales que se pueden asociar a COVID-19 son mucositis con o sin aftas o el enantema. Todos pueden ser signos clave para un diagnóstico de esta enfermedad.

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Lipodystrophy syndromes comprise a group of rare, heterogeneous disorders characterized by progressive loss of fat tissue, mainly from subcutaneous compartment and occasionally affecting visceral fat. Lipoatrophy may be partial, localized, or generalized. The latter cases are usually accompanied by metabolic-related disorders, including insulin resistance, diabetes mellitus, hyperlipemia, progressive hepatic disease and anabolic state. Treatment for lipodystrophy has increased interest in recent years because a new lipoatrophic population-patients who have HIV-associated lipodystrophy--is much more numerous than the whole number of patients affected by classic lipodystrophy entities.

To the Editor: In 2006, a new cutaneous reaction associated with heparin use was described in 3 patients, 1 Perrinaud A. Jacobi D. Machet M.C. Grodet C. Gruel Y. Machet L. Bullous hemorrhagic dermatosis occurring at sites distant from subcutaneous injections of heparin: three cases. J Am Acad Dermatol. 2006; 54: S5-S7 Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar consisting of hemorrhagic bullae appearing at sites distant from subcutaneous injections. The cause of this reaction remains unknown and only 7 confirmed cases have been published to date. 1 Perrinaud A. Jacobi D. Machet M.C. Grodet C. Gruel Y. Machet L. Bullous hemorrhagic dermatosis occurring at sites distant from subcutaneous injections of heparin: three cases. J Am Acad Dermatol. 2006; 54: S5-S7 Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar , 2 Beltraminelli H. Itin P. Cerroni L. Intraepidermal bullous hemorrhage during anticoagulation with low-molecular-weight heparin: two cases. Br J Dermatol. 2009; 161: 191-193 Crossref PubMed Scopus (23) Google Scholar , 3 Gonzales U.P. Scott G.A. Briones A.J. Pentland A.P. Remote hemorrhagic bullae occurring in a patient treated with subcutaneous heparin. Arch Dermatol. 2009; 145: 604-605 Crossref PubMed Scopus (23) Google Scholar , 4 Thuillier D. Chaby G. Dadban A. Dermatose bulleuse hémorragique associée à une réaction d'hipersensibilité retardée sous héparine de bas poids moléculaire. Ann Dermatol Venereol. 2009; 136: 705-708 Crossref PubMed Scopus (22) Google Scholar We present 5 new cases and discuss some possible triggering factors.

Currently, screening for anal high-grade squamous intraepithelial lesions (anal HSIL) relies on anal cytology and high-resolution anoscopy. Since this approach has limited sensitivity and specificity for detecting anal HSIL, there is increasing interest in the role of biomarkers for predicting anal HSIL. The aim of this study is to evaluate the diagnostic accuracy of HPV E6/E7-mRNA expression for the detection of anal HSIL in MSM infected with HIV, in comparison to DNA-HR-HPV and anal cytology. This cross-sectional screening study included 101 MSM followed at the HIV-unit of La Paz University Hospital. Intra-anal swabs from patients participating in a screening program including cytology, high-resolution anoscopy and histology were analyzed. HR-HPV-DNA detection was performed by means of the CLART® HPV2 assay (GENOMICA S.A.U., Madrid, Spain). E6/E7-mRNA detection of HR-HPV-types 16, 18, 31, 33, and 45 was performed using the NucliSENS-EasyQ assay (BioMérieux, Marcy ĺEtoile, France). HR-HPV DNA and HPVE6/E7 mRNA were detected in 82% and 57% of the anal smears respectively. Anal cytology screening was abnormal in 70.3%. For the detection of HSIL sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 71.7%, 55.6%, 57.9%, and 69.8% for E6/E7-mRNA testing, respectively, compared to 100%, 31.5%, 55.4%, and 100% for HR-HPV-DNA testing and to 83%, 40.7%, 54.9%, 73.3% of cytology testing. In comparison with the other tests, HPVE6/E7 mRNA testing yielded a lower clinical sensitivity but a higher clinical specificity and PPV for the detection of anal HSIL in MSM infected with HIV.

To describe changes in sexually transmitted infection (STI) diagnoses during the first wave of the COVID-19 pandemic in Spain.We collected demographic, chronological, and clinical data for all patients seen for a possible STI at Hospital La Paz, Centro Sanitario Sandoval, and Centro de Diagnóstico Médico in Madrid and Hospital Costa del Sol in Malaga between March 14, 2020 and June 30, 2020.We identified 674 STI diagnoses. The median age of the patients was 33 years. Most cases were observed among people aged 30 to 40 years and among men who have sex with men. The most common diagnoses were proctitis (36.5%), syphilis (16%), nongonococcal (13.3%) and gonococcal (11.3%) urethritis, genital herpes (8.8%), vulvovaginitis/cervicitis (8.3%), and genital warts (4.2%). A microbiologically confirmed diagnosis was on record for 77% of cases. The main microorganisms identified were Chlamydia trachomatis (35.7%), Neisseria gonorrhoeae (31.4%) and Treponema pallidum (17.2%). The number of STI diagnoses increased after the easing of lockdown restrictions, which resulted in greater freedom of movement and more consultations. On comparing the 2019 and 2020 STI registries from Centro Sanitario Sandoval and Hospital La Paz for the period March to June, we observed reductions (of up to 81%) in all STI diagnoses.Physical distancing and movement restrictions appear to have resulted in a reduction in the incidence of STIs, although these measures did not completely eliminate sexual risk behaviors.

Psoriasis is a chronic disease involving the skin, which significantly impacts the quality of life. Disease severity and treatment efficacy (i.e., response) are assessed through the Psoriasis Area and Severity Index (PASI). A PASI 75 response, i.e., an improvement of at least 75% with respect to the baseline PASI score, has traditionally been used as a therapeutic benchmark in clinical trials. Therapeutic advances have made PASI 90 or PASI 100 responses possible in most patients treated with some biologics. A greater response may generate social value beyond clinical outcomes that would benefit both patients and society.A 1-year economic model was applied to estimate the impact of having a PASI 75, PASI 90, or PASI 100 response in four areas of analysis (quality of life, activities of daily living, work productivity, and out-of-pocket expenditures) and the social value of having a PASI 90 or PASI 100 response in comparison with a PASI 75 response. A mixed-methods approach based on the scientific literature, a focus group with patient, and an advisory committee with psoriasis stakeholders was used. The model included three different scenarios: having a PASI 90 vs a PASI 75 response; a PASI 100 vs a PASI 90 response; and a PASI 100 vs a PASI 75 response. A sensitivity analysis was included.The annual economic impact per patient with moderate-to-severe plaque psoriasis having a PASI 75 response was estimated at Ł 6,139, mainly related to labour productivity losses and quality of life reductions. Having a PASI 90 or a PASI 100 response would reduce this impact to €3,956 or €1,353, respectively. Accordingly, the social value of having a PASI 90 instead of a PASI 75 response was estimated at €2,183, and €4,786 with a PASI 100 response.A PASI 90 or PASI 100 response would have a lower economic impact and a greater social value than a PASI 75 response for patients with moderate-to-severe plaque psoriasis.

In Brief Malignant syphilis is a rare ulcerative variety. In the classical description of the disease, the absence of spirochetes in tissue samples was considered as a diagnostic criterion. We report 3 cases of malignant syphilis; in all of them, spirochetes were identified in cutaneous biopsy samples using immunohistochemical staining. We report 3 cases of malignant syphilis. Immunohistochemical staining was used to demonstrate spirochetes in biopsy samples.

Chagas disease is a parasitosis endemic to South America. It is normally treated with benznidazole as first choice, which has been associated with numerous cutaneous reactions. However, very few benznidazole-associated severe cutaneous adverse reactions have been reported to date. The rise of Chagas disease in nonendemic countries represents a growing public health challenge. We report two patients who met the criteria for drug reaction with eosinophilia and systemic symptoms syndrome and Stevens-Johnson syndrome/toxic epidermal necrolysis according to the RegiSCAR scoring systems. They were thus deemed overlapping cases, with a lymphocyte transformation test positive for benznidazole. Both required intensive care unit admission and both survived. Considering the rising application of this drug for trypanosomiasis in immigrant populations, clinicians should be aware of this newly reported, potentially life-threatening risk.

Multi-criteria decision analysis (MCDA) is a tool that systematically considers multiple factors relevant to health decision-making. The aim of this study was to use an MCDA to assess the value of dupilumab for severe atopic dermatitis compared with secukinumab for moderate to severe plaque psoriasis in Spain. Following the EVIDEM (Evidence and Value: Impact on DEcision Making) methodology, the estimated value of both interventions was obtained by means of an additive linear model that combined the individual weighting (between 1 and 5) of each criterion with the individual scoring of each intervention in each criterion. Dupilumab was evaluated against placebo, while secukinumab was evaluated against placebo, etanercept and ustekinumab. A retest was performed to assess the reproducibility of weights, scores and value estimates. The overall MCDA value estimate for dupilumab versus placebo was 0.51 ± 0.14. This value was higher than those obtained for secukinumab: 0.48 ± 0.15 versus placebo, 0.45 ± 0.15 versus etanercept and 0.39 ± 0.18 versus ustekinumab. The highest-value contribution was reported by the patients’ group, followed by the clinical professionals and the decision makers. A fundamental element that explained the difference in the scoring between pathologies was the availability of therapeutic alternatives. The retest confirmed the consistency and replicability of the analysis. Under this methodology, and assuming similar economic costs per patient for both treatments, the results indicated that the overall value estimated of dupilumab for severe atopic dermatitis was similar to, or slightly higher than, that of secukinumab for moderate to severe plaque psoriasis.

Dermatologic TherapyVolume 32, Issue 3 e12800 Review ArticleOpen Access Treatment of actinic keratosis through inhibition of cyclooxygenase-2: Potential mechanism of action of diclofenac sodium 3% in hyaluronic acid 2.5% Gareth J. Thomas, Gareth J. Thomas Cancer Sciences Unit, University of Southampton, Southampton, United KingdomSearch for more papers by this authorPedro Herranz, Pedro Herranz Department of Dermatology, La Paz University Hospital, Madrid, SpainSearch for more papers by this authorSusana Balta Cruz, Susana Balta Cruz Almirall SA, Barcelona, SpainSearch for more papers by this authorAurora Parodi, Corresponding Author Aurora Parodi aurora.parodi@unige.it DISSAL Section of Dermatology, University of Genoa-IRCCS, AOU San Martino-IST, Genoa, Italy Correspondence Aurora Parodi, DISSAL Section of Dermatology, University of Genoa-IRCCS, AOU San Martino-IST, Largo R Benzi 10, 16132 Genoa, Italy. Email: aurora.parodi@unige.itSearch for more papers by this author Gareth J. Thomas, Gareth J. Thomas Cancer Sciences Unit, University of Southampton, Southampton, United KingdomSearch for more papers by this authorPedro Herranz, Pedro Herranz Department of Dermatology, La Paz University Hospital, Madrid, SpainSearch for more papers by this authorSusana Balta Cruz, Susana Balta Cruz Almirall SA, Barcelona, SpainSearch for more papers by this authorAurora Parodi, Corresponding Author Aurora Parodi aurora.parodi@unige.it DISSAL Section of Dermatology, University of Genoa-IRCCS, AOU San Martino-IST, Genoa, Italy Correspondence Aurora Parodi, DISSAL Section of Dermatology, University of Genoa-IRCCS, AOU San Martino-IST, Largo R Benzi 10, 16132 Genoa, Italy. Email: aurora.parodi@unige.itSearch for more papers by this author First published: 06 December 2018 https://doi.org/10.1111/dth.12800Citations: 13 Funding information: Almirall S.A. The copyright line for this article was changed on 20 July 2019 after original online publication. AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract Cyclooxygenase-2 (COX-2) and its metabolic product prostaglandin E2 (PGE2) are induced in response to growth factors, inflammatory cytokines, tumor promoters, activated oncogenes, and, in the skin, ultraviolet (UV) radiation. Accumulating evidence suggests a role for the COX-2/PGE2 pathway in tumorigenesis in various tissue types including cutaneous squamous cell carcinoma. There is also strong evidence for a role in the development of actinic keratoses (AKs) — common dysplastic lesions of the skin associated with UV radiation overexposure — considered as part of a continuum with skin cancer. Non-steroidal anti-inflammatory drugs (NSAIDs) exert their anti-inflammatory, analgesic, and antipyretic effects by reversibly or irreversibly acetylating COX isoforms, inhibiting downstream prostaglandins, and may have a chemopreventive role in malignancies, including skin cancer. Topical treatment of AK lesions with the NSAID diclofenac sodium 3% in combination with hyaluronic acid 2.5% has been shown to be effective and well tolerated, although the mechanism of action remains to be elucidated. 1 INTRODUCTION Cyclooxygenase (COX) exists as two isoforms (COX-1 and COX-2) that mediate the conversion of arachidonic acid into the precursor molecule prostaglandin (PG) H2 (PGH2; Figure 1) (Williams & Buvanendran, 2011; Zhan & Zheng, 2007). COX-1 is expressed constitutively throughout the body, whereas COX-2 is generally undetectable until it is induced in response to growth factors, inflammatory cytokines, tumor promoters, activated oncogenes, and, in the skin, ultraviolet (UV) light (Williams & Buvanendran, 2011; Zhan & Zheng, 2007). PGH2 is converted by different synthases to prostacyclin, PGD2, PGE2, PGF2α, and thromboxane A2, which sustain homeostatic functions and also mediate various pathogenic mechanisms (Fitzpatrick, 2004; Menter, Schilsky, & DuBois, 2010). Of note, PGE2 is closely associated with inflammation and carcinogenesis as a result of the activity of various cytosolic and membrane-bound PGE synthases (PGES); in particular, membrane-bound PGES-1 drives increased levels of PGE2 during inflammation and tumorigenesis (Menter et al., 2010). Deregulation of the COX-2/PGE2 pathway impacts all hallmarks of cancer, with pleiotropic effects on cell growth and survival (Greenhough et al., 2009), making inhibition of this pathway an attractive prospect for cancer therapy. Here, the present authors review the evidence for a chemopreventative role of non-steroidal anti-inflammatory drugs (NSAIDs) through inhibition of the COX-2/PGE2 pathway. In particular, the present authors discuss the evidence for a chemopreventative role of NSAIDS in the continuum of skin cancer from actinic keratosis (AK) to squamous cell carcinoma (SCC). The evidence presented may inform treatment strategies and highlights future areas of research to improve our understanding of the underlying mechanistic pathways. Figure 1Open in figure viewerPowerPoint The cyclooxygenase (COX) pathway and prostaglandin E2 (PGE2) signaling. 15-PGDH, 15-hydroxyprostaglandin dehydrogenase; AA, arachidonic acid; AC, adenylate cyclase; Ca2+, calcium; cAMP, cyclic adenosine monophosphate; cPGES, cytosolic PGE2 synthase; COX-1, cyclooxygenase 1; COX-2, cyclooxygenase 2; EP1, EP2, EP3 and EP4, PGE2 receptor-1, -2, -3, and -4; G1, G4 and G5, G-protein receptor-1, -4, and -5; mPGES 1 & 2, microsomal prostaglandin E synthase-1 and -2; NSAIDs, non-steroidal anti-inflammatory drugs; PGD2, prostaglandin D2; PGE2, prostaglandin E2; PGES, prostaglandin E synthase; PGF2α, prostaglandin F2α; PGH2, prostaglandin H2 2 NSAIDs AS CHEMOPREVENTIVE AGENTS NSAIDs are a structurally diverse drug class that have anti-inflammatory, analgesic and antipyretic properties (Williams & Buvanendran, 2011). NSAIDs exert their effects via reversible or irreversible acetylation of COX, which inhibits production of PGs from arachidonic acid. Initial evidence from pharmaco-epidemiological studies supported an association between the regular use of NSAIDs that non-selectively block COX (mainly aspirin) and reductions in the risk of some cancers (Harris, Beebe-Donk, Doss, & Burr Doss, 2005). These NSAID-related reductions in relative risk were observed in the colon, breast, lung, and prostate cancer and were of the magnitude of 36–63% (Harris et al., 2005). However, a more recent appraisal of the biomedical literature highlighted conflicting reports regarding the potential beneficial effects of regular NSAID intake on reduced risk of malignant melanoma (Goodman & Grossman, 2014). Aspirin (acetylsalicylic acid) exerts its anti-inflammatory, analgesic, and antipyretic effects via irreversible acetylation and inactivation of both COX-1 and COX-2 isoforms, making it a unique form of NSAID drug (Alfonso, Ai, Spitale, & Bhat, 2014). Regular use of aspirin in individuals without prior cardiovascular disease is not recommended for the primary prevention of vascular or non-vascular outcomes, based on nonsignificant reductions in the risk of death from cardiovascular disease or cancer mortality (odds ratio [OR] = 0.99 [95% confidence interval (CI), 0.85–1.15] and OR = 0.93 [95% CI 0.84–1.03], respectively) and concerns over an increased risk of non-trivial bleeding events (OR = 1.31 [95% CI 1.14–1.50]) (Seshasai et al., 2012). In patients diagnosed with colorectal cancer (CRC), several studies have demonstrated an association between the regular use of aspirin and improvements in CRC-specific and overall survival (Bastiaannet et al., 2012; Chan, Ogino, & Fuchs, 2009; McCowan, Munro, Donnan, & Steele, 2013; Reimers et al., 2012). Findings from a prospective study of individuals with a diagnosis of CRC (n = 1,279; median follow-up, 11.8 years) showed that regular aspirin users had a lower risk of CRC-specific and overall mortality versus aspirin nonusers (multivariate hazard ratio [HR] = 0.71 [95% CI 0.53–0.95] and multivariate HR = 0.79 [95% CI 0.65–0.97], respectively) (Chan et al., 2009). Moreover, the effect of aspirin on risk of CRC-specific mortality was even greater among new aspirin users (i.e., those who had not taken aspirin regularly before CRC diagnosis; n = 719) compared with nonusers (multivariate HR = 0.53 [95% CI 0.33–0.86]). In a subgroup of individuals with primary tumors that over-expressed COX-2 (n = 314), regular aspirin use post-diagnosis was associated with a lower risk of CRC-specific mortality than in aspirin nonusers (multivariate HR = 0.39 [95% CI 0.20–0.76]). In contrast, no such benefit was observed among those with primary tumors featuring weak or absent COX-2 expression (n = 145) (multivariate HR = 1.22 [95% CI 0.36–4.18]) (Chan et al., 2009). Besides aspirin, other traditional NSAIDs and selective COX-2 inhibitors are also prescribed to patients at a high risk of developing CRC (Cuzick et al., 2009). However, unlike low-dose aspirin, neither traditional NSAIDs nor COX-2 inhibitors have cardioprotective effects. In the development of skin cancer, there has been conflicting evidence regarding the chemopreventive role of NSAIDs (Asgari, Chren, Warton, Friedman, & White, 2010; Elmets, Ledet, & Athar, 2014; Muranushi, Olsen, Pandeya, & Green, 2015; Zhang, Liang, Ye, & Wang, 2014). A case-control study of 415 patients (43–85 years of age) diagnosed with SCC in the Kaiser Permanente Northern California population matched on age, gender, and race with 415 control subjects found no associations between the use of aspirin or other NSAIDs (self-reported regular use or pharmacy data) and SCC risk (Asgari et al., 2010). A subsequent meta-analysis of data from eight studies (seven observational studies and one randomized controlled trial) investigating the effects of NSAIDs on nonmelanoma skin cancers (NMSCs) found no significant differences between users and nonusers of NSAIDs in their risk of developing SCC (relative risk [RR] = 0.86 [95% CI 0.73–1.02], p = .085) or basal cell carcinoma (BCC) (RR = 0.94 [95% CI 0.85–1.04], p = .266) (Zhang et al., 2014). In contrast, evidence from several preclinical, epidemiological, and translational studies has suggested that COX-2 inhibitors could have potential in preventing NMSC development (Elmets et al., 2014). Additionally, a systematic literature review identified nine epidemiological studies with sufficiently robust data to be included in a meta-analysis evaluating the effects of aspirin and other NSAIDs in reducing the risk of cutaneous SCC (Muranushi et al., 2015). Users of any NSAIDs and nonaspirin NSAIDs had significantly reduced risks of developing cutaneous SCC (RR = 0.82 [95% CI 0.71–0.94] and RR = 0.85 [95% CI 0.78–0.94], respectively). Individuals with ever-use of aspirin showed a trend toward a slightly reduced risk of developing cutaneous SCC versus nonusers, although this was not statistically significant (RR = 0.88 [95% CI 0.75–1.03]). The authors concluded that not only do NSAIDs reduce the risk of developing cutaneous SCC but also that these NSAID effects (any aspirin/nonaspirin use) are more pronounced among people who have a high prevalence of AK or a history of keratinocyte cancers (RR = 0.70 [95% CI 0.57–0.86]) compared with the general population (RR = 0.91 [95% CI 0.78–1.05]), although statistical significance was lacking. Of note, the conclusions of this SCC-specific meta-analysis were based on a more comprehensive dataset compared to that of Zhang et al. (2014). 3 ACTINIC KERATOSIS AND SCC AK is a common dysplastic lesion of keratinocytes that is seen in around one in seven patients who consult a dermatologist (Kirby, Scharnitz, Seiverling, Ahrns, & Ferguson, 2015). AK develops almost exclusively as a consequence of overexposure to environmental UV radiation; lesions occur more frequently among fair-skinned individuals and are more common among Caucasian individuals (≥40 years of age) in Australia than in the United States and Europe (up to 60% vs. up to 26%, respectively) (Dodds, Chia, & Shumack, 2014; Ulrich, Pellacani, Ferrandiz, & Lear, 2014). Although some AK lesions will regress or remain stable, with focal epidermal dysplasia, hyperkeratosis, and vascular ectasia, other AK lesions will become malignant and can progress to SCC in situ or to invasive SCC (Arciniegas et al., 2015; Dodds et al., 2014). The estimated 10-year risk of AK lesion progression ranges from 1 to 10%; however, it has been reported that in individuals with multiple AK lesions the annual risk of developing invasive cutaneous SCC ranges between 0.15 and 80% (Dodds et al., 2014). Given the risk of progression, AK can be considered as part of a continuum between photo-damaged skin and invasive SCC. Of note, the global burden of disease attributable to UV radiation in people with AK was estimated to be 8,000 disability-adjusted life years (DALYs); however, SCC was associated with a much higher disease burden (59,000–83,000 DALYs) (Lucas, McMichael, Armstrong, & Smith, 2008). 4 ROLE OF COX-2 AND SCC TUMORIGENESIS COX-2 expression and PG production are induced following skin exposure to UV radiation (Zhan & Zheng, 2007). These events play a key role in inflammatory processes in the skin that are believed to be associated with progression from AK to SCC (Campione et al., 2015). Several studies in murine models have demonstrated the importance of COX-1, COX-2, PGE2, and PGE2 receptors for skin tumor development and growth (Fischer, Pavone, Mikulec, Langenbach, & Rundhaug, 2007; Morita, 2002; Simper et al., 2014; Sung, He, Hwang, & Fischer, 2006; Tiano et al., 2002; Tober et al., 2006; Zelenay et al., 2015). Targeted disruptions of the genes encoding either COX-1 or COX-2 led to altered epidermal keratinocyte differentiation and reduced skin tumorigenesis in a multistage mouse skin model (Tiano et al., 2002). An association between COX-2 inhibition and chemopreventive activity against both chemical- and UV-induced skin cancer has been reported, based on observations in transgenic mice with COX-2 overexpression that were found to be sensitized to skin carcinogenesis, whereas those with COX-2 deficiency had markedly lower tumor numbers (Zhan & Zheng, 2007). Further evidence for the importance of COX-2 in the development and progression of human skin carcinomas comes from immunohistochemical studies (Buckman et al., 1998; Kuźbicki, Lange, Stanek-Widera, & Chwirot, 2011). COX-2 expression was measured in epithelial tissues from AK, SCC, and BCC biopsies taken from volunteers 24 hours after they were exposed to different doses of UV light and compared with normal non-sun-exposed control skin biopsy samples (Buckman et al., 1998). Prominent COX-2 immunostaining was observed in SCC and AK biopsies, whereas minimal and less intense staining was identified in BCC and normal skin biopsies, respectively. Western blot analysis confirmed increased expression of COX-2 in SCC samples compared with controls (Buckman et al., 1998). In contrast, a similar COX-2 immunostaining pattern was seen when normal skin and benign epithelial lesions were compared (Kuźbicki et al., 2011). However, in comparison to BCCs where expression of COX-2 was lower than that of normal skin, significantly increased expression of COX-2 was detected in precancerous lesions, including AK, and in SCCs (Kuźbicki et al., 2011). In the skin of a subset of individuals, the response to UV radiation 24 hours post-exposure, assessed by the maximal intensity of patients' erythema response and corresponding cellular proliferation, measured by immunohistochemical staining for proliferating cell nuclear antigen, was suppressed by pretreatment with a selective COX-2 inhibitor (Rodriguez-Burford et al., 2005). This effect was not found in patients receiving placebo and was independent of skin type, age, sex, or serum levels of the COX-2 inhibitor. The difference in erythema response could potentially be extrapolated to patients' susceptibility to skin cancer and highlights the importance of identifying the subset of patients who are likely to benefit from treatment with COX-2 inhibitors (Rodriguez-Burford et al., 2005). 5 DICLOFENAC SODIUM 3% IN HYALURONIC ACID 2.5% FOR THE TREATMENT OF AK Diclofenac is an established NSAID belonging to the phenylacetic acid class that has been widely used as an anti-inflammatory analgesic since its introduction in 1973 (Altman, Bosch, Brune, Patrignani, & Young, 2015). Diclofenac sodium 3%, in combination with hyaluronic acid 2.5% (diclofenac 3%/HA 2.5%; Solaraze®, Almirall Ltd., Uxbridge, UK), is the only NSAID approved in the United States and Europe for the topical treatment of AK lesions. In an early phase II, open-label study in 29 patients with AK, among 27 patients reevaluated 30 days after treatment was discontinued, 22 (81%) showed a complete response, and a marked clinical improvement was shown in 4 (15%) patients (Rivers & McLean, 1997). The treatment was well tolerated, with adverse events relating to skin irritation at the treatment site reported in seven patients (24%) (Rivers & McLean, 1997). Results of two subsequent double-blind placebo-controlled phase III trials confirmed that treatment was generally well tolerated and effective (Rivers et al., 2002; Wolf Jr, Taylor, Tschen, & Kang, 2001). A significantly greater proportion of patients receiving diclofenac 3%/HA 2.5% gel had target lesion number scores and cumulative lesion number scores of zero compared with placebo after 60 (Rivers et al., 2002) and 90 (Wolf Jr et al., 2001) days of treatment. Investigator and patient global improvement indices (IGII and PGII, respectively) were also significantly better in those on active treatment versus placebo (Rivers et al., 2002; Wolf Jr et al., 2001). At follow-up, 30 days after treatment cessation, the proportion of patients rated as completely improved (IGII or PGII score of 4) on active treatment versus placebo was 47% versus 19% for IGII and 41% versus 17% for PGII (p < .001 for both) (Wolf Jr et al., 2001). A similar incidence of adverse events was reported in both groups (Rivers et al., 2002; Wolf Jr et al., 2001). Beyond evidence from phase III clinical studies, there is a substantially broader evidence base that supports the use of diclofenac 3%/HA 2.5% in this setting (Martin & Stockfleth, 2012). A systematic literature review published in 2012 identified 18 clinical studies (comprising a mixture of blinded and open-label study designs and case series in a total of 1,779 patients) investigating the role of diclofenac 3%/HA 2.5% at various body sites (Martin & Stockfleth, 2012). In most studies, the duration of diclofenac 3%/HA 2.5% treatment was 3–6 months; evaluated outcome measures included reductions in number of target/cumulative lesions, reduction in lesion size, and complete clinical/histological clearance. Diclofenac 3%/HA 2.5% demonstrated efficacy at difficult-to-treat and sensitive body locations such as the lips and the periocular region and was also efficacious in immunosuppressed patients (Ulrich et al., 2014). In comparative studies, diclofenac 3%/HA 2.5% had similar efficacy to and a better safety profile than the active comparator, 5-fluorouracil 5% cream (Segatto, Dornelles, Silveira, & Frantz Gde, 2013; Smith, Morhenn, & Piacquadio, 2006), and a similar efficacy and tolerability profile to imiquimod 5% cream (Akarsu, Aktan, Atahan, Koç, & Özkan, 2011; Kose, Koc, Erbil, Caliskan, & Kurumlu, 2008). Dermatologists and General Practitioners should advise all patients with AK to protect themselves from sunlight and regularly use a high sun protection factor (≥50) broad-spectrum sunscreen (Dirschka et al., 2017). In the trials evaluating the efficacy of diclofenac in AK, subjects were advised to concomitantly also use sunscreens and to avoid excessive exposure to the sun (Rivers et al., 2002; Wolf Jr et al., 2001). Topical diclofenac alone and concomitant use of sunscreens has been shown not to induce photosensitivity or phototoxicity (Ortonne, Queille-Roussel, & Duteil, 2006), but patients should be cautioned to avoid sun exposure. Ulrich et al. reviewed the available evidence on topical diclofenac 3%/HA 2.5% as a field cancerisation treatment in patients with AK and evaluated its suitability as a candidate treatment, based on a set of proposed criteria, namely: (1) mechanism of action compatible with effect on early stages of field cancerisation; (2) immediate efficacy on visible expression of field cancerisation; (3) applicability to large treatment area with little systemic absorption; (4) tolerability profile compatible with long-term use; (5) action not limited to visible AK; (6) activity beyond the short term; (7) no increased risk of organ rejection or impairing transplant function ability in transplant patients; and (8) relevant long-term (>5 to 10 years) outcomes (clears multiple AK over large areas and/or prevents evolution of invasive SCC), based on randomized controlled trial(s) (Ulrich et al., 2014). Diclofenac 3%/HA 2.5% fulfilled most of the authors' proposed criteria for a candidate treatment, and a rapid therapeutic effect was observed across a range of anatomical sites (including the scalp, face, arms, and lips; affected areas ≤50 cm2). 6 MECHANISM OF ACTION OF DICLOFENAC SODIUM 3% IN HYALURONIC ACID 2.5% The precise mechanism of action of topical diclofenac 3%/HA 2.5% in the treatment of AK has not been fully elucidated but research to-date suggests that it is likely to be related to inhibition of the COX pathway resulting in reduced PGE2 synthesis (Almirall, 2018; Maltusch, Röwert-Huber, Matthies, Lange-Asschenfeldt, & Stockfleth, 2011). In a prospective study of 20 male patients with at least three typical, clinically visible, histologically confirmed AK lesions in a 50 cm2 area on the forehead, face, or scalp, 3 months' treatment with diclofenac 3%/HA 2.5% led to a 78% reduction overall in the number of AK lesions (from 165 to 36 after 3 months), with AK reductions observed continuously over the study period in each patient (Maltusch et al., 2011). The mechanisms of action underlying the observed effects of diclofenac 3%/HA 2.5% reported in this study were investigated via histological and immunohistochemical analysis of skin biopsies. Treatment with diclofenac 3%/HA 2.5% led to a significant reduction in the expression of the inflammatory markers COX-2 (epidermis), CD3, and CD8 compared with pretreatment levels (p = .006, .005, and .013, respectively). Furthermore, posttreatment expression of markers of apoptosis and/or cell cycle arrest (p53 and p21) were significantly reduced compared with healthy skin (p53 [p = .011]) and versus pretreatment levels (p21 [p = .003]). Posttreatment expression of CD31, a marker of angiogenesis, was also significantly lower compared with pretreatment levels (p = .015). A similar but statistically nonsignificant trend was observed for the proliferation marker Ki67. The authors concluded that diclofenac 3%/HA 2.5%-related clinical improvements in AK are driven primarily by its anti-inflammatory and anti-angiogenic effects but that effects on proliferation and apoptosis also contribute. Other research groups have confirmed the anti-angiogenic effects of diclofenac 3%/HA 2.5% and have found effects on apoptotic activity (Eberle et al., 2007; Fecker et al., 2010; Kaur & Sanyal, 2011; Rodust, Fecker, Stockfleth, & Eberle, 2012). These apoptotic effects appear to be exerted in SCC cell lines via activation of the mitochondrial/intrinsic apoptosis pathways and the extrinsic death ligand-mediated apoptosis pathway (Eberle et al., 2007; Fecker et al., 2010; Rodust et al., 2012). Another COX inhibitor that has been used for the treatment of AK is piroxicam, an enolic benzothiazine and potent member of the oxicam series, which has been demonstrated to exert a significant antitumorigenic effect (Babino et al., 2016; Campione et al., 2015; Puviani et al., 2017). Piroxicam is a nonspecific COX-1 and COX-2 inhibitor, with higher inhibitory activity (10-fold) for COX-1 (Meade, Smith, & DeWitt, 1993), which inhibits the early stages of skin carcinogenesis. The mechanism of action of piroxicam includes the downregulation of prostaglandins and tromboxanes, and the inhibition of polyamine production by the blockade of ornithine decarboxylase induction, which is involved in nonmelanoma skin carcinogenesis. In addition, piroxicam is able to induce tumor cell apoptosis and suppresses metalloproteinase 2 activities (Campione et al., 2015). Diclofenac also appears to have multiple mechanisms of action besides its established inhibition of COX (Gan, 2010). Several putative effects have been described such as inhibition of synthesis of leukotrienes and phospholipase A2, modulation of free arachidonic acid levels, stimulation of peripheral nitric oxide cyclic guanosine monophosphate-potassium channel pathways, and centrally mediated and neuropathic effects (elevated plasma β-endorphin levels and N-methyl-D-aspartate pathway inhibition). Emerging mechanisms of action include inhibition of peroxisome proliferator activated receptor-γ, reduction of levels of inflammatory mediators (e.g., substance P and interleukin-6 in the plasma and synovial fluid), inhibition of the thromboxane-prostanoid receptor, and inhibition of acid-sensing ion channels (Gan, 2010). Although established mechanisms are well supported by clinical data, further research is needed to validate the proposed putative and emerging mechanisms of action. Further insights into how diclofenac 3%/HA 2.5% exerts its anti-AK effects were generated by an open-label, multicenter, phase IV trial (NCT00204542) in 65 Caucasian patients (51–81 years of age) with face or scalp AK lesions randomized to 3 or 6 months' treatment (Dirschka, Bierhoff, Pflugfelder, & Garbe, 2010). Following 3 months' treatment, 16.9% of patients (n = 11) achieved complete clinical resolution and 23.1% (n = 15) achieved full histological resolution. Furthermore, posttreatment AK grades appeared to be significantly improved versus pretreatment gradings, based on the AK grade I–III classification scheme (Röwert-Huber et al., 2007). In addition, a significantly lower number of mitoses per high-power field were counted posttreatment (p < .001 vs. pretreatment); semiquantitatively evaluated inflammatory infiltrate levels were also significantly lower posttreatment (p = .005 vs. pretreatment). Semiquantitative evaluation of biopsy specimens using immunohistochemical staining identified significant posttreatment reductions in expression of the anti-p53-antibody (directed against the p53 tumor suppressor gene [p = .009 vs. pretreatment]) and the anti-MiB-1 antibody (directed against the proliferation marker Ki-67 [p = .021 vs. pretreatment]). The authors concluded that diclofenac 3%/HA 2.5% gel induces regression of signs of cancerous transformation in AK (Röwert-Huber et al., 2007). 7 CONCLUSIONS In summary, AK is a common dysplastic lesion of keratinocytes that is associated with exposure to UV radiation and has the potential to transform to invasive SCC. As discussed, COX-2, the main COX isoform in human skin, and its principal metabolic product PGE2 are induced in response to UV radiation and have been implicated in the processes involved in the development of AK and SCC, in addition to tumorigenesis in various other tissue types. Evidence from epidemiological, preclinical, and translational studies in skin cancer reviewed herein suggests that the inhibition of COX-2 and PGE2 production with NSAIDs may have antitumor effects. In particular, in patients with existing AK lesions, topical treatment with diclofenac 3%/HA 2.5% is effective, causing regression of signs of cancerous transformation, and well tolerated, with most adverse events relating to skin irritation. Although the exact mechanism of action remains to be elucidated, there is evidence to suggest that the effects of diclofenac 3%/HA 2.5% are mediated via inflammation, angiogenesis, and apoptosis pathways. The evidence presented may inform treatment strategies and highlights future areas of research to improve our understanding of the underlying mechanistic pathways. ACKNOWLEDGMENT Medical writing support, under the direction of the authors, was provided by Stephen Paterson, PhD, on behalf of CMC CONNECT, a division of Complete Medical Communications Ltd, Glasgow, UK, funded by Almirall S.A., Barcelona, Spain, in accordance with Good Publication Practice (GPP3) guidelines. The authors would like to acknowledge the contribution of David Vilardell, who was an employee of Almirall S.A., Barcelona, Spain, at the time the manuscript was initiated. CONFLICT OF INTEREST Gareth J Thomas — advisor/speaker for Almirall S.A., Bristol-Myers Squibb, GSK and MSD; Pedro Herranz — consultant/speaker for AbbVie, Celgene, Galderma, Janssen, Novartis and Pfizer Inc; Susana Balta Cruz — employee of Almirall S.A.; and Aurora Parodi — clinical studies and congress presentations for Almirall S.A., Amgen, Celgene, Galderma, Janssen-Cilag, Leo Pharma, MSD, Novartis, Pfizer Inc and UCB. REFERENCES Akarsu, S., Aktan, S., Atahan, A., Koç, P., & Özkan, S. (2011). Comparison of topical 3% diclofenac sodium gel and 5% imiquimod cream for the treatment of actinic keratoses. Clinical and Experimental Dermatology, 36, 479– 484. Alfonso, L., Ai, G., Spitale, R. C., & Bhat, G. J. (2014). Molecular targets of aspirin and cancer prevention. British Journa

Multi-criteria decision analysis (MCDA) was proposed to surmount arbitrary clinical decisions in the field of biological therapies for psoriatic patients. At the same time, MCDA may further highlight the potential of bimekizumab for the treatment of moderate-to-severe psoriasis, compared to placebo, adalimumab, ustekinumab, secukinumab, and even ixekizumab and risankizumab.The EVIDEM framework was adapted to reflect relevant criteria for the assessment. Estimated values were obtained by means of an additive linear model combining weights and scores assigned by a multidisciplinary committee of 12 experts. Consistency and replicability were evaluated through an alternative weighting method and a re-test.Bimekizumab was assessed by the committee as an intervention with a positive value contribution for the treatment of moderate-to-severe psoriasis in comparison to any of the alternatives. The drug provides a substantial therapeutical benefits and improves the health results reported by the patients, as it combines a higher level of clearance, rapidity, and persistence with a similar safety and tolerability profile.Under a methodology with increasing use in the health field, bimekizumab was evaluated as a drug with a high added value for the treatment of moderate-to-severe psoriasis when compared to six different alternatives.

Atopic dermatitis (AD) is a chronic, inflammatory skin disease characterized by itchy, painful, and dry skin. Despite the great number of available therapies, economic evaluations are still needed to provide evidence on their cost efficiency. This research aimed to evaluate the cost effectiveness of the Janus kinase (JAK) inhibitor abrocitinib (200 mg) compared with dupilumab (300 mg), tralokinumab (300 mg), baricitinib (2 and 4 mg), and upadacitinib (15 and 30 mg) for the treatment of patients with severe AD from the Spanish National Health System (NHS) perspective.A hybrid model consisting of a decision tree linked to a Markov model was developed to estimate costs, quality-adjusted life-years (QALYs), total years in response and incremental cost-per-QALY gained (willingness-to-pay [WTP] threshold: €25,000/QALY). Adults with severe AD entered the decision tree and response (75% reduction in baseline Eczema Area and Severity Index score, EASI-75) was considered at 16 and 52 weeks. After this time, patients entered the Markov model (remainder of the 10-year time horizon), which consisted of three health states: maintenance with active therapy, subsequent treatment, or death. All costs were presented in 2022 euros (€). Additionally, cost per number-needed-to-treat (NNT) was calculated for abrocitinib and dupilumab based on a head-to-head post-hoc analysis.Abrocitinib 200 mg was dominant (i.e., lower incremental costs and higher incremental benefit) compared with all studied alternatives (dupilumab 300 mg, tralokinumab 300 mg, baricitinib 2 and 4 mg, upadacitinib 15 and 30 mg) with a QALYs gain of 0.49, 0.60, 0.64, 0.43, 0.45, and 0.08, respectively, and per-person costs savings of €22,097, €24,140, €14,825, €7,116, €12,805, and €45,189, respectively. Considering the WTP threshold, abrocitinib was dominant or cost effective compared with all alternatives for most simulations. Additionally, abrocitinib was dominant compared with all alternatives when evaluating the cost effectiveness over a 5-year time horizon. NNT showed that abrocitinib was dominant versus dupilumab.The results of the study show that abrocitinib is a cost-effective therapy compared with other JAK inhibitors and biological therapies from the Spanish NHS perspective.

Skin infections caused by dermatophytes are one of the most frequent dermatological complications in patients with acquired immunodeficiency syndrome (AIDS) resulting from infection with human immunodeficiency virus (HIV). Tinea unguium associated with AIDS is characterized by being clinically more aggressive and therapeutically more difficult to treat than in the general population. Terbinafine is considered to be a first-choice option for the treatment of dermatophyte onychomycosis in immunocompetent individuals. This drug has been used in a series of 21 HIV-positive patients diagnosed with tinea unguium for 1 year in the University Hospital La Paz, Madrid. All patients underwent a subsequent clinical follow-up for 6 months. The results showed a high percentage of clinical and mycological cures, as well as maintenance of the response after follow-up; no drug interactions or significant adverse effects related to the drug under study were recorded.

Pachyonychia congenita (PC) is a rare genodermatosis caused by a mutation in keratin genes, which can lead to hypertrophic nail dystrophy and focal palmoplantar keratoderma (predominantly plantar), amongst other manifestations. Painful blisters and callosities, sometimes exacerbated by hyperhidrosis, are major issues that can have a significant impact on patient quality of life. Many alternative treatments for this condition have been applied with variable and partial clinical response, but a definitive cure for this disease has yet to be discovered. After obtaining informed consent, two patients with genetically confirmed PC type 1 were treated with plantar injections of botulinum toxin type A. Both patients showed a marked improvement in pain and blistering with an average response time of one week, a six-month mean duration of effectiveness, and a lack of any side effects or tachyphylaxis.

Journal Article Successful treatment of refractory pruritic Fox–Fordyce disease with botulinum toxin type A Get access J. González‐Ramos, J. González‐Ramos Department of Dermatology La Paz University Hospital Paseo La Castellana 261 Madrid CP: 28046 Spain Search for other works by this author on: Oxford Academic Google Scholar M.L. Alonso‐Pacheco, M.L. Alonso‐Pacheco Department of Dermatology La Paz University Hospital Paseo La Castellana 261 Madrid CP: 28046 Spain Search for other works by this author on: Oxford Academic Google Scholar B. Goiburú‐Chenú, B. Goiburú‐Chenú Department of Dermatopathology La Paz University Hospital Paseo La Castellana 261 Madrid CP: 28046 Spain Search for other works by this author on: Oxford Academic Google Scholar A. Mayor‐Ibarguren, A. Mayor‐Ibarguren Department of Dermatology La Paz University Hospital Paseo La Castellana 261 Madrid CP: 28046 Spain Search for other works by this author on: Oxford Academic Google Scholar P. Herranz‐Pinto P. Herranz‐Pinto Department of Dermatology La Paz University Hospital Paseo La Castellana 261 Madrid CP: 28046 Spain Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 174, Issue 2, 1 February 2016, Pages 458–459, https://doi.org/10.1111/bjd.14180 Published: 01 February 2016

Objective: To evaluate the efficacy of 1% topical cidofovir cream for the treatment of anal high-grade squamous intraepithelial lesions (HSILs) in HIV-infected individuals. Design: Single-arm, open-label, pilot clinical trial. Methods: The study medication was applied intraanally three times per week for 4 weeks. Lesions were assessed with high-resolution anoscopy and biopsy at weeks 12 and 24. The primary endpoint was complete remission (CR) at week 12, defined as clinical and histological remission. We also evaluated partial remission defined as regression to low-grade squamous intraepithelial lesion. Results: We included 17 HIV-infected patients with intraanal HSIL. Median (interquartile range) age was 36 years (28–41), median (interquartile range) CD4+ cell count was 545 cells/μl (358–630), and viral load was less than 50 copies/ml in 93.7%. Two patients were lost to follow-up, one of them did not apply treatment. At 12 weeks, in the intention-to-treat population, 10 out of 16 patients [62.5%; 95% confidence interval (CI), 38.2–85.7%] had achieved CR. At 24 weeks, seven of the 10 patients (70%; 95% CI, 47–93%) remained in CR, but two out of 10 patients (20%; 95% CI, 0–40%) presented HSIL. One patient did not attend the visit at 24 weeks. Three patients with persistent HSIL at 12 weeks improved at 24 weeks (partial response in one and CR in two). The mean number of human papillomavirus genotypes decreased from 5.2 to 2.7 at 12 weeks (P = 0.002). Local adverse effects were frequent (81%), although there were no discontinuations because of adverse events. Conclusion: One percent topical cidofovir could be an appropriate alternative therapy in HIV-infected patients with anal HSIL. Clinical trial.gov unique identifier: NCT01946009.

Abstract Background and Objective The data in clinical practice regarding the effectiveness and safety of brodalumab in psoriasis are scarce, especially at scalp and palmoplantar locations. The main objective was the percentage of patients achieving absolute PASI ≤3/ ≤1/ =0 for plaque psoriasis and the percentage of patients achieving an IGA 0‐1/IGA 0 for the special locations at Week 52 of treatment. Patients and Methods Observational retrospective multicentre study in 28 Spanish Hospitals that included adult patients with plaque psoriasis treated with brodalumab, from September 2018 until March 2021. Results A total of 200 patients were included. The mean baseline PASI was 10.97 (±6.28) with a mean basal scalp ( n = 58) and palmoplantar ( n = 40) IGA of 2.10 (±0.97) and 2.15 (±1.26), respectively. At Week 52, 93.98%/75.90%/68.67% of patients reached an absolute PASI ≤3/ ≤1/ =0 in plaque psoriasis ( n = 83), with a percentage of patients achieving scalp ( n = 27) and palmoplantar ( n = 19) IGA 0‐1/IGA 0 of 96.3%/88.9% and 100%/88.9%, respectively. Fifteen per cent of patients reported any adverse events with candidiasis being the most reported (6%), but only 6% of the adverse events required the withdrawal. Conclusions Brodalumab demonstrated high PASI and IGA responses and was well tolerated in clinical practice in plaque, scalp and palmoplantar psoriasis.

El prurigo crónico nodular (PCN) es una enfermedad dermatológica crónica, caracterizada por la presencia de prurito crónico y lesiones nodulares pruriginosas cutáneas. El presente trabajo tuvo como objetivo consensuar entre un grupo de expertos, a partir de una revisión bibliográfica no sistemática, un algoritmo para el diagnóstico clínico del PCN. El algoritmo resultante se ha estructurado en tres bloques: 1) Identificación precoz del paciente con posible diagnóstico de PCN; 2) Diagnóstico y valoración del PCN y; 3) Categorización del PCN (identificación de las causas subyacentes o de las comorbilidades asociadas). Consideramos que este algoritmo clínico puede facilitar el diagnóstico correcto de los pacientes con PCN. Además, conciencia de la necesidad de un abordaje multidisciplinar y de un tratamiento específico del PCN, pasos indispensables para tomar mejores decisiones terapéuticas. Chronic nodular prurigo (CNP) is a chronic dermatological disease characterized by the presence of chronic pruritus and pruritic nodular lesions. The aim of this study was to reach consensus among a group of experts based on a non-systematic literature review and an algorithm for the clinical diagnosis of CNP. The resulting algorithm is structured in 3 blocks: 1) early identification of the patient with a possible diagnosis of CNP; 2) diagnosis and assessment of CNP; and 3) categorization of CNP (identification of the underlying causes or associated comorbidities). We believe that this clinical algorithm can facilitate the correct diagnosis of patients with CNP. Additionally, it raises awareness on the need for a multidisciplinary approach and specific treatment of CNP, steps of paramount importance to make better therapeutic decisions.

Since it was first described in the 1990s, Methicillin-Resistant Staphylococcus aureus infection among people with no contact with a hospital setting or with no traditional risk factors, has spread worldwide and is now an important epidemiological and public health problem.The present prospective and observational study was carried out from April to November 2010. All adult patients with community-acquired suppurative skin and soft tissue infection (SSTI) attending the Emergency Department were enrolled. Clinical, microbiological and epidemiological features of the infection were assessed.A total of 59 samples were collected from 59 patients and CA-MRSA was isolated in 13 of them. Prevalence of CA-MRSA in patients with suppurative SSTI seen in the emergency department was 22.03%, and was 33.3% in patients with staphylococcal infection. Is worth noting the greater presence of necrosis detected in CA-MRSA lesions. Only 3 patients required hospital admission. Eleven of the 13 strains were Panton-Valentine leucocidin producers, and 5 were resistant to non-betalactam antibiotics. CA MRSA infection is still more frequent in the immigrant population.Data on CA-MRSA prevalence in Spain are sparse. This study aims to emphasise the current importance of this emergent pathogen in our area. About one third of suppurative staphylococcal SSTI presenting in our emergency department are caused by this agent, confirming a rapid spread in our country. Some clinical features, such as the high presence of necrosis, are closely related to CA-MRSA.

Journal Article Cutaneous adverse events associated with heparin Get access P. Maldonado Cid, P. Maldonado Cid Department of Dermatology, Hospital Universitario La Paz, Madrid, Spain Dr Paola Maldonado Cid, Department of Dermatology, Hospital Universitario La Paz, P° de la Castellana 261, 28046 Madrid, Spain E‐mail: pmaldonadocid@gmail.com Search for other works by this author on: Oxford Academic Google Scholar R. M. Alonso de Celada, R. M. Alonso de Celada Department of Dermatology, Hospital Universitario La Paz, Madrid, Spain Search for other works by this author on: Oxford Academic Google Scholar L. Noguera Morel, L. Noguera Morel Department of Dermatology, Hospital Universitario La Paz, Madrid, Spain Search for other works by this author on: Oxford Academic Google Scholar M. Feito‐Rodríguez, M. Feito‐Rodríguez Department of Dermatology, Hospital Universitario La Paz, Madrid, Spain Search for other works by this author on: Oxford Academic Google Scholar C. Gómez‐Fernández, C. Gómez‐Fernández Department of Dermatology, Hospital Universitario La Paz, Madrid, Spain Search for other works by this author on: Oxford Academic Google Scholar P. Herranz Pinto P. Herranz Pinto Department of Dermatology, Hospital Universitario La Paz, Madrid, Spain Search for other works by this author on: Oxford Academic Google Scholar Clinical and Experimental Dermatology, Volume 37, Issue 7, 1 October 2012, Pages 707–711, https://doi.org/10.1111/j.1365-2230.2012.04395.x Published: 01 October 2012

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British Journal of DermatologyVolume 133, Issue 4 p. 659-660 Treatment of recurrent aphthous stomatitis with pentoxifylline A. Pizarro, A. Pizarro Departments of Pathology, Hospital La Paz,28046 Madrid, SpainSearch for more papers by this authorA. Navarro, A. Navarro Departments of Dermatology service, Hospital Juan R. Jimenez, 21080 Huelva, SpainSearch for more papers by this authorE. Fonseca, E. Fonseca Dermatology, Hospital La Paz,28046 Madrid, SpainSearch for more papers by this authorC. Vidaurrazaga, C. Vidaurrazaga Dermatology, Hospital La Paz,28046 Madrid, SpainSearch for more papers by this authorP. Herranz, P. Herranz Dermatology, Hospital La Paz,28046 Madrid, SpainSearch for more papers by this author A. Pizarro, A. Pizarro Departments of Pathology, Hospital La Paz,28046 Madrid, SpainSearch for more papers by this authorA. Navarro, A. Navarro Departments of Dermatology service, Hospital Juan R. Jimenez, 21080 Huelva, SpainSearch for more papers by this authorE. Fonseca, E. Fonseca Dermatology, Hospital La Paz,28046 Madrid, SpainSearch for more papers by this authorC. Vidaurrazaga, C. Vidaurrazaga Dermatology, Hospital La Paz,28046 Madrid, SpainSearch for more papers by this authorP. Herranz, P. Herranz Dermatology, Hospital La Paz,28046 Madrid, SpainSearch for more papers by this author First published: October 1995 https://doi.org/10.1111/j.1365-2133.1995.tb02728.xCitations: 24AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume133, Issue4October 1995Pages 659-660 RelatedInformation

Abstract: The high prevalence of psoriasis and the high spending on pharmaceuticals motivate a more evidence-based and cost-effective usage of biopharmaceuticals. A growing body of evidence exists that the implementation of therapeutic drug monitoring for biopharmaceuticals in psoriasis patients optimizes patient management and clinical outcome and enhances their efficacy. Therefore, the aim of this review was to give an overview of the literature on therapeutic drug monitoring of biopharmaceuticals in the treatment of psoriasis and to provide the useful information to dermatologists to improve health care in psoriasis patients.

El conocimiento de las rutas de origen y derivación de los pacientes atendidos en consulta dermatológica presencial y de teledermatología en España tiene interés desde el punto de vista de la gestión sanitaria. El objetivo de este estudio es describir las rutas de derivación y la frecuencia y características de la teledermatología en España. Estudio transversal descriptivo sobre la muestra del estudio DIADERM, que recogió la actividad de 80 dermatólogos españoles, seleccionados mediante muestreo aleatorio estratificado, durante 6 días. Se estudiaron el origen y destino de los pacientes en función de la financiación, el tipo de consulta y la edad de los pacientes. Se describió la frecuencia de las consultas por teledermatología, su origen y destino, el tipo de financiación, la edad de los pacientes y los diagnósticos más frecuentes, comparándolos con la consulta presencial. El origen más frecuente en la consulta privada es el directo, mientras que en la pública es la atención primaria y el propio dermatólogo. Un 66% de los pacientes se derivan a dermatología y un 27% son dados de alta. No existen diferencias en estos porcentajes entre consulta pública y privada. El índice sucesivas/primeras fue de 0,8 para la consulta pública y de 0,2 para la privada. La teledermatología representa un 1% de las consultas. El 80% procede de atención primaria y el 17% tiene origen directo. Se deriva a atención primaria el 33%, en mayor proporción que en consulta presencial. Galicia, Andalucía y Cataluña son las regiones donde representa un mayor porcentaje de consultas. Los resultados sugieren una alta capacidad resolutiva de las consultas de dermatología en España. La teledermatología representa un porcentaje pequeño de las consultas, y el acceso a ella se da en un porcentaje relevante de pacientes por vía directa. Understanding the origin and referral routes of patients seen in teledermatology and in-person dermatology consultations in Spain is of interest from the perspective of health care management. The objective of this study was to describe the referral routes and the frequency and characteristics of teledermatology consultations in Spain. We performed a descriptive cross-sectional study of data collected over 6 days from the DIADERM study sample, which included the outpatients diagnosed by 80 Spanish dermatologists, selected by means of stratified random sampling. We studied the source and destination of patients based on funding, type of consultation, and age of the patients. We reported the frequency of teledermatology consultations, their origin and destination, type of funding, age of the patients, and most common diagnoses, and compared them with the same characteristics for in-person consultations. In private consultations, most patients were direct clients, whereas the most frequent source in public consultations was primary care and the dermatologist. Sixty-six percent of patients were referred to dermatology and 27% were discharged. No differences in these percentages were found between public and private consultations. The ratio of follow-up to initial visits was 0.8 for public consultations and 0.2 for private consultations. Teledermatology accounts for 1% of consultations. Eighty percent of these come from primary care and 17% are direct visits. Thirty-three percent of these visits are referred to primary care — a greater proportion than in in-person consultations. Galicia, Andalusia, and Catalonia are the regions with the highest percentage of consultations. The results suggest that dermatologists in Spain have a considerable ability to resolve cases. Teledermatology accounts for a small percentage of consultations and access to these consultations is direct in a large percentage of cases.

Numerous epidemiology studies confirm the increasing prevalence of non-alcoholic fatty liver disease in severe psoriasis, with more than double the risk reported for patients without psoriasis (odds ratio [OR] 2.15). Liver disease is more severe in patients with psoriasis than in controls without psoriasis and is associated with the severity. Similarly, patients with fatty liver disease have more severe psoriasis. This harmful synergy has a common pathogenic origin, resulting from the frequent association between both diseases, insulin resistance and the metabolic syndrome. The disease manifests with a greater intensity when both conditions co-occur than when each manifests separately. Furthermore, psoriasis and fatty liver also have a common cytokine-mediated inflammatory background, which involves an imbalance between pro-inflammatory and anti-inflammatory cytokines. In fact, each disease plays a role in the course of the other. The dermatologist should usually detect liver disease after a specific assessment of patients who present with the metabolic syndrome. The hepatologist should be aware of the more severe condition of these patients. Various medications, such as acitretin, cyclosporine and methotrexate may prove harmful for patients with liver disease. Biologics have proven to be safe in patients with chronic liver disease. Hepatologists and dermatologists should work together to ensure the careful evaluation of the optimal therapy for each patient depending on the severity of both diseases, taking care to avoid, where possible, hepatotoxic drugs and select options that may even have a shared benefit for both diseases.

To describe changes in sexually transmitted infection (STI) diagnoses during the first wave of the COVID-19 pandemic in Spain.We collected demographic, chronological, and clinical data for all patients seen for a possible STI at Hospital La Paz, Centro Sanitario Sandoval, and Centro de Diagnóstico Médico in Madrid and Hospital Costa del Sol in Malaga between March 14, 2020 and June 30, 2020.We identified 674 STI diagnoses. The median age of the patients was 33 years. Most cases were observed among people aged 30 to 40 years and among men who have sex with men. The most common diagnoses were proctitis (36.5%), syphilis (16%), nongonococcal (13.3%) and gonococcal (11.3%) urethritis, genital herpes (8.8%), vulvovaginitis/cervicitis (8.3%), and genital warts (4.2%). A microbiologically confirmed diagnosis was on record for 77% of cases. The main microorganisms identified were Chlamydia trachomatis (35.7%), Neisseria gonorrhoeae (31.4%) and Treponema pallidum (17.2%). The number of STI diagnoses increased after the easing of lockdown restrictions, which resulted in greater freedom of movement and more consultations. On comparing the 2019 and 2020 STI registries from Centro Sanitario Sandoval and Hospital La Paz for the period March to June, we observed reductions (of up to 81%) in all STI diagnoses.Physical distancing and movement restrictions appear to have resulted in a reduction in the incidence of STIs, although these measures did not completely eliminate sexual risk behaviors.

Psoriasis is a chronic, systemic inflammatory disease that affects the skin, with a high impact on patients' quality of life. The aim of this study was to identify and determine the relative importance of unmet needs in the management of moderate-to-severe psoriasis in Spain, from a multi-stakeholder perspective. A mixed method-approach was used to collect information, design a questionnaire and a discrete-choice exercise, and elicit the unmet needs through a multidisciplinary committee composed of 12 experts. A total of 65 unmet needs were identified and categorized into 4 areas: clinical, patient-related, decision-making process, and social. Decision-making process unmet needs were perceived as the most pressing ones, followed by social, clinical and patient-related. Individually, the need to incorporate outcomes that are important to the patients and to have treatments that achieve total clearance with a rapid onset of action and long-term persistence were the most important unmet needs.

Oral recurrent aphthous ulceration (RAU) is a well-recognized complication in patients infected with human immunodeficiency virus. RAU can be progressive and destructive, causing dysphagia and secondary malnutrition. The aetiology of RAU remains unknown, and its response to available treatments is often unsatisfactory. We describe three patients with advanced AIDS who suffered from extensive RAU which failed to respond to several treatments, including topical viscous lidocaine and topical and systemic glucocorticoids. Owing to difficulties in using thalidomide (two patients had neurological conditions which precluded thalidomide use), all three patients were treated with an oral solution containing recombinant human granulocyte-macrophage colony-stimulating factor (GM-CSF, 400 microg in 5% glucose 200 mL). From the first application, all three patients showed significant improvement of their lesions and amelioration of pain, and they were completely cured in a few days. No adverse effects were recorded. The patients did not show relapses of RAU over a prolonged follow-up. Controlled trials are warranted in order to establish the role of GM-CSF as a valid, alternative option for aphthous ulcerations of the mouth in AIDS patients in whom corticosteroids or thalidomide are not suitable.

Conflict of interest: none declared. Imatinib mesylate is a tyrosine kinase inhibitor that targets the BCR‐ABL protein, c‐KIT and platelet‐derived growth factor. It is used for the treatment of chronic myeloid leukaemia and gastrointestinal stromal tumour (GIST), a rare tumour involving the gastrointestinal tract. A 71‐year‐old man presented with a cutaneous eruption on the flanks and erosions in the oral mucosa. Nine months previously he had been diagnosed with a GIST in the gastric fundus, and had been treated successfully with surgery. He had been started on imatinib 400 mg daily as adjuvant treatment He was not receiving any other treatment. Three months later he developed violaceus scaly pruritic plaques on the flanks and arms (Fig. 1a). Simultaneously, he noticed a burning sensation affecting oral mucosa. Intraoral examination revealed grey‐violaceous erosive plaques, resembling oral lichen planus, on the dorsa of the patient’s tongue and labial mucosa (Fig. 1b). Histological examination of a skin biopsy taken from the patient’s leg revealed a lichenoid band of lymphocytes and histiocytes with numerous eosinophils, and an interface dermatitis with necrotic keratinocytes within the lower layers of the epidermis (Fig. 2).

Background: Increasing evidence indicates a relationship between psoriasis and metabolic syndrome (MS). We evaluated the prevalence of MS in patients receiving systemic treatment for psoriasis in Spain, and its relationship to cardiovascular disease (CVD).Methods: This cross-sectional, multicenter, non-interventional study enrolled 368 patients with moderate-to-severe psoriasis requiring systemic treatment. Clinical parameters for psoriasis, CV risk factors, MS and CVD were assessed. Descriptive and logistic regression analyses were performed.Results: 352 patients were included (median psoriasis duration: 18 years, plaque psoriasis [95.7%], psoriatic arthritis [22.8%]). Overall, 132 patients (37.5%) fulfilled diagnostic criteria for MS; the most prevalent MS components were high blood pressure and increased waist circumference. Patients with MS were older, more likely to be obese and to have a sedentary lifestyle and hypercholesterolemia than those without MS. CVD was more prevalent in patients with MS than in those without (29.5% versus 15.9%, p = 0.002), particularly coronary heart disease (CHD), myocardial infarction and heart failure. MS was independently associated with CVD (OR 1.98, p = 0.018) and CHD (OR 2.02, p = 0.044).Conclusion: The prevalence of MS was high among patients with moderate-to-severe psoriasis requiring systemic treatment, and was associated with a higher prevalence of CVD. Dermatologists should consider implementing simple screening protocols.

Chagas disease is estimated to affect 6 to 8 million people worldwide. Adverse events to benznidazole (BNZ), which is the drug of choice, lead to the abandonment of treatment in 15% to 30% of patients.1 Cutaneous reactions are frequent, including mild maculopapular eruptions (MPEs), and less commonly, severe cutaneous adverse reactions (SCARs), such as drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), and acute generalized exanthematous pustulosis (AGEP).

The perforating dermatoses are characterized by the cardinal histologic feature of epidermal perforation or “transepithelial elimination.” The extrusion of altered dermal substances through epidermal channels without disruption of the surrounding structures is their hallmark.1 Kyrle’s disease, perforating folliculitis, reactive perforating collagenosis, and elastosis perforans serpiginosa are essentially primary perforating disorders.2 We report a case of perforating folliculitis in a HIV-infected male.

Cardiac myxomas are difficult to diagnose, not only because of a lack of specific systemic symptoms but also because, even in those cases presenting with embolic disease, emboli are exceptional. The skin is one of the organs most frequently involved by myxomatous emboli. We report an extraordinary case in which emboli of a cardiac myxoma was present in the skin biopsy, but "camouflaged" among the normal Vater-Pacini corpuscles of the palm of the hand, We also review the existing literature on myxomatous emboli identified in skin biopsies.

El manejo de apremilast en la práctica clínica complementa la información procedente de los ensayos clínicos pivotales. Tras una revisión de la literatura se consideraron, por parte de un panel de dermatólogos expertos en el manejo de la psoriasis, 5 áreas donde la evidencia sobre el uso de apremilast en la psoriasis moderada era insuficiente o controvertida, que fueron evaluadas a través de un cuestionario diseñado según la metodología Delphi. Se alcanzó consenso en 96 de los 143 ítems planteados (67%) (85 en el acuerdo y 11 en el desacuerdo). El objetivo terapéutico con apremilast debería ponderarse entre la respuesta clínica, la sintomatología asociada, la calidad de vida y la satisfacción del paciente. El perfil en el que el uso de apremilast se considera con mayores posibilidades de éxito sería el de un paciente con psoriasis moderada estable. La mayoría de los clínicos consideraron que apremilast es adecuado para pacientes en los que hayan fracasado o estén contraindicados los tratamientos convencionales, preferentemente de forma previa a la indicación de terapia biológica. Hubo consenso en reconocer apremilast como una opción terapéutica adecuada para el tratamiento en localizaciones difíciles, como la psoriasis palmoplantar y del cuero cabelludo. La necesidad de cribado, así como de su monitorización durante el seguimiento, se consideró menor que la de otros tratamientos sistémicos, convencionales y biológicos. Apremilast podría representar una opción terapéutica en un perfil de pacientes distinto al presentado en los ensayos clínicos. La ausencia de un consenso sobre la definición de psoriasis moderada, la escasa evidencia acerca del fármaco en la vida real, así como algunos aspectos relacionados con la tolerabilidad representan limitaciones a estas propuestas. Experience in the use of apremilast in clinical practice complements the information available from pivotal clinical trials. Following a review of the literature, a panel of dermatologists with expertise in the management of psoriasis considered 5 scenarios in which the evidence supporting the use of apremilast to treat moderate psoriasis is insufficient or controversial. These scenarios were then assessed using a Delphi questionnaire. Consensus was reached on 96 (67%) of the 143 items (positive in 85 and negative in 11). The therapeutic goal for apremilast should be based on 4 outcomes: clinical response, symptoms, quality of life, and patient satisfaction. The scenario in which the use of apremilast was considered to have the greatest possibility of success was in patients with stable moderate psoriasis. Most of the clinicians considered apremilast to be an appropriate treatment when conventional therapies fail or are contraindicated, preferably before the prescription of biologic therapy. Consensus was reached that apremilast is an appropriate treatment for psoriasis in difficult locations, such as the scalp or the palms and soles. It was also agreed that apremilast requires less prescreening and monitoring than other conventional and biologic systemic therapies. Apremilast could be a treatment option for patients with a different profile to that of clinical trial participants. The limitations of this proposal are the absence of consensus on the definition of moderate psoriasis, the lack of real-world evidence on the use of apremilast, and certain aspects related to tolerability.

Journal of the European Academy of Dermatology and VenereologyVolume 35, Issue 1 p. e65-e67 Letter to the Editor Maintenance of response following discontinuation of guselkumab and secukinumab in Spanish patients who participated in the ECLIPSE study R. Rivera, Corresponding Author R. Rivera rriveradiaz@hotmail.com orcid.org/0000-0002-4604-0724 Dermatology Department, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain Correspondence: R. Rivera. E-mail: rriveradiaz@hotmail.comSearch for more papers by this authorA. Martorell, A. Martorell orcid.org/0000-0003-1378-1590 Dermatology Department, Hospital de Manises, Valencia, SpainSearch for more papers by this authorA. López, A. López Dermatology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, SpainSearch for more papers by this authorL. Salgado, L. Salgado Dermatology Department, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, SpainSearch for more papers by this authorA. Sahuquillo, A. Sahuquillo orcid.org/0000-0002-9354-7464 Dermatology Department, Hospital Universitario y Politécnico La Fe, Valencia, SpainSearch for more papers by this authorP. de la Cueva, P. de la Cueva Dermatology Department, Hospital Universitario Infanta Leonor, Madrid, SpainSearch for more papers by this authorP. Herranz, P. Herranz Dermatology Department, Hospital Universitario La Paz, Madrid, SpainSearch for more papers by this authorJ.A. Ratón, J.A. Ratón Dermatology Department, Hospital Universitario de Cruces, Bilbao, SpainSearch for more papers by this authorM. Ferrán, M. Ferrán Dermatology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, SpainSearch for more papers by this authorR. Izu, R. Izu Dermatology Department, Hospital de Basurto, Bilbao, SpainSearch for more papers by this authorD. Ruiz-Genao, D. Ruiz-Genao orcid.org/0000-0003-1093-6411 Dermatology Department, Hospital Universitario Fundación Alcorcón, Madrid, SpainSearch for more papers by this authorC. García-Donoso, C. García-Donoso Dermatology Department, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, SpainSearch for more papers by this authorJ.M. Carrascosa, J.M. Carrascosa Dermatology Department, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Barcelona, SpainSearch for more papers by this author R. Rivera, Corresponding Author R. Rivera rriveradiaz@hotmail.com orcid.org/0000-0002-4604-0724 Dermatology Department, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain Correspondence: R. Rivera. E-mail: rriveradiaz@hotmail.comSearch for more papers by this authorA. Martorell, A. Martorell orcid.org/0000-0003-1378-1590 Dermatology Department, Hospital de Manises, Valencia, SpainSearch for more papers by this authorA. López, A. López Dermatology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, SpainSearch for more papers by this authorL. Salgado, L. Salgado Dermatology Department, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, SpainSearch for more papers by this authorA. Sahuquillo, A. Sahuquillo orcid.org/0000-0002-9354-7464 Dermatology Department, Hospital Universitario y Politécnico La Fe, Valencia, SpainSearch for more papers by this authorP. de la Cueva, P. de la Cueva Dermatology Department, Hospital Universitario Infanta Leonor, Madrid, SpainSearch for more papers by this authorP. Herranz, P. Herranz Dermatology Department, Hospital Universitario La Paz, Madrid, SpainSearch for more papers by this authorJ.A. Ratón, J.A. Ratón Dermatology Department, Hospital Universitario de Cruces, Bilbao, SpainSearch for more papers by this authorM. Ferrán, M. Ferrán Dermatology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, SpainSearch for more papers by this authorR. Izu, R. Izu Dermatology Department, Hospital de Basurto, Bilbao, SpainSearch for more papers by this authorD. Ruiz-Genao, D. Ruiz-Genao orcid.org/0000-0003-1093-6411 Dermatology Department, Hospital Universitario Fundación Alcorcón, Madrid, SpainSearch for more papers by this authorC. García-Donoso, C. García-Donoso Dermatology Department, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, SpainSearch for more papers by this authorJ.M. Carrascosa, J.M. Carrascosa Dermatology Department, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Barcelona, SpainSearch for more papers by this author First published: 10 July 2020 https://doi.org/10.1111/jdv.16809Citations: 4Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume35, Issue1January 2021Pages e65-e67 RelatedInformation

To the Editor: Chilblain-like lesions (CBLL) have been related to severe acute respiratory coronavirus 2 (SARS-CoV-2) infection,1Colmenero I. Santonja C. Alonso-Riaño M. et al.SARS-CoV-2 endothelial infection causes COVID-19 chilblains: histopathological, immunohistochemical and ultrastructural study of seven paediatric cases.Br J Dermatol. 2020; 183: 729-737Crossref PubMed Scopus (330) Google Scholar although solid microbiological confirmation is still lacking. We present a prospective cohort study of 37 patients (median age, 14 years) presenting new-onset CBLL during the COVID-19 outbreak in Spain that included (1) SARS-CoV-2 testing (nasopharyngeal polymerase chain reaction [PCR] and serologies) and immunologic profiles for all patients, (2) custom recall antigen experiments and intracellular cytokine production evaluation in selected cases, and (3) skin biopsy for histopathology and immunochemistry (11 samples) and SARS-CoV-2 PCR and electron microscopy (3 cases) (Supplemental Tables I-IV; available via Mendeley at https://doi.org/10.17632/vgvxtcb82c.1). CBLL mainly affected the toes (Table I), with other features including dusky erythematoedematous changes on the dorsal surfaces of the toes and fingers (24.32%), purpuric macules (37.83%), and blisters (10.81%). Two patients presented with more obvious signs of distal skin ischemia (Supplemental Figs 1-3; available via Mendeley at https://doi.org/10.17632/vgvxtcb82c.1). In most cases, the lesions fully/partially remitted with topical therapy or no therapy. Only 1 patient presented with signs of retinal vasculitis. Vascular pulses and Doppler ultrasonography showed normal blood flows in the entire series. All biopsy specimens were consistent with pernio, and 54.5% showed complement C3d and C4d deposition around small vessels (Supplemental Fig 4; available via Mendeley at https://doi.org/10.17632/vgvxtcb82c.1). Nasopharyngeal PCR had positive results in 8.1%, and SARS-CoV-2 serology results were positive in just 8.1% of patients. Recall antigen assays showed positive responses in the 3 patients who underwent them (2 with negative SARS-CoV-2 serologies). Five of the 37 patients presented mild anticardiolipin titer elevation. Interferon (IFN) alfa levels were increased in only 1 of 24 tested patients, whereas the rest of the cytokines remained within normal or undetectable levels. No virus was detected on electron microscopy or PCR testing in skin samples.Table ISummary of demographic and clinical features of the patients presenting chilblain-like lesions (N = 37)Sex, n (%) Female20 (54.05) Male17 (45.95)Mean age, y, mean ± SD22.08 ± 15.46Median age, y14Latency between systemic symptoms and skin lesions, days21.76 ± 23.01Affected areas, n (%) Toes only15 (40.55) Fingers only10 (27.03) Toes and sides of feet7 (18.92) Toes and heels2 (5.40) Toes and fingers2 (5.40) Toes, fingers, and sides of feet1 (2.70)Associated signs and symptoms, n (%) Purpuric macules14 (37.83) Erythema6 (16.21) Pruritus5 (13.51) Cold skin5 (13.51) Blisters4 (10.81) Pain3 (8.10) Edema3 (8.10) Ulceration and/or necrosis2 (5.40)History of systemic symptoms, n (%)17 (45.95)Evolution of the lesions (+2 weeks), n (%) Complete resolution16 (43.24) Partial resolution14 (37.84) Persistence4 (10.81) Worsening3 (8.11)Prescribed therapy, n (%) None24 (64.86) Topical corticosteroids8 (21.63) Oral corticosteroids1 (2.70) Pentoxifylline4 (10.81)SD, Standard deviation. Open table in a new tab SD, Standard deviation. Our patients presented with CBLL in striking parallel to the rise and fall of the COVID-19 pandemic in Madrid, but approximately 2 weeks later (Fig 1). The low proportion of positive SARS-CoV-2 serology test results would argue against the idea of a causal relationship between CBLL and SARS-CoV-2 infection. Lack of serologic test accuracy and a more prominent innate immune response might explain this discrepancy.2Netea M.G. Joosten L.A.B. Trained immunity and local innate immune memory in the lung.Cell. 2018; 175: 1463-1465Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar However, our preliminary results with SARS-CoV-2 assays suggest that patients could have been exposed to SARS-CoV-2 despite negative routine serologic test results. These patients might have had mild SARS-CoV-2 infection, although the upregulation of the type I IFN pathway could have resulted in the onset of CBLL in genetically predisposed patients. The lower rate of measured IFN alfa could be due to the fact that we measured it in a late phase of infection, according to PCR test results. The exact role of SARS-CoV-2 in the development of CBLL, if any, remains unclear.3Kanitakis J. Lesort C. Danset M. Jullien D. Chilblain-like acral lesions during the COVID-19 pandemic ("COVID toes"): histologic, immunofluorescence and immunohistochemical study of 17 cases.J Am Acad Dermatol. 2020; 83: 870-875Abstract Full Text Full Text PDF PubMed Scopus (117) Google Scholar We were unable to detect the virus in skin samples; however, the SARS-CoV-2 spike protein has been shown in the endothelial and epithelial cells of eccrine glands.4Torrelo A. Andina D. Santonja C. et al.Erythema multiforme-like lesions in children and COVID-19.Pediatr Dermatol. 2020; 37: 442-446Crossref PubMed Scopus (94) Google Scholar Additionally, immune complex deposition can lead to tissue injury through various mechanisms, including complement activation, which could contribute to their pathogenesis.5Rojko J.L. Evans M.G. Price S.A. et al.Formation, clearance, deposition, pathogenicity, and identification of biopharmaceutical-related immune complexes: review and case studies.Toxicol Pathol. 2014; 42: 725-764Crossref PubMed Scopus (119) Google Scholar In conclusion, if CBLL were secondary to SARS-CoV-2, absence of a more evident humoral response would be highlighted. Recall antigen assays could help clarify this association.

Journal of the European Academy of Dermatology and VenereologyVolume 20, Issue 2 p. 229-230 Subcutaneous mycosis produced by Aureobasidium pullulans in a renal transplant recipient D M Arranz Sánchez, Corresponding Author D M Arranz Sánchez Departments of †Dermatology and ‡Pathology, La Paz Hospital, Madrid, Spain *Corresponding author, Dulce Ma Arranz Sánchez, Dermatology, La Paz Hospital, Madrid, Spain, tel. +34 917277386; fax +34 917277050; E-mail: darranzsanchez@hotmail.comSearch for more papers by this author* M Corral De La Calle, M Corral De La Calle Departments of †Dermatology and ‡Pathology, La Paz Hospital, Madrid, SpainSearch for more papers by this authorMA Martín-Díaz, MA Martín-Díaz Departments of †Dermatology and ‡Pathology, La Paz Hospital, Madrid, SpainSearch for more papers by this authorC Rubio Flores, C Rubio Flores Departments of †Dermatology and ‡Pathology, La Paz Hospital, Madrid, SpainSearch for more papers by this authorMJ González-Beato, MJ González-Beato Departments of †Dermatology and ‡Pathology, La Paz Hospital, Madrid, SpainSearch for more papers by this authorP Herranz Pinto, P Herranz Pinto Departments of †Dermatology and ‡Pathology, La Paz Hospital, Madrid, SpainSearch for more papers by this authorRM Díaz Díaz, RM Díaz Díaz Departments of †Dermatology and ‡Pathology, La Paz Hospital, Madrid, SpainSearch for more papers by this author D M Arranz Sánchez, Corresponding Author D M Arranz Sánchez Departments of †Dermatology and ‡Pathology, La Paz Hospital, Madrid, Spain *Corresponding author, Dulce Ma Arranz Sánchez, Dermatology, La Paz Hospital, Madrid, Spain, tel. +34 917277386; fax +34 917277050; E-mail: darranzsanchez@hotmail.comSearch for more papers by this author* M Corral De La Calle, M Corral De La Calle Departments of †Dermatology and ‡Pathology, La Paz Hospital, Madrid, SpainSearch for more papers by this authorMA Martín-Díaz, MA Martín-Díaz Departments of †Dermatology and ‡Pathology, La Paz Hospital, Madrid, SpainSearch for more papers by this authorC Rubio Flores, C Rubio Flores Departments of †Dermatology and ‡Pathology, La Paz Hospital, Madrid, SpainSearch for more papers by this authorMJ González-Beato, MJ González-Beato Departments of †Dermatology and ‡Pathology, La Paz Hospital, Madrid, SpainSearch for more papers by this authorP Herranz Pinto, P Herranz Pinto Departments of †Dermatology and ‡Pathology, La Paz Hospital, Madrid, SpainSearch for more papers by this authorRM Díaz Díaz, RM Díaz Díaz Departments of †Dermatology and ‡Pathology, La Paz Hospital, Madrid, SpainSearch for more papers by this author First published: 04 January 2006 https://doi.org/10.1111/j.1468-3083.2006.01385.xCitations: 11Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume20, Issue2February 2006Pages 229-230 RelatedInformation

Auteur(s) : Cristina GOMEZ-FERNANDEZ1 crisgomezfernandez@hotmail.com, Pedro HERRANZ PINTO1, Beatriz CASADO VERRIER1, Elena SENDAGORTA CUDOS1, Maria Jose BEATO-MERINO2, Mariano CASADO JIMENEZ1 1 University Hospital La Paz, Department of Dermatology, Paseo de la Castellana, 261, 28046. Madrid, Spain 2 University Hospital La Paz, Department of Pathology, Madrid, Spain Bupropion hydrochloride is a psychotropic drug with significant antidepressant effects through the inhibition of re-uptake of norepinephrine [...]

Diffuse dermal angiomatosis is a rare benign condition considered a variant of reactive angioendotheliomatosis, usually related to vascular disease such as arteriovenous fistula or severe peripheral vascular disease. The most frequent clinical manifestations range from a solitary erythematous patch to an indurated plaque that may ulcerate. A clinical case of a 60-year-old woman who developed generalized livedoid lesions 2 days after the administration of intravenous trabectedin and subcutaneous pegfilgrastim for a recidivant myxoid liposarcoma has been reported. A biopsy of the skin lesions showed a pronounced proliferation of vessels in the upper dermis that was diagnosed as diffuse dermal angiomatosis.

Purpose: This study was conducted to examine the relationship between loss of clinical response to anti-tumor necrosis factor (TNF) therapy and the production of anti-drug antibodies (ADAs) and the potential effects of biologic immunogenicity.Materials and methods: This observational, non-interventional, cross-sectional study included patients with moderate-to-severe plaque psoriasis and secondary failure of adalimumab, etanercept and infliximab who were seen in the clinical practice setting. Clinical data and blood samples were collected after patient enrollment at the time that next doses of anti-TNF therapy were scheduled. ADA and serum drug concentrations were detected at a central reference laboratory using ELISA.Results: Among 137 enrolled patients, ADA were identified in 31/65 (48%), 0/47 and 8/19 (42%) of patients treated with adalimumab, etanercept and infliximab, respectively. The presence of ADA was associated with a slightly worse clinical response in adalimumab-treated patients (Physician Global Assessment score: 3.7 vs. 3.2, ADA-positive vs. ADA-negative patients [p < .05]; correlation between serum ADA titer and body surface area: r = .292 [p = .019]). Concomitant DMARDs were not associated with anti-TNF immunogenicity in any treatment group.Conclusions: Additional evidence is needed from studies of anti-TNF therapy in psoriasis for clinicians to gain a better understanding of the impact of immunogenicity on clinical response.

Biologic therapies have been a major breakthrough in the treatment of psoriasis because they are more selective and have a better short-term and medium-term safety profile. There are reliable data to support both the efficacy and the safety of these drugs. However, it is always useful to report the clinical experience of dermatologists who are experts in the use of biologic agents to treat psoriasis, particularly with regard to their safety. We present the results of a survey administered to the members of Spanish Psoriasis Group and based on a series of questions referring to the clinical safety of these agents. A total of 988 patients treated with efalizumab, infliximab, etanercept, and adalimumab were reported by 15 members of the group. There was a particularly high proportion of reactions (34%) to infliximab infusions. Blood test abnormalities were detected in 13.25% of patients and infections in 12.24%, with one case of pulmonary tuberculosis. Attention is drawn to the adverse effects profile of efalizumab: de novo arthritis in 5.8% and rebound in 20.9% of patients. The safety data provided by our study should be taken into account in view of the large number of patients recruited by dermatologists experienced in the use of this type of therapy. La terapia biológica ha representado un avance muy importante en el tratamiento de la psoriasis, al tratarse de una generación de fármacos más selectivos y con mejor perfil de seguridad a corto y medio plazo. Existen datos sólidos a favor de la eficacia de cada uno de estos fármacos, así como de su seguridad. A pesar de ello, siempre es útil aportar la experiencia clínica de dermatólogos expertos en el tratamiento de la psoriasis con biológicos, en especial en lo referente a su seguridad. Se realizó una encuesta a los miembros del Grupo Español de Psoriasis (GEP) basada en una serie de ítems relativos a aspectos referentes a la seguridad clínica de estos fármacos, cuyos resultados se presentan en este artículo. Un total de 988 pacientes tratados con efalizumab, etanercept, infliximab y adalimumab fueron recogidos por parte de 15 miembros del GEP. Entre los resultados obtenidos destaca la elevada proporción de reacciones a infliximab (34%). Se observaron alteraciones analíticas en el 13,25% de los pacientes e infecciones en el 12,24%, con un único caso de tuberculosis pulmonar. Es de destacar el perfil de efectos secundarios de efalizumab: artritis de novo en el 5,8% y rebote en el 20,9%. Los datos de seguridad aportados por nuestro trabajo deben tenerse en consideración, habida cuenta del importante número de pacientes reclutados por un grupo de dermatólogos expertos en el manejo de este tipo de fármacos.

Necrobiosis lipoidica (NL) is a distinctive chronic inflammatory disease typified microscopically by dermal and/ or subcutaneous palisades of histiocytes surrounding a zone of degenerated collagen. It is therefore a so-called necrobiotic granulomatous condition. Though its cause is unknown, two in three patients with NL have diabetes. NL is typically characterised by brownish-yellow ovoid plaques on pretibial skin, with an irregular indurated violaceous contour and a yellow atrophic central area. Thirty percent of cases ulcerate due to minor trauma (1 ).

Actinic keratosis (AK) lesions have the potential to develop into invasive squamous cell carcinomas (SCCs), and approaches to treatment are evolving to try to reduce the burden of SCC.To present the published clinical research surrounding the use of 0.5% 5-fluorouracil with 10% salicylic acid (low-dose 5-FU/SA) for the treatment of hyperkeratotic AKs.A review of published clinical evidence for low-dose 5-FU/SA for the treatment of AKs. The articles were selected following a MEDLINE database search of the combined terms fluorouracil, salicylic acid and actinic keratosis which represent the peer review publications of clinical studies that primarily investigate the use of Actikerall in AK.Combining low-dose 5-FU with keratolytic SA is associated with high rates of histologic clearance, reduction in lesion number/area, and sustained clinical response in clinical study and the clinical practice setting. Low-dose 5-FU/SA has also been evaluated using imaging to detect the progression of subclinical AK lesions through a course of the field-directed treatment.Low-dose 5-FU/SA is an effective and well-tolerated treatment option licensed for the lesion-directed treatment of mild-to-moderate hyperkeratotic AK lesions.

Acne is a chronic inflammatory disease whose psychosocial effects can greatly impair quality of life. Various scales are used to classify the severity of acne, and several treatment algorithms are currently applied: no consensus on a common scale or treatment guidelines has been reached. A group of Spanish experts therefore met to identify a scale the majority could accept as the most appropriate for classifying severity and treating accordingly. The group chose the following classifications: comedonal acne, mild or moderate papulopustular acne, severe papulopustular acne, moderate nodular acne, and nodular-cystic acne (or acne tending to leave scars). Consensus was reached on first- and second-choice treatments for each type and on maintenance treatment. The experts also issued specific recommendations on antibiotic use (starting with mild or moderate papulopustular acne), always in combination with retinoids and/or benzoyl peroxide. The use of isotretinoin (starting at severe papulopustular or moderate nodular acne) was also covered. El acné es una enfermedad inflamatoria crónica que conlleva una serie de efectos psicosociales que pueden afectar en gran medida la calidad de vida del paciente. Existen distintas escalas de clasificación de gravedad del acné y otros tantos algoritmos de tratamiento, sin que haya consenso sobre la escala y guía de manejo que seguir. Por ello, un grupo de expertos españoles se reúnen para consensuar por votación la forma más apropiada de clasificar el acné y el tratamiento según la gravedad del mismo. El acné se clasifica como acné comedoniano, acné papulopustuloso leve o moderado, acné papulopustuloso grave o nodular moderado y acné grave noduloquístico o con tendencia a desarrollar cicatrices. Se consensuaron una primera y una segunda opción de tratamiento para cada grado de gravedad y un tratamiento de mantenimiento. Se efectuaron recomendaciones específicas con relación al uso combinado de antibióticos (a partir de grado papulopustuloso leve o moderado), siempre en combinación con retinoides y/o peróxido de benzoilo (POB), y el uso de isotretinoína a partir del grado papulopustuloso grave o nodular moderado.

Journal of the European Academy of Dermatology and VenereologyVolume 35, Issue 4 p. e247-e249 Letter to the Editor Palmoplantar erythrodysesthesia: a diagnostic sign of COVID-19 A. Nuno-Gonzalez, Corresponding Author A. Nuno-Gonzalez [email protected] orcid.org/0000-0001-7252-1647 Department of Dermatology, Hospital Universitario La Paz, Madrid, Spain Facultad de Medicina, Universidad Autonoma de Madrid, Madrid, Spain Correspondence: A. Nuno-Gonzalez. E-mail: [email protected]Search for more papers by this authorK. Magaletsky, K. Magaletsky Department of Dermatology, Hospital Universitario La Paz, Madrid, Spain Facultad de Medicina, Universidad Autonoma de Madrid, Madrid, SpainSearch for more papers by this authorM. Feito Rodríguez, M. Feito Rodríguez orcid.org/0000-0002-2645-8904 Department of Dermatology, Hospital Universitario La Paz, Madrid, Spain Facultad de Medicina, Universidad Autonoma de Madrid, Madrid, SpainSearch for more papers by this authorA. Mayor Ibarguren, A. Mayor Ibarguren Department of Dermatology, Hospital Universitario La Paz, Madrid, Spain Facultad de Medicina, Universidad Autonoma de Madrid, Madrid, SpainSearch for more papers by this authorM.J. Beato, M.J. Beato Department of Pathology, Hospital Universitario La Paz, Madrid, SpainSearch for more papers by this authorE. Ruiz Bravo, E. Ruiz Bravo Department of Pathology, Hospital Universitario La Paz, Madrid, SpainSearch for more papers by this authorP. Herranz Pinto, P. Herranz Pinto Department of Dermatology, Hospital Universitario La Paz, Madrid, Spain Facultad de Medicina, Universidad Autonoma de Madrid, Madrid, SpainSearch for more papers by this author A. Nuno-Gonzalez, Corresponding Author A. Nuno-Gonzalez [email protected] orcid.org/0000-0001-7252-1647 Department of Dermatology, Hospital Universitario La Paz, Madrid, Spain Facultad de Medicina, Universidad Autonoma de Madrid, Madrid, Spain Correspondence: A. Nuno-Gonzalez. E-mail: [email protected]Search for more papers by this authorK. Magaletsky, K. Magaletsky Department of Dermatology, Hospital Universitario La Paz, Madrid, Spain Facultad de Medicina, Universidad Autonoma de Madrid, Madrid, SpainSearch for more papers by this authorM. Feito Rodríguez, M. Feito Rodríguez orcid.org/0000-0002-2645-8904 Department of Dermatology, Hospital Universitario La Paz, Madrid, Spain Facultad de Medicina, Universidad Autonoma de Madrid, Madrid, SpainSearch for more papers by this authorA. Mayor Ibarguren, A. Mayor Ibarguren Department of Dermatology, Hospital Universitario La Paz, Madrid, Spain Facultad de Medicina, Universidad Autonoma de Madrid, Madrid, SpainSearch for more papers by this authorM.J. Beato, M.J. Beato Department of Pathology, Hospital Universitario La Paz, Madrid, SpainSearch for more papers by this authorE. Ruiz Bravo, E. Ruiz Bravo Department of Pathology, Hospital Universitario La Paz, Madrid, SpainSearch for more papers by this authorP. Herranz Pinto, P. Herranz Pinto Department of Dermatology, Hospital Universitario La Paz, Madrid, Spain Facultad de Medicina, Universidad Autonoma de Madrid, Madrid, SpainSearch for more papers by this author First published: 08 December 2020 https://doi.org/10.1111/jdv.17074Citations: 4Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1Nuno-Gonzalez A, Martin-Carrillo P, Magaletsky K et al. Prevalence of mucocutaneous manifestations, oral and palmoplantar findings in 666 patients with COVID-19 in a field hospital in Spain. Br J Dermatol 2021; 184: 184–185. 10.1111/bjd.19564 CASPubMedWeb of Science®Google Scholar 2Galván Casas C, Català A, Carretero Hernández G et al. Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases. Br J Dermatol 2020; 183: 71-77. 10.1111/bjd.19163 CASPubMedWeb of Science®Google Scholar 3Hernandez C, Bruckner AL. Focus on “COVID Toes”. JAMA Dermatol 2020; 156: 1003. 10.1001/jamadermatol.2020.2062 PubMedWeb of Science®Google Scholar 4Mendez-Rios JD, Martens CA, Bruno DP, Porcella SF, Zheng Z-M, Moss B. Genome sequence of erythromelalgia-related poxvirus identifies it as an ectromelia virus strain. PLoS One 2012; 7: e34604. 10.1371/journal.pone.0034604 CASPubMedWeb of Science®Google Scholar 5Dobson JS, Levell NJ. Spotting Zika spots: descriptive features of the rash used in 66 published cases. Clin Exp Dermatol 2019; 44: 4–12. 10.1111/ced.13733 CASPubMedWeb of Science®Google Scholar 6Adışen E, Önder M. Acral manifestations of viral infections. Clin Dermatol 2017; 35: 40–49. 10.1016/j.clindermatol.2016.09.006 PubMedWeb of Science®Google Scholar 7Hueso L, Sanmartín O, Nagore E et al. Chemotherapy-induced acral erythema: a clinical and histopathologic study of 44 cases. Actas Dermo-Sifiliográficas Engl Ed 2008; 99: 281–290. 10.1016/S0001-7310(08)74677-5 CASPubMedGoogle Scholar 8Prévost G, Couppié P, Monteil H. Staphylococcal epidermolysis. Curr Opin Infect Dis 2003; 16: 71–76. 10.1097/00001432-200304000-00002 CASPubMedWeb of Science®Google Scholar 9Verdoni L, Mazza A, Gervasoni A et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet 2020; 395: 1771–1778. 10.1016/S0140-6736(20)31103-X CASPubMedWeb of Science®Google Scholar 10Putra BE, Adiarto S, Dewayanti SR, Juzar DA. Viral exanthem with “Spins and needles sensation” on extremities of a COVID-19 patient: a self-reported case from an Indonesian medical frontliner. Int J Infect Dis 2020; 96: 355–358. 10.1016/j.ijid.2020.05.020 CASPubMedWeb of Science®Google Scholar Citing Literature Volume35, Issue4April 2021Pages e247-e249 This article also appears in:JEADV COVID-19 articles ReferencesRelatedInformation

Patients' perception of disease management can influence compliance to treatment and thus affect outcome.To survey patients and physicians on their perceptions of biologic therapy for treating psoriasis in an outpatient setting.The subjective impact of intravenous treatment of severe psoriasis on patients and physicians in the outpatient setting was determined via two surveys.Between September and November 2014, 24 dermatologists and 90 patients were surveyed. Treatment with biologic agents in the outpatient setting was associated with a high level of patient satisfaction: 93.3% of patients considered their psoriasis well controlled and 46.1% reported complete control. Patients highly valued the feeling of greater disease control (72.2%), regular follow-up (66.7%) and rapid improvement of psoriasis (58.9%) when attending an outpatient setting. Other positive aspects of outpatient treatment were control of other health issues and perceived improvements in quality of life (QoL). Outpatient attendance was high; with 90% of patients keeping scheduled appointments and 79.2% of physicians acknowledged that they were able to monitor their patients' condition more closely.Administration of treatment in an outpatient setting may provide a feeling of improved QoL and disease control.

Chronic hepatitis C virus infection (HCV) is classically associated with such dermatologic conditions as mixed cryoglobulinemia (MC), porphyria cutanea tarda (PCT) and lichen planus. This review focuses on the response of these entities to interferon alpha (IFN) therapy, which has an immunomodulatory activity and may modify their course. The presence of certain HCV-associated dermatologic disorders, as PCT, may predict the patients virological response to IFN therapy. On the other hand, the course of some dermatologic disorders, as MC, during treatment with IFN, may be an early indicator of virologic response. In any case, physicians should know how to handle the most common dermatologic side effects of IFN, which may affect the quality of life of patients, complicating the adherence to treatment.

International Journal of DermatologyVolume 60, Issue 3 p. 372-375 Case report Recalcitrant molluscum contagiosum successfully treated with intralesional cidofovir in a patient with HIV/AIDS Lucía Quintana-Castanedo MD, Corresponding Author luciaquintana.e@gmail.com Department of Dermatology, La Paz University Hospital, Madrid, Spain Correspondence Lucía Quintana-Castanedo, md Department of Dermatology La Paz Hospital Paseo de la Castellana 261 Z.C 28046 Madrid Spain E-mail: luciaquintana.e@gmail.comSearch for more papers by this authorEloy J. Tarín-Vicente MD, Department of Dermatology, La Paz University Hospital, Madrid, SpainSearch for more papers by this authorClara Chiloeches-Fernández MD, Department of Dermatology, La Paz University Hospital, Madrid, SpainSearch for more papers by this authorElena Sendagorta-Cudós PhD, Department of Dermatology, La Paz University Hospital, Madrid, SpainSearch for more papers by this authorPedro Herranz-Pinto PhD, Department of Dermatology, La Paz University Hospital, Madrid, SpainSearch for more papers by this author Lucía Quintana-Castanedo MD, Corresponding Author luciaquintana.e@gmail.com Department of Dermatology, La Paz University Hospital, Madrid, Spain Correspondence Lucía Quintana-Castanedo, md Department of Dermatology La Paz Hospital Paseo de la Castellana 261 Z.C 28046 Madrid Spain E-mail: luciaquintana.e@gmail.comSearch for more papers by this authorEloy J. Tarín-Vicente MD, Department of Dermatology, La Paz University Hospital, Madrid, SpainSearch for more papers by this authorClara Chiloeches-Fernández MD, Department of Dermatology, La Paz University Hospital, Madrid, SpainSearch for more papers by this authorElena Sendagorta-Cudós PhD, Department of Dermatology, La Paz University Hospital, Madrid, SpainSearch for more papers by this authorPedro Herranz-Pinto PhD, Department of Dermatology, La Paz University Hospital, Madrid, SpainSearch for more papers by this author First published: 23 September 2020 https://doi.org/10.1111/ijd.15210 Conflict of interest: None. Funding source: None. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat Volume60, Issue3March 2021Pages 372-375 RelatedInformation

Atopic dermatitis (AD) can have a profound negative impact on the quality of life (QoL) of patients. We analyzed the long-term changes in AD symptoms, QoL, and patient assessment of treatment effect in adults with moderate-to-severe AD treated for 2 years with dupilumab.LIBERTY AD OLE (NCT01949311) is a multicenter, open-label extension (OLE) study in adults with moderate-to-severe AD who previously participated in dupilumab clinical trials (parent studies). Patients received dupilumab 300 mg weekly. Patient-Oriented Eczema Measure (POEM), Dermatology Life Quality Index (DLQI), EQ-5D-3L, and the Patient Global Assessment of Treatment Effect (PGATE) were assessed at weeks 48 and 100.A total of 2677 patients were included in the OLE, and 1028 completed week 100. By weeks 48 and 100, 94.1% and 95.6% of patients achieved a ≥ 4-point change in POEM from the parent study baseline (PSBL), respectively, and 93.3% and 93.4% of patients had achieved a ≥ 4-point change in DLQI from PSBL, respectively. At week 100, 35.1% of patients had a POEM score ≤ 2 (AD clear/almost clear) compared with 0.1% at PSBL, and 49.9% had a DLQI score of 0 or 1 (no effect at all on patient's life) compared with 1.5% at PSBL. At week 100, 74.5-97.3% of patients reported no effect of AD on the individual EQ-5D-3L domains, and 93.8% rated the effect of dupilumab treatment as "excellent," "very good," or "good" according to PGATE.In adults with moderate-to-severe AD, dupilumab treatment over 2 years resulted in sustained improvements in patient-reported symptoms and QoL and a favorable patient perception of treatment effect.ClinicalTrials.gov Identifier: NCT01949311. Supplementary material 1 (MP4 552250 kb).Atopic dermatitis is a common skin disease that causes scaly, itchy skin. It can have a profoundly negative effect on a patient’s quality of life (QoL). In short-term clinical trials, dupilumab treatment resulted in significant improvements in signs and symptoms of atopic dermatitis, and in the QoL reported by patients, together with acceptable safety. In this study, adults with moderate-to-severe atopic dermatitis who had completed one of the short-term clinical trials continued dupilumab treatment, including those who had taken placebo. This study allowed researchers to continue to evaluate how dupilumab worked in the long term, including its impact on patient-reported outcomes, which measure the success of treatment from the patient’s own perspective. The results were evaluated at approximately 1 and 2 years of this open-label extension study and were compared with the period just before the patient was first treated with dupilumab so that the effect of dupilumab could be seen. At approximately 1 and 2 years, most patients had achieved clinically meaningful improvements in two measures: Patient Oriented Eczema Measure, a tool used by patients to self-report the severity of their symptoms, and Dermatology Life Quality Index, which allows patients to report the effect of the disease on their QoL. Additionally, in this open-label extension study, most patients described their experience of being treated with dupilumab as “excellent,” “very good,” or “good” using the Patient Global Assessment of Treatment Effect questionnaire. Dupilumab treatment resulted in sustained improvements in atopic dermatitis and was regarded favorably by patients.

In spite of the relative control of the disease in the late 20th century, syphilis, like other sexually transmitted diseases, has undergone a strong resurgence in recent years in the large urban centers of Europe and the US. Many patients with syphilis are also HIV+. The association between the two diseases may modify the clinical evolution of syphilis and increase the incidence of neurological disorders. We discuss the cases of three patients diagnosed with both diseases last year, with neurological presentation of syphilis occurring early and ophthalmic or cochlear vestibular involvement. This recent outbreak of syphilis seems to lead to an increase in the number of atypical cases presenting in our daily practice, where we must be prepared for early diagnosis and treatment.

Skin Research and TechnologyVolume 26, Issue 4 p. 608-609 LETTER TO THE EDITOR High-frequency ultrasonography of bullous pilomatricoma Ana Isabel Rodríguez Bandera, Corresponding Author Ana Isabel Rodríguez Bandera [email protected] orcid.org/0000-0002-9734-8147 Department of Dermatology, La Paz University Hospital, Madrid, Spain Correspondence Ana Isabel Rodríguez Bandera, Department of Dermatology, La Paz University Hospital, Paseo de la Castellana 261, Z.C 28046 Madrid, Spain. Email: [email protected]Search for more papers by this authorNicholas Stewart, Nicholas Stewart The Skin Hospital, Sydney, AustraliaSearch for more papers by this authorPedro Herranz Pinto, Pedro Herranz Pinto Department of Dermatology, La Paz University Hospital, Madrid, SpainSearch for more papers by this author Ana Isabel Rodríguez Bandera, Corresponding Author Ana Isabel Rodríguez Bandera [email protected] orcid.org/0000-0002-9734-8147 Department of Dermatology, La Paz University Hospital, Madrid, Spain Correspondence Ana Isabel Rodríguez Bandera, Department of Dermatology, La Paz University Hospital, Paseo de la Castellana 261, Z.C 28046 Madrid, Spain. Email: [email protected]Search for more papers by this authorNicholas Stewart, Nicholas Stewart The Skin Hospital, Sydney, AustraliaSearch for more papers by this authorPedro Herranz Pinto, Pedro Herranz Pinto Department of Dermatology, La Paz University Hospital, Madrid, SpainSearch for more papers by this author First published: 07 January 2020 https://doi.org/10.1111/srt.12828Citations: 3 Funding information The lead author is currently sponsored by an Excellence Grant from "Fundación Piel Sana" and "Academia Española de Dermatología y Venereología (AEDV)." The sponsor has no role in the design or conduct of the study in the collection, analysis, and interpretation of data or in the preparation, review, or approval of the manuscript. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. CONFLICT OF INTEREST Authors declare no conflict of interest. Citing Literature Volume26, Issue4July 2020Pages 608-609 RelatedInformation

A young girl is reported suffering from multiple congenital anomalies typical of Rubinstein-Taybi syndrome, in association with cutaneous lesions of piebaldism and occipital poliosis. Clinical characteristics of both entities are described and cutaneous manifestations of Rubinstein-Taybi syndrome are reviewed. To the best of our knowledge, this is the first case reporting such an association.

A pesar del relativo control de la enfermedad durante la segunda mitad del siglo xx, la sífilis, como otras enfermedades de transmisión sexual, ha reaparecido con fuerza durante los últimos años en grandes focos urbanos de Europa y Norteamérica. Un porcentaje importante de pacientes con sífilis sufren además infección por virus de la inmunodeficiencia humana (VIH). La asociación de ambas enfermedades puede modificar la evolución clínica de la infección luética y aumentar la incidencia de eventos neurológicos. Presentamos los casos de tres pacientes diagnosticados durante este último año en los que ambas enfermedades coexisten, manifestándose la sífilis con clínica neurológica precoz y afectación oftálmica o cócleo-vestibular. Este reciente brote de sífilis parece traducirse en un aumento de los casos atípicos en nuestra práctica clínica diaria que debemos estar preparados para reconocer y tratar de forma precoz. In spite of the relative control of the disease in the late 20th century, syphilis, like other sexually transmitted diseases, has undergone a strong resurgence in recent years in the large urban centers of Europe and the US. Many patients with syphilis are also HIV+. The association between the two diseases may modify the clinical evolution of syphilis and increase the incidence of neurological disorders. We discuss the cases of three patients diagnosed with both diseases last year, with neurological presentation of syphilis occurring early and ophthalmic or cochlear vestibular involvement. This recent outbreak of syphilis seems to lead to an increase in the number of atypical cases presenting in our daily practice, where we must be prepared for early diagnosis and treatment.

It is well known that primary systemic amyloidosis [light chain (AL) amyloidosis] is associated with hidden dyscrasia or multiple myeloma. Acquired cutis laxa (cutis laxa acquisita; CLA) has also been described in patients with plasma cell dyscrasias, including multiple myeloma. We report a case in which haemorrhagic oral bullae were the first sign of an undiagnosed primary systemic amyloidosis related to multiple myeloma IgG‐λ and previously diagnosed CLA. There is only one report in literature of this rare triple association; however, in that case the patient did not have oral mucosal involvement or bullous amyloidosis.

International Journal of DermatologyVolume 56, Issue 11 p. 1180-1181 Case Report Subacute cutaneous lupus erythematosus induced by masitinib Daniel Nieto-Rodríguez MD, Corresponding Author Daniel Nieto-Rodríguez MD dnr348@gmail.com Department of Dermatology, La Paz Hospital, Madrid, Spain Correspondence Daniel Nieto Rodríguez, md Department of Dermatology, La Paz Hospital Paseo de la Castellana 261 Z.C 28046 Madrid Spain E-mail: dnr348@gmail.comSearch for more papers by this authorCristina Gómez-Fernández MD, Cristina Gómez-Fernández MD Department of Dermatology, La Paz Hospital, Madrid, SpainSearch for more papers by this authorJosé Manuel Rueda-Carnero MD, José Manuel Rueda-Carnero MD Department of Dermatology, La Paz Hospital, Madrid, SpainSearch for more papers by this authorPedro Herranz-Pinto MD, Pedro Herranz-Pinto MD Department of Dermatology, La Paz Hospital, Madrid, SpainSearch for more papers by this author Daniel Nieto-Rodríguez MD, Corresponding Author Daniel Nieto-Rodríguez MD dnr348@gmail.com Department of Dermatology, La Paz Hospital, Madrid, Spain Correspondence Daniel Nieto Rodríguez, md Department of Dermatology, La Paz Hospital Paseo de la Castellana 261 Z.C 28046 Madrid Spain E-mail: dnr348@gmail.comSearch for more papers by this authorCristina Gómez-Fernández MD, Cristina Gómez-Fernández MD Department of Dermatology, La Paz Hospital, Madrid, SpainSearch for more papers by this authorJosé Manuel Rueda-Carnero MD, José Manuel Rueda-Carnero MD Department of Dermatology, La Paz Hospital, Madrid, SpainSearch for more papers by this authorPedro Herranz-Pinto MD, Pedro Herranz-Pinto MD Department of Dermatology, La Paz Hospital, Madrid, SpainSearch for more papers by this author First published: 22 September 2017 https://doi.org/10.1111/ijd.13762Citations: 3 Conflict of interest: None. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume56, Issue11November 2017Pages 1180-1181 RelatedInformation

Las infecciones por virus herpes presentan una frecuencia no desdeñable en pacientes hematológicos. El primer caso corresponde a una paciente con leucemia linfática crónica con un herpes genital extenso refractario a aciclovir, con respuesta parcial a foscarnet que hubo que suspender por efectos secundarios sistémicos. El segundo caso es el de una paciente con un linfoma de Hodgkin folicular que presentaba un herpes hipertrófico refractario a tratamiento con aciclovir, que respondió a cidofovir intralesional e imiquimod tópico. Los pacientes hematológicos, al igual que otros enfermos inmunodeprimidos, pueden presentar manifestaciones atípicas de infección por virus herpes, así como resistencia a los tratamientos que actúan por medio de la timidina quinasa viral. Esto hace necesario tener una alta sospecha clínica para poder alcanzar un diagnóstico precoz, y conocer los diferentes tratamientos alternativos disponibles. Herpesvirus infections are not uncommon in hematologic patients. Our first patient, diagnosed with chronic lymphatic leukemia, presented extensive genital herpes infection refractory to treatment with aciclovir and with a partial response to foscarnet, which had to be withdrawn due to systemic adverse effects. The second patient, diagnosed with follicular Hodgkin lymphoma, presented hypertrophic herpes infection refractory to treatment with aciclovir but that responded to intralesional cidofovir and topical imiquimod. As in other immunocompromised patients, herpesvirus infection in hematologic patients can present atypical manifestations, as well as resistance to treatments that are activated by the viral thymidine kinase. A high level of clinical suspicion is therefore needed to make an early diagnosis, together with extensive knowledge of the different treatments available.

A 38-year-old white man had a 10-year history of human immunodeficiency virus (HIV) infection (A3), with no episodes of opportunistic diseases and in good immunologic recovery (CD4 cell count: 450 and indetectable HIV viral load) while on HAART. He presented with a two-month history of mild anal symptoms, including pruritus and episodic bleeding. He referred past episodes of anal warts, self-treated with several topical compounds, all proven unsuccessful. Perianal examination showed erythema and scratching. A 0.5cm sized tumor, with infiltration at the base was detected on digital exam, located at 15mm from the anal margin. Local biopsy driven by high-resolution anuscopy (AAR) yielded a final diagnosis of infiltrative epidermoid carcinoma. Might that neoplasia have been prevented?

Introduction: In our hospital, the detection of anti-TNF and anti-drug antibody levels are used in clinical practice and can aim the clinicians to provide a safe and an efficient therapy. Objective: To analyse the economic impact of the biological therapy optimization in patients with rheumatic and psoriasis by monitoring the drug and anti-drug antibody serum levels. Method: Ambispective observational study. The retrospective study period extended from 2009 to 2012 and includes the results without optimization. The prospective study period started in 201􀀖 and includes financial results with doses and administration intervals optimized. Drugs most frequently implicated were infliximab, etanercept and adalimumab. Results: We checked doses and administration intervals of 449 adults with rheumatic diseases (41.8% under optimized regimen) and 167 patients with psoriasis (38.9% under optimized regimen) in 2013. The annual cost per average patient decreased by €1,345 in arthritic diseases and by €1,417 in psoriasis compared to the previous year. Conclusion: Optimized treatments are more efficient, leading to a reduction in the annual costs per average patient. The access to the clinical information of patients and the integration of pharmacists into multidisciplinary teams alongside provide a better high-quality pharmaceutical care, and evaluation of economic and clinical results

A 56-year-old white man consulted us with a generalised rash that had occurred 3 days after being started on terazosin 2 mg/day for benign prostatic hyperplasia. His medical and family history was unremarkable, and he had not taken any other medication. He had mild fever and asthenia, and pruritus was intense. We saw a widespread eruption of scaling erythematous plaques with a violaceous hue on the trunk (figure) and extremities, affecting his palms and soles but sparing the mucous membranes. The lesions had sharp borders and covered almost the entire body surface, with patches of normal skin among them. We noted non-specific inguinal lymphadenopathy, but the remainder of clinical examination was normal. Haematological and biochemical parameters, including liver-function tests, were normal, except for mild leucocytosis (leucocytes 14·4 10/L, eosinophils 1·4 10/L) and a slightly raised erythrocyte sedimentation rate (25 mm/h). Serological tests for antinuclear antibodies, rheumatoid factor, syphilis, hepatitis B and C, and EpsteinBarr virus were all negative. Histopathological assessment of a skin biopsy sample showed a pattern suggestive of a drug reaction, consisting of subtle basal spongiosis and mild lymphocytic exocytosis, with some apoptotic keratinocytes in the basal epidermal layer. In addition, a mild perivascular lymphocytic infiltrate with scant eosinophils was present in the upper dermis. Terazosin was stopped, and treatment with oral methylprednisolone (40 mg/day) and emollients resulted in complete recovery in 2 weeks. Terazosin is a long-acting -1 selective blocking agent that was used originally for treatment of hypertension. Multicentre placebo-controlled studies have reported its efficacy in benign prostatic hypertrophy. The rare and usually mild adverse effects related to the drug’s pharmacological action are dose-related and include headache, dizziness, and asthenia. Adverse cutaneous reactions are rare, although non-specific mild rashes have been occasionally reported. In view of the clear temporal relation between the onset of terazosin therapy and the cutaneous eruption and the resolution of the skin lesions when terazosin was 95

: Various treatment options are available for use in moderate-to-severe psoriasis and election is dependent upon the clinical criteria applied by the attending physician. We undertook a survey among dermatologists to assess the treatment of moderate-to-severe psoriasis currently used in clinical practice in Spain. A cross-sectional study was performed by sending a questionnaire to dermatologists in Spain who treat patients with moderate-to-severe psoriasis. The questionnaire comprised 33 items distributed in 6 sections: profile of the dermatologist, case load, patient profile, follow-up and management of the disease, treatment regimens, and assessment of pharmacological treatments. According to the responses of the 164 dermatologists surveyed, 6.8% of patients seen in their clinics have moderate-to-severe psoriasis; of those, 45.8% receive systemic treatment and 22.9% are treated with biologic drugs. In many of those patients (50.2%), the dermatologist felt that a change in treatment was necessary; in 51.1% of cases, this change would be from systemic therapy to a biologic drug. The principal reason for the change (50.8%) would be lack of efficacy or the appearance of adverse effects. Efficacy and safety were considered essential criteria in the choice of an appropriate treatment (82.9% and 28.0% of dermatologists, respectively). Patient quality of life was also considered an essential consideration in choice of treatment by 28.0% of dermatologists. Optimal treatment for moderate-to-severe psoriasis should be effective and safe, and improve patient quality of life. This makes it essential to use drugs with an excellent efficacy and safety profile. Las estrategias terapéuticas existentes para la psoriasis moderada-grave son múltiples, siendo el criterio clínico fundamental para su elección. Para conocer la realidad terapéutica de la psoriasis moderada-grave, se realizó una encuesta de opinión basada en práctica clínica habitual en España. Estudio transversal mediante encuesta a dermatólogos que tratan a pacientes con psoriasis moderada-grave en España. La encuesta constaba de 33 ítems distribuidos en 6 secciones: perfil del dermatólogo, carga asistencial, perfil de paciente, seguimiento y manejo terapéutico de la enfermedad, pautas de tratamiento y valoración de fármacos. Según los datos de opinión y experiencia de los 164 dermatólogos encuestados, el 6,8% de los pacientes atendidos en consulta presentarían psoriasis moderada-grave, de los que el 45,8% estarían tratados con un fármaco sistémico y el 22,9% con uno biológico. En muchos de estos pacientes (50,2%) se haría un cambio de tratamiento, de sistémico a biológico en el 51,1% de los casos. El principal motivo de cambio (50,8%) sería una falta de eficacia o aparición de efectos adversos. La eficacia y seguridad serían criterios imprescindibles a considerar para la elección de un tratamiento óptimo (82,9 y 28,0% de los dermatólogos, respectivamente). Un 28,0% de los dermatólogos consideró también imprescindible la valoración de la calidad de vida de los pacientes para instaurar un tratamiento. El tratamiento óptimo para la psoriasis moderada-grave debería ser eficaz, seguro y capaz de mejorar la calidad de vida del paciente. Para ello, es imprescindible el uso de fármacos de elevada eficacia y seguridad.

An 81-year-old woman presents with slowly growing, asymptomatic lesions on both feet and ankles. Which test should be ordered to establish the diagnosis?

Cirsoid aneurysm is a small vascular proliferation characterized by small to medium-sized channels with features of arteries and veins, that present as small, blue or red asymptomatic papule. We report a case of a crisoid aneurysm on the forhead of an HIV patient that suggested a Kaposi sarcoma as a differential diagnosis.

International Journal of DermatologyVolume 54, Issue 9 p. e373-e375 Correspondence Herpes zoster: a potential risk associated with fingolimod treatment Ander Mayor Ibarguren MD, Corresponding Author Ander Mayor Ibarguren MD Department of Dermatology, La Paz University Hospital, Madrid, Spain Ander Mayor Ibarguren, md Department of Dermatology La Paz University Hospital Madrid Spain E-mail: andermayor@gmail.comSearch for more papers by this authorCristina Gómez Fernández MD, Cristina Gómez Fernández MD Department of Dermatology, La Paz University Hospital, Madrid, SpainSearch for more papers by this authorAntonio Tallón Barranco MD, Antonio Tallón Barranco MD Department of Neurology, La Paz University Hospital, Madrid, SpainSearch for more papers by this authorMireya Fernández Fournier MD, Mireya Fernández Fournier MD Department of Neurology, La Paz University Hospital, Madrid, SpainSearch for more papers by this authorJéssica González Ramos MD, Jéssica González Ramos MD Department of Dermatology, La Paz University Hospital, Madrid, SpainSearch for more papers by this authorMaría P. Romero Gómez MD, María P. Romero Gómez MD Department of Microbiology, La Paz University Hospital, Madrid, SpainSearch for more papers by this authorPedro Herranz Pinto MD, Pedro Herranz Pinto MD Department of Dermatology, La Paz University Hospital, Madrid, SpainSearch for more papers by this author Ander Mayor Ibarguren MD, Corresponding Author Ander Mayor Ibarguren MD Department of Dermatology, La Paz University Hospital, Madrid, Spain Ander Mayor Ibarguren, md Department of Dermatology La Paz University Hospital Madrid Spain E-mail: andermayor@gmail.comSearch for more papers by this authorCristina Gómez Fernández MD, Cristina Gómez Fernández MD Department of Dermatology, La Paz University Hospital, Madrid, SpainSearch for more papers by this authorAntonio Tallón Barranco MD, Antonio Tallón Barranco MD Department of Neurology, La Paz University Hospital, Madrid, SpainSearch for more papers by this authorMireya Fernández Fournier MD, Mireya Fernández Fournier MD Department of Neurology, La Paz University Hospital, Madrid, SpainSearch for more papers by this authorJéssica González Ramos MD, Jéssica González Ramos MD Department of Dermatology, La Paz University Hospital, Madrid, SpainSearch for more papers by this authorMaría P. Romero Gómez MD, María P. Romero Gómez MD Department of Microbiology, La Paz University Hospital, Madrid, SpainSearch for more papers by this authorPedro Herranz Pinto MD, Pedro Herranz Pinto MD Department of Dermatology, La Paz University Hospital, Madrid, SpainSearch for more papers by this author First published: 14 July 2015 https://doi.org/10.1111/ijd.12878Citations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume54, Issue9September 2015Pages e373-e375 RelatedInformation