Effectiveness of Mediterranean Diet Implementation in Dry Eye Parameters: A Study of PREDIMED-PLUS Trial

This study was cofounded by grants from the Spanish Ministry of Science-Instituto de Salud Carlos III (PI17/00764) and FEDER funds. The authors wish to thank Ingrid de Ruiter, MBChB, Ph.D., for English language support.The purpose of this study is to evaluate the effect of a Mediterranean diet supplemented with extra virgin olive oil and nuts on dry eye parameters. The participants in this study were randomized into one of the two interventional arms: (1) a standard intervention group, a Mediterranean diet supplemented with extra virgin olive oil and nuts; and (2) an intensive intervention group, based on a hypocaloric Mediterranean diet and an intensive lifestyle program with physical activity and weight-loss goals. In both groups, common dry eye tests were conducted at baseline and after six months: the Ocular Surface Disease Index (OSDI), the Dry Eye Scoring System (DESS), tear break-up time (TBUT), the Schirmer’s test, and the Oxford staining grade. Sixty-seven eyes were examined. After six months, dry eye parameters improved in both groups; differences between groups were favorable for the intensive intervention group. The implementation of a Mediterranean diet pattern was beneficial for the selected patients with dry eye, and could be beneficial for patients with dry eye in general. Behavioral support for diet adherence and the promotion of healthy lifestyles (exercise) and weight loss (calorie restriction) have an added positive effect.Instituto de Salud Carlos III Spanish Government PI17/00764European Union (EU

Quality of Life in Cohabitants of Patients with Hidradenitis Suppurativa: A Cross-sectional Study

The following are available online at http://www.mdpi.com/1660-4601/17/16/6000/s1, Table S1: Sociodemographic variables of patients and cohabitants; Table S2: Clinical variables of patients with hidradenitis suppurativa.Hidradenitis suppurativa (HS) is a chronic inflammatory disease that impairs patients’ physical and mental health. However, few studies have considered the consequences of HS on cohabitants. The aims of this study were to explore the impact of HS on the quality of life (QOL) of cohabitants and to assess potentially associated factors. A cross-sectional study was conducted and patients with HS and their cohabitants were invited to participate. Validated questionnaires were used to measure QOL, anxiety and depression, type D personality and sexual dysfunction. The clinical variables of patients and the demographic characteristics of cohabitants were also collected. Twenty-seven patients and 27 cohabitants were included for analysis. Patients and cohabitants presented significant QOL impairment. A direct association was found between the Dermatology Life Quality Index (DLQI) and the Familiar Dermatology Life Quality Index (FDLQI). DLQI scores were associated with the presence of negative affectivity, a trait typical of type D personality, as well as with cohabitants’ anxiety. FDLQI scores were associated with cohabitant anxiety and patient depression. Hidradenitis suppurativa damages quality of life in patients and cohabitants. Identifying potential psychological factors could help us to recognize at-risk patients and apply personalized treatments for them and their environment

¿Cuánta carga asistencial suponen las dermatosispediátricas en la actividad ambulatoria en ladermatología espa˜nola? Resultados del muestreoaleatorio nacional DIADERM

Un total de 20.097 diagnósticos fueron efectuados en pacientes menores de18 a˜nos, lo que supone un 12% del total de los codificados en DIADERM. Las infecciones víri-cas, el acné y la dermatitis atópica fueron los diagnósticos más comunes (43,9% de todos losdiagnósticos). No se observaron diferencias estadísticamente significativas en la proporción dediagnósticos atendidos en las consultas monográficas frente a las generales, así como en losregistrados en el ámbito público frente al privado. Tampoco las hubo en los diagnósticos enfunción de la época de la encuesta (enero y mayo).Conclusiones: La atención a pacientes pediátricos por parte de dermatólogos en Espa˜na suponeuna proporción significativa de la actividad habitual. Estos datos nos permiten descubrir áreasde mejora en la comunicación y la formación de los pediatras de atención primaria, comola necesidad del refuerzo de actividades formativas dirigidas al mejor tratamiento de acné ylesiones pigmentadas (y manejo básico de la dermatoscopia) en este ámbito asistencial.SurveyAbstractBackground: Visits for skin conditions are very common in pediatric primary care, and many ofthe patients seen in outpatient dermatology clinics are children or adolescents. Little, however,has been published about the true prevalence of these visits or about their characteristics.Material and methods: Observational cross-sectional study of diagnoses made in outpatientdermatology clinics during 2 data-collection periods in the anonymous DIADERM National Ran-dom Survey of dermatologists across Spain. All entries with an International Classification ofDiseases, Tenth Revision code related to dermatology in the 2 periods (84 diagnoses) were collec-ted for patients younger than 18 years and classified into 14 categories to facilitate analysisand comparison.Results: In total, the search found 20 097 diagnoses made in patients younger than 18 years (12%of all coded diagnoses in the DIADERM database). Viral infections, acne, and atopic dermatitiswere the most common, accounting for 43.9% of all diagnoses. No significant differences wereobserved in the proportions of diagnoses in the respective caseloads of specialist vs. generaldermatology clinics or public vs. private clinics. Seasonal differences in diagnoses (January vs.May) were also nonsignificant.Conclusions: Pediatric care accounts for a significant proportion of the dermatologist’s caseloadin Spain. Our findings are useful for identifying opportunities for improving communication andtraining in pediatric primary care and for designing training focused on the optimal treatmentof acne and pigmented lesions (with instruction on basic dermoscopy use) in these settings.El estudio DIADERM fue promovido por la Fundación Piel Sanade la AEDV, que recibió ayuda económica de Novarti

Sexual Dysfunction and Quality of Life in Patients with Hidradenitis Suppurativa and Their Partners

Hidradenitis suppurativa (HS) is a chronic skin disease that profoundly affects patients’ quality of life (QoL) and sexuality. Few data are available on the impact of HS on patients’ partners. We aimed to explore the QoL and sexual function of patients’ partners and the factors associated with their impairment and to compare the QoL and sexual function of single patients and those in a stable relationship. We conducted a cross-sectional study at Hospital Universitario Virgen de las Nieves (Granada, Spain) and at theWroclaw Medical University (Wroclaw, Poland). Patients over the age of 16 years attending their scheduled follow-up and their partners, if any, were included. The Dermatology Life Quality Index (DLQI) and the Family Dermatology Life Quality Index (FDLQI) were used to estimate the QoL of patients and partners, respectively. The FSFI-6 was used to determine sexual dysfunction in women and the IIEF-5 for erectile dysfunction in men. Thirty-four single patients and twenty-eight patients in a stable relationship and their partners were included. Patients had a very large impact (DLQI 12.5 7.5) and their partners a moderate impact (FDLQI 10.3 7.1) in their QoL due to HS. Women with HS had a high prevalence of sexual dysfunction (13/32, 40.6%) and men of erectile dysfunction (19/30, 63.3%). Male partners also had a high prevalence of erectile dysfunction (10/17, 58.8%), while only one female partner had sexual dysfunction (1/11, 9.1%). Factors related to disease severity, intensity of symptoms and body mass index were associated with poorer QoL in partners and time of disease evolution with greater erectile dysfunction in male partners. In conclusion, HS not only profoundly affects the QoL and sexuality of patients but also of their partners. Several risk factors have been identified, which should be taken into account in the holistic approach of the disease

Type D Personality Is Associated with Poorer Quality of Life in Patients with Chronic Spontaneous Urticaria: A Cross-sectional Study

Type D personality (TDp) is a stable personality type that has been associated with poor quality of life in the general population and in patients with a variety of diseases, such as cancer, cardiac diseases, and dermatological diseases (e.g. psoriasis). To date, the potential association between chronic spontaneous urticaria and TDp has not been studied. The aim of this study is to analyse the impact of TDp on patients with chronic spontaneous urticaria, regarding mood disturbances, quality of life, sexuality, and sleep disturbances. A cross-sectional study including 75 patients with chronic spontaneous urticaria was performed. Data on sociodemographic variables and disease activity, quality of life, sleep, sexual dysfunction, anxiety, depression and TDp were collected using validated questionnaires. TDp was present in 28% (21/75) of the patients. Although TDp was not related to worse disease control, the presence of anxiety and depression was higher in patients with TDp. Regarding quality of life, TDp was associated with poorer quality of life and higher frequency of sleep disturbances. Prevalence of TDp in patients with chronic spontaneous urticaria is similar to that in the general population. It is associated with mood status disturbances and worse quality of life regardless of disease severity, especially in the emotional and psychological domains. This group of patients could benefit from additional psychological support as a complement to their medical treatment

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

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

Dermatology Care in Spanish Public Hospitals: A Mapping Study of Health Care Resources and Medical and Surgical Activity in Dermatology Departments in 2019

Antecedentes y objetivo: No existen datos actualizados sobre los recursos asistenciales ni la actividad médico-quirúrgica de los servicios de dermatología espa˜noles. El objetivo de esta investigación es conocer la situación y actividad de dichos servicios durante el a˜no 2019. Material y métodos: Estudio transversal mediante cuestionario online distribuido a los jefes de servicio de dermatología de hospitales públicos espa˜noles. Resultados: De los 162 jefes de servicio encuestados, se obtuvo una participación del 36,4% (59/162). Se observó un déficit de personal generalizado, especialmente de dermatólogos en hospitales de complejidad media-baja. La principal causa del déficit de dermatólogos fue la ausencia de profesionales interesados. Las infraestructuras y equipamiento disponibles fueron superiores en los grandes complejos hospitalarios. La atención mixta presencial-telemática estuvo presente en más de la mitad de los centros. En el ámbito de las consultas monográficas, la de psoriasis fue la más implementada. Aproximadamente el 75% de los centros contaron con quirófanos con anestesista. Procedimientos quirúrgicos de mayor complejidad como la biopsia selectiva de ganglio centinela o la cirugía de Mohs se realizaban con mayor frecuencia en los grandes complejos hospitalarios. La hospitalización de pacientes y la presencia de dermatólogos residentes de guardia fueron igualmente más habituales en estos hospitales. La actividad docente e investigadora también se relacionó con la complejidad del hospital. Conclusiones: Nuestros resultados describen la situación de los servicios de dermatologíaespa˜noles justo antes de la pandemia por COVID-19, y pueden ser útiles para la gestión clínicay para definir líneas de trabajo y áreas de mejora.Background and objective: No recent data on health care resources and medical and surgical activity in Spanish dermatology departments are available in the literature. The aim of this study was to compile this information for 2019. Material and methods: Cross-sectional study based on an online survey sent to the heads of dermatology departments at public hospitals in Spain. Results: Of the 162 department heads contacted, 59 answered the survey (participation rate, 36.4%). General findings included a shortage of staff, especially dermatologists, in hospitals of low and medium complexity. The main reason given for the shortage of dermatologists was a lack of interested applicants. Large hospital complexes had more infrastructure and equipment. Over 50% of the departments surveyed used a combination of in-person and virtual visits. Psoriasis units were the most common specialized care units. Approximately 75% of the hospitals had operating rooms with an anesthetist. More complex procedures such as sentinel lymph node biopsy and Mohs micrographic surgery were performed more often in large hospital complexes. Hospitalization and the presence of dermatology residents working call shifts were also more common in these hospitals. Teaching and research activity differed according to hospital complexity. Conclusions: We have mapped health care resource availability and medical and surgical activity in Spanish dermatology departments prior to the COVID-19 pandemic. Our findings could be useful for improving clinical management and defining future actions and areas for improvement

Psychosocial Impairment as a Possible Cause of Sexual Dysfunction among Young Men with Mild Androgenetic Alopecia: A Cross-sectional Crowdsourcing Web-based Study

Finasteride 1 mg, one of the main treatments for male androgenetic alopecia (MAGA), may produce sexual dysfunction, but young men with MAGA could experience high psychosocial impairment because of changes in body image. Dissatisfaction with body image has been linked to an increase in problems with sexual function. To date no study has considered the possible effect of psychological impairment on sexual function of men with MAGA. Aim of our study was to explore the effect of psychosocial impairment produced by hair loss on the sexual function of men with MAGA. Patients and methods: Cross-sectional design. In total, 190 men with MAGA ranging 18-40 years old were recruited from an Internet online community. Participants completed an online survey comprising the SKINDEX-29 and the Massachusetts General Hospital Sex Functioning Questionnaire. Individuals with MAGA and moderate to severe psychosocial impairment had a higher risk of sexual dysfunction – adjusted odds ratio 2.1 (1.2-4.0; P=0.02) – compared with subjects with mild to absent impairment. Sexual desire and sexual arousal were the most affected elements of sexual response, but an increase in erectile dysfunction and reduced global satisfaction were also reported. We present the first study exploring the influence of MAGA psychosocial impairment on sexual function. Men between 18 and 40 years of age with moderate to severe MAGA psychosocial morbidity were found to have an increased risk of sexual dysfunction. Assessment of psychological morbidity and sexual function could be critical in patients with MAGA, particularly when considering treatment with finasteride.  </p

Alopecia Areata and Dexamethasone Mini-Pulse Therapy, A Prospective Cohort: Real World Evidence and Factors Related to Successful Response

The mini-pulse oral corticosteroids treatment for alopecia areata (AA) is an accessible treatment whose efficacy and adverse effects have not yet been properly described. The objective of the study was to assess the effectiveness and safety of the mini-pulse oral corticosteroids treatment in patients with AA, and to explore potential factors associated to the response in a real-world setting. An observational study of a prospective cohort to assess the effectiveness and safety of a mini-pulse dexamethasone treatment in patients with AA, who failed to improve with topical therapies, was performed. A SALT II score and other clinical and safety variables were recorded at baseline, 3, 6, 9, and 12 months. An overall significant and progressive decrease of the SALT score was found during treatment: SALT-50 response was achieved after 9 months in 51.8% of the patients. Hypothyroidism and early age of onset were predictors of the lack of response to treatment. The treatment combination with oral minoxidil showed no effect on the SALT score reduction. Dexamethasone daily and cumulative dose were associated with a higher percentage of side effects. To conclude, the mini-pulse oral corticosteroids treatment is an effective treatment for AA, although patients with an early onset of the disease and hypothyroidism may not benefit

Quality of Life and Mood Status Disturbances in Cohabitants of Patients with Alopecia Areata: A Cross-Sectional Study in a Spanish Population

A poor quality of life has been described in patients suffering from Alopecia Areata (AA). However, there is little evidence on how AA can impact on those living with patients. The aim of this study is to analyze the impact of AA on a cohabitant’s quality-of-life, mood status disturbances and sexual satisfaction. This is a cross-sectional study of AA patients and their cohabitants. Sociodemographic variables and disease severity, the quality of life, mood status disturbances and sexual dysfunction were collected using validated questionnaires. Eighty-four subjects were included in the study: 42 AA patients and 42 cohabitants. A poor quality of life and worse disease control in the patients were associated with a poorer quality of life of the family, higher scores of anxiety and depression, and the lower sexual satisfaction of cohabitants (p < 0.05). Anxiety and depression in patients were associated with worse family quality of life, higher rates of anxiety and less sexual satisfaction in cohabitants (p < 0.05). To conclude, AA seems to have an impact on the quality of life of cohabitants, leading to increased rates of anxiety, depression, a poorer quality of life, and reduced sexual satisfaction. In light of the results, a global approach for AA patients, including the care of the people who live with them, should be implemented