Terapia fotodinámica con luz de día en el tratamiento de la queilitis actínica

La queilitis actínica (QA) es una patología crónica premaligna que afecta generalmente al labio inferior y que se considera el equivalente de las queratosis actínicas en la piel1, 2, 3. Se han postulado múltiples tratamientos para la QA, no siendo ninguno de ellos definitivo. La terapia fotodinámica (TFD) con luz de día es una terapia ampliamente empleada en el tratamiento de las queratosis actínicas que ha demostrado unas tasas de efectividad similares a la TFD convencional, ocasionando un dolor nulo o mínimo4, 5. El objetivo de nuestro estudio fue describir nuestra experiencia en cuanto a la eficacia y la seguridad del tratamiento con TFD con luz de día de la QA. Entre mayo y octubre de 2018 se trataron seis pacientes. Tras un curetaje suave se les colocó un rollo de algodón en la mucosa labial interna para exponer el labio inferior y se les aplicó una cantidad suficiente de crema de aminolevulinato de metilo y, sin oclusión, se recomendó exposición a la luz del día ambiental durante dos horas. El resto de la piel se protegió con un protector solar FPS 50 +. Tras las dos horas de exposición, se lavó la zona tratada y se aplicó FPS 50 + en el labio. Se realizó otra sesión a las dos semanas y se revisó a los pacientes a los dos meses (Figura 1, Figura 2). Se evaluó a los pacientes mediante una escala clínica (superficie afecta y respuesta completa/parcial/no respuesta) y una escala EVA para el dolor. Las características de los pacientes tratados y los resultados del tratamiento están recogidos en la tabla 1. Cuatro de los pacientes (67%) mostraron una respuesta completa y dos una respuesta parcial con una reducción media de la superficie afecta de un 58,3%. El resultado medio en la escala de dolor fue de 0,5 sobre 10

Long-lasting contact dermatitis in patients with atopic dermatitis or psoriasis

[Background]: The aetiology of contact dermatitis, a common inflammatory skin disorder, is often complex and multifactorial. [Objectives]: To describe the characteristics of patients with contact dermatitis who also have concomitant atopic dermatitis or psoriasis. [Methods]: Between 2000 and 2011, adult patients with chronic contact dermatitis (six months or more), which also had concomitant atopic dermatitis or psoriasis, were recruited for a descriptive retrospective study in a tertiary care Spanish hospital. Univariate and multivariate analyses were used for the analysis of the collected data. [Results]: 76 patients with atopic dermatitis and 130 with psoriasis were recruited. The most frequent site of contact dermatitis in both groups was the hands. The most frequent clinically relevant allergen in both groups was nickel sulphate. According to multivariate logistic regression, a statistically significant association was found between facial contact dermatitis and atopic dermatitis (adjusted OR 0.2 95% CI: 0.05–0.8; P = 0.022). No differences were found between the groups for patch test results (adjusted OR 0.6 CI 95%: 0.3–1.3; P = 0.194). [Conclusions]: Although the number of patients was limited, our results provide valuable insight on the behaviour of contact dermatitis in patients with atopic dermatitis and with psoriasis. Facial contact dermatitis was positively associated with atopic dermatitis. No differences were found with respect to rates of contact hypersensitivity or positivity to different allergens

Thermography as a Method for Bedside Monitoring of Infantile Hemangiomas

Infantile hemangiomas occur in 3 to 10% of infants. To predict the clinical course and counsel on treatment, it is crucial to accurately determine the hemangiomas’ extension, volume, and location. However, this can represent a challenge because hemangiomas may present irregular patterns or be covered by hair, or their depth may be difficult to estimate. Diagnosis is commonly made by clinical inspection and palpation, with physicians basing their diagnoses on visual characteristics such as area, texture, and color. Doppler ultrasonography or magnetic resonance imaging are normally used to estimate depth or to confirm difficult assessments. This paper presents an alternative diagnosis tool—thermography—as a useful, immediate means of carrying out accurate hemangioma examinations. We conducted a study analyzing infantile hemangiomas with a custom thermographic system. In the first phase of the study, 55 hemangiomas of previously diagnosed patients were analyzed with a thermal camera over several sessions. An average temperature variation before and after treatment of −0.19 °C was measured. In the second phase, we selected nine patients and assessed their evolution over nine months by analyzing their thermographic images and implementing dedicated image processing algorithms. In all cases, we found that the thermal image analysis concurred with the independent diagnoses of two dermatologists. We concluded that a higher temperature inside the tumor in the follow-up was indicative of an undesirable evolution

Expression patterns of aquaporin 1 in vascular tumours

[Background] Aquaporins (AQPs) are a family of water channels expressed in various body tissues. Beyond osmotic balance, AQPs have recently been confirmed to be involved in processes related to cancer (tumour proliferation, angiogenesis, etc.).[Objectives] To analyse the presence of these proteins in the endothelium of several vascular tumours, both benign and malignant, in order to establish whether AQPs may be used as a marker or future therapeutic target. Materials and Methods: We studied AQP1 expression in 39 patients with vascular tumours, classified into six groups according to ISSVA classification: haemangiomas, benign vascular tumours different from infantile haemangiomas, angiosarcomas, classic Kaposi's sarcoma (KS), and epidemic KS.[Results] AQP1 expression was present in 28 of 39 patients, representing 92.9% benign lesions, whereas no expression was found in 72% of malignant lesions. AQP1 expression was associated with benign lesions with an OR of 34.5 (95% CI: 5-250); p<0.0005, and was most frequently identified with a focal endothelial pattern (38%). A kappa index of 0.823 (95% CI: 0.678-0.971) was determined regarding the patterns of expression overall.[Conclusion] The expression of AQP1 was greater in benign lesions than malignant lesions and this difference was statistically significant, thus AQP1 expression could serve as a marker for benignity of vascular tumours. In addition, the expression pattern of AQP1 was different according to the type of vascular tumour.Peer reviewe

Congreso virtual de dermatología realizado a través de Telegram® durante el confinamiento de la COVID-19: organización y evaluación

[EN]: Introduction: The COVID-19 pandemic outbreak introduced dramatic changes in all our lives, daily practice, and medical conferences. In search of a tool to spread dermatologic knowledge during confinement, an online medical meeting was held on April 25th to 26th, 2020. In this study, we aimed to assess the characteristics, opinion and satisfaction of the attendees to a free-of-charge online congress. Secondarily, we intended to explain how this meeting was prepared. Material and Methods: Online survey administered to the attendees to an online congress organised via the Telegram® Messenger App. Its organisation and planning, which needed no financial support and was done by volunteer organisers, moderators and speakers, is described step by step. Results: The satisfaction of both speakers and attendees was very high. All participants considered that this format had a great present and future, and most of them rated it as superior to regular face-to-face meetings. Female gender and predominantly private practice favoured this opinion. Discussion: The COVID-19 pandemic has forced the cancellation of most scientific gatherings. This has been seen by some authors as an excellent opportunity, encouraging medical societies and organisations to lead the change to virtual meetings. Although confinement did not allow real contact, our online meeting showed it was possible to ensure interaction and participation between attendees, moderators and speakers. Dermatologists enjoyed some dermatologic science, even despite the extraordinary circumstances disrupting their daily clinical practice. Most of them felt they were participating in something new and compelling that many felt superior to traditional meetings.[ES]: Introducción: La pandemia de COVID-19 introdujo cambios drásticos en nuestras vidas. Tratando de encontrar una herramienta adecuada para la formación y el debate dermatológico durante el confinamiento, se celebró un congreso médico on-line durante los días 25 y 26 de abril del 2020. El objetivo del presente estudio fue evaluar las características, la opinión y el grado de satisfacción de los asistentes a dicho congreso. En segundo lugar, se buscó explicar cómo se organizó este formato de reunión. Material y métodos: Se entregó un cuestionario a los asistentes a un congreso on-line realizado a través de la aplicación Telegram® Messenger App. Se describió paso a paso su organización y planificación. No se necesitó apoyo financiero, ya que fue realizado de manera voluntaria. Resultados: El grado de satisfacción tanto de los ponentes como de los asistentes fue muy elevado. Todos los participantes consideraron que este formato tenía un gran presente y futuro. La mayoría lo calificó como superior a las reuniones presenciales tradicionales. Ser del sexo femenino y tener una práctica clínica predominantemente privada favorecieron esta opinión. Discusión: La pandemia obligó a cancelar la mayoría de las reuniones científicas presenciales. Esto fue visto por algunos autores como una excelente oportunidad para mejorar y liderar el cambio a las reuniones virtuales. Aunque el confinamiento no permitió un contacto real, nuestra reunión demostró que era posible asegurar la interacción entre los participantes. Los dermatólogos pudieron participar en una actividad formativa a pesar de que debido a las circunstancias se interrumpiera su actividad práctica diaria. La mayoría de los asistentes tuvieron la sensación de que esta era una actividad nueva y atractiva, que superaba incluso a las reuniones presenciales tradicionales

Expression Pattern of Aquaporin 1 and Aquaporin 3 in Melanocytic and Nonmelanocytic Skin Tumors

[Objectives] Study of aquaporin 1 (AQP1) and aquaporin 3 (AQP3) expression to understand its potential role in the pathophysiology of skin cancer.[Methods] Analysis of AQP1 and AQP3 expression by immunohistochemistry of 72 skin biopsy specimens from melanocytic skin tumors, nonmelanocytic tumors, or healthy samples.[Results] AQP1 showed strong labeling in 100% of benign common melanocytic nevi. Small blood vessels, stroma, and melanophages surrounding different types of melanomas tumors also were positive. Tumoral melanocytes in atypical nevi and melanomas were negative for AQP1. AQP3 showed strong labeling in 100% of melanocytic nevi, 100% of atypical melanocytic nevi, and 100% of melanomas. In all basal cell carcinomas and squamous cell carcinomas, staining for AQP3 was positive.[Conclusions] To our knowledge, this work represents the first demonstration of AQP1/AQP3 expression in human melanocytic skin tumors. More studies are needed to understand the underlying molecular mechanisms of expression of both AQPs in melanocytic tumors and their potential as molecular therapeutic targets.This study was supported by the Spanish Ministry of Economy and Competition, cofunded by the Instituto de Salud Carlos III and FEDER (Fondo Europeo de Desarrollo Regional (grants PI12/01882 and PI16/00493) and by the Regional Department of Health, Fundación Pública Andaluz Progreso y Salud (grant PI 0018-2014) to R.R.-L.Peer reviewe

Ectodermal dysplasia-skin fragility syndrome: two new cases with a novel missense mutation

Desmosomal genodermatoses are a heterogeneous group of in-herited diseases caused by defective desmosomal components. Ectodermal dysplasia-skin fragility syndrome (ED-SF syndro-me) is an infrequent autosomal recessive disorder caused by mutations in the PKP1 gene encoding plakophilin

Consenso español sobre el hemangioma infantil.

Infantile haemangiomas are benign tumours produced by the proliferation of endothelial cells of blood vessels, with a high incidence in children under the age of one year (4-10%). It is estimated that 12% of them require treatment. This treatment must be administered according to clinical practice guidelines, expert experience, patient characteristics and parent preferences. The consensus process was performed by using scientific evidence on the diagnosis and treatment of infantile haemangiomas, culled from a systematic review of the literature, together with specialist expert opinions. The recommendations issued were validated by the specialists, who also provided their level of agreement. This document contains recommendations on the classification, associations, complications, diagnosis, treatment, and follow-up of patients with infantile haemangioma. It also includes action algorithms, and addresses multidisciplinary management and referral criteria between the different specialities involved in the clinical management of this type of patient. The recommendations and the diagnostic and therapeutic algorithms of infantile haemangiomas contained in this document are a useful tool for the proper management of these patients