Dermatología médico quirúrgica y venerealogía: Casos clínicos interactivos

Creemos que en la enseñanza de la medicina es fundamental aplicar al ejercicio práctico los conocimientos teóricos adquiridos a lo largo del proceso de enseñanza-aprendizaje. Con el método que seguimos pretendemos que los alumnos aprendan, a partir de casos obtenidos de la práctica clínica diaria, con una participación activa. Partimos de un caso concreto que representa una situación, más o menos compleja de la vida, en el que el estudiante pondrá a prueba sus conocimientos para establecer un proceso de análisis que le permita llagar al diagnóstico, establecer una petición razonada de pruebas complementarias que se lo faciliten y a indicar el tratamiento más adecuado al caso; en definitiva tomar la decisión más acertada ante ese paciente. Para seguir un orden lógico en el proceso de atención al paciente adoptamos en este e-book un esquema general que estructura los contenidos en varios apartados. Primero hacemos la descripción del caso clínico facilitando al estudiante los datos más significativos recogidos de la historia clínica incluida una imagen demostrativa de la enfermedad. En cada caso hacemos tres preguntas de opción múltiple (multiple choice). La primera pregunta “¿Cuál sería su diagnóstico más probable?” ofrece cinco alternativas sobre los posibles diagnósticos del caso, cada una con una respuesta razonada. Igual ocurre con las otras dos preguntas “¿Estaría indicada alguna prueba complementaria? y “¿Cuál sería su indicación terapéutica?”. En cada respuesta indicamos si es correcta o incorrecta analizando los porqués de cada decisión. Con este método pretendemos facilitar al alumno/a un contacto con el paciente dermatológico que se encontrará cuando inicien el ejercicio práctico de la medicina. Evidentemente no incluimos toda la patología dermatológica. Sólo tratamos las situaciones más frecuentes y, sobre todo, las más trascendentes, que las agrupamos de acuerdo con el programa que seguimos para la enseñanza de la asignatura. Las diferentes patologías que presentamos, en la mayoría de los casos, son enfermedades primarias, bien de tipo inflamatorio o tumoral que sólo afectan a la piel y/o mucosas aunque puedan tener repercusiones sistémicas; en otras ocasiones la afectación cutánea es secundaria a una enfermedad interna y a veces son la primera manifestación de la misma, por lo que su conocimiento facilita el diagnóstico de la enfermedad sistémica. Para establecer el diagnóstico de una enfermedad cutánea nos basamos principalmente en sus aspectos clínicos, la localización, la sintomatología y la atenta observación de las lesiones elementales. En ocasiones la duda diagnóstica se completa con pruebas complementarias, clínicas o de laboratorio. En ocasiones es necesario hacer una biopsia (patrón oro) para confirmar la sospecha clínica. En Dermatología, la biopsia podemos considerarla como “la clínica al microscopio”. Una vez establecido el diagnóstico indicaremos un tratamiento, tópico o sistémico, dirigido a la causa o fisiopatología de la dermatosis sin olvidar el tratamiento adyuvante con emolientes, hidratantes, etc, que en la mayoría de las ocasiones representa un complemento necesario

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

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

Study of the Exposome Ageing-related Factors in the Spanish Population

The authors thank Dr Almudena Fuster-Manzano and Dr Blanca Piedrafita for providing scientific support.To characterize the exposome of the Spanish population and its association with skin ageing a cross-sectional epidemiological study was conducted in men and women (18–60 years old). A total of 1,474 participants were included. Mean age (± standard deviation) was 40.84 ± 10.26 years. Most participants had Fitzpatrick skin phototype II (44.1%) and skin ageing in accordance with their current age (69.0%). In the logistic model, age, smoking habit, use of sunscreen and use of cosmetics were all significant independent predictors of skin ageing. Thus, tobacco consumption increased the score of the model towards presenting skin ageing above that expected for age, while the opposite occurred with the use of sunscreen and a complete skin care routine. The exposome therefore has an impact on skin ageing, with age, smoking habit, use of sunscreen and the use of cosmetics identified as predictors of skin ageing. Skin care routines and sunscreen use may help to prevent this process.Vich

Analysis of Undergraduate Dermatology Syllabi at Spanish Universities: Does the Weight of Theoretical Content Match the Skin Conditions Seen in Primary Care and General Dermatology Practices?

Introduction: Undergraduate dermatology courses vary in the nearly 50 Spanish medical faculties that teach the subject. This study aimed to describe the characteristics of these courses and to analyze whether the weight assigned to dermatology topics reflects the caseloads of primary care physicians and general dermatologists in the Spanish national health system. Material and methods: Cross-sectional study of syllabi used in Spanish medical faculties during the 2021---2022 academic year. We determined the number of teaching hours in public and private university curricula and compared the weight of dermatology topics covered to the dermatology caseloads of primary care physicians and general dermatologists as reported in published studies. Results: Most medical faculties taught dermatology for one semester. The median number of credits offered was 4.5. On average, lectures covered 24 theoretical topics, and seminars and workshops covered 9 topics. We identified a clear disparity between the percentage of time devoted to dermatology topics in course lectures and the skin conditions usually managed in primary care and general dermatology practices

Knowledge, Behaviour and Attitudes Related to Sun Exposure in Sportspeople: A Systematic Review

People who practice outdoor sports have an increased risk of skin cancer as they are exposed to high doses of ultraviolet (UV) radiation. Recent studies have shown that in many athletes, sun protection behaviours are inadequate, with the risk that this entails. The aim of this review is to collect the information published to date about the knowledge, attitudes and habits of athletes in relation to sun exposure and its risks. A systematic review was conducted using PubMed and Embase with the search algorithm “(skin cancer OR melanoma) AND (exercise OR sport OR athletes)”. All studies analysing the knowledge, attitudes and habits of photoprotection in athletes were included. A total of 2,365 publications were found, of which 23 were selected, including a total of 10,445 sportspeople. The majority of participants declared their voluntary intention to tan and stated that the sun made them feel better, although they also showed concern about possible damage associated with UV radiation. In most studies, less than half of the participants made adequate use of photoprotective measures. In general, most athletes had a high level of knowledge regarding the risk of skin cancer associated with sun exposure. In conclusion, most athletes are aware of the risks associated with UV radiation but do not make adequate use of photoprotective cream. New training programs on photoprotection could help improve athletes’ photoprotective behaviour, reducing the incidence of skin cancer and precancerous lesions in this population

Situación actual de la prevención del cáncer de piel: una revisión siste

Skin cancer deaths continue to rise despite the implementation of numerous preventive campaigns and programs. The aim of this systematic review was to evaluate reviews of primary and secondary skin cancer prevention strategies as reported over the past 10 years. We analyzed 63 systematic reviews and meta-analyses: 30 (46.6%) addressing primary interventions and 35 (55.6%) addressing secondary interventions. Two of the reviews covered both. The most widely reported primary prevention approaches were education programs (63.3%), followed by risk modeling to identify individuals at high risk for melanoma (17.6%), and the promotion of sunscreen use (11.8%). The most widely reported secondary prevention measures concerned imaging systems for early skin cancer detection (40%), smartphones and new technologies (22.9%), and visual diagnosis in population-based screening (17.4%). The most effective measures were primary prevention education programs to improve sun protection habits.La mortalidad por cáncer de piel continúa aumentando a pesar de las numerosas intervenciones dedicadas a su prevención. El objetivo de esta revisión es estudiar la situación de la prevención primaria y secundaria del cáncer de piel en los últimos 10 a˜nos. Se incluye un total de 63 revisiones, 30 (46,6%) revisiones incluyeron estrategias de prevención primaria y 35 (55,6%) de prevención secundaria, incorporando 2 de las revisiones información sobre ambos tipos de estrategias. Para la prevención primaria, las medidas más estudiadas fueron losprogramas educativos (63,3%), seguidos de la creación de modelos para identificar a personascon alto riesgo de desarrollar un melanoma (17,6%) y la promoción del uso de fotoprotectores(11,8%). Los sistemas de toma de imagen para el diagnóstico precoz del cáncer de piel (40%),seguidos por el empleo de smartphones y nuevas tecnologías (22,9%), así como el diagnósticovisual como cribado poblacional (17,4%), fueron las medidas de prevención secundaria másevaluadas. De todas las medidas revisadas, las estrategias de prevención primaria centradas enprogramas educativos para mejorar los hábitos de fotoprotección fueron las que resultaron másefectivas

A multicenter case-control study comparing sun exposure habits and use of photoprotection measures in patients diagnosed with different types of skin cancer

BackgroundWhile skin cancer awareness programs have significantly furthered public understanding about the harmful effects of the sun, there is a disparity between photoprotection knowledge and protection practices. ObjectiveTo compare sun exposure habits and photoprotection measures in patients diagnosed with basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma versus controls. MethodsMulticentre case-control observational study carried out by 13 Spanish dermatologists between April 2020 and August 2022. Patients diagnosed with BCC, SCC, or melanoma were considered cases. The control group consisted of individuals with no history of skin cancer. ResultsOf the 254 cases (56.2% female; mean age, 62.67 +/- 15.65), 119 (31.2%) had BCC, 62 (16.27%) SCC, and 73 (19.1%) melanoma. The control group consisted of 127 (33.33%) individuals. Avoiding sun exposure between 12:00 and 16:00 was the most commonly used photoprotection measure (habitually/always: 63.1%), followed by the use of sunscreen (habitually/always: 58.9%). Patients with melanoma were less likely to use clothing and shade to avoid sun exposure (p = 21, and the majority SPF > 50. No differences were observed in photoprotection measures between people with and without a previous history of skin cancer. ConclusionsWe describe differences in photoprotection measures and sun exposure patterns among patients diagnosed with different skin tumor types. Whether these differences may influence the type of tumor each developed will require further investigation

The Effect of Sunscreens on the Skin Barrier

Transepidermal water-loss (TEWL), stratum-corneum hydration (SCH), erythema, elasticity, pH and melanin, are parameters of the epidermal barrier function and skin homeostasis that objectively indicate the integrity of the skin barrier. Sunscreens are necessary to protect people from skin cancer, but could modify the skin barrier function. Nevertheless, there are not many studies on their impact on skin homeostasis. The aim of this study is to evaluate the impact of sunscreens on the epidermal-barrier function and skin homeostasis of healthy individuals. A prospective observational study was designed. TEWL, SCH, erythema, elasticity, pH and melanin were measured on the cheek and volar region of the forearm, using non-invasive methods before and after applying sunscreen. Four different sunscreens were tested, one full-body sunscreen and three facial sunscreens. The study included 51 healthy volunteers, 72.5% (37/51) women, with a mean age of 41.63 years. After full-body sunscreen application, temperature increased by 0.68 degrees C (p < 0.001), pH by 0.16 units (p < 0.001), and elasticity by 0.22% (p = 0.039), while melanin decreased by 10.95 AU (p < 0.001), erythema by 28.79 AU (p < 0.001) and TEWL by 0.66 g center dot m(-2)center dot h(-1) (p = 0.019). On the cheek, facial sunscreen 1 increased temperature by 0.51 degrees C, TEWL 0.7 g center dot m(-2)center dot h(-1) (p < 0.05), pH by 0.12 units (p < 0.001) and elasticity by 0.059% (p < 0.001), but decreased erythema by 19.87 AU (p < 0.05) and SCH by 5.63 AU (p < 0.001). Facial sunscreen 2 increased temperature by 0.67 degrees C, TEWL by 1.93 g center dot m(-2)center dot h(-1) (p < 0.001), pH by 0.42 units (p < 0.001) and elasticity by 0.12% (p < 0.01), but decreased melanin by 15.2 AU (p = 0.000), erythema by 38.61 AU (p < 0.05) and SCH by 10.80 AU (p < 0.01). Facial sunscreen 3 increased temperature by 1.15 degrees C, TEWL by 2.29 g center dot m(-2)center dot h(-1) (p < 0.001), pH by 0.46 units (p < 0.001) and elasticity by 0.15% (p < 0.01), but decreased erythema by 35.7 (p < 0.05) and SCH by 10.80 AU (p < 0.01). In conclusion, sunscreen could slightly modify the skin-barrier function. All of them decreased erythema, likely in relation to anti-inflammatory power

Exploring Patients' Insight, Concerns, and Expectations at Dermatology Clinic:An Observational Study in 2 Centers in Scotland and Spain

Background: Effective doctor–patient communication is of great importance in order to optimize medical consultation outcomes. However, it can be difficult to address all patients’ concerns and expectations in clinic. Objective: To identify how much patients know about their medical condition, their fears and concerns, and their expectations, as well as evaluate the benefits of using a preconsultation questionnaire routinely. Methods: This study included consecutive patients attending dermatology outpatients from Dundee (Scotland) and Granada (Spain) who completed a simple preconsultation 3-part questionnaire. Answers to this questionnaire were discussed during clinic visits. Results: Two hundred patients participated in the study. Of all, 111 (55.5%) patients already knew their diagnosis or were able to describe their symptoms and/or feelings quite accurately at their visit to Dermatology. Most patients (85%) had fears regarding their dermatological problem. A majority of patients (97%) came to clinic with specific expectations, and many (41.5%) had multiple expectations. A high proportion of patients (74%) found the questionnaire useful. Conclusion: Patients attend clinic with different levels of knowledge, fears, and expectations. We recommend using a brief and easy to use preconsultation questionnaire as a cost-effective way of enhancing doctor–patient communication

Epidermal Barrier Function and Skin Homeostasis in Skin with Permanent and Adhesive Tattoos: A Cross-Sectional Study

Tattoos are a current trend, but their impact on skin homeostasis and epidermal barrier function is not well known. So, the aims of this study are (1) to investigate epidermal barrier function and skin homeostasis in skin with permanent tattoos, adhesive temporary tattoos and non-tattooed skin, and (2) to analyze the effect of petrolatum on skin with permanent and adhesive tattoos. In total, 67 tattoos were enrolled (34 permanent tattoos and 33 adhesive tattoos). Temperature, transepidermal water loss (TEWL), stratum corneum hydration (SCH), erythema and total antioxidant capacity (TAC) were measured in skin with permanent tattoos, adhesive tattoos and non-tattooed skin before and after petrolatum application. The temperature was lower (30.47 C vs. 31.01 C; p = 0.001) on skin with permanent tattoos than non-tattooed skin, while SCH (48.24 Arbitrary Units (AU) vs. 44.15 AU; p = 0.008) was higher. Skin with adhesive tattoos showed lower temperature, SCH (21.19 AU vs. 41.31 AU; p < 0.001) and TAC (1.27 microcoulombs (uC) vs. 3.48 uC; p < 0.001), and higher TEWL (8.65 g/h/m2 vs. 6.99 g/h/m2; p = 0.003), than non-tattooed skin. After petrolatum application, the temperature decreased on skin with permanent tattoos, and TEWL and SCH decreased on skin with adhesive tattoos. Adhesive tattoos may affect skin barrier function, while permanent tattoos may have a lower impact. Tattooed and non-tattooed skin responds in different ways to moisturizers