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Resumen: Introducción: La lipoatrofia semicircular (LS) puede tener presentaciones clínicas variadas, sin criterios diagnósticos claros. Se han propuesto varios factores etiopatogénicos, incluyendo determinados ambientes laborales. En este manuscrito se pretende describir las características de un brote de casos sospechosos de LS que se inició en mayo de 2008 entre trabajadores del Ayuntamiento de Madrid. Con base en la experiencia acumulada, se describen las acciones realizadas por el Servicio de Salud Laboral y se proponen unos criterios clínicos con implicación pronóstica que permitan categorizar los casos. Material y método: Estudio observacional retrospectivo tipo serie de casos que incluye datos recogidos de forma prospectiva de los pacientes revisados en el Servicio de ITS/Dermatología del Ayuntamiento Madrid entre 2008 y 2021. Se lleva a cabo la descripción de las medidas realizadas desde Salud Laboral. A través del registro y análisis estadístico de las variables recogidas durante la evaluación clínica de los pacientes, se proponen unos patrones clínicos definidos. Resultados: Se estudiaron 75 mujeres y un hombre, seguidas en su mayoría durante un período con mediana de 37 meses. Los síntomas locales fueron poco frecuentes (14,5%). Se propone la clasificación de las pacientes en 4 grupos: LS típica, LS unilateral, lipoatrofia en banda en miembros inferiores y lipoatrofia inespecífica. Al comparar los 2 primeros grupos con los 2 últimos, pudo constatarse una evolución clínica más favorable (76 versus 25,8% de mejoría total o parcial de las lesiones), además de una asociación negativa con la presencia de hipertrofia del tejido subcutáneo (p

El estudio DIADERM fue promovido por la Fundacion Piel Sana de la AEDV, que recibio ayuda economica de Novartis. La compania farmaceutica no participo en la recogida de datos, ni en el analisis de los datos, ni en la interpretacion de los resultados., Introducción: Las infecciones e infestaciones de transmisión predominantemente sexual y otras dermatosis anogenitales forman parte de la formación específica de los médicos especialistas en Dermatología y Venereología en España. El presente estudio pretende analizar la carga que suponen dichas patologías en la actividad dermatológica pública y privada del sistema de salud español. Material y método: Estudio observacional de corte transversal de dos períodos de tiempo describiendo los diagnósticos realizados en consultas externas dermatológicas, obtenidos a través de la encuesta anónima DIADERM, realizada a una muestra aleatoria y representativa de dermatólogos. A partir de la codificación de diagnósticos CIE-10, se seleccionó toda la patología relacionada (36 diagnósticos codificados en los dos períodos), que se clasificó en 12 grupos. Resultados: Tan solo el 3,16% de los diagnósticos globales fueron de infecciones e infestaciones de transmisión predominantemente sexual y otras dermatosis anogenitales. Los 3 grupos diagnósticos más frecuentes fueron las lesiones por virus del papiloma humano anogenital, seguido de los molluscum contagiosum y las dermatosis anogenitales inflamatorias. Con significación estadística, y comparando con el global de diagnósticos, los seleccionados constituyeron más habitualmente el motivo de consulta primario y, en el ámbito privado, fue más frecuente que viniesen derivados de otros especialistas. Conclusión: Las infecciones e infestaciones de transmisión predominantemente sexual y otras dermatosis anogenitales tienen un peso muy limitado en la asistencia dermatológica en España, a pesar de que la inclusión del diagnóstico de molluscum contagiosum sobreestima estos diagnósticos. La ausencia de inclusión de centros y consultas monográficas de ITS en la muestra aleatoria contribuye a la infrarrepresentación de estas parcelas de la especialidad. Es importante hacer un esfuerzo decidido por potenciarlas con consultas y centros monográficos., Background and objective: Predominantly sexually transmitted infections (STIs) and infestations and other anogenital dermatoses are covered in the training of specialists in dermatology and venereology in Spain. This study aimed to analyze the proportion of the dermatology caseload these diseases account for within the public and private dermatological activity of the Spanish health system. Material and methods: Observational cross-sectional study of time periods describing the diagnoses made in outpatient dermatology clinics, obtained through the anonymous DIADERM survey of a representative random sample of dermatologists. Based on diagnostic codes of the International Classification of Diseases, Tenth Revision, 36 related diagnoses were selected, and classified into 12 groups. Results: Only 3.16% of diagnoses corresponded to STIs and other anogenital dermatoses. The most common diagnostic group was anogenital human papillomavirus infection, followed by molluscum contagiosum, and inflammatory anogenital dermatoses. Lesions with these diagnoses were usually the main reasons for first visits in the National Health Service. In private practice, the diagnoses usually came after referrals from other physicians. Conclusions: STIs and other anogenital dermatoses account for a very small proportion of the dermatology caseload in Spain, although the inclusion of molluscum contagiosum diagnoses overestimates these conditions. The fact that no STI centers or monographic STI consultations were included in the random sample of dermatology partly explains the under-representation of these areas of the specialty. A determined effort to support and promote monographic STI centres and clinics should be made., Fundacion Piel Sana de la AEDV

Resumen En el presente articulo de la serie «Seguridad en procedimientos dermatologicos» se aborda el diagnostico, prevencion, manejo y tratamiento de tres situaciones. Primeramente, se aborda la anafilaxia: una situacion infrecuente, grave y potencialmente mortal, que requiere una identificacion agil para un manejo urgente coordinado por parte de medicos especialistas en anestesiologia. En segundo lugar, la reaccion vasovagal, que es la complicacion medica mas frecuente durante la cirugia dermatologica (una de cada 160 intervenciones), con una evolucion habitualmente benigna autorresolutiva, pero que, en individuos muy sensibles, puede provocar una parada cardiaca por asistolia. En tercer y ultimo lugar, el sindrome de hiperventilacion aguda, que es una respuesta anomala de determinados individuos a un evento estresante, con un incremento de la ventilacion que excede la demanda metabolica. En los tres casos se incluyen recomendaciones que se plasman de forma practica y somera.

A case of a purely eccrine nevus in an adolescent patient presenting with focal hyperhidrosis on an area comprising the left forearm and the dorsal aspect of the left hand is described. No clinically evident lesions were identifiable. Dermatopathologic findings were subtle, showing only a slight increase in the number of eccrine glands. Clinicopathological correlation was paramount to achieve the diagnosis.

[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.

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. Yes 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.

Increasing evidence from experimental animal nutrition studies suggests that vitamin D may potentially influence apoptosis and tumor-associated angiogenesis, reduce the initiation of carcinogenesis, and delay the multiplication and proliferation of tumor cells [...]

Background: The impact of vitamin D supplementation on cardiovascular outcomes and mortality risk reduction remains unclear due to conflicting study findings. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs), published between 1983 and 2022, that reported the effect of vitamin D supplementation in adults versus placebo or no treatment on all-cause mortality (ACM), cardiovascular mortality (CVM), non-cardiovascular mortality (non-CVM), and cardiovascular morbidities. Only studies with a follow-up period longer than one year were included. The primary outcomes were ACM and CVM. Secondary outcomes were non-CVM, myocardial infarction, stroke, heart failure, and major or extended adverse cardiovascular events. Subgroup analyses were performed according to low-, fair- and good-quality RCTs. Results: Eighty RCTs were assessed, including 82,210 participants receiving vitamin D supplementation and 80,921 receiving placebo or no treatment. The participants’ mean (SD) age was 66.1 (11.2) years, and 68.6% were female. Vitamin D supplementation was associated with a lower risk of ACM (OR: 0.95 [95%CI 0.91–0.99] p = 0.013), was close to statistical significance for a lower risk of non-CVM (OR: 0.94 [95%CI 0.87–1.00] p = 0.055), and was not statistically associated with a lower risk of any cardiovascular morbi-mortality outcome. Meta-analysis of low-quality RCTs showed no association with cardiovascular or non-cardiovascular morbi-mortality outcomes. Conclusions: The emerging results of our meta-analysis present evidence that vitamin D supplementation appears to decrease the risk of ACM (especially convincing in the fair- and good-quality RCTs), while not showing a decrease in the specific cardiovascular morbidity and mortality risk. Thus, we conclude that further research is warranted in this area, with well-planned and executed studies as the basis for more robust recommendations.

Resumen Objetivo Describir los cambios en el comportamiento de las ITS durante la situacion de alerta sanitaria por la pandemia SARS-CoV-2. Material y metodos Se recogieron datos demograficos, cronologicos y clinicos de todos los pacientes que solicitaron atencion medica por ITS en los hospitales La Paz y Costa del Sol, y en los Centros Sandoval y de Diagnostico Medico, entre el 14/03/2020 y el 30/06/2020. Resultados Documentamos 674 casos de ITS. La mediana de edad fue de 33 anos. El mayor porcentaje de casos se dio en el rango de 30-40 anos y en hombres que tenian sexo con hombres. Los diagnosticos mas frecuentes fueron: proctitis (36,5%), sifilis (16%), uretritis no gonococica (13,3%) y gonococica (11,3%), herpes genital (8,8%), vulvovaginitis/cervicitis (8,3%) y condilomas (4,2%). En el 77% de los casos hubo confirmacion microbiologica, siendo los microorganismos mas frecuentes Chlamydia trachomatis (35,7%), Neisseria gonorrhoeae (31,4%) y Treponema pallidum (17,2%). Se constato un incremento del numero de casos de ITS tras el desconfinamiento, explicable por las mayores libertades y el aumento de consultas. Comparando los registros de ITS del Centro Sandoval y del Hospital La Paz en los cuatrimestres de marzo a junio de 2019 frente a 2020, se observo una disminucion en 2020 de todos los diagnosticos, de hasta el 81% menos que en 2019. Conclusiones Las medidas de distanciamiento y limitacion de movilidad aparentemente generaron una disminucion de la incidencia de ITS, pero sin llegar a una inhibicion completa de las conductas sexuales de riesgo.

Introduction and objective A significant part of a dermatologist’s activity involves the diagnosis and management of tumors.The aim of this study was to analyze the caseload at public and private dermatology outpatient clinics in Spain to determine the proportion of tumor diagnoses. Material and method Observational cross-sectional study of diagnoses made in dermatology outpatient clinics during 2 data-collection periods in the DIADERM study, an anonymous survey of a random, representative sample of dermatologists across Spain. Diagnoses made during the 2 periods were coded according to the 10th revision of the International Classification of Diseases. There were 165 tumor-related codes, classified into 24 groups. For the purpose of this study, these groups were then reduced to benign melanocytic lesions, malignant melanocytic lesions, benign nonmelanocytic lesions, and malignant nonmelanocytic lesions. Results Tumors accounted for 46.2% of all diagnoses; 18.5% of the tumors were malignant (a category that included in situ forms of keratinocyte cancers). Four of the 10 most common diagnoses were of malignant tumors: in situ keratinocyte cancers, basal cell carcinoma, melanoma, and squamous cell carcinoma. Significant differences were observed between malignant and benign tumors according to type of practice (public vs. private) and geographic region. Conclusion Skin cancer accounts for a significant part of the dermatologist’s caseload in Spain. Differences can be observed depending on the public/private healthcare setting and other factors.

This article, part of a the series on safety in dermatologic procedures, covers the diagnosis, prevention, management, and treatment of 3 situations or conditions. The first condition we address is anaphylaxis, an uncommon but severe and potentially fatal reaction that must be recognized quickly so that urgent management coordinated with an anesthesiologist can commence. The second is fainting due to a vasovagal reaction, which is the most common complication in dermatologic surgery. This event, which occurs in 1 out of every 160 procedures, usually follows a benign course and resolves on its own. However, in patients susceptible to vasovagal reactions, syncope may lead to asystole and cardiac arrest. The third is acute hyperventilation syndrome, which is an anomalous anxiety-related increase in breathing rate beyond metabolic requirements. Brief practical recommendations for managing all 3 events are included.

El estudio DIADERM fue promovido por la Fundación Piel Sanade la Academia Espa˜nola de Dermatología y Venereología,que recibió ayuda económica de Novartis. La compa˜nía far-macéutica no participó en la recogida de datos, ni en elanálisis de estos, ni en la interpretación de los resultados., Introducción y objetivo: La patología tumoral conforma una parte esencial de la actividad dermatológica. El presente estudio pretende analizar la carga de los tumores cutáneos en la actividad dermatológica pública y privada del sistema de salud espa˜nol. Material y método: Estudio observacional de corte transversal de 2 períodos de tiempo describiendo los diagnósticos realizados en consultas externas dermatológicas, obtenidos a través de la encuesta anónima DIADERM, realizada a una muestra aleatoria y representativa de dermatólogos. A partir de la codificación de diagnósticos CIE-10, se seleccionó toda la patología tumoral (165 diagnósticos codificados en los 2 períodos), que se clasificó en 24 grupos, posteriormente subclasificada en patología benigna y maligna, melanocítica y no melanocítica. cutáneasResultados: El 46,2% de los diagnósticos fueron de patología tumoral. El 18,5% de los diagnós-ticos globales se debió a tumores malignos (incluyendo entre estos diagnósticos los tumoresqueratinocíticos in situ). De los primeros 10 diagnósticos de patología tumoral en frecuen-cia, 4 eran malignos: tumores queratinocíticos in situ, carcinoma basocelular, melanoma ycarcinoma espinocelular. Se encontraron algunas diferencias significativas entre tumores benig-nos y malignos atendiendo al ámbito de su asistencia (público/privado), así como a factoresgeográficos.Conclusión: El cáncer cutáneo tiene un peso importante en la asistencia dermatológicaen Espa˜na. Se pueden observar algunas diferencias en función del ámbito de atenciónpúblico/privado y de otros factores., Introduction and objective: A significant part of a dermatologist’s activity involves the diagno-sis and management of tumors. The aim of this study was to analyze the caseload at public andprivate dermatology outpatient clinics in Spain to determine the proportion of tumor diagnoses.Material and method: Observational cross-sectional study of diagnoses made in dermatologyoutpatient clinics during 2 data-collection periods in the DIADERM study, an anonymous surveyof a random, representative sample of dermatologists across Spain. Diagnoses made during the2 periods were coded according to the CIE-10. There were 165 tumor-related codes, classifiedinto 24 groups. For the purpose of this study, these groups were then reduced to benign mela-nocytic lesions, malignant melanocytic lesions, benign nonmelanocytic lesions, and malignantnonmelanocytic lesions.Results: Tumors accounted for 46.2% of all diagnoses; 18.5% of the tumors were malignant (acategory that included in situ forms of keratinocyte cancers). Four of the 10 most commondiagnoses were of malignant tumors: in situ keratinocyte cancers, basal cell carcinoma, mela-noma, and squamous cell carcinoma. Significant differences were observed between malignantand benign tumors according to type of practice (public vs. private) and geographic region.Conclusion: Skin cancer accounts for a significant part of the dermatologist’s caseload in Spain.Differences can be observed depending on the public/private healthcare setting and other factors., Novartis

Background: Burnout syndrome is very prevalent among healthcare residents. Initiatives addressing workload conditions have had limited impact on burnout. The present study aims to explore the contribution of two emotion regulation strategies, namely emotion suppression and cognitive reevaluation, to residents&rsquo, burnout, while accounting for workload factors. Methods: Participants were 105 residents (68.6% women, mean age = 27.5, SD = 3.0). They completed measures of workload, burnout, and emotion regulation. The study was cross-sectional. Results: Emotional suppression was associated with higher burnout (depersonalization scale, &beta, = 0.20, p &lt, 0.05, CI 0.15&ndash, 2.48) and cognitive revaluation was linked to lower burnout (higher personal accomplishment, = 0.35, p &lt, 0.01, CI 0.16&ndash, 2.56), even after controlling for demographic and workload factors. We found interaction effects between workload variables (supervisor support and number of patient hours) and emotion regulation (p &lt, 0.05). Conclusions: The relationship between workload, emotion regulation, and burnout seems to be complex. That is, similar work conditions might generate different levels of burnout depending on the resident&rsquo, s emotional regulation strategies. This might partly explain why existing initiatives based on workload changes have had a modest impact on burnout. Results also support including emotion regulation training in prevention and treatment programs targeting burnout during residency.

Background and objective Per-visit fees and the characteristics of private practice in dermatology have been studied very little, at least in Spain. This study aims to describe how dermatologists in private practice in Spain provide services, collect payment, promote their services, and establish fees. We also analyze differences by region, age, and sex. Materials and methods We performed a descriptive, cross-sectional study based on an online questionnaire with a total of 31 questions aimed exclusively at dermatologists in private practice in Spain. The questionnaire was open for responses from May 17 to June 5, 2018. The data were analyzed by comparing region, sex, and age. Results A total of 234 questionnaires were returned, with equal numbers of male and female respondents and proportional numbers in terms of the regional sections of the Spanish Academy of Dermatology and Venereology (AEDV). Some differences were found for region, age, and sex. The fees of female dermatologists were consistently lower, even after adjusting for confounding factors by means of regression models. Conclusions We have described the characteristics of private dermatology practice in Spain. Charging of lower fees by female dermatologists requires more detailed study, probably using qualitative research techniques.

Resumen Antecedentes y objetivo Las tarifas por acto medico y los habitos de asistencia privada de los dermatologos apenas han sido objeto de estudio, al menos en nuestro entorno inmediato. Con el presente trabajo pretendemos describir habitos de prestacion de servicios, medios de cobro, promocion y fijacion de tarifas de los dermatologos que realizan asistencia privada en Espana. Secundariamente, buscamos analizar las diferencias por seccion territorial, edad y sexo. Materiales y metodos Estudio descriptivo transversal a partir de un cuestionario on-line con un total de 31 preguntas dirigido exclusivamente a dermatologos con asistencia privada en Espana, abierto a respuestas del 17 de mayo al 5 de junio de 2018. Los datos fueron analizados comparando por seccion territorial, sexo y edad. Resultados Se recibio un total de 234 respuestas, paritarias en cuanto a sexo y proporcionadas en cuanto a las secciones territoriales de la Academia Espanola de Dermatologia y Venereologia (AEDV). Pudieron constatarse algunas diferencias por seccion territorial, edad y sexo. Destacaban las tarifas sistematicamente menores de las dermatologas, incluso tras ajustar por factores de confusion mediante modelos de regresion. Conclusiones Quedan descritas caracteristicas de la asistencia privada en Dermatologia en Espana. El hecho de que haya tarifas mas baratas entre las dermatologas requiere de un estudio mas detallado, probablemente mediante tecnicas de investigacion cualitativa.

Background: The current vitamin D deficiency epidemic is accompanied by an increase in endemic skin cancer. There are still multiple controversies. This review aims to give practical recommendations regarding vitamin D among people at risk or with a personal history of skin cancer. Methods: Narrative review including human research articles published between 2011 and 2021, elaborated bearing in mind an epidemiological, patient-centered approach. Results: Ultraviolet (UV) exposure (neither artificial nor natural) is not the ideal source to synthesize vitamin D. There is conflicting epidemiological evidence regarding vitamin D, non-melanoma skin cancer (NMSC), and cutaneous melanoma (CMM), confounded by the effect of sun exposure and other factors. Conclusions: Current evidence is controversial, and there are no widely applicable strategies. We propose three practical recommendations. Firstly, sun protection recommendations should be kept among people at risk or with a personal history of skin cancer. Secondly, vitamin D should preferably be sourced through diet. In patients with melanoma or at risk of cutaneous cancer, serum vitamin D checks are warranted to detect and avoid its insufficiency.

Axillary hyperhidrosis (AH) and bromhidrosis are common causes of consultation in dermatology. Currently, the most widely prescribed treatment for AH is botulinum toxin, a very effective but temporary option; it is totally ineffective in bromhidrosis. Sympathectomy is an increasingly infrequent choice of treatment due to the high incidence of compensatory hyperhidrosis. We describe the treatment of AH and bromhidrosis with a novel microwave device that can fibrose eccrine and apocrine glands, achieving possibly permanent results. The procedure should preferably be performed under tumescent anesthesia. Side effects, principally local inflammation, are transient. Clinical effectiveness and safety, supported by recently published studies, position this technique as a first-choice option both for hyperhidrosis and for bromhidrosis.

A 60-year-old woman, with phototype III skin and with no previous family or personal history of melanoma, presented to our department for a total skin check-up. One of his relatives, who was a physician, detected a 1-mm dark pigmented macule on the right arm that had been previously unnoticed by the patient. The patient had a moderate number of melanocytic nevi, predominantly macular. 10×-magnification dermoscopic imaging showed homogeneous pigmentation. 40×-magnification dermoscopic showed a central pigmented dark blotch, and surrounding pigmented dots and apparent peripheral streaks.

Langerhans cell histiocytosis (LCH) and juvenile xanthogranuloma (JXG) are thought to originate from a common stem cell precursor, with divergent differentiation under different microenvironmental conditions. We describe an exceptional case of multiple cutaneous lesions in a 10-year-old boy, in which the coexistence of both LCH and JXG cell populations is found in every single lesion. The presence of Birbeck granules and CD207 (langerin) immunostaining in the LCH component would argue against the diagnosis of indeterminate cell histiocytosis (ICH). This unique case gives additional support to the hypothesis of a potentially common histogenesis for LCH and JXG.

There are at least two pathways driving cutaneous melanoma; one is linked to an inherent melanoma susceptibility to nevi development and the second to environmental cumulative ultraviolet light exposure. In this study, we examined the relation between nevus density, accrued sun damage and the site of primary melanoma excision. In a series of 888 consecutive cutaneous melanoma patients, melanomas appearing in skin areas with a high relative nevus density were most prominent in men, with an elevated nevus count, at sites without solar elastosis, but with an epidemiological history of previous sunburn. The present study associates melanoma development to sites with high nevus density. Our study supports more careful surveillance of body areas with increased nevus density in patients with high total body number of nevi, especially when they report a history of sunburns at these sites.

Injection of botulinum toxin is currently the most common cosmetic procedure in the United States, and in recent years it has become-together with dermal fillers-the mainstay of therapy for the prevention and treatment of facial aging. However, in some cases the treatment may lead to a somewhat unnatural appearance, usually caused by loss of facial expression or other telltale signs. In the present article, we review the 10 mistakes that should be avoided when injecting botulinum toxin. We also reflect on how treatment with botulinum toxin influences us through our facial expressions, both in terms of how we feel and what others perceive.

Resumen Antecedentes La fototerapia es una opcion terapeutica empleada en dermatitis atopica (DA) y recomendada en multiples guias. Objetivos Evaluar la eficacia de las distintas modalidades de fototerapia y fotoquimioterapia en el tratamiento de pacientes con DA moderada-grave, mediante una revision sistematica. Material y metodos Consideramos los ensayos clinicos aleatorizados (ECA) realizados en pacientes con DA, aceptando cualquier medida de desenlace. Localizamos los articulos mediante una busqueda electronica, utilizando Medline (via Ovid), Embase y Cochrane Central Register of Controlled Trials. Adicionalmente, buscamos los ensayos clinicos registrados en Current Controlled Trials y en la WHO International Clinical Trials Registry Platform. Resultados Incluimos 21 ECA en el analisis cualitativo (961 pacientes). Dos ECA incluyeron ninos y adolescentes (32 pacientes). Las modalidades UVBBE y UVA1 mostraron resultados de eficacia similares en diversas medidas de desenlace. Dos ECA incluyeron la terapia PUVA. No se describieron efectos secundarios graves. En general, el riesgo de sesgos fue elevado y la calidad de las publicaciones baja, en cuanto a comunicacion de la metodologia empleada y los resultados obtenidos. Conclusiones Existe evidencia para el uso de UVBBE y UVA1 en DA moderada-grave. La evidencia para el uso de PUVA en DA es minima, asi como los datos del uso de la fototerapia en la infancia. En futuros estudios seria recomendable estandarizar los criterios de gravedad de la DA y las escalas de valoracion de los pacientes, homogeneizar las tecnicas de irradiacion y establecer un periodo de seguimiento minimo.

Background Phototherapy is a treatment option for atopic dermatitis recommended by several guidelines. Objective To perform a systematic review of the efficacy of different modalities of phototherapy and photochemotherapy in moderate to severe atopic dermatitis. Material and methods We considered all randomized clinical trials (RCTs) performed in patients with atopic dermatitis, and accepted all outcome measures. Articles were identified via an online search of the MEDLINE (via Ovid) and Embase databases and the Cochrane Central Register of Controlled Trials. We also searched for clinical trials registered in Current Controlled Trials and in the World Health Organization's International Clinical Trials Registry Platform. Results Twenty-one RCTs (961 patients) were included in the qualitative analysis. Two of the trials included children and adolescents (32 patients). The efficacy of narrow-band UV-B and UV-A1 phototherapy was similar for the different outcome measures contemplated. Two RCTs assessed the efficacy of psoralen plus UV-A therapy (PUVA). No serious adverse events were described. In general, the publications reviewed were characterized by a high risk of bias and poor reporting of methodology and results. Conclusions There is evidence for the use of narrow-band UV-B and UV-A1 phototherapy in moderate to severe atopic dermatitis. Evidence supporting the use of PUVA in atopic dermatitis is scarce and there is little information on the use of phototherapy in childhood. For the purpose of future studies, it would be advisable to use comparable criteria and scales for the evaluation of disease severity and patients, to standardize radiation methods, and to establish a minimum follow-up time.

Vulvar lichen sclerosus (VLS) is recognized as a chronic auto-immune skin disease, which can lead to debilitating complications such as dyspareunia, urinary disorders and an increased risk for vulvar squamous cell carcinoma. Active phase and maintenance treatment involve long-term application of potent topical corticosteroids, which predispose to corticosteroid-induced adverse effects [1]. More recently, topical calcineurin inhibitors as well as photodynamic therapy were approved for the long-term [...]

// Alejandro Martin-Gorgojo 1, * , Marta Llinares 2, * , Amaya Viros 3, 4, * , Celia Requena 2 , Zaida Garcia-Casado 5 , Victor Traves 6 , Rajiv Kumar 7 and Eduardo Nagore 2, 8 1 Escuela de Doctorado, Universidad Catolica de Valencia “San Vicente Martir”, Valencia, Spain 2 Department of Dermatology, Instituto Valenciano de Oncologia (IVO), Valencia, Spain 3 Skin Cancer and Ageing Laboratory, CRUK Manchester Institute, Manchester, UK 4 Salford Royal NHS Foundation Trust, Manchester, UK 5 Department of Molecular Biology, Instituto Valenciano de Oncologia (IVO), Valencia, Spain 6 Department of Pathology, Instituto Valenciano de Oncologia (IVO), Valencia, Spain 7 Division of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany 8 Dermatology Department, School of Medicine, Universidad Catolica de Valencia “San Vicente Martir”, Valencia, Spain * These authors have contributed equally to this work Correspondence to: Eduardo Nagore, email: eduardo_nagore@ono.com Keywords: melanoma; nevus; risk; sunburn; solar elastosis Received: July 20, 2017 Accepted: September 23, 2017 Published: October 24, 2017 ABSTRACT There are at least two pathways driving cutaneous melanoma; one is linked to an inherent melanoma susceptibility to nevi development and the second to environmental cumulative ultraviolet light exposure. In this study, we examined the relation between nevus density, accrued sun damage and the site of primary melanoma excision. In a series of 888 consecutive cutaneous melanoma patients, melanomas appearing in skin areas with a high relative nevus density were most prominent in men, with an elevated nevus count, at sites without solar elastosis, but with an epidemiological history of previous sunburn. The present study associates melanoma development to sites with high nevus density. Our study supports more careful surveillance of body areas with increased nevus density in patients with high total body number of nevi, especially when they report a history of sunburns at these sites.

Keywords: methylchloroisothiazolinone; contact allergy; contact dermatitis; cosmetics; methylisothiazolinone; occupational diseases; patch test; preservatives

Iodopropynyl butylcarbamate (IPBC) is a preservative that may cause contact allergy. The first cases were reported in 1997, and IPBC is currently included in our extended European baseline series in Denmark. The authors assess trends during the period 2000-2011 concerning IPBC allergy in Denmark, and address the question of the significance of concomitant reactions to the thiuram mix. Patients/materials/methods Nine thousand seven hundred and fifty-five (6449 female; 3306 male) patients were patch tested with IPBC and the European baseline series at Gentofte Hospital during 2000-2011. The results were registered in an anonymized database, and analyzed with spss™. Fifty-four cases of IPBC contact allergy were detected. A significant rising trend during 2000-2011 was observed, with no significant changes during 2006-2011. MOAHLFA index analysis showed that IPBC contact allergy was, in our cohort, significantly more prevalent among male patients, occupational, related to hand eczema, and more frequent among patients over 40 years old. A significant relationship between IPBC and thiuram mix allergy was found. IPBC continues to be among the less frequent allergens. A 0.2% concentration in patch testing has contributed to the diagnosis of more sensitizations to this substance. Further studies are needed to clarify the reason for the over-representation of thiuram allergy in patients sensitized to IPBC.

The association of melanoma with a preexisting melanocytic nevus varies considerably between series, depending on whether the association is based on histological signs (4%-72%) or a clinically evident lesion (42%-85%). Histological association with a nevus correlates with favorable prognostic factors, whereas a clinical association correlates with unfavorable factors. In this review, we discuss the characteristics of nevus-associated melanoma from different perspectives: Whiteman's divergent pathway hypothesis for the development of cutaneous melanoma; and the factors involved in nevogenicity, including both the genetic and molecular factors involved in the development of the melanoma and its precursor lesions. Finally, a cumulative analysis of the 16 162 cases reported in the literature revealed that 29.8% of melanomas are histologically associated with a melanocytic nevus.