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espanolLa piel es el principal elemento que forma parte de la imagen corporal. La dermatologia estetica se ocupa del cuidado de la piel —higiene, apariencia y proteccion—, fomentando la salud y el bienestar de los individuos. Uno de los factores psicologicos fundamentales en el paciente estetico se corresponde con las motivaciones internas, que solo pretenden un cambio en su cuerpo, y las motivaciones externas, que esperan tambien un cambio en sus vidas y en sus relaciones sociales. Es esencial la confianza en el espe cialista, que a veces surge, precisamente, de la publicidad en los medios de comunicacion. Por otra parte, hay que tener en cuenta los trastornos de la personalidad con mayor riesgo de insatisfaccion, como la personalidad narcisista e histrionica o el trastorno dismorfofobico corporal. En ge neral, las mujeres valoran de manera mas positiva el poten cial de sus tratamientos para contribuir a su bienestar per sonal, asi como las personas mayores, que conceden mas importancia al aspecto estetico de su piel para seguir sin tiendose jovenes. EnglishThe skin is the main element that is part of the body im age. Aesthetic dermatology deals with skin care —hygiene, appearance and protection— promoting the health and well-being of individuals. One of the fundamental psycho logical factors in the aesthetic patient corresponds to the internal motivations that only seek a change in their body, and the external motivations, which also expect a change in their lives and in their social relationships. Trust in the specialist is essential, which sometimes arises precisely from advertising in the media. On the other hand, it is necessary to take into account the personality disorders with a higher risk of dissatisfaction such as narcissistic and histrionicpersonality, or body dysmorphophobic disorder. In general, women value more positively the potential of their treatments to contribute to their personal well-being, as well as older people, who attach more importance to the aesthetic aspect of their skin to con tinue feeling young

Resumen Antecedentes y objetivo Previamente se habia iniciado el proceso metodologico para la validacion transcultural al idioma espanol de la escala Hair Specific Skindex-29 (HSS-29), que mide el impacto de la alopecia androgenica femenina sobre la calidad de vida relacionada con la salud (CVRS). Para finalizar el proceso, el objetivo del estudio fue completar la validacion a traves de la determinacion de su sensibilidad al cambio y su correlacion con una escala generalista de CVRS (SF-12). Material y metodo Se establecieron dos visitas, una basal y otra tras 6 meses de tratamiento con suplemento alimenticio con actividad inhibidora de la enzima 5-alfa reductasa. En cada visita, investigadores y pacientes valoraron la gravedad de la alopecia mediante la escala Sinclair, el estado de la apariencia del cabello, y se administraron las escalas HSS-29 y SF-12. Resultados Participaron 983 mujeres con alopecia androgenica. La media de puntuacion en la escala HSS-29 cambio de 27,5 ± 18,7 en la visita basal a 19,3 ± 15,7 en la de seguimiento, y sus dimensiones funcional, emocional y sintomatica tambien cambiaron significativamente. Tanto las diferencias entre basal y seguimiento en el indice HSS-29 global como en cada una de sus dimensiones se correlacionaron significativamente con las diferencias encontradas en las dimensiones de SF-12. Los coeficientes de correlacion de Pearson oscilaron entre −0,1 y −0,4, y en todos los casos el grado de significacion fue p Conclusiones La version en espanol de la escala HSS-29 posee sensibilidad, es decir, detecta cambios relacionados con la calidad de vida cuando las condiciones objetivas varian. Igualmente, se observo una correlacion entre las escalas HSS-29 y SF-12.

espanolEl acne es una de las enfermedades de la piel de mayor prevalencia. En las ultimas decadas, se ha observado un aumento progresivo de la presencia del acne en las muje- res adultas. Se distinguen dos tipos clinicos de acne de la mujer adulta: el acne persistente, continuacion del iniciado en la adolescencia, y el acne de comienzo tardio , que aparece por primera vez en los mayores de 25 anos. A menudo, se presenta con otros signos clinicos de androgenizacion como seborrea, hirsutismo o alopecia. Las causas fundamentales son geneticas y hormonales, con alta influencia del habito tabaquico y otra comorbilidad como el ovario poliquistico o el sindrome metabolico. Los tratamientos hormonales antiandrogenicos son la base terapeutica del acne en la mujer adulta. La isotretinoina se constituye en una herramienta de extraordinaria importancia terapeutica en dosis mas bajas que en el acne adolescente. Los tratamientos topicos con combinaciones fijas y la fototerapia son eficaces en monoterapia o politerapia en muchos casos. La atencion a la mujer adulta con acne debe incluir la valoracion de los aspectos emocionales y de la calidad de vida, para adecuar el tratamiento de forma integral. EnglishAcne is one of the most prevalent skin diseases. In the last decades, the presence of acne in adult women has progressively increased. There are two clinical types of acne of the adult woman: persistent acne, an extension of acne that began in adolescence, and late-onset acne, which appears for the first time in those over 25 years. It often presents along with other clinical signs of androgenization such as seborrhea, hirsutism or alopecia. Main causes are genetic and hormonal, with high influence of smoking and other comorbidities such as polycystic ovary or metabolic syndrome. Antiandrogenic hormonal treatments are the therapeutic basis of acne in adult women. Isotretinoin is a tool of extraordinary therapeutic importance at lower doses than in adolescent acne. Topical treatments with fixed combinations and phototherapy are effective in mono- or polytherapy in many cases. Management of adult women with acne must include the assessment of emotional aspects and quality of life for an integrated adaptation of treatment.

Alopecia areata (AA) is a polygenic autoimmune disease. The immunosuppressant drugs taken by patients who undergo solid organ transplantation might therefore be useful in its control. The literature, however, contains conflicting information in this regard. This contribution describes seven patients with AA, all of whom had undergone solid organ transplantation and were receiving treatment with immunosuppressant drugs. Patterns were sought that might suggest whether the administration of these drugs was affecting the appearance, progress, or resolution of AA. Only seven out of 469 patients (incidence 1.5%) who had undergone solid organ transplantation presented at our dermatology clinic with AA. All seven had undergone kidney transplantation. Five patients also had another autoimmune disease. Two of the seven patients developed AA before undergoing transplantation. No relationship was seen between the appearance or progress of AA and treatment with immunosuppressant drugs. The present results provide further evidence that AA may appear alongside other autoimmune disease. No clear picture emerges regarding whether immunosuppressants prevent the appearance of AA, help in its resolution, or encourage its onset. (

Summary Urticarial vasculitis (UV) is a mainly leucocytoclastic vasculitis with urticarial plaques. Treating these patients is challenging as the available treatments have poor efficacy. Oral corticosteroids are considered the first-line treatment, but H1 antihistamines, dapsone, colchicine, antimalarials, ciclosporin and antileucotrienes have all been tried also. However, because of their adverse effects and/or lack of efficacy, new agents are still needed. Omalizumab, an anti-IgE antibody, shows efficacy in chronic spontaneous urticaria, and might also be a good treatment for angio-oedema and urticarial vasculitis. To our knowledge, there have been only seven relevant case reports published in the English literature. We add a new case of severe chronic recurrent urticarial vasculitis refractory to all of the drugs mentioned above. We started the patient on subcutaneous omalizumab 300 mg every 4 weeks, which produced clinical improvement within the first month and total remission in the fifth month. The patient has remained stable for 23 months, and follow-up is ongoing.

Actinic keratoses are cutaneous lesions that appear as the result of the proliferation of atypical keratinocytes. These lesions are considered pre-malignant and they can progress to squamous cell carcinoma. Ingenol mebutate has been approved as an effective treatment for AK on the face and trunk. We studied the local skin reactions to this therapy. Data about local skin reactions were collected in a series of 5 patients with photographic documentation, a visual analog scale, and a ranking of satisfaction of the patient. Moderate to severe reactions were reported in most of patients, but only one stopped treatment early. The short duration of treatment contributes to high adherence to the therapy.

Clear cell acanthoma is a rare, epidermal tumor not common in the area of the nipples; indeed, the literature describes only 8 cases, all showing unilateral presentation. We here report the first case of bilateral clear cell acanthoma with good response to topical corticosteroids. Case report: A sixteen-year old girl presented with 2 excrescent, fleshy, and exudative tumor masses in both nipples and areola mammae. A biopsy was conducted and confirmed clear cell acanthoma histopathologically. Treatment with strong corticosteroids resulted in rapid improvement and resolution. After one year of follow-up, the patient developed atopic dermatitis. Discussion: We describe the first case of bilateral clear cell acanthoma localized in the nipple/areola that resolved with powerful corticosteroids, suggesting a reactive etiology of the lesion.

Aquagenic syringeal acrokeratoderma is an infrequently described acquired, transitory keratoderma that is exacerbated when the palms and/or soles are immersed in water. It manifests as whitish or yellowish flattened, translucent papules and plaques, located in areas of pressure or trauma on the palms and/or soles. Involvement is usually bilateral. The histologic features are non-specific, showing a slight dilation of the intraepidermal portion of the eccrine sweat duct. The process tends to remit spontaneously. We present the case of two women, aged 20 and 21.

We report the case of a 32-year old woman who presented with multiple nodules in the left arm and breast that had been present for 15 years. These nodules had a bluish colour and were occasionally painful. She had gone under excision of three other nodules on the left arm with the histopathological diagnosis of spiradenoma. All of the nodules were disposed in a linear arrangement and underneath a maculo-papular erythematous lesion which clinically seemed to be an epidermal nevus. The case described in the literature of multiple spiradenomas are very rare and multiple linear spiradenomas are even rarer.

Most Spanish dermatologists are members of the Spanish Academy of Dermatology and Venereology (AEDV). Their development and history can be considered to parallel each other. The aim of our study is to determine the role women have played in the AEDV throughout its history, both in number and as officers or directors.To obtain our data, we consulted AEDV's files from the time it was founded until the year 2002. We also asked other medical associations, obtaining a response from three of them.No women joined the AEDV until 1964. After that date, the percentage rose slowly (1975, 5.5 %), until the last decade when it increased more sharply, reaching 41.34 % in 2001. There are only 11 women on the boards of directors, all in non-presidential roles. The percentages of women in Pediatrics, Ophthalmology and Pathology are similar.The number of female dermatologists in the AEDV has increased gradually, although not steadily, reaching a maximum in the last decade. Women are rarely officers or directors, and there are no female presidents. The data shows that women have gradually become more prevalent in the medical profession, the same as in the rest of society as a whole.

Mastocytosis is a hyperplastic process characterized by the infiltration of different organs and tissues by mature mastocytes. It is more frequent in childhood, although cases also occur in adults. There are significant differences between the ways mastocytosis presents in adults and children, as well as in its development and prognosis.In this work, we describe the clinicopathological findings for 9 adult patients with mastocytosis. The clinical, evolutional and genetic characteristics of mastocytosis in adults are also compared to those of childhood mastocytosis.In contrast with childhood mastocytosis, the skin lesions of adult mastocytosis are very monomorphous, and consist of macules and papules of less than 1 cm in diameter, brownish-red in color. There are few symptoms, and there is usually discrete pruritus. Darier's sign is very often negative. Furthermore, the skin lesions do not tend to spontaneously regress, which is what usually occurs in children. Finally, systemic involvement in adults is practically a constant, with mastocyte infiltration of the bone marrow in over 90 % of cases, and bone involvement in over 50 % of cases, while systemic involvement is rarer in children. In any case, even if there is infiltration of systemic organs in adult mastocytosis, there are usually no accompanying clinical symptoms. The mutation of the c-kit proto-oncogene consists of the replacement of Asp with Val at codon 816, and this is nearly always found in adult mastocytosis. It is less frequent in childhood mastocytosis.All of these findings make it possible to classify adult mastocytosis as a separate clinicopathological entity from mastocytoses in children.