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Resumen: Introducción y objetivo: Entre 2020-2021 hemos sufrido una pandemia por el virus SARS-CoV-2. Debido a los cambios sociales por la pandemia, nos hemos propuesto estudiar el comportamiento epidemiológico de las principales infecciones de transmisión sexual (ITS) bacterianas (clamidia, gonorrea y sífilis) durante este periodo y compararlo con periodos previos. Material y método: Se recogieron las muestras mensuales de clamidia, gonorrea y sífilis entre los años 2018-2021 y las muestras positivas mensuales de SARS-CoV-2 entre los años 2020-2021 del Hospital General Universitario de Valencia, analizadas por técnica PCR Multiplex. Se recogieron datos clínicos y demográficos de los pacientes con ITS. Resultados: Durante los años 2020-2021 (pandemia) se diagnosticaron más casos de ITS total (664) que durante los años 2018-2019 (prepandemia) (570), con tasas de incidencia superiores y tasas de positividad similares. Se ha observado una correlación cronológica negativa entre las muestras positivas de SARS-CoV-2 y las muestras positivas de ITS. La edad media de los pacientes con diagnóstico de clamidia, gonorrea y sífilis fue de 29,64 (IC 95% 19,33-41,14), 30,86 (IC 95% 20,24-42,45) y 37,04 (IC 95% 26,01-51,00) años, respectivamente. El número de casos de clamidia en varones ha aumentado un 13,85% (IC 95% 6,39-21,08; p = 0,0003) en los años de pandemia. Conclusión: Durante los años de pandemia, ha existido una correlación negativa entre los casos de SARS-CoV-2 y los casos de ITS, con más casos de clamidia en varones. Las ITS han aumentado en los 2 últimos años, por lo que son un importante problema de salud en la población joven y adulta que merece especial atención. Abstract: Introduction and objective: The SARS-CoV-2 pandemic brought about social changes in 2020 and 2021. The aim of this study was to evaluate the epidemiologic profiles of the main sexually transmitted infections (STIs) of bacterial origin (chlamydia, gonorrhea, and syphilis) diagnosed during this period and compare them to findings from previous years. Material and methods: Drawing on data from Hospital General Universitario in Valencia, Spain, we recorded the number of chlamydia, gonorrhea, and syphilis cases diagnosed monthly by multiplex PCR in 2018-2021 and the number of PCR-confirmed SARS-CoV-2 cases diagnosed monthly in 2020-2021. We also collected clinical and demographic information on all patients diagnosed with STIs during the years studied. Results: The total number of STIs diagnosed increased from 570 in 2018-2019 to 664 in 2020-2021. PCR positivity rates were similar in the 2 periods, but the incidence rates were higher during the pandemic. The chronologic correlation between SARS-CoV-2 and STI positivity was negative. Mean age at diagnosis was 29.64 years (95% CI, 19.33-41.14) for chlamydia, 30.86 years (95% CI, 20.24-42.45) for gonorrhea, and 37.04 years (95% CI, 26.01-51.00) for syphilis. The number of men diagnosed with chlamydia increased by 13.85% (95% CI, 6.39-21.08; P = .0003) during the pandemic. Conclusions: We observed a negative correlation between SARS-CoV-2 infections and STIs during the pandemic and an increase in chlamydia cases among men. STI cases rose during 2020-2021, indicating that they remain a significant problem that needs to be addressed in young and adult populations.

Palmoplantar psoriasis is a particularly challenging variant of psoriasis. Psoriasis at this location has a significant impact on health-related quality of life and is often recalcitrant. However, difficult cases may respond to biologic therapies. Paradoxical reactions during treatment with biological agents have been described, mostly during anti-tumor necrosis factor therapy. These typically present as a change in morphology or distribution of lesions. We present a patient with palmoplantar psoriasis treated with ixekizumab who achieved a favorable response that was coupled with a rare paradoxical reaction, reversed plantar involvement. The reason for this phenomenon and its clinical course are uncertain, but these new lesions are proving recalcitrant to complementary therapies. Provided the increasingly widespread use of biologic therapies, the incidence and diversity of paradoxical reactions are expected to increase.

Background and objective: The COVID-19 pandemic brought about social changes in 2020 and 2021. The aim of this study was to evaluate the epidemiologic profiles of the main sexually transmitted infections (STIs) of bacterial origin (chlamydia, gonorrhea, and syphilis) diagnosed during this period and compare them to findings from previous years. Material and methods: Drawing on data from Hospital General Universitario in Valencia, Spain, we recorded the number of chlamydia, gonorrhea, and syphilis cases diagnosed monthly by multiplex polymerase chain reaction (PCR) in 2018–2021 and the number of PCR-confirmed SARS-CoV-2 cases diagnosed monthly in 2020–2021. We also collected clinical and demographic information on all patients diagnosed with STIs during the years studied. Results: The total number of STIs diagnosed increased from 570 in 2018–2019 to 664 in 2020–2021. PCR positivity rates were similar in the 2 periods, but the incidence rates were higher during the pandemic. The chronologic correlation between SARS-CoV-2 and STI positivity was negative. Mean age at diagnosis was 29.64 years (95% CI, 19.33–41.14 years) for chlamydia, 30.86 years (95% CI, 20.24–42.45 years) for gonorrhea, and 37.04 years (95% CI, 26.01–51.00 years) for syphilis. The number of men diagnosed with chlamydia increased by 13.85% (95% CI, 6.39–21.08; p = .0003) during the pandemic. Conclusions: We observed a negative correlation between SARS-CoV2 infections and STIs during the pandemic and an increase in chlamydia cases among men. STI cases rose during 2020–2021, indicating that they remain a significant problem that needs to be addressed in young and adult populations. Resumen: Introducción y objetivo: Entre 2020-2021 hemos sufrido una pandemia por el virus SARS-CoV-2. Debido a los cambios sociales por la pandemia, nos hemos propuesto estudiar el comportamiento epidemiológico de las principales infecciones de transmisión sexual (ITS) bacterianas (clamidia, gonorrea y sífilis) durante este periodo y compararlo con periodos previos. Material y métodos: Se recogieron las muestras mensuales de clamidia, gonorrea y sífilis entre los años 2018-2021 y las muestras positivas mensuales de SARS-CoV-2 entre los años 2020-2021 del Hospital General Universitario de Valencia, analizadas por técnica PCR Multiplex. Se recogieron datos clínicos y demográficos de los pacientes con ITS. Resultados: Durante los años 2020-2021 (pandemia) se diagnosticaron más casos de ITS total (664) que durante los años 2018-2019 (prepandemia) (570), con tasas de incidencia superiores y tasas de positividad similares. Se ha observado una correlación cronológica negativa entre las muestras positivas de SARS-CoV-2 y las muestras positivas de ITS. La edad media de los pacientes con diagnóstico de clamidia, gonorrea y sífilis fue de 29,64 (IC 95% 19,33-41,14), 30,86 (IC 95% 20,24-42,45) y 37,04 (IC 95% 26,01-51,00) años, respectivamente. El número de casos de clamidia en varones ha aumentado 13,85% (IC 95% 6,39-21,08; p = 0,0003) en los años de pandemia. Conclusiones: Durante los años de pandemia ha existido una correlación negativa entre los casos de SARS-CoV-2 y los casos de ITS, con más casos de clamidia en varones. Las ITS han aumentado en los dos últimos años, por lo que son un importante problema de salud en la población joven y adulta que merece especial atención.

ntestinal mucosa implanted in skin is an exceedingly rare occurrence. Implantations are thought to occur during the creation of ostomy sites or other surgical procedures in which suture goes through bowel mucosa and then skin. Current ostomy literature reports this as a very uncommon complication. We present a 54-year-old man diagnosed with Crohn disease with severe perianal involvement who was referred to our outpatient clinic because of two persistent perianal cutaneous ulcerations. He previously underwent several interventions to drain complex perianal fistulas and abscesses, the last of them involved placing seton stitches to ensure continuous draining during the healing process. Physical examination revealed two painful ulcerations with bleeding on contact. A skin biopsy was performed, revealing ectopic intestinal mucosa with crypts, villi, and goblet cells. Perianal ulcerations characteristic of Crohn disease might be difficult to differentiate from ectopic implant of bowel mucosa secondary to a surgical procedure in the perianal area. Therefore, we believe a high degree of suspicion and skin biopsy are key to the diagnosis.

We present a woman with an unusual case of secondary syphilis after an unnoticed primary infection. She initially presented with multiple grayish plaques and nodules on the vulva associated with an erythematous macular symmetrical rash affecting the trunk and extremities. Despite the increasing incidence of sexually transmitted diseases such as syphilis, presentation with unusual manifestations can lead to a delayed diagnosis.

Nail psoriasis can cause great morbidity and a negative impact on the personal and work-related life of the patients. However, it responds more poorly to most drug therapies. Classically, the first line of treatment for nail psoriasis has been topical medication, but the new biological drugs seem to be the most effective treatment. Apremilast is another systemic oral drug that has shown a significant reduction of the severity in moderate-severe plaque psoriasis, as well as nail and scalp psoriasis. We present two cases of patients who exhibited a rapid response to treatment with apremilast.

Resumen: El linfogranuloma venéreo (LGV) es una infección de transmisión sexual (ITS) producida por los serovares L1, L2 y L3 de la bacteria Chlamydia trachomatis y cuya incidencia está en aumento. Presentamos una serie de 8 pacientes diagnosticados en nuestra unidad de ITS del servicio de dermatología. La edad de nuestros pacientes es menor que en otras series publicadas y el síntoma más frecuente de presentación es la tumoración adenopática inguinal. El dermatólogo debe conocer esta enfermedad y realizar una correcta toma de muestras para un diagnóstico preciso y un tratamiento precoz. Abstract: The incidence of lymphogranuloma venereum (LGV) —a sexually transmitted infection (STI) produced by the L1, L2, and L3 serovars of Chlamydia trachomatis— is increasing. The 8 patients in this case series were diagnosed with LGV in the STI unit of our dermatology department. Our patients were younger than those in previously published case series, and on presentation they most often complained of tumorous masses (lymphadenopathy) in the groin. Dermatologists should be familiar with this disease. Samples must be taken correctly to ensure an accurate diagnosis and early treatment.

Abstract Background Diabetic macular edema (DME) can be treated with different alternatives, among them Dexamethasone intravitreal implant 0.7 mg (DEX 0.7) has demonstrated that may improve both central macular thickness (CMT) and best corrected visual acuity (BCVA). This study aimed to evaluate the effect of the intravitreal dexamethasone implant Ozurdex® in patients with different subtypes of diabetic macular edema over a 6-month follow-up period. Methods Eighty-four (29 naïve and 55 previously treated) eyes were included in this retrospective study. For each patient, the BCVA [Early Treatment Diabetic Retinopathy Study (ETDRS) charts] and macular thickness on optical coherence tomography (OCT) at baseline visit and within the 2nd, 4th, and 6th months of follow-up were obtained. The main outcomes measurements were the mean change in BCVA and in CMT with respect to the baseline value. The percentage of patients gaining ≥5 letters and ≥ 10 letters in BCVA was also analyzed. Results: A total of 84 eyes, 29 (34.5%) naïve and 55 (65.5%) non-naïve, from 69 patients were included in the study. BCVA at baseline was 58.8 (16.4) and 61.8 (11.6) in naïve and refractory patients, respectively, p = 0.4513. At every visit, BCVA significantly improved from baseline in naïve and non-naïve eyes (p

Background: Acrokeratosis paraneoplastica is an infrequent paraneoplastic disease in which cutaneous lesions appear and develop in a context of an underlying malignancy. Upper aerodigestive tract carcinomas are the most common neoplasias associated with this syndrome. The aim of this report is to raise awareness of this syndrome, since the recognition of the skin lesions could allow suspicion and diagnosis of the underlying neck malignancy at an early curable stage. Methods: We report a case of a 62-year-old life-long smoking male who presented a several months evolution of multiple skin lesions, affecting both ear lobes, hands and feet. He was referred for appropriate diagnosis and treatment of the lesions. Results: After further examinations and study of the patient, the diagnosis concluded in the detection of a laryngeal squamous cell carcinoma (SCC) causing the paraneoplastic skin-affecting syndrome (acrokeratosis paraneoplastica). Conclusions: A correctly oriented clinical suspicion of the malignancy was possible due to the detection of suggestive skin lesions affecting ear lobes and other locations. Keywords: Acrokeratosis paraneoplastica, Bazex syndrome, Laryngeal carcinoma, Skin lesions, Paraneoplasia

Nodular secondary syphilis results from the hematogenous and lymphatic dissemination of spirochetes. Clinically, the lesions appear as partially infiltrated plaques or red-violaceous nodules, which can be solitary or multiple. Several hypotheses have been put forward to explain the formation of these infiltrated or granulomatous lesions. Among the most accepted are the specific hypersensitivity reactions to Treponema pallidum or the lenghty duration of the disease. We present a case of nodular syphilis where immunohistochemistry revealed the presence of multiple spirochetes invading the epidermis.