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Abstract We report a 35-year-old HIV-positive male affected by lepromatous leprosy which, to our knowledge, is the first case of its kind in Spain. The relationship between the two conditions is discussed. [ABSTRACT FROM AUTHOR]

Sunburn, immunodepression, photoaging, and photocarcinogenesis, are some of the most significant adverse effects of solar radiation in humans. Children are population group of special vulnerability, due to the fact that exposure to the sun has more pronounced biological effects compared to adults. Furthermore, childhood is a critical period for promoting the development of photo damage and photocarcinogenesis in the later stages of life if adequate measures at not put into place. This is because it is estimated that between 18 and 20 years of age is when 40% to 50% of the accumulative exposure to ultraviolet radiation up to 60 years of age is received. The most important strategy for the photoprotection of children is changes in behaviour and habits associated with exposure to the sun at all levels (school, society, family, etc.). Resorting to the shade, reduction in overall time of exposure to the sun, and physical protection (clothes, hats, and sunglasses) are the best and least costly photoprotection strategies. The photoprotectors must be incorporated into the daily routine of children in the same way as adults, and must complete a series of requirements in order to make them effective, safe, and in line with the environment., (Copyright © 2020 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Intralesional methotrexate (MTX-il) has been used as neoadjuvant therapy for keratoacanthoma but has only been utilized in a few isolated cases of cutaneous squamous cell carcinoma as neoadjuvant therapy (cSCC)., Objectives: The objective of this study was to evaluate the effectiveness in clinical practice of presurgical MTX-il infiltration to reduce the size of the cSCC. Safety and the impact on subsequent reconstructive surgical techniques was also assessment., Methods: Single, retrospective, observational study of two historical cohorts differentiated in time. Subjects included were diagnosed with infiltrating cSCC. Patients included in group-A received neoadjuvant MTX-il and patients included in group-B underwent scheduled surgery without prior infiltration. Univariate and multivariate analyses were performed., Results: Group-A patients (n = 43) showed an average reduction in the tumour area of 0.52 cm(2) , while in group-B (n = 43), the area increased by 0.49 cm(2) . A multivariate linear regression analysis demonstrated that MTX-il was the only independent variable that significantly reduced the tumour size [mean 42.6% (95% CI: 31.17-54.03)]. Tumours ≥2 cm in size required significantly a lower percentage of complex reconstructions (P = 0.026). Lower lip tumours showed a higher reduction in group treated with MTX-il (P = 0.045). The only complication observed was discomfort during methotrexate infiltration (60.47%)., Conclusions: Neoadjuvant MTX-il reduced the presurgical size of cSCC lesions and could simplify their subsequent surgery., (© 2015 European Academy of Dermatology and Venereology.)

Background: There is scarce information on the use of ciclopirox olamine in children., Aims: The aim of this study was to evaluate the efficacy and safety of ciclopirox olamine cream 1% for the treatment of dermatomycosis in pediatric patients., Methods: A multicenter, non-randomized, open-label, phase iii study was conducted on patients aged 3 months to 9 years diagnosed with dermatomycosis confirmed by direct microscopy and culture, and treated with ciclopirox olamine cream 1% for 28 days. Clinical and microbiological evaluations were performed before starting the treatment therapy, at 7, 14 and 28 days after starting the treatment, and 28 days after its completion., Results: Twenty-one patients with a median age of 2.7 years (range 3 months-9 years) were included. The most frequent mycosis location was the inguinal region (72%). The most frequently isolated etiological agent was Candida spp. (71%). No adverse events were reported in 62% of the patients. Among the mild and moderate reported adverse events, only one, irritative dermatitis, was considered as possibly related to the treatment. Safety evaluation was excellent in 95% of the patients, and good in 5%. After the first week of treatment, 12 patients out of 13 (92%) showed a clinical improvement, and 5 out of 7 (71%) had both clinical and mycological improvements. At the end of the treatment, clinical cure was observed in 7 out of 9 patients (78%). No relapses occurred., Conclusions: Ciclopirox olamine cream 1% is a safe and feasible treatment for superficial cutaneous mycotic infections, especially Candida spp. infection, in children aged between 3 months and 10 years., (Copyright © 2013 Revista Iberoamericana de Micología. Published by Elsevier Espana. All rights reserved.)

Background: Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous disorder characterized by the development of multisystem hamartomatous tumours. Topical sirolimus has recently been suggested as a potential treatment for TSC-associated facial angiofibroma (FA)., Aim: To validate a reproducible scale created for the assessment of clinical severity and treatment response in these patients., Methods: We developed a new tool, the Facial Angiofibroma Severity Index (FASI) to evaluate the grade of erythema and the size and extent of FAs. In total, 30 different photographs of patients with TSC were shown to 56 dermatologists at each evaluation. Three evaluations using the same photographs but in a different random order were performed 1 week apart. Test and retest reliability and interobserver reproducibility were determined., Results: There was good agreement between the investigators. Inter-rater reliability showed strong correlations (> 0.98; range 0.97-0.99) with inter-rater correlation coefficients (ICCs) for the FASI. The global estimated kappa coefficient for the degree of intra-rater agreement (test-retest) was 0.94 (range 0.91-0.97)., Conclusions: The FASI is a valid and reliable tool for measuring the clinical severity of TSC-associated FAs, which can be applied in clinical practice to evaluate the response to treatment in these patients., (© 2014 British Association of Dermatologists.)

Introduction: In the past 10 years, bullous pemphigoid has been associated with other comorbidities and neurologic and psychiatric conditions in particular. Case series, small case-control studies, and large population-based studies in different Asian populations, mainland Europe, and the United Kingdom have confirmed this association. However, no data are available for the Spanish population., Material and Methods: This was an observational, retrospective, case-control study with 1:2 matching. Fifty-four patients with bullous pemphigoid were selected. We compared the percentage of patients in each group with concurrent neurologic conditions, ischemic heart disease, diabetes, chronic obstructive pulmonary disease, and solid tumors using univariate logistic regression. An association model was constructed with conditional multiple logistic regression., Results: The case group had a significantly higher percentage of patients with cerebrovascular accident and/or transient ischemic attack (odds ratio [OR], 3.06; 95% CI, 1.19-7.87], dementia (OR, 5.52; 95% CI, 2.19-13.93), and Parkinson disease (OR, 5; 95% CI, 1.57-15.94). A significantly higher percentage of cases had neurologic conditions (OR, 6.34; 95% CI, 2.89-13.91). Dementia and Parkinson disease were independently associated with bullous pemphigoid in the multivariate analysis., Conclusions: Patients with bullous pemphigoid have a higher frequency of neurologic conditions., (Copyright © 2013 Elsevier España, S.L.U. and AEDV. All rights reserved.)

Background: The prognostic benefit of health care service provision and delivery policies for patients with malignant melanoma (MM) is not yet clear., Objective: To analyze the role of health care provision determinants in the initial prognosis of MM., Methods: A multicenter cross-sectional study was conducted at 14 public hospitals and recruited 3550 patients with MM between 2000 and 2009. The study variables were analyzed using univariate and multivariate models to identify their role in the variations observed., Results: In a 10-year period, the number of patients with MM increased by 78.54%, with primary in situ MM (Tis) or MMs with a Breslow thickness <1 mm (T1) representing 51.72% of the total number of MMs in 2000, increasing to 62.23% by the end of the study period (P = .005). Among the variables that explained the variation in MM frequency the year of diagnosis after 2004 (univariate odds ratio [OR], 1.43 [P < .001]; multivariate OR, 1.36 [P = .005]) and diagnosis in centers with specific fast-track referral systems (univariate OR, 1.24 [P = .01]; multivariate OR, 1.59 [P = .025]) were shown to explain the increasing frequency of Tis-T1 MM., Limitations: The primary potential limitation of this study is its retrospective nature., Conclusion: Health care provision policies and interventions aimed at improving accessibility to specialized care appear to explain the increasing frequency of Tis-T1 MM., (Copyright © 2014 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.)

Facial angiofibromas are hamartomatous growths that are closely associated with tuberous sclerosis complex and, in fact, they constitute one of the main diagnostic criteria for that disease. These lesions composed of blood vessels and fibrous tissue appear on the face at an early age. Since they have important physical and psychological repercussions for patients, several treatment options have been used to remove them or improve their appearance. However, the lack of treatment guidelines prevents us from developing a common protocol for patients with this condition. The present article aims to review the treatments for facial angiofibromas used to date and to propose a new evidence-based treatment protocol., (Copyright © 2012 Elsevier España, S.L. and AEDV. All rights reserved.)

Current trends in our setting indicate that the prevalence of actinic keratosis and similar diseases will increase in coming years and impose a greater burden on health care resources. A long list of clinical features must be taken into account when approaching the treatment of actinic keratosis. Until recently, therapeutic approaches focused solely on ablative procedures and the treatment of individual lesions and did not take into account areas of field cancerization. Now that the therapeutic arsenal has grown, standardized criteria are needed to guide the optimal choice of treatment for each patient. The elaboration of evidence-based consensus recommendations for the diagnosis and treatment of actinic keratosis generates knowledge that will help clinicians to deliver the highest level of care possible, standardizing decision-making processes and enhancing awareness among all the health professionals involved in the care pathway., (Copyright © 2013 Elsevier España, S.L. and AEDV. All rights reserved.)

Background: Phaeohyphomycosis can be caused by a number of different species, being the most common Alternaria alternata and Alternaria infectoria. The biggest risk factor for the development of the infection is immunosuppression., Aims: We present the case of a 64-year-old male renal transplant patient who came to hospital for presenting a tumour in the Achilles region which had been gradually growing in size., Methods: A skin biopsy was taken for histological study and culture of fungi and mycobacteria. Blood tests and imaging studies were performed., Results: Histopathology study and cultures identified A. infectoria as the causal agent. Imaging studies ruled out internal foci of infection. The lesion was surgically removed with no signs of recurrence after 24 months of follow-up., Conclusions: There are no treatment guidelines at present for cutaneous and subcutaneous Alternaria spp. infections. Various systemic antifungals have been used, either in combination with surgical removal or alone, with varying results. Surgery alone could be useful in the treatment of solitary, localised lesions in transplant patients in whom there are difficulties in controlling immunosuppression., (Copyright © 2012 Revista Iberoamericana de Micología. Published by Elsevier Espana. All rights reserved.)

Introduction: Pharmacoeconomic studies examining the cost-effectiveness of biological agents to treat moderate-to-severe psoriasis in real-life clinical practice are scarce. The aim of this study was to assess the efficiency, in terms of incremental cost-effectiveness, of etanercept and adalimumab in a real clinical setting., Methods: Direct and indirect costs were assessed from a Spanish societal perspective in a historical hospital cohort of patients with moderate-to-severe psoriasis attending a tertiary referral hospital over a 1-year period. The data examined included drug-related variables, use of health-care resources, transportation and work productivity losses. Effectiveness was measured as the proportion of patients achieving a reduction of at least 75% with respect to the baseline value for the Psoriasis Area Severity Index (PASI 75) during the first 52 weeks of treatment., Results: No statistically significant differences in effectiveness between etanercept (n = 135) and adalimumab (n = 48) were found (PASI 75 80% vs. 85.7%; RR = 1.07 [0.90, 1.27]; RRA = 5.7 [-8.9, 20.2]; p = 0.943). There were no significant differences in total cost per patient with etanercept as compared to adalimumab (14,843.73 ± 6,178.98  vs. 15,405.91 ± 9,106.50 ; p = 0.768)., Conclusion: Under conditions of daily clinical practice in our hospital, total health-care costs associated with the treatment of moderate-to-severe psoriasis with etanercept appear to be equivalent to those with adalimumab in the first year of treatment.

Introduction: Local botulinum toxin injections and endoscopic thoracic sympathectomy (ETS) have shown clinical effectiveness for the treatment of palmar hyperhidrosis in several studies. Although both strategies cause considerable costs for health-care systems, at the moment there are no studies examining directly their cost-effectiveness performance. The aim of the study was to assess the incremental cost-effectiveness of botulinum toxin when compared with ETS for palmar hyperhidrosis., Materials and Methods: Costs, effectiveness, and incremental cost-effectiveness ratio (ICER) were calculated. Costs were assessed from a Spanish National Health System perspective in a historical cohort of patients with palmar hyperhidrosis attending a tertiary referral hospital. Effectiveness was evaluated by using the Hyperhidrosis Disease Severity Scale (HDSS). A responder was defined as a patient who reported at least a two-grade improvement on the HDSS scale with respect to the baseline value. The horizon of time was 1 year., Results: Effectiveness was greater for ETS (n = 128) when compared with botulinum toxin (n = 100) for the treatment of palmar hyperhidrosis (92% vs. 68%; odds ratio (OR) = 6.22 [2.80, 13.80]; absolute risk ratio (ARR) = -0.24 [-0.45, -0.14]; number-needed-to-treat (NNT) = -4 [-2, -11]). Botulinum toxin had an ICER of 125 € when compared with ETS during the first year of treatment., Conclusions: In this retrospective real-world observational sample of patients with palmar hyperhidrosis, treatment with ETS appears to be more effective and less costly when compared with botulinum toxin during the first year of treatment. Analyses such as this give decision makers the tools to choose a better treatment option which is both highly effective and yet has a low cost.

Atopic dermatitis is a chronic inflammatory disease that affects 20% of children and almost 3% of adults and is associated with considerable impairment of quality of life for both patients and their families. While the condition resolves spontaneously after puberty in over 75% of cases, it can persist into adulthood. Furthermore, in young children severe forms can have serious health consequences and affect social development. There are no appropriate guidelines on how to handle cases that do not respond to routine treatment. In this article, we review the current treatments for moderate to severe atopic dermatitis, describe our experience with this disease, and propose a management algorithm., (Copyright © 2011 Elsevier España, S.L. and AEDV. All rights reserved.)

Background: Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous disorder characterized by the development of multisystem hamartomatous tumours. Facial angiofibroma appears in up to 80% of patients and has a considerable psychological impact. Various invasive procedures have been used, although they show limited effectiveness and potential adverse effects., Objectives: To evaluate the sustained clinical benefits and safety profile of topical sirolimus applied to treat facial angiofibromas., Methods: This study was a non-blinded, uncontrolled case-series comprising 10 patients with TSC-associated facial angiofibroma that was treated with 0.4% sirolimus ointment 3 times a week for 9 months. Patients were clinically evaluated at baseline and at 6, 12, 24 and 36 weeks. Plasma levels of sirolimus were determined., Results: A sustained improvement was observed in erythema and in the size and extension of the lesions as early as the first weeks of treatment. Sirolimus plasma levels remained below detection limits (0.3 ng/mL) in all cases. The formula was well-tolerated with no local or systemic adverse effects., Conclusions: Topical sirolimus seems to be an effective and safe medical alternative to surgery or laser-based treatments in patients with TSC-associated facial angiofibromas., (© 2011 The Authors. Journal of the European Academy of Dermatology and Venereology © 2011 European Academy of Dermatology and Venereology.)

Background and Objectives: the aim of this study was to determine the approaches used to treat acne in clinical practice by Spanish dermatologists. A secondary objective of the study was to compare the practices of Spanish dermatologists with the Acne Global Alliance treatment algorithm and develop a Spanish treatment algorithm for acne., Patients and Methods: a multicenter, cross-sectional survey was undertaken among 872 Spanish dermatologists. The study comprised 4 randomly distributed questionnaires. The first 3 contained the following case descriptions: severe acne associated with masculinization (case 1), mild comedonal acne (case 2), and moderate papulopustular acne (case 3). The fourth questionnaire contained 5 photographs of different types of acne and an algorithm containing various treatment options, from which dermatologists were asked to choose the most appropriate., Results: for case 1, 55% of dermatologists chose oral antiandrogens/contraceptive drugs plus topical retinoids or topical benzoyl peroxide/antibiotics. In case 2, 62% chose topical retinoids and, in case 3, 68% chose systemic antibiotics plus benzoyl peroxide. Combination therapy was considered the treatment of choice in all types of acne, with topical retinoids as the initial treatment option for mild and moderate forms and the preferred option for maintenance therapy., Conclusions: in general, Spanish dermatologists treat acne in accordance with the Acne Global Alliance treatment algorithm. The varying opinions reported in response to open questions, however, confirm the need to unify criteria for the treatment of acne., (Copyright © 2010 Elsevier España, S.L. y AEDV. All rights reserved.)

Although in most majority the psoriasis presents/displays a clinical cutaneous today fundamentally we know that it can be associated to other diseases extracutaneous, as much you will articular, digestive, metabolic, cardiovascular and even psychic. We reviewed in this article the atiopathogenics bases and the risks that the psoriáasics patients must to suffer these comorbidities.

Surgical complications are any deviation from the expected course of the surgical procedure. They occur as a consequence of one or more unexpected events, which can be avoided in the majority of cases through careful planning, a precise surgical technique, and correct postoperative care. Some complications, such as cardiac arrhythmias, anaphylaxis, and cardiorespiratory arrest, are life-threatening whereas others, occurring as a direct result of surgery, can affect the healing process and the final cosmetic appearance of the scar. We must therefore have not only the relevant training in dermatologic surgery, but also in basic and advanced cardiopulmonary resuscitation. In this review we discuss the perioperative measures necessary to avoid the onset of complications in dermatologic surgery and we define the various complications that can develop.

Alopecia areata is nonscarring telogenic alopecia of autoimmune etiology. It is estimated to be the presenting complaint in 2 % of dermatologic consultations, and can appear at any age although it is more common in young patients. Treatment depends on several factors, such as extent of the disease and age, and may be local or systemic. Local treatments aim to achieve hair regrowth, but do not alter the underlying condition, whereas systemic treatments can modify the course of the disease. In neither case does treatment provide a cure. In this article, we review most of the therapeutic options described in the literature for alopecia areata.

Severe combined immunodeficiency (SCID) is a heterogeneous group of disorders characterized by a defect of T and B cell immunity with a genetic origin in most cases. Although the X-linked recessive form is most common (60-70%), there are autosomal recessive forms (20%) and spontaneous mutations. While SCID may present with many nosocomial infections, dermatophyte infections are not common. We reported a case of SCID which was associated with a widespread skin infection with Trichophyton mentagrophytes.

T cells play an important role in the immune system and in the inflammatory response that determines the development and maintenance of psoriasis plaques. Better understanding of the pathophysiology of this disease has led to the development of specific biological treatments aimed at patients with extensive psoriasis. Traditionally, psoriasis has been treated with drugs which, in spite of their efficacy, have a toxicity associated to their long-term use. Thus, they cannot be used safely, comfortably or efficiently in many patients. Efalizumab, a biological agent specifically and selectively directed towards blocking the key steps in the pathogenesis of psoriasis, has been shown to be effective and safe in the short and long term in the treatment of psoriasis in more than 15 phase I, II and III clinical trials. In this article, the results of efficacy at 12 weeks, 6 months and three years are reviewed. Efalizumab arises as an important addition to the dermatological pharmacopoeia for the long-term treatment of psoriasis.

Granulomatous slack skin syndrome is a rare clinical and pathologic disorder. Only 42 patients have been reported, one of whom we described in 1997--the only child so far reported. We now describe the evolution of this patient and the transformation of the disease into a peripheral T-cell lymphoma, and the complications resulting in the child's death.

Capecitabine is an antineoplastic agent used for the treatment of patients with metastatic solid tumors (breast and colon). Different adverse effects have been recognized, among which we find the muco-cutaneous ones and, specifically, hyperpigmentation. We report a case of localized cutaneous hyperpigmentation secondary to capecitabine in a woman that underwent surgery for breast cancer and was receiving this drug for a month. The start of therapy was associated with dysesthesias and hyperpigmentation of the hands and feet. The pathogenesis of such manifestations is unknown. Other reported cutaneous adverse effects associated with this drug involve the nails producing onycholysis, fragility, discoloration and dystrophy.

Trichothiodystrophy comprises a heterogeneous group of autosomal recessive entities. This fact gives rise to different interrelated neuroectodermal disorders. From a structural point of view these features are the result of the low tissue sulfur content. We report a case of trichothiodystrophy initially classified as Tay syndrome that based on clinical features, complementary exams as well as on the disease evolution was labelled as PIBIDS syndrome.

Angiosarcoma that develops on a limb with chronic lymphedema is called Stewart-Treves syndrome. This typically appears as a complication of a long course lymphedema located on the arm, after mastectomy and/or radiotherapy due to breast cancer. There are cases of Stewart-Treves syndrome in chronic lymphedema in the upper limb contralateral to the breast treated for cancer and in chronic lymphedema of the leg. We present two cases of this syndrome. The first corresponds to a typical syndrome of Stewart-Treves in an 83-year-old woman who was diagnosed of angiosarcoma in a chronic lymphedema territory secondary to mastectomy and radiotherapy due to breast cancer. The second case is much rarer, since it is a case of diffuse angiosarcoma of the leg in a 42-year-old man with a history of lymphedema. Due to the aggressive nature of this syndrome, knowledge and research on its treatment are necessary.

Chronic ulcers are a challenge in dermatological therapy. It is essential to establish their etiology in order to treat them, but on many occasions local therapy is of great interest. Treatment of chronic ulcers is currently based on so-called moist wound healing, and it takes two aspects into consideration: the underlying pathology and local treatment. Local treatment is always necessary and includes: cleaning, debridement, the control of any infection, and the application of different topical agents, both medication and dressings. Recently, new therapeutic strategies are being established, some of which are still being assessed, and which include: skin replacement using biological skin substitutes, growth factors, laser, hyperbaric oxygen, electrical stimulation and negative pressure dressings. In this work, we review the therapeutic advances in this pathology, without neglecting the validity of classic treatments.

Usually the clinical diagnostic of tinea is easy for the dermatologist, but occasionally, mostly as a result of an unsuitable treatment, the cutaneous lesions can show up atypical forms. In this article tinea capitis in the elderly, tinea follicularis et granulomatosa of the legs, tinea faciei and tinea incognito are discussed.

This case confirms that cutaneous herpes simplex virus (HSV) infections in many AIDS patients is important not only for the difficulty in diagnosis of herpetic lesions, but also for the possibility that co-infection by HSV and HIV can adversely affect prognosis in these patients.

Background: Numerous publications describe the relationship between aberrant mammary tissue (AMT) and kidney-urinary tract malformations, individual/ familial alcoholism and sense organ disorders., Patients and Methods: We investigated these possible associations and reviewed 72 cases observed in our Department during the past 3 years: 30 men and 42 women, 17 of them with bilateral AMT (7 men and 10 women) and 25 patients from 9 families. Diagnosis was made according to Kajawa's classification. A detailed family history was performed asking for individual or familial alcoholism, especially in the mother, in addition to blood tests and ultrasonographic examination of the abdomen and the kidneys., Results: We only found 1 family history of alcoholism in 3 families, but in the father, never in the mother or the affected subject. No congenital/ hereditary nephrourinary defects or sense organ disorders were found., Conclusions: We believe that in our population AMT is not a marker for alcoholism, kidney-urinary malformations nor sense organ disorders.

The pseudoatrophic pityriasis versicolor is an atypical form of this disease with cutaneous atrophy provoked by the prolonged application of topical corticosteroids. The term "pseudoatrophic" is indicative of its reversible character.

A case of clinical and dermopathological characteristic cystic lymphangioma is reported. The atypical localization of the tumor and its delayed apparition were pointed out. A relation with any precipitating factor could not be established. Treatment was surgical remove.

Alagille 's syndrome, described in 1970, associates a chronic intrahepatic cholestasis (hypoplasia of the interlobulary biliary ducts), vertebral and visceral malformations, retarded physical, mental and sexual development and neonatal jaundice. A series of cutaneous manifestations are reviewed in their clinical, histological and ultrastructural aspects. Its relation with the zinc deficiency syndrome is discussed.

Seven cases of P X E, four of them seen in the last six months in our clinic, are revised in the Department of Dermatology Medical-Surgical and Venereology of Sevilla (Faculty of Medicine), realising clinical, histological and ultrastructural studies.

Five cases of Woolly hair, three generalised, and two localised are reported. On the first two, we carried out trichogrammes which were studied with polarized light, and on all five, SEM (Scanning Electron Microscopy). The data obtained coincided with previous descriptions (Pseudomonilethrix images, Pili torti, Trichorrhexis nodosa, reduced hair diameter, oval section following transversal cut, and a wavy-line disposition), although we emphasize the smaller number of layers of cuticle cells following the transversal cut, and the presence of Trichonodosis, not previously refered.