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Resumen: Antecedentes y objetivo: No se dispone de datos españoles sobre el coste asociado al linfoma cutáneo de células T (LCCT). Además, la incorporación de nuevos tratamientos hace necesario analizar el coste real de la enfermedad. El estudio MICADOS analizó dos objetivos principales: Por un lado, evaluó el impacto en la calidad de vida en los pacientes con LCCT, y por otro lado, estudió los costes de la enfermedad. En esta publicación se recoge el segundo de los objetivos del estudio. Métodos: El coste de la enfermedad se estudió bajo la perspectiva del Sistema Nacional de Salud (SNS) con un horizonte temporal de un año. Participaron 23 dermatólogos y hematólogos de 15 hospitales públicos españoles. Se incluyeron pacientes adultos con LCCT del tipo micosis fungoide (MF) y síndrome de Sézary (SS). Resultados: Se incluyeron 141 pacientes, el 57,4% masculinos, con una edad media de 63,6 años (IC 95%: 61,4-65,7). Los costes directos anuales medios por pacientes del estudio fueron de 34.214€, siendo de 11.952,47€ en estadio I, 23.506,21€ en estadio II, 38.771,81€ en estadio III y 72.748,84€ en estadio IV. El coste anual directo total estimado de todos los pacientes en España con MF/SS resultó en 78.301.171€, donde el 81% de los costes fueron atribuibles a pacientes en estadio I, el 7% al estadio II, el 6% al estadio III y el 6% al estadio IV. Conclusiones: Este estudio ofrece una evaluación precisa del coste directo del LCCT en pacientes con MF/SS en España, mostrando costes que varían sustancialmente en función del estadio. Los costes soportados por el paciente y los costes indirectos deberán considerarse en futuras investigaciones. Abstract: Background and objective: The cost of treating cutaneous T-cell lymphoma (CTCL) in Spain is unknown. With the advent of new treatments, it is more important than ever to gain an accurate picture of the true costs involved. The MICADOS study had 2 primary objectives: 1) to evaluate the impact of CTCL on patient quality of life, and 2) to evaluate the costs associated with the disease. This article reports the results of the cost analysis. Methods: We estimated the cost of treating CTCL over a period of 1 year from the perspective of the Spanish National Health System. Twenty-three dermatologists and hematologists from 15 public hospitals analyzed data for adult patients with mycosis fungoides (MF) or Sézary syndrome (SS). Results: A total of 141 patients (57.4% male) with a mean age of 63.6 years (95% CI: 61.4-65.7 years) were included. The mean direct annual cost of treating CTCL was €34,214 per patient. The corresponding costs by stage were €11,952.47 for stage I disease, €23,506.21 for stage II disease, €38,771.81 for stage III disease, and €72,748.84 for stage IV disease. The total direct annual cost of treating MF/SS in public hospitals in Spain was estimated at €78,301,171; stage I disease accounted for 81% of all costs, stage II for 7%, and stages III and IV for 6% each. Conclusions: The MICADOS study offers an accurate picture of the direct cost of treating CTCL in patients with MF/SS in Spain and shows that costs vary significantly according to disease stage. Patient-borne and indirect costs should be analyzed in future studies.

Background: Dupilumab is a new targeted therapy for severe atopic dermatitis (AD) with limited real-world evidence. Objective: Explore our experience with dupilumab for AD in clinical practice at a tertiary care center. Material and method: Unicentric observational retrospective study including adult and pediatric patients with severe AD receiving dupilumab between December 2017 and December 2021. The Eczema Area and Severity Index (EASI) score, Pruritus Numerical Rating Scale (P-NRS) and Sleep disturbance Numerical Rating Scale (S-NRS) were recovered to assess severity and response. Results: Fifty-nine patients received dupilumab: 52, 48, 26 and 13 patients reached 6, 12, 24 and 36 months of treatment, respectively. The EASI-75 response rates were 94.2%, 95.8%, 92.3% and 100% at months 6, 12, 24 and 36. The EASI-90 response rates were 63.5%, 72.9%, 84.6% and 92.3% at months 6, 12, 24 and 36. The EASI

Abstract Microorganisms colonize all possible ecological habitats, including those subjected to harsh stressors such as UV radiation. Hospitals, in particular the UV cabins used in phototherapy units, constitute an environment in which microbes are intermittently subjected to UV irradiation. This selective pressure, in addition to the frequent use of antibiotics by patients, may represent a threat in the context of the increasing problem of antimicrobial resistance. In this work, a collection of microorganisms has been established in order to study the microbiota associated to the inner and outer surfaces of UV cabins and to assess their resistance to UV light and the antibiotics frequently used in the Dermatology Service of a Spanish hospital. Our results show that UV cabins harbor a relatively diverse biocenosis dominated by typically UV-resistant microorganisms commonly found in sun-irradiated environments, such as Kocuria, Micrococcus or Deinococcus spp., but also clinically relevant taxa, such as Staphylococcus or Pseudomonas spp. The UV-radiation assays revealed that, although some isolates displayed some resistance, UV is not a major factor shaping the biocenosis living on the cabins, since a similar pool of resistant microorganisms was identified on the external surface of the cabins. Interestingly, some Staphylococcus spp. displayed resistance to one or more antibiotics, although the hospital reported no cases of antibiotic-resistance infections of the patients using the cabins. Finally, no association between UV and antibiotic resistances was found.

Resumen: Antecedentes: Dupilumab es una nueva terapia dirigida para la dermatitis atópica (DA) grave con una evidencia en la vida real aún limitada. Objetivo: Explorar nuestra experiencia con dupilumab para la DA en práctica clínica en un centro terciario. Material y método: Estudio observacional retrospectivo y unicéntrico que incluye pacientes adultos y pediátricos con DA grave en tratamiento con dupilumab entre diciembre de 2017 y diciembre de 2021. La gravedad y la respuesta se evaluaron con las escalas Eczema Area and Severity Index (EASI), Pruritus Numerical Rating Scale y Sleep Disturbance Numerical Rating Scale. Resultados: Cincuenta y nueve pacientes recibieron dupilumab: 52, 48, 26 y 13 pacientes alcanzaron los 6, 12, 24 y 36 meses de tratamiento, respectivamente. La tasa de EASI-75 fue del 94,2; 95,8; 92,3 y 100% a los 6, 12, 24 y 36 meses, respectivamente. La tasa de EASI-90 fue del 63,5; 72,9; 84,6 y 92,3% a los 6, 12, 24 y 36 meses, respectivamente. La tasa de EASI

Background and objective: The cost of treating cutaneous T-cell lymphoma (CTCL) in Spain is unknown. With the advent of new treatments, it is more important than ever to gain an accurate picture of the true costs involved. The MICADOS study had 2 primary objectives: 1) to evaluate the impact of CTCL on patient quality of life, and 2) to evaluate the costs associated with the disease. This article reports the results of the cost analysis. Methods: We estimated the cost of treating CTCL over a period of 1 year from the perspective of the Spanish National Health System. Twenty-three dermatologists and hematologists from 15 public hospitals analyzed data for adult patients with mycosis fungoides (MF) or Sézary syndrome (SS). Results: A total of 141 patients (57.4% male) with a mean age of 63.6 years (95% CI: 61.4-65.7 years) were included. The mean direct annual cost of treating CTCL was €34,214 per patient. The corresponding costs by stage were €11,952.47 for stage I disease, €23,506.21 for stage II disease, €38,771.81 for stage III disease, and €72,748.84 for stage IV disease. The total direct annual cost of treating MF/SS in public hospitals in Spain was estimated at €78,301,171; stage I disease accounted for 81% of all costs, stage II for 7%, and stages III and IV for 6% each. Conclusions: The MICADOS study offers an accurate picture of the direct cost of treating CTCL in patients with MF/SS in Spain and shows that costs vary significantly according to disease stage. Patient-borne and indirect costs should be analyzed in future studies. Resumen: Antecedentes y objetivo: No se dispone de datos españoles sobre el coste asociado al linfoma cutáneo de células T (LCCT). Además, la incorporación de nuevos tratamientos hace necesario analizar el coste real de la enfermedad. El estudio MICADOS analizó dos objetivos principales: Por un lado, evaluó el impacto en la calidad de vida en los pacientes con LCCT, y por otro lado, estudió los costes de la enfermedad. En esta publicación se recoge el segundo de los objetivos del estudio. Métodos: El coste de la enfermedad se estudió bajo la perspectiva del Sistema Nacional de Salud (SNS) con un horizonte temporal de un año. Participaron 23 dermatólogos y hematólogos de 15 hospitales públicos españoles. Se incluyeron pacientes adultos con LCCT del tipo micosis fungoide (MF) y síndrome de Sézary (SS). Resultados: Se incluyeron 141 pacientes, el 57,4% masculinos, con una edad media de 63,6 años (IC 95%: 61,4-65,7). Los costes directos anuales medios por pacientes del estudio fueron de 34.214€, siendo de 11.952,47€ en estadio I, 23.506,21€ en estadio II, 38.771,81€ en estadio III y 72.748,84€ en estadio IV. El coste anual directo total estimado de todos los pacientes en España con MF/SS resultó en 78.301.171€, donde el 81% de los costes fueron atribuibles a pacientes en estadio I, el 7% al estadio II, el 6% al estadio III y el 6% al estadio IV. Conclusiones: Este estudio ofrece una evaluación precisa del coste directo del LCCT en pacientes con MF/SS en España, mostrando costes que varían sustancialmente en función del estadio. Los costes soportados por el paciente y los costes indirectos deberán considerarse en futuras investigaciones.

Resumen: Antecedentes y objetivos: Los linfomas cutáneos primarios (LCP) son un conjunto de entidades poco frecuentes. En febrero del 2018 se describieron los resultados del primer año de funcionamiento del Registro de linfomas cutáneos primarios de la AEDV. En el presente trabajo actualizamos los resultados tras 5 años de funcionamiento. Pacientes y métodos: Registro de enfermedad de pacientes con LCP. Se recogieron datos prospectivamente de los pacientes, incluyendo diagnóstico, tratamientos, pruebas realizadas y estado actual del paciente. Se realizó un análisis descriptivo. Resultados: En diciembre del 2021 se había incluido a un total de 2020 pacientes en el Registro, pertenecientes a 33 hospitales españoles. El 59% fueron hombres, la edad media fue de 62,2 años. Se agruparon en 4 grandes grupos diagnósticos: micosis fungoide/síndrome de Sézary (1.112, 55%), LCP de células B (547, 27,1%), trastornos linfoproliferativos de células T CD30+ (222, 11%) y otros linfomas T (116, 5,8%). La mayoría presentó estadio T1, encontrándose actualmente casi el 75% en remisión completa (43,5%) o enfermedad estable (EE; 27%). Los tratamientos más usados fueron corticoides tópicos (1.369, 67,8%), fototerapia (890, 44,1%), cirugía (412, 20,4%) y radioterapia (384, 19%). Conclusión: Las características del paciente con LCP en España no difieren de otras series. El mayor tamaño del registro permite precisar mejor los datos con respecto a los resultados del primer año. Este registro facilita al grupo de linfomas de la AEDV realizar investigación clínica, surgiendo ya trabajos publicados de dicho registro. Abstract: Background and objective: Primary cutaneous lymphomas (PCL) are uncommon. Observations based on the first year of data from the Spanish Registry of Primary Cutaneous Lymphomas (RELCP, in its Spanish abbreviation) of the Spanish Academy of Dermatology and Venereology (AEDV) were published in February 2018. This report covers RELCP data for the first 5 years. Patients and methods: RELCP data were collected prospectively and included diagnosis, treatments, tests, and the current status of patients. We compiled descriptive statistics of the data registered during the first 5 years. Results: Information on 2020 patients treated at 33 Spanish hospitals had been included in the RELCP by December 2021. Fifty-nine percent of the patients were men; the mean age was 62.2 years. The lymphomas were grouped into 4 large diagnostic categories: mycosis fungoides/Sézary syndrome, 1112 patients (55%); primary B-cell cutaneous lymphoma, 547 patients (27.1%); primary CD30 + lymphoproliferative disorders, 222 patients (11%), and other T-cell lymphomas, 116 patients (5.8%). Nearly 75% of the tumors were registered in stage I. After treatment, 43.5% achieved complete remission and 27% were stable at the time of writing. Treatments prescribed were topical corticosteroids (1369 [67.8%]), phototherapy (890 patients [44.1%]), surgery (412 patients [20.4%]), and radiotherapy (384 patients [19%]). Conclusion: The characteristics of cutaneous lymphomas in Spain are similar to those reported for other series. The large size of the RELCP registry at 5 years has allowed us to give more precise descriptive statistics than in the first year. This registry facilitates the clinical research of the AEDV's lymphoma interest group, which has already published articles based on the RELCP data.

Epidermolytic acanthomas (EA) are rare benign tumors of unclear etiology that present as flat, sometimes slightly keratotic, pale or whitish papules that are usually asymptomatic. Not uncommonly, their clinical appearance in the anogenital area might lead to misdiagnosis as other lesions that commonly develop at this site, such as condylomata acuminata. Though mainly asymptomatic, there are also reports of EA presenting with persistent genital pruritus. We describe the first reported case of pruritic scrotal EA successfully treated with topical pimecrolimus.

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.

Abstract Background Few studies have explored the impact of cutaneous T‐cell lymphoma (CTCL) on health‐related quality of life (HRQoL) and compared it to other patients with cancer. Objectives The primary objective of the study was to assess the QoL of patients diagnosed with the mycosis fungoides (MF) and Sézary syndrome (SS) types of CTCL in Spain. Methods A cross‐sectional observational study was completed recruiting adult patients with MF and SS, exploring the European Organisation for Research and Treatment of Cancer‐Core Quality of Life Questionnaire, version 3 (EORTC‐QLQ‐C30v3) and Skindex‐29 HRQoL and itching intensity. Results A total of 141 patients [81 males (57.4%) and mean age of 63.6 years (95% CI: 61.4–65.7)], were included. EORTC‐QLQ‐C30 global health status showed worse scores in CTCL patients compared to healthy population (p

Apocrine hidrocystoma is a rare, benign, cystic tumor of the apocrine sweat glands. They are most commonly located around the eyes and may also be found on the scalp and neck. However, despite the fact that the nipple and areola contain numerous apocrine sweet glands, apocrine hydrocystomas have not been described previously in this area to the best of our knowledge. We report the first case of this cyst in this unsual location.

Programmed cell death receptor 1 inhibitors (anti-PD-1) constitute a form of immunotherapy for the treatment of several cancers. They are associated with cutaneous immune-related adverse events (irAE), occurring in up to 50% of patients. Lichenoid dermatitis is frequent and several presentations have been described. Although attempts have been made to study these reactions, they are yet to be fully characterized and the relationship with tumor response is unclear. We describe a case of digital ulcerative lichenoid dermatitis resembling ulcerative cutaneous lichen planus that occurred during pembrolizumab therapy for oral squamous cell carcinoma. The patient developed a painful ulcer on his index finger 18 months into therapy. Biopsy revealed epidermal ulceration with intense lichenoid dermatitis. Immunohistochemical study revealed intense CD8 positivity at the ulcer's edges and marked CD163 positivity at its base. Although idiopathic forms of this type of lichenoid dermatitis are particularly recalcitrant, our case was successfully managed with topical therapy and oncologic treatment did not require modification. One year after ending treatment the patient remains free of disease progression. It is unclear if this reaction is associated with his favorable oncologic response. This report adds an undescribed reaction to the increasing diversity of cutaneous irAE associated with anti-PD-1 therapy.

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.

Cowden syndrome (CS) is an infrequent genodermatosis caused by mutations in the phosphatase and tensin homolog (PTEN) gene in the majority of cases. As such, it belongs to the PTEN hamartoma tumor syndrome spectrum. This disease has a variable clinical expression characterized by the development of multiple hamartomatous tumors in different organs, usually during the second and third decades of life, and a high cumulative risk of several malignancies. We present a case of Cowden syndrome with late diagnosis presenting with a florid dermatological expression and multiple benign tumors, but no malignancies. A novel PTEN mutation was identified.

Resumen: Introducción y objetivo: La rosácea es una dermatosis acneiforme crónica donde la disrupción de la barrera cutánea puede provocar una facilidad para la sensibilización a distintos alérgenos. Nuestro objetivo es analizar la sensibilización alérgica de contacto en los pacientes con rosácea de nuestro medio. Material y métodos: Se realizó estudio de cohortes retrospectivo analizando todos los pacientes parchados en la consulta de Alergia Cutánea de nuestro servicio entre mayo de 1991 hasta mayo de 2019. Resultados: Durante el tiempo de estudio han sido remitidos a nuestra consulta un total de 200 pacientes con rosácea, el 2,1% del total de pacientes parchados en este tiempo. El 81% de los pacientes eran mujeres, con una edad media de 44,7 años. El 46,5% presentaron al menos un parche positivo, considerándose de relevancia presente (RP) en el 15%. Los parches positivos más frecuentes fueron níquel (26%), seguido de cloruro de cobalto (6,5%), isotiazolinonas (6%), PPDA (5,5%), mezcla II de perfumes (5%) y thiomersal (3,5%). Los parches positivos de RP más frecuentes fueron isotiazolinonas en 10/200 pacientes (5%), PPDA, mezcla II de fragancias, toluensulfonamida formaldehído resina en 4/200 pacientes cada uno (2%), tixocortol y mezcla I de fragancias en 2/200 cada uno (1%). El grupo de sustancias más frecuentemente detectadas fueron los metales, con una RP en el 12,6%, seguido de los fármacos con una RP en el 25,8%. Los conservantes y las fragancias fueron los siguientes grupos de sustancias más frecuentemente positivas, con una RP en el 70,8% y el 43,7%, respectivamente. La fuente de sensibilización más frecuente fueron los cosméticos, seguidos de los fármacos tópicos, destacando los corticoides y los antifúngicos tópicos. Conclusiones: Destacamos una elevada prevalencia de dermatitis alérgica de contacto en pacientes con rosácea, lo que sustenta la realización de pruebas epicutáneas, especialmente en aquellos con empeoramiento de sus lesiones en relación con la aplicación de productos cosméticos o fármacos tópicos. Abstract: Background and objective: Rosacea is a chronic acneiform skin disorder in which impaired skin barrier function can lead to sensitization to allergens. We aimed to analyze contact allergies in our patients with rosacea. Material and methods: Retrospective cohort study of all patients who underwent patch testing in our skin allergy clinic between May 1991 and May 2019. Results: A total of 200 patients with rosacea were referred to our clinic for patch testing during the study period; they represented 2.1% of all patch tested patients in the period. Eighty-one percent were women (mean age, 44.7 years). At least 1 positive patch test was recorded for 46.5%; 15% were of current relevance. The most frequent positive reaction was to nickel (26%), followed by cobalt chloride (6.5%), isothiazolinones (6%), p-phenylenediamine (5.5%), fragrance mix II (5%), and thimerosal (3.5%). The most common currently relevant patch test reactions were to isothiazolinones in 10 of the 200 patients (5%); to phenylenediamine, fragrance mix II, and toluensulfonamide formaldehyde resin in 4 patients (2%) each; and to tixocortol and fragrance mix I in 2 patients (1%) each. The allergen groups most often implicated were metals (of current relevance in 12.6%) and drugs (of current relevance in 25.8%). Preservatives and fragrances were the next most common allergen groups, and 70.8% and 43.7% of the positive reactions in these groups, respectively, were of current relevance. Cosmetics were the most frequent source of sensitization, followed by topical medications — notably corticosteroids and antifungal agents. Conclusions: We emphasize the high prevalence of allergic contact dermatitis in patients with rosacea, a finding which supports patch testing, especially if eruptions worsen when these patients use cosmetics and topical medications.

Background and objective: Primary cutaneous lymphomas (PCL) are uncommon. Observations based on the first year of data from the Spanish Registry of Primary Cutaneous Lymphomas (RELCP, in its Spanish abbreviation) of the Spanish Academy of Dermatology and Venereology (AEDV) were published in February 2018. This report covers RELCP data for the first 5 years. Patients and methods: RELCP data were collected prospectively and included diagnosis, treatments, tests, and the current status of patients. We compiled descriptive statistics of the data registered during the first 5 years. Results: Information on 2020 patients treated at 33 Spanish hospitals had been included in the RELCP by December 2021. Fifty-nine percent of the patients were men; the mean age was 62.2 years. The lymphomas were grouped into 4 large diagnostic categories: mycosis fungoides/Sézary syndrome, 1112 patients (55%); primary B-cell cutaneous lymphoma, 547 patients (27.1%); primary CD30+ lymphoproliferative disorders, 222 patients (11%), and other T-cell lymphomas, 116 patients (5.8%). Nearly 75% of the tumors were registered in stage I. After treatment, 43.5% achieved complete remission and 27% were stable at the time of writing. Treatments prescribed were topical corticosteroids (1369 [67.8%]), phototherapy (890 patients [44.1%]), surgery (412 patients [20.4%]), and radiotherapy (384 patients [19%]). Conclusion: The characteristics of cutaneous lymphomas in Spain are similar to those reported for other series. The large size of the RELCP registry at 5 years has allowed us to give more precise descriptive statistics than in the first year. This registry facilitates the clinical research of the AEDV's lymphoma interest group, which has already published articles based on the RELCP data. Resumen: Antecedentes y objetivos: Los linfomas cutáneos primarios (LCP) son un conjunto de entidades poco frecuentes. En febrero del 2018 se describieron los resultados del primer año de funcionamiento del Registro de linfomas cutáneos primarios de la AEDV. En el presente trabajo actualizamos los resultados tras 5 años de funcionamiento. Pacientes y métodos: Registro de enfermedad de pacientes con LCP. Se recogieron datos prospectivamente de los pacientes, incluyendo diagnóstico, tratamientos, pruebas realizadas y estado actual del paciente. Se realizó un análisis descriptivo. Resultados: En diciembre del 2021 se había incluido a un total de 2.020 pacientes en el Registro, pertenecientes a 33 hospitales españoles. El 59% fueron hombres, y la edad media fue de 62,2 años. Se agruparon en 4 grandes grupos diagnósticos: micosis fungoide/síndrome de Sézary (1.112 [55%]), LCP de células B (547 [27,1%]), trastornos linfoproliferativos de células T CD30+ (222 [11%]) y otros linfomas T (116 [5,8%]). La mayoría presentó estadio T1, encontrándose actualmente casi el 75% en remisión completa (43,5%) o enfermedad estable (EE: 27%). Los tratamientos más usados fueron corticoides tópicos (1.369 [67,8%]), fototerapia (890 [44,1%]), cirugía (412 [20,4%]) y radioterapia (384 [19%]). Conclusión: Las características del paciente con LCP en España no difieren de otras series. El mayor tamaño del registro permite precisar mejor los datos con respecto a los resultados del primer año. Este registro facilita al grupo de linfomas de la AEDV realizar investigación clínica, surgiendo ya trabajos publicados de dicho registro.

Background Bullous pemphigoid (BP) is the most common autoimmune blistering disease. Most patients are older and have associated multiple comorbidities. Topical and systemic corticosteroids are considered the first-line treatment for BP, and immunosuppressants are used as steroid-sparing treatments. However, both have side-effects and contraindications, which are even more common in this older population. New treatments targeting interleukins and receptors related to BP pathogenesis have been proposed to decrease these side-effects while achieving equal or better effectiveness and response rates. Omalizumab is a monoclonal antibody that targets IgE and has been proposed for the treatment of BP due to the evidence that IgE autoantibodies play an essential role in BP pathogenesis. Objectives To assess the efficacy and safety of omalizumab for the treatment of BP. Methods We carried out a multicentre, retrospective, observational study including patients diagnosed with BP who received omalizumab for ≥ 3 months from 15 tertiary hospitals in Spain. IgE levels prior to treatment were measured, and we evaluated the possible correlation with clinical response. We excluded patients treated with omalizumab for < 3 months, as we consider this duration to be insufficient for a comprehensive assessment of its efficacy. To evaluate the effectiveness of the treatment, we used the percentage of body surface area improvement. Results We included 36 patients. The vast majority had associated multiple comorbidities, and all patients had used other systemic therapies apart from corticosteroids before omalizumab. In total, 83% experienced some kind of treatment response and 42% of all patients treated achieved complete response. We did not find any correlation between higher IgE levels and a better response (P = 0.2). All patients tolerated omalizumab without reported side-effects. Conclusions Omalizumab is a good therapeutic alternative for BP as it provided clinical response in most patients, and nearly one-half of the cases achieved complete response. It showed no side-effects, which is crucial in older patients with BP. [ABSTRACT FROM AUTHOR]

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.

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.

Background and objective: Rosacea is a chronic acneiform skin disorder in which impaired skin barrier function can lead to sensitization to allergens. We aimed to analyze contact allergies in our patients with rosacea. Material and methods: Retrospective cohort study of all patients who underwent patch testing in our skin allergy clinic between May 1991 and May 2019. Results: A total of 200 patients with rosacea were referred to our clinic for patch testing during the study period; they represented 2.1% of all patch tested patients in the period. Eighty-one percent were women (mean age, 44.7 years). At least 1 positive patch test was recorded for 46.5%; 15% were of current relevance. The most frequent positive reaction was to nickel (26%), followed by cobalt chloride (6.5%), isothiazolinones (6%), p-phenylenediamine (5.5%), fragrance mix II (5%), and thimerosal (3.5%). The most common currently relevant patch test reactions were to isothiazolinones in 10 of the 200 patients (5%); to phenylenediamine, fragrance mix II, and toluensulfonamide formaldehyde resin in 4 patients (2%) each; and to tixocortol and fragrance mix I in 2 patients (1%) each. The allergen groups most often implicated were metals (of current relevance in 12.6%) and drugs (of current relevance in 25.8%). Preservatives and fragrances were the next most common allergen groups, and 70.8% and 43.7% of the positive reactions in these groups, respectively, were of current relevance. Cosmetics were the most frequent source of sensitization, followed by topical medications—notably corticosteroids and antifungal agents. Conclusions: We emphasize the high prevalence of allergic contact dermatitis in patients with rosacea, a finding which supports patch testing, especially if eruptions worsen when these patients use cosmetics and topical medications. Resumen: Introducción y objetivo: La rosácea es una dermatosis acneiforme crónica donde la disrupción de la barrera cutánea puede provocar una facilidad para la sensibilización a distintos alérgenos. Nuestro objetivo es analizar la sensibilización alérgica de contacto en los pacientes con rosácea de nuestro medio. Material y métodos: Se realizó estudio de cohortes retrospectivo analizando todos los pacientes parchados en la consulta de Alergia Cutánea de nuestro servicio entre mayo de 1991 hasta mayo de 2019. Resultados: Durante el tiempo de estudio han sido remitidos a nuestra consulta un total de 200 pacientes con rosácea, 2,1% del total de los pacientes parchados en este tiempo; 81% de los pacientes eran mujeres, con una edad media de 44,7 años; 46,5% presentaron al menos un parche positivo, considerándose de relevancia presente (RP) en 15%. Los parches positivos más frecuentes fueron níquel (26%), seguido de cloruro de cobalto (6,5%), isotiazolinonas (6%), PPDA (5,5%), mezcla II de perfumes (5%) y thiomersal (3,5%). Los parches positivos de RP más frecuentes fueron isotiazolinonas en 10/200 pacientes (5%), PPDA, mezcla II de fragancias, toluensulfonamida formaldehído resina en 4/200 pacientes cada uno (2%), tixocortol y mezcla I de fragancias en 2/200 cada uno (1%). El grupo de sustancias más frecuentemente detectadas fueron los metales, con una RP en 12,6%, seguido de los fármacos con una RP en 25,8%. Los conservantes y las fragancias fueron los siguientes grupos de sustancias más frecuentemente positivas, con una RP en 70,8 y 43,7%, respectivamente. La fuente de sensibilización más frecuente fueron los cosméticos, seguidos de los fármacos tópicos, destacando los corticoides y los antifúngicos tópicos. Conclusiones: Destacamos una elevada prevalencia de dermatitis alérgica de contacto en pacientes con rosácea, lo que sustenta la realización de pruebas epicutáneas, especialmente en aquellos con empeoramiento de sus lesiones en relación con la aplicación de productos cosméticos o fármacos tópicos.

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.

Resumen: Objetivo: Desarrollar recomendaciones basadas en la mejor evidencia y experiencia sobre el manejo de pacientes con psoriasis durante la edad fértil, el embarazo, el posparto y la lactancia. Métodos: Se siguió la metodología de grupos nominales y Delphi. Se seleccionó un grupo director de expertos (12 dermatólogos —de los cuales 2 fueron los coordinadores—, 1 reumatólogo, 2 ginecólogos). Se realizó una revisión sistemática de la literatura sobre fertilidad, embarazo, posparto y lactancia en pacientes con psoriasis. Con esta información los coordinadores generaron una serie de recomendaciones preliminares. Todo ello se presentó y discutió con el resto de expertos en una reunión de grupo nominal donde se definió el alcance, los usuarios, los apartados del documento, y donde se generaron las recomendaciones definitivas. El grado de acuerdo con las recomendaciones se votó siguiendo la metodología Delphi, que se extendió a 51 dermatólogos más, según una escala de 1 (total desacuerdo) a 10 (total acuerdo), definiéndose el acuerdo como una puntuación ≥ 7 por al menos el 70% de los participantes. El nivel de evidencia y el grado de recomendación se clasificaron según el modelo del Center for Evidence Based Medicine de Oxford. El documento completo final fue aprobado por el panel de expertos. Resultados: Se generaron 23 recomendaciones sobre el periodo pre-concepcional (fertilidad y anticoncepción), el embarazo (planificación, manejo farmacológico y seguimiento) y la lactancia (manejo y seguimiento). Todas las recomendaciones menos una alcanzaron el nivel de acuerdo definido. Conclusiones: En los pacientes con psoriasis en edad fértil estas recomendaciones pueden mejorar el manejo, los resultados y el pronóstico. Abstract: Objective: To develop evidence- and experience-based recommendations for the management of psoriasis during preconception, pregnancy, postpartum, and breastfeeding. Methods: The nominal group technique and the Delphi method were used. Fifteen experts (12 dermatologists, 2 of whom were appointed coordinators; 1 rheumatologist; and 2 gynecologists) were selected to form an expert panel. Following a systematic review of the literature on fertility, pregnancy, postpartum, and breastfeeding in women with psoriasis, the coordinators drew up a series of preliminary recommendations for discussion by the panel at a nominal group meeting. The experts defined the scope, sections, and intended users of the statement and prepared a final list of recommendations. Consensus was obtained using a Delphi process in which an additional 51 dermatologists rated their level of agreement with each recommendation on a scale of 1 (total disagreement) to 10 (total agreement). Consensus was defined by a score of 7 or higher assigned by at least 70% of participants. Level of evidence and strength of recommendation were reported using the Oxford Center for Evidence-Based Medicine categories. The final statement was approved by the expert panel. Results: The resulting consensus statement includes 23 recommendations on preconception (fertility and contraception), pregnancy (planning, pharmacological management, and follow-up), and breastfeeding (management and follow-up). Consensus was achieved for all recommendations generated except one. Conclusions: These recommendations for the better management of psoriasis in women of childbearing age could improve outcomes and prognosis.