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Background Since May 2022, a new outbreak of monkeypox has been reported in several countries, including Spain. The clinical and epidemiological characteristics of the cases in this outbreak may differ from those in earlier reports. Objectives To document the clinical and epidemiological characteristics of cases of monkeypox in the current outbreak. Methods We conducted a prospective cross-sectional study in multiple medical facilities in Spain to describe the cases of monkeypox in the 2022 outbreak. Results In total, 185 patients were included. Most cases started with primarily localized homogeneous papules, not pustules, in the probable area of inoculation, which could be cutaneous or mucous, including single lesions. Generalized small pustules appeared later in some of them. Heterogeneous lesions occurred during this generalized phase. All patients had systemic symptoms. Less common lesions included mucosal ulcers (including pharyngeal ulcers and proctitis) and monkeypox whitlows. Four patients were hospitalized, none died. Smallpox vaccination and well-controlled HIV disease were not associated with markers of severity. Contact during sex is the most likely mechanism of transmission. In this outbreak, cases have been described in men who have sex with men and are strongly associated with high-risk sexual behaviours. Seventy-six per cent of the patients had other sexually transmitted diseases upon screening. Conclusions The clinical findings in this outbreak differ from previous findings and highly suggest contact transmission and initiation at the entry site. The characterization of the epidemiology of this outbreak has implications for control. What is already known about this topic? Monkeypox eruption is described as consisting of pustules.The roles of HIV and previous smallpox vaccination in the prognosis are unknown.The transmission route was initially described as respiratory droplets and was later suggested to be via sexual contact. What does this study add? Initial lesions at the probable inoculation area were homogeneous and papular (pseudopustules). Generalized small pustules appeared later in some of them. Heterogeneous lesions occurred during this generalized phase. All patients had systemic symptoms.Less common signs included mucosal ulcers (including pharyngeal ulcers and proctitis) and monkeypox whitlows. Well-controlled HIV and previous smallpox vaccination were not associated with severity. No patient died.The data support the hypothesis of transmission via contact during sex. Although this might change, the outbreak is currently limited mostly to men who have sex with men, with high-risk factors for sexually transmitted diseases.

We describe the first 25 persons with HIV diagnosed with human monkeypox virus (MPXV) in our hospital in an ongoing outbreak in Spain. Proctitis was the predominant finding in 52%, and MPXV DNA was detected in rectal swabs from 90%. Proctitis and demonstration of MPXV in rectal swabs support the sexual transmission of MPXV.

Background Ablative fractional laser generates a regulated skin damage, which secondarily improves skin aging. Aims The main objective of the present study was to figure out if the adverse effects induced by laser and the skin recovery could improve with the application of a cosmetic product based on the secretion of Cryptomphalus aspersa (SCA). Patients/Methods A prospective double‐blind controlled study with vehicle in 10 patients with skin aging. The patients received one session of fractional ablative CO2 laser, and the formulation with SCA 40% was applied immediately and maintained throughout the 21‐day duration of the study. The active treatment (SCA) was applied to one hemifacial area and vehicle to the other, and the patient acting was her own control. Clinical evaluations, dermoscopy, photography, and other parameters like cutaneous hydration, elasticity, and wrinkles were evaluated. In addition, the severity of the adverse effects was evaluated. Results Significant greater decrease in the density of microcolumns produced by laser was detected on the active‐treated side, indicating greater and faster postprocedure recovery compared to the vehicle‐treated side. In addition, side effects were reduced and some antiaging effects were more apparent on the side treated with SCA 40%. Conclusion SCA 40% applied immediately after ablative laser, and during the next days, it can accelerate laser‐induced damage regeneration. In addition, SCA improves the cosmetic outcome after laser application.

Resumen Introduccion A pesar de que los unicos farmacos con indicacion aprobada en nuestro pais para la alopecia androgenica (AGA) son minoxidil topico y finasterida oral, es comun la utilizacion de numerosas terapias fuera de indicacion, provocando una gran variabilidad en el manejo de estos pacientes. El objetivo principal de este trabajo fue describir los habitos de prescripcion de los dermatologos en Espana en AGA masculina (MAGA) y AGA femenina (FAGA). Material y metodos Estudio descriptivo transversal mediante cuestionarios digitales autocumplimentados por dermatologos que ejercen en territorio espanol. Resultados Se incluyeron las respuestas de un total de 241 dermatologos. En MAGA los tratamientos mas utilizados fueron en este orden: minoxidil topico (98%), finasterida oral (96%), nutricosmeticos (44%), finasterida topica (37%), dutasterida oral (33%), plasma rico en plaquetas (14%) y laser de baja potencia (8%). En FAGA premenopausica: minoxidil topico (98%), anticonceptivos orales (81%), nutricosmeticos (72%), acetato de ciproterona (58%), finasterida oral (39%), finasterida topica (39%), espironolactona (27%), plasma rico en plaquetas (20%), dutasterida oral (20%), flutamida oral (18%) y laser de baja potencia (7%). En FAGA posmenopausica: minoxidil topico (98%), finasterida oral (84%), nutricosmeticos (68%), finasterida topica (50%), dutasterida oral (35%), plasma rico en plaquetas (21%), espironolactona (16%), acetato de ciproterona (16%), flutamida oral (9%) y laser de baja potencia (9%). Como limitaciones de nuestro estudio, no se incluyeron terapias novedosas para AGA como minoxidil oral o microinyecciones de dutasterida. Conclusiones Los agentes terapeuticos mas utilizados en MAGA y FAGA posmenopausica por los dermatologos en Espana fueron minoxidil topico, finasterida oral y nutricosmeticos, mientras que en FAGA premenopausica fueron minoxidil topico, anticonceptivos orales y nutricosmeticos.

Background Topical minoxidil and oral finasteride are the only drugs approved for the treatment of androgenetic alopecia (AGA) in Spain. However, the management of this condition is highly variable because numerous treatments are used off-label. The main aim of this study was to describe the prescribing habits of dermatologists in Spain for male AGA (MAGA) and female AGA (FAGA). Material and methods Descriptive cross-sectional study using online questionnaires completed by dermatologists working in Spain. Results The responses of 241 dermatologists were analyzed. The most common treatments prescribed for MAGA were minoxidil (98%), oral finasteride (96%), nutricosmetics (44%), topical finasteride (37%), oral dutasteride (33%), platelet-rich plasma (14%), and low-level laser therapy (8%). For premenopausal FAGA, the most common treatments were topical minoxidil (98%), oral contraceptives (81%), nutricosmetics (72%), cyproterone acetate (58%), oral finasteride (39%), topical finasteride (39%), spironolactone (27%), platelet-rich plasma (20%), oral dutasteride (20%), oral flutamide (18%), and low-level laser therapy (7%). Finally, for postmenopausal FAGA, the most common treatments prescribed were topical minoxidil (98%), oral finasteride (84%), nutricosmetics (68%), topical finasteride (50%), oral dutasteride (35%), platelet-rich plasma (21%), spironolactone (16%), cyproterone acetate (16%), oral flutamide (9%), and low-level laser therapy (9%). A limitation of our study is that we did not analyze novel AGA treatments such as oral minoxidil and dutasteride mesotherapy. Conclusions The most common treatments prescribed for AGA by dermatologists in Spain are topical minoxidil, oral finasteride, and nutricosmetics for MAGA and postmenopausal FAGA and topical minoxidil, oral contraceptives, and nutricosmetics for premenopausal FAGA.

Lymphomatoid papulosis type E (LyP) is a recently described subtype of LyP characterized by an angioinvasive infiltrate of atypical lymphocytes expressing CD30. We present a case of type E LyP with extensive cutaneous necrosis in the histopathological evaluation which was misdiagnosed as an ulcerative form of bacterial skin infection. The remarkable cutaneous necrosis showed in our case might be related to the angiodestructive infiltrate that was present in this circumstance.

Folliculitis decalvans (FD) is a primary neutrophilic scarring alopecia characterized by perifollicular papules, crusts, and pustules frequently located on the vertex. FD may affect young men and women. Since it may lead to hair loss, it can have a negative impact on patients' quality of life. Nevertheless, studies have focused on clinical, prognostic, and therapeutic aspects without considering the psychological impact of FD. In our study, we found that FD patients experienced a considerable impact on their quality of life. Interestingly, almost half of the patients considered that their alopecia was related to a poor medical care in their past. To our knowledge, this is the first description of the impact of FD on patients' quality of life, and it highlights the importance of psychological support for these patients.

In this paper, we tackle the problem of random forests for regression expressed as weighted sums of datapoints. We study the theoretical behavior of ${k}$ -potential nearest neighbors ( ${k}$ -PNNs) under bagging and obtain an upper bound on the weights of a datapoint for random forests with any type of splitting criterion, provided that we use unpruned trees that stop growing only when there are $k$ or less datapoints at their leaves. Moreover, we use the previous bound together with the concept of b-terms (i.e., bootstrap terms) introduced in this paper, to derive the explicit expression of weights for datapoints in a random ( ${k}$ -PNNs) selection setting, a datapoint selection strategy that we also introduce and to build a framework to derive other bagged estimators using a similar procedure. Finally, we derive from our framework the explicit expression of weights of a regression estimate equivalent to a random forest regression estimate with the random splitting criterion and demonstrate its equivalence both theoretically and practically.

This cohort study evaluates the association between frontal fibrosing alopecia and health-related quality of life.

Introduction: Frontal fibrosing alopecia (FFA) is a condition that likely involves an interplay of autoimmune, hormonal, and environmental factors in its pathogenesis. There is a lack of comparative studies demonstrating the presence of hormonal background differences in FFA patients compared to the general population. Materials and Methods: A single-center case-control study was designed, including 104 female FFA patients and 208 controls. Patients and controls were interviewed, and extensive data regarding their gynecological and hormonal background were recorded. Results: One hundred four cases and 208 age-matched controls were included in the study. A significant difference of 2 years in the age of menopause was detected with a consistent mean increase in fertile life for the control group of 1.7 years. After the multivariate analysis, we found previous intake of tamoxifen to be a risk factor for the development of FFA (OR 14.89). The only protective factor identified was the previous use of an intrauterine device (IUD) (OR 0.22). Conclusions: An earlier menopause and tamoxifen intake might promote or maintain FFA, while the use of an IUD might protect from developing FFA. Our results support the previously proposed hypothesis of an underlying hormonal mechanism in the etiopathogenesis of FFA and point out low-estrogen environments as an ideal condition for FFA development.

In this article we study the univariate and bivariate truncated von Mises distribution, as a generalization of the von Mises distribution. This implies the addition of two or four new truncation parameters in the univariate and, bivariate cases, respectively. The results include the definition, properties of the distribution and maximum likelihood estimators for the univariate and bivariate cases. Additionally, the analysis of the bivariate case shows how the conditional distribution is a truncated von Mises distribution, whereas the marginal is a generalization of the non-truncated marginal distribution. From the viewpoint of applications, we test the distribution with data regarding leaf inclination angles. This research aims to assert this probability distribution as a potential option for modeling or simulating any kind of phenomena where circular distributions are applicable.

Photodynamic therapy (PDT) is a clinical modality of photochemotherapy based on the accumulation of a photosensitizer in target cells and subsequent irradiation of the tissue with light of adequate wavelength promoting reactive oxygen species (ROS) formation and cell death. PDT is used in several medical specialties as an organ-specific therapy for different entities. In this review we focus on the current dermatological procedure of PDT. In the most widely used PDT protocol in dermatology, ROS production occurs by accumulation of the endogenous photosensitizer protoporphyrin IX after treatment with the metabolic precursors 5-methylaminolevulinic acid (MAL) or 5-aminolevulinic acid (ALA). To date, current approved dermatological indications of PDT include actinic keratoses (AK), basal cell carcinoma (BCC) and in situ squamous cell carcinoma (SCC) also known as Bowen disease (BD). With regards to AKs, PDT can also treat the cancerization field carrying an oncogenic risk. In addition, an increasing number of pathologies, such as other skin cancers, infectious, inflammatory or pilosebaceous diseases are being considered as potentially treatable entities with PDT. Besides the known therapeutic properties of PDT, there is a modality used for skin rejuvenation and aesthetic purposes defined as photodynamic photorejuvenation. This technique enables the remodelling of collagen, which in turn prevents and treats photoaging stygmata. Finally we explore a new potential treatment field for PDT determined by the activation of follicular bulge stem cells caused by in situ ROS formation.

© The Author(s) 2016, In this article, we analyze branching angles of the basal dendrites of pyramidal neurons of layers III and V of the human temporal cortex. For this, we use a novel probability directional statistical distribution called truncated von Mises distribution that is able to describe more accurately the dendritic-branching angles than the previous proposals. Then, we perform comparative studies using this statistical method to determine similarities and/or differences between branches and branching angles that belong to different cortical layers and regions. Using this methodology, we found that common design principles exist and govern the patterns found in the different branches that compose the basal dendrites of human pyramidal cells of the temporal cortex. However, particular differences were found between supra and infragranular cells. Furthermore, we compared the branching angles of human layer III pyramidal neurons with data obtained in the previous studies in layer III of both the rat somatosensory cortex and of several cortical areas of the mouse. Finally, we study the branching angle differences between the humans that compose our data., This work has been partially supported by the Spanish Ministry of Economy and Competitiveness through the Cajal Blue Brain (C080020-09; the Spanish partner of the Blue Brain initiative from EPFL) and TIN2013-41592-P projects, by the Regional Government of Madrid through the S2013/ICE-2845-CASI-CAM-CM project, by the European Union’s Seventh Framework Programme (FP7/2007-2013) under Grant agreement no. 604102 (Human Brain Project), and by the Spanish Ministry of Education, Culture, and Sport Fellowship (FPU13/01941).