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El estudio DIADERM fue promovido por la Fundacion Piel Sana de la AEDV, que recibio ayuda economica de Novartis. La compania farmaceutica no participo en la recogida de datos, ni en el analisis de los datos, ni en la interpretacion de los resultados., Introducción: Las infecciones e infestaciones de transmisión predominantemente sexual y otras dermatosis anogenitales forman parte de la formación específica de los médicos especialistas en Dermatología y Venereología en España. El presente estudio pretende analizar la carga que suponen dichas patologías en la actividad dermatológica pública y privada del sistema de salud español. Material y método: Estudio observacional de corte transversal de dos períodos de tiempo describiendo los diagnósticos realizados en consultas externas dermatológicas, obtenidos a través de la encuesta anónima DIADERM, realizada a una muestra aleatoria y representativa de dermatólogos. A partir de la codificación de diagnósticos CIE-10, se seleccionó toda la patología relacionada (36 diagnósticos codificados en los dos períodos), que se clasificó en 12 grupos. Resultados: Tan solo el 3,16% de los diagnósticos globales fueron de infecciones e infestaciones de transmisión predominantemente sexual y otras dermatosis anogenitales. Los 3 grupos diagnósticos más frecuentes fueron las lesiones por virus del papiloma humano anogenital, seguido de los molluscum contagiosum y las dermatosis anogenitales inflamatorias. Con significación estadística, y comparando con el global de diagnósticos, los seleccionados constituyeron más habitualmente el motivo de consulta primario y, en el ámbito privado, fue más frecuente que viniesen derivados de otros especialistas. Conclusión: Las infecciones e infestaciones de transmisión predominantemente sexual y otras dermatosis anogenitales tienen un peso muy limitado en la asistencia dermatológica en España, a pesar de que la inclusión del diagnóstico de molluscum contagiosum sobreestima estos diagnósticos. La ausencia de inclusión de centros y consultas monográficas de ITS en la muestra aleatoria contribuye a la infrarrepresentación de estas parcelas de la especialidad. Es importante hacer un esfuerzo decidido por potenciarlas con consultas y centros monográficos., Background and objective: Predominantly sexually transmitted infections (STIs) and infestations and other anogenital dermatoses are covered in the training of specialists in dermatology and venereology in Spain. This study aimed to analyze the proportion of the dermatology caseload these diseases account for within the public and private dermatological activity of the Spanish health system. Material and methods: Observational cross-sectional study of time periods describing the diagnoses made in outpatient dermatology clinics, obtained through the anonymous DIADERM survey of a representative random sample of dermatologists. Based on diagnostic codes of the International Classification of Diseases, Tenth Revision, 36 related diagnoses were selected, and classified into 12 groups. Results: Only 3.16% of diagnoses corresponded to STIs and other anogenital dermatoses. The most common diagnostic group was anogenital human papillomavirus infection, followed by molluscum contagiosum, and inflammatory anogenital dermatoses. Lesions with these diagnoses were usually the main reasons for first visits in the National Health Service. In private practice, the diagnoses usually came after referrals from other physicians. Conclusions: STIs and other anogenital dermatoses account for a very small proportion of the dermatology caseload in Spain, although the inclusion of molluscum contagiosum diagnoses overestimates these conditions. The fact that no STI centers or monographic STI consultations were included in the random sample of dermatology partly explains the under-representation of these areas of the specialty. A determined effort to support and promote monographic STI centres and clinics should be made., Fundacion Piel Sana de la AEDV

El proyecto ha sido impulsado y financiado por la Academia Española de Dermatología y Venereología (AEDV) con una beca sin restricciones de Abbvie., La definición de indicadores de calidad es una estrategia clave para garantizar la calidad de la asistencia sanitaria y su homogenización. Así, el proyecto CUDERMA surge como una iniciativa de la AEDV para definir indicadores de calidad con los que certificar unidades de distintos campos de interés en la dermatología, de los que se seleccionaron psoriasis y dermatooncología de forma inicial. El objetivo de este trabajo fue consensuar los aspectos a evaluar por los indicadores en la certificación de las unidades de psoriasis. Para ello se siguió un proceso estructurado que contempló la revisión bibliográfica de indicadores, la elaboración de un set preliminar revisado por un grupo de expertos multidisciplinar y el consenso Delphi. Un panel de 39 dermatólogos evaluó los indicadores, y los clasificó como «básicos» o «de excelencia». Finalmente se consensuaron 67 indicadores que serán estandarizados para dise˜nar la norma con la que certificar las unidades de psoriasis., Defining quality indicators is a key strategy for ensuring the quality and standardization of health care. The CUDERMA project, an initiative of the Spanish Academy of Dermatology and Venerology (AEDV), was undertaken to define quality indicators for the certification of specialized units in dermatology; the first 2 areas selected were psoriasis and dermato-oncology. The aim of this study was to reach a consensus on what should be assessed by the indicators used to certify psoriasis units. The structured process used to do this comprised a literature review to identify potential indicators, the selection of an initial set of indicators to be evaluated by a multidisciplinary group of experts and, finally, a Delphi consensus study. A panel of 39 dermatologists evaluated the selected indicators and classified them as either “essential” or “of excellence”. Consensus was finally reached on 67 indicators, which will be standardized and used to develop the certification standard for psoriasis units., Academia Española de Dermatología y Venereología (AEDV), AbbVie

Las campañas escolares de prevención del cáncer cutáneo han demostrado ser eficaces y costo-efectivas. Su éxito depende de un adecuado dise˜no, basado en la encuestación previa de la población diana (alumnos, profesores y padres). Sin embargo, son escasos los cuestionarios validados en castellano que estudien hábitos y conocimientos sobre exposición solar en infancia, y nulos en la población adultojuvenil. Objetivos: Elaborar y validar un cuestionario que explore las conductas relacionadas con la exposición solar en población adultojuvenil. Metodología: Se elaboraron 2 cuestionarios, dirigidos a población adulta (mayor de 18 a˜nos) y juvenil (11-17 a˜nos), incluyendo datos demográficos, color de piel, fototipo, quemaduras solares, prácticas, actitudes y conocimientos relacionados con la exposición solar. Tras el pilotaje y análisis de validez de contenido, se dise˜nó un estudio de validación en 2 fases: I) Análisis de la validez y consistencia interna de los ítems (estudio trasversal sobre 1.482 adolescentes-adultos, con estudio de validez de constructo [mediante análisis factorial exploratorio] y de consistencia interna [alfa de Cronbach]), II) Estudio de la estabilidad (test-retest sobre 39 sujetos). Resultados: El pilotaje demostró la validez de contenido de sendos cuestionarios. El análisis de los componentes principales reveló 2 componentes en cada dimensión estudiada, explicando más del 50% de la varianza. Todos los ítems mostraron buena correlación entre ellos. Se demostró validez en la fase i (coeficiente alfa de Cronbach entre 0,45-0,8, excepto el área de conocimientos [0,335]) y estabilidad en la fase ii (acuerdo absoluto > 60%). Skin cancer prevention campaigns in schools have been shown to be both effectiveand cost-effective. The success of such programs depends on the use of an appropriate designinformed by a prior survey of the target population (pupils, teachers, and parents). There are,however, very few validated Spanish-language questionnaires designed to study the habits andknowledge of this population with respect to sun exposure in childhood and none designed foruse with a young adult population.Objectives: To construct and validate a questionnaire designed to explore sun exposure beha-viors in a young adult population.Methodology: Two questionnaires were developed, one for adults (18+) and the other for youngadults (11-17); both included demographic information, skin color, Fitzpatrick skin type, andhistory of sunburn as well as questions on knowledge, attitudes and practices related to sunexposure. The content was then piloted and its validity analyzed. The subsequent validationstudy was divided into 2 phases as follows: 1) analysis of the validity and internal consistencyof the items in a cross-sectional study of 1,482 adults and adolescents, using exploratory factoranalysis to test construct validity and Cronbach to measure internal consistency; and 2)evaluation of test-retest reliability in 39 individuals.Results: The pilot study demonstrated the content validity of both questionnaires. Principalcomponent analysis revealed that 2 components in each of the dimensions studied accountedfor over 50% of the variance. A good correlation was found between the items studied. Validitywas demonstrated in the first phase of the analysis with a Cronbach of between 0.45 and 0.8for all components except knowledge (0.335). In the second phase, test-retest reliability wasdemonstrated (absolute agreement > 60%).Conclusions: The psychometric properties of the questionnaire make it a valid and reliable toolfor the study of knowledge, attitudes, and habits with respect to sun exposure in the youngadult school population.

Resumen Antecedentes El conocimiento de las variaciones de las enfermedades dermatologicas a lo largo del ano podria ser util para la planificacion en salud y el manejo de las enfermedades. Sin embargo, existe escasa informacion acerca de la variacion de los diagnosticos dermatologicos en diferentes epocas del ano en una muestra nacional representativa. Objetivos Evaluar si existe variacion en los diagnosticos clinicos dermatologicos entre la temporada de frio y calor en Espana. Material y metodos Los datos se han obtenido mediante una encuesta anonima realizada a una muestra aleatoria y representativa de dermatologos espanoles estratificados por area. Cada uno de los participantes recogio todos los diagnosticos clinicos durante 6 dias de consulta en 2016 (3 en la temporada de frio y 3 en la temporada de calor). Los diagnosticos se codificaron segun la CIE-10. Resultados Con una proporcion de respuesta de 62%, se recolectaron 11.223 diagnosticos clinicos. Los grupos diagnostico CIE-10 que mostraron variaciones entre temporadas fueron: otras neoplasias benignas de la piel (D23), rosacea (L71) y otros trastornos foliculares (L73), los cuales fueron mas frecuentes en la temporada de calor, y acne (L70) el cual fue mas frecuente en la temporada de frio. Ademas, describimos las diferencias en la poblacion pediatrica y segun el tipo de asistencia publica frente a privada. Algunas de estas diferencias podrian estar relacionadas con diferencias en la poblacion que consulta en las distintas temporadas. Conclusiones La frecuencia de la mayoria de los diagnosticos clinicos realizados por dermatologos no sufre variaciones a lo largo del ano. Solo algunos de los diagnosticos clinicos muestran variaciones entre la temporada de frio frente a calor. Estas variaciones observadas pueden estar en relacion con las propias enfermedades o pueden ser debidas a cambios estacionales en la demanda de consultas dermatologicas.

Skin cancer deaths continue to rise despite the implementation of numerous preventive campaigns and programs. The aim of this systematic review was to evaluate reviews of primary and secondary skin cancer prevention strategies as reported over the past 10 years. We analyzed 63 systematic reviews and meta-analyses: 30 (46.6%) addressing primary interventions and 35 (55.6%) addressing secondary interventions. Two of the reviews covered both. The most widely reported primary prevention approaches were education programs (63.3%), followed by risk modeling to identify individuals at high risk for melanoma (17.6%), and the promotion of sunscreen use (11.8%). The most widely reported secondary prevention measures concerned imaging systems for early skin cancer detection (40%), smartphones and new technologies (22.9%), and visual diagnosis in population-based screening (17.4%). The most effective measures were primary prevention education programs to improve sun protection habits.

No recent data on health care resources and medical and surgical activity in Spanish dermatology departments are available in the literature. The aim of this study was to compile this information for 2019.Cross-sectional study based on an online survey sent to the heads of dermatology departments at public hospitals in Spain.Of the 162 department heads contacted, 59 answered the survey (participation rate, 36.4%). General findings included a shortage of staff, especially dermatologists, in hospitals of low and medium complexity. The main reason given for the shortage of dermatologists was a lack of interested applicants. Large hospital complexes had more infrastructure and equipment. Over 50% of the departments surveyed used a combination of in-person and virtual visits. Psoriasis units were the most common specialized care units. Approximately 75% of the hospitals had operating rooms with an anesthetist. More complex procedures such as sentinel lymph node biopsy and Mohs micrographic surgery were performed more often in large hospital complexes. Hospitalization and the presence of dermatology residents working call shifts were also more common in these hospitals. Teaching and research activity differed according to hospital complexity.We have mapped health care resource availability and medical and surgical activity in Spanish dermatology departments prior to the COVID-19 pandemic. Our findings could be useful for improving clinical management and defining future actions and areas for improvement.

Background and objective Skin lesions are a common reason for consulting a primary care physician. Current legislation in Spain states that purely aesthetic skin problems that do not pose a health problem are not to be treated within the National Health Service. The aim of this study was to estimate the proportion of referrals from primary care physicians to dermatologists that were for cystic lesions or benign tumors and could potentially have been avoided. Material and methods We consulted cases registered in the DIADERM study dataset, which is representative of dermatology practice in Spain, and collected the main diagnoses given on referring patients from primary care. A referral diagnosis was classified as potentially avoidable if it corresponded to one of the primary care discharge diagnoses listed in a consensus paper of the Andalusian section of the Spanish Academy of Dermatology and Venereology (AEDV). Results We collected 2171 main reasons for first-visit referrals to dermatologists; 686 of them (31.6%) were for cystic lesions or benign tumors and classified as potentially avoidable. In 478 cases (22%) the patients were discharged on the first visit. The most frequent diagnoses in such cases were seborrheic keratosis (9.3%) and melanocytic nevus (8.6%). Conclusions Nearly a third of referrals from primary care to a dermatologist were for cystic lesions and benign tumors and could have been avoided. A clearer understanding of our caseload can be useful for improving planning, training, and health care system management.

Resumen Antecedentes y objetivo Las lesiones cutaneas constituyen un motivo de consulta frecuente en Atencion Primaria (AP). Aquellas que no supongan un problema de salud, sino una cuestion estetica, no deben ser tratadas en el Sistema Nacional de Salud, segun la legislacion vigente. El objetivo de este trabajo es estimar que porcentaje de derivaciones remitidas desde AP a Dermatologia por lesiones quisticas o tumores benignos corresponde a lesiones que podriamos considerar potencialmente evitables. Material y metodo Utilizamos los diagnosticos principales de los pacientes derivados de AP, recogidos en el estudio representativo nacional DIADERM. Cada uno de los diagnosticos derivados fue clasificado como potencialmente evitable si se correspondia con alguno de los diagnosticos con criterio de alta desde AP, establecidos en el documento de consenso propuesto por la seccion territorial andaluza de la Academia Espanola de Dermatologia y Venereologia. Resultados Se recogieron datos de 2.171 motivos principales de consulta derivados de AP como primeras consultas. De estos, 686 (31,6%) son diagnosticos que podrian corresponderse con derivaciones potencialmente evitables por lesiones quisticas o tumorales benignas. Un 22% (478) del total de las consultas fueron dadas de alta en la primera visita. Los diagnosticos mas frecuentes entre estos fueron las queratosis seborreicas (9,3%) y los nevus melanociticos (8,6%). Conclusiones La proporcion de derivaciones potencialmente evitables a Dermatologia desde AP por lesiones quisticas y tumorales benignas supone casi un tercio de las consultas. El conocimiento de la realidad asistencial de nuestro entorno puede ser util para mejorar la planificacion, la formacion y la gestion sanitaria.

Resumen El papel de la vitamina D en enfermedades cutaneas ha cobrado interes en los ultimos anos. La relacion entre esta vitamina y algunas dermatosis ha supuesto la publicacion de multiples trabajos al respecto. Como dermatologos, conocer sus principales fuentes, sintesis, niveles plasmaticos y algunos de los factores modificadores son varios de los aspectos a recordar. Asimismo, es preciso resaltar los ultimos descubrimientos sobre el papel de la vitamina D en las diferentes enfermedades dermatologicas, como el lupus eritematoso, la ictiosis, la dermatitis atopica, la hidrosadenitis supurativa, el acne, la alopecia areata y androgenetica, el melanoma y el cancer cutaneo no melanoma, asi como la relevancia como terapia adyuvante en pacientes en tratamiento cronico con corticoides. Acercamos al lector la informacion mas relevante y reciente de la relacion entre la vitamina D y las enfermedades de la piel, asi como la importancia de conocer los niveles de esta vitamina.

In recent years, the growing interest in the role played by vitamin D in skin disease has given rise to the publication of many studies of the relationship between this vitamin and certain skin conditions. As dermatologists, we need to understand, among other aspects, how vitamin D is synthesized and the main sources in humans, as well as plasma levels and the factors that can modify them. Of particular interest are the latest discoveries about the role of vitamin D in skin diseases such as lupus erythematosus, ichthyosis, atopic dermatitis, hidradenitis suppurativa, acne, alopecia areata, androgenetic alopecia, melanoma, and nonmelanoma skin cancer. Also of interest is the importance of vitamin D as adjuvant therapy in patients on long-term treatment with corticosteroids. In this review, we provide an overview of the most important and most recent information regarding the relationship between vitamin D and skin disease and discuss the importance of assessing individual vitamin D status and correcting deficiencies.

Background and objectives Understanding the origin and referral routes of patients seen in teledermatology and in-person dermatology consultations in Spain is of interest from the perspective of health care management. The objective of this study was to describe the referral routes and the frequency and characteristics of teledermatology consultations in Spain. Material and methods We performed a descriptive cross-sectional study of data collected over 6 days from the DIADERM study sample, which included the outpatients diagnosed by 80 Spanish dermatologists, selected by means of stratified random sampling. We studied the source and destination of patients based on funding, type of consultation, and age of the patients. We reported the frequency of teledermatology consultations, their origin and destination, type of funding, age of the patients, and most common diagnoses, and compared them with the same characteristics for in-person consultations. Results In private consultations, most patients were direct clients, whereas the most frequent source in public consultations was primary care and the dermatologist. Sixty-six percent of patients were referred to dermatology and 27% were discharged. No differences in these percentages were found between public and private consultations. The ratio of follow-up to initial visits was 0.8 for public consultations and 0.2 for private consultations. Teledermatology accounts for 1% of consultations. Eighty percent of these come from primary care and 17% are direct visits. Thirty-three percent of these visits are referred to primary care —a greater proportion than in in-person consultations. Galicia, Andalusia, and Catalonia are the regions with the highest percentage of consultations. Conclusions The results suggest that dermatologists in Spain have a considerable ability to resolve cases. Teledermatology accounts for a small percentage of consultations and access to these consultations is direct in a large percentage of cases.

Resumen Antecedentes y objetivos El conocimiento de las rutas de origen y derivacion de los pacientes atendidos en consulta dermatologica presencial y de teledermatologia en Espana tiene interes desde el punto de vista de la gestion sanitaria. El objetivo de este estudio es describir las rutas de derivacion y la frecuencia y caracteristicas de la teledermatologia en Espana. Material y metodos Estudio transversal descriptivo sobre la muestra del estudio DIADERM, que recogio la actividad de 80 dermatologos espanoles, seleccionados mediante muestreo aleatorio estratificado, durante 6 dias. Se estudiaron el origen y destino de los pacientes en funcion de la financiacion, el tipo de consulta y la edad de los pacientes. Se describio la frecuencia de las consultas por teledermatologia, su origen y destino, el tipo de financiacion, la edad de los pacientes y los diagnosticos mas frecuentes, comparandolos con la consulta presencial. Resultados El origen mas frecuente en la consulta privada es el directo, mientras que en la publica es la atencion primaria y el propio dermatologo. Un 66% de los pacientes se derivan a dermatologia y un 27% son dados de alta. No existen diferencias en estos porcentajes entre consulta publica y privada. El indice sucesivas/primeras fue de 0,8 para la consulta publica y de 0,2 para la privada. La teledermatologia representa un 1% de las consultas. El 80% procede de atencion primaria y el 17% tiene origen directo. Se deriva a atencion primaria el 33%, en mayor proporcion que en consulta presencial. Galicia, Andalucia y Cataluna son las regiones donde representa un mayor porcentaje de consultas. Conclusiones Los resultados sugieren una alta capacidad resolutiva de las consultas de dermatologia en Espana. La teledermatologia representa un porcentaje pequeno de las consultas, y el acceso a ella se da en un porcentaje relevante de pacientes por via directa.

Predominantly sexually transmitted infections (STIs) and infestations and other anogenital dermatoses are covered in the training of specialists in dermatology and venereology in Spain. This study aimed to analyze the proportion of the dermatology caseload these diseases account for within the public and private dermatological activity of the Spanish health system.Observational cross-sectional study of time periods describing the diagnoses made in outpatient dermatology clinics, obtained through the anonymous DIADERM survey of a representative random sample of dermatologists. Based on diagnostic codes of the International Classification of Diseases, Tenth Revision, 36 related diagnoses were selected, and classified into 12 groups.Only 3.16% of diagnoses corresponded to STIs and other anogenital dermatoses. The most common diagnostic group was anogenital human papillomavirus infection, followed by molluscum contagiosum, and inflammatory anogenital dermatoses. Lesions with these diagnoses were usually the main reasons for first visits in the National Health Service. In private practice, the diagnoses usually came after referrals from other physicians.STIs and other anogenital dermatoses account for a very small proportion of the dermatology caseload in Spain, although the inclusion of molluscum contagiosum diagnoses overestimates these conditions. The fact that no STI centers or monographic STI consultations were included in the random sample of dermatology partly explains the under-representation of these areas of the specialty. A determined effort to support and promote monographic STI centres and clinics should be made.

Background Scholar photoprotection campaigns are among the most effective strategies for preventing skin cancer. Analysis of the target population constitutes a valuable starting point for the implementation of primary prevention strategies. Our aim is to study photoprotection habits, attitudes and knowledge among a Spanish school community. Methods Descriptive cross-sectional study targeting schoolchildren, parents and teachers at 20 schools in the area of the Costa del Sol Health Agency in southern Spain. Two population-specific, validated questionnaires were used: the CHRESI (for children aged 0–10 years) and CHACES Questionnaire(for adults and adolescents aged > 11 years). We collected demographic data, skin colour, skin phototype, sunburn episodes, sun exposure and photoprotection practices, attitudes and knowledge. Results 1728 questionnaires were analyzed (22% parents, 14.5% teachers, 44.8% adolescents and 18.6% children). The average ages were 8 years (children), 16 years (adolescents), 39 years (teachers) and 42 years (parents). Globally, the predominant features were: male sex (52%), Spanish nationality (92%) and phototypes II–III (61%). Children, followed by adolescents, reported the highest exposure to the sun, both in frequency and in duration. Adolescents had the higher rate of sunburn (75%), followed by parents/teachers (54.1%) and children (44.1%). Children and their parents were the most likely to adopt photoprotection measures, while adolescents presented more risky attitudes. Knowledge regarding photoprotection was acceptable (6.9/10). Conclusions This study highlights the need to improve photoprotection knowledge, habits and attitudes among our target population. Scholars, parents and teachers in our area should be addressed in campaigns to promote healthy sun exposure habits, thus reducing skin cancer-related morbidity and mortality in this region.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been recently linked to dermatologic manifestations and is thought to affect more severely patients with androgenetic alopecia. We designed a prospective multicentric study which enrolled patients from March to August of 2020 with acute telogen effluvium (ATE) that had a prior SARS-CoV-2 infection confirmed either by serological tests (e.g. detection of serum antibodies against the virus via enzyme-linked immunosorbent assays (ELISA)) or detection of viral RNA using real-time reverse transcription polymerase chain reaction (RT-PCR).

Las campañas escolares de prevención del cáncer cutáneo han demostrado ser eficaces y costo-efectivas. Su éxito depende de un adecuado dise˜no, basado en la encuestación previa de la población diana (alumnos, profesores y padres). Sin embargo, son escasos los cuestionarios validados en castellano que estudien hábitos y conocimientos sobre exposición solar en infancia, y nulos en la población adultojuvenil. Objetivos: Elaborar y validar un cuestionario que explore las conductas relacionadas con la exposición solar en población adultojuvenil. Metodología: Se elaboraron 2 cuestionarios, dirigidos a población adulta (mayor de 18 a˜nos) y juvenil (11-17 a˜nos), incluyendo datos demográficos, color de piel, fototipo, quemaduras solares, prácticas, actitudes y conocimientos relacionados con la exposición solar. Tras el pilotaje y análisis de validez de contenido, se dise˜nó un estudio de validación en 2 fases: I) Análisis de la validez y consistencia interna de los ítems (estudio trasversal sobre 1.482 adolescentes-adultos, con estudio de validez de constructo [mediante análisis factorial exploratorio] y de consistencia interna [alfa de Cronbach]), II) Estudio de la estabilidad (test-retest sobre 39 sujetos). Resultados: El pilotaje demostró la validez de contenido de sendos cuestionarios. El análisis de los componentes principales reveló 2 componentes en cada dimensión estudiada, explicando más del 50% de la varianza. Todos los ítems mostraron buena correlación entre ellos. Se demostró validez en la fase i (coeficiente alfa de Cronbach entre 0,45-0,8, excepto el área de conocimientos [0,335]) y estabilidad en la fase ii (acuerdo absoluto > 60%)., Skin cancer prevention campaigns in schools have been shown to be both effectiveand cost-effective. The success of such programs depends on the use of an appropriate designinformed by a prior survey of the target population (pupils, teachers, and parents). There are,however, very few validated Spanish-language questionnaires designed to study the habits andknowledge of this population with respect to sun exposure in childhood and none designed foruse with a young adult population.Objectives: To construct and validate a questionnaire designed to explore sun exposure beha-viors in a young adult population.Methodology: Two questionnaires were developed, one for adults (18+) and the other for youngadults (11-17); both included demographic information, skin color, Fitzpatrick skin type, andhistory of sunburn as well as questions on knowledge, attitudes and practices related to sunexposure. The content was then piloted and its validity analyzed. The subsequent validationstudy was divided into 2 phases as follows: 1) analysis of the validity and internal consistencyof the items in a cross-sectional study of 1,482 adults and adolescents, using exploratory factoranalysis to test construct validity and Cronbach to measure internal consistency; and 2)evaluation of test-retest reliability in 39 individuals.Results: The pilot study demonstrated the content validity of both questionnaires. Principalcomponent analysis revealed that 2 components in each of the dimensions studied accountedfor over 50% of the variance. A good correlation was found between the items studied. Validitywas demonstrated in the first phase of the analysis with a Cronbach of between 0.45 and 0.8for all components except knowledge (0.335). In the second phase, test-retest reliability wasdemonstrated (absolute agreement > 60%).Conclusions: The psychometric properties of the questionnaire make it a valid and reliable toolfor the study of knowledge, attitudes, and habits with respect to sun exposure in the youngadult school population.

Background Ultrasonography can improve disease severity assessment in hidradenitis suppurativa (HS) patients. The use of pre-operative ultrasonography could improve surgical outcomes in HS patients. Objectives (i) To assess changes in the projected skin-excised area after the use of pre-operative ultrasonography, (ii) to explore the clinical factors potentially associated with inaccurate clinical surgical delimitation and (iii) to compare recurrence rates after pre-operative ultrasound vs clinical surgical margin delimitation at week 24. Methods Cohort study. Patient candidates for surgical treatment by wide excision and healing by secondary intention with a clinical projected skin-excised area equal to or larger than 15 cm2 were included. The main variables of interest were the clinical and ultrasound projected skin-excised area and surgical recurrence. Results Pre-operative ultrasound surgical margin delimitation increased the mean excised area by 3.67 (SD 0.86) cm2 , P = 0.004. The Bland-Altman plot showed that in 65% of surgical procedures the use of ultrasonography increased the projected skin-excised area. Higher IHS4 scores, BMI, male sex and Hurley stage II vs III all increased the difference between clinical and ultrasound surgical delimitation. At week 24, the recurrence rate in the surgical clinical delimitation cohort was 30% compared to 10% in the cohort with pre-operative ultrasonography (P = 0.10). Conclusions Pre-operative ultrasonography improves surgical margin delimitation and can lower recurrence rates at 24 weeks in HS patients. Potential risk factors for inaccurate clinical surgical delimitation are obesity, male sex, Hurley II stage and elevated IHS4 scores, so special attention should be given to these patients when ultrasonography is not available and surgical delimitation is based only on clinical examination.

Resumen Introduccion La actividad principal realizada por dermatologos tiene lugar en la consulta externa hospitalaria o en los centros privados. A diferencia de la actividad hospitalaria, que es facilmente codificada, no existen datos globales sobre los diagnosticos realizados por los dermatologos en estos niveles. El objetivo de este estudio es analizar los diagnosticos realizados en las consultas de dermatologia de los miembros de la Academia Espanola de Dermatologia y Venereologia (AEDV) en Espana. Metodologia A partir del listado de dermatologos de la AEDV se obtuvo una muestra aleatoria estratificada por secciones territoriales de la AEDV. A los dermatologos participantes se les instruyo en la forma de recoger los datos. Cada participante recogio los diagnosticos y otros datos de los pacientes atendidos durante 6 dias de consulta en 2 fases (3 dias en enero y 3 dias en mayo). Posteriormente la codificacion de los diagnosticos la realizo un dermatologo experto empleando la CIE-10. El analisis se realizo considerando el diseno muestral complejo empleado para corregir los errores estandar y el ajuste para poblaciones finitas. Resultados Se muestrearon 124 dermatologos. Finalmente participaron en el estudio el 65% de los dermatologos muestreados en la primera fase y el 59% en la segunda. El numero de pacientes estimados que consultan al dermatologo en toda Espana por mes seria de 621.562 (IC 95%: 368,130-874,995), con un promedio de 28 (25-31) pacientes por dia de consulta. El diagnostico mas frecuente fue el de queratosis actinica, seguido de carcinoma basocelular y nevus melanocitico. La forma habitual de evaluar a los pacientes es mediante visita presencial y en el 1% (0,3%-3%) de los casos se realiza teledermatologia. Conclusiones Se trata del primer estudio de ambito nacional que analiza diagnosticos hechos en las consultas de dermatologia de los miembros de la AEDV, mostrando una alta carga asistencial. Dicha informacion ademas sera de utilidad para realizar una correcta planificacion sanitaria, aprovechamiento de los recursos y planificar futuros estudios.

Background Psoriasis has been related to a large number of cardiovascular risk factors such as hypertension, diabetes mellitus and arteriosclerosis. The increased carotid intima-media thickness (IMT) could be considered to be a marker of generalized arteriosclerosis. Objective To assess the effect of systemic and biological drugs on psoriatic patients' carotid IMT. Methods A prospective study was performed. We studied 53 patients with moderate and severe psoriasis from our psoriasis dermatological unit, analysing lipid and glucose metabolism and performing a carotid IMT sonography before introduction of systemic and biological drugs. After that, we performed an 8-month closely analytic and sonographic follow-up. Results The IMT of the patients with psoriasis treated with biological drugs tended to decrease, although this occurrence was not statistically significant (P = 0.086). The subgroup analysis revealed that patients treated with methotrexate (P = 0.045) and anti-IL-12/23 (P = 0.010) presented a decrease in their IMT levels. This analysis also showed a decrease in glycaemia and insulin levels in patients treated with TNF-alpha inhibitors and ustekinumab. Conclusions Our study suggests that the carotid IMT may benefit from treatment with biological drugs, particularly anti-IL-12/23 and methotrexate in patients suffering from moderate and severe psoriasis. However, larger longitudinal studies should be performed to fully confirm these results.