Antonio Rodríguez-Pichardo

Alopecia Areata, Stress and Psychiatric Disorders: A Review

Although the results of some studies have proven negative, the influence of psychological factors in the development, evolution and therapeutic management of alopecia areata is, in general, well documented. Life events and intrapsychically generated stress can play an important role in triggering of some episodes. The comorbidity of psychiatric disorders, mainly generalized anxiety disorder, depression, and phobic states, is high. The role of treatment of concomitant psychopathological disorders is a vital one. Indeed this treatment can positively affect how the patient adapts to his/her alopecia and social setting and perhaps can even lead to a better dermatological evolution of the alopecia. Therefore, controlled studies analyzing the possible links between psychiatric symptoms, treatment with antidepressants or benzodiacepines, evolution of alopecia, medium term prognosis, and immune function are necessary. Basic psychotherapeutic support may prove to be of use in many cases and can be carried out by the dermatologist, although a subgroup of patients may need psychopharmacological or psychotherapeutic specialized treatments. Studies using operative diagnostic criteria and structured interviews are still scarce. Therefore, it seems necessary to design studies using modern psychiatric methodology. Controlled clinical trials to test the efficiency of psychoactive drugs and psychotherapy in the disease are also needed. By studying in depth these and other related aspects, we may improve the clinical management of our patients.

N-acetylcysteine in the treatment of trichotillomania

Trichotillomania is as medical condition caused by the patient himself by pulling out of is own hair, resulting in a perceptible hair loss pattern that frequently is associated with other psychiatric processes. Generally has a chronic course in most patients, and a challenging therapeutical management. There are several available options for is treatment, but the clinical response is not satisfactory in many patients. Recently, N-acetylcisteine, a glutamate modulator, has shown efficacy in the treatment of trichotillomania and other compulsive behaviors, and is considered a new alternative in the management of this condition. We describe two patients with trichotillomania successfully treated with N-acetylcysteine. Nevertheless, further studies need to be conducted to establish the appropriate treatment regimen and to evaluate it long-term efficacy in improving this chronic condition.

Congenital Triangular Alopecia (Brauer Nevus)

Abstract: Congenital triangular alopecia is manifested at 3 to 5 years of age by unilateral or, less frequently, bilateral patches of alopecia in the frontotemporal region. At this age the differential diagnosis is important, particularly as regards alopecia areata. Only about 47 cases have been reported, probably because the lesion is benign and nonprogressive. In 6200 patients seen in index visits, we found 7 with triangular alopecia, a frequency of 0.11%. We believe that males do not require treatment because of the later development of androgenic alopecia, but in women, surgical treatment is successful.

Chloracne Caused by Ingestion of Olive Oil Contaminated with PCDDs and PCDFs

1 All members of a Spanish family (father, mother and six children) developed chloracne. 2 The causative agent was found to be the familys stock of olive oil, which had become contaminated with polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs), pentachlorophenol, and hexachlorobenzene. 3 The more highly chlorinated PCDDs, in particular octachlorodibenzo-p-dioxin, were the predominant congeners in the oil. 4 Three members of the family exhibited either an overt or a sub-clinical disturbance of kidney function. The father also had a chronic respiratory problem. These changes could not be unequivocally attributed to the PCDDs. 5 Experimental toxicity of the oil was limited to the development of an hepatic porphyria in mice. 6 A serum sample, taken 5 years after consumption of the oil ceased, contained high levels of the PCDDs and PCDFs. Extrapolation back to ingested dose was used to validate dosage estimates. 7 The use of toxicity equivalence factors (TEFs) provided estimates of cumulative dosage to produce chloracne as 0.13-0.31 μg 2378-TCDD kg-1 (using EPA TEFs) or 6.7-16 μg 2378-TCDD kg-1 (using Nordic/NATO TEFs). 8 This is the first incident in which human toxicity is related primarily to ingestion of PCDDs and for which estimates of dosage can be made.

Extensive and deep dermatophytosis caused by Trichophyton mentagrophytes var. Interdigitalis in an HIV-1 positive patient

Background Cutaneous infections are common in HIV‐1 positive patients and are usually severe, recurrent, and caused by microorganisms that are unusual in immunocompetent patients.

Sexually transmitted diseases in 1161 HIV-positive patients: a 38-month prospective study in southern Spain

Background HIV infection is primarily a sexually transmitted disease (STD), but intravenous drug use (IDU) is the main risk factor for HIV infection in certain areas, including southern Europe. A number of prospective studies of dermatological findings in HIV‐1 infected patients have been published, almost all from countries where homosexuality is the main risk factor of HIV infection and without correlation with CD4 cell counts. No STD data is included in those studies.

Dermatitis artefacta of the breast: a retrospective analysis of 27 patients (1976-2006).

Background  Dermatitis artefacta (DA) is defined as all dermatological, self‐inflicted skin lesions, where the patient denies having produced the lesions.

Anaerobic bacteria in men with urethritis

Investigation of the urethral flora in men with urethritis, with particular reference to anaerobic bacteria.

Comparative clinical efficacy of two different single-dose ciprofloxacin treatments for uncomplicated gonorrhea

The clinical efficacies of two different single-dose, oral treatments with ciprofloxacin were evaluated in a double-blind randomized study of 50 men with gonococcal urethritis. Two groups of patients were studied. The 25 patients in group A (age, 18-32 years; mean = 26.2) received a single dose of 250 mg of ciprofloxacin; the 25 in group B (age, 16-42 years; mean = 26.3) received a single dose of 100 mg of ciprofloxacin. The minimal inhibitory concentrations of ciprofloxacin for all the isolates were less than or equal to 0.0015 microgram/ml. Neisseria gonorrhoeae was eradicated from all 50 patients; 80% of them were clinically cured, and 20% developed postgonococcal urethritis. There was no significant difference between the two treatments evaluated. We conclude that a single oral dose of 100 mg of ciprofloxacin could be an alternative treatment for uncomplicated gonorrhea in men. Neither treatment prevented the development of postgonococcal urethritis.

Clinical efficacy of new quinolones for therapy of nongonococcal urethritis.

Ninety-five patients with nongonococcal urethritis were enrolled in a double-blind study and were randomly assigned to a one-week treatment with ciprofloxacin (500 mg twice daily) or ofloxacin (200 mg twice daily). Two weeks after treatment the results obtained for the 79 evaluated patients were as follows: 59 patients (75%) were clinically cured, and of the 54 patients with initial positive cultures, 39 (72%) remained culture-negative. We did not find any statistically significant differences between the results obtained with the two treatments. These results did not vary with the cause. Patient compliance with the regimens of two doses per day was excellent, and no serious adverse effects occurred with either drug.