Carlos Ferrándiz

Prevalence of psoriasis in Spain (Epiderma Project: phase I)

Various national and international studies are under way to obtain reliable data on the epidemiological features of psoriasis.

Development of a treatment algorithm for actinic keratoses: a European Consensus

Actinic keratoses (AKs) are lesions caused by chronic UV radiations that have the potential to progress to invasive SCCs. The prevalence of AK is increasing worldwide, and although there are a variety of treatment modalities, along with a number of published guidelines, there is a lack of advice on treatment recommendations for AK in clinical practice. There are also considerable variations in the care of patients with AK in Europe, and so the Skin Academy (a group of leading experts in the field of dermatology and skin cancer) formed to discuss best practice in the treatment of AK. The result of these discussions is an algorithm designed to assist physicians with their treatment decisions, giving recommendations for both field directed and lesion directed treatment. The new AK Treatment Algorithm described in this paper comprises 5 key, decision making steps, which are simple and allow the flexibility to reflect cultural differences between and within countries. The algorithm also considers factors such as patient profile, medical history, and personal preference (e.g. cosmesis, and pain).This is a novel algorithm that has the capacity to grow and expand as more clinical evidence becomes available. It offers, for the first time, a summary of European best practice recommendations for the treatment of AK.

Risk of Serious Adverse Events Associated With Biologic and Nonbiologic Psoriasis Systemic Therapy: Patients Ineligible vs Eligible for Randomized Controlled Trials

OBJECTIVE To describe the use of systemic therapy for psoriasis (biologic and nonbiologic [classic] drugs) in patients not adequately represented in randomized controlled trials (RCTs) and the risk of serious adverse events (SAEs) in these patients. DESIGN A registry inception cohort was used. SETTING Thirteen dermatology departments in Spain participated. PATIENTS A consecutive sample of patients treated with biologics and a systematic sample of patients treated with classic systemic therapy were evaluated. A total of 1042 patients (2179 person-years) were included. EXPOSURE Inadequate representation in trials was defined as the presence of any of the following factors: elderly age (>70 years); type of psoriasis other than chronic plaque psoriasis; history of infection caused by hepatitis B, hepatitis C, or human immunodeficiency virus; history of cancer (excluding nonmelanoma skin cancer); and chronic renal or hepatic disease. MAIN OUTCOME MEASURES Serious adverse events as defined by the International Conference on Harmonization were evaluated. RESULTS In all, 29.8% of patients receiving systemic therapy for psoriasis would not have been eligible for RCTs. These individuals had an increased risk of SAEs (incidence rate ratio, 2.7; 95% CI, 1.5-4.7). Patients exposed to biologics had an adjusted increased risk of SAEs (incidence rate ratio, 2.3; 95% CI, 1.1-4.8) that was similar in patients eligible and ineligible for RCTs. CONCLUSIONS Patients ineligible for RCTs are an important proportion (30%) of those receiving systemic therapy for psoriasis. These patients have a higher risk of SAEs and should be closely monitored. Patients exposed to biologics (whether these patients are eligible for RCTs or ineligible) are susceptible to the same increase in risk of SAEs, but biologics add to a higher baseline risk in patients who are ineligible for RCTs. The risk-benefit ratio in ineligible patients receiving biologics might be different from the ratio in eligible patients.

A prospective study of the incidence of skin cancer and its risk factors in a Spanish Mediterranean population of kidney transplant recipients

Background  Skin cancer is the most common malignancy occurring in kidney transplant recipients (KTRs).

Actinic keratosis with atypical basal cells (AK I) is the most common lesion associated with invasive squamous cell carcinoma of the skin

Progression from actinic keratosis (AK) to invasive squamous cell carcinoma (iSCC) of the skin is thought to occur after the development of full thickness epidermal neoplasia, as in the classic pathway of cervical cancer. Nevertheless, cutaneous iSCC may also directly arise from a proliferation of atypical basaloid cells limited mostly to the epidermal basal layer (AK I), akin to what happens in the ‘differentiated pathway’ of iSCC of the vulva, oral cavity and other locations.

Expression profiles associated with aggressive behavior in Merkel cell carcinoma

Primary neuroendocrine carcinoma of the skin, or Merkel cell carcinoma, is the most aggressive cutaneous neoplasm. In spite of its similarities to small cell carcinomas from other locations, Merkel cell carcinoma shows many peculiarities probably related to its epidermal origin and the etiologic role of UV radiation. We have immunohistochemically investigated 43 markers on a tissue microarray in which 31 surgically resected Merkel cell carcinomas were represented. Of these, 15 patients remained free of disease after removal, whereas 16 developed metastases. Immunoreactivity was scored according to staining intensity and the percentage of positive cells. We found statistically significant correlations between metastatic tumor spread and overexpression of matrix metalloproteinase (MMP) 7, MMP10/2, tissue inhibitor of metalloproteinase 3, vascular endothelial growth factor (VEGF), P38, stromal NF-kappaB, and synaptophysin. Also detected were statistically significant correlations between the expression levels of MMP7 and VEGF, MMP7 and P21, MMP7 and P38, MMP10/2 and VEGF, P38 and synaptophysin, P38 and P53, and P21 and stromal NF-kappaB. These findings may be helpful in predicting the clinical course of Merkel cell carcinoma and are potentially useful for the development of targeted therapies.

Epidermal dysplasia and neoplasia in kidney transplant recipients

BACKGROUND Established data confirm an increased incidence of skin cancer, mainly squamous cell carcinoma (SCC), in long-term kidney transplant recipients (KTRs). OBJECTIVE Our purpose was to investigate prospectively the type and frequency of neoplastic and preneoplastic skin lesions in KTRs during the first 3 years of immunosuppression, as well as the influence of potential risk factors. METHODS Eighty-one consecutive KTRs were examined every 6 months during the first 3 years after transplantation. All survival analyses were performed with the EGRET statistical software package. RESULTS After a median follow-up of 34 months, 25 skin cancers developed in 12 patients; the basal cell carcinoma (BCC)/SCC ratio was 3.1:1. The cumulative risk of skin cancer developing after 3 years of graft survival was 18.1%. Only age at the time of transplantation (p = 0.005) and occupational sun exposure (p = 0.048) had statistical significance as risk factors. CONCLUSION In carefully supervised KTRs, a high incidence of cutaneous malignancy, mainly BCC, exists in the early posttransplant period. Sun exposure and the patients age at the time of transplantation seem to be the most important risk factors.

Clinical practice guideline for an integrated approach to comorbidity in patients with psoriasis

Background  The relationship between psoriasis and associated diseases has drawn particular interest in recent years. To provide appropriate management of psoriasis from an early stage, it is necessary to include prompt diagnosis of concomitant disease and to prevent and treat any comorbidity found. Such an integrated approach also serves to ensure that the drugs used to treat associated diseases do not interfere with the management of psoriasis, and vice versa.

Effect of smoking on skin elastic fibres: morphometric and immunohistochemical analysis

Background  It has been established during recent years that smoking is an independent risk factor for the development of premature facial wrinkling. The underlying mechanism is not well known, but elastic fibres of the dermis seem to be the major target of smoke components.

Sequential combined therapy with thalidomide and narrow-band (TL01) UVB in the treatment of prurigo nodularis.

BACKGROUND Prurigo nodularis (PN) is a chronic disease of which treatment choices are limited. Among them, thalidomide and phototherapy have been used with satisfactory results. Unfortunately, the possibility of side effects limits their use. OBJECTIVE To evaluate the efficacy of a sequential combined treatment with thalidomide and ultraviolet B (UVB) therapy in order to minimize side effects and, thus, making possible a long-term treatment. METHODS A prospective open trial combining thalidomide as initial therapy followed by narrow-band UVB (TL01) irradiation until complete or almost complete remission of the disease was achieved. RESULTS An excellent response was obtained after an average of 12 weeks of thalidomide therapy and 32 UVB courses. CONCLUSIONS Sequential combined therapy with thalidomide and narrow-band UVB therapy could improve the management of prurigo nodularis with minimal side effects, although it should probably be reserved to men and women over 50 years of age.