F. Rivas-Ruiz

A 30-year survey of paediatric tinea capitis in southern Spain

Backgroundu2002 Tinea capitis (TC) is the most common mycological infection in childhood. The epidemiology of TC varies depending on the geographical area and the time of study, and although it is an important public health problem in our area, only a few long‐term studies have focused on children.

Validación de un cuestionario en español sobre comportamientos, actitudes y conocimientos relacionados con la exposición solar: «Cuestionario a pie de playa»*

Resumen Introduccion Los cuestionarios son el metodo habitual de investigacion de las conductas relacionadas con la exposicion solar. Sin embargo, para que un instrumento sea valido debe acreditar sus propiedades de medicion. El objetivo del presente trabajo fue evaluar la validez y la fiabilidad de un cuestionario en espanol sobre comportamientos, actitudes y conocimientos relacionados con la exposicion solar en la playa. Pacientes y metodo Se realizo un estudio de corte transversal administrandose el cuestionario a una muestra de 422 participantes a pie de playa. Para la prueba del test-retest se encuesto a 70 participantes del medio hospitalario en dos ocasiones diferentes. Se analizaron la validez, la consistencia interna y la reproducibilidad de los items del instrumento. Resultados El analisis factorial de los componentes principales mostro valores de comunalidades y saturaciones factoriales > 0,50, y revelo la presencia de multiples dimensiones que presentaron valores de coeficiente alfa de Cronbach > 0,70. Los items de comportamientos y conocimientos evidenciaron coeficientes de correlacion intraclase y delta > 0,70. Los items del apartado de actitudes mostraron valores moderados de estabilidad (0,50-0,80). Conclusiones Se presenta el primer cuestionario sobre comportamientos, actitudes y conocimientos relacionados con la exposicion solar, elaborado en espanol, con garantias de validez y fiabilidad. Este instrumento constituira una herramienta de utilidad en la investigacion epidemiologica y del ambito de la prevencion primaria del cancer de piel en Espana.

Tinea incognito in children: 54 cases

The incidence of tinea incognito (TI) appears to have increased over recent years, although no large series of cases has been reported in children. The aim of this study was to analyse the main epidemiological, clinical and microbiological characteristics of TI diagnosed in children in comparison with other tineas. We undertook a retrospective study of 818 tineas diagnosed in children in a referral hospital between 1977 and 2006, concentrating on TI. Of the 54 TI diagnosed, 85% were in the last 15u2003years. Most children were older than 9u2003years of age. The most usual clinical forms were tinea corporis (46.3%) and tinea faciei (38.9%). Topical steroids alone had been used to treat 68.5% of the cases. Direct examination was positive in 91.5% of the cases examined. Culture was positive in 85.2% of cases. The most frequently isolated dermatophyte was Trichophyton mentagrophytes (44.4%). This is the largest case series of childhood TI reported to date. TI has increased over recent years and important differences were found between these TI and the other tineas in children over the same period.

Estudio dermoscópico del melanoma maligno cutáneo: análisis descriptivo de 45 casos

Resumen Introduccion La dermatoscopia o microscopia de epiluminiscencia es una novedosa tecnica de microscopia in vivo util para el diagnostico de las lesiones pigmentadas cutaneas. El objetivo del presente trabajo es analizar los patrones dermoscopicos de una serie consecutiva de melanomas cutaneos primarios. Material y metodos Se trata de un estudio de corte transversal, en el que se analizan las caracteristicas clinicas, histologicas y dermoscopicas de 45 melanomas primarios. Resultados Las dos terceras partes de la serie eran melanomas de espesor fino y el 50% melanomas in situ . Clinicamente, el 72 % de las lesiones eran sospechosas de melanoma (regla ABCD). Dermoscopicamente, el 93% presentaron patrones dermoscopicos especificos. El patron global mas frecuente fue el multicomponente (71 %). El 7% de las lesiones mostraron un patron inespecifico. Los hallazgos locales mas destacables fueron las manchas de pigmento irregulares (80 %), el reticulo pigmentado atipico (57 %), los puntos y globulos irregulares (68 y 62 %), las proyecciones radiales/pseudopodos (20 %) y el velo azul-gris (42 %). Ademas, destaco la presencia de areas hipopigmentadas (86 %), estructuras de regresion (80 %) y vascularizacion atipica (73 %). Las lesiones acras mostraron patrones caracteristicos de estas localizaciones. Conclusion El analisis de patrones dermoscopicos facilita el diagnostico de certeza del melanoma en estadios precoces, y es particularmente util en lesiones poco expresivas clinicamente. La identificacion de hallazgos dermoscopicos ofrece informacion complementaria al estudio histologico convencional.

Análisis de costes de la cirugía micrográfica de Mohs en el carcinoma basocelular facial de alto riesgo

INTRODUCTIONnMohs micrographic surgery (MMS) is the treatment of choice for high-risk facial basal cell carcinoma (BCC) as it offers the greatest chance of cure with maximum preservation of healthy tissue. Its use in Spanish public health care hospitals is still limited, however, due to the controversy surrounding its cost.nnnOBJECTIVESnTo determine the cost of MMS with fresh tissue to treat high-risk facial BCC and compare this to the estimated cost of conventional surgery in a Spanish public hospital. A secondary objective was to identify cost-optimization strategies for MMS.nnnMATERIAL AND METHODSnCross-sectional study of a consecutive series of patients with high-risk facial BCC who underwent MMS at the Department of Dermatology at Hospital Costa del Sol in Malaga, Spain between July 2006 and December 2007. We performed a descriptive analysis of the clinical characteristics of the patients and surgical factors. We calculated the total and mean cost of MMS and compared the results to the estimated costs of conventional surgery using patients as their own controls. Differences were analyzed according to tumor site and size, histologic subtype, and recurrence.nnnRESULTSnSeventy-nine patients (mean age, 62 years) with 81 high-risk facial BCCs, 97.5% of which were primary tumors, underwent MMS. The most common tumor site was the nose (57%) followed by the orbital region (25%). Histology showed that 64% of the tumors were infiltrative or micronodular carcinomas. Tumor-free margins were achieved in all patients, with no more than 2 stages required in 88% of the cases. The most common surgical reconstruction techniques were direct closure (21%) and closure with a local skin flap or graft (71%); the corresponding estimates for conventional surgery were 2% and 89%, respectively. The total and mean cost of MMS was e106,129.07 and e1325.80, respectively (compared to e97 700 and e1208.70 for conventional surgery). The difference in mean costs between MMS and conventional surgery was not significant (P=0.534).nnnCONCLUSIONSnMMS is a viable, effective technique that does not generate significantly higher costs than conventional surgery in selected patients with high-risk facial BCC. Certain technical and organizational strategies could contribute to optimizing the cost of MMS.

Sensibilización de contacto a alérgenos de la serie estándar en el Hospital Costa del Sol: Estudio retrospectivo (2005-2010)

BACKGROUNDnThe prevalence of contact allergy to different compounds can vary according to the population studied, the technique used, and the materials employed in patch tests. The Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) has proposed a panel of 29 allergens for use in patients with suspected allergic contact dermatitis.nnnOBJECTIVEnTo determine the prevalence of contact sensitization in a group of Spanish patients and to analyze potential associations with sociodemographic and clinical variables (sex, age, site of lesions, occupation, and diagnosis of atopic dermatitis).nnnMATERIAL AND METHODSnA retrospective study of patients with suspected contact dermatitis was undertaken at Hospital Costa del Sol in Marbella, Spain, for the period between January 1, 2005 and December 31, 2010; 839 patients were included in the analysis. Patch tests were carried out with 34 allergens, including the 29 compounds that comprise the Spanish standard panel proposed by the GEIDAC.nnnRESULTSnSensitization to at least 1 allergen in the panel was observed in 48% of patients. Women had a higher frequency of sensitization than men (56.9% vs 33.1%). The hands were the most commonly affected site (36.1%). The most frequently involved allergens were nickel sulfate (25.9%), potassium dichromate (7.6%), thiomersal (5.1%), cobalt chloride (4.5%), and fragrance mix I (3.8%). In contrast, preservatives such as paraben mix (0.1%), imidazolidinyl urea (0.1%), diazolidinyl urea (0.2%), and quinoline mix (0.2%) had low rates of sensitization. Sensitization to sesquiterpene lactones and methyldibromo glutaronitrile (euxyl K 400) were not observed.nnnCONCLUSIONSnOur results are similar to those previously reported for Spanish patients. The low level of sensitization to certain allergens such as most preservatives and sesquiterpene lactones may suggest that their use in standard patch test series should be reconsidered.

A Spanish version of the skin cancer index: a questionnaire for measuring quality of life in patients with cervicofacial nonmelanoma skin cancer

The Skin Cancer Index (SCI) is the first specific patient‐reported outcome measure for patients with cervicofacial nonmelanoma skin cancer. To date, only the original English version has been published.

Five-year economic evaluation of non-melanoma skin cancer surgery at the Costa del Sol Hospital (2006-2010).

The cost associated with treatment of non‐melanoma skin cancer is expected to rise considerably over the coming decades. This important public health problem is therefore expected to have an enormous economic impact for the various public health services.

[Cost analysis of Mohs micrographic surgery in high-risk facial basal cell carcinoma].

INTRODUCTIONnMohs micrographic surgery (MMS) is the treatment of choice for high-risk facial basal cell carcinoma (BCC) as it offers the greatest chance of cure with maximum preservation of healthy tissue. Its use in Spanish public health care hospitals is still limited, however, due to the controversy surrounding its cost.nnnOBJECTIVESnTo determine the cost of MMS with fresh tissue to treat high-risk facial BCC and compare this to the estimated cost of conventional surgery in a Spanish public hospital. A secondary objective was to identify cost-optimization strategies for MMS.nnnMATERIAL AND METHODSnCross-sectional study of a consecutive series of patients with high-risk facial BCC who underwent MMS at the Department of Dermatology at Hospital Costa del Sol in Malaga, Spain between July 2006 and December 2007. We performed a descriptive analysis of the clinical characteristics of the patients and surgical factors. We calculated the total and mean cost of MMS and compared the results to the estimated costs of conventional surgery using patients as their own controls. Differences were analyzed according to tumor site and size, histologic subtype, and recurrence.nnnRESULTSnSeventy-nine patients (mean age, 62 years) with 81 high-risk facial BCCs, 97.5% of which were primary tumors, underwent MMS. The most common tumor site was the nose (57%) followed by the orbital region (25%). Histology showed that 64% of the tumors were infiltrative or micronodular carcinomas. Tumor-free margins were achieved in all patients, with no more than 2 stages required in 88% of the cases. The most common surgical reconstruction techniques were direct closure (21%) and closure with a local skin flap or graft (71%); the corresponding estimates for conventional surgery were 2% and 89%, respectively. The total and mean cost of MMS was e106,129.07 and e1325.80, respectively (compared to e97 700 and e1208.70 for conventional surgery). The difference in mean costs between MMS and conventional surgery was not significant (P=0.534).nnnCONCLUSIONSnMMS is a viable, effective technique that does not generate significantly higher costs than conventional surgery in selected patients with high-risk facial BCC. Certain technical and organizational strategies could contribute to optimizing the cost of MMS.

Condom Use and Number of Sexual Partners among Male Syphilis Patients who Report Having Sex with Men

BACKGROUND AND OBJECTIVESnRecent years have seen a resurgence of syphilis in Spain due to changes in sexual behavior. Here we describe the incidence of the disease in our clinic and investigate its relationship with the sexual habits of men who have sex with men (MSM).nnnPATIENTS AND METHODSnA cross-sectional descriptive study of incident cases of syphilis in 2007 and 2008 was performed, followed by a case-control study of sexual behavior in the previous year to compare MSM with and without syphilis.nnnRESULTSnWe recorded 26 new cases of syphilis, 19 of which were diagnosed at early stages. Eight patients were infected with human immunodeficiency virus and 15 were classed as MSM. Sixty-five MSM without syphilis were selected as a control group. MSM with syphilis had a larger number of sexual partners: odds ratio (OR), 3.98 (95% confidence interval [CI], 0.90-17.46) for the category 2 to 5 sexual partners; OR, 3.22 (95% CI, 0.84-12.43) for the category more than 5 sexual partners. The inconsistent use of condoms was significantly more common among MSM with syphilis than among those without syphilis (OR, 3.96; 95% CI, 1.15-13.61; p=0.02).nnnCONCLUSIONSnSyphilis continues to be a public health problem in our setting, particularly among homosexual and bisexual men. In this study, inconsistent use of condoms and a greater number of sexual partners were risk factors for syphilis in MSM. The development of prevention programs targeting this at-risk population should be considered a priority.