José Carlos Moreno

Treatment of severe refractory adult atopic dermatitis with ustekinumab

with ustekinumab Editor, A 21-year-old Caucasian woman presented in March 2003 with a longstanding history of atopic dermatitis (AD) in addition to allergic contact dermatitis that emerged in response to paraphenylenediamine and had been diagnosed one year earlier (Fig. 1). She had undergone topical treatment with corticosteroids and calcineurin inhibitors with little improvement in her condition. Over the next six years, the patient underwent various treatments such as intermittent cycles of oral cyclosporine (4 mg/kg/day), ultraviolet B narrowband therapy (three times weekly), oral prednisone (1 mg/kg/day), and subcutaneous efalizumab (0.7 mg/kg initially followed by 1 mg/kg). In December 2009, the patient began treatment with ustekinumab administered in a single dose of 45 mg. Two weeks later, the patient reported a substantial clinical improvement in her condition, especially in the pruritus. This improvement was rated on a 10-point visual analog scale (VAS). The VAS value before treatment was 9. One month later, the lesions had cleared and only hyperpigmented residual lesions presented on physical examination. The VAS value of pruritus was 0. A second 45-mg dose was administered at that point, according to the recommended dosage in psoriasis (at weeks 0 and 4, followed by every 12 weeks). The patient has currently completed month 12 of treatment. Her condition remains improved and pruritus is absent (Fig. 2). Patients with AD often require systemic immunomodulatory and immunosuppressive agents (cyclosporine, azathioprine, methotrexate, and mycofenolate mofetil), but the use of these agents is limited by their potential toxicity and inadequate patient responses. Ustekinumab is a fully human immunoglobulin G1 (IgG1) monoclonal antibody that binds with high specificity to the p40

Differences between objective efficacy and perceived efficacy in patients with palmar hyperhidrosis treated with either botulinum toxin or endoscopic thoracic sympathectomy

Background  Moderate to severe palmar hyperhidrosis can disturb people’s work and social and emotional lives. Botulinum toxin and sympathectomy are currently considered the most effective treatment options but few studies have analysed the concordance between efficacy and patient satisfaction in comparisons of these two types of treatments.

Reticulohistiocitosis cutánea difusa

The reticulohistiocytoses make up a heterogeneous group of diseases whose origin lies in an accumulation of cells of histiocytic lineage in different tissues and primarily in the skin. Three main clinical forms have been described (multicentric, solitary, diffuse cutaneous), which present with identical histological, ultrastructural and immunohistochemical characteristics. We present a case of diffuse cutaneous reticulohistiocytosis, which is the least common clinical pattern in the spectrum of this disease.

Tratamiento de la hiperhidrosis

Hyperhidrosis is a condition where the sweat glands produce excessive sweat on, greater than that required for proper body thermoregulation. There are different treatments for this condition. We will focus specifically on botulinum toxin type A treatment for craniofacial hyperhidrosis as well as application techniques, advantages and disadvantages of this treatment.

Hidradenitis ecrina neutrofílica secundaria a tioguanina en paciente neutropénico

Neutrophilic eccrine hidradenitis (NEH) is an infrequent, self-limited inflammatory dermatosis characterized by a neutrophilic infiltrate around the eccrine glands. Clinically, it presents with different types of lesions. NEH occurs most frequently in patients who have undergone chemotherapy for hematologic neoplasms. We present a case of NEH in a 70-year-old neutropenic male who received thioguanine for acute myeloid leukemia. The erythematous plaques disappeared in 3-4 weeks. The histological findings were compatible with NEH. Skin cultures ruled out infectious causes.

Evaluación fotográfica de pacientes con alopecia androgenética tratados con 1 mg de finasterida (Propecia

La alopecia androgenetica es un motivo de consulta cada vez mas frecuente. La valoracion clinica de este proceso es dificil y en la mayoria de las ocasiones se hace de forma exclusivamente subjetiva. Aunque se han publicado diversos sistemas, empleados generalmente en ensayos clinicos, se trata de metodos complicados que no estan al alcance de todos los dermatologos. Por ello, nos ha parecido interesante valorar la utilidad de un metodo simple, la fotografia, en el control de los pacientes con alopecia androgenetica en tratamiento con un farmaco de probada eficacia, la finasterida, a dosis de 1 mg/dia.