Jose Carlos Ruiz-Carrascosa

Sexual dysfunction in psoriasis: a systematic review

Psoriasis has been associated with numerous psychological disorders such as low self‐esteem, depression, anxiety, sexual dysfunction or suicidal ideation. Recently, there has been a progressive increase in studies examining the impact of psoriasis on sexual function. This alteration seems to be considerable and can cause significant changes in quality of life.

Vessel resistance to blood flow in the nailfold in patients with psoriasis: a prospective case–control echo Doppler-based study

Background  Psoriasis is a disease in which endothelial cells seem to play an important pathogenic role. No report published to date has examined nail vascularity in patients with psoriasis.

Cutaneous Cryptococcus laurentii infection in an immunocompetent child

Cryptococcus laurentii is an extremely rare human pathogen. We report a case of primary cutaneous cryptococcosis caused by Cryptococcus laurentii in an immunocompetent patient, an 8-year-old child with a solitary lesion on the forearm. It was impossible to determine the source of infection and no predisposing factors were found. Oral treatment with fluconazole was totally successful. A review of the literature showed only three cases of cutaneous infection by Cryptococcus laurentii. All of the cases occurred in immunocompromised patients. To the best of our knowledge, this is the first case of Cryptococcus laurentii in an immunocompetent host.

Elevated prevalence of Type D (distressed) personality in moderate to severe psoriasis is associated with mood status and quality of life impairment: a comparative pilot study

Psoriasis may imply a remarkable psychological impairment, which can influence patients personality. The Type D personality is defined by the combination of social inhibition and negative affectivity. Furthermore, Type D personality has been associated with impaired health‐related quality of life (HRQOL) and increased cardiovascular risk, both facts being associated with moderate to severe psoriasis.

Distribution Pattern of Psoriasis Affects Sexual Function in Moderate to Severe Psoriasis: A Prospective Case Series Study

INTRODUCTION Psoriasis may significantly impair sexual function. Depression and organic factors appear to play a key role in this relationship. However, beyond genital psoriasis, the importance of the distribution pattern of the disease has not been considered. AIM To investigate the role of the distribution pattern of psoriasis in sexual dysfunction. METHODS A prospective case series study was carried out on 133 patients with moderate to severe psoriasis. MAIN OUTCOME MEASURES The participants completed the Massachusetts General Hospital-Sexual Functioning Questionnaire, the Hospital Anxiety and Depression Scale, and the Self-Administered Psoriasis Area and Severity Index. RESULTS Forty-four women (mean age 42.0 ± 14.1) and 79 men (mean age 47 ± 11.7) were included in the study. Psoriasis lesions on abdomen, genitals, lumbar region, and buttocks in women and chest, genitals, and buttocks in men were associated with an increase in sexual dysfunction. Multivariate logistic regression analysis showed that the involvement of these specific areas may be independent risk factors for sexual dysfunction in patients with moderate to severe psoriasis. CONCLUSIONS This is the first study identifying body areas other than genitals as potentially related to sexual dysfunction in psoriasis patients. The results suggest that the assessment of sexual dysfunction and the involvement of these body areas should be considered as disease severity criteria when deciding on treatment for psoriasis patients.

Elastorrexis papulosa. Presentación de un caso y claves para el diagnóstico diferencial

Elastic tissue disorders include a heterogeneous group of diseases characterized by a reduction of elastic fibers in the dermis. These rare conditions occasionally have overlapping clinical and histological findings that make diagnosis a challenge for dermatologists and dermatopathologists. We report a case of one of these entities, papular elastorrhexis, and discuss the clinical and histologic differential diagnosis with other disorders characterized by alterations of the elastic tissue. The patient was a 21-year-old woman, with no relevant medical history, who consulted for the progressive appearance since adolescence of multiple asymptomatic, raised whitish lesions on the upper chest, shoulders, and upper back. She reported no acne on these sites or on the face. Physical examination revealed multiple, slightly raised nonfollicular papules that were whitish in color and measured 1 to 4 mm in diameter (Figs. 1 and 2). On histology, orcein stain showed a marked reduction, thinning, and fragmentation of the elastic fibers in the dermis (Fig. 3). The remaining laboratory tests and imaging studies were normal. No similar lesions were detected in other members of the patient’s family. A diagnosis of papular elastorrhexis was made on the basis of the clinical and histopathological findings. The first case of papular elastorrhexis was described by Bordas et al1 in 1987 and was considered a variant of nevus anelasticus. Although familial cases have been reported,2 the condition is usually acquired after adolescence and the second decade of life, and is more common in women. It presents clinically as multiple nonfollicular, nonconfluent whitish papules, measuring 5 mm or less, distributed mainly over the upper part of the trunk (shoulders and proximal upper arms). However, recent reports have described more atypical sites on the head and neck.3 Most cases are isolated, with no concomitant disease.4 Histologically, there is a reduction and fragmentation of elastic fibers, mainly in the upper dermis.3 The clinical characteristics of papular elastorrhexis resemble incomplete forms of the Buschke-Ollendorff syndrome, in which nonconfluent skin lesions called dermatofibrosis lenticularis disseminata appear. The histology of Buschke-Ollendorff syndrome, however, is usually different, as there is an increase in the number of elastic fibers rather than a decrease.5 Even so, some authors argue that papular elastorrhexis is one of these incomplete forms with no bone involvement (osteopoikilosis) or other findings. For this reason, dermatofibrosis lenticularis disseminata, together with nevus anelasticus, is the

Carcinoma basocelular que simula adenopatías cervicales bilaterales

El carcinoma basocelular es el tumor cutáneo más común y constituye el cáncer más frecuente en la raza blanca, representando aproximadamente el 70% de las enfermedades malignas de la piel. Su incidencia actual está en aumento a nivel mundial y se produce un incremento progresivo con la edad, especialmente a partir de los 40 años. En nuestro medio constituye uno de los motivos de consulta dermatológica más frecuente, sobre todo en la población anciana. A pesar del alto número de carcinomas basocelulares que se diagnostican cada año, la tasa de metástasis es muy baja, oscilando entre el 0,0028 y el 0,5%; sin embargo, ocasionan una importante morbilidad y gasto sanitario. Estos tumores se localizan con más frecuencia en la cara y otras áreas fotoexpuestas debido a su relación con la exposición solar. Presentamos el caso de un paciente con dos carcinomas basocelulares de localización cervical y simétrica que simulaban clı́nicamente adenopatı́as cervicales.

Association Between Psoriasis and Sexual and Erectile Dysfunction in Epidemiologic Studies: A Systematic Review

Importance Sexual health is a major aspect of life. Increasing scientific evidence shows a potential association between psoriasis and sexual dysfunction (SD) and erectile dysfunction (ED). Objective To evaluate the available scientific evidence regarding epidemiologic associations and treatment outcomes between psoriasis and SD and ED. Evidence Review Information sources were MEDLINE and Embase databases, using the Scopus search engine. The search was performed on August 25, 2017. Search terms were psoriasis and sexual or sexual dysfunction, and the search was limited to epidemiologic studies published in English answering any of the 4 research questions. Quality was assessed according to the Centre for Evidence-Based Medicine. Findings Twenty-eight studies representing 52 520 cases of psoriasis and 1 806 022 controls were included for review. Of the 28 studies, 19 were cross-sectional, 3 were clinical trials, 3 were quasi-experimental, 2 were population-based cohort, and 1 was population-based case-control. Prevalence of SD and ED ranged from 40.0% to 55.6% and 34.2% to 81.1%, respectively. Two of 2 studies observed an association between psoriasis and SD after adjusting for physical and psychological comorbidities. Five of 8 studies observed an independent association between ED and psoriasis. Among patients with psoriasis, the features that showed the strongest association with SD were anxiety and depression (5 of 5 studies), psoriatic arthritis (3 of 4 studies), and genital psoriasis (5 of 7 studies). Regarding ED, anxiety and depression (2 of 2 studies) and increasing age (3 of 3 studies) showed the strongest association. All 3 clinical trials using biologic drugs showed an improvement in SD compared with placebo. Conclusions and Relevance Patients with psoriasis have physical and psychological comorbidities that have been associated with a higher risk of SD. In addition, psoriasis may play a role in its development. The presence of anxiety, depression, psoriatic arthritis, genital lesions, and increasing age should raise the awareness of SD. Biologic drugs have demonstrated the improvement of SD in patients with psoriasis.

Psoriasis comprehensive care: an evaluation of a web site.

Psoriasis is a disease that affects many facets of life. Psoriasis patients have needs that cannot be addressed within the traditional consultation structure. Although the Internet provides a number of health resources, the quality of the information is variable, and many sites are not editorially independent. After reviewing the contents available on the Internet related to psoriasis, the staff of the psoriasis unit at San Cecilio University Hospital (Granada, Spain) developed a Web site to meet the needs of psoriasis patients. A group of 241 patients who attended a follow-up visit to our psoriasis unit evaluated the Web site and provided feedback through an online survey. The result of the Web development process was the creation of “Psoriasis365” (https://sites.google.com/site/psoriasis365/). Overall, the Web site achieved high scores, the most popular section being “research.” These results suggest that the Web site can complement the healthcare of psoriasis patients and is potentially useful for research purposes.

Estudio de las consultas extraoficiales en un hospital de tercer nivel

BACKGROUND Dermatologists are regularly consulted in their place of work by patients without an official appointment (individuals accompanying other patients, doctors from other specialties, hospital workers, etc). OBJECTIVES To describe the characteristics of consulting patients, reasons for consultation, severity of complaint, diagnostic and therapeutic approach taken, and level of care provided by the consulted professionals. RESULTS The typical patient would be a middle-aged female nurse consulting for the first time for a benign melanocytic lesion. In general, the dermatologist will take an empirical or informative therapeutic approach and consider the care provided to be similar to that offered to patients with an official appointment. CONCLUSIONS Unofficial appointments, although commonly for trivial complaints, represent an additional workload in daily clinical practice.