Jose Luis Lopez-Estebaranz

Body mass index in patients with moderate-to-severe psoriasis in Spain and its impact as an independent risk factor for therapy withdrawal: results of the Biobadaderm Registry.

There are few data on the prevalence of obesity in the general psoriasis population and on the real impact of obesity on the management of psoriasis patients in the clinical setting.

Terapia biológica y psoriasis

Psoriasis is a common, persistent, inflammatory skin disorder that can have a major effect on patient quality of life. Conventional psoriasis treatment fail to meet the clinical needs for a save and remittive therapy. The implication of an immunological lymphocyte T phenomena in the pathogenesis of psoriasis has led to research for new treatment options over the past few years. With advances in molecular research and technology, several biological therapies may be employed in the treatment of psoriasis. Biological treatments are designed to modulate key steps in the pathogenesis of psoriasis. They act by: inhibition of activation of antigen-presenting cells, inhibition of activation and proliferation of lymphocytes, immune deviation (from a T1 immune response to a T2 immune response) and reduction of pathogenic T cells and blocking the activity of inflammatory cytokines. Different biological treatments are discussed in this article.

Latent tuberculosis infection and active tuberculosis in patients with psoriasis: a study on the incidence of tuberculosis and the prevalence of latent tuberculosis disease in patients with moderate-severe psoriasis in Spain. BIOBADADERM registry.

Introduction  The incidence of tuberculosis (TB) or the prevalence of latent tuberculosis infection (LTBI) in psoriasis patients has not been described in the Spanish population. We carried out a study with the objectives: (i) To describe the incidence of TB in patients with psoriasis on systemic treatment in the Spanish population; (ii) To determine the prevalence of LTBI in patients who are candidates for biological treatment; and (iii) To investigate the level of compliance with current recommendations for LTBI and TB screening.

Squamous cell carcinoma of the lip. A retrospective study of 146 patients.

Background  Squamous cell carcinoma of the lip (SCCL) accounts for 90% of all tumours of the oral cavity. We present a series of 146 patients with SCCL studied in our hospital.

Fibroxantoma atípico. Estudio clinicopatológico de 10 casos

INTRODUCTION Atypical fibroxanthoma (AFX) is a rare tumor of unknown histogenesis, considered by most authorities as a superficial form of malignant fibrous histiocytoma (MFH). The aim of this work is to report the clinicopathological features of 10 cases of AFX. MATERIAL AND METHODS Data were retrospectively collected of the computerized medical history. Clinical (age, onset-diagnosis time, location, accompanying pathology, outcome), histological (architectural pattern, cell type, ulceration, vascular or perineural invasion, subcutis involvement, pleomorphism, mitosis, inflammatory infiltrate) and immunohistochemical variable were analyzed. CASES REPORT Clinical and epidemiological features coincide with those previously reported: onset late in life, short time onset-diagnosis, involvement of skin with notable sun damage and a good outcome. Pathologically all the cases showed a spindle-cell prevalence arranged in a vaguely storiform pattern, along with both, multinucleated and eosinophilic cells. DISCUSSION The diagnosis of AXF is always of exclusion. Other spindle-cell tumors such as squamous cell carcinoma, malignant melanoma, leyomiosarcoma or dermatofibrosarcoma protuberans must be ruled out by immunohistochemical techniques. In spite of its rarity, the recognition of AFX is important in order to avoid inappropriately aggressive treatment.Resumen Introduccion El fibroxantoma atipico (FXA) es un tumor poco frecuente de histogenesis incierta, considerado por la mayoria de los autores como la variante superficial del histiocitoma fibroso maligno (HFM). El objetivo principal de este trabajo es presentar las caracteristicas clinicas e histologicas de una serie de 10 pacientes. Material y metodos Los datos fueron recogidos retrospectivamente de la historia clinica informatizada. Se analizan variables clinicas (edad de aparicion, tiempo hasta el diagnostico, localizacion, patologia acompanante, evolucion), histologicas (patron arquitectural, celularidad, ulceracion, invasion vascular o perineural, afectacion tejido celular subcutaneo, pleomorfismo, mitosis, infiltrado inflamatorio acompanante) e inmunohistoquimica. Casos clinicos Las caracteristicas clinicoepidemiologicas coinciden en general con las publicadas en la literatura especializada: edad avanzada de aparicion, poco retraso hasta el diagnostico, afectacion de piel con dano actinico y buena evolucion. Histologicamente todos los casos presentaban un predominio fusocelular, dispuesto en un patron vagamente estoriforme junto con celulas gigantes y celulas poligonales eosinofilas. Discusion El diagnostico es siempre de exclusion, y deben diferenciarse mediante inmunohistoquimica de otros tumores fusocelulares como carcinomas epidermoides, melanomas, leiomiosarcomas o dermatofibrosarcoma protuberans entre otros. A pesar de ser un tumor poco frecuente es preciso conocerlo para evitar tratamientos agresivos e innecesarios.

Descripción de los pacientes intervenidos mediante cirugía de Mohs en España. Datos basales del registro español de cirugía de Mohs (REGESMOHS)

INTRODUCTION The Spanish registry of Mohs micrographic surgery started collecting data in July 2013. The aim of the registry is to report on the use of this technique in Spain and the outcomes achieved. In the present article, we describe the characteristics of patients and the tumors treated. MATERIAL AND METHODS This is a prospective cohort study of patients treated with Mohs micrographic surgery. The participating centers are hospitals where at least one intervention of this type is performed each week. All patients considered for Mohs micrographic surgery in participating centers are included in the registry except those who have been declared legally incompetent. RESULTS Between July 2013 and October 2014, data from 655 patients were included in the registry. The most common tumor involved was basal cell carcinoma, and the most common histological subtype was infiltrative basal cell carcinoma. Most of the tumors treated were located on the face or scalp, and the most common site was the nose. Almost 40% of the tumors treated were recurrent or persistent, and preoperative tumor size was similar to that reported in other European studies and in Australia. In total, 45.5% of patients had received previous surgical treatment. CONCLUSION The findings are similar to those reported in other studies, and the data collected are useful for assessing whether the results of studies carried out elsewhere are applicable in Spain.

Long lasting interstitial generalized granuloma annulare on sun-exposed areas.

Granuloma annulare (GA) is a benign inflammatory dermatosis of unknown etiology and chronic course, with different clinical variants. The cases associated with a photodistributed pattern are rare and show a palisading histopathological pattern. We report a case of generalized GA affecting sun‐exposed areas with an interstitial pattern. The patient has been followed‐up for 6 years, presenting a recurrent course of the disease, with a good response to chloroquine and relapse when no treatment was prescribed.

Lymphomatoid papulosis: a study of 18 cases*

Lymphomatoid papulosis (LyP) is a cutaneous eruption that is clinically benign but histologically malignant. To date, more than 300 cases have been published. About 10–20% of the patients develop a lymphoma. The purpose of this study was to make a clinicopathological study of 18 patients diagnosed with LyP in our hospital from 1973 to 1990, to characterize cellular infiltrates in the lesions, to find clonal populations of T‐cells and to look for predictive factors of malignant lymphoma in LyP patients. Mean age was 48.7 years. The most frequent clinical lesions were papules (88.8%) followed by plaques (38.8%). The localizations were on extremities (100%), trunk (88%), face (22%), palms or soles (11%), perigenital (11%) and scalp (5%). Two patients have been free of disease for more than 5 years. IgA levels are increased in LyP patients. Neither HTLV I nor III can be considered as a cause of the LyP in any of our patients. Associated diseases were found in 6 cases (1 mycosis fungoides, 1 Hodgkins disease, 2 anaplastic large‐cell lymphoma and 2 large plaque parapsoriasis). Some types of parapsoriasis should be included in the ‘spectrum of Ki‐1 lymphomas’. 52 skin biopsies were studied. 17% were type A of Willemze, 67% were type B and 15% were transitional. In 12 of the samples follicular or perifollicular infiltration was found. Follicular LyP should not be considered as a distinct type of LyP. Vasculitis is an uncommon finding in LyP. In all the cases studied, large atypical cells were CD30 +; 5/7 cases had lost CD5 and 4/5 cases had lost CD7. In one case, all T‐cell antigens were negative. Cerebriform mononuclear cells were always recognized by T‐cell antibodies and they were CD30 positive in only two cases. In one case there were more CD8 + than CD4 + cells. In 5 patients skin and blood samples for genetic rearrangement (beta‐T) were taken. Only germinal line was found. We did not find any significant difference between those cases in which malignant lymphoma developed and those in which it did not.

Hiperqueratosis focal acral

Resumen —Las lesiones papulosas crateriformes en los bordes de las manos y/o pies constituyen una manifestacion clinica comun de muchas entidades que se agrupan bajo el termino de acroqueratodermias marginales. Una de ellas es la hiperqueratosis focal acral, descrita en ocasiones bajo el termino de acroqueratoelastoidosis. Aportamos el segundo caso descrito en la literatura espanola bajo el termino de hiperqueratosis focal acral.

Change over time in the rates of adverse events in patients receiving systemic therapy for psoriasis: A cohort study

To the Editor: How the incidence of adverse events in patients with psoriasis treated with systemic drugs varies over time is not well established. Information on trends in adverse events would be useful in clinical practice to inform the frequency of follow-up visits and laboratory tests. Our objective was to describe the incidence of adverse events over time. We used a cohort of patients with psoriasis who were receiving systemic therapy, the Spanish Registry of Adverse Events for Biological Therapy in Dermatological Diseases (BIOBADADERM) cohort, to calculate the incidence rate of adverse events by period of time. Incidence rate ratios were obtained by using a Poissonmixed-model regression considering the center as a random effect to take within-center clustering of patients into account. Data on 2084 patients and 7282 person-years with 5018 adverse events were included. Detailed baseline characteristics of patients exposed to each drug are described in Table I. Some drugs, such as cyclosporine or infliximab, were associated with higher rates of overall adverse events. For most drugs, rates of overall adverse events were higher in the first year (Table II). This first-year peak was especially marked for cyclosporine, although it is barely used beyond 1 year. If we focused on serious adverse events (SAEs), rates were much lower than the rates of overall adverse events and higher for cyclosporine and infliximab overall. Rates of abnormal laboratory results showed an increase in the first year in the case of classic drugs, whereas for