María Jones-Caballero

The Spanish version of Skindex‐29

Abstract

Quality of life in mild to moderate acne: relationship to clinical severity and factors influencing change with treatment

Background  Because of its effects on quality of life, acne vulgaris is more than a merely physiological or cosmetic entity.

Documento de consenso sobre fototerapia: terapias PUVA y UVB de banda estrecha

It is essential to develop a consensus document on phototherapy in order to adapt this procedure to the specific characteristics, needs and reality of our milieu. Using a review of existing literature on the subject and the experience of its own members as a reference, the Spanish Photobiology Group (GEF) of the Spanish Academy of Dermatology and Venereology (AEDV) has developed some therapeutic guidelines for the most widely used modes of phototherapy: PUVA therapy and narrow-band UVB (NBUVB) therapy. These guidelines deal with generalities about the equipment, calibration and regulation in phototherapy booths, and the concept and indications for these forms of treatment are reviewed. Recommendations are also proposed regarding patient selection, therapeutic procedures, associated pharmacological agents of interest and the prevention and management of adverse effects. The consensus document is designed as a flexible and practical instrument intended for use in daily clinical practice, aimed at optimizing the possibilities of phototherapy while reducing risks for patients and therapists.

Self-Reported Adherence to Treatment and Quality of Life in Mild to Moderate Acne

Background: Adherence to treatment is a mayor issue in dermatology, and its relationship to quality of life has barely been studied. Objective: To evaluate the relationship between scores on the Skindex-29 skin disease assessment scale and adherence to treatment in patients with acne. Methods: An observational, prospective study of 1,628 patients carried out by 252 clinicians in Spain. Results: Adherence was related to better objective and subjective severity index scores and better Skindex-29 scale scores at the end of the study. Young, male and unemployed patients had the worst adherence scores. Baseline and final Skindex-29 scale scores were significantly worse in non-adherent females, while non-adherent males scored better. Reasons for non-adherence were side effects for older patients and forgetfulness for younger ones. Conclusion: Dermatologists should explain that adherence to treatment is linked to better outcomes and better quality of life. Young females with high Skindex-29 scale scores and males with low Skindex scores are especially prone to non-adherence.

Madelung’s disease involving the tongue

Madelungs disease or benign symmetric lipomatosis is rare. Symmetric lipomatosis of the tongue as an association of Madelungs disease is very rare; up to now only two cases of this association have been reported. We report the third case of Madelungs disease with involvement of the tongue in the form of macroglossia.

La versión española de Skindex-29. Un instrumento de medida de la calidad de vida en pacientes con enfermedades cutáneas

Fundamento Los tests de calidad de vida tratan de estudiar objetivamente como afecta la enfermedada la vida del paciente. Su generacion de novo consume mas tiempo y recursos queadaptar uno existente en otro idioma. Se presenta el estudio de las propiedades metricas de laversion espanola de Skindex-29, un instrumento americano de calidad de vida orientado a pacientescon afectacion cutanea y que esta ampliamente validado. Pacientes y metodo Se administro el test a adultos en una consulta dermatologica ambulatoria.Se registraron la edad, el sexo y la patologia de cada paciente. Se hicieron tres grupos: sanos,enfermos con trastornos inflamatorios y enfermos con lesiones cutaneas aisladas o tumorales.Se evaluo la validez de construccion, la consistencia interna, la reproducibilidad a las 72 h, lasensibilidad al cambio y la factibilidad. Resultados Se analizaron 318 tests, el 65% de mujeres, con una edad media de 36 anos. Sedemostro la validez de construccion con diferencias significativas en las puntuaciones entre sanosy enfermos, asi como entre los dos grupos de enfermos. Se demostro su fiabilidad con coeficientesalfa de Cronbach superiores a 0,84 y valores de correlacion intraclase en el test-retestsuperiores a 0,7. El test se mostro sensible al cambio. El porcentaje de no respuesta fue bajo ylos efectos suelo y techo adecuados. Conclusiones La version espanola de Skindex-29 es un instrumento valido, fiable y sensible alcambio para medir los efectos de la afectacion cutanea en la calidad de vida de pacientes espanoles.

Cutaneous meningioma underlying congenital localized hypertrichosis

A 28-year-old man had a circumscribed hypertrichotic area on the left lumbar region since birth. A biopsy specimen showed numerous normal-appearing hair follicles and arrector pili muscles. In the subcutaneous layer a mass of dense collagenous connective tissue formed the background in which ill-defined foci of meningothelial cells in nests and pseudovascular spaces were seen. Collagenous structures (pseudopsammoma bodies), some of which showed calcification (psammoma bodies), were also seen. A diagnosis of cutaneous meningioma was made.

Cutaneous metaplastic synovial cyst in an Ehlers-Danlos patient

Metaplastic synovial cyst is a recently reorganized entity characterized by a cystic space lined by polygonal cells and villous structures resembling synovium pointing toward the lumen. It usually develops following trauma. We report a 15-year-old girl with Ehlers-Danlos syndrome who developed a nodular lesion of her elbow without previous trauma. Histopathological and immunohistochemical studies yielded results similar to those reported in cases of cutaneous metaplastic synovial cyst. This case appears to be the first one reported of cutaneous metaplastic synovial cyst associated with an Ehlers-Danlos syndrome. Cutaneous fragility and anomalous scarring typical of Ehlers-Danlos syndrome may be related to the development of this pseudocyst. If so, other connective-tissue diseases with increased skin fragility could be susceptible to development of such lesions.

Anticuerpos monoclonales en el tratamiento de la psoriasis

Resumen —Uno de los mecanismos para interferir en los procesos fisiopatologicos que intervienen en el desarrollo de las enfermedades y lograr efectos beneficiosos en los pacientes es la utilizacion de anticuerpos monoclonales. Su uso ha estado rodeado de graves efectos secundarios hasta la aparicion de anticuerpos quimericos y humanizados. Tambien se han usado ligandos de receptores e inmunoconjugados con toxinas para interferir en estos procesos. Aunque se han desarrollado muchas moleculas contra dianas implicadas en la psoriasis, solo algunas han demostrado resultados favorables en los ensayos clinicos. Algunos farmacos que estan cerca de su aprobacion para su uso en la psoriasis son Xanelim® (efalizumab, anti-CD11a) y Amevive® (alefacept, anti-CD2). Otros farmacos estan aprobados con otras indicaciones y podrian aprobarse para su uso en la psoriasis, como son Remicade® (infliximab, anti-TNF-α), Enbrel ® (etanercept, anti-TNF-α) y Zenapax®(daclizumab, anti-CD25). En los proximos anos estos farmacos modificaran nuestra forma de tratar la enfermedad usando infusiones intravenosas o inyecciones intramusculares o subcutaneas en dosis semanales o incluso bisemanales con escasos efectos secundarios.

Calidad de vida (I). Generalidades

Resumen —El estudio de la calidad de vida y, en concreto, en el campo sanitario, la calidad de vida relacionada con la salud (CVRS) se plantea como una necesidad de objetivar como se ve afectada la vida del paciente por la enfermedad. Comprende aspectos fisicos, psicologicos y sociales. Los instrumentos utilizados para medir la CVRS son los cuestionarios. Estos se clasifican en genericos o especificos segun su ambito de consideracion tenga unos horizontes mas o menos amplios, y existe una segunda clasificacion segun su forma de administracion (por entrevistador, autoadministrados, supervisados, entrevista telefonica o por ordenador). A la hora de elaborar un instrumento de medida de CVRS hay que considerar que cumpla una serie de propiedades: validez de contenido, validez de construccion, validez de criterio, fiabilidad, sensibilidad al cambio, interpretabilidad y factibilidad. La utilidad del uso de medidas de CVRS puede establecerse a varios niveles: la clinica, la investigacion y la politica sanitaria.