Miguel Ribera

Epidermal dysplasia and neoplasia in kidney transplant recipients

BACKGROUND Established data confirm an increased incidence of skin cancer, mainly squamous cell carcinoma (SCC), in long-term kidney transplant recipients (KTRs). OBJECTIVE Our purpose was to investigate prospectively the type and frequency of neoplastic and preneoplastic skin lesions in KTRs during the first 3 years of immunosuppression, as well as the influence of potential risk factors. METHODS Eighty-one consecutive KTRs were examined every 6 months during the first 3 years after transplantation. All survival analyses were performed with the EGRET statistical software package. RESULTS After a median follow-up of 34 months, 25 skin cancers developed in 12 patients; the basal cell carcinoma (BCC)/SCC ratio was 3.1:1. The cumulative risk of skin cancer developing after 3 years of graft survival was 18.1%. Only age at the time of transplantation (p = 0.005) and occupational sun exposure (p = 0.048) had statistical significance as risk factors. CONCLUSION In carefully supervised KTRs, a high incidence of cutaneous malignancy, mainly BCC, exists in the early posttransplant period. Sun exposure and the patients age at the time of transplantation seem to be the most important risk factors.

Eosinophilic pustular folliculitis in patients with acquired immunodeficiency syndrome.

Three patients with aids had an intensely pruritic eosinophilic pustular folliculitis associated with abundant Pityrosporum yeasts in the follicles, demonstrated by direct microscopy. The excellent response to ketoconazole treatment suggests a possible pathogenic role for Pityrosporum.

Epidermal expression of 65 and 72 kd heat shock proteins in psoriasis and AIDS-associated psoriasiform dermatitis

BACKGROUND Psoriasiform dermatitis is common in patients with AIDS. The expression of heat shock proteins by keratinocytes has been postulated to be a significant factor in the physiopathology of psoriasis and might be subject to modulation in HIV-infected patients. OBJECTIVE We sought to evaluate the epidermal expression of 65 and 72 kd heat shock proteins (HSPs) in lesions of AIDS-associated psoriasiform dermatitis (AIDS-PD) and compare it with that in psoriasis vulgaris and seborrheic dermatitis in patients not infected with HIV. METHODS Sections from paraffin-embedded blocks of biopsy specimens of AIDS-PD (eight cases), psoriasis vulgaris (eight cases), seborrheic dermatitis (four cases), and normal skin (four cases) in non-HIV-infected patients were immunohistochemically stained by the avidin-biotin-peroxidase method and two monoclonal antibodies directed against the major 65 kd HSP antigen (HSP65) and against 70/72 kd HSP. The intensity, distribution, and cellular pattern of the epidermal stain were graded and assessed blindly. RESULTS The epidermal expression of HSP65 in biopsy specimens from AIDS-PD lesions was irregular, with less intensity and less tendency to perinuclear arrangement than in psoriasis or seborrheic dermatitis not associated with AIDS. The expression of HSP72 was also less intense and more uniform in AIDS-PD. CONCLUSION The altered interplay of T cells and keratinocytes in a situation of immune derangement such as AIDS might account for the differences observed in the expression of HSP65 and HSP72 by keratinocytes in psoriasis and AIDS-PD.

Experiencia de 4 años de funcionamiento de una unidad multidisciplinar de psoriasis y artritis psoriásica

INTRODUCTION AND OBJECTIVES Up to 30% of patients with psoriasis develop joint disease, the course of which can be improved by early diagnosis and treatment. The aim of this study was to describe our experience with a new multidisciplinary psoriasis and psoriatic arthritis unit over a period of 4 years (2009-2012). MATERIAL AND METHODS Implementation of a PSOriasis Rheumatology and Dermatology unit (PSORD) to provide patient care and physician training. In the first phase of the project, referral criteria for the unit were defined and several meetings were organized to train and prepare the specialists involved in the program. In the second phase, a schedule was drawn up for monthly patient visits with the PSORD team. Starting in 2011, training was offered to dermatologists and rheumatologists from other hospitals interested in implementing a similar model. RESULTS A total of 259 visits (71% first visits, 8% no-shows) were scheduled during the period analyzed, with a median of 8 visits (range, 2-14 visits) per session. Sixty-three percent of the patients were referred from the rheumatology department. Diagnosis and treatment were modified in 32% and 47% of cases, respectively. Three training courses were held with 15 physicians from 6 hospitals, 3 of which created similar units. CONCLUSIONS The PSORD model improved the management of difficult-to-diagnose and/or uncontrolled disease, the early diagnosis and treatment of psoriatic arthritis, and collaboration between dermatologists and rheumatologists. Finally, the model lends itself to being exported to other settings.

A significant geographical area for the study of the epidemiological and ecological aspect of mediterranean sporothricosis

Two cases of sporothricosis originating from the same geographical area (Province of Barcelona) are described, including the circumstances of infection and the isolation of a wild strain of Sporothrix schenckii at the same locality. This finding could classify this particular area as a zone of interest in the epidemiological and ecological study of the mediterranean sporothricosis.