Pablo F. Peñas

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.

Leishmaniasis presenting as a dermatomyositis-like eruption in AIDS.

Three patients are described with leishmaniasis and AIDS, with cutaneous lesions mimicking dermatomyositis. Leishmania organisms were observed in great numbers in the dermis of lesional skin biopsy specimens. They were also present inside keratinocytes in all layers of the epidermis in one patient. Skin cultures from all patients and bone marrow culture in patients 1 and 3 revealed Leishmania infantum. Leishmania organisms were also found in nonlesional skin. The absence of proximal symmetric muscle weakness, elevated muscle enzymes, myopathic electromyograms, or characteristic histopathologic and immunologic features of dermatomyositis, and the rapid and complete clearance or marked improvement of the cutaneous lesions after treatment for leishmaniasis, make us consider true dermatomyositis unlikely. We suggest that leishmaniasis be included in the list of diseases capable of inducing a dermatomyositis-like eruption.

Dermatologic Treatment of Cutaneous Graft Versus Host Disease

Cutaneous involvement in graft versus host disease (GVHD) after allogeneic hematopoietic cell transplant can be separated into acute GVHD (aGVHD), lichenoid chronic GVHD (cGVHD) and sclerodermatous cGVHD. It seems clear that these syndromes result from different mechanisms and entail different treatment approaches. Standard treatment of cutaneous aGVHD involves the intensification of immunosuppressive therapy with adequate topical supportive management. In skin-limited disease, phototherapy has shown promising results. In cutaneous cGVHD, the combination of corticosteroids and cyclosporine (ciclosporin) is the recommended therapy, and other immunosuppressants may be added depending on whether lichenoid or sclerodermatous lesions are present. High response rates to phototherapy have been found in lichenoid disease, while sclerodermatous disease responds better to etretinate or extracorporeal photochemotherapy. Localized cutaneous cGVHD may be treated with topical corticosteroids alone. Few reports on the effect of treatments in GVHD clearly describe the cutaneous involvement and the influence of the treatment on the skin. Therefore, dermatologists should be deeply involved in the diagnosis and treatment of GVHD, and good dermatologic grading systems should be developed. Theses changes will increase our knowledge of cutaneous GVHD, and relevant data in the evaluation of the effect of therapy in the disease will be obtained.

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.

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.

Maculopapular eruption with enlarged macrophages in eight patients receiving G-CSF or GM-CSF

In the last years, granulocyte and granulocyte‐macrophage colony‐stimulating factors (G‐CSF and GM‐CSF) are being increasingly used and several cutaneous eruptions have been reported in relation to these treatments. In 1991 Horn et al. described three patients with maculopapular eruption that paralleled the time of infusion of GM‐CSF. Two of the cases showed an increase in the number and size of macrophages in the biopsy specimen. Since then, several cases have been reported showing this histopathological alteration that has been considered characteristic of reaction to G‐CSF or GM‐CSF. Although maculopapular eruption with enlarged macrophages can appear after chemotherapy treatment, we have found that the presentation of this eruption after the beginning of cytokine treatment is suggestive of the involment of G‐CSF and GM‐CSF in the eruption. We described eight cases of patients treated with G‐CSF or GM‐CSF that developed maculopapular eruptions with enlarged macrophages.

Keratosis punctata of the Palmar Creases: Case Report and Prevalence Study in Caucasians

Keratosis punctata of the palmar creases (KPPC) is a variant of keratosis punctata of palms and soles in which lesions are confined to palmar creases. We present a patient with KPPC and study the prevalence of the disease in Caucasians. The survey included 1,001 white patients, that were examined for palmar lesions. We could not find any case that fulfilled the diagnostic criteria for KPPC. We conclude that KPPC is a rare disease among Caucasians but rather common in the black race.

Leukocytoclastic vasculitis in subacute cutaneous lupus erythematosus: clinicopathologic study of three cases and review of the literature.

BACKGROUND Leukocytoclastic vasculitis associated with subacute cutaneous lupus erythematosus (SCLE) was observed by Sontheimer et al. in their first clinical series of patients with SCLE, although recent reports have suggested that its frequency was rare. OBJECTIVE To evaluate the prevalence of cutaneous leukocytoclastic vasculitis (CLV) in patients with SCLE and to describe the clinicopathologic manifestations, response to treatment and prognosis of this subgroup of patients. METHODS We reviewed all cases of SCLE seen at the Hospital de la Princesa from 1980 to 1995. RESULTS Three (9%) of our 27 patients with SCLE exhibited CLV and SCLE. Purpura, maculoerythematous lesions, urticaria, nodules and necrotic lesions on the leg, trunk and palmoplantar regions were present in our patients with CLV and SCLE. Histologically, SCLE-associated CLV was a small-sized vessel leukocytoclastic vasculitis with intravascular thrombosis in the deep dermis and coexistence of lesions of CLV and SCLE. CONCLUSION In our patients, CLV was self-limited and not associated with a worsened prognosis, with only cutaneous involvement in their further relapses of SCLE.