Abstract Cryotherapy is the most common treatment for actinic keratosis, but its effect is limited to individual lesions. Several topical drugs, however, are available that, in addition to treating ...individual actinic keratoses, target field cancerization and thereby act on subclinical lesions. Examples are 5-fluorouracil, imiquimod, diclofenac, and ingenol mebutate. We report on 17 patients with actinic keratoses treated with ingenol mebutate and describe our findings on treatment effectiveness, adherence, and tolerance. Complete and partial response rates were 35% and 53%, respectively. Ninety-four percent of patients fully adhered to treatment and 18% developed severe local reactions. Ingenol mebutate is an effective treatment for actinic keratosis. Although it has a similar rate of local reactions to other treatments available for actinic keratosis, its short treatment regimen favors better adherence.
Resumen La crioterapia es el tratamiento más frecuentemente utilizado para las queratosis actínicas, ejerciendo su efecto únicamente sobre lesiones individuales. Existen fármacos tópicos que tratan ...además el campo de cancerización, actuando sobre queratosis actínicas no clínicamente evidentes, entre los que se encuentran el 5-fluorouracilo, el imiquimod, el diclofenaco o el ingenol mebutato. Presentamos 17 pacientes con queratosis actínicas tratados con ingenol mebutato y describimos las observaciones en relación con la efectividad, el cumplimiento terapéutico y la tolerancia del fármaco. Las tasas de respuesta completa y parcial fueron del 35% y del 53%, respectivamente. El cumplimiento fue correcto en un 94% de los casos. En el 18% de los pacientes existieron reacciones locales intensas. El ingenol mebutato es efectivo para el tratamiento de las queratosis actínicas. Aunque presenta similar tasa de reacciones locales a los restantes tratamientos disponibles para esta indicación, su pauta corta de administración favorece el cumplimiento.
Abstract Background and objectives The study of quality of life in patients with skin disorders has become more important in recent decades. In the case of lupus erythematosus, most quality-of-life ...studies have focused on the systemic form of the disease, with less attention being paid to the cutaneous form. The main objective of this study was to evaluate quality of life in patients with cutaneous lupus erythematosus (CLE) using a dermatology-specific questionnaire: the Dermatology Life Quality Index (DLQI). Our secondary objective was to investigate associations between DLQI scores and other aspects of the disease. Material and methods Thirty-six patients with CLE completed the DLQI questionnaire. Other factors assessed were disease severity (measured using the Cutaneous Lupus Erythematosus Disease Area and Severity Index), time since diagnosis, body surface area affected, previous and current treatments, and the presence of criteria for systemic lupus erythematosus (SLE). Results According to the DLQI, CLE had a moderate, very large, or extremely large effect on quality of life in 50% of the patients analyzed (18/36). No significant associations were found between DLQI scores and disease severity, time since diagnosis, body surface area affected, number, type, or duration of pharmacologic treatments, or the presence or absence of SLE criteria. Conclusion CLE has a significant and lasting effect on patient quality of life. This effect is probably due to multiple factors, being the most important the chronic nature of the disease, the visibility of the lesions, and the fact that they can cause disfigurement.
Resumen Introducción y objetivos La determinación de la calidad de vida (CdV) en las enfermedades dermatológicas ha ganado importancia en las últimas décadas. En el caso del lupus eritematoso, la ...forma sistémica ha recibido una mayor atención, siendo el lupus eritematoso cutáneo (LEC) evaluado en menor medida. Nuestro objetivo principal consistió en determinar la CdV de los pacientes con LEC utilizando un cuestionario específico para Dermatología, el Índice de calidad de vida en Dermatología (DLQI). Los objetivos secundarios consistieron en valorar la existencia de asociación entre el DLQI y otros aspectos de la enfermedad. Material y métodos Un total de 36 pacientes con LEC completaron el cuestionario DLQI. Se evaluaron también otros factores: gravedad de la enfermedad (medida con el área e índice de severidad del lupus eritematoso cutáneo CLASI), fecha de diagnóstico, área corporal afectada, tratamientos previos y actuales y presencia de criterios de lupus eritematoso sistémico (LES). Resultados En el 50% (18/36) de los pacientes, el LEC tuvo un impacto moderado, grande o extremadamente grande en la CdV. No se encontraron asociaciones entre la puntuación en el DLQI y gravedad de la enfermedad, fecha de diagnóstico, área corporal afectada, número, duración o grupo farmacológico empleado, ni con la presencia o ausencia de criterios de LES. Conclusión El LEC tiene un impacto importante y duradero en la CdV. Entre múltiples factores, la visibilidad, el potencial desfigurante de las lesiones cutáneas, así como la evolución crónica de la enfermedad, son probablemente los principales responsables de dicho impacto.
Summary
Background Suspected toenail onychomycosis is a frequent problem. Clinical diagnosis has been considered inadequate.
Objectives To assess the diagnostic accuracy of clinical findings for ...detecting fungi in toenails, and to develop and validate a clinical diagnostic rule aimed at improving dermatologists’ diagnosis of onychomycosis.
Methods A cross‐sectional diagnostic study was performed including a total of 277 patients seen by 12 dermatologists. The gold standard was the presence of dermatophytes on culture or a positive nail plate biopsy. For each sign we described prevalence, sensitivity, specificity, positive and negative predictive values, and likelihood ratios for positive and negative results. We developed a diagnostic clinical rule and validated it in a subsample.
Results Helpful findings to predict the presence of fungi are: previous diagnosis of fungal disease; abnormal plantar desquamation (affecting > 25% of the sole); onychomycosis considered the most probable diagnosis by a dermatologist; and presence of interdigital tinea. When dermatologists considered onychomycosis the most probable diagnosis and plantar desquamation was present (13% of patients), the positive predictive value for presence of fungi was 81%. When both signs were absent (34% of patients), the positive predictive value for absence of fungi was 71%. In other situations, clinical diagnosis might not give enough information to decide on therapy.
Conclusions In 13% of the patients (a large number in absolute terms), when dermatologists consider onychomycosis the most probable diagnosis and plantar desquamation is present, therapy should be started without any further test, as clinical diagnosis is at least as accurate as laboratory tests. In other situations, an optimal management strategy should be defined.
Cryotherapy is the most common treatment for actinic keratosis, but its effect is limited to individual lesions. Several topical drugs, however, are available that, in addition to treating individual ...actinic keratoses, target field cancerization and thereby act on subclinical lesions. Examples are 5-fluorouracil, imiquimod, diclofenac, and ingenol mebutate. We report on 17 patients with actinic keratoses treated with ingenol mebutate and describe our findings on treatment effectiveness, adherence, and tolerance. Complete and partial response rates were 35% and 53%, respectively. Ninety-four percent of patients fully adhered to treatment and 18% developed severe local reactions. Ingenol mebutate is an effective treatment for actinic keratosis. Although it has a similar rate of local reactions to other treatments available for actinic keratosis, its short treatment regimen favors better adherence.
Bullous pemphigoid is the most frequent blistering disease and has been found associated to several neurological diseases, including amyotrophic lateral sclerosis.
A 63-year-old male with ...bulbar-onset amyotrophic lateral sclerosis who presented clinical and histological signs and symptoms of bullous pemphigoid.
The association does not seem to occur by chance and we suggest an autoimmune pathogenetic mechanism consisting in a crossed reaction between bullous pemphigoid antigen 1 and the protein dystonin, which is involved in the organisation/integrity of the neuronal cytoskeleton.
BACKGROUND AND OBJECTIVESThe study of quality of life in patients with skin disorders has become more important in recent decades. In the case of lupus erythematosus, most quality-of-life studies ...have focused on the systemic form of the disease, with less attention being paid to the cutaneous form. The main objective of this study was to evaluate quality of life in patients with cutaneous lupus erythematosus (CLE) using a dermatology-specific questionnaire: the Dermatology Life Quality Index (DLQI). Our secondary objective was to investigate associations between DLQI scores and other aspects of the disease.MATERIAL AND METHODSThirty-six patients with CLE completed the DLQI questionnaire. Other factors assessed were disease severity (measured using the Cutaneous Lupus Erythematosus Disease Area and Severity Index), time since diagnosis, body surface area affected, previous and current treatments, and the presence of criteria for systemic lupus erythematosus (SLE).RESULTSAccording to the DLQI, CLE had a moderate, very large, or extremely large effect on quality of life in 50% of the patients analyzed (18/36). No significant associations were found between DLQI scores and disease severity, time since diagnosis, body surface area affected, number, type, or duration of pharmacologic treatments, or the presence or absence of SLE criteria.CONCLUSIONCLE has a significant and lasting effect on patient quality of life. This effect is probably primarily due to multiple factors, including the chronic nature of the disease, the visibility of the lesions, and the fact that they can cause disfigurement.
PDF
