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Resumen Introduccion Existen escasos estudios de larga duracion sobre las enfermedades atendidas en las consultas de Dermatologia. El objetivo de este estudio es analizar los motivos de derivacion y los diagnosticos realizados en el Servicio de Dermatologia del Complejo Hospitalario de Navarra (CHN) durante el ano 2018. Metodologia Se han analizado de manera retrospectiva las primeras visitas realizadas en nuestras consultas durante el ano 2018 evaluando los siguientes parametros: el sexo, la edad, el origen del paciente, el codigo de derivacion primaria (Clasificacion Internacional de Atencion Primaria – CIAP) y el codigo diagnostico del Servicio de Dermatologia (Clasificacion Internacional de Enfermedades – CIE 9). Resultados La tasa de tderivacion a nuestro servicio en 2018 fue de 45,5 consultas presenciales/1.000 habitantes, con una ratio presencial/no presencial 12:1. Los diagnosticos CIE mas frecuentemente realizados en la consulta presencial son nevus melanociticos (15%), queratosis seborreica (12%) y queratosis actinica (9%). Un 47% de los diagnosticos CIE realizados en la consulta presencial corresponden a enfermedad tumoral benigna y maligna. Conclusiones A pesar de sus limitaciones, la codificacion resulta imprescindible para conocer a la poblacion atendida, sus necesidades reales y poder optimizar el reparto de recursos. Creemos que es importante invertir en el diagnostico clinico y dermatoscopico de las lesiones pigmentadas, para de esta manera poder mejorar la derivacion. Con la informacion actual de la que disponemos no se puede plantear un cribado o priorizacion de la derivacion con base en el analisis del codigo CIAP.

We report the case of a 90-year-old male who presented with an erythematous desquamative plaque on his left cheek. Histopathology demonstrated an epidermal lesion with multifocal epithelial growth. The cells were small, with scant cytoplasm and hyperchromatic nuclei with molding and a high mitotic and apopototic rate. Immunohistochemistry showed positivity for CK20, CK7, synaptophysin and INMS1. These findings are consistent with a Merkel cell carcinoma in situ. This tumor corresponds to a primary neuroendocrine neoplasm of the skin, which usually affects elderly people with sun-exposed skin. Usually, it presents as a dermal tumor but intraepidermal involvement alone is extremely rare. In this scenario, a broad differential diagnosis should be considered, excluding all neoplasms that may present intraepidermal forms. The evolution of this entity is unknown.

As research continues, new drugs will no doubt be added to the current pool of treatments for moderate-to-severe atopic dermatitis (AD). This raises the need for studies to determine prescriber preferences for different pharmacological options and the factors that influence their choice of treatment. Here we aim to explore physician preferences in the systemic treatment of moderate-to-severe AD, identify the sociodemographic characteristics that can influence physician preferences, and evaluate their satisfaction with current AD therapies.A discrete-choice experiment (DCE) survey was administered to physicians treating patients with AD in Spain. Results were analyzed using a conditional logit model to estimate the relative importance of each attribute and the maximum risk accepted to achieve therapeutic benefit.A total of 28 respondents completed the DCE survey (67.9% female, mean age 45.9 years). Participants identified objective clinical efficacy and risk of severe adverse events (AEs) as the most important attributes, followed by improvement in sleep and pruritus and faster onset of action from the start of the treatment. Respondents gave less importance to mode of administration and therapeutic benefit in other atopic conditions. Respondents were willing to accept an increased risk of severe AEs and mild-to-moderate AEs leading to treatment discontinuation due to intolerance in order to obtain improvements in efficacy, sleep, and pruritus, and long-term clinical benefit.Our findings can help prescribers choose the most appropriate systemic AD therapy.

Porokeratotic eccrine and hair follicle nevus is a very rare non-hereditary disorder of keratinization with eccrine and hair follicle involvement with only 9 cases described in the literature. In 2009 the term porokeratotic anexial ostial nevus was proposed to comprehend porokeratotic eccrine and hair follicle nevus and a related and more common process without follicular involvement: porokeratotic eccrine ostial and dermal duct nevus Recent findings suggest that both entities may be produced by a mutation in GJB2 gene, which is associated to KID syndrome. Herein we report 2 cases of porokeratotic eccrine and hair follicle nevus and review the existing cases in the Spanish and English literature.

We report the case of a 90-year-old male who presented with an erythematous desquamative plaque on his left cheek. Histopathology demonstrated an epidermal lesion with multifocal epithelial growth. The cells were small, with scant cytoplasm and hyperchromatic nuclei with molding and a high mitotic and apopototic rate. Immunohistochemistry showed positivity for CK20, CK7, synaptophysin and INMS1. These findings are consistent with a Merkel cell carcinoma in situ. This tumor corresponds to a primary neuroendocrine neoplasm of the skin, which usually affects elderly people with sun-exposed skin. Usually, it presents as a dermal tumor but intraepidermal involvement alone is extremely rare. In this scenario, a broad differential diagnosis should be considered, excluding all neoplasms that may present intraepidermal forms. The evolution of this entity is unknown.

OBJECTIVES To investigate the patterns of melanoma recurrence in the local population, including factors that may influence in this event and timing of relapse, and to determine the mode of detection of them. METHODS This is a retrospective cohort study of patients with melanoma who underwent sentinel lymph node biopsy at the Complejo Hospitalario de Navarra (Spain) from 2002 to 2012. The following data were collected of each patient: age, gender, date of diagnosis, location of melanoma, histological subtype, Breslow thickness, ulceration, mitosis, sentinel node status, AJCC 8th edition stage, site of first diagnosed metastasis, mode of relapse, date of first relapse and time of death. RESULTS Of 308 patients, 30% people suffered metastasis. The mean follow-up time was 68.63 months. 51.1% of relapses were locoregional and 48.9% haemato-visceral. Sentinel node status was the only variable associated with higher risk of haemato-visceral metastasis (p

Resumen Fundamento y objetivo La calcifilaxia es una vasculopatia cutanea isquemica de vasos de pequeno tamano con una alta morbimortalidad. Hasta el momento actual han sido publicadas muy pocas series de pacientes con esta enfermedad, ninguna procedente de un hospital espanol. Los principales objetivos de este trabajo son analizar el perfil demografico, clinico e histologico de los pacientes diagnosticados de calcifilaxia en nuestro servicio, para identificar posibles factores de riesgo y potenciales estrategias terapeuticas. Material y metodo Estudio retrospectivo de los casos vistos en el Servicio de Dermatologia con diagnostico de calcifilaxia con una biopsia confirmatoria, en el periodo de enero de 2010 a agosto de 2015. Resultados Se estudiaron 9 pacientes, con edades de 76-86 anos. Todos tenian comorbilidades cardiovasculares y el 67% tenia insuficiencia renal. Se observo un 33% de mortalidad. Conclusiones Ante el posible diagnostico de calcifilaxia debe realizarse una analitica sanguinea completa para descartar otras causas de ulceras cutaneas. El tratamiento de estos pacientes debe llevarse a cabo por un equipo multidisciplinar. Resaltamos el papel del tiosulfato sodico en el tratamiento de esta entidad.

Perianal complaints are often consulted in dermatology clinics, and in many cases, a conclusive diagnosis is not easily made.The aim of this study was to study and identify the epidemiological, clinical, and contact allergy features of patients with perianal dermatitis who attended at a contact dermatitis unit in a tertiary hospital in Spain.Adult patients with long-lasting (4 weeks) perianal dermatitis were recruited during the past 10 years for investigation and follow-up. Every patient underwent a diagnostic workup consisting of dermatological exploration and patch tests with the standard and specific series, as well as the patients' own products. General surgical exploration was also performed in some patients.One hundred twenty-four patients were included. The MOAHLFA index was as follows: 43.5, 0, 4.8, 11.3, 1.6, 8.1, and 75. The main final diagnoses were allergic contact dermatitis (32.3%), psoriasis (24.2%), irritant contact dermatitis (17.7%), and lichen simplex (neurodermatitis) (10%). Eighty-one patients (66.1%) showed 1 or more positive reactions, and in 52 patients (43%), positive reactions relevant to the present disease were found.Contact allergy in patients with long-lasting perianal complaints is frequent. It is mandatory for these patients to be referred to a dermatologist for an adequate evaluation and patch testing. Methylchloroisothiazolinone/methylisothiazolinone seems as the most common allergen implicated in perianal contact dermatitis.

Background and objective Calciphylaxis is a cutaneous ischaemic vascular disease of small vessels with high morbidity and mortality. To date very few series of patients with this disease have been published, none from a Spanish hospital. The main objectives of this work are to analyse the demographic, clinical and histological profile of patients diagnosed in our department to identify risk factors and potential therapeutic strategies. Material and method We made a retrospective study of the cases seen in the dermatology department with a diagnosis of calciphylaxis and who had a confirmatory biopsy in the period between January 2010 to August 2015. Results Nine patients were studied, with an age range of 76–86 years. All had cardiovascular comorbidities and 67% had renal failure. A 33% mortality was observed. Conclusions Faced with a possible diagnosis of calciphylaxis, a complete blood analysis is mandatory to rule out other causes of skin ulcers. The management of these patients should be undertaken by a multidisciplinary team. We emphasize the role of sodium thiosulfate in the treatment of this condition.