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[Abstract] Introduction: The aim of this study was to evaluate response and drug survival of biologic therapy in patients with moderate to severe plaque-type psoriasis who initiated biologic therapy at least 10 years ago, in a real-world setting. Methods: This was an observational retrospective follow-up study that included patients with moderate to severe plaque-type psoriasis who initiated biologic therapy between October 2006 and December 2009. Efficacy was expressed as the percentage of patients achieving a 50, 75 and 90% reduction from baseline in the Psoriasis Area and Severity Index (PASI 50, PASI 75, PASI 90, respectively) every 3 months during the first year of therapy and then every 12 months up to the end of follow-up or withdrawal from the study. Results: A total of 56 patients were included in the study, representing 140 treatment lines (median 2, range 1-8); of these patients, 53 were still receiving biologic therapy at the end of the study. The mean duration of biologic therapy was 140.4 (range 47.6-175.4) months. Etanercept was used in 98.2% of patients, followed by efalizumab (42.9%), adalimumab (41.1%), ustekinumab (33.9%) and infliximab (16.1%). Treatment lines were switched in 62.1% of treatments: 24.3% due to secondary failure, 20.7% due to primary failure and 3.6% due to side effects. No patient treated with anti-interleukins had to discontinue treatment due to side effects. Ustekinumab had the highest drug survival. Conclusions: This study in the real-world-setting shows maintenance of long-term efficacy and safety of biologic therapy in patients with moderate to severe plaque psoriasis in daily practice who initiated biologic therapy 10 years ago. The journal’s Rapid Service Fee was paid for by Fundación Profesor Novoa Santos (A Coruña. Spain)

Goltz syndrome is an X-linked dominant, multisystem birth defect due to PORCN mutation. The skin findings follow Blaschko's lines and often show epidermal atrophy and herniation of subcutaneous fatty tissue. Regarding treatment, light sources can offer a good therapeutic option for some manifestations of this rare disease and improve the aesthetic appearance of the skin lesions. We report two new cases of Goltz syndrome in which the cutaneous findings remarkably improved with pulsed dye laser and carbon dioxide laser.

Actinic cheilitis (AC) is a chronic condition that affects mainly the lower lip. To investigate the use of lip photopro-tection in patients with AC. A cross-sectional multicentre study of patients, =45 years of age, was performed in eight dermatology departments in the Galicia region over a period of one year. From 1,239 patients included in the study, 410 were diagnosed with AC and complete data were available for 408. An analysis of lip photopro-tection habits and possible associations in patients with AC is reported. Mean age of patients with AC was 71.9 years and 53.8% were women. More than 90% of AC patients (370/408) had never used lip photoprotection. In the group of patients who used it, 62.16% of them had only used a single stick within the previous year. The only variable significantly associated with the use of lip sun protection was low Fitzpatrick’s skin types I and II (p=0.039). Study limitations include the inclusion of patients 45 years or older and the use of a semiquantitative scale for measuring the frequency of application of lip photoprotection. To our knowledge, this is the first European study focused on lip photoprotection in patients suffering from AC. Only a minority of AC patients protect their lips from UV radiation. Specific lip sun protection recommendations should be promoted, especially in high-risk populations.

Background: Efficacy and safety profiles of ustekinumab have been proved in numerous clinical trials. However, relevant variations with daily practice have been shown and few studies value the long...

Tejera-Vaquerizo, A (Tejera-Vaquerizo, Antonio); Paradela, S (Paradela, Sabela); Toll, A (Toll, Agusti); Santos-Juanes, J (Santos-Juanes, Jorge); Jaka, A (Jaka, Ane); Lopez, A (Lopez, Alba); Canueto, J (Canueto, Javier); Bernal, A (Bernal, Alvaro); Villegas-Romero, I (Villegas-Romero, Isabel); Fernandez-Pulido, C (Fernandez-Pulido, Carla); Perandones, H (Perandones, Hector); Moreno-Ramirez, D (Moreno-Ramirez, David); Dominguez-Mahamud, C (Dominguez-Mahamud, Carolina); Salido-Vallejo, R (Salido-Vallejo, Rafael); Sanmartin, O (Sanmartin, Onofre); Almazan-Fernandez, FM (Almazan-Fernandez, Francisco M.); Rodriguez-Jimenez, P (Rodriguez-Jimenez, Pedro); Banuls, J (Banuls, Jose); Podlipnik, S (Podlipnik, Sebastian); Sandoval-Clavijo, A (Sandoval-Clavijo, Alejandra); Boada, A (Boada, Aram); Garcia-Bracamonte, B (Garcia-Bracamonte, Beatriz); Palencia, S (Palencia, Sara); Revilla-Nevreda, D (Revilla-Nevreda, David); Reola-Ramirez, E (Reola-Ramirez, Enara); Gomez-Mateo, MD (del Carmen Gomez-Mateo, Maria); Linares-Barrios, M (Linares-Barrios, Mario); Jimenez-Gallo, D (Jimenez-Gallo, David); Gonzalez-Cruz, C (Gonzalez-Cruz, Carlos); Samaniego, E (Samaniego, Elia); Navedo-De Las Heras, M (Navedo-De Las Heras, Maria); Taberner, R (Taberner, Rosa); Rodenas-Herranz, T (Rodenas-Herranz, Teresa); Garcia-Donoso, C (Garcia-Donoso, Carmen); Puig, S (Puig, Susana); Nagore, E (Nagore, Eduardo)

Background Cutaneous lupus erythematosus is a chronic autoimmune disease that can leave important sequelae. Objective To determine the factors that predict the activity and damage of the skin disease, and the impact of tobacco on the efficacy of antimalarials using the Cutaneous Lupus Erythematosus Disease Area and Severity Index. Materials and Methods A consecutive case series was performed on 260 patients with cutaneous lupus erythematosus (α = 0.05; precision ± 6.5%). We carried out a descriptive analysis of the variables included, with a multivariate analysis to measure the association of variables with the Cutaneous Lupus Erythematosus Disease Area and Severity Index activity and damage ( p value Results The Cutaneous Lupus Erythematosus Disease Area and Severity Index activity was greater in smokers than non-smokers (4.0 ±5.3 vs 1.2 ±3.4, p = 0.006). No significant differences were observed in the Cutaneous Lupus Erythematosus Disease Area and Severity Index activity when the efficacy of antimalarials was analyzed between smokers and non-smokers. Cutaneous Lupus Erythematosus Disease Area and Severity Index damage was higher in smokers than in non-smokers (2.0 ± 3.6 vs 1.2 ± 2.6, p = 0.029). Cutaneous Lupus Erythematosus Disease Area and Severity Index activity was associated with: (a) being an active smoker (odds ratio 3.04, 95% confidence interval 1.68–5.51, p Conclusion Smoking is related to an increase risk and a greater activity of cutaneous lupus erythematosus. The chronic cutaneous lupus erythematosus subtype and an increased C-reactive protein level were also associated with a higher disease activity. The sequelae were related to the activity, the chronic cutaneous lupus erythematosus subtype, and the use of topical and systemic treatment. The impact of tobacco on the efficacy of antimalarials may be caused by an increase in the severity of the disease more than by resistance in smokers.

Melanoma incidence has increased over the last few decades. How the prognosis of a previously diagnosed melanoma may be affected by a woman’s subsequent pregnancy has been debated in the literature since the 1950s, and the outcomes are essential to women who are melanoma survivors in their childbearing years. The main objective of this systematic review is to improve the understanding of whether the course of melanoma in a woman may be altered by a subsequent pregnancy and to help clinicians’ diagnosis. Eligible studies for the systematic review were clinical trials, observational cohort studies and case-control studies that compared prognosis outcomes for non-pregnant patients with melanoma, or pregnant before melanoma diagnosis, versus pregnant patients after a diagnosis of melanoma. The search strategy yielded 1101 articles, of which 4 met the inclusion criteria for the systematic review. All the studies were retrospective non-randomised cohorts with patients with melanomas diagnosed before pregnancy. According to our findings, a subsequent pregnancy was not a significant influence on the outcome of a previous melanoma. However, given the small number of identified studies and the heterogeneous data included, it is recommended to approach these patients with caution, and counselling should be given by known prognostic factors. We also reviewed the medical records of 84 patients of childbearing age (35.8 ± 6.3 years, range 21–45 years) who were diagnosed with cutaneous invasive melanoma in our hospital between 2008 and 2018 (N = 724). Of these, 11 (13.1%) had a pregnancy after melanoma diagnosis (age at pregnancy: 35.6 ± 6.3 years). No statistical differences in outcome were detected.

The therapeutic value of sentinel lymph node biopsy (SLNB) in thin melanoma remains controversial. The aim of this study is to determine the role of SLNB in the survival of thin melanomas (≤1 mm). A multicenter retrospective observational study was designed. A propensity score matching was performed to compare patients who underwent SLNB vs. observation. A multivariate Cox regression was used. A total of 1438 patients were matched by propensity score. There were no significant differences in melanoma-specific survival (MSS) between the SLNB and observation groups. Predictors of MSS in the multivariate model were age, tumor thickness, ulceration, and interferon treatment. Results were similar for disease-free survival and overall survival. The 5- and 10-year MSS rates for SLN-negative and -positive patients were 98.5% vs. 77.3% (p < 0.001) and 97.3% vs. 68.7% (p < 0.001), respectively. SLNB does not improve MSS in patients with thin melanoma. It also had no impact on DSF or OS. However, a considerable difference in MSS, DFS, and OS between SLN-positive and -negative patients exists, confirming its value as a prognostic procedure and therefore we recommend discussing the option of SLNB with patients.

Background/objectives Atypical fibroxanthoma (AFX) is a mesenchymal neoplasm of unknown incidence. It has been determined that AFX is a tumour with low aggressiveness as long as it is properly diagnosed. Our objectives were to exclude pleomorphic dermal sarcomas or other skin tumours incorrectly diagnosed as AFX in our centre after applying strict diagnostic criteria and to assess the behaviour of appropriately diagnosed AFX. Methods We conducted an observational retrospective analysis of 73 patients diagnosed with AFX in our centre between 1998 and 2018. After selecting cases fulfilling AFX criteria, we made an analysis of predictive factors for local recurrence. Crude and sex-adjusted incidence rates were calculated. Results Out of 73 cases, 62 were eventually diagnosed as AFX. We examined for absence of tumour necrosis, lymphovascular or perineural invasion and infiltration of deep structures. Cytokeratin AE1-AE3, desmin and CD34 were negative in all cases. The remaining tumours were reclassified. The incidence of AFX in our health-care area was estimated at 0.59 cases every 100 000 inhabitants per year. In our series, 72.6% of the patients were men with mean age at diagnosis of 81 years. Average tumour diameter was 12 mm. The most common location was head and neck (96.8%). Only four local recurrences were detected over a mean of 47-month follow-up. Conclusions We report a series of AFX in our health-care area. We verify its indolent course when it is properly diagnosed.

Cutaneous melanoma (CM) causes more deaths than any other skin tumor, and incidence and mortality rates have risen in recent years, especially in patients of advanced age. There are differences in the biological behavior of CM tumors in the elderly as well as differential management of the disease, evidently influenced by such factors as limited life expectancy, the high incidence of concomitant conditions in older patients, and issues of quality of life unrelated to CM itself. We review relevant current literature on the epidemiology, etiology, pathogenesis, and immunology of CM as well as research on the clinical features, prevention, and management of these tumors in the elderly.

There are few studies of teledermatology focused on the pediatric age group. The aim of this study was to assess the validity and reliability of store-and-forward teledermatology (STD) as a diagnostic tool for pediatricians and to reduce face-to-face consultations. A retrospective, observational study of 383 children and adolescents under 15 years of age, referred from primary care to Dermatology Department of University Hospital of La Coru˜na, Spain, between 2011 and 2013, using a STD consult system. Diagnoses concordance between pediatricians and teledermatologists was 39.2% of cases and partial concordance 16.7%. Agreement for global diagnosis was κ = 0.78 (p = 0.000) and for specific diagnosis was κ = 0.73 (p = 0.000). Management was concordant in 28.7% and partially concordant in 15.4%. Lower reliability was statistically associated with modification of the lesions by inappropriate treatments, incomplete clinical data or bad-quality photographic images included in the referral consultation, diagnosis of infectious diseases and rare dermatoses. The filtering percentage (as the percentage of avoided clinic-based evaluations)was 64.5%. The mean response time of the consultant dermatologistswas 3.62 days. Referrals for live consultations due to poor clinical information or insufficient quality of pictures were necessary in only 10% of the cases. The degree of diagnostic accuracy for the pediatric population using STD as a diagnostic tool was similar to that achieved in adults. Its usefulness for filtering dermatologic referral was also demonstrated in the study, so it could be suitable for integration into the routine practice of pediatricians.

La queilitis actinica (QA) es una patologia que afecta principalmente al bermellon del labio inferior dando lugar a alteraciones clinicas y patologicas. La QA se considera mayoritariamente una forma superficial de carcinoma espinocelular y el principal factor de riesgo en su desarrollo es la exposicion solar cronica. La epidemiologia de la QA ha sido escasamente analizada en el pasado. Por este motivo, se diseno un estudio multicentrico transversal en la poblacion de la comunidad autonoma de Galicia con edad igual o superior a 45 anos para evaluar la prevalencia de QA, analizar sus factores de riesgo y manifestaciones clinicas e investigar el uso de fotoproteccion especifica en los labios. Se incluyeron 1250 pacientes en el estudio y de ellos, 410 presentaron QA. La prevalencia de QA en nuestro estudio fue 31,3%. Los sujetos con edad igual o superior a 60 anos, con fototipo II de Fitzpatrick, que habian trabajado en exteriores durante mas de 25 anos y con historia previa de cancer cutaneo no melanoma tuvieron un riesgo superior de desarrollar QA. La mayoria de pacientes con QA no realizaban fotoproteccion labial y, cuando lo hicieron, esta fue insuficiente; solo los pacientes con QA y fototipo I y II de Fitzpatrick mostraron tendencia al uso de fotoproteccion labial. La presencia de otros signos de dano actinico cronico, como queratosis actinicas y/o lentigos solares, fueron prevalentes en los pacientes con QA. En vista de los resultados, es necesario que se promuevan medidas educativas que insistan en la importancia de la fotoproteccion labial, especialmente en poblaciones de alto riesgo; ademas, la exploracion labial minuciosa deberia ser obligatoria en todos los pacientes con dano actinico cronico.

Dermatological disease has a significant impact on quality of life (QoL). However, information is scarce for cutaneous lupus erythematosus (CLE) in this regard. Thus, the manifestation of and co-morbidities associated with CLE were assessed in the current study to determine factors predictive of QoL impairment. A descriptive cross-sectional study was performed on predominantly Caucasian patients with CLE, recruited at our institution between April 2013 and August 2016 (α = 0.050; precision ± 6.5%). This article is protected by copyright. All rights reserved.

Background During the last decades, the progressive ageing of the population has resulted in a rising skin cancer incidence. Although previous studies detected no higher morbidity for dermatological surgery in senior patients, their exclusion from optimal surgical treatment remains as a common clinical practice. Objective The aim of this study was to determine the diseases treated with ambulatory major dermatological surgery, the surgical morbidity and the associated variables in ≥85 year-old patients. Patients/methods This is an observational study on 247 successive patients older than 85 years of age who underwent dermatological surgery in a single Ambulatory Mayor Surgery unit. Studied variables were age, gender, tobacco-alcohol exposure, co-morbid medical conditions, blood-thinning medication, antibiotic prophylaxis, number of lesions, location, histopathological diagnosis, area of skin removed, surgical technique, type of flap, length of surgery, entrance order, suture thread, surgical complications and need of post-operative admission. Results The most common site was head and neck (82.7%). The most frequent tumour was basal cell carcinoma (45.1%), followed by squamous cell carcinoma (38.7%) and melanoma (8.3%). Direct closure was the most frequent procedure (55.6%). Of the total number of patients, 7.9% of patients suffered complications; necrosis followed by cellulitis were the most frequent. Length of surgical procedure, area of skin removed and reconstruction with skin-graft were significantly related to higher risk of post-operative complications. Conclusions No intra or post-surgical mortality or life-threatening local complications were detected. Most post-surgical local complications appeared after wide excisions and complex reconstruction techniques that prolonged the length of the surgery.

Congenital melanocytic nevi are very common lesions that nevertheless pose many controversial questions. A systematic review of the literature suggests that the risk of developing melanoma on giant congenital melanocytic nevi (GCMN) is lower than previously thought given that, in the most recent series of GCMN, only 2 % of patients developed melanoma and most did so before the age of 5 years. Therefore, prophylactic surgery should be considered on an individual basis according to the degree of clinical suspicion of melanoma and the esthetic and functional consequences. In extensive reviews of series of biopsies of melanoma, small congenital melanocytic nevi have been associated with 7 % to 8 % of cases. Many authors believe that these might represent a significant risk of malignant conversion from 10 years onwards and so recommend regular control visits during infancy and prophylactic exeresis in puberty.

Congenital melanocytic nevi are very common lesions that nevertheless pose many controversial questions. A systematic review of the literature suggests that the risk of developing melanoma on giant congenital melanocytic nevi (GCMN) is lower than previously thought given that, in the most recent series of GCMN, only 2 % of patients developed melanoma and most did so before the age of 5 years. Therefore,prophylactic surgery should be considered on an individual basis according to the degree of clinical suspicion of melanoma and the esthetic and functional consequences.In extensive reviews of series of biopsies of melanoma, small congenital melanocytic nevi have been associated with 7 % to 8 % of cases. Many authors believe that these might represent a significant risk of malignant conversion from 10 years onwards and so recommend regular control visits during infancy and prophylactic exeresis in puberty.

Selective immunoglobulin A deficiency (IgAD) is a primary immunodeficiency disease characterized by low levels (< 7 mg/dl) of serum immunoglobulin (Ig) A and normal serum levels of IgG and IgM. Patients with IgAD have increased risk for recurrent respiratory and gastrointestinal infections, autoimmune disease, asthma and allergy. A 26-year-old woman was admitted with sudden onset of painful cutaneous lesions on her lower extremities, pyrexia and arthromyalgia. Her medical history was remarkable for recurrent respiratory tract infections, self-limited episodes of acute diarrhea, atopy, splenomegaly and a 4-year history of a lung granulomatous lesion. Laboratory and imaging tests ruled out severe life-threatening infection, connective tissue disease and neoplasm. Serum protein electrophoresis showed a low IgA serum level (6.67 mg/dl), with normal serum levels of IgG and IgM, conducting to a diagnosis of selective IgAD. A skin biopsy showed necrotizing vasculitis without any sign of internal organ disease. We report a patient with IgAD and granulomatous involvement of lungs, spleen and medium-sized arteries of the skin. Although IgAD results from a failure of B-cell differentiation, we propose that deregulated immune response with production of cross-reactive antibodies and hyperstimulation of T cells and macrophages could contribute to this widespread granulomatous reaction.

Bowen's disease is a common form of intraepidermal (in situ) squamous cell carcinoma of the skin and mucous membrane. Treatment with destruction of the epidermis by any method is necessary to prevent invasive squamous cell carcinoma.To report our experience with CO2 laser vaporization in the treatment of Bowen's disease and try to identify which factors could have any influence on results.A total of 44 patients were treated with the CO2 laser in superpulsed mode, focalized at 2 W/cm2.In 86.3% of patients, a unique treatment session was required. 'Clearance after one treatment' was achieved in 86.3% of the total series of patients and only 7.9% of these patients developed recurrence of the lesion. In 11.3% of the cases, there was 'clearance after more than one treatment' without clinical recurrences in any of these patients during the follow-up. 'No response' was achieved in 2.2% of the total series of patients.We conclude that the CO2 laser in superpulsed mode is an effective, efficient, safe, functional and good cosmetics treatment for Bowen's disease and it provides the same recurrence rate as other more aggressive or more expensive modalities of treatment.

The term `Acute Syndrome of Apoptotic Pan-Epidermolysis' (ASAP) designs clinical entities characterized by massive cleavage of the epidermis resulting from hyperacute epidermal basal cell apoptotic injury. It can be seen typically in classic toxic epidermal necrolysis (TEN), but occasionally occurs in non-dru1g-induced entities called `TEN-like' diseases (e.g., lupus erythematosus (LE), acute graft versus host disease and pseudoporphyria). We would like to highlight the difficulties of establishing differential diagnoses between `TEN-like' LE and drug reactions, especially when LE has not been previously diagnosed. We report a patient with fulminate pattern of epidermal cell injury resulting in a clinical presentation having combined features of drug-induced TEN and acute cutaneous LE with laboratory findings of systemic LE (SLE) and without systemic symptoms or high-risk drug ingestion. Although most cases of ASAP in the setting of LE are drug-induced TEN, there are reported cases of `TEN-like' LE with subacute progression, absence of systemic involvement and lack of drug ingestion. Such cases usually have a previous history of SLE and positive serologic markers. Although some authors observed that these lesions could be related to systemic severity of SLE, this is the first patient reported who progresses to discoid LE and we think it could be a marker of good prognosis. Lupus (2007) 16, 741—745.

Hereditary hemorrhagic telangiectasia (HHT) or Rendu-Osler-Weber disease is an autosomal dominant disorder characterized by epistaxis, mucocutaneous telangiectases and visceral arteriovenous malformations. Cutaneous telangiectases are the most obvious sign of this disorder and are not a merely cosmetic problem owing to their risk for bleeding, which may constitute an authentic matter of concern to these patients.Three patients with type-II HHT disease who presented cutaneous and labial lesions were treated with an intense pulsed light (IPL) system associated with a long-pulsed Nd:YAG laser (Photoderm-Vasculight, Lumenis). Labial lesions were treated with the IPL system and cutaneous lesions were treated with the IPL system and the long-pulsed Nd:YAG laser. All treatments were accomplished on an outpatient basis, without anesthesia.All three patients experienced a reduction in the frequency and severity of bleeding episodes and a great cosmetic improvement, with total lesion clearance. Side effects, such as purpura, hypopigmentation, hyperpigmentation or textural changes, were not observed. Recurrences were not detected after a maximum period of 24 months of follow-up.The combination of an IPL system and a long-pulsed Nd:YAG laser is efficient and safe for the treatment of cutaneous and labial telangiectases in patients with HHT disease and constitutes an important tool in improving their quality of life.

Epidermal nevi are benign proliferations of epidermis. Numerous treatment modalities have been tried, but no ideal treatment is yet available.To report our experience with CO(2) laser vaporization in the treatment of verrucous epidermal nevi, and to identify which factors could have influence in long-term results.A total of 25 patients were treated with the CO(2) laser in the superpulsed mode, focalized at 2 W/cm(2). The patients were between 3 and 41 years old (mean: 17 years). A total of 44% of lesions were20 cm(2), 40% measured between 20 and 100 cm(2) and 16% were100 cm(2). The follow-up was 4-79 months (mean: 28 months). In 76% of patients, multiple treatment sessions were required.Good results were achieved in 92% of patients with soft, flattened nevi and in only 33% patients with keratotic nevi. In addition, 87% of the latter had moderate results and 12.5% had poor results.We conclude that the CO(2) laser in superpulsed mode is an effective and safe treatment for verrucous epidermal nevi and provides fewer recurrences than other laser therapies. We also believe that the most determining factor for the cosmetic result is thickness of the nevus.

Introduction The constant increase in the incidence of skin cancer together with the requirement for maximum exploitation of available medical resources has meant that dermatological major surgery on an outpatient basis has greatly increased in recent years. Objective This article reviews the practice of dermatological surgery in an outpatient setting over a 1-year period. Its purpose is to analyse the number of surgical procedures, the type of cutaneous processes treated and the kind of surgical intervention and anaesthesia used. We also assessed the percentage of cancellations, postsurgical hospital admission and postsurgical complications. Clinicopathological correlation and complete tumour removal were also evaluated. Material and methods Our clinical experience of major surgery of outpatients at the dermatology department of the Hospital Juan Canalejo in A Coruna (Spain), analysing 565 patients in a non-randomized pilot study running from January to December 2003, is presented. Results Six hundred and forty-four surgical procedures were performed on a total of 565 patients. The three main cutaneous processes treated were basal cell carcinoma (240), squamous cell carcinoma (117) and melanoma (77). The most frequent type of procedure was direct closure (346), followed by exeresis and flap (133) and partial- or full-thickness skin graft (29), nail apparatus surgery (56) and lip surgery (33). Twelve patients were admitted to hospital after surgery owing to the complexity of their operations or to complications arising during surgery. Five hundred and fifty-three patients were discharged after being kept under observation for a few hours. Seventeen patients (3%) suffered complications following surgery, which consisted of partial implant failure (six cases), infection of the surgical wound (six cases), intense pain (four cases) and haemorrhage (one case). There was a good clinicopathological correlation in 90.78% of non-melanoma skin cancers, of which 92.03% were completely removed. Conclusions Medium and high complexity operations for dermatological processes, traditionally performed on hospitalized patients, can be conducted on an outpatient basis. This allows hospitalization costs and waiting lists to be reduced and affords the possibility of achieving better morbidity rates and medical care than in the standard hospital setting.

Resumen —Introduccion. El carcinoma de celulas de Merkel es un tumor primario de la piel con diferenciacion neuroendocrina poco frecuente y agresivo, que aparece en areas fotoexpuestas en pacientes de raza blanca y edad avanzada. Pacientes y metodos . Se realiza un analisis retrospectivo de 5 pacientes diagnosticados de carcinoma de celulas de Merkel en el Servicio de Dermatologia del Complejo Hospitalario Universitario Juan Canalejo (A Coruna) en el periodo 1998- 2003. Resultados . Se trataba de 4 mujeres y un varon, de edades comprendidas entre 55 y 83 anos. En el momento del diagnostico, dos de ellos se encontraban en estadio Ia, dos en estadio II y otro en estadio III. En tres de ellos se detectaron ganglios regionales afectados y en un caso existia tambien diseminacion linfatica a distancia. A todos se les realizo exeresis amplia del tumor. A tres se les extirpo una adenopatia local y a dos se les practico una linfadenectomia regional. En uno de los 2 casos sin adenopatias palpables se realizo una biopsia del ganglio centinela. Cuatro pacientes recibieron radioterapia postoperatoria local. Dos pacientes desarrollaron metastasis a distancia y fallecieron; el resto no han presentado recidivas en un periodo de seguimiento que varia de 3 a 70 meses. Conclusiones . El carcinoma de Merkel es un tumor de gran malignidad, que requiere un diagnostico precoz, puesto que el factor pronostico mas importante en el estadio de la enfermedad en el momento de su diagnostico. No existe un protocolo de tratamiento, y actualmente se recomienda un tratamiento multidisciplinar, basado en el tratamiento quirurgico y radioterapia adyuvante.

Efficacy and safety profiles of etanercept have been proved in numerous clinical trials; however, efficacy is determined by means of PASI 75 and few studies consider the maintenance of long-term response. The aims of this study were to provide data on long-term response to etanercept monotherapy in daily practice and to propose a method to assess the efficacy based on the maintenance of low PASI and BSA.Patients with moderate-severe psoriasis treated with etanercept 50 mg weekly, achieving at least PASI 50 at 12 weeks, were included. Response was expressed as the percentage of patients maintaining PASI and BSA ≤5 and ≤3, respectively.We included 76 patients (73.7% male and 26.3% female). PASI remained ≤5 in 71.1%, 61.3%, 54.4%, 38.3%, 8.6% and 5.9% of patients and ≤3 in 51.3%, 46.8%, 42.1%, 34%, 8.6% and 5.9% at 3, 12, 18, 24, 36 and 42 months.The maximum response is achieved between 6 and 9 months and remains stable in about 50% of cases until 18-24 months. Response maintains beyond 42 months in 6%. Maintenance of low PASI and BSA may be a most useful measure than the initial PASI reduction, which not always means enough improvement for the patient.

Background In recent years, studies monitoring infliximab in rheumatoid arthritis and inflammatory bowel disease have confirmed the relationship between the clinical response and the infliximab and anti-infliximab antibodies serum levels. However, there is only limited evidence in the field of dermatology. Objective The aim of this study was to establish the correlation between plasma infliximab levels, the presence of anti-infliximab antibodies and the clinical response in dermatological conditions. Setting Retrospective observational study in a tertiary hospital (University Hospital of La Coruna, Spain). Method Patients with dermatological conditions being treated with infliximab (5 mg/kg/8 weeks after the induction dose) were included in the study. The concentrations of infliximab and anti-infliximab antibodies were quantified by two sandwich-type ELISA immunoassays. The patients were classified into three groups based on the efficacy: good, partial or non-efficacy at the time of each blood assessment. The development of adverse reactions was also evaluated. Main outcome measures Plasma levels of infliximab and anti-infliximab antibodies, clinical response and infusion reactions. Results 17 patients (45 assessments) were included. The good/partial efficacy rate was significantly higher in the case of >0.05 than

Objective: To report a case of lichen planopilaris in a patient treated with infliximab for longstanding refractory psoriasis. Case Summary: A 37-year-old man with recalcitrant plaque psoriasis was being treated with infliximab at a dosage of 5 mg/kg every 8 weeks, with good response. However, 11 months later the patient developed follicular keratotic papulo-pustules, perifollicular erythema, and scaling, with progressive hair toss of the frontal and parietal regions of the scalp and eyebrows. A skin biopsy from a representative lesion was consistent with the diagnosis of lichen planopilaris. Discussion: Anti-tumor necrosis factor (TNF) agents have been associated with numerous cutaneous adverse events. Lichenoid reactions are uncommon but are an emerging cutaneous adverse effect. At least 13 cases of these eruptions have been recently described. Although lichenoid reactions in patients treated with TNF-α inhibitors may be clinically very diverse, we have found no previously reported cases of lichen planopilaris induced by these agents. An objective causality assessment revealed that the adverse event was probable. Conclusions: Since anti-TNF agents are being used for a rapidly expanding number of rheumatic, digestive, and dermatologie diseases, it is expected that lichenoid eruptions and other skin toxicities are likely to be seen with increasing frequency in clinical practice.

Background Spitzoid melanoma is a rare melanoma subtype often developing in children with unknown biological potential. Objectives To compare the clinical and histopathological factors that influence the biological behaviour between spitzoid and non-spitzoid childhood melanoma, to establish if the spitzoid subset of melanoma has different prognosis than other types of childhood melanomas. Methods A comparison of the prognostic significance of clinical and pathological findings between 38 spitzoid (SM) and 99 non-spitzoid melanomas (N-SM) in children and teenagers younger than 18 years referred to UT – MD Anderson Cancer Center during the period 1992–2007. Results Children with SM were significantly younger than those with N-SM, had more frequently multiple melanocytic nevi, nodular melanoma subtype with vertical growth phase, high Breslow thickness and mitotic rate, positive sentinel lymph node biopsy and more advanced stage. N-SM had more often associated nevus. However, the mortality rate in the SM group was lower (5.9%) than in the N-SM group (12.0%). This study has two major limitations. Small size of both groups does not allow reaching statistically significant differences regarding mortality. Using metastatic potential as an inclusion criterion for SM could result in a sample selection bias of the most aggressive group of SM. Conclusions Although SM patients had poorer prognostic factors than N-SM patients, slightly lower mortality rate was detected in the SM group. This less aggressive behaviour could be due to lower potential for widespread distant metastases than conventional melanomas or younger age of children with SM.

To examine the clinical characteristics of psoriasis, prevalence of comorbidities and quality of life in psoriasis patients older than 65 years and to compare them with younger adult psoriatic patients.Prospective observational study of prevalence.Patients older than 18 years with diagnosis of psoriasis attended at the Dermatology Department of the University Hospital of A Coruña (Galicia, Spain). A total of 371 patients were included (218 males and 153 females) with ages ranging from 18 to 85 years, of whom 70 were older than 65 years.Demographic data, clinical characteristics and psoriasis treatment, history of hypertension, diabetes mellitus, smoking and alcohol consumption and quality of life impairment were registered. Body mass index, waist-hip ratio, left ventricular hypertrophy, average value of systolic and diastolic blood pressure, cholesterol, triglycerides and glucose blood levels were also measured.Patients older than 65 years have statistically significant higher prevalence of hypertension, left ventricular hypertrophy, waist-hip ratio, diabetes mellitus and raised blood glucose levels. There was also association between clinical severity of psoriasis and smoking and alcohol intake as well as between quality of life and type of psoriasis treatment.Psoriasis in patients older than 65 years represents a significant proportion of cases and its prevalence is expected to increase. Because these patients are more prone to suffer comorbidities and to develop adverse effects due to psoriasis treatment, attention to pharmacologic interactions and correction of cardiovascular risk factors and toxic habits should be especially taken in mind in this age group.

Hidradenitis suppurativa (HS) is a chronic disease with painful, inflamed lesions in the apocrine gland-bearing areas of the body and unsatisfactory treatment. TNFα blockers have been proposed as promising treatments, but only few randomized, short-term, small controlled trials have been conducted. The aim of this study was to evaluate long-term response of HS patients treated with infliximab (IFX).A long-term, prospective study of 10 patients with moderate-severe refractory HS treated with IFX was performed, including assessment of therapy safety, disease severity, and activity. Previous reports on IFX treatment for HS were reviewed.Lack of response was observed in 20% and relapse in 50% of patients, after a median period of 37 weeks. The median number of doses administered was 7.5 during 49 weeks. No life-threatening adverse events were detected. Systematic review of 61 previously published cases showed lack of response was associated with previous surgery, young age at diagnosis, and long time of evolution of the disease.Long-term IFX therapy might be an efficient, well-tolerated, safe option for patients with short-time evolution, severe HS. Relapse is common after 8 months of continuous treatment, especially in patients with more severe disease and in those treated with IFX in monotherapy.