Publications (12)11.19 Total impact
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Article: Erosive Palmoplantar Lichen Planus.
Actas Dermo-Sifiliográficas 07/2012; -
Article: [Intermittent treatment regimens and the rational (efficient) use of biologic agents in psoriasis].
Actas Dermo-Sifiliográficas 05/2011; 102(4):241-3. -
Article: [Primary cutaneous melanoma: prognostic factors not included in the classification of the American Joint Committee on Cancer].
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ABSTRACT: Skin histopathology reports of melanoma routinely include important prognostic information used in the staging system of the American Joint Committee on Cancer (AJCC). This information, which influences disease management, includes tumor depth, presence of ulceration, number of mitotic figures, and presence or absence of microsatellites. However, numerous studies have found many other factors that are not included in the AJCC classification but that are nevertheless of prognostic significance. We discuss these factors in this paper.Actas Dermo-Sifiliográficas 03/2011; 102(4):255-63. -
Article: [Approaches to the dermatopathologic diagnosis of figurate lesions].
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ABSTRACT: Both clinical and pathologic findings must be considered when diagnosing figurate skin lesions, which are often seen in routine practice. Although a skin biopsy may sometimes be diagnostic, more often the information provided is nonspecific. In an attempt to offer an approach to diagnosing these dermatoses, we have classified annular lesions according to the presence of lymphocytic, neutrophilic-eosinophilic, or granulomatous infiltrates, and infiltrates containing plasma cells. Neoplastic annular lesions are included in a separate group. Lesions containing lymphocytic infiltrates include superficial and deep erythema annulare centrifugum and the differential diagnosis includes a large number of conditions. In the neutrophilic-eosinophilic class, we include annular psoriasis, vasculitis, linear immunoglobulin A dermatosis, eosinophilic dermatitis, erythema marginatum rheumatica, and annular erythema of infancy. Sarcoidosis and granuloma annulare are the prototypical annular lesions containing granulomas. Secondary syphilis is typical of lesions containing plasma cells. Mycosis fungoides is the principal skin tumor that may initially manifest with annular lesions.Actas Dermo-Sifiliográficas 03/2011; 102(5):316-24. -
Article: [Treatment of moderate-to-severe psoriasis in clinical practice: a survey of Spanish dermatologists].
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ABSTRACT: Various treatment options are available for use in moderate-to-severe psoriasis and election is dependent upon the clinical criteria applied by the attending physician. We undertook a survey among dermatologists to assess the treatment of moderate-to-severe psoriasis currently used in clinical practice in Spain. A cross-sectional study was performed by sending a questionnaire to dermatologists in Spain who treat patients with moderate-to-severe psoriasis. The questionnaire comprised 33 items distributed in 6 sections: profile of the dermatologist, case load, patient profile, follow-up and management of the disease, treatment regimens, and assessment of pharmacological treatments. According to the responses of the 164 dermatologists surveyed, 6.8% of patients seen in their clinics have moderate-to-severe psoriasis; of those, 45.8% receive systemic treatment and 22.9% are treated with biologic drugs. In many of those patients (50.2%), the dermatologist felt that a change in treatment was necessary; in 51.1% of cases, this change would be from systemic therapy to a biologic drug. The principal reason for the change (50.8%) would be lack of efficacy or the appearance of adverse effects. Efficacy and safety were considered essential criteria in the choice of an appropriate treatment (82.9% and 28.0% of dermatologists, respectively). Patient quality of life was also considered an essential consideration in choice of treatment by 28.0% of dermatologists. Optimal treatment for moderate-to-severe psoriasis should be effective and safe, and improve patient quality of life. This makes it essential to use drugs with an excellent efficacy and safety profile.Actas Dermo-Sifiliográficas 12/2010; 101(10):858-65. -
Article: [Study and treatment of locally advanced melanoma].
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ABSTRACT: Locally advanced melanoma is characterized clinically by the appearance of in-transit or satellite metastases, and is considered stage IIIB or IIIC according to the 2002 classification of the American Joint Committee on Cancer. Despite the absence of distant metastases, the management of locally advanced melanoma is complicated and the disease is associated with a reduction in overall survival. The initial step in the approach to the patient with locally advanced melanoma involves the restaging in order to exclude the presence of distant metastases. Positron emission tomography-computed tomography is currently accepted as the most accurate restaging technique. Surgical excision of the metastases continues to be the treatment of choice for locally advanced melanoma. In the case of unresectable metastases, hyperthermic isolated limb perfusion with melphalan with or without tumor necrosis factor has achieved complete responses in up to 60% of patients treated, with very rare severe locoregional and systemic toxic effects. Radiation therapy, chemotherapy, and biochemotherapy are options that, even though they have not been tested in patients with only in-transit metastases, may have a role in unresectable, locally advanced melanoma without distant metastases.In any case, therapeutic options for locally advanced melanoma should be individualized, and should take into consideration the availability of each of these techniques as well as the experience of the health care team.Actas Dermo-Sifiliográficas 11/2009; 100(9):767-79. -
Article: [An economic analysis of presurgical teledermatology in patients with nonmelanoma skin cancer].
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ABSTRACT: In patients with nonmelanoma skin cancer, store-and-forward teledermatology allows satisfactory diagnosis and surgical planning, thus shortening waiting lists and reducing travel requirements for patients in special situations. The aim of this study was to undertake an economic analysis of presurgical teledermatology, comparing it with a conventional health care approach. The cost and cost-effectiveness of presurgical teledermatology were analyzed from a societal perspective in the setting of a public hospital with a corporate intranet. The mean delay in surgery was used to measure effectiveness. Over a 12-month period, teledermatology was used in 134 patients with nonmelanoma skin cancer. The unit cost of each intervention (teledermatology and conventional health care approach), the cost ratio between the most and least expensive alternative, and the incremental cost-effectiveness ratio were calculated. We distinguished between 2 groups of patients: those with and those without physical impediments for travel. The unit cost of the patients in whom teledermatology was used was euro 156.40 compared to euro 278.42 per patient in the conventional system; the conventional system was therefore 1.78 times more expensive than presurgical teledermatology. Teledermatology was more cost-effective, with an incremental cost-effectiveness ratio of euro 3.10 per patient and per day of delay avoided in patients without impediments for travel and euro 4.87 in those with impediments for travel. Teledermatology used for remote presurgical planning and preparation in patients with nonmelanoma skin cancer is more cost-effective than the conventional referral system in a health setting with a communication network available.Actas Dermo-Sifiliográficas 01/2009; 99(10):795-802. -
Article: [Diagnostic and therapeutic assessment of frontal fibrosing alopecia].
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ABSTRACT: Frontal fibrosing alopecia is a clinical entity characterized by recession of the frontotemporal hairline in middle-aged and older women. Since it was first described in 1994, more than 100 cases have been reported describing other clinical manifestations such as eyebrow and axillary alopecia, and perifollicular inflammation that help in the diagnosis of the disease and the differential diagnosis with other scarring alopecias. Histopathology reveals an inflammatory infiltrate and perifollicular lamellar fibrosis. Although numerous therapeutic options have been tested, including corticosteroids, finasteride, and minoxidil, none have shown clear benefits in terms of halting the progression of the alopecia.Actas Dermo-Sifiliográficas 12/2007; 98(9):594-602. -
Article: Localized Kaposi's sarcoma in a patient with pemphigus vulgaris.
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ABSTRACT: We report the case of a patient with a 13-year history of pemphigus vulgaris (PV) treated with immunosuppressive agents, prednisone and mycophenolate mofetil who had developed lesions of Kaposi's sarcoma (KS) on a sole plaque of PV that had been previously treated with intralesional injections of steroids. The lesions were surgically removed and polymerase chain reaction (PCR) demonstrated human herpesvirus-8 (HHV-8) DNA. There were neither recurrences nor later dissemination of KS following gradual decrease of the immunosuppressive therapy. We suggest that the treatment with intralesional steroids may have influenced the local reactivation of a latent infection of the virus, determining the appearance of this localized KS.Journal of the European Academy of Dermatology and Venereology 02/2006; 20(1):79-83. · 2.98 Impact Factor -
Article: Frontal fibrosing alopecia: a survey in 16 patients.
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ABSTRACT: Postmenopausal frontal fibrosing alopecia (PFFA) was described by Kossard et al. as a progressive recession of the frontal hairline affecting particularly postmenopausal women. Further cases of PFFA have been reported to date, all of them considering it as a variant of lichen planopilaris on the basis of its clinical, histological and immunohistochemical features. To describe clinical features, and response to treatment of 16 cases of frontal fibrosing alopecia diagnosed at our department in the last 6 years. In addition to clinical data, biopsies and laboratory tests (antinuclear antibodies, sex hormones, thyroid hormones) were performed in order to rule out other causes of scarring alopecia. Patients were treated with intralesional corticosteroids, finasteride, and minoxidil, depending on the stage of the disease and association to androgenetic alopecia. All patients presented progressive alopecia localized to the frontal and temporal hairlines. Eight patients (50%) had loss of eyebrows, and six patients (37.5%) had axillar alopecia. Ages ranged from 45 to 79. Three of these women were premenopausal. Androgenetic alopecia was evident in seven patients (43.8%). All patients biopsied showed perifollicular lymphocitic infiltrate with lamelar fibrosis limited to the upper portions of the follicle. The progression of the condition stopped in most patients after a variable period on treatment. When treatment was abandoned the alopecia progressed to 'clown alopecia' appearance. Cases of Kossard's type scarring alopecia affecting premenopausal women made us consider that this condition is not exclusive of postmenopausal women. Differential diagnosis should take into account conditions like female androgenetic alopecia, fibrosing alopecia in a pattern distribution, alopecia areata, and chronic lupus erythematosus. Except for the pattern of alopecia, lichen planopilaris and frontal fibrosing alopecia are indistinguishable, thus the latter is included as a variant of lichen planopilaris. Although the disease tends to spontaneous stabilization, intralesional and topical corticosteroids, and anti-androgens may stop the progression of the disease and improve the female androgenetic alopecia that usually is associated to FFA.Journal of the European Academy of Dermatology and Venereology 12/2005; 19(6):700-5. · 2.98 Impact Factor -
Article: Multiple lesions of pyoderma gangrenosum in association with hyper-reactive malarial splenomegaly.
British Journal of Dermatology 04/2004; 150(3):605-7. · 3.67 Impact Factor -
Article: Cutaneous pseudolymphoma in association with molluscum contagiosum in an elderly patient.
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ABSTRACT: Molluscum contagiosum (MC) is a common cutaneous infection, which has been reported in association with cutaneous pseudolymphoma in few cases. A 72-year-old woman with a nodule arising on the external canthus was reviewed. The lesion was surgically removed, and the histopathological study demonstrated an epidermal invagination filled by molluscum bodies and a diffuse infiltrate comprising atypical lymphocytes. Immunohistochemical stains disclosed predominance of T cells with positive CD30 labeling. Polymerase chain reaction failed to demonstrate clonal rearrangement of the T-cell receptor. After ruling out systemic involvement, the patient was followed up for 2 years with no evidence of recurrence. We report this case to the best of our knowledge and discuss the literature about atypical clinical and histological presentations of MC.Journal of Cutaneous Pathology 09/2003; 30(7):473-5. · 1.56 Impact Factor
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2003–2011
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Hospital Universitario Virgen Macarena
Sevilla, Andalusia, Spain
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