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ABSTRACT: BACKGROUND AND OBJECTIVES: The prevalence of antiphospholipid antibodies (APLAs) has been extensively studied in patients with systemic lupus erythematosus (SLE) but not in those with cutaneous lupus erythematosus (CLE). We determined the prevalence of APLAs among our patients with CLE, and analyzed their clinical and serologic characteristics. MATERIALS AND METHODS: This retrospective study analyzed 182 patients with subacute or chronic CLE who had been in follow-up for 5 years. We selected those positive for 1 or more of the following APLAs in 2 measurements at least 12 weeks apart: lupus anticoagulant (LA), anticardiolipin antibodies (ACAs), and anti-β(2)-glycoprotein i (anti-β(2)-GPI) antibodies. In the case of ACAs and anti-β(2)-GPI antibodies, only patients with titers greater than or equal to 40 U/mL were selected. RESULTS: We obtained a series of 13 patients (4 with subacute disease and 9 with chronic disease). Seven met the diagnostic criteria for SLE and only 1 met the diagnostic criteria for antiphospholipid syndrome (APS). The prevalence of APLAs was 38% among patients with SLE and 3.65% among those without SLE. The most prevalent APLA was LA, present in 10 patients. Antinuclear antibodies (ANAs) were detected in 12 patients and anti-double-stranded DNA antibodies in 11. CONCLUSIONS: The prevalence of APLAs among our patients with CLE who did not meet the diagnostic criteria for SLE was similar to that reported in the general population. This, along with the strong assocation between the presence of ANAs and the presence of APLAs, would bring into question the value of determining APLAs in patients with CLE who are negative for ANAs. We also note that there was a high prevalence of discoid lesions but a low prevalence of APS among our patients with CLE who were positive for APLAs.
Actas Dermo-Sifiliográficas 01/2013;
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ABSTRACT: The second of this series describes the characteristics of 3 types of photobiologic studies: the light test, the photochallenge test, and the photopatch test. We explain how the tests are carried out, the expected results, and their clinical usefulness in various photodermatoses. These tests are needed before attempting to induce adaptation (skin hardening or light tolerance) in the most debilitating cases.
Actas Dermo-Sifiliográficas 11/2012;
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ABSTRACT: Photodermatoses are skin conditions that are induced or exacerbated by electromagnetic radiation (including visible light, UV light, and infrared radiation) from the sun or artificial light sources. In Part 1 of this series we review current understanding of the pathophysiology of these processes and their classification. We also discuss technical aspects and the basic physics of photobiology and describe the equipment required for photobiologic testing and calibration (light sources and measurement instruments).
Actas Dermo-Sifiliográficas 11/2012;
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British Journal of Dermatology 12/2010; 163(6):1346-7. · 3.67 Impact Factor
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Actas Dermo-Sifiliográficas 06/2010; 101(5):460-2.
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ABSTRACT: We describe the case of a 44-year-old homosexual man diagnosed with HIV infection and visceral leishmaniasis. He presented nodules on the dorsum of the hands. Histological study of one of the nodules revealed necrobiotic palisading granulomas with abundant Leishmania amastigotes within the histiocytes and in the adjacent extracellular space. Tissue and peripheral blood cultures were positive for Leishmania infantum, zymodeme MON-24. A biopsy of healthy skin did not reveal the presence of Leishmania. A diagnosis of rheumatoid nodulosis with Leishmania was made and treatment was started with intravenous liposomal amphotericin, leading to slight improvement. We believe that the presence of the parasite within the nodules was the result of its dissemination during visceral leishmaniasis in an immunocompromised patient with HIV infection, and that the Leishmania did not have an etiological role in the appearance of the nodules. We present the first case of the association between Leishmania and rheumatoid nodulosis.
Actas Dermo-Sifiliográficas 03/2010; 101(2):164-7.
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ABSTRACT: In the treatment of psoriasis, biologic agents are more expensive than conventional therapy while showing similar or superior efficacy. However, their efficiency in terms of cost/efficacy (cost per responder in clinical trial conditions) is unknown. OBJECTIVE. To estimate the cost/efficacy ratios of adalimumab, etanercept, infliximab, and efalizumab in the management of moderate to severe psoriasis.
A model for the costs analysis was elaborated by building a decision tree for each of the treatments for which scientific evidence was available. The payer perspective (Spanish national health system) was used, only considering drug costs.The efficacy (proportion of patients who respond according to Psoriasis Area Severity Index [PASI] 75 criterion) was assigned according to the results of the clinical trials. When more than 1 trial was available per treatment, a meta-analysis was undertaken. In the case of weight-dependent dosing, the weight of the study participants was adjusted by age and sex to the standard Spanish population with correction for increased weight in individuals with psoriasis. Uncertainty was investigated with a sensitivity analysis.
Assigning the efficacy reported in the 15 published clinical trials, the most efficient biologic agent in terms of the cost/efficacy ratio was adalimumab, with one PASI 75 response at a cost of 8,013 Euro. For the remaining biologic agents and with different regimens, the cost per responder ranged from 9,370 Euro to 17,112 Euro. The sensitivity analysis confirmed the robustness of these figures.
Actas Dermo-Sifiliográficas 11/2009; 100(9):792-803.
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ABSTRACT: Resumen. Introducción. Los agentes biológicos en el tratamiento de la psoriasis son más caros y, en general, de eficacia similar o superior que la terapia clásica. Sin embargo, se desconoce su eficiencia en términos de cos-te/eficacia (coste por cada paciente que responde en las condiciones de los ensayos clínicos). Objetivo. Estimar los cocientes de coste/eficacia de adalimumab, etanercept, infliximab y efalizumab en el ma-nejo de la psoriasis moderada-grave. Material y métodos. Modelo de evaluación económica, construyendo un árbol de decisión para cada uno de los tratamientos sobre los que existe evidencia científica. Se ha usado la perspectiva del financiador (Sistema Na-cional de Salud), considerando sólo los costes del fármaco. La eficacia (proporción de pacientes que responden con el criterio PASI-75) asignada es la que consta en los ensayos clínicos. Cuando había más de un ensayo para cada tratamiento se han realizado metanálisis. Cuando la dosis depende del peso, este último en los sujetos del estudio se ha estandarizado por edad y sexo a la población española, corregido por el incremento de peso de los sujetos con psoriasis. La incertidumbre se ha manejado mediante análisis de sensibilidad. Resultados y conclusiones. Asignando en los modelos la eficacia de los 15 ensayos clínicos publicados, el agente biológico más eficiente en términos de coste/eficacia es adalimumab, con el que se consigue un respondedor PASI-75 a un coste de 8.013 euros. Con el resto de los biológicos y con diferentes pautas el coste/responde-dor osciló entre 9.370 € y 17.112 €. El análisis de sensibilidad confirma la robustez de estos hallazgos. Palabras clave: psoriasis, eficiencia, terapia biológica, metanálisis.
792 Actas Dermosifiliogr. 01/2009; 100:792-803.
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Actas Dermo-Sifiliográficas 03/2008; 99 Suppl 3:1-2.
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ABSTRACT: Graft-versus-host disease (GVHD) is the main complication of allogeneic bone marrow transplantation and the skin is the most commonly involved organ. The clinical presentation is varied and may resemble autoimmune diseases, such as scleroderma, lichen planus or lichen sclerosus. Chronic GVHD presenting with a butterfly malar rash mimicking lupus erythematosus is uncommon. We report a series of five patients with cutaneous lichenoid GVHD that presented with a butterfly malar rash. Two of our patients had positive antinuclear antibody titres. The evolution was poor with development of sclerodermatous GVHD lesions in three patients and relapse of their haematological disease in two.
Lupus 02/2008; 17(6):591-5. · 2.34 Impact Factor
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Actas Dermo-Sifiliográficas 01/2008; 99 Suppl 1:82.
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ABSTRACT: We report a patient with multiple myeloma associated with primary systemic amyloidosis who had a rapid evolution and a very unusual form of presentation. The association of amyloidosis in patients with multiple myeloma is 15%, and clinically evident mucocutaneous involvement occurs in up to 40% of patients.
International Journal of Dermatology 06/2007; 46(5):503-4. · 1.14 Impact Factor
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Clinical and Experimental Dermatology 06/2007; 32(3):337-8. · 1.20 Impact Factor
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ABSTRACT: Tumour necrosis factor (TNF) blockers represent an exciting advance in the management of psoriasis. However, the safety profile of these drugs is not completely established. We present a review of the literature, and report on eight patients: two with the unexpected appearance of psoriasis, and the remaining six with exacerbation and change in morphology of their existing psoriasis, all of which occurred during treatment with the TNF blockers adalimumab, etanercept and infliximab. The two new cases, neither of whom had any personal or family history of psoriasis, developed pustular psoriasis on the palms and/or soles. The other six patients, previously diagnosed with severe chronic plaque psoriasis (four patients), generalized pustular psoriasis (one) and erythrodermic psoriasis (one), developed eruptive guttate psoriasis between 15 days and 18 months after the beginning of therapy. These patients had never before presented guttate-type psoriatic lesions, and the lesions appeared in areas of the body that were free of psoriatic plaques at baseline.
Clinical and Experimental Dermatology 04/2007; 32(2):176-9. · 1.20 Impact Factor
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Actas Dermo-Sifiliográficas 12/2006; 97(9):614-5.
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Journal of the European Academy of Dermatology and Venereology 12/2006; 20(10):1328-9. · 2.98 Impact Factor
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ABSTRACT: There are numerous studies that individually evaluate the efficacy/effectiveness and toxicity of drugs in the systemic treatment of psoriasis. On the contrary, we can hardly find studies that compare each other.
To evaluate and compare the effectiveness and toxicity of mycophenolate mofetil and cyclosporin in chronic plaque psoriasis through a prospective, sequential, cross-over, non-randomized, two-phase, open-label study.
Eight patients (five women and three men; mean age 57, range 35-78) with moderate-to-severe chronic plaque psoriasis were included in the study. They were treated with oral mycophenolate mofetil (30 mg/kg/day) over a period of 16 weeks. Following a variable washout period and after a new outbreak of the disease, oral cyclosporin was introduced at a dose of 4 mg/kg/day. During both treatment regimens, follow-up visits were performed at 3, 8 and 16 weeks.
In both groups, the PASI started to decrease once treatment was begun. Cyclosporin was faster and statistically a lot more effective than mycophenolate mofetil, reaching a higher number of complete remissions and better percentages of PASI improvement from baseline (45.7%, 60.2% and 60.5% at 3, 8 and 16 weeks respectively for mycophenolate mofetil, and 89.7%, 95.3% and 95.3% respectively at the same intervals for cyclosporin). Cyclosporin was also more predictable in its action as the percentage of improvement along the follow-up visits had a much wider range for mycophenolate mofetil. Overall, the tolerability of both drugs was good. None of the patients had to discontinue treatment because of an adverse event. Two patients treated with cyclosporin showed increased plasma levels of creatinine.
Cyclosporin is more effective, fast, and predictable in its effect than mycophenolate mofetil to control moderate-to-severe chronic plaque psoriasis. Both drugs are well tolerated in short courses of treatment.
Journal of the European Academy of Dermatology and Venereology 08/2006; 20(6):702-6. · 2.98 Impact Factor
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Journal of the European Academy of Dermatology and Venereology 06/2006; 20(5):618-20. · 2.98 Impact Factor
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Journal of the European Academy of Dermatology and Venereology 06/2006; 20(5):608-10. · 2.98 Impact Factor
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ABSTRACT: Sweet's syndrome (SS) has been reported in association with many conditions, including malignancy, infections, autoimmune disorders, pregnancy and drugs.
We reviewed patients with SS-like lesions on the lymphoedema area seen in our department. Clinical manifestations, histopathologic characteristics, treatment and outcome data were recorded and analysed.
We report seven women with a history of surgery for breast cancer with axillary lymphadenectomy. Six of them were on tamoxifen. All of them had various lesions consistent with SS localized predominantly on the limb affected by the postmastectomy lymphoedema, and on the ipsilateral chest, trunk and back. One of them presented bullous lesions. Three of the cases underwent spontaneous remission, two resolved with antibiotic therapy, one healed with corticosteroids, and one with corticosteroids plus antibiotic.
Erythematous tender plaques on the area of postmastectomy lymphoedema could be considered an unusual manifestation of Sweet's syndrome. We have found only three similar cases in the literature. Although it is difficult to elucidate the pathogenesis of this entity, it has been suggested that it could be due to immune surveillance impairment.
Journal of the European Academy of Dermatology and Venereology 05/2006; 20(4):401-5. · 2.98 Impact Factor
