Motivos dermatológicos de consulta en atención primaria. Análisis de la demanda derivada

IntroductionSkin conditions are among the main reasons for seeking primary health care. Primary care physicians (PCPs) must diagnose skin conditions and determine their impact, and must therefore incorporate the relevant knowledge and skills into their education. The present study analyzes the reasons for primary care referral to dermatology (referral demand) as well as diagnostic agreement between PCPs and dermatologists informed by pathology where appropriate.Material and methodsData were collected for 755 patients and 882 initial dermatology appointments from February 1, 2012 through April 30, 2012 following primary care referral. Data obtained included age, sex, occupation, reason for referral, primary care diagnosis, and dermatologic diagnosis. Statistical analysis of the data for each diagnosed condition identified frequency, reasons for referral, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the κ statistic for diagnostic agreement.ResultsThe most common diagnoses were seborrheic keratosis, melanocytic nevus, actinic keratosis, and acne. The main reason for referral was diagnostic assessment (52.5%). For skin tumors, sensitivity of primary care diagnosis was 22.4%, specificity 94.7%, PPV 40.7%, and NPV 88.3%, with a κ of 0.211. For the more common diagnoses, primary care sensitivity was generally low and specificity high.ConclusionsAccording to our results, primary care physicians are better qualified to rule out a given skin condition in a patient (high specificity) than to establish an accurate clinical diagnosis (poor sensitivity). This suggests that knowledge and skills training should be organized for primary care physicians to improve management of skin conditions—especially skin cancer, because of its impact. A more responsive system would ensue, with shorter waiting lists and better health care.     

Afectación cutánea en la crioglobulinemia tipo II. Asociación con la infección por el virus C de la hepatitis

—Introduction. Cryoglobulins (CG) are abnormal proteins that precipitate from cooled serum. Several reports of mixed cryoglobulinemia (MC) associated with chronic hepatitis C have been published. On the clinical spectrum of MC it has been proved that purpura is the most frequent cutaneous manifestation, mainly in women. The aim of our study was to analyse the relationship between the patients with CM and VHC infection, cutaneous lesions and systemic affectation.Patients and methods. We evaluated a group of 62 patients diagnosed of MC during the period between January 1993 and December 2000 (29 women and 33 men), aged from 33 to 81 years old (mean 60 years).Results. Purpura was the most frequent cutaneous manifestation (27 out of 62: 43 %) mainly in women. The group of patients with purpura presented a high level of CG, hypocomplementemia and renal dysfunction. It was present in 27 patients (43 %). The IgMk CG type was related more commonly with purpura, renal dysfunction and hypocomplementemia if compared with IgGK. 72 % of patients with CG were VHC infected. No differences of CG have been found in HCV infected patients.Conclusions. Our results confirm the high frequency of VHC infection in patients with CG. Purpura was the most frequent clinical manifestation related with a high level of CG and more frequency of hypocomplementemia and renal dysfunction.     

Manifestaciones mucocutáneas de la infección por Histoplasma capsulatum en pacientes inmunosuprimidos

Histoplasmosis is a systemic mycosis caused by the dimorphous fungus Histoplasma capsulatum (H. capsulatum). The fungus enters the body through the respiratory tract in the form of microconidia, which are transformed into intracellular yeast-like structures in the lungs before disseminating hematogenously. Primary infection is usually asymptomatic and self-resolving. Some patients develop severe disease with acute or chronic respiratory involvement. Immunosuppressed patients, mainly those with altered cellular immunity, may have disseminated disease with variable mucocutaneous involvement characterized by papules, nodules, gummas, or ulcers with a granulomatous base. We report the case of 3 HIV-negative patients infected by H capsulatum in whom diagnosis based on the skin lesions proved essential for early initiation of treatment.     

Actualización en el diagnóstico de las infecciones de transmisión sexual

Sexually transmitted infections (STIs) are one of the most frequent and universal Public Health problems. Health professionals should be aware of the possibility of STIs due to their high morbidity and the presence of sequelae. The delay in the diagnosis is one of the factors that justifies the difficulty to infections control. Diagnostic tests allow the introduction of aetiological treatment and also lead to treating symptomatic and asymptomatic patients more effectively, as well as to interrupt the epidemiological transmission chain without delay. In this review we have made an update of the main existing diagnostic methods for the more important STIs.     

Medición de la prevalencia de la dermatitis atópica en una población escolar madrileña

—Background. The United Kingdom Working Party for Atopic Dermatitis has developed a diagnostic questionnaire, whose English and Romanian versions have been validated both in a hospital and out-of-hospital setting.Objective. Our objective was to develop a Spanish version of this questionnaire and use it to address the frequency of the disease in the general school-age population in Health Area No. 11 in Madrid.Results. The validation in a hospital setting showed a sensitivity of 76.5%, with a 95% confidence interval (CI) of 66.8-84.1%. Specificity was 90.4 % (CI = 83.8-94.6 %), the positive predictive value 85.7 % (CI = 76.4-91.8 %) and the negative predictive value 83.6 % (CI = 76.3-89 %). Five schools were selected at random, and all of their students were invited to participate in the study. 874 children were examined (Response rate: 62.9 %). The one-year period prevalence was 9.95% (7.97; 11.94). Point prevalence was 7.09% (5.39; 8.80). In the 3-7 age group, the one-year period prevalence was 11.2%; in the 8-12 group, 10.3%; and in the 13-17 group, 6.9%. There were no statistically significant differences when comparing by sex, age or type of school (public/private). The result offered by the questionnaire was validated through the clinical diagnosis of a dermatologist, in a sub-sample of 130 patients. The results obtained were: sensitivity = 63.6% (31.6; 87.6); specificity = 96.7% (91.4; 99.0); positive predictive value = 63.6 % (31.6; 87.6); negative predictive value = 96.7% (91.4; 99.0).Conclusions. We believe that the Spanish version that we have developed of the diagnostic questionnaire is useful and gives good results, along the lines of those published by other groups.     

Urticaria por frío. Caracterización de la población de una clínica ambulatoria especializada en urticaria

IntroductionCold Urticaria (ColdU) is a type of chronic inducible urticaria (CIndU) where recurrent pruritic wheals and/or angioedema occur after exposure to cold stimulus. Although it usually only affects exposed areas, systemic reactions can occur in severe cases. In this study, we seek to characterize the ColdU cases within our Centre's population of patients.Material and methodsRetrospective study based on clinical files of patients diagnosed with ColdU followed in an urticaria outpatient clinic in Portugal prior to October 2020.ResultsWe included 52 patients total (40 women) with median age of 35 years, 19 patients with symptom onset before 18 years-old. ColdU was classified as acquired in all patients. Cold provocation tests were negative in 9 patients and these were classified as atypical ColdU. No significant differences were found between those with pediatric or adult onset of disease. Most of the patients had a localized form of the disease (52%). Despite not being statistically significant, it was found that patient's temperature threshold, assessed with TempTest® 4.0, was higher and stimulation time was shorter in more severe groups. All patients were treated with non-sedating antihistamines (daily or on-demand), finding that those controlled with standard dosages had lower temperature thresholds than those needing higher dosages (p < 0.01). One patient was under treatment with omalizumab.ConclusionColdU is an heterogenous disease that can have life-threatening event consequences. Cold provocation tests and threshold assessment can be an important tool in the management treatment and in identifying severity groups.     

Evaluación de la vida sexual y de la satisfacción matrimonial en pacientes con verruga anogenital

Anogenital wart (AGW) resulting from human papilloma virus (HPV) is one of the most common sexually transmitted diseases worldwide. Herein, we aimed to evaluate the effects of AGW on patients‘marital satisfaction and sexual function. This cross-sectional study was consisted of 74 consecutive patients including 37 patients with AGW and 37 healthy controls. ENRICH Marital Satisfaction Scale and Arizona Sexual Experience Scale were completed and analyzed for all patients. ENRICH scale items were not significantly different between the two groups. Sexual function was found to be lower in female than male patients (P < .001). According to our findings marital satisfaction was not affected by AGW. However, a history of previous treatment for HPV decreased the marital satisfaction. In addition, AGW had more adverse effects on females’ sexual function compared to males. Our findings suggest that the psychiatric treatments should be considered when managing an AGW patient.     

Uso de probióticos para disminuir la gravedad de la dermatitis atópica en población pediátrica: revisión sistemática y metaanálisis

Background and objectiveProbiotics, defined as live microbial dietary supplements that provide health benefits for the host, have been suggested as a treatment for atopic dermatitis based on a variety of proposed mechanisms of action. We analyzed evidence for the efficacy of probiotics to attenuate the severity of atopic dermatitis in pediatric patients younger than the age of 18 years.Material and methodsSystematic review of trials of probiotics that included patients under the age of 18 years with a confirmed diagnosis of atopic dermatitis scored for severity using the Scoring Atopic Dermatitis SCORAD) tool. We performed a meta-analysis of the randomized placebo controlled trials. The following databases were searched: MEDLINE, Web of Science, Scopus, ClinicalTrials.gov, Epistemonikos, Trip Medical Database, and the Spanish Virtual Health Library.ResultsTwenty trials were retrieved and included in the systematic review. Sixteen supported the use of probiotics to attenuate SCORAD-evaluated severity. Meta-analysis found an overall mean difference in effect between probiotics and placebo of −0.38 (95% CI, −0.63 to −0.14) in favor of probiotics. However, trial heterogeneity was high (I² statistic, 76%) due to clinical and methodological variability.ConclusionsIn spite of clinical heterogeneity in trials attributable to different types of probiotic products and doses, and to the subjective variability of the SCORAD scale, we conclude that probiotics are beneficial for reducing the severity of atopic dermatitis as reflected by the SCORAD index.     

Comportamiento de las principales infecciones de transmisión sexual bacterianas durante la pandemia por SARS-CoV-2

Introduction and objectiveThe SARS-CoV-2 pandemic brought about social changes in 2020 and 2021. The aim of this study was to evaluate the epidemiologic profiles of the main sexually transmitted infections (STIs) of bacterial origin (chlamydia, gonorrhea, and syphilis) diagnosed during this period and compare them to findings from previous years.Material and methodsDrawing on data from Hospital General Universitario in Valencia, Spain, we recorded the number of chlamydia, gonorrhea, and syphilis cases diagnosed monthly by multiplex PCR in 2018-2021 and the number of PCR-confirmed SARS-CoV-2 cases diagnosed monthly in 2020-2021. We also collected clinical and demographic information on all patients diagnosed with STIs during the years studied.ResultsThe total number of STIs diagnosed increased from 570 in 2018-2019 to 664 in 2020-2021. PCR positivity rates were similar in the 2 periods, but the incidence rates were higher during the pandemic. The chronologic correlation between SARS-CoV-2 and STI positivity was negative. Mean age at diagnosis was 29.64 years (95% CI, 19.33-41.14) for chlamydia, 30.86 years (95% CI, 20.24-42.45) for gonorrhea, and 37.04 years (95% CI, 26.01-51.00) for syphilis. The number of men diagnosed with chlamydia increased by 13.85% (95% CI, 6.39-21.08; P = .0003) during the pandemic.ConclusionsWe observed a negative correlation between SARS-CoV-2 infections and STIs during the pandemic and an increase in chlamydia cases among men. STI cases rose during 2020-2021, indicating that they remain a significant problem that needs to be addressed in young and adult populations.