Novedades en biología molecular y su aplicación en el diagnóstico y el tratamiento del melanoma

Even though malignant melanoma accounts for 4% of all skin cancers, it is the type responsible for most deaths.The pathogenesis of melanoma is currently not well understood, although an interaction of environmental and genetic factors doubtlessly plays a role.Molecular biology in medicine has progressed increasingly rapidly in recent years. In dermatology, application of molecular biology techniques to the study of malignant melanoma has led to important advances in our knowledge of the main molecular pathways implicated in its development. These findings not only can improve our knowledge of the pathogenesis of the disease but may also have practical implications. Thus, molecular characterization of malignant melanoma may be of great help in differentiating between benign and malignant melanocytic lesions when histopathological features prove insufficient as is the case, for example, in Spitz nevus and spitzoid melanoma. In addition, knowledge of the abnormal molecular pathways in different malignant melanoma lesions can point to new therapeutic targets for treating patients with melanomas with distant metastases, in whom current chemotherapy has failed to extend life expectancy.At present, lack of availability is the main barrier to use of these techniques in dermatology—they are often limited to research, so not generally available in most hospitals. This problem will, however, be overcome when the molecular patterns become standardized, allowing a prognostic and therapeutic characterization of this important disease.     

Guía para el diagnóstico,el tratamiento y la prevención del eccema de manos

Hand eczema is a common condition associated with significantly impaired quality of life and high social and occupational costs. Managing hand eczema is particularly challenging for primary care and occupational health physicians as the condition has varying causes and both disease progression and response to treatment are difficult to predict. Early diagnosis and appropriate protective measures are essential to prevent progression to chronic eczema, which is much more difficult to treat. Appropriate referral to a specialist and opportune evaluation of the need for sick leave are crucial to the good management of these patients.These guidelines cover the diagnosis, prevention, and treatment of chronic hand eczema and highlight the role that primary care and occupational health physicians can play in the early management of this disease.     

Eficacia y seguridad del ácido hialurónico en la eliminación de los signos de envejecimiento facial

BackgroundThe continuous struggle of the human being to keep the face fresher and more youthful, without reaching reconstructive surgery, makes it necessary to test non-invasive esthetic treatments.ObjectiveThe objective was evaluate the efficacy and safety of hyaluronic acid (HA) (Hyalrepair®, Hyaluform®) in eliminating the signs of facial aging.Patients and methodIn the period between July 23, 2018 and July 4, 2019, a longitudinal, analytical, observational study was carried out in 40 subjects at the «La Pradera» International Clinic, Havana, Cuba, by members of the international school of esthetic medicine and surgery (EIMEC).ResultsThe degree of global esthetic improvement was significantly modified (much better in 90% and quite better in 5%) (p < 0.0001). The depth of the nasolabial fold decreased significantly at the end of treatment (p < 0.0001). There was a directly proportional relationship between the increase in age, the degree of skin aging, the depth of the nasolabial fold, the loss of facial volume, and the need to use a higher density and volume of HA in the subjects. The degree of satisfaction referred to increased significantly (very satisfied in 98% and satisfied in 2%) (p < 0.0001). The adverse events found were: pain (40/40), edema (30/40) and ecchymosis (10/40); all were mild to moderate intensity.ConclusionsHyalrepair® and Hyaluform® are highly effective and safe in the elimination of facial aging signs, with a high degree of satisfaction of the subjects.     

Persistencia y seguridad del apremilast en el tratamiento de la psoriasis en la práctica clínica habitual: experiencia en 30 pacientes

Apremilast is a phosphodiesterase-4 inhibitor taken orally. Little information about its use in routine clinical practice is available. We aimed to assess treatment safety and persistence rates in patients on apremilast for different forms of plaque psoriasis. This observational retrospective study included 30 patients with psoriasis who were treated with apremilast between January 2016 and December 2017 in our hospital. Twelve patients had palmar-plantar psoriasis, 8 had plaque psoriasis mainly on the scalp, and 10 had plaque psoriasis in other locations. The probable period of treatment persistence in patients in the 50th percentile was 18.5 months according to survival analysis of the series overall. Our experience suggests that apremilast is effective and safe for treating palmar-plantar psoriasis and plaques at other locations but not for treating scalp psoriasis. Adverse effects that compromise treatment occur in nearly two-thirds of the patients.     

Satisfacción del paciente y el médico con la espuma en aerosol de calcipotriol y dipropionato de betametasona para el tratamiento de la psoriasis vulgar en el cuerpo

Background and objectiveCalcipotriol and betamethasone dipropionate (Cal/BD) aerosol foam is more effective in the treatment of plaque psoriasis than earlier formulations incorporating this combination of active ingredients. The aim of this study was to evaluate patient and physician satisfaction with Cal/BD aerosol foam in the treatment of plaque psoriasis on the body.Material and methodsRetrospective observational study of 446 patients with plaque psoriasis affecting no more than 30% of the body surface area who had received treatment with Cal/BD aerosol foam for 4 weeks. The patients rated their satisfaction with the treatment using the TSQM-9 (Treatment Satisfaction Questionnaire for Medication) and the physicians on a 5-point Likert scale.ResultsPatients were highly satisfied with Cal/BD aerosol in terms of its ability to treat their condition (84%), relieve their symptoms (84.4%), and act rapidly (82.8%). With respect to convenience, the patients gave high ratings to ease of use (91.8%), ease of planning (93.9%), and ease of following instructions (89.9%). Global satisfaction was also high, with 85% of patients expressing that they were satisfied, very satisfied, or extremely satisfied with the treatment. Of the physicians, 85.7% stated that they were quite or very satisfied with the treatment.ConclusionBoth patients and physicians expressed high satisfaction with the use of Cal/BD aerosol foam for the treatment of plaque psoriasis on the body.     

Evaluación de la ecografía cutánea de 15 Mhz en la estimación preoperatoria del espesor tumoral en el melanoma maligno

BackgroundTumor thickness is of great importance in the management of cutaneous malignant melanoma (MM): this variable not only affects prognosis but is also a key factor in planning surgical margins and selecting candidates for sentinel node biopsy. Breslow depth is the standard histologic measure of thickness, but technological advances have provided imaging techniques such as cutaneous ultrasound that can potentially assess tumor thickness and enable prompt initiation of definitive treatment.Objectivesa) To evaluate the utility of ultrasound assessment of tumor thickness in MM, and b) to analyze histologic variables that affect ultrasound assessments of thickness.Materials and methodsRetrospective study of a consecutive series of 79 primary cutaneous MMs in which tumor thickness had been assessed by 15-MHz ultrasound before surgery. We gathered data from histology reports, studying Breslow depth and the presence of ulceration, regression, inflammatory infiltrate, and associated nevi. Correlation coefficients were calculated to evaluate the strength of association between Breslow depth and thickness assessed by ultrasound. We also calculated the sensitivity, specificity, and positive and negative predictive values of ultrasound measurement in the diagnosis of MMs more than 1 mm thick. Associations between histologic variables and the overestimation of thickness by ultrasound were also analyzed.ResultsThe 79 primary MMs studied had a mean (SD) Breslow depth of 0.8 (1.4) mm. There was moderate correlation and agreement between Breslow depth and the ultrasound assessment of thickness (Pearson correlation coefficient, 0.678; intraclass correlation coefficient, 0.78). The tendency of ultrasound to overestimate thickness was nonsignificantly related to the presence of a moderate to intense infiltrate and associated nevi (P > .05). The sensitivity of ultrasound for the diagnosis of MM over 1 mm thick was 82%; specificity was 80%, and positive and negative predictive values were 54% and 94%, respectively.ConclusionsUltrasound imaging quite correctly identifies thin MMs and can be useful for planning adequate surgical margins; however, there are limitations on its usefulness in the diagnosis of thick MMs. Additional studies are required to confirm whether certain histologic characteristics, such as the presence of a moderate to intense inflammatory infiltrate or associated nevi can lead to overestimation of thickness by ultrasound, limiting the clinical utility of this imaging technique in MM management.     

Actualización del tratamiento tópico en psoriasis: aportación de la combinación de calcipotriol y dipropionato de betametasona en espuma

Topical agents are the first-line treatment for mild and moderate psoriasis, but factors such as frequency of administration, organoleptic properties, and the limited short term results can reduce treatment adherence and effectiveness.Innovations in topical treatments are linked not only to the discovery of new molecules, but also to the reformulation of existing active ingredients based on improvements to administration, organoleptic properties, bioavailability, and ease of use. Calcipotriol and betamethasone dipropionate aerosol foam is a new formulation in which the active ingredients are dissolved in a mixture of volatile propellants that evaporate quickly, leaving a supersaturated solution of calcipotriol and betamethasone dipropionate that enhances penetration into the epidermis.In this article, we take a look at the new calcipotriol and betamethasone dipropionate aerosol formulation and briefly review the main evidence supporting the use of topical treatments for psoriasis.     

Actualización en el tratamiento de la infección VIH. Interés para el dermatólogo

—Treatments for human inmunodeficiency virus infection have shown a substantial change in the last four years. New combined therapies including protease inhibitors have increased sepervivence expectation, and improved life quality. However, these antiretroviral treatments are more complex and dermatologists should be ready to their management.In this paper we review treatments now available, when we begin to treat, how to evaluate their efficacy, when we stop treatment, side effect they show, when and how we change the treatment, resistance appearance, therapy for pregnant women, therapy compliance, and the special doctor to patient relationship of these cases. Remaining the numerous drugs interactions between them, and among several drugs usually used in HIV positive patients. Currently recomended therapy guide is described, and also, practical indications are included.     

Directrices españolas basadas en la evidencia para el tratamiento de la psoriasis con agentes biológicos, 2013. I. Consideraciones de eficacia y selección del tratamiento

Biologic therapy is a well-established strategy for managing moderate and severe psoriasis. Nevertheless, the high cost of such therapy, the relatively short span of clinical experience with biologics, and the abundance of literature now available on these agents have made evidence-based and consensus-based clinical guidelines necessary. The ideal goal of psoriasis treatment is to achieve complete or nearly complete clearing of lesions and to maintain it over time. Failing that ideal, the goal would be to reduce involvement to localized lesions that can be controlled with topical therapy. Although current evidence allows us to directly or indirectly compare the efficacy or risk of primary or secondary failure of available biologics based on objective outcomes, clinical trial findings cannot be directly translated to routine practice. As a result, the prescribing physician must tailor the treatment regimen to the individual patient. This update of the clinical practice guidelines issued by the Spanish Academy of Dermatology and Venereology (AEDV) on biologic therapy for psoriasis incorporates information from the most recent publications on this topic.     

Actualización en el diagnóstico y manejo del melanoma desmoplásico

Desmoplastic melanoma (DM) accounts for 0.4% to 4% of all melanomas. These skin tumors are mainly formed by amelanotic spindled melanocytes immersed in an abundant collagen stroma and are classified as pure when the desmoplastic component accounts for at least 90% of the invasive tumor and as mixed or combined otherwise. DMs are more common in men (male to female ratio, 1.7 to 2:1), and the mean age at diagnosis is 66 to 69 years. The tumors tend to occur in chronically sun-exposed areas, often in association with lentigo maligna, and are difficult to recognize because they can resemble a scar, presenting as a firm, unpigmented papule or plaque with poorly defined borders. DMs also have a strong tendency to recur locally, and pure variants rarely spread to the lymph nodes. Nonetheless, recently published series suggest that patients with DM have a similar prognosis to those with nondesmoplastic melanoma of the same thickness. The clinical management of DM varies in certain aspects from that of other melanomas and is reviewed in this article.