Publications by authors named "Agustín Buendía-Eisman"

36 Publications

Cutaneous homeostasis and epidermal barrier function in a young healthy Caucasian population.

Eur J Dermatol 2021 Apr;31(2):176-182

Dermatology Department. Faculty of Medicine, University of Granada, Granada, Spaina.

Background: Transepidermal water loss (TEWL), stratum corneum hydration (SCH), and skin surface pH are indicators of skin barrier integrity. There is scant evidence on normative data for cutaneous homeostasis parameters in healthy individuals.

Objectives: To develop normative data for skin erythema, melanin, pH, SCH, and TEWL; identify differences in these variables among different anatomical locations; and explore factors that may modify these values.

Material & Methods: A cross-sectional study was conducted in 87 healthy volunteers (34 males) aged 20 to 40 years. TEWL, SCH, pH, erythema, and melanin were measured on the cheeks, volar forearms, and palms.

Results: The lowest TEWL value corresponded to volar forearms (9.69 ± 2.94 g m·h) and the highest to palms (49.32 ± 14.55 g m·h). Erythema was more evident on cheeks than palms or volar forearms (413.51 arbitruary units [AU] vs. 259.98 AU vs. 252.02 AU). The lowest melanin index was documented for palms (92.72 ± 41.70 AU). pH levels were similar among the different locations. The erythema index was significantly higher in males versus females for all locations. Linear regression analysis adjusted for age and SCH revealed an increase in 0.45 ± 0.18 g m·h for TEWL on the cheek and 0.32 ± 0.10 g m·h for TEWL on the forearm for each one-year increase in age.

Conclusion: We provide normative data for individuals aged 20-40 years, across three anatomical locations, and propose a predictive model for TEWL on the cheek and forearm as a function of age and SCH.
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http://dx.doi.org/10.1684/ejd.2021.4021DOI Listing
April 2021

Epidermal Barrier Function and Skin Homeostasis in Skin with Permanent and Adhesive Tattoos: A Cross-Sectional Study.

J Clin Med 2021 Feb 22;10(4). Epub 2021 Feb 22.

Dermatology Department, Faculty of Medicine, University of Granada, 18012 Granada, Spain.

Tattoos are a current trend, but their impact on skin homeostasis and epidermal barrier function is not well known. So, the aims of this study are (1) to investigate epidermal barrier function and skin homeostasis in skin with permanent tattoos, adhesive temporary tattoos and non-tattooed skin, and (2) to analyze the effect of petrolatum on skin with permanent and adhesive tattoos. In total, 67 tattoos were enrolled (34 permanent tattoos and 33 adhesive tattoos). Temperature, transepidermal water loss (TEWL), stratum corneum hydration (SCH), erythema and total antioxidant capacity (TAC) were measured in skin with permanent tattoos, adhesive tattoos and non-tattooed skin before and after petrolatum application. The temperature was lower (30.47 °C vs. 31.01 °C; = 0.001) on skin with permanent tattoos than non-tattooed skin, while SCH (48.24 Arbitrary Units (AU) vs. 44.15 AU; = 0.008) was higher. Skin with adhesive tattoos showed lower temperature, SCH (21.19 AU vs. 41.31 AU; < 0.001) and TAC (1.27 microcoulombs (uC) vs. 3.48 uC; < 0.001), and higher TEWL (8.65 g/h/m vs. 6.99 g/h/m; = 0.003), than non-tattooed skin. After petrolatum application, the temperature decreased on skin with permanent tattoos, and TEWL and SCH decreased on skin with adhesive tattoos. Adhesive tattoos may affect skin barrier function, while permanent tattoos may have a lower impact. Tattooed and non-tattooed skin responds in different ways to moisturizers.
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http://dx.doi.org/10.3390/jcm10040888DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7926473PMC
February 2021

Concomitant occurrence of frontal fibrosing alopecia and trichotemnomania: The importance of trichoscopy.

Indian J Dermatol Venereol Leprol 2021 Jan-Feb;87(1):112-115

Facultad de Medicina, Universidad de Granada,Granada, Spain.

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http://dx.doi.org/10.25259/IJDVL_635_19DOI Listing
July 2019

Exploring Patients' Insight, Concerns, and Expectations at Dermatology Clinic: An Observational Study in 2 Centers in Scotland and Spain.

J Patient Exp 2020 Dec 13;7(6):1197-1202. Epub 2020 Mar 13.

School of Medicine, University of Granada, Spain.

Background: Effective doctor-patient communication is of great importance in order to optimize medical consultation outcomes. However, it can be difficult to address all patients' concerns and expectations in clinic.

Objective: To identify how much patients know about their medical condition, their fears and concerns, and their expectations, as well as evaluate the benefits of using a preconsultation questionnaire routinely.

Methods: This study included consecutive patients attending dermatology outpatients from Dundee (Scotland) and Granada (Spain) who completed a simple preconsultation 3-part questionnaire. Answers to this questionnaire were discussed during clinic visits.

Results: Two hundred patients participated in the study. Of all, 111 (55.5%) patients already knew their diagnosis or were able to describe their symptoms and/or feelings quite accurately at their visit to Dermatology. Most patients (85%) had fears regarding their dermatological problem. A majority of patients (97%) came to clinic with specific expectations, and many (41.5%) had multiple expectations. A high proportion of patients (74%) found the questionnaire useful.

Conclusion: Patients attend clinic with different levels of knowledge, fears, and expectations. We recommend using a brief and easy to use preconsultation questionnaire as a cost-effective way of enhancing doctor-patient communication.
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http://dx.doi.org/10.1177/2374373520912085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7786777PMC
December 2020

Epidermal barrier changes in patients with psoriasis: The role of phototherapy.

Photodermatol Photoimmunol Photomed 2020 Dec 30. Epub 2020 Dec 30.

Dermatology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain.

Background: Some skin diseases may modify epidermal barrier function. Psoriasis is a chronic multi-systemic inflammatory disease that affects the epidermal barrier. Phototherapy is an option for treating psoriasis, but little is known about how epidermal barrier function is modified by phototherapy in psoriatic patients.

Objectives: (a) To compare skin homeostasis between involved and uninvolved skin in psoriatic patients with healthy controls (b) To evaluate changes in the epidermal barrier function in psoriatic patients treated with phototherapy.

Methods: Sixty patients with plaque-type psoriasis and sixty gender and age-matched healthy controls were enrolled. Temperature, transepidermal water loss (TEWL), stratum corneum hydration (SCH), pH, elasticity, erythema and melanin index were measured using non-invasive tools in the healthy control and involved and uninvolved psoriatic skin before and after phototherapy.

Results: Healthy controls had lower TEWL and erythema index and higher SCH than psoriatic patients, both at uninvolved psoriatic skin and psoriasis plaques. TEWL was higher at psoriasis plaques than at uninvolved skin (19.20 vs 11.57 g/h/m ; P < .001). Following phototherapy, a decreasing trend was observed for TEWL, of 1.03 (SD 0.75) and 0.97 (SD 0.81) g/h/m for uninvolved and involved skin respectively. SCH was significantly lower at psoriatic plaques than at uninvolved skin (7.32 vs 36.62Arbitrary Units [AU]; P < .001). SCH increased by 1.15AU (SD 0.26) on psoriatic plaques after the phototherapy session (P < .001).

Conclusion: Psoriatic plaques showed epidermal barrier dysfunction compared to uninvolved skin and healthy controls. Phototherapy may improve epidermal barrier function in psoriatic patients. SCH increased after a phototherapy session on the psoriatic plaques.
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http://dx.doi.org/10.1111/phpp.12650DOI Listing
December 2020

Quality of Life of Cohabitants of People Living with Acne.

Acta Derm Venereol 2020 Oct;100(17):adv00290

Department of Dermatology, Virgen de la Victoria University Hospital, ES-29010 Málaga, Spain.

The aim of this study was to analyse the levels of anxiety, depression, and quality of life of individuals living with acne patients (cohabitants). The study included patients, cohabitants, and controls; a total of 204 participants. Patients' health-related quality of life was measured with the Dermatology Life Quality Index (DLQI), while cohabitants' quality of life was measured with the Family Dermatology Life Quality Index (FDLQI). The psychological state of all participants was measured with the Hospital Anxiety and Depression Scale (HADS). Presence of acne impaired the quality of life of 89.4% of the cohabitants. The FDLQI scores of cohabitants were significantly associated with the DLQI scores of the patients (rp = 0.294; p = 0.044). Anxiety and depression levels in cohabitants were significantly higher than in controls (p < 0.01). In conclusion, acne may have a negative impact on quality of life and psychological well-being of patients and their cohabitants.
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http://dx.doi.org/10.2340/00015555-3636DOI Listing
October 2020

Study of the Exposome Ageing-related Factors in the Spanish Population.

Acta Derm Venereol 2020 May 28;100(10):adv00153. Epub 2020 May 28.

Faculty of Medicine, University of Granada, Granada, Spain.

To characterize the exposome of the Spanish population and its association with skin ageing a cross-sectional epidemiological study was conducted in men and women (18-60 years old). A total of 1,474 participants were included. Mean age (± standard deviation) was 40.84 ± 10.26 years. Most participants had Fitzpatrick skin phototype II (44.1%) and skin ageing in accordance with their current age (69.0%). In the logistic model, age, smoking habit, use of sunscreen and use of cosmetics were all significant independent predictors of skin ageing. Thus, tobacco consumption increased the score of the model towards presenting skin ageing above that expected for age, while the opposite occurred with the use of sunscreen and a complete skin care routine. The exposome therefore has an impact on skin ageing, with age, smoking habit, use of sunscreen and the use of cosmetics identified as predictors of skin ageing. Skin care routines and sunscreen use may help to prevent this process.
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http://dx.doi.org/10.2340/00015555-3500DOI Listing
May 2020

Skin Cancer Prevalence in Outdoor Workers of Ski Resorts.

J Skin Cancer 2020 28;2020:8128717. Epub 2020 Jan 28.

Medical School, Granada University, Granada, Spain.

Background: Snow reflectivity and altitude increase the exposure of ski resort workers to solar ultraviolet radiation. The aim was to assess the presence of skin cancer in ski resorts workers and compare it with other groups of outdoor workers reviewing published studies.

Methods: An observational cross-sectional prospective study was conducted in the three largest ski resorts in Spain: Baqueira Beret, Lleida; Formigal, Huesca and Sierra Nevada, Granada. All outdoor workers including ski instructors were invited to participate in the study. The participants completed a validated questionnaire about sun exposure and underwent a skin examination.

Results: 219 workers were included in the study (80% male; mean age 43.8 (SD 11.31) years). Actinic keratosis (AK) but no other skin cancers were detected in 32 participants (14.62%). Those with AK worked in the Southernmost ski resort, were more likely to have light colour hair, and were older and with higher photoaging grade than those without them.

Conclusion: Compared to other studies, outdoor workers on ski resorts show a higher prevalence of AK than general population but a lower prevalence than other groups of outdoor workers.
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http://dx.doi.org/10.1155/2020/8128717DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7097757PMC
January 2020

Familial frontal fibrosing alopecia in two male families.

Int J Dermatol 2019 Sep 5;58(9):e178-e180. Epub 2019 Jun 5.

Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Granada, Spain.

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http://dx.doi.org/10.1111/ijd.14499DOI Listing
September 2019

Comparative Study of Shrinkage in Human Skin, Artificial Human Skin, and Mouse Skin.

Am J Dermatopathol 2018 Apr;40(4):240-246

Dermatology Unit, Granada University Hospital Complex, Granada, Spain.

Introduction: The shrinkage of surgical specimens (SS) is known in human skin (HS) but has not been studied in an artificial skin (AS) or mouse skin (MS).

Objectives: To quantify the degree of shrinkage of SS and establish its timing in HS and an in vitro and animal model to explore the possible causes of this phenomenon.

Methodology: We collected 100 SS of HS, 50 SS of AS synthesized with fibrin-agarose biomaterials and 21 SS of MS. The width and length of specimens were measured before the surgical excision (pre-SE), at 5 minutes postsurgery (ex vivo), and after 24 hours of fixation in formalin (postfixation). Histological staining was performed to analyze the differences between HS, AS, and MS that may explain the differences in shrinkage.

Results: Between pre-SE and postfixation, the width and length shrank by 16.1% and 17.1% in HS, 14.5% and 8.5% in AS, and 26.5% and 23.1% in MS (P < 0.01), respectively. Shrinkage largely occurred between pre-SE and ex vivo. Cells and interstitial fibers were scant in AS and abundant in MS.

Conclusions: Almost all of the shrinkage occurred during the first 5 minutes postsurgery. According to the AS model findings, 53.6% of SS shrinkage would be explained by the action of dermal fibers and other cellular components of the dermis.
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http://dx.doi.org/10.1097/DAD.0000000000000951DOI Listing
April 2018

Sun Exposure Habits and Sun Protection Practices of Skaters.

J Cancer Educ 2017 Dec;32(4):734-739

School of Medicine, University of Granada, Granada, Spain.

Beach activities and outdoor sports are risk factors for developing skin cancer. Skateboarding is among the most popular sports among adolescents. The aim was to analyse the sun exposure habits and sun protection practices of skaters, in comparison with corresponding sun exposure and protection practices on the beach. This cross-sectional study is based on health surveys carried out into sun exposure and protection practices among young skateboarders. The study population was composed of 102 skaters, of whom 84 (82.4 %) were male. Fifty-eight (56.8 %) of the participants reported having suffered at least one sunburn event the previous summer. Eighty-seven (91.6 %) said they practiced outdoor sports more than 90 days per year, while only six (6.1 %) spent this long at the beach. Forty-nine (52.1 %) practiced outdoor sports for 5 or more hours a day compared to 42 (43.3 %) who spent comparable periods at the beach. A long-sleeved shirt was worn more frequently during sports than at the beach. Keen skaters are a risk group for the development of skin cancer due to excessive sun exposure, high rates of sunburn and scant use of sun protection measures. Specific educational and behavioural interventions should be aimed at this risk group.
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http://dx.doi.org/10.1007/s13187-016-1036-zDOI Listing
December 2017

Adolescents' Attitudes to Sun Exposure and Sun Protection.

J Cancer Educ 2017 Sep;32(3):596-603

School of Medicine, University of Granada, Granada, Spain.

Adolescents are considered a risk group for the development of skin cancer in later life due to their high rates of sunburn. The aim of this study is to evaluate the association between attitudes to sun exposure and the sociodemographic characteristics of adolescents, their habits, practices and knowledge. As a secondary goal, we describe the magnitude and sign of the correlations between these attitudes. Cross-sectional study of adolescent students from 12 secondary schools in southern Spain, the subjects were asked to complete the 'Beach Questionnaire'. This instrument examines four dimensions of attitudes, with standardised scores of 0-100, related to the sun, sun tanning, sun protection and sun cream. The higher the score, the more positive the attitude. The study population was composed of 270 adolescents. The highest scores were obtained for attitudes towards sun protection practices (mean 66.2; SD 18.6) and towards sun tanning (mean 64.2; SD 21.1). The lowest scores were obtained for attitudes towards using sun cream (mean 50.1; SD 24.6). Significant differences were found for all four attitudes, with a positive sign for the relationship between the number of days of sun exposure and a higher score for attitudes towards sunbathing (27.3 points difference between response extremes) and for attitudes towards suntanning (20 points difference). Favourable attitudes towards sunbathing and sun tanning have most influence on inadequate habits of sun exposure and deficient measures of sun protection. Adolescents should be considered a priority group for targeted interventions to improve sun protection behaviour.
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http://dx.doi.org/10.1007/s13187-015-0976-zDOI Listing
September 2017

Sensitivity to change of the Beach Questionnaire to behaviour, attitudes and knowledge related to sun exposure: quasi-experimental before-after study.

BMC Public Health 2015 Jan 31;15:60. Epub 2015 Jan 31.

School of Medicine, Granada University, Granada, Spain.

Background: Health questionnaires must present accredited measurement properties such as validity, reliability and sensitivity to change, the latter being essential for interventions to be planned and for evaluating their effectiveness. The aim of this study was to evaluate the sensitivity to change of a Beach Questionnaire.

Methods: Quasi-experimental before-after study carried out in 2011, for a study population of adolescents attending schools in the Costa del Sol. First, the questionnaire was administered to the adolescents, after which a multicomponent educational intervention was carried out; finally, three months later, the same questionnaire was re-administered to the same adolescents. Changes were assessed in the categories of each item, using the McNemar test, and the changes in the scores, standardised to a range of 0-100, using the Student t test for paired samples, and including the mean of the differences and the 95% confidence interval. The level of statistical significance was set at p < 0.05.

Results: 228 adolescents, aged 14-17 years, and 55.3% were girls. Statistically significant changes were observed in sunburn experiences, exposure to the sun at mid-day and attitudes to sun exposure and suncreams. For the seven items related to knowledge about sun exposure, a higher rate of correct answers was observed. The analysis of changes, within the standardised range, revealed a significant improvement in the scores for sun exposure habits (MD 4.33; CI 95% 2.2-6.5), attitudes to sun exposure (MD 2.22; CI 95% 1.2-3.2) and knowledge (MD 9.10; CI 95% 7.1-11.1), but not in those for sun-protection practices (MD 0.23; CI 95% -1.2-1.7).

Conclusions: The Beach Questionnaire on behaviour, attitudes and knowledge related to sun exposure is the first such instrument in Spanish language to provide sufficient sensitivity to change. It constitutes a useful tool for epidemiologic research into photoprotection and for skin cancer prevention programmes.
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http://dx.doi.org/10.1186/s12889-015-1415-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4314809PMC
January 2015

Prevalence of common and atypical melanocytic nevi in young adults and its relationship with sun protection and exposure habits.

Eur J Dermatol 2015 Jan-Feb;25(1):45-51

Dermatology Department, School of Medicine, Granada University, Spain.

Unlabelled: Background: The incidence of melanoma in young adults is rising. The design of appropriate preventive measures requires the analysis of risk factors, including the prevalence of common and atypical melanocytic nevi (MN) and sun protection and exposure habits.

Objectives: To establish the prevalence and density of common and atypical MN in young adults (18-25 yrs) and their relationship with sun exposure and protection habits.

Methods: Cross-sectional descriptive study was undertaken in 535 university students from southern Spain to gather data on: the number, density, body localization, and characteristics of common and atypical nevi; phototype; sunburn history; sun protection and exposure habits; and family history of skin cancer.

Results: Means of 94.28 common MN and 0.06 atypical MN were detected; most MN were ≤2 mm in diameter; MN were more frequently detected on upper (p<0.01) and lower (p<0.0001 limbs in females versus males and on the trunk (p = 0.08) in males versus females. Nevus density was higher in females in all body areas. Sunburns (in the previous summer) were reported by 88.2% of participants, while cream with SPF ≥15 was not used by 75.8%. Mean number of atypical MN was higher in those with low phototypes and a family history of skin cancer.

Conclusions: Mean number of common MN was elevated and atypical MN were associated with a low phototype and a family history of skin cancer. Sunburn history was significantly associated with younger age and with sun exposure between mid-day and 6 pm.
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http://dx.doi.org/10.1684/ejd.2014.2482DOI Listing
January 2016

Quality of life in persons living with psoriasis patients.

J Am Acad Dermatol 2014 Aug 14;71(2):302-7. Epub 2014 May 14.

School of Medicine, Granada University, Granada, Spain.

Background: Numerous studies have analyzed the influence of psoriasis on the quality of life and psychosocial health of patients. However, few studies have addressed the effect of this disease on individuals living with these patients (cohabitants).

Objective: To analyze the influence of psoriasis on the levels of anxiety, depression, and quality of life of the cohabitants of psoriatic patients.

Methods: The study included patients, cohabitants, and controls, a total of 130 participants. Their quality of life was measured with the Dermatology Life Quality Index (DLQI) and Family Dermatology Life Quality Index (FDLQI), and their psychological state with the Hospital Anxiety and Depression Scale (HADS). Demographic data of participants and clinical characteristics of patients were also gathered.

Results: The presence of psoriasis impaired the quality of life of 87.8% of the cohabitants. FDLQI scores of cohabitants were significantly associated with the DLQI scores of the patients (rs = 0.554; P < .001). Anxiety and depression levels did not differ between patients and cohabitants, but were significantly higher than in the controls (P < .001).

Limitations: Additional studies with larger numbers of patients and cohabitants are required to analyze differences between groups according to psoriasis severity.

Conclusion: Psoriasis markedly worsens the global well-being of patients and their cohabitants, who experienced an impairment of their quality of life and higher levels of anxiety and depression.
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http://dx.doi.org/10.1016/j.jaad.2014.03.039DOI Listing
August 2014

Behaviour, attitudes and awareness concerning sun exposure in adolescents on the Costa del Sol.

Eur J Dermatol 2014 Jan-Feb;24(1):85-93

Dermatology Department, San Cecilio University Hospital, Granada, Spain.

Background: A history of sunburn and cumulative sun exposure during adolescence are the most important risk factors for the development of skin cancer. Skin cancer can be prevented by reducing sun exposure, particularly during adolescence, which is precisely the age group that could best benefit from primary prevention campaigns.

Objective: To determine the behaviour, attitudes and understanding of adolescents concerning sun exposure.

Methods: This cross-sectional descriptive study undertaken during 2011 included secondary school adolescents from randomly selected schools on the Costa del Sol, southern Spain. A validated beachside questionnaire was used to record data on demographics, skin colour, phototype, sun exposure habits, sunburns, practices, attitudes and knowledge about the sun.

Results: The study involved 270 students, aged 14-17 years, from 11 schools; 50.4% were female, 43.7% were aged 14 years, and 85.9% were Spanish. Most had a light skin colour (49.3%) and phototypes III (42.2%) or IV (34.8%). Most (71%) went to the beach on more than 16 days and 74.4% had had sunburn the previous summer. Sun cream was used by 47.8% and 1.1% wore long sleeves or trousers. Concerning attitudes, 60.7% stated they felt better when they were tanned, and concerning understanding, most were aware of the harmful effects of the sun on the skin.

Conclusion: Adolescents comprise a special risk group with a positive attitude towards tanning. Further studies are required to assess educational stategies in order to reduce the desire to have a suntan, and improve sun protection practices and habits targeted at this age group.
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http://dx.doi.org/10.1684/ejd.2014.2266DOI Listing
February 2015

Vitamin D insufficiency is associated with higher carotid intima-media thickness in psoriatic patients.

Eur J Dermatol 2014 Jan-Feb;24(1):53-62

Dermatology Department,, School of Medicine.

Background: Psoriasis has been associated with vitamin D insufficiency and cardiovascular risk factors. Reports show that serum 25-hydroxyvitamin D (25-OHD) levels are inversely associated with chronic inflammatory systemic diseases, cardiovascular risk factors and cardiovascular outcomes.

Objective: To analyze the association between 25-hydroxyvitamin D serum levels and subclinical carotid atherosclerosis (maximal intima-media thickness (MIMT)) in psoriasis patients and controls. MIMT was compared and associated factors were analyzed.

Patients And Method: This was a case-control study with 44 psoriatic patients without arthritis from a Dermatology outpatient clinic in Granada (Spain) and 44 controls. Confounding factors related to 25-OHD serum levels and cardiovascular risk factors were also analyzed.

Results: 25-OHD levels were significantly lower in the psoriatic than in the control group (29.20 vs. 38.00 ng/mL p<0.0001) and a significant negative correlation was found between serum 25-OHD levels and the MIMT (rs=-0.678, p<0.0001) in psoriatic patients. No correlation was found in healthy controls. This association remained after adjusting for confounders. Serum 25-OHD levels were significantly lower (p=0.003) in psoriatic patients with carotid atheromatous plaque (22.38±10.23 ng/mL) than in those without (31.74±8.62 ng/mL). Patients with a longer history of psoriasis presented significantly higher MIMT than controls (638.70±76.21 vs 594.67±80.20 μm; p=0.026 for ≥6 yrs with psoriasis).

Conclusions: In psoriasis patients, lower serum 25-OHD levels were associated with higher MIMT after adjusting for selected confounding factors. The MIMT risk increases with a longer history of psoriasis, regardless of the patient's age.
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http://dx.doi.org/10.1684/ejd.2013.2241DOI Listing
February 2015

Association of 25-hydroxyvitamin D serum levels and metabolic parameters in psoriatic patients with and without arthritis.

J Am Acad Dermatol 2013 Dec 3;69(6):938-46. Epub 2013 Oct 3.

Dermatology Department, San Cecilio University Hospital, Granada, Spain.

Background: Psoriasis has been related to a higher prevalence of cardiovascular risk factors. Vitamin-D deficiency has been associated with metabolic syndrome, cardiovascular disease, and psoriasis. However, there has been no comparative study on the effects of vitamin-D status between patients with and without psoriatic arthritis.

Objective: The objective was to assess the relationship of 25-hydroxyvitamin D [25-(OH)D] levels with lipid and glucose metabolism parameters in psoriatic patients with and without arthritis.

Methods: We studied 122 patients with psoriasis (61 without arthritis and 61 with arthritis) from the psoriasis unit (dermatology department) and rheumatology department of our hospital, analyzing lipid and glucose metabolism variables and serum 25-(OH)D concentrations. Measurements were conducted within a 2-month period to minimize seasonal bias in 25-(OH)D levels.

Results: In the psoriatic patients without arthritis, serum 25-(OH)D levels were inversely correlated with fasting glucose (r = -0.285; P = .026), total cholesterol (r = -0.440; P = .000), low-density lipoprotein (r = -0.415; P = .001), total cholesterol/high-density lipoprotein (r = -0.303; P = .01), and triglyceride (r = -0.280; P = .029) values. This association remained statistically significant for glucose, total cholesterol, and low-density lipoprotein after controlling for confounding factors in multivariate analysis. No association was found between serum 25-(OH)D levels and any metabolic parameter in the patients with psoriatic arthritis.

Limitations: This is a cross-sectional study that supports the hypothesis of an association between vitamin D and metabolic parameters but does not establish a causal relationship.

Conclusions: Serum 25-(OH)D was inversely related to lipid and glucose metabolism parameters in psoriatic patients without arthritis, whereas no such association was observed in psoriatic patients with arthritis. Interventional studies are warranted to assess the effects of vitamin-D supplements on the metabolic profile of psoriatic patients without arthritis.
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http://dx.doi.org/10.1016/j.jaad.2013.08.007DOI Listing
December 2013

"Buen Rayito Study": awareness, attitudes and behavior of teenagers to sunlight through a web based system in Spain.

Eur J Dermatol 2013 Jul-Aug;23(4):505-9

Dermatology Department, Granada School of Medicine, Av Dr. Oloriz 16, Granada. 18012, Spain.

Background: The exponential rise in cutaneous cancers underscores the need to promote primary prevention, emphasising exposure to ultraviolet radiation as the main modifiable risk factor. Children and adolescents are especially vulnerable to radiation.

Objectives: Our objectives were to determine the knowledge and behavior of a Spanish adolescent population in relation to sun exposure thorough a web-based system.

Methods: This cross-sectional study included 1525 school students aged 12-15 yrs. Students completed the survey via the website, with 23 questions and three information blocks on: physical characteristics and general state of health; sun exposure habits and effects; and knowledge of the sun and its effects.

Results: Adolescents displayed a good level of knowledge on the risks of sun exposure, but this did not correlate with healthy sun protection habits. 63.1% of students reported suffering from sunburn in the previous summer and 15.8% reported sunburn with blisters.Sunburn risk increased with the frequency of sun exposure between 12 and 6 pm "always or almost always" (OR of 1.29; p = 0.001), the use of sun protection cream (OR of 1.38; p = 0.034) and decreased with physical sun protection measures (shade) with an OR of 0.85 (p = 0.032) in a multivariate study.

Limitation: The retrospective gathering of sunburn data is a study limitation because of the possibility of a recall bias and potential inter-individual variation in the concept of burn.

Conclusion: The high percentage of sunburns suffered by adolescents in the previous summer underscores the need for skin cancer preventive programs.
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http://dx.doi.org/10.1684/ejd.2013.2075DOI Listing
June 2014

Association of 25-hydroxyvitamin D with metabolic syndrome in patients with psoriasis: a case-control study.

Acta Derm Venereol 2014 Mar;94(2):142-5

Department of Dermatology, San Cecilio University Hospital, ES-18012 Granada, Spain.

Vitamin D deficiency is associated with higher cardiovascular risk and metabolic syndrome (MeS) criteria. The main objective of this study was to analyse the association of 25-hydroxyvitamin D (25-OHD) serum levels with MeS (National Cholesterol Education Program-Adult Treatment Panel-III criteria) in 46 Spanish patients with psoriasis, but without arthritis and systemic treatment, and 46 control subjects, matched by sex and age. The patients with psoriasis showed significantly lower level of 25-OHD than controls (30.5 vs. 38.3 ng/ml; p = 0.0001). Patients with MeS had significantly lower serum levels of 25-OHD than those without MeS (24.1 ± 7.5 vs. 32.8 ± 8.9, p = 0.007), and a negative correlation was found between 25-OHD and waist circumference, diastolic blood pressure, fasting glucose, and triglyceridaemia. In the control group no significant correlation between 25-OHD and MeS was found. Al-though the sample was small, our results suggest a potential protective role for 25-OHD in the metabolic profile of patients with psoriasis without arthritis.
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http://dx.doi.org/10.2340/00015555-1642DOI Listing
March 2014

A skin lesion after cardiac catheterization.

Cleve Clin J Med 2012 Jun;79(6):424-6

Department of Dermatology, San Cecilio University Hospital, Department of Dermatology, Baza General Hospital, Department of Hisotlogy, School of Medicine, Granada University, Granada, Spain.

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http://dx.doi.org/10.3949/ccjm.79a.10108DOI Listing
June 2012

Atheroma plaque, metabolic syndrome and inflammation in patients with psoriasis.

Eur J Dermatol 2012 May-Jun;22(3):337-44

Dermatology Department, San Cecilio University Hospital, Granada, Spain.

Background: Chronic inflammation plays an important role in the development of cardiovascular risk factors. Although the prevalence of comorbidities and cardiovascular events has been described in patients with psoriasis, few studies have examined subclinical atherosclerosis in psoriasis patients.

Objective: Our objective was to investigate the prevalence of atheroma plaques in patients with severe psoriasis compared with control subjects and to analyze the association with metabolic syndrome, homocysteine levels and inflammatory parameters.

Patients And Methods: This case-control study included 133 patients, 72 with psoriasis and 61 controls consecutively admitted to the outpatient clinic in Dermatology Departments (Granada, Spain.)

Results: Carotid atheroma plaques were observed in 34.7% of the psoriatic patients versus 8.2% of the controls (p=0.001) and metabolic syndrome was diagnosed in 40.3% of the psoriatic patients versus 13.1% of the controls (p<0.001). Significantly higher mean values of insulin, aldosterone, homocysteine and acute phase parameters (fibrinogen, D-dimer, C reactive protein and erythrocyte sedimentation rate) were found in psoriatic patients. Binary logistic regression showed a strong association between psoriasis and atheroma plaque and metabolic syndrome after controlling for confounding variables.

Limitations: The absence of longitudinal quantification of metabolic syndrome parameters and intima-media thickness in psoriatic patients.

Conclusion: The chronic inflammation and hyperhomocysteinemia found in psoriatic patients may explain the association with atheroma plaque and metabolic syndrome. Cardiovascular screening by metabolic syndrome criteria assessment and carotid ultrasound in psoriasis may be useful to detect individuals at risk and start preventive treatment against the development of cardiovascular disease.
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http://dx.doi.org/10.1684/ejd.2012.1714DOI Listing
September 2012

A nodule on a woman's face.

Cleve Clin J Med 2012 Apr;79(4):282-4

Department of Dermatology, San Cecilio University Hospital, Granada, Spain.

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http://dx.doi.org/10.3949/ccjm.79a.10115DOI Listing
April 2012

Deficiency of serum concentration of 25-hydroxyvitamin D in psoriatic patients: a case-control study.

J Am Acad Dermatol 2012 Nov 2;67(5):931-8. Epub 2012 Mar 2.

Dermatology Department, San Cecilio University Hospital, Granada, Spain.

Background: Some autoimmune conditions have been associated with reduced vitamin D levels, including systemic lupus erythematosus, rheumatoid arthritis, diabetes mellitus, and multiple sclerosis.

Objective: The main objective of this study was to analyze the 25-hydroxyvitamin D (OHD) status of patients with psoriasis in comparison with control subjects without this disease.

Methods: This case-control study included 86 patients (43 with psoriasis and 43 age- and sex-matched control subjects) from the outpatient clinic of our hospital dermatology department in Granada, Spain. All patients and control subjects were studied during one 4-week period to avoid seasonal variations in vitamin D levels.

Results: Serum 25-OHD levels were significantly lower in psoriatic patients than in control subjects even after adjusting for confounding factors in a multivariate analysis (odds ratio 2.89, 95% confidence interval 1.02-7.64, P < .03 for vitamin D insufficiency). Low 25-OHD levels were negatively associated with C-reactive protein (inflammatory activation marker) and body mass index in multiple linear regression analysis. Psoriatic patients with body mass index greater than or equal to 27 kg/m(2) had a higher risk of 25-OHD insufficiency (sensitivity of 82.3% and specificity of 51.7%).

Limitations: Further studies with larger numbers of patients are required to analyze the pathogenic mechanisms underlying the relationship between 25-OHD deficiency and psoriasis.

Conclusions: The 25-OHD values are significantly lower in psoriatic patients than in control subjects. Low 25-OHD levels are negatively associated with C-reactive protein, an inflammatory activation marker, and with obesity. Psoriatic patients with a body mass index of 27 or more are likely to have vitamin D insufficiency.
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http://dx.doi.org/10.1016/j.jaad.2012.01.040DOI Listing
November 2012

An erythematous plaque on the nose.

Cleve Clin J Med 2011 Nov;78(11):728-32

Department of Dermatology, San Cecilio University Hospital, Granada, Spain.

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http://dx.doi.org/10.3949/ccjm.78a.10107DOI Listing
November 2011

Variables associated with sun protection behaviour of preschoolers.

Eur J Dermatol 2011 Nov-Dec;21(6):985-90

UGC Salud Mental Hospital Universitario San Cecilio, Avenida Dr. Olóriz No16, 18012 Granada, Spain.

Little research has been published on the variables associated with sun protection behaviour in preschoolers. We aimed to define variables associated with sun protection behaviour of a sample of Spanish preschoolers. A cross-sectional observational study was conducted in two stages: 1) the design and validation of the measurement instrument, and 2) its application in a final sample of 100 (60 valid questionnaires) children for bivariate and multivariate binary logistic regression analyses of the data. The sun protection behaviour of the children was most strongly associated with: parental sun protection behaviour, absence or low frequency of sunburn in parents and children, and lower parental perception of obstacles to sun protection. Other significant factors were lower phototype, younger age, shorter sun exposure times and awareness of the sun as a risk factor. The role of social communication programmes, dermatologists and other agents providing information or sun protection advice was contradictory and associated with lower sun protection in some cases. Parental sun protection, absence or lower frequency of sunburns in parents and children, lower phototype of children, knowledge about sun exposure as a risk factor, younger age and lower parental perception of obstacles to their children's sun protection were significantly associated with the sun protection of the children.
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http://dx.doi.org/10.1684/ejd.2011.1525DOI Listing
April 2012

Androgenetic alopecia as an early marker of benign prostatic hyperplasia.

J Am Acad Dermatol 2012 Mar 11;66(3):401-8. Epub 2011 Aug 11.

Dermatology Unit, San Cecilio University, Granada, Spain.

Background: Androgenetic alopecia (AGA) and benign prostatic hyperplasia are both androgen-dependent entities that respond to the blocking of 5-alpha-reductase.

Objectives: The objective of this study was to determine whether prostatic volumes and urinary flow changes were higher in patients with early-onset AGA than in healthy control subjects.

Methods: This was an observational case-control study of 87 men: 45 with early-onset AGA diagnosed in the dermatology department and 42 control subjects. End-point variables were prostatic volume, measured by transrectal ultrasound, and urinary flow, measured by urinary flowmetry. A hormone study was performed on all participants, and the International Prostate Symptom Score and International Index of Erectile Function score were determined.

Results: The groups did not significantly differ in mean age (cases, 52.7 years vs control subjects, 49.8 years; P = .12). Patients with AGA had significantly higher mean prostate volume (29.65 vs 20.24 mL, P < .0001), International Prostate Symptom Score (4.93 vs 1.23, P < .0001), and prostate-specific antigen value (1.53 vs 0.94 ng/mL, P < .0001) and significantly lower maximum urinary flow (14.5 vs 22.45 mL/s, P < .0001) versus control subjects. Binary logistic regression analysis showed a strong association between the presence of AGA and benign prostatic hyperplasia after adjusting for age, urinary volume, urination time, International Prostate Symptom Score, abdominal obesity, glucose levels, systolic blood pressure, insulin levels, fibrinogen, and C-reactive protein (odds ratio = 5.14, 95% confidence interval 1.23-47.36, P = .041).

Limitations: The study of larger sample sizes would facilitate stratified analyses according to the Ebling type of androgenetic alopecia.

Conclusion: There is a relationship between the presence of AGA and prostate growth-associated urinary symptoms, likely attributable to their pathophysiological similarity. This study suggests that early-onset AGA may be an early marker of urinary/prostatic symptomatology. Future studies may clarify whether treatment of patients with AGA may benefit the concomitant benign prostatic hypertrophy, which would be present at an earlier stage in its natural evolution.
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http://dx.doi.org/10.1016/j.jaad.2010.12.023DOI Listing
March 2012

Cardiovascular risk factors in patients with lichen planus.

Am J Med 2011 Jun;124(6):543-8

Department of Dermatology, San Cecilio University Hospital, Granada, Spain.

Background: Chronic inflammation was found to play an important role in the development of cardiovascular risk factors. Recently a case-control study found that lichen planus was associated with dyslipidemia in a large series of patients. However, no data were presented about lipid values, glucose levels, or blood pressure.

Objective: The objective of this case-control study was to evaluate cardiovascular risk factors included in Adult Treatment Panel III criteria for metabolic syndrome in men and women with lichen planus and in healthy controls.

Patients And Methods: This case-control study included 200 patients, 100 with lichen planus (50 men and 50 women) and 100 controls consecutively admitted to the outpatient clinic in Dermatology departments in Granada, Spain.

Results: Analysis of metabolic syndrome parameters revealed a higher significant prevalence of dyslipidemia in patients with lichen planus. No significant differences were observed in glucose levels, abdominal obesity, or blood pressure. Elevated levels of C-reactive protein, erythrocyte sedimentation rate, and fibrinogen were noted in patients with lichen planus. Adjusted odds ratio for dyslipidemia in patients with lichen planus was 2.85 (95% confidence interval, 1.33-5.09; P=.001).

Conclusion: Chronic inflammation in patients with lichen planus may explain the association with dyslipidemia. Lipid levels screening in men or women with lichen planus may be useful to detect individuals at risk and start preventive treatment against the development of cardiovascular disease.
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http://dx.doi.org/10.1016/j.amjmed.2010.12.025DOI Listing
June 2011

Sex hormone-binding globulin and risk of hyperglycemia in patients with androgenetic alopecia.

J Am Acad Dermatol 2011 Jul 20;65(1):48-53. Epub 2011 Apr 20.

Dermatology Unit, San Cecilio University Hospital, Granada, Spain.

Background: Low circulating levels of sex hormone-binding globulin (SHBG) are a strong predictor of the risk of type 2 diabetes. Androgenetic alopecia (AGA) has been related to an increase in cardiovascular risk, but the mechanism of this association has not been elucidated. AGA can be associated with low levels of SHBG and insulin resistance, which could be related to hyperglycemia and type 2 diabetes.

Objective: The objective of this study was to evaluate SHBG and blood glucose levels in men and women with early-onset AGA and control subjects to determine whether low levels of SHBG are associated with hyperglycemia.

Methods: This case-control study included 240 patients consecutively admitted to the outpatient clinic (Dermatology Department of San Cecilio University Hospital, Granada, Spain), 120 with early-onset AGA (60 men and 60 women) and 120 control subjects (60 men and 60 women) with skin diseases other than alopecia.

Results: Of patients with AGA, 39.1% presented with hyperglycemia (>110 mg/dL) versus 12.5% of controls (P < 0.0001). AGA patients with hyperglycemia or diabetes presented lower significant levels of SHBG than alopecic patients without hyperglycemia or type 2 diabetes, respectively. Patients with AGA and hyperglycemia presented significantly lower levels of SHBG than controls with hyperglycemia (22.3 vs 39.4 nmol/L for AGA patients and controls, respectively, P = .004). No significant differences in SHBG levels were noticed between patients and controls without hyperglycemia. Binary logistic regression showed a strong association between lower SHBG levels and glucose levels greater than 110 mg/dL in patients with AGA even after additional adjustment for sex, abdominal obesity, and free testosterone (odds ratio = 3.35; 95% confidence interval = 1.9-5.7; P < .001).

Limitations: The study of a wider sample of AGA patients would confirm these findings and would permit analysis of the pathogenic mechanisms underlying the increase in cardiovascular risk in patients with AGA.

Conclusion: An association between early-onset AGA, hyperglycemia/diabetes, and low levels of SHBG was observed in the current study. Low levels of SHBG could be a marker of insulin resistance and hyperglycemia/diabetes in patients with AGA.
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http://dx.doi.org/10.1016/j.jaad.2010.05.002DOI Listing
July 2011