Publications by authors named "Salvador Arias-Santiago"

198 Publications

Skin adverse events related to personal protective equipment: a systematic review and metanalysis.

J Eur Acad Dermatol Venereol 2021 Jun 2. Epub 2021 Jun 2.

Department of Dermatology, Virgen de las Nieves University Hospital, Granada, Spain.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a global pandemic that has spread all over the word. To avoid the virus transmission, healthcare workers (HCWs) must wear adequate personal protective equipment (PPE). PPE is associated with several side events, including skin reactions. The objective of this study is to summarize the prevalence, type and risk factors for cutaneous adverse events related to PPE and prevention measures to avoid them. A systematic review and metanalysis was conducted using Medline, Scopus and Embase databases from conception to 21 January 2021. All types of epidemiological studies regarding skin adverse events related to PPE were included. The literature search identified 1,007 references, 35 of them met the eligible criteria and were included for analysis, representing 31,453 participants. The media of skin side events related to PPE was 75.13%. The rate of cutaneous adverse events related to mask was 57.71% and those associated with gloves and hand hygiene products was 49.16%. Most common skin adverse events were contact dermatitis, acne and itching. The most damaged anatomical regions were the nasal bridge, the cheeks and the hands. The duration of PPE wearing was the most common risk factor. Frequent hand washing, gloves and masks were the agents most frequently related to skin reactions. N95 respirators were the most harmful mask type for the skin. Hydrocolloid use prevented from developing skin adverse events related to masks. In conclusion, the rate of cutaneous adverse events related to PPE use is high. A longer duration of PPE wearing was the most common risk factor. Using hydrocolloid could prevent from skin injuries related to mask use.
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http://dx.doi.org/10.1111/jdv.17436DOI Listing
June 2021

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

Influence of Genetic Polymorphisms on Response to Biologics in Moderate-to-Severe Psoriasis.

J Pers Med 2021 Apr 12;11(4). Epub 2021 Apr 12.

Pharmacogenetics Unit, Pharmacy Service, University Hospital Virgen de las Nieves, 18014 Granada, Spain.

Psoriasis is a chronic inflammatory skin pathology of autoimmune origin and unknown etiology. There are various therapies for treating it, including a wide range of biopharmaceuticals indicated in moderate-to-severe psoriasis. Depending on their therapeutic target, they are classified as tumor necrosis factor inhibitors (anti-TNF) or cytokine inhibitors (interleukin-12, 23, and 17 antagonists). Although they have proved effective and safe, in clinical practice, many patients show a short- and long-term suboptimal response and even varying degrees of toxicity. This variability in response may be influenced by genetic factors, such as polymorphisms in the genes involved in the pathological environment, metabolism or mechanism of action of the drug that could affect the effectiveness and toxicity of biological therapies. This review assesses pharmacogenetic studies of the impact of genetic factors on response to biopharmaceuticals and toxicity in patients diagnosed with moderate-to-severe psoriasis. The results suggest that polymorphisms detected in the HLA genes, in genes that encode cytokines (, IL genes, ), transporters (, , receptors (, , and , , , TLR genes, ) and associated proteins (, , , ), as well as other genes implicated in the pathogenesis of psoriasis (, , , , , , , , , ) can be used in the future as predictive markers of treatment response and/or toxicity with biological therapies in patients diagnosed with moderate-to-severe psoriasis, tailoring treatment to the individual patient.
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http://dx.doi.org/10.3390/jpm11040293DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8069496PMC
April 2021

Frontal Fibrosing Alopecia: A Review.

J Clin Med 2021 Apr 21;10(9). Epub 2021 Apr 21.

Dermatology Department, University Hospital Virgen de las Nieves, 18014 Granada, Spain.

Frontal fibrosing alopecia is a scarring alopecia, the prevalence of which is increasing worldwide since its first description in 1994. The reason for this emerging epidemic may be a higher exposure to an unknown trigger, although its aethiology and pathogenesis still remain enigmatic. Clinical, trichoscopic, sonographic, and histopathologic findings are allowing clinicians to understand more aspects about this type of cicatricial alopecia. Several treatments have been used in frontal fibrosing alopecia, although the 5-alpha reductase inhibitors seem to be the most promising. The aim of this report is to provide a compilation about the published data regarding frontal fibrosing alopecia in a narrative review.
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http://dx.doi.org/10.3390/jcm10091805DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8122646PMC
April 2021

The Role of Exosomes Derived From Mesenchymal Stromal Cells in Dermatology.

Front Cell Dev Biol 2021 7;9:647012. Epub 2021 Apr 7.

Cell Production and Tissue Engineering Unit, Virgen de las Nieves University Hospital, Granada, Spain.

The skin is the largest organ of the human body and its main functions include providing protection from external harmful agents, regulating body temperature, and homeostatic maintenance. Skin injuries can damage this important barrier and its functions so research focuses on approaches to accelerate wound healing and treat inflammatory skin diseases. Due to their regenerative and immunomodulatory properties, mesenchymal stromal cells (MSCs) have been reported to play a significant role in skin repair and regeneration. However, it seems that the secretome of these cells and exosomes in particular may be responsible for their functions in skin regeneration and the immunomodulation field. The present review aims to gather the available information about the role of MSC-derived exosomes for both and models of different skin conditions and to highlight the need for further research in order to overcome any limitations for clinical translation.
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http://dx.doi.org/10.3389/fcell.2021.647012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8058372PMC
April 2021

Reproductive Potential and Outcomes in Patients with Hidradenitis Suppurativa: Clinical Profile and Therapeutic Implications.

Life (Basel) 2021 Mar 26;11(4). Epub 2021 Mar 26.

Hidradenitis Suppurativa Clinic, Dermatology, Hospital Universitario Virgen de las Nieves, 18012 Granada, Spain.

There are scarce data available regarding the impact of hidradenitis suppurativa (HS) on fertility, course and outcome of pregnancy and risk associated with treatments. The aims of this study are (1) to describe the clinical profile of HS women of childbearing age with and without accomplished reproductive desires and (2) to describe the prescribed treatments based on the fulfillment of reproductive intentions. We conducted a prospective observational study that included 104 HS women of childbearing age, 50.96% (53/104) with unfulfilled reproductive desires. These women were younger (29.08 vs. 42.06 years, < 0.001), less frequently married and higher educated than women with fulfilled reproductive desires. Their age of disease onset was lower, but disease duration was shorter, in concordance with a lower International Hidradenitis Suppurativa Severity Score System (IHS4) and lower number of draining tunnels. Combined oral contraceptives were more frequently prescribed in women with unfulfilled reproductive desires (30.19% vs. 9.80%, = 0.013) while biologics were less used in this group (3.77% vs. 13.73%, = 0.08). In conclusion, a higher educational level and an earlier disease onset, with potential implications in finding a partner, may make the fulfillment of reproductive desires difficult for patients with HS. This study could help clinicians to achieve a better understanding of the specific characteristics of HS during childbearing age and consider reproductive desires when making treatment decisions.
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http://dx.doi.org/10.3390/life11040277DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8066603PMC
March 2021

Itchy Capillary Malformations: Unusual Appearance of Meyerson Phenomenon, a Case Series.

Pediatr Rep 2021 Mar 16;13(1):131-134. Epub 2021 Mar 16.

Dermatology Unit, IBS Granada, Hospital Universitario Virgen de las Nieves, 18012 Granada, Spain.

Meyerson phenomenon, also known as "halo-eczema," has been widely described over melanocytic and non-melanocytic lesions. However, its appearance over vascular anomalies is rarely observed and could lead to diagnostic errors. A case study of five patients aged between four months and two years is reported. These patients developed unique erythematous and pruritic scaly patches, being diagnosed and treated as fungal infections. Due to the lack of response to the treatment, they were referred to the pediatric dermatology practice, where the diagnosis of Meyerson phenomenon over capillary malformations was made. Topical treatment with corticosteroids led to improvement in all cases. Although Meyerson phenomenon developing over vascular anomalies is a rare condition, it is important for pediatricians and dermatologists to assess it as a part of the differential diagnosis when treating a patient with skin lesions. Recognizing this phenomenon will prevent diagnostic and therapeutic errors.
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http://dx.doi.org/10.3390/pediatric13010019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8005987PMC
March 2021

Hair Shaft Examination: A Practical Tool to Diagnose Griscelli Syndrome.

Dermatopathology (Basel) 2021 Mar 9;8(1):49-53. Epub 2021 Mar 9.

Department of Dermatology, Hospital Universitario Virgen de las Nieves, 18012 Granada, Spain.

Griscelli syndrome (GS) is a rare disease that is characterized by silvery hair and fair skin. It is included in congenital grey hair syndromes, a rare group of autosomal recessive disorders characterized by silvery grey hair and severe multisystem disorders, such as immune system impairment, defects in immunological function, ocular and skeletal alterations, and nervous system defects. Herein, we report a rare case of GS type 1 and highlight the importance of a dermatological and hair examination to make an early diagnosis of these life-threatening diseases.
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http://dx.doi.org/10.3390/dermatopathology8010010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8008316PMC
March 2021

Current Advanced Therapies Based on Human Mesenchymal Stem Cells for Skin Diseases.

Front Cell Dev Biol 2021 9;9:643125. Epub 2021 Mar 9.

Cell Production and Tissue Engineering Unit, Andalusian Network of Design and Translation of Advanced Therapies, Virgen de las Nieves University Hospital, Granada, Spain.

Skin disease may be related with immunological disorders, external aggressions, or genetic conditions. Injuries or cutaneous diseases such as wounds, burns, psoriasis, and scleroderma among others are common pathologies in dermatology, and in some cases, conventional treatments are ineffective. In recent years, advanced therapies using human mesenchymal stem cells (hMSCs) from different sources has emerged as a promising strategy for the treatment of many pathologies. Due to their properties; regenerative, immunomodulatory and differentiation capacities, they could be applied for the treatment of cutaneous diseases. In this review, a total of thirteen types of hMSCs used as advanced therapy have been analyzed, considering the last 5 years (2015-2020). The most investigated types were those isolated from umbilical cord blood (hUCB-MSCs), adipose tissue (hAT-MSCs) and bone marrow (hBM-MSCs). The most studied diseases were wounds and ulcers, burns and psoriasis. At preclinical level, studies with mice and rats were the main animal models used, and a wide range of types of hMSCs were used. Clinical studies analyzed revealed that cell therapy by intravenous administration was the advanced therapy preferred except in the case of wounds and burns where tissue engineering was also reported. Although in most of the clinical trials reviewed results have not been posted yet, safety was high and only local slight adverse events (mild nausea or abdominal pain) were reported. In terms of effectiveness, it was difficult to compare the results due to the different doses administered and variables measured, but in general, percentage of wound's size reduction was higher than 80% in wounds, Psoriasis Area and Severity Index and Severity Scoring for Atopic Dermatitis were significantly reduced, for scleroderma, parameters such as Modified Rodnan skin score (MRSC) or European Scleroderma Study Group activity index reported an improvement of the disease and for hypertrophic scars, Vancouver Scar Scale (VSS) score was decreased after applying these therapies. On balance, hMSCs used for the treatment of cutaneous diseases is a promising strategy, however, the different experimental designs and endpoints stablished in each study, makes necessary more research to find the best way to treat each patient and disease.
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http://dx.doi.org/10.3389/fcell.2021.643125DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7985058PMC
March 2021

Treatment challenges in clinically amyopathic dermatomyositis: A case series and review of new therapeutic options for skin involvement.

Dermatol Ther 2021 May 23;34(3):e14942. Epub 2021 Mar 23.

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

The term clinically amyopathic dermatomyositis (CADM) is used to represent a subgroup of patients with the typical cutaneous features of dermatomyositis (DM) in the absence of muscle involvement. Similar to classic DM, CADM can be associated with other connective tissue disorders and systemic manifestations such as interstitial lung disease and malignancy. Owing to the frequent discordance between muscle response and skin disease, the therapeutic approach to CADM represents a challenge. The current literature suggests that CADM treatment should follow a specific protocol, influenced by visceral involvement and the expression of certain myositis-specific antibodies, and different from the recommendation in the presence of myositis. Here, we present five new cases of CADM. We describe the available therapeutic options for skin manifestations in this type of DM, and we propose a step-by-step therapeutic scheme, using the cutaneous dermatomyositis disease area and severity index to assess response. Our literature review establishes mycophenolate mofetil and intravenous immunoglobulin as the most frequently successful therapies in refractory skin disease.
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http://dx.doi.org/10.1111/dth.14942DOI Listing
May 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

Cytotoxicity and Epidermal Barrier Function Evaluation of Common Antiseptics for Clinical Use in an Artificial Autologous Skin Model.

J Clin Med 2021 Feb 8;10(4). Epub 2021 Feb 8.

Cell Production and Tissue Engineering Unit, Virgen de las Nieves University Hospital, 18014 Granada, Spain.

Bioengineered artificial skin substitutes (BASS) are the main treatment used in addition to autografts when skin injuries involve a large body surface area. Antiseptic/antibiotic treatment is necessary to prevent infections in the BASS implant area. This study aims to evaluate the effect of antiseptics and antibiotics on cell viability, structural integrity, and epidermal barrier function in BASS based on hyaluronic acid during a 28 day follow-up period. Keratinocytes (KTs) and dermal fibroblasts (DFs) were isolated from skin samples and used to establish BASS. The following antibiotic/antiseptic treatment was applied every 48 h: colistin (1%), chlorhexidine digluconate (1%), sodium chloride (0.02%), and polyhexanide (0.1%). Cell viability (LIVE/DEAD assay), structural integrity (histological evaluation), and epidermal barrier function (trans-epidermal water loss, (TEWL), Tewameter) were also evaluated. Cell viability percentage of BASS treated with chlorhexidine digluconate was significantly lower ( ≤ 0.001) than the other antiseptics at day 28. Compared to other treatments, chlorhexidine digluconate and polyhexanide significantly affected the epithelium. No significant differences were found regarding epidermal barrier. These results may be useful for treatment protocols after implantation of BASS in patients and evaluating them in clinical practice. BASS represent a suitable model to test in vitro the impact of different treatments of other skin wounds.
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http://dx.doi.org/10.3390/jcm10040642DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7914612PMC
February 2021

The role of biologic treatment in special scenarios in hidradenitis suppurativa: Facial and nape phenotype, dissecting cellulitis of the scalp, and lymphedema.

Dermatol Ther 2021 03 15;34(2):e14829. Epub 2021 Feb 15.

Hidradenitis Suppurativa Clinic, Department of Dermatology, Hospital Universitario Virgen de las Nieves, Granada, Spain.

Hidradenitis suppurativa (HS) is a chronic inflammatory disorder affecting the hair follicle which typically affects the axilla, inguinal, submammary, and perianal areas. Atypical HS, such as facial HS, dissecting cellulitis of the scalp (DCS), nape HS, and HS lymphedema has also been described. There is scarce evidence about the treatment of atypical HS. To describe the efficacy of biologic drugs and adjuvant therapeutic interventions used in patients with atypical HS who had an inadequate response to systemic antibiotics. Prospective case series study of patients with atypical HS (facial HS, DCS, nape HS, and HS lymphedema) treated with biologic drugs in a HS Clinic setting. Disease activity indexes, sociodemographic, clinical, and safety variables were collected. Two patients met criteria for Facial HS, three met criteria for DCS/nape HS and three patients met criteria for HS lymphedema. Patients with facial HS achieved rapid improvement without requiring other therapies. Patients with DCS, nape HS, and HS lymphedema showed variable response, with decrease of activity indexes, and requiring adjuvant treatments. Biologic drugs are useful in the management of special HS locations. In the case of facial HS, biologic therapy seems to be quite effective as monotherapy. In the cases of DCS, HS lymphedema and nape HS, treatment combination or intensification may be needed.
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http://dx.doi.org/10.1111/dth.14829DOI Listing
March 2021

Skin Barrier Function in Psoriasis and Atopic Dermatitis: Transepidermal Water Loss and Temperature as Useful Tools to Assess Disease Severity.

J Clin Med 2021 Jan 19;10(2). Epub 2021 Jan 19.

Dermatology Department, Hospital Universitario Virgen de las Nieves, Avenida de Madrid, 15, 18012 Granada, Spain.

Multiple diagnostic tools are used to evaluate psoriasis and atopic dermatitis (AD) severity, but most of them are based on subjective components. Transepidermal water loss (TEWL) and temperature are skin barrier function parameters that can be objectively measured and could help clinicians to evaluate disease severity accurately. Thus, the aims of this study are: (1) to compare skin barrier function between healthy skin, psoriatic skin and AD skin; and (2) to assess if skin barrier function parameters could predict disease severity. A cross-sectional study was designed, and epidermal barrier function parameters were measured. The study included 314 participants: 157 healthy individuals, 92 psoriatic patients, and 65 atopic dermatitis patients. TEWL was significantly higher, while stratum corneum hydration (SCH) (8.71 vs. 38.43 vs. 44.39 Arbitrary Units (AU)) was lower at psoriatic plaques than at uninvolved psoriatic skin and healthy controls. Patients with both TEWL > 13.85 g·mh and temperature > 30.85 °C presented a moderate/severe psoriasis (psoriasis area severity index (PASI) ≥ 7), with a specificity of 76.3%. TEWL (28.68 vs. 13.15 vs. 11.60 g·m h) and temperature were significantly higher, while SCH (25.20 vs. 40.95 vs. 50.73 AU) was lower at AD eczematous lesions than uninvolved AD skin and healthy controls. Patients with a temperature > 31.75 °C presented a moderate/severe AD (SCORing Atopic Dermatitis (SCORAD) ≥ 37) with a sensitivity of 81.8%. In conclusion, temperature and TEWL values may help clinicians to determine disease severity and select patients who need intensive treatment.
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http://dx.doi.org/10.3390/jcm10020359DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7833436PMC
January 2021

Implications of Hidradenitis Suppurativa Phenotypes in Cardiovascular Risk and Treatment Decisions: A Retrospective Cohort Study.

Dermatology 2021 Jan 21:1-6. Epub 2021 Jan 21.

Hidradenitis Suppurativa Clinic, Department of Dermatology, Hospital Universitario Virgen de las Nieves, Granada, Spain.

Background: New integrative hidradenitis suppurativa (HS) lesion pattern phenotypes have been proposed, an inflammatory phenotype (IP) and a follicular phenotype (FP). They are characterized by different lesion patterns, symptoms, and risks of disease progression.

Objectives: To evaluate whether lesion pattern phenotypes (1) have a different cardiovascular risk factor profile, and (2) are associated with a different therapeutic approach in the setting of an HS clinic.

Methods: A retrospective cohort study was conducted on 233 patients with HS. They were classified according to lesion pattern phenotype criteria. Data regarding cardiovascular risk factors and treatment decisions were gathered.

Results: One hundred and seventeen HS patients (50.21%) were classified as FP and 112 (48.07%) as IP. IP was associated with more severe disease and greater impairment of quality of life. Regardless of disease severity, patients with IP may have a higher cardiovascular risk, assessed according to higher C-reactive protein (CRP) levels (12.75 vs. 5.89, p = 0.059). The lesion pattern phenotype also influenced treatment decisions regardless of disease severity. Patients with IP were more likely to be treated with systemic corticosteroids and adalimumab, showing that lesion pattern phenotypes are associated with different therapeutic approaches.

Conclusions: IP is associated with higher CRP values, suggesting a greater cardiovascular risk in these patients and also a different therapeutic approach. This information could help guide dermatologists in the management of HS patients and help to determine future treatment recommendations.
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http://dx.doi.org/10.1159/000513044DOI Listing
January 2021

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

Colour Doppler ultrasound study in patients with frontal fibrosing alopecia.

Skin Res Technol 2021 Jan 17. Epub 2021 Jan 17.

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

Background: The sonographic characteristics of frontal fibrosing alopecia have been scarcely studied. The aim of this study was to perform a colour Doppler ultrasound evaluation in frontal fibrosing alopecia.

Materials And Methods: A cross-sectional study including 99 women with frontal fibrosing alopecia and 40 control subjects was performed using ultrasound equipment with a lineal 18 MHz probe. Three areas were evaluated per patient: the alopecic area (a), the hairline implantation area (b) and healthy scalp (c). The diameter (cm) and flow (m/s) of the two most significant vessels were recorded.

Results: With regard to the hairline implantation area, patients presented higher vessel diameter (0.127 cm vs 0.103 cm, P = .03) and vessel flow (8.183 m/s vs 7.670 m/s, P = .05) than the control group. Vessel diameter was higher in the healthy scalp area in patients than in the control group (0.088 cm vs 0.078 cm, P = .03).

Conclusion: Patients presented higher vessel diameter and flow in the hairline implantation area compared to the control group.
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http://dx.doi.org/10.1111/srt.13004DOI Listing
January 2021

Impact of Gloves and Mask Use on Epidermal Barrier Function in Health Care Workers.

Dermatitis 2021 Jan-Feb 01;32(1):57-62

Instituto de Investigación Biosanitaria IBS.

Background: Coronavirus disease 2019 has rapidly spread all over the world. Personal protective equipment (PPE) including masks and gloves is needed to avoid transmission. Adverse skin reactions associated with PPE have been described, but there is no information regarding objective measures to assess skin impairment related to PPE.

Objective: The aim of the study was to evaluate the impact of using facial mask and nitrile gloves on epidermal barrier function and skin homeostasis.

Methods: A cross-sectional study was designed. Thirty-four health care workers wearing nitrile gloves and a mask for 2 hours were included. Transepidermal water loss, stratum corneum hydration, erythema, and temperature were measured.

Results: Transepidermal water loss (31.11 vs 14.24 g·m-2·h-1), temperature (33.29°C vs 32.57°C), and erythema were significantly greater at the area covered by gloves compared with the noncovered area. Transepidermal water loss (22.82 vs 13.69 g·m-2·h-1), temperature, and erythema (411.43 vs 335.52 arbitrary units) were significantly increased at the area covered by mask, whereas stratum corneum hydration was lower. Transepidermal water loss was greater at the area covered by a surgical mask than at a filtering respirator mask coded filtering facepiece 2 (27.09 vs 18.02 g·m-2·h-1, P = 0.034).

Conclusions: Skin homeostasis and epidermal barrier function may be impaired by gloves and mask use. High-quality PPE should be provided, and adequate skin prevention measures should be implemented to reduce epidermal barrier damage.
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http://dx.doi.org/10.1097/DER.0000000000000682DOI Listing
January 2021

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

Mesenchymal stromal cells in human immunodeficiency virus-infected patients with discordant immune response: Early results of a phase I/II clinical trial.

Stem Cells Transl Med 2021 Apr 2;10(4):534-541. Epub 2020 Dec 2.

Unidad Clínica Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío/Instituto Biomedicina de Sevilla/CSIC/Universidad de Sevilla, Avd. Manuel Siurto s/n, SEVILLA, España, Spain.

Between 15% and 30% of HIV-infected subjects fail to increase their CD4 T-cell counts despite continuous viral suppression (immunological nonresponders [INRs]). These subjects have a higher morbidity and mortality rate, but there are no effective treatments to reverse this situation so far. This study used data from an interrupted phase I/II clinical trial to evaluate safety and immune recovery after INRs were given four infusions, at baseline and at weeks 4, 8, and 20, with human allogeneic mesenchymal stromal cells from adipose tissue (Ad-MSCs). Based on the study design, the first 5 out of 15 INRs recruited received unblinded Ad-MSC infusions. They had a median CD4 nadir count of 16/μL (range, 2-180) and CD4 count of 253 cells per microliter (171-412) at baseline after 109 (54-237) months on antiretroviral treatment and 69 (52-91) months of continuous undetectable plasma HIV-RNA. After a year of follow-up, an independent committee recommended the suspension of the study because no increase of CD4 T-cell counts or CD4 /CD8 ratios was observed. There were also no significant changes in the phenotype of different immunological lymphocyte subsets, percentages of natural killer cells, regulatory T cells, and dendritic cells, the inflammatory parameters analyzed, and cellular associated HIV-DNA in peripheral blood mononuclear cells. Furthermore, three subjects suffered venous thrombosis events directly related to the Ad-MSC infusions in the arms where the infusions were performed. Although the current study is based on a small sample of participants, the findings suggest that allogeneic Ad-MSC infusions are not effective to improve immune recovery in INR patients or to reduce immune activation or inflammation. ClinicalTrials.gov identifier: NCT0229004. EudraCT number: 2014-000307-26.
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http://dx.doi.org/10.1002/sctm.20-0213DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7980217PMC
April 2021

Potential role of human allogeneic mesenchymal cells in the treatment of refractory fistulas in patients with hidradenitis suppurativa.

Dermatol Ther 2021 01 21;34(1):e14548. Epub 2020 Nov 21.

TECe19-Clinical and Translational Dermatology Investigation Group, Instituto de Investigación Biosanitaria, Granada, Spain.

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http://dx.doi.org/10.1111/dth.14548DOI Listing
January 2021

Advanced Medical Therapies in the Management of Non-Scarring Alopecia: Areata and Androgenic Alopecia.

Int J Mol Sci 2020 Nov 9;21(21). Epub 2020 Nov 9.

Dermatology Unit, Virgen de las Nieves University Hospital, Av de Madrid, 15, 18012 Granada, Spain.

Alopecia is a challenging condition for both physicians and patients. Several topical, intralesional, oral, and surgical treatments have been developed in recent decades, but some of those therapies only provide partial improvement. Advanced medical therapies are medical products based on genes, cells, and/or tissue engineering products that have properties in regenerating, repairing, or replacing human tissue. In recent years, numerous applications have been described for advanced medical therapies. With this background, those therapies may have a role in the treatment of various types of alopecia such as alopecia areata and androgenic alopecia. The aim of this review is to provide dermatologists an overview of the different advanced medical therapies that have been applied in the treatment of alopecia, by reviewing clinical and basic research studies as well as ongoing clinical trials.
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http://dx.doi.org/10.3390/ijms21218390DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7664905PMC
November 2020

From Grafts to Human Bioengineered Vascularized Skin Substitutes.

Int J Mol Sci 2020 Nov 2;21(21). Epub 2020 Nov 2.

Cell Production and Tissue Engineering Unit. Virgen de las Nieves University Hospital, 18014 Granada, Spain.

The skin plays an important role in the maintenance of the human's body physiological homeostasis. It acts as a coverage that protects against infective microorganism or biomechanical impacts. Skin is also implied in thermal regulation and fluid balance. However, skin can suffer several damages that impede normal wound-healing responses and lead to chronic wounds. Since the use of autografts, allografts, and xenografts present source limitations and intense rejection associated problems, bioengineered artificial skin substitutes (BASS) have emerged as a promising solution to address these problems. Despite this, currently available skin substitutes have many drawbacks, and an ideal skin substitute has not been developed yet. The advances that have been produced on tissue engineering techniques have enabled improving and developing new arising skin substitutes. The aim of this review is to outline these advances, including commercially available skin substitutes, to finally focus on future tissue engineering perspectives leading to the creation of autologous prevascularized skin equivalents with a hypodermal-like layer to achieve an exemplary skin substitute that fulfills all the biological characteristics of native skin and contributes to wound healing.
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http://dx.doi.org/10.3390/ijms21218197DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7662999PMC
November 2020

Bioengineered Skin Intended as In Vitro Model for Pharmacosmetics, Skin Disease Study and Environmental Skin Impact Analysis.

Biomedicines 2020 Oct 31;8(11). Epub 2020 Oct 31.

Cell Production and Tissue Engineering Unit, Virgen de las Nieves University Hospital, 18014 Granada, Spain.

This review aims to be an update of Bioengineered Artificial Skin Substitutes (BASS) applications. At the first moment, they were created as an attempt to replace native skin grafts transplantation. Nowadays, these in vitro models have been increasing and widening their application areas, becoming important tools for research. This study is focus on the ability to design in vitro BASS which have been demonstrated to be appropriate to develop new products in the cosmetic and pharmacology industry. Allowing to go deeper into the skin disease research, and to analyze the effects provoked by environmental stressful agents. The importance of BASS to replace animal experimentation is also highlighted. Furthermore, the BASS validation parameters approved by the OECD (Organisation for Economic Co-operation and Development) are also analyzed. This report presents an overview of the skin models applicable to skin research along with their design methods. Finally, the potential and limitations of the currently available BASS to supply the demands for disease modeling and pharmaceutical screening are discussed.
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http://dx.doi.org/10.3390/biomedicines8110464DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7694072PMC
October 2020

Metabolomic profile of cancer stem cell-derived exosomes from patients with malignant melanoma.

Mol Oncol 2021 02 25;15(2):407-428. Epub 2020 Nov 25.

Biopathology and Regenerative Medicine Institute (IBIMER), Centre for Biomedical Research (CIBM), University of Granada, Spain.

Malignant melanoma (MM) is the most aggressive and life-threatening form of skin cancer. It is characterized by an extraordinary metastasis capacity and chemotherapy resistance, mainly due to melanoma cancer stem cells (CSCs). To date, there are no suitable clinical diagnostic, prognostic or predictive biomarkers for this neoplasia. Therefore, there is an urgent need for new MM biomarkers that enable early diagnosis and effective disease monitoring. Exosomes represent a novel source of biomarkers since they can be easily isolated from different body fluids. In this work, a primary patient-derived MM cell line enriched in CSCs was characterized by assessing the expression of specific markers and their stem-like properties. Exosomes derived from CSCs and serums from patients with MM were characterized, and their metabolomic profile was analysed by high-resolution mass spectrometry (HRMS) following an untargeted approach and applying univariate and multivariate statistical analyses. The aim of this study was to search potential biomarkers for the diagnosis of this disease. Our results showed significant metabolomic differences in exosomes derived from MM CSCs compared with those from differentiated tumour cells and also in serum-derived exosomes from patients with MM compared to those from healthy controls. Interestingly, we identified similarities between structural lipids differentially expressed in CSC-derived exosomes and those derived from patients with MM such as the glycerophosphocholine PC 16:0/0:0. To our knowledge, this is the first metabolomic-based study aimed at characterizing exosomes derived from melanoma CSCs and patients' serum in order to identify potential biomarkers for MM diagnosis. We conclude that metabolomic characterization of CSC-derived exosomes sets an open door to the discovery of clinically useful biomarkers in this neoplasia.
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http://dx.doi.org/10.1002/1878-0261.12823DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7858120PMC
February 2021

Publisher Correction: Ultrasound-assisted intralesional corticosteroid infiltrations for patients with hidradenitis suppurativa.

Sci Rep 2020 Oct 13;10(1):17551. Epub 2020 Oct 13.

Dermatology Department, Hidradenitis Suppurativa Clinic, Hospital Universitario Virgen de Las Nieves, Avenida de Las Fuerzas Armadas 2, 18014, Granada, Spain.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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http://dx.doi.org/10.1038/s41598-020-74153-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7553917PMC
October 2020

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

Acta Derm Venereol 2020 10;100(17):adv00280

Faculty of Medicine, University of Granada, Avenida de la Investigación, 11, ES-18071, Granada, Spain. E-mail:

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http://dx.doi.org/10.2340/00015555-3659DOI Listing
October 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