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Gutiérrez-Meré R, Tajes I, Diéguez P, Soto-García D, Martínez-Fernández S, Batalla A. Acne Fulminans: A Narrative Review. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:763-771. [PMID: 37245603 DOI: 10.1016/j.ad.2023.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/04/2023] [Accepted: 05/06/2023] [Indexed: 05/30/2023] Open
Abstract
Acne fulminans is a severe and rare form of inflammatory acne. Lesion severity and subsequent scarring has a negative impact on the patient's quality of life. We conducted a narrative review of the literature on acne fulminans based on a search for relevant English- and Spanish-language articles published in Medline. We included case reports and case series. The main aim was to describe the clinical and demographic characteristics of patients with acne fulminans. A secondary aim was to determine whether quality of life was affected by the site or extent of lesions. We reviewed 91 articles describing 212 cases of acne fulminans. The mean age of the patients (91.94% male) was 16.6 years. A personal and family history of acne vulgaris was reported for 97.63% and 54.90% of patients, respectively. A trigger was identified in 44.79% of cases. The main cause was pharmacologic (96.63%) and the main drug isotretinoin (65.28%). The sites most often affected were the face (89.31%), the posterior trunk (77.86%), and the anterior trunk (74.81%). The predominant disease subtype was acne fulminans with systemic symptoms (59.12%), which were mostly general (97.06%). Systemic corticosteroids were the most widely used treatment (81.03%). The impact of the disease on quality of life was reported for 2 patients. In conclusion, acne fulminans mainly affects the face and trunk of male adolescents with a history of acne vulgaris. The main subtype was acne fulminans with systemic symptoms, and most patients were treated with systemic corticosteroids. The effect of acne fulminans on quality of life is underreported.
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Affiliation(s)
- R Gutiérrez-Meré
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Área Sanitaria de Pontevedra y O Salnés, Pontevedra, España; Grupo de Investigación DIPO, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, España.
| | - I Tajes
- Escuela Universitaria de Enfermería, Diputación Provincial de Pontevedra, Universidad de Vigo, Vigo, Pontevedra, España
| | - P Diéguez
- Escuela Universitaria de Enfermería, Diputación Provincial de Pontevedra, Universidad de Vigo, Vigo, Pontevedra, España
| | - D Soto-García
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Área Sanitaria de Pontevedra y O Salnés, Pontevedra, España; Grupo de Investigación DIPO, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, España
| | - S Martínez-Fernández
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Área Sanitaria de Pontevedra y O Salnés, Pontevedra, España; Grupo de Investigación DIPO, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, España
| | - A Batalla
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Área Sanitaria de Pontevedra y O Salnés, Pontevedra, España; Grupo de Investigación DIPO, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, España
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2
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Gutiérrez-Meré R, Tajes I, Diéguez P, Soto-García D, Martínez-Fernández S, Batalla A. [Translated article] Acne Fulminans: A Narrative Review. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:T763-T771. [PMID: 37506824 DOI: 10.1016/j.ad.2023.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 05/06/2023] [Indexed: 07/30/2023] Open
Abstract
Acne fulminans is a severe and rare form of inflammatory acne. Lesion severity and subsequent scarring has a negative impact on the patient's quality of life. We conducted a narrative review of the literature on acne fulminans based on a search for relevant English- and Spanish-language articles published in Medline. We included case reports and case series. The main aim was to describe the clinical and demographic characteristics of patients with acne fulminans. A secondary aim was to determine whether quality of life was affected by the site or extent of lesions. We reviewed 91 articles describing 212 cases of acne fulminans. The mean age of the patients (91.94% male) was 16.6 years. A personal and family history of acne vulgaris was reported for 97.63% and 54.90% of patients, respectively. A trigger was identified in 44.79% of cases. The main cause was pharmacologic (96.63%) and the main drug isotretinoin (65.28%). The sites most often affected were the face (89.31%), the posterior trunk (77.86%), and the anterior trunk (74.81%). The predominant disease subtype was acne fulminans with systemic symptoms (59.12%), which were mostly general (97.06%). Systemic corticosteroids were the most widely used treatment (81.03%). The impact of the disease on quality of life was reported for two patients. In conclusion, acne fulminans mainly affects the face and trunk of male adolescents with a history of acne vulgaris. The main subtype was acne fulminans with systemic symptoms, and most patients were treated with systemic corticosteroids. The effect of acne fulminans on quality of life is under-reported.
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Affiliation(s)
- R Gutiérrez-Meré
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Área Sanitaria de Pontevedra y O Salnés, Pontevedra, Spain; Grupo de Investigación DIPO, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, Spain.
| | - I Tajes
- Escuela Universitaria de Enfermería, Diputación Provincial de Pontevedra, Universidad de Vigo, Vigo, Pontevedra, Spain
| | - P Diéguez
- Escuela Universitaria de Enfermería, Diputación Provincial de Pontevedra, Universidad de Vigo, Vigo, Pontevedra, Spain
| | - D Soto-García
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Área Sanitaria de Pontevedra y O Salnés, Pontevedra, Spain; Grupo de Investigación DIPO, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, Spain
| | - S Martínez-Fernández
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Área Sanitaria de Pontevedra y O Salnés, Pontevedra, Spain; Grupo de Investigación DIPO, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, Spain
| | - A Batalla
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Área Sanitaria de Pontevedra y O Salnés, Pontevedra, Spain; Grupo de Investigación DIPO, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, Spain
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Tros BG, Kemperman PMJH, Kuckulus J, Hoekzema R, Vulink NCC. Body Dysmorphic Disorder and Self-esteem in Adolescents and Young Adults with Acne Vulgaris. Acta Derm Venereol 2023; 103:adv6232. [PMID: 37707293 PMCID: PMC10512965 DOI: 10.2340/actadv.v103.6232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 07/04/2023] [Indexed: 09/15/2023] Open
Abstract
Body dysmorphic disorder is a mental health disorder characterized by a preoccupation with a perceived flaw, which is commonly seen among dermatology patients. The objective of this study was to determine the frequency of body dysmorphic disorder and assess self-esteem among a clinical sample of adolescents and young adults being managed for acne vulgaris. A total of 105 patients, age range 13-24 years, receiving acne treatment at 1 of 2 dermatology outpatient clinic were included. A self-report questionnaire was used, which included a body dysmorphic disorder screening tool (based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnostic criteria) and the Rosenberg Self-Esteem Scale (RSES). Acne was graded with the Cook's acne grading scale. Out of 105 adolescents and young adults visiting a dermatologist due to acne, 13 (12.4%) screened positive for body dysmorphic disorder (95% confidence interval (95% CI) 6.8-20.2%). Patients with body dysmorphic disorder were more likely to have female gender (p = 0.020) and had lower self-esteem (RSES 15.8 vs 20.5, respectively, p = 0.013) compared with patients without body dysmorphic disorder. No differences were found in the frequency of body dysmorphic disorder with DSM-IV or DSM-5 criteria. This is the first study to report on the frequency of body dysmorphic disorder and self-esteem in adolescents and young adults with acne. Ultimately, more awareness of body dysmorphic disorder among adolescents and young adults presenting with dermatological disorders could lead to more rapid recognition and referral to psychiatric units.
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Affiliation(s)
- Benjamin G Tros
- Department of Psychiatry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
| | | | - Jade Kuckulus
- Department of Psychiatry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Rick Hoekzema
- Department of Dermatology, Huid Medisch Centrum, Amsterdam, The Netherlands
| | - Nienke C C Vulink
- Department of Psychiatry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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Pereira IN, Chattopadhyay R, Fitzpatrick S, Nguyen S, Hassan H. Evidence-based review: Screening body dysmorphic disorder in aesthetic clinical settings. J Cosmet Dermatol 2023. [PMID: 36847707 DOI: 10.1111/jocd.15685] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/26/2022] [Accepted: 02/02/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Body dysmorphic disorder (BDD) is a psychiatric disturbance with high incidence in aesthetic clinical settings. Early recognition may avoid unnecessary elective procedures with ethical and medicolegal consequences. AIMS To identify validated BDD screening tools and critically appraise current literature regarding its implementation and efficacy in aesthetic medicine and surgery scenarios, with the purpose of transposing the findings to the broad clinical settings in the field. METHODS Data was collected using advanced search from PubMed (MEDLINE). Having satisfied the search parameters, 12 studies referring BDD definition according to Diagnostic and Statistical Manual of Mental Disorder (DSM-5) criteria and including a BDD screening tool in clinical aesthetic settings were selected. RESULTS While BDD screening enables the recognition of at-risk individuals, further work is required to uncover the best screening tool for general aesthetic clinical practice. Level III evidence favored BDD Questionnaire (BDDQ)/BDDQ-Dermatology Version (DV), and The Dysmorphic Concern Questionnaire (DCQ) among the limited available validated screening instruments to be used outside the psychiatric environment. Based on level II self-classification, one study selected BDDQ-Aesthetic Surgery (AS) version for rhinoplasty patients. The validation process of both BDDQ-AS and Cosmetic Procedure Screening Questionnaire (COPS) had limitations. For BDD screening potential in avoiding postoperative complications, the limited studies found evaluating the outcomes following aesthetic treatments using validated BDD screening measures showed a trend toward less satisfaction with aesthetic treatment outcome among positive screening population against non-BDD counterparts. CONCLUSION Further research is necessary to establish more effective methods to identify BDD and evaluate the impact of positive findings on aesthetic intervention outcomes. Future studies may elucidate which BDD characteristics best predict a favorable outcome and provide high-quality evidence for standardized protocols in research and clinical practice.
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Affiliation(s)
| | - Rashmi Chattopadhyay
- Barts & The London School of Medicine & Dentistry, Centre for Cutaneous Research, Blizard Institute of Cell and Molecular Science, Queen Mary University, London, UK
| | - Sean Fitzpatrick
- Barts & The London School of Medicine & Dentistry, Centre for Cutaneous Research, Blizard Institute of Cell and Molecular Science, Queen Mary University, London, UK
| | - Sheila Nguyen
- Barts & The London School of Medicine & Dentistry, Centre for Cutaneous Research, Blizard Institute of Cell and Molecular Science, Queen Mary University, London, UK
| | - Haidar Hassan
- Barts & The London School of Medicine & Dentistry, Centre for Cutaneous Research, Blizard Institute of Cell and Molecular Science, Queen Mary University, London, UK
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Leung AK, Barankin B, Lam JM, Leong KF, Hon KL. Dermatology: how to manage acne vulgaris. Drugs Context 2021; 10:dic-2021-8-6. [PMID: 34691199 PMCID: PMC8510514 DOI: 10.7573/dic.2021-8-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 09/08/2021] [Indexed: 11/29/2022] Open
Abstract
Background Acne vulgaris is the most common skin disease that can lead to disfigurement and psychological distress. This article aims to provide a narrative updated review on the management of acne vulgaris. Methods A PubMed search was performed with Clinical Queries using the key term “acne”. The search strategy included clinical trials, meta-analyses, randomized controlled trials, observational studies and reviews. The search was restricted to articles published in English. Results Treatments of acne include proper skin care, topical medications, oral medications and procedural therapies. Topical agents are the first-line treatment for mild-to-moderate acne and can be used as combination therapy for more severe acne. Systemic therapies are usually prescribed for the initial treatment of moderate-to-severe acne as well as for acne that is refractory to topical therapies. Conclusion Topical retinoids are the drugs of choice for the treatment and maintenance therapy of patients with mild-to-moderate acne vulgaris. Depending on the severity of the acne, topical retinoids may be used alone or in combination with benzoyl peroxide and topical or oral antibiotics. Oral antibiotics are an important therapy for inflammatory acne unresponsive to topical therapy. Neither topical nor oral antibiotics should be used as monotherapy. Oral contraceptives and/or spironolactone are useful for many women with acne. Oral isotretinoin is the drug of choice for severe, extensive, nodular acne vulgaris but is also often used in moderate cases where scarring is evident, acne-related psychosocial distress is significant or other treatment modalities have failed.
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Affiliation(s)
- Alexander Kc Leung
- Department of Pediatrics, The University of Calgary, and The Alberta Children's Hospital, Calgary, Alberta, Canada
| | | | - Joseph M Lam
- Department of Dermatology and Skin Sciences, University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Kam Lun Hon
- Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong
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AlShahwan MA. Prevalence and characteristics of body dysmorphic disorder in Arab dermatology patients. Saudi Med J 2020; 41:73-78. [PMID: 31915798 PMCID: PMC7001078 DOI: 10.15537/smj.2020.1.24784] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/24/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To explore how prevalent body dysmorphic disorder (BDD) is among Arab dermatology patients and what characteristics of patients are associated with it. METHODS A total of 497 patients from the dermatology outpatient clinic at King Khalid University Hospital, Riyadh, Saudi Arabia, participated in this cross-sectional study conducted between October and December 2018. We asked the patients about their demographic and clinical characteristics, and then asked them to complete a dermatology-based self-report BDD questionnaire. Following this, we appointed 2 independent researchers to evaluate the dermatological flaws highlighted in the patient questionnaires and rate them using a severity scale. RESULTS Body dysmorphic disorder was found in 14.1% of Arab dermatology patients. There were significant links between female with BDD (odds ration [OR]: 2.93; 95% CI 1.24, 6.9]), having 2 or more skin conditions with BDD (OR: 4.67; 95% CI 1.33, 16.49) and having a certain skin condition such as hyperpigmentation with BDD (OR: 5.86; 95% CI 1.46, 23.61). The biggest BDD concerns were hyperpigmentation, acne, and hair loss. Conclusion: Body dysmorphic disorder was common among Arab dermatology patients, especially among women and those who have hyperpigmentation or more than one skin condition.
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Affiliation(s)
- Mohammed A AlShahwan
- Dermatology Department, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Marron SE, Miranda-Sivelo A, Tomas-Aragones L, Rodriguez-Cerdeira C, Tribo-Boixaro MJ, Garcia-Bustinduy M, Gracia-Cazaña T, Ros-Abarca S, Roe-Crespo E, Diaz-Díaz RM, Brufau-Redondo C, Martinez-Gonzalez MC, Guerra-Tapia A, González-Guerra E, Puig L. Body dysmorphic disorder in patients with acne: a multicentre study. J Eur Acad Dermatol Venereol 2019; 34:370-376. [PMID: 31515838 DOI: 10.1111/jdv.15954] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 09/04/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Body dysmorphic disorder (BDD) is a mental disorder that is difficult to diagnose, causes a lot of suffering and is more prevalent in dermatology patients than in the general population. Our objective was to screen for possible cases of BDD in patients with acne and to determine the prevalence according to DSM-IV and DSM-5 criteria, as well as to analyse the relationship between dermatological and sociodemographic variables. METHODS A total of 245 patients diagnosed with acne in 11 dermatological centres in Spain were included in the study by members of the Aragon Psychodermatology Research Group and Spanish Research Group of Psychiatric Dermatology. We used the Body Dysmorphic Disorder Questionnaire (BDDQ) as a screening tool. RESULTS In our sample, we obtained a prevalence for BDD of 10.6% (95% CI: 7.6-13.6%). The prevalence was the same with DSM-IV or DSM-5 criteria. Possible cases of BDD were predominantly women (P = 0.021), and 56% had non-inflammatory lesions vs. 30% of negative patients (P = 0.002). Positive patients as possible cases of BDD spent more than two hours on average a day worrying about their appearance. Most people only worried about one part of their body (86%), and in 95% of the cases, the part of their body that worried them was the face. The three most frequent compulsive behaviours in patients who screened positive for BDD were mirror checking (90.7%), camouflaging (79.1%) and using make-up (72.1%). CONCLUSIONS As a consequence of the high prevalence of possible cases of BDD in patients with acne observed in our study, there is a need for dermatologists to screen for BDD so that they can be referred to a mental health unit to confirm the diagnosis and be offered treatment to reduce the progression of psychosocial deterioration and the development of comorbid disorders.
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Affiliation(s)
- S E Marron
- Department of Dermatology, University Hospital Miguel Servet, Zaragoza, Spain.,Aragon Psychodermatology Research Group (GAI+PD), Zaragoza, Spain.,Spanish Research Group of Dermatology and Psychiatry (GEDEPSI) of the Spanish Academy of Dermatology and Venereology (AEDV), Madrid, Spain
| | - A Miranda-Sivelo
- Spanish Research Group of Dermatology and Psychiatry (GEDEPSI) of the Spanish Academy of Dermatology and Venereology (AEDV), Madrid, Spain.,Department of Psychiatry, General Hospital of Segovia, Segovia, Spain
| | - L Tomas-Aragones
- Aragon Psychodermatology Research Group (GAI+PD), Zaragoza, Spain.,Spanish Research Group of Dermatology and Psychiatry (GEDEPSI) of the Spanish Academy of Dermatology and Venereology (AEDV), Madrid, Spain.,Department of Psychology, University of Zaragoza, Zaragoza, Spain
| | - C Rodriguez-Cerdeira
- Spanish Research Group of Dermatology and Psychiatry (GEDEPSI) of the Spanish Academy of Dermatology and Venereology (AEDV), Madrid, Spain.,Department of Dermatology, University Hospital of Vigo, Vigo, Spain
| | - M J Tribo-Boixaro
- Spanish Research Group of Dermatology and Psychiatry (GEDEPSI) of the Spanish Academy of Dermatology and Venereology (AEDV), Madrid, Spain.,Department of Dermatology, Hospital del Mar, Barcelona, Spain
| | - M Garcia-Bustinduy
- Spanish Research Group of Dermatology and Psychiatry (GEDEPSI) of the Spanish Academy of Dermatology and Venereology (AEDV), Madrid, Spain.,Department of Dermatology, University Hospital of Canary Island, Santa Cruz de Tenerife, Spain
| | - T Gracia-Cazaña
- Aragon Psychodermatology Research Group (GAI+PD), Zaragoza, Spain.,Spanish Research Group of Dermatology and Psychiatry (GEDEPSI) of the Spanish Academy of Dermatology and Venereology (AEDV), Madrid, Spain.,Department of Dermatology, Barbastro Hospital, Barbastro, Spain
| | - S Ros-Abarca
- Spanish Research Group of Dermatology and Psychiatry (GEDEPSI) of the Spanish Academy of Dermatology and Venereology (AEDV), Madrid, Spain.,Department of Dermatology, Sant Pau Hospital, Barcelona, Spain
| | - E Roe-Crespo
- Department of Dermatology, Sant Pau Hospital, Barcelona, Spain
| | - R M Diaz-Díaz
- Spanish Research Group of Dermatology and Psychiatry (GEDEPSI) of the Spanish Academy of Dermatology and Venereology (AEDV), Madrid, Spain.,Dermatology Department, Infanta Sofía Hospital, San Sebastián de los Reyes, Madrid, Spain
| | - C Brufau-Redondo
- Spanish Research Group of Dermatology and Psychiatry (GEDEPSI) of the Spanish Academy of Dermatology and Venereology (AEDV), Madrid, Spain.,Department of Dermatology, University Hospital Reina Sofía, Murcia, Spain
| | - M C Martinez-Gonzalez
- Spanish Research Group of Dermatology and Psychiatry (GEDEPSI) of the Spanish Academy of Dermatology and Venereology (AEDV), Madrid, Spain.,Private Clinic of Dermatology, Oviedo, Spain
| | - A Guerra-Tapia
- Spanish Research Group of Dermatology and Psychiatry (GEDEPSI) of the Spanish Academy of Dermatology and Venereology (AEDV), Madrid, Spain.,Department of Dermatology, 12 de Octubre Hospital, Madrid, Spain
| | - E González-Guerra
- Spanish Research Group of Dermatology and Psychiatry (GEDEPSI) of the Spanish Academy of Dermatology and Venereology (AEDV), Madrid, Spain.,Department of Dermatology, University Hospital San Carlos, Madrid, Spain
| | - L Puig
- Department of Dermatology, Sant Pau Hospital, Barcelona, Spain
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