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Pascual JC, Hernández-Quiles R, Sánchez-García V, Viudez-Martínez A, Belinchón Romero I, Sivera Mascaró F. Topical and Intralesional Therapies for Hidradenitis Suppurativa: A Systematic Literature Review. Actas Dermosifiliogr 2024; 115:T433-T448. [PMID: 38423507 DOI: 10.1016/j.ad.2024.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/29/2023] [Accepted: 12/04/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Topical and intralesional (IL) treatments may be considered the first-line therapy in patients with hidradenitis suppurativa (HS); however, the evidence supporting their use is limited. The aim of our review is to evaluate the efficacy and safety profile of topical and IL treatments in patients with HS. MATERIALS AND METHODS We designed a systematic review of the current medical literature available following the PICO(T) method. And including all types of studies (Study type [T]) of individuals with HS of any sex, age, and ethnicity (Population [P]) who received any topical or IL treatment for HS (Intervention [I]) compared to placebo, other treatments, or no treatment at all (Comparator [C]), and reported efficacy and/or safety outcomes (Outcomes [O]). Two outcomes were defined: quality of life and the no. of patients with, at least, one adverse event. The search was conducted in the Cochrane Library, MEDLINE, and Embase databases; study selection was performed based on pre-defined criteria. The risk of bias was determined in each study. RESULTS We obtained a total of 11,363 references, 31 of which met the inclusion criteria. These studies included 1143 patients with HS, 62% of whom were women. A total of 10, 8, 6, 2, and 5 studies, respectively, evaluated the use of photodynamic therapy (PDT), glucocorticoids, resorcinol, topical antibiotics, and other interventions. Most articles were case series (n=25), with only five randomized clinical trials (RCTs) and one cohort study. RCTs showed improvement in disease activity with topical clindamycin and botulinum toxin (BTX) vs placebo, and PDT with methylene blue (MB) niosomal vs free MB; however, intralesional triamcinolone acetonide was not superior to placebo. The risk of bias was low in three RCTs and high in two RCTs. CONCLUSION The quality of evidence supporting the use of topical, or IL treatments is low. However, it supports the use of topical clindamycin, PDT, and BTX. Well-designed RCTs with standardized outcomes and homogeneous populations of patients and lesions are needed to support decision-making in the routine clinical practice.
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Affiliation(s)
- J C Pascual
- Servicio de Dermatología. Hospital General Universitario Dr. Balmis, Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (Isabial), Alicante, España.
| | - R Hernández-Quiles
- Servicio de Dermatología. Hospital General Universitario Dr. Balmis, Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (Isabial), Alicante, España
| | - V Sánchez-García
- Servicio de Dermatología. Hospital General Universitario Dr. Balmis, Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (Isabial), Alicante, España
| | - A Viudez-Martínez
- Servicio de Farmacia. Hospital General Universitario Dr. Balmis, Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (Isabial), Alicante, España
| | - I Belinchón Romero
- Servicio de Dermatología. Hospital General Universitario Dr. Balmis, Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (Isabial), Alicante, España; Departamento de Medicina Clínica. Universidad Miguel Hernández, Alicante, España
| | - F Sivera Mascaró
- Departamento de Medicina Clínica. Universidad Miguel Hernández, Alicante, España; Servicio de Reumatología. Hospital General Universitario de Elda, Alicante, España
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Pascual JC, Hernández-Quiles R, Sánchez-García V, Viudez-Martínez A, Belinchón I, Sivera F. Topical and Intralesional Therapies for Hidradenitis Suppurativa: A Systematic Literature Review. Actas Dermosifiliogr 2024; 115:433-448. [PMID: 38159839 DOI: 10.1016/j.ad.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/29/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Topical and intralesional (IL) treatments may be considered the first-line therapy in patients with hidradenitis suppurativa (HS); however, the evidence supporting their use is limited. The aim of our review is to evaluate the efficacy and safety profile of topical and IL treatments in patients with HS. MATERIALS AND METHODS We designed a systematic review of the current medical literature available following the PICO(T) method. And including all types of studies (Study type [T]) of individuals with HS of any sex, age, and ethnicity (Population [P]) who received any topical or IL treatment for HS (Intervention [I]) compared to placebo, other treatments, or no treatment at all (Comparator [C]), and reported efficacy and/or safety outcomes (Outcomes [O]). Two outcomes were defined: quality of life and the no. of patients with, at least, one adverse event. The search was conducted in the Cochrane Library, MEDLINE, and EMBASE databases; study selection was performed based on pre-defined criteria. The risk of bias was determined in each study. RESULTS We obtained a total of 11,363 references, 31 of which met the inclusion criteria. These studies included 1143 patients with HS, 62% of whom were women. A total of 10, 8, 6, 2, and 5 studies, respectively, evaluated the use of photodynamic therapy (PDT), glucocorticoids, resorcinol, topical antibiotics, and other interventions. Most articles were case series (n=25), with only five randomized clinical trials (RCTs) and one cohort study. RCTs showed improvement in disease activity with topical clindamycin and botulinum toxin (BTX) vs placebo, and PDT with methylene blue (MB) niosomal vs free MB; however, intralesional triamcinolone acetonide was not superior to placebo. The risk of bias was low in three RCTs and high in two RCTs. CONCLUSION The quality of evidence supporting the use of topical, or IL treatments is low. However, it supports the use of topical clindamycin, PDT, and BTX. Well-designed RCTs with standardized outcomes and homogeneous populations of patients and lesions are needed to support decision-making in the routine clinical practice.
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Affiliation(s)
- J C Pascual
- Department of Dermatology, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.
| | - R Hernández-Quiles
- Department of Dermatology, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - V Sánchez-García
- Department of Dermatology, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - A Viudez-Martínez
- Department of Pharmacy, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - I Belinchón
- Department of Dermatology, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain; Department of Clinical Medicine, Miguel Hernández University, Alicante, Spain
| | - F Sivera
- Department of Rheumatology, General University Hospital of Elda, Alicante, Spain; Department of Clinical Medicine, Miguel Hernández University, Alicante, Spain
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Álvarez-Chinchilla P, Poveda I, Vergara E, Illán F, Planelles M, Pascual JC. Asymptomatic hyperkeratotic linear plugs on the right hand of a young woman. Clin Exp Dermatol 2018; 44:432-434. [PMID: 30198188 DOI: 10.1111/ced.13743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2018] [Indexed: 11/28/2022]
Affiliation(s)
- P Álvarez-Chinchilla
- Department of Dermatology, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
| | - I Poveda
- Department of Dermatology, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
| | - E Vergara
- Department of Dermatology, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
| | - F Illán
- Department of Pathology, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
| | - M Planelles
- Department of Pathology, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
| | - J C Pascual
- Department of Dermatology, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
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Martorell A, Caballero A, González Lama Y, Jiménez-Gallo D, Lázaro Serrano M, Miranda J, Pascual JC, Salgado-Boquete L, Marín-Jiménez I. Management of patients with hidradenitis suppurativa. Actas Dermosifiliogr 2017; 107 Suppl 2:32-42. [PMID: 28081768 DOI: 10.1016/s0001-7310(17)30007-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory disease with a high prevalence in the population. Treatment options are both medical and surgical. Medical treatment is based on the use of antibiotics, retinoids, and anti-inflammatory drugs, in which anti-TNFα agents (infliximab y adalimumab) play a central role in the treatment of moderate-to-severe HS and enjoy the highest level of scientific support. Currently, adalimumab is the only drug approved in the summary of product characteristics for the treatment of this disease. Due to the scarcity of clinical trials in HS, there is still no therapeutic guideline backed by solid evidence and the evidence for most drugs is low. However, early treatment in patients with HS would probably reduce the complications of this disease. This review analyses the distinct treatments used in this dermatological disease and provides a therapeutic algorithm with different treatment options.
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Affiliation(s)
- A Martorell
- Servicio de Dermatología, Hospital de Manises, Valencia, España.
| | - A Caballero
- Servicio de Gastroenterología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Y González Lama
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - D Jiménez-Gallo
- Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Puerta del Mar, Servicio Andaluz de Salud, Cádiz, España
| | - M Lázaro Serrano
- Servicio de Dermatología, Hospital Universitario Basurto, Bilbao, España
| | - J Miranda
- Servicio de Gastroenterología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J C Pascual
- Servicio de Dermatología, Hospital General de Alicante, Alicante, España
| | - L Salgado-Boquete
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España
| | - I Marín-Jiménez
- Servicio de Gastroenterología, Hospital General Universitario Gregorio Marañón, Madrid, España
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Martín-Blanco A, Ancochea A, Soler J, Elices M, Carmona C, Pascual JC. Changes over the last 15 years in the psychopharmacological management of persons with borderline personality disorder. Acta Psychiatr Scand 2017; 136:323-331. [PMID: 28669135 DOI: 10.1111/acps.12767] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the pharmacological management of borderline personality disorder (BPD) in Spain from 2001 through 2016, the factors associated with prescriptions, and changes in pharmacotherapy over this time period. METHODS Retrospective, cross-sectional, observational study conducted in a sample of 457 patients with BPD consecutively admitted to a specialist BPD Program between January 2001 and November 2016. Data on sociodemographic and clinical variables, as well as pharmacological treatment upon the admission to the programme, were used to describe pharmacological prescriptions, the factors associated with these medications, and changes in prescription over the last 15 years. RESULTS Most (88.4%) patients were on pharmacological treatment, with 53.8% of persons taking ≥3 medications. No significant changes in these percentages were observed over the study period. The use of tricyclic antidepressants and benzodiazepines decreased, while the use of atypical antipsychotics increased. Axis I comorbidity was the main factor associated with pharmacological treatment and polypharmacy. CONCLUSIONS This study provides further evidence confirming the worldwide overuse of prescription medications for BPD and shows that there has been a shift in the prescription pattern in the last 15 years. These results suggest that real clinical practice only partially adheres to clinical treatment guidelines.
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Affiliation(s)
- A Martín-Blanco
- Department of Psychiatry, Santa Creu and Sant Pau Hospital, Barcelona, Spain.,Autonomous University of Barcelona, Barcelona, Spain.,Research Institute of the Santa Creu and Sant Pau Hospital (IIB Sant Pau), Barcelona, Spain.,CIBER of Mental Health (CIBERSAM), CIBERSAM, Barcelona, Spain
| | - A Ancochea
- Department of Psychiatry, Santa Creu and Sant Pau Hospital, Barcelona, Spain.,Autonomous University of Barcelona, Barcelona, Spain.,Research Institute of the Santa Creu and Sant Pau Hospital (IIB Sant Pau), Barcelona, Spain.,CIBER of Mental Health (CIBERSAM), CIBERSAM, Barcelona, Spain
| | - J Soler
- Department of Psychiatry, Santa Creu and Sant Pau Hospital, Barcelona, Spain.,Autonomous University of Barcelona, Barcelona, Spain.,Research Institute of the Santa Creu and Sant Pau Hospital (IIB Sant Pau), Barcelona, Spain.,CIBER of Mental Health (CIBERSAM), CIBERSAM, Barcelona, Spain
| | - M Elices
- Department of Psychiatry, Santa Creu and Sant Pau Hospital, Barcelona, Spain.,Autonomous University of Barcelona, Barcelona, Spain.,Research Institute of the Santa Creu and Sant Pau Hospital (IIB Sant Pau), Barcelona, Spain.,CIBER of Mental Health (CIBERSAM), CIBERSAM, Barcelona, Spain
| | - C Carmona
- Department of Psychiatry, Santa Creu and Sant Pau Hospital, Barcelona, Spain.,Autonomous University of Barcelona, Barcelona, Spain.,Research Institute of the Santa Creu and Sant Pau Hospital (IIB Sant Pau), Barcelona, Spain.,CIBER of Mental Health (CIBERSAM), CIBERSAM, Barcelona, Spain
| | - J C Pascual
- Department of Psychiatry, Santa Creu and Sant Pau Hospital, Barcelona, Spain.,Autonomous University of Barcelona, Barcelona, Spain.,Research Institute of the Santa Creu and Sant Pau Hospital (IIB Sant Pau), Barcelona, Spain.,CIBER of Mental Health (CIBERSAM), CIBERSAM, Barcelona, Spain
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González I, Pascual JC, Corona D, Hispán P, Ramos JM, Sánchez-Paya J, Jemec GB. Assessment of subclinical atherosclerosis in hidradenitis suppurativa: Reply to Dr Vinkel's letter. J Eur Acad Dermatol Venereol 2017; 31:e413-e414. [PMID: 28300331 DOI: 10.1111/jdv.14226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- I González
- Department of Dermatology, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
| | - J C Pascual
- Department of Dermatology, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
| | - D Corona
- Department of Neurology, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
| | - P Hispán
- Department of Dermatology, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
| | - J M Ramos
- Department of Internal Medicine, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
| | - J Sánchez-Paya
- Epidemiology Unit, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
| | - G B Jemec
- Department of Dermatology, Zealand University Hospital Roskilde, Copenhagen, Denmark.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
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Escribano-Stablé JC, Doménech C, Matarredona J, Pascual JC, Jaen A, Vicente J. Tacalcitol in the treatment of acquired perforating collagenosis. Case Rep Dermatol 2014; 6:69-73. [PMID: 24707254 PMCID: PMC3975195 DOI: 10.1159/000360390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Acquired perforating collagenosis (APC) is a rare perforating dermatosis characterized by transepidermal collagen elimination. We describe a 65-year-old patient, with long-standing type 2 diabetes mellitus and a 2-year history of itchy hyperkeratotic nodules situated on the back, who was subsequently diagnosed with APC. Treatment included topical corticosteroids and antihistamines, without improvement of the lesions. However, therapy with topical tacalcitol administered for 2 months produced a significant response leading to complete remission of APC.
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Affiliation(s)
| | - C Doménech
- Dermatology Department, Elx/Elche General University Hospital, Elx/Elche, Spain
| | - J Matarredona
- Dermatology Department, Elx/Elche General University Hospital, Elx/Elche, Spain
| | - J C Pascual
- Dermatology Department, Elx/Elche General University Hospital, Elx/Elche, Spain
| | - A Jaen
- Dermatology Department, Elx/Elche General University Hospital, Elx/Elche, Spain
| | - J Vicente
- Dermatology Department, Elx/Elche General University Hospital, Elx/Elche, Spain
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Vano-Galvan S, Matarredona J, Harto A, Escudero A, Pascual JC, Jaén P. Treatment of light-coloured solar lentigines with cryotherapy plus alexandrite laser. J Eur Acad Dermatol Venereol 2009; 23:850-2. [DOI: 10.1111/j.1468-3083.2008.03050.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pascual JC, Malagón A, Córcoles D, Ginés JM, Soler J, García-Ribera C, Pérez V, Bulbena A. Immigrants and borderline personality disorder at a psychiatric emergency service. Br J Psychiatry 2008; 193:471-6. [PMID: 19043150 DOI: 10.1192/bjp.bp.107.038208] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Several studies have suggested that immigrants have higher rates of psychiatric emergency service use and a higher risk of mental disorders such as schizophrenia than indigenous populations. AIMS To compare the likelihood that immigrants (immigrant group) v. indigenous population (indigenous group) will be diagnosed with borderline personality disorder in a psychiatric emergency service and to determine differences according to area of origin. METHOD A total of 11 578 consecutive admissions over a 4-year period at a tertiary psychiatric emergency service were reviewed. The collected data included socio-demographic and clinical variables and the Severity of Psychiatric Illness rating score. Psychiatric diagnosis was limited to information available in the emergency room given that a structured interview is not usually feasible in this setting. The diagnosis of borderline personality disorder was based on DSM-IV criteria. Immigrants were divided into five groups according to region of origin: North Africa, sub-Saharan Africa, South America, Asia and Western countries. RESULTS Multivariate statistical logistic regression analysis showed that all subgroups of immigrants had a lower likelihood of being diagnosed with borderline personality disorder than the indigenous population independently of age and gender. Furthermore, the rates of borderline personality disorder diagnosis were considerably lower in Asian and sub-Saharan subgroups than in South American, North African, Western or native subgroups. CONCLUSIONS Our results showed that in the psychiatric emergency service borderline personality disorder was diagnosed less frequently in the immigrant group v. the indigenous group. Our results do not support the concept of migration as a risk factor for borderline personality disorder.
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Affiliation(s)
- J C Pascual
- Department of Psychiatry, Sta. Creu i St. Pau Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Pascual JC, Perez-Ramos M, Devesa JP, Kutzner H, Requena L. Extramammary Paget's disease of the groin with underlying carcinoma and fatal outcome. Clin Exp Dermatol 2008; 33:595-8. [DOI: 10.1111/j.1365-2230.2008.02731.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pascual JC, Soler J, Baiget M, Cortés A, Menoyo A, Barrachina J, Ropero M, Gomà M, Alvarez E, Perez V. Association between the serotonin transporter gene and personality traits in borderline personality disorder patients evaluated with Zuckerman-Zuhlman Personality Questionnaire (ZKPQ). Actas Esp Psiquiatr 2007; 35:382-386. [PMID: 18004675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
INTRODUCTION The serotoninergic system seems to be implicated in characteristic symptoms of borderline personality disorder (BPD) such as affective instability, impulsivity or suicide. Some studies suggest an association between serotonin transporter gene (5-HTT) polymorphisms and some BPD symptoms. Short allele (S) of the 5-HTTLPR polymorphism in the promoter region has been shown to be associated with impulsivity, aggressive behavior, anxiety and neuroticism. Of the variable number of tandem repeat (VNTR) polymorphism in intron 2, BPD patients showed higher frequencies of the allele with the 10 repeats. The aim of this study was to determine the association between 5- HTTLPR and VNTR polymorphism of 5-HTT and personality traits in borderline personality disorder. METHOD A total of 65 BPD patients diagnosed by means of semi-structured interviews SCID-II and DIB-R were included. Two common polymorphisms of 5-HTT were genotyped: the 5-HTTLPR in the promoter region and VNTR in intron 2. Personality traits were assessed by the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ). RESULTS Patients with L allele (L/S or L/L) in the 5-HTTLPR polymorphism showed lower scores on the subscale of liking parties and friends. Patients with the allele with 10 repeat of the VNTR polymorphism, showed lower scores in impulsivity, sensation seeking and in the subscale liking of parties and friends. CONCLUSIONS The results suggest a significant association between the 5-HTT gene and some personality traits in BPD. This gene may play a role in the etiology of borderline personality disorder.
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Affiliation(s)
- J C Pascual
- Psychiatry Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona , Barcelona, Spain
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Perez V, Barrachina J, Soler J, Pascual JC, Campins MJ, Puigdemont D, Alvarez E. The clinical global impression scale for borderline personality disorder patients (CGI-BPD): a scale sensible to detect changes. Actas Esp Psiquiatr 2007; 35:229-35. [PMID: 17592784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The CGI-BPD scale is an adaptation of the Clinical Global Impression (CGI) scale designed to assess severity and post-intervention changes in patients with Borderline Personality Disorder (BPD). It contains 10 items that score the nine relevant psychopathological domains of BPD, plus an additional global score. The CGI-BPD has two formats, the CGI-BPD-S, to evaluate the present severity, and the CGIBPD- I to evaluate improvement. To establish the psychometric properties of the CGI-BPD, the test was administered to 78 BPD patients, 11 men and 67 women, within the framework of a 4-month therapeutic intervention. The modified scale showed good validity and reliability (alpha 0.85 and 0.89; CCI: 0.86 and 0.78), adequate sensitivity to change, and a two-factor structure accounting for 67.4 % of total variance. While remaining simple to administer, the CGI-BPD may correct the excessive generalisation contained in its original version and is a useful tool to evaluate severity and change in BPD patients.
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Affiliation(s)
- V Perez
- Departmento de Psiquiatría, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma (UAB) Barcelona, Spain.
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Pascual JC, Pérez V, Martín JLR, Safont G, Puigdemont D, Alvarez E. Olanzapine orally-disintegrating tablet in severe psychotic agitation: a naturalistic study. Actas Esp Psiquiatr 2007; 35:47-51. [PMID: 17323225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
INTRODUCTION This study was conducted to determine effectiveness and safety of olanzapine in patients with severe agitation. METHOD A naturalistic, open-label study in 80 acutely agitated psychotic patients visited in our psychiatric emergency department. Patients received either a 20-mg olanzapine orally-disintegrating tablet or conventional treatment depending on attending psychiatrist's preference. Efficacy was assessed by the Excitement Component of the Positive and Negative Syndrome Scale (PANSS-EC), the Agitation-Calmness Evaluation Scale (ACES) and pragmatic variables (second pharmacological intervention and need for physical restraints). RESULTS 60 % patients completed a 6 hour trial. Both groups showed a significant reduction in mean PANSS-EC score. The olanzapine-treated group showed statistically significant improvements: PANSS-EC (F=122.9; df=2.4; p=0.000), ACES (F=68.2; df=2.8; p=0.000). Treatment was well-tolerated and no serious side-effects were observed. CONCLUSIONS In this naturalistic study in patients with severe agitation, 20-mg oral olanzapine was effective, rapid and safe.
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Affiliation(s)
- J C Pascual
- Servicio de Psiquiatría, Hospital de la Santa Creu i Sant Pau, St Antoni Maria Claret 167, 08025 Barcelona, Spain
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Pascual JC, Madre M, Soler J, Barrachina J, Campins MJ, Alvarez E, Pérez V. Injectable atypical antipsychotics for agitation in borderline personality disorder. Pharmacopsychiatry 2006; 39:117-8. [PMID: 16721704 DOI: 10.1055/s-2006-941489] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Agitation is relatively common among Borderline Personality Disorder (BPD) patients in Psychiatric Emergency Services (PES). New injectable atypical antipsychotics are indicated for treatment in agitated psychotic or maniac patients but not for agitated BDP patients. Twenty agitated BPD patients were treated with intramuscular atypical antipsychotics (olanzapine or ziprasidone). Results suggest intramuscular atypical antipsychotics may be effective, fast and safe for treating acute BPD patients.
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Pascual JC, Madre M, Puigdemont D, Oller S, Corripio I, Díaz A, Faus G, Perez V, Alvarez E. [A naturalistic study: 100 consecutive episodes of acute agitation in a psychiatric emergency department]. Actas Esp Psiquiatr 2006; 34:239-44. [PMID: 16823684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
INTRODUCTION Psychomotor agitation is a common event in psychiatric emergency services (PES) with a prevalence of approximately 10 %. There is no general consensus on to how to manage psychomotor agitation; benzodiazepines, typical antipsychotics and now atypical antipsychotics have demonstrated similar efficacy. The aim of our study was to describe the epidemiology and clinical management of agitation in "real-life" in a psychiatric emergency service. METHODS A naturalistic study was performed in acutely agitated patients recruited consecutively in a psychiatric emergency service. Demographics, clinical and therapeutic characteristics were analyzed. Efficacy was assessed by the Excitement Component of the Positive and Negative Syndrome Scale (PANSS-EC) and the Agitation-Calmness Evaluation Scale (ACES). Pragmatic variables such as the need for second pharmacological intervention and the need for physical restraints were assessed. RESULTS The study included 100 patients with psychomotor agitation. Mean age was 36.2 % and 54% were women. The most prevalent diagnoses were psychotic disorder (48 %) and personality disorder (24 %). Physical restraint was required in 39 % of patients and 52 % accepted oral treatment. Haloperidol was the most frequent oral treatment and olanzapine was the most frequent intramuscular treatment. CONCLUSIONS A naturalistic approach provides data based on clinical reality in psychiatric emergency services. Strict research designs of clinical trials of efficacy imply sample selection biases and are generally distanced from the clinical reality. Atypical antipsychotics have become the first-line treatment in acute agitation
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Affiliation(s)
- J C Pascual
- Servicio de Psiquiatría, Hospital de la Santa Creu i Sant Pau, Barcelona
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Pastor N, Betlloch I, Pascual JC, Blanes M, Bañuls J, Silvestre JF. Pyoderma gangrenosum treated with anti-TNF alpha therapy (etanercept). Clin Exp Dermatol 2006; 31:152-3. [PMID: 16309525 DOI: 10.1111/j.1365-2230.2005.01972.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Affiliation(s)
- J F Silvestre
- Dermatology Department, Hospital General Universitario of Alicante, Alicante, Spain.
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Affiliation(s)
- M Blanes
- Department of Dermatology, Hospital General Universitario of Alicante, Alicante, Spain.
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Pascual JC, Fleisher AB. Tacrolimus ointment (Protopic) for atopic dermatitis. Skin Therapy Lett 2004; 9:1-5. [PMID: 15550992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Tacrolimus ointment (Protopic, Fujisawa) is an effective agent in a class of topical immunomodulators. Its mechanism of action is based on calcineurin inhibition, which results in decreased T-cell activation and inflammatory cytokine release. Tacrolimus ointment is safe and effective for short- and long-term treatment of atopic dermatitis (AD) in pediatric and adult patients. The most common adverse events associated with its use are a transient burning sensation and pruritus at the site of application. Unlike topical corticosteroid agents, tacrolimus ointment does not cause a reduction in collagen synthesis or skin thickness. Because tacrolimus ointment does not cause skin atrophy, it may be safely used for months or years on all skin areas, including the face and intertriginous areas.
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Affiliation(s)
- J C Pascual
- Department of Dermatology, Hospital General de Alicantem, Alicante, Spain
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Abstract
Polycythemia vera is classified with myelogenous leukaemia, agnogenic myeloid metaplasia and primary thrombocythemia as a myeloproliferative syndrome. Cutaneous symptoms have been reported with polycythemia vera, including facial plethora, aquagenic pruritus, urticaria, purpura, Sweet's syndrome and pyoderma gangrenosum. However, polycythemia vera associated with systemic sarcoidosis has been rarely reported. An unusual case of polycythemia vera associated with cutaneous sarcoidosis is described.
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Affiliation(s)
- J C Pascual
- Department of Dermatology, Hospital General de Alicante, Spain.
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Barrachina J, Soler J, Campins MJ, Tejero A, Pascual JC, Alvarez E, Zanarini MC, Pérez Sola V. [Validation of a Spanish version of the Diagnostic Interview for Bordelines-Revised (DIB-R)]. Actas Esp Psiquiatr 2004; 32:293-8. [PMID: 15529214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
INTRODUCTION Borderline Personality Disorder (BPD) is the most studied Axis II disorders. However, there are no Spanish versions of specific interviews. The Diagnostic Interview for Borderlines-Revised (DIB-R) is a semistructured interview used to determine the diagnosis and severity of BPD patients. The aim of this study was to validate the DIB-R for use in a Spanish-speaking sample. METHOD The psychometric characteristics of the DIB-R Spanish version were assessed in a sample of 156 patients with the possible diagnosis of borderline personality disorder. There were 29 men and 127 women with a mean age of 27.6 years (SD: 6.5; range: 18-45). The Spanish adaptation of the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) was used as gold standard. RESULTS The DIB-R showed good total internal consistency (Cronbach's alpha: 0.89) and high inter-rater reliability (within-class correlation: 0.94). Using logistic regression analyses the best cut-off was judged to be 6 or more, obtaining high sensitivity (0.81), specificity (0.94) and moderate convergent validity of the diagnosis with the SCID-II (kappa: 0.59). CONCLUSIONS The Spanish version of the DIB-R showed psychometric characteristics similar to those in the original interview and may be useful to determine BPD presence and severity.
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Affiliation(s)
- J Barrachina
- Servicio de Psiquiatría, Hospital de la Santa Creu i Sant Pau, Barcelona
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Affiliation(s)
- G Vergara
- Servicio de Dermatología, Hospital General, Universitario de Alicante, Spain
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Pascual JC, Belinchón I, Silvestre JF, Vergara G, Blanes M, Bañuls J, Betlloch I, Boix V. Sarcoidosis after highly active antiretroviral therapy in a patient with AIDS. Clin Exp Dermatol 2004; 29:156-8. [PMID: 14987273 DOI: 10.1111/j.1365-2230.2004.01487.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J C Pascual
- Department of Dermatology, Hospital General Universitario de Alicante, Spain.
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Silvestre JF, Albares MP, Escutia B, Vergara G, Pascual JC, Botella R. Contact vitiligo appearing after allergic contact dermatitis from aromatic reactive diluents in an epoxy resin system. Contact Dermatitis 2003; 49:113-4. [PMID: 14641370 DOI: 10.1111/j.0105-1873.2003.0128l.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J F Silvestre
- Department of Dermatology, Hospital General de Alicante, Alicante, Spain.
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Albares MP, Betlloch I, Guijarro J, Vergara G, Pascual JC, Botella R. Severe pruritus in a haemodialysed patient: dramatic improvement with granisetron. Br J Dermatol 2003; 148:376-7. [PMID: 12588407 DOI: 10.1046/j.1365-2133.2003.05097_11.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Arnaiz-Villena A, Rodriguez de Córdoba S, Vela F, Pascual JC, Cerveró J, Bootello A. HLA antigens in a sample of the Spanish population: common features among Spaniards, Basques, and Sardinians. Hum Genet 1981; 58:344-8. [PMID: 6948767 DOI: 10.1007/bf00294935] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Frequencies of recently described HLA-A,-B (antigens or splits) and HLA-C and HLA-DR antigens are studied in a 450 normal Spaniards sample. The linkage disequilibria are also calculated. HLA-DR7 is more frequent than in any other population studied. Aw30-B18 and Aw33-B14 associations are common and specific Spanish, Basque, and Sardinian HLA features. A11-B17 association is found in our Spanish sample and also in Basques. HLA-Bw4,-Bw6 antigens are analyzed by family mating and segregation and also using unrelated individuals. It shows a good fit as a genetic system. HLA-B antigens are included either in Bw4 or Bw6 according to expectations from other Caucasoid population results. The possibility of a common and North African origin (Iberians) for Spaniards, Basques, and Sardinians is discussed on the basis of presently available HLA data.
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