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Podoscopio N79.Indd 1ª Época VOL. 1 Nº 79 4o Trimestre de 2018 CUIDADOS Y ACTUALIZACIÓN EN EL ABORDAJE TERAPÉUTICO DE LA PSORIASIS DESCRIPCIÓN CLÍNICO-EPIDEMIOLÓGICA DE LOS TUMORES MALIGNOS DE ORIGEN MELANOCÍTICO (MELANOMAS) Sumario 79.pdf 1 4/1/19 9:24 Revista Podoscopio 1ª ÉPOCA VOL. 1_ Nº 79 4o Trimestre de 2018 Director Dr. Pedro Villalta García Sumario Coordinador de Redacción Luis Monterrubio Adánez Edita Junta de Gobierno del Colegio de Podólogos Editorial de la Comunidad de Madrid 1886_ San Bernardo, 74 bajo izqda. 28015-Madrid Telf.: 91 532 60 06 Cuidados y actualización en el abordaje Fax: 91 522 87 63 1887_ terapéutico de la psoriasis Correo electrónico: [email protected] > BEATRIZ HERNÁNDEZ BLANCO Web: www.copoma.es Junta de Gobierno Decano Descripción clínico-epidemiológica de los Dr. Pedro Villalta García 1914_ tumores malignos de origen melanocítico Vicedecano Luis Soler Mínguez (melanomas) Secretaria > JOSÉ VALERO Gema López García > NURIA SARROCA Tesorera > DAVID GONZÁLEZ Mª Montserrat Gómez Maya > JOSÉ GALLART Vocales Luis Monterrubio Adánez Natalia Fernández Ospina Juan Carlos Montero Arroyo Patrocinio Olmo Serna 1924_ Normas de publicación Manuel Meneses Garde Comisión Científica Comisión de Recursos Dr. Pedro Villalta García Presidente Francisco Matías Martín Luis Monterrubio Adánez Vicepresidente Natalia Fernández Ospina Félix Romeral Bravo Secretario Gregorio Díaz Tadeo Depósito Legal: M-42451-1983 ISSN: 0212-7393 Imprime: Copysell, S. L. Esta publicación está considerada como soporte válido para información de especialidades farmacéuticas, a tenor de lo dispuesto en el Capítulo VII del Real Decreto 3451/77, del 1 de diciembre. Referencia SVR, nº 383. La dirección se reserva la libertad de aceptar o no los trabajos enviados, y no asume la responsabilidad de los artículos firmados. Revista del Colegio de Podólogos de la Comunidad de Madrid PODOSCOPIO EDITORIAL Estimado/a compañero/a El nuevo año 2019 nos espera con multitud de proyectos y avances nuevos para desarrollar nuestra profesión El día 4 de diciembre se ha publicado la Consideramos que la reciente orden aproba- Orden 1158/2018, de 7 de noviembre, da, no desarrolla completamente todas las del Consejero de Sanidad, por la que competencias de la profesión podológica, am- se regulan los requisitos técnicos parada en la Orden CIN/728/2009, de marzo, generales y específicos de los centros y servicios por la que se establecen los requisitos para sanitarios sin internamiento, de los servicios la verificación de los títulos universitarios sanitarios integrados en una organización no oficiales que habiliten para el ejercicio de la sanitaria y de la asistencia sanitaria prestada podología, ya que en el módulo denominado por profesionales sanitarios a domicilio en “Quiropodología y Cirugía Podológica” tiene la Comunidad de Madrid, en ella, se regula como competencias “Conocer y obtener habi- la Unidad de Podología (U.4), donde nos lidades en la aplicación de las técnicas podoló- especifica las áreas diferenciadas para nuestra gicas de cirugía ungueal, de cirugía podológica actividad podológica, mejorando con respecto de partes blandas, de cirugía ósea y articular a la normativa del 31 de mayo de 2010. del pie”, igualmente en el apartado 3, punto 1. “Conocer y aplicar los fundamentos teóricos En esta orden nos especifica al área clínica para y metodológicos de la Podología y Podiatria”. quiropodología, de exploración biomecánica que podrá estar unida al área de exploración También en este mes de diciembre, la Real cuyas dimensiones sean de 10 m2, de ortopo- Academia Española de la Lengua, ha admitido dología, donde podremos realizar las plantillas dentro de la definición de “doctor, ra. m y para el tratamiento de nuestros pacientes que f. Médico u otro profesional especializado en así los diagnostiquemos, y área quirúrgica que alguna técnica terapéutica, como el dentista, bajo anestesia local y que no requieran cuida- el podólogo, etc. U. frec. como tratamiento”. dos postoperatorios podrán realizarse en las Por tal motivo, debemos estar orgullosos de clínicas, aunque en caso de requerir cuidados la nueva aceptación para la podología. postoperatorios de corta duración y no requie- El nuevo año 2019 nos espera con multitud de ran ingreso hospitalario, deberán realizarse en proyectos y avances nuevos para desarrollar las unidades de cirugía mayor ambulatoria, así nuestra profesión, uno de ellos, será continuar como regula la asistencia podológica domicilia- con la reivindicación de la inclusión de la po- ria y la sedación consciente por parte del profe- dología en la sanidad pública en atención y sional de la podología. tratamiento del pie diabético. 1886_ Podoscopio 2018; 4 (79): 1886 Revista del Colegio de Podólogos de la Comunidad de Madrid Cuidados y actualización en el abordaje terapéutico de la Psoriasis PODOSCOPIO Cuidados y actualización en el abordaje terapéutico de la psoriasis > Beatriz Hernández Blanco. Grado en Podología por la Universidad Alfonso X El Sabio. 1 RESUMEN: el tema. Siendo los criterios de exclusión los siguientes: otros idiomas que no sean inglés, La psoriasis es una enfermedad inflamatoria artículos que no sean sobre bases científicas, crónica de la piel de etiología desconocida que tratamientos aplicados en población con enfer- tiene repercusión en el pie. Presenta una gran medad de base, anteriores al año 2009, artículos variedad de tratamientos, aunque no existe privados, tratamientos realizados secundarios a ninguno de elección. La elección depende de la gravedad, extensión, perfil, beneficio-ries- una enfermedad de base. go, preferencias del paciente y de la respuesta Resultados: al tratamiento. Además, es una patología re- Se analizaron los diferentes tratamientos, poso- currente y es frecuente que se requieran dife- logía, efectos adversos, eficacia, vías de adminis- rentes tratamientos para mantener la enfer- tración, indicaciones terapéuticas que se adap- medad estable. tan a los criterios de inclusión. Objetivos y metodología: Conclusión: En esta revisión bibliográfica, actualizaremos los No existe un tratamiento más eficaz que otro, el diferentes tratamientos de la psoriasis respon- tratamiento a considerar dependerá de cada pa- diendo a los siguientes objetivos: Comparar los ciente y su finalidad (adecuado para inducir re- diferentes tratamientos y sus efectos adversos misión, tratamiento de mantenimiento, acepta- para esta patología, evaluar la efectividad del ción por el paciente…etc). Así mismo la eficacia tratamiento tópico, conocer la efectividad del tratamiento sistémico, conocer la efectividad de de cada tratamiento variará según sus diferentes las terapias biológicas y estudiar los cuidados de combinaciones. higiene necesario en la psoriasis. Palabras clave: La información se adquiere de las principales Psoriais, Tratamiento sistémico, treatment fuentes y bases de datos biomédicas: dialnet, sistemic, Tratamiento tópico, topical treatment, scielo, pubmed, sapiens. Se han aceptado los terapia biológica, biologic treatment, artículos publicados en los últimos años sobre phototherapy, photochemotherapy Revista del Colegio de Podólogos de la Comunidad de Madrid Podoscopio 2018; 4 (79): 1887-1911 _ 1887 PODOSCOPIO Cuidados y actualización en el abordaje terapéutico de la Psoriasis 2 INTRODUCCIÓN: 2.1 Concepto La psoriasis es una enfermedad inflamatoria La palabra psoriasis, deriva del griego, etimoló- crónica de la piel de etiología desconocida que gicamente significa: psor. prurito, iasis: estado.8 tiene repercusión en el pie. Se caracteriza por Descrita en 1841 por Ferdinand von Hebra, es una la presencia de manifestaciones articulares y en enfermedad inflamatoria crónica de la piel, reci- la piel, ocasionando un problema importante a divante y de etiología desconocida, caracterizada nivel epidemiológico y sanitario. 1,2 por una excesiva proliferación queratinocítica. 9,4 Puede aparecer a cualquier edad, aunque mu- Presenta una clínica variable, caracterizada por chos estudios han demostrado que los brotes y pápulas y placas eritematosas, secas, de variados picos de la enfermedad aparecen en la adoles- tamaños y configuración (redondeadas, circina- cencia y también en la etapa adulta sobre los das, arcuata, serpinginosa,anular, girata,guta- 50- 60 años. 1 ta, rupoide) cubierta de escamas estratificadas, Es por prevalencia a nivel mundial, la enferme- imbricadas y abundantes, de color grisáceo o dad dermatológica con mayor tasa de afectados. blanco nacarado y de localización casi siempre Afecta a más de 100 millones de personas en simétrica) 8,9 todo el mundo con una prevalencia del 1-4%. 2,3 La variabilidad de su duración y extensión nos La psoriasis en el pie es un trastorno frecuente permitirá observar distintos grados de expresión que puede presentar una clínica variable. Las clínica 10 manifestaciones clínicas podemos clasificarlas La psoriasis no pone en riesgo la vida del pacien- en lesiones cutáneas y afectaciones ungueales. 1 te, pero puede tener un impacto psicosocial ne- La psoriasis tiene una gran variedad de trata- gativo en diferentes etapas del desarrollo de la mientos, aunque no existe ninguno de elección. vida 9,11 La elección depende de la gravedad, extensión, 2.2 Epidemiología: perfil, beneficio-riesgo, preferencias del pacien- La prevalencia de la psoriasis en adultos oscila te y de la respuesta al tratamiento. Además, es entre 0,51% y el 11,43%, y en los niños del 0% al una patología recurrente y es frecuente que se 1,37%.12 requieran diferentes tratamientos para mante- ner la enfermedad estable. 3,5,6 En España,
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