An expert consensus on managing dupilumab-related ocular surface disorders in people with atopic dermatitis 2024.

BACKGROUND: Atopic dermatitis (AD) is the most common inflammatory skin condition which affects all ages. New therapies, including the monoclonal antibody therapy dupilumab, offer excellent efficacy. However, in clinical trials, and emphasised in real-world observations, the unexpected increased frequency of ocular adverse effects became apparent. The effectiveness of dupilumab and the unpredictability of ocular adverse effects mean that clinicians need guidance on counselling patients prior to treatment and on managing them if they arise. OBJECTIVES: The British Association of Dermatologists (BAD) and Royal College of Ophthalmologists collaborated on this consensus guidance on managing dupilumab-related ocular surface disorders (DROSD). METHODS: A multidisciplinary group was formed of adult and paediatric dermatologists and ophthalmologists with DROSD expertise, patient representation, and BAD Clinical Standards Unit. A literature search was conducted, and the results reviewed. All recommendations were reviewed, discussed and voted on. RESULTS: The recommendations pertain to dermatology and ophthalmology management, and apply to all ages, unless otherwise stated. Importantly, initiation of dupilumab for AD should not be delayed for most eye disorders except acute new problems, e.g. infections, or potentially severe conditions, e.g. a history of corneal transplant (ophthalmology advice should be sought first). There is insufficient evidence to recommend lubricant drops prophylactically. Dermatologists should assess eye complaints to diagnose DROSD; a severity grading system is provided. DROSD management differs slightly in those aged <7 years as ocular complications may affect neuro-ocular development; therefore, irrespective of DROSD severity, this population should be referred for ophthalmology advice. In those aged ≥7 years, dermatologists should feel confident to trial treatment and reserve ophthalmology advice for severe or non-responding cases. Discussion about dupilumab withdrawal should be prompted by a significant impact on quality of life, threat to sight, or other complications. CONCLUSIONS: Although dupilumab is a highly effective agent for treating AD, the risk of ocular adverse effects should not inhibit clinicians or patients from using it, but clinicians should be aware of them. If a patient develops DROSD, there are clear pathways to assess severity and offer initial management; where ineffective, dermatologists should assess the urgency and seek advice from or initiate referral to ophthalmology. While the evidence reviewed for these guidelines reflects the extensive literature on dupilumab, we believe our advice has relevance for ocular surface disorders in atopic dermatitis (AD) patients treated with tralokinumab and lebrikizumab.

Closing the textile loop: Enzymatic fibre separation and recycling of wool/polyester fabric blends.

Textile waste presents a serious environmental problem with only a small fraction of products from the fashion industry collected and re-used or recycled. The problem is exacerbated in the case of post-consumer waste by the mixture of different natural and synthetic fibres in blended textiles. The separation of mixed fibre waste, where garments are often multicomponent, presents a major recycling problem as fibres must be separated to single components to enable effective recycling. This work investigates the selective digestion of wool fibres from wool/polyester blended fabrics using an enzymatic approach. Complete degradation of wool fibres was achieved by application of a keratinase in a two-step process with addition of reducing agent and undigested polyester fibres were recovered. Electron microscopy showed complete breakdown of the natural fibres in the fabric blends, while spectroscopic and mechanical analysis of the recovered synthetic fibres confirmed that the enzymatic treatment had no significant impact on the properties of the polyester compared to virgin samples. The polyester fibres are therefore suitable to be recycled to polyester yarn and re-used in the manufacture of new garments or other products. The nutrient rich keratin hydrolysate could be used in microbial growth media or incorporated into bio-fertilisers or animal feed, contributing to the development of the circular economy.

Educando al público sobre SIDA en Lima, Perú / Educating public about AIDS in Lima, Peru

Presenta los objetivos, metodología, resultados y conclusiones