RESUMEN
BACKGROUND: Chronic hand eczema is a fluctuating, inflammatory, pruritic, often painful disease of hands and wrists that strongly impacts quality of life and occupational capabilities of patients. The aim of phase 3 DELTA 1 and DELTA 2 was to assess the efficacy and safety of twice-daily applications of the topical pan-Janus kinase inhibitor delgocitinib cream 20 mg/g versus cream vehicle in adults with moderate to severe chronic hand eczema. METHODS: Both trials were randomised, double-blinded, and vehicle-controlled, with DELTA 1 being conducted at 53 trial centres in Canada, France, Germany, Italy, Poland, and the UK and DELTA 2 at 50 trial centres in Belgium, Canada, Denmark, Germany, the Netherlands, Poland, and Spain. Adults (aged ≥18 years) with moderate to severe chronic hand eczema were randomly assigned 2:1 to twice-daily delgocitinib cream 20 mg/g or cream vehicle for 16 weeks. The primary endpoint was Investigator's Global Assessment for Chronic Hand Eczema (IGA-CHE) treatment success at week 16, defined as IGA-CHE score of 0 (clear) or 1 (almost clear, defined as only barely perceptible erythema). Efficacy and safety were assessed in all patients who were exposed to trial treatment. These trials are registered with ClinicalTrials.gov, NCT04871711 and NCT04872101. FINDINGS: Between May 10, 2021, and Oct 31, 2022, 487 patients (181 male and 306 female) were enrolled in DELTA 1; between May 25, 2021, and Jan 6, 2023, 473 patients (161 male and 312 female) were enrolled in DELTA 2. 325 patients in DELTA 1 and 314 in DELTA 2 were assigned to delgocitinib cream; 162 patients in DELTA 1 and 159 in DELTA 2 were assigned to cream vehicle. At week 16, a greater proportion of delgocitinib-treated patients versus cream vehicle patients had IGA-CHE treatment success (64 [20%] of 325 vs 16 [10%] of 162 in DELTA 1 and 91 [29%] of 313 vs 11 [7%] of 159 in DELTA 2; both trials p≤0·0055). The proportion of patients who reported adverse events was similar with delgocitinib (147 [45%] of 325 in DELTA 1 and 143 [46%] of 313 in DELTA 2) and the cream vehicle (82 [51%] of 162 in DELTA 1 and 71 [45%] of 159 in DELTA 2). Most frequent adverse events occurring in at least 2% of patients were similar in both treatment groups and included COVID-19 and nasopharyngitis. INTERPRETATION: Overall, delgocitinib cream showed superior efficacy versus cream vehicle and was well tolerated over 16 weeks. These results support the clinical benefit of delgocitinib cream as a potential treatment option for patients with moderate to severe chronic hand eczema, who are unable to adequately control their disease with basic skin care practices and topical corticosteroids. FUNDING: LEO Pharma.
Asunto(s)
Eccema , Dermatosis de la Mano , Pirroles , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedad Crónica , Método Doble Ciego , Eccema/tratamiento farmacológico , Dermatosis de la Mano/tratamiento farmacológico , Pirroles/uso terapéutico , Índice de Severidad de la Enfermedad , Crema para la Piel , Resultado del TratamientoRESUMEN
Patch testing is the only clinically applicable diagnostic method for Type IV allergy. The availability of Type IV patch test (PT) allergens in Europe, however, is currently scarce. This severely compromises adequate diagnostics of contact allergy, leading to serious consequences for the affected patients. Against this background, the European Society of Contact Dermatitis (ESCD) has created a task force (TF) (i) to explore the current availability of PT substances in different member states, (ii) to highlight some of the unique characteristics of Type IV vs. other allergens and (iii) to suggest ways forward to promote and ensure availability of high-quality patch testing substances for the diagnosis of Type IV allergies throughout Europe. The suggestions of the TF on how to improve the availability of PT allergens are supported by the ESCD, the European Academy of Allergy and Clinical Immunology, and the European Academy of Dermatology and Venereology and intend to provide potential means to resolve the present medical crisis.
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Alérgenos , Dermatitis Alérgica por Contacto , Dermatitis Profesional , Pruebas del Parche , Humanos , Pruebas del Parche/métodos , Europa (Continente) , Dermatitis Alérgica por Contacto/diagnóstico , Dermatitis Alérgica por Contacto/etiología , Alérgenos/efectos adversos , Dermatitis Profesional/diagnóstico , Dermatitis Profesional/etiología , Sociedades Médicas , Comités ConsultivosAsunto(s)
Peróxido de Benzoílo , Dermatitis Alérgica por Contacto , Dermatitis Profesional , Dermatosis de la Mano , Humanos , Dermatitis Alérgica por Contacto/etiología , Dermatitis Alérgica por Contacto/diagnóstico , Dermatitis Profesional/etiología , Dermatitis Profesional/diagnóstico , Dermatosis de la Mano/inducido químicamente , Dermatosis de la Mano/etiología , Peróxido de Benzoílo/efectos adversos , Dermatosis Facial/inducido químicamente , Dermatosis Facial/etiología , Eccema/inducido químicamente , Pruebas del Parche , Femenino , Adulto , Masculino , Blanqueadores/efectos adversos , Púrpura/inducido químicamente , Púrpura/etiologíaAsunto(s)
Alcohol Bencilo , Dermatitis Alérgica por Contacto , Dermatitis Profesional , Dermatosis de la Mano , Pintura , Humanos , Dermatitis Alérgica por Contacto/etiología , Dermatitis Alérgica por Contacto/diagnóstico , Dermatitis Profesional/etiología , Dermatitis Profesional/diagnóstico , Pintura/efectos adversos , Dermatosis de la Mano/inducido químicamente , Dermatosis de la Mano/etiología , Alcohol Bencilo/efectos adversos , Pruebas del Parche , Femenino , Masculino , Adulto , Persona de Mediana EdadRESUMEN
The impact of chronic urticaria on work has been scarcely reported, whereas its peak incidence is between the ages of 20 and 40. The aim of this study was to assess the occupational impact of chronic urticaria and its treatment, by combining objective and patient-reported data. A monocentric observational study was performed using questionnaires over a 1-year period from 2021 to 2022 in chronic urticaria patients who were in a period of professional activity and agreed to participate. Of the 88 patients included, 55.7% assessed the occupational impact of their chronic urticaria as significant, and even more severe when chronic urticaria was poorly controlled. Some 86% of patients had symptoms at work, in a third of cases aggravated by work. However, occupational physical factors were not associated with an aggravation of inducible chronic urticaria. A total of 20% reported treatment-related adverse effects affecting their work. Despite low absenteeism, presenteeism and reduced productivity were important (> 20%). Six patients (6.8%) had difficulties keeping their work. For 72.7% of the patients, the occupational physician was not informed. The occupational impact of chronic urticaria should be discussed during consultations, particularly when it is insufficiently controlled. The occupational physician should be informed in order to support patients' professional project.
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Urticaria Crónica , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Urticaria , Humanos , Adulto Joven , Adulto , Calidad de Vida , Enfermedad Crónica , Urticaria/diagnóstico , Urticaria/epidemiología , Urticaria/complicaciones , Urticaria Crónica/diagnóstico , Urticaria Crónica/tratamiento farmacológico , Urticaria Crónica/epidemiología , Encuestas y CuestionariosRESUMEN
BACKGROUND: Limited and conflicting data have been reported on the impact of dupilumab (DUPI) on patch test (PT) results and its efficacy against allergic contact dermatitis (ACD). OBJECTIVE: This study was undertaken to analyze PT reactivities and relevance during treatment with DUPI to determine whether they could detect ACD in patients with uncontrolled or worsened atopic dermatitis (AD) who were receiving this agent. METHODS: This prospective, multicenter study examined 76 DUPI-treated patients who had undergone PTs. The relevant information was collected during 3 visits. RESULTS: Overall, 36 patients (47%) had ≥1 positive PT reaction, and 142 PT results were positive. Twenty-three patients (30%) had ≥1 positive and clinically relevant PT result. Five of them had clinical eczema improvement after allergen avoidance. We compared the PT results of 36 patients before and during DUPI therapy, representing 1230 paired PT allergens, of which 1022 were the same, 34 were positive, 44 were lost, and 130 were uninterpretable. LIMITATIONS: Because the number of patients included remains limited, our findings should be confirmed with a larger sample. CONCLUSION: Our results confirmed the usefulness of PTs for patients receiving DUPI, with good PT reproducibility. We suggest that all DUPI-treated patients with AD developing partial responses or experiencing symptom worsening should undergo PTs to look for contact sensitization.
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Anticuerpos Monoclonales Humanizados , Dermatitis Alérgica por Contacto , Dermatitis Atópica , Humanos , Pruebas del Parche/métodos , Reproducibilidad de los Resultados , Estudios Prospectivos , Dermatitis Alérgica por Contacto/etiología , Dermatitis Atópica/diagnóstico , Dermatitis Atópica/tratamiento farmacológico , Dermatitis Atópica/inducido químicamente , Alérgenos/efectos adversosAsunto(s)
Dermatitis Alérgica por Contacto , Dermatitis Profesional , Eccema , Dermatosis de la Mano , Humanos , Dermatitis Alérgica por Contacto/diagnóstico , Dermatitis Alérgica por Contacto/etiología , Dermatitis Profesional/diagnóstico , Dermatitis Profesional/etiología , Plantas , Dermatosis de la Mano/inducido químicamente , Dermatosis de la Mano/diagnóstico , Pruebas del ParcheRESUMEN
OBJECTIVE: To analyse the clinical characteristics and sensitivity of an essential oil patch test series (EOS) in patients sensitized to their own essential oils (EOs). METHOD: We analysed the clinical data and patch test results obtained with the European baseline series (BSE) and an EOS, as well as the mode of use of EOs, through a questionnaire included in the patient file. RESULTS: The study included 42 patients (79% women, average age 50 years) with allergic contact dermatitis (ACD), 8 patients required hospitalization. All patients were sensitized to the EO they used, primarily lavender (Lavandula augustifolia, 8000-28-0), tea tree (Melaleuca alternifolia leaf oil, 68647-73-4), ravintsara (Cinnamomum camphora oil, 92201-50-8), and 2 cases were attributed to helichrysum (helichrysum italicum flower absolute, 90045-56-0). 71% had positive patch tests to fragrance mix I or II, 9 only to the EOS and 4 only with their personal EO. Interestingly, 40% of patients did not spontaneously mention the use of EOs, and only 33% received advice on their use at the time of purchase. CONCLUSION: Patch tests with the BSE, limonene and linalool HP, and oxidized tea tree oil is sufficient to detect most EO-sensitized patients. The most important is to test the patient's own used EOs.
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Dermatitis Alérgica por Contacto , Dermatología , Lavandula , Aceites Volátiles , Aceite de Árbol de Té , Humanos , Femenino , Persona de Mediana Edad , Masculino , Aceites Volátiles/efectos adversos , Dermatitis Alérgica por Contacto/diagnóstico , Dermatitis Alérgica por Contacto/etiología , Pruebas del Parche , Aceite de Árbol de Té/efectos adversosRESUMEN
BACKGROUND: Allergic contact dermatitis to gloves is mostly induced by rubber accelerators. The European baseline series (EBS) appears insufficient to detect glove allergy. Since 2017, it is recommended to use the European rubber series (ERS) and to test the patients' own gloves. OBJECTIVES: To investigate the clinical profile of glove-wearing patients with hand eczema (HE) and to evaluate their sensitisation profile to glove allergens and the value of testing the patients' own gloves. METHODS: We conducted a French multicentre study of patients evaluated for HE between 2018 and 2020 and tested with the EBS, the ERS and their own gloves in patch tests and semi-open (SO) tests. RESULTS: A total of 279 patients were included; 32.6% of patients had positive tests to their own gloves or to glove allergens. Almost 45% of the sensitisations to glove allergens were detected only by the ERS. Among the patients tested both in patch tests and SO tests with their own gloves with positive results, 28% had positive SO tests only. Polyvinylchloride (PVC) gloves were positive in four patients. CONCLUSION: Our series confirms the need to test the ERS. All the patients' gloves must also be tested including PVC gloves. SO tests with gloves are useful as a complement to patch tests.
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Dermatitis Alérgica por Contacto , Eccema , Dermatosis de la Mano , Humanos , Dermatitis Alérgica por Contacto/diagnóstico , Dermatitis Alérgica por Contacto/etiología , Goma/efectos adversos , Eccema/etiología , Alérgenos/efectos adversos , Pruebas del Parche , Cloruro de Polivinilo/efectos adversos , Dermatosis de la Mano/inducido químicamente , Guantes Protectores/efectos adversosRESUMEN
Dupilumab is a therapeutic antibody targeting IL-4 and IL-13 receptor subunit alpha used for the treatment of patients with atopic dermatitis (AD). Cases of psoriasis-like reactions induced under dupilumab treatment (dupilumab-induced psoriatic eruption [DI-Pso]) for AD were recently reported. To understand the pathogenesis of DI-Pso, we performed gene expression profiling studies on skin biopsies of DI-Pso (n = 7) compared with those of plaque psoriasis, AD, and healthy controls (n = 4 each). Differential gene expression was performed using enrichment and Gene Ontology analysis. Gene expression was validated by qPCR, and protein levels were assessed by immunohistochemistry. Transcriptomic and protein analysis of DI-Pso compared with that of healthy controls, plaque psoriasis, and AD skins revealed activation of T helper 17/IL-23 pathways associated with a significant expression of IL-36, surrogate marker of pustular psoriasis. By contrast, T helper 2 representative genes' expression was strongly decreased in DI-Pso across comparison. Matching analysis with public data of pustular psoriasis skin corroborated that DI-Pso and pustular psoriasis upstream regulators overlap, greater than the overlap with plaque psoriasis. Furthermore, DI-Pso showed strongly decreased expression of many barrier skin genes compared with healthy controls, plaque psoriasis, and AD. Our data indicate that the pathogenesis of DI-Pso relied on a shift of skin immune responses from a T helper 2 to an IL-36 and T helper 17 polarization and on intensified skin barrier alterations.
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Dermatitis Atópica , Exantema , Psoriasis , Humanos , Dermatitis Atópica/tratamiento farmacológico , Dermatitis Atópica/genética , Interleucina-4/genética , Interleucina-13/genética , Psoriasis/tratamiento farmacológico , Psoriasis/genéticaRESUMEN
Introduction: Few cases of skin diseases caused by exposure to artichokes have been published. Artichokes contain sesquiterpene lactones, which are known to be sensitizing. Irritant contact dermatitis (ICD) has also been diagnosed. To our knowledge, no protein contact dermatitis (PCD) has yet been reported to be induced by artichoke. Objectives: The aim of this study was to identify the different types of contact dermatitis that may be due to occupational exposure to artichokes and the professions concerned. Materials and Methods: We conducted a descriptive study, retrieving data from the French national database of occupational diseases for the period of 2001 to 2018. Results: Fifty-six cases were retrieved, and 10 cases were included in this study after data analysis and reading the clinical reports: 7 allergic contact dermatitis (ACD), 2 PCD, and 1 ICD caused by artichokes. Patients were farmers (4), agri-food workers (3), market gardener (1), cashier (1), and store employee (1). Conclusions: This is the first series of occupational contact dermatitis that can be induced by artichokes. Exposure to artichokes can lead to ICD, ACD, PCD, and perhaps contact urticaria. The sesquiterpene lactone mix patch test is not always sufficient to confirm an ACD by artichokes. Irritant contact dermatitis can be associated with ACD from artichokes or evolve on its own.
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Cynara scolymus , Dermatitis Alérgica por Contacto , Dermatitis Irritante , Dermatitis Profesional , Exposición Profesional , Sesquiterpenos , Humanos , Irritantes , Dermatitis Profesional/diagnóstico , Dermatitis Profesional/etiología , Dermatitis Alérgica por Contacto/diagnóstico , Dermatitis Alérgica por Contacto/etiología , Dermatitis Irritante/etiología , Pruebas del Parche/efectos adversos , Sesquiterpenos/efectos adversosRESUMEN
Dermatoses are among the most frequent diseases related to working conditions. Nevertheless, there is an under-reporting of occupational diseases and the management of patients with either a possible occupational dermatosis or a condition aggravated by work which could be improved. The aim of this article is to present the most common occupational dermatoses, a multidisciplinary diagnostic approach to them and to propose a screening tool for occupational exposures.
Les dermatoses sont parmi les maladies les plus fréquentes en lien avec les conditions de travail. Néanmoins, il existe une sous-déclaration en maladie professionnelle et la prise en charge des patients atteints, soit d'une possible dermatose professionnelle, soit d'une condition aggravée par le travail, qui pourrait être améliorée. L'objectif de cet article est de présenter les dermatoses professionnelles les plus communes et une démarche diagnostique pluridisciplinaire et de proposer un outil de dépistage des expositions professionnelles à risque.
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Médicos Generales , Enfermedades Profesionales , Exposición Profesional , Enfermedades de la Piel , Humanos , Enfermedades Profesionales/diagnóstico , Enfermedades Profesionales/epidemiología , Enfermedades Profesionales/etiología , Enfermedades de la Piel/diagnóstico , Enfermedades de la Piel/epidemiología , Enfermedades de la Piel/etiologíaRESUMEN
BACKGROUND AND OBJECTIVES: The repeated open application test (ROAT) is an adjuvant investigation measure to patch testing in the diagnosis of allergic contact dermatitis. ESCD recommends a 15 days duration but its overall duration varies according to publications and patients hardly adhere to prolonged ROAT duration beyond 1 week. MATERIALS AND METHODS: The Dermatology and Allergy Group of the French Society of Dermatology performed a prospective study with the aim of determining the best duration for the ROAT. RESULTS: A total of 328 ROAT results were collected for topical products, including cosmetics (60%) and topical medications (31.1%). Fifty-nine (18%) ROATs were positive, and 16 (5%) were doubtful. All the positive ROATs occurred within 10 days, with a median time to positivity of 3 days. CONCLUSION: According to our results, a minimum duration of 10 days is necessary to achieve a positive ROAT to a topical product.
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Dermatitis Alérgica por Contacto , Dermatología , Alérgenos , Dermatitis Alérgica por Contacto/diagnóstico , Dermatitis Alérgica por Contacto/etiología , Relación Dosis-Respuesta a Droga , Humanos , Pruebas del Parche/métodos , Estudios ProspectivosRESUMEN
BACKGROUND: Hand eczema is a common inflammatory skin disorder. Health care providers need continuously updated information about the management of hand eczema to ensure best treatment for their patients. OBJECTIVES: To update the European Society of Contact Dermatitis guideline on the diagnosis, prevention, and treatment on of hand eczema. METHOD: The Guideline Development Group (GDG) was established on behalf of the ESCD. A call for interest was launched via the ESCD website and via the ESCD members' mailing list. Appraisal of the evidence for therapeutic and preventive interventions was applied and a structured method of developing consensus was used and moderated by an external methodologist. The final guideline was approved by the ESCD executive committee and was in external review on the ESCD webpage for 1 month. RESULTS: Consensus was achieved for several statements and management strategies. CONCLUSION: The updated guideline should improve management of hand eczema.
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Dermatitis Alérgica por Contacto , Eccema , Dermatosis de la Mano , Dermatitis Alérgica por Contacto/diagnóstico , Dermatitis Alérgica por Contacto/prevención & control , Eccema/diagnóstico , Eccema/prevención & control , Dermatosis de la Mano/diagnóstico , Dermatosis de la Mano/prevención & control , Humanos , Pruebas del ParcheRESUMEN
BACKGROUND: There is currently no agreed cosmetic series for use across Europe. OBJECTIVES: To establish allergens currently tested in local and national cosmetic series. METHOD: Members of the European Surveillance System on Contact Allergy and the European Cooperation in Science and Technology project TD1206 ("StanDerm") were surveyed to establish their current practice. RESULTS: A wide range of allergens was tested but there was significant variation between centres on the allergens considered to be important in screening for allergy to cosmetics. The number of allergens tested in addition to the baseline series varied between 2 and 50. CONCLUSIONS: There is a need for further investigation to establish the frequency and relevance of reactions to cosmetic allergens to enable an agreed evidence-based cosmetic series to be produced. Criteria for inclusion need to be established.
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Alérgenos/toxicidad , Cosméticos/toxicidad , Dermatitis Alérgica por Contacto/diagnóstico , Pautas de la Práctica en Medicina/estadística & datos numéricos , Alérgenos/química , Cosméticos/química , Dermatitis Alérgica por Contacto/epidemiología , Dermatitis Alérgica por Contacto/etiología , Europa (Continente)/epidemiología , Unión Europea , Encuestas Epidemiológicas , Humanos , Pruebas del Parche , Vigilancia en Salud PúblicaAsunto(s)
Anticuerpos Monoclonales Humanizados/uso terapéutico , Dermatitis Alérgica por Contacto/diagnóstico , Dermatitis Atópica/tratamiento farmacológico , Dermatitis Profesional/diagnóstico , Guantes Quirúrgicos , Guanidinas/efectos adversos , Dermatosis de la Mano/diagnóstico , Cirujanos , Comorbilidad , Dermatitis Alérgica por Contacto/epidemiología , Dermatitis Alérgica por Contacto/etiología , Dermatitis Atópica/epidemiología , Dermatitis Profesional/epidemiología , Dermatitis Profesional/etiología , Dermatosis de la Mano/inducido químicamente , Dermatosis de la Mano/epidemiología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Assessment of the clinical relevance of patch test reactions is an essential part of the diagnostic work-up of patients with (occupational) contact dermatitis. However, final diagnostic information, particularly the clinical relevance of allergic patch test reactions, has hitherto been ill-represented in clinical documentation systems (patch test software) and surveillance registries based on these. OBJECTIVES: To develop, implement as a pilot study, and analyse concerning feasibility and contents a new concept of representing the full scope of diagnostic information utilized in the diagnosis of patients with (occupational) contact dermatitis. METHODS: On the basis of a European working group discussion on items to document and catalogue lists to use for this purpose, an online documentation system to collect data was set up, followed by pilot use involving 9 dermatology departments across Europe. RESULTS: Data on 176 patients with suspected occupational hand dermatitis were included; among these, work-relatedness was confirmed in 150, and in 53 non-occupational aetiology was the sole or a contributory cause. Data were further analysed with regard to occupations, product categories, substances (haptens), source of information on which the evaluation was based, and various combinations of these factors, to illustrate the usefulness of the proposed data representation. CONCLUSIONS: An improved method of data collection is presented that more accurately links allergen to exposure and to clinical disease and patient history, and thus better represents clinical relevance. This enables more precise analysis of the causation of contact dermatitis, occupational or non-occupational, and thereby better targeting of prevention. The development of future databases should incorporate the above considerations to record the results of investigation.