RESUMEN
Omalizumab is a recombinant humanized monoclonal antibody that inhibits immunoglobulin E. It has been approved for the treatment of severe asthma and chronic spontaneous urticaria refractory to other treatments. Its use in the management of chronic inducible urticaria (a type triggered by certain stimuli) is still considered off-label, although this use has been discussed in some consensus papers. This review brings together case reports and case series describing the use of omalizumab to treat chronic inducible urticaria. We analyze the most important aspects of the cases and the outcomes reported. The results seem to position omalizumab as a potentially effective, safe treatment alternative in some cases of chronic inducible urticaria.
Asunto(s)
Omalizumab/uso terapéutico , Urticaria/tratamiento farmacológico , Adolescente , Adulto , Anciano , Niño , Preescolar , Enfermedad Crónica , Evaluación de Medicamentos , Femenino , Humanos , Inmunoglobulina E/inmunología , Masculino , Persona de Mediana Edad , Estimulación Física/efectos adversos , Urticaria/etiología , Adulto JovenRESUMEN
We report 3 cases of solar urticaria in which there was no response or limited response to first-line treatments with high-dose H1 antihistamines or phototherapy. The patients were then treated with omalizumab. Symptoms improved in 2 patients, whose tolerance to sunlight increased considerably; quality of life clearly improved for 1 of these patients. The third experienced no improvement and developed a mild local reaction to the injected medication. We conclude that omalizumab may offer a potentially safe, useful alternative for patients with solar urticaria who do not respond to conventional therapy.
Asunto(s)
Omalizumab/uso terapéutico , Trastornos por Fotosensibilidad/tratamiento farmacológico , Urticaria/tratamiento farmacológico , Anciano , Evaluación de Medicamentos , Resistencia a Medicamentos , Antagonistas de los Receptores Histamínicos H1/uso terapéutico , Humanos , Iluminación/efectos adversos , Masculino , Persona de Mediana Edad , Omalizumab/efectos adversos , Trastornos por Fotosensibilidad/etiología , Trastornos por Fotosensibilidad/psicología , Fototerapia , Calidad de Vida , Luz Solar/efectos adversos , Urticaria/etiología , Urticaria/psicologíaRESUMEN
BACKGROUND: Solar urticaria is a chronic inducible urticaria also classified as an idiopathic dermatosis. The objective of this paper is to define the phenotypic characteristics of solar urticaria and to evaluate its incidence. MATERIAL AND METHOD: This was a retrospective multicenter study in which data were gathered on the epidemiology and clinical, photobiologic, laboratory, and therapeutic characteristics of solar urticaria. RESULTS: A total of 224 patients (141 women and 83 men) were included from 9 photobiology units. The mean age of the patients was 37.9 years (range, 3-73 years). A history of atopy was detected in 26.7%, and the most common presentation was allergic rhinitis (16.5%). Clinical signs were limited to sun-exposed areas in 75.9% of patients. The light spectrum most commonly implicated was visible light only (31.7%), and in 21% of cases it was only possible to trigger solar urticaria with natural light. The treatments most widely used by photobiology experts were oral antihistamines (65.46%), followed by different forms of phototherapy (34%). Complete resolution was observed most often in patients with solar urticaria triggered exclusively by visible or natural light, with statistically significant differences with respect to other wavelengths (P<.05). No increase in the annual incidence of solar urticaria was observed. CONCLUSIONS: We have presented the largest series of solar urticaria published to date. The epidemiological, clinical, and photobiologic findings confirm previously reported data, although there was a particularly high rate of negative phototests in our series. Reactivity exclusively to visible or natural light was associated with a higher probability of resolution. No increasing trend was observed in the annual incidence.
Asunto(s)
Trastornos por Fotosensibilidad/etiología , Luz Solar/efectos adversos , Urticaria/etiología , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Antagonistas de los Receptores Histamínicos/uso terapéutico , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Fenotipo , Trastornos por Fotosensibilidad/epidemiología , Trastornos por Fotosensibilidad/patología , Trastornos por Fotosensibilidad/terapia , Fototerapia , Estudios Retrospectivos , España/epidemiología , Urticaria/epidemiología , Urticaria/patología , Urticaria/terapia , Adulto JovenAsunto(s)
COVID-19 , Acantólisis , Humanos , Ictiosis , Estudios Prospectivos , SARS-CoV-2 , Centros de Atención TerciariaRESUMEN
Enoxaparin sodium is a heparin of low molecular weight with antithrombotic properties that acts by inhibiting factor Xa. We present a 59-year-old woman who developed heparin-related bullous hemorrhagic dermatosis, at sites distant from the injections, one month after starting treatment with enoxaparin.
Asunto(s)
Enoxaparina/efectos adversos , Fibrinolíticos/efectos adversos , Hemorragia/inducido químicamente , Enfermedades Cutáneas Vesiculoampollosas/inducido químicamente , Enoxaparina/administración & dosificación , Femenino , Fibrinolíticos/administración & dosificación , Humanos , Inyecciones , Síndrome de la Vena Cava Superior/tratamiento farmacológicoRESUMEN
The second of this series describes the characteristics of 3 types of photobiologic studies: the light test, the photochallenge test, and the photopatch test. We explain how the tests are carried out, the expected results, and their clinical usefulness in various photodermatoses. These tests are needed before attempting to induce adaptation (skin hardening or light tolerance) in the most debilitating cases.
Asunto(s)
Trastornos por Fotosensibilidad/diagnóstico , Humanos , Luz , Fotobiología , Pruebas Cutáneas/métodosRESUMEN
Photodermatoses are skin conditions that are induced or exacerbated by electromagnetic radiation (including visible light, UV light, and infrared radiation) from the sun or artificial light sources. In Part 1 of this series we review current understanding of the pathophysiology of these processes and their classification. We also discuss technical aspects and the basic physics of photobiology and describe the equipment required for photobiologic testing and calibration (light sources and measurement instruments).
Asunto(s)
Trastornos por Fotosensibilidad/diagnóstico , Trastornos por Fotosensibilidad/fisiopatología , Enfermedad Crónica , Diseño de Equipo , Humanos , Fotobiología/instrumentación , Trastornos por Fotosensibilidad/etiologíaRESUMEN
BACKGROUND: Phototesting is a technique that assesses the skin's sensitivity to UV radiation by determining the smallest dose of radiation capable of inducing erythema (minimal erythema dose [MED]) and anomalous responses to UV-A radiation. No phototesting protocol guidelines have been published to date. METHODOLOGY: This was a multicenter prospective cohort study in which 232 healthy volunteers were recruited at 9 hospitals. Phototests were carried out with solar simulators or fluorescent broadband UV-B lamps. Each individual received a total of 5 or 6 incremental doses of erythemal radiation and 4 doses of UV-A radiation. The results were read at 24hours. RESULTS: At hospitals where solar simulators were used, the mean (SD) MED values were 23 (8), 28 (4), 35 (4), and 51 (6) mJ/cm(2) for skin phototypes i to iv, respectively. At hospitals where broadband UV-B lamps were used, these values were 28 (5), 32 (3), and 34 (5) mJ/cm(2) for phototypes ii to iv, respectively. MED values lower than 7, 19, 27, and 38 mJ/cm(2) obtained with solar simulators were considered to indicate a pathologic response for phototypes I to IV, respectively. MED values lower than 18, 24, and 24mJ/cm(2) obtained with broadband UV-B lamps were considered to indicate a pathologic response for phototypes ii to iv, respectively. No anomalous responses were observed at UV-A radiation doses of up to 20J/cm(2). CONCLUSIONS: Results were homogeneous across centers, making it possible to standardize diagnostic phototesting for the various skin phototypes and establish threshold doses that define anomalous responses to UV radiation.
Asunto(s)
Eritema/clasificación , Eritema/etiología , Piel/efectos de la radiación , Rayos Ultravioleta , Adulto , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Pruebas Cutáneas , Luz Solar , Adulto JovenAsunto(s)
Antineoplásicos/efectos adversos , Erupciones por Medicamentos/etiología , Mesilato de Imatinib/efectos adversos , Porfirias/inducido químicamente , Erupciones por Medicamentos/patología , Femenino , Humanos , Leucemia Mielógena Crónica BCR-ABL Positiva/tratamiento farmacológico , Persona de Mediana Edad , Porfirias/patología , Piel/patologíaAsunto(s)
Clindamicina/administración & dosificación , Fármacos Dermatológicos/administración & dosificación , Nevo/tratamiento farmacológico , Tretinoina/administración & dosificación , Administración Cutánea , Anciano de 80 o más Años , Combinación de Medicamentos , Geles , Humanos , Masculino , Nevo/patología , Resultado del TratamientoAsunto(s)
Antialérgicos/uso terapéutico , Hepatitis B Crónica/complicaciones , Omalizumab/uso terapéutico , Urticaria/tratamiento farmacológico , Bencimidazoles/uso terapéutico , Enfermedad Crónica , Quimioterapia Combinada , Femenino , Humanos , Persona de Mediana Edad , Piperidinas/uso terapéutico , Prednisona/uso terapéutico , Urticaria/complicaciones , Carga Viral , Viremia/complicacionesAsunto(s)
Gammopatía Monoclonal de Relevancia Indeterminada/complicaciones , Mucinosis/etiología , Anciano , Antiinflamatorios/uso terapéutico , Clobetasol/uso terapéutico , Codo , Femenino , Humanos , Cadenas Ligeras de Inmunoglobulina/sangre , Gammopatía Monoclonal de Relevancia Indeterminada/sangre , Gammopatía Monoclonal de Relevancia Indeterminada/diagnóstico , Mucinosis/diagnóstico , Espera VigilanteAsunto(s)
Síndrome de Cogan/complicaciones , Úlcera Cutánea/etiología , Adulto , Síndrome de Cogan/tratamiento farmacológico , Errores Diagnósticos , Ectima/diagnóstico , Femenino , Humanos , Inmunosupresores/efectos adversos , Inmunosupresores/uso terapéutico , Prednisona/uso terapéutico , Piodermia Gangrenosa/diagnóstico , Enfermedades Cutáneas Bacterianas/etiología , Enfermedades Cutáneas Bacterianas/microbiología , Úlcera Cutánea/tratamiento farmacológico , Úlcera Cutánea/microbiología , Infección de Heridas/etiología , Infección de Heridas/microbiologíaRESUMEN
The medical resident's portfolio is a collection of materials that show reflective learning in the context of clinical practice. A portfolio contains documents (such as case histories and questionnaires the resident has used), images, and video recordings that reveal that an individual has acquired the competencies needed for professional practice. A portfolio is an assessment tool that simultaneously supports learning and gives evidence for certifying competence. It encourages independent continuing professional development that is incremental and centered on answering questions about what one has learned, how it might be applied, what still needs to be learned, and what must be done to reach one's goal. Answering such questions provides evidence of competencies that have been acquired and what is still lacking, allowing the trainee to develop a plan for personal improvement and evaluate subsequent achievements. The first step in creating a portfolio is to list required skills and abilities, along with the actions that will allow the resident to acquire them during each year of residency training. The ultimate goal is to define the resident's professional competence. We describe a model on which to base a training and assessment portfolio for residents in dermatology.