RESUMEN
Gabapentin and doxepin are well-known treatments of uremic pruritus in hemodialysis patients but no head-to-head studies were conducted to date. The aim of this trial is to compare the efficacy and the tolerability of gabapentin and doxepin in the treatment of uremic pruritus in hemodialysis patients. A single-blind crossover randomized trial was conducted that included hemodialysis patients with uremic pruritus. Patients were randomized to receive 10 mg doxepin daily or 100 mg gabapentin for 4 weeks and the two groups were treated conversely for another 4 weeks after a 4-week washout period. Eighty-five patients were screened for eligibility. Thirty-one met the inclusion criteria and four were excluded. Sixteen patients agreed and signed the consent and two withdrew from the study. VAS scores at baseline were 6.71 and 6.14, and dropped to 0.57 and 2.35 at week 4 in the gabapentin and doxepin groups, respectively. Mean scores of the 5-Domain Itch Scale (5-D) at baseline were 14.71 and 14.64, and dropped to 5.78 and 7.57 at week 4 in the gabapentin and doxepin groups, respectively. Mean scores of the Dermatology Life Quality Index (DLQI) at baseline were 9.6429 and 8.7857, and dropped to 0.71 and 3.35 at week 4 in the gabapentin and doxepin groups, respectively. Reductions in Visual Analog Scale (VAS), 5-D and DLQI were statistically significant (P < .05). No serious side effects were recorded. Limitations of this study include single-blind design, small number of included cases and lack of placebo control. Gabapentin was more effective than doxepin in decreasing uremic pruritus severity and improving quality of life of these patients.
Asunto(s)
Doxepina/uso terapéutico , Gabapentina/uso terapéutico , Uremia , Método Doble Ciego , Doxepina/efectos adversos , Gabapentina/efectos adversos , Antagonistas de los Receptores Histamínicos , Humanos , Prurito/diagnóstico , Prurito/tratamiento farmacológico , Prurito/etiología , Calidad de Vida , Método Simple Ciego , Uremia/complicaciones , Uremia/diagnóstico , Uremia/tratamiento farmacológicoRESUMEN
Stiff skin syndrome is a rare disease causing stony hard induration of skin usually in early childhood. We report a case of 12 years old boy who presented to our clinic with biopsy showing adipocyte entrapment which we believe is an unrecognized key pathological finding in diagnosis of this entity.
Asunto(s)
Contractura/patología , Enfermedades Cutáneas Genéticas/patología , Adipocitos/patología , Niño , Humanos , Lactante , MasculinoRESUMEN
Psoriasis vulgaris is a common chronic, inflammatory, multisystem disorder that affects approximately 1.5% to 3.4% of the population in the Middle East. The disease has an impact on the quality of life in a significant number of affected patients. The majority of patients (approximately 70%) have mild to moderate psoriasis that is manageable with topical agents, which generally show a high efficacy to safety ratio. Topical agents can be used alone when treating patients with limited disease or may be used as adjunctive therapy for patients with more extensive psoriasis undergoing systemic treatment. Treatment should also be customized to meet individual patients' needs. To optimize the topical treatment of psoriasis in the Levant and Iraq area, dermatology experts from Iraq, Jordan, Lebanon, Palestine, and Syria met and initiated a project to develop guidelines and recommendations for the topical management of psoriasis. The guidelines are based on literature evidence and experts' opinions. We present recommendations for the use of topical corticosteroids, vitamin D analogues, calcineurin inhibitors, tazarotene, salicylic acid, anthralin, and coal tar, as well as combination therapy, based on their efficacy and safety profiles.
RESUMEN
Linear IgA bullous dermatosis (LAD) is an autoimmune subepidermal blistering disorder. LAD may be either idiopathic or drug related; the most common drug being vancomycin. The clinical presentations of both idiopathic and drug-related LAD are variable and may mimic other blistering disorders. We report a case of a 76-year-old man known to have a renal cell carcinoma who presented a vancomycin-induced LAD that clinically mimicked toxic epidermal necrolysis (TEN).
Asunto(s)
Antibacterianos/efectos adversos , Dermatosis Bullosa IgA Lineal/inducido químicamente , Vancomicina/efectos adversos , Anciano , Diagnóstico Diferencial , Humanos , Dermatosis Bullosa IgA Lineal/diagnóstico , Masculino , Síndrome de Stevens-Johnson/diagnósticoRESUMEN
BACKGROUND: Understanding the patient journey is important to optimize care for patients with atopic dermatitis (AD) and overcome challenges in diagnosis and management. OBJECTIVE: To explore patient and caregiver perspectives regarding their experience with AD. METHODS: Patients and caregivers of patients with AD completed a pre-meeting survey and were invited to join an advisory board meeting in their country (China, Hong Kong, Ireland, Japan and Lebanon) to discuss the survey results. Data were analyzed descriptively. RESULTS: The survey included 31 participants (patients and caregivers) from Hong Kong (n = 7), China (n = 7), Ireland (n = 6), Japan (n = 6) and Lebanon (n = 5). The most challenging factors in the AD journey were management of symptoms before a confirmed diagnosis (68%), sudden recurrence of flares or worsening of symptoms (68%) and lifestyle changes (52%). In terms of overall AD management, 35% of participants indicated that AD was managed well, 23% had a clear treatment plan and 19% were generally satisfied with disease management. A collaborative relationship with healthcare professionals was favored. CONCLUSION: A holistic assessment of AD includes understanding patient and caregiver preferences, needs, experiences and disease perceptions. Addressing the identified gaps may improve the management of AD.
Asunto(s)
Cuidadores , Dermatitis Atópica , Humanos , Dermatitis Atópica/terapia , Estilo de Vida , Encuestas y Cuestionarios , Personal de SaludRESUMEN
INTRODUCTION: Atopic dermatitis (AD) is a complex inflammatory disease of the skin that has a significant impact on the well-being of patients and their families. The prevalence of AD has increased in developing countries and regions, including the Middle East. Despite similarities in the presentation of the disease, there is a lack of consistent management and treatment guidelines for AD. The objective of this survey was to develop further insight into the management patterns of AD from dermatologists, pediatricians, and primary care/family medicine physicians in the Middle Eastern nations of Egypt, Lebanon, the United Arab Emirates, and Saudi Arabia. METHODS: The survey was composed of 47 closed-ended, multiple-choice questions. These questions assessed physician and patient characteristics and treatment familiarity and approach. RESULTS: A total of 400 physicians, including 200 dermatologists, 100 pediatricians, and 100 primary care physicians, participated in the survey. The findings provide insight into the management of AD by physician specialty within the region. A diverse array of management approaches was observed for both referral patterns and treatments for AD in the Middle East. CONCLUSION: The diversity of management tactics highlights the lack of a standard approach for the management of AD throughout the Middle East.
RESUMEN
INTRODUCTION: Alopecia areata (AA) is an autoimmune disease characterized by nonscarring hair loss involving the scalp, face, and/or body. Literature on the prevalence, patient characteristics, management approaches, and challenges faced by patients with AA across the Middle East is limited. Therefore, a greater understanding of the current AA landscape within the region is needed. This cross-sectional study surveyed dermatologists from four countries to assess dermatologists' perspectives on the prevalence of AA within the Middle East, as well as patient characteristics, unmet needs, and management strategies. METHODS: This blinded, quantitative, observational study surveyed practicing dermatologists in Egypt, Lebanon, Saudi Arabia, and the United Arab Emirates. The survey was conducted between September 2021 and January 2022 and comprised 47 closed-ended, multiple-choice questions as well as Likert scale responses. These questions assessed the characteristics of physicians and the patients in their practices, physicians' familiarity with treatment, and physicians' treatment approaches. RESULTS: The estimated prevalence of AA varied across the region. Across all age groups treated for AA, the majority of patients had AA of mild severity (pediatric: 63%; adolescent: 60%; adult: 54%) and the scalp was reported as the most affected area (65%). Potent topical corticosteroids were the most frequently used treatment for mild to moderate and severe AA (92% and 78%, respectively). There was a lack of awareness of investigative treatments, with only 33% of dermatologists aware of these options. The greatest unmet needs in treating AA included long-term disease control, improved efficacy, faster onset of action, and better safety profiles (62%, 53%, 52%, and 51%, respectively). CONCLUSIONS: This study provided insight into the diagnosis and management of AA in the Middle East. Treatment strategies were similar regardless of the severity of AA. Long-term disease control and improved efficacy and safety profiles were identified as key unmet needs in the treatment of AA.
RESUMEN
BACKGROUND: Alopecia areata (AA) is an autoimmune disease characterized by non-scarring hair loss in adults and children. Clinical manifestations range from hair loss in small, well-circumscribed patches to total hair loss on the scalp or any other hair-bearing areas. Although the exact pathogenesis of AA is not fully understood, it is thought that loss of immune privilege caused by immunological dysregulation of the hair follicle is key. Genetic susceptibility also plays a role. Response to currently available treatments is widely variable, causing patient dissatisfaction and creating an unmet need. AA is frequently associated with multiple comorbidities, further affecting patient quality of life. AIMS AND FINDINGS: AA causes a significant burden on dermatologists and healthcare systems in the Middle East and Africa. There is a lack of data registries, local consensus, and treatment guidelines in the region. Limited public awareness, availability of treatments, and patient support need to be addressed to improve disease management in the region. A literature review was conducted to identify relevant publications and highlight regional data on prevalence rates, diagnosis, quality of life, treatment modalities, and unmet needs for AA in the Middle East and Africa.
RESUMEN
INTRODUCTION: Atopic dermatitis (AD) is a chronic skin disease that poses a significant burden on both patients and the society. AD causes the highest loss in disability-adjusted life years compared with other skin diseases. This study aimed to estimate the economic and humanistic burden of AD in adults and adolescents in seven countries in the Middle East and Africa region (Egypt, Lebanon, Saudi Arabia, Kuwait, Algeria, South Africa, and United Arab Emirates). METHODS: We conducted a literature review to identify country-specific data on this disease. Subsequently, meetings were organized with experts from each country to complete the missing data. The data were aggregated and calculation models were created to estimate the value of the humanistic and economic burden of the disease in each country. Finally, we conducted meetings with local experts to validate the results, and the necessary adjustments were made. RESULTS: On average, a patient with AD loses 0.19 quality-adjusted life years (QALYs) annually owing to this disease. The average annual healthcare cost per patient is highest in the United Arab Emirates, with an estimated value of US $3569 and a population-level indirect cost of US $112.5 million. The included countries allocated a range of 0.20-0.77% of their healthcare expenditure to AD-related healthcare services and technologies. The indirect cost of AD represents approximately 67% of the total disease cost and, on average, approximately 0.043% (range 0.022-0.059%) of the gross domestic product (GDP) of each country. CONCLUSION: Although the humanistic and economic burdens differ from country to country, AD carries a significant socioeconomic burden in all countries. The quality of life is severely affected by the disease. If AD is controlled, the costs, especially indirect costs, could decrease and the disease burden could be alleviated significantly.
Atopic dermatitis is a chronic condition characterized by inflamed and itchy skin. The prevalence and symptoms of atopic dermatitis are observed to increase in dry weather. Owing to its high prevalence in children, the majority of studies on atopic dermatitis are in children. Although it is also prevalent in adults and adolescents, its burden on adults has not been sufficiently studied, especially in Africa and the Middle East. This study quantified the burden of atopic dermatitis in adults and adolescents in seven countries in the Middle East and Africa. We estimated the economic and humanistic burden of this disease. We conducted a literature review and expert interviews to determine the effects on patients and caregivers. We created mathematical models to calculate the disease burden in each country, and local experts in each country validated the data. The study results showed that atopic dermatitis significantly affects the quality of life of patients. The direct medical costs of treatment in each country were calculated. The management of atopic dermatitis consumes around 0.200.77% of the healthcare expenditure in a country. The indirect cost of atopic dermatitis represents 0.0220.059% of the gross domestic product (GDP) of a country. The country-specific burden data are essential to guide decision-makers in arriving at evidence-based decisions and efficiently allocating available resources. This study focused on the significant indirect economic burden of the disease, which can sometimes be underestimated because the disease is not fatal.
RESUMEN
INTRODUCTION: Secukinumab has demonstrated sustained long-term efficacy with a favourable safety profile in various manifestations of psoriatic disease. We investigated effectiveness and safety of secukinumab, other biologics and conventional systemic therapies in patients with chronic plaque psoriasis in a real-world setting. METHODS: REALIA was a non-interventional, multicentre, prospective, parallel group study. Eligible patients were ≥ 18 years old with chronic plaque psoriasis commencing a new treatment with a biologic agent or conventional systemic therapies. RESULTS: At baseline, 541 patients were divided into three cohorts based on treatment initiated: conventional systemics (173), secukinumab (184) and other biologics (184). A significantly higher proportion of patients achieved almost clear to clear skin based on physician's judgement in secukinumab versus conventional systemics at month 3 (64.7% versus 22.8%, P < 0.001) and month 6 (61.8% versus 20.8%, P < 0.001). At month 12, clear to almost clear skin was achieved by 52.1% of the patients in secukinumab versus 35.8% in conventional systemics (P = 0.066). The proportion of patients achieving Psoriasis Area Severity Index (PASI) 90 on conventional systemics, secukinumab and other biologics was 18.8%, 59.7% and 40.0% at month 3 and 35.3%, 60.8% and 50.0% at month 12, respectively. Secukinumab patients showed significantly higher change in PASI total score from baseline versus conventional systemics at month 3 {least squares [LS] mean [standard error (SE)]: -14.49 [0.648] versus -8.48 [1.149], P < 0.001} and numerically higher [LS mean (SE): -13.60 (0.475) versus -10.84 (1.733), P = 0.122] at month 12. The proportion of patients with Dermatology Life Quality Index 0/1 score on conventional systemics, secukinumab and other biologics was 22.6%, 65.0% and 41.6% at month 3 and 32.0%, 63.5% and 41.3% at month 12, respectively. Safety profile was comparable across cohorts. CONCLUSIONS: Secukinumab is effective and well tolerated in patients with chronic plaque psoriasis in a real-world setting in an Asia-Pacific and Middle East population, and these results are in agreement with clinical outcomes of secukinumab reported in randomised clinical trials. TRIAL REGISTRATION NUMBER: 170803-001645.
RESUMEN
A 28-year-old man had presented a severe photosensitivity since his infancy. In March 2008, the clinical examination showed large crusts on the dorsum of his hands, on the edge of his ears with destruction of the underlying cartilage, and on his nose and cheeks. He also presented erythematosus fibrous scars on the temples. The diagnosis of hydroa vaccinforme was made. Phototesting including repeated UVA1 phototest was strongly positive with purpuric lesions from day 7 to day 10 and hypertrophic scars at day 67. A sequential histological study of the UVA1 triggered lesions was performed and showed bullous cleavage, dense inflammatory infiltrate in the whole dermis with numerous neutrophilic cells, nuclear dusts, superficial focal thrombosis of small blood vessels at day 10. We report an unusual case of hydroa vaccinforme with purpuric lesions leading to fibrous scars and with important infiltration of neutrophils in the dermis of the photoinduced lesions.
Asunto(s)
Cicatriz/patología , Dermis/patología , Hidroa Vacciniforme/patología , Rayos Ultravioleta/efectos adversos , Adulto , Humanos , MasculinoRESUMEN
PURPOSE: Dermatologists practicing in African and Middle Eastern countries face numerous challenges when managing patients with plaque psoriasis, especially those with disease in a difficult-to-treat anatomic area or those who are a pediatric, geriatric, or pregnant patient. The publication of comprehensive, up-to-date, region-specific clinical guidelines may help to address some of these challenges and improve outcomes. We conducted a literature review to identify recent guidelines and other publications describing patients with plaque psoriasis in Africa and the Middle East. PATIENTS AND METHODS: An online literature search of the PubMed database was conducted to identify publications reporting clinical guidelines and research studies on plaque psoriasis. The search included all articles published from January 2008 to March 2020 inclusive. The titles and abstracts of all search results were screened by a reader to identify those that described patients in Africa or the Middle East. RESULTS: A total of 145 publications were identified by the literature search and screened by a reader. There were 10 publications that described patients in Africa or the Middle East: 4 research articles, 3 reviews, 2 guidelines, and 1 case study. The 2010 guidelines from South Africa made recommendations for treating plaque psoriasis of varying severity, although without specific recommendations for difficult-to-treat anatomic areas or pediatric, geriatric, or pregnant patients. The 2014 guideline on biologics from Saudi Arabia included recommendations for the use of these agents in patients with plaque psoriasis, including difficult-to-treat anatomic areas and pediatric patients (TNF inhibitors only), but provided no recommendations for pregnant or geriatric patients. CONCLUSION: There is an urgent unmet need for comprehensive clinical guidelines on the management of patients with plaque psoriasis in Africa and the Middle East. Region-specific studies on the epidemiology, burden of disease, and the safety and effectiveness of newer pharmacotherapies are needed to support the development of such guidelines.
RESUMEN
Polymorphic light eruption (PLE) is the most common photosensitivity disorder. Typically, PLE manifests in the spring or summer months as a recurrent pruritic papular and/or vesicular eruption occurring on photoexposed skin areas following sun exposure. The milia are caused by proliferative tendencies of the epithelium after injury. These may occur in areas of subepidermal bullous eruption. We report an original case of bullous PLE complicated by milia. Such association has not been reported previously.
Asunto(s)
Luz , Trastornos por Fotosensibilidad/patología , Adulto , Humanos , MasculinoRESUMEN
Henoch-Schönlein purpura is a small vessel vasculitis occurring mainly in childhood and rarely in adulthood. Typical cutaneous eruption may begin as macular or urticarial erythematous lesions progressing to a palpable purpura. In adults, the disease has a propensity to be more severe and chronic and affects mainly the ankles and feet. Bullae, vesicles and ulcers are occasionally seen in this group. The prognosis depends on renal involvement, commonly seen in adults. We report a new case of Henoch-Schönlein purpura in a 36-year-old man presenting with a bullous eruption followed by the appearance of abdominal pain and hematuria.
Asunto(s)
Vasculitis por IgA/diagnóstico , Enfermedades Cutáneas Vesiculoampollosas/diagnóstico , Dolor Abdominal/diagnóstico , Adulto , Hematuria/diagnóstico , Humanos , Dermatosis de la Pierna/diagnóstico , MasculinoRESUMEN
BACKGROUND: Immune-mediated inflammatory diseases (IMIDs) are chronic conditions that may cause tissue damage and disability, reduced quality of life and increased mortality. Various treatments have been developed for IMIDs, including immune modulators and targeted biologic agents. However, adherence remains suboptimal. METHODS: An adherence survey was used to evaluate physicians' beliefs about adherence to medication in IMID and to evaluate if and how they manage adherence. The survey was distributed to 100 randomly selected physicians from three different specialties. Results were analyzed by four academic experts commissioned to develop an action plan to address practical and perceptual barriers to adherence, integrating it into treatment goals to maximize outcomes in IMID, thereby elevating local standards of care. RESULTS: Eighty-two physicians participated in this study and completed the questionnaire. Most defined adherence as compliance with prescribed treatment. Although the majority of surveyed physicians (74%) did not systematically measure adherence in their practice, 54% identified adherence as a treatment goal of equal or greater importance to therapeutic endpoints. Lack of time and specialized nursing support was reported as an important barrier to measuring adherence. The expert panel identified four key areas for action: 360° education (patient-nurse-physician), patient-physician communication, patient perception and concerns, and market access/cost. An action plan was developed centered on education and awareness, enhanced benefit-risk communication, development of adherence assessment tools and promotion of patient support programs. CONCLUSION: Nonadherence to medication is a commonly underestimated problem with important consequences. A customized target-based strategy to address the root causes of non-adherence is essential in the management of chronic immune-mediated diseases.
RESUMEN
The incidence of psoriasis in Africa and the Middle East (AfME) is high as in other regions and represents a significant problem for both dermatologists and patients. Psoriasis co-morbidities such as obesity, cardiovascular disease and psoriatic arthritis (PsA) are also particularly common in these regions and may be under-recognized and under-treated. Despite this, regional guidelines to aid physicians on the appropriate use of biologic agents in their clinical practice are limited. A group of expert dermatologists from across the AfME region were surveyed to help establish best practice across the region, alongside supporting data from the literature. Although biologics have significantly improved patient outcomes since their introduction, the results of this survey identified several unmet needs, including the lack of consensus regarding their use in clinical practice. Discrepancy also exists among AfME physicians concerning the clinical relevance of immunogenicity to biologics, despite increasing data across inflammatory diseases. Significant treatment and management of challenges for psoriasis patients remain, and a move towards individualized, tailored care may help to address these issues. The development of specific local guidelines for the treatment of both psoriasis and PsA could also be a step towards understanding the distinct patient profiles in these regions.
Asunto(s)
Productos Biológicos/uso terapéutico , Fármacos Dermatológicos/uso terapéutico , Psoriasis/tratamiento farmacológico , África , Artritis Psoriásica/tratamiento farmacológico , Actitud del Personal de Salud , Productos Biológicos/efectos adversos , Toma de Decisiones Clínicas , Análisis Costo-Beneficio , Fármacos Dermatológicos/efectos adversos , Manejo de la Enfermedad , Encuestas de Atención de la Salud , Humanos , Medio Oriente , Pautas de la Práctica en Medicina/estadística & datos numéricosRESUMEN
BACKGROUND: Paget's disease is an uncommon epidermal cancer, affecting all skin regions wherever apocrine glands are present. It is divided into extramammary (EMPD) and mammary Paget's disease (MPD). It can be confined to the epithelium or may be associated with an underlying adenocarcinoma. The diagnosis is confirmed by skin biopsy and the treatment depends on characteristics of the underlying cancer. Surgery is the first-line treatment. Imiquimod, a topical immunomodulator, approved its efficiency in several skin neoplasms and has been shown as a safe treatment for EMPD. However, it has never been reported for the treatment of MPD. OBSERVATIONS: We report on two cases of EMPD and MPD successfully treated with imiquimod 5% cream. CONCLUSION: This non-surgical method may be considered as a primary treatment when Paget's disease is not associated with an underlying malignancy. The good prognosis with a long-term survival, the anatomic localization and the poor general condition of elderly people may favor imiquimod as an alternative treatment. On the other hand, it will reduce the extent of excision when it anticipates surgery.
Asunto(s)
Aminoquinolinas/uso terapéutico , Antineoplásicos/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Enfermedad de Paget Extramamaria/tratamiento farmacológico , Enfermedad de Paget Mamaria/tratamiento farmacológico , Neoplasias Cutáneas/tratamiento farmacológico , Administración Cutánea , Anciano , Anciano de 80 o más Años , Aminoquinolinas/administración & dosificación , Antineoplásicos/administración & dosificación , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/patología , Diagnóstico Diferencial , Femenino , Ingle , Humanos , Imiquimod , Enfermedad de Paget Extramamaria/diagnóstico , Enfermedad de Paget Extramamaria/patología , Enfermedad de Paget Mamaria/diagnóstico , Enfermedad de Paget Mamaria/patología , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/patologíaRESUMEN
Subcutaneous nodular sarcoidosis is a rare cutaneous manifestation of systemic sarcoidosis. We report a new case in a 45-year-old woman with a 7-year history of subcutaneous nodules and a new onset of dyspnea. She was treated with corticosteroids but her disease recurred upon withdrawal. A 6-month course of doxycycline in a dose of 200 mg/d led to complete remission. We also emphasize the value of systemic work-up and regular screening in such cases.
Asunto(s)
Antibacterianos/uso terapéutico , Doxiciclina/uso terapéutico , Sarcoidosis/tratamiento farmacológico , Enfermedades de la Piel/tratamiento farmacológico , Tejido Subcutáneo , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Bazex syndrome or acrokeratosis paraneoplastica is a rare dermatosis usually associated with a squamous cell carcinoma of upper aerodigestive tract or with metastases in the cervical lymph nodes. It presents as psoriasiform violaceous scaly patches over extremities, tip of the nose, earlobes and helices. This syndrome evolves in three stages parallel to the growth of the tumor, thus the utility of recognition of the syndrome which may unmask the associated neoplasia at an early stage. Treatment consists of treating the underlying neoplasia whether by surgery, chemotherapy and/or radiotherapy. Recurrence of cutaneous lesions may reveal the recurrence of the tumor.
Asunto(s)
Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/terapia , Queratosis/diagnóstico , Queratosis/terapia , Síndromes Paraneoplásicos/diagnóstico , Síndromes Paraneoplásicos/terapia , Carcinoma de Células Escamosas/secundario , Oído Externo/patología , Neoplasias de Cabeza y Cuello/patología , Humanos , Uñas/patología , Nariz/patología , Psoriasis , SíndromeRESUMEN
BACKGROUND: There is considerable debate about the prevalence and relevance of food allergy (FA) in atopic dermatitis (AD). The aim of this study was to investigate the prevalence of and risk factors for FA in a cohort of children with AD attending a multidisciplinary paediatric allergy clinic. METHODS: The analysis was performed on 386 children (50.8% boys, median age 4 years) consecutively evaluated for AD. A diagnosis of FA was established on positive skin tests and/or a specific IgE value or a positive oral food challenge. RESULTS: Point prevalence of FA was 17.8%. Egg, peanuts, milk, tree nut and mustard accounted for 93% of cases. 37.7% of children had ≥2 positive food reactions. Risk factors associated with FA were young age (OR=7.9 when ≤2 years compared with ≥5 years), moderate to severe AD (OR=7.8 for severe and 2.4 for moderate AD) and onset of AD before 3 months of age (OR=5.7). CONCLUSION: Point prevalence of FA in children with AD is lower than initially reported in patients recruited in a paediatric allergology setting. Children≤2 years of age with early-onset or severe AD are at higher risk of FA and may be candidates for FA evaluation.