RESUMO
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.
Assuntos
Omalizumab/uso terapêutico , Urticária/tratamento farmacológico , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Doença Crônica , Avaliação de Medicamentos , Feminino , Humanos , Imunoglobulina E/imunologia , Masculino , Pessoa de Meia-Idade , Estimulação Física/efeitos adversos , Urticária/etiologia , Adulto JovemRESUMO
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.
Assuntos
Omalizumab/uso terapêutico , Transtornos de Fotossensibilidade/tratamento farmacológico , Urticária/tratamento farmacológico , Idoso , Avaliação de Medicamentos , Resistência a Medicamentos , Antagonistas dos Receptores Histamínicos H1/uso terapêutico , Humanos , Iluminação/efeitos adversos , Masculino , Pessoa de Meia-Idade , Omalizumab/efeitos adversos , Transtornos de Fotossensibilidade/etiologia , Transtornos de Fotossensibilidade/psicologia , Fototerapia , Qualidade de Vida , Luz Solar/efeitos adversos , Urticária/etiologia , Urticária/psicologiaRESUMO
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.
Assuntos
Transtornos de Fotossensibilidade/etiologia , Luz Solar/efeitos adversos , Urticária/etiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fenótipo , Transtornos de Fotossensibilidade/epidemiologia , Transtornos de Fotossensibilidade/patologia , Transtornos de Fotossensibilidade/terapia , Fototerapia , Estudos Retrospectivos , Espanha/epidemiologia , Urticária/epidemiologia , Urticária/patologia , Urticária/terapia , Adulto JovemAssuntos
COVID-19 , Acantólise , Humanos , Ictiose , Estudos Prospectivos , SARS-CoV-2 , Centros de Atenção TerciáriaRESUMO
BACKGROUND: Psoriasis patients over 65 years-old (elderly) constitute a growing group, underrepresented in clinical trials, and likely to be more prone to adverse events. OBJECTIVE: To describe safety of systemic psoriasis therapy in patients over 65 years-old compared to younger patients. METHODS: Patients registered in Biobadaderm, a Spanish national registry of psoriasis patients treated with systemic therapy, were grouped in elderly (≥ 65 years old) and younger patients. Rates of adverse events were described by severity and type, and the risks compared in both groups, taking into account exposure to classic or biologic drugs, using Cox regression. RESULTS: 175 (9.8%) of 1793 patients were elderly. Overall risk of adverse events was not higher in elderly (drug group adjusted HR 1.09 (95%CI: 0.93-1.3)). Serious adverse events were more common in elderly (drug group adjusted HR 3.2 (95%CI: 2.0-5.1)). Age adjusted HR of all adverse events was lower for patients exposed to biologics compared to classic drugs in the whole sample (HR 0.7 (95%CI: 0.6-0.7)). Age did not seem to modify the effect of therapy (biologic vs. classic) in the risk of adverse events (likelihood ratio test for interaction, p = 0.12 for all adverse events, p = 0-09 for serious adverse events). CONCLUSIONS: Serious adverse events are more common in elderly patients, although they may be related to other variants that are associated with this age group and not due to the treatment itself. Use of biologics was associated with lower risk of adverse events in the whole group. We found no differences in this association between young and elderly. These results are reassuring, although uncontrolled confounding could not be excluded as an explanation for these findings, and the power of the study to detect differences was low.
Assuntos
Produtos Biológicos/efeitos adversos , Fármacos Dermatológicos/efeitos adversos , Psoríase/tratamento farmacológico , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios não Esteroides/efeitos adversos , Anticorpos Monoclonais/efeitos adversos , Criança , Pré-Escolar , Feminino , Humanos , Imunossupressores/efeitos adversos , Lactente , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Espanha , Adulto JovemRESUMO
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.
Assuntos
Enoxaparina/efeitos adversos , Fibrinolíticos/efeitos adversos , Hemorragia/induzido quimicamente , Dermatopatias Vesiculobolhosas/induzido quimicamente , Enoxaparina/administração & dosagem , Feminino , Fibrinolíticos/administração & dosagem , Humanos , Injeções , Síndrome da Veia Cava Superior/tratamento farmacológicoRESUMO
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).
Assuntos
Transtornos de Fotossensibilidade/diagnóstico , Transtornos de Fotossensibilidade/fisiopatologia , Doença Crônica , Desenho de Equipamento , Humanos , Fotobiologia/instrumentação , Transtornos de Fotossensibilidade/etiologiaRESUMO
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.
Assuntos
Transtornos de Fotossensibilidade/diagnóstico , Humanos , Luz , Fotobiologia , Testes Cutâneos/métodosRESUMO
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.
Assuntos
Eritema/classificação , Eritema/etiologia , Pele/efeitos da radiação , Raios Ultravioleta , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Testes Cutâneos , Luz Solar , Adulto JovemAssuntos
Antineoplásicos/efeitos adversos , Toxidermias/etiologia , Mesilato de Imatinib/efeitos adversos , Porfirias/induzido quimicamente , Toxidermias/patologia , Feminino , Humanos , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Pessoa de Meia-Idade , Porfirias/patologia , Pele/patologiaAssuntos
Clindamicina/administração & dosagem , Fármacos Dermatológicos/administração & dosagem , Nevo/tratamento farmacológico , Tretinoína/administração & dosagem , Administração Cutânea , Idoso de 80 Anos ou mais , Combinação de Medicamentos , Géis , Humanos , Masculino , Nevo/patologia , Resultado do TratamentoAssuntos
Antialérgicos/uso terapêutico , Hepatite B Crônica/complicações , Omalizumab/uso terapêutico , Urticária/tratamento farmacológico , Benzimidazóis/uso terapêutico , Doença Crônica , Quimioterapia Combinada , Feminino , Humanos , Pessoa de Meia-Idade , Piperidinas/uso terapêutico , Prednisona/uso terapêutico , Urticária/complicações , Carga Viral , Viremia/complicaçõesAssuntos
Síndrome de Cogan/complicações , Úlcera Cutânea/etiologia , Adulto , Síndrome de Cogan/tratamento farmacológico , Erros de Diagnóstico , Ectima/diagnóstico , Feminino , Humanos , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Prednisona/uso terapêutico , Pioderma Gangrenoso/diagnóstico , Dermatopatias Bacterianas/etiologia , Dermatopatias Bacterianas/microbiologia , Úlcera Cutânea/tratamento farmacológico , Úlcera Cutânea/microbiologia , Infecção dos Ferimentos/etiologia , Infecção dos Ferimentos/microbiologiaAssuntos
Gamopatia Monoclonal de Significância Indeterminada/complicações , Mucinoses/etiologia , Idoso , Anti-Inflamatórios/uso terapêutico , Clobetasol/uso terapêutico , Cotovelo , Feminino , Humanos , Cadeias Leves de Imunoglobulina/sangue , Gamopatia Monoclonal de Significância Indeterminada/sangue , Gamopatia Monoclonal de Significância Indeterminada/diagnóstico , Mucinoses/diagnóstico , Conduta ExpectanteRESUMO
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.