Contact dermatitis from glucose sensors in Spain: A multicentric approach.

BACKGROUND: Allergic contact dermatitis from glucose sensors may interfere with their ongoing application. OBJECTIVE: To evaluate a series of Spanish patients with contact dermatitis to glucose sensors regarding former sources of contact allergens, patch test results, and outcomes from the ongoing use of the device. METHODS: A series of patients with contact dermatitis from glucose sensors was investigated in eight dermatology departments across Spain (epidemiological features, brands, latency time to develop dermatitis, the ability to continue using the devices as well as the patch test results). RESULTS: Thirty patients were evaluated (mean age 20.9 years). A total of 66.7% were children and 66.7% female. Ninety per cent used Freestyle Libre (FSL). Eight of 26 (30.8%) reacted to isobornyl acrylate (IBOA) and two of 20 (10.0%) to N,N dimethylacrylamide (DMAA). The mean latency time to develop dermatitis was 9 months. Sixteen of 29 (55.2%) patients continued using the same sensor causing the reaction. Thirteen of 29 (44.8%) patients were unable to continue using the sensor because of severe reactions. Of these, five were positive to IBOA, one to IBOA and DMAA, one to DMAA, one to colophony, and one to isopropyl alcohol wipes. In one patient, the outcome was unknown. CONCLUSION: The frequency of sensitisation to IBOA and DMAA, was lower than in other European series, but similar to a previously published Spanish article. Legislation requiring manufacturers to provide information regarding the composition of medical devices and cooperate with the investigations into contact dermatitis is urgently needed.

Secukinumab-induced paradoxical hidradenitis suppurativa.

Paradoxical reactions during treatment with biological agents may be defined as an appearance or exacerbation of a pathological condition that usually responds to this class of drug. Typical examples of paradoxical adverse effect are, among others, palmoplantar pustular and psoriasiform reactions or HS, in patients during a treatment of rheumatoid arthitis or IBD mainly. A few reports have been described an exacerbation of psoriasis1, palmoplantar pustular, or pustular psoriasis eruption with secukinumab. Marasca et al. highlights the immunological complexity that surrounds autoinflammatory diseases showing the potential double pathogenetic face of secukinumab in HS, describing a case of secukinumab-induced HS and a case of HS caused by adalimumab treatment and controlled by secukinumab therapy. Real world evidence and results from clinical trials with secukinumab for HS, will possibly show the real role that anti-IL-17 drugs play in this complex disease.

Is omalizumab safe and effective in oncological patients?

A 42-year-old female with a personal history of Grade II infiltrating ductal breast carcinoma, treated under surgical procedure in 2018, whose hormonal profile included estrogen, progesteronic and HER-2 positive receptors, and a Ki67 proliferative index (20-25%), was referred to our dermatological outpatient clinic complaining worsening of her chronic spontaneous urticaria. The patient was under treatment with etuximide, exemestane, anastrozole, and trastuzumab. Our patient reported intermittent episodes of hives of 8 years of evolution with good control with second-generation antihistamines. However, in the past year, the intensity and frequency of the outbreaks was increased with the development of angioedema until completing 23 consultations through the emergency department being treated in all of the episodes with short cycles of oral corticosteroids. This case reported is particularly complex due to different points that we develop below: (a) oncological patient as special population; (b) differential diagnosis with other forms of urticaria such as vasculitis urticaria, inducible urticaria, and autoimmune progesterone dermatitis; (c) spontaneous chronic urticaria of difficult control at labeled dose of omalizumab; (d) concomitant treatment with another biological drug.

Chronic hand eczema and hepatogenic pruritus with good response to apremilast.

Hand eczema (HE) presents a high prevalence and severe impact on the quality of life of the patients. HE is a worldwide problem recognized for his high socio-occupational involvement. Treatment is mainly based on adequate recommendations for hand care together with topical anti-inflammatory treatments. Frequently, patients require systemic treatments such alitretinoin, among others. The comorbidities of the patients and the side effects of the treatments sometimes require prescribing other treatments off label on the technical data. This role in immunomodulation has led to the development of new studies that investigate what role does apremilast have in eczematous diseases, such as atopic dermatitis. We present this case for the quick and complete response of HE with apremilast, and the effective control of hepatogenic pruritus. These finding open a new possibility and alternative treatment of this complex and difficult of control with the treatments already described in the literature.