Efficacy and safety of tralokinumab in the treatment of head and neck pattern atopic dermatitis: A multicentre study of 12 patients.

BACKGROUND/OBJECTIVES: The evaluation of the efficacy and safety of new molecules for atopic dermatitis (AD) in real clinical practice is very important to obtain information that clinical trials (EECC) lack. The pattern of AD in the head and neck (H&N) continues to be a challenge in treatment today, despite the new molecules, and real-life data on the use of tralokinumab is still missing. This is the first daily practice study of tralokinumab treatment in patients with H&N AD pattern. The objective is to evaluate the efficacy and safety of tralokinumab in the short term (16 weeks) in patients with AD with H&N pattern, for the first time. METHODS: A multicentre prospective observational study was conducted, including patients with moderate-severe AD and H&N pattern who started tralokinumab treatment in four hospitals in Andalusia. Values of severity and quality of life scales, as well as patient-reported outcomes (PROs), were collected at baseline and at Weeks 4 and 16. Safety events were also recorded. RESULTS: Twelve patients were included. An improvement was observed in all efficacy and quality of life parameters evaluated at 16 weeks with respect to the baseline. No serious adverse events were recorded. CONCLUSIONS: In real clinical practice, tralokinumab is demonstrated to be an effective and safe treatment for patients with AD and H&N pattern at short term.

Miliaria crystallina induced by idarubicin and all-trans-retinoic acid: Two case reports.

Miliaria crystallina is a benign, self-limiting disorder of the eccrine sweat glands characterized by the obstruction of the sweat ducts, which leads to secondary sweat retention into stratum corneum. We present two patients with MC during treatment with idarubicin and all-trans-retinoic acid (ATRA) for acute promyelocytic leukaemia (APL). Anthracyclines can be excreted through sweat and induce MC through exfoliation. The use of idarubicin in combination with ATRA would favour the process of producing a peeling effect. Reports of MC associated with idarubicin and ATRA are scarce. Recognizing this benign entity and its triggers will help to differentiate it from other skin reactions, improving the management of patients by avoiding unnecessary studies and treatments.

Resolution of inverse psoriasis after treatment with levodopa for Parkinson's disease.

Inverse psoriasis is characterized by the development of erythematous shiny plaques at intertriginous areas of the body. It has a prevalence of 2% worldwide. The usefulness of levodopa in psoriasis was discovered in 1970 but nowadays it is not a standard therapy for this condition. A 74-year-old woman was diagnosed with Parkinson's disease subsequent to the development of extensive inverse psoriasis. The skin lesions were resistant to classical topical and systemic medications. Treatment with levodopa was initiated in order to treat her neurological problem and progressive remission of the skin lesions was noted. We highlight the role of dopamine in the pathophysiology of this dermatosis.

Treatment of prurigo nodularis with lenalidomide.

Prurigo nodularis (PN) is an intensely pruriginous dermatological disorder whose treatment is challenging for dermatologists. It is characterized by eruptions of papules and hyperkeratotic nodules, some of which are eroded, on the extensor surfaces of the limbs. The most commonly used treatments for this condition are oral antihistamines and topical or systemic steroids. Thalidomide is an effective treatment option in cases of recalcitrant PN; however, its most frequent adverse effect is neurotoxicity, which often results in its discontinuation. Lenalidomide is an analogue of thalidomide that is more powerful and associated with less neurotoxicity than thalidomide. We report the third case of PN treated with lenalidomide, which involved a patient who was refractory to thalidomide. Lenalidomide may be a more effective treatment for PN than thalidomide and has a more favorable side effects profile than its counterpart.

Treatment of thromboangiitis obliterans (Buerger's disease) with high-potency vasodilators.

Thromboangiitis obliterans (TAO) or Buerger's disease is a vascular inflammatory thrombotic occlusive and segmental disease affecting distal small and medium-sized arteries of the limbs. Tobacco is the main trigger factor and avoiding it is the main treatment. Frequently, it is necessary to use high-potency vasodilators, such as iloprost, bosentan, sildenafil, or alprostadil, to relieve symptoms and reduce the risk of amputation. Iloprost is the only one that has been shown to be effective in randomized clinical trials. We report the third case of TAO treated with sildenafil and a new case treated with bosentan. This condition can be diagnosed and treated by a dermatologist. We would like to highlight the excellent clinical response despite the fact that patients continued to smoke. This finding may have important therapeutic implications because early treatment may prevent amputation and can be effective even during the process of giving up smoking.

Post intensive care syndrome in survivors of COVID-19 who required mechanical ventilation during the third wave of the pandemic: A prospective study.

BACKGROUND: Post intensive care syndrome is defined as the presence of any impairment affecting the physical, psychiatric, or cognitive domains as a result of critical illnesses. OBJECTIVES: To explore functional, cognitive and psychological outcomes at 30 days post hospital discharge among survivors of COVID-19-associated acute respiratory distress syndrome, who required mechanical ventilation. METHODS: Prospective cohort study. We included adult patients with COVID-19-associated acute respiratory distress syndrome, invasively ventilated in two ICUs in Buenos Aires. We measured functional, cognitive and psychological impairments with Barthel index, Montreal Cognitive Assessment test, Patient Health Questionnaire-9 and General Anxiety Disorder-7. Primary outcome was post-intensive care syndrome. Secondary outcome was mortality at 60 days. RESULTS: We admitted 40 patients, median age was 69 (60-75) and mostly male (75%). Mortality at 60 days was 37%. Cox regression analysis identified diabetes and Apache II as independent predictors of mortality. Out of 22 patients studied, 14 (64%) developed PICS after discharge. With a physical, cognitive and psychological impairment in 64%, 41% and 32% of patients, respectively. Obesity, days of mechanical ventilation, Apache II, vasopressors use, delirium duration and cumulative midazolam dose were associated with functional dependence. CONCLUSIONS: We identified a high prevalence of functional, cognitive and mental impairment at 30 days after hospital discharge in COVID-19-associated acute respiratory distress syndrome survivors, invasively ventilated. The physical domain was the most frequently affected. These findings suggest the need for long-term follow-up of this population.

Prognostic Role of Non-Identification of Sentinel Lymph Node in Cutaneous Melanoma Patients: An Observational Retrospective Study.

Background: Sentinel lymph node (SLN) status is recognized as the most important prognostic factor for patients with cutaneous melanoma. However, sometimes it is not possible to identify SLN. The phenomenon of non-identification of SLN and its prognostic role have not been thoroughly evaluated in melanoma literature. The objective of this study was to identify which patient or tumor variables may be associated to non-identification of SLN and to evaluate the prognostic role of non-identification of SLN. Methods: Observational retrospective study of 834 cutaneous melanoma patients who underwent SLN biopsy at Instituto Valenciano de Oncología. Results: Forty-two patients (5%) presented non-identification of SLN. Patients with age at diagnosis of ≥ 64 years, obesity (BMI ≥ 30), and head and neck localization were at higher risk of non-identification of SLN. Non-identified SLN patients had worse nodal disease-free survival with respect to negative SLN patients, but not worse melanoma-specific survival. Conclusions: Our findings suggest a need to follow-up patients with non-identified SLN in the same way as patients with positive SLN.

Heterozygous Cylindromatosis Gene Mutation c.1628_1629delCT in a Family with Brook-Spiegler Syndrome.

Brooke-Spiegler Syndrome (BSS) is a rare genodermatosis characterized by the progressive formation of adnexal skin tumors in the scalp and face, mainly trichoepitheliomas, cylindromas, and spiradenomas. It has also been associated with salivary glands neoplasms. It is due to mutations in the tumor suppressor gene cylindromatosis (CYLD gene) localized on chromosome 16q12-q13. Around 93 mutations have been described. The study of CYLD gene in patients and their relatives is of vital importance to establish the molecular diagnosis and offer appropriate genetic counseling. There is a low risk of malignancy and patients require long-term follow-up. A case of BSS in a family is described. The existence of the genetic mutation at the CYLD gene c. 1628_1629delCT in three of the women affected was demonstrated. This mutation has only been described once in a previous study.