Standard and Expanded Series Patch Testing Update by the Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC). / Actualización de la batería estándar y batería ampliada de pruebas alérgicas de contacto por el Grupo Español de Investigación en Dermatitis de Contacto y Alergia Cutánea (GEIDAC).

After the meeting held by the Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) back in October 2021, changes were suggested to the Spanish standard series patch testing. Hydroxyethyl methacrylate (2% pet.), textile dye mixt (6.6% pet.), linalool hydroperoxide (1% pet.), and limonene hydroperoxide (0.3% pet.) were, then, added to the series that agreed upon in 2016. Ethyldiamine and phenoxyethanol were excluded. Methyldibromoglutaronitrile, the mixture of sesquiterpene lactones, and hydroxyisohexyl 3-cyclohexene (Lyral) were alo added to the extended Spanish series of 2022.

Can atopic dermatitis be prevented?

Atopic dermatitis has become a health problem in our setting due to its rising prevalence, impact on quality of life, associated costs, and role in the progression to other atopic diseases. Furthermore, atopic dermatitis has no definitive cure and therefore preventive measures are important. In this article, we review the latest advances in both primary prevention (reduction of the incidence of atopic dermatitis) and secondary prevention (reduction of associated morbidity and reduction of the atopic march). We analyze the different preventive strategies available, including modification of the immune system through microbial exposure, induction of immune tolerance through antigen exposure, and restoration of skin barrier function to halt the atopic march. Dermatologists need to be familiar with these strategies in order to apply them where necessary and to accurately inform patients and their relatives to prevent misguided or inappropriate actions.

[Splenic marginal zone B-cell lymphoma with epidermotropic skin involvement]. / Linfoma B esplénico de la zona marginal con afectación cutánea epidermotropa.

Marginal zone B-cell lymphoma (MZL) is subclassified into extranodal MZL of mucosa-associated lymphoid tissue (including cutaneous lymphomas), splenic MZL, and nodal MZL. We report the case of a 68-year-old man with erythematous-violaceous plaques and nodules. Skin biopsy showed an epidermotropic lymphocytic infiltration and cytology and immunohistochemistry were consistent with MZL. The workup revealed disease in the peripheral blood and bone marrow and massive splenomegaly. Splenectomy confirmed the diagnosis of splenic MZL and led to resolution of the skin lesions. Cutaneous recurrence was treated successfully with chemotherapy and rituximab but caused fatal hepatitis due to hepatitis B virus reactivation. Skin involvement by splenic MZL is uncommon; this form of the disease can present epidermotropism, a very rare finding in primary cutaneous MZL. Treatment consists of splenectomy, which may be associated with chemotherapy and/or rituximab; this treatment may lead to reactivation of latent hepatitis B infection and screening for hepatitis should therefore be performed prior to starting therapy.

[Treatment of mucosal vascular malformations with variable-pulse neodymium:yttrium-aluminum-garnet laser]. / Tratamiento de malformaciones vasculares de mucosas con láser Nd:YAG de pulso variable.

BACKGROUND AND OBJECTIVES: Treatment of mucosal vascular lesions is a challenge for dermatologists, although various approaches have proven efficacy, including surgery, sclerotherapy, intralesional injection of corticosteroids, transfixion, and laser therapy. The aim of this study was to describe the results of treatment with neodymium:yttrium-aluminum-garnet (Nd:YAG) laser in 11 patients with venous malformations and varicosities. PATIENTS AND METHODS: We describe the use of variable-pulse Nd:YAG to treat venous malformations or varicosities in the oral or genital mucosa of 8 women and 3 men seen in our hospital over a 1-year period. RESULTS: The following laser parameters were used: wavelength, 1064 nm; fluence, 100 to 200J/cm(2); spot diameter, 3 to 5mm; and pulse duration, 30 to 65 ms. The size of the lesions ranged from 5 to 30 mm. In all cases, a clearance of 75% to 100% was achieved in a single session with excellent healing and no significant side effects. CONCLUSIONS: Given its efficacy and ease of use, Nd:YAG may become a treatment of choice for mucosal vascular lesions. Comparative studies are now required to assess its potential superiority over other treatment options.

[Recommendations on the management of urticaria in Primary Care]. / Recomendaciones para el manejo de la urticaria en Atención Primaria.

Urticaria is a common cause for patient consultations in Primary Care (PC). However, the optimal approach to managing urticaria in PC is controversial and not well-established. For this reason, there is a clear need to clarify the causes of urticaria and to develop treatment protocols to improve urticaria management in the PC setting. The present work has been developed with this objective. A group of experts in PC and dermatology, with specific expertise in treating urticaria, have reviewed the main clinical guidelines and publications on urticaria in order to develop clear, interdisciplinary recommendations on managing urticaria. In this article, consensus-based recommendations are presented that include simple, practical diagnostic, and treatment algorithms. These guidelines will help to optimise the management of patients with urticaria, increasing their quality of life and reducing the socioeconomic costs associated with this illness.

[Atypical internuclear ophthalmoplegia in a patient with subacute lymphocytic meningitis]. / Oftalmoplejía internuclear atípica en un paciente con meningitis linfocitaria subaguda.

The local expression of tuberculous meningitis has an high incidence. They respond to a Koch bacillus direct lesion or vasculitis disease. The clinic implication of ocular movement is frequent and usually answers to a nervous trunk direct injury. Exceptionally the clinic expression of the oculomotor disturbance is due to a conjugate ocular tract or nucleus damage. The posterior internuclear ophthalmoplegia is a well-known manifestation and correspond with a dwindle of the medial longitudinal fasciculus electrical transmission and lies in falling of the medial rectus to move synchronously with the contralateral rectus on attempted lateral gaze to either side. In such a case the medial longitudinal fasciculus is damaged between the sith nerve nucleous below and the opposite third nerve nucleus above. A patient with AIDS B3 category who presents right internuclear ophthalmoplegia and right eye vertical conjugate gaze impairment with left vertical nystagmus due to a paramedial mesencephalic stroke as debut of a linfocitary subacute meningitis is present.

[Clinical manifestations associated with antiphospholipid antibodies]. / Manifestaciones clínicas asociadas a anticuerpos antifosfolípido.

The antiphospholipid antibodies are immunoglobulins able to join negative charge phospholipids. The have been related to a great variety of conditions, specially among connective tissue illness although the idiopathic form seems to be the most frequent. Their presence must be ruled out in cases of young patients with stroke, deep veins thrombosis, acute heart attack and woman suffer multiple abortions and foetal death. These antibodies appear to be related to different clinical entities like Sneddon syndrome. Evans syndrome, "chorea gestationis", migraine. The laboratory determinations are based in direct methods (ELISA, RIA, ...) as well as in indirect ones (activated partial thromboplastin time, reptilase time, ...). The appropriate management and treatment may be based upon clinical expression, in case of arterial thrombosis (type II APS), or deep vein thrombosis (Type II) long term anticoagulation is indicated; Association with pentoxifylline in the case of retinal thrombosis (type IIIa), Stroke (type IIIb) cases may require long term anticoagulation as well as aspirin. Type IV cases are better managed with an individualised treatment.