Real-world adalimumab survival and discontinuation factors in hidradenitis suppurativa.

BACKGROUND AND OBJECTIVES: Survival analyses can provide valuable insights into effectiveness and safety as perceived by prescribers. Here, we aimed to evaluate adalimumab (ADA) survival and the interruption risk factors in a multicentre cohort of patients with hidradenitis suppurativa (HS). Moreover, we performed a subanalysis considering the periods before and after the onset of the COVID-19 pandemic. METHODS: We conducted a retrospective study including 539 adult patients with HS who received ADA from 1 May 2015 to 31 December 2022. Overall drug survival was analysed using Kaplan-Meier survival curves and compared between the subgroups via stratified log-rank test. Possible predictors for overall drug survival and reasons for discontinuation were assessed using univariate and multivariate Cox regression. RESULTS: Overall, 50.1% were females with a mean age of 43.5 ± 1 years and a mean BMI of 29.5 ± 6.7. At the start of ADA, 95.29% were biologic-naïve and 24.63% had undergone surgical treatment. During follow-up, 9.46% of patients required dose escalation, while 39.92% interrupted ADA. Concomitant therapy was used in 64.89% of cases. A subanalyses comparing pre- and post-pandemic periods revealed a tendency to initiate ADA treatment at a younger age, among patient with higher BMI and at a lower HS stage after COVID-19 pandemic. Interestingly, ADA demonstrated extended survival compared to previous studies, with a median overall drug survival of 56.2 months (95% CI 51.2 to 80.3). The primary causes for discontinuation were inefficacy (51.69%), followed by adverse effects (21.35%). Female sex, longer delay in HS diagnosis, higher baseline IHS4 score and concomitant spondyloarthritis were associated with poorer ADA survival or increased risk of discontinuation. CONCLUSIONS: ADA demonstrated prolonged survival (median 56.2 months). While addition of antibiotics did not have a positive effect on survival rate, basal IHS4 proved useful in predicting ADA survival.

Presence of perineuritis in a case of papular purpuric gloves and socks syndrome associated with mononeuritis multiplex attributable to B19 parvovirus.

A previously healthy 16-year-old boy developed papular purpuric gloves and socks syndrome concomitant with mononeuritis multiplex attributable to acute infection with parvovirus B19. A cutaneous biopsy showed lymphocytic lichenoid vasculitis and perineuritis. We discuss the relevance of these pathologic findings, and we suggest a correlation with the patient's neurologic condition. This case illustrates the difficulties in differentiating dysesthesia accompanying cutaneous manifestations of exanthem from neurologic disease on the basis of the clinical appearance alone.

Micosis fungoide invisible / Invisible mycosis fungoides

Presentamos el caso de una mujer de 80 años que acudió a la consulta por cuadro de prurito generalizado de 1 año de evolución, sin lesiones cutáneas evidentes salvo signos de excoriación. Una biopsia de piel sin lesiones fue compatible con una micosis fungoide. A los tres meses la paciente desarrolló unas placas de aspecto purpúrico en tronco y muslos cuya biopsia evidenció una micosis fungoide asociada a extravasación eritrocitaria, cumpliendo las características de la variante de MF púrpura pigmentada-like

A 80-year-old woman who complain for a persistent pruritus, which began a year before is reported. There were not evident lesions except for excoriations on the upper back. A biopsy from normal-Iooking skin was compatible with mycosis fungoides . Three months after the patient developed some purpuric patches on her trunk and thighs which also showed histopathological features of mycosis fungoides with hemorrhage, clinically compatible with the pigmented purpura-like variant of mycosis fungoides

Granuloma actínico. Estudio clínico e histológico de cinco casos / Actinic granuloma. Clinical and histological study of five cases

Se presentan 5 pacientes con lesiones anulares en la cara y el cuello que fueron estudiados desde un punto de vista clínico e histológico, y que diagnosticamos de granuloma actínico de O'Brien. Además, hemos revisado la literatura médica reciente analizando la patogenia de esta entidad y el papel de la exposición solar como factor desencadenante. Hacemos mención especial a la controversia que suscita el granuloma actínico como una entidad específica y las diferencias histológicas con el granuloma anular en zonas de piel fotoexpuestas (AU)