Efficacy and Safety of Dupilumab for the Treatment of Severe Atopic Dermatitis in Clinical Practice: A Single Center Experience / Eficacia y seguridad de dupilumab para el tratamiento de la dermatitis atópica grave en la práctica clínica: experiencia en un centro terciario

Background Dupilumab is a new targeted therapy for severe atopic dermatitis (AD) with limited real-world evidence. Objective Explore our experience with dupilumab for AD in clinical practice at a tertiary care center. Material and method Unicentric observational retrospective study including adult and pediatric patients with severe AD receiving dupilumab between December 2017 and December 2021. The Eczema Area and Severity Index (EASI) score, Pruritus Numerical Rating Scale (P-NRS) and Sleep disturbance Numerical Rating Scale (S-NRS) were recovered to assess severity and response. Results Fifty-nine patients received dupilumab: 52, 48, 26 and 13 patients reached 6, 12, 24 and 36 months of treatment, respectively. The EASI-75 response rates were 94.2%, 95.8%, 92.3% and 100% at months 6, 12, 24 and 36. The EASI-90 response rates were 63.5%, 72.9%, 84.6% and 92.3% at months 6, 12, 24 and 36. The EASI <7 response rates were 92.3%, 91.7%, 88.5% and 100% at months 6, 12, 24 and 36. The P-NRS ≥4 reduction rates were 86%, 87.5%, 92.3% and 100% at months 6, 12, 24 and 36. The S-NRS ≥4 reduction rates were 82.7%, 85.4%, 100% and 100% at months 6, 12, 24 and 36. Adverse events were mild and occurred in 20.3% of patients, all of them adults. Conclusion Our findings support dupilumab's favorable efficacy and tolerability profile in clinical practice. Dupilumab offers a rapid and sustained response, regardless of combined therapy. Longer follow-ups are still required to adequately assess its performance (AU)

Antecedentes Dupilumab es una nueva terapia dirigida para la dermatitis atópica (DA) grave con una evidencia en la vida real aún limitada. Objetivo Explorar nuestra experiencia con dupilumab para la DA en práctica clínica en un centro terciario. Material y método Estudio observacional retrospectivo y unicéntrico que incluye pacientes adultos y pediátricos con DA grave en tratamiento con dupilumab entre diciembre de 2017 y diciembre de 2021. La gravedad y la respuesta se evaluaron con las escalas Eczema Area and Severity Index (EASI), Pruritus Numerical Rating Scale y Sleep Disturbance Numerical Rating Scale. Resultado Cincuenta y nueve pacientes recibieron dupilumab: 52, 48, 26 y 13 pacientes alcanzaron los 6, 12, 24 y 36 meses de tratamiento, respectivamente. La tasa de EASI-75 fue del 94,2; 95,8; 92,3 y 100% a los 6, 12, 24 y 36 meses, respectivamente. La tasa de EASI-90 fue del 63,5; 72,9; 84,6 y 92,3% a los 6, 12, 24 y 36 meses, respectivamente. La tasa de EASI <7 fue del 92,3; 91,7; 88,5 y 100% a los 6, 12, 24 y 36 meses, respectivamente. La Pruritus Numerical Rating Scale ≥4 fue del 86; 87,5; 92,3 y 100% a los 6, 12, 24 y 36 meses, respectivamente. La tasa de reducción Sleep Disturbance Numerical Rating Scale ≥4 fue del 82,7; 85,4; 100 y 100% a los 6, 12, 24 y 36 meses, respectivamente. Los eventos adversos fueron leves y ocurrieron en el 20,3% de los pacientes, todos adultos. Conclusión Nuestros hallazgos apoyan el perfil favorable de eficacia y tolerabilidad de dupilumab en práctica clínica real. Dupilumab ofrece una respuesta rápida y mantenida, independientemente del uso de terapia combinada. Se requieren seguimientos más prolongados para evaluar su funcionamiento a largo plazo (AU)

[Artículo traducido]Eficacia y seguridad de dupilumab para el tratamiento de la dermatitis atópica grave en la práctica clínica: experiencia en un centro terciario / Efficacy and Safety of Dupilumab for the Treatment of Severe Atopic Dermatitis in Clinical Practice: A Single Center Experience

Antecedentes Dupilumab es una nueva terapia dirigida para la dermatitis atópica (DA) grave con una evidencia en la vida real aún limitada. Objetivo Explorar nuestra experiencia con dupilumab para la DA en práctica clínica en un centro terciario. Material y método Estudio observacional retrospectivo y unicéntrico que incluye pacientes adultos y pediátricos con DA grave en tratamiento con dupilumab entre diciembre de 2017 y diciembre de 2021. La gravedad y la respuesta se evaluaron con las escalas Eczema Area and Severity Index (EASI), Pruritus Numerical Rating Scale y Sleep Disturbance Numerical Rating Scale. Resultados Cincuenta y nueve pacientes recibieron dupilumab: 52, 48, 26 y 13 pacientes alcanzaron los 6, 12, 24 y 36 meses de tratamiento, respectivamente. La tasa de EASI-75 fue del 94,2; 95,8; 92,3 y 100% a los 6, 12, 24 y 36 meses, respectivamente. La tasa de EASI-90 fue del 63,5; 72,9; 84,6 y 92,3% a los 6, 12, 24 y 36 meses, respectivamente. La tasa de EASI <7 fue del 92,3; 91,7; 88,5 y 100% a los 6, 12, 24 y 36 meses, respectivamente. La Pruritus Numerical Rating Scale ≥4 fue del 86; 87,5; 92,3 y 100% a los 6, 12, 24 y 36 meses, respectivamente. La tasa de reducción Sleep Disturbance Numerical Rating Scale ≥4 fue del 82,7; 85,4; 100 y 100% a los 6, 12, 24 y 36 meses, respectivamente. Los eventos adversos fueron leves y ocurrieron en el 20,3% de los pacientes, todos adultos. Conclusión Nuestros hallazgos apoyan el perfil favorable de eficacia y tolerabilidad de dupilumab en práctica clínica real. Dupilumab ofrece una respuesta rápida y mantenida, independientemente del uso de terapia combinada. Se requieren seguimientos más prolongados para evaluar su funcionamiento a largo plazo (AU)

Background Dupilumab is a new targeted therapy for severe atopic dermatitis (AD) with limited real-world evidence. Objective Explore our experience with dupilumab for AD in clinical practice at a tertiary care center. Material and method Unicentric observational retrospective study including adult and pediatric patients with severe AD receiving dupilumab between December 2017 and December 2021. The Eczema Area and Severity Index (EASI) score, Pruritus Numerical Rating Scale (P-NRS) and Sleep disturbance Numerical Rating Scale (S-NRS) were recovered to assess severity and response. Results Fifty-nine patients received dupilumab: 52, 48, 26 and 13 patients reached 6, 12, 24 and 36 months of treatment, respectively. The EASI-75 response rates were 94.2%, 95.8%, 92.3% and 100% at months 6, 12, 24 and 36. The EASI-90 response rates were 63.5%, 72.9%, 84.6% and 92.3% at months 6, 12, 24 and 36. The EASI <7 response rates were 92.3%, 91.7%, 88.5% and 100% at months 6, 12, 24 and 36. The P-NRS ≥4 reduction rates were 86%, 87.5%, 92.3% and 100% at months 6, 12, 24 and 36. The S-NRS ≥4 reduction rates were 82.7%, 85.4%, 100% and 100% at months 6, 12, 24 and 36. Adverse events were mild and occurred in 20.3% of patients, all of them adults. Conclusion Our findings support dupilumab's favorable efficacy and tolerability profile in clinical practice. Dupilumab offers a rapid and sustained response, regardless of combined therapy. Longer follow-ups are still required to adequately assess its performance (AU)

Efficacy and Safety of Dupilumab for the Treatment of Severe Atopic Dermatitis in Clinical Practice: A Single Center Experience. / [Artículo traducido]Eficacia y seguridad de dupilumab para el tratamiento de la dermatitis atópica grave en la práctica clínica: experiencia en un centro terciario.

BACKGROUND: Dupilumab is a new targeted therapy for severe atopic dermatitis (AD) with limited real-world evidence. OBJECTIVE: Explore our experience with dupilumab for AD in clinical practice at a tertiary care center. MATERIAL AND METHOD: Unicentric observational retrospective study including adult and pediatric patients with severe AD receiving dupilumab between December 2017 and December 2021. The Eczema Area and Severity Index (EASI) score, Pruritus Numerical Rating Scale (P-NRS) and Sleep disturbance Numerical Rating Scale (S-NRS) were recovered to assess severity and response. RESULTS: Fifty-nine patients received dupilumab: 52, 48, 26 and 13 patients reached 6, 12, 24 and 36 months of treatment, respectively. The EASI-75 response rates were 94.2%, 95.8%, 92.3% and 100% at months 6, 12, 24 and 36. The EASI-90 response rates were 63.5%, 72.9%, 84.6% and 92.3% at months 6, 12, 24 and 36. The EASI <7 response rates were 92.3%, 91.7%, 88.5% and 100% at months 6, 12, 24 and 36. The P-NRS ≥4 reduction rates were 86%, 87.5%, 92.3% and 100% at months 6, 12, 24 and 36. The S-NRS ≥4 reduction rates were 82.7%, 85.4%, 100% and 100% at months 6, 12, 24 and 36. Adverse events were mild and occurred in 20.3% of patients, all of them adults. CONCLUSION: Our findings support dupilumab's favorable efficacy and tolerability profile in clinical practice. Dupilumab offers a rapid and sustained response, regardless of combined therapy. Longer follow-ups are still required to adequately assess its performance.

Efficacy and Safety of Dupilumab for the Treatment of Severe Atopic Dermatitis in Clinical Practice: A Single Center Experience.

BACKGROUND: Dupilumab is a new targeted therapy for severe atopic dermatitis (AD) with limited real-world evidence. OBJECTIVE: Explore our experience with dupilumab for AD in clinical practice at a tertiary care center. MATERIAL AND METHOD: Unicentric observational retrospective study including adult and pediatric patients with severe AD receiving dupilumab between December 2017 and December 2021. The Eczema Area and Severity Index (EASI) score, Pruritus Numerical Rating Scale (P-NRS) and Sleep disturbance Numerical Rating Scale (S-NRS) were recovered to assess severity and response. RESULTS: Fifty-nine patients received dupilumab: 52, 48, 26 and 13 patients reached 6, 12, 24 and 36 months of treatment, respectively. The EASI-75 response rates were 94.2%, 95.8%, 92.3% and 100% at months 6, 12, 24 and 36. The EASI-90 response rates were 63.5%, 72.9%, 84.6% and 92.3% at months 6, 12, 24 and 36. The EASI <7 response rates were 92.3%, 91.7%, 88.5% and 100% at months 6, 12, 24 and 36. The P-NRS ≥4 reduction rates were 86%, 87.5%, 92.3% and 100% at months 6, 12, 24 and 36. The S-NRS ≥4 reduction rates were 82.7%, 85.4%, 100% and 100% at months 6, 12, 24 and 36. Adverse events were mild and occurred in 20.3% of patients, all of them adults. CONCLUSION: Our findings support dupilumab's favorable efficacy and tolerability profile in clinical practice. Dupilumab offers a rapid and sustained response, regardless of combined therapy. Longer follow-ups are still required to adequately assess its performance.

Pseudoxantoma elástico infantil en paciente con beta-talasemia / Pseudoxanthoma elasticum in childhood in patient with Beta-thalassaemia

El pseudoxantoma elástico (PXE) es una enfermedad hereditaria rara, que cursa con alteraciones del tejido conectivo, debido a una alteración en el cromosoma 16p del gen ABCC6. Desde una perspectiva clínica, da lugar a manifestaciones predominantemente cutáneas, cardiacas y oftalmológicas. La asociación de β-talasemia y cuadros clínicos compatibles con PXE (síndromes PXE-like) ha sido descrita en la literatura en pacientes con β-talasemia mayor e intermedia, que es indistinguible clínicamente del PXE clásico. Presentamos el caso de un niño de 10 años con beta-talasemia minor y lesiones características de PXE. Cabe destacar el beneficio de la imagen multimodal para el diagnóstico y seguimiento de las lesiones

Pseudoxanthoma elasticum (PXE) is a rare genetic disorder characterised by elastic tissue alterations and caused by mutations in a single gene, ABCC6, on chromosome 16p that includes manifestations that are predominantly cutaneous, ocular and cardiovascular. PXE-like lesions in association with β-thalassemia have previously been reported in the literature in patients with Beta-thalassaemia intermediate and major, being clinically indistinguishable from classic PXE. The case is presented of a 10-year-old boy with β-thalassaemia minor and characteristic lesions of PXE. It is worth noting the benefit of multimodal imaging in the diagnosis and monitoring of the lesions

Pseudoxanthoma elasticum in childhood in patient with ß-thalassaemia. / Pseudoxantoma elástico infantil en paciente con ß-talasemia.

Pseudoxanthoma elasticum (PXE) is a rare genetic disorder characterised by elastic tissue alterations and caused by mutations in a single gene, ABCC6, on chromosome 16p that includes manifestations that are predominantly cutaneous, ocular and cardiovascular. PXE-like lesions in association with ß-thalassemia have previously been reported in the literature in patients with ß-thalassaemia intermediate and major, being clinically indistinguishable from classic PXE. The case is presented of a 10-year-old boy with ß-thalassaemia minor and characteristic lesions of PXE. It is worth noting the benefit of multimodal imaging in the diagnosis and monitoring of the lesions.

Asociación entre penfigoide ampolloso e inhibidores de la dipeptidilpeptidasa-4: estudio de cohortes retrospectivo / Association Between Bullous Pemphigoid and Dipeptidyl Peptidase 4 Inhibitors: A Retrospective Cohort Study

ANTECEDENTES: La asociación entre los inhibidores de la dipeptidil peptidasa 4 (iDPP-4) y el penfigoide ampolloso (PA) se ha demostrado en varios estudios. El objetivo principal de este estudio era estimar el uso del tratamiento con iDPP-4i en pacientes diagnosticados de PA en nuestro entorno. MATERIAL Y MÉTODOS: Seleccionamos pacientes diagnosticados histológicamente de PA en nuestro departamento entre octubre de 2015 y octubre de 2018. Realizamos una revisión retrospectiva para evaluar los datos clínicos-epidemiológicos y los patrones de inmunofluorescencia directa (IFD). RESULTADOS: De los 70 pacientes diagnosticados con PA durante el período de estudio, el 50% eran diabéticos y el 88,57% de ellos estaban siendo tratados con un iDPP-4 en el momento del diagnóstico de PA. El iDPP-4 más frecuente era la linagliptina (utilizada en el 18,6% de los pacientes), seguida de la vildagliptina (el 17,1%). La mediana de tiempo de latencia entre el inicio del tratamiento con iDPP-4 y el diagnóstico de PA fue de 27,5 meses, siendo de 16 meses para la linagliptina y 39 meses para la vildagliptina (log Rank < 0,01). La IFD fue negativaUn resultado negativo de DIF fue significativamente más común en pacientes que no fueron tratados con un DPP-4i. El patrón DIF más fuertemente (y significativamente) asociado con el tratamiento con DPP-4i fueron los depósitos lineales de inmunoglobulina G a lo largo de la unión dermoepidérmica. El tratamiento con DPP-4i se retiró en el 87% de los pacientes y el 96% de ellos logró una respuesta completa. CONCLUSIÓN: El tratamiento con DPP-4i es muy común en pacientes con BP en nuestro entorno. El período de latencia entre el inicio del tratamiento y el inicio de la PA parece ser más corto con linagliptina que con otros tipos de gliptinas. Los pacientes que reciben tratamiento con DPP-4i pueden mostrar patrones DIF diferentes a los que no reciben tratamiento

BACKGROUND: The association between dipeptidyl peptidase 4 inhibitors (DPP-4i) and bullous pemphigoid (BP) has been demonstrated in several studies. The main aim of this study was to estimate the use of DPP-4i treatment in patients diagnosed with BP in our setting. METHODS: We selected patients histologically diagnosed with BP in our department between October 2015 and October 2018 and performed a retrospective chart review to assess clinical and epidemiological data and direct immunofluorescence (DIF) patterns. RESULTS: Of the 70 patients diagnosed with BP during the study period, 50% were diabetic and 88.57% of these were being treated with a DPP-4i when diagnosed with BP. The most common DPP-4i was linagliptin (used in 18.6% of patients), followed by vildagliptin (17.1%). The median latency period between initiation of DPP-4i treatment and diagnosis of BP was 27.5 months for all treatments, 16 months for linagliptin, and 39 months for vildagliptin (log rank < 0.01). A negative DIF result was significantly more common in patients not being treated with a DPP-4i. The DIF pattern most strongly (and significantly) associated with DPP-4i treatment was linear immunoglobulin G deposits along the dermal-epidermal junction. DPP-4i treatment was withdrawn in 87% of patients and 96% of these achieved a complete response. CONCLUSIONS: DPP-4i treatment is very common in patients with BP in our setting. The latency period between start of treatment and onset of BP seems to be shorter with linagliptin than with other types of gliptins. Patients receiving DPP-4i treatment may show different DIF patterns to those not receiving treatment

Experiencia en el uso de fototerapia en pacientes pediátricos y comparación de esta técnica frente a pacientes adultos / Comparison of Phototherapy in Pediatric and Adult Patients

INTRODUCCIÓN: La fototerapia se basa en el uso de radiación ultravioleta para el tratamiento de distintas enfermedades dermatológicas. Su eficacia y seguridad está ampliamente establecida en adultos y existen publicaciones que también lo avalan como un tratamiento efectivo y seguro en pacientes pediátricos con afecciones cutáneas recalcitrantes. MATERIAL Y MÉTODOS: Estudio retrospectivo desde 2002 hasta 2017 que incluye a todos los pacientes menores de 17 años que recibieron fototerapia en nuestro servicio. Además, se seleccionaron al azar 122 pacientes adultos que recibieron este tratamiento durante el mismo periodo de tiempo. RESULTADOS: Se realizaron un total de 98 tratamientos pediátricos, 61% en niñas y 39% en niños, con una media de edad de 10,5 años. Las 3 enfermedades más frecuentemente tratadas fueron la psoriasis (48% de pacientes), el vitíligo (17%) y la dermatitis atópica (16%). El 86% de los pacientes recibió fototerapia con radiación ultravioleta B de banda estrecha (UVB-BE), mientras que el 7% recibió fototerapia con radiación ultravioleta A con psoralenos (PUVA). No existían diferencias estadísticamente significativas en cuanto a dosis, duración o número de sesiones con respecto a la población adulta tratada con UVB-BE ni con PUVA. Se alcanzó una respuesta completa en el 35% de los pacientes pediátricos, sin diferencias con respecto a los adultos. Únicamente el 16% de los pacientes mostró efectos adversos, en su mayoría en forma de eritema leve. Encontramos mayor adherencia al tratamiento en los pacientes pediátricos que en los adultos (p < 0,05). CONCLUSIONES: La fototerapia con UVB-BE y/o PUVA parece un tratamiento seguro y eficaz en niños, sin ser necesarios protocolos de tratamiento diferentes a los empleados en adultos. La adherencia al tratamiento es mayor que en los pacientes adultos

INTRODUCTION: Phototherapy involves the use of UV radiation to treat different dermatologic diseases. Its efficacy and safety have been thoroughly established in adults and some publications indicate that it is also an effective and safe treatment in pediatric patients with refractory skin diseases. MATERIAL AND METHODS: Retrospective study that included all patients under 17 years of age and 122 randomly selected adults who received phototherapy in our department between 2002 and 2017. RESULTS: Ninety-eight pediatric patients (61% girls and 39% boys) with a mean age of 10.5 years received phototherapy. The 3 most frequently treated diseases were psoriasis (48% of patients), vitiligo (17%), and atopic dermatitis (16%). Eighty-six percent of the patients received phototherapy with narrowband UV-B, whereas 7% received phototherapy with psoralen and UV-A (PUVA). No statistically significant differences were found in terms of dosage, duration, or number of sessions compared to the adult population treated with narrowband UV-B therapy or PUVA. A complete response was achieved in 35% of the pediatric patients and no differences were found with respect to the adults. Only 16% of the children showed adverse effects, mostly in the form of mild erythema. We found greater adherence to treatment in the pediatric patients than in the adult patients (P < .05). CONCLUSIONS: Narrowband UV-B therapy and PUVA appear to be safe and effective in children and can be administered using the same treatment protocols as those used in adults. Adherence to treatment is greater in children than in adult patients

Infecciones genitales por virus herpes tipo 1 y virus herpes tipo 2 en Valencia, España: estudio observacional retrospectivo / Genital Infection With Herpes Simplex Virus Type 1 and Type 2 in Valencia, Spain: A Retrospective Observational Study

INTRODUCCIÓN Y OBJETIVO: Se ha constatado un cambio en la epidemiología del herpes genital en los últimos años con un aumento de la incidencia del virus herpes (VHS) tipo 1. El objetivo de nuestro estudio es analizar las características clínico-epidemiológicas de los pacientes diagnosticados de un herpes genital. MATERIAL Y MÉTODOS: Se diseñó un estudio observacional retrospectivo donde se incluyeron todos los pacientes diagnosticados de herpes genital entre enero de 2016 y enero de 2019 en una Unidad de Infecciones de Transmisión Sexual (ITS) en Valencia, España. RESULTADOS: Se diagnosticaron 895 ITS, de las cuales 126 fueron un herpes genital (14%), 68 (54%) en mujeres y 58 (46%) en hombres. En 110 de ellos (87,3%) se confirmó el herpes genital por la detección de ADN viral por técnicas moleculares. Se diagnosticaron 52 casos de VHS tipo 1 (47,3%) y 58 casos de VHS tipo 2 (52,7%). En el 69,5% de los hombres se detectó el VHS tipo 2, mientras que en el 59,3% de las mujeres se detectó el VHS tipo 1. La edad media de las mujeres diagnosticadas de VHS tipo 1 fue de 26 años, mientras que la de las mujeres diagnosticadas de VHS tipo 2 fue de 34 años (p = 0,015). Las recurrencias de las lesiones en los pacientes con VHS tipo 1 y VHS tipo 2 fue del 13% y del 40%, respectivamente. CONCLUSIÓN: Destacamos un aumento de la prevalencia del VHS tipo 1 en nuestro medio como agente causante de herpes genital, especialmente en mujeres jóvenes. Esto tiene un valor pronóstico importante dado el menor riesgo de recurrencias que tiene

INTRODUCTION AND OBJECTIVE: The epidemiology of genital herpes has changed in recent years with an increase in the incidence of herpes simplex virus type 1 (HSV-1) infection. The aim of this study was to analyze the clinical and epidemiological characteristics of patients diagnosed with genital herpes. MATERIAL AND METHODS: A retrospective observational study was designed. All patients diagnosed with genital herpes between January 2016 and January 2019 in a Sexually Transmitted Infections Unit (ITS) in Valencia, Spain, were included. RESULTS: We identified 895 STI diagnoses. Of these, 126 (14%) were genital herpes; 68 (54%) of these cases were in women and 58 (46%) in men. Diagnosis was confirmed by molecular detection of HSV DNA in 110 cases (87.3%). Of these, 52 were cases of HSV-1 infection (47.3%) and 58 were HSV-2 infection (52.7%). HSV-2 was more common in men (69.5%), while HSV-1 was more common in women (59.3%). In the subgroup of women, mean age at diagnosis was 26 years for HSV-1 and 34 years for HSV-2 (P = .015). Recurrent genital herpes rates were 13% for HSV-1 and 40% for HSV-2. CONCLUSIONS: There has been an increase in the number of cases of genital herpes caused by HSV-1 in our setting, with young women in particular being affected. This has important prognostic implications because genital herpes caused by HSV-1 is less likely to recur

Comparison of Phototherapy in Pediatric and Adult Patients. / Experiencia en el uso de fototerapia en pacientes pediátricos y comparación de esta técnica frente a pacientes adultos.

INTRODUCTION: Phototherapy involves the use of UV radiation to treat different dermatologic diseases. Its efficacy and safety have been thoroughly established in adults and some publications indicate that it is also an effective and safe treatment in pediatric patients with refractory skin diseases. MATERIAL AND METHODS: Retrospective study that included all patients under 17 years of age and 122 randomly selected adults who received phototherapy in our department between 2002 and 2017. RESULTS: Ninety-eight pediatric patients (61% girls and 39% boys) with a mean age of 10.5 years received phototherapy. The 3 most frequently treated diseases were psoriasis (48% of patients), vitiligo (17%), and atopic dermatitis (16%). Eighty-six percent of the patients received phototherapy with narrowband UV-B, whereas 7% received phototherapy with psoralen and UV-A (PUVA). No statistically significant differences were found in terms of dosage, duration, or number of sessions compared to the adult population treated with narrowband UV-B therapy or PUVA. A complete response was achieved in 35% of the pediatric patients and no differences were found with respect to the adults. Only 16% of the children showed adverse effects, mostly in the form of mild erythema. We found greater adherence to treatment in the pediatric patients than in the adult patients (P<.05). CONCLUSIONS: Narrowband UV-B therapy and PUVA appear to be safe and effective in children and can be administered using the same treatment protocols as those used in adults. Adherence to treatment is greater in children than in adult patients.

Genital Infection With Herpes Simplex Virus Type 1 and Type 2 in Valencia, Spain: A Retrospective Observational Study. / Infecciones genitales por virus herpes tipo 1 y virus herpes tipo 2 en Valencia, España: estudio observacional retrospectivo.

INTRODUCTION AND OBJECTIVE: The epidemiology of genital herpes has changed in recent years with an increase in the incidence of herpes simplex virus type 1 (HSV-1) infection. The aim of this study was to analyze the clinical and epidemiological characteristics of patients diagnosed with genital herpes. MATERIAL AND METHODS: A retrospective observational study was designed. All patients diagnosed with genital herpes between January 2016 and January 2019 in a Sexually Transmitted Infections Unit (ITS) in Valencia, Spain, were included. RESULTS: We identified 895 STI diagnoses. Of these, 126 (14%) were genital herpes; 68 (54%) of these cases were in women and 58 (46%) in men. Diagnosis was confirmed by molecular detection of HSV DNA in 110 cases (87.3%). Of these, 52 were cases of HSV-1 infection (47.3%) and 58 were HSV-2 infection (52.7%). HSV-2 was more common in men (69.5%), while HSV-1 was more common in women (59.3%). In the subgroup of women, mean age at diagnosis was 26 years for HSV-1 and 34 years for HSV-2 (P=.015). Recurrent genital herpes rates were 13% for HSV-1 and 40% for HSV-2. CONCLUSIONS: There has been an increase in the number of cases of genital herpes caused by HSV-1 in our setting, with young women in particular being affected. This has important prognostic implications because genital herpes caused by HSV-1 is less likely to recur.

Association Between Bullous Pemphigoid and Dipeptidyl Peptidase 4 Inhibitors: A Retrospective Cohort Study. / Asociación entre penfigoide ampolloso e inhibidores de la dipeptidilpeptidasa-4: estudio de cohortes retrospectivo.

BACKGROUND: The association between dipeptidyl peptidase 4 inhibitors (DPP-4i) and bullous pemphigoid (BP) has been demonstrated in several studies. The main aim of this study was to estimate the use of DPP-4i treatment in patients diagnosed with BP in our setting. METHODS: We selected patients histologically diagnosed with BP in our department between October 2015 and October 2018 and performed a retrospective chart review to assess clinical and epidemiological data and direct immunofluorescence (DIF) patterns. RESULTS: Of the 70 patients diagnosed with BP during the study period, 50% were diabetic and 88.57% of these were being treated with a DPP-4i when diagnosed with BP. The most common DPP-4i was linagliptin (used in 18.6% of patients), followed by vildagliptin (17.1%). The median latency period between initiation of DPP-4i treatment and diagnosis of BP was 27.5 months for all treatments, 16 months for linagliptin, and 39 months for vildagliptin (log rank < 0.01). A negative DIF result was significantly more common in patients not being treated with a DPP-4i. The DIF pattern most strongly (and significantly) associated with DPP-4i treatment was linear immunoglobulin G deposits along the dermal-epidermal junction. DPP-4i treatment was withdrawn in 87% of patients and 96% of these achieved a complete response. CONCLUSIONS: DPP-4i treatment is very common in patients with BP in our setting. The latency period between start of treatment and onset of BP seems to be shorter with linagliptin than with other types of gliptins. Patients receiving DPP-4i treatment may show different DIF patterns to those not receiving treatment.

Dermatitis alérgica de contacto pediátrica. Estudio clínico-epidemiológico en un hospital terciario / Pediatric Allergic Contact Dermatitis: Clinical and Epidemiological Study in a Tertiary Hospital

Introducción: Los estudios epidemiológicos sobre incidencia de dermatitis alérgica de contacto en población pediátrica son escasos. Algunos trabajos consideran que se trata de una entidad infradiagnosticada, y que en muchos casos no se sospecha clínicamente, no realizándose pruebas epicutáneas. No obstante se han comunicado tasas prevalencia de hasta el 20% de sensibilización a alérgenos en la población pediátrica, por lo que probablemente debería ser tenida en cuenta como una posibilidad diagnóstica en este grupo de edad. Material y método: Se ha realizado un análisis retrospectivo de la base de datos de alergia cutánea del servicio de Dermatología del Hospital General seleccionando los casos diagnosticados en niños de entre 0 y 16 años durante los últimos 15 años (año 2000 hasta 2015). El estudio incluye variables epidemiológicas (edad, sexo, antecedentes de atopia) y clínicas (localización de las lesiones, baterías de alérgenos empleadas, alérgenos positivos y su relevancia). Resultados: De los 4.593 pacientes estudiados con pruebas epicutáneas en los últimos 15 años, 265 (6%) correspondían a niños de 0-16 años. Ciento cuarenta y cuatro pacientes (54,3%) mostraron positividad para al menos uno de los alérgenos parcheados. Los alérgenos más frecuentemente identificados fueron en orden decreciente: tiomersal, cloruro de cobalto, colofonia, parafenilendiamina, dicromato potásico, mercurio y níquel. La sensibilización fue considerada de relevancia presente en 177 casos (61,3%). Conclusión: Más de la mitad de los niños estudiados mostraron sensibilización a uno o más alérgenos, con un porcentaje importante de sensibilizaciones relevantes. Todo niño con sospecha clínica de dermatitis alérgica de contacto debería ser remitido para realización de pruebas epicutáneas. Al no existir pruebas estandarizadas en este colectivo se requiere un alto nivel de sospecha clínica y un conocimiento de los alérgenos más frecuentemente implicados de cara a seleccionar los alérgenos a parchar (AU)

Background: Few epidemiological studies have investigated the incidence of allergic contact dermatitis in children. Underdiagnosis has been observed in some studies, with many cases in which the condition is not suspected clinically and patch tests are not performed. However, the prevalence of pediatric sensitization to allergens has been reported to be as high as 20%, and the diagnosis should therefore be contemplated as a possibility in this age group. Material and methods: We performed a retrospective analysis of the skin allergy database of the Dermatology Department of Consorcio Hospital General Universitario de Valencia. Children between 0 and 16 years of age diagnosed with allergic contact dermatitis in the previous 15 years (between 2000 and 2015) were included in the analysis. Epidemiological (age, sex, history of atopy) and clinical (site of the lesions, allergen series applied, positive reactions, and their relevance) variables were gathered. Results: Patch tests had been performed on 4,593 patients during the study period. Of these, 265 (6%) were children aged between 0 and 16 years. A positive reaction to at least one of the allergens tested was observed in 144 (54.3%) patients in that group. The allergens most frequently identified were the following (in decreasing order of frequency): thiomersal, cobalt chloride, colophony, paraphenylenediamine, potassium dichromate, mercury, and nickel. The sensitization was considered relevant in 177 (61.3%) cases. Conclusions: More than half of the children studied showed sensitization to 1 or more allergens, with a high percentage of relevant sensitizations. All children with a clinical suspicion of allergic contact dermatitis should be referred for patch testing. As no standardized test series have been developed for this age group, a high level of clinical suspicion and knowledge of the allergens most commonly involved are required when selecting the allergens to be tested (AU)

Pediatric Allergic Contact Dermatitis: Clinical and Epidemiological Study in a Tertiary Hospital. / Dermatitis alérgica de contacto pediátrica. Estudio clínico-epidemiológico en un hospital terciario.

BACKGROUND: Few epidemiological studies have investigated the incidence of allergic contact dermatitis in children. Underdiagnosis has been observed in some studies, with many cases in which the condition is not suspected clinically and patch tests are not performed. However, the prevalence of pediatric sensitization to allergens has been reported to be as high as 20%, and the diagnosis should therefore be contemplated as a possibility in this age group. MATERIAL AND METHODS: We performed a retrospective analysis of the skin allergy database of the Dermatology Department of Consorcio Hospital General Universitario de Valencia. Children between 0 and 16 years of age diagnosed with allergic contact dermatitis in the previous 15 years (between 2000 and 2015) were included in the analysis. Epidemiological (age, sex, history of atopy) and clinical (site of the lesions, allergen series applied, positive reactions, and their relevance) variables were gathered. RESULTS: Patch tests had been performed on 4,593 patients during the study period. Of these, 265 (6%) were children aged between 0 and 16 years. A positive reaction to at least one of the allergens tested was observed in 144 (54.3%) patients in that group. The allergens most frequently identified were the following (in decreasing order of frequency): thiomersal, cobalt chloride, colophony, paraphenylenediamine, potassium dichromate, mercury, and nickel. The sensitization was considered relevant in 177 (61.3%) cases. CONCLUSIONS: More than half of the children studied showed sensitization to 1 or more allergens, with a high percentage of relevant sensitizations. All children with a clinical suspicion of allergic contact dermatitis should be referred for patch testing. As no standardized test series have been developed for this age group, a high level of clinical suspicion and knowledge of the allergens most commonly involved are required when selecting the allergens to be tested.

Lesión ungueal en un escolar, ¿qué sospechar? / Nail injury in a seven-year-old girl, what to suspect?

Las alteraciones ungueales en los niños representan un motivo de consulta frecuente en Atención Primaria. El adecuado desarrollo de las uñas depende de varios procesos fisiológicos, tanto locales como sistémicos, por lo que un gran número de afecciones pueden generar alteraciones ungueales. Durante la infancia existen diferencias fisiológicas del aparato ungueal con los adultos. Conocer estas variaciones fisiológicas es imprescindible para un correcto manejo. Se presenta el caso clínico de una niña de siete años con lesiones ungueales con piqueteado ungueal y estriación (AU)

The nail changes in children are a common reason for consultation in primary care. The proper development of nails depends on various physiological processes, both local and systemic, so a large number of conditions can cause nail changes. During infancy, there are physiological differences on nails with adults. Knowing these physiological variations is essential for proper management. The case of a seven-year-old girl with nail lesions with nail pitting and striations is presented (AU)

Dermatitis alérgica de contacto a cosméticos, estudio clínico-epidemiológico en un hospital terciario / Allergic contact dermatitis due to cosmetics: A clinical and epidemiological study in a tertiary hospital

La dermatitis alérgica de contacto (DAC) a cosméticos es una dolencia con una incidencia creciente en la población, paralelamente a la generalización del uso de cosméticos en la sociedad, así como a su proliferación y diversificación. El objetivo del estudio es determinar la prevalencia de DAC a cosméticos en nuestro medio, analizar su evolución temporal y sus características clínico-epidemiológicas, así como definir los alérgenos y los cosméticos implicados. Se ha realizado un estudio prospectivo durante los años 2005-2013 en la Unidad de Alergia Cutánea del Hospital General Universitario de Valencia, y se ha comparado de forma retrospectiva con el periodo previo de 1996-2004. Se ha incluido a 5.419 pacientes estudiados con pruebas epicutáneas durante el periodo total del estudio. La prevalencia media de DAC a cosméticos ha aumentado de 9,8% en el periodo 1996-2004 a 13,9% en el periodo 2005-2013. La DAC a cosméticos se ha correlacionado con el sexo femenino, pero no con la atopia. El kathon CG (mezcla de metilcloroisotiazolinona y metilisotiazolinona), las fragancias y la parafenilendiamina (PPDA) se han mantenido como las causas más frecuentes, aunque en los últimos años los acrilatos y los filtros solares han sido alérgenos emergentes

The incidence of allergic contact dermatitis (ACD) to cosmetics in the general population is rising with the increasing use of cosmetic products and their proliferation and diversification. The aims of this study were to determine the prevalence of ACD to cosmetics in our setting, analyze changes over time, describe the clinical and epidemiological features of this allergic reaction, and identify the allergens and cosmetics involved. We performed a prospective study at the skin allergy unit in Hospital General Universitario de Valencia in Spain between 2005 and 2013 and compared our findings with data collected retrospectively for the period 1996 to 2004. The 5419 patients who underwent patch testing during these 2 periods were included in the study. The mean prevalence of ACD to cosmetics increased from 9.8% in the first period (1996-2004) to 13.9% in the second period (2005-2013). A significant correlation was found between ACD to cosmetics and female sex but not atopy. Kathon CG (blend of methylchloroisothiazolinone and methylisothiazolinone), fragrances, and paraphenylenediamine were the most common causes of ACD to cosmetics during both study periods, and acrylates and sunscreens were identified as emerging allergens during the second period

Allergic contact dermatitis due to cosmetics: A clinical and epidemiological study in a tertiary hospital. / Dermatitis alérgica de contacto a cosméticos, estudio clínico-epidemiológico en un hospital terciario.

The incidence of allergic contact dermatitis (ACD) to cosmetics in the general population is rising with the increasing use of cosmetic products and their proliferation and diversification. The aims of this study were to determine the prevalence of ACD to cosmetics in our setting, analyze changes over time, describe the clinical and epidemiological features of this allergic reaction, and identify the allergens and cosmetics involved. We performed a prospective study at the skin allergy unit in Hospital General Universitario de Valencia in Spain between 2005 and 2013 and compared our findings with data collected retrospectively for the period 1996 to 2004. The 5419 patients who underwent patch testing during these 2 periods were included in the study. The mean prevalence of ACD to cosmetics increased from 9.8% in the first period (1996-2004) to 13.9% in the second period (2005-2013). A significant correlation was found between ACD to cosmetics and female sex but not atopy. Kathon CG (blend of methylchloroisothiazolinone and methylisothiazolinone), fragrances, and paraphenylenediamine were the most common causes of ACD to cosmetics during both study periods, and acrylates and sunscreens were identified as emerging allergens during the second period.

Angiomas en penacho en la infancia. Serie de 9 casos y revisión de la literatura / Tufted angiomas in childhood: A series of 9 cases and a literature review

INTRODUCCIÓN: El angioma en penacho o tufted angioma (TA) es una tumoración vascular benigna poco frecuente, que suele aparecer en la infancia, aunque existen casos de aparición en la edad adulta. Su presentación clínica es muy variable. Se manifiesta típicamente como una mácula, pápula o nódulo eritematovioláceo en el tronco o el cuello. Histológicamente, se caracteriza por agregados de lóbulos angiomatosos en la dermis formando pequeños penachos de capilares. PACIENTES Y MÉTODOS: Estudio retrospectivo observacional de los casos diagnosticados de TA en los últimos 20 años en nuestro centro. RESULTADOS: Presentamos un total de 9 casos de angiomas en penacho en la infancia. El 77,7% de los casos fueron congénitos, lo que representa una frecuencia superior a la descrita previamente. Nuestros pacientes presentaron regresión espontánea en el 55,5% de los casos, siendo más frecuente en el grupo de TA congénitos. A diferencia de las otras series descritas en la literatura, observamos un mayor porcentaje de pacientes con regresión espontánea, un predominio femenino (6 de los 9 niños) y una localización más frecuente en miembros los superiores. Ninguno de nuestros pacientes presentó fenómeno de Kasabach-Merritt. CONCLUSIONES: Dada la alta tasa de involución espontánea en TA congénitos o tempranos, en ausencia de otras complicaciones, la vigilancia sería una buena opción de manejo, monitorizando estrechamente al paciente

INTRODUCTION: Tufted angioma (TA) is a rare benign vascular tumor that mostly appears during infancy or early childhood, although there are cases reported in adults. Clinical presentation and evolution of TA can vary. Histologically, it takes on a classic appearance of vascular tufts ('cannon ball' like appearance). PATIENTS AND METHODS: A retrospective observational study was conducted that included all patients diagnosed with TA at our center in the last 20 years. Results A series of 9 cases of tufted angioma in childhood are presented, 77.7% of which were congenital. This represents a frequency higher than previously described. Spontaneous regression was observed in 55.5% of the cases, and was more frequent in the congenital TA group. Unlike other TA series reported in the literature, a higher proportion of patients with spontaneous regression was observed in this series, with a higher prevalence in females (6 out of 9 children) and predominantly located in the upper limbs. None of our patients had Kasabach-Merritt phenomenon. CONCLUSIONS: There are many ways of treating TA, but none are uniformly effective. Given the high rate of spontaneous regression in congenital or early TA, we suggest that, in the absence of other complications, monitoring would be a good option for management

Queilitis fotoalérgica de contacto por clorpromazina: descripción de 2 casos / Photoallergic Contact Dermatitis Due to Chlorpromazine: A Report of 2 Cases

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