[Translated article] Allergic Contact Dermatitis to Topical Ophthalmic Drugs: Review of Frequently Used Allergens in Spain.

Allergic contact dermatitis induced by the use of ophthalmic topical drugs is one of the most common causes of eyelid dermatitis. The introduction of new formulations, both of active ingredients and excipients, and the lack of marketing in some of them, makes patch testing in patients whose source of contact are topical ophthalmic drugs truly challenging. Across this manuscript, most, if not all, topical ophthalmic drugs used in our national health system have been collected, including information on the allergens available, and the concentration and vehicle advised for those that still remain unavailable.

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.

Dispositivos médicos en pacientes diabéticos y dermatitis de contacto / Medical Devices in Patients With Diabetes and Contact Dermatitis

El desarrollo y comercialización de los sensores de glucosa y las bombas de insulina han supuesto una revolución en el control de los pacientes diabéticos. En los últimos años se han detectado múltiples casos de dermatitis de contacto relacionados con estos dispositivos médicos, con el creciente interés sobre los alérgenos responsables de la sensibilización. Isobornil acrilato fue sin duda el alérgeno principal del dispositivo FreeStyle, motivando al fabricante a modificar la composición eliminando este alérgeno. Curiosamente, este alérgeno está presente en casi todos los sensores comercializados. La colofonia y derivados del ácido abiético desempeñan un papel relevante en cuanto al adhesivo. Recientemente aparecen nuevos componentes identificados como alérgenos, no comercializadas, como el dipropilene glicol diacrilato, la N,N-dimetilacrilamida, o el metacrilato de trietilenglicol, que están siendo foco de estudio. El impacto positivo que tiene el uso de estos dispositivos puede verse mermado por la sensibilización a uno de sus ingredientes, obligando en ocasiones a abandonar el dispositivo, y por ende, restando calidad de vida. El dermatólogo debe posicionarse respecto al estudio dirigido de estos pacientes, dando soporte a los servicios de endocrinología, con la finalidad de orientar tanto el cuidado de la piel como las alternativas posibles, especialmente con la colaboración de los fabricantes.(AU)

The development and commercialization of glucose sensors and insulin pumps has revolutionized the management of diabetes. These devices have been linked to multiple cases of contact dermatitis in recent years, however, giving rise to a growing interest in identifying the sensitizing allergens. Isobornyl acrylate was clearly identified as one of the main allergens responsible for contact dermatitis among users of the FreeStyle glucose sensor and was subsequently removed from the product ingredients. Remarkably, however, it is still used in most other sensors on the market. The common adhesive ingredients colophony and abietic acid derivatives have also been shown to be sensitizing agents. New components under study, such as dipropylene glycol diacrylate, N,N-dimethylacrylamide, and triethylene glycol methacrylate have recently been identified as allergens, though they are not commercially available for clinical testing. The benefits offered by glucose sensors and insulin pumps may be offset by sensitization to product ingredients, in some cases forcing discontinuation and diminishing quality of life. Dermatologists should play a role in this clinical and research scenario, offering case-by-case guidance to endocrinologists on skin care and possible alternatives for patients with glucose sensors and insulin pumps who develop contact dermatitis. They should also collaborate with the manufacturers developing these devices.(AU)

[Translated article] Medical Devices in Patients With Diabetes and Contact Dermatitis / Dispositivos médicos en pacientes diabéticos y dermatitis de contacto

El desarrollo y comercialización de los sensores de glucosa y las bombas de insulina han supuesto una revolución en el control de los pacientes diabéticos. En los últimos años se han detectado múltiples casos de dermatitis de contacto relacionados con estos dispositivos médicos, con el creciente interés sobre los alérgenos responsables de la sensibilización. Isobornil acrilato fue sin duda el alérgeno principal del dispositivo FreeStyle, motivando al fabricante a modificar la composición eliminando este alérgeno. Curiosamente, este alérgeno está presente en casi todos los sensores comercializados. La colofonia y derivados del ácido abiético desempeñan un papel relevante en cuanto al adhesivo. Recientemente aparecen nuevos componentes identificados como alérgenos, no comercializadas, como el dipropilene glicol diacrilato, la N,N-dimetilacrilamida, o el metacrilato de trietilenglicol, que están siendo foco de estudio. El impacto positivo que tiene el uso de estos dispositivos puede verse mermado por la sensibilización a uno de sus ingredientes, obligando en ocasiones a abandonar el dispositivo, y por ende, restando calidad de vida. El dermatólogo debe posicionarse respecto al estudio dirigido de estos pacientes, dando soporte a los servicios de endocrinología, con la finalidad de orientar tanto el cuidado de la piel como las alternativas posibles, especialmente con la colaboración de los fabricantes.(AU)

The development and commercialization of glucose sensors and insulin pumps has revolutionized the management of diabetes. These devices have been linked to multiple cases of contact dermatitis in recent years, however, giving rise to a growing interest in identifying the sensitizing allergens. Isobornyl acrylate was clearly identified as one of the main allergens responsible for contact dermatitis among users of the FreeStyle glucose sensor and was subsequently removed from the product ingredients. Remarkably, however, it is still used in most other sensors on the market. The common adhesive ingredients colophony and abietic acid derivatives have also been shown to be sensitizing agents. New components under study, such as dipropylene glycol diacrylate, N,N-dimethylacrylamide, and triethylene glycol methacrylate have recently been identified as allergens, though they are not commercially available for clinical testing. The benefits offered by glucose sensors and insulin pumps may be offset by sensitization to product ingredients, in some cases forcing discontinuation and diminishing quality of life. Dermatologists should play a role in this clinical and research scenario, offering case-by-case guidance to endocrinologists on skin care and possible alternatives for patients with glucose sensors and insulin pumps who develop contact dermatitis. They should also collaborate with the manufacturers developing these devices.(AU)

[Translated article] Drug Survival in Cyclosporine Treatment for Moderate to Severe Atopic Dermatitis: Analysis of the Spanish Atopic Dermatitis Registry (BIOBADATOP).

BACKGROUND: The past 5 years have seen a proliferation of new treatments for atopic dermatitis (AD). We analyzed recent drug survival data for cyclosporine in this setting. Because the Spanish National Healthcare system requires patients with AD to be treated with cyclosporine before they can be prescribed other systemic treatments, drug survival for cyclosporine may be shorter than in other diseases. MATERIAL AND METHOD: Multicenter, observational, prospective cohort study using data from the Spanish Atopic Dermatitis Registry (BIOBADATOP). Data from the Spanish Registry of Systemic Treatments in Psoriasis (BIOBADADERM) were used to create a comparison cohort. RESULTS: We analyzed data for 130 patients with AD treated with cyclosporine (median drug survival, 1 year). Median cyclosporine survival in the psoriasis comparison group (150 patients) was 0.37 years. Drug survival was significantly longer in AD than in psoriasis (P<.001). CONCLUSION: Drug survival of cyclosporine in the BIOBADATOP registry is similar to that described in other series of patients with AD and longer than that observed in the BIOBADADERM psoriasis registry.

Allergic Contact Dermatitis to Topical Ophthalmic Drugs: Review of Frequently Used Allergens in Spain. / Dermatitis alérgica de contacto a productos oftalmológicos: revisión de los alérgenos de uso frecuente en España.

Allergic contact dermatitis induced by the use of ophthalmic topical drugs is one of the most common causes of eyelid dermatitis. The introduction of new formulations, both of active ingredients and excipients, and the lack of marketing in some of them, makes patch testing in patients whose source of contact are topical ophthalmic drugs truly challenging. Across this manuscript, most, if not all, topical ophthalmic drugs used in our national health system have been collected, including information on the allergens available, and the concentration and vehicle advised for those that still remain unavailable.

[Translated article] Medical Devices in Patients With Diabetes and Contact Dermatitis.

The development and commercialization of glucose sensors and insulin pumps has revolutionized the management of diabetes. These devices have been linked to multiple cases of contact dermatitis in recent years, however, giving rise to a growing interest in identifying the sensitizing allergens. Isobornyl acrylate was clearly identified as one of the main allergens responsible for contact dermatitis among users of the FreeStyle glucose sensor and was subsequently removed from the product ingredients. Remarkably, however, it is still used in most other sensors on the market. The common adhesive ingredients colophony and abietic acid derivatives have also been shown to be sensitizing agents. New components under study, such as dipropylene glycol diacrylate, N,N-dimethylacrylamide, and triethylene glycol methacrylate have recently been identified as allergens, though they are not commercially available for clinical testing. The benefits offered by glucose sensors and insulin pumps may be offset by sensitization to product ingredients, in some cases forcing discontinuation and diminishing quality of life. Dermatologists should play a role in this clinical and research scenario, offering case-by-case guidance to endocrinologists on skin care and possible alternatives for patients with glucose sensors and insulin pumps who develop contact dermatitis. They should also collaborate with the manufacturers developing these devices.

Drug Survival in Cyclosporine Treatment for Moderate to Severe Atopic Dermatitis: Analysis of the Spanish Atopic Dermatitis Registry (BIOBADATOP). / Supervivencia de la ciclosporina en el tratamiento de la dermatitis atópica moderada-grave: Registro Español de Dermatitis Atópica (BIOBADATOP).

BACKGROUND: The past 5 years have seen a proliferation of new treatments for atopic dermatitis (AD). We analyzed recent drug survival data for cyclosporine in this setting. Because the Spanish National Healthcare system requires patients with AD to be treated with cyclosporine before they can be prescribed other systemic treatments, drug survival for cyclosporine may be shorter than in other diseases. MATERIAL AND METHOD: Multicenter, observational, prospective cohort study using data from the Spanish Atopic Dermatitis Registry (BIOBADATOP). Data from the Spanish Registry of Systemic Treatments in Psoriasis (BIOBADADERM) were used to create a comparison cohort. RESULTS: We analyzed data for 130 patients with AD treated with cyclosporine (median drug survival, 1 year). Median cyclosporine survival in the psoriasis comparison group (150 patients) was 0.37 years. Drug survival was significantly longer in AD than in psoriasis (P<.001). CONCLUSION: Drug survival of cyclosporine in the BIOBADATOP registry is similar to that described in other series of patients with AD and longer than that observed in the BIOBADADERM psoriasis registry.

Prurito en dermatología. Enfermedades y su tratamiento. Parte 2 / Pruritus in Dermatology: Part 2 — Diseases and Their Treatment

El prurito es el síntoma principal en múltiples enfermedades dermatológicas y sistémicas. La dermatitis atópica, la psoriasis, la dermatitis de contacto, la urticaria, el liquen simple crónico, la micosis fungoides, las cicatrices, las enfermedades autoinmunes, la enfermedad renal o hepática crónica, entre otras, asocian prurito que puede requerir un manejo terapéutico distinto. Aunque los antihistamínicos parecen ser la primera línea de tratamiento, en realidad su papel queda limitado a la urticaria y reacciones por fármacos, ya que los mecanismos fisiopatológicos de cada una de las entidades tratadas a lo largo de este manuscrito serán distintas. En estos últimos años han aparecido nuevas moléculas para el tratamiento del prurito, con perfiles de eficacia y seguridad muy atractivos para su uso en práctica clínica. Sin duda, es un momento crucial para el desarrollo de la dermatología en el campo del prurito, y una oportunidad para ser más exigentes con los objetivos a alcanzar en estos pacientes (AU)

Pruritus is the main symptom of many dermatologic and systemic diseases. Atopic dermatitis, psoriasis, contact dermatitis, urticaria, lichen simplex chronicus, mycosis fungoides, scars, autoimmune diseases, kidney or liver diseases among others are all associated with itch that may require different approaches to management. Although antihistamines seem to be the first line of therapy, in reality their role is limited to urticaria and drug-induced reactions. In fact, the pathophysiologic mechanisms of each of the conditions covered in this review will differ. Recent years have seen the emergence of new drugs whose efficacy and safety profiles are very attractive for the management of pruritus in clinical practice. Clearly we are at a critical moment in dermatology, in which we have the chance to be more ambitious in our goals when treating patients with pruritus (AU)

[Translated article] Pruritus in Dermatology: Part 2—Diseases and Their Treatment / Prurito en dermatología. Enfermedades y su tratamiento. Parte 2

Pruritus is the main symptom of many dermatologic and systemic diseases. Atopic dermatitis, psoriasis, contact dermatitis, urticaria, lichen simplex chronicus, mycosis fungoides, scars, autoimmune diseases, kidney or liver diseases among others are all associated with itch that may require different approaches to management. Although antihistamines seem to be the first line of therapy, in reality their role is limited to urticaria and drug-induced reactions. In fact, the pathophysiologic mechanisms of each of the conditions covered in this review will differ. Recent years have seen the emergence of new drugs whose efficacy and safety profiles are very attractive for the management of pruritus in clinical practice. Clearly we are at a critical moment in dermatology, in which we have the chance to be more ambitious in our goals when treating patients with pruritus (AU)

El prurito es el síntoma principal en múltiples enfermedades dermatológicas y sistémicas. La dermatitis atópica, la psoriasis, la dermatitis de contacto, la urticaria, el liquen simple crónico, la micosis fungoides, las cicatrices, las enfermedades autoinmunes, la enfermedad renal o hepática crónica, entre otras, asocian prurito que puede requerir un manejo terapéutico distinto. Aunque los antihistamínicos parecen ser la primera línea de tratamiento, en realidad su papel queda limitado a la urticaria y reacciones por fármacos, ya que los mecanismos fisiopatológicos de cada una de las entidades tratadas a lo largo de este manuscrito serán distintas. En estos últimos años han aparecido nuevas moléculas para el tratamiento del prurito, con perfiles de eficacia y seguridad muy atractivos para su uso en práctica clínica. Sin duda, es un momento crucial para el desarrollo de la dermatología en el campo del prurito, y una oportunidad para ser más exigentes con los objetivos a alcanzar en estos pacientes (AU)

Prurito en dermatología. Generalidades y pruritógenos. Parte 1 / Pruritus in Dermatology: Part 1 — General Concepts and Pruritogens

El prurito es el síntoma más frecuente asociado a enfermedades dermatológicas y sistémicas. Su diagnóstico es clínico, aunque en ocasiones será necesario realizar pruebas complementarias para identificar o confirmar el origen. La medicina traslacional ha permitido descubrir nuevos mediadores pruritógenos y nuevos receptores. Saber reconocer adecuadamente la principal vía por la que media el prurito en cada paciente será clave para el éxito terapéutico. La vía histaminérgica predomina en enfermedades como la urticaria o las reacciones a fármacos, mientras que la vía no histaminérgica predomina prácticamente en la mayoría de las otras dermatosis incluidas en esta revisión. La clasificación del prurito, las pruebas complementarias, la fisiopatología y los pruritógenos implicados, incluyendo citoquinas y otras moléculas, así como la sensibilización central al prurito que sufren estos pacientes formarán parte de este primer manuscrito sobre el prurito (AU)

Pruritus is the most common symptom of dermatologic and systemic diseases. The diagnosis of pruritus is clinical, although additional tests may be necessary to identify or confirm the cause. Translational medicine has led to the discovery of new mediators of itch, or pruritogens, as well as new receptors. Knowing how to properly recognize the main pathway that mediates itch in each patient is the key to successful treatment. Although the histaminergic pathway predominates in conditions like urticaria or drug-induced pruritus, it is the nonhistaminergic pathway that predominates in nearly all other skin diseases covered in this review. Part 1 of this 2-part review discusses the classification of pruritus, additional testing, the pathophysiology of itch and the pruritogens implicated (including cytokines and other molecules), and central sensitization to itch (AU)

[Translated article] Pruritus in Dermatology: Part 1-General Concepts and Pruritogens / Prurito en dermatología. Generalidades y pruritógenos. Parte 1

Pruritus is the most common symptom of dermatologic and systemic diseases. The diagnosis of pruritus is clinical, although additional tests may be necessary to identify or confirm the cause. Translational medicine has led to the discovery of new mediators of itch, or pruritogens, as well as new receptors. Knowing how to properly recognize the main pathway that mediates itch in each patient is the key to successful treatment. Although the histaminergic pathway predominates in conditions like urticaria or drug-induced pruritus, it is the nonhistaminergic pathway that predominates in nearly all other skin diseases covered in this review. Part 1 of this 2-part review discusses the classification of pruritus, additional testing, the pathophysiology of itch and the pruritogens implicated (including cytokines and other molecules), and central sensitization to itch (AU)

El prurito es el síntoma más frecuente asociado a enfermedades dermatológicas y sistémicas. Su diagnóstico es clínico, aunque en ocasiones será necesario realizar pruebas complementarias para identificar o confirmar el origen. La medicina traslacional ha permitido descubrir nuevos mediadores pruritógenos y nuevos receptores. Saber reconocer adecuadamente la principal vía por la que media el prurito en cada paciente será clave para el éxito terapéutico. La vía histaminérgica predomina en enfermedades como la urticaria o las reacciones a fármacos, mientras que la vía no histaminérgica predomina prácticamente en la mayoría de las otras dermatosis incluidas en esta revisión. La clasificación del prurito, las pruebas complementarias, la fisiopatología y los pruritógenos implicados, incluyendo citoquinas y otras moléculas, así como la sensibilización central al prurito que sufren estos pacientes formarán parte de este primer manuscrito sobre el prurito (AU)

Pruritus in Dermatology: Part 2 - Diseases and Their Treatment. / Prurito en dermatología. Enfermedades y su tratamiento. Parte 2.

Pruritus is the main symptom of many dermatologic and systemic diseases. Atopic dermatitis, psoriasis, contact dermatitis, urticaria, lichen simplex chronicus, mycosis fungoides, scars, autoimmune diseases, kidney or liver diseases among others are all associated with itch that may require different approaches to management. Although antihistamines seem to be the first line of therapy, in reality their role is limited to urticaria and drug-induced reactions. In fact, the pathophysiologic mechanisms of each of the conditions covered in this review will differ. Recent years have seen the emergence of new drugs whose efficacy and safety profiles are very attractive for the management of pruritus in clinical practice. Clearly we are at a critical moment in dermatology, in which we have the chance to be more ambitious in our goals when treating patients with pruritus.

Pruritus in Dermatology: Part 1 - General Concepts and Pruritogens. / Prurito en dermatología. Generalidades y pruritógenos. Parte 1.

Pruritus is the most common symptom of dermatologic and systemic diseases. The diagnosis of pruritus is clinical, although additional tests may be necessary to identify or confirm the cause. Translational medicine has led to the discovery of new mediators of itch, or pruritogens, as well as new receptors. Knowing how to properly recognize the main pathway that mediates itch in each patient is the key to successful treatment. Although the histaminergic pathway predominates in conditions like urticaria or drug-induced pruritus, it is the nonhistaminergic pathway that predominates in nearly all other skin diseases covered in this review. Part 1 of this 2-part review discusses the classification of pruritus, additional testing, the pathophysiology of itch and the pruritogens implicated (including cytokines and other molecules), and central sensitization to itch.