Comparison of patch testing Brazilian (Green) propolis and Chinese (poplar-type) propolis: Clinical epidemiological study using data from the Information Network of Departments of Dermatology (IVDK).

BACKGROUND: Propolis types differ regarding their chemical composition. OBJECTIVES: To compare patch test results based on Brazilian (Green) propolis with data based on Chinese (poplar-type) propolis, and to evaluate the specifications of raw materials used for the PT preparations. METHODS: In the Information Network of Departments of Dermatology (IVDK), 1290 consecutive patients were patch tested with Brazilian (Green) propolis (NH400, SmartPractice Europe). Patch test reactivity was compared with results obtained with Chinese (poplar-type) propolis (NA71, SmartPractice Europe) by calculating frequencies and corresponding 95% confidence intervals. Data on the specifications of raw materials used for NH400 and NA71 were obtained from the manufacturer. RESULTS: Positive reactions to NH400 were found in 303 (23.5%) patients with unclear clinical relevance in most cases. Patients reacting to NH400 were less often sensitised to fragrances and colophony, but more often to nickel sulphate and cobalt chloride than patients reacting to NA71. The NH400 batch used contained high levels of aerobic bacteria, and was not purified by ethanolic extraction. CONCLUSIONS: Pattern of concomitant reactivity along with raw material properties suggests that the high frequency of positive reactions to NH400 may primarily result from bacterial contamination or impurities in the PT preparation rather than from propolis constituents.

[Paederus Dermatitis, a disease not to forget] / Dermatitis por Paederus, una enfermedad para no olvidar.

Paederus contact dermatitis is a skin disease caused by beetles of the genus Paederus and the release of a vesicant substance called paederin. It is worldwide distributed; However, it is more common in rainy seasons and hot climates. The clinical manifestations are vesicle-pustules that settle on erythematous skin. Treatment is based on washing with soap and water to neutralize the action of the toxin and the administration of topical steroids in short cycles. We report the case of a 28-year-old male patient who came to the dermatology clinic with a 48-hour history of two erythematous plaques with central blisters plus superficial ulceration located on the flexor aspect of the arm and right forearm, accompanied by a sensation of burning and itching at the site of the lesions, without other accompanying symptoms. As background, he states that he was on vacation in the coastal region of Ecuador when the lesions appeared. An incisional biopsy was performed and due to the clinical characteristics and the history of travel to a tropical region, it was diagnosed as Paederus dermatitis and treatment with antihistamines, topical steroids and cold compresses was indicated. After 8 days of treatment, the lesions subsided, leaving post-inflammatory hyperpigmentation.

La dermatitis de contacto por Paederus es una enfermedad cutánea causada por los coleópteros del género Paederus y la liberación de una sustancia vesicante llamada paederina. Es de distribución mundial; sin embargo, es más frecuente en temporadas de lluvia y en climas cálidos. Las manifestaciones clínicas son vesículo-pústulas que se asientan sobre piel eritematosa. El tratamiento se basa en el aseo con agua y jabón para neutralizar la acción de la toxina y la administración de esteroides tópicos en ciclos cortos. Se comunica el caso de un paciente masculino de 28 años, que acude a consulta de dermatología con cuadro de 48 horas de evolución de dos placas eritematosas con ampollas centrales más ulceración superficial localizadas en cara flexora de brazo y antebrazo derecho, acompañadas de una sensación de ardor y prurito en el lugar de las lesiones, sin síntomas acompañantes. Como antecedente refiere que se encontraba de vacaciones en la región costera de Ecuador al momento de aparecer las lesiones. Se realizó una biopsia incisional y por las características clínicas y el antecedente de viaje a una región tropical se diagnosticó como dermatitis por Paederus y se indicó tratamiento con antihistamínicos, esteroides tópicos y compresas frías. Después de 8 días de tratamiento, las lesiones remitieron dejando una hiperpigmentación postinflamatoria.

Linear IgA bullous dermatosis in a latin adolescent treated with cyclosporine and prednisone.

INTRODUCTION: Linear IgA bullous dermatosis (LABD) is a rare autoimmune disease. Although dapsone is the initial treatment, other immunomodulators are used in resistant cases or when dapsone is unavailable. CASE REPORT: A 12-year-old Mexican child, with no relevant medical history, developed in May 2023 a disseminated dermatosis affecting all body segments, including mucous membranes, characterized by erythematous patches and plaques evolving into the formation of serous and serosanguinous blisters and vesicles, distributed in a "string of pearls" pattern. LABD was suspected and confirmed by skin biopsy, which showed a subepidermal blister with neutrophilic infiltration and linear Immunoglobulin A deposits at the dermo-epidermal junction by direct immunofluorescence. Treatment with prednisone (2 mg/kg/day) and cyclosporine (5 mg/kg/day) resulted in improvement and lesion remission within 2 weeks. Both drugs needed to be discontinued for 3 months due to intermittent blistering. Cyclosporine was continued as maintenance therapy at a dose of 4 mg/kg/day for 8 months. CONCLUSIONS: The report highlights the use of cyclosporine as an alternative immunomodulator for DAAL, an immunosuppressive agent used in autoimmune disorders. Few cases, including this one, have described complete remission and control of the dermatosis with cyclosporine, accompanied by prednisone at the start of treatment.

INTRODUCCIÓN: La dermatosis ampollosa por IgA lineal es una enfermedad autoinmunitaria rara. Aunque la dapsona es el tratamiento inicial, se usan otros inmunomoduladores en casos resistentes o cuando la dapsona no está disponible. CASO CLÍNICO: Un niño mexicano de 12 años, sin antecedentes relevantes, desarrolló en mayo de 2023 una dermatosis diseminada a todos los segmentos corporales, incluyendo las mucosas, caracterizada por manchas y placas eritematosas que evolucionaron hacia la formación de ampollas y vesículas serosas y serohemáticas, distribuidas en forma de «cadena de perlas¼. Se sospechó dermatosis ampollosa por IgA lineal y se confirmó mediante biopsia cutánea, que mostró una ampolla subepidérmica con infiltrado neutrófilo y depósitos lineales de IgA en la unión dermoepidérmica mediante inmunofluorescencia directa. El tratamiento con prednisona (2 mg/kg al día) y ciclosporina (5 mg/kg al día) resultó en mejoría y la remisión de las lesiones a las 2 semanas. Fue necesario dejar ambos fármacos durante 3 meses debido a la aparición intermitente de ampollas. Se dejó ciclosporina como terapia de mantenimiento a dosis de 4 mg/kg al día por 8 meses. CONCLUSIONES: El reporte destaca el uso de ciclosporina como inmunomodulador alternativo para la dermatosis ampollosa por IgA lineal, un agente inmunosupresor utilizado en trastornos autoinmunitarios. Pocos casos, incluido este, han descrito la remisión completa y el control de la dermatosis con ciclosporina, acompañada de prednisona al inicio del tratamiento.

Prurigo: review of its pathogenesis, diagnosis, and treatment

Abstract Prurigo is a reactive, hyperplastic skin condition characterized by pruritic papules, plaques, and/or nodules. The temporal classification includes acute/subacute and chronic disease (≥ 6 weeks), with different clinical variants, synonymies, and underlying etiological factors. The immunology of chronic prurigo shows similarities with atopic dermatitis due to the involvement of IL-4 and IL-13, IL-22, and IL-31. Treatment includes antihistamines, topical steroids, dupilumab, and JAK inhibitors. Several conditions manifest clinically as prurigo-like lesions, and the correct clinical diagnosis must precede correct treatment. Furthermore, chronic prurigos represent a recalcitrant and distressing dermatosis, and at least 50% of these patients have atopic diathesis, the treatment of which may induce adverse effects, especially in the elderly. The quality of life is significantly compromised, and topical treatments are often unable to control symptoms and skin lesions. Systemic immunosuppressants, immunobiologicals, and JAK inhibitors, despite the cost and potential adverse effects, may be necessary to achieve clinical improvement and quality of life. This manuscript reviews the main types of prurigo, associated diseases, their immunological bases, diagnosis, and treatment.

Correlation between disease severity indices and quality of life measurement tools in atopic dermatitis patients / Correlación entre los índices de gravedad de la enfermedad y las herramientas de medición de la calidad de vida en pacientes con dermatitis atópica

INTRODUCTION: Reports regarding the correlation and effect size of change of the full spectrum of quality of life and disease severity measures applied in-person to patients with atopic dermatitis are scarce. OBJECTIVES: To assess quality-of-life with 3 different instruments and to evaluate disease severity indices and to determine their correlation and effect size of change between two measurements. MATERIALS AND METHODS: Patient-level data were obtained through two in-person visits. Sociodemographic information and data related to disease distribution, severity (through the BSA, EASI, SCORAD, POEM, and itching scales), and the impact of atopic dermatitis on quality of life using the DLQI and Skindex-29, and EQ-5D, were assessed. The correlation between change in quality-of-life scores and disease severity scores in addition to the standardized effect size were also evaluated. RESULTS: Only 139 out of 212 patients completed the follow-up visit. BSA highly correlated with SCORAD and EASI, and the lowest correlation was found with POEM. The best correlation of pruritus VAS was found with sleep disturbance. The SCORAD score highly correlated with EASI, and the lowest correlation was found with POEM. The magnitude of the effect at initiation of the study vs follow-up was in average moderate to important. CONCLUSIONS: Patients with atopic dermatitis experience a substantial burden on quality of life. Disease activity correlates better with quality-of-life measurements when the disease is less severe after starting therapy. POEM and Skindex-29 seem to be optimal to determine disease severity and quality of life in adults with atopic dermatitis.

Introducción: La información publicada sobre la correlación entre la magnitud del efecto de todo el espectro de la calidad de vida y la gravedad de la enfermedad en pacientes con dermatitis atópica es escasa. Objetivos: Evaluar la calidad de vida con tres instrumentos diferentes y los índices de gravedad de la enfermedad en pacientes con dermatitis atópica para determinar su correlación y el tamaño del efecto del cambio. Materiales y métodos: Los datos de los pacientes se obtuvieron a partir de dos visitas. Se evaluó la información sociodemográfica y los datos relacionados con la distribución y la gravedad de la enfermedad (mediante de las escalas BSA, EASI, SCORAD, POEM, prurito) y el impacto de la dermatitis atópica en la calidad de vida utilizando el Dermatology Life Quality Index, Skindex-29 y EQ-5D. También se evaluó la correlación entre el cambio en las puntuaciones de calidad de vida y las de gravedad de la enfermedad, además del tamaño del efecto estandarizado. Resultados: Solo 139 de los 212 pacientes completaron la visita de seguimiento. El área de superficie corporal se correlacionó fuertemente con el SCORAD y el EASI, y la correlación más débil fue con el POEM. La mejor correlación del prurito medido con la escala visual análoga se halló con la alteración del sueño. El puntaje SCORAD se correlacionó altamente con el EASI mientras que la correlación más baja se encontró con el POEM. La magnitud del efecto al inicio del estudio respecto al seguimiento fue en promedio de moderada a importante. Conclusiones: Los pacientes con dermatitis atópica experimentan una carga sustancial en la calidad de vida. La actividad de la enfermedad se correlaciona mejor con las mediciones de calidad de vida cuando esta es menos grave, después de comenzar la terapia. Los índices POEM y Skindex-29 parecen ser óptimos para determinar la gravedad de la enfermedad y la calidad de vida en adultos con dermatitis atópica.

Qualitative study with mothers of children with atopic dermatitis: emotional and social impacts.

INTRODUCTION: Atopic Dermatitis (AD) is the most common skin disease in childhood and its control requires the support of the family members. This disease significantly interferes with the Quality of Life (QoL) of children and families, however, literature on the social and emotional impact of the disease on the caregivers is lacking. OBJECTIVE: To evaluate the emotional and social impact of AD on mothers of children with the disease. METHOD: This is a qualitative study of semi-structured interviews with mothers of children diagnosed with AD. The following variables were evaluated: diagnosis and start of treatment, knowledge about the disease, and impact on the mothers' lives. The material was analyzed using Lawrence Bardin's content analysis technique. The AD severity was assessed by SCORAD. RESULTS: A total of 23 interviews were conducted with mothers of children diagnosed with AD. In 82.6% of the cases, the mothers presented conflicts in the face of the first contacts with the disease. In 43.5% of cases, mothers were solely responsible for their children's treatment. About 56.6% defined AD as a cause of suffering and difficulty and 21.7% pointed out the AD experience as a learning experience. CONCLUSION: The AD is a chronic disease that has a psychological and social impact on the lives of mothers. In the treatment of AD, mothers must be screened and offered psychological support to improve adherence to treatment in the long term.

In silico analysis of molecular mimicry between human aquaporin 3, Aspergillus fumigatus aquaporin and aquaporins from allergic sources.

Background: Atopic dermatitis (AD) is a chronic inflammatory skin condition that has a significant impact on quality of life. The immune response and allergy symptoms in AD are triggered by the recognition of specific allergens by IgE antibodies. Cross-reactivity can lead to auto-IgE responses, potentially worsening AD symptoms. Our research aimed to enhance our understanding of allergenic sources, including A. fumigatus, and their role in AD. We focused on molecular mimicry between human AQP3 and A. fumigatus aquaporin. Methods: In our in-silico analysis, we compared the amino acid sequences of human aquaporin 3 (AQP3) and A. fumigatus aquaporin with 25 aquaporins from various allergenic sources, sourced from the UniProt and NCBI databases. Phylogenetic relationship analysis and homology-based modeling were conducted. We identified conserved antigenic regions located within the 3D structures. Results: The global identity levels among the studied aquaporins averaged 32.6%. One antigenic site exhibited a remarkable local region, with a conserved identity of 71.4%. We categorized the aquaporins into five monophyletic clades (A-E), with group B showing the highest identity (95%), including six mammalian aquaporins, including AQP3. When comparing A. fumigatus aquaporins, the highest identity was observed with Malassezia sympodialis at 35%. Both human and A. fumigatus aquaporins have three linear and three discontinuous epitopes. Conclusions: We identified potential linear and conformational epitopes of AQP3, indicating a possible molecular mimicry between humans and A. fumigatus aquaporins. This suggests autoreactivity and potential cross-reactivity, although further validation using in vitro and in vivo experiments is required.

Sleep and quality of life in adults with atopic dermatitis: cross sectional study.

Summary: Background.Atopic dermatitis (AD) is a chronic pruritic inflammatory skin disease that causes sleep disturbances and worsens quality of life. However, few studies have been conducted on sleep in adults with atopic dermatitis. This study aimed to evaluate sleep and quality of life in adults with AD. Methods. A cross-sectional study was conducted with 36 adults diagnosed with AD and 21 healthy volunteers (controls), who completed questionnaires on sleep, itching, and quality of life. Disease severity was estimated using SCORing Atopic Dermatitis (SCORAD). All participants wore actigraphy watches for one week to objectively assess sleep quality. Results. Adults with AD slept worse than controls as measured by self-report (Global Pittsburgh Sleep Quality Index, mean ± SD, 9.33 ± 3.59 vs 5.00 ± 2.30, p < 0.001) and by actigraphy (sleep efficiency, SE), mean ± SD, 74.48 ± 11.63 vs 85.6 ± 6.53, p < 0.001). Actigraphy showed that adults with AD slept, on average, almost one hour less (p = 0.010), stayed awake during sleep for almost 44 minutes more (p < 0.001), and woke up 25% more than the controls (p = 0.047). In the AD group, SE and total sleep time were significantly inversely correlated with SCORAD (rs = -0.601, p < 0.001 and rs = -0.604, p < 0.001, respectively), but no significant correlation was found between itch and SE. A decreased quality of life was observed in adults with AD (DLQI, mean ± SD, 8.75 ± 6.7). Conclusions. Adults with AD slept worse than the controls and had a diminished quality of life. Actigraphy is a useful tool to objectively measure sleep quality in adults with AD especially those with moderate to severe disease.

[Allergic contact dermatitis due to Furacin®]. / Allergic contact dermatitis due to Furacin®.

BACKGROUND: Allergic sensitization to topical antimicrobial treatments is a well-known problem. Furacin® is one of the most widely used in our environment. It contains 0.2% nitrofurazone and polyethylene glycol (PEG) as a vehicle. CASE REPORT: 57-year-old male with no history of interest. He presented skin rash, blisters, and serous exudate 2-3 days after starting treatment with Furacin® (applied to an infected skin wound). Epicutaneous tests were performed with a true test battery, nitrofurantoin 1% in petrolatum, PEG15000 and 4000 1% in petrolatum, pure PEG 400, PEG monomethyl ether 350 1% in water. Positive result at 96 hours for nitrofurantoin. CONCLUSION: Nitrofurazone is widely used as a topical antibiotic because of its bactericidal spectrum. It (including its excipients) should be considered in case of adverse reactions after application.

ANTECEDENTES: La sensibilización o alergia a medicamentos antimicrobianos tópicos es un problema conocido. Furacin® representa uno de los fármacos más prescritos en nuestro medio; sus principios activos son: nitrofurazona al 0.2% y polietilenglicol (PEG) como vehículo. REPORTE DE CASO: Paciente masculino de 57 años, sin antecedentes de interés para el padecimiento actual, que inició con erupción cutánea, ampollas y exudado seroso 2 a 3 días después de aplicar Furacin® en una herida cutánea infectada. Se llevaron a cabo pruebas epicutáneas con batería true test, nitrofurantoína al 1% en vaselina, PEG 15000 y 4000 al 1% en vaselina, PEG 400 puro, y PEG monometil éter 350 al 1% en agua, con resultado positivo para nitrofurantoina luego de 96 horas. CONCLUSIÓN: La nitrofurazona se indica ampliamente como antibiótico tópico, debido a su espectro bactericida; no obstante, debe considerarse (incluidos sus excipientes) en pacientes que manifiestan reacciones adversas después de su aplicación.

Prevention of radiation induced dermatitis in head and neck cancer patients using cryptomphalus aspersa secretion.

INTRODUCTION: Radiotherapy (RT) is a technique widely used in oncology, acquiring special prominence in head and neck cancer (HNC). RT of HNC may be associated with secondary effects including skin reaction, being dermatitis the most common radio-induced side effect during treatment. PURPOSE: The use of a wide variety of agents is reported to handle skin toxicity. The aim of the present work is to evaluate the different level-concentration of Snail Cryptomphalus Aspersa (SCA) that best protect from radiation-induced radiodermatitis in HNC. MATERIAL AND METHOD: We performed a single institutional pilot study to assess the skin toxicity with 0%, 5%, 10% and 15% SCA concentration during RT treatment and 1 and 3 months after the treatment finished according to the Radiation Therapy Oncology Group (RTOG) scoring. A total of 72 patients with HNC diagnosis who received RT with/without Chemotherapy (Ch) between January of 2018 and June of 2020 were assessed. Radiodermatitis grade was stastistically correlated with the SCA level-concentration and with the influence of extranodal extension status (ENE). RESULTS: A reduction in the rate of grade ≥ II patients' dermatitis was dependent on SCA level-concentration. We found that with higher SCA level-concentration (10 and 15%, patients had 34 and 38% grade ≥ II respectively), this was less than with 0 and 5% SCA level-concentration where a 58% radiodermatitis grade ≥ II was found by Cox regression analysis; p = 0.017 and p = 0.045 respectively. CONCLUSION: We could conclude that the application of a 10-15% SCA level-concentration after adjusting by ENE, was the best concentration to reduce the rate of grade ≥ II radiodermatitis.

Eritrodermia posterior a infección por Chikungunya: un reto diagnóstico / Erythroderma after Chikungunya infection: a diagnostic challenge

RESUMEN La eritrodermia es un síndrome inflamatorio cutáneo grave que se caracteriza por eritema y descamación generalizada en más del 90 % del cuerpo. Este síndrome puede ser la etapa final de diversas enfermedades dermatológicas o el inicio de ciertas patologías como la psoriasis, que es la causa más común. Las enfermedades febriles son causa de exacerbaciones de psoriasis. Se cree que el virus actúa como un superantígeno y activa la inmunidad celular causando cambios inmunológicos con clínica variada en individuos predispuestos. Presentamos el caso de un paciente de sexo masculino que debuta con una forma grave de psoriasis posterior a infección por chikungunya.

ABSTRACT Exfoliative dermatitis is a severe cutaneous inflammatory syndrome characterized by generalized erythema and scaling over more than 90 % of the body. This syndrome can be the final stage of various dermatological diseases or the beginning of certain pathologies such as psoriasis, which is the most common cause. Febrile illnesses are cause of psoriasis exacerbations. It is believed that the virus acts as a superantigen and activates cellular immunity causing immunological changes with varied symptoms in predisposed individuals. We present the case of a male patient who presented with a severe form of psoriasis after chikungunya infection.

Correlation between disease severity indices and quality of life measurement tools in atopic dermatitis patients / Correlación entre los índices de gravedad de la enfermedad y las herramientas de medición de la calidad de vida en pacientes con dermatitis atópica

Abstract Introduction. Reports regarding the correlation and effect size of change of the full spectrum of quality of life and disease severity measures applied in-person to patients with atopic dermatitis are scarce. Objectives. To assess quality-of-life with 3 different instruments and to evaluate disease severity indices and to determine their correlation and effect size of change between two measurements. Materials and methods. Patient-level data were obtained through two in-person visits. Sociodemographic information and data related to disease distribution, severity (through the BSA, EASI, SCORAD, POEM, and itching scales), and the impact of atopic dermatitis on quality of life using the DLQI and Skindex-29, and EQ-5D, were assessed. The correlation between change in quality-of-life scores and disease severity scores in addition to the standardized effect size were also evaluated. Results. Only 139 out of 212 patients completed the follow-up visit. BSA highly correlated with SCORAD and EASI, and the lowest correlation was found with POEM. The best correlation of pruritus VAS was found with sleep disturbance. The SCORAD score highly correlated with EASI, and the lowest correlation was found with POEM. The magnitude of the effect at initiation of the study vs follow-up was in average moderate to important. Conclusions. Patients with atopic dermatitis experience a substantial burden on quality of life. Disease activity correlates better with quality-of-life measurements when the disease is less severe after starting therapy. POEM and Skindex-29 seem to be optimal to determine disease severity and quality of life in adults with atopic dermatitis.

Resumen Introducción. La información publicada sobre la correlación entre la magnitud del efecto de todo el espectro de la calidad de vida y la gravedad de la enfermedad en pacientes con dermatitis atópica es escasa. Objetivos. Evaluar la calidad de vida con tres instrumentos diferentes y los índices de gravedad de la enfermedad en pacientes con dermatitis atópica para determinar su correlación y el tamaño del efecto del cambio. Materiales y métodos. Los datos de los pacientes se obtuvieron a partir de dos visitas. Se evaluó la información sociodemográfica y los datos relacionados con la distribución y la gravedad de la enfermedad (mediante de las escalas BSA, EASI, SCORAD, POEM, prurito) y el impacto de la dermatitis atópica en la calidad de vida utilizando el Dermatology Life Quality Index, Skindex-29 y EQ-5D. También se evaluó la correlación entre el cambio en las puntuaciones de calidad de vida y las de gravedad de la enfermedad, además del tamaño del efecto estandarizado. Resultados. Solo 139 de los 212 pacientes completaron la visita de seguimiento. El área de superficie corporal se correlacionó fuertemente con el SCORAD y el EASI, y la correlación más débil fue con el POEM. La mejor correlación del prurito medido con la escala visual análoga se halló con la alteración del sueño. El puntaje SCORAD se correlacionó altamente con el EASI mientras que la correlación más baja se encontró con el POEM. La magnitud del efecto al inicio del estudio respecto al seguimiento fue en promedio de moderada a importante. Conclusiones. Los pacientes con dermatitis atópica experimentan una carga sustancial en la calidad de vida. La actividad de la enfermedad se correlaciona mejor con las mediciones de calidad de vida cuando esta es menos grave, después de comenzar la terapia. Los índices POEM y Skindex-29 parecen ser óptimos para determinar la gravedad de la enfermedad y la calidad de vida en adultos con dermatitis atópica.

Safety and efficacy of biologic drugs in children or adolescents with atopic dermatitis: A systematic review and meta-analysis of randomized controlled trials.

Children and adolescents suffering from moderate-to-severe atopic dermatitis (AD) face a significant disease burden that greatly impacts their quality of life. Treatment options for AD are currently limited. To assess the safety and efficacy of biologic drugs, dupilumab, lebrikizumab, or tralokinumab, in improving outcomes in patients with moderate to severe inadequately controlled AD. We searched PubMed, Embase and Cochrane databases for randomized controlled trials (RCTs) comparing dupilumab, lebrikizumab or tralokinumab to placebo in patients with AD. We computed odds ratios (ORs) for binary endpoints, with 95% confidence intervals (CIs), random effects model was used and a p-value <0.05 was considered as statistically significant. We analysed data into Review Manager 5.4. A total of five RCTs and 973 patients were included, of whom 592 were prescribed a biologic drug. Compared with placebo, patients receiving a biologic drug had a greater improvement, achieved an Investigator Global Assessment (IGA) score of 0 or 1 (OR 5.05; 95% CI 3.08-8.29), Eczema Area and Severity Index (EASI) 75 (OR 6.87; 95% CI 4.71-10.02), EASI 50 (OR 8.89; 95% CI 6.18-12.78) and EASI 90 (8.30; 95% CI 4.81-14.31). The proportion of patients with 3 points or more (OR 6.56; 95% CI 4.34-9.90) or 4 points or more (OR 8.09; 95% CI 5.19-12.59) improvement from baseline in peak pruritus NRS was significantly higher with biologic drugs than placebo. There were no significant differences between groups regarding adverse events (OR 0.79; 95% CI 0.58-1.07), and conjunctivitis (OR 2.08; 95% CI 1.00-4.33). In this meta-analysis, dupilumab, lebrikizumab, and tralokinumab have shown significant improvements in signs, symptoms and quality of life in children or adolescents with moderate to severe AD. Larger studies may be needed to continue evaluating the safety and efficacy of these biologic drugs in this patient population.

Molecular analysis of cutaneous yeast isolates in the mycobiota of children with atopic dermatitis.

The skin of patients with atopic dermatitis (AD) has a greater diversity of mycobiota. An observational, prospective, cross-sectional, analytical, and comparative study was conducted involving 80 patients with AD Group (ADG) and 50 individuals without AD (wADG) in a tertiary hospital in Brazil. Skin scale samples were collected from the frontal, cervical, fossae cubital, and popliteal regions and identified using molecular biology techniques. The results showed that 47.5% of ADG had identified yeasts compared to 0% of wADG (P < .001). The yeasts Rhodotorula mucilaginosa and Candida parapsilosis were the most abundant. The probability of colonization increased with age, showing values of 40% at 60 months and 80% at 220 months (P = .09). The cervical region (12.5%) was colonized to the greatest extent. Our findings revealed that positive mycology was not more probable when the scoring of atopic dermatitis or eczema area and severity index value increased (P = .23 and .53, respectively). The results showed that the sex, age, and different population types directly affected the composition of the mycobiota in the population analyzed. A higher frequency of colonization and greater diversity of yeast species were detected in the cutaneous mycobiota of children with AD.

Atopic dermatitis (AD) is a skin disease that can be colonized by microorganisms. We evaluated patients with and without the disease and found a higher frequency of colonization by Rhodotorula mucilaginosa and Candida parapsilosis on the skin of children with AD.

Translation and cross-cultural adaptation of the Nordic Occupational Skin Symptoms Questionnaire to Brazilian Portuguese.

Introduction: Occupational skin diseases are a frequently self-reported condition in industrialized countries. However, there are few developed and standardized self-report instruments to screen the population at risk for occupational dermatological diseases. Objectives: Translation and cross-cultural adaptation of the long and short versions of The Nordic Occupational Skin Symptoms Questionnaire into Brazilian Portuguese. Methods: The process of translation and cross-cultural adaptation of the questionnaire was developed following the good practice recommendations of the International Society for Pharmacoeconomics and Outcomes Research. Results: After translation into Brazilian Portuguese, the first reconciled version of the questionnaire was evaluated in a first round of interviews with 28 individuals, including patients with dermatological disease and healthy people. In the first meeting of the study review group, changes were made to 43 questions (75.4%) (e.g., inclusion of definition of terms, reformulation of instructions, and changes to alternative words or synonyms). In the second meeting of the study review group, there were modifications in three questions, creation of the second consensus version in Brazilian Portuguese, and then the back-translation of this version. After the second round of cognitive interviews, which took place with 10 patients, we had the third review group meeting (no modification was made) and definition of the final version of the questionnaire. Conclusions: The short and long versions of the Nordic Occupational Skin Symptoms Questionnaire questionnaire are available in Brazilian Portuguese.

Introdução: As doenças ocupacionais de pele são uma condição frequentemente autorrelatada em países industrializados. No entanto, existem poucos instrumentos de autorrelato desenvolvidos e padronizados para triagem da população de risco para doenças ocupacionais de pele. Objetivos: Tradução e Adaptação Transcultural da versão longa e curta do Nordic Occupational Skin Symptoms Questionnaire para o português brasileiro. Métodos: O processo de tradução e adaptação transcultural do questionário foi desenvolvido seguindo as boas práticas recomendadas pela International Society for Pharmacoeconomics and Outcomes Research. Resultados: Após a tradução para o português brasileiro, a primeira versão conciliada do questionário foi avaliada em uma primeira rodada de entrevistas com 28 indivíduos entre pacientes com doença dermatológica e pessoas saudáveis. Na primeira reunião do grupo de revisão do estudo, foram feitas alterações em 43 questões (75,4%) (por exemplo, inclusão de definição de termos, reformulação de instruções e alteração para palavras alternativas ou sinônimos). Na segunda reunião do grupo de revisão do estudo, houve modificações em três questões, criação da segunda versão de consenso em português brasileiro e, posteriormente, a retrotradução desta versão. Após a segunda rodada de entrevistas cognitivas, que ocorreram com 10 pacientes, tivemos a terceira reunião do grupo de revisão (não houve modificação) e definição da versão final do questionário. Conclusões: As versões curta e longa do questionário Nordic Occupational Skin Symptoms Questionnaire estão disponíveis em português brasileiro.

WhatsApp and atopic dermatitis: a clinical trial.

OBJECTIVE: To evaluate the effect of text messages with information about atopic dermatitis (AD) on the quality of life (QoL) of children and their caregivers and on the severity of the disease. METHODS: Researcher-blinded randomized controlled clinical trial. The experimental group (EG) received messages about AD and the control group (CG) about general health. A total of 56 children under 15 years of age and their caregivers, allocated to the CG and EG, were assessed on admission, after one month, and after four months. Improvement in QoL was measured by the Children's Dermatology Life Quality Index (CDLQI), the Infants' Dermatitis Quality of Life Index (IDQOL), and the Dermatitis Family Impact Questionnaire (DFIQ), and improvement in the severity of AD by the Scoring of Atopic Dermatitis (SCORAD) and the Eczema Area and Severity Index (EASI). RESULTS: Median age was of nine years, 33 (58.9 %) were girls. The CG and EG had similar results, except for the higher frequency of mild AD in the CG and moderate/severe AD in the EG-these severity categories were kept grouped together. Regarding mild and moderate/severe AD in the EG, the SCORAD score decreased (p = 0.03 and p < 0.001). The EASI in both groups showed a significant reduction (mild AD: CG: p = 0.01, EG: p = 0.04; moderate/severe AD: CG: p = 0.05, EG: p = 0.02). The QoL of children and caregivers improved only in the EG (p = 0.01). Intergroup analysis showed no differences. CONCLUSION: The improvement in the severity of AD in both groups suggests the positive effects of educational interventions in general, not only those specific to the disease.

Budget impact and cost per responder analysis of upadacitinib for the treatment of moderate to severe atopic dermatitis from the perspective of the social security and the private sector in Argentina.

OBJECTIVES: Our study assessed the budget impact and cost per responder of upadacitinib15mg and 30 mg for moderate to severe atopic dermatitis (MS-AD) treatment from social security and private health sector perspective in Argentina. METHODS: A budget impact model was adapted to depict clinical and economic aspects of treatment over a 5-years horizon time. Scenario analyses and deterministic sensitivity analyses were performed. A 16-weeks cost per responder model was adapted based on a network meta-analysis. Primary analyses assessed the cost per Eczema Area and Severity Index 50, 75 and 90 at week 16. RESULTS: The inclusion of upadacitinib 15 mg and 30 mg in the biological treatment mix for MS-AD was associated with an average budget saving per-member per-month ofU$S0.062 (social security) and U$S0.064 (private sector). Percentage of patients with access to treatment, acquisition cost of upadacitinib 30 mg and prevalence of MS-AD were the most influential parameters in the budget impact results. At week 16, upadacitinib 30 mg was associated with the lowest number needed to treat and the lowest cost per responder for all outcomes. CONCLUSION: The introduction of upadacitinib in MS-AD treatment was associated with modest savings for the social security and private payer budget in Argentina.

Oral Janus Kinase Inhibitors in Pediatric Atopic Dermatitis.

PURPOSE OF REVIEW: To analyze the efficacy and safety of Janus kinase inhibitors (JAKi) in the treatment of pediatric AD. RECENT FINDINGS: Adolescents with moderate and severe atopic dermatitis (AD) need systemic therapies, as stated several recent practice guidelines. (JAKi) have shown their efficacy in the treatment of adult AD, however, there is a lack of information concerning efficacy and safety of their use in pediatric AD. We found that the JAKi's abrocitinib (ABRO), baricitinib (BARI), and upadacitinib (UPA), are all an effective treatment option with a very fast onset of action for adolescents with moderate-to-severe AD. BARI was not effective in children between 2 and 10 years with moderate-to-severe AD. Fortunately, major safety issues with JAKi in adolescents with AD have not been documented in the trials, so far, contrasting with the reports in adults with AD, where these events have very rarely occurred. There are some reports of herpes zoster (HZ) infection in adolescents on JAKi, but it is not a major safety concern. Acne is a relatively common AE with UPA in adolescents; however, it is responsive to standard treatment. This review will help the clinician to choose among the JAKi according to the needs and clinical features of patients with moderate and severe AD. In the following years, with the advent of new biologicals and JAKi, these therapies will fall into place in each phase of the evolution of patients with AD.