Comorbilidades en dermatitis atópica: actualización y controversias / Comorbidities in Atopic Dermatitis: An Update and Review of Controversies

El desarrollo de dermatitis atópica (DA) precoz se considera un factor de riesgo para cualquier enfermedad atópica, especialmente cuando las manifestaciones cutáneas son persistentes y se acompañan de multisensibilización y de historia familiar. Se ha propuesto que la DA pueda tener también efectos sinérgicos con la inflamación presente en otros órganos y sistemas, tal y como ocurre en otras enfermedades inflamatorias inmunomediadas. La mayor parte de estudios permiten comprobar una relación estadística entre la obesidad, diversas comorbilidades cardiometabólicas y la DA, siendo mayor en aquellos pacientes con enfermedad más grave o activa durante un mayor periodo de tiempo. Existen, sin embargo, escasos estudios más allá de evaluaciones epidemiológicas que ahonden en evidencias funcionales. Por otro lado, existen numerosos factores de confusión, tales como el deterioro de la calidad de vida y la afectación psicológica asociadas a la DA que podrían favorecer hábitos poco saludables, incluyendo sedentarismo o tabaquismo, lo que a su vez incrementaría el riesgo de morbimortalidad. La inflamación crónica con una diferenciación hacia un patrón Th2 y el uso de fármacos inmunosupresores de forma prolongada pueden ser un factor de riesgo para el desarrollo de algunas enfermedades hematológicas, aunque puede representar un factor protector para otras. La presencia de citocinas proinflamatorias capaces de atravesar la barrera hematoencefálica podría facilitar un incremento de enfermedades psicológicas tales como la depresión, la ansiedad, la ideación suicida o los trastornos de la atención en forma de déficit de atención o hiperactividad. Sin embargo, pueden influir también otros factores como el prurito crónico o los trastornos del sueño

Early onset of atopic dermatitis is considered a risk factor for any atopic disease, especially when the skin manifestations are persistent, and there is sensitization to multiple allergens and a family history. Atopic dermatitis is also thought to exert a synergistic effect with inflammation present in other organs and systems, as is the case in other immune-mediated inflammatory diseases. Most studies show a statistical relationship between obesity, various cardiometabolic comorbid conditions, and atopic dermatitis; this relationship is more marked when the disease is more severe or active over a longer period of time. However, other than epidemiological assessments, few studies provide in-depth evidence of functional mechanisms. Furthermore, various confounders, such as deterioration of quality of life and the psychological aspects of atopic dermatitis, could favor unhealthy habits, including a sedentary lifestyle and smoking, which could in turn increase the risk of morbidity and mortality. Chronic inflammation with differentiation toward a type 2 helper T cell pattern and the long-term use of immunosuppressants could be risk factors for some hematologic diseases, although they could exert a protective effect in others. The presence of proinflammatory cytokines capable of crossing the blood-brain barrier could favor an increase in the frequency of psychological diseases (eg, depression, anxiety, and suicidal ideation) and attention disorders (eg, attention deficit or hyperactivity). However, other factors, such as chronic pruritus and sleep disorders, could also play roles

Comorbidities in Atopic Dermatitis: An Update and Review of Controversies. / Comorbilidades en dermatitis atópica: actualización y controversias.

Early onset of atopic dermatitis is considered a risk factor for any atopic disease, especially when the skin manifestations are persistent, and there is sensitization to multiple allergens and a family history. Atopic dermatitis is also thought to exert a synergistic effect with inflammation present in other organs and systems, as is the case in other immune-mediated inflammatory diseases. Most studies show a statistical relationship between obesity, various cardiometabolic comorbid conditions, and atopic dermatitis; this relationship is more marked when the disease is more severe or active over a longer period of time. However, other than epidemiological assessments, few studies provide in-depth evidence of functional mechanisms. Furthermore, various confounders, such as deterioration of quality of life and the psychological aspects of atopic dermatitis, could favor unhealthy habits, including a sedentary lifestyle and smoking, which could in turn increase the risk of morbidity and mortality. Chronic inflammation with differentiation toward a type 2 helper T cell pattern and the long-term use of immunosuppressants could be risk factors for some hematologic diseases, although they could exert a protective effect in others. The presence of proinflammatory cytokines capable of crossing the blood-brain barrier could favor an increase in the frequency of psychological diseases (eg, depression, anxiety, and suicidal ideation) and attention disorders (eg, attention deficit or hyperactivity). However, other factors, such as chronic pruritus and sleep disorders, could also play roles.

Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases.

BACKGROUND: The cutaneous manifestations of COVID-19 disease are poorly characterized. OBJECTIVES: To describe the cutaneous manifestations of COVID-19 disease and to relate them to other clinical findings. METHODS: We carried out a nationwide case collection survey of images and clinical data. Using a consensus we described five clinical patterns. We later described the association of these patterns with patient demographics, the timing in relation to symptoms of the disease, the severity and the prognosis. RESULTS: The lesions may be classified as acral areas of erythema with vesicles or pustules (pseudo-chilblain) (19%), other vesicular eruptions (9%), urticarial lesions (19%), maculopapular eruptions (47%) and livedo or necrosis (6%). Vesicular eruptions appear early in the course of the disease (15% before other symptoms). The pseudo-chilblain pattern frequently appears late in the evolution of the COVID-19 disease (59% after other symptoms), while the rest tend to appear with other symptoms of COVID-19. The severity of COVID-19 shows a gradient from less severe disease in acral lesions to more severe in the latter groups. The results are similar for confirmed and suspected cases, in terms of both clinical and epidemiological findings. Alternative diagnoses are discussed but seem unlikely for the most specific patterns (pseudo-chilblain and vesicular). CONCLUSIONS: We provide a description of the cutaneous manifestations associated with COVID-19 infection. These may help clinicians approach patients with the disease and recognize cases presenting with few symptoms. What is already known about this topic? Previous descriptions of cutaneous manifestations of COVID-19 were case reports and mostly lacked illustrations. What does this study add? We describe a large, representative sample of patients with unexplained skin manifestations and a diagnosis of COVID-19, using a consensus method to define morphological patterns associated with COVID-19. We describe five clinical patterns associated with different patient demographics, timing and prognosis, and provide illustrations of these patterns to allow for easy recognition.