Pressure ulcers related to prone positioning: a pandemic amidst a pandemic.

OBJECTIVE: To explore the epidemiology and risk factors associated with the development of pressure ulcers (PUs) in patients receiving prone positioning (PP) ventilatory therapy; to compare the inflammatory status of patients who develop PUs with those who do not; and to describe the experience and useful findings that have allowed us to improve the management of these patients to reduce the incidence of PUs. METHOD: An observational, descriptive and longitudinal study was conducted, where sociodemographic and laboratory data were collected from patients who were hospitalised and required PP ventilatory therapy in critical care areas (CCA) during the months of May-October 2020. RESULTS: From the total number of patients who required PP during their CCA stay (n=240), 202 (84.2%) developed a PU. The four most frequent areas where a PU appeared were: the head and neck (n=115); the pinna (n=21); the torso (n=21); and the lower limbs (n=21). Patients who developed PU were more frequently males with higher initial levels of creatinine phosphokinase and ferritin. The incidence for each month of follow-up decreased from 8.3% to 5.8%. CONCLUSION: Regardless of the intervention, a multidisciplinary approach is required to optimise the prevention and treatment of these wounds. While PUs are often the result of other medical conditions or poor health status in general, the vast majority of PUs are avoidable.

Assessing the Efficacy of Monthly 308 nm Excimer Lamp Double-Stacked Pulse Adjusted Therapy for Alopecia Areata.

Introduction: Alopecia areata (AA) is an autoimmune disease characterized by T cell-mediated attack on the hair follicle. Although there are a wide range of therapies, the majority of them are not satisfactory due to side effects, pain due to intralesional injections or limited efficacy. In this study, we sought to evaluate the efficacy, influence factors, and safety of 308 nm excimer lamp used in a monthly basis in a double-stacked pulse manner for the treatment of AA. Methods: This was a prospective study, using 308 nm excimer lamp in a double-stacked pulse therapy for AA. The primary endpoint was the improvement in SALT score. Results: A total of 40 patients with AA were enrolled in this study. Forty (100%) patients achieved clinical response. Hyperpigmentation and erythema occurred on the treated alopecic areas of all patients but they were considered tolerable. Patients of younger age or with a smaller area of affection had a better overall treatment response. Conclusion: 308 nm excimer lamp therapy is an excellent option for single or multiple AA because it achieves a good clinical response with less adverse effects than other therapies. This therapy may be useful for low-income countries where new JAK inhibitors are not available, however, for patients with extensive hair loss, it is not as effective and thus, it may be unfit for patients with alopecia totalis and alopecia universals.

Role of Oral Minoxidil in Patterned Hair Loss.

Recent studies have shown that low-dose oral minoxidil (OM) can be a safe and effective treatment of numerous hair disorders including male-patterned hair loss (MPHL) and female-patterned hair loss (FPHL). There are several practical advantages of OM over its topical formulation: enhanced cosmesis, cost-savings, and the possibility of co-therapy with other topical formulations or topicals used for camouflage. This treatment may be particularly helpful for patients who are unable to tolerate topical minoxidil or other systemic treatments. Doses ranging from 0.25 to 1.25 mg daily are usually used for FPHL and doses ranging from 2.5 to 5 mg/day for MPHL. The low side-effect profile of low-dose OM allows for long-term adherence to the medication and favorable clinical response, resulting in stabilization and improvement of hair loss. More studies are needed to test the efficacy of OM in other types of alopecia as well as additional comparative studies assessing OM to other commonly used medications.

Emerging drugs for the treatment of alopecia areata.

INTRODUCTION: Alopecia Areata (AA) is the second most common non-scarring hair loss disorder, with a prevalence of 1 in 1000 and a lifetime incidence of 2% worldwide. Data from a recent American study shows that from 68,121 patients with the diagnosis of AA, 37,995 (55.8%) were prescribed treatment for AA within a year of diagnosis, however there are still no therapies able to induce permanent remission, or treatments that guarantee hair regrowth/remissions in 100% of cases, especially in longstanding/severe AA. Recently, oral baricitinib has been approved for AA, being the first drug approved for this specific indication. AREAS COVERED: The current review will provide a summary of current pharmacological approaches and novel therapeutics in development. EXPERT OPINION: New and very effective drugs have become available for the treatment of severe AA, and many others are expected soon. However, even new, effective treatments are not effective in all patients and recurrence rates after treatment interruption are high. AA is a systemic disease with important impact on quality of life and should not be considered just as an aesthetic problem. Treatment of the disease should take in account and possibly also address treatment of comorbidities.

Sporotrichosis in Children: Case series and Narrative Review.

Purpose of Review: Pediatric sporotrichosis has not been sufficiently studied; this review aims to evaluate the risk and prognostic factors related to the development of sporotrichosis associated to this age group. Also, we want to evaluate the causes of the increased number of cases of sporotrichosis in the pediatric population such as environmental changes in endemic areas, the biodiversity, and virulence among the pathogenic clade causing sporotrichosis in different areas of the globe, and especially the progression of the zoonotic transmission of infections caused by Sporothrix brasiliensis infections, associated to zoonotic transmission in Brazil and other endemic sporotrichosis countries. Recent Findings: After evaluating a case series of 40 patients, we found that pediatric sporotrichosis in Mexico is mainly caused by Sporothrix schenckii which prevails in rural areas and is mainly sapronotically transmitted. In Brazil, the longest and largest pediatric sporotrichosis outbreak is caused by Sporothrix brasiliensis, etiologically related to sick cats, directly from lesions containing a high yeast cell burden. When affecting children S. schenckii and S. brasiliensis may cause distinct clinical manifestations especially in the onset of the disease and affected anatomical site. In Mexico, most of the patients are successfully treated with potassium iodide, whereas in Brazil, all patients respond to itraconazole. Summary: Sporothrix schenckii is the major etiologic agent in Mexico, being sapronotically transmitted, while in Brazil, Sporothrix brasiliensis is only transmitted by cats. In Mexico, the disease prevails in male patients (60%) from rural areas; in Brazil, the disease is more frequent in females (60%) from an urban region. Due to the zoonotic sporotrichosis outbreak in Brazil, the time of evolution seems to be shorter in Brazilian patients than in Mexican patients. Most Brazilian patients presented with facial lesions, including ocular involvement, while in Mexico, most of the children presented upper limbs involvement. In Mexico, treatment with potassium iodide in children was observed to induce faster remission than itraconazole, but controlled studies are lacking to evaluate this versus itraconazole, due to the low number of cases. A comparative study should be designed to evaluate the best and safest antifungal therapy for pediatric sporotrichosis. Supplementary Information: The online version contains supplementary material available at 10.1007/s12281-022-00429-x.

Evaluating the Therapeutic Potential of Ritlecitinib for the Treatment of Alopecia Areata.

Alopecia areata (AA) is an autoimmune condition that causes patchy hair loss, affecting up to 147 million people globally. Currently, there are no treatments approved by US Food and Drug Administration (FDA) specific for AA, and there are few effective therapeutic options for widespread and persistent illness. There is an ongoing need for a treatment that demonstrates a good clinical response with a benefit-risk ratio that is suitable for long-term use, especially for patients with chronic, extensive disease. Several clinical trials and case studies that have assessed Janus kinase inhibitors have had encouraging results. Ritlecitinib, a selective JAK3/TEC kinase inhibitor has been demonstrated to inhibit the action of signaling molecules and immune cells that are responsible for hair loss in people with alopecia areata. Furthermore, several clinical trials are investigating the utility of ritlecitinib in patients with vitiligo, rheumatoid arthritis, Crohn's disease, and ulcerative colitis. Advantages of using ritlecitinib when compared with other non-selective JAK inhibitors include avoiding JAK1/JAK2 inhibition's clinical repercussions, which include pharmacodynamic effects such as increased cholesterol and liver enzymes, and those related to JAK2 inhibition (thrombocytopenia, anemia). Treatment with Ritlecitinib 50 mg and 30 mg daily for 24 weeks has been shown to induce hair regrowth with a significant proportion of patients reaching SALT 20 (≤20% scalp hair loss) after six months of therapy compared to placebo. Additional research is needed for long-term effects.

Pain Management in Patients with Severe Pemphigus Vulgaris.

To describe the pain management and clinical course of patients with severe Pemphigus Vulgaris (PV) admitted to a third-level Intensive Care Unit (ICU). This was a retrospective cohort study conducted in the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán over the period 2013-2020. Study population comprised patients with severe PV admitted to the ICU. Eleven patients with severe PV were included. Mean age of presentation was 43.6 years. Percentage of the total body surface area affected ranged from 70 to 85% (mean: 80%). Visual Analogue Scale was used for pain assessment upon admission. Nine patients (72%) reported a 10/10 pain. The median Morphine Equivalent Daily Dose was 200 mg (range: 90-518 mg). Mortality was 27% during the ICU stay. One patient (9%) continued to experience severe pain and consume opioids after discharge. PV is a life-threatening disease characterized by painful, persistent erosions and ulcers. Integrated and multidisciplinary approach is often required. Opioids remain the mainstay for acute pain control in patients with severe PV. Biological, psychological, and social factors influence patients' daily opioid requirements and dose escalation. Successful pain management contributes to improving the quality of life, and the suppression and remission of PV.

Acroangiodermatitis of the hand secondary to a dysfunctional arteriovenous fistula.

Acroangiodermatitis (AAD) is often seen in association with various vascular anomalies such as venous insufficiency, vascular syndromes, and conditions associated with thrombosis. This is the first case reported in the literature associated with arteriovenous fistula stenosis in a patient with chronic kidney disease on hemodialysis. This case is being described for its rarity and to familiarize the clinicians with this unusual complication, especially, to prevent them from thinking of this condition as an infectious complication. It is essential to recognize the uniqueness of the pathophysiology of this disease and to do a clear distinction with that of a venous ulcer. With this work we also aim to help health practitioners with proper management of the condition. As we've seen, surgical treatment in appropriately selected cases corrects the reflux of the venous system and successfully improves the appearance of the verrucous lesion. Our patient was successfully treated by correcting the arteriovenous fistula stenosis with near-complete subsidence of the verrucous lesion within days of the procedure. Acroangiodermatitis management must be conducted with a multidisciplinary approach (dermatology, vascular surgery, and internal medicine). It is essential the comprehensive management of these patients, to ensure prompt recovery and avoid chronic effects, as well as to guarantee the quality of life in the future.