European recommendations for management of immune checkpoint inhibitors-derived dermatologic adverse events. The EADV task force 'Dermatology for cancer patients' position statement.

The introduction of immune checkpoint inhibitors (ICIs) opened a new era in oncologic therapy. The favourable profile of ICIs in terms of efficacy and safety can be overshadowed by the development of immune-related adverse events (irAEs). Dermatologic irAEs (dirAEs) appear in about 40% of patients undergoing immunotherapy and mainly include maculopapular, psoriasiform, lichenoid and eczematous rashes, auto-immune bullous disorders, pigmentary disorders, pruritus, oral mucosal lesions, hair and nail changes, as well as a few rare and potentially life-threatening toxicities. The EADV task force Dermatology for Cancer Patients merged the clinical experience of the so-far published data, incorporated the quantitative and qualitative characteristics of each specific dirAEs, and released dermatology-derived, phenotype-specific treatment recommendations for cutaneous toxicities (including levels of evidence and grades of recommendation). The basic principle of management is that the interventions should be tailored to serve the equilibrium between patients' relief from the symptoms and signs of skin toxicity and the preservation of an unimpeded oncologic treatment.

Pénfigo vulgar: estudio de cohorte retrospectivo de sus características clínicas, tratamientos empleados y evolución / Pemphigus Vulgaris: A Retrospective Cohort Study of Clinical Features, Treatments, and Outcomes

ANTECEDENTES: El pénfigo vulgar (PV) es una enfermedad infrecuente y grave. Su tratamiento consiste en el uso de glucocorticoides sistémicos (GS) junto a fármacos ahorradores (FA) de los mismos. OBJETIVOS: Describir y analizar las características demográficas y clínicas de pacientes con PV. MATERIALES Y MÉTODOS: Estudio de cohorte retrospectivo, en adultos con PV, en un periodo de 12 años. RESULTADOS: Se incluyeron 32 pacientes. En 20 pacientes (63%) el inicio fue en mucosas; la región oral fue la más afectada, seguida de la vulvar. La afectación mucosa fue más frecuente en mujeres (p = 0,03). Los pacientes cuyo PV comenzó en esta localización afectaron en su evolución a más de una mucosa, de forma independiente de la edad y el sexo (p = 0,003). El comienzo de la enfermedad antes de los 40 años se asoció con un compromiso cutáneo generalizado (p = 0,003), con la necesidad de tratamiento con FA (p = 0,05) y con cierta refractariedad a los tratamientos (p = 0,02). La azatioprina fue el FA más prescrito (n = 22). Se observó corticodependencia en 8 pacientes (25%) y recaídas en 26 (81%). Se alcanzó una remisión completa con/sin tratamiento en 15 de los casos (47%). La mediana del tiempo libre de enfermedad fue de 14 meses y la mortalidad, del 6% (n = 2). CONCLUSIÓN: El inicio del PV antes de los 40años podría ser un factor de mal pronóstico, ya que en estos pacientes observamos una mayor probabilidad de presentar compromiso cutáneo generalizado, requerimiento de FA y refractariedad al tratamiento

BACKGROUND: Pemphigus vulgaris (PV) is an uncommon, serious disease that is treated with systemic corticosteroids and corticosteroid-sparing agents. OBJECTIVES: To describe and analyze the demographic and clinical characteristics of patients with PV. MATERIAL AND METHODS: Retrospective cohort study of adults diagnosed with PV over a period of 12 years. RESULTS: PV presented with mucosal lesions in 20 of the 32 patients studied (63%); the most common site was the oral mucosa followed by the vulva. Mucosal involvement was more common in women (P=.03). Lesions were found at more than 1 mucosal site in patients whose disease began in the mucosa, independently of age or sex (P = .003). Disease onset before the age of 40years was associated with generalized skin lesions (P = .003), a need for corticosteroid-sparing therapy (P = .05), and refractory PV (P = .02). Azathioprine was the most widely prescribed corticosteroid-sparing agent (in 22 patients). Eight patients (25%) were dependent on corticosteroids and disease recurred in 26 (81%). Complete remission, with or without treatment, was achieved in 15 patients (47%). Patients remained disease-free for a median of 14 months, and 2 patients died (6%). CONCLUSION: Onset before the age of 40 years could be a sign of poor prognosis in patients with PV, as it was significantly associated with a higher risk of generalized skin involvement, a need for corticosteroid-sparing therapy, and refractory disease

Pemphigus Vulgaris: A Retrospective Cohort Study of Clinical Features, Treatments, and Outcomes. / Pénfigo vulgar: estudio de cohorte retrospectivo de sus características clínicas, tratamientos empleados y evolución.

BACKGROUND: Pemphigus vulgaris (PV) is an uncommon, serious disease that is treated with systemic corticosteroids and corticosteroid-sparing agents. OBJECTIVES: To describe and analyze the demographic and clinical characteristics of patients with PV. MATERIAL AND METHODS: Retrospective cohort study of adults diagnosed with PV over a period of 12years. RESULTS: PV presented with mucosal lesions in 20 of the 32 patients studied (63%); the most common site was the oral mucosa followed by the vulva. Mucosal involvement was more common in women (P=.03). Lesions were found at more than 1 mucosal site in patients whose disease began in the mucosa, independently of age or sex (P=.003). Disease onset before the age of 40years was associated with generalized skin lesions (P=.003), a need for corticosteroid-sparing therapy (P=.05), and refractory PV (P=.02). Azathioprine was the most widely prescribed corticosteroid-sparing agent (in 22 patients). Eight patients (25%) were dependent on corticosteroids and disease recurred in 26 (81%). Complete remission, with or without treatment, was achieved in 15 patients (47%). Patients remained disease-free for a median of 14months, and 2 patients died (6%). CONCLUSION: Onset before the age of 40 years could be a sign of poor prognosis in patients with PV, as it was significantly associated with a higher risk of generalized skin involvement, a need for corticosteroid-sparing therapy, and refractory disease.

A simple method of infecting rabbits with Bovine herpesvirus 1 and 5.

This report describes an alternative technique to inoculate rabbits and to reproduce infection by Bovine herpesvirus 1 and 5. First, the nostrils are anaesthetized by aspersion with local anaesthetic. A few seconds later, and after proving the insensitivity of the zone, the rabbits are put on their back legs with their nostrils upwards and the inoculum is introduced slowly into each nostril by using disposable droppers. Clinical signs, viral isolation from nasal swabs, histological lesions found, positive polymerase chain reaction and antibodies production confirm the infection. This very simple and bloodless technique, where the animals are exposed to minor distress, may be useful for evaluating the virulence of BoHV-1 and BoHV-5 strains, to study the establishment of latent virus infection and to test the potential of experimental vaccines or properties of antiviral drugs. It may be also suitable for experimental infection with other respiratory viruses in this animal model.