Consensus document on the diagnostic algorithm for chronic nodular prurigo. / Consenso sobre el algoritmo diagnóstico del prurigo crónico nodular.

Chronic nodular prurigo (CNP) is a chronic dermatological disease characterized by the presence of chronic pruritus and pruritic nodular lesions. The aim of this study was to reach consensus among a group of experts based on a non-systematic literature review and an algorithm for the clinical diagnosis of CNP. The resulting algorithm is structured in 3 blocks: 1) early identification of the patient with a possible diagnosis of CNP; 2) diagnosis and assessment of CNP; and 3) categorization of CNP (identification of the underlying causes or associated comorbidities). We believe that this clinical algorithm can facilitate the correct diagnosis of patients with CNP. Additionally, it raises awareness on the need for a multidisciplinary approach and specific treatment of CNP, steps of paramount importance to make better therapeutic decisions.

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.

[Translated article] Four-year Epidemiological Surveillance of the Spanish Registry of Research in Contact Dermatitis and Cutaneous Allergy: Current Situation and Trends.

BACKGROUND: The epidemiological surveillance of contact dermatitis is one of the objectives of the Spanish Registry of Research in Contact Dermatitis and Cutaneous Allergy. Knowing whether the prevalence of positive tests to the different allergens changes over time is important for this monitoring process. OBJECTIVES: To describe the various temporary trends in allergen positivity in the GEIDAC standard series from 2018 through December 31, 2022. METHODS: This was a multicenter, observational trial of consecutive patients analyzed via patch tests as part of the study of possible allergic contact dermatitises collected prospectively within the Spanish Registry of Research in Contact Dermatitis and Cutaneous Allergy. The data was analyzed using 2 statistical tests: one homogeneity test (to describe the changes seen over time) and one trend test (to see whether the changes described followed a linear trend). RESULTS: A total of 11327 patients were included in the study. Overall, the allergens associated with a highest sensitization were nickel sulfate, methylisothiazolinone, cobalt chloride, methylchloroisothiazolinone/methylisothiazolinone, and fragrance mix i. A statistically significant decrease was found in the percentage of methylisothiazolinone positive tests across the study years with an orderly trend. CONCLUSIONS: Although various changes were seen in the sensitizations trends to several allergens of the standard testing, it became obvious that a high sensitization to nickel, methylchloroisothiazolinone/methylisothiazolinone and fragrances mix i remained. Only a significant downward trend was seen for methylisothiazolinone.

[Translated article] Requirements for Accessing New Dermatology Drugs in Spain: Results of the EQUIDAD Study.

BACKGROUND: Although the Spanish Ministry of Health prepares national therapeutic positioning reports (TPRs) and drug reimbursement policies, each of the country's 17 autonomous communities (ACs) is responsible for health care services and prescription requirements in its territory. The aim of the EQUIDAD study was to describe and explore potential differences in prescription requirements for new dermatology drugs across the autonomous communities. MATERIAL AND METHODS: Cross-sectional study conducted in April and May, 2023. Two dermatologists with management responsibilities from each autonomous community reported on territorial and more local prescription requirements for drugs covered by national TPRs issued between 2016 and 2022. RESULTS: Thirty-three researchers from 17 autonomous communities participated. The data submitted revealed between-community inequities in access to new drugs. Overall, 64.7% of the regions imposed additional prescription requirements to those mentioned in the TPRs for psoriasis. This percentage was lower for atopic dermatitis (35.3%) and melanoma (11.8%). The most common requirement for accessing a new drug was a previous prescription for another drug. Differences and additional requirements were also detected at the local level (i.e., differences between hospitals within the same autonomous community). CONCLUSIONS: Spain's autonomous communities have multiple regional and local prescription requirements that are not aligned with national TPR recommendations. These differences result in inequitable access to new drugs for both patients and practitioners across Spain.

Toward Precision Medicine in Atopic Dermatitis Using Molecular-Based Approaches / Hacia una medicina de precisión en la Dermatitis Atópica mediante el uso de enfoques moleculares

Atopic dermatitis is the most common chronic inflammatory skin disorder, affecting up to 20% of children and 10% of adults in developed countries. The pathophysiology of atopic dermatitis is complex and involves a strong genetic predisposition and T-cell driven inflammation. Although our understanding of the pathology and drivers of this disease has improved in recent years, there are still knowledge gaps in the immune pathways involved. Therefore, advances in new omics technologies in atopic dermatitis will play a key role in understanding the pathogenesis of this burden disease and could develop preventive strategies and personalized treatment strategies. In this review, we discuss the latest developments in genetics, transcriptomics, epigenomics, proteomics, and metagenomics and understand how integrating multiple omics datasets will identify potential biomarkers and uncover nets of associations between several molecular levels (AU)

La dermatitis atópica es el trastorno inflamatorio de la piel crónico más común. Afecta hasta a 20% de los niños y a 10% de los adultos en países desarrollados. La fisiopatología de la dermatitis atópica es compleja e implica una fuerte predisposición genética e inflamación impulsada por células T. Aunque nuestra comprensión de la patología y las causas de esta enfermedad ha mejorado en los últimos años, aún existen lagunas de conocimiento en las vías inmunológicas involucradas. En consecuencia, los avances en nuevas tecnologías ómicas en la dermatitis atópica desempeñarán un papel clave en la comprensión de la patogénesis de esta enfermedad y podrían desarrollar estrategias preventivas y tratamientos personalizados. En esta revisión se discuten los últimos avances en genética, transcriptómica, epigenómica, proteómica y metagenómica, y entendemos cómo la integración de múltiples conjuntos de datos ómicos identificará posibles biomarcadores y descubrirá redes de asociaciones entre varios niveles moleculares (AU)

[Artículo traducido] Hacia una medicina de precisión en la dermatitis atópica mediante el uso de enfoques moleculares / Toward Precision Medicine in Atopic Dermatitis Using Molecular-Based Approaches

La dermatitis atópica es el trastorno inflamatorio de la piel crónico más común. Afecta hasta a 20% de los niños y a 10% de los adultos en países desarrollados. La fisiopatología de la dermatitis atópica es compleja e implica una fuerte predisposición genética e inflamación impulsada por células T. Aunque nuestra comprensión de la patología y las causas de esta enfermedad ha mejorado en los últimos años, aún existen lagunas de conocimiento en las vías inmunológicas involucradas. En consecuencia, los avances en nuevas tecnologías ómicas en la dermatitis atópica desempeñarán un papel clave en la comprensión de la patogénesis de esta enfermedad y podrían desarrollar estrategias preventivas y tratamientos personalizados. En esta revisión se discuten los últimos avances en genética, transcriptómica, epigenómica, proteómica y metagenómica, y entendemos cómo la integración de múltiples conjuntos de datos ómicos identificará posibles biomarcadores y descubrirá redes de asociaciones entre varios niveles moleculares (AU)

Atopic dermatitis is the most common chronic inflammatory skin disorder, affecting up to 20% of children and 10% of adults in developed countries. The pathophysiology of atopic dermatitis is complex and involves a strong genetic predisposition and T-cell driven inflammation. Although our understanding of the pathology and drivers of this disease has improved in recent years, there are still knowledge gaps in the immune pathways involved. Therefore, advances in new omics technologies in atopic dermatitis will play a key role in understanding the pathogenesis of this burden disease and could develop preventive strategies and personalized treatment strategies. In this review, we discuss the latest developments in genetics, transcriptomics, epigenomics, proteomics, and metagenomics and understand how integrating multiple omics datasets will identify potential biomarkers and uncover nets of associations between several molecular levels (AU)

Toward Precision Medicine in Atopic Dermatitis Using Molecular-Based Approaches. / [Artículo traducido] Hacia una medicina de precisión en la dermatitis atópica mediante el uso de enfoques moleculares.

Atopic dermatitis is the most common chronic inflammatory skin disorder, affecting up to 20% of children and 10% of adults in developed countries. The pathophysiology of atopic dermatitis is complex and involves a strong genetic predisposition and T-cell driven inflammation. Although our understanding of the pathology and drivers of this disease has improved in recent years, there are still knowledge gaps in the immune pathways involved. Therefore, advances in new omics technologies in atopic dermatitis will play a key role in understanding the pathogenesis of this burden disease and could develop preventive strategies and personalized treatment strategies. In this review, we discuss the latest developments in genetics, transcriptomics, epigenomics, proteomics, and metagenomics and understand how integrating multiple omics datasets will identify potential biomarkers and uncover nets of associations between several molecular levels.

Toward Precision Medicine in Atopic Dermatitis Using Molecular-Based Approaches.

Atopic dermatitis is the most common chronic inflammatory skin disorder, affecting up to 20% of children and 10% of adults in developed countries. The pathophysiology of atopic dermatitis is complex and involves a strong genetic predisposition and T-cell driven inflammation. Although our understanding of the pathology and drivers of this disease has improved in recent years, there are still knowledge gaps in the immune pathways involved. Therefore, advances in new omics technologies in atopic dermatitis will play a key role in understanding the pathogenesis of this burden disease and could develop preventive strategies and personalized treatment strategies. In this review, we discuss the latest developments in genetics, transcriptomics, epigenomics, proteomics, and metagenomics and understand how integrating multiple omics datasets will identify potential biomarkers and uncover nets of associations between several molecular levels.

Four-year Epidemiological Surveillance of the Spanish Registry of Research in Contact Dermatitis and Cutaneous Allergy: Current Situation and Trends. / Vigilancia epidemiológica en los últimos 4 años del Registro Español de Investigación en Dermatitis de Contacto y Alergia Cutánea: situación actual y tendencias.

BACKGROUND: The epidemiological surveillance of contact dermatitis is one of the objectives of the Spanish Registry of Research in Contact Dermatitis and Cutaneous Allergy. Knowing whether the prevalence of positive tests to the different allergens changes over time is important for this monitoring process. OBJECTIVES: To describe the various temporary trends in allergen positivity in the GEIDAC standard series from 2018 through December 31, 2022. METHODS: This was a multicenter, observational trial of consecutive patients analyzed via patch tests as part of the study of possible allergic contact dermatitises collected prospectively within the Spanish Registry of Research in Contact Dermatitis and Cutaneous Allergy. The data was analyzed using 2 statistical tests: one homogeneity test (to describe the changes seen over time) and one trend test (to see whether the changes described followed a linear trend). RESULTS: A total of 11327 patients were included in the study. Overall, the allergens associated with a highest sensitization were nickel sulfate, methylisothiazolinone, cobalt chloride, methylchloroisothiazolinone/methylisothiazolinone, and fragrance mix i. A statistically significant decrease was found in the percentage of methylisothiazolinone positive tests across the study years with an orderly trend. CONCLUSIONS: Although various changes were seen in the sensitizations trends to several allergens of the standard testing, it became obvious that a high sensitization to nickel, methylchloroisothiazolinone/methylisothiazolinone and fragrances mix i remained. Only a significant downward trend was seen for methylisothiazolinone.

Requirements for Accessing New Dermatology Drugs in Spain: Results of the EQUIDAD Study. / Condicionantes de acceso a nuevos medicamentos dermatológicos en España: resultados del proyecto EQUIDAD.

BACKGROUND: Although the Spanish Ministry of Health prepares national therapeutic positioning reports (TPRs) and drug reimbursement policies, each of the country's 17 autonomous communities (ACs) is responsible for health care services and prescription requirements in its territory. The aim of the EQUIDAD study was to describe and explore potential differences in prescription requirements for new dermatology drugs across the autonomous communities. MATERIAL AND METHODS: Cross-sectional study conducted in April and May, 2023. Two dermatologists with management responsibilities from each autonomous community reported on territorial and more local prescription requirements for drugs covered by national TPRs issued between 2016 and 2022. RESULTS: Thirty-three researchers from 17 autonomous communities participated. The data submitted revealed between-community inequities in access to new drugs. Overall, 64.7% of the regions imposed additional prescription requirements to those mentioned in the TPRs for psoriasis. This percentage was lower for atopic dermatitis (35.3%) and melanoma (11.8%). The most common requirement for accessing a new drug was a previous prescription for another drug. Differences and additional requirements were also detected at the local level (i.e., differences between hospitals within the same autonomous community). CONCLUSIONS: Spain's autonomous communities have multiple regional and local prescription requirements that are not aligned with national TPR recommendations. These differences result in inequitable access to new drugs for both patients and practitioners across Spain.

[Cerebral palsy in literature, cinema and television]. / La paralisis cerebral en la literatura, el cine y la television.

INTRODUCTION: Cerebral palsy is defined as a group of developmental disorders affecting movement and posture that limit a person's activity. They due to non-progressive alterations that occurred in the developing foetal or infant brain in the early years of life and are often accompanied by epilepsy and cognitive, sensory, communication or behavioural disorders. Cerebral palsy has been portrayed in literature, cinema and television, and this study aims to explore how it has been represented in these media. DEVELOPMENT: Cerebral palsy has frequently been represented in literature, cinema and television and with varying degrees of realism. The symptoms, the experiences of patients, relatives and caregivers, treatments, supporting products, architectural barriers or social and labour relations have all been portrayed. Sometimes they have been represented in a way that is very close to reality, while in other cases the most dramatic aspects have been amplified to add to the plot. CONCLUSIONS: Cerebral palsy has been widely represented in works of fiction and testimonies, comics, films, short films, documentaries and television series, sometimes in a very realistic way, while in others it has been done in a way that may increase the stigma surrounding this condition by offering a distorted vision of reality. Nevertheless, in any event they have helped to make this condition more visible.

TITLE: La paralisis cerebral en la literatura, el cine y la television.Introduccion. La paralisis cerebral se define como un grupo de trastornos del desarrollo del movimiento y la postura que limitan la actividad de la persona, que se deben a alteraciones no progresivas que se produjeron en el cerebro fetal o infantil en desarrollo en los primeros años de vida y que se acompaña con frecuencia de epilepsia, alteraciones cognitivas, sensoriales, de la comunicacion o el comportamiento. La paralisis cerebral se ha mostrado en la literatura, el cine y la television, y este estudio tiene por objetivo conocer como se ha representado en estos medios. Desarrollo. La paralisis cerebral se ha representado en la literatura, el cine y la television de manera exhaustiva y con mayor o menor acierto. Se ha mostrado la sintomatologia, las vivencias de pacientes, familiares y cuidadores, los tratamientos, los productos de apoyo, las barreras arquitectonicas o las relaciones sociales y laborales. En ocasiones, la representacion se ha realizado de forma muy ajustada a la realidad, mientras que en otros casos se han amplificado los aspectos mas dramaticos para dar consistencia a la trama. Conclusiones. La paralisis cerebral se ha representado ampliamente en obras de ficcion y testimonio, comics, peliculas, cortometrajes, documentales y series de television, en ocasiones de manera muy realista, mientras que en otras se ha podido contribuir a incrementar el estigma ofreciendo una vision distorsionada de la realidad, pero que en cualquier caso han contribuido a dar visibilidad a este cuadro patologico.

[Muscular dystrophies in literature, cinema and television]. / Las distrofias musculares en la literatura, el cine y la television.

INTRODUCTION: Muscular dystrophies are inherited disorders, produced by a genetic mutation, with a slow or rapid progression, that basically affect striated muscle tissue. There are several clinical forms, the most frequent being Duchenne's muscular dystrophy and Becker muscular dystrophy. AIM: To analyse how muscular dystrophies have been portrayed in literature, cinema and television. DEVELOPMENT: Muscular dystrophy is a disorder that has been reflected in literature, cinema and television. In some cases it is only mentioned, sometimes it plays a secondary role in the plot, and in others it is the lead character who suffers from the disease. In general, reference is made to Duchenne's disease and, albeit less frequently, to Becker muscular dystrophy, although in some cases the patient is just said to be suffering from muscular dystrophy, without specifying what clinical variety it belongs to. Testimonials, novels, comics, fiction films, documentaries, short films and television programmes have all been produced with the aim of making the disease and its implications more widely known, as well as making the public aware of the need to invest resources in research. CONCLUSIONS: Muscular dystrophy has been portrayed quite realistically in literature, cinema and television, and Duchenne's muscular dystrophy is the clinical variety that has been shown most often. Aspects that have been reflected include its symptoms, progression, prognosis, the role of the family and caregivers, sexuality, palliative care, patients' will to overcome difficulties and the need to raise society's awareness of the condition and to invest more resources in research.

TITLE: Las distrofias musculares en la literatura, el cine y la television.Introduccion. Las distrofias musculares son enfermedades hereditarias, producidas por una mutacion genetica, lentas o rapidamente progresivas, que afectan fundamentalmente a la musculatura estriada. Existen diversas formas clinicas, y las mas frecuentes son la distrofia muscular de Duchenne y la distrofia muscular de Becker. Objetivo. Analizar como se han representado las distrofias musculares en la literatura, el cine y la television. Desarrollo. La distrofia muscular ha sido reflejada en la literatura, el cine y la television. En algunos casos solo se menciona, en otros tiene un papel secundario en la trama y en otros es un personaje principal el que sufre la enfermedad. Generalmente se hace referencia a la enfermedad de Duchenne, y con menos frecuencia a la de Becker, aunque en algunos casos solo se menciona que el paciente presenta distrofia muscular, sin especificar a que variedad clinica pertenece. Podemos encontrar obras de testimonio, novelas, comics, largometrajes de ficcion, documentales, cortos y programas televisivos que pretenden dar a conocer la enfermedad y sus implicaciones, y concienciar a la poblacion sobre la necesidad de invertir recursos en la investigacion. Conclusiones. La distrofia muscular ha sido representada con realismo en la literatura, el cine y la television, y la distrofia muscular de Duchenne es la variedad clinica que se ha mostrado mas habitualmente. Se han reflejado los sintomas, la evolucion, el pronostico, el papel de la familia y los cuidadores, la sexualidad, los tratamientos paliativos, el espiritu de superacion, y la necesidad de concienciar a la sociedad y de invertir mas recursos en investigacion.

Description of Patients Treated with Biologic Drugs as First-Line Systemic Therapy in the BIOBADADERM Registry Between 2008 and 2016. / Descripción de los pacientes que reciben biológicos como primer tratamiento sistémico en el registro BIOBADADERM durante el periodo 2008-2016.

INTRODUCTION AND OBJECTIVES: Biologic drugs are usually prescribed as second-line treatment for psoriasis, that is, after the patient has first been treated with a conventional psoriasis drug. There are, however, cases where, depending on the characteristics of the patient or the judgement of the physician, biologics may be chosen as first-line therapy. No studies to date have analyzed the demographics or clinical characteristics of patients in this setting or the safety profile of the agents used. The main aim of this study was to characterize these aspects of first-line biologic therapy and compare them to those observed for patients receiving biologics as second-line therapy. MATERIAL AND METHOD: We conducted an observational study of 181 patients treated in various centers with a systemic biologic drug as first-line treatment for moderate to severe psoriasis between January 2008 and November 2016. All the patients were registered in the Spanish Registry of Adverse Events Associated with Biologic Drugs in Dermatology. RESULTS: The characteristics of the first- and second-line groups were very similar, although the patients receiving a biologic as first-line treatment for their psoriasis were older. No differences were observed for disease severity (assessed using the PASI) or time to diagnosis. Hypertension, diabetes, and liver disease were all more common in the first-line group. There were no differences between the groups in terms of reasons for drug withdrawal or occurrence of adverse effects. CONCLUSIONS: No major differences were found between patients with psoriasis receiving biologic drugs as first- or second-line therapy, a finding that provides further evidence of the safety of biologic therapy in patients with psoriasis.

Economic Impact of Atopic Dermatitis in Adults: A Population-Based Study (IDEA Study). / Impacto económico de la dermatitis atópica en adultos: estudio de base poblacional (estudio IDEA).

OBJECTIVE: To determine resource usage and costs associated with atopic dermatitis in adults according to severity and comorbid conditions in daily clinical practice. PATIENTS AND METHODS: We performed an observational, retrospective study based on a review of registries of patients aged ≥18 years who sought health care in 2013 and 2014 in an area of Catalonia, Spain, with a population of 215,634 persons. We established 3 classes of severity depending on the treatment prescribed. The variables evaluated were total comorbid conditions, concomitant/specific medication, and direct/indirect health care costs. The statistical analysis was based on multiple regression models. Statistical significance was set at P<.05. RESULTS: We included 6,186 patients with a diagnosis of atopic dermatitis (mean age, 47.1 years; women, 61.6%). We established 3 groups based on severity, as follows: mild (n=3,445 [55.7%]); moderate (n=2,361 [38.2%]); and severe (n=380 [6.1%]). Severe atopic dermatitis was associated with risk of presenting comorbid conditions (ß=0.192), namely, asthma (ß=0.138), depression (ß=0.099), cardiovascular events (ß=0.087), obesity (ß=0.085), and smoking (ß=0.025); P<.001. Costs reached €9.3 million (health care costs, 75.5%; loss of productivity, 24.5%), with an average unit cost of €1,504 per year. The corrected average unit cost (ANCOVA) was greater in severe atopic dermatitis compared with moderate and mild disease (€3,397 vs. €2,111 vs. €885; P<.001), respectively. CONCLUSIONS: Severe atopic dermatitis generates considerable usage of health care resources and high costs for the National Health System. These are in proportion with the severity of the disease. General comorbid conditions and asthma were the factors with the greatest impact on health care costs.

[Multiple sclerosis in literature, cinema and television]. / La esclerosis multiple en la literatura, el cine y la television.

INTRODUCTION: Today, the care of patients with multiple sclerosis and those around them represents a clinical and therapeutic challenge for healthcare professionals. The aim of this study is to analyse the appearance of multiple sclerosis in literature, cinema and television, and to reflect upon the image it has in these media. DEVELOPMENT: Several representative works that have addressed multiple sclerosis were reviewed, and many of them were seen to offer a very true-to-life vision of the disease. Likewise, a review was also conducted of the most relevant films and TV series that, on occasions, offer the general public a close look at the impact of the disease on patients or relatives, although they are sometimes somewhat exaggerated for the sake of increased dramatic effect and offer a slightly distorted view of reality. CONCLUSIONS: Literature largely reflects the real epidemiology, the symptoms and development of the disease, while less attention seems to be given to the diagnostic and therapeutic options open to patients. Cinema and television have offered a correct image but sometimes with the addition of more dramatic effects. It is important for literature, cinema and television to offer a realistic view of this neurological disease so as to make it better known among the public and to help lessen the stigma attached to it.

TITLE: La esclerosis multiple en la literatura, el cine y la television.Introduccion. En la actualidad, la atencion del paciente con esclerosis multiple y su entorno supone un reto clinico y terapeutico para los profesionales de la salud. El objetivo del presente trabajo es analizar la aparicion de la esclerosis multiple en la literatura, el cine y la television, y reflexionar sobre su imagen en dichos medios. Desarrollo. Se han revisado algunas obras representativas que han abordado la esclerosis multiple, y se ha observado que en muchas de ellas se ofrece una vision muy fidedigna de la enfermedad. Del mismo modo, se han revisado las principales peliculas y series de television que, en ocasiones, son un reflejo cercano al publico general de la vision e impacto de la enfermedad sobre los pacientes o familiares, no exentas de excesos dramaticos y distorsiones de la realidad. Conclusiones. La literatura refleja, en gran medida, la epidemiologia real, los sintomas y la progresion de la enfermedad, mientras que las opciones diagnosticas y terapeuticas parecen estar en un segundo plano. El cine y la television han ofrecido una imagen correcta, pero en ocasiones atendiendo mas a efectos dramaticos. Es importante que la literatura, el cine y la television ofrezcan una vision ajustada a la realidad de esta enfermedad para dar a conocer esta afeccion neurologica y contribuir a disminuir su estigma.