Epidemiologic features and burden of atopic dermatitis in adolescent and adult patients: A cross-sectional multicenter study.

BACKGROUND: Atopic dermatitis (AD) is considered as one of the most frequent chronic skin conditions. Previous AD epidemiologic studies have been mainly retrospective and/or have been performed through surveys instead of in-person visits. Epidemiological studies concerning AD in Latin American countries are scarce. OBJECTIVE: To describe sociodemographic and clinical features and the economic burden of AD on children and adult patients in Colombia through in-person visits. METHODS: This was a cross-sectional study of 212 patients that included sociodemographic and clinimetric data. The diagnostic criteria of Hanifin and Rajka was used and data relating to disease distribution, disease severity (through the BSA: Body surface area; EASI: Eczema Area and Severity Index; SCORAD: Scoring Atopic Dermatitis), Fitzpatrick's skin phototypes, personal and familiar history of allergic diseases, previous treatments, and personal history of comorbidities, was collected. RESULTS: Patient age range was 12-76, and 52.8% were female. Disease distribution was mainly flexural (19.6%). Early age start, Denni-Morgan fold, and infections tendency were more frequent in adolescents compared to adults. Mean age of diagnosis was 12 years old, AD diagnosis was made mostly by a dermatologist, 48.1% (102 patients) reported alcohol consumption, and 59% of consumers were heavy drinkers. Comorbidities found were: chronic rhinitis (68.9%) food allergy (32.5%), allergic conjunctivitis (29.7%), and asthma (28.8%). Around 81% earned less than $896 US dollars and 59% invested 6-30% of their monthly budget yearly, and 40% had work or school absenteeism. Mean scores of BSA, EASI, and SCORAD involvement were 32.6, 13.7, and 42.4, respectively. CONCLUSIONS: This study adds well-supported data through an in-depth clinical and economical characterization of Colombian adolescents and adult patients with atopic dermatitis and shows its high impact and burden on patients and their families. It also contributes to understand the burden of AD in Latin America.

Atopic dermatitis in the COVID-19 era: Results from a web-based survey.

Given that the COVID-19 era has changed the behavior of all individuals, and since previous reports about its possible impact on atopic dermatitis (AD) patients remained speculative, in this survey we aimed to explore the real impact of COVID-19 among AD patients. All participants provided verbal consent prior to completing the survey. A 37-question web-based survey with no personal identifiers was sent to 212 previously identified AD patients. Itching, sleep disturbances, SARS-CoV-2, illness cost, economic dependence, monthly income, and monthly investment in AD before and during the pandemic, were all included in the analysis. A response rate of 73.1% was obtained. The mean age of participants was 30 years-old, and 57% were women. Around 75% reported AD worsening, and 59.4% of the patients reported sleep problems. Uncertainty, anxiety, and pessimism were frequent during the pandemic. Only 1.3% tested positive for SARS-CoV-2, and it was only significantly associated with comorbidities (p=0.03; Chi2 Test). A significant difference was found in economic dependence and monthly income when compared between before and during the pandemic. This study provides probably the best possible assessment of the clinical, social, and economic effects of the pandemic on patients with an already proven diagnosis of AD.

Omalizumab: opción terapéutica para la urticaria crónica espontánea de difícil control con vasculitis asociada, reporte de tres casos / Omalizumab: therapeutic option in chronic spontaneous urticaria difficult to control with associated vasculitis, report of three cases

Introducción. Aproximadamente el 50 % de los casos de urticaria crónica no mejoran adecuadamente con las dosis convencionales de antihistamínicos, por lo cual se han planteado múltiples opciones terapéuticas, entre las cuales el omalizumab es una herramienta novedosa que ahora cuenta con evidencia de alta calidad que soporta su uso en los casos difíciles, que mejora rápidamente el índice sintomático y el uso de medicamentos, y cuenta con un buen perfil de seguridad. Objetivo. Presentar tres casos de mujeres adultas con urticaria crónica espontánea de más de ocho años de evolución, que no mejoraron con el tratamiento con altas dosis de antihistamínicos, asociados a antileucotrienos e inmunomoduladores y en quienes se combinaban varios mecanismos fisiopatológicos: urticaria crónica espontánea con componente de autoinmunidad, componente de presión y urticaria vasculítica. Materiales y métodos. Se reportan los casos con sus respectivas evaluaciones clínicas y de laboratorio, los medicamentos usados y la respuesta después del inicio de omalizumab y se hace una revisión de la literatura científica sobre uso de este medicamento en la urticaria crónica. Resultados. En los tres casos presentados se obtuvo una mejoría completa de los síntomas tras el inicio del omalizumab. Conclusión. El omalizumab es una opción terapéutica exitosa en casos de urticaria crónica de difícil control con vasculitis asociada, cuando se han agotado las opciones propuestas por las guías internacionales.

Introduction: Approximately 50% of chronic urticaria cases do not respond adequately to conventional doses of antihistamines, so a number of other therapeutic options have been suggested. Among these, omalizumab is an innovative tool, which now has high-quality evidence that supports its use in difficult cases, rapidly improving the symptom index and the use of medications with a good safety profile. Objective: To report three cases of adult women with spontaneous chronic urticaria with an evolution of more than eight years, which did not improve with high doses of antihistamines and leukotriene receptor blockers, associated with immunomodulatory therapy in which several etiologic mechanisms were combined: chronic spontaneous urticaria with autoimmune and pressure components, and vasculitis. Materials and methods: We report the cases with their clinical and laboratory evaluations, used medication, the response after the start of omalizumab and we performed a review of the literature on the use of this drug in chronic urticaria. Results: In all the presented cases, we obtained complete improvement of symptoms after starting omalizumab. Conclusion: Omalizumab is a successful treatment option in cases of difficult to control chronic urticaria with associated vasculitis in which the options proposed by international guidelines have been exhausted.

[Omalizumab: therapeutic option in chronic spontaneous urticaria difficult to control with associated vasculitis, report of three cases]. / Omalizumab: opción terapéutica para la urticaria crónica espontánea de difícil control con vasculitis asociada, reporte de tres casos.

INTRODUCTION: Approximately 50% of chronic urticaria cases do not respond adequately to conventional doses of antihistamines, so a number of other therapeutic options have been suggested. Among these, omalizumab is an innovative tool, which now has high-quality evidence that supports its use in difficult cases, rapidly improving the symptom index and the use of medications with a good safety profile. OBJECTIVE: To report three cases of adult women with spontaneous chronic urticaria with an evolution of more than eight years, which did not improve with high doses of antihistamines and leukotriene receptor blockers, associated with immunomodulatory therapy in which several etiologic mechanisms were combined: chronic spontaneous urticaria with autoimmune and pressure components, and vasculitis. MATERIALS AND METHODS: We report the cases with their clinical and laboratory evaluations, used medication, the response after the start of omalizumab and we performed a review of the literature on the use of this drug in chronic urticaria. RESULTS: In all the presented cases, we obtained complete improvement of symptoms after starting omalizumab. CONCLUSION: Omalizumab is a successful treatment option in cases of difficult to control chronic urticaria with associated vasculitis in which the options proposed by international guidelines have been exhausted.

[Cold urticaria: case series and literature review]. / Urticaria por frío: serie de casos y revisión del tema.

Cold urticaria is one of the five most common causes of chronic urticaria and is grouped as a physical urticaria. It can occur after exposure to cold, either through solid objects, air or liquids. Patients may have symptoms of urticaria, angioedema, respiratory distress and even anaphylaxis when the skin is exposed to a cold environment, such as handling refrigerated objects, swimming in cold water or entering an air-conditioned room. Five cases of cold urticaria are presented, followed by a brief literature review.

Tuberculosis cutánea: reto diagnóstico / Cutaneous tuberculosis, a diagnostic challenge

La tuberculosis cutánea se caracteriza por un amplio espectro de signos clínicos, razón por la cual es necesario mantener un alto índice de sospecha ante lesiones cutáneas crónicas de evolución tórpida. Presentamos el caso de una paciente con tuberculosis cutánea agresiva, su aproximación diagnóstica y el entorno sociocultural, que afectaron su evolución.

Urticaria por frío: serie de casos y revisión del tema / Cold urticaria: case series and literature review

La urticaria por frío es una de las cinco causas más frecuentes de urticarias crónicas; está incluida en el grupo de urticarias físicas y puede ocurrir luego de la exposición al frío, ya sea a través de un objeto, el aire o un líquido. Los pacientes pueden presentar síntomas de urticaria, angioedema, dificultad respiratoria e, incluso, anafilaxia al sacar objetos de la nevera, nadar en agua fría o al entrar a cuartos con aire acondicionado. A continuación se presentan cinco pacientes con diagnóstico de esta enfermedad y una breve revisión del tema.

Cold urticaria is one of the five most common causes of chronic urticaria and is grouped as a physical urticaria. It can occur after exposure to cold, either through solid objects, air or liquids. Patients may have symptoms of urticaria, angioedema, respiratory distress and even anaphilaxis when the skin is exposed to a cold environment, such as handling refrigerated objects, swimming in cold water or entering an air-conditioned room. Five cases of cold urticaria are presented, followed by a brief literature review.

Enfoque semiológico de las patologías de piel del neonato / Semiology of skin diseases of newborns

La dermatología del neonato es una causa común de consulta. Se hace una revisión del tema con énfasis en las diferencias en la piel del neonato, los cuidados generales y una aproximación semiológica a las principales patologías.

Talidomida como inmunomodulador / Talidomide as immunomoludator

La eficacia de la talidomida en el tratamiento de diferentes trastornos inflamatorios y autoinmunes parece deberse a su efecto inmunomodulador y antiinflamatorio. Además, puede aumentar el efecto antitumoral de algunos agentes usados para el tratamiento de las neoplasias. La talidomida se ha usado con éxito en enfermedades como: eritema nodoso leproso, estomatitis aftosa recurrente, enfermedad de injerto contra hospedero, lupus eritematoso sistémico, y recientemente ha sido aprobada por la FDA para el tratamiento de las úlceras aftosas relacionadas con la infección por el VIH. El efecto adverso más severo es la teratogenicidad, siendo las focomelias o amelias las malformaciones más comunes. Por ello, toda mujer en edad reproductiva debe ser informada acerca de los riesgos de tomar este medicamento

Inflamacion minima persistente / Persistent minimun inflamation

Los individuos predispuestos genéticamente a desencadenar reacciones alérgicas luego del contacto con diferentes antígenos, principalmente estacionales, no muestran un infiltrado inflamatorio o expresión de la molécula ICAM-1 sobre diferentes órganos blancos cuando no han sido previamente sensibilizados. Sin embargo, si estos individuos son expuestos a los alergenos que previamente los habían sensibilizado, se presenta un infiltrado celular característico y la expresión del ICAM-1 sobre las células epiteliales, fenómenos que están estrictamente relacionados con la exposición alergénica y que no desaparecen definitivamente en los períodos libres de síntomas. El hecho de que estos marcadores histológicos de la inflamación existan en ausencia de sintomatología es muy importante, y este fenómeno ha sido llamado inflamación mínima persistente (IMP)