Prurito en dermatología. Enfermedades y su tratamiento. Parte 2 / Pruritus in Dermatology: Part 2 — Diseases and Their Treatment

El prurito es el síntoma principal en múltiples enfermedades dermatológicas y sistémicas. La dermatitis atópica, la psoriasis, la dermatitis de contacto, la urticaria, el liquen simple crónico, la micosis fungoides, las cicatrices, las enfermedades autoinmunes, la enfermedad renal o hepática crónica, entre otras, asocian prurito que puede requerir un manejo terapéutico distinto. Aunque los antihistamínicos parecen ser la primera línea de tratamiento, en realidad su papel queda limitado a la urticaria y reacciones por fármacos, ya que los mecanismos fisiopatológicos de cada una de las entidades tratadas a lo largo de este manuscrito serán distintas. En estos últimos años han aparecido nuevas moléculas para el tratamiento del prurito, con perfiles de eficacia y seguridad muy atractivos para su uso en práctica clínica. Sin duda, es un momento crucial para el desarrollo de la dermatología en el campo del prurito, y una oportunidad para ser más exigentes con los objetivos a alcanzar en estos pacientes (AU)

Pruritus is the main symptom of many dermatologic and systemic diseases. Atopic dermatitis, psoriasis, contact dermatitis, urticaria, lichen simplex chronicus, mycosis fungoides, scars, autoimmune diseases, kidney or liver diseases among others are all associated with itch that may require different approaches to management. Although antihistamines seem to be the first line of therapy, in reality their role is limited to urticaria and drug-induced reactions. In fact, the pathophysiologic mechanisms of each of the conditions covered in this review will differ. Recent years have seen the emergence of new drugs whose efficacy and safety profiles are very attractive for the management of pruritus in clinical practice. Clearly we are at a critical moment in dermatology, in which we have the chance to be more ambitious in our goals when treating patients with pruritus (AU)

[Translated article] Pruritus in Dermatology: Part 2—Diseases and Their Treatment / Prurito en dermatología. Enfermedades y su tratamiento. Parte 2

Pruritus is the main symptom of many dermatologic and systemic diseases. Atopic dermatitis, psoriasis, contact dermatitis, urticaria, lichen simplex chronicus, mycosis fungoides, scars, autoimmune diseases, kidney or liver diseases among others are all associated with itch that may require different approaches to management. Although antihistamines seem to be the first line of therapy, in reality their role is limited to urticaria and drug-induced reactions. In fact, the pathophysiologic mechanisms of each of the conditions covered in this review will differ. Recent years have seen the emergence of new drugs whose efficacy and safety profiles are very attractive for the management of pruritus in clinical practice. Clearly we are at a critical moment in dermatology, in which we have the chance to be more ambitious in our goals when treating patients with pruritus (AU)

El prurito es el síntoma principal en múltiples enfermedades dermatológicas y sistémicas. La dermatitis atópica, la psoriasis, la dermatitis de contacto, la urticaria, el liquen simple crónico, la micosis fungoides, las cicatrices, las enfermedades autoinmunes, la enfermedad renal o hepática crónica, entre otras, asocian prurito que puede requerir un manejo terapéutico distinto. Aunque los antihistamínicos parecen ser la primera línea de tratamiento, en realidad su papel queda limitado a la urticaria y reacciones por fármacos, ya que los mecanismos fisiopatológicos de cada una de las entidades tratadas a lo largo de este manuscrito serán distintas. En estos últimos años han aparecido nuevas moléculas para el tratamiento del prurito, con perfiles de eficacia y seguridad muy atractivos para su uso en práctica clínica. Sin duda, es un momento crucial para el desarrollo de la dermatología en el campo del prurito, y una oportunidad para ser más exigentes con los objetivos a alcanzar en estos pacientes (AU)

Pruritus in Dermatology: Part 2 - Diseases and Their Treatment. / Prurito en dermatología. Enfermedades y su tratamiento. Parte 2.

Pruritus is the main symptom of many dermatologic and systemic diseases. Atopic dermatitis, psoriasis, contact dermatitis, urticaria, lichen simplex chronicus, mycosis fungoides, scars, autoimmune diseases, kidney or liver diseases among others are all associated with itch that may require different approaches to management. Although antihistamines seem to be the first line of therapy, in reality their role is limited to urticaria and drug-induced reactions. In fact, the pathophysiologic mechanisms of each of the conditions covered in this review will differ. Recent years have seen the emergence of new drugs whose efficacy and safety profiles are very attractive for the management of pruritus in clinical practice. Clearly we are at a critical moment in dermatology, in which we have the chance to be more ambitious in our goals when treating patients with pruritus.

Haptenos, proteínas y dermatitis atópica / Haptens, Proteins, and Atopic Dermatitis

La dermatitis atópica (DA) es una enfermedad inflamatoria crónica multifactorial. La dermatitis de contacto alérgica (DCA) y la dermatitis de contacto por proteínas (DCP) son patologías alérgicas que pueden ser comórbidas a la DA y ser causa de algunas de las exacerbaciones. Aunque la DCA tiene una prevalencia similar en pacientes atópicos que en la población general, debemos considerarla una comorbilidad frecuente en la DA por la disrupción de la barrera cutánea. Por ello, se recomienda la realización de pruebas epicutáneas a los pacientes atópicos. Dupilumab podría ser útil para el tratamiento de la DCA mediada por vía Th2 y exacerbar aquellas que ocurren por vía Th1, aunque se precisan más estudios para establecer conclusiones. El mecanismo por el que la exposición a proteínas ambientales produce exacerbaciones en la DA es controvertido, pero es un fenómeno habitual en la práctica clínica diaria. Se recomienda estudio mediante prick test a pacientes con clínica sugestiva y recomendar conductas evitativas ante pacientes sintomáticos y pruebas positivas (AU)

Atopic dermatitis is a chronic inflammatory disease that is multifactorial in nature. Allergic contact dermatitis and protein contact dermatitis are allergic conditions that may occur in the context of atopic dermatitis and be the cause of exacerbations. Although the prevalence of allergic contact dermatitis is similar in atopic patients and the general population, these 2 conditions are frequently associated because atopic inflammation disrupts the skin barrier. Skin tests are therefore recommended in atopic individuals. Dupilumab could be useful for treating allergic contact dermatitis if it is mediated by type 2 helper T cells but could exacerbate inflammation if mediated by TH1 cells: further study is needed before conclusions can be drawn. Although the mechanism by which exposure to environmental proteins exacerbates atopic dermatitis remains under discussion, such exacerbations are routinely seen in clinical practice. Prick testing is recommended in symptomatic atopic dermatitis. When prick-test findings are positive, patients should be advised to avoid the culprit substances (AU)

[Translated article] Haptens, Proteins, and Atopic Dermatitis / Haptenos, proteínas y dermatitis atópica

Atopic dermatitis is a chronic inflammatory disease that is multifactorial in nature. Allergic contact dermatitis and protein contact dermatitis are allergic conditions that may occur in the context of atopic dermatitis and be the cause of exacerbations. Although the prevalence of allergic contact dermatitis is similar in atopic patients and the general population, these 2 conditions are frequently associated because atopic inflammation disrupts the skin barrier. Skin tests are therefore recommended in atopic individuals. Dupilumab could be useful for treating allergic contact dermatitis if it is mediated by type 2 helper T cells but could exacerbate inflammation if mediated by TH1 cells: further study is needed before conclusions can be drawn. Although the mechanism by which exposure to environmental proteins exacerbates atopic dermatitis remains under discussion, such exacerbations are routinely seen in clinical practice. Prick testing is recommended in symptomatic atopic dermatitis. When prick-test findings are positive, patients should be advised to avoid the culprit substances (AU)

La dermatitis atópica (DA) es una enfermedad inflamatoria crónica multifactorial. La dermatitis de contacto alérgica (DCA) y la dermatitis de contacto por proteínas (DCP) son patologías alérgicas que pueden ser comórbidas a la DA y ser causa de algunas de las exacerbaciones. Aunque la DCA tiene una prevalencia similar en pacientes atópicos que en la población general, debemos considerarla una comorbilidad frecuente en la DA por la disrupción de la barrera cutánea. Por ello, se recomienda la realización de pruebas epicutáneas a los pacientes atópicos. Dupilumab podría ser útil para el tratamiento de la DCA mediada por vía Th2 y exacerbar aquellas que ocurren por vía Th1, aunque se precisan más estudios para establecer conclusiones. El mecanismo por el que la exposición a proteínas ambientales produce exacerbaciones en la DA es controvertido, pero es un fenómeno habitual en la práctica clínica diaria. Se recomienda estudio mediante prick test a pacientes con clínica sugestiva y recomendar conductas evitativas ante pacientes sintomáticos y pruebas positivas (AU)

Haptens, Proteins, and Atopic Dermatitis. / Haptenos, proteínas y dermatitis atópica.

Atopic dermatitis is a chronic inflammatory disease that is multifactorial in nature. Allergic contact dermatitis and protein contact dermatitis are allergic conditions that may occur in the context of atopic dermatitis and be the cause of exacerbations. Although the prevalence of allergic contact dermatitis is similar in atopic patients and the general population, these 2 conditions are frequently associated because atopic inflammation disrupts the skin barrier. Skin tests are therefore recommended in atopic individuals. Dupilumab could be useful for treating allergic contact dermatitis if it is mediated by type 2 helper T cells but could exacerbate inflammation if mediated by TH1 cells: further study is needed before conclusions can be drawn. Although the mechanism by which exposure to environmental proteins exacerbates atopic dermatitis remains under discussion, such exacerbations are routinely seen in clinical practice. Prick testing is recommended in symptomatic atopic dermatitis. When prick-test findings are positive, patients should be advised to avoid the culprit substances.

Sensibilización alérgica de contacto en pacientes con rosácea / Contact Allergy in Patients with Rosacea

Introducción y objetivo La rosácea es una dermatosis acneiforme crónica donde la disrupción de la barrera cutánea puede provocar una facilidad para la sensibilización a distintos alérgenos. Nuestro objetivo es analizar la sensibilización alérgica de contacto en los pacientes con rosácea de nuestro medio. Material y métodos Se realizó estudio de cohortes retrospectivo analizando todos los pacientes parchados en la consulta de Alergia Cutánea de nuestro servicio entre mayo de 1991 hasta mayo de 2019. Resultados Durante el tiempo de estudio han sido remitidos a nuestra consulta un total de 200 pacientes con rosácea, el 2,1% del total de pacientes parchados en este tiempo. El 81% de los pacientes eran mujeres, con una edad media de 44,7años. El 46,5% presentaron al menos un parche positivo, considerándose de relevancia presente (RP) en el 15%. Los parches positivos más frecuentes fueron níquel (26%), seguido de cloruro de cobalto (6,5%), isotiazolinonas (6%), PPDA (5,5%), mezclaII de perfumes (5%) y thiomersal (3,5%). Los parches positivos de RP más frecuentes fueron isotiazolinonas en 10/200 pacientes (5%), PPDA, mezclaII de fragancias, toluensulfonamida formaldehído resina en 4/200 pacientes cada uno (2%), tixocortol y mezclaI de fragancias en 2/200 cada uno (1%). El grupo de sustancias más frecuentemente detectadas fueron los metales, con una RP en el 12,6%, seguido de los fármacos con una RP en el 25,8%. Los conservantes y las fragancias fueron los siguientes grupos de sustancias más frecuentemente positivas, con una RP en el 70,8% y el 43,7%, respectivamente. La fuente de sensibilización más frecuente fueron los cosméticos, seguidos de los fármacos tópicos, destacando los corticoides y los antifúngicos tópicos. Conclusiones Destacamos una elevada prevalencia de dermatitis alérgica de contacto en pacientes con rosácea, lo que sustenta la realización de pruebas epicutáneas (AU)

Background and objective Rosacea is a chronic acneiform skin disorder in which impaired skin barrier function can lead to sensitization to allergens. We aimed to analyze contact allergies in our patients with rosacea. Material and methods Retrospective cohort study of all patients who underwent patch testing in our skin allergy clinic between May 1991 and May 2019. Results A total of 200 patients with rosacea were referred to our clinic for patch testing during the study period; they represented 2.1% of all patch tested patients in the period. Eighty-one percent were women (mean age, 44.7years). At least 1positive patch test was recorded for 46.5%; 15% were of current relevance. The most frequent positive reaction was to nickel (26%), followed by cobalt chloride (6.5%), isothiazolinones (6%), p-phenylenediamine (5.5%), fragrance mixII (5%), and thimerosal (3.5%). The most common currently relevant patch test reactions were to isothiazolinones in 10 of the 200 patients (5%); to phenylenediamine, fragrance mixII, and toluensulfonamide formaldehyde resin in 4 patients (2%) each; and to tixocortol and fragrance mixI in 2 patients (1%) each. The allergen groups most often implicated were metals (of current relevance in 12.6%) and drugs (of current relevance in 25.8%). Preservatives and fragrances were the next most common allergen groups, and 70.8% and 43.7% of the positive reactions in these groups, respectively, were of current relevance. Cosmetics were the most frequent source of sensitization, followed by topical medications — notably corticosteroids and antifungal agents. Conclusions We emphasize the high prevalence of allergic contact dermatitis in patients with rosacea, a finding which supports patch testing, especially if eruptions worsen when these patients use cosmetics and topical medications (AU)

[Translated article] Contact Allergy in Patients With Rosacea / Sensibilización alérgica de contacto en pacientes con rosácea

Background and objective Rosacea is a chronic acneiform skin disorder in which impaired skin barrier function can lead to sensitization to allergens. We aimed to analyze contact allergies in our patients with rosacea. Material and methods Retrospective cohort study of all patients who underwent patch testing in our skin allergy clinic between May 1991 and May 2019. Results A total of 200 patients with rosacea were referred to our clinic for patch testing during the study period; they represented 2.1% of all patch tested patients in the period. Eighty-one percent were women (mean age, 44.7years). At least 1positive patch test was recorded for 46.5%; 15% were of current relevance. The most frequent positive reaction was to nickel (26%), followed by cobalt chloride (6.5%), isothiazolinones (6%), p-phenylenediamine (5.5%), fragrance mixII (5%), and thimerosal (3.5%). The most common currently relevant patch test reactions were to isothiazolinones in 10 of the 200 patients (5%); to phenylenediamine, fragrance mixII, and toluensulfonamide formaldehyde resin in 4 patients (2%) each; and to tixocortol and fragrance mixI in 2 patients (1%) each. The allergen groups most often implicated were metals (of current relevance in 12.6%) and drugs (of current relevance in 25.8%). Preservatives and fragrances were the next most common allergen groups, and 70.8% and 43.7% of the positive reactions in these groups, respectively, were of current relevance. Cosmetics were the most frequent source of sensitization, followed by topical medications — notably corticosteroids and antifungal agents. Conclusions We emphasize the high prevalence of allergic contact dermatitis in patients with rosacea, a finding which supports patch testing, especially if eruptions worsen when these patients use cosmetics and topical medications (AU)

Introducción y objetivo La rosácea es una dermatosis acneiforme crónica donde la disrupción de la barrera cutánea puede provocar una facilidad para la sensibilización a distintos alérgenos. Nuestro objetivo es analizar la sensibilización alérgica de contacto en los pacientes con rosácea de nuestro medio. Material y métodos Se realizó estudio de cohortes retrospectivo analizando todos los pacientes parchados en la consulta de Alergia Cutánea de nuestro servicio entre mayo de 1991 hasta mayo de 2019. Resultados Durante el tiempo de estudio han sido remitidos a nuestra consulta un total de 200 pacientes con rosácea, el 2,1% del total de pacientes parchados en este tiempo. El 81% de los pacientes eran mujeres, con una edad media de 44,7años. El 46,5% presentaron al menos un parche positivo, considerándose de relevancia presente (RP) en el 15%. Los parches positivos más frecuentes fueron níquel (26%), seguido de cloruro de cobalto (6,5%), isotiazolinonas (6%), PPDA (5,5%), mezclaII de perfumes (5%) y thiomersal (3,5%). Los parches positivos de RP más frecuentes fueron isotiazolinonas en 10/200 pacientes (5%), PPDA, mezclaII de fragancias, toluensulfonamida formaldehído resina en 4/200 pacientes cada uno (2%), tixocortol y mezclaI de fragancias en 2/200 cada uno (1%). El grupo de sustancias más frecuentemente detectadas fueron los metales, con una RP en el 12,6%, seguido de los fármacos con una RP en el 25,8%. Los conservantes y las fragancias fueron los siguientes grupos de sustancias más frecuentemente positivas, con una RP en el 70,8% y el 43,7%, respectivamente. La fuente de sensibilización más frecuente fueron los cosméticos, seguidos de los fármacos tópicos, destacando los corticoides y los antifúngicos tópicos. Conclusiones Destacamos una elevada prevalencia de dermatitis alérgica de contacto en pacientes con rosácea, lo que sustenta la realización de pruebas epicutáneas (AU)

Dermatitis de contacto a alérgenos de la Batería Estándar Española en población del sur de Gran Canaria / Contact Dermatitis to Allergens in the Spanish Standard Series: Patch Test Findings in the South of Gran Canaria

Introducción y objetivos El eccema de contacto es un motivo frecuente de consulta. El grado y la frecuencia de sensibilización a alérgenos varían dependiendo de la población de referencia atendida. Revisamos los resultados de sensibilización a alérgenos de la Batería Estándar Española en una población dedicada mayoritariamente al sector turístico (Islas Canarias). Material y métodos Estudio descriptivo retrospectivo tomando la base de datos de la Unidad de Dermatitis de Contacto del Servicio de Dermatología del Complejo Hospitalario Universitario Insular de Las Palmas de Gran Canaria, incluyéndose pacientes parcheados con la Batería Estándar Española desde enero de 2005 hasta junio de 2018. Se recogieron edad, sexo, atopia, localización, positividades y relevancia. Resultados Se estudiaron 1.568 pacientes. El 71,6% fueron mujeres, con una baja proporción de atopia (14,2%) y dermatitis ocupacional (15,8%). La mayoría fueron mayores de 40años (65,2%). Los alérgenos positivos más frecuentes fueron níquel (36,5%), metilcloroisotiazolinona/metilisotiazolinona (11,9%), metilisotiazolinona (11,8%), parafenilendiamina (7,5%) y dicromato potásico (6,3%). Conclusiones En la población estudiada se observa una mayor frecuencia de sensibilización respecto al resto de España para la mayoría de los alérgenos, siendo estas diferencias especialmente llamativas en el caso del níquel, de la metilcloroisotiazolinona/metilisotiazolinona y de la parafenilendiamina (AU)

Background and objectives Contact dermatitis is a common reason for consultation in dermatology. Sensitization levels and frequency, however, vary from one population to the next. The aim of this study was to review patch test results showing sensitization to allergens in the Spanish standard series in the Canary Islands, where a large proportion of the population works in tourism. Material and methods Retrospective, descriptive study of data from the dermatology department's contact dermatitis unit at Complejo Hospitalario Universitario Insular in Las Palmas de Gran Canaria, Spain. We studied results recorded for patients patch tested with the Spanish standard series between January 2005 and June 2018. Results Data for 1568 patients were studied; 71.6% were women, and overall rates of atopy (14.2%) and occupational dermatitis (15.8%) were low. Most patients with a positive test (65.2%) were older than 40years. The main allergens eliciting positive reactions were nickel (36.5%), methylchloroisothiazolinone/methylisothiazolinone (11.9%), methylisothiazolinone (11.8%), paraphenylenediamine (7.5%), and potassium dichromate (6.3%). Conclusions Contact sensitization rates were higher than those reported elsewhere in Spain for most of the allergens studied. The differences were particularly notable for nickel, methylchloroisothiazolinone/methylisothiazolinone, and paraphenylenediamine (AU)

[Translated article] Contact Dermatitis to Allergens in the Spanish Standard Series: Patch Test Findings in the South of Gran Canaria / Dermatitis de contacto a alérgenos de la Batería Estándar Española en población del sur de Gran Canaria

Background and objectives Contact dermatitis is a common reason for consultation in dermatology. Sensitization levels and frequency, however, vary from one population to the next. The aim of this study was to review patch test results showing sensitization to allergens in the Spanish standard series in the Canary Islands, where a large proportion of the population works in tourism. Material and methods Retrospective, descriptive study of data from the dermatology department's contact dermatitis unit at Complejo Hospitalario Universitario Insular in Las Palmas de Gran Canaria, Spain. We studied results recorded for patients patch tested with the Spanish standard series between January 2005 and June 2018. Results Data for 1568 patients were studied; 71.6% were women, and overall rates of atopy (14.2%) and occupational dermatitis (15.8%) were low. Most patients with a positive test (65.2%) were older than 40years. The main allergens eliciting positive reactions were nickel (36.5%), methylchloroisothiazolinone/methylisothiazolinone (11.9%), methylisothiazolinone (11.8%), paraphenylenediamine (7.5%), and potassium dichromate (6.3%). Conclusions Contact sensitization rates were higher than those reported elsewhere in Spain for most of the allergens studied. The differences were particularly notable for nickel, methylchloroisothiazolinone/methylisothiazolinone, and paraphenylenediamine (AU)

Introducción y objetivos El eccema de contacto es un motivo frecuente de consulta. El grado y la frecuencia de sensibilización a alérgenos varían dependiendo de la población de referencia atendida. Revisamos los resultados de sensibilización a alérgenos de la Batería Estándar Española en una población dedicada mayoritariamente al sector turístico (Islas Canarias). Material y métodos Estudio descriptivo retrospectivo tomando la base de datos de la Unidad de Dermatitis de Contacto del Servicio de Dermatología del Complejo Hospitalario Universitario Insular de Las Palmas de Gran Canaria, incluyéndose pacientes parcheados con la Batería Estándar Española desde enero de 2005 hasta junio de 2018. Se recogieron edad, sexo, atopia, localización, positividades y relevancia. Resultados Se estudiaron 1.568 pacientes. El 71,6% fueron mujeres, con una baja proporción de atopia (14,2%) y dermatitis ocupacional (15,8%). La mayoría fueron mayores de 40años (65,2%). Los alérgenos positivos más frecuentes fueron níquel (36,5%), metilcloroisotiazolinona/metilisotiazolinona (11,9%), metilisotiazolinona (11,8%), parafenilendiamina (7,5%) y dicromato potásico (6,3%). Conclusiones En la población estudiada se observa una mayor frecuencia de sensibilización respecto al resto de España para la mayoría de los alérgenos, siendo estas diferencias especialmente llamativas en el caso del níquel, de la metilcloroisotiazolinona/metilisotiazolinona y de la parafenilendiamina (AU)

Epidemiological, Clinical, and Allergy Profile of Patients With Atopic Dermatitis and Hand Eczema: Evaluation of the Spanish Contact Dermatitis Registry (REIDAC). / Perfil epidemiológico, clínico, y alérgico en pacientes con dermatitis atópica y dermatitis de las manos. Evaluación del Registro Español de Dermatitis de Contacto (REIDAC).

BACKGROUND: Hand eczema is common in patients with atopic dermatitis (AD), but few studies have described the characteristics of these patients in large, representative populations from different geographic regions and occupational settings. OBJECTIVE: To describe the epidemiological, clinical, and allergy profile of patients with hand eczema who underwent patch testing and compare patients with and without AD. METHODS: Analysis of data from the Spanish Contact Dermatitis Registry, a multicenter registry of patients who undergo patch testing in Spain. RESULTS: We included 1466 patients with hand eczema who were patch tested between January 2018 and June 2020. Those with AD were younger and had had symptoms for longer before testing. They were also more likely to have been exposed to occupational triggers (38% vs 53% for patients without AD). The only profession for which significant differences were found was hairdressing. The most common allergens were nickel sulfate, methylchloroisothiazolinone/methylisothiazolinone, cobalt chloride, potassium dichromate, fragrance mixes I and II, and formaldehyde. The most common diagnoses were allergic contact dermatitis (24% vs 31% in patients with and without AD, P=.0224) and irritant contact dermatitis (18% and 35% respectively, P<.001). CONCLUSIONS: AD is common in patients with predominant hand eczema who undergo patch testing. Patients with hand eczema and AD have different clinical and epidemiological characteristics to hand eczema patients in general and their final diagnosis following patch testing is also different.

Contact Dermatitis to Allergens in the Spanish Standard Series: Patch Test Findings in the South of Gran Canaria. / Dermatitis de contacto a alérgenos de la Batería Estándar Española en población del sur de Gran Canaria.

BACKGROUND AND OBJECTIVES: Contact dermatitis is a common reason for consultation in dermatology. Sensitization levels and frequency, however, vary from one population to the next. The aim of this study was to review patch test results showing sensitization to allergens in the Spanish standard series in the Canary Islands, where a large proportion of the population works in tourism. MATERIAL AND METHODS: Retrospective, descriptive study of data from the dermatology department's contact dermatitis unit at Complejo Hospitalario Universitario Insular in Las Palmas de Gran Canaria, Spain. We studied results recorded for patients patch tested with the Spanish standard series between January 2005 and June 2018. RESULTS: Data for 1568 patients were studied; 71.6% were women, and overall rates of atopy (14.2%) and occupational dermatitis (15.8%) were low. Most patients with a positive test (65.2%) were older than 40years. The main allergens eliciting positive reactions were nickel (36.5%), methylchloroisothiazolinone/methylisothiazolinone (11.9%), methylisothiazolinone (11.8%), paraphenylenediamine (7.5%), and potassium dichromate (6.3%). CONCLUSIONS: Contact sensitization rates were higher than those reported elsewhere in Spain for most of the allergens studied. The differences were particularly notable for nickel, methylchloroisothiazolinone/methylisothiazolinone, and paraphenylenediamine.

Contact Allergy in Patients with Rosacea. / Sensibilización alérgica de contacto en pacientes con rosácea.

BACKGROUND AND OBJECTIVE: Rosacea is a chronic acneiform skin disorder in which impaired skin barrier function can lead to sensitization to allergens. We aimed to analyze contact allergies in our patients with rosacea. MATERIAL AND METHODS: Retrospective cohort study of all patients who underwent patch testing in our skin allergy clinic between May 1991 and May 2019. RESULTS: A total of 200 patients with rosacea were referred to our clinic for patch testing during the study period; they represented 2.1% of all patch tested patients in the period. Eighty-one percent were women (mean age, 44.7years). At least 1positive patch test was recorded for 46.5%; 15% were of current relevance. The most frequent positive reaction was to nickel (26%), followed by cobalt chloride (6.5%), isothiazolinones (6%), p-phenylenediamine (5.5%), fragrance mixII (5%), and thimerosal (3.5%). The most common currently relevant patch test reactions were to isothiazolinones in 10 of the 200 patients (5%); to phenylenediamine, fragrance mixII, and toluensulfonamide formaldehyde resin in 4 patients (2%) each; and to tixocortol and fragrance mixI in 2 patients (1%) each. The allergen groups most often implicated were metals (of current relevance in 12.6%) and drugs (of current relevance in 25.8%). Preservatives and fragrances were the next most common allergen groups, and 70.8% and 43.7% of the positive reactions in these groups, respectively, were of current relevance. Cosmetics were the most frequent source of sensitization, followed by topical medications - notably corticosteroids and antifungal agents. CONCLUSIONS: We emphasize the high prevalence of allergic contact dermatitis in patients with rosacea, a finding which supports patch testing, especially if eruptions worsen when these patients use cosmetics and topical medications.

Perfil epidemiológico, clínico, y alérgico en pacientes con dermatitis atópica y dermatitis de las manos. Evaluación del Registro Español de Dermatitis de Contacto (REIDAC) / Epidemiological, Clinical, and Allergy Profile of Patients With Atopic Dermatitis and Hand Eczema: Evaluation of the Spanish Contact Dermatitis Registry (REIDAC)

Background: Hand eczema is common in patients with atopic dermatitis (AD), but few studies have described the characteristics of these patients in large, representative populations from different geographic regions and occupational settings. Objective: To describe the epidemiological, clinical, and allergy profile of patients with hand eczema who underwent patch testing and compare patients with and without AD. Methods: Analysis of data from the Spanish Contact Dermatitis Registry, a multicenter registry of patients who undergo patch testing in Spain. Results: We included 1466 patients with hand eczema who were patch tested between January 2018 and June 2020. Those with AD were younger and had had symptoms for longer before testing. They were also more likely to have been exposed to occupational triggers (38% vs 53% for patients without AD). The only profession for which significant differences were found was hairdressing. The most common allergens were nickel sulfate, methylchloroisothiazolinone/methylisothiazolinone, cobalt chloride, potassium dichromate, fragrance mixes I and II, and formaldehyde. The most common diagnoses were allergic contact dermatitis (24% vs 31% in patients with and without AD, P=.0224) and irritant contact dermatitis (18% and 35% respectively, P<.001). Conclusions: AD is common in patients with predominant hand eczema who undergo patch testing. Patients with hand eczema and AD have different clinical and epidemiological characteristics to hand eczema patients in general and their final diagnosis following patch testing is also different (AU)

Antecedentes: La dermatitis de las manos (DM) es frecuente en los pacientes con dermatitis atópica (DA). Pocos estudios describen las características de estos pacientes a partir de poblaciones amplias y representativas de ámbitos geográficos y laborales diferentes. Objetivos: Describir el perfil epidemiológico, clínico y alérgico de los pacientes con DM a los que se realizan pruebas epicutáneas, comparando los pacientes con DA con los pacientes sin DA. Métodos. El estudio se ha realizado a partir de los datos del REIDAC, un registro multicéntrico nacional de pacientes a los que se realizan pruebas epicutaneas. Resultados: Se incluyeron 1466 pacientes parcheados por DM desde enero de 2018 hasta junio de 2020. Los pacientes con DA fueron más jóvenes y con una duración de los síntomas mayor. Los antecedentes ocupacionales como desencadenantes se registraron en menor medida que en los pacientes no atópicos (38 vs 53%). La única profesión en la que se encontraron diferencias significativas fue la peluquería. Los alérgenos más detectados fueron el sulfato de níquel, la metilcloroisotiazolinona/metilisotiazolinona, el cloruro de cobalto, el dicromato potásico, mezcla de fragancias I y II, y el formaldehido. Los diagnósticos más frecuentes fueron dermatitis alérgica de contacto (DAC); 24% en atópicos vs 31% en no atópicos (p 0.0224) y el eccema de contacto irritativo; 18% atópicos vs 35% no atópicos (p<0.001). Conclusiones: La DA es frecuente en los pacientes parcheados con afectación predominante de las manos. Existen diferencias clínicas, epidemiológicas y de diagnóstico final de estos pacientes con respecto al conjunto de pacientes con DM (AU)

[Translated article] Epidemiological, Clinical, and Allergy Profile of Patients With Atopic Dermatitis and Hand Eczema: Evaluation of the Spanish Contact Dermatitis Registry (REIDAC) / Perfil epidemiológico, clínico, y alérgico en pacientes con dermatitis atópica y dermatitis de las manos. Evaluación del Registro Español de Dermatitis de Contacto (REIDAC)

Antecedentes: La dermatitis de las manos (DM) es frecuente en los pacientes con dermatitis atópica (DA). Pocos estudios describen las características de estos pacientes a partir de poblaciones amplias y representativas de ámbitos geográficos y laborales diferentes. Objetivos: Describir el perfil epidemiológico, clínico y alérgico de los pacientes con DM a los que se realizan pruebas epicutáneas, comparando los pacientes con DA con los pacientes sin DA. Métodos. El estudio se ha realizado a partir de los datos del REIDAC, un registro multicéntrico nacional de pacientes a los que se realizan pruebas epicutaneas. Resultados: Se incluyeron 1466 pacientes parcheados por DM desde enero de 2018 hasta junio de 2020. Los pacientes con DA fueron más jóvenes y con una duración de los síntomas mayor. Los antecedentes ocupacionales como desencadenantes se registraron en menor medida que en los pacientes no atópicos (38 vs 53%). La única profesión en la que se encontraron diferencias significativas fue la peluquería. Los alérgenos más detectados fueron el sulfato de níquel, la metilcloroisotiazolinona/metilisotiazolinona, el cloruro de cobalto, el dicromato potásico, mezcla de fragancias I y II, y el formaldehido. Los diagnósticos más frecuentes fueron dermatitis alérgica de contacto (DAC); 24% en atópicos vs 31% en no atópicos (p 0.0224) y el eccema de contacto irritativo; 18% atópicos vs 35% no atópicos (p<0.001). Conclusiones: La DA es frecuente en los pacientes parcheados con afectación predominante de las manos. Existen diferencias clínicas, epidemiológicas y de diagnóstico final de estos pacientes con respecto al conjunto de pacientes con DM (AU)

Background: Hand eczema is common in patients with atopic dermatitis (AD), but few studies have described the characteristics of these patients in large, representative populations from different geographic regions and occupational settings. Objective: To describe the epidemiological, clinical, and allergy profile of patients with hand eczema who underwent patch testing and compare patients with and without AD. Methods: Analysis of data from the Spanish Contact Dermatitis Registry, a multicenter registry of patients who undergo patch testing in Spain. Results: We included 1466 patients with hand eczema who were patch tested between January 2018 and June 2020. Those with AD were younger and had had symptoms for longer before testing. They were also more likely to have been exposed to occupational triggers (38% vs 53% for patients without AD). The only profession for which significant differences were found was hairdressing. The most common allergens were nickel sulfate, methylchloroisothiazolinone/methylisothiazolinone, cobalt chloride, potassium dichromate, fragrance mixes I and II, and formaldehyde. The most common diagnoses were allergic contact dermatitis (24% vs 31% in patients with and without AD, P=.0224) and irritant contact dermatitis (18% and 35% respectively, P<.001). Conclusions: AD is common in patients with predominant hand eczema who undergo patch testing. Patients with hand eczema and AD have different clinical and epidemiological characteristics to hand eczema patients in general and their final diagnosis following patch testing is also different (AU)

Exantema intertriginosoflexural y simétrico (SDRIFE) por piroxicam: a propósito de un caso clínico / Symmetrical drug related intertriginous and flexural exanthema secondary to piroxicam: a case report

Resumen El exantema intertriginoso y flexural simétrico por fármacos (SDRIFE) es una toxicodermia que se presenta con exantema limitado a pliegues, sobretodo en región glútea y genital, y representa una reacción a la exposición sistémica a un medicamento sin sensibilización previa. Presentamos el caso de una paciente mujer adulta previamente sana, que consulta por este tipo de reacción medicamentosa asociada al uso de piroxicam intramuscular, manejada de forma exitosa con antihistamínicos, esteroides tópicos y sistémicos.

Abstract Symmetrical drug related intertriginous and flexural exanthema is a cutaneous drug eruption that is characterized by exanthema limited to creases, buttocks and the upper inner thighs. It represents a reaction to systemic exposure to a drug, without previous sensitization. We present the case of a woman, previously healthy, who consulted due to this drug reaction after being injected with piroxicam, who was successfully treated with antihistamines, topical and systemic corticosteroids.

Lesiones cutáneas asociadas al uso de bombas de insulina y sistemas de monitoreo: un problema desafiante / Insulin pumps and glucose monitors related cutaneous lesions: a challenging problem

Los cuidados actuales de la diabetes incluyen altos niveles de tecnología y los pacientes utilizan diferentes dispositivos que pueden ayudar en su control metabólico, pero pueden impactar negativamente en su piel. Sensores de glucosa como el Freestyle, Dexcom, el Enlite de Medtronic y los sistemas de infusión continua de insulina contienen diferentes productos químicos que están en contacto directo con la piel del paciente y pueden causar una dermatitis irritativa o de contacto alérgica. Las lesiones incluyen eczema, prurito, heridas, cicatrices y cambios en la pigmentación de la piel. Los productos químicos involucrados que pueden ocasionarlas son el isobornil acrilato, N, N- dimetilacrilamida, etil cianoacrilato y colophonium, forzando a los pacientes a cambiar los sitios de infusión, el set de infusión o el sensor mismo más pronto de lo esperado, para reducir el nivel de daño en la piel. Existe gran número de productos que permiten proteger la piel y reducir el contacto de la piel con la cánula de la bomba o el sensor. Para reducir o prevenir el daño existen productos como cremas o spray y parches de hidrocoloide que actúan como barrera y existen técnicas para aplicar y retirar cuidadosamente los parches y adhesivos de los dispositivos. Una vez que las lesiones se han producido, el tratamiento incluye pomadas y a veces corticoides tópicos y/o antibióticos. Para prevenir o reducir el daño de la piel asociado al sensor y uso de la bomba de insulina, la industria que los produce debería incluir la información en relación a los productos químicos incluidos en cada dispositivo.

Diabetes care nowadays includes a high level of technology and patients use different devices which can help them in their glycemic control, but can have a negative impact on their skin. Glucose sensors such as Freestyle, Dexcom, Medtronic Enlite and also continuous subcutaneous insulin infusion systems contain different chemical products which are in direct contact with the patient's skin and can cause irritative or allergic contact dermatitis. Lesions include eczema, pruritus, wounds, scars and changes in skin pigmentation. The chemical products which can induce them are isobornyl acrylate, N, N- dimethylacrylamide, ethyl cyanoacrylate and colophonium, forcing patients to change the infusion site, set or the sensor itself, earlier than expected, in order to reduce the level of skin damage. There are a number of products which can protect the skin and reduce it's contact with the pump cannula or the sensor. To reduce or prevent damage, we have products such as barrier cream or spray films and hydrocolloid blister plasters and actions such as careful application and removal of device's patches and adhesives. Once lesions are established, treatment includes ointments and sometimes topical steroids and/ or antibiotics. In order to prevent or reduce skin damage related to sensor and insulin pump use, the manufacturers should include the information related to the chemicals included in each device.

Alérgenos candidatos para ser incluidos en la serie estándar española a partir de los datos del Registro Español de Dermatitis de Contacto / Candidate Allergens for Inclusion in the Spanish Standard Series Based on Data from the Spanish Contact Dermatitis Registry

Antecedentes y objetivo La actualización de las series estándar de pruebas epicutáneas debe basarse en datos objetivos de frecuencia de sensibilización de los alérgenos que componen cada batería. La última renovación de la batería estándar española se realizó en 2016 y de la europea en 2019, quedando pendiente valorar la inclusión de alérgenos emergentes. Material y método Desarrollamos un estudio observacional, prospectivo y multicéntrico de los pacientes consecutivos del registro del Grupo Español de Investigación en Dermatitis y Alergia Cutánea sometidos a pruebas epicutáneas con hidroperóxido de linalool, hidroperóxido de limoneno, 2-hidroxi-etil-metacrilato, benzisotiazolinona, octilisotiazolinona, mezcla textil, metabisulfito sódico, propóleo, bronopol, mezcla de compuestas II, diazolidinil urea, imidazolidinil urea, decil glucósido y lauril glucósido, durante los años 2019 y 2020. Resultados Se analizó una muestra de 4.654 pacientes estudiados con diazolidinil urea, imidazolidinil urea y bronopol, y de 1.890 pacientes con el resto de los alérgenos. El índice MOAHLFA fue: M 30%, O 18%, A 15%, H 29%, L 6,5%, F 23%, A 68%. Siete alérgenos mostraron una frecuencia de sensibilización mayor del 1%: hidroperóxido de linalool, 2-hidroxi-etil-metacrilato, benzisotiazolinona, hidroperóxido de limoneno, mezcla textil, metabisulfito sódico y propóleo. Tres alérgenos mostraron una frecuencia de relevancia presente superior al 1%: hidroperóxido de linalool, 2-hidroxi-etil-metacrilato e hidroperóxido de limoneno; para benzisotiazolinona y mezcla textil, esta frecuencia fue de entre el 0,9 y el 1%. Conclusiones Nuestros resultados indican que debería valorarse la inclusión de siete nuevos alérgenos en la batería estándar española. Estos resultados podrían contribuir a la próxima actualización de la batería basal europea (AU)

Background Standard patch test series must be updated using objective data on allergen sensitization. The Spanish standard series was last updated in 2016 and the European series in 2019, and the inclusion of several emerging allergens needs to be evaluated. Material and methods We conducted a prospective, observational, multicenter study of consecutive patients from the registry of the Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) who were patch tested in 2019 and 2020 with linalool hydroperoxide, limonene hydroperoxide, 2-hydroxyethyl-methacrylate, benzisothiazolinone, octylisothiazolinone, textile dye mix (TDM), sodium metabisulfite, propolis, bronopol, Compositae mix II, diazolidinyl urea, imidazolidinyl urea, decyl glucoside, and lauryl glucoside. Results We analyzed data for 4654 patients tested with diazolidinyl urea, imidazolidinyl urea, and bronopol, and 1890 tested with the other allergens. The values for the MOAHLFA index components were 30% for male, 18% for occupational dermatitis, 15% for atopic dermatitis, 29% for hand, 6.5% for leg, 23% for face, and 68% for age > 40 years. Sensitization rates above 1% were observed for 7 allergens: linalool hydroperoxide, 2-hydroxyethyl-methacrylate, benzisothiazolinone, limonene hydroperoxide, TDM, sodium metabisulfite, and propolis. Three allergens had a current relevance rate of over 1%: linalool hydroperoxide, 2-hydroxyethyl-methacrylat, and limonene hydroperoxide. Benzisothiazolinone and TDM had a relevance rate of between 0.9% and 1%. Conclusions Our results indicate that 7 new allergens should be considered when extending the Spanish standard patch test series. The data from our series could be helpful for guiding the next extension of the European baseline series (AU)