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.

Disseminated lymphangiomas as a cutaneous manifestation of Noonan syndrome.

Lymphangioma is a known, but rare manifestation of Noonan syndrome. We present the case of disseminated and circumscribed cutaneous lymphangiomas in the context of Noonan syndrome. Oral rapamycin is a promising treatment in these extensive and morbidity-causing cases.

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.

Is it Useful to Calculate Minimal Erythema Dose Before Narrowband UV-B Phototherapy? / ¿Es útil la determinación de la dosis eritematógena mínima previa a la fototerapia ultravioleta B de banda estrecha?

INTRODUCTION AND OBJECTIVES: The starting dose for narrowband UV-B phototherapy is determined by a patient's skin phototype or minimal erythema dose (MED). Calculation of MED identifies patients with unsuspected photosensitivity. The aim of this study was to investigate the influence of factors such as concomitant use of photosensitizing agents, diagnosis, and combination with acitretin in patients with psoriasis on the frequency and severity of adverse effects in patients with a low MED to narrowband UV-B phototherapy. MATERIAL AND METHODS: We undertook a retrospective observational cohort study between February 1, 2009 and March 31, 2015. MED values were classified as normal or low. RESULTS: In total, 302 patients with different skin conditions started narrowband UV-B phototherapy at a dose determined by their MED. No differences were found between patients with a low MED and those with a normal MED for number of drugs taken (P=.071) or use of photosensitizing agents (P=0.806). Following adjustment for age, sex, and phototype, the multivariate analysis showed that psoriasis exerted a protective effect against a low MED (OR=0.31 [95% CI, 0.16-0.58]). No significant risk of erythema or pruritus was detected in patients with a low MED (OR=1.68; 95% CI, 0.91-3.29 and OR=2.04; 95% CI, 0.99-4.22, respectively). CONCLUSIONS: Psoriasis protects against a low MED. Although erythema and pruritus were more common in patients with a low MED, the differences were not significant.

Adherence and patient satisfaction with topical treatment in psoriasis, and the use, and organoleptic properties of such treatments: a Delphi study with an expert panel and members of the Psoriasis Group of the Spanish Academy of Dermatology and Venereology.

BACKGROUND: Topical therapy is key to the successful management of psoriasis, and patient adherence to treatment contributes to its effectiveness in the long-term. OBJECTIVES: To establish consensus on adherence to topical treatment in psoriasis, draw up recommendations on how adherence could be improved, and evaluate the properties of the main vehicles used. METHOD: We designed a questionnaire on adherence to topical treatments in psoriasis and another on the properties of the main vehicles used; the 2 questionnaires were evaluated using the Delphi method by a panel of experts and members of the Psoriasis Group of the Spanish Academy of Dermatology and Venereology, respectively. RESULTS: Consensus was reached on the following statements: a) treatment adherence increases the effectiveness of topical treatments in psoriasis; b) to improve adherence, it is necessary to improve communication between patients and health care staff, provide written instructions, and simplify treatment with easy-to-use, pleasant products that are preferably applied only once a day; c) treatment satisfaction increases adherence and tends to improve the health-related quality of life of the patient. Ointment was rated the worst vehicle, while foams and solutions were rated the best. Creams and lipophilic gels were considered to be better than ointment in several respects. CONCLUSION: To improve adherence to topical regimens in psoriasis and the effectiveness of such therapy, we need to give patients more information, simplify treatment regimens, and prescribe easy-to-use products that will ensure satisfaction.

[Importance of epidemiologic surveillance in contact dermatitis: Spanish surveillance system on contact allergies]. / Importancia de la vigilancia epidemiológica en el eczema de contacto. La Red Española de Vigilancia de Alergia de Contacto.

The high prevalence of contact dermatitis means that this common medical problem has considerable personal, societal, and economic impact. Clinical and epidemiologic research is needed if we are to shed light on the real situation of contact dermatitis in Spain. In this article we will look at epidemiologic research from a practical point of view and analyze the role of the dermatologist in planning and designing studies. The advantages of multicenter studies are discussed, along with the roles of national and international surveillance networks. We present the Spanish Surveillance System on Contact Allergies, which serves as a bridge between Spanish dermatologists and the European Surveillance System on Contact Allergies. The present and future aims of the Spanish network are described.

[Epidemiology of contact dermatitis in Spain. Results of the Spanish Surveillance System on Contact Allergies for the year 2008]. / Epidemiología del eczema de contacto en España. Resultados de la Red Española de Vigilancia en Alergia de Contacto (REVAC) durante el año 2008.

BACKGROUND: The epidemiology of contact dermatitis can be analyzed using clinical data from skin allergy units. OBJECTIVES: The aims of this study were to define the profile of patients attending a skin allergy unit and to determine the prevalence of the most common sensitizations in this population. MATERIAL AND METHODS: Throughout 2008, a retrospective observational study was carried out in the 5 hospitals of the Spanish Surveillance System on Contact Allergies. All patients underwent skin patch tests with the Spanish standard series. The frequencies of sensitization were normalized for age and gender. RESULTS: Data were gathered on 1161 patients. The 5 allergens that gave the most frequent positive reactions were nickel sulfate (25.88%), potassium dichromate (5.31%), cobalt chloride (5.10%), fragrance blends (4.64%), and balsam of Peru (4.44%). The least frequently detected reactions were to quinolone-clioquinol mix and sesquiterpene lactone mix. There was a 35% prevalence of sensitization to nickel among women. CONCLUSIONS: The profile of sensitizations in Spain is similar to that of other Southern European countries. Nickel sulfate continues to be the most prevalent allergen, particularly in women. The low prevalence of sensitization to quinolone-clioquinol mix and sesquiterpene lactone mix supports their exclusion of the Spanish series.

Is p-Phenylenediamine Still a Prevalent Contact Allergen in Spain? / ¿Sigue siendo la parafenilendiamina un alérgeno de contacto prevalente en España?

OBJECTIVES: To analyze trends in the prevalence of contact sensitization to p-phenylenediamine between 2004 and 2014, taking into consideration that the concentration of this product in cosmetics was regulated in 2009. To explore risk factors for contact allergy to p-phenylenediamine. MATERIAL AND METHODS: Retrospective observational study of patients suspected of having contact dermatitis from allergy to p-phenylenediamine during the years between 2004 and 2015 in 8 tertiary level hospitals. The patients underwent patch testing (TRUE-test) with the standard series of the Spanish Research Group on Contact Dermatitis and Skin Allergies. This series included p-phenylenediamine 1%. We followed international recommendations for the statistical analysis of data related to contact allergies. RESULTS: Three hundred eighty-six out of 9341 patients (4.1%) had positive reactions to p-phenylenediamine. The prevalence tended to decrease in the early years (2004-2007) and then leveled off at around 4%. Risk factors for developing contact dermatitis from p-phenylenediamine were sex, age over 40 years, multiple sensitivities, and profession, notably workers in hair salons and those who handle rubber and plastics. CONCLUSIONS: The prevalence of p-phenylenediamine allergy remains high among patients with contact eczema. Risk factors for p-phenylenediamine contact allergy are consistent with previous reports.

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)

Morphometric characterization of the human neuroendocrine Merkel cells.

In this study, the neuroendocrine Merkel cells (NEMCs) from adult human epidermis are defined morphometrically, using the MOP 20 image analyzer to measure 21 parameters of either the cell as a whole, or particular cellular structures. Maximum diameter (8.09 microns), perimeter (26.51 microns), area (36.87 microns2) and form factor (0.626) for the cell as a whole, and maximum diameter (5.08 microns), perimeter (18.74 microns), area (12.54 microns2) and form factor (0.452) for the nucleus were determined. Also measured were nuclear-cytoplasmic ratio (0.5595), filament thickness (10 nm), and granular numerical density (7.02 granules/micron2). Maximum diameter, area, and form factor of neurosecretory granules were 94.23 nm, 5020.05 nm2, and 0.93, respectively. Length of desmosomes linking NEMCs to keratinocytes was determined (286.9 nm) and compared with that of interkeratinocytic desmosomes (385 nm). In addition, length and diameter of cellular processes (spine-like processes (1.58 micron X 0.26 micron), interstitial processes (1.39 micron X 0.25 micron), and microvilli (0.35 micron X 0.25 micron) were measured after separation and classification according to the particular morphologic characteristics of each.

Unilateral psoriasis: a case individualized by means of involucrin.

Several authors have questioned the existence of unilateral (linear) psoriasis. These authors have suggested that the condition is actually an inflammatory linear verrucous epidermal nevus, or the result of an isomorphic effect on a pre-existing epidermal nevus. We report the case of a 25-year-old man, with no relevant personal or family history, who presented with a number of pruritic, punctiform erythematosquamous lesions that were linearly distributed over the left side of the body. Clinical examination and results of histopathologic and histochemical studies indicated unilateral psoriasis. Our findings confirm that involucrin immunohistochemistry can be a useful diagnostic tool in cases of this type. Treatment with keratolytics and topical calcipotriol led to a significant, but only temporary, improvement.

[Hypomelanosis of Ito. A possibly under-diagnosed heterogeneous neurocutaneous syndrome]. / Hipomelanosis de Ito. Un síndrome neurocutáneo heterogéneo y posiblemente infradiagnosticado.

INTRODUCTION: Hypomelanosis of Ito (HI) or incontinentia pigmenti achromians is a multisystemic neurocutaneous disorder that is associated to neurological complications in a high percentage of patients. AIMS: The purpose of this study is to review the most significant features in a series of 14 patients with HI. PATIENTS AND METHODS: We conducted a retrospective study in which the following data were analysed: age, sex, familial and personal history, clinical features and complementary explorations that were carried out. We report the cases of nine females and five males aged between 4 months and 14 years. RESULTS: All the patients presented neurological anomalies, including psychomotor or mental retardation in 11 (associated to autistic behaviour in two of them), neuroradiological anomalies in seven, microcephalus in three and epileptic seizures in two. Other significant complications were musculoskeletal and ocular anomalies (each of which were present in nine patients), dental disorders in six, coarse facies and dysmorphic ears in four patients, hypoacusis in five and congenital heart disease in two. The following were also observed, but as isolated events: choanal atresia, cleft palate, segmental dilatation of the colon, cryptorchidism, inguinal hernia, low height, vesicoureteral reflux and premature pubarche. CONCLUSIONS: There is no biological marker that identifies HI and a number of clinical forms only appear in the skin in a very mild form, which means they sometimes going unnoticed or are not considered to be important enough to establish a diagnosis. This entity may, therefore, be more frequent than we think and its prevalence is perhaps underestimated.