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BACKGROUND: Atopic dermatitis (AD) and allergic contact dermatitis (ACD) are inflammatory skin conditions whose association is not clearly defined. OBJECTIVES: To identify differences in ACD profile between patients with and without AD among those referred for patch testing. Additionally, to determine the prevalence of sensitisation to standard Spanish contact allergens in both groups. METHODS: We analysed two groups (AD and non-AD) within the Spanish Registry of Research in Contact Dermatitis and Cutaneous Allergy (REIDAC). Contact allergy, clinical relevance and epidemiological data were compared between them. RESULTS: A total of 5055 patients were included. Among them, 23% (1168) had a history or final diagnosis of AD. At least one positive reaction was seen in 468 (40%) of AD patients and 1864 (48%) of non-AD patients. In both groups, the most common positive reactions were to nickel sulphate, methylchloroisothiazolinone/methylisothiazolinone and cobalt chloride. Age-adjusted OR for sensitisation to nickel sulphate was 0.72 (95% CI: 0.61-0.86), indicating a decreased likelihood of sensitisation in AD patients compared to non-AD individuals. CONCLUSIONS: We did not find an increased presence of ACD in patients with AD referred for patch testing, exhibiting similar profiles to non-AD population, except for a negative relationship between AD and sensitisation to nickel sulphate.
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BACKGROUND: The past 5 years have seen a proliferation of new treatments for atopic dermatitis (AD). We analyzed recent drug survival data for cyclosporine in this setting. Because the Spanish National Healthcare system requires patients with AD to be treated with cyclosporine before they can be prescribed other systemic treatments, drug survival for cyclosporine may be shorter than in other diseases. MATERIAL AND METHOD: Multicenter, observational, prospective cohort study using data from the Spanish Atopic Dermatitis Registry (BIOBADATOP). Data from the Spanish Registry of Systemic Treatments in Psoriasis (BIOBADADERM) were used to create a comparison cohort. RESULTS: We analyzed data for 130 patients with AD treated with cyclosporine (median drug survival, 1 year). Median cyclosporine survival in the psoriasis comparison group (150 patients) was 0.37 years. Drug survival was significantly longer in AD than in psoriasis (P<.001). CONCLUSION: Drug survival of cyclosporine in the BIOBADATOP registry is similar to that described in other series of patients with AD and longer than that observed in the BIOBADADERM psoriasis registry.
Assuntos
Dermatite Atópica , Psoríase , Humanos , Ciclosporina/uso terapêutico , Dermatite Atópica/tratamento farmacológico , Imunossupressores/uso terapêutico , Estudos Prospectivos , Psoríase/tratamento farmacológico , Sistema de Registros , Resultado do TratamentoRESUMO
BACKGROUND: In recent years, remarkable improvements in our understanding of atopic dermatitis (AD) have revolutionized treatment perspectives, but access to reliable data from clinical practice is essential. MATERIALS AND METHOD: The Spanish Atopic Dermatitis Registry, BIOBADATOP, is a prospective, multicenter database that collects information on patients of all ages with AD requiring systemic therapy with conventional or novel drugs. We analyzed the registry to describe patient characteristics, diagnoses, treatments, and adverse events (AEs). RESULTS: We studied data entries for 258 patients who had received 347 systemic treatments for AD. Treatment was discontinued in 29.4% of cases, mostly due to a lack of effectiveness (in 10.7% of cases). A total of 132 AEs were described during follow-up. Eighty-six AEs (65%) were linked to a systemic treatment, most commonly dupilumab (39AEs) and cyclosporine (38AEs). The most common AEs were conjunctivitis (11patients), headache (6), hypertrichosis (5), and nausea (4). There was 1severe AE (acute mastoiditis) associated with cyclosporine. CONCLUSIONS: Initial findings on AEs from the Spanish BIOBADATOP registry are limited by short follow-up times precluding comparisons or calculation of crude and adjusted incidence rates. At the time of our analysis, no severe AEs had been reported for novel systemic therapies. BIOBADATOP will help answer questions on the effectiveness and safety of conventional and novel systemic therapies in AD.
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Dermatite Atópica , Humanos , Dermatite Atópica/tratamento farmacológico , Dermatite Atópica/epidemiologia , Estudos Prospectivos , Ciclosporina/uso terapêutico , Administração Cutânea , Sistema de Registros , Resultado do Tratamento , Índice de Gravidade de DoençaRESUMO
BACKGROUND: The presence of cutaneous nodules in patients with gastroenteropancreatic neuroendocrine tumours (GEP-NETs) receiving depot somatostatin analogs (SSAs) is a diagnostic challenge as differential diagnosis between injection site reactions and metastases is essential. OBJECTIVE: To characterize the clinical, radiological, cytological and histopathological features of subcutaneous nodules in patients with GEP-NETs treated with SSAs. MATERIALS AND METHODS: Retrospective, cross-sectional study of patients with GEP-NETs treated with SSAs in whom subcutaneous nodules were detected on routine abdominal computed tomography (CT) scans. High resolution and colour Doppler ultrasonography was performed. Those patients with inconclusive radiological studies went through fine-needle aspiration cytology (FNAC) and/or biopsy. RESULTS: Twelve patients (five males, seven females) were included (six midgut carcinoid NETs, six pancreatic NETs). Three patients received intramuscular depot octreotide, seven subcutaneous lanreotide, and two both treatments. CT scan findings were nonspecific. Sonography revealed a hyperechoic pattern in recent injections, and a hypoechoic pattern with a characteristic hyperechoic peripheral rim in long-term injections (more than 3 months after injection). On colour Doppler sonography, nodules showed no signs of intralesional vascularity. Fine-needle aspiration cytology (FNAC) was performed in five patients, revealing a characteristic acellular proteinaceous material. Biopsy in four patients showed different reactional infiltrates around the acellular material. CONCLUSIONS: High resolution and colour Doppler ultrasonography may be very useful for the differential diagnosis of subcutaneous nodules in patients with GEP-NETs treated with SSAs. FNAC and a biopsy are useful tests for confirmation of the diagnosis in patients with inconclusive findings. We propose a management algorithm.
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Neoplasias Intestinais/tratamento farmacológico , Neoplasias Intestinais/patologia , Tumores Neuroendócrinos/tratamento farmacológico , Tumores Neuroendócrinos/patologia , Octreotida/administração & dosagem , Neoplasias Pancreáticas/tratamento farmacológico , Neoplasias Pancreáticas/patologia , Peptídeos Cíclicos/administração & dosagem , Neoplasias Cutâneas/secundário , Somatostatina/análogos & derivados , Somatostatina/antagonistas & inibidores , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/patologia , Adulto , Idoso , Biópsia por Agulha , Estudos Transversais , Preparações de Ação Retardada , Diagnóstico Diferencial , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Exame Físico , Estudos Retrospectivos , Neoplasias Cutâneas/diagnóstico por imagem , Somatostatina/administração & dosagem , Tela Subcutânea/efeitos dos fármacos , Tela Subcutânea/patologia , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia Doppler em Cores/métodosRESUMO
Omalizumab is a recombinant humanized monoclonal antibody that inhibits immunoglobulin E. It has been approved for the treatment of severe asthma and chronic spontaneous urticaria refractory to other treatments. Its use in the management of chronic inducible urticaria (a type triggered by certain stimuli) is still considered off-label, although this use has been discussed in some consensus papers. This review brings together case reports and case series describing the use of omalizumab to treat chronic inducible urticaria. We analyze the most important aspects of the cases and the outcomes reported. The results seem to position omalizumab as a potentially effective, safe treatment alternative in some cases of chronic inducible urticaria.
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Omalizumab/uso terapêutico , Urticária/tratamento farmacológico , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Doença Crônica , Avaliação de Medicamentos , Feminino , Humanos , Imunoglobulina E/imunologia , Masculino , Pessoa de Meia-Idade , Estimulação Física/efeitos adversos , Urticária/etiologia , Adulto JovemRESUMO
We report 3 cases of solar urticaria in which there was no response or limited response to first-line treatments with high-dose H1 antihistamines or phototherapy. The patients were then treated with omalizumab. Symptoms improved in 2 patients, whose tolerance to sunlight increased considerably; quality of life clearly improved for 1 of these patients. The third experienced no improvement and developed a mild local reaction to the injected medication. We conclude that omalizumab may offer a potentially safe, useful alternative for patients with solar urticaria who do not respond to conventional therapy.
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Omalizumab/uso terapêutico , Transtornos de Fotossensibilidade/tratamento farmacológico , Urticária/tratamento farmacológico , Idoso , Avaliação de Medicamentos , Resistência a Medicamentos , Antagonistas dos Receptores Histamínicos H1/uso terapêutico , Humanos , Iluminação/efeitos adversos , Masculino , Pessoa de Meia-Idade , Omalizumab/efeitos adversos , Transtornos de Fotossensibilidade/etiologia , Transtornos de Fotossensibilidade/psicologia , Fototerapia , Qualidade de Vida , Luz Solar/efeitos adversos , Urticária/etiologia , Urticária/psicologiaAssuntos
COVID-19 , Acantólise , Humanos , Ictiose , Estudos Prospectivos , SARS-CoV-2 , Centros de Atenção TerciáriaAssuntos
Ciclosporina/farmacocinética , Ciclosporina/uso terapêutico , Imunossupressores/farmacocinética , Imunossupressores/uso terapêutico , Psoríase/tratamento farmacológico , Administração Oral , Adulto , Ciclosporina/sangue , Monitoramento de Medicamentos , Feminino , Humanos , Imunossupressores/sangue , Masculino , Memória Episódica , Psoríase/sangue , Índice de Gravidade de DoençaAssuntos
Autoanticorpos/metabolismo , Autoimunidade/efeitos dos fármacos , Fármacos Dermatológicos/uso terapêutico , Psoríase/tratamento farmacológico , Ustekinumab/uso terapêutico , Anticorpos Antinucleares/metabolismo , Antígenos Nucleares/metabolismo , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Psoríase/imunologiaAssuntos
Clindamicina/administração & dosagem , Fármacos Dermatológicos/administração & dosagem , Nevo/tratamento farmacológico , Tretinoína/administração & dosagem , Administração Cutânea , Idoso de 80 Anos ou mais , Combinação de Medicamentos , Géis , Humanos , Masculino , Nevo/patologia , Resultado do TratamentoAssuntos
Antialérgicos/uso terapêutico , Hepatite B Crônica/complicações , Omalizumab/uso terapêutico , Urticária/tratamento farmacológico , Benzimidazóis/uso terapêutico , Doença Crônica , Quimioterapia Combinada , Feminino , Humanos , Pessoa de Meia-Idade , Piperidinas/uso terapêutico , Prednisona/uso terapêutico , Urticária/complicações , Carga Viral , Viremia/complicaçõesAssuntos
Gamopatia Monoclonal de Significância Indeterminada/complicações , Mucinoses/etiologia , Idoso , Anti-Inflamatórios/uso terapêutico , Clobetasol/uso terapêutico , Cotovelo , Feminino , Humanos , Cadeias Leves de Imunoglobulina/sangue , Gamopatia Monoclonal de Significância Indeterminada/sangue , Gamopatia Monoclonal de Significância Indeterminada/diagnóstico , Mucinoses/diagnóstico , Conduta ExpectanteRESUMO
INTRODUCTION: Solar urticaria is an uncommon photodermatosis. First-line treatment is with antihistamines; second-line treatment includes induction of light tolerance using UV phototherapy. OBJECTIVES: We aimed to describe and evaluate the effectiveness of a desensitization protocol with narrowband UV-B in patients with solar urticaria. MATERIAL AND METHODS: We performed a retrospective study of patients with solar urticaria with an action spectrum in the UV-A range, the visible light range, or both who had received therapy with narrowband UV-B for induction of light tolerance. Short courses of treatment were administered (<20 sessions, 3 per week) during spring. The initial dose was determined according to the skin type. The Skindex-29 was administered before treatment and after summer; a nonvalidated questionnaire was also administered after summer to evaluate disease activity and satisfaction with treatment. RESULTS: We included 8 patients with an action spectrum (4 with visible light and 4 with UVA plus visible light). Seventeen courses (1-6 per patient) were administered per year. The number of sessions per year ranged from 11 to 20. The mean dose of narrowband UV-B per course was 7.45J/cm2. No patients experienced flares or adverse effects during treatment. The response was satisfactory in 6 patients. The improvement in the overall Skindex-29 score was greater than 20% in 78.6% of cases. The improvement in the function and symptoms subscales was over 20% in 71% and 64% of cases, respectively. CONCLUSION: Induction of light tolerance with narrowband UV-B in solar urticaria is safe and effective in a high percentage of patients.
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Transtornos de Fotossensibilidade/radioterapia , Luz Solar/efeitos adversos , Terapia Ultravioleta , Urticária/radioterapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Retrospectivos , Terapia Ultravioleta/métodos , Adulto JovemRESUMO
Patients with chronic inflammatory diseases being treated with immunosuppressive drugs, and with tumor necrosis factor inhibitors in particular, have an increased risk of infection by Mycobacterium tuberculosis. Screening for latent tuberculosis infection and preventive therapy to reduce the risk of progression to active tuberculosis are mandatory in this group of patients. This updated multidisciplinary consensus document presents the latest expert opinions on the treatment and prevention of tuberculosis in candidates for biologic therapy and establishes recommendations based on current knowledge relating to the use of biologic agents.