Are antihistamines still used during omalizumab treatment for chronic spontaneous urticaria?

Background: The guidelines for the treatment of chronic spontaneous urticaria (CSU) recommend adding omalizumab to the treatment of patients with uncontrolled disease despite four-fold doses of second-generation antihistamines (AH). On the contrary, some studies revealed that omalizumab was effective without concomitant AH and several authors suggest tapering off AH when CSU is controlled with omalizumab. Objectives: The aim of our study was to evaluate the use of AH during treatment with omalizumab in patients with CSU in real clinical practice. Materials & Methods: This was a multicentre cross-sectional and observational study conducted by the Catalan and Balearic Chronic Urticaria Network (XUrCB) based on a cohort of 298 CSU patients treated with omalizumab. Results: In total, 23.5% of our patients decided themselves to stop taking AH during omalizumab treatment. The ratio of patients with CSU without concomitant inducible urticaria and the percentage of patients with a good response to omalizumab (UAS7≤6 and/or UCT ≥12) were higher in those who stopped taking AH. Conclusion: More studies are required to identify the phenotypic characteristics of patients responding to omalizumab as monotherapy in order to avoid overtreating with AH. Our study suggests that patients with CSU without concomitant inducible urticaria and those who achieve a good response to omalizumab tend to be controlled by omalizumab without AH. In order to establish guidelines on how to stop AH, further evidenced-based studies are required.

Manifestaciones cutáneas del lupus eritematoso / Cutaneous manifestations of lupus erythematosus

Las lesiones en la piel producidas por el LE constituyen una de lasmanifestaciones más visibles y frecuentes de esta enfermedad. Estas lesiones muestran una gran variabilidad, tanto en su expresión clínica comomicroscópica, lo que dificulta su comprensión y estudio. Los pacientes queexpresan enfermedad en la piel no tienen, en su mayoría, complicacionessistémicas graves pero sí importante morbilidad dada la extensión, cronicidad, riesgo de cicatrices y desfiguramiento de la apariencia física quelas lesiones cutáneas pueden ocasionar. Los mecanismos patogénicos exactos que conducen al desarrollo de lesiones cutáneas en el LE no se conocenpero probablemente la radiación ultravioleta juega un papel importante.La apoptosis de los queratinocitos inducida por esta radiación y los estí-mulos proinflamatorios que se desencadenan como consecuencia del déficit en la eliminación de estas células apoptóticas constituyen probablementelos pilares en los que se basa la etiopatogenia de esta enfermedad en la piel.Sin embargo, restan múltiples interrogantes aún por dilucidar. El tratamiento se basa en la fotoprotección, la aplicación tópica de corticoides yla administración oral de antipalúdicos (AU)

Skin lesions are the most visible and frequent symptoms in lupuserythromatosus (LE). These lesions vary greatly in their clinical as well asmicroscopic features, which difficults the understanding and study of LE.Most of the patients that express skin disease do not suffer from serioussystemic complications, but from important morbidity given the extension, chronicity, chances of scarring and disfigurement that skin lesionsmay cause. The exact pathogenic mechanisms that induce the development of skin lesions in LE are unknown at present; however, ultraviolet(UV) radiation could play an important role. UV- induced keratinocyteapoptosis as well as proinflammatory stimuli release because of uncomplete apoptotic cell clearance may be the pillars of the etiology of this skindisease. Nonetheless, there are still many questions to answer. The treatment consists of photoprotection, topical administration of corticoids aswell as oral administration of antimalarial drugs (AU)

[Dermatomyositis]. / Dermatomiositis.

Dermatomyositis is a form of idiopathic inflammatory myopathy that involves skeletal muscle and skin. The objectives of this review are to briefly describe the cutaneous manifestations of the disease, to raise some questions still debated about amyopathic dermatomyositis, and to reflect current knowledge of an interesting aspect in dermatomyositis as it is the risk to develop malignancy. Although clear evidence for a significant dermatomyositis-cancer association exists, optimal clinical or biological factors that predict an association with cancer have not been identified. Recently, some specific autoantibodies in dermatomyositis have been shown to be associated with internal malignancy. They open up the possibility to have available serological markers for detecting cancer-associated myositis in the near future.

Dermatosis erosivopustulosa del cuero cabelludo. Descripción de siete casos / Erosive pustular dermatosis of the scalp: report of seven cases

Se describen siete pacientes afectos de una dermatosis erosivopustulosa del cuero cabelludo. Las lesiones, localizadas en el cuero cabelludo y de evolución muy tórpida, consistían en placas erosivas y húmedas, cubiertas por costras amarillentas, que finalmente conducían a una alopecia cicatrizal. Ocasionalmente en los bordes de estas placas pudieron observarse pústulas aisladas. Los estudios microbiológicos fueron esencialmente negativos y los hallazgos histopatológicos inespecíficos. La aplicación de glucocorticoides tópicos de moderada y elevada potencia resultó muy eficaz. En todos los pacientes se pudo recoger el antecedente de una agresión de diversa índole en la zona del cuero cabelludo donde se inició la dermatosis, con más frecuencia un herpes zoster en la vertiente oftálmica del nervio trigémino o el tratamiento tópico de queratosis actínicas con ácido retinoico o crioterapia. De acuerdo con otros autores creemos que la agresión previa del cuero cabelludo constituye un factor desencadenante, fundamental en el desarrollo de esta dermatosis (AU)