Risk factors and clinical characteristics of acute and chronic cutaneous graft-versus-host disease in pediatric patients undergoing hematopoietic stem cell transplantation.

Acute and chronic cutaneous graft-versus-host disease (GVHD) are common complications following hematopoietic stem cell transplantation (HSCT) in pediatric patients. In this retrospective study, we explored the risk factors and clinical characteristics of acute and chronic cutaneous GVHD in a case series of children undergoing HSCT at a tertiary referral hospital. We found that 36% of acute cutaneous GVHD was severe and these patients were more likely to have an unrelated donor, and that children with acute cutaneous GVHD who progressed to chronic cutaneous GVHD had a higher proportion of malignant diseases, total body irradiation, and bronchiolitis obliterans compared to those who did not progress to chronic cutaneous GVHD. Our study highlights the importance of identifying and monitoring these high-risk patients to improve the clinical management and outcomes of cutaneous GVHD in pediatric HSCT recipients.

Cutaneous infections by dematiaceous opportunistic fungi: Diagnosis and management in 11 solid organ transplant recipients.

BACKGROUND: The incidence of cutaneous infections by dematiaceous fungi is rising in our environment due to the high number of solid organ transplant recipients (SOTR). OBJECTIVE: To review our experience in the management of cutaneous phaeohyphomycoses in a Spanish reference centre for dermatological care of SOTR. METHODS: Retrospective clinical, histopathological and microbiological review of all SOTR diagnosed of a phaeohyphomycosis in a 7-year period. RESULTS: Eleven SOTR were identified (8 lung and 3 kidney). The lesions were solitary in six patients and multiple in five, affecting mostly the lower extremities. Early lesions showed epidermal hyperplasia and a diffuse dermal suppurative granulomatous infiltrate that was progressively substituted by fibrosis when the lesions were treated. Septated fungal structures with refractile walls were identified. DNA sequencing confirmed the presence of Alternaria spp (8 cases), Cladosporium cladosporioides, Microsphaeropsis arundinis and Exophiala oligosperma. Three patients with single lesions were treated with surgery, while the other 8 required long-term antifungal therapy, including itraconazole, voriconazole and/or terbinafine, combined with surgery and reduction in tacrolimus doses. CONCLUSION: A clinical, histopathological and microbiological correlation is essential to corroborate this diagnosis. Solitary lesions are easily treated with surgery, but larger or multiple lesions may require long medical treatments combined with surgery and modification of immunosuppressive medication. The list of dematiaceous fungi implicated in cutaneous infections is expanding, in line with the availability of more sophisticated identification methods and the increasing number of immunosuppressed patients.

Eficacia y seguridad de eberconazol crema al 1% en el tratamiento de las micosis cutáneas: resultados de 2 estudios comparativos frente a clotrimazol crema al 1% y miconazol crema al 2% / Efficacy and safety of eberconazole 1% cream in the treatment of cutaneous mycoses: results of two comparative studies of clotrimazole 1% cream versus miconazole 2% cream

El eberconazol es un derivado imidazólico tópico de amplio espectro que en estudios preclínicos demostró ser eficaz y tener una potente actividad antimicótica sobre levaduras y hongos, así como una seguridad óptima en estudios de fase I. No presenta hipersensibilidad retardada, no produce fotosensibilidad ni efecto fototóxico, con escasa absorción sistémica. Con objeto de demostrar la eficacia de eberconazol en el tratamiento de las micosis cutáneas, se diseñaron 2 ensayos clínicos comparativos frente a clotrimazol crema al 1% y miconazol crema al 2% de idéntico diseño: multicéntrico, doble ciego y aleatorizado, con una pauta de administración cada 12 h y una duración del tratamiento de 4 semanas. El eberconazol demostró eficacia superior en el tratamiento de las dermatofitosis y eficacia similar en el tratamiento de la candidiasis y la pitiriasis versicolor respecto al clotrimazol, y equivalencia terapéutica respecto al miconazol; no se encontraron diferencias entre los tratamientos en el perfil de seguridad (AU)

Eberconazole is a topical, broad-spectrum imidazole derivative that has been shown to be effective and to have potent antimycotic activity against yeasts and fungi in preclinical studies, with optimal safety in phase I trials. Eberconazole causes no delayed hypersensitivity, photosensititvity or phototoxic effects and has little systemic absorption. To demonstrate the efficacy of eberconazole in the treatment of cutaneous mycoses, two comparative clinical trials of clotrimazole 1% cream versus miconazole 2% cream were carried out with identical design: both were multicenter, double-blind, randomized trials, with doses administered every 12 hours and a treatment duration of 4 weeks. Eberconazole demonstrated greater efficacy in the treatment of dermatophytoses and similar efficacy in the treatment of candidosis and pityriasis versicolor versus clotrimazole, and therapeutic equivalence versus miconazole. No differences in safety profile were found between the treatments (AU)