Comorbidity identification and referral in atopic dermatitis: a consensus document.

BACKGROUND: Atopic dermatitis (AD) is associated with different comorbidities. OBJECTIVE: To develop evidence-based and practical recommendations for comorbidity detection in patients with AD in daily practice. METHODS: We employed a modified RAND/UCLA methodology, including a systematic literature review (SLR). A group of six experts on AD was established. We conducted a comprehensive search strategy on Medline, Embase, and Cochrane Library up to June 2020. The selection criteria included studies with AD patients with any comorbidity reporting data on comorbidity prevalence, burden, and management. The included studies quality was assessed. The SLR results were discussed in a nominal group meeting, and several recommendations were generated. The recommendation agreement grade was tested on additional experts through a Delphi process. RESULTS: The recommendations cover the following issues: (1) Which comorbidities should be investigated at the first and subsequent visits; (2) how and when should comorbidities be investigated (screening); (3) how should patients with specific comorbidities be referred to confirm their diagnosis and initiate management; (4) specific recommendations to ensure an integral care approach for AD patients with any comorbidity. CONCLUSIONS: These recommendations seek to guide dermatologists, patients, and other stakeholders in regard to early comorbidity identification and AD patient referral to improve decision-making.

Frequency of sensitization to the individual fragrances of fragrance mix I and II according to the factors included in the MOAHLFA index.

BACKGROUND: Fragrances constitute the second most frequent cause of allergic contact dermatitis in Spain. OBJECTIVES: To determine the rate of sensitization to the individual fragrances of fragrance mix (FM) I and FM II for each of the demographic and clinical factors included in the MOAHLFA (male, occupational dermatitis, atopic dermatitis, hand dermatitis, leg dermatitis, facial dermatitis, age) index. METHODS: We conducted a 5-year retrospective study in 23 Spanish centres. We identified the patients who had undergone patch testing with a specific fragrance series after reacting positively to fragrance markers in a baseline series. We obtained the MOAHLFA index items in this population, then calculated for each demographic and clinical factor the frequencies of sensitization to the individual fragrances of FM I and FM II. RESULTS: A specific fragrance series was patch tested in 1013 patients. The most frequent allergens in men, women, children, and retired people were Evernia prunastri (16%), geraniol (16.6%), isoeugenol (17.9%), and geraniol (22.4%), respectively. Citral (20.5%) and hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC) (14.5%) were the most common allergens in occupational eczemas and were also associated with a large proportion of hand and facial dermatitis. CONCLUSIONS: Frequency of sensitization to the individual fragrances of FM I and FM II varies with age, sex, affected body region, and history of occupational or atopic dermatitis.

Efficacy and safety of bilastine in reducing pruritus in patients with chronic spontaneous urticaria and other skin diseases: an exploratory study.

Purpose: To evaluate the efficacy/safety of bilastine in pruritus relief in patients with chronic spontaneous urticaria (CSU) or other pruritic skin diseases.Methods: In this multicenter, open-label, exploratory study (EudraCT No.: 2016-001505-17), 115 adults with CSU (n = 34), eczema/dermatitis (n = 30), prurigo (n = 25) or cutaneous pruritus (n = 26), received bilastine 20 mg once daily for 8 weeks, or in non-responder patients (<30% improvement in pruritus score at week 2), 40 mg/day from week 2.Results: The mean change in weekly pruritus severity score from baseline to week 8 (primary endpoint) was reduced with bilastine (overall and by disease group); overall, percentage and absolute reductions were 71.16% and 1.63 points, respectively (p < .001). Updosed non-responders (n = 31) had improved weekly pruritus severity scores from baseline to week 8; percentage and absolute reductions were 49.08% and 1.13 points, respectively (p < .001). Bilastine improved the Dermatology Life Quality Index at weeks 4 and 8 (p < .001) in all disease groups, and the 7-day Urticaria Activity Score in CSU patients (p < .001). Bilastine was well tolerated.Conclusions: Bilastine relieved pruritus associated with urticaria and other skin diseases, with a very good safety profile.

Structural Changes of Subcutaneous Tissue Valued by Ultrasonography in Patients with Cellulitis Following Treatment with the PnKCelulitis® Program.

Background: Poor eating habits, a sedentary lifestyle, and limited physical activity are predisposing factors for the development of cellulite. The PnKCelulitis® Programme (Pronokal Group, Barcelona, Spain) is a new approach to the treatment of cellulite that combines dietary guidelines, physical exercise, and the application of an anti-cellulite cream. Objective: We sought to objectively and via cutaneous ultrasound assess the benefit of the new multidisciplinary anti-cellulite treatment program and to evaluate any visual changes in the appearance of the skin. Materials and methods: Twenty women with Grades 1 to 3 cellulite were included in the study. All women underwent the multidisciplinary treatment. Clinical controls assessed the evolution of the degree of cellulite; the anthropometric parameters (e.g., weight, body mass index, and mean and low abdominal circumference) and body composition were assessed by bioimpedance. Ultrasound assessments were performed blinded at the beginning and at the end of treatment to assess the following: thickness of the skin, dermis, and hypodermis; areas of indentation; and changes in the echogenicity of the dermis. Results: The degree of cellulite was reduced in all locations, and 90 percent (18/20) of the sample saw their cellulite reduced by at least one degree. Cellulite in the abdomen disappeared in all of the women who had initially presented with it. Most of the subjects with cellulite in the buttocks (70%, 13/19) completed the treatment with Grade 0. There was a decrease in weight and a reduction of abdominal perimeters at the expense of only body fat. Significant decreases in the thickness of the skin and hypodermis and in areas of indentation were observed (p<0.05), in addition to an increase in the echogenicity of the dermis in 18 of the 20 patients. Conclusions: The multidisciplinary treatment program evaluated in this study appears to be an effective and safe treatment for patients with different degrees of cellulite, both clinically and via ultrasound imaging. Additional research with a larger patient cohort is needed to support our findings.

Development and validation of a questionnaire on 'Satisfaction with dermatological treatment of hand eczema' (DermaSat).

OBJECTIVE: To develop a self-administered short questionnaire to assess patient satisfaction with medical treatment for hand eczema (dermatitis) with good psychometric properties. METHOD: The content of the questionnaire was determined on the basis of clinical consultation with groups of patients, from studying the existing instruments, and from discussions with a panel of seven experts. A first draft version containing 38 items organised in six dimensions was tested on a pilot sample of patients to assess its legibility. The extended version was then tested on a sample of 217 patients of both genders enrolled at 18 hospitals representative of the national distribution. The questionnaire was supplied together with the Morisky-Green compliance questionnaire, the health-related quality of life (HRQL) SF-12 questionnaire, and a visual analogue scale (VAS) of perceived health status to assess concurrent validity. The dimensionality was reduced by means of exploratory factor analysis, and reliability was evaluated on the basis of internal consistency and two halves reliability estimates. Item discriminant capability and questionnaire discriminant validity with respect to known groups of patients (by gender, principal diagnosis, age, disease severity and treatment) were also assessed. RESULTS: The reduction and validation sample was composed of 54% women and 46% men, of various educational levels with an average age of 43 years (SD = 13.7). Of those who responded, 26% were diagnosed with hyperkeratotic dermatitis of the palms and 27% of the fingertips, and 47% with recurring palmar dyshidrotic eczema. The questionnaire was shortened to a version containing 17 items grouped in six dimensions: effectiveness, convenience, impact on HRQL, medical follow-up, side effects, and general opinion. Cronbach's alpha coefficient reached a value of 0.9. The dimensions showed different degrees of correlation, and the scores had a normal distribution with an average of 58.4 points (SD = 18.01). Treatment satisfaction scores attained correlations between 0.003 and 0.222 with the HRQL measures, and showed higher correlations with the effectiveness (r = 0.41) and tolerability (0.22) measures, but very low correlation with compliance (r = 0.015). Significant differences were observed between some diagnoses and treatments. CONCLUSIONS: The shortened questionnaire proved to have good psychometric properties, providing excellent reliability, satisfactorily reproducing the proposed structure and supplying evidence of validity.

Urticaria a frígore. Respuesta al tratamiento con montelukast / Cold urticaria responding to treatment with montelukast

Las urticarias físicas representan un grupo de enfermedades de causa indeterminada, y con un tratamiento en ocasiones dificultoso. La urticaria a frígore es precipitada por la exposición de la piel a bajas temperaturas, y los pacientes que la padecen deben ser estudiados para descartar una criopatía, especialmente la presencia de crioglobulinas en sangre. El tratamiento de la urticaria a frígore puede ser decepcionante, y suele basarse en la combinación de antihistamínicos anti-H1. Según los estudios publicados, los leucotrienos son mediadores importantes en la urticaria a frígore, y se ha comunicado el éxito del tratamiento de la misma con fármacos antagonistas de los leucotrienos, solos o combinados con antihistamínicos. Se describe un caso de urticaria a frígore que fue controlada mediante la administración combinada de cetirizina y montelukast. (AU)

Estudio epidemiológico de la dermatitis alérgica de contacto en España (2001) / Epidemiological study of allergic contact dermatitis in Spain (2001)

Introducción: El estudio mediante pruebas de contacto estándar es fundamental para diagnosticar y tratar cualquier paciente en el que se sospeche una dermatitis de contacto. El primer estudio estadístico con pruebas epicutáneas estándar del Grupo Español de Investigación de Dermatitis de Contacto (GEIDC) data de 1977. Veinticinco años más tarde, se realiza este estudio que tiene como objetivo valorar la prevalencia y la relevancia de las positividades a los alergenos de la serie estándar del GEIDC. Métodos: Todos los pacientes fueron estudiados mediante la serie estándar del GEIDC (29 alergenos) en 13 centros dermatológicos. Se valoraron los siguientes parámetros: sexo, edad, localización, diagnóstico, causa del eccema, positividades y relevancia total, presente y pasada. Resultados: El 55,11% de los 3.832 pacientes estudiados (2.300 mujeres y 1.532 varones) tuvieron alguna positividad en la serie estándar. Los diagnósticos más frecuentes fueron la dermatitis de contacto alérgica en el 31,02% e irritativa en el 15,88%. El origen más común de la dermatitis fue profesional en el 16,66% de los casos, y la metalurgia y la construcción fueron las ocupaciones más prevalentes. Más de la mitad de los pacientes sufrían eccema en manos (54,34%). El alergeno más prevalente fue el níquel (26,64%) seguido de cobalto (9,89%) y cromo (8,66%). Conclusiones: Comparando los datos de este estudio con el realizado por el GEIDC en 1977 comprobamos cómo ha aumentado la alergia a níquel mientras ha disminuido la debida a cromo y cobalto. Alergenos no incluidos años atrás como tiomersal, mezcla de perfumes y Kathon CG muestran actualmente una alta prevalencia. Es siempre fundamental establecer la relevancia de las pruebas positivas, que es alta en este estudio para las gomas y para el níquel (AU)