Global influence of dupilumab on Quality of Life in a severe asthma patient with T2 multimorbidities: a case report on atopic dermatitis, chronic rhinosinusitis with nasal polyposis, and eosinophilic esophagitis.

INTRODUCTION: Interleukin (IL)-4 and IL-13 are considered key drivers of type 2 inflammatory diseases. Dupilumab is a fully human monoclonal antibody that blocks the shared receptor component for IL-4 and IL-13, thus inhibiting signaling of both cytokines. CASE STUDY: We report a case of a patient with uncontrolled severe asthma and other T2 inflammatory diseases (atopic dermatitis, chronic rhinosinusitis with nasal polyposis and eosinophilic esophagitis) treated with dupilumab. RESULTS: After one year of treatment, dupilumab improved asthma control together with lung function parameters and airway inflammation. Additionally, a positive impact on quality of life (QoL), evaluated by validated questionnaires, across all the diseases was observed. CONCLUSION: In this case report, a positive and objectively measurable of global improvement on QoL across all four T2 comorbidities was observed after treatment with dupilumab, demonstrating the important role of IL-4 and IL-13 and the existence of a unifying pathological mechanism in T2 diseases.

Identifying biomarkers of treatment response to ciclosporin in atopic dermatitis through multiomic predictive modelling: DERMATOMICS study protocol.

INTRODUCTION: There is a need to optimise the management of atopic dermatitis (AD), improving the efficacy of treatments and reducing the toxicity associated with them. Although the efficacy of ciclosporine (CsA) in the treatment of AD has been thoroughly documented in the literature, the optimal dose has not been yet established. The use of multiomic predictive models of treatment response could optimise CsA therapy in AD. METHODS AND ANALYSIS: The study is a low-intervention phase 4 trial to optimise the treatment of patients with moderate-severe AD requiring systemic treatment. The primary objectives are to identify biomarkers that could allow for the selection of responders and non-responders to first-line treatment with CsA and to develop a response prediction model to optimise the CsA dose and treatment regimen in responding patients based on these biomarkers. The study is divided into two cohorts: the first comprised of patients starting treatment with CsA (cohort 1), and the second, of patients already receiving or who have received CsA therapy (cohort 2). ETHICS AND DISSEMINATION: The study activities began following authorisation by the Spanish Regulatory Agency (AEMPS) and the Clinical Research Ethics Committee of La Paz University Hospital approval. Trial results will be submitted for publication in an open access peer-reviewed medical speciality-specific publication.Trial registration of this study can be located at the EU Clinical Trials Register, available from https://euclinicaltrials.eu/search-for-clinical-trials/?lang=en. Our clinical trial was registered in the website before the enrolment of the first patient complying with European regulations. EU Clinical Trials Register is a primary registry according the WHO. Once our trial was included in a primary and official registry, in order to extend the accessibility to our research, we also registered it retrospectively in clinicaltrials.gov; however, this is not mandatory as per our regulation. TRIAL REGISTRATION NUMBER: NCT05692843.

Long-Term Omalizumab in Elderly Patients with Chronic Urticaria: Is It a Safe Therapy?

BACKGROUND: Biologics have revolutionized the treatment of many diseases. In this regard, omalizumab (OMA), an anti-IgE monoclonal antibody, is the recommended therapeutic option for patients with chronic spontaneous urticaria (CSU) refractory to second-generation H1-antihistamines. Several studies confirm the efficacy and safety of the drug. However, the literature focusing on the elderly population is scarce, as this age group is often excluded from clinical trials. Therefore, the pharmacological treatment of CSU in elderly patients is a challenge that is increased by their comorbidities and consequent polypharmacy. OBJECTIVES: We describe the real-life safety profile of OMA in elderly patients (≥70 years) with CSU and chronic inducible urticaria (CIndU). We aimed to provide data for daily clinical practice in this vulnerable patient group. METHOD: A retrospective review was performed of the records of patients with CSU/CIndU from May 2003 to December 2019 in the Hospital Universitario La Paz. We describe qualitative and quantitative data according to measures of central tendency. Comparisons between qualitative and quantitative data were performed with the Mann-Whitney U test and the Fisher's test for qualitative variables. A p value <0.05 was considered statistically significant. RESULTS AND CONCLUSIONS: Eighty-nine patients were included, divided into two groups (<70 vs. ≥70 years). The overall rate of adverse events (AEs) was 48%, mainly mild. No association between age and AE was found (p = 0.789). No serious AE such as anaphylaxis was detected. CSU predominated in both groups. CIndU was less prevalent in the elderly (p = 0.017). There was no association between age and the other variables. Although the frequency of neoplasms was slightly higher in the elderly with OMA, we found no difference compared to the incidence of neoplasms in the general population. Therefore, our data suggest that OMA may be a safe treatment in elderly people with CSU/CIndU for prolonged periods of treatment, although further studies with larger samples are needed to corroborate our observations.

Contact dermatitis from glucose sensors in Spain: A multicentric approach.

BACKGROUND: Allergic contact dermatitis from glucose sensors may interfere with their ongoing application. OBJECTIVE: To evaluate a series of Spanish patients with contact dermatitis to glucose sensors regarding former sources of contact allergens, patch test results, and outcomes from the ongoing use of the device. METHODS: A series of patients with contact dermatitis from glucose sensors was investigated in eight dermatology departments across Spain (epidemiological features, brands, latency time to develop dermatitis, the ability to continue using the devices as well as the patch test results). RESULTS: Thirty patients were evaluated (mean age 20.9 years). A total of 66.7% were children and 66.7% female. Ninety per cent used Freestyle Libre (FSL). Eight of 26 (30.8%) reacted to isobornyl acrylate (IBOA) and two of 20 (10.0%) to N,N dimethylacrylamide (DMAA). The mean latency time to develop dermatitis was 9 months. Sixteen of 29 (55.2%) patients continued using the same sensor causing the reaction. Thirteen of 29 (44.8%) patients were unable to continue using the sensor because of severe reactions. Of these, five were positive to IBOA, one to IBOA and DMAA, one to DMAA, one to colophony, and one to isopropyl alcohol wipes. In one patient, the outcome was unknown. CONCLUSION: The frequency of sensitisation to IBOA and DMAA, was lower than in other European series, but similar to a previously published Spanish article. Legislation requiring manufacturers to provide information regarding the composition of medical devices and cooperate with the investigations into contact dermatitis is urgently needed.

[Annular elastolytic giant cell granuloma: a case report located in non-sun exposed areas]. / Granuloma elastolítico anular de células gigantes: a propósito de un caso localizado en áreas no fotoexpuestas.

Annular elastolytic giant cell granuloma (AEGCG) is an uncommon entity clinically characterized by erythematous annular plaques with atrophic and hypopigmented center, that predominates in sun-exposed zones. The histology shows a granulomatous infiltrate without palisading image, made up of lymphocytes, histiocytes and giant cells, with phagocytosis of elastic fibers, without necrobiosis or mucin deposit. We present the case of a male patient with atypical clinical manifestation on the non-sun exposed skin and AEGCG characteristic histology.

Granuloma elastolítico anular de células gigantes: a propósito de un caso localizado en áreas no fotoexpuestas / Annular elastolytic giant cell granuloma: a case report located in non-sun exposed areas

El granuloma elastolítico anular de células gigantes (GEACG) es una entidad poco frecuente, caracterizada clínicamente por placas eritematosas anulares de centro atrófico e hipopigmentado, que predominan en zonas fotoexpuestas. En la histología presentan un infiltrado granulomatoso sin formación de imagen en empalizada, compuesto por linfocitos, histiocitos y células gigantes, con fagocitosis de fibras elásticas, sin necrobiosis ni depósito de mucina. Presentamos el caso de un paciente con manifestaciones clínicas atípicas en piel no fotoexpuesta, y una histología característica de GEACG

Annular elastolytic giant cell granuloma (AEGCG) is an uncommon entity clinically characterized by erythematous annular plaques with atrophic and hypopigmented center, that predominates in sun-exposed zones. The histology shows a granulomatous infiltrate without palisading image, made up of lymphocytes, histiocytes and giant cells, with phagocytosis of elastic fibers, without necrobiosis or mucin deposit. We present the case of a male patient with atypical clinical manifestation on the non-sun exposed skin and AEGCG characteristic histology

Carcinoma sebáceo extraocular de presentación atípica / Atypical presentation of extraocular sebaceous carcinoma

El carcinoma sebáceo es un tumor cutáneo maligno poco frecuente. Aparece en el 75% de los casos en localización oculopalpebral, rica en varios tipos de glándulas sebáceas. La cabeza y cuello son las regiones extraoculares donde se han descrito con mayor frecuencia. Su curso clínico es agresivo y son habituales las recurrencias locales y las metástasis a distancia. Se presenta un caso de una mujer de 79 años que fue diagnosticada de un carcinoma sebáceo extraocular en mejilla derecha, varias hiperplasias sebáceas y un carcinoma intraepidérmico con diferenciación sebácea. Tras realizar una completa evaluación de historia familiar y personal de la paciente se descartó la asociación con el síndrome de Muir-Torre (AU)

Reconstrucción de la región ciliar mediante colgajo de deslizamiento en V-T / V-T Advancement flap for eyebrown reconstruction

La región ciliar y supraciliar son áreas de frecuente asiento de lesiones tumorales cuya corrección quirúrgica puede ser problemática. La reconstrucción tras la excisión del tumor debe realizarse sin distorsión anatómica, intentando evitar la elevación de la ceja, la asimetría respecto a la región frontal contralateral y, en lo posible, la pérdida de folículos pilosos. Presentamos el caso de una mujer de 72 años con un carcinoma epidermoide de mediano tamaño, localizado en ceja y región supraciliar izquierda. Tras la excisión se empleó un colgajo de deslizamiento en V-T para la corrección del defecto resultante, con un resultado funcional y estético satisfactorio. En este trabajo realizamos la descripción de esta técnica y revisamos las diferentes posibilidades reconstructivas tras cirugía oncológica en la región ciliar. (AU)

Candidiasis hiperplásica oral pseudotumoral / Pseudotumoral hyperplastic form of oral candidiasis

La Candidiasis oral es una de las infecciones más frecuentes producidas por el género Candida, cuya aparición está determinada por una conjunción de factores favorecedores locales o sistémicos. Clásicamente se han establecido cuatro formas clínico-evolutivas bien diferenciadas: pseudomembranosa, atrófica aguda, atrófica crónica e hiperplásica crónica. La Candidiasis hiperplásica crónica es un cuadro poco frecuente, con mala respuesta al tratamiento antifúngico convencional. Presentamos el caso de un varón de 70 años, fumador, que desarrolló una Candidiasis hiperplásica oral cuya forma de presentación clínica fue poco habitual, simulando una lesión tumoral. La ausencia de respuesta al tratamiento antimicótico prolongado y la posibilidad de degeneración neoplásica determinaron la excisión quirúrgica. Comentamos los principales aspectos etiopatogénicos, clínicos, diagnósticos y terapéuticos de esta entidad (AU)