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An aqueous antiseptic containing "chlorhexidine digluconate/benzalkonium chloride/benzyl alcohol" (CBB) is widely used in France. The only previous documented study dealing with allergic contact dermatitis (ACD) to this antiseptic is one small case series in children. The French Vigilance Network for Dermatology and Allergy (REVIDAL-GERDA) has collected many cases in the last few years.To evaluate the clinical and sensitization profiles of patients diagnosed with ACD to CBB.We performed a retrospective study of patients with contact dermatitis to CBB and positive tests to CBB and/or at least one of its components. All patients had to be tested with all components of CBB.A total of 102 patients (71 adults and 31 children) were included. The lesions were extensive in 63% of patients and 55% had delayed time to diagnosis. CBB patch tests were positive in 93.8% of cases. The allergen was identified in 97% of patients, mainly benzyl alcohol in adults (81.7%) and chlorhexidine digluconate in children (54.8%). About 32.4% of the patients were sensitized to several components.CBB is a cause of ACD at all ages. The components of the antiseptic should be tested. The sensitization profile seems to be different between adults and children.

Abrocitinib is an oral Janus kinase 1 inhibitor with demonstrated efficacy in moderate-to-severe atopic dermatitis (AD). To evaluate the long-term safety profile of abrocitinib and provide relevant information for practitioners. Data from patients who received ≥1 dose of abrocitinib 200 mg or 100 mg in the JADE clinical program were pooled in two cohorts. The consistent-dose (CD) cohort comprised patients who received the same abrocitinib dose during the entire exposure time in parent phase 3 studies and/or the long-term extension study JADE EXTEND (NCT03422822). Parent studies were: JADE MONO-1 (NCT03349060), JADE MONO-2 (NCT03575871), JADE TEEN (NCT03796676), JADE COMPARE (NCT03720470), JADE DARE (NCT04345367; 200 mg only) and JADE REGIMEN (NCT03627767); in JADE REGIMEN only patients from the open-label run-in phase (200 mg only) who did not subsequently enter the randomized phase were included. Patients from the phase 2b study (NCT02780167) were also included in the CD cohort. The variable-dose (VD) cohort comprised patients who received different doses of abrocitinib (200 and 100 mg) throughout exposure time in the parent study JADE REGIMEN and in JADE EXTEND, if enrolled. Patients included in the VD cohort completed the open-label period of JADE REGIMEN (abrocitinib 200 mg only) and entered the randomized phase (abrocitinib 200 mg, abrocitinib 100 mg or placebo); some patients subsequently entered the JADE REGIMEN rescue phase (abrocitinib 200 mg) and/or JADE EXTEND (abrocitinib 200 or 100 mg). The data cutoff was 16 April 2021. A Cox regression analysis evaluated risk factors for specific events of interest. Data from 3582 patients (4313.4 patient-years) were analysed: 2784 patients in the CD cohort (abrocitinib 200 mg, n = 1761, abrocitinib 100 mg, n = 1023) and 798 patients in the VD cohort. Duration of exposure was ≥48 weeks in 43.6%, 66.9% and 86.1% and ≥96 weeks in 18.0%, 23.2% and 45.4% of patients in the CD 200 mg, 100 mg and VD cohorts, respectively. In the CD and VD cohorts, the median age was 30.0 and 29.0 years; 490 (17.6%) and 145 patients (18.2%) were adolescents, and 143 (5.1%) and 30 patients (3.8%) were aged ≥65 years at screening, respectively. Incidence rates (IRs; unique patients with events per 100 patient-years) of serious adverse events (SAEs), deaths, and treatment-emergent adverse events of special interest are shown in Table 1. IRs for SAEs were consistent across abrocitinib doses but were higher in patients aged ≥65 years vs. younger patients. Serious infections were the most frequent SAEs; frequency was not dose related. Herpes zoster (HZ), herpes simplex and pneumonia were the most frequent serious infections. From a Cox regression analysis, potential risk factors for treatment-emergent HZ included abrocitinib dose, baseline age, medical history of HZ, absolute lymphocyte count

Topical non-steroidal anti-inflammatory drugs (NSAIDs) can cause allergic contact dermatitis (ACD) and photocontact dermatitis. Although topical diclofenac is associated with fewer side effects than other topical NSAIDs, rare cases of contact dermatitis have been reported.

Resume Cas clinique Nous rapportons l’observation d’une patiente ayant presente un angiœdeme du visage de facon concomitante a une injection intraveineuse d’alteplase, comme traitement thrombolytique d’un accident vasculaire cerebral (AVC) ischemique. Le bilan allergologique (prick-test et intradermoreaction) etait negatif, et la reintroduction d’alteplase bien toleree, eliminant une hypersensibilite allergique IgE (Immunoglobuline E) dependante. Discussion La survenue d’angiœdeme est un effet secondaire classique de l’alteplase. Il est souvent spontanement resolutif, mais peut entrainer un risque vital. Les facteurs de risque sont le sexe feminin, un AVC ischemique du cortex insulaire et un traitement par IEC (inhibiteur de l’enzyme de conversion). Sa physiopathologie est mal comprise, regroupant 3 principales hypotheses : une hypersensibilite dependant des IgE, une degranulation mastocytaire non specifique ou une activation bradykinique. Les tests cutanes, suivis d’une reintroduction d’alteplase en cas de negativite, sont donc interessants pour eliminer un mecanisme IgE. L’alteplase n’etant activee qu’en presence de fibrine, sa reintroduction n’entraine pas de risque hemorragique en l’absence de thrombose. Conclusion Une meilleure connaissance des angioedemes survenant sous alteplase pourrait permettre d’ameliorer leur gestion en urgence, mais aussi leur prise en charge allergologique.

International audience; IntroductionLes inhibiteurs des Janus kinases (JAKi) font partie des traitements dernièrement arrivés sur le marché pour traiter la dermatite atopique (DA) modérée à sévère. Leur efficacité et leur tolérance ont été prouvées dans des essais cliniques, mais il n’y a pas encore de données en vraie vie. Notre objectif était d’évaluer l’efficacité et la tolérance en vraie vie de l’upadacitinib (UPADA), inhibiteur sélectif de JAK-1 et du baricitinib (BARI), inhibant JAK 1 et 2.Matériel et méthodesIl s’agit d’une étude rétrospective, multicentrique, française. Tous les patients adultes recevant de l’UPADA ou du BARI entre mars 2021 et janvier 2022 pour une DA, non opposés au recueil de leurs données, ont été inclus. Le critère de jugement principal était le pourcentage de patients atteignant le score Investigator's Global Assessment (IGA) à 0, 1 ou - 2 points comparé au score initial, à 3 mois (M3, défini comme le score le plus élevé recueilli entre les 2e, 3e et 4e mois). Les critères de jugement secondaires étaient les variations des scores Scoring Atopic Dermatitis (SCORAD), Eczema Area and Severity Index (EASI), Pruritus Numerical Rating Scale (PNRS), DLQI (Dermatological Life Quality Index) à M3 et 6 mois (M6, défini comme le score recueilli le plus élevé entre les 5e, 6e et 7e mois) comparés aux scores initiaux. Tous les effets indésirables (EI) survenant sous JAKi étaient recueillis.RésultatsCent patients issus de 18 centres ont été inclus. Cinquante-quatre, 12 et 34 patients étaient traités par UPADA 15 mg/jour, UPADA 30 mg/jour et BARI 4 mg/jour respectivement. La plupart des patients présentait une DA sévère avant introduction du JAKi (IGA médian à 3, IQR 3 ; 4) et avaient reçu en moyenne 3 traitements systémiques dont du dupilumab et de la ciclosporine dans plus de 70 % des cas, arrêtés pour intolérance ou inefficacité. Parmi ces 100 patients, 33/54 (61,1 %), 11/12 (91,7 %) et 14/34 (41,2 %) dans les groupes UPADA 15 mg, UPADA 30 mg et BARI 4 mg respectivement atteignaient à M3 un score IGA 0, 1 ou - 2 points comparé à l’IGA initial. La diminution médiane du PNRS à M3 était de −3 (IQR −5,5 ; −1,5), −5 (IQR −7 ; −1) et −2 (IQR −3 ; 0), dans les groupes UPADA 15 mg, UPADA 30 mg et BARI 4 mg respectivement. La durée médiane de suivi était de 3 mois (IQR 3 ; 6). Soixante patients rapportaient au moins un EI, le plus souvent sans gravité. Les EI plus fréquents étaient l’élévation du cholestérol total ou LDL (23,2 % des cas), des triglycérides (18,2 %), les éruptions papuleuses du visage (12,9 %), les cytolyses (11,1 %) et les infections herpétiques (6,4 %). Aucun EI thromboembolique ni cardiovasculaire majeur n’était observé. Le traitement était arrêté chez 18 des 100 patients dans la période d’étude.DiscussionIl s’agit de résultats originaux sur l’utilisation des JAKi en vraie vie dans la DA. L’efficacité des JAKi semble confirmée dans une population de patients particulièrement sévère et difficile à traiter. Les données de tolérance sont rassurantes, sous réserve d’une période de suivi courte.

The cutaneous microbiota contributes to skin barrier function, ensuring effective protection against pathogens and contributing to the maintenance of epidermal integrity. Dysbiosis is frequently present in atopic dermatitis (AD), a chronic inflammatory disease associated with skin barrier defects. Dysbiosis is associated with reduced bacterial diversity and marked Staphylococcus aureus colonization, which is favoured in the case of certain local AD-specific properties such as reduced skin acidity, eased bacterial adhesion and decreased antimicrobial peptide production. Furthermore, S. aureus-associated skin dysbiosis, via the production of staphylococcal virulence factors, may also participate in the immunopathology of AD by altering the epidermal barrier and inducing an inflammatory response. However, there are currently no arguments for recommending screening for, and treatment of S. aureus-associated dysbiosis outside the setting of cutaneous superinfection. Nonetheless, modulation of the skin microbiota may hold promise for AD management. Here, we describe the relationships that exist between the skin microbiota and AD.

BACKGROUND Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by unrelenting pruritus and recurrent eczematous lesions. It affects up to 15% of children and adolescents and up to 5% of adults, and confers a high and multifactorial burden to patients, families and society. With increasing awareness of this substantial burden, AD has become a priority for healthcare systems. AIM The Atopic Dermatitis Quality of Care (ADQoC) initiative set out to describe good practices for addressing the challenges that impede the management of AD. METHODS The initiative carried out a literature review and surveyed 32 expert care centres, catalogued findings, and analysed and elucidated global challenges to AD care along with good practice implementations that can address them. RESULTS The four challenges to quality care for AD are: (i) misconceptions about AD; (ii) delayed referral and access to AD specialists; (iii) poor patient access to AD treatments and poor adherence to medications; and (iv) managing the complexity of AD and its comorbidities. The initiative highlighted 5 of 10 good practice implementations as high priority for any AD care centre to focus on: (i) clinical assessment and diagnosis; (ii) a structured multidisciplinary care team; (iii) monitoring and evaluating care quality; (iv) patient education and communication; and (v) collaboration and exchange with patient groups. CONCLUSION These implementations can provide benefits for patients, healthcare providers and the healthcare system. They directly contribute to the efficacy of treatment, improved healthcare provider efficiency, improved education for patients and healthcare providers, and improved costs to healthcare systems. The initiative was launched on https://atopicdermatitiscare.kpmg.co.uk/ to provide an easy-to-use educational platform.

Background Cancer patients are being exposed to antineoplastic drugs more frequently and for longer periods, resulting in a higher risk of hypersensitivity reactions. The aim of this study was to assess the pharmaceutical time and direct cost of drug allergy explorations following immediate hypersensitivity reactions to antineoplastic agents. Methods A micro-costing method was used to collect data on consumption of human and material resources for allergy exploration preparations. The monetisation was carried out on the basis of prices and hourly wage costs applied in 2018. The number and type of allergy explorations prepared by the pharmacy as well as nature of antineoplastic drugs tested, and the number of culprit drugs reintroductions were collected. Results Almost 1.5 h is required to realise allergy tests for one patient including pharmacist time for prescription analysis and pharmacy technician's time for tests preparation. The mean manufacturing cost of these tests is estimated at €62.87 (€57.82–65.49) per culprit drug for one patient. Programming patients according to culprit drugs tested allows rationalising healthcare provider time and increasing efficiency. From January 2010 to December 2018, 277 patients were tested and 490 allergy explorations were performed, corresponding to more than 5000 preparations. Mostly, the culprit drug could be reintroduced ( n = 383, 78.2%) allowing patients to receive the best possible treatment. Conclusion Management of hypersensitivity reactions is constantly progressing, as it contributes to improving patient care in oncology. This activity is time-consuming for the pharmacy team but allows patients with previous hypersensitivity reaction to continue effective treatment.

Alcoholic chlorhexidine 2 % is recommended for the prevention of catheter infections. A retrospective study was conducted in a nutritional assistance unit in a cohort of patients with a long-term central venous route. The tolerance (number of skin reactions) and efficacy (number of infections/days of catheters) of this antiseptic used in repeated care in these patients were described.