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Sensitization to acrylates is a concern in the occupational/environmental dermatology field.To describe an occupational allergic contact dermatitis (ACD) outbreak from a smartphone screen protector glue.Thirteen affected workers of a chain store selling phone screen protectors were investigated in five Spanish dermatology departments. The glue datasheet and label were assessed. A chemical analysis of the glue was performed. Based on this, some patients underwent additional testing.All patients (all female, mean age: 25) had severe fingertip dermatitis. The datasheet/label indicated that the glue contained isobornyl acrylate (IBOA), a "photoinitiator" and polyurethane oligomer. The company informed us that the ingredients were polyurethane acrylate, "methacrylate" (unspecified), acrylic acid, hydroxyethyl methacrylate, propylmethoxy siloxane, and photoinitiator 184. Isobornyl acrylate (or IBOA) and N,N-dimethylacrylamide (DMAA) were patch tested in eight and two cases, respectively, with negative results. A chemical analysis revealed 4-acryloylmorpholine (ACMO); isobornyl methacrylate (IBMA), and lauryl acrylate in one glue sample. Seven patients were patch tested with dilutions of the identified substances and six of seven were positive for ACMO 0.5% pet.An outbreak of occupational ACD, likely from ACMO in a glue is described. Further investigations are needed to corroborate the role played by each compound identified in the chemical analyses.

Introduction: Refractory cases of alopecia areata (AA) may be considered a therapeutic challenge. Intralesional methotrexate (IL-MTX) has been used in other dermatological diseases rather than AA. Likewise, its topical use as an immunosuppressant drug may be of interest for the control of the lymphoid infiltrate in AA. On the other hand, the use of fractional ablative laser is supported in literature as an alternative or complementary treatment in AA, whilst the generation of columns of thermal damage may favour the migration of cells and cytokines that are beneficial. Case Presentation: In this paper, we present 2 cases in which IL-MTX and ablative fractional CO2 laser were combined with excellent outcomes. Conclusion: Previous research encompasses a total of 23 patients. Most patients presented with patchy AA. The doses administered ranged from 2.5 to 50 mg with an average frequency of 3 weeks. On average, most patients required a minimum of 3 sessions. One case employed 1% topical methotrexate ointment. Adverse local events were mild and transient. In conclusion, the concomitant application of these treatments has not been reported previously. Specific recommendations relating to the appropriate dosing of the drug, frequency of administration, and requirements for analytical control studies should be determined in further studies.

The incidence of lymphogranuloma venereum (LGV) — a sexually transmitted infection (STI) produced by the L1, L2, and L3 serovars of Chlamydia trachomatis — is increasing. The 8 patients in this case series were diagnosed with LGV in the STI unit of our dermatology department. Our patients were younger than those in previously published case series, and on presentation they most often complained of tumorous masses (lymphadenopathy) in the groin. Dermatologists should be familiar with this disease. Samples must be taken correctly to ensure an accurate diagnosis and early treatment.

Resumen: El linfogranuloma venéreo (LGV) es una infección de transmisión sexual (ITS) producida por los serovares L1, L2 y L3 de la bacteria Chlamydia trachomatis y cuya incidencia está en aumento. Presentamos una serie de 8 pacientes diagnosticados en nuestra unidad de ITS del servicio de dermatología. La edad de nuestros pacientes es menor que en otras series publicadas y el síntoma más frecuente de presentación es la tumoración adenopática inguinal. El dermatólogo debe conocer esta enfermedad y realizar una correcta toma de muestras para un diagnóstico preciso y un tratamiento precoz. Abstract: The incidence of lymphogranuloma venereum (LGV) —a sexually transmitted infection (STI) produced by the L1, L2, and L3 serovars of Chlamydia trachomatis— is increasing. The 8 patients in this case series were diagnosed with LGV in the STI unit of our dermatology department. Our patients were younger than those in previously published case series, and on presentation they most often complained of tumorous masses (lymphadenopathy) in the groin. Dermatologists should be familiar with this disease. Samples must be taken correctly to ensure an accurate diagnosis and early treatment.

Resumen Antecedentes La asociacion entre los inhibidores de la dipeptidil peptidasa 4 (iDPP-4) y el penfigoide ampolloso (PA) se ha demostrado en varios estudios. El objetivo principal de este estudio era estimar el uso del tratamiento con iDPP-4i en pacientes diagnosticados de PA en nuestro entorno Material y metodos Seleccionamos pacientes diagnosticados histologicamente de PA en nuestro departamento entre octubre de 2015 y octubre de 2018. Realizamos una revision retrospectiva para evaluar los datos clinicos-epidemiologicos y los patrones de inmunofluorescencia directa (IFD). Resultados De los 70 pacientes diagnosticados con PA durante el periodo de estudio, el 50% eran diabeticos y el 88,57% de ellos estaban siendo tratados con un iDPP-4 en el momento del diagnostico de PA. El iDPP-4 mas frecuente era la linagliptina (utilizada en el 18,6% de los pacientes), seguida de la vildagliptina (el 17,1%). La mediana de tiempo de latencia entre el inicio del tratamiento con iDPP-4 y el diagnostico de PA fue de 27,5 meses, siendo de 16 meses para la linagliptina y 39 meses para la vildagliptina (log Rank Conclusion El tratamiento con DPP-4i es muy comun en pacientes con BP en nuestro entorno. El periodo de latencia entre el inicio del tratamiento y el inicio de la PA parece ser mas corto con linagliptina que con otros tipos de gliptinas. Los pacientes que reciben tratamiento con DPP-4i pueden mostrar patrones DIF diferentes a los que no reciben tratamiento

The association between dipeptidyl peptidase 4 inhibitors (DPP-4i) and bullous pemphigoid (BP) has been demonstrated in several studies. The main aim of this study was to estimate the use of DPP-4i treatment in patients diagnosed with BP in our setting.We selected patients histologically diagnosed with BP in our department between October 2015 and October 2018 and performed a retrospective chart review to assess clinical and epidemiological data and direct immunofluorescence (DIF) patterns.Of the 70 patients diagnosed with BP during the study period, 50% were diabetic and 88.57% of these were being treated with a DPP-4i when diagnosed with BP. The most common DPP-4i was linagliptin (used in 18.6% of patients), followed by vildagliptin (17.1%). The median latency period between initiation of DPP-4i treatment and diagnosis of BP was 27.5 months for all treatments, 16 months for linagliptin, and 39 months for vildagliptin (log rank 0.01). A negative DIF result was significantly more common in patients not being treated with a DPP-4i. The DIF pattern most strongly (and significantly) associated with DPP-4i treatment was linear immunoglobulin G deposits along the dermal-epidermal junction. DPP-4i treatment was withdrawn in 87% of patients and 96% of these achieved a complete response.DPP-4i treatment is very common in patients with BP in our setting. The latency period between start of treatment and onset of BP seems to be shorter with linagliptin than with other types of gliptins. Patients receiving DPP-4i treatment may show different DIF patterns to those not receiving treatment.

Background and objective The epidemiology of genital herpes has changed in recent years with an increase in the incidence of herpes simplex virus type 1 (HSV-1) infection. The aim of this study was to analyze the clinical and epidemiological characteristics of patients diagnosed with genital herpes. Material and methods We designed a descriptive, observational study to analyze all cases of genital herpes diagnosed at a sexually transmitted infections (STI) clinic in Valencia, Spain. Results We identified 895 STI diagnoses. Of these, 126 (14%) were genital herpes; 68 (54%) of these cases were in women and 58 (46%) in men. Diagnosis was confirmed by molecular detection of HSV DNA in 110 cases (87.3%). Of these, 52 were cases of HSV-1 infection (47.3%) and 58 were HSV-2 infection (52.7%). HSV-2 was more common in men (69.5%), while HSV-1 was more common in women (59.3%). In the subgroup of women, mean age at diagnosis was 26 years for HSV-1 and 34 years for HSV-2 (P = .015). Recurrent genital herpes rates were 13% for HSV-1 and 40% for HSV-2. Conclusions There has been an increase in the number of cases of genital herpes caused by HSV-1 in our setting, with young women in particular being affected. This has important prognostic implications because genital herpes caused by HSV-1 is less likely to recur.

Resumen Introduccion La fototerapia se basa en el uso de radiacion ultravioleta para el tratamiento de distintas enfermedades dermatologicas. Su eficacia y seguridad esta ampliamente establecida en adultos y existen publicaciones que tambien lo avalan como un tratamiento efectivo y seguro en pacientes pediatricos con afecciones cutaneas recalcitrantes. Material y metodos Estudio retrospectivo desde 2002 hasta 2017 que incluye a todos los pacientes menores de 17 anos que recibieron fototerapia en nuestro servicio. Ademas, se seleccionaron al azar 122 pacientes adultos que recibieron este tratamiento durante el mismo periodo de tiempo. Resultados Se realizaron un total de 98 tratamientos pediatricos, 61% en ninas y 39% en ninos, con una media de edad de 10,5 anos. Las 3 enfermedades mas frecuentemente tratadas fueron la psoriasis (48% de pacientes), el vitiligo (17%) y la dermatitis atopica (16%). El 86% de los pacientes recibio fototerapia con radiacion ultravioleta B de banda estrecha (UVB-BE), mientras que el 7% recibio fototerapia con radiacion ultravioleta A con psoralenos (PUVA). No existian diferencias estadisticamente significativas en cuanto a dosis, duracion o numero de sesiones con respecto a la poblacion adulta tratada con UVB-BE ni con PUVA. Se alcanzo una respuesta completa en el 35% de los pacientes pediatricos, sin diferencias con respecto a los adultos. Unicamente el 16% de los pacientes mostro efectos adversos, en su mayoria en forma de eritema leve. Encontramos mayor adherencia al tratamiento en los pacientes pediatricos que en los adultos (p Conclusiones La fototerapia con UVB-BE y/o PUVA parece un tratamiento seguro y eficaz en ninos, sin ser necesarios protocolos de tratamiento diferentes a los empleados en adultos. La adherencia al tratamiento es mayor que en los pacientes adultos.

Resumen Introduccion Ixekizumab es un farmaco efectivo y seguro en el tratamiento de pacientes con psoriasis dentro de ensayos clinicos. Nuestro objetivo es valorar la eficacia y seguridad de ixekizumab en la practica clinica habitual. Material Estudio retrospectivo incluyendo todos los pacientes que han recibido ixekizumab en 2 servicios de dermatologia de la ciudad de Valencia. Resultados Se incluyeron un total de 75 pacientes, siendo el 53,3% varones y el 46,7% mujeres con una edad media de 48,61 anos. El 77,3% (58 pacientes) presentaba una psoriasis en placas, mientras que el 22,7% (17 pacientes) presentaba psoriasis de predominio en un area especial. La comorbilidad mas frecuente fue obesidad en el 48% de ellos y el 40% eran naive a biologicos. El PASI inicial medio fue de 9,99, mientras que el PASI medio a la semana 16 era de 1,5. Las respuestas de PASI75 y PASI90 fueron independientes de las comorbilidades analizadas, del sexo, de la edad y del PASI basal. Los pacientes naive a biologicos respondieron mejor que los pacientes que habian recibido tratamiento biologico previo, tanto en la semana 16 como en la semana 52 de forma estadisticamente significativa. Estas observacion tambien se mantuveroni en los pacientes con psoriasis en un area especial. El 25,7% de los pacientes referia algun efecto adverso, siendo lo mas frecuente reaccion en el sitio de inyeccion. No se observaron reacciones adversas graves. Conclusiones El estudio plasma nuestra experiencia en la practica clinica real de ixekizumab, siendo un farmaco efectivo y seguro para el tratamiento de la psoriasis.

Background Ixekizumab has proven efficacy and safety for the treatment of psoriasis in clinical trials. The aim of this study was to evaluate its effectiveness and safety in routine clinical practice. Methods Retrospective study of all patients treated with ixekizumab in 2 dermatology departments in the city of Valencia, Spain. Results Seventy-five patients (53.3% men and 46.7% women) with a mean age of 48.61 years were studied; 77.3% (n = 58) had plaque psoriasis and 22.7% (n = 17) had psoriasis predominantly affecting a specific area. The most common comorbidity was obesity (present in 48% of patients) and 40% of the overall group had not been previously treated with a biologic drug. Mean psoriasis area and severity index (PASI) fell from 9.99 at baseline to 1.5 at week 16. PASI-75 and PASI-90 (improvements of at least 75% and 90% in PASI) were independent of sex, age, baseline PASI, and the comorbidities analyzed. Responses at week 16 and 52 were significantly better in biologic-naive patients for the overall group and the subgroup of patients with localized psoriasis. Adverse effects were reported for 25.7% of patients and the most common effect was injection-site reaction. There were no serious adverse effects. Conclusions Our findings show that ixekizumab is both effective and safe in the treatment of psoriasis in routine clinical practice.

Resumen Introduccion La incidencia de uretritis por Haemophilus esta aumentando. Nuestro objetivo principal es describir las caracteristicas clinico-microbiologicas de estos pacientes. Como objetivo secundario discutiremos el tratamiento mas adecuado en funcion de las resistencias antibioticas testadas. Material y metodos Seleccionamos los pacientes de la Unidad de Infecciones de Transmision Sexual diagnosticados microbiologicamente de uretritis entre julio de 2015 y julio de 2018. De ellos, seleccionamos aquellos en los que se aislo un Haemophilus mediante cultivo agar chocolate. Las resistencias antibioticas se testaron mediante metodo de difusion disco-placa. De estos pacientes se recogieron los datos de forma transversal y prospectiva durante las visitas en consultas externas. Resultados Se aislo un Haemophilus spp. en 33,6% de los pacientes diagnosticados de uretritis. De estos pacientes, la manifestacion clinica mas frecuente fue la supuracion uretral (57,9%) y el 60% eran hombres que tienen sexo con hombres, siendo el aislamiento de este microorganismo mas frecuente de forma estadisticamente significativa entre los hombres que tienen sexo con hombres que el aislamiento de Neisseria o Chlamydia. Haemophilus spp. se encontro de forma aislada en el 39,5% de los pacientes, siendo el mas frecuente H. parainfluenzae en el 84,2%. El 34,2% de los casos de Haemophilus aislados fueron resistentes a azitromicina y el 26,3% eran resistentes tanto a azitromicina como a tetraciclinas. En los casos en los que no se perdio el seguimiento del paciente (n = 17; 44,7%), el tratamiento administrado de forma empirica consiguio una remision clinica y microbiologica en 11 pacientes, mientras que en 6 fue necesario administrar una pauta de un nuevo antibiotico. Conclusiones Haemophilus es un nuevo agente etiologico de uretritis no gonococicas cuya incidencia esta en aumento, especialmente entre hombres que tienen sexo con hombres que practican sexo oral sin proteccion. Estos pacientes pueden presentar una clinica similar a una uretritis gonococica. Es necesario confirmar la erradicacion debido al elevado numero de resistencias antibioticas testadas en Haemophilus spp.

Introduction: The incidence of urethritis due to Haemophilus species is increasing. The main aim of this study was to describe the clinical and microbiological characteristics of patients with this form of urethritis. A secondary aim was to discuss the adequacy of treatments in patients with different types of antibiotic resistance. Material and methods: We studied patients with a microbiologically confirmed diagnosis of urethritis seen at the Sexually Transmitted Infections Unit of our hospital between July 2015 and July 2018. We selected all patients in whom Haemophilus species were isolated on chocolate agar. Antibiotic resistance was tested using the disk-diffusion method. Cross-sectional data were collected prospectively during outpatient visits. Results: Haemophilus species were isolated in 33.6% of cases. The most common clinical manifestation was urethral discharge (57.6%); 60% of the patients were men who have sex with men and in this subgroup Haemophilus species were significantly more common than either Neisseria or Chlamydia species. Haemophilus species were found in isolation in 39.5% of patients and the most common one was Haemophilus parainfluenzae (isolated in 84.2% of cases). In total, 34.2% of patients were resistant to azithromycin and 26.3% were resistant to both azithromycin and tetracycline. Empirical treatment achieved clinical and microbiologic cure in 11 of the patients who were not lost to follow-up (n = 17; 44.7%). The remaining 6 patients required treatment with a new antibiotic. Conclusions: Haemophilus species are a new cause of nongonococcal urethritis, whose incidence is rising, particularly in men who have sex with men who engage in unprotected oral sex. The clinical manifestations are similar to those seen in gonococcal urethritis. Eradication of infection must be confirmed due to the high rate of antibiotic resistance associated with Haemophilus species. (C) 2018 AEDV. Published by Elsevier Espana, S.L.U. All rights reserved.

Epidermolytic acanthomas (EA) are rare benign tumors of unclear etiology that present as flat, sometimes slightly keratotic, pale or whitish papules that are usually asymptomatic. Not uncommonly, their clinical appearance in the anogenital area might lead to misdiagnosis as other lesions that commonly develop at this site, such as condylomata acuminata. Though mainly asymptomatic, there are also reports of EA presenting with persistent genital pruritus. We describe the first reported case of pruritic scrotal EA successfully treated with topical pimecrolimus.

Coronavirus disease 2019 (COVID‐19), caused by severe acute respiratory syndrome‐related coronavirus 2 (SARS‐CoV‐2), was first reported in China on December 2019. Almost 5 months into the pandemic, little is still known about cutaneous manifestations in COVID‐19. In fact, the prevalence of cutaneous signs varies greatly in the literature, ranging from 0.2% to 20.4%. Given their potential association with COVID‐19, acral lesions have received special attention worldwide, both in the medical literature and the media. Our aim is to share our experience regarding acral manifestations during this pandemic.

The differential diagnosis of Grover disease (GD) includes pemphigus foliaceus. However, the focal nature of the histologic findings and negative direct immunofluorescent point to the diagnosis of GD. It has been associated with a variety of systemic and cutaneous diseases, but its association with other primary acantholytic disorders has been rarely documented. In this article, we describe the first case of GD in association with pemphigus foliaceus.

Pemphigus foliaceus is an autoimmune bullous disease with autoantibodies against desmoglein 1. Case reports of pemphigus after surgery have also been described, which may simulate an infection of the surgical wound, a contact dermatitis, or even a tumor recurrence. Cytoimmunofluorescence can help to establish a rapid diagnosis.

Chlorpromazine is known to produce both systemic phototoxic and photoallergic reactions. However, it may also cause photoallergic contact dermatitis and, albeit exceptionally, allergic contact dermatitis (ACD). We present a series of photoallergic contact dermatitis and ACD to chlorpromazine diagnosed at a tertiary centre cutaneous allergy unit between 1980 and 2019.

Background/objectives Several studies have reported that non-alcoholic fatty liver disease (NAFLD) is more frequent in patients with psoriasis, but few have reviewed the presence of liver fibrosis in those patients. Methods Cross-sectional cohort, single-centre study, continuously selecting all patients with moderate-severe psoriasis seen at the Psoriasis Unit of a Tertiary Hospital. The grade of liver steatosis was assessed using liver ultrasound, and the quantity of liver fibrosis was graded using a transitional vibration-controlled elastography (Fibroscan®). Results A total of 71 patients (66.2% male) were included, with an average age of 46.6 years old. The maximum historical PASI average was 14.4 while the baseline PASI average at the time of the study was 2. A third (36%) of patients met the criteria for metabolic syndrome 52% of patients had steatosis; being male, having metabolic syndrome comorbidities, elevated AST/ALT enzymes, dyslipidemia and high initial PASI were significantly related. 14% of patients had moderate liver fibrosis (≥7.6 KPa). In 30% of them, no ultrasound liver steatosis was observed. Conclusions Elastography may be a useful tool along with ultrasound to evaluate liver disease in patients with psoriasis.

Background Since 2009, an increasing number of published cases of allergic contact dermatitis (ACD) from isothiazolinones in Europe was observed, amounting to an epidemic. However, only few studies have assessed the current situation after changes in European regulation. Objectives To analyze the incidence of isothiazolinone-related ACD in our area in the last decade. Methods A retrospective study analyzed all patients patch tested in the allergy unit in a tertiary hospital in Spain between January 2010 and June 2019. Positive patch-test reactions to methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI) and/or MI alone were recorded. Results A total of 243 patients (9.55%) with positive patch-test reactions to MCI/MI and/or MI alone among 2544 consecutively patch-tested patients were recorded. An initial increase in the prevalence of MCI/MI allergy was observed, from 4.5% in 2010 reaching a peak in 2015, which was followed by a significant decrease until July 2019 with 3.1% prevalence in 2019. Conclusions As shown in our data, regulatory interventions have resulted in a dramatic decrease in the prevalence of MCI and MI ACD, reaching a pre-epidemic level of 3.1% in 2019.

Dupilumab, a biologic drug approved for the treatment of moderate-to-severe atopic dermatitis, has been associated with resolution or improvement in pre-existing alopecia areata. We report a case of significant improvement of AA after Dupilumab-onset treatment for atopic dermatitis and review the literature.