Search

Part 2 of this series on granulomatous diseases focuses on skin biopsy findings. Whereas the first part treated noninfectious conditions (metabolic disorders and tumors, among other conditions), this part mainly deals with various types of infectious disease along with other conditions seen fairly often by clinical dermatologists.

This series of 2 articles on dermatopathologic diagnoses reviews conditions in which granulomas form. Part 1 clarifies concepts, discusses the presentation of different types of granulomas and giant cells, and considers a large variety of noninfectious diseases. Some granulomatous diseases have a metabolic origin, as in necrobiosis lipoidica. Others, such as granulomatous mycosis fungoides, are related to lymphomas. Still others, such as rosacea, are so common that dermatologists see them nearly daily in clinical practice.

Resumen: La patología vascular oclusiva es causante de diversas y variadas manifestaciones clínicas, algunas de ellas con catastróficas consecuencias para el paciente. Dado que las causas de tal oclusión son muy variadas, hemos abordado en un artículo previo reciente en esta misma revista las causas trombóticas. En el presente artículo recopilamos diversas causas adicionales de oclusión intravascular. Abstract: Vascular occlusion has multiple, diverse clinical manifestations, some of which can have grave consequences for patients. It also has a wide variety of causes, including thrombi, which we recently addressed in part I of this review. In this second part, we look at additional causes of vascular occlusion.

Vascular occlusion has multiple, diverse clinical manifestations, some of which can have grave consequences for patients. It also has a wide variety of causes, including thrombi, which we recently addressed in partI of this review. In this second part, we look at additional causes of vascular occlusion.

This series of 2 articles on dermatopathologic diagnoses reviews conditions in which granulomas form. Part 1 clarifies concepts, discusses the presentation of different types of granulomas and giant cells, and considers a large variety of noninfectious diseases. Some granulomatous diseases have a metabolic origin, as in necrobiosis lipoidica. Others, such as granulomatous mycosis fungoides, are related to lymphomas. Still others, such as rosacea, are so common that dermatologists see them nearly daily in clinical practice.

Resumen Antecedentes y objetivo Los ensayos pivotales de omalizumab en urticaria cronica espontanea (UCE) tienen un periodo de tratamiento de entre 12 y 24 semanas. Sin embargo, muchos pacientes en practica clinica requieren periodos de tratamiento mas prolongados. Por ello el objetivo es presentar un algoritmo de manejo del farmaco. Materiales y metodos El documento de consenso que detallamos nace de la puesta en comun, aceptacion, revision y confrontacion de la literatura reciente del grupo de trabajo de UCE «Xarxa d’Urticaria Catalana i Balear» (XUrCB). Resultados Se inicia el tratamiento a dosis autorizada y se ajusta la dosis en intervalos trimestrales en funcion del Urticaria Activity Score de los ultimos 7 dias (UAS7) y/o el Urticarial Control Test (UCT). Conclusiones El algoritmo propuesto pretende servir de guia respecto a como ajustar dosis, como y cuando parar el farmaco y el modo de reintroducirlo en casos de recaida.

Resumen La dermatitis de contacto alergica (DCA) es una enfermedad frecuente en la practica clinica diaria, con una prevalencia que ha aumentado en los ultimos anos. Clinicamente se caracteriza por grados variables de eritema, vesiculacion, descamacion y liquenificacion, signos que tambien estan presentes en otros procesos eccematosos. Las pruebas epicutaneas constituyen la principal herramienta diagnostica para confirmar una DCA, sin embargo, su correcta interpretacion requiere de una correcta correlacion entre la anamnesis (historial de exposicion) y el examen fisico. En este articulo se describen de forma practica y didactica los patrones clinicos mas frecuentes de DCA dependiendo de su localizacion. El conocimiento de estos patrones no solo ayudara al clinico en el diagnostico diferencial, sino que tambien le permitira sospechar el posible alergeno y su forma de aplicacion.

Resumen Las caracteristicas clinicas de la piel y mucosa asi como las patologias dermatologicas de los pacientes con sindrome de Down son en ocasiones cronicas y de dificil manejo. La xerosis intensa y la dermatitis peribucal resultan en un reto terapeutico para el especialista. El manejo multidisciplinar y proactivo involucrando a la familia y al paciente que es capaz de entender y seguir rutinas resultan fundamentales para evitar complicaciones comunes como la sobreinfeccion. Las nuevas formulaciones cosmeticas que incluyen activos capaces de proteger y restituir la funcion barrera son de ayuda para evitar las comorbilidades y el uso excesivo de farmacos. Los autores realizan una revision de las principales patologias y condiciones especificas de la piel asi como de las medidas para su correcto manejo.

The clinical features of the skin and mucosa as well as the dermatological pathologies of patients with Down syndrome are sometimes chronic and difficult to treat. Intense xerosis and perioral dermatitis result in a therapeutic challenge for the specialist. Multidisciplinary and proactive management involving the family and the patient who is able to understand and follow routines are fundamental to avoid common complications such as superinfection. New cosmetic formulations that include active agents capable of protecting and restoring barrier function are helpful in avoiding comorbidities and excessive drug use. The authors perform a review of the main pathologies and specific conditions of the skin as well as the measures for its correct management.

The efficacy of omalizumab in the treatment of chronic spontaneous urticaria has been demonstrated in phase iii clinical trials, but limited information is available regarding real-life effectiveness using the weekly Urticarial Activity Score (UAS7). The aim of the study was to assess clinical response (UAS7≤6) and complete response (UAS7=0) rates at weeks 12 and 24 in a real-life cohort and to identify possible predictors of response to omalizumab.Clinical records of consecutive patients with moderate-to-severe chronic spontaneous urticaria (UAS≥16) treated with omalizumab at a university-affiliated reference dermatology department in Barcelona, Spain, from February 2014 to September 2017 were retrospectively reviewed. UAS7 values and patients' evolution were assessed according to a predefined protocol. Statistical analysis of data was done using SPSS 18 statistical package (SPSS 18 Inc., Chicago, IL, USA) software.Forty-eight patients were included in the study. All of them completed at least 24-weeks of treatment and follow-up. At week 12, clinical response rates (UAS76) were 70.8% and complete response rates (UAS7=0) were 47.9%. At week 24, clinical response rates were 64.6% and complete response rates were 52.1%.with long-term urticaria (≥18 months' duration) were less likely to achieve a clinical response at week 12 (odds ratio: 0.25; 95% confidence interval 0.06-0.96). Previous immunosuppressive treatment tended to be associated with a lower probability of complete response at week 12 (odds ratio: 0.27 95% confidence interval: 0.07-1.02). H1-antihistamine treatment was associated with lower probability of response at week 24 (odds ratio: 0.1 95% 95% confidence interval: 0.01-0.88) CONCLUSIONS: The effectiveness and safety of omalizumab in real life are similar to efficacy and safety in clinical trials. Duration of disease, previous immunosuppressive therapy and requirement for concomitant H1-antihistamine treatment may be helpful in predicting response to omalizumab treatment.

Pivotal trials with omalizumab for treatment of chronic spontaneous urticaria (CSU) are generally run over 12 to 24weeks. However, in clinical practice, many patients need longer treatment. In this article, we present an algorithm for treatment with omalizumab.The consensus document we present is the result of a series of meetings by the CSU working group of "Xarxa d'Urticària Catalana i Balear" (XUrCB) at which data from the recent literature were presented, discussed, compared, and agreed upon.Treatment with omalizumab should be initiated at the authorized dose, and is adjusted at 3-monthly intervals according to the Urticaria Activity Score Over 7days, the Urticaria Control Test, or both.The algorithm proposed is designed to provide guidance on how to adjust omalizumab doses, how and when to discontinue the drug, and how to reintroduce it in cases of relapse.

Background and objective Pivotal trials with omalizumab for treatment of chronic spontaneous urticaria (CSU) are generally run over 12 to 24 weeks. However, in clinical practice, many patients need longer treatment. In this article, we present an algorithm for treatment with omalizumab. Material and methods The consensus document we present is the result of a series of meetings by the CSU working group of “Xarxa d’Urticaria Catalana i Balear” (XUrCB) at which data from the recent literature were presented, discussed, compared, and agreed upon. Results Treatment with omalizumab should be initiated at the authorized dose, and is adjusted at 3-monthly intervals according to the Urticaria Activity Score Over 7 days, the Urticaria Control Test, or both. Conclusions The algorithm proposed is designed to provide guidance on how to adjust omalizumab doses, how and when to discontinue the drug, and how to reintroduce it in cases of relapse.

Allergic contact dermatitis (ACD) is a common disease in daily clinical practice, and its prevalence has increased in recent years. It is characterized clinically by varying degrees of erythema, vesiculation, flaking, and lichenification, though these signs can also be present in other eczematous diseases. Patch testing is the main diagnostic tool to confirm ACD, but its accurate interpretation requires correct correlation with the medical history (details of exposure) and physical examination. We provide a practical and instructive description of the most common clinical patters of ACD depending on the area affected. Knowledge of these patterns will not only help the clinician reach the diagnosis but will suggest possible allergens and forms of contact.