Actas dermo-sifiliograficas最新文献

Interleukin 12/23 inhibitors (IL-12/23i) and interleukin 17 and 23 inhibitors (IL-17i and IL-23i) represent the drug classes with the most favorable expectations for therapeutic response. However, the introduction of biosimilars has led many centers, for reasons of efficiency, to prioritize tumor necrosis factor inhibitors (TNFi) as first-line therapy. Data on whether prior exposure to TNFi may affect the drug survival of IL-17i and IL-23i therapies are lacking. Using data from the Biobadaderm registry, we compared treatment persistence among patients with psoriasis who received IL-17i or IL-23i as first-line therapy and those who received these agents after prior TNFi treatment. Rates of treatment discontinuation and adverse events (AEs) were compared between groups. Results showed that overall drug survival was higher in patients treated first line with IL-17i or IL-23i vs those treated after TNFi exposure. However, no significant differences were observed between groups in treatment discontinuation due to inefficacy or serious AEs. Overall AE rates were similar, with no differences in serious AEs or serious infections. Although global AE rates and discontinuation due to AEs were higher in patients previously on TNFi who subsequently received IL-17i or IL-23i vs biologic-naïve patients, these differences did not reach statistical significance. In conclusion, this study suggests that prior exposure to TNFi may influence the persistence of IL-17i and IL-23i therapies in patients with psoriasis.

Introduction: Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are the current first-line therapy for non-small cell lung cancer (NSCLC). Acneiform rash is a common adverse effect of this treatment, leading to treatment interruption and affecting the patients' quality of life.

Methods: We conducted a systematic review to assess the role of oral tetracyclines in the prevention of acneiform rash on patients with NSCLC on EGFR TKIs. We conducted a search across Pubmed, Web of Science and Cochrane databases in January 2025. Studies were included if they evaluated prophylactic treatment with oral tetracyclines for acneiform rash in patients with non-small cell lung cancer initiating concomitant epidermal growth factor receptor tyrosine kinase inhibitor therapy.

Results: Two of the 7 selected studies found tetracyclines to reduce all-grade rash - doxycycline (74.2% to 57.2%) and tetracycline (75.6% to 44.5%; p = 0.046). Two found tetracyclines did not reduce all-grade rash but were effective in reducing high-grade rash - doxycycline (19% to 4%; p < 0.001) and minocycline (28% to 12%; p = 0.0455). Single-arm studies reported varying rash incidences rates with minocycline (from 44.8% to 68.3%), inferior to those found in the major trials used for comparison (67% and 77.7%).

Conclusion: Oral tetracyclines appear to reduce the incidence of all-grade acneiform rash or, alternatively, to decrease the incidence of high-grade rash. Preventive treatment for acneiform rash at the initiation of epidermal growth factor receptor tyrosine kinase inhibitor therapy should therefore be considered. Further controlled trials are needed to confirm the efficacy of oral tetracyclines in preventing acneiform rash.

Background: One of the main strategies in the prevention of photodermatoses is the use of topical sunscreens, which sometimes must be applied together with topical drugs specific for the dermatosis with the possibility that the efficacy of the sunscreen may be altered.

Objectives: The aim of this study was to analyse whether the efficacy of the sunscreen could be affected when applied together with topical drugs routinely used in patients with photodermatoses and whether there is any variation when they are applied before or after the drug.

Methods: Ninety-three volunteer patients with photodermatoses participated. Very high SPF sunscreens were used with corticosteroids, antibiotics and topical antifungals as active ingredients. Paravertebral areas were delimited in each individual and the sunscreen was applied alone and in association with a drug in different sequential order. Ultraviolet reflectance photography and image analysis were used to compare the level of UV absorption by the sunscreen/drug combinations in the different areas.

Results: UV reflectance analysis showed no difference in the efficacy of the sunscreen applied before or after the various drugs used. In the antifungal group, a significant increase in the effect of the sunscreen was observed when the antifungal was applied first.

Conclusions: The efficacy of sunscreens was not altered by combined use with corticosteroids, antibiotics or topical antifungals. These results are of great relevance for patients with photodermatosis who often have to combine these active ingredients with photoprotection.

Pseudomonas aeruginosa is a gram-negative opportunistic bacillus of great relevance in dermatology due to its ability to cause a wide spectrum of skin infections. These infections can be characterized by a greenish discoloration and a distinctive odor and can range from mild signs, such as folliculitis, green nail syndrome, hot hand-foot syndrome, and uncomplicated acute otitis externa, which generally respond to conservative therapy and topical antibiotics, to deeper and potentially severe infections, such as subcutaneous nodules, malignant otitis externa, ecthyma gangrenosum, and necrotizing infections, which require a multidisciplinary approach, systemic antibiotics and surgical procedures. The growing antimicrobial resistance of P. aeruginosa poses a significant therapeutic challenge. This article provides a literature review focused on the various presentations and clinical signs of this pathogen, its resistance mechanisms, and the different therapeutic options.

Topical clascoterone (TC) is the first topical antiandrogen approved by the Food and Drug Administration (FDA) for the treatment of acne and is currently under evaluation for approval in Europe. Through bibliographic searches in Medline and Google Scholar, we conducted a narrative review to assess the usefulness of TC in acne management. Several randomized clinical trials have demonstrated its efficacy and safety (with virtually no systemic adverse effects), but few have compared its effectiveness with other topical agents or its use in combination. It is a highly interesting therapeutic alternative, particularly for patients who do not tolerate other topical treatments or in cases of acne with a strong hormonal component. U.S. treatment guidelines conditionally recommend it for acne management due to its high cost. The strength of recommendation is lower than that of topical retinoids and benzoyl peroxide.

Background: An adverse drug reaction (ADR) is a harmful and unintended response to drugs administered in therapeutic doses. Among these, cutaneous adverse reactions (CARs) are one of the most frequent clinical forms, which may occasionally be severe (SCARs).

Objectives: To describe the epidemiology of SCARs managed in a pediatric hospital.

Methods: A retrospective observational study of patients under 18 years of age who presented with a SCARs between January 1, 2011, and December 31, 2022.

Exclusion criteria: immunosuppression, IgE-mediated allergic reactions, incomplete data, and no need for hospitalization.

Results: Of the 2433 patients diagnosed with a CAR, 34 (1.4%) presented with a SCAR. The main drugs involved were antibiotics, followed by NSAIDs and anticonvulsants. In 97.1% of cases (33 patients), the reason for prescribing the medications was an acute pathology. The final diagnoses were as follows: severe maculopapular rash in 21 patients, DRESS syndrome in 6, generalized exanthematous pustulosis in 3, erythema multiforme in 2, Stevens-Johnson syndrome in 1 and toxic epidermal necrolysis in 1. Two patients (5.9%) had a poor outcome. No deaths were reported in this series.

Conclusion: SCARs are very rare in pediatrics with a predominance of severe maculopapular rash. Clinical outcomes are generally favorable, although approximately 5% may present acute complications or sequelae, some of which may be severe. Therefore, upon initial suspicion of any of these SCARs, the potentially causal drugs should be immediately discontinued.

Background: MF/SS-CTCL-QoL is the first specific questionnaire to measure the quality of life (QoL) of patients with Mycosis Fungoides (MF) and Sézary Syndrome (SS). It was developed by the Cutaneous Lymphoma Foundation.

Objectives: 1) Translate and cross-culturally adapt the MF/SS-CTCL-QoL to Spanish (Spain). 2) To study correlation and concordance of the MF/SS-CTCL-QoL with PROM (Patient Reported Outcome Measurements): EORTC QLQ-C30, Dermatology Life Quality Index (DLQI) and Skindex-29.

Material and methods: Using a 10-step procedure, including expert meetings and surveys of adult patients with MF or SS, a Spanish version of the MF/SS-CTCL-QoL was developed. Subsequently, its comprehensibility, completeness and relevance were evaluated. A correlation study was performed using Spearman's rho coefficient and concordance using the intraclass correlation coefficient (ICC), between MF/SS-CTCL-QoL and the EORTC QLQ-C30, DLQI and Skindex-29 questionnaires.

Results: Translation was satisfactory for professionals and patients, with minimal adaptations required. Excellent correlation (0.8499) was observed between MF/SS-CTCL-QoL and Skindex-29, good (0.7394) with DLQI and poor (0.5602) with EORTC QLQ-C30. Agreement was moderate (0.699) with DLQI, significant (0.865) with Skindex-29 and low (0.568) with EORTC QLQ-C30.

Conclusions: The Spanish version of MF/SS-CTCL-QoL represents a useful tool for the clinical management of patients with MF and SS. It is linguistically equivalent to the original, assesses the same dimensions with an adequate level of comprehensibility. There is an excellent correlation with Skindex-29, good with DLQI and poor with EORTC QLQ-C30.

Background and objective: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease. Treatment for moderate-to-severe HS includes biologic therapies (adalimumab and secukinumab), resulting in increased disease management costs. Our aim was to estimate the difference between secukinumab and adalimumab in terms of pharmacological costs and costs per responding patient 1 year into therapy from the Spanish National Health System (NHS) perspective.

Material and methods: We designed a decision tree comparing different treatment sequences, starting with a different first-line therapy. Patients switched arms based on achieving HS clinical response ≥ 50% (based on the SUNSHINE, SUNRISE, and PIONEER clinical trials results). A cohort of 100 patients was considered. Only treatment costs in euro (2023 base year) were considered for the analysis. A panel of experts validated the model structure and parameters.

Results: After 52-weeks into therapy, treatment sequences in the secukinumab group resulted in a total cost of euro1,198,912, corresponding to euro16,858 per responder. Total costs in the adalimumab treatment group were 2.5% higher, corresponding to euro19,701 per responder. A total of 80% of responders who start treatment with secukinumab do not change treatment, while only 31% of responders who start treatment with adalimumab stay on the same treatment.

Conclusions: The results of our financial assessment can help decision makers in selecting the most efficient therapeutic approach for treating patients with moderate-to-severe HS and poses secukinumab as a suitable therapeutic option for the Spanish NHS.

Background: The gut microbiota interacts with the immune system and plays an important role in many inflammatory diseases such as psoriasis, although the exact mechanisms in this disease are not yet well understood.

Objectives: To characterize differences in the microbiota between patients with psoriasis and healthy controls, and to assess the relationship between these differences and the interleukins involved in psoriasis.

Methods: A cross-sectional observational study was conducted in which sociodemographic data, blood samples, and stool samples were collected from patients with psoriasis and healthy controls attending our center between June 2019 and May 2020. Cytokines (interleukin (IL) 17, 22, 23, 31, 33, 36, interferon (IFN) γ, and transforming growth factor (TGF) β) were analyzed using ELISA, and microbiota was analyzed through 16S amplicon sequencing.

Results: Thirty-six patients and 23 controls were included. Absolute abundance analysis found a higher abundance of the phylum Synergistota in the control group (p<0.05). Differential abundance analysis found higher abundance of the genus Subdoligranulum and Lactobacillus, and the species Bacteroides plebeius (p<0.05), and lower abundance of the species Senegalimassilia anaerobia and the genus Ruminococcus (p<0.05) in the psoriasis group. A relationship was observed between Subdoligranulum and TNFα, IL17, IL22, IL23, IL31, IL33, IL36, IFNγ, and TGFβ (p<0.05), as well as between Lactobacillus and IL17, IL23, IL36, TNFα, and TGFβ (p<0.05).

Conclusions: Significant alterations in the gut microbiota of patients with psoriasis were detected and a relationship with inflammatory interleukins, suggesting their involvement in the disease. These findings could aid in the development of future probiotic treatments for psoriasis.