Actas dermo-sifiliograficas最新文献

Skin cancer is a growing global health challenge, emphasizing the need for early detection. In recent years, 3D total-body photography has emerged as a promising tool in dermatology. This non-invasive imaging technique provides a comprehensive visual representation of a patient's skin, enabling the early detection of suspicious lesions and the surveillance of existing nevi. Despite its promising role in early melanoma detection, ongoing research is essential to validate its real-world impact and address its current limitations. Although it enhances diagnostic accuracy, this technique currently does not replace the need for a thorough examination by a dermatologist. This review provides a comprehensive overview of the most recent findings on the application of 3D total-body photography in melanoma diagnosis.

Background: Patients with chronic spontaneous urticaria frequently relapse after discontinuing omalizumab and require its reintroduction. Although prior optimization might reduce recurrences, there is scarce evidence on this issue. Moreover; predictors of relapse have been identified in non-optimized patients before suspension.

Methods: We conducted a multicenter retrospective study with patients who discontinued omalizumab after optimization at a 12-month follow-up. Univariate and multivariate (tree classification method and Cox regression) analyses were performed.

Results: A total of 131 patients were included, 32.8% of whom relapsed after 12 months. Relapsed patients had longer disease duration (24.00 vs 11.00 months; p = 0.032), quicker response to standard dosage (1.00 vs. 3.00 months;; p = 0.014), fewer complete responses pre-optimization (83.70% vs 95.50%; p = 0.023), and shorter treatment duration at 300 mg/4 weeks (6 vs 7 months; p = 0.035). Multivariate analysis revealed that patients with low baseline C-reactive protein (CRP) and total immunoglobulin E (IgE) who underwent prolonged treatment were more likely to maintain a sustained remission at 12 months.

Conclusion: Optimization seems to reduce the relapse rate after discontinuation. The most relevant factors for recurrence are associated with the duration of treatment at different doses of omalizumab, along with the baseline CRP and total IgE levels. To minimize relapse after suspension, a 12-month treatment regimen at 300 mg/4 weeks followed by an 18-month dose tapering is proposed.

In recent decades, the use of certain oral anticholinergics for the treatment of hyperhidrosis has become widespread, often off-label but supported by multiple studies, including clinical trials, demonstrating their effectiveness and an apparently good safety profile. Similarly, various studies published in recent years have associated the use of anticholinergics to the development of dementia, particularly in elderly patients. Additionally, other studies have suggested that hyperhidrosis itself may be an early symptom of developing dementia. However, to date, no research has specifically linked the use of oral anticholinergics for hyperhidrosis treatment with the development of dementia. We present the currently available data on this controversial topic.

Background and objectives: Hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC), or Lyral® is a fragrance marker that is part of the Fragrance Mix II (FM II) and is still patched as an independent allergen within the European and other baseline series despite the European Commission banning its use in cosmetics in 2021. We aimed to study the prevalence of sensitization to the HICC in Spain and its simultaneous positivity with the FM II to determine whether it should be part of the Spanish standard path test series.

Material and method: We analysed all consecutive patients simultaneously patch-tested with HICC and FM II from the Spanish Contact Dermatitis Registry (REIDAC) from June 1^st, 2018 through December 31^st, 2023.

Results: A total of 96 (0.8%) out of 12,029 patients analyzed tested positive to HICC and 396 (3.3%) to FM II. In 53% and 64% of the patients, respectively, findings were considered currently relevant. A total of 72 out of 96 (75%) HICC positives would be detected if only FM II were patched.

Conclusions: Prevalence of HICC sensitization in Spain is low and has decreased in recent years. HICC is a prohibited fragrance in cosmetics and FM II detects 3 in 4 sensitized patients. Our results suggest that HICC should remain outside the Spanish standard patch test series and support its exclusion from the European standard patch test series.

Background: Biosynthetic porcine type I collagen dressing is useful to close ulcers and secondary intention healing of surgical cancer wounds.

Objective: To identify factors associated with the healing time of such wounds.

Methods: We conducted a retrospective observational study of patients on oncological dermatological surgery in a cancer center. Healing time was studied based on age, sex, personal history of comorbidities, usual medication, anatomical location, type of surgery performed and size of the defect. Statistical analysis was performed using the ANOVA test and logistic regression.

Results: A total of 306 patients were included with a median age of 73 years (62.4%, men). The statistically significantly characteristics associated with a healing time ≤ 66 days were location-auricle, nose, inner canthus, hand, retroauricular region and nail bed-use of the Mohs technique and defect sizes ≤ 5.28 cm².

Limitations: This is a retrospective study from a single center.

Conclusion: The use of biosynthetic porcine type I collagen dressings for the definitive closure of dermatological surgical cancer wounds seems particularly suitable for small defects of the inner canthus of the eye, hand, auricle, nose, forehead, retroauricular region, and nail bed.

Introduction: Hidradenitis suppurativa (HS) is a chronic skin disease whose impact on skin homeostasis has not been adequately studied at present. Knowledge about how skin function changes in these patients, and could be of interest not only to improve the topical management of the disease, but also as an objective measure of disease activity. The aim of this study was to compare skin homeostasis and the epidermal barrier function in lesional and healthy skin areas of patients with HS.

Methods: We conducted a cross-sectional study. Skin homeostasis and the epidermal barrier function of lesions were assessed in HS patients using validated tools. A healthy perilesional skin control was assigned to each lesion to compare skin homeostasis parameters.

Results: A total of 43 patients were included: 22 nodules, 10 abscesses and 25 draining tunnels were measured. The male-to-female ratio was 20:23, and the mean age, 35.95 years (SD, 14.82). Increased transepidermal water loss (TEWL) and erythema were found in nodules, abscesses and draining tunnel vs healthy skin. A direct association was observed between inflammatory nodules TEWL and IHS4 stage. In draining tunnels, a direct association was observed between TEWL and smoking. A trend of increasing TEWL values was observed as a function of Hurley stage.

Conclusion: HS lesions exhibit epidermal barrier dysfunction that depends on the severity of inflammatory activity. These results could be useful to develop objective classification systems for the severity and degree of involvement of HS or help in the development of vehicles for specific drugs, antiseptics and dressings for the management of this disease.

Introduction: Dupilumab is an IL-4 / IL-13 inhibitor monoclonal antibody approved for the treatment of moderate-to-severe atopic dermatitis (AD) with remarkable safety and efficacy profiles. However, former studies have reported an increase in serum eosinophils during treatment, with undetermined clinical significance.

The objective: of this study is to evaluate changes in blood eosinophils and other laboratory parameters while on dupilumab.

Methods: We conducted a multicenter, prospective, observational study from 2018 through 2022 with adolescent and adult patients with moderate-to-severe atopic dermatitis treated with dupilumab from Hospital Universitario Virgen de las Nieves, Spain, and Coimbra University Hospital, Portugal. Clinical scoring of the dermatitis, complete blood count, total serum IgE and LDH levels were collected at baseline and on weeks 8, 16, 24 and 48.

Results: We included a total of 81 patients (41 women/40 men; mean age of 30.86 ± 12.26 years). Clinical and demographic characteristics were similar across centres. AD severity scales (EASI, SCORAD, ItchVAS and SleepVAS) showed sustained improvement from week 8 of treatment onwards. Eosinophil levels were significantly higher on week 16 (0.69 x10³/μL) vs baseline (0.41 x10³/μL) (p = 0.018) and returned to baseline levels on week 48 (0.59 x10³/μL, p > 0.05). LDH and IgE levels decreased during the study.

Conclusion: Our study showed a significant clinical improvement of AD but a mild and self-limited increase in eosinophil levels on week 16, not associated with any clinical signs. Therefore, elevated serum eosinophil levels in AD patients on dupilumab does not seem clinically relevant and should not condition treatment withdrawal.

Background: Actinic keratoses (AKs) are chronic, recurrent precancerous lesions primarily induced by long-term sun exposure, commonly found on sun-exposed areas such as the face, neck, hands, forearms, and lower legs. AKs are prevalent, affecting millions worldwide, and pose a significant risk of transforming into invasive squamous cell carcinomas (SCCs).

Objective: This systematic review aims to update the scientific evidence on the role of oral bioactives, nutraceuticals, or dietary supplements in the treatment of AKs and field cancerization, while evaluating their safety and efficacy profile.

Methods: A review plan was pre-registered in the PROSPERO database (CRD42023485985). Following the PRISMA guidelines, we identified, selected, and included relevant studies. We screened a total of 234 articles, thoroughly reviewed 38 full texts, and ultimately included 21 articles published from 2013 through 2023 for analysis.

Results: The selected studies were categorized into 3 groups based on the chemical nature of the supplements: polyphenols (11 studies), vitamins (8 studies), and others (2 studies). The studies included preclinical (9) and clinical (12) studies. Clinical trials have demonstrated the efficacy profile of polyphenolic supplements, such as Polypodium leucotomos extract (PLE) and others in improving skin health and reducing the risk of skin cancers. Preclinical studies highlighted the protective effects of polyphenols against UV-induced damage and neoplastic transformation. Vitamin supplementation studies revealed mixed results, with clear data showing benefits in reducing the risk of precancerous lesions and skin cancers after nicotinamide (NAM) treatment, while others did not demonstrate significant protective effects.

Conclusions: The review confirms the efficacy of polyphenols in preventing and treating AKs and related skin conditions. However, the role of vitamins and other supplements requires further investigation due to inconsistent and/or scarce findings. Future clinical trials should focus on diverse populations at higher risk of skin cancer and explore new ingredients as well as combinations of various ingredients to optimize therapeutic applications.

Although secondary intention healing (SIH) is a fundamental aspect of postoperative care following Mohs micrographic ssurgery (MMS), it is currently underutilized. SIH constitutes a safe, cost-effective, and versatile method for wound closure. SIH offers multiple advantages, including enhanced cancer surveillance, reduced pain, and promosing esthetic outcomes, particularly not only on certain anatomical regions such as the medial canthus, antihelix, temple, or alar crease, but also for relatively small and superficial defects on the eyelids, ears, lips, and nose, including the alar region, and defects on the hands dorsal regions. Careful patient selection and thorough risk assessment are imperative to mitigate potential complications, including retraction, hyper/hypopigmented scars, or delayed healing. This comprehensive review aims to inform evidence-based decision-making on the role of SIH in MMS, synthesizing its indications, advantages, complications, wound care, and integration with other reconstructive methods.

Skin aging is a complex, continuous, multifactorial process resulting from cumulative morphological and functional changes in the skin over time.This happens because of 2 processes: intrinsic and extrinsic skin aging. Intrinsic skin aging occurs naturally over time and reflects each person's genetic makeup, or heredity. Extrinsic skin aging, on the other hand, is due to exposomal factors, such as solar radiation, air pollution, tobacco or nutrition, being the first 2 the most important of all. Exposure to air pollutants, primarily gases such as ground-level ozone and particulate matter, can accelerate the process via 4 key mechanisms: reactive oxygen species generation, inflammation, skin microbiome disruption, and aryl hydrocarbon receptor activation. Regarding solar radiation, all wavelengths reaching the Earth's surface have an impact on the skin, having a synergistic effect with air pollution ("photo-pollution"). Here, we discuss this phenomenon and mitigation strategies, including sunscreens, cosmetics with film-forming plus antioxidant ingredients, and oral supplementation.