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Resumen: Antecedentes: En España, aunque el Ministerio de Sanidad elabora el informe de posicionamiento terapéutico (IPT) y las condiciones de reembolso de los fármacos, las Comunidades Autónomas (CC. AA.) gestionan los servicios de salud y deciden sobre las condiciones de prescripción en su ámbito territorial. El objetivo del estudio EQUIDAD fue describir los condicionantes para la prescripción de los nuevos fármacos en Dermatología en las CC. AA. y sus posibles diferencias. Material y métodos: Estudio transversal realizado en abril-mayo del 2023. Dos dermatólogos con responsabilidades directivas de cada Comunidad Autónoma (C. A.) informaron sobre los condicionantes autonómicos y locales en la prescripción de los fármacos cuyo IPT para el tratamiento de enfermedades dermatológicas fue publicado en los años 2016-2022. Los datos fueron recogidos mediante un cuestionario online. Resultados: Un total de 33 investigadores de 17 CC. AA. participaron en el estudio. Se observaron inequidades entre CC. AA. para el acceso a los nuevos fármacos. Existieron condicionantes autonómicos adicionales al IPT en psoriasis en el 64,7% de las CC. AA., siendo este porcentaje menor en dermatitis atópica (35,3%) o melanoma (11,8%). El más frecuente fue el requisito de un orden de prescripción previo para el uso del fármaco. En algunas CC. AA. se detectaron además variaciones y condicionantes locales (diferencias entre centros de una misma C. A.). Conclusiones: Existe una multiplicidad de criterios tanto a nivel autonómico como local que añade restricciones adicionales a las establecidas por los IPT y que plantean una situación de inequidad entre los pacientes y los profesionales de las diferentes CC. AA. en el acceso a los nuevos fármacos. Abstract: Background: Although the Spanish Ministry of Health prepares national therapeutic positioning reports (TPRs) and drug reimbursement policies, each of the country's 17 autonomous communities (ACs) is responsible for health care services and prescription requirements in its territory. The aim of the EQUIDAD study was to describe and explore potential differences in prescription requirements for new dermatology drugs across the autonomous communities. Material and methods: Cross-sectional study conducted in April and May, 2023. Two dermatologists with management responsibilities from each autonomous community reported on territorial and more local prescription requirements for drugs covered by national TPRs issued between 2016 and 2022. Results: Thirty-three researchers from 17 autonomous communities participated. The data submitted revealed between-community inequities in access to new drugs. Overall, 64.7% of the regions imposed additional prescription requirements to those mentioned in the TPRs for psoriasis. This percentage was lower for atopic dermatitis (35.3%) and melanoma (11.8%). The most common requirement for accessing a new drug was a previous prescription for another drug. Differences and additional requirements were also detected atthe local level (i.e., differences between hospitals within the same autonomous community). Conclusions: Spain's autonomous communities have multiple regional and local prescription requirements that are not aligned with national TPR recommendations. These differences result in inequitable access to new drugs for both patients and practitioners across Spain.

Background: Atopic dermatitis (AD) profoundly impacts quality of life as a chronic inflammatory skin disease. Allergen exposure triggers specific IgE antibodies, initiating allergy symptoms. Cross-reactivity, linked to auto-IgE responses, potentially influences AD severity. Exploring new allergens and self-autoantigens, like Aspergillus fumigatus, enhances knowledge of AD triggers. Our focus was on analyzing molecular mimicry between human AQP3 and A. fumigatus aquaporin, alongside various allergenic sources. Objective: Conduct an in silico assessment of potential molecular mimicry between human aquaporins, A. fumigatus, and diverse allergenic sources. Methods: Amino acid sequences of human AQP3 and A. fumigatus aquaporin were compared through multiple alignments with 25 aquaporins from diverse allergenic sources. Phylogenetic analysis and homology-based modeling were executed, and ElliPro server predicted conserved antigenic regions on 3D structures. Results: Global identity among studied aquaporins was 32.6%, with a specific conserved local region at 71.4%. Five monophyletic clades (A-E) were formed, and Group B displayed the highest identity (95%), including 6 mammalian aquaporins, notably AQP3. A. fumigatus aquaporin exhibited the highest identity with Malassezia sympodialis (35%). Three linear and three discontinuous epitopes were identified in both human and A. fumigatus aquaporins. The Root Mean Square Deviation (RMSD) from overlapping aquaporin structures was 1.006. Conclusion: Identification of potential linear and conformational epitopes on human AQP3 suggests likely molecular mimicry with A. fumigatus aquaporins. High identity in a specific antigenic region indicates potential autoreactivity and a probable antigenic site involved in cross-reactivity. Validation through in vitro and in vivo studies is essential for further understanding and confirmation.

The probability of influencing the skin microbiome for addressing skin disorders opens a novel aisle of therapy. This study aimed to evaluate the efficacy of skin microbiota transplantation (sMt) for cutaneous adverse food reactions (caFr) in dogs. Ten client-owned dogs with caFr were included in the study. Unenriched heterologous sMt was performed using Nivea Skin Refining Clear-Up Strips (N-cUs). The bacterial microbiota of skin samples was analysed by next-generation sequencing of the 16S rRNA gene. Other relevant biomarkers were involved in VAS (visual analogue scale of pruritus score), CADESI-04 (canine atopic dermatitis extent and severity index) and epidermal corneometric analysis. Increased Faecalibacterium (0 to 1.9 %), Peptoclostridium (5.49 % to 9.11 %) and Collinsella (0.65 % to 8.91 %), and decreased Fusobacterium (19.16 % to 9.06 %), Porphyromona (8.75 % to 0.13 %), Streptococcus (1.63 % to 0.14 %) and Staphylococcus (1.09 % to 0.49 %) was evidenced before and after sMt, respectively. Treatment with sMt effectively controlled clinical signs and drastically reduced median VAS pruritus (6.5 vs. 2) and CADESI-04 scores (74.50±22.62 to 19.30±11.30) (p

Introduction: Atopic dermatitis (AD) is a chronic and refractory inflammatory skin disease characterized by relapsing eczematous and pruritic skin lesions. Understanding the specific gene expression patterns associated with AD is crucial for advancing diagnosis and targeted treatment development. Using bioinformatics methods, candidate genes and biological pathways involved in AD pathogenesis were identified based on gene expression profiles in the Gene Expression Omnibus (GEO) database. Materials and Methods: A comprehensive analysis of four pooled transcriptomic datasets obtained from the Gene Expression Omnibus (GEO) database were conducted. Differential gene expression analysis was performed using the GEO2R. The differentially expressed genes (DEGs) between lesion skin of AD patients and normal skin of individuals were analyzed using the Gene Ontology (GO) term enrichment analysis, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway, and protein-protein interaction (PPI) network to explore the functional roles of these genes. Results: Among the patient-level gene expression datasets, we identified 133 shared DEGs, consisting of 48 upregulated genes and 85 downregulated genes. GO analyses revealed these DEGs to be significantly enriched in biological processes including inflammatory responses, cytokine-mediated signaling pathway. These DEGs were also enriched in the KEGG pathway, including viral protein interaction with cytokine and cytokine receptor, C-type lectin receptor signaling pathway, cytokine-cytokine receptor interaction, JAK-STAT signaling pathway, and Adipocytokine signaling pathway. Conclusion: By comparing with other studies using the same method, we found that in addition to the already confirmed pathways such as inflammatory response, different studies have found changes in different hub genes and metabolic pathways, which prompts us to develop individualized treatments for AD.

Resumen: El prurito es el síntoma principal en múltiples enfermedades dermatológicas y sistémicas. La dermatitis atópica, la psoriasis, la dermatitis de contacto, la urticaria, el liquen simple crónico, la micosis fungoides, las cicatrices, las enfermedades autoinmunes, la enfermedad renal o hepática crónica, entre otras, asocian prurito que puede requerir un manejo terapéutico distinto. Aunque los antihistamínicos parecen ser la primera línea de tratamiento, en realidad su papel queda limitado a la urticaria y reacciones por fármacos, ya que los mecanismos fisiopatológicos de cada una de las entidades tratadas a lo largo de este manuscrito serán distintas. En estos últimos años han aparecido nuevas moléculas para el tratamiento del prurito, con perfiles de eficacia y seguridad muy atractivos para su uso en práctica clínica. Sin duda, es un momento crucial para el desarrollo de la dermatología en el campo del prurito, y una oportunidad para ser más exigentes con los objetivos a alcanzar en estos pacientes. Abstract: Pruritus is the main symptom of many dermatologic and systemic diseases. Atopic dermatitis, psoriasis, contact dermatitis, urticaria, lichen simplex chronicus, mycosis fungoides, scars, autoimmune diseases, kidney or liver diseases among others are all associated with itch that may require different approaches to management. Although antihistamines seem to be the first line of therapy, in reality their role is limited to urticaria and drug-induced reactions. In fact, the pathophysiologic mechanisms of each of the conditions covered in this review will differ. Recent years have seen the emergence of new drugs whose efficacy and safety profiles are very attractive for the management of pruritus in clinical practice. Clearly we are at a critical moment in dermatology, in which we have the chance to be more ambitious in our goals when treating patients with pruritus.

Introduction: Atopic dermatitis is an inflammatory disease which can significantly affect quality of life of patients. Especially severe forms of this disease are challenging to treat and for a long time forms of treatment have been limited. Because of that- it is crucial to find new ways of treatment which can be registered and impove moderate and severe dermatitis. Aim of study: Fundament purpose of this literature review is focusing on effectiveness, safety, side effects or different potential medical applications of Dupilumab. The main question, which is formulated in the title- is Dupilumab a chance for patients with moderate to severe atopic dermatitis? State of knowledge: Nowadays Dupilumab is well known drug and a lot of trials and analysis focus on efficacy, safety in treatment of moderate and severe dermatitis. The development of Dupilumab and different potential, clinical applications is also a chance for other groups of patients- for example patients with asthma, chronic rhinosinusitis with nasal polyps, eosinophilic esophagitis, prurigo nodularis. Conclusion: Dupilumab is definitely a relevant and essential element of treatment therapy for patients with moderate to severe atopic dermatitis. There were many analysis and researches which confirmed effectiveness, safety level and described Dupilumab impact on many different parameteres and scales focused on symptoms and life quality of patients during treatment with Dupilumab.

Background: Targeted systemic therapies, including abrocitinib, baricitinib, dupilumab, tralokinumab and upadacitinib, are new treatments for moderate to severe atopic dermatitis (AD). We evaluated the efficacy and the costs of these targeted systemic therapies in the treatment of adult patients with moderate to severe AD. Methods: The clinical efficacy was assessed considering the results of a previous network meta-analysis (NMA). The analysis involved five therapies approved in Italy for the treatment of moderate to severe AD: abrocitinib (ABR), baricitinib (BAR), dupilumab (DUP), tralokinumab (TRA) and upadacitinib (UPA). According to the NMA, the cost of the treatment was based on the number of administrations dispensed at 16 weeks and the clinical efficacy was measured by the number needed to treat (NNT) compared to placebo using the improvement ≥ 75% (EASI-75) or ≥ 90 (EASI-90) from baseline of the eczema area and severity index (EASI). Only the ex-factory price of the targeted systemic therapies was considered. The cost per NNT was adopted as a cost-effectiveness indicator. Results: At 16 weeks, the cost per NNT based on EASI-75 was lower for UPA 15 mg (€ 6,384.00) compared to BAR 4 mg (€ 11,619.73) and 2 mg (€ 14,524.66), ABR 100 mg (€ 16,265.22), DUP 300 mg (€ 16,115.04) and TRA 300 mg (€ 31,710.24). UPA 15 (€ 8,512.00) also showed the lower cost per NNT based on EASI-90 at 16 weeks compared to BAR 4 mg (€ 14,788.75) and 2 mg (€ 20,862.70), ABR 100 mg (€ 25,922.69), DUP 300 mg (€ 25,992.00) and TRA 300 mg (€ 41,067.36). Conclusions: The findings show that upadacitinib is the most cost-effective option (cost per NNT) for the treatment of moderate to severe atopic dermatitis.

Atopic dermatitis is a chronic inflammatory disease with recurrent exacerbations, persistent itching, erythema, dry skin due to damage to the epidermal barrier, and staphylococcal infections. The causative factors are mutations in the gene encoding filaggrin, dysregulation of the immune system, changes in the skin microbiome and lipids in the stratum corneum and deficiency of antimicrobial peptides AMPs. The disease mainly affects children, causing a significant deterioration in the quality of life, and its first symptoms occur in approximately 90% before the age of 5. Lesions most often appear on the bends of elbows and knees, on the face and neck, but may also affect the skin of the entire body (erythroderma). The location of the eruptions depends on age. Atopic dermatitis is the result of complex genetic, epigenetic, environmental and immunological interactions with a coexisting epidermal barrier defect. The disease is diagnosed based on the Hanifin and Rajka criteria. Treatment of atopic dermatitis is symptomatic and selected individually. They include the elimination of provoking factors, care of the epidermal barrier, and anti-inflammatory and anti-pruritic therapy.

Resumen: Antecedentes: Dupilumab es una nueva terapia dirigida para la dermatitis atópica (DA) grave con una evidencia en la vida real aún limitada. Objetivo: Explorar nuestra experiencia con dupilumab para la DA en práctica clínica en un centro terciario. Material y método: Estudio observacional retrospectivo y unicéntrico que incluye pacientes adultos y pediátricos con DA grave en tratamiento con dupilumab entre diciembre de 2017 y diciembre de 2021. La gravedad y la respuesta se evaluaron con las escalas Eczema Area and Severity Index (EASI), Pruritus Numerical Rating Scale y Sleep Disturbance Numerical Rating Scale. Resultados: Cincuenta y nueve pacientes recibieron dupilumab: 52, 48, 26 y 13 pacientes alcanzaron los 6, 12, 24 y 36 meses de tratamiento, respectivamente. La tasa de EASI-75 fue del 94,2; 95,8; 92,3 y 100% a los 6, 12, 24 y 36 meses, respectivamente. La tasa de EASI-90 fue del 63,5; 72,9; 84,6 y 92,3% a los 6, 12, 24 y 36 meses, respectivamente. La tasa de EASI

Introduction and purpose: Atopic dermatitis (AD) is chronic inflammatory skin disorder. It typically begins in infancy or childhood and might persist into adulthood. AD is characterized by dry, itchy, eczematous skin. The lesions can vary in intensification from mild to severe according to patient age or body region. AD requires ongoing management to control the symptoms. Skin manifestations along with the demand of treatment and care regimens significantly impact quality of life (QOL) in patients with AD. Individuals suffering from this condition are more prone to developing mental health disorders, which are often linked to emotional stress they experience. Exposure to stress exacerbates AD and stimulates skin changes, which in turn leads to intensification of treatment regimens. This cause-and-effect chain can be considered as a vicious circle mechanism. The aim of the review is to highlight the phenomenon by examining current literature on this topic in order to raise the awareness of healthcare professionals regarding this subject as well as implement appropriate and complete support for patients struggling with AD. A brief description of the state of knowledge: The pathophysiology of AD is multifactorial. Numerous studies explore the impact of stress on the deterioration of AD symptoms and delve into its pathogenic concepts. Simultaneously, researchers highlight increased psychological distress in AD patients, which surpass that observed in many other chronic conditions. Summary: Psychological factors play a significant role in AD. It demands considering mental health screening and support as a part of clinical practice, treating AD patients. Further research is necessary to provide efficient and comprehensive interventions.

Introduction and purpose. Atopic dermatitis (AD) is a common chronic inflammatory skin disease that affects many children and adults around the world. It has been also empirically known that some environmental factors such as exposure to the sun can be beneficial for patients with AD. The purpose of this literature review is to present positive impact, as well as challenges and risks of heliotherapy and phototherapy on patients suffering from AD. Material and methods. The article is a review of publications obtained from the PubMed database and published between 2017-2023. Based on the keywords "phototherapy" "heliotherapy"and "atopic dermatitis", 14 articles were selected. Finally, 1 meta-analysis and 3 observational studies were included in the rewiev. Brief description of the state of knowledge. People with AD have a compromised skin barrier, which favors infiltration by activated Th2 cells, and their cytokine, causing thickening of the skin. It makes management of AD challenging. It is known that most patients’ skin condition improves due to sun exposure. This is why an artificial UV radiation (UVR) is employed for the treatment. The idea is to administrate a non-ionizing radiation to the skin. Both sunlight and artificial light have a significant immunosuppressive effect on the skin. Summary. Phototherapy as well as heliotherapy improved skin condition of people suffering from AD. It was appreciable by the end of few weeks of studies and also afer 3 months, reflected by improvement in PO-SCORAD, VAS and DLQI scales. During some of the studies there have been incidents of side-effects. More research is necessary to define a long-term effect of this kind of treatment and the role of chronic and prolonged therapy of AD.

Resumen: La dermatitis atópica (DA) es una enfermedad inflamatoria crónica multifactorial. La dermatitis de contacto alérgica (DCA) y la dermatitis de contacto por proteínas (DCP) son patologías alérgicas que pueden ser comórbidas a la DA y ser causa de algunas de las exacerbaciones. Aunque la DCA tiene una prevalencia similar en pacientes atópicos que en la población general, debemos considerarla una comorbilidad frecuente en la DA por la disrupción de la barrera cutánea. Por ello, se recomienda la realización de pruebas epicutáneas a los pacientes atópicos. Dupilumab podría ser útil para el tratamiento de la DCA mediada por vía Th2 y exacerbar aquellas que ocurren por vía Th1, aunque se precisan más estudios para establecer conclusiones. El mecanismo por el que la exposición a proteínas ambientales produce exacerbaciones en la DA es controvertido, pero es un fenómeno habitual en la práctica clínica diaria. Se recomienda estudio mediante prick test a pacientes con clínica sugestiva y recomendar conductas evitativas ante pacientes sintomáticos y pruebas positivas. Abstract: Atopic dermatitis is a chronic inflammatory disease that is multifactorial in nature. Allergic contact dermatitis and protein contact dermatitis are allergic conditions that may occur in the context of atopic dermatitis and be the cause of exacerbations. Although the prevalence of allergic contact dermatitis is similar in atopic patients and the general population, these 2 conditions are frequently associated because atopic inflammation disrupts the skin barrier. Skin tests are therefore recommended in atopic individuals. Dupilumab could be useful for treating allergic contact dermatitis if it is mediated by type 2 helper T cells but could exacerbate inflammation if mediated by TH1 cells: further study is needed before conclusions can be drawn. Although the mechanism by which exposure to environmental proteins exacerbates atopic dermatitis remains under discussion, such exacerbations are routinely seen in clinical practice. Prick testing is recommended in symptomatic atopic dermatitis. When prick-test findings are positive, patients should be advised to avoid the culprit substances.

Introduction: Atopic dermatitis is a chronic, relapsing disease with a multifactoral etiology. The basic disorder of the atopic dermatitis is the disruption of the epidermal barrier. The family history of atopy is a high risk factor of the development of the disease. The clinical manifestations are heterogeneous and vary depending on patient’s age, disease duration and current disease activity according to the SCORAD scale. Objective: The aim of the review is to analyze the latest information on the characteristics, diagnosis and treatment of atopic dermatitis, including new biological medications. Methods and materials: The sources available in PubMed database have been analyzed using the keywords: „atopic dermatitis”, „epidermal barrier”, „SCORAD index”, „topical treatment”, „biological therapy”, „Janus kinase inhibitors”. Current state of knowledge: Atopic dermatitis is only treated symptomatically. The greatest therapeutic challenge is to reduce the pruritus which significantly impairs the quality of life. Topical corticosteroids may cause local side effects. The most severe cases of the disease require systemic treatment with immunosuppressants. Conclusions: The complex pathogenesis of atopic dermatitis is the object of research. Understanding the immunological mechanisms responsible for the development of the disease allows to introduce new therapeutic options. Previous studies have confirmed the effectiveness of biological medications in reducing disease activity, which is a chance to improve the quality of live of the patients suffering from atopic dermatitis.

The article discusses the phenomenon of allergic march, which is a progressive process of atopic disease development in allergic patients. The inflammatory process changes localization, causing various symptoms such as atopic dermatitis, food allergy, asthma, allergic rhinitis and eosinophilic esophagitis. Allergic march has a major impact on the development of asthma and allergic rhinitis. The diversity of allergic march trajectories is due to the interaction of genetic, environmental and psychosocial factors. Understanding these mechanisms is crucial to prevent effectively the progression of allergic diseases. The article also discusses the advantages of sublingual immunotherapy (SILT) in the treatment of allergic diseases. SILT shows safety profile and may be more acceptable treatment option for the patients comparing to the traditional subcutaneous immunotherapy (SCIT). There are evidence of the beneficial effects of SILT in reducing allergy symptoms and improving quality of life in allergic patients.

Resumen: La dermatitis atópica (DA) es una enfermedad cutánea inflamatoria crónica con síntomas tales como el prurito, que pueden causar una carga significativa en la vida del paciente. Los resultados percibidos por los pacientes (PRO) complementan a los resultados clínicos evaluados en la DA por los médicos. Esta revisión sistemática tiene como objetivo identificar y describir las medidas de los resultados percibidos por los pacientes (PROM) utilizadas en estudios observacionales de DA durante la última década en España. Se identificaron 18 PROM para medir 13 PRO diferentes que evalúan múltiples aspectos de la enfermedad, incluyendo los síntomas y la gravedad de la enfermedad, la interferencia con las actividades diarias, el impacto psicosocial y laboral, el empoderamiento del paciente y la calidad de vida relacionada con la salud (CVRS). La CVRS, los síntomas (principalmente el prurito) y la ansiedad/depresión fueron los PRO más evaluados, siendo el Dermatology Life Quality Index, la Escala Visual Analógica del prurito y la Hospital Anxiety and Depression Scale, las PROM más frecuentemente empleadas, respectivamente. El número creciente de estudios observacionales sobre DA que incluyen PROM en España sugiere un aumento de la importancia de los PRO en el manejo de la DA. Abstract: Atopic dermatitis (AD) is a chronic inflammatory skin disease with symptoms such as pruritus that can be a major burden for patients. Patient-reported outcomes (PRO) complement clinician-reported outcomes in AD. This systematic review aims to identify and describe patient-reported outcome measures (PROM) used in observational studies of AD over the last decade in Spain. Eighteen PROM were identified to measure 13 different PRO that assess multiple aspects of the disease, including symptoms and disease severity, impact on daily activities and on work productivity/functioning, psychosocial impact, patient empowerment, and health-related quality of life (HRQoL). HRQoL, symptoms (particularly pruritus), and anxiety/depression were the most frequently assessed PRO, and the Dermatology Quality of Life Index, the Visual Analogue Pruritus Scale, and the Hospital Anxiety and Depression Scale were the most frequently used PROM, respectively. The growing number of observational studies on AD including PROM in Spain suggests that PRO are becoming increasingly important in the management of AD.

Resumen: La citoquina IL-31 es una neurocitoquina que estimula las neuronas sensoriales relacionadas con el picor, contribuye a la inflamación, la disfunción y remodelación de la barrera epidérmica. Al interrelacionar los sistemas inmunológico y nervioso constituye un factor clave en el tratamiento de dermatitis atópica y del prurigo nodular. Nemolizumab es un anticuerpo monoclonal humanizado que bloquea la subunidad α del receptor de la IL-31 y modula la respuesta neuroinmunitaria, bloquea directamente la señalización del prurito y alivia rápidamente el prurito, controlando la inflamación y reduciendo la gravedad del eccema en dermatitis atópica y las lesiones pruriginosas del prurigo nodular al restaurar la función epitelial y promover la integridad de la barrera cutánea.Este artículo resume la nueva información relacionada con las funciones de la IL-31 y presenta la evidencia y resultados disponibles hasta el momento de los ensayos clínicos de nemolizumab en dermatitis atópica y prurigo nodular. Abstract: Interleukin 31 (IL-31) is a neurocytokine that stimulates sensory neurons involved in pruritus. It contributes to skin barrier inflammation, dysfunction, and remodeling. As the immune and nervous systems are interrelated, IL-31 has a key role in the treatment of atopic dermatitis and prurigo nodularis. Nemolizumab is a humanized monoclonal antibody that blocks the α subunit of the IL-31 receptor, modulates the neuroimmune response, and rapidly alleviates itching by directly blocking signaling. It reduces inflammation and lesion severity in atopic dermatitis and prurigo nodularis by restoring epithelial function and promoting skin barrier integrity.This review synthesizes the latest information on the functions of IL-31 and presents the current evidence, including clinical trial results, on the use of nemolizumab in the treatment of atopic dermatitis and prurigo nodularis.

Resumen: El prurigo crónico es una entidad con una apariencia clínica común pero que puede ser secundaria a un gran número de patologías. Históricamente ha sido una enfermedad no bien definida y con escasas terapias disponibles, por lo que su manejo es muy complejo. Clínicamente se caracteriza por lesiones escoriadas e hiperqueratósicas en el contexto de un paciente con prurito crónico. Ante la sospecha de un prurigo crónico, es fundamental realizar un buen diagnóstico diferencial e identificar todas sus posibles causas. En los últimos años se han producido importantes avances con la aparición de nuevos criterios diagnósticos y con el desarrollo de nuevos fármacos. Un mayor conocimiento de esta patología redundará en el beneficio de unos pacientes que hasta el momento carecen de un tratamiento claramente efectivo. Abstract: Chronic prurigo is itself a common condition, but it can also occur secondary to a large number of diseases. Management is challenging as historically chronic prurigo has been poorly defined and very few treatments are available. Clinically, it presents as excoriated, hyperkeratotic lesions. When chronic prurigo is suspected, a comprehensive differential diagnosis is essential. New diagnostic criteria have appeared in recent years and new drugs have been developed. Although no truly effective treatment is yet available, patients will benefit from a greater understanding of this condition.

Resumen: Antecedentes: La dermatitis de las manos (DM) es frecuente en los pacientes con dermatitis atópica (DA). Pocos estudios describen las características de estos pacientes a partir de poblaciones amplias y representativas de ámbitos geográficos y laborales diferentes. Objetivos: Describir el perfil epidemiológico, clínico y alérgico de los pacientes con DM a los que se realizan pruebas epicutáneas, comparando los pacientes con DA con los pacientes sin DA. Métodos. El estudio se ha realizado a partir de los datos del REIDAC, un registro multicéntrico nacional de pacientes a los que se realizan pruebas epicutaneas. Resultados: Se incluyeron 1466 pacientes parcheados por DM desde enero de 2018 hasta junio de 2020. Los pacientes con DA fueron más jóvenes y con una duración de los síntomas mayor. Los antecedentes ocupacionales como desencadenantes se registraron en menor medida que en los pacientes no atópicos (38 vs 53%). La única profesión en la que se encontraron diferencias significativas fue la peluquería. Los alérgenos más detectados fueron el sulfato de níquel, la metilcloroisotiazolinona/metilisotiazolinona, el cloruro de cobalto, el dicromato potásico, mezcla de fragancias I y II, y el formaldehido. Los diagnósticos más frecuentes fueron dermatitis alérgica de contacto (DAC); 24% en atópicos vs 31% en no atópicos (p 0.0224) y el eccema de contacto irritativo; 18% atópicos vs 35% no atópicos (p

Introduction Probiotics are defined as "live microorganisms which when administered in adequate amounts confer a health benefit on the host" by the World Health Organization (WHO). Probiotics help to regulate innate and adaptive host immune responses by combating aggressive commensal bacteria and improving epithelial barrier function. Probiotics have shown positive results in the treatment of various inflammatory skin conditions. Aim of the study The aim of the study was to investigate the potential efficacy of probiotics in the treatment of dermatological diseases, such as acne vulgaris; atopic dermatitis; psoriasis. Materials and methods A search was conducted using PubMed and Google Scholar databases. Articles were searched in English using the following key words: probiotics; dermatology; acne vulgaris; eczema; atopic dermatitis; psoriasis. Results Probiotics reduced the amount of inflammatory acne lesions and the erythema index in acne vulgaris patients. Patients with atopic dermatitis who received probiotics also experienced an immediate and long-lasting improvement in their symptoms and skin quality. Individuals noticed enhanced skin smoothness and moisture, self-acceptance, and a decrease in the SCORAD index. It was also proven that oral probiotic supplementation successfully reduced psoriasis symptoms by lowering plasma levels of inflammatory markers such as IL-6, TNF-α, and CRP. Furthermore, the chance of psoriasis recurrence was reduced. Conclusion The reviewed literature indicates that probiotics may be helpful in treating skin conditions like psoriasis, atopic dermatitis, and acne vulgaris. Probiotics demonstrated encouraging results in the treatment of inflammatory skin conditions by altering the immune response as a result of modifying the gut microbiome.

Resumen: Antecedentes: La dermatitis atópica (DA) moderada-grave tiene un impacto significativo en la vida de los pacientes, muchos de los cuales requieren tratamiento sistémico para controlar los síntomas (p. ej., prurito). Algunos tratamientos son usados fuera de indicación. Este estudio describió características sociodemográficas y clínicas, patrones de tratamiento, uso de recursos sanitarios (URS) y costes asociados en adultos con DA que iniciaron tratamiento sistémico o fototerapia en la práctica habitual. Métodos: Este estudio observacional retrospectivo de historias clínicas electrónicas en la base de datos BIG-PAC identificó adultos con diagnóstico previo de DA (CIE-9: 691.8 o 692.9) que comenzaron con corticosteroides orales, inmunosupresores, biológicos o fototerapia entre el 01/01/2012 y el 31/12/2016. Se siguió a los pacientes durante tres años desde el inicio del tratamiento, hasta el 31/12/2019. Los datos sobre las características clínicas de los pacientes, patrones de tratamiento, URS y costes se analizaron de forma descriptiva. Resultados: Los pacientes (n = 1995) tenían una edad media de 60 años, 64% eran mujeres, con una media de 23 años desde el diagnóstico (84% tenían ≥ 18 años al inicio de la DA). Las principales comorbilidades fueron ansiedad (38%), hipertensión arterial (36%) y dislipidemia (35%). La mayoría de los pacientes utilizaron corticosteroides orales como primer tratamiento sistémico (84%; duración media 29 días) e inmunosupresores en 13% de los pacientes (duración media 117 días, ciclosporina en 5% y metotrexato en 4%). La mitad de los pacientes requirieron una segunda línea de tratamiento sistémico y 12% una tercera. El uso de inmunosupresores y biológicos aumentó simultáneamente con las líneas de tratamiento. Aproximadamente 13% de los pacientes recibieron tratamientos sistémicos de forma continua durante los tres años de seguimiento. El coste medio por paciente a tres años fue de 3.835 euros, con un coste medio anual de 1.278 euros. Conclusiones: Los resultados sugieren una alta carga económica y de comorbilidad en esta población del mundo real de adultos con DA, y la necesidad de nuevos tratamientos sistémicos indicados para DA. Abstract: Background: Moderate–severe atopic dermatitis (AD) has a significant impact on patients’ lives, with many requiring systemic treatment to manage symptoms (e.g., pruritus). Several drugs are used off-label to treat AD. This study describes sociodemographic/clinical characteristics, treatment patterns, health resource use (HRU) and costs in adults with AD who initiated systemic treatment or phototherapy in routine practice. Methods: This retrospective observational study of electronic medical records in the BIG-PAC database identified adults with prior diagnosis of AD (ICD-9: 691.8 or 692.9) starting oral corticosteroids, immunosuppressants, biologics or phototherapy between 01/01/2012 and 31/12/2016. Patients were followed for 3 years from treatment initiation, up to 31/12/2019. Data on patient characteristics, treatment patterns, HRU and costs were analyzed descriptively. Results: Patients (N = 1995) had a mean age of 60 years, 64% were female, with a mean time of 23 years since diagnosis (84% were ≥ 18 years at AD onset). Main comorbidities were anxiety (38%), arterial hypertension (36%) and dyslipidemia (35%). Most patients used oral corticosteroids as first systemic (84%; median duration 29 days) and immunosuppressants in 13% of patients (median duration 117 days, 5% cyclosporine and 4% methotrexate). Half of patients required a second line systemic and 12% a third line. The use of immunosuppressants and biologics increased with treatment lines. About 13% of patients received systemic treatments continuously over the 3-year follow-up. The average 3-year per patient cost was 3835 euros, with an average annual cost of 1278 euros. Conclusions: Results suggest a high comorbidity and economic burden in this real-world adult population with AD, and the need for systemic treatments indicated for use in AD.

Introduction The globe is currently experiencing a new pandemic due to the introduction of the SARS-CoV-2 strain of the human coronavirus. The virus infects people and causes COVID-19, a lung condition that can be fatal in susceptible people and is characterized by fever, pneumonia, and shortness of breath. The prevalence of hand eczema among healthcare professionals working in COVID-19 units has grown, and it has been linked to increased hand sanitation habits. Aim of the study The purpose of the study was to examine the prevalence of hand eczema as a consequence of more intensive hand hygiene among healthcare workers during COVID-19 pandemic. Materials and methods A search was conducted using PubMed and Google Scholar databases. Articles were searched in English using the following key words: hand eczema; hand dermatitis; atopic dermatitis; COVID-19; SARS-CoV-2. Results Healthcare workers developed hand eczema more frequently in COVID-19 outbreak. The risk of hand eczema was raised by frequent use of hand hygiene products, alcohol-based hand sanitizers, wearing gloves, previous atopic dermatitis history and female sex gender. Due to excessive hand hygiene the natural skin barrier function was impaired, leading to hand eczema. The use of preventive skincare products can lower the risk of hand eczema development. Conclusion Findings demonstrated positive correlation between hand eczema prevalence among healthcare professionals and COVID-19 pandemic. Hand washing and the use of disinfectants disrupt the natural skin barrier function, leading to allergic and irritating hand eczema. In order to continue practicing hand hygiene during the continuing pandemic, proper prevention strategies and education should be implemented.

Introduction: Atopic dermatitis (AD) is the most common chronic inflammatory skin disease. It is characterized by damaged epidermal barrier, skin dysbiosis and pruritus. It affects up to 20% of the population of developed countries. AD represents a heterogeneous condition belonging to the spectrum of atopic diseases. It occurs in the form of multiple phenotypes with varied pathogenesis requiring different therapeutic strategies. Aim of the study: To summarize the current state of knowledge on AD phenotypes and related therapeutic options. Methods and materials: A review of the literature available in PudMed and Google Scholar databases was conducted. The following keywords were used: "atopic dermatitis", "atopic dermatitis phenotypes", "atopic dermatitis current treatment". Results: There are many phenotypes of AD. However, due to the lack of a consistent classification system, identifying phenotypes is greatly hindered. It is possible to use the division of phenotypes into groups based on age, lesion topography, lesion morphology and patient ethnicity. Various drugs are available for the treatment of AD, but therapeutic strategies for specific phenotypes are sparse and insufficiently understood due to the problem of identifying phenotypes and the complexity of the endotypes behind them. Treatment of AD is not currently based on phenotype-specific targeted therapy. Conclusion: Development of personalized therapy for the treatment of AD requires additional research using uniform definitions of phenotypes and endotypes. It is necessary to create a classification system for AD phenotypes.

Background: Despite advances made in treatments for atopic dermatitis (AD), information on its impact and interaction with atopic comorbidities, such as asthma, rhinoconjunctivitis, and ocular disease is limited. This study aims to assess the clinical-epidemiological characteristics of patients with AD-treatment response included-while taking into consideration atopic comorbidities like these., Materials and Methods: Data were analyzed from the multicenter BIOBADATOP registry (a prospective cohort of AD patients initiating systemic treatment). We conducted a descriptive analysis of the main characteristics collected in the registry in relation to atopic comorbidity., Results: We included a total of 509 patients, mostly adults (81.9%) with severe AD (73.7%). Patients with personal atopic comorbidity (64%) more frequently exhibited flexural dermatitis (89.7% vs 81.5%), a higher mean of previous systemic treatments (1.6 vs 1.3), and higher baseline values on the POEM scale (19.6 vs 17.9). Patients with familial atopic comorbidity (40.7%) had a higher incidence of pediatric/adolescent patients (24.2% vs 13.9%) and a history of allergic rhinoconjunctivitis (61.1% vs 47.1%). No differences regarding treatment response were observed at the 6- and 12-month follow-ups based on the presence or absence of atopic comorbidities., Conclusions: Results suggest that a history of atopic comorbidity is associated with an early onset and persistent course of AD. Although no differences were reported in the short-term treatment response, further follow-up is required to better understand the impact of comorbidities on AD., (Copyright © 2024. Publicado por Elsevier España, S.L.U.)

Background: Atopic dermatitis (AD) is one of the most prevalent skin diseases, but there are numerous knowledge gaps surrounding the impact this disease has on quality of life (QoL), mental health, and out-of-pocket expenses involved in the management of AD. The available scientific evidence on the multidimensional burden of AD is usually based on studies with measures reported by patients themselves., Methods: In this context, the MEASURE-AD trial was developed as a cross-sectional, multicenter, multinational trial using patient- and physician-reported measures to characterize the multidimensional burden of AD in adults with moderate-to-severe AD., Results: This paper presents the results of the Spanish cohort. We found that Spanish adults with moderate-to-severe AD and high EASI score (21.1-72) had a significantly increased disease burden, high severity of symptoms such as itch and sleep disturbances, impaired mental health and QoL, higher use of health care resources, and more out-of-pocket expenses than patients with low EASI scores (0-7 or 7.1-21)., Conclusions: This study provides information to better understand disease burden, and identify aspects to be improved in the management of AD., (Copyright © 2024 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Atopic dermatitis is a chronic skin condition that affects up to 20% of children and 10% of adults worldwide. Due to the high burden of dermatological signs and symptoms, atopic dermatitis has a significant impact on the quality of life of patients and their families. In the absence of objective measures to accurately assess severity and symptom burden, patient-reported outcome measures are essential to monitor the impact and progression of the disease, as well as the efficacy of treatments. Although there are currently no standardised guidelines for their use in clinical practice, there are some initiatives, such as the Harmonise Outcome Measures for Eczema and Vivir con Dermatitis Atópica, that can provide guidance. As healthcare systems move toward value-based healthcare models, patient-reported measures are becoming increasingly important for incorporating the patient perspective and improving the quality of healthcare services. The use of these measures can help monitor disease activity and guide treatment decisions. This article discusses the impact of atopic dermatitis and describes the patient-reported outcome measures commonly used in atopic dermatitis and the recommendations of the initiatives that have selected a core set of measures to best assess atopic dermatitis in clinical practice. Considering the recommendations of these initiatives and based on our experience in clinical practice, we propose the use of the Dermatology Life Quality Index to assess the impact of the disease on quality of life, the Patient-Oriented Eczema Measure to assess symptom severity, and the Numerical Rating Scale or the Visual Analogue Scale to measure itch intensity. To systematise the administration of these measures and to integrate them into hospital information systems and medical records, we emphasise the importance of telemedicine platforms that allow the electronic administration of these instruments., Competing Interests: Declaration of competing interest None declared., (Copyright © 2024. Publicado por Elsevier España, S.L.U.)

Resumen: Introducción y objetivo: Los probióticos, definidos como microorganismos vivos que proveen un beneficio para la salud del huésped, se han propuesto como una opción terapéutica para la dermatitis atópica (DA), habiéndose identificado varios mecanismos de acción. Se evaluó la eficacia del uso de probióticos para disminuir la gravedad de dermatitis atópica en pacientes pediátricos menores de 18 años. Material y métodos: Se realizó una revisión sistemática y metaanálisis que incluyó ensayos clínicos aleatorizados en pacientes menores de 18 años con diagnóstico establecido de dermatitis atópica, cuya gravedad estuvo medida por el Scoring Atopic Dermatitis (SCORAD) comparando el efecto de probióticos con el placebo, mediante la investigación en bases de datos MEDLINE, Web Of Science (WOS), Scopus, ClinicalTrials.gov, Epistemonikos, Trip medical database, Biblioteca virtual en salud (BVS). Resultados: Se obtuvieron 20 estudios que fueron incluidos en la revisión sistemática, de los cuales 16 apoyan el uso de probióticos para reducir la gravedad del SCORAD en la dermatitis atópica. En el metaanálisis se obtuvo como resultado global una diferencia de medias de −0,38, con un IC 95% de −0,63 a −0,14, a favor del uso de probióticos; sin embargo, se encontró una alta heterogeneidad en los estudios debido a la variabilidad clínica y metodológica, con un I2 = 76%. Conclusiones: El uso de probióticos es beneficioso para reducir la gravedad de la DA medida según SCORAD, a pesar de la presencia de una alta heterogeneidad clínica, derivada de sus diferentes tipos, dosis y variabilidad de una escala subjetiva como es el SCORAD. Abstract: Background and objective: Probiotics, defined as live microbial dietary supplements that provide health benefits for the host, have been suggested as a treatment for atopic dermatitis based on a variety of proposed mechanisms of action. We analyzed evidence for the efficacy of probiotics to attenuate the severity of atopic dermatitis in pediatric patients younger than the age of 18 years. Material and methods: Systematic review of trials of probiotics that included patients under the age of 18 years with a confirmed diagnosis of atopic dermatitis scored for severity using the Scoring Atopic Dermatitis SCORAD) tool. We performed a meta-analysis of the randomized placebo controlled trials. The following databases were searched: MEDLINE, Web of Science, Scopus, ClinicalTrials.gov, Epistemonikos, Trip Medical Database, and the Spanish Virtual Health Library. Results: Twenty trials were retrieved and included in the systematic review. Sixteen supported the use of probiotics to attenuate SCORAD-evaluated severity. Meta-analysis found an overall mean difference in effect between probiotics and placebo of −0.38 (95% CI, −0.63 to −0.14) in favor of probiotics. However, trial heterogeneity was high (I2 statistic, 76%) due to clinical and methodological variability. Conclusions: In spite of clinical heterogeneity in trials attributable to different types of probiotic products and doses, and to the subjective variability of the SCORAD scale, we conclude that probiotics are beneficial for reducing the severity of atopic dermatitis as reflected by the SCORAD index.

Dupilumab is a recombinant human monoclonal antibody of the IgG4 class. Its mechanism of action can most broadly be described as inhibition of interleukin 4 and 13-mediated signal transduction. These cytokines are the main drivers of inflammatory diseases such as atopic dermatitis (AD) and asthma. Currently, dupilumab is the subject of many studies and scientific articles. More and more papers are being written about the efficacy of this drug and the side effects. Based on publications from the PubMed database, we present selected cases of atopic dermatitis patients who experienced uncharacteristic and unclear hair-related changes, such as hair loss, growth and change in hair colour, after dupilumab administration.

Vitamin D is an important substance that has a pleiotropic range of action in the human body. Its important role is to influence the cells of the immune system and regulate the body's inflammatory response. Many physiological processes at the immune level have been discovered to prove this. Vitamin D deficiency is common and results mainly from limited sun exposure at certain latitudes or from insufficient dietary supply. This likely increases the risk of many diseases, including autoimmune diseases. Numerous evidence shows that also in skin diseases such as AD or psoriasis, the level of calcitriol is of great importance, and its supplementation in the prevention and treatment of these diseases promotes frequent remissions and improves the clinical condition of patients. Therapy with high doses of vitamin D analogues can be effective and safe. The exact knowledge of the properties of this vitamin probably allows for its real and effective use in the treatment of skin diseases. However, numerous large-scale studies are still needed to more accurately determine the dosage, effects of this therapy and to use this preparation with certainty and the highest possible effectiveness in everyday medical practice.

Resumen: La dermatitis atópica (DA) es una enfermedad cutánea crónica que puede desencadenarse debido a situaciones psicológicas y ciertos alérgenos. Los pacientes con DA pueden haber experimentado una exacerbación de la enfermedad debido al estilo de vida durante la pandemia de la COVID-19, incluyendo el confinamiento domiciliario y el incremento del estrés. Obtuvimos los datos electrónicos de 100 pacientes de DA ingresados en nuestro hospital de 2016 a 2019, y les llamamos con una línea telefónica específica.De los 100 pacientes, 43 eran varones y 57 mujeres (edad media ± DE: 45,85 ± 16,90), de los cuales 60 (37 mujeres y 23 varones, con edad media de 42,22 ± 14,71) experimentaron el brote de la enfermedad durante la etapa de la COVID-19. La exacerbación de la DA guardó relación con la alteración de la dosis de tratamiento, un largo historial de dermatitis atópica, la duración del eccema, el autoaislamiento, la frecuencia del lavado de manos, la desinfección de las manos, y la puntuación POEM (P

Atopic dermatitis (AD) is a chronic, inflammatory skin disease affecting all age groups, particularly children. This systematic review provides an overview of the humanistic and economic disease burden in the pediatric population with AD in Spain. The evidence, collected from 11 observational studies published over the past 10 years, exhibits the most common characteristics of the patients, disease burden, patient-reported outcomes, use of resources, and treatment patterns. The burden of AD extends beyond physical symptoms, with associated comorbidities such as asthma and impaired health-related quality of life and mental health disorders, particularly in severe cases. Traditional therapies, primarily topical corticosteroids, face adherence and efficacy challenges. Despite promising innovative treatments and available biological therapies, their use is still limited in the pediatric population. The findings of the present review highlight the scarce scientific evidence on the economic burden of pediatric AD, as well as the most updated humanistic evidence on this disease. At the same time, the need for individualized care and innovative therapeutic interventions to address the multifaceted challenges of pediatric AD in Spain is evident., (Copyright © 2024 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)