Reacciones a la infusión de infliximab en pacientes dermatológicos

Infliximab is a chimeric monoclonal antibody that binds to and blocks tumor necrosis factor α and is the most effective biologic agent approved for the treatment of moderate-to-severe psoriasis. It is administered by intravenous infusion, usually in day hospitals on an outpatient basis. The main problem with the administration of infliximab is the possibility of infusion reactions, which may be immediate or delayed; these reactions are related to the immunogenicity of this monoclonal antibody, leading to the production of anti-infliximab antibodies. Infusion reactions to infliximab are not usually anaphylactic (ie, they are not mediated by immunoglobulin E), and re-exposure of the patient using specific protocols to prevent and treat these reactions is therefore possible. The extensive experience in the use of infliximab for the treatment of rheumatic conditions and chronic inflammatory bowel disease has made it possible to develop infusion reaction management protocols; these can be applied to dermatologic patients, who constitute a growing proportion of patients treated with intravenous biological agents. The aim of this review is to draw up a consensus protocol for the treatment of infusion reactions in dermatologic patients treated with infliximab.     

Motivos dermatológicos de consulta en atención primaria. Análisis de la demanda derivada

IntroductionSkin conditions are among the main reasons for seeking primary health care. Primary care physicians (PCPs) must diagnose skin conditions and determine their impact, and must therefore incorporate the relevant knowledge and skills into their education. The present study analyzes the reasons for primary care referral to dermatology (referral demand) as well as diagnostic agreement between PCPs and dermatologists informed by pathology where appropriate.Material and methodsData were collected for 755 patients and 882 initial dermatology appointments from February 1, 2012 through April 30, 2012 following primary care referral. Data obtained included age, sex, occupation, reason for referral, primary care diagnosis, and dermatologic diagnosis. Statistical analysis of the data for each diagnosed condition identified frequency, reasons for referral, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the κ statistic for diagnostic agreement.ResultsThe most common diagnoses were seborrheic keratosis, melanocytic nevus, actinic keratosis, and acne. The main reason for referral was diagnostic assessment (52.5%). For skin tumors, sensitivity of primary care diagnosis was 22.4%, specificity 94.7%, PPV 40.7%, and NPV 88.3%, with a κ of 0.211. For the more common diagnoses, primary care sensitivity was generally low and specificity high.ConclusionsAccording to our results, primary care physicians are better qualified to rule out a given skin condition in a patient (high specificity) than to establish an accurate clinical diagnosis (poor sensitivity). This suggests that knowledge and skills training should be organized for primary care physicians to improve management of skin conditions—especially skin cancer, because of its impact. A more responsive system would ensue, with shorter waiting lists and better health care.     

Análisis de los diagnósticos realizados en la actividad ambulatoria dermatológica en España: muestreo aleatorio nacional DIADERM

Introduction

Dermatologists perform most of their work in outpatient or private clinics. Data on the diagnoses made by dermatologists in these settings are lacking, however, as outpatient activity, unlike hospital activity, is difficult to code. The aim of this study was to analyze the diagnoses made by members of the Spanish Academy of Dermatology and Venereology (AEDV) at dermatology clinics in Spain.

Hallazgos cutáneos no considerados criterios diagnósticos de la NF1. Estudio de casos y controles

BackgroundThe diagnosis of Neurofibromatosis type 1 (NF1) is usually delayed in children without a family history. We aimed to define the prevalence and characteristics of prevalent skin manifestations in NF1 compared to the general population, which continue to be excluded from the diagnostic criteria for NF1.Patients and methodsCase–control study, matched by age groups, in which 108 patients with a diagnosis of NF1 and 137 healthy controls were included.ResultsThe prevalence of nevus anemicus (NA) (P<.001) and juvenile xanthogranulomas (JXG) (P<.001) was significantly higher in the population affected by NF1 than in the control population. A specificity of 99.27% (confidence interval): 95.4–99.96%] and a positive predictive value (PPV) of 98.80% [92.54–99.94%] were estimated for NA and a specificity of 99.27% [95.4–99.96%] and a PPV of 92.86% [64.17–99.63%] for JXG in the diagnosis of NF1 in children who present 6 or more Café-au-lait macules. Statistically significant differences were also evidenced in the distribution by phototypes (P=.025) and in relation to generalized itching with no other cause (P<.001).ConclusionsNA and JXG are relevant clinical findings for the diagnosis of NF1, especially during the first years of life. We consider that its inclusion among the diagnostic criteria of the disease should be evaluated.     

Manifestaciones dermatológicas asociadas a la gravedad de la infección por COVID-19. Estudio observacional transversal retrospectivo de 144 pacientes

IntroductionCOVID-19 infection is a disease caused by the type 2 coronavirus that causes severe acute respiratory syndrome (SARS-CoV-2) that affects the respiratory mucosa and all those organs that present the type 2 angiotensin receptor (ACE2), within them the skin. Several authors have mentioned the importance of reporting and carrying out databases on skin lesions caused by this virus, since it is related to the detection, severity and prognosis of the systemic condition.Material and methodsA retrospective cross-sectional observational study was carried out on the cases of patients who presented dermatological manifestations due to COVID-19, registered in the physical database of the National Specialized Hospital of Villa Nueva, Guatemala, from January 1st to December 31, 2021.ResultsA total of 144 patients presented dermatological manifestations due to COVID-19, which were: acral lesions (42%), rash (21%), subcutaneous emphysema (12%), oral mucosal lesions (7%), necrosis (6%), erythema multiforme (5%), telogen effluvium (2%), vesicular lesions (2%), urticaria (1%), pityriasis rosea Gibert (1%) and livedo-type lesion (1%). A statistically significant association (p = 0,00) was found in patients who presented dermatological manifestations with vasculonecrotic damage as they were more likely to suffer from severe to critical disease (OR 2,91; 95% CI 1063-3083).ConclusionsEarly identification of cutaneous semiology is essential for timely management of complications associated with COVID-19 disease.     

Seguridad en los procedimientos dermatológicos: oclusión vascular por materiales de relleno

Ischemic events are the most serious complications of facial antiaging treatment with dermal fillers. Ischemia can cause Nicolau syndrome, blindness, or even stroke. This article discusses how to prevent ischemic complications and what steps to take should a dermatologic emergency develop. A thorough understanding of facial anatomy is important. Preferred procedural techniques involve the use of cannulas and retrograde injection. When ischemia is detected in the skin, hyaluronidase should be injected, preferably through a cannula. If ocular ischemia occurs, the patient should be transferred to a hospital with stroke code activation.     

Factores de riesgo relacionados con la infección de la herida quirúrgica en cirugía dermatológica. Estudio prospectivo en un hospital de tercer nivel

Introduction and objectivesDermatological surgery usually has few complications, the most frequent being surgical site infection (SSI), with an incidence of < 5%. Our objective is to determine complications related to dermatological surgery and to analyze the factors associated with SSI.Materials and methodsWe conducted a prospective observational study that included patients treated with dermatological surgery between June 2013 and May 2014 in a third level public hospital. Clinical characteristics of patients, lesions removed as well as surgical procedure information were collected. For statistical analysis, χ² was used for categorical variables, and then a multivariate analysis using logistic regression was performed. A p-value < 0.5 was considered significant.Results1,131 patients underwent 1,335 surgical excisions. The overall complication rate was 5.84%, with the SSI being the most frequent (3.1%). The presence of an active neoplasm, the removal of more than one lesion in the same surgical act, and the use of subcutaneous sutures was associated with a higher rate of infections in the univariate analysis. Still, only the latter maintained statistical significance in the multivariate analysis (p < 0.001, OR 4.42, 95% CI 2.09–9.65). Nagelkerke's R² 0.157.ConclusionsOur study's SSI rate is comparable to that of other similar published studies (< 5%). The use of subcutaneous suture was associated with a higher rate of SSI; however, only 15% of SSIs would be justified by the use of this type of suture.