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BACKGROUND: Atopic dermatitis (AD) and allergic contact dermatitis (ACD) are inflammatory skin conditions whose association is not clearly defined. OBJECTIVES: To identify differences in ACD profile between patients with and without AD among those referred for patch testing. Additionally, to determine the prevalence of sensitisation to standard Spanish contact allergens in both groups. METHODS: We analysed two groups (AD and non-AD) within the Spanish Registry of Research in Contact Dermatitis and Cutaneous Allergy (REIDAC). Contact allergy, clinical relevance and epidemiological data were compared between them. RESULTS: A total of 5055 patients were included. Among them, 23% (1168) had a history or final diagnosis of AD. At least one positive reaction was seen in 468 (40%) of AD patients and 1864 (48%) of non-AD patients. In both groups, the most common positive reactions were to nickel sulphate, methylchloroisothiazolinone/methylisothiazolinone and cobalt chloride. Age-adjusted OR for sensitisation to nickel sulphate was 0.72 (95% CI: 0.61-0.86), indicating a decreased likelihood of sensitisation in AD patients compared to non-AD individuals. CONCLUSIONS: We did not find an increased presence of ACD in patients with AD referred for patch testing, exhibiting similar profiles to non-AD population, except for a negative relationship between AD and sensitisation to nickel sulphate.

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BACKGROUND: The past 5 years have seen a proliferation of new treatments for atopic dermatitis (AD). We analyzed recent drug survival data for cyclosporine in this setting. Because the Spanish National Healthcare system requires patients with AD to be treated with cyclosporine before they can be prescribed other systemic treatments, drug survival for cyclosporine may be shorter than in other diseases. MATERIAL AND METHOD: Multicenter, observational, prospective cohort study using data from the Spanish Atopic Dermatitis Registry (BIOBADATOP). Data from the Spanish Registry of Systemic Treatments in Psoriasis (BIOBADADERM) were used to create a comparison cohort. RESULTS: We analyzed data for 130 patients with AD treated with cyclosporine (median drug survival, 1 year). Median cyclosporine survival in the psoriasis comparison group (150 patients) was 0.37 years. Drug survival was significantly longer in AD than in psoriasis (P<.001). CONCLUSION: Drug survival of cyclosporine in the BIOBADATOP registry is similar to that described in other series of patients with AD and longer than that observed in the BIOBADADERM psoriasis registry.

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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 (AU)

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 (AU)

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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 (AU)

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 (AU)

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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.

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Antecedentes y objetivo El prurigo crónico nodular (PCN) es una enfermedad recientemente definida, de etiología heterogénea e infradiagnosticado en la actualidad. Está asociado a múltiples comorbilidades y los avances en su patogenia han abierto puertas a un mejor manejo y tratamiento. Presentamos una serie de pacientes con PCN con el objetivo de aportar nuestra experiencia en el manejo de esta entidad. Material y métodos Se realizó un estudio observacional, retrospectivo y unicéntrico que incluye pacientes con PCN atendidos en el Servicio de Dermatología de un hospital terciario entre 2009 y 2021. Se recogieron variables sociodemográficas y clínicas. Resultados Se incluyó 74 pacientes, mayoritariamente mujeres (63,5%), con una media de 57 años. La asociación del PCN con otras enfermedades cutáneas fue del 39,2%, sobre todo dermatitis atópica (62%). El 54,1% de los pacientes presentaron comorbilidad endocrina y el 44,4% comorbilidad cardiovascular. La asociación con enfermedad psiquiátrica fue del 36,5%. La biopsia cutánea fue útil para confirmar la sospecha clínica en el 70% de los casos. El valor medio de la IgE fue superior a la normalidad (516 UI/mL), independientemente de la existencia de predisposición atópica. Se utilizó una media de tres tratamientos para el PCN por paciente. El metotrexato, los antihistamínicos y los corticoides tópicos y orales fueron los más empleados, estando el primero entre los más eficaces. Conclusione El PCN es una enfermedad compleja asociada a un gran número de comorbilidades, que requiere una aproximación multidisciplinar con el dermatólogo como eje central. El manejo terapéutico clásico es probablemente inadecuado (AU)

Background and objective Chronic nodular prurigo (CNPG) is a recently defined and currently underdiagnosed disease with a variety of causes. It is associated with multiple comorbidities, and its management and treatment have improved with a better understanding of its pathogenesis. The aim of this study was to describe our experience with a series of patients with CNPG. Material and methods Single-center, observational, retrospective study of the sociodemographic and clinical characteristics of patients with CNPG seen at the dermatology department of a tertiary care hospital between 2009 and 2021. Results We included 74 patients, mostly women (63.5%), with a mean age of 57 years. Overall, 39.2% of patients had a concomitant skin condition, mainly atopic dermatitis (62%). Other comorbidities included endocrine disorders (54.1%), cardiovascular disease (44.4%), and psychiatric disorders (36.5%). Skin biopsy helped confirm the clinical diagnosis in 70% of cases. The mean immunoglobulin E level was higher than normal (516 IU/mL), regardless of atopic predisposition. On average, patients received 3 treatments, the most common choices being methotrexate, antihistamines, and topical and oral corticosteroids. Methotrexate was among the most effective options. Conclusions CNPG is a complex disease associated with multiple comorbidities. It requires a multidisciplinary approach, with the dermatologist at the center. Classical treatment approaches are probably insufficient (AU)

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Background and objective Chronic nodular prurigo (CNPG) is a recently defined and currently underdiagnosed disease with a variety of causes. It is associated with multiple comorbidities, and its management and treatment have improved with a better understanding of its pathogenesis. The aim of this study was to describe our experience with a series of patients with CNPG. Material and methods Single-center, observational, retrospective study of the sociodemographic and clinical characteristics of patients with CNPG seen at the dermatology department of a tertiary care hospital between 2009 and 2021. Results We included 74 patients, mostly women (63.5%), with a mean age of 57 years. Overall, 39.2% of patients had a concomitant skin condition, mainly atopic dermatitis (62%). Other comorbidities included endocrine disorders (54.1%), cardiovascular disease (44.4%), and psychiatric disorders (36.5%). Skin biopsy helped confirm the clinical diagnosis in 70% of cases. The mean immunoglobulin E level was higher than normal (516 IU/mL), regardless of atopic predisposition. On average, patients received 3 treatments, the most common choices being methotrexate, antihistamines, and topical and oral corticosteroids. Methotrexate was among the most effective options. Conclusions CNPG is a complex disease associated with multiple comorbidities. It requires a multidisciplinary approach, with the dermatologist at the center. Classical treatment approaches are probably insufficient (AU)

Antecedentes y objetivo El prurigo crónico nodular (PCN) es una enfermedad recientemente definida, de etiología heterogénea e infradiagnosticado en la actualidad. Está asociado a múltiples comorbilidades y los avances en su patogenia han abierto puertas a un mejor manejo y tratamiento. Presentamos una serie de pacientes con PCN con el objetivo de aportar nuestra experiencia en el manejo de esta entidad. Material y métodos Se realizó un estudio observacional, retrospectivo y unicéntrico que incluye pacientes con PCN atendidos en el Servicio de Dermatología de un hospital terciario entre 2009 y 2021. Se recogieron variables sociodemográficas y clínicas. Resultados Se incluyó 74 pacientes, mayoritariamente mujeres (63,5%), con una media de 57 años. La asociación del PCN con otras enfermedades cutáneas fue del 39,2%, sobre todo dermatitis atópica (62%). El 54,1% de los pacientes presentaron comorbilidad endocrina y el 44,4% comorbilidad cardiovascular. La asociación con enfermedad psiquiátrica fue del 36,5%. La biopsia cutánea fue útil para confirmar la sospecha clínica en el 70% de los casos. El valor medio de la IgE fue superior a la normalidad (516 UI/mL), independientemente de la existencia de predisposición atópica. Se utilizó una media de tres tratamientos para el PCN por paciente. El metotrexato, los antihistamínicos y los corticoides tópicos y orales fueron los más empleados, estando el primero entre los más eficaces. Conclusiones El PCN es una enfermedad compleja asociada a un gran número de comorbilidades, que requiere una aproximación multidisciplinar con el dermatólogo como eje central. El manejo terapéutico clásico es probablemente inadecuado (AU)

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BACKGROUND AND OBJECTIVE: Chronic nodular prurigo (CNPG) is a recently defined and currently underdiagnosed disease with a variety of causes. It is associated with multiple comorbidities, and its management and treatment have improved with a better understanding of its pathogenesis. The aim of this study was to describe our experience with a series of patients with CNPG. MATERIAL AND METHODS: Single-center, observational, retrospective study of the sociodemographic and clinical characteristics of patients with CNPG seen at the dermatology department of a tertiary care hospital between 2009 and 2021. RESULTS: We included 74 patients, mostly women (63.5%), with a mean age of 57 years. Overall, 39.2% of patients had a concomitant skin condition, mainly atopic dermatitis (62%). Other comorbidities included endocrine disorders (54.1%), cardiovascular disease (44.4%), and psychiatric disorders (36.5%). Skin biopsy helped confirm the clinical diagnosis in 70% of cases. The mean immunoglobulin E level was higher than normal (516 IU/mL), regardless of atopic predisposition. On average, patients received 3 treatments, the most common choices being methotrexate, antihistamines, and topical and oral corticosteroids. Methotrexate was among the most effective options. CONCLUSIONS: CNPG is a complex disease associated with multiple comorbidities. It requires a multidisciplinary approach, with the dermatologist at the center. Classical treatment approaches are probably insufficient.

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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 (AU)

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 (AU)

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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 (AU)

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 (AU)

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BACKGROUND: Hand eczema is common in patients with atopic dermatitis (AD), but few studies have described the characteristics of these patients in large, representative populations from different geographic regions and occupational settings. OBJECTIVE: To describe the epidemiological, clinical, and allergy profile of patients with hand eczema who underwent patch testing and compare patients with and without AD. METHODS: Analysis of data from the Spanish Contact Dermatitis Registry, a multicenter registry of patients who undergo patch testing in Spain. RESULTS: We included 1466 patients with hand eczema who were patch tested between January 2018 and June 2020. Those with AD were younger and had had symptoms for longer before testing. They were also more likely to have been exposed to occupational triggers (38% vs 53% for patients without AD). The only profession for which significant differences were found was hairdressing. The most common allergens were nickel sulfate, methylchloroisothiazolinone/methylisothiazolinone, cobalt chloride, potassium dichromate, fragrance mixes I and II, and formaldehyde. The most common diagnoses were allergic contact dermatitis (24% vs 31% in patients with and without AD, P=.0224) and irritant contact dermatitis (18% and 35% respectively, P<.001). CONCLUSIONS: AD is common in patients with predominant hand eczema who undergo patch testing. Patients with hand eczema and AD have different clinical and epidemiological characteristics to hand eczema patients in general and their final diagnosis following patch testing is also different.

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The terms control and remission and other key terms used in chronic urticaria (CU) such as flare-up, relapse, exacerbation, and recurrence have not been fully defined in the literature. Disease monitoring and treatment goals in clinical practice are not well established. After a qualitative appraisal of available evidence, we aimed to find a consensus definition of control and remission, clarify key terminology, provide guidance on how to monitor the disease, and establish treatment goals in clinical practice. A modified Delphi consensus approach was used. Based on a literature review, a scientific committee provided 137 statements addressing controversial definitions and terms, available patient-reported outcomes (PROs), and recommendations on how to measure therapeutic objectives in CU. The questionnaire was evaluated by 138 expert allergists and dermatologists. A consensus was reached on 105 out of the 137 proposed items (76.6%). The experts agreed that complete control and remission of CU could be defined as the absence of signs or symptoms while on treatment and in the absence of treatment, respectively. Consensus was not reached on the definition of other key terms such as flare-up, exacerbation, and recurrence. The panel agreed that the objective of therapy in CU should be to achieve complete control. PROs that define the degree of control (complete, good, partial, or absence) were established. An algorithm for disease assessment is provided. In conclusion, this work offers consensus definitions and tools that may be useful in the management of patients with CU.

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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.

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BACKGROUND: Chronic Urticaria (CU) is a debilitating disease whose treatment is mainly symptomatic. UCREX study aimed to identify CU patients' profile, disease management and quality-of-life (QoL) in daily clinical practice in Spain. METHODS: Observational, 12-months prospective, multicenter study, included de novo or established CU patients attending to dermatology/allergy consultations in 39 Spanish hospitals. MAIN VARIABLES: Urticaria Activity Score (UAS), UAS over 7 days (UAS7). Secondary variables: CU-QoL Questionnaire (CU-Q2oL), EuroQol-5 dimensions (EQ-5D), Medical Outcomes Study Sleep (MOS-Sleep) scale, Hospital Anxiety and Depression Scale (HADS). RESULTS: 361 patients included. Of them, 176 (48.8%) considered for the main objective analysis. Mean age (SD) of 46.6 (14.2) years and 71.8% women. The year prior to inclusion, most patients (57.1%) were treated with non-sedating H1-antihistamines (NS-H1AH). At baseline, mean (SD) 3.6 (6.8) visits were registered to primary care. Mean (SD) UAS7 at baseline was 14.3 (11.0) and CU-Q2oL 24.1 (17.0) which tended to improve by 8.6 (9.7) and 13.9 (15.0), respectively, at 12-months. MOS-Sleep and EQ-5D remained steady during the study, except pain/discomfort and anxiety/depression which went from 58.7% and 49.6% to 29.6% and 26.9%, respectively. At baseline, HADS showed a mean (SD) anxiety of 8.7 (4.5) and depression 5.1 (4.4), decreasing to 7.0 (4.3) and 4.7 (4.3), respectively, at 12-months. CONCLUSIONS: Although most CU patients are treated with NS-H1AH, disease activity is still important, negatively affecting patients' QoL, work activity and healthcare resources use. An appropriate disease management could be the basis for symptoms control, QoL improvement and resources optimization.

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Background: Hand eczema is common in patients with atopic dermatitis (AD), but few studies have described the characteristics of these patients in large, representative populations from different geographic regions and occupational settings. Objective: To describe the epidemiological, clinical, and allergy profile of patients with hand eczema who underwent patch testing and compare patients with and without AD. Methods: Analysis of data from the Spanish Contact Dermatitis Registry, a multicenter registry of patients who undergo patch testing in Spain. Results: We included 1466 patients with hand eczema who were patch tested between January 2018 and June 2020. Those with AD were younger and had had symptoms for longer before testing. They were also more likely to have been exposed to occupational triggers (38% vs 53% for patients without AD). The only profession for which significant differences were found was hairdressing. The most common allergens were nickel sulfate, methylchloroisothiazolinone/methylisothiazolinone, cobalt chloride, potassium dichromate, fragrance mixes I and II, and formaldehyde. The most common diagnoses were allergic contact dermatitis (24% vs 31% in patients with and without AD, P=.0224) and irritant contact dermatitis (18% and 35% respectively, P<.001). Conclusions: AD is common in patients with predominant hand eczema who undergo patch testing. Patients with hand eczema and AD have different clinical and epidemiological characteristics to hand eczema patients in general and their final diagnosis following patch testing is also different (AU)

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<0.001). Conclusiones: La DA es frecuente en los pacientes parcheados con afectación predominante de las manos. Existen diferencias clínicas, epidemiológicas y de diagnóstico final de estos pacientes con respecto al conjunto de pacientes con DM (AU)

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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<0.001). Conclusiones: La DA es frecuente en los pacientes parcheados con afectación predominante de las manos. Existen diferencias clínicas, epidemiológicas y de diagnóstico final de estos pacientes con respecto al conjunto de pacientes con DM (AU)

Background: Hand eczema is common in patients with atopic dermatitis (AD), but few studies have described the characteristics of these patients in large, representative populations from different geographic regions and occupational settings. Objective: To describe the epidemiological, clinical, and allergy profile of patients with hand eczema who underwent patch testing and compare patients with and without AD. Methods: Analysis of data from the Spanish Contact Dermatitis Registry, a multicenter registry of patients who undergo patch testing in Spain. Results: We included 1466 patients with hand eczema who were patch tested between January 2018 and June 2020. Those with AD were younger and had had symptoms for longer before testing. They were also more likely to have been exposed to occupational triggers (38% vs 53% for patients without AD). The only profession for which significant differences were found was hairdressing. The most common allergens were nickel sulfate, methylchloroisothiazolinone/methylisothiazolinone, cobalt chloride, potassium dichromate, fragrance mixes I and II, and formaldehyde. The most common diagnoses were allergic contact dermatitis (24% vs 31% in patients with and without AD, P=.0224) and irritant contact dermatitis (18% and 35% respectively, P<.001). Conclusions: AD is common in patients with predominant hand eczema who undergo patch testing. Patients with hand eczema and AD have different clinical and epidemiological characteristics to hand eczema patients in general and their final diagnosis following patch testing is also different (AU)

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BACKGROUND: Chronic Urticaria (CU) is a debilitating disease whose treatment is mainly symptomatic. UCREX study aimed to identify CU patients' profile, disease management and quality-of-life (QoL) in daily clinical practice in Spain. METHODS: Observational, 12-months prospective, multicenter study, included de novo or established CU patients attending to dermatology/allergy consultations in 39 Spanish hospitals. MAIN VARIABLES: Urticaria Activity Score (UAS), UAS over 7 days (UAS7). Secondary variables: CU-QoL Questionnaire (CU-Q2oL), EuroQol-5 dimensions (EQ-5D), Medical Outcomes Study Sleep (MOS-Sleep) scale, Hospital Anxiety and Depression Scale (HADS). RESULTS: 361 patients included. Of them, 176 (48.8%) considered for the main objective analysis. Mean age (SD) of 46.6 (14.2) years and 71.8% women. The year prior to inclusion, most patients (57.1%) were treated with non-sedating H1-antihistamines (NS-H1AH). At baseline, mean (SD) 3.6 (6.8) visits were registered to primary care. Mean (SD) UAS7 at baseline was 14.3 (11.0) and CU-Q2oL 24.1 (17.0) which tended to improve by 8.6 (9.7) and 13.9 (15.0), respectively, at 12-months. MOS-Sleep and EQ-5D remained steady during the study, except pain/discomfort and anxiety/depression which went from 58.7% and 49.6% to 29.6% and 26.9%, respectively. At baseline, HADS showed a mean (SD) anxiety of 8.7 (4.5) and depression 5.1 (4.4), decreasing to 7.0 (4.3) and 4.7 (4.3), respectively, at 12-months. CONCLUSIONS: Although most CU patients are treated with NS-H1AH, disease activity is still important, negatively affecting patients' QoL, work activity and healthcare resources use. An appropriate disease management could be the basis for symptoms control, QoL improvement and resources optimization.

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Background: Chronic Urticaria (CU) is a debilitating disease whose treatment is mainly symptomatic. UCREX study aimed to identify CU patients’ profile, disease management and quality-of-life (QoL) in daily clinical practice in Spain. Methods: Observational, 12-months prospective, multicenter study, included de novo or established CU patients attending to dermatology/allergy consultations in 39 Spanish hospitals. Main variables: Urticaria Activity Score (UAS), UAS over 7 days (UAS7). Secondary variables: CU-QoL Questionnaire (CU-Q2oL), EuroQol-5 dimensions (EQ-5D), Medical Outcomes Study Sleep (MOS-Sleep) scale, Hospital Anxiety and Depression Scale (HADS). Results: 361 patients included. Of them, 176 (48.8%) considered for the main objective analysis. Mean age (SD) of 46.6 (14.2) years and 71.8% women. The year prior to inclusion, most patients (57.1%) were treated with non-sedating H1-antihistamines (NS-H1AH). At baseline, mean (SD) 3.6 (6.8) visits were registered to primary care. Mean (SD) UAS7 at baseline was 14.3 (11.0) and CU-Q2oL 24.1 (17.0) which tended to improve by 8.6 (9.7) and 13.9 (15.0), respectively, at 12-months. MOS-Sleep and EQ-5D remained steady during the study, except pain/discomfort and anxiety/depression which went from 58.7% and 49.6% to 29.6% and 26.9%, respectively. At baseline, HADS showed a mean (SD) anxiety of 8.7 (4.5) and depression 5.1 (4.4), decreasing to 7.0 (4.3) and 4.7 (4.3), respectively, at 12-months. Conclusions: Although most CU patients are treated with NS-H1AH, disease activity is still important, negatively affecting patients’ QoL, work activity and healthcare resources use. An appropriate disease management could be the basis for symptoms control, QoL improvement and resources optimization

Antecedentes: La urticaria crónica (UC) es una enfermedad debilitante cuyo tratamiento es principalmente sintomático. El estudio UCREX tuvo como objetivo identificar el perfil de los pacientes con UC, el manejo de la enfermedad y la calidad de vida (CdV) en la práctica clínica diaria en España. Métodos: Estudio observacional, prospectivo, multicéntrico de 12 meses, que incluyó pacientes con UC de novo o establecida que acudieron a la consulta de dermatología/alergología de 39 hospitales españoles. Las variables principales fueron: el Urticaria Activity Score (UAS) y el UAS por siete días (UAS7). Las variables secundarias fueron: el cuestionario de CdV de urticaria crónica (CU-Q2oL), el EuroQol-5 Dimensiones (EQ-5D), la escala Medical Outcomes Study Sleep (MOS-Sleep) y la escala hospitalaria de ansiedad y depresión (HADS). Resultados: Se incluyeron 361 pacientes, de los cuales 176 (48,8%) formaron parte del análisis del objetivo principal. La edad media (DE) fue de 46,6 (14,2) años y el 71,8% eran del sexo femenino. El año anterior al periodo de inclusión de los pacientes, la mayoría de ellos (57,1%) se habían tratado con antihistamínicos H1 no sedantes (AHNS-H1). En la basal, se registró una media (DE) de 3,6 (6,8) de visitas a atención primaria. La media (DE) del UAS7 en la basal fue de 14,3 (11,0) y del CU-Q2oL 24,1 (17,0), observándose una tendencia en la mejoría en 8,6 (9,7) y 13,9 (15,0), respectivamente, a los 12 meses. El MOS-Sleep y el EQ-5D se mantuvieron estables durante el estudio, excepto por el dolor/malestar y la ansiedad/depresión que pasaron de 58,7 y 49,6% a 29,6 y 26,9%, respectivamente. En situación basal, el HADS mostró una ansiedad media (DE) de 8,7 (4,5) y una depresión de 5,1 (4,4), disminuyendo respectivamente a 7,0 (4,3) y 4,7 (4,3) a los 12 meses. Conclusiones: Aunque la mayoría de los pacientes son tratados con AHNS-H1, la actividad de la enfermedad sigue siendo importante, afectando negativamente a su CdV (AU)

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Antecedentes: La urticaria crónica (UC) es una enfermedad debilitante cuyo tratamiento es principalmente sintomático. El estudio UCREX tuvo como objetivo identificar el perfil de los pacientes con UC, el manejo de la enfermedad y la calidad de vida (CdV) en la práctica clínica diaria en España. Métodos: Estudio observacional, prospectivo, multicéntrico de 12 meses, que incluyó pacientes con UC de novo o establecida que acudieron a la consulta de dermatología/alergología de 39 hospitales españoles. Las variables principales fueron: el Urticaria Activity Score (UAS) y el UAS por siete días (UAS7). Las variables secundarias fueron: el cuestionario de CdV de urticaria crónica (CU-Q2oL), el EuroQol-5 Dimensiones (EQ-5D), la escala Medical Outcomes Study Sleep (MOS-Sleep) y la escala hospitalaria de ansiedad y depresión (HADS). Resultados: Se incluyeron 361 pacientes, de los cuales 176 (48,8%) formaron parte del análisis del objetivo principal. La edad media (DE) fue de 46,6 (14,2) años y el 71,8% eran del sexo femenino. El año anterior al periodo de inclusión de los pacientes, la mayoría de ellos (57,1%) se habían tratado con antihistamínicos H1 no sedantes (AHNS-H1). En la basal, se registró una media (DE) de 3,6 (6,8) de visitas a atención primaria. La media (DE) del UAS7 en la basal fue de 14,3 (11,0) y del CU-Q2oL 24,1 (17,0), observándose una tendencia en la mejoría en 8,6 (9,7) y 13,9 (15,0), respectivamente, a los 12 meses. El MOS-Sleep y el EQ-5D se mantuvieron estables durante el estudio, excepto por el dolor/malestar y la ansiedad/depresión que pasaron de 58,7 y 49,6% a 29,6 y 26,9%, respectivamente. En situación basal, el HADS mostró una ansiedad media (DE) de 8,7 (4,5) y una depresión de 5,1 (4,4), disminuyendo respectivamente a 7,0 (4,3) y 4,7 (4,3) a los 12 meses. Conclusiones: Aunque la mayoría de los pacientes son tratados con AHNS-H1 (AU)

Background: Chronic Urticaria (CU) is a debilitating disease whose treatment is mainly symptomatic. UCREX study aimed to identify CU patients’ profile, disease management and quality-of-life (QoL) in daily clinical practice in Spain. Methods: Observational, 12-months prospective, multicenter study, included de novo or established CU patients attending to dermatology/allergy consultations in 39 Spanish hospitals. Main variables: Urticaria Activity Score (UAS), UAS over 7 days (UAS7). Secondary variables: CU-QoL Questionnaire (CU-Q2oL), EuroQol-5 dimensions (EQ-5D), Medical Outcomes Study Sleep (MOS-Sleep) scale, Hospital Anxiety and Depression Scale (HADS). Results: 361 patients included. Of them, 176 (48.8%) considered for the main objective analysis. Mean age (SD) of 46.6 (14.2) years and 71.8% women. The year prior to inclusion, most patients (57.1%) were treated with non-sedating H1-antihistamines (NS-H1AH). At baseline, mean (SD) 3.6 (6.8) visits were registered to primary care. Mean (SD) UAS7 at baseline was 14.3 (11.0) and CU-Q2oL 24.1 (17.0) which tended to improve by 8.6 (9.7) and 13.9 (15.0), respectively, at 12-months. MOS-Sleep and EQ-5D remained steady during the study, except pain/discomfort and anxiety/depression which went from 58.7% and 49.6% to 29.6% and 26.9%, respectively. At baseline, HADS showed a mean (SD) anxiety of 8.7 (4.5) and depression 5.1 (4.4), decreasing to 7.0 (4.3) and 4.7 (4.3), respectively, at 12-months. Conclusions: Although most CU patients are treated with NS-H1AH, disease activity is still important, negatively affecting patients’ QoL, work activity and healthcare resources use. An appropriate disease management could be the basis for symptoms control, QoL improvement and resources optimization

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The terms control and remission and other key terms used in chronic urticaria (CU) such as flare-up, relapse, exacerbation, and recurrence have not been fully defined in the literature. Disease monitoring and treatment goals in clinical practice are not well established. After a qualitative appraisal of available evidence, we aimed to find a consensus definition of control and remission, clarify key terminology, provide guidance on how to monitor the disease, and establish treatment goals in clinical practice. A modified Delphi consensus approach was used. Based on a literature review, a scientific committee provided 137 statements addressing controversial definitions and terms, available patient-reported outcomes (PROs), and recommendations on how to measure therapeutic objectives in CU. The questionnaire was evaluated by 138 expert allergists and dermatologists. A consensus was reached on 105 out of the 137 proposed items (76.6%). The experts agreed that complete control and remission of CU could be defined as the absence of signs or symptoms while on treatment and in the absence of treatment, respectively. Consensus was not reached on the definition of other key terms such as flare-up, exacerbation, and recurrence. The panel agreed that the objective of therapy in CU should be to achieve complete control. PROs that define the degree of control (complete, good, partial, or absence) were established. An algorithm for disease assessment is provided. In conclusion, this work offers consensus definitions and tools that may be useful in the management of patients with CU (AU)

El concepto de control y remisión de la enfermedad, así como otros términos clave utilizados en la urticaria crónica (UC), como reagudización, recaída, exacerbación o recurrencia, no están totalmente aclarados en la literatura. Tampoco está bien establecido el seguimiento de la enfermedad y los objetivos del tratamiento en la práctica clínica. Tras una evaluación cualitativa de la evidencia, nos propusimos encontrar una definición consensuada de control y remisión de la UC, aclarar terminología clave, proporcionar orientación sobre cómo monitorizar la enfermedad y establecer objetivos de tratamiento en la práctica clínica. Para llegar a un consenso, se utilizó una técnica Delphi modificada. Basándose en una revisión de la literatura, un comité científico elaboró 137 aseveraciones que abordaban definiciones y términos controvertidos, el uso de Patient Reported Outcomes (PROs) y recomendaciones sobre cómo medir los objetivos terapéuticos en la UC. El cuestionario fue evaluado por 138 alergólogos y dermatólogos expertos. Se alcanzó un consenso en 105 de las 137 aseveraciones propuestas (76,6%). Los expertos estuvieron de acuerdo en que el control completo y la remisión de la CU podrían definirse como la ausencia de signos o síntomas de la enfermedad mientras se está en tratamiento y en ausencia de tratamiento, respectivamente. No se alcanzó un consenso sobre la definición de otros términos clave como reagudización, exacerbación o recurrencia. El panel estuvo de acuerdo en que el objetivo terapéutico de la CU debe ser lograr un control completo. Se establecieron los PROs que definen el grado de control de la CU (completo, bueno, parcial o ausencia de control). Además, se creó un algoritmo para la evaluación de la enfermedad. En conclusión, este trabajo ofrece definiciones y herramientas de consenso que pueden ser útiles en el manejo de los pacientes con CU (AU)

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