Presentación de PowerPoint...Foam baths or showers Rigorous rubbing after bath Antiseptics...
Transcript of Presentación de PowerPoint...Foam baths or showers Rigorous rubbing after bath Antiseptics...
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Dr. Ignasi Figueras
INMUNOALERGIA CUTÁNEA
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ATOPIC DERMATITIS
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ATOPIC DERMATITIS
▪ Diagnostic, stratification and differential diagnostic
Scheerer 2018. Der Hautarzt
Congenital onset: think about icthyoses
Genetic-immunological type (IL-4, IL-13 and IgE
Genetic-barrier type (Filaggrin and LEKTI)
Non-genetic immunological type (allergic sensitization)
Non-genetic barrier type (dry-skin, itch, microbiome, photo-toxic)
Atopic dermatitis
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RISK FACTORS FOR AD
Kelleher JACI 2014Simpson JACI 2014
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AD BIOMARKERS
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AD REGISTRY
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AD TREATMENT I
▪ Mistakes:
▪ Petrolatum on the scalp
▪ Urea in the face
▪ Urea <3 yo (3 yo 3%, 5yo 5%, 10yo 10%)
▪ Ointments in intertriginous areas
▪ Foam baths or showers
▪ Rigorous rubbing after bath
Antiseptics – microbiome alterations (showed reduceddiversity during flares). No need for antibiotics. Onlyantiinflamatory and diveristy comes back. Only atb if there’s infection.
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AD TREATMENT II
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C. Vestergaard, A. Wollenberg, et al. European task force on atopic dermatitis position paper: treatment of parental atopic dermatitis during preconception, pregnancy and lactation period. JEADV 2019
SYSTEMIC TREATMENT IN PREGNANT WOMEN
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ECZEMAS
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DAC DIAGNOSTIC - Goossens
▪ DETERMINTATION OF THE RELEVANCE!!!
▪ Semi-open testing – based on experience of the author. ▪ Cosmetics, disinfectants, industrial products (MDA secreening for
isocyanates)
▪ Avoid false-positive or irritants or severe reactions due to occlusions
▪ Avoid False-negative reactions due to too high dilutions.
▪ Never test
▪ Corrosive or toxic materials
▪ Unknown products
▪ Highly acidic or alkaline products
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URTICARIA
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URTICARIA I
▪ Angioedema:
▪ Histaminergic 40-60% in CSU patients
▪ Kininergic
▪ Never wheals
▪ Excess bardikinin
▪ NOT MAST CELL DEGRANULATION
▪ Risk of suffocation with angioedema
▪ H : acute urticaria very rare but possible in the context of anaphylaxis // CU never
▪ BK: possible. ACEI possible, C1 def H or A yes
PHASE 1: onset symptoms to onset of dyspneaPHASE 2: onset of dyspnea to loss of consciousnessPHASE 3: onset of loss of consciousness to death
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URTICARIA II
▪ CINDU Treatment: avoidance + antiH1 followed by OMA if no response. ▪ Dermographism: OMA evidence A 150/300mg, same as antiH’s. 1 case of benralizumab
▪ Cholinergic: antiH, OMA 300mg and canazol up to 600mg
▪ Cold urticaria: antiH, OMA 150/300mg and Ketotifen
▪ Solar urticaria: antiH and omalizumab. Solar urticaria: antiH and omalizumab.
▪ Delayed pressure urticaria: antiH and montelukast with desloratadine. OMA evidence level B
▪ Aquagenic urticaria: none grade A and B. Everything is grade C (antiH, OMA…)
▪ Heat urticaria: none grade A and B. Everything is C
▪ Vibratory angioedema: none grade A and B. Everything is C
▪ Eosinopenia in CSU associated with high disease activity, autoimmunity and poor response to tt