Introduction The COVID‐19 pandemic dramatically disrupts health care around the globe. The impact of the pandemic on chronic urticaria (CU) and its management are largely unknown. Aim To understand how CU patients are affected by the COVID‐19 pandemic; how specialists alter CU patient management; and the course of CU in patients with COVID‐19. Materials and Methods Our cross‐sectional, international, questionnaire‐based, multicenter UCARE COVID‐CU study assessed the impact of the pandemic on patient consultations, remote treatment, changes in medications, and clinical consequences. Results The COVID‐19 pandemic severely impairs CU patient care, with less than 50% of the weekly numbers of patients treated as compared to before the pandemic. Reduced patient referrals and clinic hours were the major reasons. Almost half of responding UCARE physicians were involved in COVID‐19 patient care, which negatively impacted on the care of urticaria patients. The rate of face‐to‐face consultations decreased by 62%, from 90% to less than half, whereas the rate of remote consultations increased by more than 600%, from one in 10 to more than two thirds. Cyclosporine and systemic corticosteroids, but not antihistamines or omalizumab, are used less during the pandemic. CU does not affect the course of COVID‐19, but COVID‐19 results in CU exacerbation in one of three patients, with higher rates in patients with severe COVID‐19. Conclusions The COVID‐19 pandemic brings major changes and challenges for CU patients and their physicians. The long‐term consequences of these changes, especially the increased use of remote consultations, require careful evaluation.
Pemphigus refers to a group of potentially life-threatening autoimmune diseases of the skin and mucous membranes, characterized by the formation of blisters and erosions of the skin. An autoimmune process, directed against keratinocyte desmosomal cadherins, interferes with the adhesive function of these molecules. This results in the separation of keratinocytes and clinical manifestation of blistering. Differences in the particular antigens targeted by the antibodies and in the distribution of these antigens in the different regions of the body and in the separate layers of the epidermis result in different clinical manifestations of the disease. Diagnosis of pemphigus is based on three independent groups of criteria: clinical features (flaccid blisters and erosions on skin and oral mucosa), histologic findings (epidermal acantholysis) and immunological tests (circulating and skin-fixed antibodies against keratinocyte surface antigens). The principle aim of treatment is to reduce inflammatory response and autoantibody production, thereby achieving disease remission.Systemic corticosteroids are still the most useful drugs in the treatment of pemphigus and continue to be the mainstay of therapy for this disease.Adjuvant drugs, such as immunosuppressants, are commonly used in combination, in order to increase efficacy and have a steroid-sparing effect,thereby allowing reduced maintenance doses and less side effects of systemic corticosteroids. Other options include intravenous immunoglobulin and plasmapheresis. However, more research is needed to develop treatments with the least possible toxicity.
Highly variable results have been described for the use of topical diphenylcyclopropenone (DPCP) in the treatment of alopecia areata (AA). We enrolled 41 patients in a prospective open clinical trial. Of these, 17 patients had either AA totalis (AAT) or AA universalis (AAU), and 24 had severe alopecia (> 50% scalp involvement). After sensitization with DPCP 2% in acetone, progressively higher concentrations were applied once a week for a period of 6-12 months. Of the 41 patients, 38 (16 with AAT or AAU and 22 with extensive AA) completed therapy. Significant hair regrowth was observed in 15 of the 38 patients (39.5%) at 6 months: 5 with AAT or AAU (31.25%) and 10 with extensive alopecia (45.4%). The above results were sustained in 66.6% of patients for a 12-month-follow up- period. In our study, topical immunotherapy with DPCP proved to be an effective treatment, with prolonged therapeutic results.
A case of rituximab-related urticarial reaction in cutaneous B-cell lymphomaEditor Only a few cases of rituximab-related urticarial reaction have been reported in patient treated for B-cell lymphoma. This phenomenon may be related to the killing of tumoral CD20 B cells in the site of the tumour. We reported another case of urticarial reaction during rituximab infusion in a patient with cutaneous lymphoma.A 43-year-old man was referred to our hospital because of unusual erythematous skin patches involving the dorsal right infraaxillar regions. Biopsies confirmed the diagnosis of cutaneous follicular B-cell lymphoma. Complete evaluation did not reveal systemic disease. After an unsuccessful treatment with topical steroids, external radiotherapy was delivered with complete remission. However, a cutaneous relapse occurred 2 years later with thoracic and dorsal skin lesions. The patient was treated with four weekly intravenous infusions of 375 mg/m 2 of rituximab, the first infusion over a 6-h period, and the three consecutives over 1 h. One hour after the start of the first infusion and despite pre-medication with diphenhydramine, acetaminophen and steroid, the patient developed an urticarial reaction at the site of tumour patches and excision scars. The infusion was stopped for 2 h and the lesions spontaneously resolved. The patient could therefore complete the planned treatment with no side-effects. Surprisingly, the three last infusions of rituximab were well tolerated despite an accelerated infusion over 1 h. 1 Evaluation after the four cycles showed a complete remission status. The patient is still in complete remission with a 12-month follow-up.To date, few cases of localized rituximab-related urticarial reactions have been described. 2,3 These cases show urticarial lesions only located on the tumour sites. Moreover, this effect was observed during the first infusion which was realized according to the manufacturer guidelines with infusion times of 6 h and not during fast infusion of 1 h. 1 This could favour a more antitumoral effect rather than an anaphylactic mechanism. It is not known if this kind of reaction represents an indirect sign of antitumoral effect of rituximab on malignant CD20 B cells. Of note, the three reported patients experienced a complete remission after rituximab monotherapy. It is possible that this cutaneous reaction could be associated with a better response to rituximab as suggested for rash induced by epidermal growth factor receptor inhibitors 4 or bortezomib-induced cutaneous vasculitis. 5 Interestingly, the three reported cases only concerned primary cutaneous lymphomas. Maybe, the high concentration of malignant B cells into cutaneous lesions in primary cutaneous B-cell lymphoma may explain why this reaction has not been reported in systemic lymphoma. Additionally, all the reported cases concerned primary cutaneous B-cell lymphoma of follicular type. 2,3 The sensitivity of follicular B cells to rituximab may explain why the cases described actually are restricted to these lympho...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.