No abstract

This is an open access article under the terms of the Creat ive Commo ns Attri bution-NonCo mmercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Immunosuppression is a well-documented precipitant of porokeratosis (PK). However, PK is not considered among the most common cutaneous disorders in immunosuppressed patients. We studied prospectively a series of 103 renal transplant patients and found 11 cases (10.68%) of PK. Our series represents the highest incidence of PK in transplant patients reported so far. Our findings suggest that PK in transplant recipients may be more frequent than previously thought.

Methotrexate (MTX) is the most frequently used conventional systemic drug in the treatment of psoriasis. Despite over 50years of experience in this setting, certain aspects of the use of this drug in clinical practice are still little standardized and poorly understood. For this reason, a group of 15 experts took part in a consensus development conference to achieve consensus on a series of recommendations on the use of MTX in psoriasis. The guidelines, which were developed on the basis of a systematic review of the literature, were validated by 2 rounds of voting and categorized by level of evidence and grade of recommendation. Before MTX can be used to treat moderate to severe psoriasis, the patient must be evaluated to assess the suitability of the treatment, including consideration of vaccination status and screening for tuberculosis and pregnancy. The recommended starting dose for a patient with no risk factors is 10 to 20mg/wk, the therapeutic dose for most patients is 15mg/wk, and the maximum dose is 20mg/wk. Most patients who respond to treatment will show improvement within 8weeks. Parenteral administration of MTX is desirable when there is a risk of erroroneous dosing, nonadherence, gastrointestinal intolerance, or inadequate response to the therapeutic dose taken orally. Noninvasive methods are preferred for monitoring hepatotoxicity. MTX is a good treatment option for patients with a history of cancer, but is not recommended in patients with chronic hepatitisB infection or individuals who are seropositive for human immunodeficiency virus.

No abstract

Background Dermatologic care was halted because of the coronavirus disease 2019 pandemic, prompting us to study the usefulness of direct-to-patient teledermatology via a mobile application. We aimed to evaluate the service as a tool for avoiding face-to-face consultations, describe the main conditions diagnosed, and assess levels of patient and physician satisfaction. Material and method Prospective descriptive study of new patients who met the inclusion criteria. Descriptive statistics for all variables were analyzed with SPSS. Results Of the 1,497 patients who agreed to participate in the study, 25% (n = 374) sent an image to a consultant dermatologist through the mobile application. Sixty-four patients (17%) were discharged directly and referred to primary care for follow-up. A face-to-face consultation was avoided for at least 3 months in 85% of patients (n = 318); 87.1% (n = 325) received a diagnosis and the dermatologist's level of confidence in this diagnosis was 7 or higher in 77.5% of cases (n = 290). The quality of the images sent was considered sufficient in 52.1% of cases. Patients rated their satisfaction with a score of 4.5 out of 5. Eleven of the 16 dermatologists rated their satisfaction as good overall. The most common conditions were inflammatory and melanocytic lesions. The main diagnoses were nevi, acne, and eczema. Discussion Direct-to-patient store-and-forward teledermatology is an effective means of evaluating new patients. Both clinicians and patients expressed high levels of satisfaction with the service. Systems enabling the addition of digital images to patient records are necessary to ensure the efficiency of teledermatology.

Objectives To assess the attitudes and opinions about generic antiretroviral drugs (ARVs) and single-tablet regimen (STR) de-simplification among physicians prescribing HIV treatment in the cohort of the Spanish HIV/AIDS Research Network (CoRIS). Methods An online questionnaire with 27 structured questions was sent to all physicians (n = 199) who prescribed ARVs among the 45 centres participating in the cohort. Results A total of 169 (84.9%) physicians answered the questionnaire. Only 4.1% of the physicians would never prescribe generic ARVs, but 53.3% would not prescribe them if the number of pills per day increased and 89.3% would not prescribe them if the number of doses per day increased. However, 84.0% of the physicians agreed to prescribe generic ARVs if doing so would decrease costs for the public healthcare system. The percentages of physicians stating that generic ARVs (compared with branded ones) would be associated with worse adherence, more adverse effects or more probability of virological failure, provided that the number of pills and doses per day would not change, were low: 0.6%, 7.7% and 3.6%, respectively. However, these percentages were much higher if the generic ARV entailed breaking an STR: 63.9%, 18.9% and 42.0%, respectively. Most physicians stated that they needed more information about the effectiveness and safety of generic ARVs and the price difference compared with their branded equivalents. Conclusions Although most physicians were confident about prescribing generic ARVs, the majority had strong concerns about de-simplifying STR, and they also needed more information about generic drugs.

Background Tralokinumab was recently approved for the treatment of moderate to severe AD and is the first selective IL-13 inhibitor that specifically neutralizes IL-13 with high affinity. Objectives To determine the real-life short-term effectiveness and safety of Tralokinumab treatment in AD patients with moderate to severe AD Methods A multicentre retrospective study was conducted including adult patients with moderate to severe AD who initiated Tralokinumab treatment from 1 April to 30 June 2022 in 16 spanish hospitals. Demographic and disease characteristics, severity and quality of life scales were collected at the baseline visit and at weeks 4 and 16. Results Eighty-five patients were included. Twenty-seven patients (31.8%) were non-naïve to advanced therapy (biological or JAK inhibitors). All included patients had severe disease with baseline EASI scores of 25.4 ± 8.1, DLQI 15.8 ± 5.4 and PP-NRS 8.1 ± 1.8. Sixty-five percent of the patients had an IGA of 4. At week 16, all scales improved significantly. The mean EASI decreased to 7.5 ± 6.9 (70.4% improvement), SCORAD improved 64.1% and PP-NRS, 57.1%. Also, 82.4%, 57.6% and 21.2% of the patients achieved EASI 50, 75 and 90, respectively. The percentage of EASI75 responders was significantly higher among naïve versus non-naïve patients (67.2% vs 40.7%). The safety profile was quite acceptable. Conclusions Patients, with a long history of disease and prior multidrug failure, showed a good response to Tralokinumab, confirming clinical trial results.