Revisión de las fórmulas magistrales (medicamentos individualizados) de mayor interés en dermatología pediátrica

En dermatología pediátrica, la correcta elección de la dosis de principio activo, así como del excipiente, se vuelve fundamental para conseguir los resultados terapéuticos deseados, por lo que se deben tener en cuenta aspectos tan variados como las características de la lesión, las del paciente y las del medicamento seleccionado. En la población pediátrica se plantean dificultades añadidas, tales como la limitada variedad de especialidades comerciales que se ajusten a sus particularidades. Por ello, la formulación magistral o formulación de medicamentos individualizados supone una buena alternativa terapéutica que permite emplear principios activos en los rangos terapéuticos aceptados, vehiculizados en las formas farmacéuticas idóneas, asociar varios en un mismo medicamento e incluso adaptar el vehículo al estado de la lesión, así como a las necesidades intrínsecas del paciente. Las formulaciones recogidas en este artículo, se basan en una amplia experiencia clínica y permiten a los médicos prescriptores adaptar el tratamiento de forma personalizada. The administration of appropriate doses of active ingredients and excipients is crucial for achieving desired treatment outcomes in pediatric dermatology. A number of factors need to be considered, including the characteristics of the lesion, the patient, and the drug. An additional challenge in pediatric settings is the limited number of commercially available formulations suitable for use in children. Drug compounding, which is the preparation of medications tailored to the needs of individual patients, is a good alternative for pediatric populations for a number of reasons. Using a customized compound, the clinician can prescribe formulations that contain the optimal dose of the active ingredients within acceptable limits and the most suitable vehicle and formulation components. Compounding can also be used to combine several active ingredients in a single medication and even adapt the vehicle to the characteristics of the lesion and the needs of the patient. The pharmaceutical formulations described in this review are based on extensive clinical experience and can be customized to meet individual needs

Photodynamic Therapy Combined with Antibiotics or Antifungals against Microorganisms That Cause Skin and Soft Tissue Infections: A Planktonic and Biofilm Approach to Overcome Resistances

The present review covers combination approaches of antimicrobial photodynamic therapy (aPDT) plus antibiotics or antifungals to attack bacteria and fungi in vitro (both planktonic and biofilm forms) focused on those microorganisms that cause infections in skin and soft tissues. The combination can prevent failure in the fight against these microorganisms: antimicrobial drugs can increase the susceptibility of microorganisms to aPDT and prevent the possibility of regrowth of those that were not inactivated during the irradiation; meanwhile, aPDT is effective regardless of the resistance pattern of the strain and their use does not contribute to the selection of antimicrobial resistance. Additive or synergistic antimicrobial effects in vitro are evaluated and the best combinations are presented. The use of combined treatment of aPDT with antimicrobials could help overcome the difficulty of fighting high level of resistance microorganisms and, as it is a multi-target approach, it could make the selection of resistant microorganisms more difficult

The use of HSQoL-24 in an assessment of quality-of-life impairment among hidradenitis suppurativa patients: First look at real-life data

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder with well-documented effects on patients’ quality of life (QoL). The aim of this study was to evaluate the QoL of patients with HS via the use of a newly developed questionnaire: Hidradenitis Suppurativa Quality of Life-24 (HSQoL-24). This study was performed on a population of 342 HS patients. Their QoL was assessed via the HSQoL-24 questionnaire. The perceived impairment of QoL due to HS in the studied group was considered to be serious (mean HSQoL-24 score: 58.3 ± 21.0 points). Women tended to experience a significantly higher impact from the disease than men (61.6 ± 19.2 points vs. 51.1 ± 23.1 points, p < 0.001). The HS severity had an effect on the perceived QoL, with statistically significant differences being evident between the self-assessed HS severity groups. The level of QoL impairment correlated positively with the number of affected body areas (r = 0.285, p < 0.001) and the duration of the disease (r = 0.173, p = 0.001), while the patients’ age at disease onset correlated negatively with the HSQoL-24 global score (r = -0.182, p = 0.001). Patients living in their family house scored higher than other groups. The least affected were patients who lived alone. The study shows that the HSQoL-24 questionnaire is a reliable, HS-specific tool for measuring the QoL among patients with HS in real-life clinical settings. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

Psychosocial burden in adult patients with atopic dermatitis

P16 Objective: Atopic dermatitis affects patients’ quality of life (QoL) in many ways. It is important to analyze the impact that the disease produces in order to better define the healthcare needs of adult patients with atopic dermatitis. Patients and Methods: 14 adult patients with atopic dermatitis were interviewed. The qualitative interviews were semi-structured and supported by a simple script, which allowed a complete and flexible interview. Results: Six affected areas of the patient’s life with atopic dermatitis were identified: economic, work-related, personal, psychosocial, clinical and relational. It is emphasized that atopic dermatitis has a great psychosocial impact on the adult patient, since it alters interpersonal relationships, generates rejection, stigmatization and social isolation, limits the patient in various areas and activities of their daily life or alters sleep, among others. The visible aspect, the itching-scratching cycle, the lack of awareness and ignorance of the disease, the lack of a definitive solution among the treatments and the side effects of some of them are of great concern. Conclusions: The QoL of the patients with atopic dermatitis is negatively affected and a holistic multidisciplinary intervention is necessary in order to mitigate the negative impact of the disease

Quality of life in hidradenitis suppurativa: psychometric properties of HSQOL-24

P14 Introduction: Hidradenitis Suppurativa (HS) has been associated with impaired quality of life (QoL). There are various measuring systems to assess physical severity; however, there are no specific QoL questionnaires for this disease in the Spanish language. Objective: To develop and validate a disease-specific instrument to measure QoL in patients with HS. Methods: A literature search was carried out to prepare a semi structured interview for patients with HS, as well as a Delphi expert consensus among health professionals. The validation with a sample of 130 patients is presented. The preliminary validation of the HSQoL-24 was passed twice to a group of 30 patients with 30 ± 10 days of interval. The DLQI and the Skindex-29 were used for its validation. Results: Cronbach alpha 0.87 indicates a good internal consistency of the questionnaire. The intraclass correlation coefficient (ICC) with the DLQI was 0.70 (p-value) (< 0.001), and 0.87 (p-value) (< 0.001) with the Skindex-29. Conclusions: The HSQoL-24 is the first specific self-administered questionnaire to assess QoL in patients with HS in Spanish. It is user friendly and easy to. This study demonstrates the excellent properties of the instrument: comprehensibility, reliability (test-retest), internal consistency, validity, comparison with DLQI and SKINDEX-29, and discriminative capacity

Patient reported outcomes (PROS) in psoriasis patients

P20 Introduction: Psoriasis is a chronic skin disease with negative physical, mental and social manifestations. Method: We carried out a longitudinal and prospective study under routine clinical practice conditions. The objective of the study was to measure quality of life with the Short Form-36 Survey (SF-36) and correlate the results with clinical variables using the PASI and BSA in a group of 17 patients with moderate to severe psoriasis treated with Ustekinumab. Results: In the baseline evaluation we observed the following results: 35.3% reported physical malfunction, 64.7% debilitating pain, 82.3% poor health in general, 76.4% bad vitality, 88.2% social malfunction, 100% emotional malfunction and 82.3% poor mental health. At week 78 we observed the following results: 41.15% reported very good physical functioning, 76.1% no pain, 58.8% good general health, 58.8% very good vitality, 70%, 5% good social functioning, 70.5% good emotional functioning and 52.9% good mental health. Conclusion: We observed that the perception of patients with moderate-severe psoriasis regarding their health at the beginning of treatment with Ustekinumab was poor and that they experienced a significant improvement throughout the successive weeks of treatment

Quality of life in hidradenitis suppurativa : Validation of the hsqol-24

Altres ajuts: reports grants, personal fees, non-financial support and other from Abbvie, Almirall, Amgen, Boehringer, Celgene, Janssen-Cilag, Leo Pharma, Lilly, MSD-Schering-Plough, Novartis, Pfizer and UCB, outside the submitted work. TGC reports personal fees from Lilly and Novartis, outside the submitted work. LP reports grants and personal fees from AbbVie, Almirall, Amgen, Boehringer Ingelheim, Celgene, Janssen, Leo-Pharma, Lilly, Novartis, Pfizer, Regeneron, Roche, Sanofi, and UCB, personal fees from Baxalta, Biogen, Fresenius-Kabi, JS Biocad, Mylan, Sandoz, Samsung-Bioepis, and Bristol Myers Squibb, outside the submitted work. The other authors have no conflicts of interest to declare.To date, there are no disease-specific instruments in Spanish to assess quality of life of patients with hidra-denitis suppurativa. A multicentre study was pre-viously carried out in Spain between 2016 and 2017 to develop the Hidradenitis Suppurativa Quality of Life-24 (HSQoL-24), a disease-specific questionnaire to assess quality of life in patients with hidradenitis suppurativa. The objectives of this study are to revali-date the HSQoL-24 in Spanish with a larger sample of patients, and to present the English version. In this multi centre study in Spain, patients with hidradenitis suppurativa completed the HSQoL-24, the Dermatology Life Quality Index and the Skindex-29. The Hurley staging system was used to assess the severity of the disease. Validation of the questionnaire was carried out in 130 patients, of whom 75 (57.7%) were women. This study demonstrates adequate values of reliability and validity of the HSQoL-24, confirming the previous test re-test validation and making this questionnaire one of wide clinical validity in terms of results perceiv-ed by patients

Pioderma gangrenoso bilateral asociado a colitis ulcerosa y proctocolectomía restauradora

La enfermedad inflamatoria intestinal (EII) se relaciona con un amplio espectro de manifestaciones extra-intestinales. Entre ellas, las afecciones dermatológicas -como el eritema nudoso (EN), las aftas orales o el pioderma gangrenoso (PG)- son las segundas en frecuencia. El PG es una dermatosis neutrofílica que ocurre en aproximadamente un 1% de los pacientes con EII, siendo más frecuente en mujeres que en varones1. Recientes estudios apuntan a una mayor incidencia del PG en pacientes con colitis ulcerosa (CU) que con enfermedad de Crohn (EC), y en prácticamente la totalidad de los casos publicados existe o ha existido afectación cólica1. El PG puede ocurrir antes, después o de manera simultánea al diagnóstico de la EII, y parece no estar relacionado con su curso y gravedad2. Se caracteriza por la aparición de una o varias pústulas en la piel que rápidamente evolucionan a una úlcera muy dolorosa, a veces de gran tamaño, de fondo exudativo, con un borde de crecimiento violáceo perilesional sobreelevado. El estudio anatomopatológico no es específico, pero permite excluir otras causas potenciales de ulceración, como las infecciones o la isquemia crónica. Su tratamiento incluye medidas locales, como el desbridamiento del tejido necrótico y los antibióticos tópicos y, en la mayoría de los casos, es necesario el tratamiento sistémico con corticoides (prednisona 1-1, 5 mg/kg/día o equivalente). En los casos refractarios —hasta un 50% en algunas series— se emplean inmunosupresores como los inhibidores de la calcineurina o los anti-TNF alfa..

The psychological burden of skin diseases in Spain

P16 Objective: Atopic dermatitis affects patients’ quality of life (QoL) in many ways. It is important to analyze the impact that the disease produces in order to better define the healthcare needs of adult patients with atopic dermatitis. Patients and Methods: 14 adult patients with atopic dermatitis were interviewed. The qualitative interviews were semi-structured and supported by a simple script, which allowed a complete and flexible interview. Results: Six affected areas of the patient’s life with atopic dermatitis were identified: economic, work-related, personal, psychosocial, clinical and relational. It is emphasized that atopic dermatitis has a great psychosocial impact on the adult patient, since it alters interpersonal relationships, generates rejection, stigmatization and social isolation, limits the patient in various areas and activities of their daily life or alters sleep, among others. The visible aspect, the itching-scratching cycle, the lack of awareness and ignorance of the disease, the lack of a definitive solution among the treatments and the side effects of some of them are of great concern. Conclusions: The QoL of the patients with atopic dermatitis is negatively affected and a holistic multidisciplinary intervention is necessary in order to mitigate the negative impact of the disease