Departamento de Dermatología

Real-World Impact of Calcipotriol/Betamethasone Dipropionate Aerosol Foam on Quality of Life in Patients With Plaque Psoriasis: A Prospective Observational Study

Real-World Impact of Calcipotriol/Betamethasone Dipropionate Aerosol Foam on Quality of Life in Patients With Plaque Psoriasis: A Prospective Observational Study Torres, Tiago; Martorell, Antonio; Leal Filipe, Paulo; Caridad, Soria; Mota, Fernando; Pardo, José; Ribera, Miquel; Ruiz Villaverde, Ricardo Background and Aim: Quality of life (QoL) of psoriasis patients treated with calcipotriol/betamethasone dipropionate (Cal/BD) foam has not been thoroughly evaluated in real-world settings. This study evaluated the change in plaque psoriasis patients’ QoL after 4 weeks of first treatment with Cal/BD foam and after 6 months under daily practice conditions. Methods: A prospective, noninterventional study evaluated QoL, treatment adherence, satisfaction, and efficacy through the dermatology life quality index (DLQI), the Morisky-Green scale, the treatment satisfaction questionnaire for medication (TSQM-9), and the change in the body surface area (BSA) with plaque psoriasis, among others. Results: A total of 172 adult patients with plaque psoriasis were included. After 4 weeks of treatment, 53.5% of patients had a DLQI score ≤ 1. Mean absolute change in the DLQI score from baseline was −4.2 after 4 weeks of treatment and −4.0 after the 6-month follow-up (p < 0.0001). Improvement in the BSA was statistically significant after the first treatment period and after the 6-month follow-up with a mean reduction of 2.4% and 2.6%, respectively (p < 0.0001). Mean absolute change in global satisfaction between the end of the 4-week treatment period and the 6-month follow-up was −4.3 (p = 0.0049). In total, 41% of patients were compliant after the first treatment period, and 55.3% were moderately compliant. Higher patient treatment satisfaction was moderately correlated with lower DLQI scores after 4 weeks (r = −0.527; p < 0.0001). Statistically significant differences between DLQI groups were found in the BSA: patients with DLQI ≤ 1 after 4 weeks of treatment had a lower BSA than patients with DLQI > 1 (1.3 ± 1.8 vs. 2.8 ± 2.7, respectively; p < 0.0001). Conclusion: After 4 weeks of treatment, daily use of Cal/BD foam in plaque psoriasis patients resulted in an improvement in QoL that was related to an improvement in both satisfaction and efficacy.

Laboratory Changes During Dupilumab Treatment for Atopic Dermatitis

Laboratory Changes During Dupilumab Treatment for Atopic Dermatitis Flor, D.; Montero Vílchez, Carolina; Montero Vílchez, Trinidad; Arias Santiago, Salvador Antonio; Gonçalo, M. Introduction Dupilumab is an IL-4/IL-13 inhibitor monoclonal antibody approved for the treatment of moderate-to-severe atopic dermatitis (AD) with remarkable safety and efficacy profiles. However, former studies have reported an increase in serum eosinophils during treatment, with undetermined clinical significance. The objective of this study is to evaluate changes in blood eosinophils and other laboratory parameters while on dupilumab. Methods We conducted a multicenter, prospective, observational study from 2018 to 2022 with adolescent and adult patients with moderate-to-severe atopic dermatitis treated with dupilumab from Hospital Universitario Virgen de las Nieves, Spain, and Coimbra University Hospital, Portugal. Clinical scoring of the dermatitis, complete blood count, total serum IgE and LDH levels were collected at baseline and on weeks 8, 16, 24 and 48. Results We included a total of 81 patients (41 women/40 men; mean age of 30.86 ± 12.26 years). Clinical and demographic characteristics were similar across centres. AD severity scales (EASI, SCORAD, ItchVAS and SleepVAS) showed sustained improvement from week 8 of treatment onwards. Eosinophil levels were significantly higher on week 16 (0.69 × 103/μL) vs baseline (0.41 × 103/μL) (p = 0.018) and returned to baseline levels on week 48 (0.59 × 103/μL, p > 0.05). LDH and IgE levels decreased during the study. Conclusion Our study showed a significant clinical improvement of AD but a mild and self-limited increase in eosinophil levels on week 16, not associated with any clinical signs. Therefore, elevated serum eosinophil levels in AD patients on dupilumab does not seem clinically relevant and should not condition treatment withdrawal.; Introducción Dupilumab es un anticuerpo monoclonal inhibidor de la IL-4/IL-13 aprobado para el tratamiento de la dermatitis atópica (DA) con perfiles de eficacia y seguridad notables. Sin embargo, estudios previos han informado de un aumento de los eosinófilos séricos durante el tratamiento, con un significado clínico indeterminado. El objetivo de este estudio es evaluar los cambios en los eosinófilos en sangre y otros parámetros de laboratorio durante el tratamiento con dupilumab. Métodos Se realizó un estudio observacional prospectivo multicéntrico entre 2018 y 2022 con pacientes adolescentes y adultos con DA moderada a grave tratados con dupilumab del Hospital Universitario Virgen de las Nieves, España, y del Hospital Universitario de Coimbra, Portugal. Se recogieron puntuaciones clínicas de la dermatitis, hemograma completo, IgE sérica total y niveles de LDH al inicio y en las semanas 8, 16, 24 y 48 de tratamiento. Resultados Se incluyeron 81 pacientes (41 mujeres/40 hombres; edad media de 30,86 ± 12,26 años). Las características clínicas y demográficas fueron similares entre centros. Las escalas de gravedad de la DA (EASI, SCORAD, ItchVAS y SleepVAS) mostraron una mejoría sostenida a partir de las 8 semanas de tratamiento. Los niveles de eosinófilos fueron significativamente mayores en la semana 16 (0,69 x103/μL) que al inicio (0,41 x103/μL) (p = 0,018) y volvieron a los niveles basales en la semana 48 (0,59 x103/μL, p >0,05). Los niveles de LDH e IgE disminuyeron durante el estudio. Conclusión Nuestro estudio mostró una mejoría clínica significativa de la DA de los pacientes tratados con dupiluman, con un aumento leve y autolimitado de los niveles de eosinófilos en la semana 16, no asociado a ninguna manifestación clínica. Por lo tanto, el aumento de los eosinófilos séricos en pacientes con DA tratados con dupilumab no es clínicamente relevante y no debe condicionar la suspensión del tratamiento. This research was funded by Instituto de Salud Carlos III through the project PI23/01875. and TM-V was supported by a postdoctoral fellowship from the Instituto de Salud Carlos III (CM22/00083). This study is a part of Carolina Montero-Vilchez's doctoral thesis at the Clinical Medicine and Public Health program of Universidad de Granada.

Microtopography and Barrier Function in Healthy Skin: Differences between Forearm, Cheek and Palm

Microtopography and Barrier Function in Healthy Skin: Differences between Forearm, Cheek and Palm Sanabria de la Torre, Raquel; Ceres Muñoz, María; Pretel Lara, Carlota; Montero Vílchez, Trinidad; Arias Santiago, Salvador Antonio (1) Background: Skin barrier function resides mostly in the stratum corneum, which consists of a protein component, the corneocyte (bricks), which provides a scaffold for the second component, the extracellular matrix, consisting of multilayers of lipids (mortar). These two components closely interact and this could be the basis for the differences in the biophysical properties of the skin between anatomical regions. So, the aim of this study was to compare skin microstructural properties between body sites. (2) Methods: A comparative study was conducted that included healthy individuals without previous skin diseases. Skin barrier function parameters and microtopography parameters (smoothness, roughness, desquamation, wrinkles, surface, volume, contrast, variance, homogeneity, anisotropy, total cell count, flaking index, skin surface hardness, brightness, deformability and friction) were measured on the forearm, cheek and palm. (3) Results: 44 participants were included in this study, with a mean age of 38.8 ± 15.0 years. Significant differences were found between body sites for 14 of the 15 parameters evaluated. Smoothness was higher on the forearm than on the cheek and palm (240.02 Sems vs. 348.16 vs. 408.19 Sems, p < 0.05). Hardness was higher on the palm than on the forearm and cheek (13.22 AU vs. 9.44 AU vs. 7.94 AU, p < 0.05). Moreover, we observed that sociodemographic characteristics such as age, sex, tobacco and/or alcohol use, influenced the parameters evaluated. (4) Conclusions: The differences in skin barrier function and microtopography between anatomical regions reflects the different structure of skin in each body part and could help to understand the influence of the sociodemographic characteristics on theses parameters. This information could be useful for comparison with pathological skin characteristics and for targeting new treatments. Author Keywords: body sites; healthy skin; homeostasis; microtopography; skin barrier function; skin biophysical parameters.; OpenAire Keywords: Chemistry, Aging, skin biophysical parameters, homeostasis, microtopography, skin barrier function, healthy skin, Pharmaceutical Science, Chemical Engineering (miscellaneous), Surgery, body sites, Dermatology, QD1-999

The paradigm of IL-23-independent production of IL-17F and IL-17A and their role in chronic inflammatory diseases

The paradigm of IL-23-independent production of IL-17F and IL-17A and their role in chronic inflammatory diseases Navarro-Compán, Victoria; Arias Santiago, Salvador Antonio Interleukin-17 family (IL-17s) comprises six structurally related members (IL-17A to IL-17F); sequence homology is highest between IL-17A and IL-17F, displaying certain overlapping functions. In general, IL-17A and IL-17F play important roles in chronic inflammation and autoimmunity, controlling bacterial and fungal infections, and signaling mainly through activation of the nuclear factor-kappa B (NF-κB) pathway. The role of IL-17A and IL-17F has been established in chronic immune-mediated inflammatory diseases (IMIDs), such as psoriasis (PsO), psoriatic arthritis (PsA), axial spondylarthritis (axSpA), hidradenitis suppurativa (HS), inflammatory bowel disease (IBD), multiple sclerosis (MS), and asthma. CD4+ helper T cells (Th17) activated by IL-23 are well-studied sources of IL-17A and IL-17F. However, other cellular subtypes can also produce IL-17A and IL-17F, including gamma delta (γδ) T cells, alpha beta (αβ) T cells, type 3 innate lymphoid cells (ILC3), natural killer T cells (NKT), or mucosal associated invariant T cells (MAIT). Interestingly, the production of IL-17A and IL-17F by innate and innate-like lymphocytes can take place in an IL-23 independent manner in addition to IL-23 classical pathway. This would explain the limitations of the inhibition of IL-23 in the treatment of patients with certain rheumatic immune-mediated conditions such as axSpA. Despite their coincident functions, IL-17A and IL-17F contribute independently to chronic tissue inflammation having somehow non-redundant roles. Although IL-17A has been more widely studied, both IL-17A and IL-17F are overexpressed in PsO, PsA, axSpA and HS. Therefore, dual inhibition of IL-17A and IL-17F could provide better outcomes than IL-23 or IL-17A blockade. The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fimmu.2023.1191782/ full#supplementary-material

Frontal Fibrosing Alopecia Quality of Life Index: A Validated Disease-Specific Questionnaire Involving Women

Frontal Fibrosing Alopecia Quality of Life Index: A Validated Disease-Specific Questionnaire Involving Women Porriño Bustamante, María Librada; Montero Vílchez, Trinidad; Fernández Pugnaire, María Antonia; Arias Santiago, Salvador Antonio Quality of life (QoL) can be affected in patients with alopecia. The few studies that evaluate QoL in FFA use unspecific questionnaires. The aim of this report was to design and validate a specific questionnaire to assess the impairment of QoL in FFA patients. A specific questionnaire, called the Frontal Fibrosing Alopecia Quality of Life Index (FFA-QLI), was designed and validated using the Dermatology Life Quality Index (DLQI). One-hundred and one women with FFA were included. Cronbach’s alpha value was 0.865, and the intraclass correlation coefficient between all the items in the questionnaire was 0.870. The FFA-QLI correlated positively with the DLQI (r = 0.729, p < 0.001). Patients with severe FFA showed a higher FFA-QLI (19.72) score compared to those with a mild disease (14.11) (p = 0.002), and the area under the curve for identifying severe disease was greater in the FFA-QLI than in the DLQI. The cut-off points were used to select patients with mild, moderate, and severe impairment in QoL. A score < 21 in the FFA-QLI corresponded to a low impact on QoL; values > 35 matched with greater QoL impairment; and values ranging from 21 to 35 corresponded to moderate QoL alteration. To conclude, a validated disease-specific questionnaire to assess QoL in FFA patients is here presented, with a greater power to discriminate severe cases of FFA than the DLQI.