Dr. Ignasi Figueras

INMUNOALERGIA CUTÁNEA

ATOPIC DERMATITIS

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

RISK FACTORS FOR AD

Kelleher JACI 2014Simpson JACI 2014

AD BIOMARKERS

AD REGISTRY

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.

AD TREATMENT II

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

ECZEMAS

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

URTICARIA

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

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