Miguel Angel Descalzo

Anti-TNFα agents have been associated with the reactivation of granulomatous infections, including leishmaniasis. Cases of atypical or recurrent cutaneous (CL) or mucocutaneous leishmaniasis (MCL) have been reported in patients on biologics. We conducted a retrospective analysis of a multicenter database to describe the clinical characteristics and management of CL and MCL in patients receiving biological therapy in an endemic area. Clinical features, diagnostics, therapies, and outcomes were analyzed. Seventy-one patients were included (63 CL and 8 MCL). The most common underlying condition was inflammatory bowel disease (33.8%). Lesions were multifocal in 40% and larger than 1 cm in 94.4%. Treatment failures were more frequent in MCL (50%) than CL (8.1%). Biologic therapy was discontinued in 53.5%, leading to worsening of the underlying disease in 44.7%. No significant difference in cure rates was observed between patients who continued vs. discontinued biologics (p=0.868). These findings highlight the clinical burden of CL and MCL in patients undergoing anti-TNFα therapy and suggest that discontinuation of biologic therapy did not significantly impact cure rates, emphasizing the need for standardized strategies balancing infection control and underlying inflammatory disease management.

Background: Current relevance of positive patch‐test reactions guides management in allergic contact dermatitis (ACD), yet its clinical predictors and the use of predictive models in clinical practice remain underused. Objectives: To identify demographic and clinical factors associated with current relevance in ACD and to develop overall and allergen‐specific predictive models. Methods: A multicentric REIDAC study included data from patch‐tested patients with the Spanish baseline series. Exposure history, anatomical sites, atopic status, and occupational data were recorded. Logistic regression (LR) models were trained and internally validated to predict current relevance overall and for top frequent allergens. Model discrimination was assessed with area under the receiver‐operating characteristic curve (AUC). Results: Among 17 005 patients, 4077 (24.0%) had at least one currently relevant reaction. The final overall LR model achieved an AUC for the validation sample of 0.679. Allergen‐specific AUC parameters (LR) varied among allergens but performed best for nickel (AUC = 0.770). The independent factors associated with current relevance were female gender, specific body sites (hand, neck, head, leg, feet) and two occupations (hairdresser and construction workers). The use of other models (LASSO, gradient boosting) revealed similar results. Conclusions: Prediction modelling may moderately predict current relevance in ACD and several clinical variables are associated with current relevance in ACD.

BACKGROUND: Scabies is a skin disease caused by the mite Sarcoptes scabiei, resulting in intense itching and rash, and sometimes secondary infections with complications. Scabies is not typically a notifiable disease, which makes estimating its burden of disease challenging. In recent years, sharp increases have been reported in Europe. AIM: This study characterises scabies epidemiology in Spain from 2011 to 2023. METHODS: This retrospective study triangulated data from primary care, hospital admissions, occupational diagnoses and outbreaks. Annual incidence rates (IRs) were calculated to assess temporal evolution, demographics and geographic distribution. Joinpoint regression identified IR changes, and time-series analysis explored seasonality. Occupational and outbreak data analysis identified high-risk activities and settings. RESULTS: Incidence rates increased across all data sources, with marked acceleration from 2020–21. The greatest rise was seen in primary care (annual percentage change rose from 22.8% (95% CI: 7.2–31.9) in 2011–20 to 65.8% (95% CI: 47.5–96.6) in 2020–23). The IR was highest amongst 15–24-year-olds. Hospitalisations, with highest IR among people > 65 years, peaked each January. Occupational diagnoses were predominantly registered in healthcare settings (82.0%). Islands and northern coastal regions were most affected. Outbreaks were most frequent in households and nursing homes, with largest outbreaks in healthcare settings. CONCLUSIONS: Given the increasing incidence of scabies in Spain, a strong response is needed to improve prevention, diagnosis, and treatment. Improved surveillance and targeted public health initiatives could mitigate further spread, as well as further research to better elucidate the mite-related and epidemiological factors that underline the recent increases across Europe.

Background: We estimate annual viral influenza-associated mild-to-moderate illness, hospitalizations, and deaths in 6 South American countries (Argentina, Brazil, Chile, Ecuador, Paraguay, and Uruguay) during the 2015–2019 influenza seasons as a first step in evaluating the full value of influenza vaccination in the subregion. Methods: We applied a multiplier method using monthly hospital discharge and vital statistics death records, influenza surveillance data, and population projections to estimate mild-to-moderate influenza-associated illness, hospitalizations, and deaths. We estimated the uncertainty bounds based on the 2.5th and 97.5th percentiles of the Monte Carlo simulated distributions for the number of cases and obtained the ranges from the minimum value of the 2.5th and the maximum value of the 97.5th percentile. Results: In selected countries with a total population of 307 million people, the yearly influenza-associated burden of disease ranged between 51 and 78 million mild-to-moderate influenza illnesses, between 323 379 and 490 049 hospitalizations, and between 22 662 and 46 971 deaths during the 2015–2019 influenza seasons. Conclusions: Each year, influenza is associated with millions of illnesses, hundreds of thousands of hospitalizations, and tens of thousands of deaths in 6 South American countries, affecting a significant portion of the population. Such findings can be used to estimate the number of illnesses averted through vaccination programs and the cost-benefit of influenza vaccines.

Introduction: Patch test results may be influenced by age‐related factors. However, there is still discordant evidence between age and patch test results.Objectives: We aim to evaluate the patch test results reflecting skin sensitisation, their relevance and association with clinical features by age group.Methods: Prospective multicentric study of all patients patch tested with the Spanish baseline series in participating centres. Age groups were pre‐defined as children (0‐ to 11‐years), adolescents (12‐ to 18‐years), young adults (19‐ to 30‐years), middle‐aged adults (31‐ to 65‐years) and older adults (≥66‐years). Occurrence of sensitisation, relevance and clinical features were compared by age group. Factors associated with skin sensitisation were investigated with multivariate logistic regression.Results: A total of 13 368 patients were patch‐tested. Differences in positive patch test results and relevance by age were detected with the highest proportion in middle‐aged adults. Age‐related trend differences were found for nickel, potassium dichromate, caines, colophony, Myroxylon pereirae resin, 2‐hydroxyethyl methacrylate and limonene hydroperoxide. The multivariate logistic analysis (adjusted for sex, atopic dermatitis, body location and occupational dermatitis) showed an association between the age group of 31–65 (OR: 1.41, 95% CI: 1.26–1.58) and above 66‐years (OR: 1.15, 95% CI: 1.01–1.32) with a higher proportion of positive results, compared with young adults.Conclusions: Positive patch test results vary according to age, with the highest occurrence in middle‐aged adults. Most haptens did not present age‐related differences, reinforcing the use of baseline series regardless of age.

Background: Current frequency and features for positivity to textile dye mix (TDM) in Spain are unknown.Objectives: To study the frequency, clinical features and simultaneous positivity between TDM, para‐phenylenediamine (PPD) and specific disperse dyes.Materials and Methods: We analysed all consecutive patients patch‐tested with TDM from the Spanish Contact Dermatitis Registry (REIDAC), from 1 January 2019 to 31 December 2022. Within this group, we studied all selected patients patch‐tested with a textile dye series.Results: Out of 6128 patients analysed, 3.3% were positive to the TDM and in 34% of them, the sensitization was considered currently relevant. TDM positivity was associated with working as a hairdresser/beautician and scalp, neck/trunk and arm/forearm dermatitis. From TDM‐positive patients, 57% were positive to PPD. One hundred and sixty‐four patients were patch‐tested with the textile dye series. Disperse Orange 3 was the most frequent positive dye (16%). One of every six cases positive to any dye from the textile dye series would have been missed if patch‐tested with the TDM alone.Conclusions: Positivity to TDM is common in Spain and often associated with PPD sensitization. TDM is a valuable marker of disperse dyes allergy that should be part of the Spanish and European standard series.

Background: Since May 2022, a new outbreak of monkeypox has been reported in several countries, including Spain. The clinical and epidemiological characteristics of the cases in this outbreak may differ from those in earlier reports. Objectives: To document the clinical and epidemiological characteristics of cases of monkeypox in the current outbreak. Methods: We conducted a prospective cross-sectional study in multiple medical facilities in Spain to describe the cases of monkeypox in the 2022 outbreak. Results: In total, 185 patients were included. Most cases started with primarily localized homogeneous papules, not pustules, in the probable area of inoculation, which could be cutaneous or mucous, including single lesions. Generalized small pustules appeared later in some of them. Heterogeneous lesions occurred during this generalized phase. All patients had systemic symptoms. Less common lesions included mucosal ulcers (including pharyngeal ulcers and proctitis) and monkeypox whitlows. Four patients were hospitalized, none died. Smallpox vaccination and well-controlled HIV disease were not associated with markers of severity. Contact during sex is the most likely mechanism of transmission. In this outbreak, cases have been described in men who have sex with men and are strongly associated with high-risk sexual behaviours. Seventy-six per cent of the patients had other sexually transmitted diseases upon screening. Conclusions: The clinical findings in this outbreak differ from previous findings and highly suggest contact transmission and initiation at the entry site. The characterization of the epidemiology of this outbreak has implications for control. What is already known about this topic? Monkeypox eruption is described as consisting of pustules.The roles of HIV and previous smallpox vaccination in the prognosis are unknown.The transmission route was initially described as respiratory droplets and was later suggested to be via sexual contact. What does this study add? Initial lesions at the probable inoculation area were homogeneous and papular (pseudopustules). Generalized small pustules appeared later in some of them. Heterogeneous lesions occurred during this generalized phase. All patients had systemic symptoms.Less common signs included mucosal ulcers (including pharyngeal ulcers and proctitis) and monkeypox whitlows. Well-controlled HIV and previous smallpox vaccination were not associated with severity. No patient died.The data support the hypothesis of transmission via contact during sex. Although this might change, the outbreak is currently limited mostly to men who have sex with men, with high-risk factors for sexually transmitted diseases.

The therapeutic value of sentinel lymph node biopsy (SLNB) in thin melanoma remains controversial. The aim of this study is to determine the role of SLNB in the survival of thin melanomas (≤1 mm). A multicenter retrospective observational study was designed. A propensity score matching was performed to compare patients who underwent SLNB vs. observation. A multivariate Cox regression was used. A total of 1438 patients were matched by propensity score. There were no significant differences in melanoma-specific survival (MSS) between the SLNB and observation groups. Predictors of MSS in the multivariate model were age, tumor thickness, ulceration, and interferon treatment. Results were similar for disease-free survival and overall survival. The 5- and 10-year MSS rates for SLN-negative and -positive patients were 98.5% vs. 77.3% (p < 0.001) and 97.3% vs. 68.7% (p < 0.001), respectively. SLNB does not improve MSS in patients with thin melanoma. It also had no impact on DSF or OS. However, a considerable difference in MSS, DFS, and OS between SLN-positive and -negative patients exists, confirming its value as a prognostic procedure and therefore we recommend discussing the option of SLNB with patients.

Randomized studies to assess the efficacy of Mohs micrographic surgery in basal cell and squamous cell carcinomas are limited by methodological and ethical issues and a lack of long follow-up periods. This study presents the “real-life” results of a nationwide 7-years cohort on basal cell carcinoma and squamous cell carcinoma treated with Mohs micrographic surgery. A prospective cohort was conducted in 22 Spanish centres (from July 2013 to February 2020) and a multivariate analysis, including characteristics of patients, tumours, surgeries and follow-up, was performed. A total of 4,402 patients followed up for 12,111 patient-years for basal cell carcinoma, and 371 patients with 915 patient-years of follow-up for squamous cell carcinoma were recruited. Risk factors for recurrence included age, non-primary tumours and more stages or unfinished surgeries for both tumours, and immunosuppression for squamous cell carcinoma. Incidence rates of recurrence were 1.3 per 100 person-years for basal cell carcinoma (95% confidence interval 1.1–1.5) and 4.5 for squamous cell carcinoma (95% confidence interval 3.3–6.1), being constant over time (0–5 years). In conclusion, follow-up strategies should be equally intense for at least the first 5 years, with special attention paid to squamous cell carcinoma (especially in immunosuppressed patients), elderly patients, non-primary tumours, and those procedures requiring more stages, or unfinished surgeries.