Mild Erythema Research Articles

Phase III Randomized Pair Comparison of a Barrier Film vs. Standard Skin Care in Preventing Radiation Dermatitis in Post-lumpectomy Patients with Breast Cancer Receiving Adjuvant Radiation Therapy

IntroductionPatients undergoing adjuvant radiotherapy to the breast often experience radiation dermatitis ranging from mild erythema to moist desquamation. In post-lumpectomy patients, the axilla and inframammary fold are at an increased risk for friction dermatitis. Dermatitis can impact patients’ quality-of-life and may require treatment break/cessation. Our objectives are to assess the efficacy of 3M Cavilon Barrier Film (BF) in preventing and/or delaying the onset of grade-two dermatitis and reducing patient-reported sensation scores.MethodsA total of 55 patients were randomized to receive BF on the medial or lateral breast. BF was applied twice weekly during treatment. Skin toxicity was evaluated weekly by a blinded clinical investigator using the Skin Toxicity Assessment Tool (STAT) and the modified Radiation Therapy Oncology Group Visual Assessment Score (RTOG VAS). On day one, baseline photographs were taken; seven-to-ten days post-treatment, patients returned for photographs, the STAT/RTOG VAS, and patient-opinion questions in the form of the global questionnaire.ResultsThe paired analysis found BF did not significantly reduce dermatitis either during or post-treatment. However, the unpaired analysis found significantly reduced RTOG VAS on the lateral compartment during treatment (BF:0.91 vs. Control:1.21, p = 0.0408). This difference resolved post-treatment. Additionally, BF was able to reduce pruritus (p = 0.047) on the medial components and burning sensations on the lateral components (p = 0.035). There was no significant difference between the time-to-onset or proportion of patients who developed grade-two dermatitis.ConclusionIn an unpaired analysis, BF significantly reduced dermatitis on the lateral compartment during treatment. Additionally, BF significantly reduced pruritus and burning sensations. A larger study using a more reliable scoring method is required to clarify the effect of BF on radiation-associated skin toxicity.

Safety and efficacy of hydroxytyrosol-based formulation on skin inflammation: in vitro evaluation on reconstructed human epidermis model.

Atopic dermatitis is a multifactorial immune-mediated skin disorder characterized by an alteration of epidermal barrier function and onset of skin lesions, which range from mild erythema to severe lichenification. Treatment consists in hydration with possible use of topical or immunomodulatory corticosteroids, which, however sometimes showed side effects. Recently, the interest in natural compounds has grown significantly and among these, hydroxytyrosol (HT) plays a pivotal role due to its strong and well-known anti-inflammatory activity. The aim of this study was to investigate the safety and efficacy of Fenolia® Eudermal Cream 15 (HT-based formulation) on epidermal barrier impaired as consequence of skin injury. Whit this purpose, morphologic and structural as well as anti-inflammatory evaluations, after treatment with pro-inflammatory mediators (PBS 1 X and LPS) and HT-based formulation on reconstructed human epidermis (RHE) were carried out by qualitative (hematoxylin/eosin- and immunostaining) and quantitative (MTT assay, IL-1α and IL-8 release by ELISA) techniques. Furthermore, HT absorption through the epidermal barrier was evaluated by RP-LC-DAD analysis. A rise in the thickness of the epidermis as well as an appropriate maturation and protein expression (Loricrin, Fillagrin, E-Cadherin and Cytokeratins 5&6) were detected in treated RHE samples. In particular, the HT-based formulation was found to stimulate cell proliferation, as evidenced by the significant increase in Ki67 expression, which suggests the involvement of repair mechanisms, increasing epithelial regeneration and differentiation and improving the epidermal barrier effect. Furthermore, HT-based formulation showed a statistically significant anti-inflammatory activity by reducing both IL-1α and IL-8 release by RHE tissues, greater than the reference drug dexamethasone. Finally, excellent transcutaneous absorption values were found for HT, demonstrating how this new formulation increases the availability of the bioactive compound. In light of these results, Fenolia® Eudermal Cream 15 could be an effective agent to counteract atopic dermatitis. Graphical abstract Safety and efficacy of hydroxytyrosol-based formulation on skin inflammation: in vitro evaluation on reconstructed human epidermis model.

Experiencia en el uso de fototerapia en pacientes pediátricos y comparación de esta técnica frente a pacientes adultos

IntroductionPhototherapy involves the use of UV radiation to treat different dermatologic diseases. Its efficacy and safety have been thoroughly established in adults and some publications indicate that it is also an effective and safe treatment in pediatric patients with refractory skin diseases. Material and methodsRetrospective study that included all patients under 17 years of age and 122 randomly selected adults who received phototherapy in our department between 2002 and 2017. ResultsNinety-eight pediatric patients (61% girls and 39% boys) with a mean age of 10.5 years received phototherapy. The 3 most frequently treated diseases were psoriasis (48% of patients), vitiligo (17%), and atopic dermatitis (16%). Eighty-six percent of the patients received phototherapy with narrowband UV-B, whereas 7% received phototherapy with psoralen and UV-A (PUVA). No statistically significant differences were found in terms of dosage, duration, or number of sessions compared to the adult population treated with narrowband UV-B therapy or PUVA. A complete response was achieved in 35% of the pediatric patients and no differences were found with respect to the adults. Only 16% of the children showed adverse effects, mostly in the form of mild erythema. We found greater adherence to treatment in the pediatric patients than in the adult patients (P<.05). ConclusionsNarrowband UV-B therapy and PUVA appear to be safe and effective in children and can be administered using the same treatment protocols as those used in adults. Adherence to treatment is greater in children than in adult patients.

Oral lichen planus: A disease or a spectrum of tissue reactions? Types, causes, diagnostic algorhythms, prognosis, management strategies.

Oral lichen planus and lichenoid lesions comprise a group of disorders of the oral mucosa that likely represent a common reaction pattern to 1 or more unknown antigens. The coexistence of hyperkeratotic striation/reticulation, varying degrees of mucosal inflammation from mild erythema to severe widespread ulceration, and a band-like infiltrate of mononuclear inflammatory cells including activated T lymphocytes, macrophages, and dendritic cells, are considered suggestive of oral lichen planus and lichenoid lesions. Several classification systems of oral lichen planus and lichenoid lesions have been attempted, although none seem to be comprehensive. In this paper, we present a classification of oral lichen planus and lichenoid lesions that includes oral lichen planus, oral lichenoid contact lesions, oral lichenoid drug reactions, oral lichenoid lesions of graft vs. host disease, discoid lupus erythematosus, and systemic lupus erythematosus, lichen planus-like variant of paraneoplastic pemphigus/paraneoplastic autoimmune multiorgan syndrome, chronic ulcerative stomatitis, lichen planus pemphigoides, solitary fixed drug eruptions, and lichen sclerosus. We present the clinical and diagnostic aspects of oral lichen planus and lichenoid lesions, and discuss related treatment options.

Keloid treatment: what about adjuvant radiotherapy?

Background: Keloids are debilitating fibrous skin proliferations with a high recurrence rate after surgical treatment. Postoperative radiotherapy (PORT) is a well-tolerated adjuvant treatment to reduce the risk of recurrence, but the optimal regimen for this combined treatment remains unknown. The aim of this study is to evaluate the efficacy of combining surgical excision and immediate PORT.Methods: We retrospectively reviewed the records of patients with keloid lesions treated with adjuvant PORT in the period 2005–2014 at Geneva University Hospitals. Main outcomes were the rates of complications and recurrence in patients with a minimal follow-up of 1 year, including the Patient and Observer Scar Assessment Scale satisfaction scores.Results: 10 patients with 16 keloids were eligible (mean follow-up, 37 months). Only one recurrence was reported (6%). In 12.5% of cases, mild erythema appeared in the early postoperative period. No major complications were observed. The overall patient and observer satisfaction rate was excellent.Conclusion: Surgical excision combined with immediate PORT is an effective and easy treatment with good esthetic results and an acceptable recurrence rate. It should be considered for patients with persistent keloid formation after failure of other treatments and those at high risk of relapse.

A cream of herbal mixture to improve melasma.

SummaryBackgroundMelasma is an acquired, common hyperpigmented disorder on the face. While many therapeutic approaches are available, their efficacy is moderate.ObjectiveTo investigate the safety and efficacy of a cream containing herbal mixture for melasma.MethodsA total of 90 volunteers with melasma were enrolled in this randomized, double‐blind, controlled clinical study, and they were randomly divided into three groups (A, B, and C). Patients in group A were treated with a cream containing herbal mixture, while groups B and C were treated with arbutin cream and placebo, respectively, twice daily for 12 weeks. Melasma area and severity index (MASI) score, melanin index (MI), erythema index (EI), changes in density of inflammatory cells, and adverse events were evaluated every 4 weeks.ResultsAlthough MASI scores declined significantly in both groups A and B (P < 0.05), a greater reduction was seen in group A (13.00−9.82 = 3.18 for group A; 12.65−10.84 = 1.81 for group B). Moreover, the cream containing herbal mixture, but not arbutin cream and placebo, significantly reduced EI and density of inflammatory cells after 12‐week treatment (P < 0.05). No adverse reactions were observed in either group A or group C. In group B, two subjects experienced mild erythema and itching, which disappeared after stop using the arbutin cream.ConclusionThe cream containing herbal mixture is safe and effective for melasma.

Facial Contouring by Using Dermal Fillers and Botulinum Toxin A: A Practical Approach

BackgroundThe perception of an attractive face is largely subjective. The purpose of this paper is to provide an insight and a practical approach to facial contouring management with hyaluronic acid (HA) implants and botulinum toxin A.MethodsThis study is presenting the clinical experience of the authors regarding facial contouring. After a careful medical history, patients underwent an exhaustive aesthetic assessment that includes photographs and videos. Realistic treatment goals were discussed and agreed with the patient. Comprehensive treatment strategies for facial contouring, including HA implants and/or botulinum toxin A injections, were selected according to the patient needs.ResultsBased on the MD codes®, developed by Mauricio de Maio, these treatment strategies have been adapted to six different basic categories of facial shapes, namely round, square, triangular, inverted triangle, rectangle, oval and oblong faces. The incidence of complications was low and, in all the cases, was mild (edema, erythema and local ecchymosis), of limited duration, and was resolved without sequela.ConclusionsThe current article presented the personal experiences of the authors on a specific subject, and this fact should be considered when interpreting data from this paper. As other aesthetic treatments, facial contouring should be focused on the patient needs and to select a specific aesthetic approach according to different facial shapes. Finally, it is essential to have a good understanding of the potential associated complications, because it will help the specialist to take the necessary precautions to prevent them, and if they ever arise, to be able to deal with them effectively.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

209 Post-IPP Glans Necrosis: Successful Management with Debridement and Tissue Membrane Allograft

Glans necrosis is a rare but devastating complication of penile implant surgery. Current management standards include complete removal of the prosthesis, which portends to corporal fibrosis and a more difficult salvage procedure during any future penile implant surgery. There have been few studies investigating surgical options during treatment of post-surgical glans necrosis. Herein we describe the first-reported use of a minimally-processed human umbilical cord membrane in the management of glans necrosis following penile implant surgery. A 55 year old male underwent routine inflatable penile implant (IPP) placement for medically-refractory erectile dysfunction. On post-operative day 15, the patient complained of continued penile pain and was noted to have mild erythema on his glans, along with three small blisters. Oral broad-spectrum antibiotics and antifungal medications were prescribed, however by post-operative day 23 re-examination confirmed early necrosis of the glans (Fig 1). The patient was immediately taken to the operative room, where in accordance with his wishes, the necrotic tissue was sharply debrided and his prosthesis was left in-situ (Fig 2). An Avive™ soft tissue membrane (AxoGen, Inc.) was grafted over the wound defect and a suprapubic catheter was inserted (Fig 3).

The Decline of PUVA Therapy in Vietnam: Effective Treatment of Narrow Band UVB in Vietnamese Vitiligo Patients.

AIM:To examine the efficacy and safety of Narrowband ultraviolet B (NB-UVB) in Vietnamese vitiligo patients.METHODS:We recruited thirty-one patients (14 males, 17 females), aged from 7 to 67 years, with both segmental vitiligo (SV) and non-segmental vitiligo (NSV), treated three times weekly with NB-UVB. The starting dose for adults from 15 years old and children less than 15 years old was 200 mJ/cm2 and 150 mJ/cm2, respectively, with 50 mJ/cm2 and 20 mJ/cm2 dose increments at each subsequent visit, respectively, until mild erythema lasting less than 24 hrs reported by patient, given for a period of 6 months. Response to therapy was assessed based on VASI score changes.RESULTS:Based upon our results, 38.7% (12/31) of patients achieved a very good response of more than 50% VASI changes, 41.9% (13/31) obtained a good response (VASI changed from 25 to 50%). Total good and very good response to therapy significantly increased with prolonged treatment, increasing from 19.4% to 64.5% and 80.6% after 2, 4 and 6 months, respectively. Localised NSV patients obtained good and very good response significantly more frequently than generalised NSV (55.6% versus 18.2%). Adverse effects were minimal, of which one case developed herpes simplex, and 4 cases reported mild photo burn reaction which completely disappeared after adjusting the dose.CONCLUSION:NB-UVB therapy is an effective and safe tool in the management of Vietnamese vitiligo patients.

Reconstruction of Alar-Perialar Defects with a Combined Subcutaneous and Cutaneous Pedicled Rotation-Advancement Nasolabial Flap

Aim of the Study: During the reconstruction of alar defects involving the upper lip, reconstructive surgeons face the need for various thicknesses of tissues crucial to preserving the facial sulcus which is important for a cosmetically acceptable result. Our aim was to reconstruct the deep perialar and thinner lateral nasal alar defect in a single step procedure with a suitable flap which is reliable, has appropriate blood supply and provides an esthetically good result. Materials and Methods: Extended alar defect was reconstructed with a combined flap in 10 cases. During the procedure, a subcutaneous pedicle was created and the proximal part of the flap was rotated into the defect as a rotational flap. The procedure and the follow-up have been photo-documented in all cases. Furthermore, the perfusion of the flaps was monitored by means of laser Doppler flowmetry. Postoperative complications were evaluated with a semi-quantitative score and the patients completed a patient satisfaction questionnaire, too. Results: An optimal esthetic result was obtained in all cases after the operation. The lateral nasal alar part of the defect was reconstructed with the thinner proximal part of the flap while the deeper perialar region involving the upper lip was covered with the thicker distal part. The flaps have shown sufficient blood flow after the operation. There was no significant pin cushioning or “trap-door” effect in any case. Mild erythema and edema was found in few cases. The patients were satisfied with the cosmetic result of the intervention. Conclusions: The flap is suitable for the reconstruction of alar defects involving the perialar region. It has the advantage of covering the deeper perialar and the thinner alar defects, whilst eliminating the pin cushioning effect of the conventional subcutaneous island pedicle flaps.

Facial aesthetic fat graft retention rates after filtration, centrifugation, or sedimentation processing techniques measured using three-dimensional surface imaging devices.

Objective:How to increase the long-term retention rate of autologous fat grafting has been widely discussed. This study aimed to evaluate long-term fat graft retention rates for the most widely used fat processing methods in the area of facial esthetic surgery, including centrifugation, filtration, and sedimentation, using three-dimensional (3D) imaging.Data Sources:PubMed, Embase, Wiley/Cochrane Library, and Web of Science databases were comprehensively searched from inception to July 2018 according to the guidelines of the American Society of Plastic Surgeons Fat Graft Task Force Assessment Methodology.Study Selection:Articles were screened using predetermined inclusion and exclusion criteria. Data collected included patient characteristics, follow-up devices, fat grafting techniques, and clinical outcomes. Patient cohorts were pooled, and fat graft retention rates were calculated. Complications were summarized according to different clinical characteristics.Results:Of 77 articles, 10 clinical studies met the inclusion criteria and reported quantified measurement outcomes with 3D imaging which provide precise volumetric data with approximately 2% standard deviation compared to real volumes. Data of 515 patients were included. Fat grafting retention varied from 21% to 82%. We found filtration and centrifugation techniques could result in better retention outcomes. However, retention varied within each processing technique, with no significant difference among the 3 techniques. Twenty-two complications were reported among 515 patients, including donor-site hematoma (1 case), mild post-operative erythema (2 cases), mild volumetric asymmetries (2 cases), chronic edema (2 cases), overcorrection (2 cases), skin irregularity (6 cases), and headache or dysesthesia (7 cases).Conclusions:Filtration and centrifugation techniques may result in better fat grafting retention outcomes than gravity sedimentation; however, more accurate statistical evidence is needed. Controversies continue to exist with respect to the performance of the different fat-processing techniques in fat graft retention.

Using a nonablative monopolar radiofrequency laser in the treatment of acne vulgaris

Background: Acne vulgaris is a prevalent cutaneous disorder that significantly affects patient quality of life. There have been several reports of successful acne treatment using lasers. However, few studies have reported the use of radiofrequency (RF) lasers for acne. Objective: The purpose of this study was to evaluate the efficacy and safety of a noninvasive monopolar RF laser in the treatment of acne vulgaris on the face. Methods: A randomized, prospective, split-face study was performed. Eleven participants were recruited. Patients were treated with the RF laser on one half of the face and no laser treatment on the other half. Two treatments were performed at 2-week intervals. Patients returned for follow-up 2 weeks after the final treatment. Results: After 4 weeks, the lesion counts of papules, comedones, red macules, and the sebumeter measured values all significantly decreased on the treated area compared to those on untreated areas. In the photograph analysis, the grade of acne (using Cook's acne grading method) also significantly improved after treatment. Patients reported tolerable pain and mild erythema with laser treatment. However, there were no permanent adverse events. Conclusion: Treatment with the noninvasive RF laser successfully reduces acne lesions (papules, comedones, and red macules) and sebum secretion without severe adverse events.

Efficacy and safety of topical spironolactone 5% gel versus placebo in the treatment of acne vulgaris

Background Acne is an inflammatory disorder of the pilosebaceous unit that imposes negative effects on the psychological state of patients. Indeed, even mild acne can adversely affect the patients’ quality of life. Therefore, successful management is needed. Spironolactone is one of the effective systemic treatments for acne, but its adverse effects limit its use. Objectives To assess the effectiveness and safety of 5% spironolactone gel in the treatment of acne. Patients and methods This study was a split-face study in which 22 adult patients with mild and moderate acne vulgaris were instructed to apply topical 5% spironolactone gel to their right hemifaces and topical placebo gel to their left hemifaces twice daily for 8 weeks. Results This study reported a statistically significant reduction in the total lesion count and acne severity index from the baseline. The improvement was significantly higher in the spironolactone side than the placebo side. Spironolactone mainly improves comedones and inflammatory papules. Minimal tolerable adverse effects were recorded in the form of stinging and mild erythema. Conclusion The data provided by this study support the use of topical spironolactone in the treatment of mild to moderate acne vulgaris.

Facial Tightening Following a Single Acoustic Wave Treatment Using Focused and Radial Acoustic Waves

Background: Acoustic wave has been used for many medical purposes, and although it is widely applied in cosmetic procedures, it has not been conducted for facial rejuvenation and tightening. Acoustic wave has been proven to penetrate deeper than subcutaneous tissue, independent of skin color, and to be beneficial for skin tightening and body contouring. Objective: To evaluate the effectiveness of a single acoustic wave treatment session using unique focused and radial acoustic waves for facial tightening. Participants: Sixty Asian patients were treated between the years 2016 and 2018. The single acoustic wave treatment session consists of focused long planar acoustic pulses thought to have an effect on cells and their metabolism resulting in an increased release of fat, and radial short acoustic pulses thought to have an effect on tissues activating blood and lymphatic flow. Patients did not undergo any form of medical aesthetic treatment during the study. Measurements: Digital photographs and three-dimensional imaging were used to evaluate the results. Results: Objective assessments with digital photographs and superimposed three-dimensional color images showed preferable facial tightening effects and marked volumetric reduction on the lower one-third of the face. These results were obtained without the edematous reactions observed in laser and radiofrequency therapies, and were sustained up to 12 months. All of the patients reported satisfaction with the results and convenience of the procedure. Complications were minor and transitory, consisting of a slight tingly sensation to the teeth during the treatment, and mild erythema resolving within 5 hours. Side effects were not observed. Conclusions: The advantages of the single acoustic wave treatment are the high potency of facial tightening effects, reduction of discomfort and side effects. Taken together, these characteristics facilitate the ability to give repeated treatments and provide an alternative or adjunct treatment for patients with improved results.

Fractional Ablative Carbondioxide Laser Resurfacing for Acne Scars - A Single Centered Study

Introduction: Pulsed carbon dioxide laser devices are considered highly effective treatment options for skin resurfacing. The aim of this study was to evaluate the efficacy and safety of an ablative 10,600-nm carbon dioxide fractional laser system on moderate to severe acne scarsMaterials and Methods: Forty participants (Fitzpatrick skin types III–IV) ranging from the age group of 25-45 who had moderate to severe acne scars were included in the study.CO2 Fractional laser was used, Unit: eCO2 Lutronic Korea; FDA approved, in 3 sessions at one month interval and 4th and 5th sessions at the interval of 2 months. Comparison was done on a monthly basis for the improvement of scars at one monthly interval and any other symptoms like pain, recovery time for wound healing and complications of laser like hyperpigmentation were noted by asking the patient to fill up a questionaire.Results: All the patients completed the treatment.At the end of the session participants experienced a reduction in the size of the scars. At the first laser session, they presented 10-25%, at the second session 20-45% and at the third session 30-60%. All participants felt an ascending improvement rate during and after the course of treatment. An average improvement of 71% was observed. Twelve of sixteen patients showed mild erythema which was transient and recovered at its own.Conclusions: Fractional Co2 laser ablation provides a safe and effective treatment of moderate to severe facial acne.

Thermotherapy: Improving the vascular access cannulation procedure

Vascular access is essential to perform an adequate hemodialysis. Needle cannulation in vascular access is usually painful. There is little scientific evidence on the analgesic effect of thermotherapy. The aim of this study was to evaluate the analgesic effect of thermotherapy on vascular access cannulation. We performed a 2-week single center prospective study. Demographic data and vascular access location were collected. The main outcome was pain perceived in vascular access cannulation measured by the visual analog scale. We performed two phases of study: phase I was performed with usual cannulation procedure, and in phase II, we applied local thermotherapy for 15 min (hot packs: 60 s, 600 W). Also, main hemodynamic data, local, and vascular access-related complications were recorded. A total of 34 patients were enrolled, with a mean age of 67.3 ± 16.4 years and 49.1 ± 66.3 months on hemodialysis. Main cardiovascular risk factors are hypertension (81.8%) and diabetes mellitus (39.4%). Most common vascular access is left radiocephalic fistula (45.5%). Mean weekly/patient cannulation is 6.03 ± 0.2. Mean visual analog scale is 3.8 ± 2.4. At the end of the study, thermotherapy on the vascular access revealed a significant decrease in visual analog scale (3.9 ± 2.4 vs 2.6 ± 2.0, p = 0.002), without hemodynamic changes pre- and post-intervention, nor changes in analgesic or antihypertensive treatment. One patient had a mild surface erythema. No further complications related to vascular access were observed. (1) Thermotherapy on the vascular access reduced the pain caused by needle cannulation in our patients, without complications related to vascular access. (2) We will consider its clinical application in those painful vascular access cannulations at our hemodialysis unit. (3) Further studies are required to assess other potential beneficial effects added to thermotherapy in vascular access cannulation procedure.

RECURRENT IMMEDIATE HYPERSENSITIVITY REACTION TO RADIOCONTRAST MEDIA DESPITE PREMEDICATION FOUND TO BE IGE-MEDIATED

Introduction The majority of radiocontrast media (RCM) reactions are from direct mast cell degeneration,[1] but there are some patients with recurrent reactions despite standard premedication who may have immediate hypersensitivity reactions[1] (IHR). Although some have found skin testing a helpful tool,[2] consensus on the best method of diagnosis and treatment is lacking. Case Description The patient is a 73-year-old Caucasian female with history of angioedema and urticaria after RCM administration on three separate occasions, despite premedication[3] with the last two exposures, history of asthma, and bicuspid aortic valve status post replacement in 2016. She presented with dyspnea and chest discomfort, diagnosed with severe prosthetic stenosis, and TAVR was recommended. Due to need for cardiac intervention with RCM, the patient underwent skin prick testing followed by intradermal testing with Iodixanol, resulting positive. Therefore, an IgE-mediated IHR to contrast dye was deduced and the patient received a desensitization protocol[4] in addition to a stronger premedication regimen[4] prior to her cardiac intervention. This was successful in preventing angioedema or urticaria, with only mild pruritus and erythema on her extremities, which resolved within 24 hours. Discussion With at least seventy million patients exposed to RCM yearly,[5] Allergist face a growing need for an efficient IHR evaluation protocol. Risk factors for recurrent reaction currently include prior severe allergic reaction to any substance, drug allergies, chronic oral glucocorticoid use, and allergy to four or more allergens.[6] Without all variables for IHR in RCM known, there remains much ambiguity in evaluation strategy, with further research required. The majority of radiocontrast media (RCM) reactions are from direct mast cell degeneration,[1] but there are some patients with recurrent reactions despite standard premedication who may have immediate hypersensitivity reactions[1] (IHR). Although some have found skin testing a helpful tool,[2] consensus on the best method of diagnosis and treatment is lacking. The patient is a 73-year-old Caucasian female with history of angioedema and urticaria after RCM administration on three separate occasions, despite premedication[3] with the last two exposures, history of asthma, and bicuspid aortic valve status post replacement in 2016. She presented with dyspnea and chest discomfort, diagnosed with severe prosthetic stenosis, and TAVR was recommended. Due to need for cardiac intervention with RCM, the patient underwent skin prick testing followed by intradermal testing with Iodixanol, resulting positive. Therefore, an IgE-mediated IHR to contrast dye was deduced and the patient received a desensitization protocol[4] in addition to a stronger premedication regimen[4] prior to her cardiac intervention. This was successful in preventing angioedema or urticaria, with only mild pruritus and erythema on her extremities, which resolved within 24 hours. With at least seventy million patients exposed to RCM yearly,[5] Allergist face a growing need for an efficient IHR evaluation protocol. Risk factors for recurrent reaction currently include prior severe allergic reaction to any substance, drug allergies, chronic oral glucocorticoid use, and allergy to four or more allergens.[6] Without all variables for IHR in RCM known, there remains much ambiguity in evaluation strategy, with further research required.

C1 INHIBITOR ADMINISTRATION IN PEDIATRIC PATIENTS WITH HEREDITARY ANGIOEDEMA: PATIENT COMPLIANCE WITH INTRAVENOUS THERAPY

Introduction Adherence in a pediatric population can be a barrier to therapy. Here we report compliance, safety, efficacy and QoL outcomes in patients aged 6-11years who received intravenous (IV) C1-INH for routine prevention of angioedema attacks. Methods In a single blind, crossover design, patients received IV 500U and 1000U of C1-INH every 3-4 days for 12 weeks. Endpoints assessed were the monthly normalized number of attacks (NNA), adverse event reporting, completion of the youth version of the EQ-5D-Y descriptive system/VAS questionnaire, and C1 INH treatment adherence. Results Of 12 enrolled patients, 7 (58.3%) were female with a median (range) age 10.0 (7-11) years. All 12 patients were administered ≥90% of all C1-INH doses. Ten (83.3%) patients were 100% compliant with receiving all doses (n=480 doses) across both treatment arms. Overall, 58.3% and 91.7% of patients achieved a ³70% reduction from baseline with 500U and 1000U C1-INH, respectively. No patients discontinued due to an AE and few injection site reactions were noted; one patient (8.3%) who received 1000U C1-INH reported 1 related TEAE of mild pruritus and 1 related TEAE of mild erythema. The mean (SD) change in the EQ-5D VAS score from baseline to week 9 of treatment with 500U and 1000U C1-INH was 10.4 (19.0) and 21.6 (13.4), respectively. Conclusions This study demonstrated that high levels of compliance with IV administration of C1-INH can be achieved in a pediatric population. IV administration of C1 INH is well tolerated, efficacious and indicative of improved QoL.

Œdèmes des membres inférieurs cortico-sensibles chez une patiente âgée de 85 ans présentant une pseudopolyarthrite rhizomélique

IntroductionPolymyalgia rheumatica (PMR) can be associated with distal swelling indicating an associated RS3PE syndrome. We report a case of PMR associated with oedema of the lower limbs, which resolved rapidly under glucocorticoid therapy. Case reportA 85-year-old woman presented with a 4 month history of PMR responding to the 2012 EULAR/ACR classification criteria. Examination of the lower limbs revealed pitting oedema bilaterally up to the knees, with mild erythema and warmth. Hypoalbuminemia (30g/L) was present. There was no cardiac, renal or hepatic cause to explain leg swelling. FDG-PET/CT demonstrated increased metabolism in the periarticular area of shoulders and hips. There was no sign of aortitis or neoplasia. Under treatment with prednisone 10mg/day leg swelling disappeared concomitantly to a weight loss of 8kg within 8days. ConclusionThis case, the first to report leg swelling of inflammatory origin in the context of PMR, could indicate an increased vascular permeability caused by inflammation in the elderly.

Vitamin D enhanced pork from pigs exposed to artificial UVB light in indoor facilities

Vitamin D deficiency is a recognized problem in Europe; this can be minimized by fortifying a broader range of foods. Our aim was to investigate the potential for enhancing the vitamin D content of pork from pigs raised in indoor facilities, by exposing the pigs to UVB for a period just before slaughter. Three groups of six pigs were exposed to 0, 0.7 or 1 SED/day for 28 days. A fourth group was exposed to 2 SED; this treatment was not completed due to mild erythema. The highest increase of vitamin D3 was achieved with 1 SED; the vitamin D3 content in loin was 3.7 ng/g; more than a factor of 2 higher compared to previously reported results from studies using 2000 IU/kg feed, the maximum allowed level in Europe. This is the first time an increase in the vitamin D content of pork has been reported as a result of using artificial UVB exposure of slaughter pigs in indoor facilities. However, the maximum production of vitamin D was probably not reached as a linear relationship between UVB dose and vitamin D content was found; therefore, the UVB-lighting method described still calls for further investigation to realise its full potential to enhance vitamin D in pork.