Rodríguez-Garijo, N. (Nuria)
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- Generalized morphea following the COVID vaccine: A series of two patients and a bibliographic review(Wiley, 2022) Estenaga, Á. (Ángela); Morelló-Vicente, A. (Ana); España, A. (Agustín); Rodríguez-Garijo, N. (Nuria); Antoñanzas-Perez, J. (Javier); Aguado, L. (Leyre)The appearance of morphea after vaccination has been reported to date as single and deep lesions that appear exactly at the site of the skin puncture. It was therefore postulated that the origin could be the trauma related to the injection. The aim of this article is to review the various hypotheses offered in the published literature about generalized morphea following vaccination. We present two cases of generalized morphea after COVID-19 vaccination and review the published literature on immune-related cutaneous reactions. As previously reported, antigenic crossreactivity between vaccine spike proteins and human tissues could cause certain immune-mediated diseases, including generalized morphea. Herein we report two cases of generalized morphea probably induced by the COVID-19 vaccine, given the temporal relationship with its administration. In summary, environmental factors such as vaccination against SARS-COV-2 could induce an immune system dysregulation, which would have an important role in the pathogenesis of morphea. We present two cases of generalized morphea probably induced by the COVID-19 vaccine, given the time elapsed between vaccination and the onset of the skin lesions.
- Cocaine-induced pyoderma gangrenosum-like lesions(Wiley, 2018) Tomás-Velázquez, A. (Alejandra); Moreno, E. (Esther); España, A. (Agustín); Gil-Sanchez, M.P. (María Pilar); Rodríguez-Garijo, N. (Nuria); Idoate, M.A. (Miguel Ángel); Querol-Cisneros, E. (Elena)Cocaine consumption is increasing at an alarming rate. This drug produces euphoria, anorexia, increased alertness and diminished sleep requirements. It is estimated that up to 80 % of cocaine is contaminated with levamisole, a substance which may potentiate the drug’s chemical effects [ 1 ] . Multiple mucocutaneous manifestations have been associated with cocaine use [ 2 ] , including cocaine-induced pyoderma gangre-nosum (CIPG), cocaine-induced midline destructive lesions (CIMDL) and retiform purpura (RP). We present three cases of cocaine abuse with skin lesions compatible with PG, and review the epidemiological, clinical, histopathological and immunological characteristics of CIPG and RP. We suggest that these two conditions are more closely related than previously thought. Additionally, in our opinion, no specific immunological or histological profile would be indicative of levamisole toxicity.
- Acute parvovirus B19 infection: Analysis of 46 patients(Elsevier, 2020) Tomás-Velázquez, A. (Alejandra); Estenaga, Á. (Ángela); España, A. (Agustín); Escribano, A. (Ángela); Rodríguez-Garijo, N. (Nuria); Reina, G. (Gabriel)Introduction: Parvovirus B19 (PVB19) infection has a high incidence and worldwide distribution. It has a broad clinical spectrum, with skin, joint and haematological manifestations being the most common. The objective of this study was to determine the epidemiology and clinical–analytical manifestations of acute PVB19 infection. Patients and methods: A retrospective study of patients with a positive IgM serology for PVB19 (10 years). Forty-six patients were included and their demographic, clinical and analytical characteristics were analyzed. Results: Primary infection was most prevalent in women (ratio 2.2:1) aged 41 (mean age). Joint involvement was the most common manifestation (65%). Skin abnormalities were observed in more than half of patients (24 cases): rash (28%), megalerythema (9%), “gloves and socks” involvement (6.5%), periflexural rash (4%) and oedema (4%). Anaemia was the main haematological alteration (35%). The symptoms were self-limiting and resolved in 1–2 weeks in most patients. Conclusions: Although there is a variable clinical spectrum, polyarthralgias and generalized maculopapular rash with fever and anaemia are the typical and most frequent manifestations of primary infection by PVB19 and are usually self-limiting.
- Angioedema severity and impact on quality of life: Chronic histaminergic angioedema versus chronic spontaneous urticaria(2022) Sabaté-Brescó, M. (Marina); Labrador-Horrillo, M. (Moises); Herrera-Lasso, V. (Valeria); Diaz-Donado, C. (Carmen); Baeza, M.L. (María Luisa); Azofra, J. (Julián); Gil, M.P. (María Pilar); Veleiro, B. (Beatriz); Gaig, P. (Pere); Rodríguez-Garijo, N. (Nuria); Sala-Cunill, A. (Anna); Guilarte, M. (Mar); Ferrer-Cardona, M. (Marta)Histamine-mediated angioedema is the most frequent form of angioedema. It is classified as idiopathic histaminergic acquired angioedema (IH-AAE)1 when allergies and other causes have been excluded and a positive treatment response to antihistamines, corticosteroids, or omalizumab has been reported. Idiopathic histaminergic acquired angioedema may occur in isolation, when it is termed chronic histaminergic angioedema (CHA), or it may be associated with wheals in chronic spontaneous urticaria angioedema (CSU-AE). The term CHA is equivalent to IH-AAE and mast cell-mediated angioedema. However, this term reflects the chronic and recurrent course of the disease. Therefore, we propose that the term CHA be internationally discussed in the following guidelines. Chronic spontaneous urticaria is classically characterized by the presence of recurrent episodes of wheals (hives) with or without angioedema for at least 6 weeks.2 Chronic histaminergic angioedema is typically considered a subtype of CSU without wheals. However, a recent study3 found several features that differentiate CHA from CSU, which suggests that CHA is a separate entity. Quality of life (QoL) studies specifically for CHA patients have not been performed, and their QoL has been assessed only in the context of CSU-AE.
- Popper’s Dermatitis: An Unusual Diagnostic Challenge(Wiley, 2021) Tomás-Velázquez, A. (Alejandra); Estenaga, Á. (Ángela); Gil-Sanchez, M.P. (María Pilar); Rodríguez-Garijo, N. (Nuria); Antoñanzas-Perez, J. (Javier); Aguado, L. (Leyre)Volatile nitrites, and especially isobutyl nitrite or “Popper”, are popular drugs of abuse in Europe, mainly in men that have sex with men (MSM). Inhalation is the most common route of consumption, but direct contact with skin or muco- sal membranes has been associated with a local adverse event called “Popper’s dermatitis”. To date, just five cases have been reported, most of them on the face, but also on other parts of the body [1, 2].
- Methotrexate-induced epidermal necrosis in a child with osteosarcoma(John Wiley & Sons Ltd., 2020) Tomás-Velázquez, A. (Alejandra); Gutierrez-Jimeno, M. (Miriam); Moreno, E. (Esther); Rodríguez-Garijo, N. (Nuria); Aguado, L. (Leyre); Querol-Cisneros, E. (Elena)Methotrexate is a folic acid antagonist used to treat psoria-sis, rheumatoid arthritis and neoplasms. It is renally excreted unchanged, at levels of about 90% within 24 hours. Several risk factors for intoxication have been described, including folate deficiency, liver cirrhosis, renal failure or the use of me-dications such as sulfonamides, salicylate and nonsteroidal anti-inflammatory drugs. Adverse cutaneous reactions such as photosensitivity, alopecia, urticaria, mucositis, erythe-ma, desquamation, Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) are well known. Methotrexate epidermal necrosis (MEN) should also be considered because of its severity, its similarity to TEN and the importance of rapidly administering appropriate treatment. Some cases of MEN have been reported in psoriasis patients, in whom the occurrence with an underlying skin disease has been found to be more common.
- Reactive granulomatous dermatitis as a histological pattern including manifestations of interstitial granulomatous dermatitis and palisaded neutrophilic and granulomatous dermatitis: a study of 52 patients(Wiley, 2020) Paricio, J.J. (J. J.); España, A. (Agustín); Mascaró-Galy, J.M. (José Manuel); Bielsa, I. (I.); Iranzo, P. (Pilar); Quer, A. (A.); Rodríguez-Garijo, N. (Nuria); Idoate, M.A. (Miguel Ángel)Background: Confusion exists regarding interstitial granulomatous dermatitis (IGD) and palisaded neutrophilic and granulomatous dermatitis (PNGD). Objective: To determine whether IGD and PNGD are two different entities, or whether they must be considered as two subtypes of the same reactive pattern, and thus whether the unification of the nomenclature is necessary. Methods: Observational retrospective multicentre study of patients with IGD and PNGD evaluated between 1999 and 2019 and review of their clinical and histological features. Results: We identified 52 patients (38 women and 14 men). Clinical and histological findings of IGD were observed in 88.4% of cases. The most common cutaneous lesions were plaques/macules (IGD) or annular plaques and papules/nodules (PNGD), located mostly on the limbs and trunk. The rope sign was developed in two patients with IGD that associated autoimmune disorders. Similar associated comorbidities (75%) were found in both entities, mainly autoimmune diseases (53.8%). In IGD, the infiltrate was predominantly lympho-histiocytic. Neutrophilic infiltrates, karyorrhexis and skin lesions with limited clinical course were mainly associated with PNGD biopsies. In biopsies with a limited recurrent course, a predominant lymphocytic inflammatory infiltrate was found. Collagen degeneration was present in 75.9% of cases. The floating sign was observed only in IGD type patients (63%). Overlapping histological findings were found in one fourth of cases, especially between IGD and interstitial granuloma annulare. Interface dermatitis, apparently unrelated to drug intake, was observed in 4 cases of IGD. Conclusion: We support the term reactive granulomatous dermatitis to unify both the clinical and histological findings of IGD and PNGD, and the overlapping between IGD and interstitial granuloma annulare. According to this, a spectrum of histological changes will be found depending on the clinical course of the skin lesions.
- A Comparative Study of Sex Distribution, Autoimmunity, Blood, and Inflammatory Parameters in Chronic Spontaneous Urticaria with Angioedema and Chronic Histaminergic Angioedema(2021) Sabaté-Brescó, M. (Marina); Labrador-Horrillo, M. (Moises); Herrera-Lasso, V. (Valeria); Diaz-Donado, C. (Carmen); Baeza, M.L. (María Luisa); Gil-Sanchez, M.P. (María Pilar); Azofra, J. (Julián); Kaplan, A.P. (Allen .P); Veleiro, B. (Beatriz); Gaig, P. (Pere); Rodríguez-Garijo, N. (Nuria); Sala-Cunill, A. (Anna); Guilarte, M. (Mar); Ferrer-Cardona, M. (Marta)Background Recurrent idiopathic histaminergic angioedema is currently classified as a subtype of angioedema, as well as a subtype of chronic spontaneous urticaria (CSU), based on the fact that both are mast cell-mediated and respond to the same treatments. Objective In the present work, we sought to verify whether chronic histaminergic angioedema (CHA) is an entity distinct from CSU or represents a CSU subtype that lacks hives. Methods We performed a prospective study comparing 68 CHA patients, angioedema without hives, with 63 CSU patients, with hives and angioedema, from whom we collected demographic and clinical data, as well as blood and serum markers. Results We found key pathogenic features that differentiate CHA from CSU: gender distribution, basophil number, and antibodies against the IgE receptor. The male/female ratio in CHA was 0.78, whereas in CSU it was 0.36 (P = .0466). Basopenia was more often seen in CSU (n = 13 [20%]) than in CHA (n = 5 [7%]). Finally, 31.15% of CSU sera induced basophil activation, whereas no CHA sera were able to activate normal basophils. By contrast, nonspecific inflammation or immune markers, for example, erythrocyte sedimentation rate, C-reactive protein, or IgG antithyroid antibodies, were very similar between both groups. IgE anti–IL-24 could not be assessed because a control population did not differ from CSU. Conclusions Inclusion of CHA as part of the spectrum of CSU is an assumption not evidence-based, and when studied separately, important differences were observed. Until there is further evidence, CHA and CSU should not necessarily be considered the same disorder, and it is our opinion that review articles and guidelines should reflect that possibility.
- Serum Amyloid A as a potential biomarker for disease activity in chronic spontaneous urticaria(Elsevier, 2024) Sabaté-Brescó, M. (Marina); Labrador-Horrillo, M. (Moises); Herrera-Lasso, V. (Valeria); Diaz-Donado, C. (Carmen); Baeza, M.L. (María Luisa); Veleiro, B. (Beatriz); Carvallo, Á. (Álvaro); Rodríguez-Garijo, N. (Nuria); Guilarte, M. (Mar); Ferrer-Cardona, M. (Marta)Background: Chronic spontaneous urticaria (CSU) is an inflammatory skin disease with a complex physiopathology. Serum amyloid A (SAA), an acute-phase reactant, has been proposed as a potential biomarker in urticaria but has yet to be studied in a population with CSU or correlated with disease activity as indicated by the Urticaria Activity Score summed over 7 days (UAS7). Objective: We sought to determine SAA-1 levels in patients with CSU and correlate them with its activity and control, as well as with clinical features of CSU and other potential blood biomarkers. Methods: We conducted a retrospective multicenter study of 67 patients with CSU, from whom we obtained demographic and clinical data, UAS7 as an indicator of CSU activity, and blood and serum markers. Results: SAA-1 levels positively correlated with UAS7 (rs = 0.47, P < .001). SAA-1 levels were higher in patients with noncontrolled (UAS7 > 6) CSU than in those with controlled (UAS ≤ 6) CSU (P < .001) and were also higher in patients with concomitant angioedema (P = .003) or delayed pressure urticaria (P = .003). Conclusion: We propose SAA-1 as a potential biomarker for activity in CSU. Further studies are required to evaluate its potential role as a biomarker for other CSU outcomes, such as response to treatment.
- Linear basal cell carcinoma of the lower eyelid: Reconstruction with a musculocutaneous transposition flap(Elsevier, 2018) Rodríguez-Garijo, N. (Nuria); Redondo-Bellón, P. (Pedro)Linear basal cell carcinoma (LBCC) is a rare morphologic variant of basal cell carcinoma. It is defined as a basal cell carcinoma that grows following a linear pattern, with a longitudinal diameter longer that its width. This entity was first reported by Lewis in 1985,1 and since then approximately 50 new cases have been described. LBCC characteristically spreads following relaxed skin tension lines, and the most frequent site is the lower eyelid. Currently, some controversy exists regarding the most appropriate surgical approach and reconstructive technique for LBCC. For this reason, we present 2 cases recently managed in our center.