With the advancement of knowledge in relation to the physiopathogenesis of atopic dermatitis (AD), several new therapeutic forms have been developed. There are also new guidelines for self-care. On ...the other hand, there is still an underdiagnosis of AD in Mexico. Thus, the need was seen to develop a national guide, with a broad base among the different medical groups that care for patients with AD. The Atopic Dermatitis Guidelines for Mexico (GUIDAMEX) was developed with the ADAPTE methodology, with the endorsement and participation of ten national medical societies, from physicians in Primary Healthcare to allergists and dermatologists. Throughout the manuscript, key clinical questions are answered that lead to recommendations and suggestions for the diagnosis of AD (including differential diagnosis with immunodeficiency syndromes), the recognition of comorbidities and complications, non-pharmacological treatment including therapeutic education, treatment of flares and maintenance therapy. The latter encompasses general measures to avoid triggering factors, first-line treatment focussed on repair of the skin barrier, second-line treatment (topical proactive therapy), and third-line phototherapy or systemic treatment, including dupilumab and JAK inhibitors.
Diagnostic and therapeutic caveats in Griscelli syndrome Castaño‐Jaramillo, Lina‐Maria; Lugo‐Reyes, Saul O.; Cruz Muñoz, Mario E. ...
Scandinavian journal of immunology,
June 2021, 2021-Jun, 2021-06-00, 20210601, Volume:
93, Issue:
6
Journal Article
Peer reviewed
Open access
Griscelli syndrome (GS) is a rare autosomal recessive disease with characteristic pigment distribution, and there are currently 3 types according to the underlying genetic defect and clinical ...features. We present the case of a girl born from consanguineous parents who presented with predominant neurologic symptoms, silvery hair and granulomatous skin lesions. Cerebral magnetic resonance revealed diffuse white matter lesions, and central nervous system (CNS) lymphocytic infiltration was suspected. The patient underwent haematopoietic stem cell transplantation with graft failure and autologous reconstitution. She developed elevated liver enzyme with a cholestatic pattern. Multiple liver biopsies revealed centrilobular cholestasis and unspecific portal inflammation that improved with immunomodulatory treatment. She was revealed to have an impaired cytotoxicity in NK cells and a decreased expression of RAB27A. However, no variants were found in the gene. All types of GS present with pigment dilution and irregular pigment clumps that can be seen through light microscopy in hair and skin biopsy. Dermic granulomas and immunodeficiency with infectious and HLH predisposition have been described in GS type 2 (GS2). Neurologic alterations might be seen in GS type 1 (GS1) and GS type 2 (GS2), due to different mechanisms. GS1 presents with neurologic impairment secondary to myosin Va role in neuronal development and synapsis. Meanwhile, GS2 can present with neurologic impairment secondary to SNC HLH. Clinical features and cytotoxicity might aid in differentiating GS1 and GS2, especially since treatment differs.
Mexican consensus on cow's milk protein allergy Alfonso, Ramírez Mayans Jaime; Rubí, Ignorosa Arellano Karen; Manuel, Toro Monjaraz Erick ...
Allergologia et immunopathologia,
2024, Volume:
52, Issue:
1
Journal Article
Peer reviewed
Open access
The aim of this study is to present the current views of a diverse group of experts on the diagnosis and treatment of Cow's Milk Protein Allergy (CMPA) in children under 2 years of age in Mexico.
The ...study, led by a scientific committee of five experts in CMPA, was divided into six phases, including a modified Delphi process. A total of 20 panelists, all of whom were pediatric specialists, participated in administering a comprehensive 38-item questionnaire. The questionnaire was divided into two blocks: Diagnosis and Treatment (20 items each).
Consensus was reached on all the proposed items, with an agreement rate of over 70% for each of them. As a result, a diagnostic and treatment algorithm was developed that emphasized the reduction of unnecessary diagnostic studies and encouraged breastfeeding whenever possible. In cases where breast milk is not available, appropriate use of hypoallergenic formulas was recommended. In addition, recommendations on treatment duration and gradual reintroduction of cow's milk protein were provided.
The recommendations endorsed by 20 Mexican pediatricians through this study are applicable to everyday clinical practice, thereby enhancing the diagnosis and treatment of children under 2 years of age with CMPA. This, in turn, will foster improved health outcomes and optimize the utilization of healthcare resources.
INTRODUCCIÓN: una meta a alcanzar en los niños que usan pañal es mantener una piel intacta dentro del área cubierta por éste y así evitar la dermatitis por pañal.OBJETIVO: comparar la eficacia de dos ...tipos de pañal para prevenir o tratar la dermatitis por pañal.MATERIALES Y MÉTODOS: ensayo clínico aleatorizado en lactantes de 6 a 12 meses de edad, con o sin dermatitis por pañal, que utilizaron pañales Huggies UltraConfort® o BBTips®. Se investigó la presencia o ausencia de dermatitis por pañal y la evaluación de la eficacia del pañal por el médico y el cuidador. El análisis estadístico incluyó análisis uni- y bivariado.RESULTADOS: en el grupo sin dermatitis por pañal se evaluaron 68 lactantes con edad promedio de 8.54 ± 2.09 meses. Había tenido eventos previos de dermatitis por pañal 72%. Catorce lactantes tuvieron dermatitis por pañal. La comparación entre ambos tipos de pañal demostró que BBTips® fue más eficaz que Huggies UltraConfort ®. En el grupo con dermatitis por pañal se evaluaron 66 pacientes con edad promedio de 8.65 ± 2.4 meses. Había tenido eventos previos de dermatitis por pañal 88%. A los 15 días se habían resuelto 53% de las dermatitis por pañal y al mes 88%. La comparación entre ambos tipos de pañal no demostró diferencias significativas en la eficacia.CONCLUSIONES: en el aspecto preventivo BBTips® fue superior a Huggies UltraConfort®. Ambos pañales tuvieron eficacia similar en el tratamiento de la dermatitis por pañal.
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