The question is: Atopic patient, with 78% of body surface Affected. IgA=98.00mg/dL, IgE=>2000.00KU/L, with serologies (-). Leukocytosis =13000mm³, Segmented=-8840mm³, Eosinophiles=130mm³, Monocytes=390mm³, Microbiological skin culture=Aspergillus spp (+). 20 days after the leukogram, the following was presented: Leukocytes=11030mm³, Eosinophils=1831mm³, Neutrophils=6309mm³
Current symptoms: Insomnia, pruritus, Intense Atopic Triad Crisis.
In general: We will use
Itraconazole 300mg, for how long to use in cutaneous aspergillosis? and can I combine it with methotrexate 7.5mg /week?
HOW DO I MAKE THE BEST DRUG MANAGEMENT OF THIS SITUATION?
# DERMATOLOGY
P.S.: filaggrin and profilaggrin tests are not available in the region, bewm with serum interleukin dosage..
to be clear I know the evolution of AD and its immunopathology, the question itself is this UNCOMMON EVENT OF CUTANEOUS ASPERGILOSIS AND HOW I MANAGE ITRACONAZOLE EFFICIENTLY BECAUSE THE PATIENT HAS HAD VERY RECURRENT PRURIGINOUS CRISES THAT TAKE HIM TO THE EMERGENCY SERVICE HOSDPITALAR.
Dear doctor
Go To
Association between atopic dermatitis and serious cutaneous, multiorgan and systemic infections in US adults
Shanthi Narla, and Jonathan I. Silverberg,
Ann Allergy Asthma Immunol. 2018 Jan; 120(1): 66–72.e11.
doi: 10.1016/j.anai.2017.10.019
"Introduction
Atopic dermatitis (AD) is a chronic inflammatory skin disease affecting 13% of children1 and 7–10% of adults across the United States. It is well established that AD is associated with a higher incidence of certain cutaneous infections, including Staphylococcus aureus colonization, molluscum contagiosum and eczema herpeticum (EH), and possibly cutaneous warts. In fact, predisposition toward cutaneous infection is one of the Hanifin and Rajka minor diagnostic criterion for AD8. The mechanism of such predisposition is thought to be multifactorial, including impaired epidermal barrier function9, decreased expression of antimicrobial peptides, and abnormal innate immune response in skin.
Recent US population-based studies showed that AD is also associated with higher rates of extra-cutaneous infection in both children and adults, such as infections of the upper and lower respiratory tracts, ears and urinary tract. Those studies utilized surveys with questions about self- or caregiver-reported AD and infections. In the present study, we sought to determine whether there is an association between healthcare diagnosed AD and serious infections in adults. We hypothesized that adults with AD have significantly higher prevalences of cutaneous, respiratory, multi-organ and systemic infections.
In conclusion, adults with AD had significantly higher odds of cutaneous, respiratory, multi-organ and systemic infections. Serious infections were associated with a substantial financial-burden in patients with AD."
to be clear I know the evolution of AD and its immunopathology, the question itself is this UNCOMMON EVENT OF CUTANEOUS ASPERGILOSIS AND HOW I MANAGE ITRACONAZOLE EFFICIENTLY BECAUSE THE PATIENT HAS HAD VERY RECURRENT PRURIGINOUS CRISES THAT TAKE HIM TO THE EMERGENCY SERVICE HOSDPITALAR.
Terri Purvis
So doctor, as everything is in the public health system, you have to make an appointment, and obey a waiting list, the serological study was requested, so I still don't have the result. however, the treatment with itraconazole is extensive, demanding a lot of time. and the idea is to treat the patient's atopic dermatitis, which is serious, but I'm a little afraid of associating it with methotrexate, due to the reaction between the two drugs and the bouts of itching and the question of the appearance of his skin, it could lead him to a psychiatric situation, which is already ongoing, the patient does not leave the house, he has a sad facial expression and this has worried me a lot. the ideal would be to use an immunobiological medicine, but they are significantly expensive here in Brazil. So what I have in hand is MTX, but how safe would it be to use with the anti-fungal? Another concern I have when withdrawing from itraconazole?it's too complex for me
I know it's hard to see a patient suffer, see his family suffer. And as much as you are passionate about medicine, and I know your method, you shouldn't get emotionally involved with the case. you are an excellent student but separate things a little, this will give you more clarity in interpretation and decision making
Dear doctor
Go To
Atakan N, Yalçın B, Özkaya E, Küçük ÖS, Öztürkcan S, Salman A, Borlu M, Şentürk N, Akman-Karakaş A, Serdaroğlu S. Atopic dermatitis diagnosis and treatment consensus report. Turkderm-Turk Arch Dermatol Venereol 2022;56(Suppl 2):86-121 Turkderm-Turk Arch Dermatol Venereol 2022;56(Suppl 2):86-121 DOI:10.4274/turkderm.galenos.2022.73368
"Introduction
Atopic dermatitis (AD) is a chronic, itchy, and recurrent inflammatory skin disease. It is characterized by dry skin, itch-scratch cycle, and eczematous lesions. AD, which is known as a childhood disease because of its common occurrence, is also an important health problem in adults. Other atopic comorbidities accompanying the disease and severe itching and insomnia have significant adverse effects on the quality of life (QoL) and increase the burden of the disease. With increasing prevalence rates throughout each year, particularly in developed countries, AD has a heterogeneous clinical presentation that varies with age and different degrees of severity. The treatment includes the use of topical or systemic agents after identifying the actual needs of the patients. Especially, the identification of molecules responsible for pathogenesis recently has allowed the development of tailored treatments.
Differential diagnosis of atopic dermatitis
The diseases that should be considered primarily in the differential diagnosis of AD vary according to the patient’s age and the location of the lesions. The disease groups that should be considered in the differential diagnosis, in general, include chronic inflammatory dermatoses such as seborrheic and contact dermatitis; infectious diseases, primarily scabies; primary immunodeficiency syndromes, and autoimmune and metabolic skin diseases. Although there are no specific types of tests recommended for routine use in the differential diagnosis, some laboratory tests and histopathological examinations are required for distinguishing AD from primary immunodeficiencies, especially in childhood, and from cutaneous T-cell lymphoma in adults."
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