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Imamura S, Oda Y, Fukumoto T, Mizuno M, Suzuki M, Washio K, Nishigori C, Fukunaga A. Solar urticaria: clinical characteristics, treatment effectiveness, long-term prognosis, and QOL status in 29 patients. Front Med (Lausanne) 2024; 11:1328765. [PMID: 38435390 PMCID: PMC10904580 DOI: 10.3389/fmed.2024.1328765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction Solar urticaria (SU), a relatively rare skin inflammatory and photosensitivity disease, is often resistant to standard urticaria treatment. Quality of life (QOL) among SU patients has not been extensively explored. This study was performed to clarify the clinical features and effectiveness of therapies (e.g., hardening therapy) for SU and to determine QOL among SU patients. Methods The authors examined the characteristics, treatments, and QOL statuses of 29 Japanese SU patients using medical records and a questionnaire approach. Results Among 29 patients, H1 antihistamine therapy (H1) was effective in 22 (75.8%) patients. H2 antihistamine therapy (H2) was effective in three of seven (42.9%) patients. Ultraviolet radiation A (UVA) hardening therapy was effective in eight of nine (88.9%) patients. Visible light (VL) hardening therapy was ineffective in three of three patients. In one patient who underwent both UVA and VL hardening therapy, only UVA hardening therapy was effective. In the questionnaire, 18 patients (90%) reported some improvement compared with disease onset (four had complete remission, six had completed treatment although mild symptoms persisted, and eight were receiving treatment with moderate symptoms), whereas two patients reported exacerbation. Patients in complete remission had a mean disease duration of 4 years, whereas patients not in remission had a mean disease duration of 8.8 years. The mean Dermatology Life Quality Index (DLQI) score for the current status was 7.4. There was a correlation between DLQI and symptom/treatment status. However, neither DLQI and action spectra nor DLQI and treatments exhibited significant differences. Discussion The questionnaire revealed current QOL status and long-term prognosis in SU patients. Compared with disease onset, most patients showed improvement when assessed for this study. Both H1 and H2 should be attempted for all SU patients. UVA hardening therapy may be an option for SU patients with an action spectrum that includes UVA.
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Affiliation(s)
- Shinya Imamura
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
- Department of Dermatology, Kobe City Hospital Organization, Kobe City Medical Center West Hospital, Kobe, Japan
| | - Yoshiko Oda
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Fukumoto
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mayuko Mizuno
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mariko Suzuki
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken Washio
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Chikako Nishigori
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsushi Fukunaga
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
- Department of Dermatology, Osaka Medical and Pharmaceutical University, Osaka, Japan
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Afvari S, Zippin JH. Type I hypersensitivity in photoallergic contact dermatitis. JAAD Case Rep 2024; 44:47-49. [PMID: 38292568 PMCID: PMC10825262 DOI: 10.1016/j.jdcr.2023.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Affiliation(s)
- Shawn Afvari
- Department of Dermatology, Weill Cornell Medical College, New York, New York
- New York Medical College School of Medicine, Valhalla, New York
| | - Jonathan H. Zippin
- Department of Dermatology, Weill Cornell Medical College, New York, New York
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Pesqué D, Ciudad A, Andrades E, Soto D, Gimeno R, Pujol RM, Giménez-Arnau AM. Solar Urticaria: An Ambispective Study in a Long-term Follow-up Cohort with Emphasis on Therapeutic Predictors and Outcomes. Acta Derm Venereol 2024; 104:adv25576. [PMID: 38189220 PMCID: PMC10789168 DOI: 10.2340/actadv.v104.25576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/17/2023] [Indexed: 01/09/2024] Open
Abstract
Solar urticaria is a rare photodermatosis with several unknown pathogenic, clinical and therapeutic aspects. This study analysed the clinical and therapeutic features of a long-term follow-up solar urticaria cohort, with a focus on omalizumab management and outcomes, and characterized omalizumab response with the use of the high-affinity immunoglobulin E (IgE) receptor (FcεRI) and the Urticaria Control Test. An observational, unicentric, ambispective study was conducted from 2007 to 2023. Solar urticaria was diagnosed in 41 patients with a median follow-up of 60 months. Thirteen patients were prescribed omalizumab, with a median treatment time of 48 months. A significant decrease in FcεRI baseline levels and subsequent median increase in Urticaria Control Test was evidenced after omalizumab prescription in all patients. Drug survival at 48 months was at 88.9%. Omalizumab stepping-down protocol led to sustained omalizumab discontinuation in only 1 patient. Median basal Urticaria Control Test was lower (p < 0.01) in patients who were prescribed omalizumab and in patients without remission. This study contributes to our knowledge of omalizumab outcomes in real-life clinical practice and highlights the pathogenic importance of IgE-mediated pathways in solar urticaria, where FcεRI emerges as a possible biomarker of omalizumab response.
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Affiliation(s)
- David Pesqué
- Department of Dermatology, Hospital del Mar Research Institute, Department of Medicine, Autonomous University of Barcelona/Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
| | - Andrea Ciudad
- Department of Dermatology, Hospital del Mar Research Institute, Barcelona, Spain
| | - Evelyn Andrades
- Department of Immunology, IMIM Hospital del Mar Research Institute, Barcelona, Spain
| | - Dulce Soto
- Department of Immunology, IMIM Hospital del Mar Research Institute, Barcelona, Spain
| | - Ramon Gimeno
- DDepartment of Immunology, IMIM Hospital del Mar Research Institute, Barcelona, Spain
| | - Ramon M Pujol
- Department of Dermatology, Hospital del Mar Research Institute, Barcelona, Spain
| | - Ana M Giménez-Arnau
- DDepartment of Dermatology, Hospital del Mar Research Institute. Universitat Pompeu Fabra, Barcelona, Spain.
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Fukunaga A. [ADVANCES IN THE TREATMENT AND ELUCIDATION OF THE PATHOPHYSIOLOGY OF CHRONIC URTICARIA]. Arerugi 2021; 70:1363-1370. [PMID: 34911888 DOI: 10.15036/arerugi.70.1363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Atsushi Fukunaga
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine
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Uetsu N, Nomura Y, Matsuyama Y, Okamoto H. Characteristics and clinical significance of augmentation spectra in solar urticaria. J Dermatol 2020; 47:369-377. [PMID: 31960491 DOI: 10.1111/1346-8138.15234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 12/23/2019] [Indexed: 11/30/2022]
Abstract
Solar urticaria has unique spectra, such as inhibition and augmentation. The clinical significance of these spectra, especially augmentation, is not well understood. Reported cases of solar urticaria with augmentation spectra are extremely rare in the published English-language work. The purposes of this study were to evaluate the clinical features of solar urticaria with augmentation spectra and to elucidate the mechanisms and clinical importance of the spectra. We experienced 11 cases (five females, six males; mean age, 40.1 years; range, 1-74) of solar urticaria with augmentation spectra from April 2007 to July 2019. Augmentation spectra were UV-B in three cases, UV-A in two, visible light in four, UV-A and UV-B in one, and UV-A and visible light in one. Augmentation spectra were observed before action spectra in four cases, after in six, and before and after in one. Injection of sera irradiated with action spectra and augmentation spectra in vitro induced stronger immediate reactions than those of only action spectrum-irradiated sera in four of five cases. The results of injection tests suggested that augmentation spectra enhance the production of urticaria-forming factor. Clinically, we observed severe urticarial reactions in four cases, including anaphylaxis in three and moderate urticarial reactions in three. These results suggest that augmentation spectra are not as rare as previously thought and that they are associated with the severity of solar urticaria. Therefore, phototesting for both augmentation and action spectra should be performed to provide appropriate guidance for patients with solar urticaria.
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Affiliation(s)
- Naoko Uetsu
- Department of Dermatology, Kansai Medical University, Osaka, Japan
| | - Yuki Nomura
- Department of Dermatology, Kansai Medical University, Osaka, Japan
| | - Yoshie Matsuyama
- Department of Dermatology, Kansai Medical University, Osaka, Japan
| | - Hiroyuki Okamoto
- Department of Dermatology, Kansai Medical University, Osaka, Japan
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Morgado-Carrasco D, Giácaman-Von der Weth M, Fustá-Novell X, Podlipnik S, Pérez-Ferriols A, Aguilera P. Clinical response and long-term follow-up of 20 patients with refractory solar urticaria under treatment with omalizumab. J Am Acad Dermatol 2019; 88:1110-1111. [PMID: 31150709 DOI: 10.1016/j.jaad.2019.05.070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/15/2019] [Accepted: 05/21/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Daniel Morgado-Carrasco
- Dermatology Department, Photobiology Unit, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | - Xavier Fustá-Novell
- Dermatology Department, Photobiology Unit, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Sebastián Podlipnik
- Dermatology Department, Photobiology Unit, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | - Paula Aguilera
- Dermatology Department, Photobiology Unit, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.
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Photiou L, Foley P, Ross G. Solar urticaria - An Australian case series of 83 patients. Australas J Dermatol 2018; 60:110-117. [PMID: 30585308 DOI: 10.1111/ajd.12975] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 11/17/2018] [Indexed: 12/24/2022]
Abstract
Solar urticaria (SU) is a rare form of urticaria with a pathogenesis that is poorly understood. It affects all skin types, can be difficult to diagnose, and is challenging to manage effectively. We conducted a retrospective review of patients with SU in our institution. A total of 83 patients (56 females) were identified as having SU. The mean age was 32 years (7-74) at first development of symptoms/signs of SU. Pruritus was the most common symptom reported (79%). Of the 60 patients who underwent monochromator testing at least once, 35 had SU confirmed with most reacting to visible light and UVA, or to UVA alone. Antihistamines and sun avoidance remain the mainstay treatment for SU but other treatments, including omalizumab, are of potential interest in treating patients with recalcitrant SU. The characterisation of this large case series of patients may help dermatologists recognise and manage this rare disorder appropriately.
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Affiliation(s)
- Louise Photiou
- St Vincent's Hospital, Melbourne, Victoria, Australia.,The Victorian Melanoma Service, The Alfred Hospital, Melbourne, Victoria, Australia.,Sinclair Dermatology, East Melbourne, Victoria, Australia.,Skin and Cancer Foundation Inc, Carlton, Victoria, Australia
| | - Peter Foley
- St Vincent's Hospital, Melbourne, Victoria, Australia.,Skin and Cancer Foundation Inc, Carlton, Victoria, Australia.,Department of Dermatology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Gayle Ross
- St Vincent's Hospital, Melbourne, Victoria, Australia.,The Royal Melbourne Hospital, Melbourne, Victoria, Australia
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McNeil MM, Nahhas AF, Braunberger TL, Hamzavi IH. Afamelanotide in the Treatment of Dermatologic Disease. Skin Therapy Lett 2018; 23:6-10. [PMID: 30517779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Afamelanotide, an α-melanocyte stimulating hormone analogue, has become an emerging therapeutic option for a variety of skin conditions previously refractory to other treatments. Its efficacy has been demonstrated in several dermatologic conditions, including erythropoietic protoporphyria (EPP), solar urticaria, polymorphic light eruption (PMLE), vitiligo, acne, and Hailey-Hailey disease. Its relatively low risk side effect profile makes it an attractive treatment option and also paves the way for innovative use in other disorders.
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Affiliation(s)
- Morgan M McNeil
- Michigan State University College of Osteopathic Medicine, East Lansing, MI, USA
| | - Amanda F Nahhas
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
- Department of Dermatology, Beaumont-Farmington Hills, Farmington Hills, MI, USA
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Haylett AK, Koumaki D, Rhodes LE. Solar urticaria in 145 patients: Assessment of action spectra and impact on quality of life in adults and children. Photodermatol Photoimmunol Photomed 2018. [PMID: 29533487 DOI: 10.1111/phpp.12385] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Solar urticaria (SU) is a rare chronic inducible urticaria triggered via uncharacterized chromophores. We detail responses of a large patient series to monochromator phototesting and broadband ultraviolet radiation (UVR); relationship to life quality is explored. METHODS Retrospective review of all SU patients undergoing standardized diagnostic photoinvestigation at a specialist centre during 2000-2016. From 2011, patients completed dermatology life quality index (DLQI) questionnaires for the past week and year. RESULTS In 145 patients (mean: 35.8, range: 3-69 years; 18 aged <18 years; 100 female), combined phototesting with broadband UVR and monochromator sources successfully provoked 74.5% patients, with 65.6% provoked by broadband UVR alone and 57.9% by monochromated radiation alone. The narrow wavebands most frequently eliciting wheal and flare response were between 370 and 400 nm, with 25% patients at 300 ± 5 nm, 53.6% at 320 ± 10 nm, 66.7% at 330 ± 10 nm, 77.4% at 350 ± 20 nm, 83.3% at 370 ± 20 nm, 86.9% at 400 ± 20 nm, 44% at 500 ± 20 nm and 17.8% at 600 ± 20 nm. In 62 patients, the DLQI revealed 56.1% had very to extremely large impact in the past week (all patients: mean score: 11.1, range: 0-29) rising to 69.8% for the past year (12.5, 0-30); adults and children were similarly affected. Patients with positive photoprovocation had higher DLQI score than those who were negative (DLQI for past week: mean: 12.6 ± SEM 1.1 vs 4.6 ± 1.4, P < .01). CONCLUSION SU is predominantly provoked by longer UVA-shorter visible radiation, which penetrates window-glass and where sunscreens are less effective; impact on life quality is considerable. Photoprotective agents effective against this spectrum are needed.
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Affiliation(s)
- Ann K Haylett
- Centre for Dermatology Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester and Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Dimitra Koumaki
- Centre for Dermatology Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester and Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Lesley E Rhodes
- Centre for Dermatology Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester and Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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de Gálvez MV, Aguilera J, Sánchez-Roldán C, Herrera-Ceballos E. Infrared radiation increases skin damage induced by other wavelengths in solar urticaria. Photodermatol Photoimmunol Photomed 2018; 32:284-290. [PMID: 27622861 DOI: 10.1111/phpp.12270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/07/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Photodermatoses are typically investigated by analyzing the individual or combined effects of ultraviolet A (UVA), ultraviolet B (UVB), and visible light using light sources that simulate portions of the solar spectrum. Infrared radiation (IRR), however, accounts for 53% of incident solar radiation, but its effects are not taken into account in standard phototest protocols. AIMS The aim was to analyze the effects of IRR, alone and combined with UVA and visible light on solar urticaria lesions, with a distinction between infrared A (IRA) and infrared B (IRB). METHODS We performed standard phototests with UVA and visible light in four patients with solar urticaria and also tested the effects after blocking IRB with a water filter. To analyze the direct effect of IRR, we performed phototests with IRA and IRB. RESULTS Initial standard phototests that were all positive found the induction of erythema and whealing, while when IRR was blocked from the UVA and visible light sources, three of the patients developed no lesions, while the fourth developed a very small wheal. CONCLUSION These results suggest that IRR has the potential to produce and exacerbate lesions caused by other types of radiation. Consideration of these effects during phototesting could help prevent diagnostic errors.
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Affiliation(s)
- María Victoria de Gálvez
- Photobiological Dermatology Laboratory, Medical Research Center, Department of Dermatology and Medicine, Faculty of Medicine, University of Málaga, Málaga, Spain
| | - José Aguilera
- Photobiological Dermatology Laboratory, Medical Research Center, Department of Dermatology and Medicine, Faculty of Medicine, University of Málaga, Málaga, Spain
| | - Cristina Sánchez-Roldán
- Photobiological Dermatology Laboratory, Medical Research Center, Department of Dermatology and Medicine, Faculty of Medicine, University of Málaga, Málaga, Spain
| | - Enrique Herrera-Ceballos
- Photobiological Dermatology Laboratory, Medical Research Center, Department of Dermatology and Medicine, Faculty of Medicine, University of Málaga, Málaga, Spain.,Dermatology Service, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
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Morgado-Carrasco D, Fustà-Novell X, Podlipnik S, Combalia A, Aguilera P. Clinical and photobiological response in eight patients with solar urticaria under treatment with omalizumab, and review of the literature. Photodermatol Photoimmunol Photomed 2018; 34:194-199. [PMID: 29171925 DOI: 10.1111/phpp.12370] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/16/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Solar urticaria (SU) is a rare photodermatosis. Treatment is challenging, and outcomes are often disappointing. Omalizumab is an anti-IgE, currently approved for treatment of chronic spontaneous urticaria. We sought to evaluate therapy with omalizumab in refractory SU and describe predictive factors for response. MATERIALS/METHODS Patients with refractory SU under treatment with omalizumab were included in this study. Clinical outcome was evaluated using the Urticaria Activity Score 7 (UAS7), Dermatology Life Quality Index (DLQI) and Pruritus Visual Analogue Scale (VAS). Complete clinical response (CCR) was defined as having an UAS7 = 0, DLQI <6 and VAS = 0. Phototesting was performed and compared to baseline. We performed a PubMed search to identify reported cases of SU in adults treated with omalizumab, analysing their characteristics in order to predict response to omalizumab. RESULTS Eight patients were included. Median age was 45.5 years (range, 23-64). Light spectrum most commonly implicated was UV-A. Clinical outcomes: 89% (7/8) achieved CCR with omalizumab. Phototesting was normal in 42.8% (3/7) of them. In our review, we identified 38 patients (including the current case series), and 68.4% showed favourable outcomes with omalizumab. Median time since onset of SU was lower in responders. CONCLUSIONS Omalizumab can be an effective treatment in refractory SU.
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Affiliation(s)
- Daniel Morgado-Carrasco
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Xavier Fustà-Novell
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Sebastian Podlipnik
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Andrea Combalia
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Paula Aguilera
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
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