Dermatite atópica em adultos: além da pele / Atopic dermatitis in adults: beyond the skin

Introdução: A dermatite atópica (DA) é doença inflamatória da pele, recidivante e que acomete crianças e adultos e compromete a qualidade de vida destes doentes. Objetivos: Avaliar o impacto da DA moderada a grave na vida social e na qualidade de vida de pacientes adultos, assim como as suas expectativas quanto à evolução da doença e do seu tratamento. Métodos: Duzentos adultos (18 a 65 anos) com diagnóstico médico de DA moderada a grave responderam por via telefônica questionário com perguntas sobre a sua doença, interferência com o seu dia a dia, a atividade laboral, medicação em uso, assim como as suas expectativas com relação a novos tratamentos. Resultados: Na população avaliada houve predomínio de mulheres, média de idade de 37 anos, com nível elevado de escolaridade, e na sua maioria pertencentes às classes sociais A e B (68%). O tempo médio para obtenção do diagnóstico foi de 15 meses a partir dos primeiros sintomas. Lesões em dobras e pescoço, eritema, prurido e xerose foram os sinais/sintomas mais frequentes. As formas mais graves acompanharam-se por maior impacto no trabalho, autoestima e qualidade de vida. Setenta por cento procurou tratamento psicoterápico. Apesar de estarem em tratamento regular, um terço apresenta exacerbações da DA. Hidratantes e corticosteroides tópicos têm sido os mais utilizados. Em busca de cura, 90% abriria mão de objetos de desejo para iniciar tratamento de alto custo, desde que fosse eficaz. Conclusões: A DA compromete a qualidade de vida dos pacientes que buscam por soluções terapêuticas mais definitivas.

Introduction: Atopic dermatitis (AD) is a recurrent inflammatory skin disease that affects children and adults and compromises the quality of life of these patients. Objectives: To evaluate the impact of moderate-to-severe on social life and quality of life of adult patients with AD, as well as their expectations regarding new treatments. Methods: Two hundred adults aged 18 to 65 years with medical diagnosis of moderate-to-severe AD answered telephone-administered questions about their condition, impact on daily life and work, use of medication and expectations regarding new treatments. Results: In the study sample, most patients were female, their mean age was 37 years, and most of them had high level of education and belonged to upper social level (68%). The mean time to diagnosis was 15 months after the first symptoms. Lesions in folds and neck, erythema, pruritus and xerosis were the most common signs and symptoms. The most severe forms were related to greater impact on work, self-esteem and quality of life. Seventy percent sought psychotherapeutic treatment. Despite being under regular treatment, a third of patients had AD exacerbations. Moisturizers and topical corticosteroids were the most frequently used treatments. Ninety percent of respondents would forgo objects of desire to initiate a high-cost therapy as long as it was effective. Conclusions: AD compromises the quality of life of patients seeking more definitive therapeutic solutions.

Vegetable moisturizing raw material from "Caatinga" Brazilian biome: safety and efficacy evaluations of O/W cosmetic emulsions containing Kalanchoe brasiliensis extract

The purpose of this study was to evaluate the safety of Kalanchoe brasiliensis extract, followed by the development of an oil in water emulsion containing the K. brasiliensis leaves extract and evaluating its clinical moisturizing efficacy. The formulations containing sodium acrylates/ Beheneth-25 methacrylate Crosspolymer (and) hydrogenated polydecene (and) lauryl glucoside and 0.5% of extract were prepared. The extract was considered as non-irritating through skin irritant tests. The stability testing was carried out in different conditions for 90 days. The skin hydration was measured by capacitance measurement and transepidermal water loss using biophysical techniques. The results indicate that the formulation containing 0.5% of extract increased the hydration of the stratum corneum up to 5 h after application on the forearm. The transepidermal water loss was reduced when compared to the untreated area and placebo area. Therefore, we can conclude that the increased skin hydration and protection of barrier function can be attributed to the K. brasiliensis extract. This research presents a new raw material from the Brazilian Caatinga biome and shows its possible application in the development of cosmetic products.

Guia prático de atualização em dermatite atópica - Parte II: abordagem terapêutica. Posicionamento conjunto da Associação Brasileira de Alergia e Imunologia e da Sociedade Brasileira de Pediatria / Updated practical guide on atopic dermatitis - Part II: treatment approach. Joint position paper of the Brazilian Association of Allergy and Immunology and the Brazilian Society of Pediatrics

Nas últimas décadas o conhecimento sobre a etiopatogenia da dermatite atópica (DA) avançou muito. Além da identificação dos principais agentes desencadeantes e/ou agravantes envolvidos na expressão clínica da DA, verificou-se ser a integridade da barreira cutânea um dos pontos fundamentais para a manutenção da homeostase da pele. Assim, no tratamento do paciente com DA, além da evitação dos agentes desencadeantes e/ou irritantes, o uso de hidratantes é parte fundamental, e acredita-se que tenha ação preventiva de surtos agudos. Além disso, a aquisição de agentes anti-inflamatórios de uso tópico tem permitido o controle de pacientes com formas leves a moderadas da DA. Embora tenham uso mais restrito, os agentes imunossupressores sistêmicos também têm sido empregados no tratamento de pacientes com DA grave ou refratária aos procedimentos habituais. Comenta-se também a imunoterapia alérgeno-específica como tratamento adjuvante da DA para alguns pacientes, sobretudo alérgicos aos ácaros e com manifestações respiratórias associadas. A aquisição de novos agentes, os imunobiológicos, também são apresentados à luz das evidências científicas e clínicas atuais. O presente guia prático de atualização em dermatite atópica ­ abordagem terapêutica teve por objetivo rever os esquemas de tratamento disponíveis e empregados no acompanhamento de pacientes com DA, além de apresentar terapêuticas futuras, como os agentes imunobiológicos que em breve estarão à disposição para o tratamento de formas mais graves e/ou refratárias da DA.

Over the last few decades, knowledge of the etiopathogenesis of atopic dermatitis (AD) advanced greatly. The main triggering and/or aggravating factors involved in the clinical expression of AD have been identified, and cutaneous barrier integrity has been found to be key for the maintenance of skin homeostasis. Thus, when treating patients with AD, in addition to avoiding triggering and/ or irritating agents, recommending the use of skin moisturizers is paramount ­ and believed to have a preventive action against acute outbreaks. Moreover, topical anti-inflammatory agents have allowed AD control in patients with mild to moderate forms of the disease. Although more restricted, systemic immunosuppressive agents have also been used in the treatment of patients with severe or refractory AD. Specific allergen immunotherapy is presented as a possible adjunctive treatment for AD in some patients, especially those allergic to mites and presenting associated respiratory manifestations. Finally, the use of new immunobiological agents is discussed in the light of the scientific and clinical evidence currently available. The objectives of this updated practical guide on atopic dermatitis ­ treatment approach were to review the treatment regimens available and used in the follow-up of patients with AD and to present new therapies (e.g., immunobiological agents) that will soon be available for the treatment of more severe and/ or refractory forms of AD.

Hydrolyzed collagen interferes with in vitro photoprotective effectiveness of sunscreens

ABSTRACT The chronological skin aging is a progressive and natural process with genetic and physiological changes. However, ultraviolet (UV) radiation may accelerate the oxidative stress, generating carcinogenesis and photoaging. Natural compounds and their applications are considered a trend in the cosmetic market. The protein-based film-forming compounds play an important role, once it collaborates for the better distribution of sunscreens on the skin. Here we investigated the in vitro photoprotective effectiveness of sunscreens containing the hydrolyzed collagen associated with UVA, UVB and/or inorganic filters. Sunscreens were developed with octocrylene (7.5%), butyl methoxydibenzoylmethane (avobenzone) (3.0%) and/or titanium dioxide (5.0%), associated or not with the hydrolyzed collagen (3.0%). In vitro photoprotective effectiveness was determined in a Labsphere(r) UV2000S by the establishment of the sun protection factor (SPF) and critical wavelength (nm) values. Physicochemical and organoleptic characteristics were also assayed. The hydrolyzed collagen subjectively improved the formulation sensory characteristics. However, this bioactive compound led to a decrease of the SPF values of the photoprotective formulations containing octocrylene alone and octocrylene + butyl methoxydibenzoylmethane + TiO2. This inadequate interaction may be considered during the development of new sunscreens intended to contain protein-based components.

Use of Opuntia ficus-indica (L. ) Mill extracts from Brazilian Caatinga as an alternative of natural moisturizer in cosmetic formulations

ABSTRACT The aim of this work was the obtainment of Opuntia fícus-indica (L.) Mill extract for the development of cosmetic formulations and in vivo evaluation of its moisturizing effects. The formulations were tested for preliminary and accelerated stability. Organoleptic characteristics, pH values and rheological behavior were assessed. The evaluation of moisturizing efficacy of the emulsions formulated with 3.0% of Polyacrylamide (and) C13-14 Isoparaffin (and) Laureth-7 containing 1.0 and 3.0% of O. ficus-indica hydroglycolic extract (EHG001) was performed using the capacitance method (Corneometer(r)) and the transepidermal water loss - TEWL evaluation (Tewameter(r)). The emulsions formulated were stable, exhibiting pseudoplastic and thixotropic behavior. The results of evaluation of moisturizing efficacy showed increased skin hydration after five hours by mainly increasing the skin barrier effect. The formulations containing 1.0 and 3.0% of EHG001 enhanced the skin barrier effect by reducing TEWL up to four hours after application. The results observed suggest that O. ficus-indica hydroglycolic extract may act through a humectant and occlusion mechanism.

Determination of the critical hydrophile-lipophile balance of licuri oil from Syagrus coronata: application for topical emulsions and evaluation of its hydrating function

The aims of this study were to determine the critical hydrophile-lipophile balance (HLB) of licuri oil, and to perform a clinical assay to evaluate its hydrating effects. For the determination of the HLB, serial emulsions were prepared with the oil. Regarding the clinical study, 13 human subjects were recruited to evaluate the hydrating power of the emulsified preparation containing licuri oil, and comparing it with the same preparation containing sweet almond oil (SAO). The critical HLB of licuri oil was represented by the zones within the concentrations of 10% for the oil and 15% for the pair of tensoactive agents, with a value of 11.8. Both preparations showed similar hydrating power. We propose that licuri oil can be considered a new lipophilic adjuvant with hydrating characteristics, which can be used in cosmetic preparations, replacing consecrated oils, such as SAO.

O objetivo deste estudo foi determinar o EHL crítico do óleo licuri e realizar um ensaio clínico para avaliar os seus efeitos hidratantes. Para a determinação do EHL foram preparadas emulsões seriadas contendo esse óleo. Em relação ao estudo clínico, avaliamos o poder hidratante de preparação emulsionada com óleo de licuri, comparando-a com a mesma preparação contendo óleo de amêndoas doces (OAD), em 13 voluntários. O EHL crítico do óleo de licuri foi representado pelas zonas dentro das concentrações de 10% para o óleo e 15% para o par de tensoativos, com um valor de 11,8 e ambas as preparações mostraram poder hidratante similar. Desta forma, o óleo de licuri pode ser considerado um novo adjuvante lipofílico com função hidratante, o qual pode ser usado em preparações cosméticas, substituindo óleos de consagrado uso, tais como o OAD.

Preparation, characterization and evaluation of moisturizing and UV protecting effects of topical solid lipid nanoparticles

Solid lipid nanoparticles (SLN) were recently proposed as carriers for various pharmaceutical and cosmetic actives. These lipid nanoparticles can act as moisturizers and physical sunscreens on their own. Therefore, the full potential of these carriers has yet to be determined. The present study was aimed to determine and compare moisturizing and UV-protecting effects of different solid lipid nanoparticles (SLN) prepared by different solid lipids including Glyceryl monostearate (GMS), Precirol® (P) and cetyl palmitate (CP) as carrier systems of moisturizers and sunscreens. The influence of the size and matrix crystallinity of the solid lipids on the occlusive factor, skin hydration and UV-protection were evaluated by in vitro and in vivo methods. The SLN were prepared by high-shear homogenization and ultrasound methods. Size, zeta potential and morphological characteristics of the samples were assessed by transmission electron microscopy (TEM) and thermotropic properties with differential scanning calorimetry (DSC) technique. Results of the assessments showed that SLN-CP significantly increases skin hydration and UV-protection, compared to SLN-GMS and SLN-P. It was demonstrated that the size of SLN, crystallinity index of solid lipid in SLN and probably other mechanisms besides the occlusive factor can influence skin hydration and UV-protection indices. Furthermore, findings of the assessments demonstrated significant difference between in vitro and in vivo assessments regarding occlusive factor and moisturizing effects. Findings of the present study indicate that the SLN-CP could be a promising carrier for sunscreens and moisturizers.

Nanopartículas lipídicas sólidas (NLS) foram, recentemente, propostas como carreadores de vários ativos cosméticos e farmacêuticos. Essas nanopartículas lipídicas podem atuar como hidratantes e protetores solares físicos por si só. Assim sendo, determinou-se o potencial desses carreadores. Os objetivos do presente estudo foram determinar e comparar os efeitos hidratantes e protetores contra UV das diferentes partículas lipídicas sólidas (NLS) preparadas com diferentes lipídios sólidos, incluindo o monoestearato de gligerila (MSG), Precirol® (P) e palmitato de cetila (PC) como sistemas carreadores de hidratantes e de protetores solares. A influência do tamanho e da cristalinidade da matriz dos lipídios sólidos no fator oclusivo, na hidratação da pele e na proteção ao UV foi avaliada por métodos in vitro e in vivo. As NLS foram preparadas por homogeneização por alto corte e métodos de ultrassom. Tamanho, potencial zeta e características morfológicas das amostras foram determinados por microscopia de transmissão eletrônica (MTE) e as propriedades termotrópicas, com diferentes técnicas de calorimetria diferencial de varredura (CDV). Os resultados mostraram que NLS-PC aumenta significativamente a hidratação da pele e a proteção ao UV, comparativamente à NLS-MSG e à NLS-P. Demonstrou-se que o tamanho da NLS, índice de cristalinidade do lipídio sólido na NLS e, provavelmente, outros mecanismos além do fator oclusivo podem influenciar a hidratação da pele e os índices de proteção ao UV. Além disso, os resultados mostraram diferença significativa entre as avaliações in vitro e in vivo com relação ao fator oclusivo e aos efeitos hidratantes. Os resultados do presente estudo indicam que NLS-PC poderia ser um carreador promissor para protetores solares e hidratantes.

Sindrome de Netherton / Netherton Syndrome

Presentamos dos pacientes con la triada disgnostica del Sindrome de Netherton:ictiosis lineal circunfleja,tricorresis invaginada y diatesis atopica.En ambos casos la biopsia de las lesiones de piel y la microscopia por barrido electronico,fueron decisivas para el diagnostico.Los hallazgos histopatologicos del borde externo de las lesiones fueron compatibles con dermatitis psoriasiforme.La tricorresis invaginada o pelo en caña de bambu,se encontro presente a lo largo del pelo.Las manifestaciones atopicas fueron inconstantes.La edad de los pacientes exigio el planteo de terapeuticas poco agresivas.

Aditivos em alimentos / Food addictives

Identificou-se os aditivos empregados na elaboraçäo de 52 produtos do grupo de leite e derivados e 55 do grupo carne e derivados, os quais foram comparados com aqueles permitidos pela legislaçäo. Para cada produto, foram avaliadas no mínimo duas marcas. Os dados dos aditivos foram coletados através das informaçöes dos rótulos. Os resultados mostraram que os aditivos estäo explicitados nas embalagens conforme legislaçäo vigente. Os conservantes P.VIII e P.VIII, nitratos e nitritos, respectivamente, foram constatados em 100 por cento das amostras de charque, contrariando a legislaçäo