RESUMO
Doxycycline is a synthetic tetracycline that was approved in 1967. This wide-spectrum antibiotic has been shown to also have useful anti-inflammatory properties that make it suitable for the treatment of a number of noninfectious conditions. Tetracyclines are probably the most commonly prescribed antibiotics in dermatology, where they are usually used at doses lower than those effective against infections. They also have an excellent efficacy and safety profile. Because of doxycycline's ability to inhibit the molecular pathways associated with certain processes, this antibiotic can be used to treat hair follicle diseases, granulomatous diseases, and vascular proliferation, among other conditions. The main properties of doxycycline and its many applications in dermatology make this drug one that specialists should become familiar with.
Assuntos
Dermatologia , Doxiciclina , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Doxiciclina/uso terapêutico , Tetraciclinas/uso terapêuticoRESUMO
Intravenous immunoglobulin (IVIG) replacement therapy has been used in immune deficiency diseases for more than 50 years. The indications for this treatment have evolved, however, and IVIG therapy is now used in various diseases in which the immune system plays a prominent role. IVIG therapy has carved out a niche in dermatology for the treatment of such conditions as dermatomyositis, autoimmune bullous diseases, and toxic epidermal necrolysis. Special attention has been paid to this therapy in recent years. New guidelines have been published and should be taken into consideration in dermatology. This review provides a practical guide to IVIG use in our specialty.
Assuntos
Imunoglobulinas Intravenosas/uso terapêutico , Dermatopatias/terapia , Doenças Autoimunes/terapia , Contraindicações de Medicamentos , Humanos , Imunoglobulinas Intravenosas/administração & dosagem , Imunoglobulinas Intravenosas/efeitos adversos , Infusões Subcutâneas , Seleção de Pacientes , Guias de Prática Clínica como Assunto , Pré-MedicaçãoRESUMO
BACKGROUND: Psoriasis has been related to a large number of cardiovascular risk factors such as hypertension, diabetes mellitus and arteriosclerosis. The increased carotid intima-media thickness (IMT) could be considered to be a marker of generalized arteriosclerosis. OBJECTIVE: To assess the effect of systemic and biological drugs on psoriatic patients' carotid IMT. METHODS: A prospective study was performed. We studied 53 patients with moderate and severe psoriasis from our psoriasis dermatological unit, analysing lipid and glucose metabolism and performing a carotid IMT sonography before introduction of systemic and biological drugs. After that, we performed an 8-month closely analytic and sonographic follow-up. RESULTS: The IMT of the patients with psoriasis treated with biological drugs tended to decrease, although this occurrence was not statistically significant (P = 0.086). The subgroup analysis revealed that patients treated with methotrexate (P = 0.045) and anti-IL-12/23 (P = 0.010) presented a decrease in their IMT levels. This analysis also showed a decrease in glycaemia and insulin levels in patients treated with TNF-alpha inhibitors and ustekinumab. CONCLUSIONS: Our study suggests that the carotid IMT may benefit from treatment with biological drugs, particularly anti-IL-12/23 and methotrexate in patients suffering from moderate and severe psoriasis. However, larger longitudinal studies should be performed to fully confirm these results.
Assuntos
Espessura Intima-Media Carotídea , Fármacos Dermatológicos/farmacologia , Metotrexato/farmacologia , Psoríase/tratamento farmacológico , Ustekinumab/farmacologia , Adulto , Produtos Biológicos/uso terapêutico , Glicemia/efeitos dos fármacos , Glicemia/metabolismo , Fármacos Dermatológicos/uso terapêutico , Feminino , Humanos , Insulina/sangue , Lipoproteínas LDL/sangue , Estudos Longitudinais , Masculino , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Túnica Íntima/efeitos dos fármacos , Túnica Média/efeitos dos fármacos , Ustekinumab/uso terapêuticoAssuntos
Herpesvirus Humano 1/isolamento & purificação , Erupção Variceliforme de Kaposi/diagnóstico , Aciclovir/uso terapêutico , Adulto , Antivirais/uso terapêutico , Cloxacilina/uso terapêutico , Dermatite Atópica/complicações , Humanos , Erupção Variceliforme de Kaposi/complicações , Erupção Variceliforme de Kaposi/tratamento farmacológico , Erupção Variceliforme de Kaposi/virologia , MasculinoAssuntos
Eritema/etiologia , Leishmaniose Cutânea/diagnóstico , Idoso de 80 Anos ou mais , Antiprotozoários/uso terapêutico , Nádegas , Eritema/patologia , Humanos , Leishmaniose Cutânea/complicações , Leishmaniose Cutânea/tratamento farmacológico , Masculino , Meglumina/uso terapêutico , Antimoniato de Meglumina , Compostos Organometálicos/uso terapêuticoAssuntos
Doença de Crohn/complicações , Dermatite/etiologia , Adalimumab/uso terapêutico , Adulto , Celulite (Flegmão)/diagnóstico , Doença de Crohn/tratamento farmacológico , Doença de Crohn/patologia , Dermatite/diagnóstico , Dermatite/tratamento farmacológico , Dermatite/patologia , Diagnóstico Diferencial , Substituição de Medicamentos , Células Gigantes/patologia , Granuloma/diagnóstico , Granuloma/etiologia , Granuloma/patologia , Humanos , Infliximab/uso terapêutico , Masculino , Sarcoidose/diagnóstico , Coxa da PernaAssuntos
Hipertricose/congênito , Meningocele/diagnóstico , Nevo/congênito , Neoplasias Cutâneas/congênito , Espinha Bífida Cística/diagnóstico , Siringomielia/diagnóstico , Doenças Assintomáticas , Pré-Escolar , Feminino , Humanos , Região Lombossacral , Imageamento por Ressonância Magnética , Meningocele/diagnóstico por imagem , Meningocele/embriologia , Espinha Bífida Cística/diagnóstico por imagem , Espinha Bífida Cística/embriologia , Siringomielia/congênito , Siringomielia/diagnóstico por imagemRESUMO
Overgrowth syndromes are characterized by global or localized disproportionate growth associated with other anomalies, including vascular malformations and neurological and/or visceral disorders. CLOVES (Congenital Lipomatous asymmetric Overgrowth of the trunk with lymphatic, capillary, venous, and combined-type Vascular malformations, Epidermal naevi, Scoliosis/Skeletal and spinal anomalies) is an overgrowth syndrome caused by mosaic activating mutation in gene PIK3CA, which gives rise to abnormal PI3K-AKT-mTOR pathway activation. These mutations are responsible for the clinical manifestations of the syndrome, which include low- and high-flow vascular malformations, thoracic lipomatous hyperplasia, asymmetric growth, and visceral and neurological disorders. These common anomalies are illustrated with figures from two personal cases. Identification of the clinical and genetic characteristics of CLOVES syndrome is crucial for the differential diagnosis with other overgrowth syndromes, such as Proteus or Klippel-Trenaunay (K-T) syndromes, and for the therapeutic management of the different anomalies. In this context, a new entity comprising different syndromes with phenotypic mutations in PIK3CA has been proposed, designated PIK3CA-related overgrowth spectrum (PROS), with the aim of facilitating clinical management and establishing appropriate genetic study criteria.