Assuntos
Bacillus thuringiensis/patogenicidade , Dermatoses do Pé/tratamento farmacológico , Dermatoses do Pé/fisiopatologia , Antibacterianos/uso terapêutico , Epiderme/patologia , Eritromicina/uso terapêutico , Dermatoses do Pé/etiologia , Humanos , Pessoa de Meia-Idade , Dermatopatias Bacterianas/tratamento farmacológico , Dermatopatias Bacterianas/etiologiaRESUMO
A 12-year-old boy presented with severe, bilateral foot dermatitis. Extended patch testing was performed, revealing a significant positive reaction to mixed dialkyl thioureas. A thorough review of his history revealed that he was likely being exposed through his neoprene taekwondo shoes. After implementation of allergen avoidance measures, his dermatitis resolved. This case emphasizes awareness of potential allergen exposures and offers helpful avoidance strategies.
Assuntos
Dermatite Alérgica de Contato/etiologia , Dermatoses do Pé/etiologia , Sapatos/efeitos adversos , Tioureia/efeitos adversos , Alérgenos/farmacologia , Criança , Dermatite Alérgica de Contato/fisiopatologia , Seguimentos , Dermatoses do Pé/fisiopatologia , Humanos , Masculino , Testes do Emplastro/métodos , Medição de Risco , Índice de Gravidade de DoençaRESUMO
Hiking has become very popular due to the physical and mental health benefits it provides. Skin lesions may occur with hiking and various factors contribute to their development. Although some lesions may appear to have little importance, something as simple as chaffing can cause serious ulcers in people with at-risk feet. Few studies have analyzed preexisting physical characteristics in hiking and addressed the development of lesions in hikers. This observational and longitudinal study examines the development of foot lesions during hiking, taking into account the influence of existing skin disorders, nail disorders, and/or toe deformities and other intrinsic factors of participants. The feet of 109 hikers doing a 29.6-km hike were analyzed, considering the intrinsic factors of participants and the possible influence of these factors in the development of foot lesions during the walk. The results show that some preexisting physical factors of participants such as gender, existing systemic disease, preexisting keratosis, dermatosis, nontraumatic and traumatic onychopathies, and toe deformities significantly predispose to the development of skin lesions. These factors also predispose to muscle lesions except for nontraumatic and traumatic onychopathies and toe deformities. Due to the influence of preexisting physical factors, such as preexisting keratosis, dermatosis, and toe deformities, in the development of foot lesions in hikers, it is worthwhile and advisable to check these factors before a hike to reduce the incidence of foot disorders. Ensuring adequate podiatry treatment a few days before the walk and warmup of muscles properly before starting are recommended.
Assuntos
Dermatoses do Pé/epidemiologia , Traumatismos do Pé/epidemiologia , Recreação , Lesões dos Tecidos Moles/epidemiologia , Caminhada , Adulto , Causalidade , Feminino , Seguimentos , Dermatoses do Pé/fisiopatologia , Doenças do Pé/epidemiologia , Doenças do Pé/fisiopatologia , Traumatismos do Pé/fisiopatologia , Humanos , Incidência , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Medição de Risco , Dermatopatias/epidemiologia , Dermatopatias/fisiopatologia , Lesões dos Tecidos Moles/fisiopatologia , EspanhaAssuntos
Dermatoses do Pé/patologia , Hiperpigmentação/patologia , Micose Fungoide/patologia , Psoríase/patologia , Neoplasias Cutâneas/patologia , Adulto , Biópsia por Agulha , Diagnóstico Diferencial , Dermatoses do Pé/fisiopatologia , Dermatoses da Mão/patologia , Dermatoses da Mão/fisiopatologia , Humanos , Hiperpigmentação/diagnóstico , Imuno-Histoquímica , Masculino , Micose Fungoide/diagnóstico , Psoríase/diagnóstico , Neoplasias Cutâneas/diagnósticoRESUMO
BACKGROUND: Mechanical hyperkeratotic lesions (MHL) are common condition amongst population of all ages. Such problems may be associated with pain, reduction in mobility, changes of gait and risk of falls and is believed to affect the quality of life (QoL), general health and optimal foot health. OBJECTIVE: The main aim of this study was to describe and compare both foot and general health-related QoL in two groups of participants: (i) with MHL and (ii) healthy controls. METHOD: A total sample of 150 patients, mean age 49.50 ± 36.50 years, was recruited from an outpatient clinic. Demographic data, medical history and clinical characteristics of overall health were determined, and the obtained values were compared by the Foot Health Status Questionnaire (FHSQ). RESULTS: The FHSQ scores of the sample with MHL showed lower scores than control subjects in sections one and two for footwear, general and foot health, foot pain, foot function and physical activity (P < 0.01), but not for social capacity and vigour (P > 0.01). CONCLUSIONS: People with MHL showed a decrease in QoL, based on FHSQ scores, regardless of gender.
Assuntos
Dermatoses do Pé/complicações , Pé/fisiopatologia , Ceratose/complicações , Dor/etiologia , Qualidade de Vida , Estresse Mecânico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Exercício Físico , Feminino , Dermatoses do Pé/fisiopatologia , Humanos , Ceratose/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Sapatos , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: Palmoplantar psoriasis is a variant of psoriasis vulgaris which can severely impair quality of life. OBJECTIVES: The main objectives of this double-blind, placebo-controlled, randomized study were to assess the efficacy and impact on quality of life and work productivity of apremilast for the treatment of moderate-to-severe palmoplantar psoriasis. METHODS: A total of 100 patients with moderate-to-severe palmoplantar psoriasis were randomized to either apremilast 30 mg bid or placebo for 16 weeks. At Week 16, all patients received apremilast 30 mg bid until Week 32. The primary endpoint was the proportion of patients who achieved a Palmoplantar Psoriasis Physician Global Assessment (PPPGA) of 0/1 at Week 16. RESULTS: There was no significant difference in the proportion of patients who achieved a PPPGA of 0/1 at Week 16 between patients randomized to apremilast (14%) and placebo (4%; P = 0.1595). After 32 weeks of treatment with apremilast, 24% of patients achieved a PPGA of 0/1. In addition, apremilast was superior to placebo in achieving Palmoplantar Psoriasis Area Severity Index (PPPASI) 75 (apremilast: 22%; placebo: 8%; P = 0.0499), in improving PPPASI (apremilast: -7.4 ± 7.1; placebo: -3.6 ± 5.9; P = 0.0167), Dermatology Life Quality Index score (apremilast: -4.3 ± 5.1; placebo: -0.8 ± 4.5; P = 0.0004) and in reducing activity impairment (apremilast: -11.0 ± 22.3; placebo: 2.5 ± 25.5; P = 0.0063). CONCLUSION: Despite the absence of a significant difference between apremilast and placebo in proportion of patients achieving a PPPGA of 0/1, the presence of significant differences observed for several secondary endpoints suggests that apremilast may have a role in the treatment of moderate-to-severe palmoplantar psoriasis.
Assuntos
Dermatoses do Pé/tratamento farmacológico , Dermatoses da Mão/tratamento farmacológico , Inibidores da Fosfodiesterase 4/uso terapêutico , Psoríase/tratamento farmacológico , Talidomida/análogos & derivados , Método Duplo-Cego , Eficiência , Feminino , Dermatoses do Pé/fisiopatologia , Dermatoses da Mão/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Placebos , Psoríase/fisiopatologia , Qualidade de Vida , Índice de Gravidade de Doença , Talidomida/uso terapêutico , TrabalhoRESUMO
Sensitive skin is a widespread condition, which is most frequently reported by women. Changing hormone levels during the menstrual cycle and menopause have been suggested among the stimuli triggering sensitive skin. To investigate the perceived influence of fluctuating hormone levels on self-assessed sensitive skin, including symptoms and stimuli linked to skin sensitivity, as well as potential changes in facial and body skin and sensitive body parts, depending on hormonal status. A digital questionnaire was distributed to a population of women aged 20-65 years old. A total of 278 women were included in the analysis. About 42% premenopausal women declared a perception of (increased) skin sensitivity just before and during the menstrual cycle, while this was reported by almost 32% of peri- and postmenopausal women following the menopause. The majority of reported symptoms included the presence of bumps/pimples, dryness, itching, and redness, and the majority of reported stimuli were shaving, weather, toiletries, and emotions. No differences emerged regarding characteristics of facial and body skin across different hormonal status. Significant differences in sensitivity of body parts emerged for the face and feet, reported by a larger percentage of premenopausal women and peri- and postmenopausal women, respectively. The prevalence of the perceived effects of fluctuating hormone levels on self-assessed sensitive skin in women is high. These effects should be taken into consideration in skin testing and dermatological practice, and support the need for selecting personal care routine or treatment during the menstrual cycle and menopause.
Assuntos
Menopausa/fisiologia , Ciclo Menstrual/fisiologia , Dermatopatias/fisiopatologia , Fenômenos Fisiológicos da Pele , Adulto , Idoso , Cosméticos/efeitos adversos , Estudos Transversais , Emoções , Eritema/fisiopatologia , Dermatoses Faciais/fisiopatologia , Feminino , Dermatoses do Pé/fisiopatologia , Humanos , Pessoa de Meia-Idade , Perimenopausa/fisiologia , Pós-Menopausa/fisiologia , Pré-Menopausa/fisiologia , Prurido/fisiopatologia , Dermatopatias/etiologia , Inquéritos e Questionários , Tempo (Meteorologia) , Adulto JovemAssuntos
Poliarterite Nodosa/patologia , Vasculite/tratamento farmacológico , Vasculite/patologia , Biópsia por Agulha , Colchicina/uso terapêutico , Diagnóstico Diferencial , Quimioterapia Combinada , Feminino , Seguimentos , Dermatoses do Pé/tratamento farmacológico , Dermatoses do Pé/etiologia , Dermatoses do Pé/fisiopatologia , Dermatoses da Mão/tratamento farmacológico , Dermatoses da Mão/etiologia , Dermatoses da Mão/fisiopatologia , Humanos , Imuno-Histoquímica , Metotrexato/uso terapêutico , Poliarterite Nodosa/diagnóstico , Prednisona/uso terapêutico , Doenças Raras , Índice de Gravidade de Doença , Resultado do Tratamento , Vasculite/complicações , Adulto JovemRESUMO
Serratia marcescens is a Gram-negative bacillus belonging to the Enterobacteriaceae family. Cutaneous infection with Serratia is rare, and usually occurs in immunocompromised individuals. Primary cutaneous infections are uncommon, but they are typically severe and are associated with significant morbidity and mortality. The pathogenetic factors leading to S. marcescens infection are not fully understood, but contributing virulence factors include proteases, secreted exotoxins, and the formation of biofilm. We report a case of cellulitis occurring in a splenectomized patient, which led to multiple wound debridements and a transmetatarsal amputation. This dramatic case led us to review the published literature on soft tissue infections caused by S. marcescens.
Assuntos
Amputação Cirúrgica/métodos , Celulite (Flegmão) , Ciprofloxacina/administração & dosagem , Fasciite Necrosante , Dermatoses do Pé , Infecções por Serratia , Serratia marcescens/isolamento & purificação , Esplenectomia/efeitos adversos , Tienamicinas/administração & dosagem , Idoso , Antibacterianos/administração & dosagem , Biópsia/métodos , Celulite (Flegmão)/etiologia , Celulite (Flegmão)/patologia , Celulite (Flegmão)/fisiopatologia , Celulite (Flegmão)/terapia , Desbridamento/métodos , Fasciite Necrosante/etiologia , Fasciite Necrosante/patologia , Fasciite Necrosante/fisiopatologia , Fasciite Necrosante/terapia , Dermatoses do Pé/etiologia , Dermatoses do Pé/patologia , Dermatoses do Pé/fisiopatologia , Dermatoses do Pé/terapia , Humanos , Masculino , Meropeném , Infecções por Serratia/etiologia , Infecções por Serratia/patologia , Infecções por Serratia/fisiopatologia , Infecções por Serratia/terapia , Dermatopatias Vesiculobolhosas/etiologia , Dermatopatias Vesiculobolhosas/patologia , Dermatopatias Vesiculobolhosas/fisiopatologia , Dermatopatias Vesiculobolhosas/terapia , Resultado do TratamentoRESUMO
BACKGROUND: Plaque-type palmoplantar psoriasis (PPTP) is a chronic recalcitrant dermatosis with treatment modalities ranging through topical, phototherapy or systemic. Phototherapy options include various forms of ultraviolet B (UVB) and ultraviolet A with prior psoralen sensitization (PUVA). Currently, few comparative studies have been reported. PURPOSE: To compare Broad-Band UVB (BB-UVB) versus paint PUVA (p-PUVA) in regard to efficacy and safety in the treatment of PPTP. METHODS: A retrospective non-randomized cohort study comprised of all the patients with PPTP treated in our phototherapy centre during 2010-2012, either with BB-UVB or p-PUVA. RESULTS: Among the 248 patients included in this study, 122 received BB-UVB and 126 followed p-PUVA treatment. About 36 (30%) and 53 (42%) had complete remission, 29 (24%) and 59 (47%) responded partially and 57 (47%) and 14 (11%) patients did not improve with BB-UVB and p-PUVA, respectively. The odds ratio for remission (p-PUVA: BB-UVB) was 7.9. Duration of remission was 21.9 ± 1.34 months for p-PUVA and 16.75 ± 1.83 months for BB-UVB. CONCLUSION: Both BB-UVB and p-PUVA are good therapeutic options for PPTP. P-PUVA emerges as the superior treatment modality, yielding a better and more extended response. BB-UVB represents a feasible alternative in patients with milder disease or possible contraindications for p-PUVA.
Assuntos
Dermatoses do Pé/terapia , Dermatoses da Mão/terapia , Terapia PUVA/métodos , Psoríase/terapia , Terapia Ultravioleta/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Dermatoses do Pé/tratamento farmacológico , Dermatoses do Pé/fisiopatologia , Dermatoses do Pé/radioterapia , Dermatoses da Mão/tratamento farmacológico , Dermatoses da Mão/fisiopatologia , Dermatoses da Mão/radioterapia , Humanos , Masculino , Pessoa de Meia-Idade , Psoríase/tratamento farmacológico , Psoríase/fisiopatologia , Psoríase/radioterapia , Estudos Retrospectivos , Resultado do Tratamento , Raios UltravioletaAssuntos
Telefone Celular , Computadores de Mão , Eritema , Dermatoses do Pé , Calefação , Temperatura Alta/efeitos adversos , Hidroquinonas/administração & dosagem , Administração Tópica , Adolescente , Adulto , Biópsia , Fármacos Dermatológicos/administração & dosagem , Diagnóstico Diferencial , Eritema/diagnóstico , Eritema/etiologia , Eritema/fisiopatologia , Eritema/terapia , Feminino , Dermatoses do Pé/diagnóstico , Dermatoses do Pé/etiologia , Dermatoses do Pé/fisiopatologia , Dermatoses do Pé/terapia , Calefação/efeitos adversos , Calefação/instrumentação , Humanos , Masculino , Prognóstico , Pele/patologiaRESUMO
Tyrosine kinase inhibitors are novel antineoplastic drugs that make use of the molecular abnormalities that have been discovered in certain types of tumours. These agents are associated with important dermatological side effects. This case report discusses an atypical presentation of the hand-foot syndrome in one patient treated with sorafenib. A 78-year-old man, recently started on sorafenib for the treatment of hepatocarcinoma with lung metastasis, presented to the emergency room with painful blistering lesions on the palms, soles and scrotum for 1â week. A punch biopsy was performed and sorafenib was withheld. Direct immunofluorescence study was negative for an autoimmune blistering disorder and histopathology stains did not show any microorganisms. A diagnosis of hand-foot syndrome was made. After 2â weeks, the patient showed marked improvement and the plan was to restart sorafenib at a lower dosage.
Assuntos
Vesícula/induzido quimicamente , Toxidermias/etiologia , Dermatoses do Pé/etiologia , Niacinamida/análogos & derivados , Compostos de Fenilureia/efeitos adversos , Inibidores de Proteínas Quinases/efeitos adversos , Administração Oral , Administração Tópica , Corticosteroides/administração & dosagem , Idoso , Vesícula/fisiopatologia , Carcinoma Hepatocelular/tratamento farmacológico , Carcinoma Hepatocelular/secundário , Toxidermias/fisiopatologia , Dermatoses do Pé/fisiopatologia , Dermatoses da Mão/induzido quimicamente , Dermatoses da Mão/fisiopatologia , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/patologia , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/secundário , Masculino , Niacinamida/efeitos adversos , Niacinamida/uso terapêutico , Compostos de Fenilureia/uso terapêutico , Prognóstico , Inibidores de Proteínas Quinases/uso terapêutico , Escroto , Índice de Gravidade de Doença , Sorafenibe , Síndrome , Resultado do TratamentoRESUMO
Opportunistic onychomycosis is defined, when a non-dermatophyte mould is cultured from an abnormal nail unit in the absence of a dermatophyte. The presumption is that the mould has caused the abnormal clinical appearance of the nail unit, yet there are no data available to substantiate this claim. Reports have only identified the mould being recovered from the nail unit niche. A review of the published dermatologic literature describing toenail opportunistic onychomycosis by non-dermatophyte fungi has shown toenails with onycholysis, nail bed (NB) keratosis and nail plate surface abnormalities. The appearance of these clinical changes is indistinguishable from the diagnosis of the Asymmetric Gait Nail Unit Signs (AGNUS). AGNUS is produced by the friction of the closed shoe in patients with an asymmetric gait, resulting primarily from the ubiquitous uneven flat feet. Most commonly, species of Acremonium (Cephalosporium), Aspergillus, Fusarium, Scopulariopsis and rarely species of many different fungi genera are capable of surviving and reproducing in a keratinous environment and change the clinical appearance of the involved nail unit. AGNUS toenails predispose to the colonization by the non-dermatophyte opportunistic fungi but not by dermatophyte fungi.
Assuntos
Dermatoses do Pé/etiologia , Marcha , Onicomicose/etiologia , Dermatoses do Pé/fisiopatologia , Humanos , Onicomicose/fisiopatologiaRESUMO
BACKGROUND: Friction blister research has focused on prevention and treatment approaches rather than exploring the pathophysiology of the friction blister. Increased skin hydration has been purported to be a key risk factor in friction blister development. This study aimed to test the effect of increased skin surface hydration on the risk of friction blister creation. METHODS: The skin on one foot was hydrated by soaking the foot in water. Intermittent loading was carried out until an observable change of 3°C was evident using infrared thermography. The contra lateral foot acted as a control. Skin hydration and elasticity was measured using electrical capacitance and negative pressure respectively. RESULTS: The rate of temperature change of the hydrated group was significantly greater than that of the non-hydrated foot group (P = 0.001) and showed a strong positive correlation (r = 0.520) with skin surface hydration. Weak negative correlations were seen between skin elasticity and rate of temperature change in response to load application (r = -0.166) and skin surface hydration and elasticity at baseline (r = -0.195). CONCLUSION: In controlled experimental conditions increased skin surface hydration increases the rate of temperature change of the skin in response to load application and consequently increases the risk of blister creation.
Assuntos
Vesícula/etiologia , Vesícula/fisiopatologia , Água Corporal/metabolismo , Calcanhar/lesões , Calcanhar/fisiopatologia , Estimulação Física , Água/farmacologia , Adolescente , Adulto , Vesícula/prevenção & controle , Módulo de Elasticidade , Dermatoses do Pé/fisiopatologia , Dermatoses do Pé/prevenção & controle , Fricção , Humanos , Masculino , Fatores de Risco , Absorção Cutânea , Temperatura Cutânea , Propriedades de Superfície , Adulto JovemRESUMO
BACKGROUND: Localized myxoedema is a rare dermopathy in patients with Graves' disease. The pretibial area is the most commonly affected region but herein we present a case of myxoedema of the big toe. PATIENTS AND METHODS: A 44-year-old male with Graves' disease ongoing for seven years presented bilateral ophthalmopathy and myxoedema of the big toes. The myxoedema was treated successfully with intralesional steroids. DISCUSSION: The physiopathology of myxoedema involves fibroblast activation and glycosaminoglycan production. This activation could result from stimulation of TSH receptors at their surface by TSH receptor antibodies (TRAK) or from an inflammatory process. The pretibial topography may be related to the high frequency in this area of microtrauma, with modulation of the cytokine microenvironment. CONCLUSION: The atypical localization seems to correlate with a Koebner phenomenon. Treatment of Graves' disease is generally insufficient to resolve the cutaneous problems. Topical corticosteroid therapy generally results in rapid improvement of recent lesions.
Assuntos
Dermatoses do Pé/patologia , Doença de Graves/patologia , Mixedema/patologia , Dedos do Pé/patologia , Adulto , Biópsia , Carbimazol/uso terapêutico , Descompressão Cirúrgica , Fibroblastos/metabolismo , Fibroblastos/patologia , Dermatoses do Pé/tratamento farmacológico , Dermatoses do Pé/etiologia , Dermatoses do Pé/fisiopatologia , Glicosaminoglicanos/análise , Glicosaminoglicanos/metabolismo , Doença de Graves/complicações , Doença de Graves/tratamento farmacológico , Doença de Graves/fisiopatologia , Doença de Graves/cirurgia , Oftalmopatia de Graves/etiologia , Oftalmopatia de Graves/cirurgia , Terapia de Reposição Hormonal , Humanos , Imunoglobulinas Estimuladoras da Glândula Tireoide/imunologia , Imunossupressores/administração & dosagem , Imunossupressores/uso terapêutico , Injeções Intralesionais , Masculino , Metimazol/uso terapêutico , Mixedema/tratamento farmacológico , Mixedema/etiologia , Mixedema/fisiopatologia , Receptores da Tireotropina/imunologia , Receptores da Tireotropina/fisiologia , Tireoidectomia , Tiroxina/uso terapêutico , Triancinolona/administração & dosagem , Triancinolona/uso terapêuticoAssuntos
Dermatoses do Pé , Dermatoses da Mão , Adulto , Criança , Dermatite Esfoliativa/etiologia , Dermatite Esfoliativa/fisiopatologia , Eczema Disidrótico/etiologia , Eczema Disidrótico/fisiopatologia , Dermatoses do Pé/classificação , Dermatoses do Pé/etiologia , Dermatoses do Pé/fisiopatologia , Dermatoses da Mão/classificação , Dermatoses da Mão/etiologia , Dermatoses da Mão/fisiopatologia , Doença de Mão, Pé e Boca/etiologia , Doença de Mão, Pé e Boca/fisiopatologia , Humanos , Dermatopatias Genéticas/etiologia , Dermatopatias Genéticas/fisiopatologia , Tinha dos Pés/etiologia , Tinha dos Pés/fisiopatologia , Verrugas/etiologia , Verrugas/fisiopatologiaRESUMO
BACKGROUND: Livedoid vasculopathy (LV) is a disease characterized by multiple painful and recurrent ulcerations on the feet, accompanied by atrophic scars. Many researchers suggest that a hypercoagulable status is the pathogenetic factor for LV. However, the cause of LV remains elusive. OBJECTIVE: We sought to determine if endothelial dysfunction is present in patients with LV. METHODS: This prospective study included 16 patients with LV and active ulcers and 16 matched control subjects. We reviewed detailed clinical parameters, including antinuclear antibody, high-sensitivity C-reactive protein, protein C, protein S, homocysteine, anti-SSA, anti-SSB, anticardiolipin antibody, and serum lipid profiles. Flow-mediated vasodilation of the brachial artery was used as an indicator of vascular endothelial function using high-resolution 2-dimensional ultrasonic imaging. RESULTS: Blood pressure, blood biochemistry, high-sensitivity C-reactive protein, and homocysteine were not significantly different in patients with LV and control subjects. Nitroglycerin-mediated vasodilation was not significantly different in patients with LV and control subjects. However, flow-mediated vasodilation was much less in patients with LV than in the control group (3.58 ± 2.32% vs 7.51 ± 2.40%, P < .001). LIMITATIONS: The study was performed at a single site with a limited sample size. CONCLUSION: Peripheral vascular endothelial dysfunction was demonstrated in patients with LV by reduction of brachial flow-mediated vasodilation.
Assuntos
Endotélio Vascular/fisiopatologia , Dermatoses do Pé/fisiopatologia , Dermatopatias Vasculares/fisiopatologia , Vasodilatação , Adulto , Transtornos da Coagulação Sanguínea/complicações , Feminino , Pé/irrigação sanguínea , Dermatoses do Pé/sangue , Humanos , Masculino , Dermatopatias Vasculares/sangueRESUMO
A case of psoriasiform dermatitis in an adult male rhesus macaque is reported. Appearing spontaneously, the condition presented the clinical and histopathological features of human palmoplantar nonpustular psoriasis. The animal developed multiple scaly plaques on his palms and soles, as well as nail hyperkeratosis and widening of the nail root. Microscopically, the skin lesions showed epidermal hyperkeratosis with multifocal parakeratosis, neutrophil microabscesses in the stratum corneum, a loss of granule cell layer under the microabscesses, acanthosis, and elongation of the rete ridges; the superficial dermis showed a dense inflammatory infiltrate containing lymphocytes, macrophages and neutrophils, as well as dilated and tortuous blood vessels. The lesions improved for 15 days after intramuscular corticosteroid depot therapy and worsened slightly afterwards. Later, a spontaneous, progressive remission coincided with the beginning of spring and lasted until the end of summer; the skin lesions practically disappeared during this period, and the nails looked nearly normal. During the next autumn and winter only nail hyperkeratosis was present. Serum analyses showed hyperproteinaemia and hyperglobulinaemia during the outbreak phase and normal values during remission. The clinical and histopathological features of this case, as well as its evolution, are compared with the three other reported cases of psoriasiform skin lesions in nonhuman primates. To the authors' knowledge, this is the first report of a definite palmoplantar nonpustular psoriasiform dermatitis in a rhesus macaque.
Assuntos
Dermatoses do Pé/veterinária , Dermatoses da Mão/veterinária , Macaca mulatta , Doenças dos Macacos/diagnóstico , Doenças dos Macacos/tratamento farmacológico , Doenças da Unha/veterinária , Psoríase/veterinária , Animais , Anti-Inflamatórios/uso terapêutico , Dexametasona/uso terapêutico , Dermatoses do Pé/diagnóstico , Dermatoses do Pé/tratamento farmacológico , Dermatoses do Pé/fisiopatologia , Dermatoses da Mão/diagnóstico , Dermatoses da Mão/tratamento farmacológico , Dermatoses da Mão/fisiopatologia , Masculino , Doenças dos Macacos/fisiopatologia , Doenças da Unha/diagnóstico , Doenças da Unha/tratamento farmacológico , Doenças da Unha/fisiopatologia , Psoríase/diagnóstico , Psoríase/tratamento farmacológico , Psoríase/fisiopatologia , Remissão Espontânea , Resultado do TratamentoRESUMO
Hand-foot syndrome (HFS), or palmar-plantar erythrodysesthesia, is a common side effect in patients taking long-term 5-fluorouracil treatment and is the most frequently reported side effect of oral capecitabine therapy (≥ 50% of patients). Although the pathogenesis of HFS is not fully understood, it may be due to damaged deep capillaries in the soles of the feet and palms of the hands, leading to a COX inflammatory-type reaction, or related to enzymes involved in the metabolism of capecitabine, namely, thymidine phosphorylase and dihydropyrimidine dehydrogenase. Ethnic variations in the clinical manifestation of HFS warrant further attention, and an alternative system for grading HFS in non-white patients has been proposed. In addition to treatment interruption and dose reduction, supportive treatments can help alleviate symptoms. Because capecitabine is an oral therapy administered at home, it is crucial that patients understand the importance of complying with treatment, be aware of the possibility of HFS, and inform the doctor or nurse immediately if symptoms of HFS develop. Several cases of HFS are presented.
Assuntos
Desoxicitidina/análogos & derivados , Fluoruracila/análogos & derivados , Dermatoses do Pé/induzido quimicamente , Dermatoses da Mão/induzido quimicamente , Administração Oral , Animais , Antimetabólitos Antineoplásicos/administração & dosagem , Antimetabólitos Antineoplásicos/efeitos adversos , Antimetabólitos Antineoplásicos/metabolismo , Capecitabina , Desoxicitidina/administração & dosagem , Desoxicitidina/efeitos adversos , Desoxicitidina/metabolismo , Diagnóstico Diferencial , Fluoruracila/administração & dosagem , Fluoruracila/efeitos adversos , Fluoruracila/metabolismo , Dermatoses do Pé/diagnóstico , Dermatoses do Pé/fisiopatologia , Dermatoses da Mão/diagnóstico , Dermatoses da Mão/fisiopatologia , Humanos , Grupos RaciaisRESUMO
BACKGROUND: Palmoplantar psoriasis is associated with significant quality-of-life issues. Its epidemiology and phenotypical expression remain ill defined. OBJECTIVE: We reviewed the literature and our clinical experience and developed a new quality-of-life assessment tool. METHODS: We conducted a retrospective review of 150 patients with palmoplantar psoriasis. RESULTS: In all, 78 (52%) patients displayed predominantly hyperkeratotic palmoplantar lesions, 24 (16%) pustular, 18 (12%) combination, and 30 (20%) had an indeterminate phenotype. In 27 (18%) patients, lesions were confined to the palms and soles. A new quality-of-life index was constructed to characterize disease severity. In all, 27 (18%) had mild, 72 (48%) moderate, and 51 (34%) severe disease involvement. Palmoplantar disease severity appeared independent from the degree of body surface area involvement. LIMITATIONS: This was a retrospective review. The quality-of-life index remains to be statistically verified in prospective clinical studies. CONCLUSION: Defining morphologic subtypes together with the use of a specific quality-of-life assessment tool in patients with palmoplantar psoriasis will improve our understanding and treatment of this recalcitrant form of psoriasis.