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1.
Clin Exp Dermatol ; 47(8): 1578-1581, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35340055

RESUMO

M2 macrophages are copious in generalized pustular psoriasis (GPP). M2 macrophages seem to acquire new skills and share common characteristics in GPP. HAM56 may play a role in attracting immature neutrophils to the inflammatory environment in GPP.


Assuntos
Interleucinas , Macrófagos , Doenças da Imunodeficiência Primária , Psoríase , Dermatopatias Vesiculobolhosas , Doença Aguda , Humanos , Interleucinas/deficiência , Macrófagos/imunologia , Neutrófilos , Psoríase/tratamento farmacológico
3.
An Bras Dermatol ; 99(2): 269-276, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38135557

RESUMO

The concept of "Cumulative Life Course Impairment" (CLCI) characterizes the set of factors harmful to the lives of patients resulting from the stigma and physical and psychological impairment associated with different chronic diseases, which can accumulate irreversibly over the course of patients lives. The sum of these factors often makes it impossible for these individuals to enjoy their lives fully, intensely and adequately. On the other hand, CLCI also incorporates coping strategies, including external factors and personality characteristics, which may act as modulating or protective factors of vulnerability to the CLCI. Although psoriasis is the most studied dermatological disease in relation to its impact on quality of life and CLCI, several other chronic inflammatory diseases such as atopic dermatitis, hidradenitis suppurativa, and alopecia areata have also been evaluated in relation to the magnitude of the damage to patients lives.


Assuntos
Psoríase , Qualidade de Vida , Humanos , Efeitos Psicossociais da Doença , Acontecimentos que Mudam a Vida , Adaptação Psicológica , Psoríase/complicações , Psoríase/psicologia , Doença Crônica
4.
An Bras Dermatol ; 99(5): 670-679, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38851892

RESUMO

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory disease that leads to the formation of nodules, abscesses and fistulas, with the formation of scars and fibrosis, causing significant impairment in patient quality of life. The diagnosis is clinical, using scores to classify the severity of the condition; currently the most recommended classification is the International Hidradenitis Suppurativa Severity Scoring System (IHS4). Doppler ultrasound has been used to complement the clinical evaluation of patients with HS. It is possible to observe subclinical lesions that change the staging, the severity of the case, and its treatment, either clinical or surgical. Correct treatment is essential to minimize the consequences of this disease for the patient. OBJECTIVE: To establish an outpatient protocol for the use of Doppler ultrasound in the care of patients with HS. METHODS: A narrative review of the literature was carried out on the use of Doppler ultrasound in patients with hidradenitis suppurativa; a referring protocol and technique orientations for imaging assessment in HS were created. RESULTS: Recommendation to perform ultrasound evaluation of symptomatic areas eight weeks after using antibiotics and four, 12, and 24 weeks after starting immunobiologicals; apply SOS-HS ultrasound severity classification. STUDY LIMITATIONS: The review did not cover all literature on ultrasound and HS; no systematic review was carried out, but rather a narrative one. CONCLUSIONS: The correct assessment of patients staging must be carried out using dermatological ultrasound to avoid progression to scars and fibrosis, which compromise patients quality of life.


Assuntos
Hidradenite Supurativa , Índice de Gravidade de Doença , Ultrassonografia Doppler , Hidradenite Supurativa/diagnóstico por imagem , Humanos , Ultrassonografia Doppler/métodos , Protocolos Clínicos , Qualidade de Vida
5.
Artigo em Inglês | MEDLINE | ID: mdl-38865572

RESUMO

Hyalohyphomycosis and phaeohyphomycosis are groups of mycoses caused by several agents and show different clinical manifestations. We report a case of an immunocompromised patient who presented rare manifestations of opportunistic mycoses: mycetoma-like hyalohyphomycosis on his right foot caused by Colletotrichum gloeosporioides, followed by cutaneous phaeohyphomycosis on his right forearm caused by Exophiala oligosperma. Further to the rarity of this case, the patient's lesion on the foot shows that the clinical aspects of mycetomas could falsely appear in other fungal infections similar to hyalohyphomycosis. We also show that the muriform cells that were seen in the direct and anatomopathological examination of the skin are not pathognomonic of chromoblastomycosis, as observed in the lesion of the patient's forearm.


Assuntos
Cromoblastomicose , Micetoma , Humanos , Masculino , Cromoblastomicose/patologia , Cromoblastomicose/diagnóstico , Cromoblastomicose/microbiologia , Cromoblastomicose/tratamento farmacológico , Micetoma/patologia , Micetoma/microbiologia , Micetoma/diagnóstico , Micetoma/tratamento farmacológico , Diagnóstico Diferencial , Hospedeiro Imunocomprometido , Hialoifomicose/patologia , Hialoifomicose/microbiologia , Hialoifomicose/diagnóstico , Exophiala/isolamento & purificação , Pessoa de Meia-Idade
6.
An Bras Dermatol ; 98(1): 36-46, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36369200

RESUMO

BACKGROUND: Mohs micrographic surgery is an established technique in the treatment of cutaneous neoplasms. It offers higher cure rates and the main indications are non-melanoma malignant skin tumors. Few studies have been performed on the treatment of rare tumors through this technique. OBJECTIVE: To study rare skin tumors and rare variants of basal cell carcinoma and squamous cell carcinoma submitted to Mohs micrographic surgery in a tertiary service in relation to frequency, disease-free evolution, and applicability of this surgical procedure for this group of tumors. METHODS: This was a retrospective observational study including rare skin tumors and less common variants of basal cell carcinoma and squamous cell carcinoma treated using Mohs micrographic surgery, between October 2008 and April 2021. RESULTS: During the study period, 437 tumors were treated using Mohs micrographic surgery, and 22 (5%) rare skin tumors were selected. The tumors comprised three dermatofibrosarcomas protuberans, two atypical fibroxanthomas, two spiradenomas, two hypercellular fibrohistiocytomas, one primary cutaneous adenocarcinoma, one trichoblastoma, one porocarcinoma, one chondroid syringoma, one cutaneous angiosarcoma, one Merkel cell carcinoma, and one sebaceous carcinoma. Six other cases of rare basal cell carcinoma variants with trichoepitheliomatous differentiation, metatypical basal cell carcinoma, and clear cell squamous cell carcinoma were included. There were no cases of recurrence after an average of six years of follow-up. STUDY LIMITATIONS: This is a retrospective study on rare neoplasms carried out in a single referral center, and this surgical technique isn't widely available in the public service. CONCLUSION: This retrospective case series showed that Mohs micrographic surgery is an appropriate treatment for rare skin tumors. They corresponded to 5% of the tumors treated by the technique during a 12-year-period, with no recurrences identified.


Assuntos
Carcinoma Basocelular , Carcinoma de Células Escamosas , Neoplasias Cutâneas , Neoplasias das Glândulas Sudoríparas , Humanos , Estudos Retrospectivos , Cirurgia de Mohs/métodos , Brasil , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/patologia , Carcinoma Basocelular/cirurgia , Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/cirurgia , Carcinoma de Células Escamosas/patologia , Centros de Atenção Terciária , Neoplasias das Glândulas Sudoríparas/cirurgia , Recidiva Local de Neoplasia/cirurgia
7.
Dermatol Ther (Heidelb) ; 13(11): 2797-2815, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37794274

RESUMO

INTRODUCTION: Hidradenitis suppurativa (HS) is a chronic skin condition causing considerable distress. It impacts mobility, social interaction, and quality of life. In Brazil, there is a notable gap in epidemiological data and patient experiences regarding HS. METHODS: This study, spanning 2019 to 2022, employed netnography to probe the experiences of Brazilian patients with HS. This approach gleans insights from online interactions, offering a direct view into patients' lives. RESULTS: Notably, the data illuminated the challenges patients face, such as difficulties in obtaining a diagnosis and the complexities involved in managing a chronic, and often debilitating, condition. Furthermore, patients' experiences with various treatments, encompassing antibiotics, biologic agents, lifestyle alterations, surgical procedures, and alternative remedies, were also examined. CONCLUSION: By undertaking a longitudinal analysis of patient interactions, the study aimed to offer a richer understanding of HS, from its diagnosis to its treatment. It underscores the necessity for a more patient-centered approach when managing this condition. We hope that this enhanced understanding can facilitate better care for those affected by HS.

8.
Clin Cosmet Investig Dermatol ; 16: 2029-2044, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37560253

RESUMO

Background: Hidradenitis suppurativa (HS) is a chronic skin condition. Its complexity and impact on patients highlight the need for multidisciplinary care that can address the physical, psychological, and social aspects. Centers of excellence can ideally provide the necessary infrastructure, resources, and expertise to effectively treat HS. However, there are still no consolidated models of centers of excellence in HS, and establishing their foundations is an intricate research challenge. Purposely, design and co-creation as innovation techniques are helpful approaches to this type of research. Methods: In this study, we conducted a co-creation with consensus among HS specialists to propose the criteria and requirements to establish outpatient centers of excellence of HS in Brazil. We followed a linear process with mixed methods in 6 stages. Results: The process resulted in 10 categories for establishing outpatient centers, including their respective requirements, rationale, and classification. The categories include onboarding and welcoming; infrastructure and procedures; infusion therapy; flows and referrals; staffing; disease management; metrics during diagnosis; metrics during treatment; awareness and advocacy; research and education. Discussion: The idealized outpatient centers can play a role in the complete multidisciplinary treatment for HS and advancing the science of healthcare services by providing a focus for research, training, and translation of findings into practice.

9.
An Bras Dermatol ; 97(1): 63-74, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34838431

RESUMO

Generalized pustular psoriasis (von Zumbusch) is a rare and acute eruption characterized by multiple sterile pustules over an erythematous and edematous background, eventually associated with psoriasis vulgaris. Classically, it manifests as a potentially severe systemic picture and demands prompt diagnosis and intervention. The duration of each flare-up and intervals between the pustular episodes is extremely variable. Recently, genetic abnormalities have been identified mainly in the familial and early variants of this disease. The therapeutic arsenal is limited; however, new drugs being evaluated aim to control both pustular flare-ups and disease recurrences.


Assuntos
Exantema , Psoríase , Dermatopatias Vesiculobolhosas , Doença Aguda , Doença Crônica , Humanos , Psoríase/diagnóstico , Psoríase/tratamento farmacológico
10.
An Bras Dermatol ; 96(1): 17-26, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33288370

RESUMO

BACKGROUND: Non-melanoma skin cancer is the most common type of malignancy in the Western world, and surgical excision is the preferred approach. The approach adopted in the face of incomplete excisions of basal cell carcinoma is still controversial. OBJECTIVES: To compare the number of tumor recurrences after treatment for incompletely excised basal cell carcinoma. METHODS: Selection and statistical analysis of medical records of patients who had compromised margins after excision of basal cell carcinoma in a tertiary hospital from 2008 to 2013. RESULTS: A total of 120 medical records were analyzed; the mean age was 69.6 years, and 50% of the patients were female. The most prevalent histological type was nodular; the mean size was 1.1 cm, and the tumor location with the highest incidence was the nose. The lateral margin was the most frequently positive. Clinical follow-up was more widely adopted; only 40 patients underwent a second surgery. The total number of patients who had tumor recurrence was 34 (28.3%). Only the malar location significantly influenced the incidence of recurrence (p = 0.02). The mean follow-up time was 29.54 months, with no significant difference between the follow-ups, although 32.9% of the patients followed-up clinically showed recurrence, against only 20% of those who underwent a second surgery. STUDY LIMITATIONS: Mean follow-up time of less than five years and sample size. CONCLUSIONS: The presence of compromised margins does not necessarily imply recurrence. Location, tumor size, histological subtype, previous epithelial tumors, and clinical conditions of the patient must be considered when choosing the best treatment option.


Assuntos
Carcinoma Basocelular , Neoplasias Cutâneas , Idoso , Carcinoma Basocelular/epidemiologia , Carcinoma Basocelular/cirurgia , Feminino , Humanos , Recidiva Local de Neoplasia/epidemiologia , Prognóstico , Estudos Retrospectivos , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/cirurgia
11.
Ultrastruct Pathol ; 34(1): 2-6, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20070147

RESUMO

Some Bartonella species are able to invade red blood cells (RBC) and may cause persistent infection in the susceptible host. Use of transmission electron microscopy (TEM) demonstrates, inside erythrocytes, the typical triple-walled agents. However, when examining ultrathin sections of blood cells, the authors have, on several occasions, detected intraerythrocytic abnormalities that mimic but are not typical of Bartonella spp. Small endovesicles, pseudoinclusions, cavities, and irregular hemoglobin granules distribution, resulting in regions of increased or decreased electron density, may be observed in the erythrocytes and platelets, which may be confused with bartonellas. So far, detailed ultrastructural findings of Bartonella spp. in blood cells have not yet been described. Aiming to improve TEM interpretation of blood cells changes, in routine examination of blood sections of patients with suspected bartonellosis, the authors studied the morphological findings they have observed, and present their putative nature, according to information in the literature.


Assuntos
Artefatos , Bartonella henselae/fisiologia , Eritrócitos/microbiologia , Corpos de Inclusão/microbiologia , Bartonella henselae/ultraestrutura , Eritrócitos/ultraestrutura , Humanos , Corpos de Inclusão/ultraestrutura , Microscopia Eletrônica de Transmissão/métodos
12.
J Clin Virol ; 123: 104246, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31927151

RESUMO

The goal was to characterize the clinical-epidemiological profile of patients with mucocutaneous tumoural herpes simplex virus (MCT HSV) lesions across the world. Two researchers extracted and independently reviewed data from the literature search engine PubMed/MEDLINE through October 2018. From 110 reported patients, the following data were available: the patients' ages ranged from 7 to 76 years; the majority was male (62.73 %-69/110) and immunosuppression was found in 97.25 % (106/109, missing 1) cases, of whom 88 were HIV- related. Lesions size varied from 0.2-13 cm, settling in the anogenital region in 76.36 % (84/110) patients; 84.13 % (53/63, missing 47) complained of pain and multiple recurrences were found in 44.94 % (40/89, missing 21) cases. On clinical basis, the initial hypothesis was neoplasia in 36/53 patients. Histopathological diagnosis was achieved in 90 % (90/100, missing 10) cases and was sample size-dependent. Type 2 HSV was detected in 86.07 % (68/79, missing 31) lesions. MCT HSV lesions recurrence after treatment was reported in 33.96 % (18/53, missing 57) patients. Pathophysiology is poorly understood. Physicians should be aware of MCT HSV lesions in immunosuppressed patients to avoid inappropriate therapeutic strategies.


Assuntos
Herpes Simples/complicações , Herpes Simples/patologia , Neoplasias/virologia , Simplexvirus/patogenicidade , Aciclovir/uso terapêutico , Adolescente , Adulto , Idoso , Criança , Feminino , Herpes Simples/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/patologia , Recidiva , Adulto Jovem
13.
Ultrastruct Pathol ; 33(4): 151-4, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19728230

RESUMO

The authors present the case of a young man with aplastic anemia who went into shock and died after several red blood cell unit transfusions. Immunohematological studies did not show any abnormality and blood cultures from patients and blood bags were negative. The ultrastructural findings, allied with current scientific knowledge, permitted the diagnosis of Bartonella sp. infection. In face of this diagnosis, two possibilities should be considered: the first one is that the patient was already infected by the bacteria before the last RBC unit transfusion. The pathogen could be involved in aplastic anemia etiology and in the failure to recover hemoglobin levels, in spite of the transfusions. The second possibility is that the RBC unit was contaminated with a Bartonella sp., which would have led to a state of shock, causing the death of the patient.


Assuntos
Infecções por Bartonella/etiologia , Transfusão de Eritrócitos/efeitos adversos , Adulto , Anemia Aplástica/terapia , Causas de Morte , Evolução Fatal , Humanos , Masculino
14.
An. bras. dermatol ; 99(2): 269-276, Mar.-Apr. 2024. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1556850

RESUMO

Abstract The concept of "Cumulative Life Course Impairment" (CLCI) characterizes the set of factors harmful to the lives of patients resulting from the stigma and physical and psychological impairment associated with different chronic diseases, which can accumulate irreversibly over the course of patients lives. The sum of these factors often makes it impossible for these individuals to enjoy their lives fully, intensely and adequately. On the other hand, CLCI also incorporates coping strategies, including external factors and personality characteristics, which may act as modulating or protective factors of vulnerability to the CLCI. Although psoriasis is the most studied dermatological disease in relation to its impact on quality of life and CLCI, several other chronic inflammatory diseases such as atopic dermatitis, hidradenitis suppurativa, and alopecia areata have also been evaluated in relation to the magnitude of the damage to patients lives.

15.
Clin Case Rep ; 7(5): 1091-1093, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31110752

RESUMO

We report an uncommon presentation of bullous dermatosis by linear IgA. There are few cases reported in the literature with this form of presentation starting with mucosal lesions and then evolving into a similar bullous pemphigoid pattern. In addition, we emphasize the importance of direct immunofluorescence for the definitive diagnosis.

16.
Skin Appendage Disord ; 5(6): 401-404, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31799273

RESUMO

Acral lentiginous melanoma is rare in Caucasians, but it is the most common among individuals with a higher phototype, such as Blacks and Asians. It is usually presented under the palmoplantar and/or nail region. Subungual melanoma is an acral lentiginous melanoma subtype in which the initial diagnostic approach does not have a consensus. We report a case of a woman with tumoral melanocytic lesion on the fifth toenail, of insidious growth, where the amputation of the nail apparatus technique was used as an excisional biopsy for an extensive lesion. The patient is followed up in an outpatient clinic setting without lymph node or distance metastasis.

19.
An Bras Dermatol ; 94(2 Suppl 1): 7-19, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31166401

RESUMO

Hidradenitis suppurativa is a chronic immune mediated disease of universal distribution that causes great damage to the quality of life of the affected individual, whose prevalence is estimated at 0.41% in the Brazilian population. The objective of this work was update on physiopathogenesis, diagnosis and classification of hidradenitis suppurativa and to establish therapeutic recommendations in the Brazilian reality. It was organized as a work group composed of eight dermatologists from several institutions of the country with experience in the treatment of hidradenitis suppurativa and carried out review on the topic. Recommendations were elaborated and voted by modified Delphi system and statistical analysis of the results was performed. The Brazilian consensus on the clinical approach of hidradenitis suppurativa had the support of the Brazilian Society of Dermatology.


Assuntos
Consenso , Hidradenite Supurativa/terapia , Brasil , Dermatologia , Hidradenite Supurativa/diagnóstico , Humanos , Índice de Gravidade de Doença , Sociedades Médicas
20.
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1559118

RESUMO

ABSTRACT Hyalohyphomycosis and phaeohyphomycosis are groups of mycoses caused by several agents and show different clinical manifestations. We report a case of an immunocompromised patient who presented rare manifestations of opportunistic mycoses: mycetoma-like hyalohyphomycosis on his right foot caused by Colletotrichum gloeosporioides, followed by cutaneous phaeohyphomycosis on his right forearm caused by Exophiala oligosperma. Further to the rarity of this case, the patient's lesion on the foot shows that the clinical aspects of mycetomas could falsely appear in other fungal infections similar to hyalohyphomycosis. We also show that the muriform cells that were seen in the direct and anatomopathological examination of the skin are not pathognomonic of chromoblastomycosis, as observed in the lesion of the patient's forearm.

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