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1.
Adv Rheumatol ; 64(1): 25, 2024 04 11.
Artigo em Inglês | MEDLINE | ID: mdl-38605415

RESUMO

BACKGROUND: Nail involvement is frequent in patients with psoriasis (Pso) and psoriatic arthritis (PsA) and there is a relationship between nail involvement and inflammation of the enthesis. The main objective of the present study is to describe the ultrasound findings and clinical characteristics of nails from patients with psoriasis and psoriatic arthritis with and without nail dystrophy. METHODS: A cross-sectional study including consecutive patients with PsO and PsA was carried out. The study patients were divided into 4 groups, totaling 120 participants. Group 1: patients with psoriasis vulgaris and clinically normal nails; Group 2: patients with psoriasis vulgaris and onychodystrophy; Group 3: patients with psoriatic arthritis and clinically normal nails; Group 4: patients with psoriatic arthritis and onychodystrophy; All patients were submitted to dermatological and rheumatological clinical analysis. Ultrasound examinations was performed by a single examiner, blinded to all clinical data, with ultrasound high resolution, in B-mode or gray-scale (GS), Power Doppler (PD) and Spectral Doppler. RESULTS: A significant difference was found between the groups regarding the variable Psoriasis Area and Severity Index (PASI) (p = 0.008) and body surface area (BSA) (p = 0.005), with patients with psoriatic arthritis having lower PASI and BSA compared to patients with only cutaneous psoriasis. A positive relationship was found with the average ultrasound thickness of the nail bed and the Nail Psoriasis Severity Index (NAPSI) in correlation analysis (rho = 0.344). When we grouped patients with psoriasis and psoriatic arthritis, there was no significant difference between the cutaneous psoriasis groups and the psoriatic arthritis groups in terms of nail plate GS (p = 0.442), nail bed PD (p = 0.124). CONCLUSION: Greater nail bed thickness indicates early psoriatic nail disease, as confirmed in our study correlating NAPSI with nail bed thickness. Ultrasonography is a low-cost exam, promising in the evaluation, showing that the ultrasound grayscale is consistent with those who have dystrophic nails, but it can't distinguish psoriasis from psoriatic arthritis, even in those with nail dystrophy.


Assuntos
Artrite Psoriásica , Doenças da Unha , Psoríase , Humanos , Artrite Psoriásica/complicações , Artrite Psoriásica/diagnóstico por imagem , Unhas/diagnóstico por imagem , Estudos Transversais , Psoríase/complicações , Psoríase/diagnóstico por imagem , Doenças da Unha/diagnóstico por imagem , Doenças da Unha/etiologia
3.
Adv Rheumatol ; 64: 25, 2024. tab
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1556788

RESUMO

Abstract Background Nail involvement is frequent in patients with psoriasis (Pso) and psoriatic arthritis (PsA) and there is a relationship between nail involvement and inflammation of the enthesis. The main objective of the present study is to describe the ultrasound findings and clinical characteristics of nails from patients with psoriasis and psoriatic arthritis with and without nail dystrophy. Methods A cross-sectional study including consecutive patients with PsO and PsA was carried out. The study patients were divided into 4 groups, totaling 120 participants. Group 1: patients with psoriasis vulgaris and clinically normal nails; Group 2: patients with psoriasis vulgaris and onychodystrophy; Group 3: patients with psoriatic arthritis and clinically normal nails; Group 4: patients with psoriatic arthritis and onychodystrophy; All patients were submitted to dermatological and rheumatological clinical analysis. Ultrasound examinations was performed by a single examiner, blinded to all clinical data, with ultrasound high resolution, in B-mode or gray-scale (GS), Power Doppler (PD) and Spectral Doppler. Results A significant difference was found between the groups regarding the variable Psoriasis Area and Severity Index (PASI) (p = 0.008) and body surface area (BSA) (p = 0.005), with patients with psoriatic arthritis having lower PASI and BSA compared to patients with only cutaneous psoriasis. A positive relationship was found with the average ultrasound thickness of the nail bed and the Nail Psoriasis Severity Index (NAPSI) in correlation analysis (rho = 0.344). When we grouped patients with psoriasis and psoriatic arthritis, there was no significant difference between the cutaneous psoriasis groups and the psoriatic arthritis groups in terms of nail plate GS (p = 0.442), nail bed PD (p = 0.124). Conclusion Greater nail bed thickness indicates early psoriatic nail disease, as confirmed in our study correlating NAPSI with nail bed thickness. Ultrasonography is a low-cost exam, promising in the evaluation, showing that the ultrasound grayscale is consistent with those who have dystrophic nails, but it can't distinguish psoriasis from psoriatic arthritis, even in those with nail dystrophy.

5.
Skin Appendage Disord ; 8(5): 399-405, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36161087

RESUMO

Introduction: The etiological agents of onychomycosis are dermatophyte fungi, nondermatophyte filamentous fungi (NDFF), and yeasts. Nail clippings are an accurate tool for diagnosing onychomycosis. The objective of this study was to correlate the characteristics of fungi observed in nail clipping examinations with the results for agents isolated in culture, indicating whether the fungus found on microscopy is a dermatophyte, NDFF, or yeast. Methods: An observational descriptive study of onychomycosis nail clippings stained with PAS comparing culture results with microscopic criteria of fungi morphology, arrangement/orientation, and location of organisms in the nail and presence of neutrophils, serous lakes, and bacterial colonies was conducted. Results: Thirty-three nail clippings from 29 participants were analyzed. A statistically significant correlation (p < 0.05) was found between smooth/thin/long hyphae with a "combed" pattern and dermatophyte agents (sensitivity 89.4%, specificity 91.5%), and between irregular/thick/short anarchic distributed hyphae and nondermatophytes (sensitivity 61.5%, specificity 89.4%). No statistical association with region where fungi were in the nail or with the presence of neutrophils, serous lakes or bacteria was found. Small, rounded, yeast-like organisms correlated with Candida infection. Conclusions: Although not a substitute for culture, microscopic analysis of fungal structures offers good accuracy for differentiating agents of onychomycosis.

8.
Surg. cosmet. dermatol. (Impr.) ; 14: e20220074, jan.-dez. 2022.
Artigo em Português | LILACS-Express | LILACS | ID: biblio-1369138

RESUMO

O microagulhamento tem sido tradicionalmente usado para induzir a formação de colágeno. No couro cabeludo, foi observado que estimula a fase anágena e o ciclo capilar, mas faltam estudos que demonstrem as alterações histopatológicas após o procedimento. Relatamos o caso de uma mulher de 37 anos com história de alopecia de padrão feminino há 15 anos, com rarefação difusa proeminente na região fronto-parietal e miniaturização capilar observada à dermatoscopia. A condição permaneceu estável por 7 anos com uso de espironolactona e minoxidil tópico. A paciente foi submetida a três sessões de microagulhamento no couro cabeludo em intervalos mensais. A análise histopatológica foi realizada antes das sessões e um mês após a última sessão. O padrão de alopecia permaneceu o mesmo, sem alterações significativas na contagem de folículos após as intervenções, apesar de discreta melhora clínica e dermatoscópica. Não foram observados tratos fibrosos ou inflamação após o procedimento. A análise histopatológica é importante para avaliar a segurança do microagulhamento do couro cabeludo em curto e longo prazo, para investigar sinais como inflamação e fibrose, bem como para determinar a eficácia deste procedimento no tratamento da alopecia, e estudos com maior número de casos são necessários


Microneedling has traditionally been used to induce collagen formation. Scalp microneedling has been seen to stimulate the capillary cycle and anagen phase, but studies demonstrating histopathological changes after this procedure are lacking. Here we present the case of a 37-year-old woman with a 15-year history of female pattern alopecia, with diffuse hair thinning prominent in the frontoparietal region and hair miniaturization seen in dermoscopy. The patient's condition remained stable for seven years with use of spironolactone and topical minoxidil. The patient underwent three scalp microneedling sessions at monthly intervals. Histopathological analysis was conducted before the sessions and one month after the last session. Despite slight clinical and dermoscopic improvement, the alopecia pattern remained the same, without significant changes in follicle count after the interventions. Neither inflammation nor fibrous tracts were observed after the procedure. The histopathological analysis is essential to assess the safety of scalp microneedling in the short and long term, investigate signs such as inflammation and fibrosis, and determine the effectiveness of this procedure in treating alopecia. Studies with a more significant number of cases are necessary

11.
An. bras. dermatol ; An. bras. dermatol;95(5): 594-601, Sept.-Oct. 2020. graf
Artigo em Inglês | LILACS, Coleciona SUS (Brasil) | ID: biblio-1130954

RESUMO

Abstract Background: The treatment of basal cell carcinoma depends on its histological subtype. Therefore, a biopsy should be performed before definitive treatment. However, as the biopsy is only a sample of the tumor, it does not always shows every histological subtype present in the neoplasm. Few studies have compared the histological findings of biopsies with the findings of Mohs micrographic surgery. By evaluating the totality of the peripheral margins, in addition to sampling large tumor areas, this technique provides a more representative amount of tissue than preoperative biopsy. Objectives: a) Determine the agreement between the histological subtype of basal cell carcinoma from punch biopsy and the findings of Mohs surgery; b) To assess, among the discordant cases, the prevalence of non-aggressive tumors in the preoperative biopsy that were reclassified as aggressive by Mohs surgery. Methods: Retrospective analysis of 79 cases of basal cell carcinomas submitted to punch biopsy and subsequent Mohs surgery. Results: The agreement between the classification of the subtypes in the biopsy and in Mohs surgery was 40.5%. Punch biopsy was able to predict the most aggressive basal cell carcinoma growth pattern in 83% of cases. Study limitations: Retrospective nature, sample size, and biopsies performed by different professionals. Conclusions: The agreement between the histopathological subtypes of basal cell carcinoma as seen in preoperative biopsy and Mohs surgery was low. However, preoperative biopsy presented good accuracy (83%) in detecting aggressive histopathological subtypes.


Assuntos
Humanos , Neoplasias Cutâneas/cirurgia , Carcinoma Basocelular/cirurgia , Biópsia , Estudos Retrospectivos , Cirurgia de Mohs
12.
An Bras Dermatol ; 95(5): 594-601, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32693938

RESUMO

BACKGROUND: The treatment of basal cell carcinoma depends on its histological subtype. Therefore, a biopsy should be performed before definitive treatment. However, as the biopsy is only a sample of the tumor, it does not always shows every histological subtype present in the neoplasm. Few studies have compared the histological findings of biopsies with the findings of Mohs micrographic surgery. By evaluating the totality of the peripheral margins, in addition to sampling large tumor areas, this technique provides a more representative amount of tissue than preoperative biopsy. OBJECTIVES: a) Determine the agreement between the histological subtype of basal cell carcinoma from punch biopsy and the findings of Mohs surgery; b) To assess, among the discordant cases, the prevalence of non-aggressive tumors in the preoperative biopsy that were reclassified as aggressive by Mohs surgery. METHODS: Retrospective analysis of 79 cases of basal cell carcinomas submitted to punch biopsy and subsequent Mohs surgery. RESULTS: The agreement between the classification of the subtypes in the biopsy and in Mohs surgery was 40.5%. Punch biopsy was able to predict the most aggressive basal cell carcinoma growth pattern in 83% of cases. STUDY LIMITATIONS: Retrospective nature, sample size, and biopsies performed by different professionals. CONCLUSIONS: The agreement between the histopathological subtypes of basal cell carcinoma as seen in preoperative biopsy and Mohs surgery was low. However, preoperative biopsy presented good accuracy (83%) in detecting aggressive histopathological subtypes.


Assuntos
Carcinoma Basocelular , Neoplasias Cutâneas , Biópsia , Carcinoma Basocelular/cirurgia , Humanos , Cirurgia de Mohs , Estudos Retrospectivos , Neoplasias Cutâneas/cirurgia
13.
J Am Acad Dermatol ; 83(2): 493-500, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32289390

RESUMO

BACKGROUND: Basal cell carcinomas (BCCs) with high-risk features are preferably treated by Mohs micrographic surgery. Studies have shown clinicopathologic characteristics that may predict more stages required for clearance. However, few studies have correlated such factors with the number of millimeters removed per stage. OBJECTIVE: To determine margins necessary for BCC clearance according to tumor features, especially for tumors less than 6 mm, and to suggest initial margins for Mohs micrographic surgery and margins for wide local excision. METHODS: Retrospective analysis of 295 consecutive Mohs micrographic surgeries for primary BCCs. Variables analyzed included patient age, sex, immunostatus, lesion size, location, histologic subtype, borders, stage number, and millimeters excised per stage. RESULTS: BCCs less than 6 mm had a clearance rate of 96% with 3-mm margins. In adjusted multivariable analysis, superficial, micronodular, infiltrative, and morpheaform subtypes were associated with larger margins, whereas clinically well-defined tumors were associated with smaller margins. LIMITATIONS: Because of the limited sample of certain subtypes, a 3-mm margin is better suited for nodular tumors. CONCLUSION: These data help guide initial Mohs micrographic surgery and wide local excision margins required for tumor clearance according to tumor features. Nodular BCCs less than 6 mm may be cleared with 3-mm margins instead of the current 4-mm margin recommendation.


Assuntos
Carcinoma Basocelular/cirurgia , Margens de Excisão , Cirurgia de Mohs/normas , Guias de Prática Clínica como Assunto , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basocelular/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgia de Mohs/estatística & dados numéricos , Estadiamento de Neoplasias , Estudos Retrospectivos , Pele/patologia , Neoplasias Cutâneas/patologia , Resultado do Tratamento
14.
Dermatopathology (Basel) ; 6(4): 213-219, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31828062

RESUMO

This study describes the clinical characteristics and microscopic findings of nails from 25 patients with palmoplantar pustulosis. METHODS: This is a cross-sectional study of adult patients with clear-cut palmoplantar pustulosis. Onychodystrophy severity was evaluated in fingernails using the nail psoriasis severity index (NAPSI). A fragment of the most dystrophic fingernail was collected from each patient and submitted to routine histotechnical processing. The following microscopic parameters were evaluated: nail plate and subungual region thickness, presence or absence of parakeratosis, number of layers of parakeratosis, and presence of neutrophils, serous lakes, bacteria, blood, and fungi. RESULTS: Twenty-one patients (84%) presented onychodystrophy with a mean NAPSI score of 12.67. The most common nail change was pitting (76.19% of patients). On average, nail plate thickness and subungual region thickness measured 0.42 and 0.14 mm, respectively. Neutrophils and fungi were not observed, but serous lakes were found in 4.7%, bacteria in 28.57%, blood in 4.76%, and parakeratosis in 19.05% of the patients. CONCLUSIONS: although palmoplantar pustulosis is a disease with great amounts of neutrophils in the epidermis, those cells were not found in the nail clippings studied herein. Furthermore, when clinical aspects and microscopic findings of palmoplantar pustulosis are compared to those of similar studies in psoriasis vulgaris, they show different characteristics.

17.
An Bras Dermatol ; 94(3): 344-347, 2019 07 29.
Artigo em Inglês | MEDLINE | ID: mdl-31365667

RESUMO

BACKGROUND: Of all nail disorders seen in dermatology offices, half of them are due to onychomycosis. The main differential diagnosis is nail psoriasis. The objective of this study was to compare the microscopic findings, other than the presence of fungi, in the clipping of onychomycosis versus normal nails and nail psoriasis. METHODS: Cross-sectional study of onychomycosis cases, analyzed by clipping and compared with data on normal nails and those with nail psoriasis. RESULTS: Sixty-two onychomycosis samples were compared with 30 normal nails and 50 nails with psoriasis. In onychomycosis, measurement of subungual region, serous lakes, neutrophils and number of layers of parakeratosis are more intense than in psoriasis. Onychocariosis is less common in psoriasis, while bacteria are more frequent. The nail transition zone is more commonly blurred and irregular in onychomycosis. CONCLUSION: Clipping helps in the differential diagnosis of onychomycosis and nail psoriasis and may be useful even when fungi are not found.


Assuntos
Doenças da Unha/patologia , Unhas/patologia , Onicomicose/patologia , Estudos Transversais , Diagnóstico Diferencial , Humanos , Doenças da Unha/microbiologia , Unhas/microbiologia , Neutrófilos , Onicomicose/microbiologia , Paraceratose , Psoríase/microbiologia , Psoríase/patologia
18.
An. bras. dermatol ; An. bras. dermatol;94(3): 344-347, May-June 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1011119

RESUMO

Abstract: Background: Of all nail disorders seen in dermatology offices, half of them are due to onychomycosis. The main differential diagnosis is nail psoriasis. The objective of this study was to compare the microscopic findings, other than the presence of fungi, in the clipping of onychomycosis versus normal nails and nail psoriasis. Methods: Cross-sectional study of onychomycosis cases, analyzed by clipping and compared with data on normal nails and those with nail psoriasis. Results: Sixty-two onychomycosis samples were compared with 30 normal nails and 50 nails with psoriasis. In onychomycosis, measurement of subungual region, serous lakes, neutrophils and number of layers of parakeratosis are more intense than in psoriasis. Onychocariosis is less common in psoriasis, while bacteria are more frequent. The nail transition zone is more commonly blurred and irregular in onychomycosis. Conclusion: Clipping helps in the differential diagnosis of onychomycosis and nail psoriasis and may be useful even when fungi are not found.


Assuntos
Humanos , Onicomicose/patologia , Doenças da Unha/patologia , Unhas/patologia , Paraceratose , Psoríase/microbiologia , Psoríase/patologia , Estudos Transversais , Onicomicose/microbiologia , Diagnóstico Diferencial , Doenças da Unha/microbiologia , Unhas/microbiologia , Neutrófilos
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