RESUMEN
BACKGROUND: There is a need to improve the quality of communication between clinicians and parents of young patients with atopic eczema (AE). OBJECTIVE: To create a tool to measure the suffering that caregivers experience in association with their child's AE (Caregiver Pictorial Representation of Illness and Self-Measure, Caregiver-PRISM), assess the validity and reliability, and identify factors associated with caregiver suffering. METHODS: Caregiver-PRISM was administered to 45 parents of patients from an AE outpatient service (Padua, Italy). RESULTS: Caregiver-PRISM had a good test-retest reliability (r = 0.85; t7 = 4.13; p < 0.05), content validity and construct validity when used in parents of AE children. Parents with a less positive family affective climate, higher education, or with children following a diet experienced higher suffering associated with their child's AE, demonstrated by lower Caregiver-PRISM scores (p < 0.05). CONCLUSION: Our results support the use of Caregiver-PRISM in parents of AE patients to assess suffering associated with patients' illness.
Asunto(s)
Cuidadores/psicología , Dermatitis Atópica/psicología , Padres/psicología , Calidad de Vida , Autoevaluación (Psicología) , Estrés Psicológico/psicología , Adulto , Niño , Preescolar , Dermatitis Atópica/complicaciones , Dermatitis Atópica/epidemiología , Femenino , Humanos , Incidencia , Lactante , Italia/epidemiología , Masculino , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Estrés Psicológico/etiología , Encuestas y CuestionariosRESUMEN
Increasing data suggests that there is a connection between stress and the appearance of psoriasis symptoms. We therefore performed a clinical trial enrolling 40 participants who were randomly allocated to either an 8-week cognitive-behavioural therapy (CBT) (treatment group) plus narrow-band UVB phototherapy or to an 8-week course of only narrow-band UVB phototherapy (control group). We evaluated the clinical severity of psoriasis (PASI), General Health Questionnaire (GHQ)-12, Skindex-29 and State-Trait Anxiety Inventory (STAI) at baseline and by the end of the study. Sixty-five percent of patients in the treatment group achieved PASI75 compared with 15% of standard UVB patients (p = 0.007). GHQ-12 cases were reduced from 45% to 10% in the treatment group and from 30% to 20% in the control group (p = 0.05). The Skindex-29 emotional domain showed a significant improvement in the CBT/biofeedback group compared with control patients (-2.8 points, p = 0.04). This study shows that an adjunctive 8-week intervention with CBT combined with biofeedback increases the beneficial effect of UVB therapy in the overall management of psoriasis, reduces the clinical severity of psoriasis, improving quality of life and decreases the number of minor psychiatric disorders.
Asunto(s)
Biorretroalimentación Psicológica , Terapia Cognitivo-Conductual , Psoriasis/psicología , Psoriasis/terapia , Terapia Ultravioleta , Adulto , Anciano , Terapia Combinada , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Método Simple Ciego , Resultado del TratamientoAsunto(s)
Adalimumab/administración & dosificación , Antiinflamatorios/administración & dosificación , Fármacos Dermatológicos/administración & dosificación , Etanercept/administración & dosificación , Psoriasis/tratamiento farmacológico , Adalimumab/efectos adversos , Adulto , Anciano , Antiinflamatorios/efectos adversos , Fármacos Dermatológicos/efectos adversos , Etanercept/efectos adversos , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Psoriasis/diagnóstico , Psoriasis/inmunología , Recurrencia , Inducción de Remisión , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Factor de Necrosis Tumoral alfa/inmunologíaAsunto(s)
Dermatosis de la Mano/etiología , Hipopigmentación/etiología , Pigmentación de la Piel , Piel/fisiopatología , Agua/efectos adversos , Femenino , Dermatosis de la Mano/diagnóstico , Humanos , Hipopigmentación/diagnóstico , Hipopigmentación/fisiopatología , Remisión Espontánea , Piel/patología , Adulto JovenRESUMEN
Vitamin D plays an important role in maintaining the homeostasis of various biological systems. Beside its well-known function in calcium and phosphate metabolism, it plays a major role in pathophysiology of skin and adnexa. Indeed, vitamin D, through its receptor (VDR), decreases keratinocyte proliferation, improves their differentiation and modulates both cutaneous innate (antimicrobial activity and antigen presentation) and adaptative immunity (T and B lymphocyte function). The maintenance of normal hair is dependant on the integrity of the dermis, epidermis and hair cycles. Beside its effect on epidermal differentiation, VDR plays a vital role in preserving the hair follicle integrity. While the relevance of VDR has been fully elucidated, the real value of vitamin D in the hair follicle cycle still remains uncertain. To date, results in literature remain contradicting and far from definitive; still, the role of vitamin D in the various forms of human alopecia is likely to be significant. The aim of this article is to review evidence about the role of vitamin D and its receptor in trichology, with a focus on scarring and non-scarring alopecia and in particular on the potential therapeutic use of Vitamin D for hair and scalp disorders.
Asunto(s)
Enfermedades del Cabello/etiología , Receptores de Calcitriol/fisiología , Dermatosis del Cuero Cabelludo/etiología , Vitamina D/fisiología , Vitaminas/fisiología , HumanosRESUMEN
Alopecia areata (AA) is an organ-specific autoimmune disorder that targets anagen phase hair follicles. The course is unpredictable and current available treatments have variable efficacy. Nowadays, there is relatively little evidence on treatment of AA from well-designed clinical trials. Moreover, none of the treatments or devices commonly used to treat AA are specifically approved by the Food and Drug Administration. The Italian Study Group for Cutaneous Annexial Disease of the Italian Society of dermatology proposes these Italian guidelines for diagnosis and treatment of Alopecia Areata deeming useful for the daily management of the disease. This article summarizes evidence-based treatment associated with expert-based recommendations.
Asunto(s)
Alopecia Areata/terapia , Enfermedades Autoinmunes/terapia , Folículo Piloso/inmunología , Alopecia Areata/diagnóstico , Alopecia Areata/inmunología , Enfermedades Autoinmunes/diagnóstico , Enfermedades Autoinmunes/inmunología , Medicina Basada en la Evidencia , Humanos , ItaliaRESUMEN
Pityriasis versicolor is one of the most frequent epidermal mycotic infections in the world, but its atrophic variant is rarely described. The aetiology of the atrophy is still unknown, and two main hypotheses have been formulated, one suggesting a correlation with long-term use of topical steroids and the other a delayed type hypersensitivity to epicutaneous antigens derived from components of the fungus. Atrophic pityriasis versicolor is a benign disease, but needs to be distinguished from other more severe skin diseases manifesting with cutaneous atrophy. The diagnosis can be easily confirmed by direct microscopic observation of the scales soaked in 15% potassium hydroxide, which reveals the typical 'spaghetti and meatball' appearance, or by a skin biopsy in doubtful cases. Here, we describe a case of extensive atrophic pityriasis versicolor occurring in a woman affected by Sjögren's syndrome which completely resolved after topical antifungal treatment.
Asunto(s)
Síndrome de Sjögren/complicaciones , Piel/patología , Tiña Versicolor/complicaciones , Administración Cutánea , Adulto , Antifúngicos/uso terapéutico , Atrofia/complicaciones , Femenino , Humanos , Cetoconazol/uso terapéutico , Tiña Versicolor/tratamiento farmacológicoRESUMEN
Cetuximab is a monoclonal antibody that competitively inhibits the epidermal growth factor receptor (EGFR). It is used for the treatment of metastatic colorectal cancer after first-line therapy. We report the first case of a pustular psoriasiform drug eruption induced by cetuximab in a patient with colorectal cancer. This paradoxical side effect could be the result of an imbalance in downstream molecular pathways due to the EGFR signal blockade that could, in selected patients, induce alternative signalling pathways related to keratinocyte proliferation.
Asunto(s)
Antineoplásicos/efectos adversos , Cetuximab/efectos adversos , Neoplasias Colorrectales/tratamiento farmacológico , Receptores ErbB/metabolismo , Psoriasis/etiología , Piel/efectos de los fármacos , Anciano , Anticuerpos Monoclonales/efectos adversos , Anticuerpos Monoclonales/uso terapéutico , Antineoplásicos/uso terapéutico , Proliferación Celular , Cetuximab/uso terapéutico , Neoplasias Colorrectales/metabolismo , Resistencia a Antineoplásicos , Humanos , Queratinocitos/efectos de los fármacos , Masculino , Psoriasis/metabolismo , Transducción de Señal , Piel/metabolismo , Piel/patologíaRESUMEN
We report acute radiation dermatitis on a patient's back and left arm, which developed 4â weeks after endovascular embolisation of a spinal arteriovenous malformation. Vesciculation and erosions were followed by a gradual re-epithelisation of the skin resulting in rectangular hyperpigmented patches that resolved almost completely within 1â month. Fluoroscopic radiodermatitis has been reported with more frequency over the past decades because of the rise in duration and number of procedures performed under fluoroscopic guidance. Articles concerning this issue are mostly limited to case reports after coronary interventions, renal artery catheterisations, transjugular intrahepatic portosystemic shunt procedures and embolisations of intracranial arteriovenous malformation. To the best of our knowledge, only two cases of radiation dermatitis after spinal arteriovenous malformation embolisation have been reported to date.
Asunto(s)
Fístula Arteriovenosa/terapia , Embolización Terapéutica/efectos adversos , Radiodermatitis/diagnóstico , Administración Tópica , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana Edad , Radiodermatitis/tratamiento farmacológico , Radiodermatitis/etiología , Esteroides/administración & dosificación , Esteroides/uso terapéutico , Resultado del TratamientoRESUMEN
Darier's disease (DD) is an autosomal dominant inherited genodermatosis which is often under- or misdiagnosed. In the majority of cases, the disease manifests in adolescents or young adults with small brownish-yellow, warty, hyperkeratotic papules in multiple seborrheic areas of the body. Localized DD (LDD) is a clinical variant, first described by Kreibich in 1906; only a few cases are reported in the literature. We described the case of an aged woman presenting with LDD, and we review the literature on this subject.