Sociodemographic and clinical profile of patients with occupational contact dermatitis seen at a work-related dermatology service, 2000 - 2014

Abstract: BACKGROUND: Occupational dermatoses are common, especially contact dermatitis. Epidemiological studies on these dermatoses are scarce in Brazil and they are necessary as part of the public policy to protect workers' health. OBJECTIVES: To identify sociodemographic and clinical profile of patients with occupational contact dermatitis seen between 2000 and 2014 at an occupational dermatology service. METHODS: It is a cross-sectional and retrospective study, based on information obtained from the service's database. RESULTS: Of 560 patients with conclusive patch test, 289 (46.9%) presented occupational dermatoses and 213 occupational contact dermatitis with predominance of the allergic type in relation to the irritative type (149:64 respectively). The odds of occupational dermatoses were higher among men and lower among patients aged 50 years or older and with higher level of education. Regarding the possibility of presenting occupational allergic contact dermatitis, only the gender variable was statistically significant. The professions most seen were cleaners, construction workers, painters, mechanics/metallurgists and cooks. The commonest allergens were nickel sulfate, potassium dichromate, cobalt chloride, carba-mix and formaldehyde. STUDY LIMITATIONS: The main limitations of this study are the fact that it was carried out in a tertiary service of occupational dermatoses and the lack of access to some allergens outside the patch test baseline series. CONCLUSIONS: It was possible to identify the sociodemographic and clinical profile of patients with suspected occupational contact dermatitis seen at the Service, beyond the professional groups and allergens related to a high risk of occupational contact dermatitis in this population.

An observational and descriptive study of the epidemiology of and therapeutic approach to onychomycosis in dermatology offices in Brazil / Estudo obervacional descritivo da epidemiologia e abordagem terapêutica da onicomicose nos consultórios dermatológicos no Brasil

Onychomycosis is a type of fungal infection that accounts for over 50% of all onycopathies. Some authors consider superficial mycosis the most difficult to be treated. Very few studies have been carried out in order to assess the epidemiology of onychomycosis in Brazil. To describe the epidemiological profile of onychomycosis in Brazilian dermatology offices and to assess the etiology of the disease, how often mycosis exams are requested, and the treatment adopted. A descriptive, observational study was carried out between May and July, 2010. Thirty-eight dermatologists from different Brazilian regions participated in the study, and 7,852 patients with any skin diseases who had all of their nails examined were included in the study. Of the 7,852 patients, 28.3% were clinically diagnosed as having onychomycosis. Women over 45 years old who practiced exercises or with a personal history of the disease showed greater likelihood of having onychomycosis. The disease was most seen in the feet, and the majority of cases involved the hallux. On the hands, the index finger was the most affected. Mycosis exams were not requested for all clinically suspected cases. When exams were done, results showed that the most common fungus was Trichophyton rubrum. The most common clinical lesion was distal-lateral. The most prescribed topical treatments were amorolfine and ciclopirox olamine, while systemic treatments included fluconazole and terbinafine. This study was important to describe the epidemiological behavior of onychomycosis in Brazilian ...

Fundamentos: As onicomicoses são infecções fúngicas que representam mais de 50% de todas onicopatias e são consideradas por alguns autores a micose superficial de mais difícil tratamento. Poucos estudos foram feitos para investigar a epidemiologia da onicomicose no Brasil. Descrever perfil epidemiológico da onicomicose nos consultórios brasileiros de dermatologia. Também observar a etiologia, a freqüência da solicitação do exame micológico e a terapia empregada. Foi realizado um estudo descritivo e observacional no período de Maio a Julho de 2010. Participaram 38 dermatologistas de diferentes regiões do Brasil e foram incluídos 7852 pacientes. Dos 7852 pacientes, 28.3% apresentaram diagnóstico de onicomicose. Mulheres, maiores de 45 anos, praticantes de esportes, ou com histórico pessoal da doença, apresentaram chance maior de adquirir onicomicose. A doença foi mais frequente nos pés, sendo o hálux, o dedo mais acometido. Nas mãos, o primeiro dedo foi o mais atingido. Exame micológico não foi solicitado para todos os casos. Quando realizado, o fungo mais freqüente foi o Trichophyton rubrum. A lesão clinica mais comum foi a distal-lateral. Os tratamentos tópicos mais prescritos foram amorolfina e ciclopirox olamina, enquanto os sistêmicos foram o fluconazol e a terbinafina. Este estudo foi de fundamental importância para descrever o comportamento epidemiológico ...

Onicomicose por Scytalidium spp.: estudo clínico-epidemiológico em um hospital universitário do Rio de Janeiro, Brasil / Onycomychosis due to Scytalidium spp.: a clinical and epidemiologic study at a University Hospital in Rio de Janeiro, Brazil

FUNDAMENTOS: O Scytalidium spp. é fungo filamentoso, saprobio do solo e plantas, considerado, atualmente, patógeno primário das unhas. A prevalência das infecções ungueais causadas por este fungo vem aumentando nas últimas décadas, embora ainda sejam poucos os trabalhos publicados sobre sua epidemiologia. OBJETIVO: Estudo clínico-epidemiológico dos pacientes portadores de onicomicose por Scytalidium spp. em um hospital universitário do Rio de Janeiro. MÉTODOS: Foram avaliados os dados clínico-epidemiológicos de 30 pacientes com onicomicose por Scytalidium spp. por meio do estudo observacional de 1.295 pacientes que se submeteram a exame micológico ungueal no período de 16 meses. RESULTADOS: A maioria dos pacientes era do sexo feminino (66,6 por cento), a média de idade foi de 56,7 anos e 63,3 por cento eram não-brancos. O nível de escolaridade em 53,3 por cento dos pacientes era o ensino fundamental e a renda familiar predominante foi de 3 a 5 salários mínimos em 36,6 por cento dos entrevistados. Em 90 por cento dos casos, as unhas dos pododáctilos foram acometidas, sendo a alteração clínica mais comum a onicólise (18 pacientes) e em 66,6 por cento dos casos observou-se melanoníquia. O tempo de evolução da doença foi maior do que cinco anos em 43,3 por cento dos casos. Dezenove pacientes (63,3 por cento) já haviam realizado tratamento medicamentoso para o quadro atual. CONCLUSÕES: Os dados mostram que a infecção ungueal pelo Scytalidium spp. é crônica, mais comum no sexo feminino (2:1) e atinge indivíduos adultos. Clinicamente, é semelhante às dermatofitoses. A prevalência na amostra estudada foi de 4,86 por cento e correspondeu a 26,92 por cento dos exames positivos.

BACKGROUND: Scytalidium sp. is a filamentous (thread-like), saprobic fungus which affects soil and plants. It is currently considered a primary pathogen of the nail. The prevalence of nail infections caused by this fungus has been increasing in recent decades, although few published studies have been done on its epidemiology. OBJECTIVE: To study clinico-epidemiological data referring to patients with onychomycosis caused by Scytalidium spp. at a University Hospital in Rio de Janeiro. METHODS: We evaluated the clinical and epidemiological data of 30 patients with onychomycosis by Scytalidium sp. through an observational study of 1295 patients who underwent mycological nail tests over a period of 16 months. RESULTS: The majority of the patients were female (66.6 percent), with an average age of 56.7 years. 63.3 percent of them were nonwhite. 53.3 percent of the patients had attended elementary school and 36.6 percent referred a family income of 3 to 5 minimum wages. In 90 percent of cases, the toenails were affected, primarily with onycholysis (18 patients), and in 66 percent of the cases melanonychia was observed. In 43.3 percent of cases the disease had progressed for more than 5 years. 19 patients (63.3 percent) had undergone some medical treatment for their current condition. CONCLUSIONS: Our data show that nail infection by Scytalidium sp. is chronic, affecting adults, particularly females (2:1). Clinically the disease resembles dermatophytosis. Prevalence of the disease in our sample was 4.86 percent, accounting for 26.92 percent of the positive tests.

Aspectos epidemiológicos de pacientes com lesões ungueais e cutâneas causadas por Scytalidium spp / Epidemiological aspects of patients with ungual and cutaneous lesions caused by Scytalidium spp

FUNDAMENTO: As dermatomicoses causadas por fungos filamentosos não dermatófitos são infecções raras, exceto as onicomicoses, cuja prevalência vem crescendo nos últimos anos. Dentre esses agentes etiológicos destacam-se o Scytalidium dimidiatum e o S. hyalinum, fungos emergentes responsáveis por micoses em unhas e pele. OBJETIVO: Investigar as características epidemiológicas das onicomicoses e micoses de outras localizações causadas pelos fungos do gênero Scytalidium, utilizando-se como parâmetros sexo, idade e localizações das lesões. MÉTODOS: Avaliaram-se 81 amostras com cultura positiva para o gênero em estudo, oriundas de 74 pacientes encaminhados ao Laboratório de Investigação em Dermatologia (ID) situado na cidade do Rio de Janeiro (RJ), no período de 1997 a 2006. As amostras foram submetidas a confirmação diagnóstica por exame direto e cultura. RESULTADOS: A prevalência de onicomicoses por Scytalidium spp. foi de 0,87 por cento, entre as idades de 41 e 60 anos (48,64 por cento). Em relação à localização das lesões, os pés foram mais acometidos (91,36 por cento), com predomínio do hálux esquerdo. No exame direto, as estruturas mais encontradas foram hifas hialinas; na cultura, a espécie S. dimidiatum foi a mais frequente. CONCLUSÃO: As onicomicoses por Scytalidium spp. são raras e o S. dimidiatum foi a espécie mais isolada neste laboratório no período em estudo.

BACKGROUND: Dermatomycoses caused by non-dermatophyte filamentous fungi are rare infections, except for onychomycosis, whose prevalence has increased over the past few years. Among these etiologic agents, we highlight Scytalidium dimidiatum and S. hyalinum, emergent fungi that cause mycoses that affect the nails and skin. OBJECTIVE: To investigate the characteristics of onychomycosis and other mycoses caused by the fungi Scytalidium spp, using sex, age and site of infection as parameters. METHODS: Eighty-one samples were evaluated showing positive culture for Scytalidium spp, obtained from 74 patients referred to the Laboratory of Investigation in Dermatology (ID) located in the city of Rio de Janeiro, RJ, between 1997 and 2006. The samples were submitted to diagnostic confirmation through direct exam and culture. RESULTS: The prevalence of onychomycosis caused by Scytalidium spp. was of 0,87 percent. The most prevalent age was between 41-60 years (48.64 percent). Regarding the site of infection, the feet (91.36 percent) were most affected, with predominance of the left hallux. Hyaline hyphae were the most common structures in direct examination and the species S. dimidiatum was the most frequent in culture. CONCLUSION: Onychomycosis caused by Scytalidium spp. is rare and S. dimidiatum was the most isolated species in this laboratory during the period of the study.

Onychomycosis: Clinico-mycologic study of 130 patients from Himachal Pradesh, India.

BACKGROUND: Onychomycosis is a common nail infection caused by dermatophytes, yeast or other nondermatophyte molds and has diverse clinical presentations. Although common in this part of the country, no significant clinico-mycologic data is available. OBJECTIVES: This study was carried out to document the clinico-mycologic pattern of onychomycosis in Himachal Pradesh (India). METHODS: All consecutive patients of onychomycosis diagnosed clinically during March 2005 to February 2006 were studied for clinical forms, number of nails involved and severity of infection. The clippings from the most severely affected nails were subjected to potassium hydroxide (KOH) mounts for direct microscopy and fungal culture on Sabouraud's dextrose agar. RESULTS: These 130 patients (M:F 98:32) were between 8-76 years of age (mean 41.35 +/- 14.98 years). The prevalence of onychomycosis was higher among farmers and office workers (20% each). Finger or toe nails were exclusively involved in 56.9 and 32.3% patients respectively while these were involved concurrently in the rest of the 10.8% patients. Distal and lateral subungual onychomycosis seen in 73.1% of the specimens was the most common clinical type. KOH- and culture-positivity were recorded in 59.2 and 37.6% cases respectively. Dermatophytes and yeast (Candida albicans) were isolated in 40.8% each of the cultured nail specimens while nondermatophytic molds (NDM) were cultured in 18.6% of the samples. Various dermatophytes cultured were Trichophyton rubrum (32.6%), T. mentagrophytes (6.1%) and T. verrucosum (2.1%) respectively. Aspergillus spp. (6.1%) was the most commonly isolated NDM while other detected molds were Acremonium spp, Fusarium spp,, Scopulariopsis spp, Curvularia spp. and Penicillium marneffei. Peripheral vascular disorders (7.69%), occupational trauma (13.8%), close association with animals (60.78%) and a family history of onychomycosis (26.15%) were a few of the predisposing factors identified. CONCLUSION: Onychomycosis is not uncommon in this part of the country and has similar clinico-mycologic profiles in the different cases detected.

A clinical and mycological study of onychomycosis in HIV infection.

BACKGROUND: Onychomycosis is one of the early manifestations of HIV infection with a prevalence of 15-40%. Multiple nail involvement, isolation of both common and rare species and resistance to treatment are the characteristics of onychomycosis in HIV. AIM: To study the epidemiology, clinical manifestations of onychomycosis in HIV-infected individuals and to identify the various causative fungi microbiologically. METHODS: A total of 250 HIV infected patients, diagnosed by ELISA, were screened for nail involvement; of which 60 patients i.e, 40 males and 20 females, who had clinically suspected untreated fungal infection were included in this study. RESULTS: Of the 60 respondents, 34 (56.66%) were from the 31-40 years age group. Amongst the 40 males, there were 20 manual laborers and 14 farmers; while 18 of 20 females were housewives. Toenail involvement was seen in 38 patients (63.33%), fingernail in 12 patients (20%) while 10 (16.66%) patients had involvement of both. Twenty eight (46.66%) patients gave history of some trauma, 6 (10%) had diabetes mellitus and only 1 patient (1.66%) had history of peripheral vascular disease. Nineteen (31.66%) patients had associated tinea pedis, 5 (8.33%) had tinea manuum, 10 (16.66%) had tinea corporis and 7 (11.66%) had tinea cruris. Twenty one (35%) respondents had distal and lateral superficial onychomycosis (DLSO), 5 (8.33%) had proximal subungual onychomycosis (PSO), 1 (1.66%) had superficial white onychomycosis (SWO), while 33 (55%) had total dystrophic onychomycosis (TDO). Fungal elements were demonstrated by KOH mount in 49 patients (81.66%) and growth was seen in 32 (53.33%) cultures. Dermatophytes were isolated in 13 (21.66%) and nondermatophytic molds (NDM) in 19 (31.66%). Out of the 13 positive dermatophyte cultures, Trichophyton rubrum was isolated on 11 and Trichophyton mentagrophytes on 2 cultures. Of the 19 non-dermatophytic cultures, Aspergillus niger was isolated on 3 and Candida spp. on 12 while Cladosporium spp, Scytalidium hyalinum, Penicillium spp. and Gymnoascus dankaliensis on 1 each. CONCLUSIONS: Total dystrophic onychomycosis was the most common clinical type and NDM were the predominant causative organisms.

Study of onychomycosis: prevailing fungi and pattern of infection.

A mycological study of onychomycosis was undertaken in 88 patients. The nails were judged to be infected by their clinical appearance. Direct microscopy of the nail clips in 20% KOH solution was positive in 72 (81.8%) and culture was positive in 43 (48.8%) cases. Out of the samples cultured, dermatophytes were grown in 26 cases (29.5%), non dermatophyte moulds in 12 (13.6%) and Candida spp. in 5 (5.6%) while 45 (51.1%) samples yielded no growth. Amongst dermatophytes, T. rubrum was found to be commonest etiological agent (57.6%) followed by T. mentagrophyte. Amongst the non-dermatophyte mould (NDM), Aspergillus spp. was the most prevalent species followed by Alternaria spp, Curvularia spp. and Fusarium spp. Commonest age group affected was above 31 years. Males were predominantly affected (65%), male to female ratio being 1.8:1. Fingernails were affected more frequently than toe nails with the ratio of 3:1. Distal and lateral subungual onychomycosis (DLSO) was more common (50%) than other clinical pattern followed by proximal subungual onychomycosis (PSO) (20.4%), white superficial onychomycosis (SWO) (2%), total dystrophic onychomysosis (TDO) (14%) and paronychia (10.2%).

Multicentric squamous cell carcinoma over lesions of porokeratosis palmaris et plantaris disseminata and giant porokeratosis.

Porokeratosis is a specific disorder of keratinization that has five clinical types and shows a characteristic 'cornoid lamella' on histopathology. Malignant degeneration has been described in all forms of porokeratosis. To the best of our knowledge, this is the first Indian report of multicentric squamous cell carcinoma complicating porokeratosis.

Estudio clínico micológico de onicomicosis en ancianos / Clinico-mycological study of onychomycosis in elderly patients

Physical examination of nails was carried out in 210 elderly patients and nail scrapings were obtained from onychomycosis suggested lesions in order to determine their causative agents, incidence and clinical characteristics. Diagnostic was confirmed by the isolation of the agents from 74 patients, mainly from toe-nails (incidence 35.2). Tinea pedis occurred in 25 of the cases and Diabetes mellitus was the most prevalent associated disease and the most frequent clinical characteristics were the thickening, the opacity and the presence of longitudinal strias in the surface of the nails. It was compared the results obtained by microscopic examination and by culture. Trichophyton rubrum was the most common dermatophyte isolated; Candida parapsilosis was dominant among Candida species.

Disidrose: estudo prospectivo de 600 casos / Dyshidrosis: prospective study of 600 cases

O autor realizou um estudo prospectivo em 600 pacientes portadores de disdrose. Após uma revisäo bibliográfica a respeito mostra os resultados obtidos em relaçäo ao sexo, raça, idade, profissäo, localizaçöes das lesöes, meses de freqüência e possíveis causas etiológicas