RESUMO
BACKGROUND: Chronic leg ulcers affect a large portion of the adult population and cause a significant social and economic impact, related to outpatient and hospital care, absence from work, social security expenses, and reduced quality of life. The correct diagnosis and therapeutic approach are essential for a favorable evolution. OBJECTIVE: To gather the experience of Brazilian dermatologists, reviewing the specialized literature to prepare recommendations for the diagnosis and treatment of the main types of chronic leg ulcers. METHODS: Seven specialists from six university centers with experience in chronic leg ulcers were appointed by the Brazilian Society of Dermatology to reach a consensus on the diagnosis and therapeutic management of these ulcers. Based on the adapted DELPHI methodology, relevant elements were considered in the diagnosis and treatment of chronic leg ulcers of the most common causes; then, the recent literature was analyzed using the best scientific evidence. RESULTS: The following themes were defined as relevant for this consensus - the most prevalent differential etiological diagnoses of chronic leg ulcers (venous, arterial, neuropathic, and hypertensive ulcers), as well as the management of each one. It also included the topic of general principles for local management, common to chronic ulcers, regardless of the etiology. CONCLUSION: This consensus addressed the main etiologies of chronic leg ulcers and their management based on scientific evidence to assist dermatologists and other health professionals and benefit the greatest number of patients with this condition.
Assuntos
Dermatologia , Úlcera da Perna , Úlcera Varicosa , Adulto , Brasil , Consenso , Humanos , Úlcera da Perna/diagnóstico , Úlcera da Perna/terapia , Qualidade de Vida , Úlcera Varicosa/diagnóstico , Úlcera Varicosa/terapiaRESUMO
INTRODUCTION: American tegumentary leishmaniasis (ATL) and leprosy share common areas of prevalence, but reports of coinfection are scarce. METHODS: We report a series of 9 ATL-leprosy cases and discuss the association. An integrative diagram to analyze the clinico-immunological features of coinfection with both diseases. RESULTS: Nine patients with leishmaniasis (5 cutaneous, 3 mucocutaneous, 1 disseminated case) exhibited concurrent infection with distinct clinical forms of leprosy. Our diagram-based analysis evidenced a divergent clinico-immunological spectrum for each disease in 8 out of 9 cases. CONCLUSIONS: The spectrum of ATL-leprosy comorbidity suggests that the host has a specific immune response against each pathogen.
Assuntos
Coinfecção/imunologia , Leishmaniose Cutânea/imunologia , Hanseníase/imunologia , Células Th1/imunologia , Células Th2/imunologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Leishmaniose Cutânea/complicações , Hanseníase/complicações , Masculino , Pessoa de Meia-IdadeRESUMO
Abstract INTRODUCTION: American tegumentary leishmaniasis (ATL) and leprosy share common areas of prevalence, but reports of coinfection are scarce. METHODS: We report a series of 9 ATL-leprosy cases and discuss the association. An integrative diagram to analyze the clinico-immunological features of coinfection with both diseases. RESULTS: Nine patients with leishmaniasis (5 cutaneous, 3 mucocutaneous, 1 disseminated case) exhibited concurrent infection with distinct clinical forms of leprosy. Our diagram-based analysis evidenced a divergent clinico-immunological spectrum for each disease in 8 out of 9 cases. CONCLUSIONS: The spectrum of ATL-leprosy comorbidity suggests that the host has a specific immune response against each pathogen.
Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Leishmaniose Cutânea/imunologia , Células Th2/imunologia , Células Th1/imunologia , Hanseníase/imunologia , Leishmaniose Cutânea/complicações , Coinfecção/imunologia , Hanseníase/complicações , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Corticosteroids and/or thalidomides have been associated with thromboembolism events (TBE) in multibacillary (MB) leprosy. This report aimed to determine genetic and laboratory profiles associated with leprosy and TBE. METHODS: Antiphospholipid antibodies (aPL), coagulation-related exams, prothrombin and Leiden's factor V mutations, and ß2-glycoprotein-I (ß2GPI) Val247Leu polymorphism were assessed. RESULTS: Six out of seven patients with leprosy were treated with prednisone and/or thalidomide during TBE and presented at least one positive aPL. All patients presented ß2GPI polymorphism, and one showed prothrombin mutation. CONCLUSIONS: Corticosteroid or thalidomide adverse effects and aPL and ß2GPI polymorphisms may cause TBE in patients with MB leprosy.
Assuntos
Corticosteroides/administração & dosagem , Síndrome Antifosfolipídica , Hanseníase Multibacilar/imunologia , Talidomida/administração & dosagem , Corticosteroides/efeitos adversos , Adulto , Idoso , Anticorpos Antifosfolipídeos/sangue , Anticorpos Antifosfolipídeos/efeitos dos fármacos , Anticorpos Antifosfolipídeos/genética , Síndrome Antifosfolipídica/sangue , Síndrome Antifosfolipídica/tratamento farmacológico , Síndrome Antifosfolipídica/genética , Ensaio de Imunoadsorção Enzimática , Fator V/análise , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Hanseníase Multibacilar/tratamento farmacológico , Hanseníase Multibacilar/genética , Masculino , Pessoa de Meia-Idade , Mutação , Polimorfismo Genético , Protrombina/análise , Talidomida/efeitos adversos , Tromboembolia Venosa/tratamento farmacológico , beta 2-Glicoproteína I/sangueRESUMO
Abstract INTRODUCTION Corticosteroids and/or thalidomides have been associated with thromboembolism events (TBE) in multibacillary (MB) leprosy. This report aimed to determine genetic and laboratory profiles associated with leprosy and TBE. METHODS Antiphospholipid antibodies (aPL), coagulation-related exams, prothrombin and Leiden's factor V mutations, and ß2-glycoprotein-I (ß2GPI) Val247Leu polymorphism were assessed. RESULTS Six out of seven patients with leprosy were treated with prednisone and/or thalidomide during TBE and presented at least one positive aPL. All patients presented ß2GPI polymorphism, and one showed prothrombin mutation. CONCLUSIONS Corticosteroid or thalidomide adverse effects and aPL and ß2GPI polymorphisms may cause TBE in patients with MB leprosy.