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3.
Aten Primaria ; 56(7): 102922, 2024 Jul.
Artigo em Espanhol | MEDLINE | ID: mdl-38583414

RESUMO

The care of migrant patients includes initial screening and lifelong monitoring, highlighting the importance of preventing and tracking chronic, communicable and non-communicable diseases. The prevalence of hypertension, diabetes mellitus, dyslipidemia, and obesity varies by ethnicity, influenced by genetic factors, lifestyle, and socio-economic status. Preventive measures, health promotion, and risk factor identification are crucial. Chronic communicable diseases may manifest years after transmission, underscoring the necessity of primary care screening, especially for populations from endemic or high-risk areas. Imported skin lesions are a common reason for consultation among migrant and traveller patients. Their ethiology is varied, ranging from common conditions such as scabies, mycoses, and urticaria to tropical dermatoses like filariasis and leprosy.


Assuntos
Dermatopatias , Migrantes , Humanos , Doença Crônica , Dermatopatias/etiologia , Doenças não Transmissíveis/epidemiologia , Doenças Transmissíveis/epidemiologia
4.
Am J Trop Med Hyg ; 110(2): 364-369, 2024 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-38169455

RESUMO

Skin diseases are a major public health concern in Indonesia, although access to specialized care in remote areas is limited. We initiated a low-cost teledermatology service in Sumba, a remote island in eastern Indonesia. Eighteen healthcare workers (HCWs) at five primary healthcare centers received training to manage common skin diseases and submit clinical cases beyond their expertise to an online platform. Submitted cases were reviewed by at least one dermatologist. Diagnostic agreement between HCWs and dermatologists was calculated. The HCWs participated in a satisfaction survey 2 years after project initiation. Since October 2020, of 10,384 patients presenting with skin complaints in a 24-month period, 307 (3%) were submitted for a teledermatology consultation. The most frequent skin diseases were infections and infestations (n = 162, 52.8%) and eczematous (85, 27.7%) and inflammatory (17, 5.5%) conditions. Fifty-three patients (17.3%) were diagnosed with a neglected tropical skin disease, including leprosy and scabies. Dermatologist advice was provided within a median of 50 minutes (interquartile range, 18-255 minutes), with 91.9% of consultations occurring within 24 hours. The diagnostic agreement level between HCWs and dermatologists significantly improved over time, from 46.9% in the first 6-month period (κ = 0.45; 95% CI, 0.37-0.54) to 77.2% in the last 6-month period (κ = 0.76; 95% CI, 0.67-0.86; global P < 0.001). The HCWs reported that the teledermatology service was extremely/very useful in supporting daily practice (100%) and improved their knowledge of skin diseases tremendously/a lot (92%). Teledermatology can improve accessibility and quality of skin services in medically underserved areas, providing opportunities for scalability and knowledge transfer to frontline HCWs.


Assuntos
Dermatologia , Dermatopatias , Telemedicina , Humanos , Indonésia/epidemiologia , Dermatopatias/diagnóstico , Dermatopatias/terapia , Higiene da Pele
5.
J Ethnopharmacol ; 324: 117818, 2024 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-38296173

RESUMO

ETHNOPHARMACOLOGICAL RELEVANCE: Ferns form an important part of the human diet. Young fern fiddleheads are mostly consumed as vegetables, while the rhizomes are often extracted for starch. These edible ferns are also often employed in traditional medicine, where all parts of the plant are used, mostly to prepare extracts. These extracts are applied either externally as lotions and baths or internally as potions, decoctions and teas. Ailments traditionally treated with ferns include coughs, colds, fevers, pain, burns and wounds, asthma, rheumatism, diarrhoea, or skin diseases (eczema, rashes, itching, leprosy). AIM OF THE REVIEW: This review aims to compile the worldwide knowledge on the traditional medicinal uses of edible fern species correlating to reported biological activities and isolated bioactive compounds. MATERIALS AND METHODS: The articles and books published on edible fern species were searched through the online databases Web of Science, Pubmed and Google Scholar, with critical evaluation of the hits. The time period up to the end of 2022 was included. RESULTS: First, the edible fern species were identified based on the literature data. A total of 90 fern species were identified that are eaten around the world and are also used in traditional medicine. Ailments treated are often associated with inflammation or bacterial infection. However, only the most common and well-known fern species, were investigated for their biological activity. The most studied species are Blechnum orientale L., Cibotium barometz (L.) J. Sm., Diplazium esculentum (Retz.) Sw., Marsilea minuta L., Osmunda japonica Thunb., Polypodium vulgare L., and Stenochlaena palustris (Burm.) Bedd. Most of the fern extracts have been studied for their antioxidant, anti-inflammatory and antimicrobial activities. Not surprisingly, antioxidant capacity has been the most studied, with results reported for 28 edible fern species. Ferns have been found to be very rich sources of flavonoids, polyphenols, polyunsaturated fatty acids, carotenoids, terpenoids and steroids and most of these compounds are remarkable free radical scavengers responsible for the outstanding antioxidant capacity of fern extracts. As far as clinical trials are concerned, extracts from only three edible fern species have been evaluated. CONCLUSIONS: The extracts of edible fern species exert antioxidant anti-inflammatory and related biological activities, which is consistent with their traditional medicinal use in the treatment of wounds, burns, colds, coughs, skin diseases and intestinal diseases. However, studies to prove pharmacological activities are scarce, and require chemical-biological standardization. Furthermore, correct botanical classification needs to be included in publications to simplify data acquisition. Finally, more in-depth phytochemical studies, allowing the linking of traditional use to pharmacological relevance are needed to be done in a standardized way.


Assuntos
Queimaduras , Resfriado Comum , Gleiquênias , Dermatopatias , Humanos , Etnofarmacologia , Fitoterapia , Antioxidantes , Resfriado Comum/tratamento farmacológico , Extratos Vegetais/farmacologia , Extratos Vegetais/uso terapêutico , Compostos Fitoquímicos/farmacologia , Compostos Fitoquímicos/uso terapêutico , Anti-Inflamatórios/farmacologia , Anti-Inflamatórios/uso terapêutico , Queimaduras/tratamento farmacológico , Tosse/tratamento farmacológico , Dermatopatias/tratamento farmacológico
6.
Br J Dermatol ; 190(3): 305-315, 2024 Feb 16.
Artigo em Inglês | MEDLINE | ID: mdl-37889986

RESUMO

Inflammasomes are cytoplasmic protein complexes that play a crucial role in protecting the host against pathogenic and sterile stressors by initiating inflammation. Upon activation, these complexes directly regulate the proteolytic processing and activation of proinflammatory cytokines interleukin (IL)-1ß and IL-18 to induce a potent inflammatory response, and induce a programmed form of cell death called pyroptosis to expose intracellular pathogens to the surveillance of the immune system, thus perpetuating inflammation. There are various types of inflammasome complexes, with the NLRP1 (nucleotide-binding domain, leucine-rich-containing family, pyrin domain-containing-1) inflammasome being the first one identified and currently recognized as the predominant inflammasome sensor protein in human keratinocytes. Human NLRP1 exhibits a unique domain structure, containing both an N-terminal pyrin (PYD) domain and an effector C-terminal caspase recruitment domain (CARD). It can be activated by diverse stimuli, such as viruses, ultraviolet B radiation and ribotoxic stress responses. Specific mutations in NLRP1 or related genes have been associated with rare monogenic skin disorders, such as multiple self-healing palmoplantar carcinoma; familial keratosis lichenoides chronica; autoinflammation with arthritis and dyskeratosis; and dipeptidyl peptidase 9 deficiency. Recent research breakthroughs have also highlighted the involvement of dysfunctions in the NLRP1 pathway in a handful of seemingly unrelated dermatological conditions. These range from monogenic autoinflammatory diseases to polygenic autoimmune diseases such as vitiligo, psoriasis, atopic dermatitis and skin cancer, including squamous cell carcinoma, melanoma and Kaposi sarcoma. Additionally, emerging evidence implicates NLRP1 in systemic lupus erythematosus, pemphigus vulgaris, Addison disease, Papillon-Lefèvre syndrome and leprosy. The aim of this review is to shed light on the implications of pathological dysregulation of the NLRP1 inflammasome in skin diseases and investigate the potential rationale for targeting this pathway as a future therapeutic approach.


Assuntos
Dermatite , Dermatopatias , Neoplasias Cutâneas , Humanos , Inflamassomos , Proteínas Adaptadoras de Transdução de Sinal/genética , Proteínas Reguladoras de Apoptose/metabolismo , Proteínas NLR/metabolismo , Neoplasias Cutâneas/patologia , Dermatopatias/etiologia , Inflamação/genética , Interleucina-1beta/metabolismo
7.
Am J Trop Med Hyg ; 109(6): 1260-1265, 2023 12 06.
Artigo em Inglês | MEDLINE | ID: mdl-37931307

RESUMO

Since the introduction of multidrug therapy (MDT), various disabilities/morbidities due to leprosy have been prevented. However, there is a subset of patients in whom the skin lesions do not resolve completely or remain unchanged despite a full course of MDT, which is a great source of anxiety to the patient and their family members. Hence, we tried to ascertain the putative causes and risk factors of persistent skin lesions (PSLs) by analyzing the clinical, histopathological, bacteriological, and drug resistance patterns. This is a retrospective, cohort study wherein 35 patients who had PSLs after completion of MDT were included. The majority of the patients were 18 to 30 years of age, with males predominating. Borderline tuberculoid leprosy was the most common clinical spectrum observed (71.4%). The majority had PSLs distributed predominantly over photo-exposed sites (upper limbs > trunk > face). Eight patients (22.8%) had a history of contact with leprosy patients in their family, and six patients (17.1%) had associated comorbidities. Improvement in histopathological parameters such as a decrease in granuloma fraction was observed in 22 patients (62.8%) with PSLs after release from treatment in comparison with baseline. Four patients (11.4%) were noted to have drug resistance (three to rifampicin and one to dapsone). Thus, our study emphasizes that leprosy patients with PSLs after completion of MDT should undergo histopathological evaluation and drug resistance studies.


Assuntos
Hanseníase , Dermatopatias , Masculino , Humanos , Hansenostáticos , Estudos Retrospectivos , Quimioterapia Combinada , Estudos de Coortes , Hanseníase/complicações , Hanseníase/tratamento farmacológico , Hanseníase/epidemiologia , Dapsona/uso terapêutico , Dapsona/efeitos adversos , Dermatopatias/tratamento farmacológico
8.
Clin Dermatol ; 41(6): 782-788, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37778706

RESUMO

The cult (system of religious beliefs and rituals) of saints in Western Europe appeared in the 3rd century CE and gained momentum from the 4th to the 6th centuries. Its importance for European society in late antiquity and the early Middle Ages was undeniable; holy medicine was the only hope for sick people because the number of physicians was insufficient, and usually physicians were helpless in the face of most of the ailments that plagued society at that time. The number of saints had increased over the years, and people sought medical help from them through prayer and other religious practices. Some saints "specialized" in the treatment of various wounds, including skin diseases. Our research revealed many saints who were patrons of wounds and skin. They can be collected in three groups: patron saints against snakebites and dog bites; patron saints of the treatment of wounds, ulcers, burns, and frostbite; and patron saints against spreadable diseases such as ergotism, leprosy, and scabies. The large number of saints who were patrons against snakebites and dog bites shows the relevance and importance of the problem. In our research, we tried to find out whether the cult of saints led to the development of hospitals for the treatment of skin diseases like ergotism in the hospital of Brother St. Anthony or only in miracles of healing emphasizing the power of faith in the cure of diseases.


Assuntos
Ergotismo , Santos , Dermatopatias , Mordeduras de Serpentes , Animais , Cães , Humanos , Religião e Medicina , Mordeduras de Serpentes/terapia , Santos/história
10.
Indian J Dermatol Venereol Leprol ; 89(5): 688-690, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37609754

RESUMO

The Janus kinase (JAK)-signal transducer and activator of transcription (STAT) pathway is a key regulatory signaling system for cellular proliferation, differentiation, and apoptosis. In addition, JAK signaling pathway plays critical roles in orchestrating immune response through its interactions with the cytokine receptors and the transcriptions factors. Several key cytokines use JAK-STAT signaling proteins to transduce intra-cellular signals which are involved in the pathogenesis of autoimmune and inflammatory diseases such as in psoriatic disease (psoriasis, psoriatic arthritis), atopic dermatitis, alopecia areata, vitiligo, rheumatoid arthritis, ankylosing spondylitis, lupus erythematosus, Sjogren's syndrome, and other autoimmune diseases. In recent years, understandings of the molecular mechanisms of JAK-STAT pathway in the inflammatory proliferative cascades of autoimmune diseases has led to the development of JAK inhibitors and has opened a new dimension for the treatment of systemic and cutaneous inflammatory diseases. In this symposium we have provided a broad perspective on the use of Janus kinase inhibitors in cutaneous autoimmune diseases.


Assuntos
Doenças Autoimunes , Inibidores de Janus Quinases , Dermatopatias , Humanos , Inibidores de Janus Quinases/uso terapêutico , Janus Quinases , Fatores de Transcrição STAT/metabolismo , Transdução de Sinais , Dermatopatias/tratamento farmacológico , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/tratamento farmacológico
11.
PLoS Negl Trop Dis ; 17(8): e0011230, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37578966

RESUMO

BACKGROUND: Deep learning, which is a part of a broader concept of artificial intelligence (AI) and/or machine learning has achieved remarkable success in vision tasks. While there is growing interest in the use of this technology in diagnostic support for skin-related neglected tropical diseases (skin NTDs), there have been limited studies in this area and fewer focused on dark skin. In this study, we aimed to develop deep learning based AI models with clinical images we collected for five skin NTDs, namely, Buruli ulcer, leprosy, mycetoma, scabies, and yaws, to understand how diagnostic accuracy can or cannot be improved using different models and training patterns. METHODOLOGY: This study used photographs collected prospectively in Côte d'Ivoire and Ghana through our ongoing studies with use of digital health tools for clinical data documentation and for teledermatology. Our dataset included a total of 1,709 images from 506 patients. Two convolutional neural networks, ResNet-50 and VGG-16 models were adopted to examine the performance of different deep learning architectures and validate their feasibility in diagnosis of the targeted skin NTDs. PRINCIPAL FINDINGS: The two models were able to correctly predict over 70% of the diagnoses, and there was a consistent performance improvement with more training samples. The ResNet-50 model performed better than the VGG-16 model. A model trained with PCR confirmed cases of Buruli ulcer yielded 1-3% increase in prediction accuracy across all diseases, except, for mycetoma, over a model which training sets included unconfirmed cases. CONCLUSIONS: Our approach was to have the deep learning model distinguish between multiple pathologies simultaneously-which is close to real-world practice. The more images used for training, the more accurate the diagnosis became. The percentages of correct diagnosis increased with PCR-positive cases of Buruli ulcer. This demonstrated that it may be better to input images from the more accurately diagnosed cases in the training models also for achieving better accuracy in the generated AI models. However, the increase was marginal which may be an indication that the accuracy of clinical diagnosis alone is reliable to an extent for Buruli ulcer. Diagnostic tests also have their flaws, and they are not always reliable. One hope for AI is that it will objectively resolve this gap between diagnostic tests and clinical diagnoses with the addition of another tool. While there are still challenges to be overcome, there is a potential for AI to address the unmet needs where access to medical care is limited, like for those affected by skin NTDs.


Assuntos
Úlcera de Buruli , Aprendizado Profundo , Micetoma , Dermatopatias , Humanos , Inteligência Artificial , Úlcera de Buruli/diagnóstico , Projetos Piloto , Dermatopatias/diagnóstico , Doenças Negligenciadas/diagnóstico
13.
Artigo em Inglês | MEDLINE | ID: mdl-37317726

RESUMO

Neuropathic itch is a relatively common yet under-reported cause of systemic pruritus. It is a debilitating condition often associated with pain, which impairs the patient's quality of life. Although much literature exists about renal and hepatic pruritus, there is a dearth of information and awareness about neuropathic itch. The pathogenesis of neuropathic itch is complex and can result from an insult at any point along the itch pathway, ranging from the peripheral receptors and nerves until the brain. There are several causes of neuropathic itch, many of which do not produce any skin lesions and are thus, often missed. A detailed history and clinical examination are necessary for the diagnosis, while laboratory and radiologic investigations may be needed in select cases. Several therapeutic strategies currently exist involving both non-pharmacological and pharmacological measures, the latter including topical, systemic, and invasive options. Further research is ongoing to clarify its pathogenesis and to design newer targeted therapies with minimal adverse effects. This narrative review highlights the current understanding of this condition, focusing on its causes, pathogenesis, diagnosis, and management, along with newer investigational drugs.


Assuntos
Doenças do Sistema Nervoso Periférico , Dermatopatias , Humanos , Qualidade de Vida , Prurido/diagnóstico , Prurido/etiologia , Prurido/terapia , Dermatopatias/complicações , Encéfalo
14.
JAMA ; 330(3): 275-276, 2023 07 18.
Artigo em Inglês | MEDLINE | ID: mdl-37389854

RESUMO

A previously healthy individual in his 20s had 3 months of annular skin lesions, with numbness and paresthesia in the affected areas. Physical examination revealed multiple tattoos, bilateral palpable thickened auricular and ulnar nerves, and claw-hand deformity; test results for rapid plasma reagin, antinuclear antibodies, rheumatoid factor, acid-fast bacilli, mycobacteria, and fungi were negative, and biopsy did not identify Mycobacterium leprae. What is the diagnosis and what would you do next?


Assuntos
Contratura , Mãos , Hanseníase Tuberculoide , Neuropatias Fibulares , Dermatopatias , Humanos , Contratura/etiologia , Contratura/patologia , Mãos/patologia , Hanseníase Tuberculoide/complicações , Hanseníase Tuberculoide/diagnóstico , Neuropatias Fibulares/etiologia , Neuropatias Fibulares/patologia , Pele/patologia , Dermatopatias/etiologia , Dermatopatias/patologia
15.
PLoS Negl Trop Dis ; 17(5): e0011314, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-37172044

RESUMO

CONTEXT: Since 2013, the World Health Organization has recommended integrated control strategies for neglected tropical diseases (NTDs) with skin manifestations. We evaluated the implementation of an integrated approach to the early detection and rapid treatment of skin NTDs based on mobile clinics in the Ouémé and Plateau areas of Benin. METHODS: This descriptive cross-sectional study was performed in Ouémé and Plateau in Benin from 2018 to 2020. Consultations using mobile teams were performed at various sites selected by reasoned choice based on the epidemiological data of the National Program for the Control of Leprosy and Buruli Ulcer. All individuals presenting with a dermatological lesion who voluntarily approached the multidisciplinary management team on the day of consultation were included. The information collected was kept strictly anonymous and was entered into an Excel 2013 spreadsheet and analyzed with Stata 11 software. RESULTS: In total, 5,267 patients with various skin conditions consulted the medical team. The median age of these patients was 14 years (IQR: 7-34 years). We saw 646 (12.3%) patients presenting NTDs with skin manifestations, principally scabies, in 88.4% (571/646), followed by 37 cases of Buruli ulcer (5.8%), 22 cases of leprosy (3.4%), 15 cases of lymphatic filariasis (2.3%) and one case of mycetoma (0.2%). We detected no cases of yaws. CONCLUSION: This sustainable approach could help to decrease the burden of skin NTDs in resource-limited countries.


Assuntos
Úlcera de Buruli , Hanseníase , Dermatopatias , Humanos , Criança , Adolescente , Adulto Jovem , Adulto , Úlcera de Buruli/diagnóstico , Úlcera de Buruli/tratamento farmacológico , Úlcera de Buruli/epidemiologia , Benin/epidemiologia , Estudos Transversais , Hanseníase/diagnóstico , Hanseníase/epidemiologia , Dermatopatias/diagnóstico , Dermatopatias/epidemiologia , Dermatopatias/terapia , Doenças Negligenciadas/diagnóstico , Doenças Negligenciadas/epidemiologia , Doenças Negligenciadas/prevenção & controle , Encaminhamento e Consulta
19.
Int J Mol Sci ; 24(5)2023 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-36902053

RESUMO

Cutaneous granulomatoses represent a heterogeneous group of diseases, which are defined by macrophage infiltration in the skin. Skin granuloma can be formed in the context of infectious and non-infectious conditions. Recent technological advances have deepened our understanding of the pathophysiology of granulomatous skin inflammation, and they provide novel insights into human tissue macrophage biology at the site of ongoing disease. Here, we discuss findings on macrophage immune function and metabolism derived from three prototypic cutaneous granulomatoses: granuloma annulare, sarcoidosis, and leprosy.


Assuntos
Dermatite , Sarcoidose , Dermatopatias , Humanos , Pele , Macrófagos , Inflamação , Biologia
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