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2.
J Investig Med High Impact Case Rep ; 8: 2324709620927884, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32462938

RESUMO

The distinction between persistent infection and immunologic reactions in leprosy is often difficult but critically important since their management is different. We present the case of a 51-year-old Vietnamese female who presented in 2015 with areas of erythema and skin infiltration on face and chest, as well as edema on her hands and feet. Skin biopsy was consistent with lepromatous leprosy. She was treated with rifampin, clarithromycin, and levofloxacin for 2 years. Her lower extremity edema was attributed to type 2 immunological reaction for which she was started on prednisone and methotrexate, but she was lost to follow-up for 19 months. She presented with new skin lesions and pain on her extremities. New biopsies revealed an intense neutrophilic infiltrate in the dermis and acid-fast bacilli focally within cutaneous nerve twigs. As compared with the initial biopsy, the inflammatory infiltrates were diminished and the bacilli had a degenerating appearance. These findings were consistent with type 2 immunological reaction. The patient was treated with thalidomide with improvement in the appearance of the skin lesions. A follow-up biopsy showed lack of neutrophilic infiltrates and decreased number of bacilli. This case illustrates the importance of differentiating between persistent infection and immunologic reactions in leprosy. Clinicians should be aware of these complications. A high index of suspicion and accurate interpretation of skin biopsy results are essential for appropriate diagnosis.


Assuntos
Eritema Nodoso/etiologia , Hanseníase Virchowiana/tratamento farmacológico , Hanseníase Virchowiana/patologia , Pele/patologia , Biópsia , Edema/etiologia , Eritema Nodoso/patologia , Feminino , Humanos , Hansenostáticos/uso terapêutico , Hanseníase Virchowiana/classificação , Hanseníase Virchowiana/imunologia , Pessoa de Meia-Idade , Prednisona/uso terapêutico
5.
BMC Infect Dis ; 19(1): 455, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31117984

RESUMO

BACKGROUND: Leprosy typically manifests with skin and peripheral nerve involvement. Musculoskeletal complaints are the third most common, and can be the sole presenting manifestation. They range from arthralgia/arthritis in reactional states to full mimics of systemic rheumatic diseases. Remitting Seronegative Symmetrical Synovitis with Pitting Oedema syndrome has only been described once in a patient with already diagnosed Leprosy. CASE REPORT: A 68-year-old male, from an endemic region of familial amyloid polyneuropathy, presented with an inaugural Remitting Seronegative Symmetrical Synovitis with Pitting Oedema like syndrome, more that 20 years after travelling to Leprosy endemic areas. Arthritis would resurface whenever oral prednisone was tapered, so methotrexate was started, controlling the complaints. Only one year later, after the appearance of peripheral neuropathy and skin lesions, it was possible to diagnose Leprosy, through the identification of Mycobacterium leprae bacilli in a peripheral nerve biopsy. CONCLUSION: This report is an example of the heterogeneity of manifestations of Leprosy, namely rheumatic, and the challenge of diagnosing it when typical complaints are absent. It is also a reminder that this disease should be considered whenever a patient with a combination of skin/neurologic/rheumatic complaints has travelled to endemic countries in the past.


Assuntos
Edema/diagnóstico , Hanseníase/etiologia , Mycobacterium leprae/isolamento & purificação , Sinovite/diagnóstico , Idoso , Antibacterianos , Artrite/tratamento farmacológico , Artrite/etiologia , Edema/etiologia , Humanos , Hanseníase/tratamento farmacológico , Hanseníase/microbiologia , Masculino , Mycobacterium leprae/patogenicidade , Prednisona/administração & dosagem , Prednisona/uso terapêutico , Pele/microbiologia , Pele/patologia , Síndrome , Sinovite/etiologia
6.
Artigo em Inglês | MEDLINE | ID: mdl-30560814

RESUMO

Lasers and light-based devices are indispensable to an aesthetic dermatology practice. The growing popularity of lasers has been matched by a sharp increase in the incidence of complications. The Indian skin with its high melanin content is more prone to injury and careful setting of laser parameters, early detection of complications and immediate therapy are vital to avoiding permanent sequelae. We review the various complications that occur during laser procedures and their management.


Assuntos
Terapia a Laser/efeitos adversos , Fototerapia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Pigmentação da Pele , Vesícula/diagnóstico , Vesícula/etiologia , Vesícula/prevenção & controle , Edema/diagnóstico , Edema/etiologia , Edema/prevenção & controle , Humanos , Terapia a Laser/tendências , Terapia com Luz de Baixa Intensidade/efeitos adversos , Terapia com Luz de Baixa Intensidade/tendências , Fototerapia/tendências , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/prevenção & controle
8.
PLoS Negl Trop Dis ; 11(10): e0006011, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29028793

RESUMO

BACKGROUND: Leprosy reactions are a significant cause of morbidity in leprosy population. Erythema nodosum leprosum (ENL) is an immunological complication affecting approximately 50% of patients with lepromatous leprosy (LL) and 10% of borderline lepromatous (BL) leprosy. ENL is associated with clinical features such as skin lesions, neuritis, arthritis, dactylitis, eye inflammation, osteitis, orchitis, lymphadenitis and nephritis. ENL is treated mainly with corticosteroids and corticosteroids are often required for extended periods of time which may lead to serious adverse effects. High mortality rate and increased morbidity associated with corticosteroid treatment of ENL has been reported. For improved and evidence-based treatment of ENL, documenting the systems affected by ENL is important. We report here the clinical features of ENL in a cohort of patients with acute ENL who were recruited for a clinico-pathological study before and after prednisolone treatment. MATERIALS AND METHODS: A case-control study was performed at ALERT hospital, Ethiopia. Forty-six LL patients with ENL and 31 non-reactional LL matched controls were enrolled to the study and followed for 28 weeks. Clinical features were systematically documented at three visits (before, during and after predinsolone treatment of ENL cases) using a specifically designed form. Skin biopsy samples were obtained from each patient before and after treatment and used for histopathological investigations to supplement the clinical data. RESULTS: Pain was the most common symptom reported (98%) by patients with ENL. Eighty percent of them had reported skin pain and more than 70% had nerve and joint pain at enrolment. About 40% of the patients developed chronic ENL. Most individuals 95.7% had nodular skin lesions. Over half of patients with ENL had old nerve function impairment (NFI) while 13% had new NFI at enrolment. Facial and limb oedema were present in 60% patients. Regarding pathological findings before treatment, dermal neutrophilic infiltration was noted in 58.8% of patients with ENL compared to 14.3% in LL controls. Only 14.7% patients with ENL had evidence of vasculitis at enrolment. CONCLUSION: In our study, painful nodular skin lesions were present in all ENL patients. Only 58% patients had dermal polymorphonuclear cell infiltration showing that not all clinically confirmed ENL cases have neutrophilic infiltration in lesions. Very few patients had histological evidence of vasculitis. Many patients developed chronic ENL and these patients require inpatient corticosteroid treatment for extended periods which challenges the health service facility in resource poor settings, as well as the patient's quality of life.


Assuntos
Eritema Nodoso/patologia , Eritema Nodoso/fisiopatologia , Hanseníase Virchowiana/patologia , Hanseníase Virchowiana/fisiopatologia , Pele/patologia , Adolescente , Corticosteroides/efeitos adversos , Corticosteroides/uso terapêutico , Adulto , Biópsia , Estudos de Casos e Controles , Edema/etiologia , Eritema Nodoso/tratamento farmacológico , Etiópia/epidemiologia , Extremidades , Feminino , Hospitais , Humanos , Hanseníase Dimorfa/complicações , Hanseníase Virchowiana/complicações , Hanseníase Virchowiana/microbiologia , Masculino , Pessoa de Meia-Idade , Infiltração de Neutrófilos , Dor , Qualidade de Vida , Pele/efeitos dos fármacos , Pele/imunologia , Pele/microbiologia , Vasculite/etiologia , Vasculite/patologia , Adulto Jovem
9.
J Ethnopharmacol ; 195: 298-308, 2017 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-27880883

RESUMO

ETHNOPHARMACOLOGICAL RELEVANCE: 3ß,6ß,16ß-Trihydroxylup-20(29)-ene (TTHL) is a triterpene isolated from the flowers of Combretum leprosum, a plant used in folk medicine in the north of Brazil for the treatment of skin disorders. AIM OF THE STUDY: In the present study, TTHL was evaluated as a potential topical anti-inflammatory and anti-proliferative agent through in vivo and in vitro models. MATERIAL AND METHODS: Anti-inflammmatory and anti-proliferative effects of TTHL were assessed using Swiss mice in acute and chronic models of skin inflammation induced by 12-O-tetradecanoylphorbol-acetate (TPA) application. Anti-proliferative activity was proved through in vitro experiments with the HaCaT human keratinocyte cell line. RESULTS: Treatment with TTHL inhibited inflammatory parameters such as oedema formation and cellular infiltration in acute and chronic models. In the chronic model, TTHL also inhibited epidermal hyperproliferation, as evidenced by reduction of epidermis thickness and proliferating cell nuclear antigen expression. The anti-proliferative effect was confirmed by the capability of TTHL in reducing the proliferation and inducing cell apoptosis of HaCaT cells. Suggesting a mechanism of action, TTHL showed activation of corticosteroid receptors, but without the induction of corticosteroid-related cutaneous side effects. CONCLUSION: Our results demonstrate consistent anti-inflammatory and anti-proliferative activity and assign TTHL as a valuable tool in the development of a new treatment for skin inflammatory and proliferative diseases, such as psoriasis.


Assuntos
Anti-Inflamatórios/farmacologia , Proliferação de Células/efeitos dos fármacos , Dermatite de Contato/prevenção & controle , Queratinócitos/efeitos dos fármacos , Psoríase/prevenção & controle , Pele/efeitos dos fármacos , Triterpenos/farmacologia , Animais , Apoptose/efeitos dos fármacos , Linhagem Celular , Doença Crônica , Dermatite de Contato/etiologia , Dermatite de Contato/metabolismo , Dermatite de Contato/patologia , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Edema/induzido quimicamente , Edema/prevenção & controle , Feminino , Antagonistas de Hormônios/farmacologia , Humanos , Queratinócitos/metabolismo , Queratinócitos/patologia , Camundongos , Mifepristona/farmacologia , Antígeno Nuclear de Célula em Proliferação/metabolismo , Psoríase/induzido quimicamente , Psoríase/metabolismo , Psoríase/patologia , Receptores de Glucocorticoides/efeitos dos fármacos , Receptores de Glucocorticoides/metabolismo , Pele/metabolismo , Pele/patologia , Acetato de Tetradecanoilforbol , Fatores de Tempo
11.
Artigo em Inglês | MEDLINE | ID: mdl-26924405

RESUMO

BACKGROUND: Autologous platelet-rich plasma has recently attracted significant attention throughout the medical field for its wound-healing ability. AIMS: This study was conducted to investigate the potential of platelet-rich plasma combined with fractional laser therapy in the treatment of acne scarring. METHODS: Sixteen patients (12 women and 4 men) who underwent split-face therapy were analyzed in this study. They received ablative fractional carbon dioxide laser combined with intradermal platelet-rich plasma treatment on one half of their face and ablative fractional carbon dioxide laser with intradermal normal saline on the other half. The injections were administered immediately after laser therapy. The treatment sessions were repeated after an interval of one month. The clinical response was assessed based on patient satisfaction and the objective evaluation of serial photographs by two blinded dermatologists at baseline, 1 month after the first treatment session and 4 months after the second. The adverse effects including erythema and edema were scored by participants on days 0, 2, 4, 6, 8, 15 and 30 after each session. RESULTS: Overall clinical improvement of acne scars was higher on the platelet-rich plasma-fractional carbon dioxide laser treated side but the difference was not statistically significant either 1 month after the first treatment session (P = 0.15) or 4 months after the second (P = 0.23). In addition, adverse effects (erythema and edema) on the platelet-rich plasma-fractional carbon dioxide laser-treated side were more severe and of longer duration. LIMITATIONS: Small sample size, absence of all skin phototypes within the study group and lack of objective methods for the evaluation of response to treatment and adverse effects were the limitations. CONCLUSION: This study demonstrated that adding platelet-rich plasma to fractional carbon dioxide laser treatment did not produce any statistically significant synergistic effects and also resulted in more severe side effects and longer downtime.


Assuntos
Acne Vulgar/diagnóstico , Acne Vulgar/terapia , Cicatriz/diagnóstico , Cicatriz/terapia , Lasers de Gás/uso terapêutico , Plasma Rico em Plaquetas , Adulto , Terapia Combinada/efeitos adversos , Edema/induzido quimicamente , Edema/etiologia , Feminino , Humanos , Injeções Intradérmicas/efeitos adversos , Terapia a Laser/efeitos adversos , Terapia a Laser/métodos , Lasers de Gás/efeitos adversos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
16.
Artigo em Inglês | MEDLINE | ID: mdl-25201839

RESUMO

BACKGROUND: Leprosy remains an important health problem mainly in the African and South-East Asia regions. Type 1 reaction is an immune-mediated phenomenon known to complicate at least 30% of patients of leprosy. Diagnosing type 1 reaction correctly is important for timely institution of therapy to prevent and treat neuropathy-associated disability and morbidity. There is paucity of literature on definitive criteria for histologic diagnosis of type 1 reaction. This study was conducted to determine the key histologic variables for diagnosing type 1 reaction. METHODS: This was a prospective study recruiting 104 patients with borderline leprosy. Three pathologists blinded to the clinical diagnosis independently assessed the cases. The agreement between each histological variable and clinical diagnosis was then calculated by using Cohen's kappa (Κ) coefficient. RESULTS: Histological diagnosis of type 1 reaction was given to 27 (67.5%) of 40 clinically diagnosed cases of type 1 reaction cases. Histological variables chosen as key variables for histological diagnosis of type 1 reaction were presence of giant cells, dermal edema, intragranuloma edema, granuloma fraction 31-50%, and presence of medium to large giant cells. CONCLUSION: This study has shown that T1R are still underdiagnosed histologically in comparison with clinical assessments. The key variables for diagnosing type 1 reaction were proposed.


Assuntos
Hanseníase Dimorfa/patologia , Pele/patologia , Adulto , Apoptose , Biópsia , Estudos de Casos e Controles , Edema/patologia , Feminino , Células Gigantes/patologia , Granuloma/patologia , Humanos , Masculino , Estudos Prospectivos
17.
J Ethnopharmacol ; 155(1): 552-62, 2014 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-24952279

RESUMO

ETHNOPHARMACOLOGICAL RELEVANCE: Serotherapy against snakebite is often unavailable in some regions over Brazil, where people make use of plants from folk medicine to deal with ophidic accidents. About 10% of Combretum species have some ethnopharmacological use, including treatment of snakebites. MATERIALS AND METHODS: We evaluated the ability of the extract of Combretum leprosum and its component arjunolic acid to reduce some in vivo and in vitro effects of Bothrops jararacussu and Bothrops jararaca venoms. The protocols investigated include phospholipase, proteolytic, collagenase, hyaluronidase, procoagulant, hemorrhagic, edematogenic, myotoxic and lethal activities induced by these venoms in Swiss mice. RESULTS: Oral pre-treatment with arjunolic acid reduced the Bothrops jararacussu lethality in up to 75%, while preincubation prevented the death of all the animals. Hemoconcentration effect of Bothrops jararacussu venom was confirmed two hours after i.p. injection, while preincubation with arjunolic acid preserved the hematocrit levels. Both Combretum leprosum extract and arjunolic acid abolished the myotoxic action of Bothrops jararacussu venom. Preincubation of Bothrops jararacussu venom with the extract or arjunolic acid prevented the increase of plasma creatine kinase activity in mice. The hemorrhagic activity of Bothrops jararaca crude venom was reduced down to about 90% and completely inhibited by preincubation with 10 mg/kg or 100 mg/kg Combretum leprosum extract, respectively, while the preincubation and the pretreatment with 30 mg/kg of arjunolic acid reduced the venom hemorrhagic activity down to about 12% and 58%, respectively. The preincubation of the venom with both extract and 30 mg/kg arjunolic acid significantly reduced the bleeding amount induced by Bothrops jararacussu venom. The extract of Combretum leprosum decreased the edema formation induced by Bothrops jararacussu venom both in preincubation and pretreatment, but not in posttreatment. Similarly, arjunolic acid preincubated with the venom abolished edema formation, while pre- and posttreatment have been partially effective. Some enzymatic activities of Bothrops jararacussu and Bothrops jararaca venoms, i.e. phospholipase A2, collagenase, proteolytic and hyaluronidase activities, were to some extent inhibited by the extract and arjunolic acid in a concentration-dependent manner. CONCLUSIONS: Altogether, our results show that Combretum leprosum extract can inhibit different activities of two important Brazilian snake venoms, giving support for its popular use in folk medicine in the management of venomous snakebites.


Assuntos
Combretum/química , Venenos de Crotalídeos/antagonistas & inibidores , Extratos Vegetais/farmacologia , Triterpenos/farmacologia , Animais , Antivenenos/administração & dosagem , Antivenenos/isolamento & purificação , Antivenenos/farmacologia , Bothrops , Brasil , Relação Dose-Resposta a Droga , Edema/tratamento farmacológico , Edema/etiologia , Etnofarmacologia , Hemorragia/tratamento farmacológico , Hemorragia/etiologia , Masculino , Medicina Tradicional , Camundongos , Extratos Vegetais/administração & dosagem , Raízes de Plantas , Mordeduras de Serpentes/tratamento farmacológico , Mordeduras de Serpentes/fisiopatologia , Triterpenos/administração & dosagem , Triterpenos/isolamento & purificação
18.
Artigo em Inglês | MEDLINE | ID: mdl-24823404

RESUMO

Adult onset Still's disease is a rare but potentially serious disease. We present five cases of adult-onset Still's disease seen by us over a period of one year. The patients were all females and 28-39 years of age. Symptoms had been present for 2-6 weeks in three patients. The other two had been on a few years' follow-up for rheumatoid arthritis before the onset of rashes and fever. The patients had persistent erythematous maculopapular eruptions on face, body and extremities, with moderate to severe pruritus and/or a burning sensation that decreased their quality of life. The typical evanescent rash was not observed. High ferritin values were detected in all the patients and total serum IgE was increased in two. All the patients were started on oral prednisolone (0.5-1.0 mg/kg/day), and methotrexate (10-15 mg/week) had to be added in three patients. One patient was started on tocilizumab due to recalcitrant disease and one was lost to follow-up. Further investigation and classification of the various atypical cutaneous findings in adult-onset Still's disease is necessary.


Assuntos
Edema/patologia , Eritema/patologia , Exantema/patologia , Pele/patologia , Doença de Still de Início Tardio/patologia , Adulto , Feminino , Humanos
19.
Artigo em Inglês | MEDLINE | ID: mdl-24448146

RESUMO

Mondor's disease is a rare condition, which involves the thrombophlebitis of the superficial veins of the breast and anterior chest wall. A 37-year-old woman presented with sudden onset of local pain and edema on her right chest wall, accompanied by a longitudinal retraction of the skin during arm abduction in the area. Clinical, histological and ultrasonographic findings confirmed Mondor's disease and the treatment was symptomatic, using pain relievers and warm compresses. The symptomatology remitted within 2 weeks of therapy. Mondor's disease is a rare condition where ultrasound complements the clinical evaluation and allows the characterization of certain abnormalities, which correlated with functional biochemical data and other procedures may substitute the need of biopsy.


Assuntos
Edema/etiologia , Dor/etiologia , Parede Torácica/irrigação sanguínea , Tromboflebite/diagnóstico , Adulto , Feminino , Humanos , Tromboflebite/complicações , Tromboflebite/terapia
20.
Dermatol Online J ; 21(3)2014 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-25780976

RESUMO

Otophyma is a rare condition characterized by edematous deformation of the ear that is considered to be the end-stage of an inflammatory process such as rosacea and eczema. This report illustrates a case in an elderly male, originally thought to have leprosy. Biopsy revealed a nodular infiltration of inflammatory cells around adnexal structures and an intraepidermal cyst. No acid-fast organisms were identified. We present a patient who is of a different ethnic group than usually seen with this disease and provide a review of the clinical presentation, histopathological features, and management of this rare condition.


Assuntos
Deformidades Adquiridas da Orelha/etnologia , Deformidades Adquiridas da Orelha/patologia , Orelha Externa/patologia , Edema/etnologia , Edema/patologia , Diagnóstico Diferencial , Deformidades Adquiridas da Orelha/cirurgia , Orelha Externa/cirurgia , Edema/cirurgia , Cisto Epidérmico/etnologia , Cisto Epidérmico/patologia , Humanos , Hanseníase/diagnóstico , Masculino , Pessoa de Meia-Idade
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