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2.
PLoS One ; 15(1): e0227654, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31929590

RESUMO

Tuberculoid leprosy (TT) is characterized by cutaneous lesions called plaques. Although microvascular ultrastructure of TT patients' skin is well-documented, little is known about functional aspects of their microcirculation. We aimed, for the first time, to evaluate, in vivo, the microcirculation of TT cutaneous lesions. Seven TT patients, males, under treatment were included in the study. The spectral analysis of frequency components of flowmotion (endothelial, sympathetic, myogenic, cardiac and respiratory) was performed using laser Doppler flowmetry (LDF). Endothelial dependent and independent vasodilatations were assessed by LDF associated to acetylcholine (ACh) and sodium nitroprusside (SNP) iontophoresis, respectively. Vessel density (VD), perfused vessel density (PVD), proportion of perfused vessels (PPV%), microvascular flow index (MFI) and flow heterogeneity index (FHI), reflecting tissue perfusion and oxygenation, were evaluated through sidestream dark field (SDF) imaging. All microvascular analysis were performed in TT lesions and in healthy skin in the contralateral limb of the same patient, used as control skin. VD, PVD and PPV% and MFI were significantly lower in the cutaneous lesion compared to contralateral healthy skin. The contribution of different frequency components of flowmotion, endothelial dependent and independent vasodilatations and FHI were not statistically different between control skin and cutaneous lesion. Our results suggest that TT cutaneous lesions have a significant impairment of tissue perfusion, which may aggravate peripheral nerve degeneration caused by Mycobacterium leprae infection.


Assuntos
Hanseníase Tuberculoide/diagnóstico por imagem , Microcirculação , Microvasos/diagnóstico por imagem , Pele/diagnóstico por imagem , Acetilcolina/metabolismo , Adulto , Estudos Transversais , Humanos , Hanseníase Tuberculoide/fisiopatologia , Hanseníase Tuberculoide/terapia , Masculino , Microvasos/fisiopatologia , Pessoa de Meia-Idade , Nitroprussiato/metabolismo , Pele/irrigação sanguínea , Pele/fisiopatologia , Adulto Jovem
4.
PLoS One ; 12(4): e0175743, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28419120

RESUMO

Leprosy is a chronic granulomatous infection of skin and peripheral nerves caused by Mycobacterium leprae and is considered the main infectious cause of disability worldwide. Despite the several studies regarding leprosy, little is known about its effects on microvascular structure and function in vivo. Thus, we have aimed to compare skin capillary structure and functional density, cutaneous vasomotion (spontaneous oscillations of arteriolar diameter), which ensures optimal blood flow distribution to skin capillaries) and cutaneous microvascular blood flow and reactivity between ten men with lepromatous leprosy (without any other comorbidity) and ten age- and gender-matched healthy controls. Orthogonal polarization spectral imaging was used to evaluate skin capillary morphology and functional density and laser Doppler flowmetry to evaluate blood flow, vasomotion and spectral analysis of flowmotion (oscillations of blood flow generated by vasomotion) and microvascular reactivity, in response to iontophoresis of acetylcholine and sodium nitroprusside. The contribution of different frequency components of flowmotion (endothelial, neurogenic, myogenic, respiratory and cardiac) was not statistically different between groups. However, endothelial-dependent and -independent vasodilatations elicited by acetylcholine and sodium nitroprusside iontophoresis, respectively, were significantly reduced in lepromatous leprosy patients compared to controls, characterizing the existence of microvascular dysfunction. These patients also presented a significant increase in the number of capillaries with morphological abnormalities and in the diameters of the dermal papilla and capillary bulk when compared to controls. Our results suggest that lepromatous leprosy causes severe microvascular dysfunction and significant alterations in capillary structure. These structural and functional changes are probably induced by exposure of the microvascular bed to chronic inflammation evoked by the Mycobacterium leprae.


Assuntos
Capilares/fisiopatologia , Hanseníase Virchowiana/fisiopatologia , Microcirculação , Dermatopatias Bacterianas/fisiopatologia , Pele/irrigação sanguínea , Acetilcolina/administração & dosagem , Adulto , Estudos Transversais , Feminino , Humanos , Iontoforese , Fluxometria por Laser-Doppler , Hanseníase Virchowiana/diagnóstico , Masculino , Mycobacterium leprae/isolamento & purificação , Nitroprussiato/administração & dosagem , Fluxo Sanguíneo Regional , Pele/fisiopatologia , Dermatopatias Bacterianas/diagnóstico , Vasodilatação
5.
Med Hypotheses ; 84(5): 456-9, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25686506

RESUMO

Hansen's disease is one of the oldest skin diseases in the world characterized by a spectrum of clinical manifestations that are associated with stigmatization and poor quality of life. It is also considered a model disease for investigating the human immune system because of its association with immune reactions, which are thought to be a reflection of the host's immunological response, promoting intense cellular activity or humoral secretion. This relationship between the cellular and microbial components of skin and their regulation by local immune responses may be modulated by a currently neglected behavior: sleep. Recent studies have demonstrated that sleep deprivation may aggravate the progression of chronic dermatological diseases, which in turn can lead to a non-restorative sleep pattern. Indeed, sleep is essential for immune and skin integrity. Thus, we propose here a hypothesis linking Hansen's disease, sleep and immunity in a bidirectional relationship. Hansen's disease patients may demonstrate a worse sleep quality than the general population through the modulation of immunological environment; and sleep restriction, a hallmark of modern society, being a possible predictor of the disease progression.


Assuntos
Hanseníase/imunologia , Modelos Biológicos , Pele/fisiopatologia , Sono/imunologia , Humanos , Pele/imunologia
6.
Indian J Dermatol Venereol Leprol ; 79 Suppl 7: S1-9, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23974689

RESUMO

Psoriasis is a chronic inflammatory papulosquamous disease characterized by multiple remissions and relapses. For long, it was believed to be primarily a disorder of keratinization. However, the successful use of traditional immunosupressants and newer immunomodulatory agents in the treatment of psoriasis led to the belief that psoriasis is primarily a disease of Th1 cell immune dysregulation. Recent developments have brought up several new findings such as the role of Th17 cells and evidence of skin barrier dysfunction in psoriasis, akin to atopic dermatitis. The present review aims to focus on these new developments and explain the pathogenesis of psoriasis on the basis of currently available information.


Assuntos
Imunidade Adaptativa , Imunidade Inata , Psoríase/fisiopatologia , Pele/fisiopatologia , Humanos , Psoríase/genética , Psoríase/imunologia , Pele/lesões , Células Th1/imunologia , Células Th17/imunologia
7.
PLoS Negl Trop Dis ; 6(12): e1975, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23272267

RESUMO

BACKGROUND: Leprosy is an infectious disease affecting skin and peripheral nerves resulting in increased morbidity and physical deformities. Early diagnosis provides opportune treatment and reduces its complications, relying fundamentally on the demonstration of impaired sensation in suggestive cutaneous lesions. The loss of tactile sensitivity in the lesions is preceded by the loss of thermal sensitivity, stressing the importance of the thermal test in the suspicious lesions approach. The gold-standard method for the assessment of thermal sensitivity is the quantitative sensory test (QST). Morphological study may be an alternative approach to access the thin nerve fibers responsible for thermal sensitivity transduction. The few studies reported in leprosy patients pointed out a rarefaction of thin dermo-epidermal fibers in lesions, but used semi-quantitative evaluation methods. METHODOLOGY/PRINCIPAL FINDINGS: This work aimed to study the correlation between the degree of thermal sensitivity impairment measured by QST and the degree of denervation in leprosy skin lesions, evaluated by immunohistochemistry anti-PGP 9.5 and morphometry. Twenty-two patients were included. There were significant differences in skin thermal thresholds among lesions and contralateral skin (cold, warm, cold induced pain and heat induced pain). The mean reduction in the density of intraepidermal and subepidermal fibers in lesions was 79.5% (SD = 19.6) and 80.8% (SD = 24.9), respectively. CONCLUSIONS/SIGNIFICANCE: We observed a good correlation between intraepidermal and subepidermal fibers deficit, but no correlation between these variables and those accounting for the degree of impairment in thermal thresholds, since the thin fibers rarefaction was homogeneously intense in all patients, regardless of the degree of sensory deficit. We believe that the homogeneously intense denervation in leprosy lesions should be objective of further investigations focused on its diagnostic applicability, particularly in selected cases with only discrete sensory impairment, patients unable to perform the sensory test and especially those with nonspecific histopathological finds.


Assuntos
Hanseníase/patologia , Hanseníase/fisiopatologia , Fibras Nervosas/patologia , Fibras Nervosas/fisiologia , Pele/patologia , Pele/fisiopatologia , Sensação Térmica , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Imuno-Histoquímica , Hanseníase/diagnóstico , Masculino , Pessoa de Meia-Idade , Exame Neurológico/métodos , Limiar Sensorial , Adulto Jovem
9.
Artigo em Inglês | MEDLINE | ID: mdl-21508564

RESUMO

For a better understanding of various dermatoses, it is imperative for any physician practising dermatology to have a good theoretical knowledge of the underlying pathophysiologic processes involved in various systemic diseases involving the skin. For an easy grasp over this topic, we have discussed the various phenomena under three broad categories, like (a) clinical--Meyerson, Meirowsky, pathergy, Renbok, (b) laboratory--LE cell, prozone and (c) histopathology--Splendore-Hoeppli.


Assuntos
Dermatologia/métodos , Dermatopatias/patologia , Dermatopatias/fisiopatologia , Pele/patologia , Pele/fisiopatologia , Humanos
10.
J Eur Acad Dermatol Venereol ; 24(6): 704-8, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19929940

RESUMO

BACKGROUND: Oxidative stress (OS) results from an imbalance between free radical generating and scavenging systems. The end product of lipid peroxidation, malondialdehyde (MDA) serves as a marker of cellular damage. Superoxide dismutase (SOD) traps free radicals and acts as a free radical scavenging system. OBJECTIVE: To study OS indices in paucibacillary (PB) and multibacillary (MB) leprosy in tissues and blood. MATERIALS AND METHODS: The study group comprised untreated PB patients (n = 14), untreated MB patients (n = 18) and normal human volunteers (n = 20). SOD activity, MDA level and MDA/SOD ratio were estimated in both blood and tissue. RESULTS: Compared with controls, SOD activity in tissues decreased significantly in both PB and MB patients, while SOD activity in erythrocytes decreased significantly only in MB. In addition, MDA levels increased significantly in tissues of both PB and MB patients. Moreover, the mean level of MDA in plasma of MB patients was significantly higher, whereas there was no significant difference in that of PB patients. This study showed significant increase in OS index (MDA/SOD ratio) in tissue of PB and MB patients and in blood of MB patients only, whereas there was no significant difference in OS index in blood of PB patients compared with that in the controls. CONCLUSION: Oxidative stress was observed in both tissues and blood of MB patients and in tissues of PB patients, denoting its crucial involvement in the pathogenesis of leprosy. This can constitute an important tool in prognosis, treatment and control of leprosy.


Assuntos
Hanseníase/metabolismo , Malondialdeído/metabolismo , Pele/metabolismo , Superóxido Dismutase/metabolismo , Adolescente , Adulto , Biomarcadores/metabolismo , Biópsia , Estudos de Casos e Controles , Estudos de Coortes , Humanos , Hanseníase/patologia , Hanseníase/fisiopatologia , Peroxidação de Lipídeos/fisiologia , Estresse Oxidativo/fisiologia , Espécies Reativas de Oxigênio/metabolismo , Pele/patologia , Pele/fisiopatologia , Adulto Jovem
12.
J Neurosci Methods ; 179(2): 319-22, 2009 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-19428543

RESUMO

OBJECTIVE: To propose an electronic method for sensitivity evaluation in leprosy and to compare it to the Semmes-Weinstein monofilaments. METHODS: Thirty patients attending the Dermatology outpatient clinic of HCFMRP-USP were consecutively evaluated by both the electronic aesthesiometer and Semmes-Weinstein monofilaments on hand and foot test points. The intraclass correlation coefficient (ICC) was calculated to determine the variability of the electronic measures and the Kappa coefficient was calculated to determine the agreement between methods according to their categories (altered and non-altered tactile sensitivity). RESULTS: The ICC was approximately 1, demonstrating repeatability. The Kappa coefficient showed more than 75 and 63% agreement on the hand and foot points, respectively. The mean agreement between the 2 methods for the 7 points of the right and left hand was 77.14 and 75.71%, respectively. The mean agreement for all 10 points was 74.33 and 63.66% on the right and left foot, respectively. In cases of disagreement the detection of altered tactile sensitivity by the electronic esthesiometer on the right and left foot was 90.91 and 84.25%, respectively, with no detection by the monofilaments. CONCLUSION: The results suggest that the electronic esthesiometer is a reliable and easy application, capable of evaluating alterations of tactile sensitivity in leprosy patients.


Assuntos
Eletrodiagnóstico/instrumentação , Hanseníase/complicações , Medição da Dor/instrumentação , Limiar Sensorial/fisiologia , Distúrbios Somatossensoriais/diagnóstico , Tato/fisiologia , Avaliação da Deficiência , Progressão da Doença , Eletrodiagnóstico/métodos , Pé/inervação , Pé/fisiopatologia , Mãos/inervação , Mãos/fisiopatologia , Humanos , Nociceptores/fisiologia , Dor/diagnóstico , Dor/fisiopatologia , Medição da Dor/métodos , Nervos Periféricos/patologia , Nervos Periféricos/fisiopatologia , Estimulação Física/instrumentação , Estimulação Física/métodos , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Células Receptoras Sensoriais/fisiologia , Pele/inervação , Pele/fisiopatologia , Distúrbios Somatossensoriais/etiologia , Distúrbios Somatossensoriais/fisiopatologia
15.
Artigo em Inglês | MEDLINE | ID: mdl-16394477

RESUMO

Acute skin failure is a state of total dysfunction of the skin resulting from different dermatological conditions. It constitutes a dermatological emergency and requires a multi-disciplinary, intensive care approach. Its effective management is possible only when the underlying pathomechanism of each event is clear to the treating clinician. The concept of skin failure is new to non-dermatologist clinicians and sketchy among many dermatologists. Here the pathomechanism of skin failure has been analyzed and a guideline for monitoring has been provided. There is a need for intensive care units for patients with acute skin failure.


Assuntos
Regulação da Temperatura Corporal/fisiologia , Dermatopatias/fisiopatologia , Pele/fisiopatologia , Humanos , Equipe de Assistência ao Paciente , Higiene da Pele , Dermatopatias/mortalidade , Perda Insensível de Água/fisiologia , Desequilíbrio Hidroeletrolítico/fisiopatologia
18.
Indian J Lepr ; 76(4): 299-304, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-16119139

RESUMO

Loss of sensation is an important feature of leprosy. Loss of sweating over the affected site due to loss of autonomic function occurs in leprosy. We have studied a simple, non-invasive, rapid method, using 1% ninhydrin in acetone, to detect loss of sweat function. The test was effective in detecting and grading the sweat function in 84 cases of different types of leprosy. We were able to detect normal sweating in 16 patients with hypopigmented lesion due to causes other than Hansen's disease.


Assuntos
Hanseníase/complicações , Hanseníase/fisiopatologia , Ninidrina , Sudorese , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Cor , Humanos , Pele/fisiopatologia
19.
In. Schwarz, Richard; Brandsma, Wim. Surgical reconstruction rehabilitation in leprosy and other neuropathies. Kathmandu, Ekta Books, 2004. p.11-24, ilus, tab.
Monografia em Inglês | SES-SP, HANSEN, SESSP-ILSLACERVO, SES-SP | ID: biblio-1247029
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