RESUMO
BACKGROUND: Vulvar lichen sclerosus (VLS) is a chronic, relapsing, inflammatory dermatosis that has significant impact on patients' quality of life (QoL). While disease severity and associated QoL impact have been studied, factors associated with treatment adherence and their relation to QoL in VLS remain unexplored. OBJECTIVE: The objectives of this study were to describe demographics, clinical characteristics, and skin-related QoL in VLS patients and to assess the relationship between QoL and treatment adherence. METHODS: This was a cross-sectional, single institution, electronic survey study. The relationship between adherence, measured using the validated Domains of Subjective Extent of Nonadherence (DOSE-Nonadherence) scale, and skin-related QoL, using the Dermatology Life Quality Index (DLQI) score, was assessed using Spearman correlation. RESULTS: Of 28 survey respondents, 26 provided complete responses. Among 9 patients classified as adherent and 16 classified as nonadherent, mean DLQI total score was 1.8 and 5.4, respectively. Spearman correlation between summary nonadherence score and DLQI total was 0.31 (95% CI: -0.09-0.63) overall and 0.54 (95% CI: 0.15-0.79) when patients who reported missing doses due to asymptomatic disease were excluded. Most frequently reported factors preventing treatment adherence included application/treatment time (43.8%) and asymptomatic or well-controlled disease (25%). CONCLUSIONS: Though Qol impairment was relatively small in both our adherent and nonadherent groups, we identified important factors preventing treatment adherence, with the most common being application/treatment time. These findings may help dermatologists and other providers generate hypotheses as to how to facilitate better treatment adherence among their patients with VLS, with the goal of optimizing QoL.
Assuntos
Líquen Escleroso Vulvar , Feminino , Humanos , Líquen Escleroso Vulvar/tratamento farmacológico , Líquen Escleroso Vulvar/complicações , Qualidade de Vida , Estudos Transversais , Cooperação e Adesão ao TratamentoRESUMO
Squamous cell carcinomas (SCCs) often arise secondary to UV-induced DNA damage resulting in genetic mutations, but can also occur in the setting of prolonged inflammation. Folliculitis decalvans (FD) is a rare cicatricial alopecia with a complex, multifactorial pathogenesis that results in chronic inflammation and scarring. We present a patient with severe, chronic FD who developed metastatic squamous cell carcinoma of the scalp.
Assuntos
Carcinoma de Células Escamosas/secundário , Foliculite/complicações , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias Cutâneas/patologia , Carcinoma de Células Escamosas/complicações , Carcinoma de Células Escamosas/cirurgia , Doença Crônica , Neoplasias de Cabeça e Pescoço/complicações , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Excisão de Linfonodo , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Pescoço , Couro Cabeludo , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/cirurgiaAssuntos
Borrelia burgdorferi/imunologia , Exantema/etiologia , Doença de Lyme/complicações , Pele/patologia , Anticorpos Antibacterianos/análise , Diagnóstico Diferencial , Ensaio de Imunoadsorção Enzimática , Exantema/diagnóstico , Exantema/microbiologia , Humanos , Doença de Lyme/diagnóstico , Doença de Lyme/microbiologia , Masculino , Pessoa de Meia-Idade , Pele/microbiologiaAssuntos
Fármacos Dermatológicos/administração & dosagem , Histiocitose de Células de Langerhans/diagnóstico , Histiocitose de Células de Langerhans/tratamento farmacológico , Metotrexato/administração & dosagem , Vulva/patologia , Doenças da Vulva/diagnóstico , Doenças da Vulva/tratamento farmacológico , Biópsia , Feminino , Histiocitose de Células de Langerhans/patologia , Histocitoquímica , Humanos , Imuno-Histoquímica , Microscopia , Pessoa de Meia-Idade , Pós-Menopausa , Resultado do Tratamento , Doenças da Vulva/patologiaRESUMO
Patients that suffer from factitial dermatosis mutilate their skin, often lacking any consciousness of self-injury, attributing the resulting lesions to spontaneous development. The case hereby described shows how the health providers' interventions led a patient from a baseline undiagnosed factitious disorder to frank delusions of infestation with Mycobacterium Kansasii, and a relentless search for antibiotic treatments. We highlight the need for educating health practitioners on the characteristics of psycho-cutaneous disorders.