Shave Excision Versus Elliptical Excision of Nonpigmented Intradermal Melanocytic Nevi: Comparative Assessment of Recurrence and Cosmetic Outcomes.

BACKGROUND: Nonpigmented intradermal melanocytic nevi (IMN) are benign lesions often removed for cosmetic reasons. There is no consensus as to the best technique for IMN excision. OBJECTIVE: To compare cosmetic outcomes and risk of recurrence after shave excision versus elliptical excision of IMN. MATERIALS AND METHODS: In this randomized clinical trial, patients underwent shave excision or elliptical excision with sutured closure of IMN of the face or back. Recurrence, patient satisfaction, cosmetic outcome, postoperative discomfort, scar size, discoloration, and presence of hypertrophic or keloid scars were evaluated at 3, 6, and 9 months. RESULTS: Overall, 145 nevi were removed from 45 patients (86.7% women, mean age 52.1 ± 12.5 years). The recurrence rate was 11.7%, occurring only after shave excision; 94.1% of recurrences were observed at 3-month follow-up. Shave excision was associated with less discomfort 48 hours after intervention but a greater likelihood of involved lateral and deep margins (p < .001). Scars were larger after elliptical excision and suture than after shave excision (p < .01). The mean patient satisfaction was higher in the shave excision group (p < .004). CONCLUSION: Shave excision of IMN is associated with higher rates of involved surgical margins and recurrence than elliptical excision but provides superior cosmesis and patient satisfaction.

Striae Gravidarum, Acne, Facial Spots, and Hair Disorders: Risk Factors in a Study with 1284 Puerperal Patients.

OBJECTIVE: To determine the prevalence of skin changes during pregnancy and to relate their occurrence to specific factors in a population of south Brazil. METHODS: A cross-sectional analytical study was carried out with 1284 puerperal patients. A questionnaire about skin changes during pregnancy was developed and applied by the authors to all puerperal women admitted in a tertiary hospital in south Brazil. RESULTS: The appearance of striae during pregnancy was reported by 633 women (49.5%) and had a statistically significant association with primiparity, presence of stretch marks before pregnancy, and gestational weight gain above 21 kg. Facial blemishes were reported by 33.9% (n = 434) and were associated with a positive family history, multiparity, and the use of facial sunscreen (p < 0.0001). The onset or worsening of acne was identified in 35.7% (n = 456) and was statistically associated with primiparity and Fitzpatrick phototypes IV and V. Hair alterations were reported by 44.5% (n = 569) and were associated with primiparity (p = 0.029). CONCLUSION: Although most of the skin changes during pregnancy are considered "physiologic," they can cause significant discomfort. Thus, it is important to know them and to understand which risk factors may be associated with such changes.

Ensaio clínico randomizado sobre a análise comparativa entre excisão de nevos melanocítos intradérmicos por shaving versus excisão em elipse e sutura / Comparative analysis between sutured elliptical excision and shaving of intradermal melanocytic nevi: a Randomized Clinical Trial

Introdução: apesar de os nevos melanocíticos intradérmicos serem lesões benignas, muitos pacientes recorrem ao dermatologista para sua exérese. Entretanto, não existem estudos sobre o melhor método para esse procedimento. Objetivo: comparar em ensaio clínico randomizado a exérese de nevos melanocíticos intradérmicos na face, por shaving e excisão em elipse com sutura Métodos: foram selecionados pacientes com nevos melanocíticos intradérmicos na face para os dois métodos, randomicamente. Os resultados foram descritos quanto à satisfação do paciente e aos registros fotográficos avaliados por médico cegado. Resultados: 18 pacientes foram submetidos à exérese de nevos melanocíticos intradérmicos. A média de tamanho da cicatriz após seis meses foi de 8,11mm para as lesões excisadas por fuso e de 2,92mm para as por shaving (p < 0,05). A média da nota dos pacientes após seis meses foi 9,67 (fuso) e 9,57 (shaving) (p = 0,8). A média pelo médico cegado foi 7,78 (fuso) e 7,86 (shaving) (p = 0,91). Ocorreu recidiva da lesão em 28,6% dos pacientes submetidos ao shaving. Conclusões: As duas formas de excisão se equivalem quanto à satisfação do paciente e nota dada pela equipe médica quanto aos resultados estéticos da cicatriz. Contudo, a exérese por fuso tem a vantagem de apresentar menor índice de recidiva.

Introduction: Although the intradermal melanocytic nevi are benign lesions, many patients seek for dermatologists for their excision. However, there are no studies about the best method for this procedure. Objective: To compare in a randomized clinical trial the excision of intradermal melanocytic nevi in the face for shaving and elliptical excision with suture Methods: Patients with intradermal melanocytic nevi on the face were selected for removal by shaving or ellipse, randomly. The results were described regarding patient satisfaction and photographic records evaluated by a blinded physician. Results: 18 patients underwent excision of intradermal melanocytic nevi. The mean scar size after six months of the procedure was of 8,11mm for the excision in ellipse and 2,92mm for the shaving (p < 0.05). The mean score of the patients after six months was 9.67 (ellipse) and 9.57 (shaving) (p = 0.8). The mean by the blinded physician was of 7.78 (ellipse) and 7.86 (shaving) (p = 0.91). 28.6% of patients undergoing shaving had recurrence of the nevus. Conclusions: The two forms are of excision are equivalent concerning patients satisfaction and the judgment of medical team about the aesthetic results of the scar. However, ellipse with suture excision has the advantage of having a lower relapse.

Skin changes after bariatric surgery.

Today, obesity is considered an epidemic all over the world and it is recognized as one of the major public health problems. Bariatric surgery is considered an appropriate therapeutic option for obesity with progressively increasing demands. The changes resulting from massive weight loss after bariatric surgery are related to numerous complications. This article will present the dermatological alterations that can be found after bariatric surgery. They will be subdivided into dermatoses that are secondary to metabolic and nutritional disorders, those derived from cutaneous structural modifications after major weight loss and the influence the latter may have in improving of certain dermatoses.

Skin changes after bariatric surgery

Today, obesity is considered an epidemic all over the world and it is recognized as one of the major public health problems. Bariatric surgery is considered an appropriate therapeutic option for obesity with progressively increasing demands. The changes resulting from massive weight loss after bariatric surgery are related to numerous complications. This article will present the dermatological alterations that can be found after bariatric surgery. They will be subdivided into dermatoses that are secondary to metabolic and nutritional disorders, those derived from cutaneous structural modifications after major weight loss and the influence the latter may have in improving of certain dermatoses.

Assessing depression and anxiety in the caregivers of pediatric patients with chronic skin disorders / Avaliacao da depressao e ansiedade em cuidadores de pacientes pediatricos

BACKGROUND: The literature has shown that the presence of emotional disturbances in caregivers of children with skin diseases affects the course and treatment of the disease. Anxiety and depression are among the most frequently reported psychiatric diagnoses related to this fact. OBJECTIVE: To evaluate the presence of anxiety and depression in caregivers of pediatric patients with chronic skin disorders, exemplified by atopic dermatitis, psoriasis and vitiligo, and correlate them to the quality of life of the patients. METHODS: The sample consisted of 118 patients with atopic dermatitis, vitiligo and psoriasis, monitored by their main caregiver. The levels of anxiety and depression in the caregivers were assessed using the Hamilton Anxiety Scale and the Beck Depression Inventory, respectively. The Children's Dermatology Life Quality Index was applied. RESULTS: Anxiety was observed in 36% of the caregivers of the patients with atopic dermatitis, in 36% of those of children affected by psoriasis, and in 42% of those responsible for pediatric patients with vitiligo. Depression occurred in 36% of the caregivers of patients with atopic dermatitis, in 36% of those of children affected by psoriasis and in 26% of those responsible for pediatric patients with vitiligo. There was a significant correlation between poor quality of life scores in patients with vitiligo and the presence of depression and anxiety in their caregivers. CONCLUSION: Emotional disorders tend to be present among close family members of children with the chronic skin diseases studied and their prevention can help in controlling and treating these diseases. .

FUNDAMENTOS: A literatura tem demonstrado que a presença de distúrbios emocionais nos cuidadores de crianças com dermatoses influenciam no curso e tratamento da doença. A ansiedade e a depressão estão entre os diagnósticos psiquiátricos descritos, porém a maioria das publicações afere esta relação de forma indireta e não de escalas diretas para ansiedade e depressão. OBJETIVO: Avaliar a presença de ansiedade e depressão nos cuidadores de pacientes pediátricos com dermatite atópica, vitiligo e psoríase e correlacioná-las à qualidade de vida dos pacientes. MATERIAIS E MÉTODOS: Amostra composta por 118 pacientes com dermatite atópica, vitiligo e psoríase acompanhados pelo principal responsável por seus cuidados diários. A avaliação da ansiedade nos cuidadores foi realizada através da Escala de Hamilton de Ansiedade e a depressão através do Inventário de Beck para Depressão. Foi aplicado o Índice de Qualidade de Vida na Dermatologia Infantil. RESULTADOS: Ansiedade foi verificada em 36% dos cuidadores do grupo de pacientes com dermatite atópica, em 36% do grupo com psoríase e 42% do grupo com vitiligo. Depressão ocorreu em 36% dos cuidadores de pacientes com dermatite atópica, 36% dos responsáveis pelos pacientes com psoríase, e em 26% dos cuidadores de pacientes com vitiligo. Observou-se uma correlação significativa entre a pior qualidade de vida dos pacientes com vitiligo e a presença de depressão e ansiedade nos seus cuidadores. CONCLUSÃO: Distúrbios emocionais tendem a estar presentes no nicho familiar de crianças portadoras das dermatoses crônicas estudadas, e que a prevenção pode auxiliar no controle e no tratamento destas doenças. .

Assessing depression and anxiety in the caregivers of pediatric patients with chronic skin disorders.

BACKGROUND: The literature has shown that the presence of emotional disturbances in caregivers of children with skin diseases affects the course and treatment of the disease. Anxiety and depression are among the most frequently reported psychiatric diagnoses related to this fact. OBJECTIVE: To evaluate the presence of anxiety and depression in caregivers of pediatric patients with chronic skin disorders, exemplified by atopic dermatitis, psoriasis and vitiligo, and correlate them to the quality of life of the patients. METHODS: The sample consisted of 118 patients with atopic dermatitis, vitiligo and psoriasis, monitored by their main caregiver. The levels of anxiety and depression in the caregivers were assessed using the Hamilton Anxiety Scale and the Beck Depression Inventory, respectively. The Children's Dermatology Life Quality Index was applied. RESULTS: Anxiety was observed in 36% of the caregivers of the patients with atopic dermatitis, in 36% of those of children affected by psoriasis, and in 42% of those responsible for pediatric patients with vitiligo. Depression occurred in 36% of the caregivers of patients with atopic dermatitis, in 36% of those of children affected by psoriasis and in 26% of those responsible for pediatric patients with vitiligo. There was a significant correlation between poor quality of life scores in patients with vitiligo and the presence of depression and anxiety in their caregivers. CONCLUSION: Emotional disorders tend to be present among close family members of children with the chronic skin diseases studied and their prevention can help in controlling and treating these diseases.

Alterações nos hábitos de fotoexposição e fotoproteção de pacientes após diagnóstico de carcinoma basocelular / Changes in patients' habits regarding exposure to the sun and photoprotection after basal cell carcinoma diagnosis

Introdução: o câncer da pele é o tipo mais comum de neoplasia nos seres humanos, e a radiação ultravioleta é considerada sua principal causa. O carcinoma basocelular é a mais frequente das neoplasias cutâneas, e a fotoproteção é sua medida preventiva mais importante. Ainda existe, todavia, certa resistência ao uso dos fotoprotetores pela população em geral, e a literatura não relata se essa resistência nos pacientes com diagnóstico de carcinoma basocelular é diferente da que se observa na população em geral. Objetivos: avaliar se há mudanças nos hábitos de fotoproteção e fotoexposição após o diagnóstico de carcinoma basocelular nos pacientes atendidos no Ambulatório de Dermatologia da Universidade Federal de Ciências da Saúde de Porto Alegre. Métodos: estudo transversal com 120 pacientes diagnosticados e tratados de carcinoma basocelular que responderam a questionário referente aos hábitos de fotoproteção e fotoexposição antes e depois do diagnóstico da doença. Resultados: dos 120 pacientes entrevistados, 73,3% referiram mudanças de fotoexposição e fotoproteção após o diagnóstico de carcinoma basocelular. Entre os que negaram mudanças de comportamento frente ao sol (26,7%), os principais motivos alegados foram o fato de não temer novos tumores e o alto custo do protetor solar. Conclusões: o diagnóstico de CBC motivou a maioria dos pacientes a melhorar as medidas preventivas de proteção solar. Cerca de um terço da população estudada, porém, ainda resiste a executá-las, alegando como causa principal o custo dos fotoprotetores. Assim, devem ser programadas campanhas de conscientização sobre a importância das medidas fotoprotetoras na prevenção do câncer de pele e visando à distribuição gratuita de protetores solares na rede pública para a população em geral e, principalmente, os pacientes de alto risco.

Introduction: Skin cancer is the most common type of neoplasia in humans, with ultraviolet radiation being considered the main cause. Basal cell carcinoma is the most frequent cutaneous neoplasia, and photoprotection is seen as the most effective measure in its prevention. Nonetheless, there is still some resistance to the use of sunscreens among the general population. There is also a lack of reports in the literature on whether such resistance differs in patients with basal cell carcinoma. Objectives: To evaluate whether there is change in habits regarding exposure to the sun and use of sunscreen after diagnosis of basal cell carcinoma in patients treated at the Dermatology Outpatient Clinic of Universidade Federal de Ciências da Saúde de Porto Alegre (RS), Brazil. Methods: A cross-sectional study was carried out with 120 patients diagnosed and treated for basal cell carcinoma, who responded to a questionnaire regarding their sun exposure habits and use of photoprotection methods before and after diagnosis. Results: Of the 120 patients interviewed, 73.3% reported changes in their habits regarding exposure to the sun and use of sunscreen after receiving a diagnosis of basal cell carcinoma. The main reasons alleged by those who denied having changed their behavior towards sun exposure (26.7%), were the lack of fear of new tumors, as well as the high cost of sunscreens. Conclusions: A diagnosis of basal cell carcinoma motivates most patients to improve their use of preventive measures regarding protection from the sun. Nonetheless, about a third of the studied population still resisted such measures, the main reason cited being the high cost of sunscreens. Therefore, awareness campaigns about the importance of using photoprotection methods to prevent skin cancer must be implemented, and the development of programs aimed at making sunscreens available to the general population ­ especially to high-risk patients ­ must be sought.

Comparação entre ácido tioglicólico 2,5%, hidroquinona 2%, haloxyl 2 % e peeling de ácido glicólico 10 % no tratamento da hiperpigmentação periorbital / Comparison of 2,5% thioglycolic acid, 2% hydroquinone, 2% Haloxyl, and 10 % thioglycolic acid peeling in the treatment of periorbital hyperpigmentation

Introduction: Periorbital hyperpigmentation is a multifactorial dyschromia that involves the eyelid's vascularization and melanin hyperpigmentation. Objective:To compare the efficacy of 2.5% thioglycolic acid, 2% hydroquinone, 2% Haloxyl, and 10% thioglycolic acid peel in the reduction of dark circles. Methods: Eighty patients were divided into four groups. Groups 1, 2, and 3 underwent treatments with 2.5% thioglycolic acid, 2% hydroquinone, and 2% Haloxyl, respectively. Group 4 underwent five biweekly sessions of chemical exfoliation with 10% thioglycolic acid. All patients were evaluated by two physicians after the treatment: the one who performed the treatment, and another who was blinded to the outcome. The assessment was carried out using photographs and a clinical satisfaction questionnaire distributed to the patients. Results: The best results occurred in Groups 1 and 2. Group 3 had slightly inferior results, possibly due to the low concentration used. Group 4 had the least significant results, however this outcome may have been influenced by the higher age of the group members and the lack of daily use of medications. Conclusions: There is still not an ideal treatment for dark circles, with the currently available therapeutic resources only alleviating the difference in color between the lower eyelids and the rest of the face.

Introduction: Periorbital hyperpigmentation is a multifactorial dyschromia that involves the eyelid's vascularization and melanin hyperpigmentation. Objective:To compare the efficacy of 2.5% thioglycolic acid, 2% hydroquinone, 2% Haloxyl, and 10% thioglycolic acid peel in the reduction of dark circles. Methods: Eighty patients were divided into four groups. Groups 1, 2, and 3 underwent treatments with 2.5% thioglycolic acid, 2% hydroquinone, and 2% Haloxyl, respectively. Group 4 underwent five biweekly sessions of chemical exfoliation with 10% thioglycolic acid. All patients were evaluated by two physicians after the treatment: the one who performed the treatment, and another who was blinded to the outcome. The assessment was carried out using photographs and a clinical satisfaction questionnaire distributed to the patients. Results: The best results occurred in Groups 1 and 2. Group 3 had slightly inferior results, possibly due to the low concentration used. Group 4 had the least significant results, however this outcome may have been influenced by the higher age of the group members and the lack of daily use of medications. Conclusions: There is still not an ideal treatment for dark circles, with the currently available therapeutic resources only alleviating the difference in color between the lower eyelids and the rest of the face.

Assessment of the quality of life of pediatric patients with the major chronic childhood skin diseases.

BACKGROUND: The skin is the primary interface of the human being with the external environment and the presence of skin diseases can have substantial effects on the quality of life. OBJECTIVE: This study aims to make a comparative evaluation of the quality of life of pediatric patients with atopic dermatitis, psoriasis and vitiligo and correlate the findings with the total body surface and the areas with the disease exposed to view. METHODS: The sample consisted of 118 patients with atopic dermatitis, vitiligo and psoriasis, aged between 5 and 16 years, who were asked to answer the Children's Dermatology Life Quality Index (CDLQI) questionnaire. A dermatological examination for the measurement of total body surface affected by the disease was performed. RESULTS: The three groups showed an impaired quality of life. Patients with atopic dermatitis and psoriasis showed a significantly greater impact on the QoL than the group with vitiligo. There is a trend towards impaired quality of life in patients from the three groups of dermatoses, which is related to increments in both the total affected area and affected area exposed to view (r = 0.428 and p <0.001, r = 0.381 and p <0.001, respectively). CONCLUSION: The assessed children had impaired quality of life. However, there is a significantly greater impact in the groups with atopic dermatitis and psoriasis than in the group with vitiligo. This may be due to lack of symptoms in vitiligo and the fact this group presented a statistically smaller affected body surface than the other two groups.

Assessment of the quality of life of pediatric patients with the major chronic childhood skin diseases / Avaliação da qualidade de vida em pacientes pediátricos com as principais dermatoses crônicas da infância

BACKGROUND: The skin is the primary interface of the human being with the external environment and the presence of skin diseases can have substantial effects on the quality of life. OBJECTIVE: This study aims to make a comparative evaluation of the quality of life of pediatric patients with atopic dermatitis, psoriasis and vitiligo and correlate the findings with the total body surface and the areas with the disease exposed to view. METHODS: The sample consisted of 118 patients with atopic dermatitis, vitiligo and psoriasis, aged between 5 and 16 years, who were asked to answer the Children's Dermatology Life Quality Index (CDLQI) questionnaire. A dermatological examination for the measurement of total body surface affected by the disease was performed. RESULTS: The three groups showed an impaired quality of life. Patients with atopic dermatitis and psoriasis showed a significantly greater impact on the QoL than the group with vitiligo. There is a trend towards impaired quality of life in patients from the three groups of dermatoses, which is related to increments in both the total affected area and affected area exposed to view (r = 0.428 and p <0.001, r = 0.381 and p <0.001, respectively). CONCLUSION: The assessed children had impaired quality of life. However, there is a significantly greater impact in the groups with atopic dermatitis and psoriasis than in the group with vitiligo. This may be due to lack of symptoms in vitiligo and the fact this group presented a statistically smaller affected body surface than the other two groups.

FUNDAMENTOS: A pele é a principal interface do ser humano com o meio externo e a presença de doenças cutâneas pode levar a repercussões importantes na qualidade de vida. OBJETIVOS: O presente estudo tem como objetivo fazer uma avaliação comparativa entre a qualidade de vida dos pacientes pediátricos com dermatite atópica, vitiligo e psoríase e correlacioná-la à superfície corporal total e às áreas expostas à visualização acometidas pela doença. MÉTODOS: Amostra composta por 118 pacientes com dermatite atópica, vitiligo e psoríase na faixa etária entre 5 a 16 anos para a aplicação do questionário Índice de Qualidade de Vida para Dermatologia em Crianças (CDLQI). Realizado exame dermatológico para a aferição da superfície corporal total acometida pela doença. RESULTADOS: Os três grupos de pacientes pediátricos demonstraram ter redução na qualidade de vida. Os pacientes com dermatite atópica e psoríase apresentaram um impacto na QoL significativamente maior que o grupo com vitiligo. Há uma tendência na redução da qualidade de vida dos pacientes dos três grupos de dermatoses relacionado ao aumento tanto da superfície total quanto da superfície exposta à visualização (r=0,428 e p<0,001; r=0,381 e p<0,001, respectivamente). CONCLUSÃO: As crianças avaliadas com dermatite atópica, psoríase e vitiligo apresentaram redução na qualidade de vida. Porém, há um impacto significativamente maior nos grupos de pacientes com dermatite atópica e psoríase em relação ao grupo com vitiligo. Este fato pode dever-se a ausência de sintomas no vitiligo e ao grupo ter apresentado uma superfície corporal comprometida estatisticamente menor que outros dois grupos.

Skin changes in pediatric transplant patients.

The advent of organ transplantation identified a new group of diseases. Dermatologists are studying transplant-associated diseases along with the atypical behavior of already known dermatoses. Pediatric patients have been treated as an extension of adult population, but unique aspects of age required clarification. A prospective cohort was studied including patients from both genders up to 17 yr of age who were recipients of kidney, liver or BMT during 2003 in Porto Alegre, Brazil. Regular skin examinations were performed up to the sixth month after the procedure, and an analysis was determined by ID (i.e. = number of skin changes/number of patients-month x 100). Thirty-nine patients were examined: 20 were kidney transplant recipients; 11 were BMT recipients (10 autologous transplants and 1 allogeneic transplant); and 8 were liver transplant recipients. Skin changes result primarily from the use of medication (87.2). Individually, kidney transplant patients presented the highest ID of skin changes because of medications (104.1). BMT recipients presented the highest ID of alterations occurring on skin appendages (85.4) and liver transplant recipients had the highest ID of vascular changes (94.9). In conclusion, this study shows that cutaneous alterations in pediatric transplant recipients present some particularities not described in adult recipients, such as ichthyosiform xerosis in renal recipients and skin scaling with pellagroid appearance in bone marrow recipients. Also, dermatoses secondary to medication use were the main finding in pediatric population.

Acute hemorrhagic edema of infancy: a case report.

BACKGROUND: Acute hemorrhagic edema of infancy (AHEI), or Seidlmayer's disease, is a type of leukocytoclastic vasculitis proper of infants and children. It is characterized by a local increase in temperature, erythematous edema and purpuric lesions involving mainly the face and extremities. There usually is no visceral involvement. The disease is self-limited, bearing a benign clinical course. Infection, drugs and immunization have been considered as precipitating factors. The main differential diagnosis is Henoch-Schönlein purpura (HSP). METHODS: We describe a classic example of acute hemorrhagic edema of infancy, and comment on the clinical features, pathology, immunopathology and proposed therapy. We characterize the differences between AHEI and HSP. RESULTS: A course of corticosteroids was given to avoid quick progression of disease. CONCLUSION: Acute hemorrhagic edema of infancy is a rare disease, and the most striking classic feature of the disease is the contrast between the acuteness of the cutaneous lesions and the good general condition of the patient. Considering its clinical features, pathology and immunopathology, AHEI can be justifiably characterized as a unique disorder, distinct from HSP.