Clinical characterization, physical frailty, and depression in elderly patients with psoriasis from a reference center in Brazil: a cross-sectional study

Abstract Background: There are few studies dedicated to the characterization of the geriatric population with psoriasis, which has particularities in terms of clinical manifestations and therapeutic limitations. As psoriasis is a chronic disease, presenting a higher prevalence with age, the increase in life expectancy in Brazil demands knowledge about the behavior of the disease among the elderly. Objectives: To characterize elderly people with psoriasis from a tertiary service, from the clinical-epidemiological point of view, presence of comorbidities, physical frailty, and affective impact, and to compare these aspects with adults with psoriasis and elderly people without the disease. Methods: Cross-sectional study of 64 elderly patients with psoriasis, 64 adults with psoriasis, and 64 elderly patients without the disease. Clinical-demographic aspects, the Beck depression scale, and Skindex-16 were evaluated. Indicators of physical frailty were evaluated in elderly patients: handgrip, sit-to-stand test, fatigue, and weight loss >5%. Results: In the elderly, the mean age (SD) of psoriasis onset was 44 (10) years, men represented 47% of the sample, the prevalence of arthritis was 22%, and ungual involvement occurred in 72%. Topical corticosteroids were used more often among elderly people with psoriasis (100%) than among adults with the disease (86%), with no difference among other systemic treatments. Diabetes mellitus occurred in 30% of the elderly. Hypertension (59%), dyslipidemia (52%), depression (34%), and fatigue (59%) were more prevalent among the elderly with psoriasis than among the healthy controls.

Clinical characterization, physical frailty, and depression in elderly patients with psoriasis from a reference center in Brazil: a cross-sectional study.

BACKGROUND: There are few studies dedicated to the characterization of the geriatric population with psoriasis, which has particularities in terms of clinical manifestations and therapeutic limitations. As psoriasis is a chronic disease, presenting a higher prevalence with age, the increase in life expectancy in Brazil demands knowledge about the behavior of the disease among the elderly. OBJECTIVES: To characterize elderly people with psoriasis from a tertiary service, from the clinical-epidemiological point of view, presence of comorbidities, physical frailty, and affective impact, and to compare these aspects with adults with psoriasis and elderly people without the disease. METHODS: Cross-sectional study of 64 elderly patients with psoriasis, 64 adults with psoriasis, and 64 elderly patients without the disease. Clinical-demographic aspects, the Beck depression scale, and Skindex-16 were evaluated. Indicators of physical frailty were evaluated in elderly patients: handgrip, sit-to-stand test, fatigue, and weight loss >5%. RESULTS: In the elderly, the mean age (SD) of psoriasis onset was 44 (10) years, men represented 47% of the sample, the prevalence of arthritis was 22%, and ungual involvement occurred in 72%. Topical corticosteroids were used more often among elderly people with psoriasis (100%) than among adults with the disease (86%), with no difference among other systemic treatments. Diabetes mellitus occurred in 30% of the elderly. Hypertension (59%), dyslipidemia (52%), depression (34%), and fatigue (59%) were more prevalent among the elderly with psoriasis than among the healthy controls. STUDY LIMITATIONS: The study was carried out in a public reference service for patients with psoriasis, all of which were undergoing treatment. CONCLUSIONS: Elderly people with psoriasis from a tertiary service showed greater affective impairment, metabolic comorbidities, and physical frailty than elderly controls.

Sexually-transmitted monkeypox: report of two cases

Abstract Monkeypox is an emerging infection that has spread to all continents since May 2022. It is caused by the zoonotic monkeypox virus, consisting of double-stranded DNA, belonging to the Orthopoxvirus genus of the Poxviridae family, which has high transmissibility, especially by contact with the skin, favoring its sexual transmission. This case report describes a same-sex male couple, both aged 28 years old, without comorbidities. In the index case, perioral and penile lesions started ten days before the consultation, with rapid progression and a high fever that started eight days after the appearance of the lesions. In the second case, the perioral lesions started three days after the partner; however, he remained afebrile. Both were isolated, treated with symptomatic measures, and, after ulceration, the lesions completely regressed in 14 days. Dermatologists should be aware of manifestations of monkeypox, which may include vesiculopustular lesions in areas of sexual contact, as well as oligosymptomatic cases or cases with few skin lesions.

Pigmented eccrine poroma in an atypical location

Abstract Eccrine poroma is the term that includes benign neoplasms of the terminal duct of the eccrine sweat glands, which may clinically and dermoscopically resemble other melanoma and non-melanoma skin tumors. They are often located on the extremities (especially palms and soles), presenting as normochromic or erythematous papules and nodules, measuring up to 2 cm. Pigmented variants are uncommon, accounting for less than 20% of cases. This report describes a 37-year-old man who developed a large pigmented eccrine poroma on his right shoulder, causing diagnostic difficulty. Histopathological examination revealed a nodular neoplasm consisting of small, monomorphic, cuboidal cells, with ample, eosinophilic cytoplasm and well-defined borders, in addition to conspicuous intercellular bridges, with melanin deposits diffusely distributed inside them. The absence of cytological atypia, cellular pleomorphism, increased mitotic activity, and necrosis foci corroborated the diagnostic exclusion of porocarcinoma, which can develop from eccrine poroma.

Sexually-transmitted monkeypox: report of two cases.

Monkeypox is an emerging infection that has spread to all continents since May 2022. It is caused by the zoonotic monkeypox virus, consisting of double-stranded DNA, belonging to the Orthopoxvirus genus of the Poxviridae family, which has high transmissibility, especially by contact with the skin, favoring its sexual transmission. This case report describes a same-sex male couple, both aged 28 years old, without comorbidities. In the index case, perioral and penile lesions started ten days before the consultation, with rapid progression and a high fever that started eight days after the appearance of the lesions. In the second case, the perioral lesions started three days after the partner; however, he remained afebrile. Both were isolated, treated with symptomatic measures, and, after ulceration, the lesions completely regressed in 14 days. Dermatologists should be aware of manifestations of monkeypox, which may include vesiculopustular lesions in areas of sexual contact, as well as oligosymptomatic cases or cases with few skin lesions.

Pigmented eccrine poroma in an atypical location.

Eccrine poroma is the term that includes benign neoplasms of the terminal duct of the eccrine sweat glands, which may clinically and dermoscopically resemble other melanoma and non-melanoma skin tumors. They are often located on the extremities (especially palms and soles), presenting as normochromic or erythematous papules and nodules, measuring up to 2 cm. Pigmented variants are uncommon, accounting for less than 20% of cases. This report describes a 37-year-old man who developed a large pigmented eccrine poroma on his right shoulder, causing diagnostic difficulty. Histopathological examination revealed a nodular neoplasm consisting of small, monomorphic, cuboidal cells, with ample, eosinophilic cytoplasm and well-defined borders, in addition to conspicuous intercellular bridges, with melanin deposits diffusely distributed inside them. The absence of cytological atypia, cellular pleomorphism, increased mitotic activity, and necrosis foci corroborated the diagnostic exclusion of porocarcinoma, which can develop from eccrine poroma.

Aseptic Folliculitis in Freshwater and Marine Fishermen.

Folliculitis is a common skin disease, usually benign, which causes inflammation and eventual infections of hair follicles. They may have an infectious etiology, mainly due to the bacteria Staphylococcus aureus; it also occurs due to localized irritation, such as in areas of skin friction and for long periods of immersion in water, as in athletes and workers who are continuously exposed to the aquatic environment. Herein, we report on two fishermen, from fluvial and maritime environments, who presented with chronic aseptic folliculitis associated with daily immersion of their lower extremities while exercising the profession and that regressed when there was a decrease in their contact with water.

Popularidade e uso medicinal do pinhão-roxo (Jatropha gossipifolia L. ) em comunidades ribeirinhas do pantanal do Mato Grosso do Sul, com ênfase em envenenamentos causados por arraias fluviais / Popularity and medicinal use of purple pine nut (Jatropha gossipifolia L.) in riverside communities in the Pantanal of Mato Grosso do Sul, with an emphasis on poisonings caused by river stingrays

O Pantanal é a maior planície inundável do planeta. A população humana da região utiliza vegetais que encontram no dia a dia e, com o tempo, isso os levou a descobrir diferentes finalidades alimentares e até usos terapêuticos dessas plantas. Este estudo tem como objetivo compreender a popularidade do pinhão-roxo (Jatropha gossipifolia L.) e seu uso como planta medicinal em duas comunidades ribeirinhas do município de Corumbá (MS), Brasil, com ênfase nos envenenamentos causados por arraias de água doce, frequentes na área. Mais da metade dos entrevistados utilizou o pinhão-roxo em várias doenças, especialmente no controle de sangramentos e na cicatrização de feridas. O uso de infusões em úlceras crônicas causadas por peixes peçonhentos é amplamente mencionado pelos pescadores entrevistados, particularmente em envenenamentos com necrose cutânea causada por arraias de água doce. Outras indicações citadas são o tratamento de micoses cutâneas e odontalgias, que não são mencionadas nas referências anteriores, indicando a necessidade de estudos clínicos e farmacológicos adicionais para avaliar esses propósitos.

Palmar hyperhidrosis: clinical, pathophysiological, diagnostic and therapeutic aspects

Abstract Palmar hyperhidrosis affects up to 3% of the population and inflict significant impact on quality of life. It is characterized by chronic excessive sweating, not related to the necessity of heat loss. It evolves from a localized hyperactivity of the sympathetic autonomic system and can be triggered by stressful events. In this study, the authors discuss clinical findings, pathophysiological, diagnostic and therapeutic issues (clinical and surgical) related to palmar hyperhidrosis.

Síndrome de sweet clássica: relato de caso típico / Sweet classic syndrome: typical case

Contexto: A síndrome de Sweet (SS) caracteriza-se por lesões de aparecimento súbito, eritêmato-edematosas, dolorosas, associadas a sintomas sistêmicos, infiltração de neutrófilos maduros ao estudo histopatológico e resposta rápida e efetiva com corticoterapia. Descrição do caso: Apresentamos caso de mulher de 44 anos com quadro clinico-laboratorial típico da forma clássica da SS e regressão das lesões após48 horas da introdução de corticoterapia sistêmica. Discussão: São descritas três formas da SS: clássica, induzida por drogas e associada amalignidades. A forma clássica acomete principalmente mulheres entre 30-50 anos de idade. Pode haver associação com doenças autoimunes ou infecciosas. O tratamento padrão ouro para forma clássica é feito com corticoterapia sistêmica, sendo a rápida resposta, após instituído tratamento, um dos critérios diagnósticos da doença. Grande parte dos casos apresenta episódios de recorrência após o primeiro episódio.O tratamento das formas associada a malignidade e induzida por drogas é feito com o tratamento da doença de base e a suspensão da droga,respectivamente. Conclusão: O reconhecimento precoce da síndrome, assim como sua abordagem de acordo com seu subtipo permite tratamento adequado e diminuição da morbidade associada, assim como a pesquisa de comorbidades que podem estar associadas.

Palmar hyperhidrosis: clinical, pathophysiological, diagnostic and therapeutic aspects.

Palmar hyperhidrosis affects up to 3% of the population and inflict significant impact on quality of life. It is characterized by chronic excessive sweating, not related to the necessity of heat loss. It evolves from a localized hyperactivity of the sympathetic autonomic system and can be triggered by stressful events. In this study, the authors discuss clinical findings, pathophysiological, diagnostic and therapeutic issues (clinical and surgical) related to palmar hyperhidrosis.

Cirsoid aneurysm of the scalp: case report / Aneurisma cirsoide do couro cabeludo: relato de caso

We report a case of a 23-year-old man presented with a painful swelling over his right occipital region. Selective right carotid angiogram demonstrated a markedly tortuous and dilated right occipital artery feeding into a circular or cirsoid aneurysm in the right occipital scalp. Percutaneous occlusion of the cirsoid aneurysm was not attempted and the patient underwent a successful resection of the fistula with good outcome after three months followed up.

Relatamos um caso de paciente masculino de 23 anos com lesão pulsatile em região occipital direita. Angiografia digital seletiva da artéria occipital direita mostrou artéria occipital direita dilatada e tortuosa formando aneurisma cirsoide do couro cabeludo. Oclusão percutânea não era possível e o paciente foi submetido à ressecção cirúrgica da fístula com sucesso. O seguimento em três meses mostrou boa recuperação.

[Chronic ulcers of the lower limbs: area evaluation by digital photography]. / Ulceras crônicas dos membros inferiores: avaliação pela fotografia digital.

OBJECTIVES: To evaluate results of digital imaging analysis in estimating the areas of chronic ulcers in the lower limbs. METHODS: In a prospective study the ulcer areas were estimated by the classic planimetric method, where ulcer perimeters are drawn on a transparent plastic film. Areas were then measured in millimetered paper. These values were considered as gold standards to evaluate standardized digital photographs of ulcers and of drawings for area estimation. A known length of adhesive was placed adjacent to ulcers to estimate the proportion of pixels relative to real millimeters. RESULTS: Forty two lesions from 20 patients with chronic lower limb ulcers were evaluated. Areas ranged from 0.24 to 101.65cm2. Planimetric measures strongly correlated with photos of the ulcers (R(2)=0.86 p<0.01), however, their correlation with digital photos of the ulcer drawings was even higher (R(2)=0.99 p<0.01). CONCLUSIONS: Standardized digital photography proved to be a quick, precise and non-invasive method to estimate ulcer areas. The evaluation of measurements from drawings of ulcer perimeters should be preferred to direct photographic analysis of the ulcers.