Humanistic and Economic Impact of Moderate to Severe Plaque Psoriasis in Brazil.

INTRODUCTION: Psoriasis is an immune-mediated, chronic, inflammatory disease, which has a substantial humanistic and economic burden. This study aimed to assess the impact of this disease on health-related quality of life (HRQoL), work productivity, and direct and indirect costs from a societal perspective among Brazilian patients. METHODS: This is a cross-sectional, observational, multicenter study, enrolling patients with moderate to severe plaque psoriasis according to physician evaluation. Data collection was performed from December 2015 to November 2016 through face-to-face interviews using a structured questionnaire and five standardized patient-reported outcomes instruments. Direct costs were estimated by multiplying the amount of resources used (12-month recall period) by the corresponding unit cost. Indirect costs were grouped in two time horizons: annual costs (income reduction and absenteeism) and lifetime costs (demission and early retirement). RESULTS: A total of 188 patients with moderate to severe plaque psoriasis were included, with mean age of 48.0 (SD 13.1). "Anxiety and depression" and "pain and discomfort" were the most impaired dimensions, according to the EuroQol Five-Dimension-Three-Level (EQ-5D-3L). The highest effect was found for "symptoms and feelings" [mean (SD) 2.4 (1.7)] Dermatology Life Quality Index (DLQI) subscale. Psoriatic arthritis (PsA) presence and biologic-naïve status were associated with worse HRQoL. Presenteeism was more frequent than absenteeism, according to the Work Productivity and Activity Impairment questionnaire-General Health (WPAI-GH) [17.4% vs. 6.3%], while physical demands and time management were the most affected Work Limitations Questionnaire (WLQ) subscales [means (SD) 23.5 (28.5) and 17.7 (24.9), respectively]. The estimated annual cost per patient was USD 4034. Direct medical costs accounted for 87.7% of this estimate, direct non-medical costs for 2.4%, and indirect costs for 9.9%. CONCLUSIONS: Results evidenced that moderate to severe plaque psoriasis imposes substantial costs to society. Our data showed that this disease negatively affects both work productivity and HRQoL of Brazilian patients. Subgroups with PsA and biologic-naïve patients presented lower HRQoL, showing the impact of this comorbidity and the relevance of biologics in psoriasis treatment. FUNDING: Novartis Biociências S.A.

Chromoblastomycosis: clinical experience and review of literature.

BACKGROUND: Chromoblastomycosis is a tropical chronic infectious dermatosis characterized by the moriform bodies. To review all cases of chromoblastomycosis attended in the reference service of dermatology. METHODS: Series of cases of chromoblastomycosis attended in a dermatology reference service. Through an integrated system search of assistance, based on CID-10 B43, we reviewed epidemiological and comorbidities data, clinical presentations, treatments, and outcomes of each clinical case. RESULTS: From 2011 to 2017, we had five new cases of chromoblastomycosis. The average age was 65.6 years. All of them were men. One patient was HIV-positive, and another patient was immunosuppressed by the use of mycophenolate mofetil and prednisone due to renal transplant. Two patients had no history of evident trauma. The time between onset of symptoms and diagnosis ranged from 7 to 600 months. Fonsecaea pedrosoi was the isolated fungi. All cases were formally confirmed. Itraconazole with or without other therapies was effective in all cases. CONCLUSIONS: We report five never reported cases of chromoblastomycosis, and we review the clinical experience in diagnosis and treatment of chromoblastomycosis, an infrequent and neglected subcutaneous mycosis.

Preenchimento na região glabelar ­ dissecando as razões da alta incidência de complicações e cegueira / Glabellar region filling: examining the reasons for the high incidence of complications and blindness

Introdução: Os preenchimentos constituem uma das opções mais procuradas na atualidade para tratar o envelhecimento. A glabela é área sujeita a complicações decorrentes da aplicação de preenchedores, sendo as mais comuns eritema transitório, reações granulomatosas, oclusão rterial e cegueira. Os mecanismos etiopatogênicos que levam à perda da visão após a injeção de preenchedores na região glabelar, porém, permanecem desconhecidos. Objetivos: Avaliar a porcentagem de pacientes com obstrução grave da artéria carótida interna que apresentam reversão do fluxo carotídeo, com a finalidade de demonstrar um dos possíveis mecanismos que pode levar à maior incidência de complicações por preenchedores na glabela. Métodos: Realizado estudo prospectivo, com duplex-scan no Serviço de Radiologia do Hospital de Base de São José do Rio Preto. Resultados: Nossos resultados evidenciaram que a reversão do fluxo carotídeo (sistema carotídeo externo para o interno) em pacientes com obstrução hemodinamicamente significativa da artéria carótida interna é evento comum, possível de ser documentado, podendo acarretar sérias consequências, sendo a mais temível a cegueira. Conclusão: O preenchimento na região glabelar deve ser evitado em razão do risco da reversão do fluxo carotídeo e posterior oclusão da artéria central da retina conduzindo à cegueira.

Introduction: Fillings are currently one of the most sought-after treatments for aging. The glabella area is subject to complications arising from the application of fillers, the most common of which are transient erythema, granulomatous reactions, arterial occlusion, and blindness. Nevertheless, the pathogenic mechanisms that lead to a loss of sight following the injection of fillers in the glabellar region remain unknown. Objective: To evaluate the percentage of patients with severe obstruction of the internal carotid artery who present carotid flow reversal, in order to demonstrate a possible cause of a higher incidence of complications linked to the use of filling substances in the glabella. Methods: Prospective study carried out with duplex scan at the Radiology Department of the Hospital de Base de São José do Rio Preto, São Paulo, Brazil. Results: Advance detection of carotid flow reversal (external to internal carotid system) ­ which is a common event in patients with a hemodynamically significant obstruction of the internal carotid artery ­ can prevent serious consequences ­ the most critical of which is blindness. Conclusion: Filling procedures in the glabellar region must be avoided due to the risk of carotid flow reversal and subsequent occlusion of the central retinal artery, which causes blindness.