RESUMEN
Resumen: Introducción: la dermatitis herpetiforme (DH) es una enfermedad cutánea inflamatoria que cursa en empujes y remisiones. Es una manifestación extraintestinal de la enfermedad celíaca (EC), de la que puede ser la primera manifestación clínica(1). La enfermedad celíaca es una enfermedad sistémica autoinmune, asociada con enteropatía, desencadenada por la ingesta de gluten en individuos genéticamente predispuestos(2-4). Se ha demostrado una asociación con el HLA DQ2 y HLA DQ8 en ambas enfermedades(5). Objetivo: mostrar las características de los pacientes con DH y EC que se asisten en las policlínicas de dermatología y gastroenterología del Hospital Universitario Dr. Manuel Quintela. Metodología: se realizó un estudio descriptivo, observacional, retrospectivo y longitudinal de una serie de casos. Criterios de inclusión: pacientes asistidos en servicios de dermatología y gastroenterología del Hospital de Clínicas, con diagnóstico de DH confirmado con histopatología y/o inmunofluorescencia directa; desde julio de 2000 a junio de 2018 inclusive. Quedaron excluidos aquellos pacientes en los que no se pudo acceder al estudio histopatológico de piel. Resultados: incluimos un total de 15 pacientes, 9 de sexo masculino y 6 de sexo femenino. La edad media al diagnóstico de DH fue de 49 años. 4 pacientes recibieron tratamiento con dapsona, con rápida respuesta de la dermatosis, sin efectos adversos graves. En 13 pacientes la DH fue el síntoma guía para el diagnóstico de EC. 5 pacientes con EC asintomática, 6 con síntomas clásicos, 4 con síntomas no clásicos.
Summary: Introduction: dermatitis herpetiformis (DH) is an inflammatory cutaneous disease comprising relapses and remissions. It is an extraintestinal manifestation of coeliac disease, which can even be its first clinical manifestation. Coeliac disease (CD) is an autoimmune systemic disease, associated with enteropathy, that is induced by the intake of gluten in genetically predisposed individuals. In both diseases an association between HLA DQ2 and HLA DQ8 has been proved. Objective: to present the characteristics of patients with Dermatitis herpetiformis (DH) and Coeliac disease (CD) who are assisted in the dermatology and gastroenterology polyclinics at the "Dr. Manuel Quintela" University Hospital. Methodology: descriptive, observational, retrospective and longitudinal study of a series of cases. Inclusion criteria: patients assisted at the dermatology and gastroenterology services of the University Hospital, with a diagnosis of Dermatitis herpetiformis (DH) confirmed by histopathology and/or direct immunofluorescence (DIF), from July, 200 to June 2018 inclusive. Patients whose skin histopathological exam could not be accessed were excluded from the study. Results: 15 patients were included, 9 male and 6 female. Average age upon diagnosis of DH is 49 years old. 4 patients were treated with dapsona, evidencing a fast response to dermatosis, and no severe adverse effects. In 13 patients, DH was the guiding symptom to diagnose coeliac disease. However, 5 patients had asymptomatic CD, 6 presented classical symptoms and 4 non-classical symptoms.
Resumo: Introdução: a dermatite herpetiforme (DH) é uma doença inflamatória da pele que ocorre em impulsos e remissões. É uma manifestação extra-intestinal da doença celíaca (DC), da qual pode ser a primeira manifestação clínica. A doença celíaca é uma doença autoimune sistêmica associada à enteropatia, desencadeada pela ingestão de glúten em indivíduos geneticamente predispostos. Uma associação com HLA DQ2 e HLA DQ8 foi demonstrado em ambas as doenças. Objetivo: mostrar as características dos pacientes com HD e DC atendidos nas policlínicas dermatológicas e gastroenterológicas do "Dr. Manuel Quintela". Metodologia: foi realizado um estudo descritivo, observacional, retrospectivo e longitudinal de uma série de casos. Critérios de inclusão: pacientes atendidos nos serviços de dermatologia e gastroenterologia do Hospital de Clínicas, com diagnóstico de HD confirmado pela histopatologia e / ou imunofluorescência direta; de julho de 2000 a junho de 2018 inclusive. Foram excluídos os pacientes em que não foi possível acessar o estudo histopatológico da pele. Resultados: incluímos um N total de 15 pacientes, 9 homens e 6 mulheres. A idade média no diagnóstico de DH é de 49 anos. 4 pacientes receberam tratamento com dapsona, com resposta rápida da dermatose, sem efeitos adversos graves. Em 13 pacientes, a DH foi o sintoma norteador para o diagnóstico de DC. 5 pacientes com DC assintomática, 6 com sintomas clássicos, 4 com sintomas não clássicos.
Asunto(s)
Enfermedad Celíaca , Dermatitis HerpetiformeRESUMEN
The role of circumcision in partially protecting against sexually transmitted infections (STIs) and other dermatoses has been documented. Neonatal circumcision is not routinely practiced in South America. Although it is logical to assume that male genital dermatoses are more prevalent in Hispanic men, they are underrepresented in the existing literature. Objective: To describe the epidemiological characteristics from our male genital dermatology unit in Montevideo (Uruguay), the diagnoses, and correlate them with circumcision status and comorbidities. Methods: A retrospective observational cohort study was conducted. A dermatologist and urologist evaluated all patients using standard questionnaires. In 3 years and 8 months, 269 patients were seen. Median age was 41, prevalence of neonatal circumcision was 0.7%, HIV was 4.2%, STIs were 24.9%, non-STIs were 63.9%, and both (STI + non-STI) were 11.2%. Most frequent entities: eczema/balanoposthitis (27.1%), condyloma (24.9%), and lichen sclerosus (15.6%). Data correlating circumcision and other diagnoses did not reach statistical significance. HIV was positively associated with other STIs (p < 0.05), and an association with balanoposthitis was seen; however, it did not reach statistical significance (p < 0.1). Main limitation was small sample size. This is the first study of its kind based on Hispanic patients. Collaboration between specialties proved to be fundamental. Further studies are needed in this demographic to find an association between circumcision, comorbidities, and genital dermatoses.
