Assuntos
Adamantano/análogos & derivados , Doenças Autoimunes/induzido quimicamente , Dipeptídeos/efeitos adversos , Penfigoide Bolhoso/induzido quimicamente , Penfigoide Bolhoso/diagnóstico , Adamantano/efeitos adversos , Autoanticorpos/metabolismo , Diagnóstico Diferencial , Humanos , Síndrome de Stevens-Johnson/diagnósticoRESUMO
Organizing pneumonia is defined histopathologically by intra-alveolar buds of granulation tissue, consisting of intermixed myofibroblasts and connective tissue. The pathological pattern of organizing pneumonia may be idiopathic or related to a determined cause, termed secondary organizing pneumonia. We report a 68-year-old woman with a longstanding history of chronic plaque psoriasis, treated with the tumor necrosis factor (TNF) inhibitor, adalimumab. After 8 years of treatment, she developed a gradual-onset, non-productive cough with associated generalized fatigue and mild dyspnea. Radiological investigations demonstrated ground-glass opacities in the left lower lobe and bronchoscopy revealed a fibroinflammatory process consistent with organizing pneumonia. Her biologic treatment was ceased and corticosteroid treatment commenced, with resolution of both her symptoms and the radiological findings. Given the increasing incidence of biologic treatment in the management of dermatological conditions, clinicians should be aware of secondary organizing pneumonia as a possible side effect of TNF inhibitor therapy.
Assuntos
Adalimumab/efeitos adversos , Pneumonia em Organização Criptogênica/induzido quimicamente , Psoríase/tratamento farmacológico , Inibidores do Fator de Necrose Tumoral/efeitos adversos , Adalimumab/uso terapêutico , Idoso , Pneumonia em Organização Criptogênica/diagnóstico , Feminino , Humanos , Psoríase/complicações , Inibidores do Fator de Necrose Tumoral/uso terapêuticoAssuntos
Dapsona/administração & dosagem , Dermatopatias Vesiculobolhosas/tratamento farmacológico , Administração Cutânea , Administração Oral , Idoso de 80 Anos ou mais , Axila , Dapsona/efeitos adversos , Relação Dose-Resposta a Droga , Feminino , Humanos , Pele/efeitos dos fármacos , Pele/patologia , Dermatopatias Vesiculobolhosas/patologia , Resultado do TratamentoAssuntos
Toxidermias/etiologia , Piperidinas/efeitos adversos , Pirimidinas/efeitos adversos , Pirróis/efeitos adversos , Urticária/induzido quimicamente , Alopecia/tratamento farmacológico , Humanos , Masculino , Piperidinas/administração & dosagem , Inibidores de Proteínas Quinases/administração & dosagem , Inibidores de Proteínas Quinases/efeitos adversos , Pirimidinas/administração & dosagem , Pirróis/administração & dosagem , Adulto JovemAssuntos
Mutação/genética , Nevo Pigmentado/etiologia , Nevo Pigmentado/patologia , Nevo Sebáceo de Jadassohn/patologia , Proteínas Proto-Oncogênicas p21(ras)/genética , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/patologia , Humanos , Masculino , Nevo Sebáceo de Jadassohn/complicações , Nevo Sebáceo de Jadassohn/genética , Adulto JovemRESUMO
Alopecia areata (AA) severity varies from a single small patch to complete loss of scalp hair, body hair, eyelashes and eyebrows. While 40% of all affected individuals only ever get one patch and will achieve a spontaneous complete durable remission within 6 months, 27% will develop additional patches but still achieve complete durable remission within 12 months and 33% will develop chronic AA. Without systemic treatment, 55% of individuals with chronic AA will have persistent multifocal relapsing and remitting disease, 30% will ultimately develop alopecia totalis and 15% will develop alopecia universalis. The unpredictable course and psychological distress attributable to AA contributes to the illness associated with AA. Numerous topical, intralesional and systemic agents are currently used to treat AA; however, there is a paucity of data evaluating their use, effectiveness and tolerability. Topical therapy, including topical glucocorticosteroids, minoxidil and immunotherapy, can be used in cases of limited disease. There are no universally agreed indications for initiating systemic treatment for AA. Possible indications for systemic treatment include rapid hair loss, extensive disease (≥50% hair loss), chronic disease, severe distress or a combination of these factors. Currently available systemic treatments include glucocorticosteroids, methotrexate, ciclosporin, azathioprine, dapsone, mycophenolate mofetil, tacrolimus and sulfasalazine. The optimal treatment algorithm has not yet been described. The purpose of this consensus statement is to outline a treatment algorithm for AA, including the indications for systemic treatment, appropriate choice of systemic treatment, satisfactory outcome measures and when to discontinue successful or unsuccessful treatment.
Assuntos
Alopecia em Áreas/terapia , Alopecia em Áreas/diagnóstico , Doenças Autoimunes/complicações , Progressão da Doença , Síndrome de Down/complicações , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Imunoterapia , Minoxidil/uso terapêutico , Doenças da Unha/complicações , Prognóstico , Vasodilatadores/uso terapêuticoAssuntos
Cor de Cabelo , Síndrome dos Cabelos Anágenos Frouxos/diagnóstico , Minoxidil/uso terapêutico , Administração Oral , Criança , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Seguimentos , Humanos , Síndrome dos Cabelos Anágenos Frouxos/tratamento farmacológico , Síndrome dos Cabelos Anágenos Frouxos/psicologia , Medição de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Cryosurgery is an effective, simple and inexpensive treatment used extensively in general practice and dermatology. It is used most commonly for actinic keratoses and warts; however, a large number of benign, premalignant and malignant skin diseases can also be treated. OBJECTIVE: The objective of this article is to help readers improve their cryosurgery technique. DISCUSSION: Application of the cryogenic agent (most commonly liquid nitrogen) to the skin induces rapid freezing followed by slow thawing. This produces cell injury, vascular stasis and occlusion, and inflammation. The quantity of cryogen delivered onto the skin (dose), technique, duration of thawing and amount of surrounding tissue frozen are dependent on the body region and type of lesion. If clinical diagnosis is not possible, either a skin biopsy or referral to a dermatologist is recommended. We strongly discourage blind treatment of undiagnosed skin lesions.
Assuntos
Criocirurgia/métodos , Criocirurgia/normas , Dermatopatias/terapia , Contraindicações , Humanos , Nitrogênio/farmacocinética , Nitrogênio/uso terapêutico , Pele/lesões , Pele/fisiopatologiaRESUMO
A 46-year-old premenopausal woman presented with familial frontal fibrosis alopecia affecting the temples bilaterally. The diagnosis was confirmed histologically. Her past history included rheumatoid arthritis treated with hydroxychloroquine 400 mg daily and methotrexate 20 mg weekly. Serial intralesional injections of triamcinolone did not limit the progression of hair loss. Treatment with dutasteride 0.1 mg daily and minoxidil 1 mg daily stabilised hair loss and artificial fibre hair transplantation initially led to a satisfactory cosmetic outcome. Unfortunately, the patient developed implant folliculitis uncontrolled by antibiotics, necessitating the removal of the fibres 12 months post-transplantation.