25-Hydroxyvitamin D as a biomarker of vitamin D status in plaque psoriasis and other dermatological diseases: a cross-sectional study

ABSTRACT BACKGROUND: Hypovitaminosis D is a public health problem associated with several chronic inflammatory and immunological diseases, including psoriasis. OBJECTIVES: This study aimed to determine the prevalence of hypovitaminosis D in patients with plaque psoriasis. A comparison was made between vitamin D levels in patients with psoriasis and those with other non-inflammatory dermatoses without photosensitivity. In addition, it evaluated the effects of the patients' Fitzpatrick skin phototype and the season of the year on the serum levels of vitamin D. DESIGN AND SETTINGS: A retrospective cross-sectional study was conducted at an outpatient clinic in a university center in Juiz de Fora (MG), Brazil. METHODS: A review of dermatology patients' demographic data, including skin phototype and serum levels of 25-hydroxyvitamin D [25(OH)D], over 12 months in 2016. RESULTS: This study included 554 patients: 300 patients allocated to the plaque psoriasis group and 254 control patients with other dermatological diseases. Regarding the season of the year, 229, 132, 62, and 131 participants were evaluated in summer, autumn, winter, and spring, respectively. As for the skin phototype, 397, 139, and 18 patients had phototypes III, IV, and V, respectively. The serum levels of 25(OH)D were significantly lower in the psoriasis group (24.91 ± 7.16 ng/mL) than in the control group (30.37 ± 8.14 ng/mL). CONCLUSIONS: Hypovitaminosis D (< 30 ng/mL) was present in 76.66% of patients with psoriasis versus 53.94% of control patients. Vitamin D deficiency (< 20 ng/mL) was observed in 25% of the patients with psoriasis versus 8.66% in the control group (P < 0.001). The season and patient's skin phototype were independent predictors of serum vitamin D levels.

Is vitamin D status relevant to psoriasis and psoriatic arthritis? A retrospective cross-sectional study

Abstract BACKGROUND: Psoriasis is a systemic, immune-mediated disease characterized by inflammatory manifestations in the skin and joints. Vitamin D deficiency is currently considered a pandemic and is associated with comorbidities including psoriasis and psoriatic arthritis (PsA). OBJECTIVES: To determine the prevalence of hypovitaminosis D [25(OH)D] in patients with plaque psoriasis, with and without PsA, and of independent predictors of serum 25(OH)D levels. DESIGN AND SETTING: Retrospective cross-sectional study conducted among 300 patients at an outpatient clinic in a university center in Juiz de Fora, Minas Gerais, Brazil. METHODS: Demographic and clinical data (psoriasis area and severity index [PASI], family history, age at onset, disease duration, and the presence of PsA according to Classification Criteria for Psoriatic Arthritis), skin phototype, and season of the year were reviewed. RESULTS: Hypovitaminosis D (< 30 ng/mL) was highly prevalent in patients with psoriasis with and without PsA (82.2% and 74.9%, respectively). An inverse correlation between PASI and vitamin D was found (without PsA r = -0.59 and, PsA r = -0.52, P < 0.001), and multivariate regression revealed that hypovitaminosis D was associated with disease severity, season, and phototype. It was confirmed by binary logistic regression between PASI and vitamin D deficiency (< 30 ng/mL), (odds ratio, OR 1.78 CI: -0.20-0.53, P < 0.001). CONCLUSION: Hypovitaminosis D (< 30 ng/mL) was highly prevalent in psoriatic patients with and without PsA. Season and skin phototype were associated with 25(OH)D levels. An inverse association between PASI and serum 25(OH)D levels was established.

Is vitamin D status relevant to psoriasis and psoriatic arthritis? A retrospective cross-sectional study.

BACKGROUND: Psoriasis is a systemic, immune-mediated disease characterized by inflammatory manifestations in the skin and joints. Vitamin D deficiency is currently considered a pandemic and is associated with comorbidities including psoriasis and psoriatic arthritis (PsA). OBJECTIVES: To determine the prevalence of hypovitaminosis D [25(OH)D] in patients with plaque psoriasis, with and without PsA, and of independent predictors of serum 25(OH)D levels. DESIGN AND SETTING: Retrospective cross-sectional study conducted among 300 patients at an outpatient clinic in a university center in Juiz de Fora, Minas Gerais, Brazil. METHODS: Demographic and clinical data (psoriasis area and severity index [PASI], family history, age at onset, disease duration, and the presence of PsA according to Classification Criteria for Psoriatic Arthritis), skin phototype, and season of the year were reviewed. RESULTS: Hypovitaminosis D (< 30 ng/mL) was highly prevalent in patients with psoriasis with and without PsA (82.2% and 74.9%, respectively). An inverse correlation between PASI and vitamin D was found (without PsA r = -0.59 and, PsA r = -0.52, P < 0.001), and multivariate regression revealed that hypovitaminosis D was associated with disease severity, season, and phototype. It was confirmed by binary logistic regression between PASI and vitamin D deficiency (< 30 ng/mL), (odds ratio, OR 1.78 CI: -0.20-0.53, P < 0.001). CONCLUSION: Hypovitaminosis D (< 30 ng/mL) was highly prevalent in psoriatic patients with and without PsA. Season and skin phototype were associated with 25(OH)D levels. An inverse association between PASI and serum 25(OH)D levels was established.

25-Hydroxyvitamin D as a biomarker of vitamin D status in plaque psoriasis and other dermatological diseases: a cross-sectional study.

BACKGROUND: Hypovitaminosis D is a public health problem associated with several chronic inflammatory and immunological diseases, including psoriasis. OBJECTIVES: This study aimed to determine the prevalence of hypovitaminosis D in patients with plaque psoriasis. A comparison was made between vitamin D levels in patients with psoriasis and those with other non-inflammatory dermatoses without photosensitivity. In addition, it evaluated the effects of the patients' Fitzpatrick skin phototype and the season of the year on the serum levels of vitamin D. DESIGN AND SETTINGS: A retrospective cross-sectional study was conducted at an outpatient clinic in a university center in Juiz de Fora (MG), Brazil. METHODS: A review of dermatology patients' demographic data, including skin phototype and serum levels of 25-hydroxyvitamin D [25(OH)D], over 12 months in 2016. RESULTS: This study included 554 patients: 300 patients allocated to the plaque psoriasis group and 254 control patients with other dermatological diseases. Regarding the season of the year, 229, 132, 62, and 131 participants were evaluated in summer, autumn, winter, and spring, respectively. As for the skin phototype, 397, 139, and 18 patients had phototypes III, IV, and V, respectively. The serum levels of 25(OH)D were significantly lower in the psoriasis group (24.91 ± 7.16 ng/mL) than in the control group (30.37 ± 8.14 ng/mL). CONCLUSIONS: Hypovitaminosis D (< 30 ng/mL) was present in 76.66% of patients with psoriasis versus 53.94% of control patients. Vitamin D deficiency (< 20 ng/mL) was observed in 25% of the patients with psoriasis versus 8.66% in the control group (P < 0.001). The season and patient's skin phototype were independent predictors of serum vitamin D levels.

Prevalence of psoriatic arthritis among patients with plaque psoriasis: a Brazilian retrospective study.

BACKGROUND: Psoriatic arthritis is the most frequent and impactful comorbidity among psoriatic patients and appears in most cases after skin disease. Dermatologists play a key role in its early diagnosis and treatment. OBJECTIVE: To determine the prevalence of psoriatic arthritis and associated variables among patients with plaque psoriasis seen at a reference center for treating psoriasis. DESIGN AND SETTING: Retrospective cross-sectional study conducted among 300 patients at an outpatient clinic in a university center in Juiz de Fora, MG, Brazil. METHODS: Standardized records of 300 patients with plaque psoriasis were examined. Demographic data and medical variables relating to psoriasis (Psoriasis Area and Severity Index (PASI), family history, age at onset and disease progression) and psoriasis arthritis (CASPAR criteria) were evaluated. Laboratory and radiographic tests in the medical records were reviewed. RESULTS: Seventy-three (24.3%) of these 300 patients with plaque psoriasis had psoriatic arthritis. Asymmetric oligoarthritis (58.9%) was the most common clinical form, followed by polyarthritis (20.5%), distal interphalangeal arthritis (15.2%) and spondyloarthritis (5.4%). Dactylitis was present in 21.9% and enthesitis in 35.6% of patients. Compared with patients without arthritis, patients with arthritis had higher average age, higher frequency of positive family history of psoriasis, longer duration of evolution and higher PASI rates. CONCLUSION: Psoriatic arthritis is often underdiagnosed. Since dermatologists perform the initial approach, these professionals need to be trained to diagnose this comorbidity and treat it, together with rheumatologists.

Prevalence of psoriatic arthritis among patients with plaque psoriasis: a Brazilian retrospective study

ABSTRACT BACKGROUND: Psoriatic arthritis is the most frequent and impactful comorbidity among psoriatic patients and appears in most cases after skin disease. Dermatologists play a key role in its early diagnosis and treatment. OBJECTIVE: To determine the prevalence of psoriatic arthritis and associated variables among patients with plaque psoriasis seen at a reference center for treating psoriasis. DESIGN AND SETTING: Retrospective cross-sectional study conducted among 300 patients at an outpatient clinic in a university center in Juiz de Fora, MG, Brazil. METHODS: Standardized records of 300 patients with plaque psoriasis were examined. Demographic data and medical variables relating to psoriasis (Psoriasis Area and Severity Index (PASI), family history, age at onset and disease progression) and psoriasis arthritis (CASPAR criteria) were evaluated. Laboratory and radiographic tests in the medical records were reviewed. RESULTS: Seventy-three (24.3%) of these 300 patients with plaque psoriasis had psoriatic arthritis. Asymmetric oligoarthritis (58.9%) was the most common clinical form, followed by polyarthritis (20.5%), distal interphalangeal arthritis (15.2%) and spondyloarthritis (5.4%). Dactylitis was present in 21.9% and enthesitis in 35.6% of patients. Compared with patients without arthritis, patients with arthritis had higher average age, higher frequency of positive family history of psoriasis, longer duration of evolution and higher PASI rates. CONCLUSION: Psoriatic arthritis is often underdiagnosed. Since dermatologists perform the initial approach, these professionals need to be trained to diagnose this comorbidity and treat it, together with rheumatologists.

Successful therapeutic approach in a patient with elephantiasic pretibial myxedema

Abstract Localized pretibial myxedema is a dermopathy whose treatment is a challenge in dermatology, occurring in 0.5-4% of patients with Graves' disease. This autoimmune thyroid condition stimulates the production of hyaluronic acid and glycosaminoglycans that are deposited particularly in the pretibial region. Clinically, it presents as a localized, circumscribed, and non-depressible infiltrate in plaques. Several treatment modalities have been proposed, and their results vary, with worse response observed in severe cases. This report presents the case of a patient with elephantiasic pretibial myxedema who was subjected to intralesional corticosteroid applications, resulting in an excellent and encouraging therapeutic response that was maintained.

Successful therapeutic approach in a patient with elephantiasic pretibial myxedema.

Localized pretibial myxedema is a dermopathy whose treatment is a challenge in dermatology, occurring in 0.5-4% of patients with Graves' disease. This autoimmune thyroid condition stimulates the production of hyaluronic acid and glycosaminoglycans that are deposited particularly in the pretibial region. Clinically, it presents as a localized, circumscribed, and non-depressible infiltrate in plaques. Several treatment modalities have been proposed, and their results vary, with worse response observed in severe cases. This report presents the case of a patient with elephantiasic pretibial myxedema who was subjected to intralesional corticosteroid applications, resulting in an excellent and encouraging therapeutic response that was maintained.

Excision of furuncular myiasis larvae using a punch: a simple, practical and aesthetic method.

Myiasis refers to Diptera larvae infesting vertebrate animals. There are two forms of the disease: primary and secondary. In primary myiasis, fly larvae invade and develop in healthy tissue; in secondary myiasis, flies lay their eggs in skin ulcerations, and the larvae develop in tissue necrosis products. Furuncular myiasis is a type of primary myiasis. Treatment for it consists of techniques such as the production of localized hypoxia to force the emergence of the larvae, and mechanical or surgical removal of the maggots. These techniques, however, are painful and often unsuccessful. We propose a new technique for extraction of myiasis larvae, which might facilitate the surgical procedure and constitute a virtually painless and aesthetic option for the patient.

Excision of furuncular myiasis larvae using a punch: a simple, practical and aesthetic method

Abstract: Myiasis refers to Diptera larvae infesting vertebrate animals. There are two forms of the disease: primary and secondary. In primary myiasis, fly larvae invade and develop in healthy tissue; in secondary myiasis, flies lay their eggs in skin ulcerations, and the larvae develop in tissue necrosis products. Furuncular myiasis is a type of primary myiasis. Treatment for it consists of techniques such as the production of localized hypoxia to force the emergence of the larvae, and mechanical or surgical removal of the maggots. These techniques, however, are painful and often unsuccessful. We propose a new technique for extraction of myiasis larvae, which might facilitate the surgical procedure and constitute a virtually painless and aesthetic option for the patient.

Perfil dos usuários do ambulatório de dermatologia antroposófica - HU/CAS- UFJF, Juiz de Fora - MG / The patient´s profile of the anthroposophic dermatology service - HU/CAS - UFJF, Juiz de Fora - MG

Este trabalho busca demonstrar o perfil do usuário da Medicina Antroposófica (MA) no Ambulatório de Dermatologia do Hospital Universitário ? Centro de Atenção à Saúde da Universidade Federal de Juiz de Fora (HU/CAS-UFJF), assim como avaliar sua aceitação pela comunidade.O ambulatório surgiu dentro de uma visão mais abrangente da Medicina, em conformidade com a Organização Mundial de Saúde, que vem estimulando o uso da Medicina Tradicional e Complementar/Alternativa nos Sistemas de Saúde de forma integrada às técnicas modernas da medicina ocidental; e visa difundir a prática Médica Antroposófica em Juiz de Fora demonstrando sua eficácia e qualidade.Para tal feito, foi realizado um estudo retrospectivo, quali-quantitativo, através da coleta de dados, a partir de prontuários de 2008 e 2009 do HU/CAS-UFJF, seguida da análise das informações.O resultado demonstrou que a MA foi eficaz em mais de 75% dos tratamentos propostos, com média de cura/melhora completa em 40% dos casos analisados. Discute-se então, sobre os resultados encontrados e percebe-se que têm semelhanças com os da literatura em relação à frequência das doenças dermatológicas. As conclusões são positivas e contribuem para a legitimidade da Medicina Antroposófica.

This paper seeks to demonstrate the patients’ profile of the Anthroposophical Medicine (AM) in the Dermatology Clinic of the Hospital Undergraduate / Secondary Service Center, Federal University of Juiz de Fora - MG (HU / CAS-UFJF) as well as evaluate its acceptance by the community. This Clinic of AM emerged within a more comprehensive vision of medicine in accordance with the World Health Organization which has encouraged the use of Traditional Medicine and Complementary / Alternative Systems in an integrated manner with the modern Western medicine techniques, and aims to spread the Anthroposophical Medicine experience in Juiz de Fora and demonstrate its effectiveness and quality. For this, it was performed a retrospective study and quali-quantitative data collection made in the period of June- December 2009 from medical files of the HU/ CAS - UFJF, followed by analysis of the collected data. The findings were that the AM was effective in more than 75% of the proposed treatments, with healing / improvement average of 100% in 40% of cases. It is argued then about the results and perceives that has similarities with the literature in relation to frequency. The conclusions are positive and contribute to the legitimacy of Medicine Antroposófica.

Hay-Wells syndrome: a case report.

Hay-Wells syndrome is a rare form of ectodermal dysplasia initially described by Hay and Wells in 1976. It is an autosomal dominant disorder with varying forms of expression featuring congenital abnormalities of the skin, hair, teeth, nails and sweat glands. The present report describes the case of a 17-year old white boy, the son of nonconsanguineous parents, who presented ankyloblepharon filiforme adnatum, ectodermal dysplasia and a cleft palate at birth, which are considered cardinal signs of this syndrome by most authors. We also highlight the importance of implementing multidisciplinary follow-up of these patients.

Síndrome de Hay-Wells: relato de caso / Hay-Wells syndrome: a case report

A síndrome de Hay-Wells é uma forma rara de displasia ectodérmica, descrita inicialmente em 1976 por Hay e Wells, de caráter autossômico dominante com expressão variável, composta por anomalias congênitas da pele, cabelos, dentes, unhas e glândulas sudoríparas. Descrevemos o caso de um paciente de 17 anos, filho de pais não consangüíneos, que apresentava anquiloblefaron filiforme adenatum, displasia ectodérmica e fenda palatina ao nascimento, sinais considerados cardinais pela maioria dos autores. Destacamos também a importância do acompanhamento multidiscliplinar dos pacientes.

Hay-Wells syndrome is a rare form of ectodermal dysplasia initially described by Hay and Wells in 1976. It is an autosomal dominant disorder with varying forms of expression featuring congenital abnormalities of the skin, hair, teeth, nails and sweat glands. The present report describes the case of a 17-yearold white boy, the son of nonconsanguineous parents, who presented ankyloblepharon filiforme adnatum, ectodermal dysplasia and a cleft palate at birth, which are considered cardinal signs of this syndrome by most authors. We also highlight the importance of implementing multidisciplinary follow-up of these patients.

Síndrome da unha amarela: relato de caso / Yellow nail syndrome: case report

A síndrome da unha amarela é uma doença rara, caracterizada pela tríade de linfedema, derrame pleural e unhas Distróficas de crescimento lento e coloração amarelada. Várias associações já foram descritas, entre elas, afecções crônicas do aparelho respiratório, doenças autoimunes, malignidades e estados de imunodeficiência. Entre os casos citados na literatura, apenas cerca de um terço se apresenta com todos os achados e o caso relatado a seguir é um exemplo da tríade clássica.

The yellow nail syndrome is a rare disease, in which there is a triad of lymphedema, pleural effusion and slow-growing dystrophic yellow nails. Many associations have already been described; among them, chronic respiratory tract diseases, autoimmune disorders, malignancies and immunodeficiency conditions. Only one third of cases in the literature show all findings. The case reported next is an example of the classical triad.

Nonsurgical technique for incomplete earlobe cleft repair.

BACKGROUND: Earlobe cleft is a common problem caused by the wearing of jewelry or decorative objects. Incomplete earlobe clefts are usually bilateral and are often converted to complete clefts as part of the surgical repair procedure. OBJECTIVE: We present a nonsurgical procedure for incomplete earlobe cleft repair using trichloroacetic acid 90%. METHODS AND MATERIALS: We assessed 32 patients with a total of 53 earlobes to be noninvasively repaired. RESULTS: Complete treatment varied from 2 to 50 days, an average of 15 days between the first and last application of trichloroacetic acid 90%. No recurrences were observed during 1 year of follow-up. All of the clefts were totally repaired, and all of the patients were satisfied with the aesthetic results. CONCLUSIONS: Considering the surgical limitations, the noninvasive procedure described here may be considered to be a good option for incomplete earlobe cleft repair because of its good functional and cosmetic results, low cost, minimum risk, and easy application.

Estudo nosológico das dermatoses diagnosticadas no hospital da Universidade Federal de Juiz de Fora / Dermatoses diagnosed at the university hospital of the Federal University of Juiz de Fora

O censo dermatológico das diversas regiões brasileiras apresenta inegável importância para a Sociedade Brasileira de Dermatologia no intuito de se priorizar também seu papel social, assim como sua função no desenvolvimento da política de saúde do país. O objetivo do trabalho é o levantamento nosológico das dermatoses mais freqüentes de uma ampla região que abrange parte do Estado de Minas Gerais e do Estado do Rio de Janeiro, com a finalidade de fornecer dados para posteriores trabalhos e iniciativas afins específicas. Foram avaliados 14.784 prontuários dermatológicos referentes ao período de 02 de fevereiro de 2003 a 02 de fevereiro de 2006. Deste total, ao excluírem-se os retornos, obtiveram-se um total de 9.031 pacientes atendidos, valor referente ao número de patologias diagnosticadas e tratadas no Serviço de Dermatologia do Hospital Universitário da Universidade Federal de Juiz de Fora. Os diagnósticos foram subdivididos de forma compacta e didática. Os resultados mais frequentes foram Tumores Cutâneos com 19,9% do total; Infecções Cutâneas com 19,89%; Eczemas com 13,56% e Afecções dos Anexos com 10,56%. Quanto às infecções, estas representam um grande percentual dos casos analisados, o que se deve provavelmente ao baixo nível socioeconômico dos pacientes em estudo. O presente Censo Dermatológico fornece subsídios para as diversas instâncias governamentais no planejamento das políticas de saúde na área da dermatologia, assim como para os programas de formação em dermatologia.

A dermatological survey of the different Brazilian regions provides scope for the Brazilian Dermatology Society to both play its social role and influence the national health policies. The objective of this study is the data-gathering nosological survey of the most frequently diagnosed dermatological conditions in a region comprising part of the states of Minas Gerais and Rio de Janeiro, Brazil. 14.784 medical records of Dermatology from the period February 2, 2003 to February 2, 2006 were assessed.After exclusion of follow-up visits, 9.031 patients were seen at the Dermatology Clinic. Diagnoses were clustered in a compact and didatic way. The results were that 19.9% of the patients were diagnosed with skin tumors, 19.89% with skin infections, 13.56% with eczema, and 10.56% with infection of the skin annexes. The low socioeconomic status of the patients is likely to account for the high percentage of skin infections. This dermatological census informs different government levels about priorities for health policies and professional education.