RESUMO
Globalization entails several medical problems along with economic and social complications. Migrations from other continents, increasing numbers of tourists worldwide, and importation of foreign parasites (eg, Aedes albopictus) have made diseases previously unknown in Europe a reality. The rapid spread of the coronavirus disease 2019 pandemic throughout the world is a warning that other epidemics are still possible. Most, if not all of these diseases, transmitted by viruses or bacteria, present with cutaneous symptoms and signs that are highly important for a speedy diagnosis, a fundamental concept for arresting the diseases and saving lives. Dermatologists play a significant role in delineating cutaneous and mucosal lesions that are often lumped together as dermatitis. We provide a review of many of these cutaneous and mucosal lesions that sometimes are forgotten or even ignored.
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Infecções Bacterianas , COVID-19 , Dermatopatias , Humanos , Pandemias , SARS-CoV-2 , Dermatopatias/diagnósticoAssuntos
COVID-19/complicações , Coinfecção , Infecções por Vírus Epstein-Barr/complicações , Pitiríase Rósea/complicações , Infecções por Roseolovirus/complicações , Ativação Viral , Adolescente , Anticorpos Antivirais/sangue , Infecções por Vírus Epstein-Barr/virologia , Herpesvirus Humano 4/imunologia , Herpesvirus Humano 6/imunologia , Herpesvirus Humano 7/imunologia , Humanos , Masculino , Infecções por Roseolovirus/virologiaRESUMO
BACKGROUND: Sexually transmitted infections (STIs) may impact on the patient's physical, psychological and sexual health and negatively influence their Quality of Life (QOL). Studies on this topic are scarce. This study aimed to assess the impact of STIs different from HIV on QOL, mood and sexual functioning in the patients attending our STIs center in comparison with patients affected by chronic inflammatory bowel diseases (IBD). METHODS: An anonymous questionnaire was provided. It included 3 validated questionnaires: the European Quality of Life 5 dimensions 5 levels; the Beck Depression Inventory-II for depressive symptoms; the Changes in Sexual Functioning Questionnaire (CSFQ) for sexual functioning. RESULTS: Seventy-three STIs patients and 51 IBD patients participated in the study. The mean EQ-5D-5L questionnaire scores were 86.72 in STIs and 89.21 in IBD patients, without statistically significant difference between the two groups. Symptoms of depression were more common and severe in STIs patients compared to IBD patients. Sexual functioning was slightly worse in STIs patients than in IBD patients. CONCLUSIONS: This is one the very few studies focused on the impact of STIs on patient's physical, psychological and sexual health. Physicians dealing with STIs should consider the possible psychological consequences of the disease.
Assuntos
Doenças Inflamatórias Intestinais , Infecções Sexualmente Transmissíveis , Afeto , Humanos , Qualidade de Vida , Comportamento Sexual , Infecções Sexualmente Transmissíveis/epidemiologiaRESUMO
Data on the prevalence of sexually transmitted infections (STIs) and risk factors among incarcerated people are few and data about STIs awareness among inmates are even lacking. This study aimed to assess prevalence of STIs, risky behaviours and STIs level of knowledge in male inmates of the Casa Circondariale-Genova Marassi, the main penitentiary in Genoa, Italy. Between January and June 2019, 662 inmate medical records were retrospectively examined to obtain clinical and laboratory data about STIs. To investigate the inmate level of knowledge of STIs and their risky behaviours, 111consenting participants answered, anonymously, a written questionnaire. One hundred and twenty-two patients had at least one infectious disease when entered the prison: HIV (1.8%), HBV (2.7%), HCV (12.5%) and syphilis (1.3%). When asked to select from a list of diseases which ones they thought to be sexually transmitted, only 12% of the inmates answered correctly; most of them ignored which body fluids are at risk for HIV transmission, which STIs can induce tumors and if any vaccination exists to prevent STIs. Substance abuse was common among inmates that frequently exchanged needles for injecting drugs. To reduce the STIs incidence, it is necessary to target high-risk populations: everyone entering a prison should be offered a systematic screening of all STIs, including those currently neglected. Since STIs knowledge among inmates is poor and risky behaviours are diffuse, informative interventions in prison may provide an opportunity to educate such a high-risk population.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Comportamentos de Risco à Saúde , Prisioneiros/estatística & dados numéricos , Comportamento Sexual , Infecções Sexualmente Transmissíveis/epidemiologia , Adolescente , Adulto , Idoso , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco , Adulto JovemRESUMO
After the incidental observation of an almost complete resolution of maculopapular eruption in a patient having simultaneously secondary syphilis and trichomonas vaginalis infection, we extended the treatment with tinidazole (500 mg 4 times daily for 7 days) to 10 other early syphilis patients before the start of the conventional penicillin treatment. All patients showed marked improvement of their lesions in a few days. After the introduction of the conventional penicillin regimen, the lesions further improved and VDRL titers declined at least 4-fold within 6 months in all patients. Tinidazole is a 5-nitroimidazole derivative as well as metronidazole but with a longer plasma half-life. It is activated intracellularly by bacterial/parasitic enzymes to a redox cytotoxic intermediate that damages large protein molecules and inhibits repair and transcription of DNA affecting also the cell wall. With this action, tinidazole might also have a synergic action with penicillin and doxycycline, facilitating the entry of such drugs. It is possible that tinidazole has the same bactericidal action on spirochetes other than Borrelia, such as Treponema pallidum, explaining its rapid therapeutic action on the lesions of early syphilis. Whether this action could be confirmed by studies on larger series of patients, tinidazole might be considered in case of allergy to penicillin or other antibiotics usually prescribed in syphilis.
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Antibacterianos/administração & dosagem , Antitricômonas/administração & dosagem , Sífilis/tratamento farmacológico , Tinidazol/administração & dosagem , Administração Oral , Adolescente , Adulto , Feminino , Humanos , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Penicilina G Benzatina/administração & dosagem , Sífilis/complicações , Vaginite por Trichomonas/tratamento farmacológico , Trichomonas vaginalis/efeitos dos fármacos , Adulto JovemRESUMO
Any infectious illness presenting with an eruption in a pregnant patient may be associated with an increased risk of fetal loss. The viruses that can infect the placenta during maternal infection and can be transmitted to the fetus and cause congenital disease include the rubella virus, the measles virus, the varicella zoster virus, parvovirus B19, human cytomegalovirus, arboviruses, and hepatitis E virus type 1. In addition, some bacteria responsible for exanthematous diseases, like Treponema pallidum, can be transmitted during pregnancy from the mother to the fetus and cause fetal loss. All these infectious agents can cause typical and/or atypical exanthems whose etiologic diagnosis is sometimes difficult but important to determine, especially in pregnant women because of the potential risk to the fetus. In the last 20 years, we have extensively studied pityriasis rosea from the clinical and laboratory perspectives, demonstrating the pathogenic role of human herpesvirus (HHV)-6 and -7. We synthesize the available evidence that PR may be associated with active HHV-6/7 infection and therefore with complications during pregnancy and fetal loss. We have also summarized the emerging infectious illnesses of dermatologic interest that may represent life-threatening health conditions for the fetus: measles, rubella, arbovirus infection, and syphilis.
Assuntos
Infecções Bacterianas/complicações , Transmissão Vertical de Doenças Infecciosas , Pitiríase Rósea/etiologia , Pitiríase Rósea/patologia , Complicações Infecciosas na Gravidez/etiologia , Complicações na Gravidez/etiologia , Complicações na Gravidez/patologia , Pele/patologia , Viroses/complicações , Feminino , Herpesvirus Humano 6 , Humanos , Gravidez , Infecções por Roseolovirus/complicaçõesRESUMO
Excessive hair shedding is a common and alarming phenomenon, usually complained about by women. The disorder, named telogen effluvium (TE), bears several problems which are discussed in this essay. They are as follows: 1) how profuse a hair loss must be for TE to be diagnosed; 2) its heterogeneity that needs to be properly classified; 3) its distinction from androgenetic alopecia (AGA) with which it is often associated; 4) its main symptom, trichodynia, which is unclear how frequent and how diagnostic could be; 5) why histopathology has been reported to be nonspecific; and 6) its management, from diagnosis to treatment. A common mistake of the dermatologist is to minimize the complaint. Instead, the disorder may have a profound impact on the patients' mind and would require attention, time, and empathy.
RESUMO
The progressive reduction of the number of terminal hairs and the simultaneous increase in the number of vellus hairs (hair miniaturization) are the current explanation of human baldness. In a 2.5-year study on 43 male subjects with androgenetic alopecia (AGA), we found that oral finasteride augmented the total number of hairs by 55%, but failed to decrease the prevalence of vellus hairs. While our data may explain why, in AGA, hairs become progressively softer and combable, they cannot explain why areas of hair rarefaction develop. We propose that the longer duration and higher frequency of kenogen hairs are the real mechanism through which the scalp hairs rarefy.
RESUMO
BACKGROUND: Recently, Herpes simplex virus (HSV)-1 seroprevalence declined among adolescents, rendering young people lacking HSV-1 antibodies more susceptible to genital HSV-1 acquisition, if sexually exposed. The aim of the present study was to identify the possible risk factors for the development of HSV-1 related Herpes genitalis (HG). METHODS: From January 2012 to December 2015, patients with HG attending three Sexually Transmitted Infections Units in Northern Italy were recruited. A genital swab on the lesions for the search of HSV-1/2 DNA through real time polymerase chain reaction (PCR) and a serum sample for HSV-1/2 specific serology were performed. Moreover, patients were asked whether they had personal history of herpes labialis (HL). Patients with PCR proved HSV-1 HG were included as cases; asymptomatic subjects attending STI Units for a blood check were recruited as controls and were checked for HSV-1/2 serology. RESULTS: The study included 141 cases and 70 controls. Specific HSV-1 antibodies were found in 34.7% of the cases and 67% of the controls. History of recurrent herpes labialis (RHL) was found in 4% of the cases and 31% of the controls. The occurrence of RHL in HSV-1 seropositive patients resulted lower in the case group compared to the control group. CONCLUSIONS: We can speculate about a protective role for RHL against the clinical appearance of HSV-1 HG. The clinical usefulness of our study involved especially the counselling in serodiscordant couples. The presence of HSV-1 antibodies in asymptomatic sexual partners does appear protective for HG manifestation only in presence of RHL history.
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Anticorpos Antivirais/análise , Herpes Genital/diagnóstico , Herpes Labial/diagnóstico , Infecções Sexualmente Transmissíveis/diagnóstico , Adolescente , Adulto , DNA Viral/análise , Feminino , Herpes Genital/epidemiologia , Herpes Labial/epidemiologia , Herpesvirus Humano 1/isolamento & purificação , Herpesvirus Humano 2/isolamento & purificação , Humanos , Itália , Masculino , Recidiva , Fatores de Risco , Estudos Soroepidemiológicos , Parceiros Sexuais , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/virologia , Adulto JovemAssuntos
Fumar Cigarros/epidemiologia , Disbiose/epidemiologia , Microbioma Gastrointestinal , Intestino Delgado/microbiologia , Rosácea/epidemiologia , Bactérias/isolamento & purificação , Comorbidade , Disbiose/microbiologia , Disbiose/prevenção & controle , Feminino , Humanos , Itália/epidemiologia , Masculino , não Fumantes/estatística & dados numéricos , Razão de Chances , Rosácea/microbiologia , Fumantes/estatística & dados numéricosAssuntos
Alopecia/etiologia , Febre Botonosa/complicações , Febre/complicações , Adulto , Feminino , Febre/microbiologia , HumanosRESUMO
Herpes zoster (HZ) is typically characterized by pain involving the area of vesicular eruption. Several patients, however, complain of unilateral radicular pain without rash (zoster sine herpete [ZSH]). To evaluate whether the severity and duration of pain and the use of analgesics are greater in ZSH patients than in typical HZ with rash, 16 consecutive patients with acute unilateral pain, without vesicular eruption (ZSH), were compared with 16 controls suffering from typical HZ eruption. Only patients with laboratory evidence of varicella-zoster virus (VZV) reactivation were selected. Serum samples were obtained from all patients at their initial visit and 1 and 2 months later. Monthly, the administered therapies and the average pain score (visual analog scale [VAS] score) were recorded. VZV DNA persisted statistically higher in ZSH sera than HZ sera 1 month after onset (P = 0.0007). ZSH patients averaged greater pain than HZ patients, scoring VAS 76.88 and 66.88 ( P = 0.0012), respectively. ZSH patients used significantly more opioid therapy than HZ patients ( P = 0.0449; OR, 9.00). This is the first study comparing pain in ZSH and HZ patients: greater severity and duration of pain and more opioid use was detected in patients with ZSH.
Assuntos
Dor Aguda/epidemiologia , Herpesvirus Humano 3/crescimento & desenvolvimento , Neuralgia Pós-Herpética/epidemiologia , Ativação Viral , Zoster Sine Herpete/patologia , Dor Aguda/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Analgésicos/uso terapêutico , Uso de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia Pós-Herpética/tratamento farmacológicoRESUMO
BACKGROUND: Pityriasis rosea (PR) is a self-limiting exanthematous disease associated with human herpesvirus (HHV)-6 and/or HHV-7 reactivation. In pregnant women, PR may be associated with pregnancy complications. OBJECTIVE: To determine relevant risk factors in the development of negative pregnancy outcome in PR. METHODS: Between 2005 and 2017 at the Department of Dermatology, University of Genoa, we recruited 76 women who developed PR during pregnancy. In 60 patients without known risk factors for intrauterine fetal death (30 with pregnancy complications and 30 without) we analyzed the pregnancy week of PR onset, presence of enanthem and of constitutional symptoms, PR body surface area involvement, age, and in 50 patients (20 with pregnancy complications and 30 without), the viral load of HHV-6 and HHV-7 (copies/mL). RESULTS: In logistic regression analysis, early onset of PR (p = 0.0017) and enanthem (p = 0.0392) proved to be significantly associated with pregnancy complications. HHV-6 viral load (copies/mL) (p < 0.0001), constitutional symptoms (p < 0.001), and PR body surface area involvement (p < 0.004) were also significantly associated with pregnancy complications. CONCLUSION: The onset of PR before week 15 and enanthem may be considered major risk factors that should alarm the dermatologist. Constitutional symptoms and involvement of > 50% of the body area may be considered minor risk factors.
Assuntos
DNA Viral/sangue , Herpesvirus Humano 6/isolamento & purificação , Herpesvirus Humano 7/isolamento & purificação , Doenças da Boca/epidemiologia , Pitiríase Rósea/epidemiologia , Complicações na Gravidez/epidemiologia , Aborto Espontâneo/sangue , Aborto Espontâneo/epidemiologia , Adulto , Índice de Apgar , Feminino , Forame Oval Patente/sangue , Forame Oval Patente/epidemiologia , Idade Gestacional , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Doenças da Boca/virologia , Mucosa Bucal , Hipotonia Muscular/sangue , Hipotonia Muscular/epidemiologia , Pitiríase Rósea/sangue , Pitiríase Rósea/virologia , Poli-Hidrâmnios/sangue , Poli-Hidrâmnios/epidemiologia , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/virologia , Fatores de Risco , Carga ViralRESUMO
INTRODUCTION: Aortitis is a well-recognized manifestation of the tertiary stage of syphilis. EVIDENCE ACQUISITION: Although often regarded as an unexpected diagnosis, actually new cases of cardiovascular syphilis continue to be reported. Presumably, Treponema pallidum invades the aortic wall and the inflammatory response progresses towards obliterative endarteritis and necrosis of the muscular and elastic fibers in the aortic media. The consequent weakening of the aortic wall can lead to severe complications, represented by aortic aneurysm, aortic valvular insufficiency, aortic root dilation and coronary ostial stenosis. We perused the literature of the last 6 years to assess the prevalence and possible changes over time of syphilis cardiovascular manifestations. EVIDENCE SYNTHESIS: Forty four articles were collected, reporting on 66 patients. Many patients presented more than one complication. Aortic aneurysm was the most frequent involvement, detected in 71% of patients. Fusiform or saccular aneurysms often interested the thoracic aorta, primarily located on the ascending segment. The second most common complication was the aortic valvular insufficiency, found in 47% of patients. Coronary ostial stenosis and dilation of the aortic root were less frequent. CONCLUSIONS: Comparing our study with the previous ones, the cardiovascular involvement appeared roughly constant over time. Although many articles fail to provide useful information, such as a detailed history and the presence of risk factors, we must note that most patients had no predisposing factors and denied a primary infection. Cardiovascular syphilis is still present nowadays and it is important not to forget the "great imitator" in the event of its characteristic symptoms.
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Aorta/fisiopatologia , Sífilis Cardiovascular/fisiopatologia , Aneurisma Aórtico/etiologia , Insuficiência da Valva Aórtica/etiologia , Estenose Coronária/etiologia , Humanos , Sífilis Cardiovascular/complicações , Sífilis Cardiovascular/diagnósticoRESUMO
Contrary to the classical view of the hair cycle, in which telogen is the resting phase that precedes the release of the hair shaft, another phase has been introduced, exogen. Exogen is the phase wherein the processes for the release of the hair shaft are initiated and successfully executed. Exogen ends when the shaft is liberated. Accordingly, human hairs would be preferably released not with telogen but with exogen roots. To better understand this somehow revolutionary point and what occurs in telogen effluvium (TE) and in androgenetic alopecia (AGA), we undertook a morphological study. We examined 25 women of comparable age by collecting shedding hairs by the Modified Wash Test under stringent diagnostic criteria. Eight patients were "normal", 5 had AGA, 9 TE, and 3 had a TE+AGA overlap. Hair roots were divided into early telogen, full telogen, and exogen. Exogens accounted, in normal women, for 2.6% of all hairs, for 5.2% in AGA, for 6.6% in TE, and for 2.3% in TE+AGA, without any significant difference. Our exogen prevalence (2.6%) did not vary in patients with AGA and TE. Therefore, the pathogenetic role of exogen in AGA and TE seems negligible.
RESUMO
BACKGROUND: Pityriasis rosea (PR) is an exanthematous disease associated with the endogenous systemic reactivation of human herpesvirus-6 (HHV-6) and human herpesvirus-7 (HHV-7). Oropharyngeal lesions may be associated with the exanthema, but anecdotal evidence suggests that few dermatologists are aware of their occurrence. OBJECTIVE: Classifying oropharyngeal lesions in PR, establishing their prevalence, and assessing their possible association with different PR forms. METHODS: The records of all PR cases diagnosed in the Dermatology Clinic of Genoa University between 2003 and 2016 were retrospectively reviewed to examine sex and age of the patients, PR type, presence of enanthema, systemic symptoms, specific anti-HHV-6 and or HHV-7 serology, and HHV-6 and/or HHV-7 DNA loads. RESULTS: The oropharyngeal mucosa was carefully examined in 527 patients with PR. Painless oropharyngeal lesions were observed in 149 patients with PR (28%) and classified as erythematomacular, macular and papular, erythematovesicular, and petechial lesions. The petechial and macular and papular patterns were those most frequently observed. There was no statistically significant difference in the levels of HHV-6 and HHV-7 viremia in the plasma of patients with enanthema and those without. LIMITATIONS: Because this was a retrospective study, biopsies on mucosal lesions were not performed. CONCLUSION: Our findings showed that enanthemas are frequently associated with forms of PR different from the classic form.