Comparative Study of the Use of Trichloroacetic Acid and Phenolic Acid in the Treatment of Atrophic-Type Acne Scars.

BACKGROUND: Many therapies involving varying degrees of complexity have been used to treat acne scars, but none is considered the gold standard treatment. OBJECTIVE: A comparative evaluation of 88% phenol and 90% trichloroacetic acid (TCA) applied using the chemical reconstruction of skin scars (CROSS) technique. MATERIALS AND METHODS: A nonrandomized, single-blinded self-controlled clinical trial was conducted among patients with ice pick-type and boxcar-type atrophic acne scars. Using 88% phenol on the left hemiface and 90% TCA on the right hemiface was adopted as the standard practice of the CROSS technique. The dermatological quality of life index (DLQI) questionnaire, acne scar grading scale Échelle d´Evaluation Clinique des Cicatrices d'Acne (ECCA), and evaluation of improvement were performed pretreatment and post-treatment. RESULTS: Regarding ECCA, significant differences were found in pretreatment and post-treatment (p < .001). Regarding tolerance to pain, it was found that the discomfort felt with 90% TCA was significantly less than that felt with 88% phenol (p = .020). Regarding the quality of life measured with the DLQI, the results showed that the mean score in post-treatment assessment was significantly lower than that in the pretreatment assessment (p < .05). Hypochromia and enlargement scar were only seen after the use of 90% TCA. CONCLUSION: This study confirmed the efficacy of both TCA and phenol for treating such scars, with less severe complications from the use of phenol.

Epidemiology of melasma in Brazilian patients: a multicenter study.

BACKGROUND: Melasma is an acquired, irregularly patterned, light to dark-brown hypermelanosis, with symmetric distribution mostly over the face. The aim of this study was to evaluate clinical characteristics and factors related to melasma in Brazilian patients. METHODS: This was a cross-sectional, multicenter study performed in Brazil. Investigators examined and questioned 953 patients over 18 years of age on clinical characteristics and other factors related to their melasma. RESULTS: Melasma was more prevalent in women (97.5%) and in Fitzpatrick skin phototypes II (12.8%), III (36.3%), and IV (39.7%). Skin phototypes II and III and family history of melasma had early onset of the disorder when compared with skin phototypes IV, V, and VI (P<0.0001). Similar results were also observed when these same groups were compared with the absence of family history (P<0.0001). Extra-facial melasma was more frequent in postmenopausal women compared with those who were not experiencing menopause (14.2% vs. 3.5%, P<0.0001). CONCLUSIONS: Data suggested that the age of melasma onset are related to skin phototypes and family history. Additionally, extra-facial melasma was more common in menopausal women. This is the first study on the epidemiology of melasma in Brazil involving a large sample of the population. These data can be a source of new relevant research on the cause and development of melasma.

Prevalence of community-acquired methicillin-resistant Staphylococcus aureus and antibiotic resistance in patients with atopic dermatitis in Porto Alegre, Brazil.

BACKGROUND: Atopic dermatitis (AD) is a skin manifestation of atopy caused by hyperreactivity to various antigens. Studies have shown that 60-100% of patients with this condition present with colonization by Staphylococcus aureus. Given increasing rates of antimicrobial resistance, the sensitivity to antimicrobials of S. aureus colonizing atopic patients has been investigated. Cross-sectional studies worldwide suggest that the prevalence of methicillin-resistant S. aureus infection (MRSA) in the AD population varies from 0% to 30.8%. OBJECTIVES: The objectives of this study were to determinate the prevalence of S. aureus and MRSA in patients with AD in two dermatologic centers in Porto Alegre, Brazil. METHODS: A total of 91 patients with AD attending two dermatologic centers in Porto Alegre were enrolled in this study from December 2009 to July 2011. Two skin swabs were taken from each patient, one from the nares and the other from a non-infected eczematous skin lesion. The swabs were sent to the laboratory, where standard procedures to isolate bacteria and identify S. aureus, antimicrobial resistance, and sensitivity patterns were carried out. The severity of AD was defined using the Eczema Area and Severity Index (EASI). RESULTS: Of the 91 patients sampled, 67 (73.6%) patients were found to be positive for S. aureus colonization. Nasal swabs were positive in 55 (60.4%) patients, lesional swabs in 44 (48.4%) patients, and both lesional and nasal swabs were positive in 32 (35.2%) patients. Patients with positive swabs had a higher mean ± standard deviation EASI score [mean (9.1 ± 8.8)] compared with patients with negative swabs (3.9 ± 3.6) (P = 0.002). None of the 91 patients showed any evidence of MRSA infection. Overall, nearly 32% of the S. aureus isolated from nasal swabs and 36.40% of the S. aureus isolated from lesional swabs was resistant to erythromycin. CONCLUSIONS: The results of this study confirm a high rate of S. aureus colonization in pediatric patients with AD and indicate a relevant association between colonization and high EASI score. No MRSA was found in cultures from this sample of patients in southern Brazil. Nearly one-third of isolates were identified as resistant to erythromycin, an antibiotic that is commonly used in pediatric patients.

A dermatite atópica na criança: uma visão psicossomática / Atopic dermatitis in infants: a psychosomatic approach

A pele é a nossa fronteira com o mundo, fazendo trocas e contato com o meio ambiente. Sendo assim, não seria ela capaz de sinalizar, através de suas alterações, o nosso anseio pelo outro, a necessidade de "trocas afetivas"? Os autores apresentam a observação da evolução clínica e emocional de uma criança de 2 anos de idade, portadora de dermatite atópica, participante do Grupo de Apoio à Dermatite Atópica, com sua formação pioneira interdisciplinar, durante 9 meses de acompanhamento da criança no grupo. Como resultados, foram evidenciadas mudanças no comportamento da criança frente ao livre brincar, uma interação social mais concreta, com diminuição da irritabilidade e agressividade e, principalmente, maior e melhor vinculação entre a dupla mãe-criança, assim como marcada melhora do quadro dermatológico. Conclui-se que a abrangência, proporcionada pelo atendimento interdisciplinar, possibilita uma intervenção precoce na relação mãe-criança, podendo ser considerada como uma estratégia de prevenção em saúde mental materno-infantil, evitando possíveis patologias futuras.

Avaliação dos sintomas emocionais e comportamentais em crianças portadoras de dermatite atópica / Evaluation of emotional and behavioral symptoms in children and adolescents with atopic dermatitis

INTRODUÇÃO: A dermatite atópica (DA) é uma doença inflamatória crônica da pele que apresenta um impacto significativo na qualidade de vida dos pacientes, em conseqüência de episódios recorrentes durante a vida. Considerando estudos recentes que descrevem a associação entre aspectos psicológicos e DA, acredita-se que a investigação da existência de um possível perfil comportamental destas crianças possa auxiliar o desenvolvimento de intervenções psicoterápicas específicas, assim como aumentar o conhecimento sobre a doença. MÉTODOS: Este trabalho tem como objetivo realizar uma avaliação do perfil sociocomportamental de crianças portadoras de DA, comparando-as com crianças sem a doença. Neste estudo, do tipo caso-controle, foram incluídos dois grupos com idades entre 4 e 18 anos: o grupo-estudo, com pacientes portadores de DA que consultam no ambulatório do Hospital de Clínicas de Porto Alegre (HCPA), e o grupo-controle, composto por crianças e adolescentes sem doença dermatológica, matriculados em escola da rede pública de Porto Alegre. O tamanho estimado da amostra foi de 25 indivíduos em cada grupo. A coleta dos dados realizou-se através do Child Behavior Checklist (CBCL), validado no Brasil com o nome de Inventário de Comportamento da Infância e Adolescência. RESULTADOS: Foram encontradas diferenças estatisticamente significativas nas duas dimensões globais (internalização e externalização), sendo que as crianças portadoras de DA mostraram mais sintomas relacionados com ansiedade, depressão, alterações de pensamento e comportamento agressivo quando comparadas com crianças sem a doença. CONCLUSÃO: Os resultados demonstram a necessidade de abordagens interdisciplinares no tratamento da criança com DA, valorizando não só as lesões dermatológicas, como também os aspectos emocionais dos indivíduos.