Frequency of perfume in 398 children's cosmetics.

OBJECTIVE: Perfume (Parfum) or fragrance is a natural or synthetic cosmetic ingredient added to emit a pleasant aroma or to improve the odor of a cosmetic formula. It is a mixture of substances, not revealed by the manufacturer, which may contain ingredients with allergenic potential, endocrine disruptors, and other possible harmful effects on human health. This study aims to analyze children's cosmetics labels to assess the presence of Perfume. METHODS: The researchers randomly visited points of sale in Curitiba, the capital of a southern Brazilian state; in order to catalog the largest possible number of children's cosmetics items. RESULTS: 398 children's cosmetics were analyzed and found Parfum on 295 (74.1 %) of the labels, including 90.4 and 79,1 % of the shampoos and wet wipes, respectively. CONCLUSION: Exposure of children's skin to fragrances can lead to local side effects such as allergies, but also to systemic effects, and the lack of knowledge of the general population and health professionals about its possible deleterious effects emphasizes the importance of changes in the regulation of cosmetics aiming to reduce the use of this ingredient.

Clinical features and nail clippings in 52 children with psoriasis.

BACKGROUND/OBJECTIVES: Nail clipping, the act of cutting the distal portion of a nail for microscopic analysis, can complement the diagnosis of skin diseases with nail involvement, such as psoriasis. This study aimed to describe histopathologic findings on 81 nails from 52 children and adolescents with skin psoriasis and to determine whether these changes correlated with the severity of skin and nail involvement. METHODS: Children with psoriasis were enrolled in this cross-sectional study to obtain Psoriasis Area and Severity Index (PASI) and Nail Psoriasis Severity Index (NAPSI) scores. The most altered nails were processed using periodic acid-Schiff with diastase staining. RESULTS: Fifty-two patients with a median age of 10.5 years were included. The median Nail Psoriasis Severity Index score of the 20 nails from these patients was 17 (range 3-80). The most common findings were pitting (94.2%), leukonychia (73.0%), and longitudinal ridges (63.5%). Eighty-one nail fragments were collected by clipping. Neutrophils were found in 6 samples (7.6%) and serous lakes in 15 (19%). Median nail plate thickness was 0.3 mm (range 0.1-0.63 mm). Patients whose nails had neutrophils had a higher median PASI score (6.1 vs 2.0, P = .03). Patients whose nails had serous lakes had higher median PASI (5.3 vs 1.9, P = .008) and NAPSI (median 45.0 vs 18.0, P = .006) scores. CONCLUSION: There seems to be a correlation between some microscopic nail features in children with psoriasis and their PASI and NAPSI scores, so nail clippings from children with suspected psoriasis may help with diagnosis, especially in the presence of neutrophils, and in excluding onychomycosis.

Impacto da dermatite atópica na qualidade de vida da família / Impact of atopic dermatitis on the quality of life of the family

Objetivo: Relacionar o impacto da gravidade da dermatite atópica na qualidade de vida dos cuidadores dos pacientes. Método: Estudo transversal e analítico, com aplicação de questionários aos cuidadores de pacientes com dermatite atópica, que foram consultados consecutivamente de agosto a dezembro de 2015. A gravidade da doença foi determinada conforme o índice de pontuação da dermatite atópica (Scoring Atopic Dermatitis ­ SCORAD) e foi classificada como leve (pontuação ≤ 20), moderada (> 20 a ≤ 40) ou grave (> 40). O questionário utilizado para avaliar qualidade de vida do cuidador foi o Dermatitis Family Impact Questionnaire ­ DFI, validado para o português. Resultados: Cento e um cuidadores participaram do estudo; 31,7% cuidavam de pacientes com dermatite atópica leve; 36,6% moderada; e 31,7% grave. A média dos índices de qualidade de vida foi de 9,1±6,7. Os índices de qualidade de vida dos cuidadores foram piores quanto mais grave a dermatite atópica da criança (correlação de Spearman 0,53; p < 0,0001). Os domínios mais afetados foram gastos com o tratamento, sono e sentimento de cansaço e exaustão. O valor médio de gastos com o tratamento foi de 200 reais ao mês, o que representou um percentual de 7,5% do salário mensal. Houve diferença significativa no percentual de gastos/salário conforme a gravidade da dermatite pelo SCORAD (5% na DA leve; 7,2% na moderada e 10% na grave). Conclusão: Os índices de qualidade de vida dos cuidadores de pacientes com dermatite atópica são piores quanto maior a gravidade da doença, em razão dos gastos com tratamento, sono e exaustão.

Objective: To study the impact of atopic dermatitis severity on the quality of life of the patient's caregivers. Methods: This was an analytical cross-sectional study in which questionnaires were applied to caregivers of patients with atopic dermatitis seen consecutively from August to December 2015. Disease severity was determined according to the Scoring Atopic Dermatitis (SCORAD) index and graded as mild (score ≤ 20), moderate (> 20 to ≤ 40), or severe (> 40). The questionnaire used to evaluate the quality of life of caregivers was the Dermatitis Family Impact (DFI), validated to Portuguese. Results: One hundred and one caregivers participated in the study; 31.7% of them took care of patients with mild atopic dermatitis, 36.6% of moderate, and 31.7% of patients with severe atopic dermatitis. The mean quality of life score was 9.1±6.7. Quality of life indexes worsened with atopic dermatitis severity (Spearman correlation 0.53; p < 0.0001). The domains most strongly affected were treatment expenses, sleep, and fatigue/exhaustion. The mean monthly expense with treatment was 200 reais, accounting for 7.5% of the family's monthly income. There was a significant difference in the expense/ income percentage according to disease severity as measured by the SCORAD index (5% in mild, 7.2% in moderate, and 10% in severe atopic dermatitis). Conclusion: Quality of life indexes for caregivers of patients with atopic dermatitis worsen as the severity of the disease increases, mainly because of treatment expenses, lack of sleep, and exhaustion.

Guia prático de atualização em dermatite atópica - Parte I: etiopatogenia, clínica e diagnóstico. Posicionamento conjunto da Associação Brasileira de Alergia e Imunologia e da Sociedade Brasileira de Pediatria / Updated practical guide on atopic dermatitis - Part I: etiopathogenesis, clinical features, and diagnosis. Joint position paper of the Brazilian Association of Allergy and Immunology and the Brazilian Society of Pediatrics

A dermatite atópica (DA) é uma doença crônica e recidivante que acomete principalmente pacientes da faixa etária pediátrica. A fisiopatologia inclui fatores genéticos, alterações na barreira cutânea e imunológicas. A prevalência da DA no Brasil, entre adolescentes, oscila entre 7,1% e 12,5%, com tendência à estabilização. O diagnóstico é clínico, e exames complementares auxiliam na determinação dos fatores desencadeantes. A identificação dos fatores irritantes e/ou desencadeantes envolvidos permite melhor controle das crises. Entre os fatores desencadeantes destacam-se os agentes infecciosos, alérgenos alimentares e aeroalérgenos. Tomando-se como ponto de partida o "Guia Prático para o Manejo da Dermatite Atópica ­ opinião conjunta de especialistas em alergologia da Associação Brasileira de Alergia e Imunopatologia e da Sociedade Brasileira de Pediatria" publicado em 2006, foi realizada revisão e atualização dos conceitos apresentados por grupo de alergologistas, dermatologistas e pediatras especializados no tratamento de pacientes com DA. O objetivo desta revisão foi elaborar um documento prático e que auxilie na compreensão dos mecanismos envolvidos na DA, assim como dos possíveis fatores de risco associados a sua apresentação, bem como sobre a avaliação subsidiária disponível para a identificação dos fatores associados à DA.

Atopic dermatitis (AD) is a chronic, recurrent skin disease that mainly affects pediatric patients. The pathophysiology of AD includes genetic factors, skin barrier abnormalities, and immunological factors. The prevalence of AD in Brazil, among adolescents, ranges from 7.1% to 12.5%, with a trend towards stabilization. The diagnosis of AD is clinical, and complementary tests can help determine the triggering factors. Identification of the irritating and/or triggering factors involved allows better control of exacerbations. Among the triggering factors, infectious agents, food allergens, and aeroallergens stand out. Taking as a starting point the Practical Guide for the Management of Atopic Dermatitis ­ joint opinion of specialists in allergology of the Brazilian Association of Allergy and Immunopathology and of the Brazilian Society of Pediatrics, published in 2006, the present paper describes the results of the review and update of different concepts related to AD, conducted by a group of allergists, dermatologists, and pediatricians specializing in the treatment of patients with AD. The objective of this review was to design a practical document that can help improve our understanding of the mechanisms involved in AD, possible risk factors associated with its presentation, as well as ancillary tests available to identify factors associated with AD.

Guia prático de atualização em dermatite atópica - Parte II: abordagem terapêutica. Posicionamento conjunto da Associação Brasileira de Alergia e Imunologia e da Sociedade Brasileira de Pediatria / Updated practical guide on atopic dermatitis - Part II: treatment approach. Joint position paper of the Brazilian Association of Allergy and Immunology and the Brazilian Society of Pediatrics

Nas últimas décadas o conhecimento sobre a etiopatogenia da dermatite atópica (DA) avançou muito. Além da identificação dos principais agentes desencadeantes e/ou agravantes envolvidos na expressão clínica da DA, verificou-se ser a integridade da barreira cutânea um dos pontos fundamentais para a manutenção da homeostase da pele. Assim, no tratamento do paciente com DA, além da evitação dos agentes desencadeantes e/ou irritantes, o uso de hidratantes é parte fundamental, e acredita-se que tenha ação preventiva de surtos agudos. Além disso, a aquisição de agentes anti-inflamatórios de uso tópico tem permitido o controle de pacientes com formas leves a moderadas da DA. Embora tenham uso mais restrito, os agentes imunossupressores sistêmicos também têm sido empregados no tratamento de pacientes com DA grave ou refratária aos procedimentos habituais. Comenta-se também a imunoterapia alérgeno-específica como tratamento adjuvante da DA para alguns pacientes, sobretudo alérgicos aos ácaros e com manifestações respiratórias associadas. A aquisição de novos agentes, os imunobiológicos, também são apresentados à luz das evidências científicas e clínicas atuais. O presente guia prático de atualização em dermatite atópica ­ abordagem terapêutica teve por objetivo rever os esquemas de tratamento disponíveis e empregados no acompanhamento de pacientes com DA, além de apresentar terapêuticas futuras, como os agentes imunobiológicos que em breve estarão à disposição para o tratamento de formas mais graves e/ou refratárias da DA.

Over the last few decades, knowledge of the etiopathogenesis of atopic dermatitis (AD) advanced greatly. The main triggering and/or aggravating factors involved in the clinical expression of AD have been identified, and cutaneous barrier integrity has been found to be key for the maintenance of skin homeostasis. Thus, when treating patients with AD, in addition to avoiding triggering and/ or irritating agents, recommending the use of skin moisturizers is paramount ­ and believed to have a preventive action against acute outbreaks. Moreover, topical anti-inflammatory agents have allowed AD control in patients with mild to moderate forms of the disease. Although more restricted, systemic immunosuppressive agents have also been used in the treatment of patients with severe or refractory AD. Specific allergen immunotherapy is presented as a possible adjunctive treatment for AD in some patients, especially those allergic to mites and presenting associated respiratory manifestations. Finally, the use of new immunobiological agents is discussed in the light of the scientific and clinical evidence currently available. The objectives of this updated practical guide on atopic dermatitis ­ treatment approach were to review the treatment regimens available and used in the follow-up of patients with AD and to present new therapies (e.g., immunobiological agents) that will soon be available for the treatment of more severe and/ or refractory forms of AD.

Progeria and the early aging in children: a case report.

The Hutchinson-Gilford syndrome or progeria is a rare autosomal dominant syndrome characterized by premature aging and involvement of internal systems, such as the circulatory and locomotor. The diagnosis is essentially clinical and the manifestations become more evident from the first year of life. Long term outcome data from Progeria Research Foundation clinical trials have demonstrated an increase in survival in recent years. Even though new trials are ongoing, the recognition of this syndrome is essential to prevent cardiovascular and cerebrovascular complications. A patient, initially asymptomatic, who developed characteristic signs of the syndrome at the age of 6 months is reported. She was referred for evaluation only when she was two years and eleven months old. The diagnosis of Hutchinson-Gilford syndrome was suspected owing to clinical characteristics. The diagnosis was confirmed by genetic testing. A mutation c.1824C> T in exon 11 of the LMNA gene was detected. She was registered in the Progeria Research Foundation and was invited to participate in the weighing and supplementation program. She was included in the lonafarnib protocol study. This medication is a farnesyl transferase inhibitor that prevents the production of progerina and slows cardiovascular and neurological complications of the syndrome. This case highlights the importance of diagnosing progeria patients because they may be referred to the Progeria Research Foundation, which offers genetic screening and inclusion in clinical and therapeutic follow-up protocols without any costs. Progeria trials and research may also contribute to new drug developments related to prevention of aging and atherosclerosis in the near future.

Onychomycosis by Fusarium oxysporum probably acquired in utero.

Fusarium oxysporum has been described as a pathogen causing onychomycosis, its incidence has been increasing in immunocompetent and disseminated infection can occur in immunosuppressed individuals. We describe the first case of congenital onychomycosis in a child caused by Fusarium oxysporum. The infection being acquired in utero was proven by molecular methods with the identification of the fungus both in the nail and placenta, most probably as an ascending contamination/infection in a HIV-positive, immunosuppressed mother.

Vitamina D e dermatite atópica: o que há de novo? / Vitamin D and atopic dermatitis: what is new?

Não há consenso sobre quais são os valores ideais da vitamina D em crianças saudáveis. Porém, níveis séricos altos ou baixos parecem ter influência na fisiopatologia das doenças alérgicas. Há dados na literatura atual que demonstram os potenciais efeitos da vitamina D em aumentar a atividade dos peptídeos antimicrobianos e suprimir a resposta inflamatória, apontando uma relação inversa entre os níveis de vitamina D e a gravidade da dermatite atópica. O objetivo do presente trabalho foi revisar artigos publicados sobre a relação entre níveis séricos de vitamina D e dermatite atópica, uma vez que a vitamina D tem sido implicada em várias ações imunomoduladoras e alguns estudos têm descrito sua influência na gravidade da dermatite atópica, porém com resultados conflitantes. Este estudo baseou-se em revisão de artigos originais, artigos de revisão e consensos publicados nos últimos 10 anos, obtidos a partir da pesquisa dos termos “vitamin D” e “atopic dermatitis”, nos bancos de dados online. Concluímos que a suplementação da vitamina D pode trazer benefícios no tratamento da dermatite atópica. No entanto, mais pesquisas são necessárias para determinar se existe alguma relação entre os níveis de vitamina D e a gravidade da dermatite atópica.

There is no consensus about optimal values of vitamin D in normal children. However, high or low serum levels seem to influence the pathophysiology of allergic diseases. There is evidence supporting the potential effects of vitamin D on increasing the activity of antimicrobial peptides and suppressing the inflammatory response, indicating an inverse relationship between vitamin D levels and the severity of atopic dermatitis. Our objective was to review published articles on the relationship between serum vitamin D levels and atopic dermatitis, as vitamin D has been implicated in several immunoregulatory actions, and some studies have reported an influence on the severity of atopic dermatitis, with conflicting results. The present study reviewed original articles, review articles, and consensus documents published in the past 10 years, retrieved in online databases using the keywords “vitamin D” and “atopic dermatitis.” We conclude that vitamin D supplementation may be beneficial in the treatment of atopic dermatitis. However, more research is needed to determine whether there is any relationship between vitamin D levels and atopic dermatitis severity.

Desmoplastic hypopigmented hairless nevus: a variant with progressive depigmentation, induration, and overgrowth.

Large congenital melanocytic nevus rarely presents itself without hairs, with hardened skin and progressive depigmentation. We report a girl who presented with a large congenital melanocytic nevus in the left cheek. Over the years, the nevus became pruriginous, light brown, bumpy, and hard. Histology revealed nevus cells interspersed with dense fibrosclerotic collagen bundles. There are few reported cases of large congenital melanocytic nevus with this evolution, so-called desmoplastic hypopigmented hairless nevus.

Polyomavirus BK: possibly associated skin eruption in a patient with hemorrhagic cystitis.

A 14-year-old girl with Fanconi anemia was submitted to allogeneic hematopoietic stem cell transplantation. After 17 days she developed hemorrhagic cystitis due to polyoma BK virus (BKV), confirmed by PCR (polymerase chain reaction). Two weeks after the appearance of the urinary symptoms the patient presented numerous papules and vesicles on both hands and feet. PCR of the skin lesions and plasma was positive for BKV. The relationship of BKV with frequent infections in immunocompromised patients is well established. The positive PCR of vesicular fluid suggests that this was the causative agent of the skin lesion in this case. There are no reports of skin lesions with positive PCR for BKV.

Tricotilomanía: abordaje diferenciado según la franja etaria en la infancia / Trichotillomania: differentiated approach depending on the age group in children

Introducción: La tricotilomanía se caracteriza por áreas de alopecia causadas por la tracción de cabellos realizada por el mismo paciente y es más frecuente en edades pediátricas. No obstante, existen pocos trabajos sobre esta enfermedad. Este estudio tiene como objetivo delinear las características clínicas y evolutivas de la tricotilomanía en un grupo de niños Resultados: Hubo 47 casos de tricotilomanía, de los cuales 32 (68%) fueron niñas. Se observó una mayor predisposición en el género femenino luego de los 5 años (mientras en las menores de 5 años el 56% estuvo afectada, en las mayores de 5 años el porcentaje se elevó al 76%). La edad media de inicio fue de 6 años, variando entre los 7 meses y los 11 años. La presencia de factores precedentes como cambios en la dinámica familiar, problemas psicológicos y enfermedades se determinó en 29 pacientes y fue más común en los niños mayores de 5 años. La región parieto-temporal fue la más afectada y las pestañas y cejas las menos comprometidas. En el 74% de los casos se inició tratamiento con placebo y se obtuvo una buena respuesta...

Introduction: Trichotillomania is characterised by alopecic areas caused by patients pulling out their hair. There are few works on this disease in the pediatric age group. The aim of this study is to delineate the clinical characteristics and evolution of trichotillomania in childhood.Results: There were 47 cases, 32 (68%) girls, with a higher difference between genders was observed over the age of 5 (of the group of under 5, 56% were while over this age they represented the 76%). Median age at onset was 6 years, ranging from 7 months to 11 years. Prior factors such as changes in family dynamics, psychological problems and diseases occurred in 29 patients, more current in the over 5 years old. The parieto-temporal region was the most affected and eyelashes and eyebrows the least removed. Placebo treatment was instituted in 74% with good response...

Prurigo por picaduras de insectos: estudio epidemiológico / Prurigo by insect stings: epidemiologic study

Introducción: El prurigo es una reacción cutánea de hipersensibilidad a la picadura de insectos. El objetivo de este trabajo es determinar la incidencia y características clínicas de los pacientes afectados por prurigo en el servicio de Dermatología Pediátrica del Hospital de Clínicas de Curitiba, Paraná, Brasil. Materiales y métodos: Estudio descriptivo y retrospectivo en el que se evalúan los datos de la primera consulta de pacientes entre 0 y 14 años de edad, con diagnóstico clínico de prurigo, atendidos entre 1978 y 2005. En el mismo se analiza la distribución de esta entidad por sexo, raza, edad de inicio del cuadro, procedencia del paciente y estación del año al momento de la consulta. Resultados: Entre 19.410 primeras consultas, el 9% de ellas tuvo diagnóstico de prurigo. El 50% de los pacientes provenía de Curitiba y 38% del área metropolitana circundante. La mitad eran de sexo masculino y el 80% eran caucásicos. Hubo predominio de consulta en los meses de primavera y verano. La edad media fue de 12 meses, siendo el 63% de los pacientes menores de 2 añoDiscusión: En estos 27 años de experiencia, el diagnóstico de prurigo fue frecuente. La incidencia en la literatura es variable y nuestros hallazgos coinciden con los de algunas series de casos previamente publicadas. La proporción de caucásicos afectados en este estudio es semejante a la observada en la población general de Curitiba, de lo que se desprende que no hubo predominio racial. Los síntomas se iniciaron tempranamente en nuestros pacientes, probablemente por las condiciones climáticas y el ambiente doméstico que predisponen a la proliferación de los insectos. Concluimos que el prurigo es prevalente en nuestro medio y su inicio es precoz.

Introduction: Prurigo or papular urticaria is a cutaneous reaction from hypersensitivity to insect bites. The purpose of this work is to determine the incidence and clinical characteristics of patients with papular urticaria at the Pediatric Dermatology Division of the Hospital de Clínicas outpatient unit, Curitiba, Paraná, Brazil. Materials and methods: This descriptive and retrospective study evaluates data from first consultation of patients between 0 to 14 years of age, with clinically diagnosed papular urticaria, seen between 1978 and 2005. Data of disease distribution considering gender, race, age at beginning of symptoms, place of origin and season in which the consultation occurred, is herein analyzed. Results: There were 19,410 first consultations and 9% were diagnosed as papular urticaria. Fifty percent of patients came from Curitiba and 38% from surrounding cities. Half of the affected children were male and 80% were Caucasians. Most of the consultations were seen during spring and summer. Median age was 12 months and 63% patients were younger than two years. Discussion: In our 27 years of experience, the diagnosis of papular urticaria was frequent. The incidence in literature is variable, but we have found similar data with previously reported serious of cases. The proportion of affected Caucasians in this study correlates with the racial distribution of Curitiba’s general population, so we can address that there was no racial prevalence. The early beginning of symptoms in our patients may be explained by the fact that weather and environmental conditions predispose to insect proliferation. We can conclude that papular urticaria is a common diagnosis in our environment and its beginning is usually early in life.

Lichen striatus: description of 89 cases in children.

Lichen striatus (LS) is a benign, self-limited, linear, inflammatory dermatosis of unknown etiology that usually affects children. We analyzed 89 cases in regard to age of appearance, sex, race, symptoms, seasonal incidence, localization of lesions and affected side of the body, and presence of atopy. Lesions predominated on the inferior limbs, with no preponderance of any age, and were asymptomatic in the majority of the instances. There was no difference in the incidence of LS in regard to the season of the year. A possible association of lichen sclerosus with atopy and pruritus was observed.