Investigation of possible relationship between atopic dermatitis and salivary biomarkers, stress, and sleep disorders.

Atopic dermatitis (AD) is a chronic, relapsing, multifactorial inflammatory disease with genetic, environmental, and immunological characteristics. The quality of life and sleep of patients and their families are affected by AD, which triggers stress, described as one of the factors that worsens AD. Salivary biomarkers such as cortisol, alpha-amylase, chromogranin A, and melatonin have been associated with stress and sleep disturbances. Therefore, the evaluation of stress and sleep disorders using salivary biomarkers in AD patients is important. This review aims to describe the possible relationship between atopic dermatitis and stress, sleep disorders, and salivary biomarkers, seeking to contribute to better understanding and clinical management of AD. This descriptive study is characterized as a narrative literature review. A literature search was conducted of studies published in English and Portuguese between January 2012 and October 2022 that are available in electronic media from various databases, such as Scientific Electronic Library Online, Latin American and Caribbean Literature on Health Sciences, and PubMed. AD is associated with different degrees of impact on the lives of individuals who present with the disease. Psychological stress may induce changes in saliva composition and worsen AD; at the same time, the severity of the disease may be associated with emotional impact. Further studies are needed to assess and correlate AD severity, stress, and sleep disturbances with salivary biomarkers in order to better understand this association.

The effect of probiotics on the clinical status of adult patients with atopic dermatitis: a systematic review.

OBJECTIVES: To describe, through a literature review, the results and benefits of oral and topical probiotics for adult patients with atopic dermatitis. DESIGN: A systematic review of articles published over a 13-year period was conducted to answer the following questions: (1) what information is given in the scientific literature concerning the use of probiotics in adult patients with atopic dermatitis? (2) Was there an improvement in the clinical status of the patients? (3) Was there a change in the microbial profile in patients after using such approaches? (4) Among the probiotics used, which was the most used in adult AD patients? (5) What was the average time of these interventions? (6) What were the outcomes? RESULTS: Seven studies with different sample sizes, ranging from 16 to 109 patients, were included in this review. These studies were all clinical trials (7/7), and probiotics (7/7) was the model of intervention chosen. Probiotics showed a potential to relieve the symptoms of the study groups with a reduction of pruritus and SCORAD when compared to the placebo groups. However, their effectiveness varied according to the strain, period, and form of administration. CONCLUSIONS: Many studies have demonstrated that probiotics improve the symptoms of atopic dermatitis and even its prevention. However, there is still much controversy and divergence concerning the real benefits. Despite this, probiotics have demonstrated a fair ability in improving AD adult patients' symptoms in terms of decreasing pruritus and severity related to SCORAD.

Avaliação de informações na internet sobre dermatite atópica pediátrica / Evaluation of internet information on pediatric atopic dermatitis / Evaluación de información en internet sobre dermatitis atópica pediátrica

Objetivo: Avaliar conteúdos apresentados na internet relacionados à Dermatite Atópica em crianças e adolescentes. Método: trata-se de um estudo exploratório, realizado por meio do site de buscas Google®, utilizando-se um questionário semiestruturado para a avaliação. Construiu-se um banco de dados no software Microsoft Excel 2010®. Procedeu-se, após a organização dos dados, à avaliação de cada página, com um roteiro de dez perguntas semiestruturado, com três possíveis respostas. Resultados: avaliaram-se 31 sites. Aponta-se que 29 descrevem o que é a Dermatite Atópica e 25 relatam os sintomas característicos desta doença. Registra-se, quanto ao diagnóstico, que, em 21 sites, não se esclarece a necessidade do diagnóstico clínico por parte de um profissional de saúde e, em 23 páginas, encontram-se orientações quanto ao tratamento. Acrescenta-se que 14 sites não evidenciam a autoria do conteúdo. Conclusão: alerta-se, que os usuários devem estar atentos à autenticidade das informações apresentadas neste meio, visto que informações inconsistentes podem expor o indivíduo a situações de risco. Considera-se importante, por isso, que essa busca seja realizada em fontes confiáveis e não substitua a avaliação e a conduta do profissional de saúde.(AU)

Objective: to evaluate internet contents related to Atopic Dermatitis in children and adolescents. Method: this is an exploratory study, carried out through the Google® search engine, using a semistructured questionnaire for evaluation. A database was built using Microsoft Excel 2010® software. After organizing the data, we proceeded to the evaluation of each page, with a script of ten semistructured questions, with three possible answers. Results: a total of 31 sites were evaluated. It was found that 29 described what atopic dermatitis is and 25 reported the characteristic symptoms of this disease. Regarding diagnosis, 21 sites did not clarify the need for clinical diagnosis by a health professional, and 23 pages provided guidance on treatment. It should be added that 14 sites do not show the authorship of the content. Conclusion: it is warned that users should be aware of the authenticity of the information presented in this medium, since inconsistent information can expose the individual to risky situations. It is considered important, therefore, that this search be conducted in reliable sources and not replace the evaluation and conduct of the health professional.(AU)

Objetivo: evaluar los contenidos presentados en internet relacionados con la Dermatitis Atópica en niños y adolescentes. Método: se trata de un estudio exploratorio, realizado a través del buscador Google®, utilizando un cuestionario semiestructurado para la evaluación. Se creó una base de datos con el software Microsoft Excel 2010®. Después de organizar los datos, se evaluó cada página mediante un guión semiestructurado de diez preguntas con tres posibles respuestas. Resultados: se evaluaron 31 sitios. Se señala que 29 describen qué es la Dermatitis Atópica y 25 informan los síntomas característicos de esta enfermedad. En cuanto al diagnóstico, 21 sitios no aclaran la necesidad de un diagnóstico clínico por parte de un profesional de la salud y, en 23 páginas, hay pautas sobre el tratamiento. Además, 14 sitios no muestran la autoría del contenido. Conclusión: se advierte que los usuarios deben ser conscientes de la autenticidad de la información presentada en este medio, ya que información inconsistente puede exponer al individuo a situaciones de riesgo. Por tanto, se considera importante que esta búsqueda se realice a partir de fuentes fiables y no sustituya la valoración y conducta del profesional sanitario.(AU)

Alopecia Areata-Part III: Prognosis and Treatment.

The prognosis of alopecia areata is better in cases with single and small lesions, and the variability of the extension of the disease is one of the criteria for the choice of treatment modality. Several medications have been described in the literature for the treatment of alopecia areata, including corticosteroids, minoxidil, and diphencyprone. The authors review treatments for alopecia areata.

Alopecia areata--Part II: diagnosis and pathology.

Alopecia areata is characterized by the abrupt appearance of round or oval, non-scarring, flat, single or multiple areas of alopecia, which may coalesce forming large patches of alopecia. The diagnosis is usually clinical but there are important differentials and dermatopathology may help in this definition.

Alopecia areata--Part I: Background .

Alopecia areata is a trichosis characterized by loss of hair, with the abrupt onset of round or oval, nonscarring, flat, single or multiple areas of alopecia lesions, which can coalesce. Several hypotheses have been raised to explain its etiology, with autoimmunity being accepted until today, along with genetic factors.

HLA antigens in individuals with down syndrome and alopecia areata.

AIM: To describe human leukocyte antigen (HLA) alleles in individuals with Down syndrome and alopecia areata. METHODS: A cross-sectional study was conducted, which evaluated 109 individuals. Ten with down syndrome (DS) and alopecia areata (AA), ten with DS without AA and ten with AA without DS, and their families. The individuals were matched by gender and age. The following data were computed: gender, age, ethnic group, karyotype, clinical presentation and family history of alopecia areata. Descriptive analysis: measures of central tendency and frequency distribution. Inferential analysis: Fisher's exact test to compare categorical data between the three groups and Kruskal-Wallis ANOVA test for numerical data. RESULTS: Seventy per cent of evaluated individuals in the DS and AA group were male; presented mean age of 18.6 (SD ± 7.2) years and 70% were Caucasian. We observed involvement of the scalp, with a single lesion in 10% and multiple in 90% of subjects. It was observed that there is no significant difference in the frequency distributions of the alleles HLA loci A, B, C, DRB1 and DQB1 of subjects studied. However, according to Fisher's exact test, there is a trend (P = 0.089) of DS group to present higher proportions of HLA-A 36 and HLA-B 15 than the AA group and AA and DS group. CONCLUSION: There was a tendency for the DS group, to present proportion of HLA-A 36 and HLA-B 15 higher than the AA group and group of individuals with AA and DS. However, there was no significant difference in the frequency distribution of the alleles.

Clinical characteristics of alopecia areata in Down syndrome.

This study was undertaken to better understand clinical characteristics, environmental and physical events in Down syndrome (DS) and alopecia areata (AA). This cross-sectional study included 18 DS patients who were currently presenting or had presented AA. We evaluated gender, age, location and type of AA, presence of autoimmune disease or atopy, AA in first-degree relatives, and environmental, physical, and clinical intercurrences. The mean age of study subjects was 11.6 (SD ± 5.5) years and mean age at AA onset 7.2 (2.5 to 15.2) years. The duration of alopecia episodes varied, with a mean of 2.7 (0.1 to 18.7) years. Recurrence of AA was reported in 27.7% (5/18) of subjects, with a mean number of recurrences of 3.6. Localized type AA was seen in 83.4% of individuals, with the most frequent location on the scalp (100%). Seven of the individuals presented atopy. Fourteen individuals had undergone environmental and/or clinical intercurrences. In conclusion, the most frequent presentation of AA in DS is the non-recurrent, localized form on the scalp, with a varied period of duration. Changes in the individuals' routine occurred in more than half of the study group. We suggest further studies of the psychology and immunogenetics in the etiopathology of AA in DS.

Reconstrução completa de asa nasal com retalho de Spear após cirurgia micrográfica de Mohs no tratamento de carcinoma basocelular / Complete reconstruction of the nasal ala with a Spear's flap, following Mohs micrographic surgery in the treatment of basal cell carcinoma

O carcinoma basocelular é tumor maligno localmente invasivo, com maior incidência em caucasianos. A asa nasal é localização frequente dessa neoplasia. O tratamento de eleição é cirúrgico, sendo a cirurgia micrográfica de Mohs uma das técnicas indicadas, por apresentar grande acurácia no controle histológico das margens e alto índice de cura com baixas taxas de recidiva. Nessa localização se faz necessária não apenas a cura, mas também a tentativa da manutenção da estética facial. Descrevem-se cinco casos de amputação completa da asa nasal após cirurgia micrográfica de Mohs, seguida de reconstrução com retalho de Spear.

Basal cell carcinoma is a locally invasive malignant tumor, most frequently affecting Caucasian people. The nasal ala is a frequent site for this neoplasia. The treatment of choice is surgical, and Mohs micrographic surgery is one of the indicated techniques for presenting great accuracy in the histological control of margins and high cure rates with low recurrence rates. In this location, not only is a cure needed, but also the maintenance of facial aesthetics. The authors describe five cases of complete amputation of the nasal ala after Mohs micrographic surgery, with reconstruction using the Spear's flap.

Cirurgia micrográfica de Mohs: estudo de 93 tumores operados em um centro de referência no Rio de Janeiro / Mohs micrographic surgery: a study of 93 tumors operated on in a specialist center in Rio de Janeiro

Introdução: A cirurgia micrográfica de Mohs é opção terapêutica que aumenta a taxa de cura de vários tipos de câncer de pele, com maior preservação tecidual e menores taxas de recidiva. Objetivo: Traçar o perfil clínico e histológico dos tumores operados pela cirurgia micrográfica de Mohs, em serviço privado de referência nessa técnica no município do Rio de Janeiro, Brasil, e relacioná-lo com o número de fases e tipo de reconstrução cirúrgica realizada. Métodos: Estudo retrospectivo, observacional, transversal, com revisão de prontuários. Resultados: Foram relacionados 93 tumores em 84 pacientes operados no período entre abril/2010 e agosto/2012 e seguidos até agosto/2013 (12 a 42 meses). Dados encontrados: 47,61% homens e 52,38% mulheres; idade média de 62,89 anos; fototipos predominantes II (44%) e III (43%); seis casos (6,45%) de carcinoma espinocelular; 87 (93,54%) de carcinoma basocelular; 74,19% de tumores primários; nariz como localização mais frequente (46,24%); uma fase cirúrgica realizada na maioria dos casos, tendo sido o retalho (44%) o tipo de fechamento mais realizado. Houve recidiva em um paciente, que foi reoperado em outubro/2012 e segue sem recidiva. Conclusões: A cirurgia de Mohs mostrou-se eficaz, com altos índices de cura e mínima taxa de recidiva, especialmente nas lesões da área de risco do H da face.

ORIGINAL ARTICLE Mohs micrographic surgery: a study of 93 tumors operated on in a specialist center in Rio de Janeiro Cirurgia micrográfica de Mohs: estudo de 93 tumores operados em um centro de referência no Rio de Janeiro Frederico H. Sanchez1; Juliany Lima Estefan2; Lidiany Lima Estefan3 1. Head of the Center for Micrographic Surgery of Rio de Janeiro, Policlínica Ronaldo Gazolla-Rio de Janeiro (RJ); Preceptor at the Dermatologic Surgery Fellow Program, Hospital Federal Bonsucesso-Rio de Janeiro (RJ), Brazil 2. Dermatologist Physician, MSc in Clinical Medicine from the Universidade Federal do Rio de Janeiro (UFRJ)-Rio de Janeiro (RJ), Brazil 3. Collaborating Physician at the Center for Micrographic Surgery of Rio de Janeiro, Policlínica Ronaldo Gazolla Received on: 10 August 2013 Approved on: 9 October 2013 Financial support: None Conflict of interest: None The present study was carried out at the Center for Micrographic Surgery of Rio de Janeiro-Rio de Janeiro (RJ), Brazil. Correspondence: Centro de Cirurgia Micrográfica do Rio de Janeiro Dr. Frederico H. Sanchez Rua da Assembléia 10 / sala 2807-Centro Cep: 20011-000-Rio de Janeiro-RJ, Brazil E-mail: fredhsanchez@gmail.com Abstract Introduction: Mohs micrographic surgery is a treatment option that increases the cure rate in various types of skin cancer, offering greater tissue preservation and lower recurrence rates. Objective: To describe clinically and histologically the tumors operated on with Mohs micrographic surgery, and to draw correlations to the number of stages and the type of surgical reconstruction performed. The operations were performed at a private clinic in the municipality of Rio de Janeiro, Brazil that is a specialist center for this technique. Methods: Retrospective, observational, cross-sectional/transversal study was carried out based on the review of medical records. Results: A study was conducted of 93 tumors in 84 patients, operated on between April 2010 and August 2012, and followed up with until August 2013 (12 to 42 months). Findings: 47.61% of patients were men and 52.38% were women, the mean age was 62.89 years; predominant phototypes: II (44%) and III (43%); 6 cases (6.45%) of squamous cell carcinoma, 87 (93.54%) of basal cell carcinoma; 74.19% were primary tumors; the nose was the most frequent site (46.24%); a single surgical stage was performed in most cases, with flaps (44%) being the more frequently performed type of closure. There was recurrence in one patient, who required reoperation in October 2012 and followed without new recurrence. Conclusions: Mohs surgery has proven effective with high cure rates and a minimal recurrence rate, especially in lesions located in the face's H area of risk.

Clinical and dermoscopic findings in Goltz syndrome: case report.

Focal dermal hypoplasia or Goltz syndrome is a rare X-linked genodermatosis characterized by cutaneous and musculoskeletal defects. Dermoscopy is a noninvasive auxiliary method for the diagnosis of lesions, whether melanocytic or not. Its widespread use in dermatology is resulting in the description of new patterns and characterization of lesions not reported before its use. A typical case of Goltz syndrome presenting multiple malformations was observed and submitted to dermoscopy. Dermoscopy findings of the papillomas in raspberry form in the perioral and ocular regions, revealed a unique vascular pattern, different from viral warts; dermoscopy of some brownish maculas resembling lentigo in the periphery of skin atrophic areas are described as lentigo-like lesions, an uncommon pattern of melanocytic lesions, but without criteria suggestive of malignancy.