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1.
Clin Dermatol ; 37(6): 668-674, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31864446

RESUMO

Adult-onset Still's disease (AOSD) is a rare, systemic, inflammatory disorder characterized by spiking fevers, an evanescent eruption, arthritis, and multiorgan involvement. The disease has been recently classified as a polygenic autoinflammatory disorder at the "crossroads" of autoinflammatory and autoimmune diseases. The highly characteristic salmon-colored eruption is a cutaneous manifestation of a generalized inflammatory reaction and an important diagnostic criterion. In addition to the evanescent eruption, there are atypical persistent papules and plaques in many patients with AOSD. Emerging data suggest that AOSD with this typical evanescent eruption has a different clinicopathologic presentation and clinical course than AODS with atypical cutaneous manifestations. It appears that there are two subtypes of AOSD with different immunologic profiles, including (1) a systemic disease with high fever, organ involvement, and elevated levels of ferritin, and (2) a chronic disease course with arthritis as the predominant finding. These observations provide novel insight into the disease pathogenesis, suggesting that the underlying mechanisms might differ between these two forms, partially explaining the reported differences in drug response. Recent advances in the understanding of AOSD are summarized with a focus on the spectrum of cutaneous manifestations and its relationship to systemic inflammation.

2.
Dermatol Ther ; : e13171, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31750979

RESUMO

Both epidemiological and experimental studies have demonstrated the crucial connection between air pollution exposure and skin disorders. The exact mechanisms by which air pollutants mediate skin damage remain largely unknown. Therefore, it is very necessary to investigate the mechanism of air pollution-induced skin damage and explore some potential protective and therapeutic methods. In this review, we focus on the qualitative and quantitative skin exposure assessment methodologies-a relatively new field of interdisciplinary research.

3.
Open Access Maced J Med Sci ; 7(6): 937-942, 2019 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-30976336

RESUMO

BACKGROUND: Erysipelas is a common infectious skin disease. A typical feature of erysipelas, especially on the lower limbs, is the tendency to reoccur and the study aimed to define the comorbidities associated with it. AIM: We aimed to investigate systemic and local comorbidities in patients diagnosed with erysipelas on the lower limbs. MATERIAL AND METHODS: We conducted a retrospectively-prospective, population-based cohort study which included all patients diagnosed with erysipelas on the lower limbs, during two years. Patients were divided into two groups: patients with first episode and patients with recurrent erysipelas. These two groups were compared, with particular emphasis on systemic and local comorbidities. RESULTS: The study included 313 patients, of which 187 with the first episode of erysipelas and 126 with a recurrent. Regarding the analyzed systemic risk factors, the recurrent erysipelas was significantly associated with obesity (p < 0.0001), insulin dependent diabetes mellitus (p = 0.0015), history of malignant disease (p = 0.02) and tonsillectomy (p = 0.000001). For a p-value < 0.0001, significantly more frequent finding of peripheral arterial occlusive disease, chronic oedema/lymphoedema, fungal infections of the affected leg and chronic ulcer was confirmed in recurrent erysipelas. Neuropathy had 23% of the recurrent cases and 8.6% in patients without recurrence, and the difference was found to be significant for p = 0.0003. The only dissection of the lymph nodes was found more frequently in recurrent erysipelas (p = 0.017), but no associations with other analysed local surgery on the affected leg. Patients with recurrent erysipelas had ipsilateral coexisting dermatitis p = 0.00003 significantly more frequent. Minor trauma often preceded the first episode of erysipelas p = 0.005. CONCLUSION: Identification and treatment of modifiable risk factors are expected to reduce the risk of a subsequent episode of erysipelas on the lower limbs.

4.
Dermatol Ther ; 32(4): e12622, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30152568

RESUMO

Trichotillomania (hair pulling disorder) is a fairly common but underreported disorder characterized by recurrent episodes of pulling hair from different parts of the body. Currently classified in Diagnostic and Statistical Manual of Psychiatric Disorders (DSM-5) under the heading of the "Obsessive-compulsive spectrum and related disorders." The estimated prevalence data suggest that 0.5-2% of the general population suffers from this disorder. Stress and anxiety are directly correlated to the production of trichotillomania symptoms. The psychosocial aspects of trichotillomania are greatly underestimated, but recent literature suggests an increased interest in this neglected area. Although no FDA approved medications are available for the treatment of trichotillomania, a variety of medications including N-acetylcysteine have shown benefit in case reports. Combined liaison clinics, with an interdisciplinary approach, are highly advisable in the treatment of these cases.

5.
Artigo em Inglês | MEDLINE | ID: mdl-30289118

RESUMO

Scleredema adultorum of Buschke is a rare fibromucinous, scleroderma-like connective tissue disease most commonly found in a post-infectious setting or linked to hematological disorders or diabetes. Lichen sclerosus et atrophicus is an autoimmune condition only in 2.5% of cases localized exclusively at an extragenital site, occurring in up to 34% of patients in association with other autoimmune diseases such as vitiligo, thyroid disorders, alopecia areata, lichen planus, morphea, pernicious anemia and systemic lupus erythematosus. In particular, a stronger link with an autoimmune background in lichen sclerosus et atrophicus has been observed in women who showed higher prevalence for autoimmune conditions and circulating autoantibodies. Literature reveals a genetic susceptibility linked to specific HLA types. We report three patients who developed lichen sclerosus et atrophicus superimposed on skin involved by scleredema adultorum of Buschke. Although the association of lichen sclerosus et atrophicus with scleredema adultorum of Buschke could be coincidental, both diseases could be considered part of the spectrum of sclerodermoid disorders with common underlying pathogenetic mechanisms; which could explain the sequential or simultaneous occurrence of both lesions in our patients.

6.
Open Access Maced J Med Sci ; 6(8): 1458-1461, 2018 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-30159077

RESUMO

BACKGROUND: Hydroxyurea (HU) is an antimetabolite agent that interferes with the S-phase of cellular replication and inhibits DNA synthesis, with little or no effect on RNA or protein synthesis. It is used in the treatment of many myeloproliferative disorders (MD) and is particularly a first line treatment drug for intermediate to high-risk essential thrombocythemia. Although safe and very well tolerated by the patients suffering from MD, there have been numerous reports of a broad palette of cutaneous side effects associated with prolonged intake of the medication. These may include classical symptoms such as xerosis, diffuse hyperpigmentation, brown-nail discolouration, stomatitis and scaling of the face, hands, and feet or more serious side effects such as actinic keratosis lesions, leg ulcers and multiple skin carcinomas. CASE REPORT: We report a case of a 52-year-old man, on long-term therapy with HU for essential thrombocytosis, with several concurrent skin lesions. Despite the perennial use of HU, the cutaneous changes were neglected. The local dermatological examination revealed oval perimalleolar ulcer on the right leg, with dimensions 6 x 4 cm, clearly demarcated from the surroundings with regular margins, periulcerous erythema, with very deep and highly fibrinous bed of the ulcer, positive for bacterial infection. The ulcer was treated with topical wound therapy with alginate and parenteral antibiotics. The extended dermatological screening also showed two nummular lesions in the right brachial region, presenting as erythematous papules with sharp margins from the surrounding skin, gritty desquamation and dotted hyperpigmentations inside the lesion. Further dermoscopy and biopsy investigations confirmed a diagnosis of basal cell carcinoma. Nasal actinic keratosis was also noted. The patient was advised for discontinuing or substituting the HU therapy. CONCLUSION: We present this case to draw attention to the various cutaneous side effects that occur with perennial HU use and suggest an obligatory reference to a dermatological consult.

7.
Dermatol Ther ; 31(5): e12627, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30133906

RESUMO

Despite the great advances in our understanding of disease pathogenesis and a rich variety of therapeutic options, including the availability of newer biologic agents, there is still no cure for psoriasis. Based on low levels of satisfaction in the treatment they receive and their overall care, it is not surprising that a substantial part of patients turn to complementary and alternative therapies. Integrative medicine is an exciting new approach to health care. The dermatologist should recognize this growing trend and become familiar with the current literature on integrative therapies for psoriasis. Several complementary therapies, those that have been found to be safe and effective, can be recommended as part of an integrative treatment plan.


Assuntos
Terapias Complementares , Psoríase/terapia , Terapias Complementares/efeitos adversos , Terapias Complementares/tendências , Humanos , Medicina Integrativa/tendências , Motivação , Aceitação pelo Paciente de Cuidados de Saúde , Relações Médico-Paciente , Psoríase/complicações , Psoríase/economia , Psoríase/psicologia
9.
Pediatr Dermatol ; 34(6): 726-727, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28851117

RESUMO

Cryotherapy, widely used in the treatment of common warts, can cause long-term side effects when used in the treatment of warts near the nail bed. Here we present the case of a 11-year-old girl who developed canaliform dystrophy and long-term hypopigmentation following cryotherapy of warts on the proximal nail folds.


Assuntos
Crioterapia/efeitos adversos , Unhas Malformadas/etiologia , Criança , Feminino , Humanos , Hipopigmentação/etiologia , Unhas/patologia , Remissão Espontânea , Verrugas/terapia
12.
J Dtsch Dermatol Ges ; 15(6): 621-627, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28513987

RESUMO

BACKGROUND: Numerous risk factors place palliative care patients at an increased risk of skin infections, dermatitis, and pressure sores. Furthermore, worsening of chronic skin disorders can be expected, as well as the development of treatment-induced and malignancy-related dermatoses. The objective of the present study was to investigate the prevalence and treatment of dermatological conditions in patients receiving hospital-based palliative care. METHODS: Two hundred seventy-one palliative patients were enrolled. All assessments were conducted by dermatologists. Skin lesions were classified into seven categories: infections, skin tumors, dermatitis, chronic wounds, nail and hair disorders, pruritus, and other unclassified conditions. Treatment modalities were classified as topical only or systemic. RESULTS: Overall, 1,267 dermatological conditions were recorded, 49 % of which were hospital-acquired. All patients had at least one dermatological condition, and more than 50 different dermatological disorders were noted. The most common group of skin disorders was dermatitis (18.3 % of all dermatological conditions), followed by nail and hair disorders (17.5 %). Almost 16 % of dermatological conditions were treated systemically. CONCLUSIONS: Dermatological conditions are a common and clinically significant problem for palliative patients. The inclusion of dermatologists in multidisciplinary palliative teams should prove helpful in the management of these patients.


Assuntos
Estado Terminal/epidemiologia , Dermatite/epidemiologia , Doenças do Cabelo/epidemiologia , Doenças da Unha/epidemiologia , Cuidados Paliativos/estatística & dados numéricos , Dermatopatias Infecciosas/epidemiologia , Neoplasias Cutâneas/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Estado Terminal/enfermagem , Dermatite/diagnóstico , Feminino , Doenças do Cabelo/diagnóstico , Humanos , Doença Iatrogênica/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças da Unha/diagnóstico , Prevalência , Fatores de Risco , Distribuição por Sexo , Adulto Jovem
13.
Acta Dermatovenerol Croat ; 25(1): 77-79, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28511755

RESUMO

Beau lines are transverse, band-like depressions extending from one lateral edge of the nail to the other and affecting all nails at corresponding levels (1). Onychomadesis is considered an extreme form of Beau line with subsequent separation of the proximal nail plate from the nail bed. Both fall along a spectrum of nail plate abnormalities that occur secondary to temporary nail matrix arrest (NMA). Various systemic and dermatologic conditions have been reported in association with onychomadesis (2-7) (Table 1). Nail changes can affect all or some of the nails and both the fingernails and toenails; however, fingernails are more frequently affected. The severity of the nail changes varies depending on the underlying cause, its duration, and environmental factors (8). We present a case of onychomadesis following cutaneous leukocytoclastic vasculitis (CLCV). A 61-year-old woman presented to the Dermatology Clinic complaining of a purpuric rash that began on her lower extremities and rapidly progressed to her abdomen and upper extremities over the previous five days. Her medical history was remarkable for hypertension and diet-controlled diabetes mellitus. Her medications included enalapril, which she had been taking for the past four years. On three consecutive days before the skin eruption, the patient took oral diclofenac sodium for hip pain. A clinical examination revealed non-blanching petechial rash on the legs, abdomen, and upper limbs up to the elbow (Figure 1, A) with leukocytoclastic vasculitis on biopsy (Figure 1, B). Direct immunofluorescence was negative. Laboratory investigations revealed a white blood cell count of 14.5 × 109/L with a normal differential count, and a platelet count of 380 × 109/L. Westergren erythrocyte sedimentation rate was 65 mm/1st h, and C reactive protein was at 8.5 mg/dL. Antinuclear antibodies, rheumatoid factor, immune complexes, and cryoglobulinemia were negative, as were B and C hepatitis virus serological tests. Her renal, cardiac, pulmonary, and abdominal exams were normal. Diclofenac was discontinued due to a clinical suspicion of drug-induced cutaneous vasculitis. The rash resolved in 2 weeks without treatment, leaving post-inflammatory hyperpigmentation. Four weeks later, she presented with painless, palpable grooves on all 10 fingernails (Figure 2). The grooves were 3 to 4 mm in width, at a similar distance from the proximal nail fold. There were no signs of periungual inflammation. The patient denied any recent history of trauma, unusual activities, or chemical exposure. Routine serum biochemistry and hematology results were normal. Repeated potassium hydroxide preparations and fungal cultures of the nail clippings were negative. A diagnosis of Beau lines and onychomadesis was made. Nail changes were tolerable and did not require any specific treatment. During the follow up, the Beau lines advanced with the linear growth of the nails and disappeared (Figure 3 and 4). Four fingernails developed complete nail shedding (onychomadesis). No toenail alterations were observed in this period. A complete recovery of the nail plate surface was observed after 4 months. The nail matrix epithelium is formed by highly proliferating cells that differentiate and keratinize to produce the nail plate. The nail matrix epithelium is very susceptible to toxic noxae, and acute damage results in a defective nail plate formation. Nail matrix arrest is a term used to describe a temporary inhibition of the nail matrix proliferation that can present as Beau lines and onychomadesis (8). The width of Beau lines relates to the duration of the etiological agent. As the nail adheres firmly to the nail bed, the onychomadesis remains latent for several weeks before leading to temporary shedding (8,9). There are several proposed etiological mechanisms for NMA. NMA associated with fever, severe infection, and major medical illnesses can be explained by an inflammation of the matrix, periungual tissues, or digital blood vessels (8); chemotherapy agents temporary inhibit the mitotic activity in nail matrix (10); the detection of Coxackie virus in the shedding nail particle, following hand, foot, and mouth disease, suggests that the viral replication itself may directly damage the nail matrix (11). However, as nail changes are not unique, it may be difficult to incriminate a single etiological agent. Our patient presented with an onset of Beau lines seven weeks after the initial CLCV lesions, which suggests that vasculitis might have acted as a trigger for NMA. As the fingers were not affected by CLCV, an indirect effect of vasculitis is more plausible. Leukocytoclastic vasculitis is a small-vessel inflammatory disease mediated by a deposition of immune complexes. Thus, the circulating immune complexes may be involved in the damage of nail bed microvasculature. Considering that the patient had been receiving enalapril and diclofenac, it is less likely that those drugs were involved in the pathogenesis of NMA. Enalapril was continued, and the nail changes were resolved while patient was still on enalapril. Furthermore, diclofenac is a widely prescribed drug and its association with NMA is yet to be described in literature. We described a patient who developed Beau lines and onychomadesis following cutaneous leukocytoclastic vasculitis. This clinical observation can expand the spectrum of possible causes of nail matrix arrest.

14.
Open Access Maced J Med Sci ; 4(3): 423-427, 2016 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-27703567

RESUMO

BACKGROUND: Malnutrition is common in elderly and is a risk factor for pressure ulcers. AIM: The aim of the present study was to determine the prevalence of malnutrition in geriatric and palliative patients hospitalised in long-term care facility, and to examine the influence of nutritional status on the prevalence of pressure ulcers (PU). MATERIAL AND METHODS: Descriptive, observational and cross-sectional study including 2099 patients admitted to the Hospital during a 24 month period (January 2013 to December 2014). We recorded: demographic data, body mass index (BMI), Braden score, laboratory parameters of interest (albumin, total protein, RBC count, haemoglobin and iron levels) and presence or absence of malnutrition and pressure ulcers. RESULTS: The pressure ulcer prevalence was 12.9% (256 out of 2099). Based on the BMI classification, 61.7% of patients had a good nutritional status, 27.4% were undernourished, and 2.1% were considered malnourished. Nutritional status was statistically significantly different between patients with and without PU (p < 0.0001). This study also showed that hypoproteinemia, hypoalbuminemia, low RBC was positively associated with PU prevalence. CONCLUSION: The results highlight the impact of nutritional status on the prevalence of pressure ulcers in hospitalised geriatric and palliative population. It is of paramount importance to correctly evaluate the presence of malnutrition in patients at risk of pressure ulcers.

15.
Am J Dermatopathol ; 36(7): 594-6, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24950420

RESUMO

Eosinophilic ulcer of the oral mucosa is considered to be a benign, reactive, and self-limiting lesion, with unclear pathogenesis, manifesting as a rapidly developing solitary ulcer. We report the case of a 52-year-old man who presented with 4 synchronous ulcerations of the tongue. Histopathological examination showed polymorphic inflammatory infiltrate, rich in eosinophils, involving the superficial mucosa and the deeper muscle layer. Immunohistochemical analysis revealed single CD30 cells scattered within an inflammatory infiltrate. All the lesions began to regress spontaneously within 1 week after biopsy. A 4-year follow-up showed no recurrence.


Assuntos
Eosinofilia/patologia , Úlceras Orais/patologia , Humanos , Masculino , Pessoa de Meia-Idade
16.
Dermatol Ther ; 27(5): 281-3, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24964349

RESUMO

Despite the growing attention on safety and efficacy of conventional treatments, there is little information available on complementary and alternative medicine (CAM) used in psoriasis. In order to collect comprehensive information on CAM use, we conducted a face-to-face interview with 122 patients with psoriasis. All unconventional treatments for psoriasis used in the last 12 months were recorded. Fifty-seven patients (46.7%) used one of the CAM methods in the previous year, including topical and systemic antipsoriatics, dietary supplements, and diet. Forty-one different nonconventional topical treatments were used. Seven patients (5.7%) took nonconventional systemic medication, and 15.5% used dietary supplements. There were three patients who reported current adherence to a diet as treatment of psoriasis. Clinicians are often not informed that their patients are using complementary therapies. CAM may offer benefits as well as risks to patients with psoriasis. It is important to remind patient to report all ongoing and past topical and systemic treatments. The use of medications with unknown composition, efficiency, and safety should be discouraged.


Assuntos
Terapias Complementares/métodos , Fármacos Dermatológicos/administração & dosagem , Suplementos Nutricionais , Psoríase/terapia , Administração Cutânea , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapias Complementares/efeitos adversos , Fármacos Dermatológicos/efeitos adversos , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Psoríase/diagnóstico , Psoríase/dietoterapia , Medição de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
18.
J Dtsch Dermatol Ges ; 11(12): 1169-75, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24267013

RESUMO

BACKGROUND AND OBJECTIVES: Previous studies have shown a higher prevalence of metabolic syndrome in patients with psoriasis compared to controls. However, little attention has been paid to the effect of systemic anti-psoriatic drugs on the metabolic syndrome. The aim of this study was to investigate the association between psoriasis and the metabolic syndrome, by comparing untreated patients with psoriasis and population based control. PATIENTS AND METHODS: We conducted a hospital-based case-control study that included 122 untreated patients with plaque psoriasis and 122 age- and gender-matched controls. RESULTS: There was no significant difference in the prevalence of the metabolic syndrome between the patients with psoriasis (24.6 %) and the controls (22.9 %) (OR 1.095, 95 % CI 0.607-1.974). Among the components of the metabolic syndrome only hypertriglyceridemia and abdominal obesity were associated with psoriasis. The psoriatic patients with metabolic syndrome had a higher mean age (p =  0.001), and higher mean BMI (p =  0.001) compared with the psoriatic patients without metabolic syndrome. The metabolic syndrome was not associated with the severity of psoriasis. CONCLUSIONS: Untreated patients with psoriasis have no significantly higher prevalence of the metabolic syndrome than healthy controls. Our data suggest that systemic antipsoriatic drugs may play an important role in the pathogenesis of the metabolic syndrome.


Assuntos
Hipertrigliceridemia/epidemiologia , Síndrome Metabólica/epidemiologia , Obesidade/epidemiologia , Psoríase/epidemiologia , Adulto , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Valores de Referência , Fatores de Risco , Adulto Jovem
20.
Med Sci Monit ; 11(7): CR337-43, 2005 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-15990691

RESUMO

BACKGROUND: Intermittent pneumatic compression (IPC) has been successfully used in the treatment of venous ulcers, although the optimal setting of pressure, inflation and deflation times has not yet been established. The aim of this study was to compare the effect of two different combinations of IPC pump settings (rapid vs slow) in the healing of venous ulcers. MATERIAL/METHODS: 104 patients with pure venous ulcers were randomized to receive either rapid IPC or slow IPC for one hour daily. The primary and secondary end points were the complete healing of the reference ulcer and the change in the area of the ulcer over the six months observational period, respectively. RESULTS: Complete healing of the reference ulcer occurred in 45 of the 52 patients treated with rapid IPC, and in 32 of the 52 patients treated with slow IPC. Life table analysis showed that the proportion of ulcers healed at six months was 86% in the group treated with the fast IPC regimen, compared with 61% in the group treated with slow IPC (p=0.003, log-rank test). The mean rate of healing per day in the rapid IPC group was found to be significantly faster compared to the slow IPC group (0.09 cm2 vs 0.04 cm2, p=0.0002). CONCLUSIONS: Treatment with rapid IPC healed venous ulcers more rapidly and in more patients than slow IPC. Both IPC treatments were well tolerated and accepted by the patients. These data suggest that the rapid IPC used in this study is more effective than slow IPC in venous ulcer healing.


Assuntos
Dispositivos de Compressão Pneumática Intermitente , Úlcera Varicosa/terapia , Cicatrização , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
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