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6.
J Am Acad Dermatol ; 2020 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-32068050

RESUMO

BACKGROUND: Even with the addition of dermoscopy, a significant morphologic overlap exists between irritated seborrheic keratosis (ISK) and squamous cell carcinoma (SCC). OBJECTIVE: The aim of this study was to investigate the dermoscopic criteria that could serve as potent predictors for the differential diagnosis between ISK and SCC. METHODS: Dermoscopic images of histopathologically diagnosed ISKs and SCCs were evaluated by 3 independent investigators for the presence of predefined criteria. RESULTS: A total of 104 SCCs and 61 ISKs were included. The main dermoscopic predictors of SCC were dotted vessels (odds ratio [OR], 10.4), branched linear vessels (OR, 5.30), white structureless areas (OR, 6.78), white circles surrounding follicles (OR, 23.45), a diffuse irregular (OR, 2.55) or peripheral (OR, 2.8) vessel arrangement, and a central scale arrangement (OR, 3.35). Dermoscopic predictors of ISK were hairpin vessels (OR, 0.38), a diffuse regular vessel arrangement (OR, 0.39 and OR, 0.36), and white halos surrounding vessels covering more than 10% of the lesion (OR, 0.29 and OR, 0.12). LIMITATIONS: First, the retrospective design of the study; second, the differential diagnosis included in the study was restricted to ISK and SCC. CONCLUSIONS: We confirmed the significant morphologic overlap between ISK and SCC, but we also identified potent predictors for the differential diagnosis between these 2 entities.

7.
J Am Acad Dermatol ; 82(2): 398-406, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31499156

RESUMO

BACKGROUND: In retrospective studies, a second primary melanoma (SPM) develops in 2%-20% of melanoma patients. Scarce evidence exists on the usefulness of total-body photography (TBP) and digital dermatoscopic documentation (DDD) for detecting SPMs. OBJECTIVE: The primary aim was to quantify the risk and investigate the time of occurrence of SPMs. Secondary aims were to identify risk factors for SPM and to assess the usefulness of TBP and DDD for SPM detection. METHODS: This prospective cohort included patients with recently diagnosed melanoma that underwent sequential clinical and dermatoscopic examinations for up to 5 years. Life table analysis and Kaplan-Meier survival analysis were performed. Multivariate Cox models were constructed to identify factors affecting the outcome. RESULTS: An SPM developed in 46 of 977 (4.7%) patients. Life table analysis revealed a 5-year cumulative risk of 8.0% for SPM. High nevus count, fair phototype, and occupational sun exposure were potent predictors of SPM. Of all new melanomas, 17.3% were diagnosed by clinical and dermatoscopic examination, 48.1% by TBP, and 34.6% by DDD. LIMITATIONS: All patients followed the same protocol and diagnostic bias associated with sequential dermatoscopic imaging. CONCLUSION: In this cohort, melanoma patients were at 8% risk of an SPM developing within 5 years. TBP and DDD significantly contributed to the early detection of SPM.


Assuntos
Melanoma/epidemiologia , Segunda Neoplasia Primária/epidemiologia , Neoplasias Cutâneas/epidemiologia , Adulto , Idoso , Dermoscopia , Feminino , Humanos , Masculino , Melanoma/patologia , Pessoa de Meia-Idade , Segunda Neoplasia Primária/patologia , Fotografação , Vigilância da População , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Neoplasias Cutâneas/patologia , Fatores de Tempo
8.
J Am Acad Dermatol ; 82(3): 575-585.e1, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29438767

RESUMO

BACKGROUND: Several European countries recently developed international diagnostic and management guidelines for pemphigus, which have been instrumental in the standardization of pemphigus management. OBJECTIVE: We now present results from a subsequent Delphi consensus to broaden the generalizability of the recommendations. METHODS: A preliminary survey, based on the European Dermatology Forum and the European Academy of Dermatology and Venereology guidelines, was sent to a panel of international experts to determine the level of consensus. The results were discussed at the International Bullous Diseases Consensus Group in March 2016 during the annual American Academy of Dermatology conference. Following the meeting, a second survey was sent to more experts to achieve greater international consensus. RESULTS: The 39 experts participated in the first round of the Delphi survey, and 54 experts from 21 countries completed the second round. The number of statements in the survey was reduced from 175 topics in Delphi I to 24 topics in Delphi II on the basis of Delphi results and meeting discussion. LIMITATIONS: Each recommendation represents the majority opinion and therefore may not reflect all possible treatment options available. CONCLUSIONS: We present here the recommendations resulting from this Delphi process. This international consensus includes intravenous CD20 inhibitors as a first-line therapy option for moderate-to-severe pemphigus.


Assuntos
Fatores Imunológicos/administração & dosagem , Pênfigo/diagnóstico , Pênfigo/terapia , Plasmaferese , Guias de Prática Clínica como Assunto , Academias e Institutos/normas , Administração Intravenosa , Antígenos CD20/imunologia , Terapia Combinada/métodos , Terapia Combinada/normas , Consenso , Técnica Delfos , Dermatologia/métodos , Dermatologia/normas , Quimioterapia Combinada/métodos , Quimioterapia Combinada/normas , Europa (Continente) , Glucocorticoides/administração & dosagem , Humanos , Pênfigo/imunologia , Rituximab/administração & dosagem , Índice de Gravidade de Doença
11.
Dermatol Clin ; 36(4): 359-368, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30201145

RESUMO

In addition to its "traditional" application for the early diagnosis of melanoma and nonmelanoma skin cancers, dermoscopy gains appreciation in fields beyond dermato-oncology. Nowadays, dermoscopy has been established as a reliable adjunctive tool to the everyday clinical practice of general dermatology. Morphology and distribution of vascular structures, background colors, follicular abnormalities, and the presence of scales are important features that should be evaluated. Clinical examination remains the undoubted mainstay of diagnosis in inflammatory and infectious diseases.


Assuntos
Dermatite/diagnóstico por imagem , Dermoscopia , Dermatopatias Papuloescamosas/diagnóstico por imagem , Humanos , Ceratose/diagnóstico por imagem , Líquen Escleroso e Atrófico/diagnóstico por imagem , Lúpus Eritematoso Discoide/diagnóstico por imagem , Psoríase/diagnóstico por imagem , Rosácea/diagnóstico por imagem , Esclerodermia Localizada/diagnóstico por imagem
14.
Dermatol Pract Concept ; 7(1): 49-50, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28243495

RESUMO

Dermoscopy is already considered a fairly established method for diagnosing scabies. This is because dermoscopy enables the visualization both of the burrow and the mite itself, forming the so-called "jet with a contrail" structure. In the present report we present an extraordinary case of a patient with scabies lesions on the face and neck, which was misdiagnosed during sequential visits and underwent unnecessary surgical diagnostic procedures. Finally, the diagnostic problem was solved when dermoscopy was applied.

15.
Dermatol Pract Concept ; 6(4): 7-12, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27867739

RESUMO

BACKGROUND: Biologic agents are routinely used in the treatment of severe psoriasis. The evaluation of treatment response is mainly based on the physician's global clinical assessment. OBJECTIVE: To investigate whether dermoscopy might enhance the assessment of response of psoriasis to treatment with biologic agents. METHODS: Patients with severe psoriasis scheduled to receive a biologic agent were enrolled in the study. A target lesion from each patient was clinically and dermoscopically documented at baseline and after one, two and six months. The clinical response was evaluated by the recruiting clinicians at all visits, while dermoscopic images were evaluated by two independent investigators, blinded to the clinical information. Chi Square test was used for cross-tabulation comparisons, while odds ratios, 95% confidence intervals and p values were calculated using univariate logistic regression. RESULTS: Overall, there was a significant correlation between clinical response and vessel distribution at all time points: a regular vessel distribution correlated with no response, a clustered distribution with partial response, and the dermoscopic absence of vessels with complete response. The presence of dermoscopic hemorrhagic dots was a potent predictor of favorable clinical response at the subsequent visit at all time points. Among lesions initially clinically responding and later recurring, 87.5% displayed dermoscopic dotted vessels despite the macroscopic remission. CONCLUSION: Dermoscopy might be a useful additional tool for evaluating the response of psoriatic patients to biologic agents. Hemorrhagic dots represent an early predictor of clinical response, while the persistence or reappearance of dotted vessels might predict clinical persistence or recurrence, respectively.

16.
Artigo em Inglês | MEDLINE | ID: mdl-27799806

RESUMO

Hidradenitis suppurativa (HS) is a chronic, recurrent, inflammatory skin disease that affects the hair follicles of the aprocrine gland-bearing anatomical areas of the body. It is characterized by deep painful nodules and abscesses that rupture and contribute to the formation of sinus tracks and scarring. The management of HS is based on the assessment of disease severity and a combination of medical and surgical treatment according to the European Guidelines. Adalimumab, a recombinant, fully humanized, anti-tumor necrosis factor alpha (anti-TNF-α) monoclonal antibody, is the only officially approved treatment for the management of moderate-to-severe HS. Case reports, concerning 42 patients who received adalimumab for severe HS (with the standard dose regimen for psoriasis), reported a cumulative response rate of 58% (≥50% in 23 patients) with a relapse rate of 71% (10 out of 14 patients). The most recent and most well-powered phase III, randomized placebo-controlled trials for the evaluation of the efficacy and safety of adalimumab in treatment of moderate-to-severe HS (PIONEER studies I and II) showed that the Hidradenitis Suppurativa Clinical Response (HiSCR) rate at week 12 was significantly higher for patients randomized to adalimumab compared to placebo. Adverse events were comparable to placebo. In conclusion, adalimumab, to date, holds the most robust data regarding treatment efficacy in HS. Larger, registry-based studies are needed to further establish the efficacy and safety profile of this anti-TNF-α agent in HS.

17.
Future Oncol ; 11(22): 2975-84, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26450622

RESUMO

The dermoscopic findings of basal cell carcinoma (BCC) were first described more than a decade ago and the list of BCC-related criteria has been several times updated and enriched. Today, the dermatoscope is considered the key tool for the diagnosis of BCC, since it allows its early detection and enables its discrimination from other pigmented and nonpigmented skin tumors. The dermoscopic pattern of BCC results from several combinations of well-known BCC criteria, depending on several factors, including histopathologic subtype, location, gender, age and pigmentary trait. In addition, recent evidence highlighted that dermoscopy is also useful in the management of BCC, since it provides information on the tumor subtype, the presence of pigmentation or ulceration and the response to nonablative treatments.


Assuntos
Carcinoma Basocelular/diagnóstico , Dermoscopia , Neoplasias Cutâneas/diagnóstico , Carcinoma Basocelular/patologia , Carcinoma Basocelular/terapia , Dermoscopia/métodos , Gerenciamento Clínico , Humanos , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/terapia
18.
Curr Probl Dermatol ; 47: 45-54, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26370643

RESUMO

Female pattern hair loss, or female pattern androgenetic alopecia, is a nonscarring alopecia with a multi-factorial etiology that mostly affects postmenopausal women and is characterized by a reduction in hair density over the crown and frontal scalp. The clinical picture is characterized by a diffuse rarefaction of scalp hair over the mid-frontal scalp and a more-or-less intact frontal hairline without any signs of inflammation or scarring. Although the disease poses only a cosmetic concern, it is chronic and may have a significant negative psychological impact on the affected person. The aim of treating female pattern hair loss is to reduce hair loss and, to a certain extent, succeed in promoting hair regrowth. Various treatment methods are available, but it remains unclear which are the most effective. Early initiation of treatment and the combination of various modalities seem to be more efficacious than monotherapy.


Assuntos
Inibidores de 5-alfa Redutase/uso terapêutico , Alopecia/terapia , Antagonistas de Androgênios/uso terapêutico , Antifúngicos/uso terapêutico , Cabelo/transplante , Cetoconazol/uso terapêutico , Minoxidil/uso terapêutico , Vasodilatadores/uso terapêutico , Administração Cutânea , Alopecia/diagnóstico , Alopecia/genética , Antagonistas de Receptores de Andrógenos/uso terapêutico , Acetato de Ciproterona/uso terapêutico , Dutasterida/uso terapêutico , Feminino , Finasterida/uso terapêutico , Flutamida/uso terapêutico , Humanos , Pós-Menopausa , Espironolactona/uso terapêutico
19.
Curr Probl Dermatol ; 47: 76-86, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26370646

RESUMO

Scarring alopecia or cicatricial alopecia results from follicular damage that is sufficient to cause the destruction and replacement of pilosebaceous structures by scar tissue. Primary scarring alopecias represent a group of disorders that primarily affect the hair follicles, as opposed to secondary scarring alopecias, which affect the dermis and secondarily cause follicular destruction. Inflammation may predominantly involve lymphocytes or neutrophils. Cicatricial alopecias that mainly involve lymphocytic inflammation include discoid lupus erythematosus, lichen planopilaris, frontal fibrosing alopecia, central centrifugal alopecia, and pseudopelade (Brocq). Cicatricial alopecias that are due to predominantly neutrophilic inflammation include folliculitis decalvans, tufted folliculitis, and dissecting cellulitis of the scalp. Folliculitis keloidalis is a cicatricial alopecia with a mixed inflammatory infiltrate.


Assuntos
Alopecia/diagnóstico , Cicatriz/diagnóstico , Dermatoses do Couro Cabeludo/diagnóstico , Acne Queloide/diagnóstico , Acne Queloide/terapia , Alopecia/terapia , Celulite (Flegmão)/diagnóstico , Celulite (Flegmão)/terapia , Cicatriz/terapia , Fibrose/diagnóstico , Fibrose/terapia , Foliculite/diagnóstico , Foliculite/terapia , Humanos , Líquen Plano/diagnóstico , Líquen Plano/terapia , Lúpus Eritematoso Discoide/diagnóstico , Lúpus Eritematoso Discoide/terapia , Couro Cabeludo/patologia , Dermatoses do Couro Cabeludo/terapia , Dermatopatias Genéticas/diagnóstico , Dermatopatias Genéticas/terapia
20.
Clin J Am Soc Nephrol ; 6(4): 748-52, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21258039

RESUMO

BACKGROUND AND OBJECTIVES: Uremic xerosis is a bothersome condition that is poorly responsive to moisturizing and emollient therapy. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A randomized, double-blind, intraindividual (left versus right comparison), multicentric clinical study was performed on 100 patients with moderate to severe uremic xerosis for 7 days, during which the patients applied twice daily an emulsion combining glycerol and paraffin (test product) on one allocated lower leg, and the emulsion alone (comparator) on the other lower leg. This was followed by an open-labeled use of the test product on all of the xerotic areas for 49 days. The main efficacy parameter was treatment response on each lower leg, as defined by a reduction from baseline of at least two grades in a five-point clinical score on day 7. RESULTS: Among the 99 patients analyzed, the test product was highly effective with a treatment response in 72 patients (73%), whereas 44 patients (44%) responded to the comparator (P<0.0001, intergroup analysis). This was associated with an objective reduction in the density and thickness of the scales on day 7 (P<0.0001 compared with the comparator) and a substantial improvement of the uremic pruritus (75%) and quality of life of the patients at study end (P<0.001, intragroup analysis). The test product was very well tolerated, with product-related local intolerance (exacerbated pruritus, local burning, or erythema) occurring in only five patients (5%). CONCLUSIONS: Uremic xerosis can be managed successfully when an appropriate emollient therapy is used.


Assuntos
Emolientes/uso terapêutico , Glicerol/uso terapêutico , Parafina/uso terapêutico , Dermatopatias/tratamento farmacológico , Uremia/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Feminino , Glicerol/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Parafina/efeitos adversos , Estudos Prospectivos , Dermatopatias/etiologia
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