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2.
Med Sci Monit ; 26: e928788, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33338031

RESUMO

BACKGROUND Diabetic wound (DW) treatment is a serious challenge for clinicians, and the underlying mechanisms of DWs remain elusive. We sought to identify the critical genes in the development of DWs and provide potential targets for DW therapies. MATERIAL AND METHODS Datasets of GSE38396 from the Gene Expression Omnibus (GEO) database were reviewed. Pathway analysis was performed using the Kyoto Encyclopedia of Genes and Genomes (KEGG), Gene Ontology term analyses were carried out, and Cytoscape software (Cytoscape 3.7.2) was used to construct the protein interaction network. Serum samples from patients with diabetes and control participants were collected, and the expression of estrogen receptor 1 (ESR1) was measured by quantitative reverse-transcription polymerase chain reaction. In addition, the function of ESR1 in human skin fibroblasts was investigated in vitro. RESULTS Eight samples were analyzed using the Morpheus online tool, which identified 637 upregulated and 448 downregulated differentially expressed genes. The top 5 KEGG pathways of upregulated differentially expressed genes were associated with sphingolipid metabolism, estrogen signaling, ECM-receptor interaction, MAPK signaling, and PI3K-Akt signaling. The hub genes for DWs were JUN, ESR1, CD44, SMARCA4, MMP2, BMP4, GSK3B, WDR5, PTK2, and PTGS2. JUN, MMP2, and ESR1 were the upregulated hub genes, and ESR1 was found to be consistently enriched in DW patients. Inhibition of ESR1 had a stimulative role in human skin fibroblasts. CONCLUSIONS ESR1 was identified as a crucial gene in the development of DWs, which suggests potential therapeutic targets for DW healing.


Assuntos
Complicações do Diabetes/genética , Receptor alfa de Estrogênio/genética , Fibroblastos/metabolismo , Úlcera Cutânea , Células Cultivadas , Bases de Dados Genéticas , Regulação da Expressão Gênica , Ontologia Genética , Humanos , Transdução de Sinais , Úlcera Cutânea/etiologia , Úlcera Cutânea/genética , Úlcera Cutânea/metabolismo , Cicatrização/genética
3.
Gerokomos (Madr., Ed. impr.) ; 31(3): 198-201, sept. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-197356

RESUMO

Las lesiones cutáneas asociadas a humedad son aquellas localizadas en la piel, presentadas como inflamación y/o erosión, causadas por exposición prolongada a fuentes de humedad con potencial irritativo. Los pacientes geriátricos, por cambios de estructura y resistencia de la piel, tienen más riesgo de padecerlas. Se presentan tres casos de pacientes geriátricos con estas lesiones. Exploración: Las pacientes presentan diversos tipos de lesiones: dermatitis intertriginosa, dermatitis asociada a la incontinencia y dermatitis asociada al exudado. Plan de actuación/tratamiento: Se realizó un abordaje global e interdisciplinar, además de local, incluyendo manejo de la humedad y uso de películas barrera siliconadas. RESULTADOS: La evolución fue satisfactoria, con disminución o eliminación del eritema y la sintomatología asociada. DISCUSIÓN: El abordaje global e interdisciplinar, y el uso de películas barrera siliconadas, ha mejorado el confort y la evolución de las lesiones y reducido el tiempo de cura. Es preciso dar, a las lesiones por humedad en pacientes geriátricos, la relevancia que precisan


Moisture associated skin damage are those located on the skin, presented as inflammation and/or erosion, caused by prolonged exposure to moisture sources with irritative potential. Geriatric patients, due to structural changes and resistance of the skin, have a higher risk of suffering from them. Three cases of geriatric patients with these lesions are presented. Exploration: The patients present diverse types of injuries: intertriginous dermatitis, dermatitis associated with incontinence and dermatitis associated with exudate. Action/treatment plan: A global and interdisciplinary approach was carried out, in addition to local, including humidity management and use of silicone barrier films. RESULTS: The evolution was satisfactory, diminishing or eliminating the erythema and the associated symptomatology. DISCUSSION: The global and interdisciplinary approach, and the use of silicone barrier films, has improved comfort, the evolution of injuries and reduced the time of healing. It is necessary to give the relevance these injuries require in geriatric patients


Assuntos
Humanos , Feminino , Idoso , Idoso de 80 Anos ou mais , Umidade/efeitos adversos , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/enfermagem , Eritema/enfermagem , Hiperidrose/complicações , Dermatite/complicações , Ferimentos e Lesões/classificação , Higiene , Úlcera Cutânea/etiologia , Úlcera Cutânea/patologia
4.
Dermatol Online J ; 26(6)2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32815697

RESUMO

Cutis marmorata telangiectatica congenita (CMTC) is a rare, congenital, vascular disorder that may sometimes be associated with ulcerations of the involved skin. We present a case of CMTC, asymptomatic since birth, that began developing painful ulcerations during adolescence. Although laser therapy may benefit the superficial aspect of this vascular anomaly, the presence of deeper involvement in lesions with ulcerations may not respond favorably to laser therapy and the best approach needs to be further evaluated.


Assuntos
Dermatopatias Vasculares/complicações , Úlcera Cutânea/etiologia , Telangiectasia/congênito , Adolescente , Humanos , Terapia a Laser , Masculino , Telangiectasia/complicações
6.
Immunol Med ; 43(3): 107-114, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32324110

RESUMO

Systemic sclerosis (SSc) induces skin thickening and numerous symptoms involving the entire body. Collagen deposition, immune disorder, and vascular abnormalities is currently estimated to be three major causal factors involved in the respective conditions. Vascular abnormalities usually develop in the initial phase of this disease, and may exist in all phases; therefore, they markedly influence the patient's quality of life. This article reviews recent findings about 'narrow-sense' vascular lesions (including Raynaud's phenomenon, skin ulcers, nailfold bleedings, pitting scars, telangiectasia, and pulmonary hypertension) and 'broad-sense' vascular lesions (such as calcinosis or erectile dysfunction). Affected blood vessels can be classified into arteriole/small artery and capillary blood vessels. Furthermore, pathological changes include the proliferation of the vascular endothelial or smooth muscle cells, lumen stenosis by collagen accumulation of the vascular intima, vasodilation or fragility, and apoptosis. There may be interaction between vascular lesions, autoimmune disorder, and collagen deposition. Thus, various symptoms of this disease may be controlled through the treatment of vascular lesions.


Assuntos
Qualidade de Vida , Escleroderma Sistêmico/complicações , Doenças Vasculares/etiologia , Calcinose/etiologia , Colágeno/metabolismo , Células Endoteliais/patologia , Disfunção Erétil/etiologia , Feminino , Humanos , Hipertensão Pulmonar/etiologia , Masculino , Miócitos de Músculo Liso/patologia , Doença de Raynaud/etiologia , Úlcera Cutânea/etiologia , Telangiectasia/etiologia
7.
Dermatol Online J ; 26(1)2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-32155028

RESUMO

Trigeminal trophic syndrome is an uncommon condition characterized by paresthesia, itch, and self-inflicted wounds following the trigeminal dermatome(s). Similar processes adhering to cervical nerve distributions have been reported, calling into question the specificity of trigeminal trophic syndrome for the trigeminal network. Herein, we report patient with trigeminal trophic syndrome adhering to the C2 dermatome, a previously unreported distribution.


Assuntos
Dermatoses Faciais/patologia , Parestesia/patologia , Úlcera Cutânea/etiologia , Nervo Trigêmeo , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Dermatoses Faciais/complicações , Feminino , Humanos , Parestesia/complicações , Prurido/patologia , Úlcera Cutânea/patologia , Síndrome
8.
Clin Podiatr Med Surg ; 37(2): 231-246, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32146980

RESUMO

Gaseous nitric oxide under increased atmospheric pressure (gNOp) has shown ability to kill multidrug-resistant bacteria in an in vitro model and in a live mammalian (porcine) model. Factors impacting the kill rate of the multidrug-resistant bacteria include atmospheric pressures, concentration of gaseous NO, flow rate, and duration of application. Using successful in vitro parameters, gNOp showed multilog reduction of bacteria in a live mammalian (porcine) model. The in vitro testing system, using the EpiDerm-FT skin model (stem cell grown skin), was used to develop an infected wound model for Acinetobacter baumannii, Pseudomonas aeruginosa, Staphylococcus aureus, and methicillin-resistant S aureus.


Assuntos
Acinetobacter baumannii/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Óxido Nítrico/farmacologia , Pseudomonas aeruginosa/efeitos dos fármacos , Úlcera Cutânea/tratamento farmacológico , Staphylococcus aureus/efeitos dos fármacos , Animais , Pressão Atmosférica , Modelos Animais de Doenças , Farmacorresistência Bacteriana Múltipla , Úlcera Cutânea/etiologia , Suínos
9.
Arthritis Rheumatol ; 72(7): 1049-1058, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32134199

RESUMO

Systemic sclerosis (SSc) is an autoimmune rheumatic disease with heterogeneous clinical manifestations and a variable course in which the severity of the pathology dictates the disease prognosis and course. Among autoimmune rheumatic diseases, SSc has the highest mortality rate among all rheumatic diseases, though there are exciting new therapeutic targets that appear to halt the progression of SSc manifestations such as skin or lung fibrosis. In selected patients, high-intensity regimens with autologous stem cell transplantation can favorably modify the course. In what was once thought to be an untreatable disease, targeted therapies have now changed the outlook of SSc to a treatable disorder. Herein, we discuss the targeted therapies modifying the outlook on selected organ involvement and creating opportunities for future treatment. We also present a framework for defining low disease activity in SSc.


Assuntos
Cardiopatias/terapia , Nefropatias/terapia , Doenças Pulmonares Intersticiais/terapia , Hipertensão Arterial Pulmonar/terapia , Doença de Raynaud/terapia , Escleroderma Sistêmico/terapia , Úlcera Cutânea/terapia , Doença Aguda , Anti-Hipertensivos/uso terapêutico , Progressão da Doença , Antagonistas dos Receptores de Endotelina/uso terapêutico , Fibrose , Dedos , Cardiopatias/etiologia , Cardiopatias/fisiopatologia , Transplante de Células-Tronco Hematopoéticas , Humanos , Imunossupressores/uso terapêutico , Nefropatias/etiologia , Nefropatias/fisiopatologia , Doenças Pulmonares Intersticiais/etiologia , Doenças Pulmonares Intersticiais/fisiopatologia , Miocárdio/patologia , Avaliação de Resultados em Cuidados de Saúde , Prostaglandinas I/uso terapêutico , Hipertensão Arterial Pulmonar/etiologia , Hipertensão Arterial Pulmonar/fisiopatologia , Doença de Raynaud/etiologia , Doença de Raynaud/fisiopatologia , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/fisiopatologia , Índice de Gravidade de Doença , Úlcera Cutânea/etiologia , Úlcera Cutânea/fisiopatologia
11.
Clin Dermatol ; 38(1): 42-51, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32197748

RESUMO

Skin rashes have exanthema as a synonym, a term derived from the Greek words exanthem, meaning "to appear," and anthos, which denotes "flourishing." The relevant factors for characterization of a rash include distribution, configuration, and organization of the lesions, in addition to evidence of systemic involvement through toxemia, adenopathy, and conjunctive lesions, hepatosplenomegaly, excoriations or phlogosis, neck rigidity, or neurologic dysfunction. A rash may evolve to cutaneous ulceration in many instances, which is relevant for the diagnosis, the followup, and the therapeutic management of the patient. Systemic diseases with exanthemas that result in ulcerations prevail over diseases that are restricted to signs and/or merely cutaneous clinical manifestations. A variety of etiologies can present cutaneous rashes with ulcers, subject or not to systemic involvement by the underlying disease, among which stand out the bullous diseases, infectious and parasitic diseases, noninfectious granulomatous diseases, vasculitis, paraneoplastic syndromes, autoimmune diseases of the connective tissue, neutrophilic diseases, lichen planus, and drug hypersensitivity syndrome. The authors present a detailed review of some diseases corresponding to each one of the mentioned etiologies, updating the clinical manifestations and therapeutic proposals.


Assuntos
Exantema/complicações , Úlcera Cutânea/etiologia , Doenças Autoimunes/complicações , Exantema/patologia , Granuloma/complicações , Humanos , Infecções/complicações , Síndromes Paraneoplásicas/complicações , Doenças Parasitárias/complicações , Dermatopatias Vesiculobolhosas/complicações , Úlcera Cutânea/patologia , Síndrome de Sweet/complicações , Vasculite/complicações
12.
Nat Rev Rheumatol ; 16(4): 208-221, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32099191

RESUMO

Raynaud phenomenon is a symptom complex caused by impaired digital perfusion and can occur as a primary phenomenon or secondary to a wide range of underlying causes. Raynaud phenomenon occurs in virtually all patients with systemic sclerosis (SSc) and is often the earliest clinical manifestation to occur. Careful assessment is required in patients with Raynaud phenomenon to avoid missing secondary causes such as SSc. Digital ulcers are a painful and disabling visible manifestation of digital vascular injury in patients with SSc. Progress has been made in the classification and assessment of digital ulcers and in understanding ulcer pathogenesis, and there are a wide range of treatments available to both prevent and heal digital ulcers, some of which are also used in Raynaud phenomenon management. In this Review, the assessment of patients with Raynaud phenomenon is discussed, including 'red flags' that are suggestive of SSc. The pathogenesis, classification and assessment of SSc-associated digital ulcers are also covered, alongside an overview of management approaches for SSc-associated Raynaud phenomenon and digital ulcers. Finally, unmet needs are discussed and the concept of a unified vascular phenotype in which therapies that affect the vasculature to support disease modification strategies is introduced.


Assuntos
Dedos/irrigação sanguínea , Doença de Raynaud/complicações , Escleroderma Sistêmico/complicações , Úlcera Cutânea/etiologia , Humanos , Úlcera Cutânea/diagnóstico
13.
World J Surg Oncol ; 18(1): 36, 2020 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-32046724

RESUMO

BACKGROUND: Sarcomas sometimes invade the skin and become exposed, producing malignant wounds characterized by bleeding, exudate, odor, and infection. Malignant cutaneous sarcomas are generally incurable and ultimately impair patients' quality of life. Mohs' chemosurgery is a previously published technique for chemical fixation of a cutaneous tumor and subsequent excision. CASE PRESENTATION: We present the case of a 44-year-old man with an undifferentiated pleomorphic sarcoma arising in the right chest wall and rupturing through the skin. The tumor manifested as a malignant wound with ulceration, bleeding, exudate, and a strong odor. Treatment with systemic chemotherapy and Mohs' chemosurgery was initiated. After repeated courses, the tumor demonstrated significant shrinkage. We were then able to perform wide resection and reconstruction with a rectus abdominis musculocutaneous flap. Pathologic examination of the resected specimen confirmed negative margins. CONCLUSIONS: Mohs' chemosurgery with concurrent systemic chemotherapy is an effective and reliable treatment option for achieving pre-operative local control of sarcomas that rupture through the skin.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Cirurgia de Mohs/métodos , Recidiva Local de Neoplasia/terapia , Sarcoma/terapia , Neoplasias Cutâneas/terapia , Úlcera Cutânea/terapia , Adulto , Cloretos/administração & dosagem , Terapia Combinada/métodos , Humanos , Masculino , Terapia Neoadjuvante/métodos , Gradação de Tumores , Recidiva Local de Neoplasia/complicações , Recidiva Local de Neoplasia/patologia , Pomadas , Período Pré-Operatório , Qualidade de Vida , Sarcoma/complicações , Sarcoma/patologia , Pele/patologia , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/patologia , Úlcera Cutânea/etiologia , Resultado do Tratamento , Compostos de Zinco/administração & dosagem
14.
Interact Cardiovasc Thorac Surg ; 30(5): 783-784, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32048710

RESUMO

Although radiation therapy is widely used to treat breast cancer, high doses of radiation may cause various complications. We report a case of a left ventricular aneurysm complicated with an intractable skin ulcer caused by radiation therapy for breast cancer. The communication between the aneurysm and skin ulcer caused severe bleeding. An urgent left ventricular repair and chest wall reconstruction with a rectus abdominis flap were performed successfully.


Assuntos
Neoplasias da Mama/radioterapia , Aneurisma Cardíaco/etiologia , Aneurisma Cardíaco/cirurgia , Neoplasias Induzidas por Radiação/etiologia , Neoplasias Induzidas por Radiação/cirurgia , Úlcera Cutânea/etiologia , Idoso , Neoplasias da Mama/complicações , Neoplasias da Mama/cirurgia , Feminino , Humanos , Neoplasias Induzidas por Radiação/diagnóstico , Procedimentos Cirúrgicos Reconstrutivos , Úlcera Cutânea/patologia , Úlcera Cutânea/cirurgia , Retalhos Cirúrgicos , Toracoplastia
16.
Arthritis Res Ther ; 22(1): 3, 2020 01 06.
Artigo em Inglês | MEDLINE | ID: mdl-31907061

RESUMO

BACKGROUND: We aimed to develop a patient-reported outcome measure, in accordance with the US Food and Drug Administration guidance, to capture the impact of systemic sclerosis-related digital ulcers (SSc-DUs) on hand function. Psychometric analyses were conducted to evaluate and document the measurement properties of the resulting instrument-the Hand Disability in Systemic Sclerosis-Digital Ulcers (HDISS-DU®). METHODS: The HDISS-DU was developed through a series of confirmatory, qualitative concept-elicitation interviews (N = 36) to provide supportive evidence that the instrument captures all relevant issues and functional limitations relating to SSc-DUs in this patient population. Psychometric analyses used blinded data from two randomised, controlled, phase 3 trials in patients with SSc-DUs (N = 517). The analyses included assessment of reliability, construct validity, responsiveness and thresholds for meaningful change. RESULTS: Qualitative interviews confirmed that the HDISS-DU had good content coverage and patients understood the HDISS-DU instructions, items and response scale. The HDISS-DU demonstrated excellent internal consistency and test-retest reliability, with satisfactory construct validity. Overall, the HDISS-DU was highly responsive to change in digital ulcer severity: the no-change group (for other criterion measures) had mean differences and effect sizes close to 0, while mean differences were mostly negative (indicating improvement) for the improvement groups (for other criterion measures) and vice versa. The preliminary threshold for meaningful change was a 0.50 difference in HDISS-DU score. CONCLUSIONS: Using data from two large studies of SSc-DU patients, these psychometric analyses support the reliability, validity, discriminating ability and responsiveness to change of the HDISS-DU for evaluating treatment outcomes in future clinical studies and clinical practice.


Assuntos
Avaliação da Deficiência , Medidas de Resultados Relatados pelo Paciente , Psicometria/instrumentação , Escleroderma Sistêmico/complicações , Úlcera Cutânea , Adulto , Feminino , Dedos/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Úlcera Cutânea/etiologia
17.
J Foot Ankle Res ; 13: 1, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31956341

RESUMO

Background: The "cancer analogy" is powerful for communicating risk to and organizing care for patients with diabetic foot syndrome. One potentially underappreciated similarity between cancer and foot ulcers is that both can recur at anatomical locations distinct from the primary occurrence, albeit with different physiological mechanisms. Few studies have characterized the location of diabetic foot ulcer recurrence, and these have been limited by considering only the first recurrent wound following a recent-healed wound. We therefore characterized the anatomical locations at which diabetic foot ulcers are likely to recur considering multiple wounds during follow-up and the locations of all prior wounds documented in the participant's history. Methods: We completed a secondary analysis of existing data from a 129 participant multi-center study of participants in diabetic foot remission. The primary outcome was plantar foot ulceration, and each participant was followed for 34 weeks or until withdrawing consent, allowing characterization of all wounds occurring. We stratified the anatomical locations of wounds prior to the trial by the following outcome categories during the trial: no recurrence, recurrence to the same anatomical location, recurrence to a different anatomical location on the same foot, and recurrence to the contralateral foot. Results: A large percentage (48%) of wounds recurred to the contralateral foot, and the proportion of subsequent foot ulcer to the contralateral limb was largely unaffected by the anatomical location of foot ulcer prior to the study. Only 17% of prior diabetic foot ulcers were followed by recurrence to the same anatomical location. Rates of recurrence remained high during treatment of a wound (0.41 foot ulcer/ulcer-year). Participants had documented wounds to 2.2 distinct anatomical locations on average, and more than 60% of participants had wounds to more than one plantar location by the end of the study. Conclusions: Given the significant morbidity, mortality, and resource utilization associated with foot ulcer recidivism, quality and evidenced-based preventive care is essential. Our results better characterize the burden of recurrence and to what anatomy recurrence is most likely. These insights may benefit providers and patients alike for the provision of high-quality preventive care thereby resulting in reduced morbidity, mortality, and cost. Trial registration: The study providing the data for this secondary analysis was registered on ClinicalTrials.gov (NCT02647346) on January 6, 2016. The study was retrospectively registered.


Assuntos
Pé Diabético/patologia , Úlcera Cutânea/patologia , Adulto , Ensaios Clínicos como Assunto , Pé Diabético/etiologia , Pé Diabético/prevenção & controle , Feminino , Hallux/patologia , Humanos , Perna (Membro)/patologia , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Recidiva , Indução de Remissão , Prevenção Secundária , Úlcera Cutânea/etiologia , Úlcera Cutânea/prevenção & controle
18.
Pharm Biol ; 58(1): 124-130, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31967912

RESUMO

Context: Burn therapy (MEBT)/moist exposed burn ointment (MEBO) is an effective traditional Chinese medicine method to treat diabetic wound, but the mechanism is unclear. Autophagy has been proved to be closely related with wound healing, so MEBO/MEBT is hypothesized to promote diabetic wound healing by regulating autophagy.Objective: To explore the mechanism of moist exposed MEBT/MEBO promoting diabetic wound repair.Materials and methods: Eighty male Wistar rats were randomly assigned to control (n = 20) and diabetic group induced by intraperitoneal injection of STZ (n = 60), which were further randomly assigned to MEBO, Kangfuxin and model groups (n = 20 each). All rats underwent full-thickness skin resection in the back. Wound healing was dynamically observed and wound tissues were collected at five time points for pathological examination, autophagosome and the expression of PI3K, Akt and mTOR.Results: The healing time in the control group was the shortest, no statistically significant difference was found between the MEBO and the Kangfuxin group (p = 0.76). The morphology of autophagosomes ranged large to small, which was the most obvious in the MEBO group. The mRNA and protein expression of PI3K, Akt and mTOR in each group reached the peak on Day 5, the levels in the MEBO group were the highest (F = 18.43, 19.97, 15.36, p < 0.05). On Day 11, the expression levels in each group began to decline.Discussion and conclusions: In this study, we discussed the molecular mechanism of MEBT/MEBO promoting the repair of diabetic ulcer wounds through autophagy and PI3K-Akt-mTOR signalling pathway, which provides a new way for drug design in the future.


Assuntos
Diabetes Mellitus Experimental/tratamento farmacológico , Sitosteroides/administração & dosagem , Úlcera Cutânea/tratamento farmacológico , Cicatrização/efeitos dos fármacos , Animais , Autofagia/efeitos dos fármacos , Diabetes Mellitus Experimental/complicações , Masculino , Fosfatidilinositol 3-Quinase/metabolismo , Proteínas Proto-Oncogênicas c-akt/metabolismo , Ratos , Ratos Wistar , Transdução de Sinais/efeitos dos fármacos , Sitosteroides/farmacologia , Úlcera Cutânea/etiologia , Serina-Treonina Quinases TOR/metabolismo
20.
Scand J Rheumatol ; 49(3): 239-243, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31928291

RESUMO

Objective: Despite being a cardinal clinical sign of systemic sclerosis (SSc), digital pitting has been little studied. Our objective was to test, in a pilot study, the hypothesis that pitting is painful and associated with digital vascular disease severity.Method: Fifty patients with SSc were recruited: 25 with and 25 without digital pitting. Fingertip pain was assessed on a 0-10 scale. Thermography of both hands assessed surface temperature, allowing calculation of the distal-dorsal difference (temperature gradient) for each finger. Nailfold capillaroscopy was performed in each finger using a dermatoscope, and graded on a 0-3 scale (0 = normal; 3 = grossly abnormal).Results: In the 25 patients with digital pitting, 65 fingers in total were affected (mainly the index and middle fingers). Pain scores were higher in 'pitting' patients [median 4 (interquartile range 3-8) vs 0 (0-2), p < 0.001], and pitting patients reported that pitting impacted on activities of everyday living. Temperature gradients along the fingers did not differ significantly between patients with and without pitting (p = 0.248). Pitting patients were more likely to have 'grossly abnormal' capillaries than those without pitting, and less likely to have 'no/mild' nailfold capillary changes.Conclusions: Digital pitting is painful and impacts on hand function. Capillaroscopy findings provide further support for an association between pitting and severity of digital vascular change. Larger, more comprehensive studies are required to examine the pathophysiology of pitting and to pave the way to therapeutic intervention, ideally including preventive strategies.


Assuntos
Dedos/fisiopatologia , Dor/fisiopatologia , Esclerodermia Difusa/fisiopatologia , Esclerodermia Limitada/fisiopatologia , Idoso , Estudos de Casos e Controles , Feminino , Dedos/irrigação sanguínea , Dedos/patologia , Humanos , Masculino , Angioscopia Microscópica , Pessoa de Meia-Idade , Dor/etiologia , Projetos Piloto , Esclerodermia Difusa/complicações , Esclerodermia Difusa/patologia , Esclerodermia Limitada/complicações , Esclerodermia Limitada/patologia , Escleroderma Sistêmico/fisiopatologia , Venenos de Escorpião , Índice de Gravidade de Doença , Úlcera Cutânea/etiologia , Termografia
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