Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 9.249
Filtrar
3.
Br J Dermatol ; 183(1): e17, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32745236

RESUMO

La enfermedad COVID-19 es una infección provocada por SARS-CoV-2. Se descubrió en diciembre de 2019, y en marzo de 2020 la Organización Mundial de la Salud anunció que ocasionaba una pandemia. La enfermedad puede afectar a varios órganos y algunas descripciones previas indicaban que puede afectar a la piel. Los investigadores, dermatólogos de toda España, revisaron 375 casos con COVID-19 sospechado o confirmado, para desarrollar una clasificación de las lesiones que se asocian a COVID-19 y aportar imágenes. Las lesiones de los primeros 120 casos fueron revisadas por cuatro dermatólogos, sin conocer otra información clínica, para reconocer los patrones de lesiones que se asocian con la COVID-19. Luego aplicaron estos patrones al resto de imágenes, mientras se mejoraban. De esta forma se describieron 5 grandes tipos de lesiones. Los grupos son: lesiones que parecen sabañones, brotes de pequeñas vesículas, ronchas, erupciones elevadas rojizas y lesiones de livedo o necrosis. La livedo son manchas que se producen por una alteración de la circulación de la sangre en la piel, mientras la necrosis es la muerte prematura de tejidos. Estos signos de COVID-19 se asocian con diferentes grados de gravedad de la enfermedad: las lesiones que parecen sabañones aparecen en las formas menos graves y la livedo o necrosis en los más graves. Los autores han señalado que algunas de las manifestaciones de la COVID-19 en la piel pueden aparecer de forma frecuente por otras causas, especialmente las ronchas y las erupciones. Por eso es posible que no sean muy útiles para el diagnóstico.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Dermatopatias/virologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Dermatopatias/diagnóstico
6.
Hautarzt ; 71(9): 677-685, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32710130

RESUMO

BACKGROUND: In recent years, many medical specialties with a visual focus have been revolutionized by image analysis algorithms using artificial intelligence (AI). As dermatology belongs to this field, it has the potential to play a pioneering role in the use of AI. OBJECTIVE: The current use of AI for the diagnosis and follow-up of dermatoses is reviewed and the future potential of these technologies is discussed. MATERIALS AND METHODS: This article is based on a selective review of the literature using Embase and MEDLINE and the keywords "psoriasis", "eczema", "dermatoses" and "acne" combined with "artificial intelligence", "machine learning", "deep learning", "neural network", "computer-guided", "supervised machine learning" or "unsupervised machine learning" were searched. RESULTS: In comparison to examiner-dependent intra- and interindividually fluctuating scores for the assessment of inflammatory dermatoses (e.g. the Psoriasis Areas Severity Index [PASI] and body surface area [BSA]), AI-based algorithms can potentially offer reproducible, standardized evaluations of these scores. Whereas promising algorithms have already been developed for the diagnosis of psoriasis, there is currently only scarce work on the use of AI in the context of eczema. CONCLUSIONS: The latest developments in this field show the enormous potential of AI-based diagnostics and follow-up of dermatological clinical pictures by means of an autonomous computer-based image analysis. These noninvasive, optical examination methods provide valuable additional information, but dermatological interaction remains indispensable in daily clinical practice.


Assuntos
Inteligência Artificial , Redes Neurais de Computação , Dermatopatias/diagnóstico , Dermatopatias/terapia , Aprendizado Profundo , Humanos , Aprendizado de Máquina
7.
PLoS One ; 15(7): e0235410, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32726308

RESUMO

Patient satisfaction is an important indicator of health care quality, and it remains an important goal for optimal treatment outcomes to reduce the level of misdiagnoses and inappropriate or absent therapeutic actions. Digital support tools for differential diagnosis to assist clinicians in reaching the correct diagnosis may be helpful, but how the use of these affect patients is not clear. The primary objective of this feasibility study was to investigate patient experience and satisfaction in a primary care setting where general practitioners (GPs) used a visual clinical decision support system (CDSS) compared with standard consultations. Secondary objectives were diagnostic accuracy and length of consultation. Thirty-one patients with a dermatologist-confirmed skin diagnosis were allocated to consult GPs that had been randomized to conduct either standard consultations (SDR, n = 21) or CDSS (n = 16) on two separate study days one week apart. All patients were diagnosed independently by multiple GPs (n = 3-8) in both the SDR and CDSS study arms. Using the CDSS, more patients felt involved in the decision making (P = 0.05). In addition, more patients were exposed to images during the consultations (P = 6.8e-27), and 83% of those that were shown images replied they felt better supported in the consultation. The use of CDSS significantly improved the diagnostic accuracy (34%, P = 0.007), and did not increase the duration of the consultation (median 10 minutes in both arms). This study shows for the first time that compared with standard GP consultations, CDSS assist the GP on skin related diagnoses and improve patient satisfaction and diagnostic accuracy without impacting the duration of the consultations. This is likely to increase correct treatment choices, patient adherence, and overall result in better healthcare outcomes.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Sistemas Especialistas , Satisfação do Paciente , Dermatopatias/diagnóstico , Adulto , Erros de Diagnóstico/prevenção & controle , Estudos de Viabilidade , Feminino , Clínicos Gerais , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Encaminhamento e Consulta , Dermatopatias/epidemiologia , Dermatopatias/patologia
9.
J Am Acad Dermatol ; 83(4): 1118-1129, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32622888

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) has associated cutaneous manifestations. OBJECTIVE: To characterize the diversity of cutaneous manifestations of COVID-19 and facilitate understanding of the underlying pathophysiology. METHODS: Case series from an international registry from the American Academy of Dermatology and International League of Dermatological Societies. RESULTS: The registry collected 716 cases of new-onset dermatologic symptoms in patients with confirmed/suspected COVID-19. Of the 171 patients in the registry with laboratory-confirmed COVID-19, the most common morphologies were morbilliform (22%), pernio-like (18%), urticarial (16%), macular erythema (13%), vesicular (11%), papulosquamous (9.9%), and retiform purpura (6.4%). Pernio-like lesions were common in patients with mild disease, whereas retiform purpura presented exclusively in ill, hospitalized patients. LIMITATIONS: We cannot estimate incidence or prevalence. Confirmation bias is possible. CONCLUSIONS: This study highlights the array of cutaneous manifestations associated with COVID-19. Many morphologies were nonspecific, whereas others may provide insight into potential immune or inflammatory pathways in COVID-19 pathophysiology.


Assuntos
Betacoronavirus/imunologia , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Sistema de Registros/estatística & dados numéricos , Dermatopatias/imunologia , Adolescente , Adulto , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/virologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/imunologia , Pneumonia Viral/virologia , Índice de Gravidade de Doença , Dermatopatias/diagnóstico , Dermatopatias/epidemiologia , Dermatopatias/virologia , Adulto Jovem
12.
Br J Dermatol ; 183(3): 431-442, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32479680

RESUMO

BACKGROUND: The infection caused by the recently identified SARS-CoV-2, called coronavirus disease-19 (COVID-19), has rapidly spread throughout the world. With the exponential increase of patients worldwide, the clinical spectrum of COVID-19 is being better defined and new symptoms are emerging. Numerous reports are documenting the occurrence of different cutaneous manifestations in patients with COVID-19. OBJECTIVES: To provide a brief overview of cutaneous lesions associated with COVID-19. METHODS: A literature search was performed in the PubMed, Scopus and Web of Science databases up to 30 April 2020. This narrative review summarizes the available data regarding the clinical and histological features of COVID-19-associated skin manifestations. RESULTS: The literature reports showed a great heterogeneity in COVID-19-associated cutaneous manifestations, as well as in their latency periods and associated extracutaneous symptoms. Pathogenic mechanisms are unknown, although the roles of a hyperactive immune response, complement activation and microvascular injury have been hypothesized. Based on our experience and the literature data, we subdivided the reported cutaneous lesions into six main clinical patterns: (i) urticarial rash; (ii) confluent erythematous-maculopapular-morbilliform rash; (iii) papulovesicular exanthem; (iv) chilblain-like acral pattern; (v) livedo reticularis-livedo racemosa-like pattern; and (vi) purpuric 'vasculitic' pattern. These six patterns can be merged into two main groups: the first - inflammatory and exanthematous - includes the first three groups listed above, and the second includes the vasculopathic and vasculitic lesions of the last three groups. CONCLUSIONS: The possible presence of cutaneous findings leading to suspect COVID-19 puts dermatologists in a relevant position. Further studies are needed to delineate the diagnostic and prognostic values of such cutaneous manifestations.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Dermatopatias/diagnóstico , Betacoronavirus/imunologia , Betacoronavirus/patogenicidade , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Diagnóstico Diferencial , Humanos , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Prognóstico , Pele/irrigação sanguínea , Pele/imunologia , Pele/patologia , Dermatopatias/epidemiologia , Dermatopatias/etiologia , Dermatopatias/patologia
15.
J Am Acad Dermatol ; 83(3): 870-875, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32502585

RESUMO

BACKGROUND: During the coronavirus disease 2019 pandemic, several acral chilblain-like lesions were observed in young patients with suspected, but mostly unconfirmed, infection with severe acute respiratory syndrome coronavirus 2. The histopathologic aspect of these lesions is as yet poorly known. OBJECTIVE: To investigate the pathologic features of chilblain-like lesions. METHODS: Biopsies were obtained from 17 cases of chilblain-like lesions during the coronavirus disease 2019 pandemic in France and were studied by routine histologic examination, immunohistochemistry, and direct immunofluorescence. The patients had suspected but unconfirmed infection with severe acute respiratory syndrome coronavirus 2 (negative nasopharyngeal polymerase chain reaction and serologic test results). RESULTS: Chilblain-like lesions showed many features in common with those reported in idiopathic and autoimmune-related chilblains, including epidermal necrotic keratinocytes, dermal edema, perivascular and perieccrine sweat gland lymphocytic (predominantly CD3/CD4+) inflammation, and frequent vascular changes (endothelialitis, microthromboses, fibrin deposition, and immunoreactant deposits on vessels). CONCLUSIONS: Chilblain-like lesions show histopathologic features similar to those of idiopathic and autoimmune-related chilblains, with a high rate of vascular changes and direct immunofluorescence positivity. The role of severe acute respiratory syndrome coronavirus 2 in the development of these puzzling lesions remains to be elucidated.


Assuntos
Betacoronavirus/isolamento & purificação , Pérnio/diagnóstico , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Dermatopatias/diagnóstico , Pele/patologia , Adolescente , Adulto , Betacoronavirus/imunologia , Biópsia , Pérnio/imunologia , Pérnio/patologia , Pérnio/virologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/virologia , Diagnóstico Diferencial , Feminino , Imunofluorescência , França , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/imunologia , Pneumonia Viral/virologia , Pele/imunologia , Pele/virologia , Dermatopatias/imunologia , Dermatopatias/patologia , Dermatopatias/virologia , Dedos do Pé , Adulto Jovem
16.
J Am Acad Dermatol ; 83(3): 958-959, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32531304
19.
J Am Acad Dermatol ; 83(2): 486-492, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32479979

RESUMO

BACKGROUND: Increasing evidence suggests pernio-like lesions are cutaneous manifestations of coronavirus infectious disease 2019 (COVID-19). OBJECTIVE: To describe clinical and pathologic findings of pernio-like lesions in patients with confirmed or suspected COVID-19. METHODS: An international dermatology registry was circulated to health care providers worldwide through the American Academy of Dermatology, International League of Dermatologic Societies, and other organizations. RESULTS: We documented 505 patients with dermatologic manifestations associated with COVID-19, including 318 (63%) with pernio-like lesions. Patients with pernio-like lesions were generally young and healthy, with relatively mild COVID-19. Of 318 patients with confirmed or suspected COVID-19 by providers, 23 (7%) were laboratory-confirmed COVID-19 positive, and 20 others (6%) were close contacts of patients with confirmed COVID-19. Given current testing criteria, many patients lacked COVID-19 testing access. For 55% of patients, pernio-like lesions were their only symptom. In patients with other COVID-19 symptoms, pernio-like lesions typically appeared after other symptoms. Pernio-like lesions lasted a median of 14 days (interquartile range, 10-21 days). LIMITATIONS: A case series cannot estimate population-level incidence or prevalence. In addition, there may be confirmation bias in reporting. We cannot exclude an epiphenomenon. CONCLUSIONS: Pernio-like skin changes of the feet and hands, without another explanation, may suggest COVID-19 infection and should prompt confirmatory testing.


Assuntos
Betacoronavirus/isolamento & purificação , Pérnio/virologia , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Dermatopatias/virologia , Adolescente , Adulto , Viés , Pérnio/diagnóstico , Pérnio/epidemiologia , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Feminino , , Mãos , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Sistema de Registros/estatística & dados numéricos , Índice de Gravidade de Doença , Dermatopatias/diagnóstico , Dermatopatias/epidemiologia , Fatores de Tempo , Adulto Jovem
20.
J Cosmet Dermatol ; 19(8): 1826-1827, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32502318

RESUMO

The rapidly increasing number of COVID-19-infected patients and evidence of human-to-human transmission even within the asymptomatic incubation period prompted the attention of the entire world. The field of dermatology and procedural dermatology is not exempt from this global issue. We cannot deny the fact that this situation will have a lasting impact on the health-seeking behaviors of our patients. It is necessary for dermatologists and dermatologic surgeons to be aware of the potential risks and precautions when re-emerging their practices after COVID-19.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/prevenção & controle , Dermatologia/tendências , Controle de Infecções/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Dermatopatias/terapia , Telemedicina/tendências , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Técnicas Cosméticas/economia , Técnicas Cosméticas/normas , Técnicas Cosméticas/tendências , Dermatologia/economia , Dermatologia/organização & administração , Dermatologia/normas , Diagnóstico Diferencial , Humanos , Controle de Infecções/economia , Controle de Infecções/organização & administração , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Dermatopatias/diagnóstico , Dermatopatias/economia , Dermatopatias/virologia , Telemedicina/economia , Telemedicina/organização & administração , Telemedicina/normas
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA