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1.
An Bras Dermatol ; 94(6): 751-753, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31789263

RESUMO

Lobular capillary hemangioma or pyogenic granuloma is a benign vascular tumor of the skin or mucous membranes. Most patients present a single lesion. It manifests clinically as an erythematous, friable, and fast-growing tumor. This report details a case with exuberant presentation in a patient with ankylosing spondylitis, using adalimumab. Factors triggering pyogenic granuloma are not well known. They may spontaneously regress, but most require treatment.


Assuntos
Adalimumab/uso terapêutico , Antirreumáticos/uso terapêutico , Granuloma Piogênico/patologia , Dermatopatias/patologia , Espondilite Anquilosante/tratamento farmacológico , Granuloma Piogênico/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Dermatopatias/etiologia , Espondilite Anquilosante/complicações , Fator de Necrose Tumoral alfa/antagonistas & inibidores
2.
Medicine (Baltimore) ; 98(52): e18509, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876739

RESUMO

To evaluate progression of skin atrophy during 8 years of complete Conus-Cauda Syndrome and its recovery after 2 years of surface Functional Electrical Stimulation a cohort study was organized and implemented.Functional assessments, tissue biopsies, and follow-up were performed at the Wilhelminenspital, Vienna, Austria; skin histology and immunohistochemistry at the University of Padova, Italy on 13 spinal cord injury persons suffering up to 10 years of complete conus/cauda syndrome. Skin biopsies (n. 52) of both legs were analyzed before and after 2 years of home-based Functional Electrical Stimulation delivered by large anatomically shaped surface electrodes placed on the skin of the anterior thigh. Using quantitative histology we analyzed: 1. Epidermis atrophy by thickness and by area; 2. Skin flattening by computing papillae per mm and Interdigitation Index of dermal-epidermal junctions; 3. Presence of Langerhans cells.Linear regression analyses show that epidermal atrophy and flattening worsen with increasing years post- spinal cord injury and that 2 years of skin electrostimulation by large anatomically shaped electrodes reverses skin changes (pre-functional Electrical Stimulation vs post-functional Electrical Stimulation: thickness 39%, P < .0001; area 41%, P < .0001; papillae n/mm 35%, P < 0.0014; Interdigitation index 11%, P < 0.018), producing a significant recovery to almost normal levels of epidermis thickness and of dermal papillae, with minor changes of Langerhans cells, despite 2 additional years of complete Conus-Cauda Syndrome.In complete Conus-Cauda Syndrome patients, the well documented beneficial effects of 2 years of surface h-b Functional Electrical Stimulation on strength, bulk, and muscle fiber size of thigh muscles are extended to skin, suggesting that electrical stimulation by anatomically shaped electrodes fixed to the skin is also clinically relevant to counteract atrophy and flattening of the stimulated skin. Mechanisms, pros and cons are discussed.


Assuntos
Terapia por Estimulação Elétrica/métodos , Epiderme/patologia , Dermatopatias/terapia , Traumatismos da Medula Espinal/complicações , Medula Espinal , Adulto , Atrofia , Biópsia , Humanos , Pessoa de Meia-Idade , Pele/patologia , Dermatopatias/etiologia , Dermatopatias/patologia , Traumatismos da Medula Espinal/patologia , Síndrome , Coxa da Perna , Adulto Jovem
3.
Rev Med Suisse ; 15(672): 2125-2130, 2019 Nov 20.
Artigo em Francês | MEDLINE | ID: mdl-31746568

RESUMO

In elderly or chronically ill patients, nutritional deficiencies are common and the presence of related skin lesions is not unusual. Recognition of such cutaneous involvement is important regarding the diagnosis essentially based on clinical elements. By using some clinical case reports, we will describe several pathologies related to nutritional deficiencies like scurvy, pellagra and acquired acrodermatitis enteropathica.


Assuntos
Desnutrição/complicações , Desnutrição/patologia , Dermatopatias/etiologia , Dermatopatias/patologia , Acrodermatite/etiologia , Acrodermatite/patologia , Doença Crônica , Humanos , Pelagra/etiologia , Pelagra/patologia , Escorbuto/etiologia , Escorbuto/patologia , Dermatopatias/diagnóstico
4.
Medicine (Baltimore) ; 98(43): e17607, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651869

RESUMO

BACKGROUND: This study aims to provide the best possible evidence-based information on the efficacy and safety of sifalimumab for treatment of skin injury (SI) caused by systemic lupus erythematosus (SLE). METHODS: In this study, electronic databases of MEDLINE, EMBASE, Cochrane Library, PsycINFO, CINAHL Plus, Global Health, WHO Global Index Medicus, Virtual Health Library, Social Care Online, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure will be searched comprehensively from inceptions to June 30, 2019 without language restrictions. We will include randomized controlled trials (RCTs) on evaluating the efficacy and safety of sifalimumab for SI caused by SLE. Two investigators will conduct study selection, data extraction, and risk of bias assessment independently. We will use RevMan 5.3 Software to perform statistical analysis. RESULTS: This study will lie in the exhaustive and systematic nature of the literature search and its methods for evaluating quality and analyzing RCTs data. Considering the controversial efficacy of the treatment for sifalimumab, this study is responsible for improving the existing evidence on the efficacy and safety of sifalimumab for SI caused by SLE. CONCLUSION: The results of this study will provide latest evidence for judging whether sifalimumab is an effective intervention for patients with SI caused by SLE or not. STUDY REGISTRATION: CRD42019148225.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Fármacos Dermatológicos/uso terapêutico , Lúpus Eritematoso Sistêmico/complicações , Dermatopatias/tratamento farmacológico , Pele/lesões , Anticorpos Monoclonais Humanizados , Humanos , Projetos de Pesquisa , Dermatopatias/etiologia , Revisão Sistemática como Assunto , Resultado do Tratamento
5.
Br J Nurs ; 28(16): S24-S32, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31518526

RESUMO

This clinical study focuses on peristomal skin complications (PSCs). For many patients, the causative factor behind peristomal moisture-associated skin damage was contact dermatitis caused by effluent leakage, resulting in sore and excoriated skin. PSCs are costly to the patient in relation to pain, time and worry and also impact nursing activity levels and healthcare costs. The study identifies the number of patients presenting with PSC, the causative factors and their resolution using medical grade Manuka honey flanges.


Assuntos
Governança Clínica , Complicações Pós-Operatórias/prevenção & controle , Dermatopatias/prevenção & controle , Estomas Cirúrgicos/efeitos adversos , Humanos , Complicações Pós-Operatórias/etiologia , Medição de Risco , Dermatopatias/etiologia , Reino Unido
6.
Artigo em Inglês | MEDLINE | ID: mdl-31484409

RESUMO

Increased exposure times to various health risk factors and the vulnerability of building users might result in significantly higher prevalence rates of sick building syndrome (SBS) in a hospital setting compared to other indoor environments. The purpose of our study was to assess the association between SBS symptoms and measured environmental parameters at a Slovenian general hospital. A combination of a self-assessment study and field measurements was conducted in order to estimate the health risk factors for SBS symptoms among the users of a Slovenian general hospital. The Chi-square test was used to analyse the association between observed health and environmental parameters. The response rate was 67.5%. A total of 12.0% of healthcare workers at hospital wards reported at least six SBS symptoms, 19.0% reported 2-3 SBS symptoms. At the observed hospital wards, the most deviations were recorded for the level of lighting (83.3%), noise level (73.6%), and room temperature (55.3%). A statistically significant association was found between indoor environmental quality and skin-related SBS symptoms (χ2 = 0.009; p = 0.006). This information will be of great value in defining an integral strategy of environmental health activities aimed at healthier indoor environmental quality in hospitals.


Assuntos
Hospitais Gerais , Síndrome do Edifício Doente/etiologia , Adulto , Estudos Transversais , Feminino , Pessoal de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Síndrome do Edifício Doente/epidemiologia , Dermatopatias/epidemiologia , Dermatopatias/etiologia , Eslovênia/epidemiologia
7.
Wilderness Environ Med ; 30(3): 310-320, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31477508

RESUMO

This case report describes the typical features of the dermatological progression of a patient stung by a (probable) box jellyfish. The purpose is to guide clinicians and patients to an understanding of what to expect after such a sting using the clinical narrative and unique sequential photographs of the injury. With knowledgeable consultation from experienced physicians and meticulous care, this envenomation healed without the need for skin grafting.


Assuntos
Mordeduras e Picadas/complicações , Mordeduras e Picadas/tratamento farmacológico , Cubomedusas , Dermatopatias/terapia , Pele/patologia , Adulto , Animais , Mordeduras e Picadas/terapia , Camboja , Humanos , Pele/fisiopatologia , Dermatopatias/tratamento farmacológico , Dermatopatias/etiologia , Resultado do Tratamento , Adulto Jovem
8.
Int J Mol Sci ; 20(16)2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31398812

RESUMO

Recent scientific research has shown the use of chlorin, phthalocyanines, and porphyrins derivatives as photosensitizers in photodynamic therapy in the treatment of various pathologies, including some of the major skin diseases. Thus, the main goal of this critical review is to catalog the papers that used these photosensitizers in the treatment of acne vulgaris, psoriasis, papillomavirus infections, cutaneous leishmaniasis, and skin rejuvenation, and to explore the photodynamic therapy mechanisms against these conditions alongside their clinical benefits.


Assuntos
Indóis/uso terapêutico , Fotoquimioterapia , Fármacos Fotossensibilizantes/uso terapêutico , Porfirinas/uso terapêutico , Dermatopatias/tratamento farmacológico , Pele/efeitos dos fármacos , Animais , Humanos , Indóis/farmacologia , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/farmacologia , Porfirinas/farmacologia , Pele/patologia , Dermatopatias/diagnóstico , Dermatopatias/etiologia , Resultado do Tratamento
9.
Tumori ; 105(6): NP57-NP62, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31456503

RESUMO

INTRODUCTION: Immunotherapy has shown efficacy in the treatment of different malignancies. Nivolumab, an immune checkpoint inhibitor directed against programmed death-1, has been approved for non-small cell lung cancer (NSCLC) in pretreated patients. Although it is generally well-tolerated, immunotherapy may be complicated by a wide range of immune-mediated adverse events. We describe the case of an uncommon skin toxicity arising as alopecia universalis induced by nivolumab in a patient with NSCLC. CASE DESCRIPTION: A 58-year-old man received nivolumab for metastatic NSCLC after progression to 3 lines of chemotherapy. The treatment was prescribed in June 2016, and induced a rapid and significant disease response. Nivolumab was well-tolerated until May 2017, when partial alopecia at hair and eyelashes appeared. In the next months, alopecia became complete and extended to the whole body surface. The dermatologic picture was compatible with alopecia areata. A topical steroid therapy was attempted, without benefit. The patient refused systemic treatments and is still undergoing nivolumab without new toxicities and with persistent disease response. CONCLUSIONS: This case suggests that alopecia areata may be a rare immune-related adverse event of immune checkpoint agents. Its late onset in our patient is uncommon and unexpected, underlining that the risk of nivolumab-induced toxicity is not limited to the beginning of treatment. Despite its rarity, alopecia areata should be considered in the range of adverse events potentially induced by immune checkpoint inhibitors even in the long term. Potential association between toxicity and efficacy of immunotherapy in NSCLC warrants further investigation.


Assuntos
Antineoplásicos Imunológicos/efeitos adversos , Carcinoma Pulmonar de Células não Pequenas/complicações , Neoplasias Pulmonares/complicações , Nivolumabe/efeitos adversos , Dermatopatias/diagnóstico , Dermatopatias/etiologia , Antineoplásicos Imunológicos/uso terapêutico , Biópsia , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Humanos , Imuno-Histoquímica , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Terapia de Alvo Molecular/efeitos adversos , Terapia de Alvo Molecular/métodos , Nivolumabe/uso terapêutico , Dermatopatias/tratamento farmacológico , Esteroides/uso terapêutico , Tomografia Computadorizada por Raios X , Resultado do Tratamento
10.
Ther Umsch ; 76(2): 71-75, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31429391

RESUMO

Skin changes as a characteristic of internal diseases Abstract. Numerous skin changes are of great importance, as they can be groundbreaking for basic internal diseases or indicate associated complications or side effects of therapies. The early detection of such marker manifestations allows immediate action to prevent potentially serious consequences. For example, specific skin changes in limited forms of collagenosis may not only be diagnostically significant, but also prognostically significant, which allows gentler therapies if the course of the disease is more favourable. The most important prerequisite for a correct diagnosis of cutaneous lesions is a careful and complete skin status with additional consideration of the adjacent mucous membranes and skin appendages. In a first step, the primary anatomical site, morphology and lesion location should be identified and then the distribution assessed. This article describes more frequent skin manifestations in diseases of different organ systems (with the exception of infections, less frequent metabolic disorders and drug side effects).


Assuntos
Dermatopatias , Pele , Diagnóstico Diferencial , Humanos , Pele/patologia , Dermatopatias/diagnóstico , Dermatopatias/etiologia
11.
Eur Arch Otorhinolaryngol ; 276(11): 3067-3072, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31451899

RESUMO

PURPOSE: To investigate skin-related postoperative outcomes following a tissue preservation technique in percutaneous hydroxyapatite-coated bone-anchored hearing aid (BAHA) abutment implantation. METHODS: A retrospective medical records review of adult patients, who underwent single-stage BAHA implantation between July 2013 and November 2017 at a tertiary centre was conducted. Surgical procedures were performed by a single surgeon using a linear incision soft tissue preservation technique. Patients were reviewed at 1 week, 4 weeks, 3 months, 6 months, and annually postoperatively and soft tissue reactions were graded using Holger's score RESULTS: There were 102 patients included with a slight female preponderance (female:male 56:46). There were 586 follow-up episodes during the study period. From the recorded follow-up episodes, Holger's scores were documented as follows: Holger score 0 (89%); 1 (7%); 2 (2%); 3 (1.9%). Three patients (3%) required peri-abutment soft tissue excision (Holger 3) and insertion of longer abutments. One patient (1%) reported atraumatic implant loss. The BAHA was re-implanted in two patients (2%) due to traumatic dislodgement. There was a statistically significant association (p = 0.009) when the mean time to minor skin complications was compared with mean time to a significant skin reaction. CONCLUSION: Tissue preservation technique is the procedure of choice for BAHA abutment implant surgery. It confers excellent soft tissue outcomes and an excellent implant survival rate.


Assuntos
Durapatita/uso terapêutico , Auxiliares de Audição , Complicações Pós-Operatórias/prevenção & controle , Implantação de Prótese , Dermatopatias , Pele , Materiais Biocompatíveis/uso terapêutico , Prótese Ancorada no Osso , Materiais Revestidos Biocompatíveis/uso terapêutico , Feminino , Perda Auditiva/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão/efeitos adversos , Tratamentos com Preservação do Órgão/métodos , Osseointegração , Implantação de Prótese/efeitos adversos , Implantação de Prótese/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Dermatopatias/etiologia , Dermatopatias/prevenção & controle
12.
Life Sci ; 233: 116714, 2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31376370

RESUMO

Increased levels of particulate matter (PM) air pollutants in East Asia have resulted in detrimental health impacts increasing morbidity and mortality. Epidemiological studies suggest a possible relation between the cutaneous exposure of PM and increased oxidative stress and inflammation which lead to skin lesions. The present study utilizes an integrated cell culture model of keratinocytes and fibroblasts to mimic viable skin layers and investigate the possible effects of PM exposure after penetration through corneocytes. The skin perfection is upheld by homeostatic functionality of epidermal cells and the integrity of connective tissues. Exposure to xenobiotics could alter the skin cell homeostasis aggravating premature skin aging. Stimulation of HaCaT keratinocytes by PM collected from Beijing, China (CPM) increased the intracellular ROS levels triggering a cascade of events aggravating inflammatory responses and connective tissue degradation. In HDF fibroblasts, treatment with preconditioned keratinocyte culture media augmented inflammatory responses, cellular differentiation, and connective tissue degradation. Above events were marked by the increased intracellular ROS, inflammatory mediators, pro-inflammatory cytokines, matrix metalloproteinases (MMP)-1 and -2 levels, collagenase, and elastase activity. Fucosterol treatment of keratinocytes dose-dependently attenuated the detrimental effects both in keratinocytes and fibroblasts restoring the conditions near to physiological levels. Further evaluations could be advanced on developing fucosterol, in forms such as rejuvenating cosmeceuticals which could attenuate detrimental responses of CPM exposure.


Assuntos
Fibroblastos/efeitos dos fármacos , Inflamação/tratamento farmacológico , Queratinócitos/efeitos dos fármacos , Material Particulado/efeitos adversos , Dermatopatias/tratamento farmacológico , Pele/efeitos dos fármacos , Estigmasterol/análogos & derivados , Poluentes Atmosféricos/efeitos adversos , Células Cultivadas , Técnicas de Cocultura , Citocinas/metabolismo , Fibroblastos/metabolismo , Fibroblastos/patologia , Humanos , Inflamação/etiologia , Inflamação/metabolismo , Inflamação/patologia , Queratinócitos/metabolismo , Queratinócitos/patologia , NF-kappa B/metabolismo , Estresse Oxidativo , Espécies Reativas de Oxigênio/metabolismo , Pele/patologia , Dermatopatias/etiologia , Dermatopatias/metabolismo , Dermatopatias/patologia , Estigmasterol/farmacologia
13.
An Bras Dermatol ; 94(3): 361-362, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31365671

RESUMO

Perinevic dermatosis neglecta is an underestimated skin condition usually affecting children and adolescents, characterized by the appearance of dirt-like brownish pigmentation around a preexisting nevus and often a matter of concern for parents. We describe the clinical and dermoscopic findings in a case of perinaevic dermatosis neglecta and discuss the possible etiology of this phenomenon.


Assuntos
Melanoma/diagnóstico , Dermatopatias/diagnóstico , Anti-Infecciosos Locais/uso terapêutico , Criança , Dermoscopia , Diagnóstico Diferencial , Etanol/uso terapêutico , Humanos , Hiperpigmentação/complicações , Masculino , Nevo Pigmentado/complicações , Dermatopatias/tratamento farmacológico , Dermatopatias/etiologia
14.
Vet Dermatol ; 30(5): 403-e122, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31297888

RESUMO

BACKGROUND: Ischaemic dermatopathy encompasses a poorly understood subset of canine diseases that share similar clinical and histological features. Very little information is currently available regarding population characteristics, progression and outcome. HYPOTHESIS/OBJECTIVES: This study aimed to describe the clinical features and therapeutic outcomes of ischaemia dermatopathy, excluding familial dermatomyositis, using cases diagnosed by histopathological analysis. ANIMALS: One hundred and seventy-seven cases submitted for histopathological analysis between 2005 and 2016 met inclusion criteria, of which 93 had complete medical records available. METHODS AND MATERIALS: Both records and pointed surveys were used to retrieve information. Scoring systems were created to subjectively evaluate clinical outcomes and likelihood of a vaccine association. RESULTS: Of 177 cases, toy and miniature poodles, Chihuahuas, Maltese, Yorkshire terriers and Jack Russell terriers were significantly over-represented (P < 0.001). Of the 93 cases for which historical data were obtained, median age at skin biopsy was five years (0.42-13 years) and median body weight was 7.3 kg (range 1.32-50.3 kg). The condition in 45 dogs (48.3%) was found likely to be associated with vaccination. Younger ages (P = 0.011) and higher body weights (P = 0.003) were positively correlated with greater likelihood of vaccination. Body weight <10 kg (P = 0.0045) and older ages (P = 0.0048) were significantly associated with worse outcomes. CONCLUSIONS AND CLINICAL IMPORTANCE: This study provides support for breed predispositions and identifies potential prognostic factors. Importantly, over half of the cases were considered unlikely to be vaccine-associated, demonstrating the need to investigate other underlying causes of this condition.


Assuntos
Doenças do Cão/patologia , Isquemia/veterinária , Dermatopatias/veterinária , Envelhecimento , Animais , Peso Corporal , Cães , Isquemia/patologia , Dermatopatias/etiologia , Dermatopatias/patologia , Vacinação/efeitos adversos
15.
Vet Dermatol ; 30(5): 442-e137, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31342594

RESUMO

BACKGROUND: Solar-induced thermal burns of dark skin over the dorsum have been reported in dogs, sheep and a pig. OBJECTIVES: This report describes an outbreak of solar-induced thermal burns over the dorsal skin of criollo and Texel sheep in Uruguay. ANIMALS AND METHODS: Cross-bred criollo and pure-bred Texel adult ewes from a flock of 80 animals presented with severe skin lesions. Eight animals were evaluated clinically and skin biopsy specimens were collected from three ewes for histopathology. Epidemiological data were collected. RESULTS: Black/brown criollo sheep presented with extensive, wide, linear dorsal skin necrosis extending from the interscapular to the lumbosacral area. Necrotic skin was firm, dry and largely detached from the underlying subcutis. Nonpigmented Texel sheep showed milder lesions with rapid re-epithelialization and healing. Histological features were consistent with third-degree burns, characterized by full-thickness coagulative necrosis of epidermis and dermis, including blood vessels and adnexa. The cumulative incidence of the disease was 21% during the 30 days post-shearing, affecting 50% of criollo and 7.4% of Texel sheep (P < 0.001). CONCLUSIONS: The findings are consistent with post-shearing, sun-induced thermal burns leading to dorsal skin necrosis. Risk factors include sunlight exposure during hot months after shearing, dark skin and obesity.


Assuntos
Necrose/veterinária , Doenças dos Ovinos/etiologia , Dermatopatias/veterinária , Queimadura Solar/veterinária , Luz Solar/efeitos adversos , Animais , Necrose/epidemiologia , Necrose/etiologia , Ovinos , Doenças dos Ovinos/patologia , Dermatopatias/epidemiologia , Dermatopatias/etiologia , Queimadura Solar/epidemiologia , Queimadura Solar/patologia , Uruguai , Cicatrização
16.
Clin Dermatol ; 37(4): 296-305, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31345316

RESUMO

The skin represents the first bearer of marks of time as well as an easily accessible model for the assessment and determination of the involved molecular mechanisms. The deterioration of important skin functions due to intrinsic and extrinsic aging leads to clinical manifestations, which mirror several internal age-associated diseases, such as neurodegenerative, cardiovascular, skeletal, and endocrine/metabolic skin diseases. Current molecular data indicate that skin aging, especially intrinsic aging, mirrors age-related deficiencies in the entire human body. These data and the development of new biologic technologies highlight the importance of the skin in aging research and should enable future interdisciplinary projects on internal diseases, which could barely have been performed until recently due mainly to the lack of respective tissue.


Assuntos
Envelhecimento da Pele , Fatores Etários , Humanos , Envelhecimento da Pele/genética , Envelhecimento da Pele/fisiologia , Dermatopatias/etiologia
17.
Clin Dermatol ; 37(4): 326-335, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31345320

RESUMO

The world population of adults aged 60 years or more is increasing globally, and this development can impact skin disease morbidity and mortality, as well as being reflected in the health care system organization. There is substantial evidence that the burden from a remarkable number of skin nonmalignant and malignant conditions is greater in the elderly. Dermatologic research and clinical education in dermatology should focus on both challenges and opportunities created by aging. Skin aging due to intrinsic and extrinsic factors can alter significantly epidermal and dermal structure and functions. Dermal aging can be linked to a great number of complications in routine dermatologic conditions, with slow healing as an example of a severe complication in the elderly. This may be attributed to aged dermal fibroblasts modifying the tissue microenvironment via a shift in their soluble factors and extracellular matrix repertoire. This senescence-associated secretory phenotype can explain the particular proclivity of aged skin to develop malignancies.


Assuntos
Envelhecimento da Pele , Dermatopatias/etiologia , Fatores Etários , Fibroblastos , Humanos , Pele/citologia , Envelhecimento da Pele/fisiologia , Cicatrização
18.
Clin Dermatol ; 37(4): 346-350, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31345322

RESUMO

The term "dermatoporosis" was introduced a decade ago to highlight the need to pay attention to the problems posed by premature skin aging beyond esthetic considerations. People with this condition have a thinner skin that becomes fragile, tends to tear, and may lead to deep dissecting hematomas-as a final stage-corresponding to a medical emergency. Various studies have demonstrated a high prevalence of dermatoporosis in the elderly, with women being more exposed than men. We have developed a scoring system for dermatoporosis, providing different strategies to treat and prevent this skin condition, as well as a followup of patients treated at the University Hospital of Geneva.


Assuntos
Dermatopatias , Fatores Etários , Idoso , Senilidade Prematura , Feminino , Humanos , Masculino , Prevalência , Dermatopatias/tratamento farmacológico , Dermatopatias/epidemiologia , Dermatopatias/etiologia
19.
Medicine (Baltimore) ; 98(28): e16372, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305435

RESUMO

BACKGROUND: Acute graft-vs-host disease (aGVHD) is a common complication of allogenic hematopoietic stem-cell transplantation (allo-HSCT) and skin is the most common and often the 1st site at which aGVHD develops. Cutaneous aGVHD is usually treated with oral and/or topical corticosteroids as the 1st-line treatment; however, steroid-refractory aGVHD not only impairs patients' quality of life but also causes significant morbidity and mortality after allo-HSCT. Narrow-band ultraviolet B (NB-UVB) phototherapy has been utilized for a wide range of immunologic inflammatory skin diseases, but there is limited information on the efficacy, safety, and biomarkers for response prediction of NB-UVB for cutaneous aGVHD. AIMS: The purpose of this study is to investigate the efficacy and safety of NB-UVB phototherapy for steroid-refractory cutaneous aGVHD. PATIENTS AND METHODS: A total of 40 subjects aged from 16 to 70 years with steroid-refractory cutaneous aGVHD after allo-HSCT will be included in the trial. Patients with worse than stage 2 intestine/liver aGVHD will be excluded. Eligible patients will undergo NB-UVB phototherapy until resolution or further worsening of rash or occurrence of an unmanageable adverse event. The primary endpoint is the overall response rate. The secondary outcomes include rates for complete response, partial response, stable disease, progressive disease, duration of response, sparing effect on calcineurin inhibitors and/or corticosteroids, safety, and predictive biomarkers for treatment response. ETHICS AND DISSEMINATION: The protocol has been approved by the institutional Clinical Research Review Board of Kyoto Prefectural University of Medicine. Written informed consent will be obtained from all patients before registration, in accordance with the Declaration of Helsinki. Results of the study will be disseminated via publications in peer-reviewed journals. TRIAL REGISTRATION: Trial registration numbers UMIN000032426 and jRCTs052180005.


Assuntos
Ensaios Clínicos Fase II como Assunto , Doença Enxerto-Hospedeiro/terapia , Dermatopatias/terapia , Transplante de Células-Tronco , Terapia Ultravioleta , Doença Aguda , Adolescente , Adulto , Idoso , Anti-Inflamatórios/uso terapêutico , Resistência a Medicamentos , Humanos , Pessoa de Meia-Idade , Retratamento , Dermatopatias/etiologia , Esteroides/uso terapêutico , Transplante Homólogo , Terapia Ultravioleta/efeitos adversos , Terapia Ultravioleta/métodos , Adulto Jovem
20.
Internist (Berl) ; 60(8): 805-813, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31300830

RESUMO

Cutaneous vasculitides present with typical clinical signs depending on the size and distribution of the affected vessels. Since there are no large vessels in the skin, giant cell arteritis and Takayasu's arteritis only rarely lead to cutaneous symptoms. The classical systemic polyarteritis nodosa (PAN) is very rare. More frequent is cutaneous PAN presenting with a typical localized livedo racemosa and palpable subcutaneous nodules. The ANCA-associated vasculitides, which belong to the small vessel vasculitides, usually show systemic involvement and manifest on the skin with a diverse picture. Immune complex vasculitides are characterized by deposition of immunoglobulins on the walls of small vessels. The most common form is IgA vasculitis with the cardinal symptoms of palpable, round or oval and partially branched (retiform) purpura and a clear predilection for the legs. Serum disease is a príme example of systemic immune complex diseases due to large circulating immune complexes. Cryoglobulinemic vasculitis primarily involves small as well as medium sized vessels. Simultaneous involvement of vessels of different sizes is characteristic for vasculitis in systemic lupus erythematosus (SLE), Sjögren's syndrome, rheumatoid arthritis and sarcoidosis. Recurrent macular vasculitis in hypergammaglobulinemia is an episodic macular vasculitis of the small blood vessels. Bacteremic vasculitis of the small vessels (without direct microbial infection of the vessel wall) can typically also affect capillaries of dermal papillae and is usually accompanied by a disseminated intravascular coagulation (DIC). In some cases more than one distinct cutaneous vasculitis can occur in the same patient.


Assuntos
Artrite Reumatoide/patologia , Arterite de Células Gigantes/patologia , Livedo Reticular/patologia , Dermatopatias Vasculares/diagnóstico , Dermatopatias/diagnóstico , Dermatopatias/etiologia , Pele/patologia , Eritema/patologia , Humanos , Púrpura/patologia , Púrpura de Schoenlein-Henoch
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