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1.
Contact Dermatitis ; 82(1): 10-17, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31461531

RESUMO

BACKGROUND: Chronic hand eczema (CHE) is a major burden for patients. Maintenance treatment involves prevention measures limiting detrimental behaviour and aggravating factors. OBJECTIVE: To evaluate the effect of a standardised care program including therapeutic patient education (TPE) on hand care behaviours, clinical severity, quality of life, and work productivity. METHODS: A single-centre study was conducted prospectively. Together with the prescription of a topical steroid, patients participated in individual TPE sessions. Evaluations were performed initially and repeated three months after the therapeutic intervention. They included a structured analysis of hand care behaviours, the assessment of the mTLSS (modified Total Lesion Symptom Score), DLQI (Dermatology Life Quality Index), and WPAI (Work Productivity and Activity Impairment). RESULTS: Seventy-one patients were included (30 men, 42.3%). Three months after completion of the standardised care program, hand care behaviours such as hand washing and rinsing, hand drying, wearing protective gloves, using moisturizing creams, and following specific treatments and recommendations for CHE improved significantly in the 58 patients who completed the study and were associated with a significant improvement in the mTLSS, DLQI, and WPAI scores. CONCLUSIONS: TPE helps patients change their hand care behaviours and adopt skin protection measures, and may improve CHE severity, quality of life, and work productivity.


Assuntos
Corticosteroides/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Eczema/terapia , Dermatoses da Mão/terapia , Higiene das Mãos/métodos , Comportamentos Relacionados com a Saúde , Educação de Pacientes como Assunto/métodos , Administração Cutânea , Adulto , Doença Crônica , Terapia Combinada , Eczema/diagnóstico , Eczema/psicologia , Eficiência , Feminino , Seguimentos , Dermatoses da Mão/diagnóstico , Dermatoses da Mão/psicologia , Indicadores Básicos de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Índice de Gravidade de Doença , Resultado do Tratamento
2.
Rev Fac Cien Med Univ Nac Cordoba ; 76(4): 257-260, 2019 12 11.
Artigo em Espanhol | MEDLINE | ID: mdl-31833751

RESUMO

INTRODUCTION: The Achenbach syndrome was described in the '50s by the German physician Walter Achenbach and corresponds to an entity characterized by the appearance of ecchymosis or purpura and even bruises on the fingers and sometimes on the feet. It courses benignly and is self-limited. METHODS: We present the case of a 60-year-old woman who was diagnosed with this syndrome after performing laboratory tests, antibodies and images without finding alterations in them, with improvement after receiving analgesia and physical means. RESULTS: The Achenbach syndrome continues to be an unknown entity, with few reports in the literature. Up to the year 2 016, 12 case reports had been identified worldwide, concluding that it is a pathology that mainly affects women between the fifth and sixth decade of life. CONCLUSION: Although this nosological entity is benign and its pathophysiology is not entirely clear, it is important that during the initial approach it is consulted for similar episodes in the past and if it is an acute event, look for other alterations such as delay in capillary refill, coldness distal, absence of pulses and thus discarding acute ischemic pathology with diagnostic exams.


Assuntos
Dedos , Dermatoses da Mão/diagnóstico , Hematoma/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Síndrome
3.
Actas dermo-sifiliogr. (Ed. impr.) ; 110(8): 666-672, oct. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-185505

RESUMO

Introducción: La dermatitis de pies es un motivo frecuente de consulta en las Unidades de Alergia Cutánea. Objetivos: Conocer las características demográficas, el diagnóstico y los alérgenos más frecuentemente implicados en los pacientes a los que se les han practicado pruebas epicutáneas. Material y métodos: Estudio observacional transversal en un Servicio de Dermatología con todos los pacientes estudiados con la batería estándar española durante 13 años (2004-2016). Comparamos los resultados de las pruebas epicutáneas y los diagnósticos finales entre los distintos subgrupos de pacientes con eczema de pies. Resultados: Estudiamos un total de 3.265 pacientes; 308 (9,4%) presentaban eczema en los pies, 176 (57,9%) tenían afectación solo en los pies y 132 (42,1%) afectación concomitante en manos y pies. En el subgrupo con afectación exclusiva en los pies se observó un mayor porcentaje de pacientes con pruebas epicutáneas positivas (61,5% solo pies, 53,4% manos y pies). En el subgrupo de afectación concomitante de manos y pies se observó un menor porcentaje de pruebas epicutáneas positivas entre los menores de 18 años (51,3% en menores y 64,4% en mayores). El alérgeno con relevancia presente más frecuente en todos los subgrupos fue el dicromato potásico. La dermatitis de contacto alérgica (49,1%) fue el diagnóstico más frecuente en los pacientes con afectación exclusiva de los pies, mientras que en los pacientes con eczema en manos y pies fue la psoriasis (33,6%) en los adultos y la dermatitis atópica en los menores de 18 años (60,0%). Conclusión: La realización de pruebas epicutáneas es de gran utilidad tanto en los pacientes con eczema de afectación exclusiva de los pies como en aquellos con afectación concomitante de manos y pies


Introduction: Foot eczema is a common complaint encountered by skin allergists. Objective: To study a series of patients with foot eczema who underwent patch testing and describe their demographic profile, diagnoses, and the main allergens involved. Material and methods: Cross-sectional observational study of all patients tested with the standard Spanish patch test series at a dermatology department over a period of 13 years (2004-2016). We studied patch test results and definitive diagnoses by comparing different subgroups of patients with foot eczema. Results: Of the 3,265 patients included in the study, 308 (9.4%) had foot eczema, 176 (57.9%) had foot eczema only and 132 (42.1%) had concomitant foot and hand eczema. Positive patch test results were more common in patients with foot eczema only (positivity rate of 61.5% vs. 53.4% for foot and hand eczema). In the subgroup of patients with concomitant foot and hand involvement, patients aged under 18 years had a lower rate of positive results (51.3% vs. 64.6% for patients >18 years). Potassium dichromate was the most common allergen with current relevance in all subgroups. The main diagnosis in patients with foot involvement only was allergic contact dermatitis (49.1%). In the subgroup of patients with concomitant hand and foot eczema, the main diagnoses were psoriasis in adults (33.6%) and atopic dermatitis in patients aged under 18 years (60.0%). Conclusion: Patch tests are a very useful diagnostic tool for patients with foot eczema with or without concomitant hand involvement


Assuntos
Humanos , Masculino , Feminino , Dermatopatias Eczematosas/diagnóstico , Testes do Emplastro/métodos , Alérgenos , Dermatoses do Pé/diagnóstico , Eczema/diagnóstico , Dermatoses do Pé/etiologia , Dermatoses do Pé/fisiopatologia , Estudos Transversais , Distribuição por Sexo , Distribuição por Idade , Dermatoses da Mão/diagnóstico
4.
Hautarzt ; 70(10): 778-789, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31506756

RESUMO

The head and hands are the two most common locations for allergic contact dermatitis manifestation. In hand eczema, contact with a contact allergen is a frequent (co-)factor in the triggering and maintenance of eczema. For all hand eczemas lasting longer than 3 months, an allergological examination by means of patch testing is recommended. In patients with allergic contact dermatitis of the hands, nickel, MCI/MI, fragrance mix I, cobalt, thiuram mix, Balsam of Peru, chromium and fragrance mix II have been described in a multicenter European study as the most common contact allergens of the standard series. In the information network of dermatological clinics (IVDK) a total of 56,170 patients were patch-tested in the years 2014 to 2018. In all, 16,807 of these patients (29.9%) suffered from hand eczema, of which 7725 (46.0%) had occupational dermatosis (OD) and 6820 (40.6%) had no OD. For the remaining patients this was unknown. The top 30-list of allergens in hand eczema patients without and with OD included 22 common contact allergens, but with different reaction frequency. In hand eczema patients without OD, the following contact allergens also belong to this list: octyl gallate, sorbic acid, tert-butylhydroquinone, propylene glycol, mercury (II) amide chloride, tolubalsam, jasmine absolute, and sandalwood oil. For hand eczema patients with OD, these are instead: tetramethylthiurammonosulfide, tetramethylthiuramdisulfide, 1,3-diphenylguanidine, p­phenylenediamine, p­toluylenediamine, iodopropinylbutylcarbamate, glutaraldehyde, and monoethanolamine. In the case of OD of the hands, early involvement of the responsible statutory accident insurance by initiating the dermatologist procedure ("Hautarztverfahren") is necessary in order to work together towards successful allergen avoidance by means of substitution and optimizing personal protective equiment.


Assuntos
Alérgenos/efeitos adversos , Dermatite Alérgica de Contato/diagnóstico , Eczema/induzido quimicamente , Dermatoses da Mão/induzido quimicamente , Testes do Emplastro/métodos , Dermatite Ocupacional , Eczema/diagnóstico , Dermatoses da Mão/diagnóstico , Humanos
6.
Hautarzt ; 70(10): 790-796, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31515578

RESUMO

The treatment of hand eczema represents a great challenge in the daily clinical practice for dermatologists. There are various forms of local, physical and systemic treatment, such as alitretinoin which is the only registered systemic treatment option for severe chronic hand eczema. In 2017 dupilumab was approved for the treatment of moderate to severe atopic dermatitis and can theoretically also be applied for atopic hand eczema. The first and most important step in treatment is to identify the underlying etiology of the hand eczema with the appropriate diagnostic measures, ranging from skin biopsy to allergy testing including occupational products. An important component of treatment is the basic treatment in the form of consistent and stage-adapted skin care. Treatment of hand eczema should follow a step by step procedure whereby the basic treatment should be maintained and, depending on the etiology and clinical type, should be supplemented by topical, systemic and physical treatment forms, also often used in parallel. Mild to moderate forms of hand eczema are usually treated with the basic treatment, emollients and topical glucocorticoids according to various guidelines. In moderate to severe forms of hand eczema UV phototherapy and systemic treatment should be implemented. This article summarizes the most important treatment modalities based on case reports and series, clinical studies, guidelines and expert recommendations.


Assuntos
Fármacos Dermatológicos/uso terapêutico , Eczema/terapia , Emolientes/uso terapêutico , Dermatoses da Mão/tratamento farmacológico , Terapia Ultravioleta , Alitretinoína/uso terapêutico , Dermatite Atópica/tratamento farmacológico , Dermatite Atópica/prevenção & controle , Dermatite Atópica/terapia , Gerenciamento Clínico , Eczema/diagnóstico , Dermatoses da Mão/diagnóstico , Humanos , Resultado do Tratamento
7.
Hautarzt ; 70(10): 760-765, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31468073

RESUMO

BACKGROUND: Using current diagnostic tools for hand eczema, namely clinical picture and histology, differential diagnoses such as psoriasis palmaris usually cannot be ruled out. OBJECTIVES: Discussion of current diagnostic possibilities for hand eczema; presentation and critical evaluation of proposed biomarkers for molecular diagnostics and outlook how diagnostics in dermatology will change in the near future. MATERIALS AND METHODS: In this article, we discuss basic research and provide a review of the literature. RESULTS: Molecular diagnostics has the potential to substantially improve diagnosis of hand eczema; prerequisites are prospective validation of proposed markers and availability of valid and cost-effective diagnostics. CONCLUSIONS: In the near future, the diagnosis of hand eczema will be complemented by software algorithms and artificial intelligence on the one hand and simple, precise, and economic molecular diagnostic devices on the other.


Assuntos
Dermatologia , Eczema/diagnóstico , Dermatoses da Mão/diagnóstico , Medicina de Precisão , Algoritmos , Inteligência Artificial , Dermatologia/tendências , Humanos , Patologia Molecular , Software
8.
Cutis ; 103(6): 315-317, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31348454

RESUMO

The advent of acrylate-based nail treatments-known as gels, dips, or shellac-has resulted in an uptick in nail-related acrylate allergy. Acrylate dermatitis related to nail services can affect both clients and technicians and can present on the hands, fingers, and wrists, as well as on the face and neck. Nail acrylate allergy occurs from sensitization to acrylate monomers; 2-hydroxyethyl methacrylate (HEMA), 2-hydroxypropyl methacrylate, ethyl cyanoacrylate, and others have been identified as relevant allergens. Patch testing with HEMA and ethyl cyanoacrylate can screen for nail acrylate allergy. Avoidance is key, and we recommend less-permanent, acrylate-free nail polishes as alternatives.


Assuntos
Acrilatos/efeitos adversos , Dermatite Alérgica de Contato/etiologia , Dermatoses da Mão/etiologia , Unhas , Acrilatos/imunologia , Alérgenos/imunologia , Dermatite Alérgica de Contato/diagnóstico , Dermatite Alérgica de Contato/imunologia , Dermatoses da Mão/diagnóstico , Dermatoses da Mão/imunologia , Humanos , Testes do Emplastro
9.
J Dermatol ; 46(10): 911-913, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31342551

RESUMO

A 73-year-old healthy woman noticed black pigmentation on both thumbnails for 6 years. Upon her visit to our clinic, she had pigmented onychomycosis with onycholysis in the distal area. There was no evidence of paronychia. Direct microscopy using Zoomblue™ and histopathological examination showed aggregated blastoconidia. Fontana-Masson staining confirmed fungal melanin production. A combination of morphological features and genetic testing identified the isolates as Candida parapsilosis. Fungal melanonychia due to C. parapsilosis is rare, with only six cases reported since 1979. The minimum inhibitory concentration of the isolates was 0.25 µg/mL for itraconazole, less than 0.03 µg/mL for ravuconazole and 2.0 µg/mL for terbinafine. Both oral terbinafine treatment and itraconazole pulse therapy performed for 6 months were unsuccessful. The disease was ultimately cured with a 3-month treatment of oral fosravuconazole.


Assuntos
Candida parapsilosis/isolamento & purificação , Dermatoses da Mão/tratamento farmacológico , Melanose/tratamento farmacológico , Onicomicose/tratamento farmacológico , Tiazóis/administração & dosagem , Triazóis/administração & dosagem , Administração Oral , Idoso , Antifúngicos/administração & dosagem , Feminino , Dermatoses da Mão/diagnóstico , Dermatoses da Mão/microbiologia , Humanos , Melanose/diagnóstico , Melanose/microbiologia , Onicomicose/diagnóstico , Onicomicose/microbiologia , Pró-Fármacos/administração & dosagem , Resultado do Tratamento
10.
Actas Dermosifiliogr ; 110(8): 666-672, 2019 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31208672

RESUMO

INTRODUCTION: Foot eczema is a common complaint encountered by skin allergists. OBJECTIVE: To study a series of patients with foot eczema who underwent patch testing and describe their demographic profile, diagnoses, and the main allergens involved. MATERIAL AND METHODS: Cross-sectional observational study of all patients tested with the standard Spanish patch test series at a dermatology department over a period of 13 years (2004-2016). We studied patch test results and definitive diagnoses by comparing different subgroups of patients with foot eczema. RESULTS: Of the 3,265 patients included in the study, 308 (9.4%) had foot eczema, 176 (57.9%) had foot eczema only and 132 (42.1%) had concomitant foot and hand eczema. Positive patch test results were more common in patients with foot eczema only (positivity rate of 61.5% vs. 53.4% for foot and hand eczema). In the subgroup of patients with concomitant foot and hand involvement, patients aged under 18 years had a lower rate of positive results (51.3% vs. 64.6% for patients >18 years). Potassium dichromate was the most common allergen with current relevance in all subgroups. The main diagnosis in patients with foot involvement only was allergic contact dermatitis (49.1%). In the subgroup of patients with concomitant hand and foot eczema, the main diagnoses were psoriasis in adults (33.6%) and atopic dermatitis in patients aged under 18 years (60.0%). CONCLUSION: Patch tests are a very useful diagnostic tool for patients with foot eczema with or without concomitant hand involvement.


Assuntos
Dermatite Alérgica de Contato/diagnóstico , Eczema/diagnóstico , Doenças do Pé/diagnóstico , Testes do Emplastro , Psoríase/diagnóstico , Adolescente , Adulto , Fatores Etários , Alérgenos/efeitos adversos , Alérgenos/análise , Corantes/efeitos adversos , Estudos Transversais , Dermatite Alérgica de Contato/epidemiologia , Dermatite Alérgica de Contato/etiologia , Eczema/induzido quimicamente , Eczema/epidemiologia , Feminino , Doenças do Pé/induzido quimicamente , Doenças do Pé/epidemiologia , Dermatoses da Mão/diagnóstico , Dermatoses da Mão/epidemiologia , Humanos , Masculino , Testes do Emplastro/métodos , Dicromato de Potássio/efeitos adversos , Psoríase/epidemiologia , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
11.
Pediatr. aten. prim ; 21(82): 165-167, abr.-jun. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-184591

RESUMO

La dermatitis palmar juvenil de las piscinas es una dermatosis por fricción, típica de la infancia, causada por el roce continuo de la piel húmeda de las palmas de las manos, y ocasionalmente de las plantas de los pies, con las superficies rugosas de las piscinas. Es posible que dicha dermatosis sea relativamente frecuente, aunque existen muy pocos casos descritos en la literatura científi­ca, por lo que, a menudo, es desconocida y, seguramente, está infradiagnosticada


Juvenile palmar dermatitis acquired at swimming pools is a friction dermatosis, typical of childhood, caused by the continuous rubbing of the wet skin of the palms of the hands, and occasionally of the soles of the feet, with the rough surfaces of the pools. It is possible that this dermatosis is relatively frequent but, nevertheless, there are very few cases described in the literature so that it is often unknown and probably underdiagnosed. Therefore, two cases of said entity that affect the same family are reported


Assuntos
Humanos , Feminino , Pré-Escolar , Exantema/etiologia , Dermatoses da Mão/diagnóstico , Dermatite de Contato/diagnóstico , Piscinas , Fatores de Risco
14.
Mycoses ; 62(8): 659-664, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31062415

RESUMO

Because of their similar clinical presentation, discrimination between nail psoriasis and onychomycosis often is difficult. We aim to investigate the actual frequency of onychomycosis in psoriatic patients and to compare it between psoriatic and non-psoriatic patients. This retrospective study included a total of 9281 patients, referring to our Mycology Laboratory from September 2003 to May 2018. The patients are divided into two groups: PsoGroup (patients with psoriasis) and non-PsoGroup (non-psoriatic patient). Direct microscopic examination with 20% KOH and culture was carried out in both groups. In PsoGroup (711 patients, 59.50% female, 40.50% male, median age of 52.22 ± 15.01), the prevalence of onychomycosis was 49.08%. On the other hand, in non-PsoGroup (8570 patients (71.65% female, 28.35% male, median age of 48.51 ± 19.31 years), the prevalence of onychomycosis was 51.30%. There was no statistically significant difference between the prevalence of onychomycosis in PsoGroup 49.08% (349/711) compared to 51.30% (4397/8570) of non-PsoGroup (P = 0.2578). However, yeasts were significantly more prevalent in non-psoriatic than in psoriatic patients (P = 0.0144.). In our Mycological Laboratory, we observed a similar prevalence of onychomycosis in psoriatic patients and non-psoriatic patients. However, the spectrum of fungal species isolated was different from each other, with a higher prevalence of yeasts in non-PsoGroup that reflect a recent oriental trends.


Assuntos
Dermatoses da Mão/epidemiologia , Unhas/microbiologia , Onicomicose/diagnóstico , Onicomicose/epidemiologia , Psoríase/epidemiologia , Adulto , Idoso , Arthrodermataceae/isolamento & purificação , Aspergillus/isolamento & purificação , Candida/isolamento & purificação , Feminino , Dermatoses do Pé/diagnóstico , Dermatoses do Pé/epidemiologia , Dermatoses do Pé/microbiologia , Dermatoses da Mão/diagnóstico , Dermatoses da Mão/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Unhas/patologia , Onicomicose/microbiologia , Prevalência , Psoríase/microbiologia , Estudos Retrospectivos
19.
Dermatol Online J ; 25(3)2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30982309

RESUMO

A sporotrichoid pattern describes a clinical presentation in which inflammatory nodules spread along the path of lymphatic drainage, being reported in association with several infectious, neoplastic, and inflammatory skin conditions. Herein, we report a 65-year-old man presenting with a three-month history of erythematous nodules in a linear distribution along the left hand and forearm. He reported recent rose gardening and regular contact with an aquarium. The diagnosis was made through culture of skin biopsy tissue and isolation of Mycobacterium marinum. The patient was treated with a combination of clarithromycin and rifampicin and clinical resolution was evident within two months. We present a patient with a sporotrichoid cutaneous infection by Mycobacterium marinum, highlighting that even with the availability of novel microbiological detection techniques, tissue culture remains an essential tool for diagnostic confirmation.


Assuntos
Infecções por Mycobacterium não Tuberculosas/diagnóstico , Dermatopatias Bacterianas/diagnóstico , Idoso , Antibacterianos/uso terapêutico , Biópsia , Claritromicina/uso terapêutico , Técnicas de Cultura , Antebraço , Dermatoses da Mão/diagnóstico , Dermatoses da Mão/tratamento farmacológico , Dermatoses da Mão/patologia , Humanos , Masculino , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Infecções por Mycobacterium não Tuberculosas/patologia , Rifampina/uso terapêutico , Dermatopatias Bacterianas/tratamento farmacológico , Dermatopatias Bacterianas/patologia
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