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2.
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
3.
Clin Podiatr Med Surg ; 36(4): 685-694, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31466575

RESUMO

The lower extremity presents several challenges from a dermatologic standpoint: there are different anatomic areas that not only vary from a stratum corneum thickness and histologic standpoint but are also subject to trauma that is unique (shoe gear, gait cycle). Attention to appropriate diagnosis and management is always warranted but should be especially vigilant to those treating issues of the lower extremity. This article reviews diagnosis and treatment of the most common skin and nail conditions of the foot and ankle.


Assuntos
Dermatoses do Pé/diagnóstico , Dermatoses do Pé/terapia , Doenças da Unha/diagnóstico , Doenças da Unha/terapia , Feminino , Dermatoses do Pé/etiologia , Humanos , Masculino , Doenças da Unha/etiologia , Adulto Jovem
5.
Contact Dermatitis ; 81(4): 242-248, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31125134

RESUMO

BACKGROUND: Cobalt contact allergy is common, but clinical relevance is often difficult to determine. OBJECTIVES: To examine the aetiology, prevalence and clinical characteristics of cobalt-allergic patients who were patch tested between 2002 and 2017 at the Department of Dermatology and Allergy, Herlev-Gentofte Hospital. METHODS: Patch test data, along with patient characteristics and causative exposures, from all adult dermatitis patients seen and tested between 2002 and 2017 were analysed. Associations were tested with the χ 2 test and logistic regression. RESULTS: A total of 13 475 adults aged 18 to 99 years were patch tested. The overall prevalence of cobalt allergy and the prevalence of isolated cobalt allergy were 3.3% and 1.5%, respectively. The prevalence of isolated cobalt allergy decreased from 2.4% in 2006 to 2009 to 1.1% in 2014 to 2017 (Ptrend = 0.00003). Leather exposure as a relevant cause of allergic cobalt dermatitis increased from 3.7% in 2002 to 2009 to 8.3% in 2010 to 2017 (P = 0.04). The current clinical relevance of positive patch test reactions, that is, a positive reaction to cobalt combined with a history of current skin exposure to a source of cobalt, was 20.1%. CONCLUSIONS: We conclude that cobalt allergy is relatively common, but causative exposures are largely unknown, and the proportion of positive patch test reactions with clinical relevance is low. It is therefore currently unclear how we can better protect consumers and workers from cobalt exposure.


Assuntos
Cobalto/efeitos adversos , Dermatite Alérgica de Contato/epidemiologia , Dermatite Alérgica de Contato/etiologia , Dermatoses Faciais/epidemiologia , Dermatoses do Pé/epidemiologia , Dermatoses da Mão/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Dinamarca/epidemiologia , Dermatoses Faciais/etiologia , Feminino , Dermatoses do Pé/etiologia , Luvas Protetoras/efeitos adversos , Dermatoses da Mão/etiologia , Humanos , Joias/efeitos adversos , Masculino , Pessoa de Meia-Idade , Testes do Emplastro , Prevalência , Fatores Sexuais , Sapatos/efeitos adversos , Adulto Jovem
6.
Am J Clin Dermatol ; 20(5): 691-698, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31111408

RESUMO

Onychomycosis is a common disorder that is difficult to cure. Prevalence is lower in children (0.7%), but athletes are 2.5-fold more likely to develop the disease, with infections of the toenails seven times more prevalent than those of the fingernails. This is a concern for athletes as it can interfere with their performance. The risk of developing onychomycosis is increased by the warm environment of many sports activities; the use of occlusive footwear; the warm, moist environment associated with socks and sweating; shared, close quarters among athletes; and trauma to the foot and toenail. Once infected, onychomycosis treatment requires a long duration of treatment with strict compliance, a potential problem for younger patients. Treatment carries the risk of significant side effects, and recurrence rates remain high. Avoiding infection can be a potent first line of defense and may circumvent the need for treatment. Preventive recommendations such as keeping toenails short and proper washing of laundry, to name a few, can be effective and are discussed here. Technological improvements such as synthetic, moisture-wicking socks and well-ventilated, mesh shoes have also been shown to reduce moisture and injury. Education about preventing fungal spread and improving hygiene in the locker room, gym, and pool are of critical importance. This overview of onychomycosis focuses primarily on the preventive measures and innovative changes in athletic gear. It also provides a compact step-by-step guide to prevention intended to be useful for both the general public and the professional. It can be reproduced to use as a handout for athletes, trainers, and coaches.


Assuntos
Atletas , Dermatoses do Pé/prevenção & controle , Onicomicose/prevenção & controle , Sapatos/efeitos adversos , Dermatoses do Pé/epidemiologia , Dermatoses do Pé/etiologia , Humanos , Higiene , Onicomicose/epidemiologia , Onicomicose/etiologia , Educação de Pacientes como Assunto , Prevalência , Fatores de Risco
7.
Pediatr Dermatol ; 36(4): 517-519, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31063241

RESUMO

A 12-year-old boy presented with severe, bilateral foot dermatitis. Extended patch testing was performed, revealing a significant positive reaction to mixed dialkyl thioureas. A thorough review of his history revealed that he was likely being exposed through his neoprene taekwondo shoes. After implementation of allergen avoidance measures, his dermatitis resolved. This case emphasizes awareness of potential allergen exposures and offers helpful avoidance strategies.


Assuntos
Dermatite Alérgica de Contato/etiologia , Dermatoses do Pé/etiologia , Sapatos/efeitos adversos , Tioureia/efeitos adversos , Alérgenos/farmacologia , Criança , Dermatite Alérgica de Contato/fisiopatologia , Seguimentos , Dermatoses do Pé/fisiopatologia , Humanos , Masculino , Testes do Emplastro/métodos , Medição de Risco , Índice de Gravidade de Doença
9.
Dermatol Online J ; 25(1)2019 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-30710900

RESUMO

Bullous lupus erythematosus is a rare clinical form of lupus. The diagnosis is challenging and involves the exclusion of other subepidermal bullous dermatoses. We present a 21-year-old woman with erythematosus, polycyclic plaques with vesiculobullae along the periphery, creating an erythema gyratum repens-like pattern on acral regions. The cutaneous biopsy, analytical, and autoimmune studies support the diagnosis of systemic lupus erythematosus. Dapsone and glucocorticosteroids were given with prompt resolution of the lesions within two weeks. To our knowledge this is the first case of bullous lupus erythematosus with this atypical acral presentation.


Assuntos
Dermatoses do Pé/diagnóstico , Dermatoses da Mão/diagnóstico , Dermatoses da Perna/diagnóstico , Lúpus Eritematoso Sistêmico/diagnóstico , Dermatopatias Vesiculobolhosas/diagnóstico , Anti-Infecciosos/uso terapêutico , Dapsona/uso terapêutico , Eritema , Feminino , Dermatoses do Pé/tratamento farmacológico , Dermatoses do Pé/etiologia , Dermatoses do Pé/patologia , Glucocorticoides/uso terapêutico , Dermatoses da Mão/tratamento farmacológico , Dermatoses da Mão/etiologia , Dermatoses da Mão/patologia , Humanos , Dermatoses da Perna/tratamento farmacológico , Dermatoses da Perna/etiologia , Dermatoses da Perna/patologia , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/imunologia , Lúpus Eritematoso Sistêmico/patologia , Dermatopatias Vesiculobolhosas/tratamento farmacológico , Dermatopatias Vesiculobolhosas/etiologia , Dermatopatias Vesiculobolhosas/patologia , Adulto Jovem
10.
Nat Rev Rheumatol ; 15(2): 113-122, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30610219

RESUMO

Dactylitis is diffuse swelling of the digits that is usually related to an underlying inflammatory or infiltrative disorder. Psoriatic arthritis (PsA) is the most common severe disease thought to cause dactylitis. Our understanding of the pathogenesis of PsA-related dactylitis comes from experimental animal models of PsA-like disease, as well as advances in imaging and other clinical studies. Clinical trials in PsA have increasingly included dactylitis as an important secondary outcome measure. These studies indicate that cytokines drive multi-locus microanatomical pan-digital pathology. Given the importance of pro-inflammatory cytokines, the pathogenesis of dactylitis is best understood as an initial aberrant innate immune response to biomechanical stress or injury, with subsequent adaptive immune mechanisms amplifying the dactylitis inflammatory response. Regarding the treatment of dactylitis, no studies have been conducted using dactylitis as the primary outcome measure, and the current knowledge comes from analysis of dactylitis as a secondary outcome measure.


Assuntos
Artrite Psoriásica/complicações , Dermatoses do Pé/etiologia , Dermatoses da Mão/etiologia , Animais , Artrite Psoriásica/diagnóstico por imagem , Artrite Psoriásica/tratamento farmacológico , Modelos Animais de Doenças , Dermatoses do Pé/diagnóstico por imagem , Dermatoses do Pé/tratamento farmacológico , Dermatoses da Mão/diagnóstico por imagem , Dermatoses da Mão/tratamento farmacológico , Humanos , Fenômenos Imunogenéticos , Índice de Gravidade de Doença
13.
An. bras. dermatol ; 93(5): 696-700, Sept.-Oct. 2018. tab
Artigo em Inglês | LILACS | ID: biblio-949946

RESUMO

Abstract: Background: In our country, the Brazilian Standard Series is the most used for the etiological diagnosis of allergic contact dermatitis to shoes. However, there is no assessment of the usefulness of specific allergens for shoes. Objectives: To measure the improvement in diagnostic accuracy of allergic contact dermatitis to shoes with the use of a specific complementary series in patch testing and describe the characteristics of the affected population, such as gender, location of lesions, time of evolution, and the most common allergens. Methods: This retrospective study evaluated the results of 52 patients with suspected shoe dermatitis subjected to patch tests with the standard and specific series to quantify the gain in diagnostic accuracy. Results: Among the 52 suspected cases, 29 cases (56%) were confirmed. In 13 (45%) cases the diagnosis was determined through the specific series, which results in an 81% increase in the number of diagnoses. Study limitation: Small sample size. Conclusions: Women were more commonly affected, with a mean time for the final diagnosis of 45 months, and the most common localization was the dorsum of the feet. There was an increase in diagnostic accuracy with the introduction of new haptens in the patch test of patients with suspected shoes dermatitis.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Sapatos/efeitos adversos , Alérgenos/análise , Dermatite Alérgica de Contato/diagnóstico , Dermatoses do Pé/diagnóstico , Brasil , Testes do Emplastro , Alérgenos/efeitos adversos , Estudos Retrospectivos , Dermatite Alérgica de Contato/etiologia , Dermatoses do Pé/etiologia
15.
An Bras Dermatol ; 93(4): 590-591, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30066774

RESUMO

Syphilis is a worldwide sexually transmitted infection caused by Treponema pallidum subspecies pallidum. Its association with other STIs, including HIV, demands early diagnosis and immediate treatment of patients. We herein report an unusual serpiginous form of secondary syphilis.


Assuntos
Dermatoses do Pé/etiologia , Dermatoses da Mão/etiologia , Sífilis/complicações , Adulto , Antibacterianos/administração & dosagem , Dermatoses do Pé/diagnóstico , Dermatoses do Pé/tratamento farmacológico , Dermatoses da Mão/diagnóstico , Dermatoses da Mão/tratamento farmacológico , Humanos , Injeções Intramusculares , Masculino , Penicilina G Benzatina/administração & dosagem , Sífilis/diagnóstico , Sífilis/tratamento farmacológico
17.
An Bras Dermatol ; 93(5): 696-700, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30156619

RESUMO

BACKGROUND: In our country, the Brazilian Standard Series is the most used for the etiological diagnosis of allergic contact dermatitis to shoes. However, there is no assessment of the usefulness of specific allergens for shoes. OBJECTIVES: To measure the improvement in diagnostic accuracy of allergic contact dermatitis to shoes with the use of a specific complementary series in patch testing and describe the characteristics of the affected population, such as gender, location of lesions, time of evolution, and the most common allergens. METHODS: This retrospective study evaluated the results of 52 patients with suspected shoe dermatitis subjected to patch tests with the standard and specific series to quantify the gain in diagnostic accuracy. RESULTS: Among the 52 suspected cases, 29 cases (56%) were confirmed. In 13 (45%) cases the diagnosis was determined through the specific series, which results in an 81% increase in the number of diagnoses. STUDY LIMITATION: Small sample size. CONCLUSIONS: Women were more commonly affected, with a mean time for the final diagnosis of 45 months, and the most common localization was the dorsum of the feet. There was an increase in diagnostic accuracy with the introduction of new haptens in the patch test of patients with suspected shoes dermatitis.


Assuntos
Alérgenos/análise , Dermatite Alérgica de Contato/diagnóstico , Dermatoses do Pé/diagnóstico , Sapatos/efeitos adversos , Alérgenos/efeitos adversos , Brasil , Dermatite Alérgica de Contato/etiologia , Feminino , Dermatoses do Pé/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Testes do Emplastro , Estudos Retrospectivos
18.
An. bras. dermatol ; 93(4): 590-591, July-Aug. 2018. graf
Artigo em Inglês | LILACS | ID: biblio-949935

RESUMO

Abstract: Syphilis is a worldwide sexually transmitted infection caused by Treponema pallidum subspecies pallidum. Its association with other STIs, including HIV, demands early diagnosis and immediate treatment of patients. We herein report an unusual serpiginous form of secondary syphilis.


Assuntos
Humanos , Masculino , Adulto , Sífilis/complicações , Dermatoses do Pé/etiologia , Dermatoses da Mão/etiologia , Penicilina G Benzatina/administração & dosagem , Sífilis/diagnóstico , Sífilis/tratamento farmacológico , Dermatoses do Pé/diagnóstico , Dermatoses do Pé/tratamento farmacológico , Dermatoses da Mão/diagnóstico , Dermatoses da Mão/tratamento farmacológico , Injeções Intramusculares , Antibacterianos/administração & dosagem
20.
Acta Dermatovenerol Croat ; 26(1): 68-70, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29782305

RESUMO

Dear Editor, Pitted keratolysis (PK), also known as keratosis plantaris sulcatum, is a non-inflammatory, bacterial, superficial cutaneous infection, characterized by many discrete superficial crateriform ''pits'' and erosions in the thickly keratinized skin of the weight-bearing regions of the soles of the feet (1). The disease often goes unnoticed by the patient, but when it is noticed it is because of the unbearable malodor and hyperhidrosis of the feet, which are socially unacceptable and cause great anxiety to many of the patients. PK occurs worldwide, with the incidence rates varying based on the environment and occupation. The prevalence of this condition does not differ significantly based on age, sex, or race. People who sweat profusely or wash excessively, who wear occlusive footwear, or are barefoot especially in hot and humid weather are extremely prone to this condition (2). Physicians commonly misdiagnose it as tinea pedis or plantar warts. Treatment is quite simple and straightforward, with an excellent expected outcome if treated properly. We report a case of a 32-year-old male patient with skin changes of approximately one-year duration diagnosed as plantar verrucae, who was referred to our Department for cryotherapy. The patient presented with asymptomatic, malodorous punched-out pits and erosions along with hyperkeratotic skin on the heel and metatarsal region of the plantar aspect of both feet. The arches, toes, and sides of the feet were spared (Figure 1). Except for these skin changes, the patient was healthy and denied any other medical issues. He was an athlete active in martial arts and had a history of sweating of feet and training barefoot on the tatami mat for extended periods of time. The diagnosis of PK was established based on the clinical findings (crateriform pitting and malodor), negative KOH test for hyphae, and a history of prolonged sweating in addition to contact of the skin with tatami mats, which are often a source of infection if hygiene measures are not adequately implemented. Swabs could have been helpful to identify causative organisms, but they were not crucial for the diagnosis and treatment. The patient was prescribed with general measures to prevent excessive sweating (cotton socks, open footwear, and proper hygiene), antiseptic potassium permanganate foot soaks followed by clindamycin 1% and benzoyl peroxide 5% in a gel vehicle twice daily. At the one-month follow-up visit, the skin changes, hyperhidrosis, and malodor were entirely resolved (Figure 2). Pitted keratolysis is common among athletes (3,4). The manifestations of PK are due to a superficial cutaneous infection caused by several bacterial Gram-positive species including Corynebacterium species, Kytococcus sedentarius, Dermatophilus congolensis, Actynomices keratolytica, and Streptomyces that proliferate and produce proteinase and sulfur-compound by-products under appropriate moist conditions (5-7). Proteinases digest the keratin and destroy the stratum corneum, producing the characteristic skin findings, while sulfur compounds (sulfides, thiols, and thioesters) are responsible for the malodor. Athletes and soldiers who wear occlusive footwear for prolonged periods of time or even barefooted people that sweat extensively and spend time on wet surfaces such as laborers, farmers, and marine workers are more prone to this problem (3,4,8-11). Martial arts athletes are at greater risk of skin infections due to the constant physical contact that can lead to transmission of viral, bacterial, and fungal pathogens directly but also indirectly through contact with the mat and the skin flora of an another infected individual. A national survey of the epidemiology of skin infections among US high school athletes conducted by Ashack et al. supported the prevalent theory that contact sports are associated with an increased risk of skin infections. In this study, wrestling had the highest skin infection rate of predominantly bacterial origin (53.8%), followed by tinea (35.7%) and herpetic lesions (6.7%), which is consistent with other literature reporting (12). Being barefoot on the tatami mat in combination with excessive sweating and non-compliance with hygiene measures makes martial arts athletes more susceptible to skin infections, including PK. The diagnosis is clinical, by means of visual examination and recognition of the characteristic odor. Dermoscopy can be useful, revealing abundant pits with well-marked walls that sometimes show the bacterial colonies (13). Cultures, if taken, show Gram-positive bacilli or coccobacilli. Because of the ease of diagnosis on clinical findings, biopsy of pitted keratolysis is rarely performed. Skin scraping is often performed to exclude tinea pedis, which is one of the main differential diagnosis, the others including verrucae, punctate palmoplantar keratoderma, keratolysis exfoliativa, circumscribed palmoplantar hypokeratosis, and basal cell nevus syndrome. If unrecognized and left untreated, skin findings and smelly feet can last for many years. Sometimes, if unrecognized, PK can be mistreated with antifungals, or even with aggressive treatment modalities such as cryotherapy. Appropriate treatment includes keeping feet dry with adequate treatment of hyperhidrosis, preventive measures, and topical antibiotic therapy. Topical forms of salicylic acid, sulfur, antibacterial soaps, neomycin, erythromycin, mupirocin, clindamycin and benzoyl peroxide, clotrimazole, imidazoles, and injectable botulinum toxin are all successful in treatment and prevention of PK (14,15). Topical antibiotics are the first line of medical treatment, among which fusidic acid, erythromycin 1% (solution or gel), mupirocin 2%, or clindamycin are the most recommended (14). As in our case, a fixed combination of two approved topical drugs - clindamycin 1%-benzoyl peroxide 5% gel, had been already demonstrated by Vlahovich et al. as an excellent treatment option with high adherence and no side-effect (16). The combined effect of this combination showed significantly greater effect due to the bactericidal and keratolytic properties of benzoyl peroxide. Additionally, this combination also lowers the risk of resistance of causative microorganisms to clindamycin. Skin infections are an important aspect of sports-related adverse events. Due to the interdisciplinary nature, dermatologists are not the only ones who should be aware of the disease, but also family medicine doctors, sports medicine specialists, and occupational health doctors who should educate patients about the etiology of the skin disorder, adequate prevention, and treatment. Athletes must enforce the disinfecting and sanitary cleaning of the tatami mats and other practice areas. Keeping up with these measures could significantly limit the spread of skin infections that can infect athletes indirectly, leading to significant morbidity, time loss from competition, and social anxiety as well.


Assuntos
Antibacterianos/uso terapêutico , Fármacos Dermatológicos/uso terapêutico , Hiperidrose/complicações , Artes Marciais , Dermatopatias Bacterianas/etiologia , Dermatopatias Bacterianas/terapia , Acrodermatite/etiologia , Acrodermatite/microbiologia , Acrodermatite/terapia , Adulto , Atletas , Seguimentos , Dermatoses do Pé/etiologia , Dermatoses do Pé/microbiologia , Dermatoses do Pé/terapia , Humanos , Hiperidrose/fisiopatologia , Hiperidrose/terapia , Masculino , Medição de Risco , Higiene da Pele/métodos , Dermatopatias Bacterianas/microbiologia , Resultado do Tratamento
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