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2.
J Drugs Dermatol ; 19(9): 858-864, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-33026745

RESUMO

As the coronavirus epidemic continues, a host of new cutaneous complications is seen on the faces of frontline healthcare workers wearing personal protective equipment on a daily basis. To minimize the risk of COVID-19 infection, healthcare workers wear tight-fitting masks that lead to an excessive amount of pressure on the facial skin. Mechanical pressure, mask materials, and perspiration can all lead to various types of cutaneous lesions such as indentations of the face, skin tears, post-inflammatory hyperpigmentation, ulceration, crusting, erythema, and infection. The objective of this article is to provide effective and straightforward recommendations to those health care providers using facial masks in order to prevent skin-related complications. J Drugs Dermatol. 2020;19(9):858-864. doi:10.36849/JDD.2020.5259.


Assuntos
Infecções por Coronavirus/prevenção & controle , Dermatoses Faciais/etiologia , Traumatismos Faciais/etiologia , Máscaras/efeitos adversos , Pandemias/prevenção & controle , Equipamento de Proteção Individual/efeitos adversos , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/epidemiologia , Eritema/etiologia , Eritema/fisiopatologia , Exantema/etiologia , Exantema/fisiopatologia , Dermatoses Faciais/fisiopatologia , Traumatismos Faciais/epidemiologia , Traumatismos Faciais/fisiopatologia , Feminino , Saúde Global , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Exposição Ocupacional/prevenção & controle , Saúde do Trabalhador , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Medição de Risco
3.
Int J Infect Dis ; 98: 359-365, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32619757

RESUMO

OBJECTIVES: This study aimed to describe the demographic and clinical parameters of women infected by Zika virus who had infants with stigmata of Congenital Zika Syndrome (CZS) versus those who had normal-appearing infants at birth, thereby providing further details on the clinical caveats of neonatal ZIKV infection. METHODOLOGY: This cross-sectional study was performed in the state of Mato Grosso do Sul, Central-West region of Brazil, and included 117 mother-infant pairs who were interviewed and 120 gestational outcomes. All mothers had laboratory confirmation by qRT-PCR of ZIKV infection during pregnancy. RESULTS: The prevalence of congenital abnormalities related to ZIKV was 2.69 cases per 10,000 live births during this period. Exanthem was the main clinical finding, observed in 92.5% of the mothers in this study. Regarding the timing of ZIKV infection, the first trimester was the most frequent time of infection among mothers of infants with CZS (54.55%) (p=0.0007). The case fatality rate was 5% (n=6). Among the 23 children who were classified as having CZS, 13 (56.52%) of them presented with microcephaly. Only 13 (56.52%) children with CZS were tested by qRT-PCR for ZIKV infection at birth, five (38%) were positive. CONCLUSIONS: This study highlights the congenital alterations of ZIKV infection during pregnancy in an epidemic burst, demonstrating that the alterations found in other studies are similar to the present research.


Assuntos
Microcefalia/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Adulto , Brasil/epidemiologia , Estudos Transversais , Exantema/diagnóstico , Exantema/epidemiologia , Exantema/fisiopatologia , Exantema/virologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Microcefalia/diagnóstico , Microcefalia/fisiopatologia , Microcefalia/virologia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/fisiopatologia , Complicações Infecciosas na Gravidez/virologia , Resultado da Gravidez , Estudos Retrospectivos , Adulto Jovem , Zika virus/genética , Zika virus/isolamento & purificação , Zika virus/fisiologia
4.
Medicine (Baltimore) ; 99(21): e20389, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481338

RESUMO

RATIONALE: Acute generalized exanthematous pustulosis (AGEP) is a severe pustular cutaneous adverse drug reaction. Sterile, non-follicular pustules overlying the erythematous skin characterize this reaction. PATIENT CONCERNS: A 30-year-old Asian women presented with sterile, non-follicular lesions with pus-fluid levels on her back 2 days after taking clindamycin. Skin biopsy revealed a spongiotic change in the epidermis with a focal subcorneal pustule and perivascular eosinophil and lymphocyte infiltration. DIAGNOSIS: Clindamycin-induced AGEP. INTERVENTIONS: We discontinued clindamycin treatment and prescribed systemic corticosteroids. OUTCOMES: The pustule stopped spreading within 1 day and the rash improved within 2 days. LESSONS: AGEP is a pustular cutaneous adverse drug reaction that can appear with pus-fluid levels, clinically mimicking Sneddon-Wilkinson disease. The differentiation between both conditions is a history of drug use, characteristic skin lesions and histopathology.


Assuntos
Pustulose Exantematosa Aguda Generalizada/etiologia , Clindamicina/efeitos adversos , Pustulose Exantematosa Aguda Generalizada/tratamento farmacológico , Corticosteroides/uso terapêutico , Adulto , Clindamicina/uso terapêutico , Exantema/tratamento farmacológico , Exantema/etiologia , Exantema/fisiopatologia , Feminino , Humanos , Faringite/tratamento farmacológico
5.
Arthritis Rheumatol ; 72(7): 1134-1142, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32017464

RESUMO

OBJECTIVE: To identify potential clusters of systemic lupus erythematosus (SLE) organ-specific flares and their relationship to fine particulate matter pollution (PM2.5), temperature, ozone concentration, resultant wind, relative humidity, and barometric pressure in the Hopkins Lupus Cohort, using spatiotemporal cluster analysis. METHODS: A total of 1,628 patients who fulfilled the Systemic Lupus International Collaborating Clinics classification criteria for SLE and who had a home address recorded were included in the analysis. Disease activity was assessed using the Lupus Activity Index. Assessment of rash, joint involvement, serositis, and neurologic, pulmonary, renal, and hematologic activity was quantified on a 0-3 visual analog scale (VAS). An organ-specific flare was defined as an increase in VAS of ≥1 point compared to the previous visit. Spatiotemporal clusters were detected using SaTScan software. Regression models were used for cluster adjustment and included individual, county-level, and environmental variables. RESULTS: Significant clusters unadjusted for environmental variables were identified for joint flares (P < 0.05; n = 3), rash flares (P < 0.05; n = 4), hematologic flares (P < 0.05; n = 3), neurologic flares (P < 0.05; n = 2), renal flares (P < 0.001; n = 4), serositis (P < 0.001; n = 2), and pulmonary flares (P < 0.001; n = 2). The majority of the clusters identified changed in significance, temporal extent, or spatial extent after adjustment for environmental variables. CONCLUSION: We describe the first spatiotemporal clusters of lupus organ-specific flares. Seasonal, as well as multi-year, cluster patterns were identified, differing in extent and location for the various organ-specific flare types. Further studies focusing on each individual organ-specific flare are needed to better understand the driving forces behind these observed changes.


Assuntos
Poluição do Ar/estatística & dados numéricos , Pressão Atmosférica , Lúpus Eritematoso Sistêmico/fisiopatologia , Material Particulado , Exacerbação dos Sintomas , Tempo (Meteorologia) , Adulto , Artrite/fisiopatologia , Estudos de Coortes , Exantema/fisiopatologia , Feminino , Doenças Hematológicas/fisiopatologia , Humanos , Umidade , Pneumopatias/fisiopatologia , Nefrite Lúpica/fisiopatologia , Vasculite Associada ao Lúpus do Sistema Nervoso Central/fisiopatologia , Masculino , Ozônio , Serosite/fisiopatologia , Análise Espaço-Temporal , Temperatura , Vento
9.
Curr Neurovasc Res ; 16(3): 208-214, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31237213

RESUMO

OBJECTIVE: This study aims to analyze the clinical characteristics, treatment and prognosis of children with cutaneous polyarteritis nodosa (CPAN), in order to improve the understanding of this disease. METHODS: Data of 14 children with CPAN, who were hospitalized in the Beijing Children's Hospital of Capital Medical University from January 2006 to December 2016, were collected. The clinical characteristics of all patients were summarized, the antistreptolysin-O (ASO)-positive and ASO-negative groups were compared, and the follow-up results were analyzed. X2-test, Fisher's exact probability test, t-test and Mann-Whitney test were used for statistical analysis. RESULTS: Among these 14 CPAN patients, nodular rash was the most common manifestation (14/14). The ASO-positive group had more nodules in the lower limbs and the ASO-negative group appeared more in the upper limbs, which were statistically significant (p<0.05). ASOpositive children were more likely to have joint symptoms (P<0.05), and were more prone to elevated white blood cells (P<0.05). Follow-ups were performed on nine patients, and the prognoses were all good. The occurrence of systemic polyarteritis nodosa was not observed. CONCLUSION: The main clinical manifestation of children with CPAN is skin nodules, which rarely affects the internal organs. Streptococcal infection is often the main cause. Anti-infection treatment should be simultaneously considered.


Assuntos
Poliarterite Nodosa/diagnóstico , Poliarterite Nodosa/fisiopatologia , Criança , Exantema/diagnóstico , Exantema/tratamento farmacológico , Exantema/fisiopatologia , Feminino , Seguimentos , Glucocorticoides/uso terapêutico , Humanos , Masculino , Poliarterite Nodosa/tratamento farmacológico
11.
J Am Acad Dermatol ; 81(1): 111-122, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31103317

RESUMO

BACKGROUND: Eruptive squamous atypia (ESA), which is an idiopathic, sometimes koebnerizing, proliferation of atypical but well-differentiated keratinocytes (also termed eruptive keratoacanthoma), is often misdiagnosed as cancer and managed by excisional surgery, provoking further koebnerization. A clear definition of this phenomenon and treatment outcome data are lacking. OBJECTIVE: To define ESA and evaluate efficacy of intralesional (IL) 5-fluorouracil (5-FU) treatment. METHODS: A retrospective cohort study examined patients with ESA that arose spontaneously or within a recent surgical scar and was treated with IL 5-FU at a tertiary academic center between January 2008 and December 2016. Complete clearance, partial clearance, and number of surgical excisions performed were tabulated. RESULTS: Of 30 patients with 136 ESA lesions, 20 (67%) had resolution of ESA with IL 5-FU monotherapy. In all, 10 patients (33%) required additional therapy (topical 5-FU, steroids, cryotherapy, or acitretin). No IL 5-FU-treated ESA lesions required surgical excision. The number of excisional procedures decreased significantly (P = .006), with 27 patients (90%) needing fewer excisions 12 months after versus 12 months before initiation of IL 5-FU therapy. Dyspigmentation was the only adverse event. LIMITATIONS: Limitations include retrospective analysis and use of data from a single institution. CONCLUSION: With close clinical monitoring, IL 5-FU can be used to successfully treat ESA.


Assuntos
Carcinoma de Células Escamosas/patologia , Exantema/patologia , Fluoruracila/administração & dosagem , Ceratoacantoma/tratamento farmacológico , Ceratoacantoma/patologia , Neoplasias Cutâneas/patologia , Adulto , Biópsia por Agulha , Carcinoma de Células Escamosas/diagnóstico , Estudos de Coortes , Bases de Dados Factuais , Diagnóstico Diferencial , Relação Dose-Resposta a Droga , Esquema de Medicação , Exantema/tratamento farmacológico , Exantema/fisiopatologia , Feminino , Humanos , Imuno-Histoquímica , Injeções Intralesionais , Ceratoacantoma/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Neoplasias Cutâneas/diagnóstico , Estatísticas não Paramétricas , Resultado do Tratamento
12.
J Allergy Clin Immunol Pract ; 7(4): 1148-1156.e5, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30737191

RESUMO

Infant anaphylaxis is an emerging risk, with food allergy the most common cause. Although the presentation of anaphylaxis involves the same systems as in older children and adults, there are real-world challenges to identifying symptoms of an allergic emergency in nonverbal children, as well as implementing optimal treatment. Recognition of anaphylaxis in infants can be challenging because allergic symptoms and certain normal infant behaviors may overlap. Intramuscular epinephrine is the treatment of choice for infants, as it is for older children and adults, and an epinephrine autoinjector approved by the Food and Drug Administration is now available for infants weighing between 7.5 and 15 kg. A panel of experts sought to develop guiding principles for the recognition, diagnosis, and management of anaphylaxis in infants, and provide a framework for the development of new guidelines and future research. Accordingly, anaphylaxis emergency action planning for infants was addressed by the panel. In considering formation of future infant anaphylaxis guidelines, health care providers should be aware of the needs to improve the recognition, diagnosis, and management of infants with anaphylaxis. Future research should identify and validate clinical criteria for the diagnosis of anaphylaxis in infants, as well as risk factors for the most severe reactions.


Assuntos
Anafilaxia/diagnóstico , Anafilaxia/terapia , Epinefrina/administração & dosagem , Hipersensibilidade Alimentar/diagnóstico , Simpatomiméticos/administração & dosagem , Anafilaxia/etiologia , Anafilaxia/fisiopatologia , Pré-Escolar , Tosse/etiologia , Tosse/fisiopatologia , Choro , Exantema/etiologia , Exantema/fisiopatologia , Hipersensibilidade Alimentar/complicações , Hipersensibilidade Alimentar/terapia , Humanos , Lactente , Comportamento do Lactente , Injeções Intramusculares/instrumentação , Agulhas , Sons Respiratórios/etiologia , Sons Respiratórios/fisiopatologia , Vômito/etiologia , Vômito/fisiopatologia
13.
South Med J ; 112(1): 45-51, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30608632

RESUMO

OBJECTIVES: Zika virus is an emerging infection that has posed vexing challenges to the US public health system. Improved characterization of patients with possible and confirmed infection is needed to better understand risks for infection in US travelers and to inform evolving evaluation guidelines. METHODS: We performed a retrospective electronic health record review of patients evaluated for Zika virus infection at an academic travel clinic in Atlanta, Georgia, from January 1 through August 31, 2016. We evaluated 46 patients who presented to the clinic during this period for evaluation of possible Zika virus infection, including patients with Zika virus symptoms, asymptomatic patients with possible exposure to Zika virus, and referral visits for Zika virus testing. RESULTS: Among the 46 patients evaluated, 30 (65.2%) were tested for Zika virus, 8 of whom (17.4%) had laboratory evidence of infection (7 confirmed, 1 probable). Cases, including confirmed and probable infections, most commonly had fever, rash, conjunctivitis, headache, and myalgia, although differences compared with noncases were not statistically significant. Many patients evaluated were not tested because of stringent testing criteria. CONCLUSIONS: Our findings may help inform improvements in timely clinical decision making for Zika virus testing. This may assist clinicians and public health agencies. Wider access to accurate screening modalities will help providers evaluate and advise patients.


Assuntos
Viagem , Infecção por Zika virus/diagnóstico , Adulto , Instituições de Assistência Ambulatorial , Infecções Assintomáticas , Conjuntivite/etiologia , Conjuntivite/fisiopatologia , Exantema/etiologia , Exantema/fisiopatologia , Feminino , Febre/etiologia , Febre/fisiopatologia , Georgia/epidemiologia , Cefaleia/etiologia , Cefaleia/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Mialgia/etiologia , Mialgia/fisiopatologia , Encaminhamento e Consulta , Estudos Retrospectivos , Infecção por Zika virus/complicações , Infecção por Zika virus/fisiopatologia
14.
Mil Med ; 184(5-6): e467-e469, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30215756

RESUMO

Vaccines have a well-demonstrated therapeutic benefit. However, the spectrum of potential dermatologic vaccine side effects ranges from localized skin irritation to acute and delayed response. Currently, there are limited published data correlating dermatoses with alterations in the immune system following vaccination. The mechanism by which group A beta-hemolytic streptococci may precede the manifestation of guttate psoriasis is included as a mechanism foundation as we further describe the immunopathogenesis of immune-mediated linear dermatoses. We present a rare case of linear lichen planus following intramuscular influenza vaccination, not associated with an injection site reaction. Immune-related dermatoses may be underreported, and a vaccine history should be considered in all patients with a skin condition that is otherwise attributed as idiopathic.


Assuntos
Líquen Plano/diagnóstico , Vacinação/efeitos adversos , Adulto , Exantema/etiologia , Exantema/fisiopatologia , Humanos , Líquen Plano/etiologia , Líquen Plano/patologia , Masculino
15.
Future Oncol ; 15(3): 331-343, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30523696

RESUMO

Targeted anticancer therapies are an important weapon in the fight against cancer. Targeted therapies interfere with specific molecules necessary for tumor growth and cancer progression. They are divided mainly to either monoclonal antibodies or small molecules inhibitors. Their primary objective is to target directly and precisely the cancer cells leading to a minimal side-effects profile. The dermatologic adverse reactions of these targeted therapies is different from those seen with classical cytotoxic chemotherapy. Rashes, xerosis, hand-foot-skin reaction and mucositis are the most frequent side effects. In this paper, we aim to present a comprehensive review of the dermatologic side effects of targeted therapies including, specific side effects related to recently, approved targeted therapies.


Assuntos
Anticorpos Monoclonais/efeitos adversos , Neoplasias/tratamento farmacológico , Dermatopatias/fisiopatologia , Bibliotecas de Moléculas Pequenas/efeitos adversos , Anticorpos Monoclonais/uso terapêutico , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Exantema/induzido quimicamente , Exantema/fisiopatologia , Síndrome Mão-Pé/etiologia , Síndrome Mão-Pé/fisiopatologia , Humanos , Mucosite/induzido quimicamente , Mucosite/fisiopatologia , Neoplasias/complicações , Dermatopatias/induzido quimicamente , Dermatopatias/classificação , Bibliotecas de Moléculas Pequenas/uso terapêutico
18.
J Nutr Sci Vitaminol (Tokyo) ; 64(4): 277-283, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30175791

RESUMO

The current adverse event reporting system for dietary supplements lacks the ability to collect and analyze ongoing case reports in sufficient numbers to detect health issues. We conducted an online survey to collect data on skin manifestations due to supplement use in consumers and to identify the suspected products and ingredients. An online survey was conducted among 63,737 dietary supplement users in 2016. Those who self-reported experiences of skin anthema or itching caused by supplement use and recognized a causal relationship as almost certain (0.8%) were invited to provide further details of symptoms and products. Most of the users experienced mild symptoms with "itching and/or rash of body part." After the onset of skin manifestations, 69.3% ceased supplement use, while 26.6% continued supplement use, including those who reduced the amount or frequency of use. Respondents who visited the hospital in response to symptoms accounted for 26.0%, while 53.3% did not seek treatment. The products used were identified in 155 of 300 eligible respondents. Although those products were composed of multiple ingredients, the accumulated data suggested that cutaneous symptoms were related to the following constituents: "Peptides or animal by-products" (31.0%), "Herbal/Botanical" (23.2%) and "Fats and lipid" (13.5%). Conducting an online survey to elicit information directly from consumers identified components of supplements that are involved in skin manifestations that could lead to serious damage, and may fill a void in the current adverse event reporting system.


Assuntos
Suplementos Nutricionais/efeitos adversos , Dermatopatias/etiologia , Adulto , Idoso , Comportamento do Consumidor , Autoavaliação Diagnóstica , Exantema/diagnóstico , Exantema/etiologia , Exantema/fisiopatologia , Exantema/terapia , Feminino , Pesquisas sobre Serviços de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Internet , Japão , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Prurido/diagnóstico , Prurido/etiologia , Prurido/fisiopatologia , Prurido/terapia , Autocuidado , Autorrelato , Índice de Gravidade de Doença , Dermatopatias/diagnóstico , Dermatopatias/fisiopatologia , Dermatopatias/terapia , Adulto Jovem
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