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4.
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
5.
Int J Dermatol ; 58(11): 1305-1310, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31187480

RESUMO

BACKGROUND: Though melasma is a common skin condition in India, epidemiological studies are few and geographically confined. The present study was designed to gain insights into factors involved in causation and aggravation of melasma, demographic distribution, clinical presentations, and treatment patterns. METHODS: A cross-sectional multicentric study was conducted in 10 centers distributed across the four regions of India. Data including demographics, personal and family medical history, triggering and aggravating factors, clinical patterns, and details of past treatment regimens were recorded, and severity was estimated using the modified Melasma Area and Severity Index (MASI) score. Data collected by site dermatologists were collated and analyzed. RESULTS: The study evaluated 1,001 patients with melasma from 10 centers. Mean age was 38.02 years. Females dominated (85%). Proportion of males was highest in the east (22.2%) and lowest in the south (10.8%). Majority of patients belonged to intermediate skin phototypes. There was a significant difference (P = 0.000) between duration of sun exposure and duration of cooking fire/occupational heat exposure across the four regions. There was a significant association (P = 0.003, Mann-Whitney U test) and a positive correlation between duration of cooking heat/occupational heat exposure and severity of melasma. Sunscreens were used by only one-fifth of the study population (19.6%) whereas use of steroids and triple combinations was more common (28%). CONCLUSION: One of the largest studies on melasma from the subcontinent, this study describes the epidemiological determinants of melasma. Data suggests that the duration of cooking fire/occupational heat exposure may be linked to severity of melasma. Sunscreen use seems inadequate in Indian patients; use of steroid-containing medications is more common.


Assuntos
Glucocorticoides/uso terapêutico , Temperatura Alta/efeitos adversos , Melanose/epidemiologia , Exposição Ocupacional/efeitos adversos , Protetores Solares/administração & dosagem , Adolescente , Adulto , Idade de Início , Idoso , Culinária , Estudos Transversais , Feminino , Fogo , Humanos , Índia/epidemiologia , Masculino , Melanose/diagnóstico , Melanose/etiologia , Melanose/terapia , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Índice de Gravidade de Doença , Luz Solar/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
7.
Pediatr Dermatol ; 36(4): e97-e98, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31125459

RESUMO

Koolen-de Vries syndrome (KdVS), also referred to as the 17q21.31 microdeletion syndrome, is a rare genetic disorder characterized by developmental delay, typical facial dysmorphism, and congenital defects. Associated anomalies include many cutaneous findings. Here, we report a 17-year-old boy with KdVS (17q21.31 microdeletion syndrome) who presented with diffuse freckling and multiple pigmented lesions, found to be most consistent with atypical café-au-lait macules (CALMs) on biopsy. We review the cutaneous findings commonly associated with KdVS (17q21.31 microdeletion syndrome) and propose the addition of diffuse freckling and atypical CALMs, histologically similar to those that may be found in neurofibromatosis type 1, to the cutaneous findings associated with KdVS (17q21.31 microdeletion syndrome).


Assuntos
Anormalidades Múltiplas/diagnóstico , Manchas Café com Leite/diagnóstico , Deficiência Intelectual/diagnóstico , Melanose/diagnóstico , Neurofibromatose 1/diagnóstico , Anormalidades Múltiplas/genética , Adolescente , Manchas Café com Leite/complicações , Manchas Café com Leite/genética , Deleção Cromossômica , Cromossomos Humanos Par 17/genética , Seguimentos , Predisposição Genética para Doença , Humanos , Deficiência Intelectual/complicações , Deficiência Intelectual/genética , Masculino , Melanose/complicações , Neurofibromatose 1/complicações , Doenças Raras , Medição de Risco
8.
J Cosmet Dermatol ; 18(4): 1066-1073, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31033184

RESUMO

BACKGROUND: Sunscreens have long been an indispensable part in treating melasma as ancillary agents. None of previous studies have evaluated the role of sunscreens alone in the improvement of melasma. AIMS: Our objective was to study the role of broad-spectrum sunscreen with sun protection factor 19 and PA+++ as the sole agent for improvement of melasma. METHODS: A total of 100 patients with melasma were included in the study. Following proper method of application of 3 mL sunscreen, thrice daily, Melasma Area Severity Score (MASI) and Hindi language version of the MELASQOL scale (Hi-MELAQOL) was done at baseline and 12 weeks. RESULTS: The mean MASI in the study group at the beginning and at the end of the study was 12.38 ± 14.7 and 9.15 ± 4.7, respectively, whereas the mean value of Hi-MELASQOL at the beginning and at the end of the study was 47.2 ± 14 and 38.1 ± 14.2, respectively. The differences of both were statistically significant. Spearman's correlation between MASI and Hi-MELASQOL before and after the study was positive but insignificant. CONCLUSION: There was both an objective and subjective improvement in melasma after 12 weeks of sunscreen use in terms of both MASI, showing an objective improvement of melasma after using sunscreens alone and also in Hi-MELASQOL showing that use of sunscreens significantly improved quality of life of melasma patients. In our study, we have attempted to re-instate the importance of sunscreens to patients and dermatologists who are inclining more toward various skin lightening agents for treatment of melasma, which have many side effects.


Assuntos
Melanose/tratamento farmacológico , Qualidade de Vida , Protetores Solares/administração & dosagem , Administração Cutânea , Adulto , Feminino , Humanos , Masculino , Melanose/diagnóstico , Melanose/etiologia , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Fator de Proteção Solar , Luz Solar/efeitos adversos , Protetores Solares/química , Inquéritos e Questionários/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
9.
Pediatr Dermatol ; 36(4): 497-500, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30868657

RESUMO

Neurocutaneous melanosis (NCM) is the condition of abnormal melanocyte deposition in the leptomeninges and brain parenchyma. Associated with congenital melanocytic nevi, NCM can result in neurologic deficits, hydrocephalus, and rarely, malignant transformation of cells. We present the case of a 16-year-old boy with NCM who developed malignant leptomeningeal melanoma following immunosuppression with a TNFα inhibitor. To our knowledge, this is the first reported case of a patient with known NCM undergoing malignant transformation after anti-TNF therapy for inflammatory bowel disease.


Assuntos
Adalimumab/efeitos adversos , Transformação Celular Neoplásica/patologia , Melanose/patologia , Neoplasias Meníngeas/secundário , Neoplasias Meníngeas/cirurgia , Síndromes Neurocutâneas/patologia , Neoplasias Cutâneas/patologia , Adalimumab/uso terapêutico , Adolescente , Seguimentos , Humanos , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Doenças Inflamatórias Intestinais/tratamento farmacológico , Doenças Inflamatórias Intestinais/patologia , Imagem por Ressonância Magnética/métodos , Masculino , Melanose/diagnóstico , Melanose/terapia , Neoplasias Meníngeas/diagnóstico por imagem , Síndromes Neurocutâneas/diagnóstico , Síndromes Neurocutâneas/terapia , Nevo Pigmentado/diagnóstico , Nevo Pigmentado/patologia , Nevo Pigmentado/cirurgia , Doenças Raras , Medição de Risco , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/terapia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
11.
Odontoestomatol ; 21(33): 54-61, ene.-jun. 2019.
Artigo em Espanhol | LILACS, InstitutionalDB | ID: biblio-1008943

RESUMO

La encía hiperpigmentada es un problema estético para los pacientes debido a la exposición gingival al momento de sonreír. La principal pigmentación gingival ocurre de forma fisiológica principalmente como respuesta frente a los traumatismos, sustancias químicas y radiación ultravioleta. En el presente artículo se realizó una revisión bibliográfica sobre los criterios para el diagnóstico y tratamiento de la pigmentación gingival (melanosis). Se exploró los artículos de las bases de datos PubMed, EMBASE y SciELO desde el año 2005 (enero) hasta la actualidad (diciembre del 2018). Los criterios clínicos para su diagnóstico están basados en la severidad y extensión de las pigmentaciones sobre la encía marginal y adherida; de esta forma, la melanosis gingival es más común a nivel de la encía adherida con tonalidades que varían entre el castaño claro y castaño oscuro. Se concluye que todas las técnicas de depigmentación gingival son efectivas; las diferencias se encuentran en el costo, rapidez de cicatrización, confort y grado de dolor posoperatorio.


Hyperpigmentation of the gingiva is an aesthetic problem for patients with gingival exposure when smiling. The main gingival pigmentation occurs primarily physiologically as a response to trauma, chemicals and ultraviolet radiation. The aim of this study is to review the literature on the criteria for diagnosing and treating gingival pigmentation (melanosis). The author studied articles from the PubMed, EMBASE and SciELO databases from 2005 (January) to present (December 2018). The clinical criteria for diagnosis are based on the severity and extent of the pigmentation on the marginal and attached gingiva. In this way, gingival melanosis is more common at the attached gingiva level, with shades ranging from light chestnut to dark brown. In conclusion, all gingival depigmentation techniques are effective, the differences being cost, healing speed, comfort and degree of postoperative pain.


Assuntos
Gengiva , Melanose , Melanose/diagnóstico
13.
Indian J Dermatol Venereol Leprol ; 85(3): 282-286, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30409925

RESUMO

Background: Use of sunscreens on the face is becoming popular, and patients with melasma are prescribed sunscreen for use on the face. Results of a few Western studies on the effect of sunscreen use on serum vitamin D concentration are not applicable to Indian conditions. Aims: To examine the effect of use of a high sun protection factor (SPF 50+, PA++++) sunscreen on face in patients with melasma on serum concentration of 25-hydroxyvitamin D. Methods: Forty-five Indian patients (Fitzpatrick skin types III and IV) with melasma were advised to use a sunscreen with SPF 50 + for 3 months, 43 (33 female, 10 male; age 32.9 ± 8 years) completed the study. Patients staying outdoor for <4 hours applied sunscreen once daily after bath. Patients staying outdoors for >4 hours reapplied sunscreen 4 hours after first application. Patients were provided a container to measure the amount of sunscreen for use, which was approximately equal to recommended thickness. Compliance was tested by weighing the used tubes and tubes in use during monthly visits. Serum concentration of 25-hydroxyvitamin D was tested before and after the study period. Results: Amount of sunscreen advised (100.5 ± 29.2 ml) and the actual amount used (96.6 ± 27.9 ml) were similar (P = 0.53, t-test). The difference between serum concentrations of 25-hydroxyvitamin D at the baseline (19.20 ± 9.06 ng/ml) and at 3 months (18.91 ± 8.39 ng/ml) was not significant (P = 0.87, paired t-test, 95% confidence interval of difference -3.33 to 3.92). No correlation was found between the amount of sunscreen used and the percentage change in serum 25-hydroxyvitamin D concentration at 3 months (rho = 0.099, P = 0.528, Spearman's rank correlation). Limitations: Longer duration of application and a larger sample size may detect minor differences in vitamin D concentration. Conclusion: Using a high SPF sunscreen on the face, along with physical photoprotection advice, in patients with melasma for 3 months does not influence serum 25-hydroxyvitamin D concentration in Indian conditions.


Assuntos
Face , Melanose/sangue , Roupa de Proteção , Fator de Proteção Solar/métodos , Protetores Solares/administração & dosagem , Vitamina D/análogos & derivados , Adulto , Biomarcadores/sangue , Face/fisiologia , Feminino , Seguimentos , Humanos , Masculino , Melanose/diagnóstico , Melanose/tratamento farmacológico , Roupa de Proteção/tendências , Absorção Cutânea/efeitos dos fármacos , Absorção Cutânea/fisiologia , Luz Solar/efeitos adversos , Vitamina D/sangue , Adulto Jovem
14.
Artigo em Inglês | MEDLINE | ID: mdl-30333359

RESUMO

Background: Melasma poses a great challenge as its treatment modalities are unsatisfactory. Treatment using tranexamic acid is a novel concept. Aim: This study aimed to compare the therapeutic efficacy and safety of oral tranexamic acid and tranexamic acid microinjections in patients with melasma. Methods: This is a prospective, randomized, open-label study with a sample size of 64, 32 in each treatment arm. Thirty-two patients were administered localized microinjections (4 mg/ml) of tranexamic acid monthly in 1 arm, while in the other arm, 32 were given oral tranexamic acid 250 mg twice a day. Patients were followed up for 3 consecutive months. Clinical photographs were taken at each visit, and a modified melasma area and severity index scoring was performed at the beginning and end of treatment. Results: Improvement in melasma area and severity index score in the oral group was 57.5% as compared to 43.5% in the intralesional group. All 32 patients in the oral group (100%) showed >50% improvement, out of which 8 showed >75% improvement. In the intralesional group, 17 (53%) patients had >50% improvement, of which 3 had >75% improvement. The remaining 15 patients in this group had <50% improvement. Thus, the oral group showed a more significant response as compared to the intralesional group. No major adverse effects were observed in both the groups. At 6-month follow-up, two patients (6.2%) in the oral group had recurrence as compared to three patients (9.4%) in the intralesional group. Limitations: A small sample size was one of the limitations in this study. The dose of tranexamic acid in microinjections and the frequency of injections could have been increased. Conclusion: Tranexamic acid provides rapid and sustained improvement in the treatment of melasma. It is easily available and affordable. Oral route is undoubtedly efficacious, but the results of microinjections, while encouraging, can probably be enhanced by either increasing the frequency of injections or increasing the concentration of the preparation.


Assuntos
Melanose/diagnóstico , Melanose/tratamento farmacológico , Microinjeções/métodos , Ácido Tranexâmico/administração & dosagem , Administração Oral , Adulto , Antifibrinolíticos/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
15.
J Cosmet Dermatol ; 18(3): 870-873, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30105847

RESUMO

BACKGROUND: Melasma is a common acquired hyperpigmentation disorder observed mainly in young women. Hydroquinone is the basic treatment that its effect alone and in combination with other medications has been proven. Liposomes are microscopic vesicles in which water and lipid-soluble medications can be introduced to enhance their efficacy and specificity. The aim of this study was to compare therapeutic effects of topical liposomal hydroquinone with its conventional form on melasma. METHODS: This double-blind randomized clinical trial study was conducted on 20 women. Participants were asked to apply a certain amount of topical liposomal hydroquinone on one side of the face and conventional hydroquinone on the other side for three months. Skin pigmentation severity was measured using Melasma Area and Severity Index (MASI) at each visit, separately for each side of the face every month until one month after the last treatment, the data were recorded in a questionnaire and were analyzed by SPSS 16 software, paired sample t test, and repeated measurement ANOVA. RESULTS: MASI score in both case and control groups significantly reduced (P < 0.001) but no significant difference between the case and control groups was observed at any time interval (P > 0.05). CONCLUSION: This study shows that liposomal hydroquinone has a significant therapeutic effect on melasma, but we did not observe any superiority in comparison with the conventional method. Therefore, it can be considered in the treatment protocol of this disease.


Assuntos
Hidroquinonas/administração & dosagem , Melanose/tratamento farmacológico , Administração Cutânea , Adulto , Método Duplo-Cego , Face , Feminino , Humanos , Lipossomos , Melanose/diagnóstico , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
18.
Artigo em Inglês | MEDLINE | ID: mdl-30027914

RESUMO

The Q-switched Nd:YAG laser is an established modality of treatment for epidermal and dermal pigmented lesions. The dual wavelengths of 1064nm and 532nm are suited for the darker skin tones encountered in India. Though this laser has become the one of choice for conditions such as nevus of Ota, Hori's nevus and tattoos, its role in the management of melasma and other acquired dermal melanoses is not clear. Despite several studies having been done on the Q-switched Nd:YAG laser in melasma, there is no consensus on the protocol or number of sessions required. Acquired dermal melanoses are heterogenous entities with the common features of pigment incontinence and dermal melanophages resulting in greyish macular hyperpigmentation. This article reviews the current literature on laser toning in melasma and the role of the Q-switched Nd:YAG laser in stubborn pigmentary disorders such as lichen planus pigmentosus. As the pathology is primarily dermal or mixed epidermal-dermal in these conditions, the longer wavelength of 1064nm is preferred due to its deeper penetration. Generally multiple sessions are needed for successful outcomes. Low fluence Q-switched Nd:YAG laser at 1064nm utilizing the multi-pass technique with a large spot size has been suggested as a modality to treat melasma. Varying degrees of success have been reported but recurrences are common on discontinuing laser therapy. Adverse effects such as mottled hypopigmentation have been reported following laser toning; these can be minimized by using larger spot sizes of 8 to 10mm with longer intervals (2 weeks) between sessions.


Assuntos
Terapia a Laser/métodos , Lasers de Estado Sólido/uso terapêutico , Melanose/diagnóstico , Melanose/terapia , Pigmentação da Pele , Feminino , Humanos , Lasers , Masculino
19.
Klin Onkol ; 31(6): 463-464, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30545226

RESUMO

The authors declare they have no potential conflicts of interest concerning drugs, pro-ducts, or services used in the study. The Editorial Board declares that the manu-script met the ICMJE recommendation for biomedical papers. Submitted: 17. 6. 2017 Accepted: 1. 11. 2018.


Assuntos
Melanoma/diagnóstico , Melanose/diagnóstico , Nevo Azul/diagnóstico , Doenças Raras/diagnóstico , Neoplasias Cutâneas/diagnóstico , Humanos
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