Perfil clínico de pacientes dermatológicos encaminhados para avaliação oftalmológica / Clinical profile of dermatological patients referred to ophthalmological evaluation

RESUMO Objetivo: Analisar o perfil clínico de pacientes em acompanhamento dermatológico encaminhados para avaliação oftalmológica. Métodos: A amostra foi composta de pacientes dermatológicos encaminhados para avaliação oftalmológica, nos anos de 2016 e de 2017. Estudou-se a concomitância de doenças dermatológicas com as afecções oftalmológicas por meio da coleta simultânea do histórico dermatológico (prontuários registrados com dados gerais e diagnóstico) e de dados da consulta oftalmológica após o encaminhamento. Resultados: Foram avaliados pela oftalmologia 224 pacientes, sendo 65% do sexo feminino, 80% caucasianos, com idade variando entre 1 mês e 85 anos. As situações cujo encaminhamento foi mais prevalente foram psoríase, lúpus, vitiligo e rosácea (18,3%, 13,8%, 12,9% e 10,7%, respectivamente). Fototerapia crônica e uso de hidroxicloroquina representaram 35,7% e 22,3% dos pacientes. Casos de neurofibromatose, micose fungoide, líquen plano, neoplasias de pele, atopias, pênfigo e esclerodermia também estiveram presentes. Cegueira legal foi detectada em 6%, e deficiências visuais ligadas a afecções dermatológicas foram verificadas em 16,5% dos casos. As alterações oculares mais prevalentes foram catarata (18,9%), blefarite (15,9%), pterígio (5,3%) e conjuntivite (5,3%). Conclusão: Encontrou-se elevada frequência de alterações oftalmológicas em uma população de pacientes com doenças dermatológicas. Assim, o estudo e a análise de manifestações oculares em pacientes dermatológicos podem auxiliar na detecção precoce e na prevenção de complicações.

ABSTRACT Objective: To analyze the clinical profile of patients under dermatological care and referred to ophthalmological evaluation. Methods: The sample comprised dermatology patients referred to ophthalmological evaluation in 2016 and 2017. The simultaneous occurrence of skin and ophthalmic diseases was studied, by collecting dermatological history (medical records containing general data and diagnosis) and ophthalmic consultation data following referral. Results: A total of 224 patients were assessed, 65% were female, 80% were white, and age varied between one month and 85 years. The conditions more often referred were psoriasis, lupus, vitiligo and rosacea (18.3%, 13.8%, 12.9% and 10.7%, respectively). Chronic phototherapy and use of hydroxychloroquine were observed in 35.7% and 22.3% of patients, respectively. Cases of neurofibromatosis, mycosis fungoides, lichen planus, skin cancer, atopic dermatitis, pemphigus and scleroderma were also reported. Legal blindness was detected in 6% and visual impairment related to skin conditions in 16.5% of patients. The most prevalent ocular changes were cataracts (18.9%), blepharitis (15.9%), pterygium (5.3%) and conjunctivitis (5.3%). Conclusion: A high frequency of ophthalmic changes in a population of dermatological patients was found. In this context, studying and analyzing ocular manifestations in dermatological patients could be useful in early detection and prevention of complications.

Body dysmorphic disorder in patients attending a dermatology clinic in Nigeria: sociodemographic and clinical correlates

Abstract: Background: Body dysmorphic disorder is a relatively common psychiatric disorder in the context of dermatology and cosmetic and plastic surgery but is underdiagnosed and underreported in Africa. Objective: To evaluate the prevalence of body dysmorphic disorder and symptoms of anxiety/depression and determine their sociodemographic and clinical correlates. Methods: A systematic random sampling design was made to recruit 114 patients with skin diseases. Sociodemographic and clinical data were obtained. The Body Dysmorphic Disorder Modification of the Yale-Brown Obsessive-Compulsive Scale, Hospital Anxiety and Depression Scale was administered, and data were analyzed using SPSS 20. Results: Mean age of participants was 37.70±17.47 years, and 67/114 (58.8%) were females. Prevalence of body dysmorphic disorder was 41/114 (36.0%), and prevalence of anxiety/depression symptoms was 35/114 (30.7%). Prevalence of body dysmorphic disorder in patients with anxiety/depression symptoms was 15/41 (36.6%), and patients with facial disorders expressed the highest burden of anxiety/depression symptoms, in 15/35 (42.9%). Factors associated with significantly higher mean body dysmorphic disorder include age<50years (p=0.039), and anxiety/depression (p<0.001), education below high school was associated with higher mean anxiety/depression score (P= 0.031). In a binary logistic regression model, presence of anxiety/depression symptoms was predictive of body dysmorphic disorder (OR=10.0, CI: 4.1-28.2, p<0.001). Study limitations: the study is uncontrolled, conducted in a single source of care, thus limiting generalization to nonrelated settings. Conclusion: Prevalence of body dysmorphic disorder is high among dermatology patients and most prevalent in facial disorders. Facial diseases are associated with the highest burden of anxiety/depression symptoms. This is a clarion call for dermatologists to routinely assess for body dysmorphic disorder and appropriately refer affected patients to mental health care.

Comportamiento de las afecciones cutáneas en el adulto mayor. Policlínico Docente Héroes del Moncada. Municipio Cárdenas. Matanzas / Behaviour of skin affections in elder people. Teaching Policlinic Heroes del Moncada. Municipality of Cardenas. Matanzas

RESUMEN Introducción: el incremento de la calidad de vida de la población y del adulto mayor, la integración de todas las disciplinas médicas, las acciones de prevención y ambientales conllevarán a lograr una longevidad satisfactoria. Objetivo: describir el comportamiento de las afecciones cutáneas en el adulto mayor. Materiales y métodos: se realizó un estudio descriptivo, retrospectivo, acerca del comportamiento de afecciones cutáneas en pacientes adultos mayores, vistos en la consulta de Dermatología en el policlínico docente Héroes del Moncada en el municipio de Cárdenas en el período correspondiente a los años 2015 y 2016. La muestra estuvo constituida por 707 pacientes atendidos en consulta por afecciones cutáneas, en el período estudiado. Para la obtención de los datos se revisaron las hojas de cargo del departamento de estadística. Resultados: en los pacientes atendidos prevaleció el sexo masculino en los adultos mayores, las afecciones más frecuentes diagnosticadas fueron las micosis superficiales, los tumores malignos y las lesiones precancerosas y se detectaron más de una afección en un mismo paciente. Conclusiones: las dermatosis en el adulto resultó de frecuente incidencia en consulta, predominando el sexo masculino (AU).

ABSTRACT Introduction: The population's and elder peoples´ increment of the quality of life, the integration of all the medical disciplines, health and environmental prevention will lead to achieve a satisfactory longevity. Objective: Describing the behavior of cutaneous affections in the adult principal. Material and methods: A descriptive, retrospective study was conducted on the behavior of cutaneous disorders in elderly patients, seen in the Dermatology clinic in the Héroes del Moncada teaching polyclinic in the municipality of Cárdenas in the period corresponding to the years 2015 and 2016. The sample It was constituted by 707 patients attended in consultation for cutaneous affections, in the period studied. To obtain the data, the charge sheets of the statistics department were reviewed. Results: In the patients attended the male sex prevailed in the elderly, the most frequent conditions diagnosed were superficial mycoses, malignant tumors and precancerous lesions and more than one condition was detected in the same patient. Conclusions: Them dermatosis in adult frequent music demands counselling, fundamentally in the masculine sex (AU).

Profile of dermatological consultations in Brazil (2018)

Abstract: Background: Dermatological diseases are among the primary causes of the demand for basic health care. Studies on the frequency of dermatoses are important for the proper management of health planning. Objectives: To evaluate the nosological and behavioral profiles of dermatological consultations in Brazil. Methods: The Brazilian Society of Dermatology invited all of its members to complete an online form on patients who sought consultations from March 21-26, 2018. The form contained questions about patient demographics, consultation type according to the patient's funding, the municipality of the consultation, diagnosis, treatments and procedures. Diagnostic and therapeutic decisions were compared between subgroups. Results: Data from 9629 visits were recorded. The most frequent causes for consultation were acne (8.0%), photoaging (7.7%), nonmelanoma skin cancer (5.4%), and actinic keratosis (4.7%). The identified diseases had distinct patterns with regard to gender, skin color, geographic region, type of funding for the consultation, and age group. Concerning the medical conducts, photoprotection was indicated in 44% of consultations, surgical diagnostic procedures were performed in 7.3%, surgical therapeutic procedures were conducted in 19.2%, and cosmetic procedures were performed in 7.1%. Study limitations: Nonrandomized survey, with a sample period of one week. Conclusion: This research allowed us to identify the epidemiological profiles of the demands of outpatients for dermatologists in various contexts. The results also highlight the importance of aesthetic demands in privately funded consultations and the significance of diseases such as acne, nonmelanoma skin cancer, leprosy, and psoriasis to public health.

Seasonality of the hospitalizations at a dermatologic ward (2007-2017)

Abstract: There is little data in the literature concerning dermatologic admissions. Several diseases are seasonal in incidence and clinical worsening. We performed a survey of hospitalizations in the dermatology ward of a public hospital (April/2007 to May/2017). There were 1790 hospitalizations, whose main diagnoses were infectious dermatoses, neoplasias, psoriasis, bullous diseases and cutaneous ulcers. In winter, there were fewer hospitalizations for bacterial infections and urticaria, but more for leprosy. In summer, there were fewer hospitalizations for systemic and subcutaneous mycoses, but more for zoodermatoses and erythema multiforme. In the fall, more patients were admitted with mycoses. Spring favored urticaria and angioedema, but less cases of erythema multiforme and diabetic foot.

Prevalence of dermatoses in patients referred for evaluation in an outpatient clinic of specialties

Abstract: Background: Brazilian Unified Health System presents a long waiting period for a dermatology appointment, varying from 34 to 239 days. Objectives: Analyze the prevalence of cutaneous diseases evaluated by dermatologists in a specialized center, in patients referred from the primary care, and to present possible interventions for the primary units. Methods: Retrospective analyses of the International Codes of Diseases (ICD-10) described in every dermatology appointment in a specialty center in Sao Paulo from January 2014 to August 2015. Results: A total of 7.350 consultations were included. Superficial mycosis corresponded to 1,058 (14.4%) of the main complaints and dermatophytosis was the most frequently used ICD, corresponding to 481 individual consultations (6.5%), followed by onychomycosis, responsible for 464 consultations (6.3%), acne in 347 (4,7%). and contact dermatitis in 311 consultations (4,2%). Study limitations: The study was based on retrospective analysis of ICD described and no previous orientation for a solid use of the codes was performed to the dermatology team; consultations in which the ICD was not informed or a non-especific ICD was used were excluded; different dermatologists were responsible for the consultations. Conclusion: Superficial mycosis corresponded to 14.4% of the chief complaints in the studied period and was the most frequent cause of reference from primary care doctors to dermatologists. Prevalence data obtained in the present study could assist the capacitation policies in the primary care system, focusing the dermatology teaching in the most prevalent dermatological disorders.

Prevalence of dermatological complaints in patients undergoing treatment for breast cancer

Abstract: BACKGROUND: Internal malignancies such as breast cancer, as well as their treatment can often result in skin changes. OBJECTIVE: To assess the prevalence of dermatological complaints in patients who are undergoing oncological treatment for breast cancer in a hospital in Tubarão, Santa Catarina, Brazil. METHODS: Observational, cross-sectional study, from October 2015 to February 2016 in which 152 patients with the diagnosis of breast cancer, undergoing treatment with chemotherapy, radiotherapy, hormone therapy and/or surgery, were interviewed and completed a research protocol developed by the author. RESULTS: The treatment of breast cancer was associated with dermatological complaints in 94.1% of the interviewed, being with hair loss the most frequent, present in 79.6% of the sample, followed by nail changes (56%). Patients with lighter skin phototypes (I, II and III) had a lower risk (p=0.045) of developing skin changes when compared to darker phototypes. Radiation therapy (p=0.011) and oncological surgery (pFisher=0.004) were statistically significant when related to skin changes. STUDY LIMITATIONS: Inherent to the design of the study, as well as recall bias. CONCLUSIONS: It was found that most patients diagnosed with breast cancer showed dermatologic manifestations during the proposed cancer treatment. Patients undergoing radiotherapy and surgery showed skin changes with greater statistical significance.

Most frequent dermatoses at a vulvar pathology outpatient clinic

Abstract: The vulva corresponds to the external female genitalia. Special features of this region favor a wide range of diseases, whose knowledge allows for better clinical management, impacting on the quality of life. This is a cross-sectional and descriptive study carried out at a vulvar pathology outpatient clinic, between May and December/ 2015. Data obtained from a standard form included demographic parameters, habits, and vulvar dermatosis and allowed to identify the epidemiological profile of patients with vulvar dermatosis treated in this outpatient clinic and to determine the most prevalent dermatoses. Our results, partially concordant with the literature, provide original data that should stimulate further studies

Análisis de las interconsultas con dermatología pediátrica de pacientes hospitalizados en un hospital pediátrico universitario / Analysis of pediatric dermatology inpatient consultations in a pediatric teaching hospital

Introducción. Las dermatosis son frecuentes en niños. Nuestro objetivo fue describir las interconsultas con dermatología de niños hospitalizados. Población y métodos. Se analizaron las solicitudes de interconsultas con dermatología pediátrica de 539 pacientes consecutivos (de 0 a 18 años de edad) entre enero de 2004 y abril de 2010; para determinar en la interconsulta, el grupo de dermopatías, diagnóstico principal, departamento solicitante, patrón diagnóstico, modalidad de tratamiento y derivación a otro departamento. Resultados. De 539 niños hospitalizados, 310 (57, 51%) eran varones y 229 (42, 49%), mujeres. El departamento de pediatría general (37, 5%), fue el que consultó más frecuentemente, seguido por oncología (15, 6%) y cirugía pediátrica (11%). La mayoría (32%) habían sido hospitalizados por una dermopatía o enfermedad relacionada. Las alergias cutáneas (47%) fueron las principales dermatosis consultadas, seguidas por enfermedades infecciosas (14, 7%) y trastornos sistémicos con manifestaciones cutáneas (10, 2%). La dermatitis atópica (7, 4%) y el eccema sin clasificar (7, 4%) fueron las dermatosis más frecuentes, seguidos de la urticaria papulosa (5, 4%). En el 80% de los pacientes, el diagnóstico fue clínico; requirieron biopsia cutánea el 15, 9% y análisis de laboratorio el 4%. El 51% de los pacientes requirió tratamiento local, el 6%, tratamiento sistémico, el 31%, sistémico combinado y ningún tratamiento en el 11, 1%. Se derivó a otro departamento al 2% de los pacientes. Conclusiones.Este estudio obtuvo datos importantes sobre los trastornos de piel y su tratamiento en niños hospitalizados desde la perspectiva de la interconsulta.

Introduction. Although skin diseases are associated with low rate of hospitalization, dermatological manifestations are frequent in hospitalized patients. The aim of the study was to describe the inpatient dermatological consultations in a pediatric teaching hospital. Population and Methods. Recorded data from inpatient pediatric dermatology consultation requests on a total of 539 consecutive inpatients (aged 0-18 years) from January 2004 to April 2010 were analyzed for consult diagnosis, dermatological disease group, primary diagnosis, requesting department, diagnostic pattern, treatment modality and referral to another department. Results. Of the 539 inpatients, 310 (57.51%) were males and 229 (42.49%) were females. The most frequent requesting department was general pediatrics (37.5%) followed by oncology (15.6%) and pediatric surgery (11.1%). Most of the patients (32.1%) had been hospitalized for dermatological or related disease followed by acute lymphoblastic leukemia (4.1%), chronic renal failure (2.6%), bronchopneumonia (2.6%) and epilepsy (2.4%). Allergic skin diseases (47.1%) were the leading group of dermatoses, which were followed by infectious diseases (14.7%), and systemic diseases with cutaneous manifestations (10.2%). Atopic dermatitis (7.4%) and unclassified eczema (7.4%) were the most frequent dermatoses followed by papular urticaria (5.4%). Most of the patients (80.0%) had diagnosis on clinical basis, whereas skin biopsy was performed in 15.9% and laboratory investigation in 4.1% of the patients. Local treatment was applied to 50.8% of the patients, systemic treatment to 5.8%, local and systemic treatment together to 31.0% while no treatment was given to 11.1%. Only 1.9% of the patients were referred to another department. Conclusions. This study provided important data on the spectrum of skin disorders and their management in pediatric inpatients from the consultation perspective in a pediatric teaching hospital with multispecialty clinics.

Consulta dermatológica geriátrica: comparación epidemiológica entre tres centros de salud / Geriatric dermatological consultation: epidemiological comparison between three health centers

El envejecimiento de la población es un fenómeno a nivel mundial, conllevando a una merma progresiva de todas las funciones de la piel. Involucra una alta prevalencia de patologías como xerosis, prurito, infecciones y neoplasias. Este estudio busca establecer las patologías dermatológicas más frecuentes en pacientes de 65 años o más de tres centros de salud con distintas características demográficas, sociales y administrativas, y las posibles diferencias entre ellos, por medio del análisis descriptivo de sus fichas clínicas entre abril de 2010 y abril de 2011. Los resultados mostraron una mayor prevalencia de patologías dermatológicas en el centro de salud primario, presentándose con mayor frecuencia en pacientes de sexo femenino. Sin importar el centro de salud de origen, las enfermedades infecciosas de la piel son el grupo de mayor prevalencia. Estos resultados coinciden con otros estudios a nivel latinoamericano, pero difieren de estudios realizados en países desarrollados.

The aging population is a worldwide phenomenon which implies all functions including skin, with pathological prevalence of xerosis, itching, infection, and neoplasia. This study establish the dermatological pathologies most frequently seen in patients 65 years and older in three health centers with distinct demographic, social, and administrative characteristics - and the possible differences between them – through the descriptive analysis of their medical records from April 2010 to April 2011. The results showed a greater prevalence of dermatological pathologies in the first health center, with greater frequency in female patients. No matter the health center, infectious diseases of the skin are the prevalent group. The results concur with other Latin American studies, but differ from studies in developed countries.

Sports-related dermatoses among road runners in Southern Brazil

BACKGROUND: Road running is a growing sport. OBJECTIVES: To determine the prevalence of sports-related dermatoses among road runners. METHODS: Cross-sectional study of 76 road runners. Assessment was performed by means of a questionnaire, interview, and clinical examination. The chi-square and linear trend tests were used for analysis. RESULTS: Most athletes were men (61%), aged 38±11 years, who ran mid- or long-distance courses (60.5%) for 45 to 60 minutes (79%), for a total of 25-64 km (42.1% ) or more than 65 km (18.4%) per week. The most prevalent injuries were blisters (50%), chafing (42.1%), calluses (34.2%), onychomadesis (31.5%), tinea pedis (18.4%), onychocryptosis (14.5%), and cheilitis simplex (14.5%). Among athletes running >64 km weekly, several conditions were significantly more frequent: calluses (p<0.04), jogger's nipple (p<0.004), cheilitis simplex (p<0.05), and tinea pedis (p<0.004). There was a significant association between the weekly running distance and the probability of skin lesions. Of the athletes in our sample, 57% trained before 10 a.m., 86% wore clothing and accessories for sun protection, 62% wore sunscreen, and 19.7% experienced sunburn. Traumatic and environmental dermatoses are common in practitioners of this outdoor sport, and are influenced by the weekly running distance. CONCLUSION: In this group of athletes, rashes, blisters, sunburn, and nail disorders were recurrent complaints regardless of running distance. Calluses, athlete's foot, chapped lips, and jogger's nipple predominated in individuals who ran longer routes. .

Dermatoses em renais cronicos em terapia dialitica / Skin lesions in chronic renal dialysis

Objetivo: As desordens cutâneas e das mucosas são comuns em pacientes em hemodiálise a longo prazo. A diálise prolonga a expectativa de vida, dando tempo para a manifestação destas anormalidades. Os objetivos deste estudo foram avaliar a prevalência de problemas dermatológicos em pacientes com doença renal crônica (DRC) em hemodiálise. Métodos: Cento e quarenta e cinco pacientes com doença renal crônica em hemodiálise foram estudados. Todos os pacientes foram completamente analisados para as alterações cutâneas, de cabelos, mucosas e unhas por um único examinador e foram coletados dados de exames laboratoriais. Os dados foram armazenados em um banco de dados do Microsolft Excel e analisados por estatística descritiva. As variáveis contínuas foram comparadas pelo teste t de Student e as variáveis categóricas utilizando o teste do qui-quadrado ou o teste Exato de Fischer, conforme adequado. Resultados: O estudo incluiu 145 pacientes, com idade média de 53,6 ± 14,7 anos, predominantemente do sexo masculino (64,1%) e caucasianos (90,0%). O tempo médio de diálise foi de 43,3 ± 42,3 meses. As principais doenças subjacentes foram: hipertensão arterial em 33,8%, diabetes mellitus em 29,6% e glomerulonefrite crônica em 13,1%. As principais manifestações dermatológicas observadas foram: xerose em 109 (75,2%), equimose em 87 (60,0%), prurido em 78 (53,8%) e lentigo em 33 (22,8%) pacientes. Conclusão: O nosso estudo mostrou a presença de mais do que uma dermatose por paciente. As alterações cutâneas são frequentes em pacientes em diálise. Mais estudos são necessários para melhor caracterização e manejo destas dermatoses. .

Objective: Cutaneous and mucosal disorders are the most common problems in patients on long-term hemodialysis. The dialysis prolongs the life expectancy, giving time of these changes to manifest. The aim of this study was to evaluate the prevalence of dermatologic problems among patients with chronic renal disease (CRD) undergoing hemodialysis. Methods: One hundred forty-five patients with chronic renal disease undergoing hemodialysis were studied. All patients were thoroughly examined for skin changes, hair, nails and mucous membranes by a single examiner and laboratory tests were assessed. The data were stored in a database Microsoft Excel and analyzed using descriptive statistics. The continuous variables were compared using Student's t-test and categorical variables the chi-square test or Fisher's Exact test. Results: The study included 145 patients, mean age of 53.6 ± 14.7 years, predominantly male (64.1%) and caucasian (90.0%). The average time of dialysis was 43.3 ± 42.3 months. The main underlying diseases were: hypertension in 33.8%, diabetes mellitus in 29.6% and chronic glomerulonephritis in 13.1% of the patients. The main dermatologic manifestations observed were: xerosis in 109 (75.2%), ecchymosis in 87 (60.0%), pruritus in 78 (53.8%) and lentigo in 33 (22.8%) patients. Conclusion: Our study showed the presence of more than one alteration per patient. Cutaneous alterations are frequent in patients on dialysis. Further studies are needed to better characterization and management of these dermatosis. .

Study of dermatoses in kidney transplant patients / Estudo das dermatoses em pacientes transplantados renais

BACKGROUND: The increasing in the number of kidney transplant recipients has favored, more frequently than before, the emergence of dermatoses and warranted their study through subsequent publications. OBJECTIVES: to evaluate the frequency of dermatoses in kidney transplant recipients. METHODS: kidney transplant recipients with suspected dermatoses between March 1st 2009 and June 30th 2010. RESULTS: 53 patients (28 males and 25 females), aged between 22 and 69 (mean age = 45 years) were evaluated. Most of them came from the cities of Ceilândia, Samambaia and São Sebastião/DF, and had already been transplanted for 5 to 10 years before (37.7%); 62.3% were recipients of living donors and 83% were prednisone-treated. The most prevalent dermatoses were of fungal (45.3%) and viral (39.6%) etiologies. Among the non-melanoma malignant neoplasms, the basal cell carcinoma prevailed (six cases), in spite of the low incidence. Concerning fungal dermatoses, 12 cases of onychomycosis, five of pityriasis versicolor and four of pityrosporum folliculitis were reported. For diagnosis, in most cases (64.2%), laboratory examinations (mycological and histopathological) were performed. CONCLUSION: cutaneous manifestations in kidney transplant recipients are generally secondary to immunosuppression. The infectious dermatoses, especially those of fungal origin, are frequently found in kidney transplant recipients and their occurrence increases progressively according to the time elapsed from the transplantation, which makes follow-up important. .

FUNDAMENTOS: o crescente aumento do número dos transplantados renais tem favorecido o aparecimento mais frequente das dermatoses e permitido o estudo em sucessivos trabalhos. OBJETIVOS: avaliar a frequência das dermatoses em pacientes transplantados renais. MÉTODOS: captação de pacientes transplantados renais durante o período de 1° de março de 2009 a 30 de junho de 2010 com suspeita de dermatoses. RESULTADOS : foram avaliados 53 pacientes (28 homens e 25 mulheres), entre 22 e 69 anos (com uma média de 45 anos), a maioria procedente de Ceilândia, Samambaia e São Sebastião/DF, entre 5 e 10 anos de transplante renal (37,7%), sendo 62,3% receptor de doador vivo e 83% em uso de prednisona. As dermatoses mais prevalentes foram as de etiologia fúngica (45,3%) e viral (39,6%). Das neoplasias malignas não-melanoma, apesar da baixa incidência, predominou o carcinoma basocelular (seis casos). Com relação s dermatoses de origem fúngica, ocorreram 12 casos de onicomicoses, cinco casos de pitiríase versicolor e quatro casos de foliculite pitirospórica. Para realização do diagnóstico, na maioria dos casos (64,2%), foi utilizado os exames laboratoriais ( micológicos e histopatológicos). CONCLUSÃO: as manifestações cutâneas em pacientes transplantados renais são geralmente secundárias imunossupressão. As dermatoses infecciosas, principalmente as de etiologia fúngica, são frequentes em pacientes transplantados renais, e sua ocorrência aumenta progressivamente, conforme o tempo transcorrido, a partir do transplante, sendo importante o acompanhamento. .

Study on dermatoses and their prevalence in groups of confirmed alcoholic individuals in comparison to a non-alcoholic group of individuals / Estudo das dermatoses e sua prevalencia em individuos comprovadamente alcoolistas comparativamente a um grupo de individuos não alcoolistas

BACKGROUND: The direct relationship between alcoholism and dermatoses has been evaluated in recent researches. However, there are few objective surveys that demonstrate and prove a direct relationship between alcohol and a specific dermatosis. OBJECTIVES: to verify the prevalence of dermatoses in alcoholics, analize the dermatological changes found in these patients and their evolution during alcoholic abstinence. Also, to compare the results obtained with a non-alcoholic control group and with the data found in medical literature. METHODS: the dermatologic conditions of 278 alcoholic patients (250 men, 28 women) were studied over a period of 4 years, and compared to those of a control group of 271 non-alcoholic individuals (249 men, 22 women), members of the Military Police Force. The individuals in both groups were between 20 and 60 years old. RESULTS: Pellagra, nummular eczema, purpura pigmentosa chronica (also known as pigmented purpuric dermatosis) and psoriasis were more frequent in the group of alcoholics and, apparently, occurred in parallel with alcoholism that seems to play a role in the evolution of these dermatoses. The dermatopathies were more frequent before the age of forty, regardless of factors such as profession, race or gender. CONCLUSION: the association of dermatoses and alcoholism was extremely significant according to the statistical data. Alcoholism can be considered a risk factor for pellagra, psoriasis, nummular eczema and purpura pigmentosa chronica dermatoses, which can, as well, be considered alcoholism indicators. .

FUNDAMENTOS: A relação direta entre o alcoolismo e as dermatoses vem sendo avaliada em recentes pesquisas. No entanto são poucos os estudos objetivos que demonstram e comprovam uma relação direta entre o álcool e uma determinada dermatose. OBJETIVOS: Verificar a prevalência de dermatoses em alcoolistas, avaliar as alterações dermatológicas encontradas nesses doentes e sua evolução frente abstinência alcoólica. Comparar os resultados obtidos com um grupo controle não alcoolista e com os resultados encontrados na literatura mundial. MÉTODO: Foram estudados, durante 4 anos, sob o ponto de vista dermatológico, 278 doentes alcoolistas (250 homens, 28 mulheres) comparativamente a 271 indivíduos (249 homens, 22 mulheres) não alcoolistas integrantes da Policia Militar, que constituíram o grupo controle, ambos com idades entre 20 e 60 anos. RESULTADOS: As dermatoses pelagra, eczema numular, púrpura pigmentosa crônica e psoríase foram mais frequentes no grupo dos alcoolistas e aparentemente surgiram paralelamente ao alcoolismo, que parece interferir na evolução destas dermatoses. As dermatopatias foram mais frequentes antes dos quarenta anos, não sendo significativos os fatores profissão, cor e sexo. CONCLUSÃO: a associação das dermatoses com alcoolismo foi altamente significativa, como indicaram os dados estatísticos. O alcoolismo pode ser considerado fator de risco para as dermatoses pelagra, psoríase, eczema numular e púrpura pigmentar crônica, podendo estas serem consideradas indicadoras de alcoolismo .

Impact on the quality of life of dermatological patients in southern Brazil / Impacto na qualidade de vida de pacientes dermatológicos no sul do Brasil

BACKGROUNDS: Skin diseases are extremely frequent and may affect quality of life; therefore, it is important to assess it and identify which factors are associated with it. OBJECTIVES: To assess quality of life and its associated factors in dermatological patients. METHODS: A cross-sectional study involving a sample of 548 patients seen at the Dermatology Outpatient Clinic of Sistema Único de Saúde (the Brazilian National Public Health System), University Hospital, Federal University of Rio Grande do Sul (RS). Information related to socio-demographic data, medical consultation and quality of life was collected by means of the Dermatology Life Quality Index. RESULTS: A median of 7 and a mean of 7.7 (SD = 5.0) were obtained with the Dermatology Life Quality Index. The skin diseases with higher scores on the Dermatology Life Quality Index were psoriasis (median = 15.5), vitiligo (median = 13), atopic dermatitis (median = 12) and acne (median = 10). With respect to factors associated with quality of life, it was found that younger, single patients with a low income, one skin disease and longer disease duration presented poorer quality of life. CONCLUSION: The assessment of the impact of dermatoses on patients' quality of life is important for clinical management. It is essential to detect patients at higher risk of experiencing worse quality of life in order to treat them in a more integrated way.

FUNDAMENTOS: As doenças de pele são extremamente freqüentes e os pacientes podem ter a qualidade de vida afetada. Assim é importante medi-la, bem como verificar quais os fatores que podem estar associados. OBJETIVOS: Verificar a qualidade de vida em pacientes dermatológicos e os fatores associados. MÉTODOS: Estudo tranversal com uma amostra de 548 pacientes atendidos no ambulatório de dermatologia do Sistema Único de Saúde do Hospital Universitário da Universidade Federal do Rio Grande. As informações foram coletadas em um questionário pré-codificado e referiam-se à dados sócio-demográficos, da consulta e qualidade de vida. RESULTADOS: O escore total do Dermatology Life Quality Index foi uma mediana de 7 e uma média de 7,7 (DP=5,0). As dermatoses com escore maior no Dermatology Life Quality Index foram psoríase (mediana = 15,5), vitiligo (mediana =13), dermatite atópica (mediana = 12), acne (mediana=10). Com respeito aos fatores associados à qualidade de vida, identificou-se que pacientes mais jovens, com menor renda, solteiros, com uma dermatose e com um tempo maior de evolução da doença, apresentam pior qualidade de vida. CONCLUSÃO: A avaliação do impacto na qualidade de vida em pacientes com dermatoses é importante para o manejo clínico. É essencial a detecção daqueles pacientes com maior risco de apresentar uma qualidade de vida pior, para poder abordá-los de uma forma mais integrada.

Prevalência de dermatoses em escolares na região do ABC paulista / Prevalence of dermatosis in scholars in the region of ABC paulista

FUNDAMENTOS: A literatura mostra que a prevalência de doenças dermatológicas em crianças e adolescentes com idades de 7-14 anos é consideravelmente significante, bem como a falta de tratamento e possível agravamento da situação. OBJETIVOS: Realização de uma análise investigativa para apontar a prevalência de dermatoses em indivíduos de 714 anos, assim como para verificar se estas estão diretamente ligadas ou não a suas respectivas situações socioeconômicas. MÉTODOS: Analisaram-se 200 crianças e adolescentes com idades de 7-14 anos, entre os meses de agosto e novembro de 2006, sendo 100 crianças em duas escolas públicas localizadas na periferia e 100 em duas escolas particulares localizadas em bairro de classe média alta na cidade de Santo André, Grande São Paulo. Para tanto, utilizou-se o método investigativo, com exame clínico de toda a superfície corpórea, de mucosas e de gânglios palpáveis, sendo a amostra populacional analisada de acordo com o teste qui-quadrado. RESULTADOS: 87,5 por cento das crianças apresentaram algum tipo de dermatose; encontraram-se 46 dermatoses, destacando-se: a) nevos melânicos (p<0,001); b) acne grau II (p=0,004); c) pitiríase alba (p<0,001); d) livedo reticular (p=0,025); e) pediculose (p<0,001); f) asteatose (p<0,001); g) dermatite friccional (p=0,007). Constatou-se uma pequena predominância das dermatoses nas crianças das escolas públicas (53,14 por cento). CONCLUSÕES: A amostra dessa população indicou que 87,5 por cento das crianças apresentaram dermatoses, uma prevalência muito maior do que a encontrada na literatura (30 por cento a 50 por cento) e uma prevalência discretamente mais elevada nas escolas públicas. O estudo mostrou a indiferença dos pais e responsáveis, o que aponta para a necessidade de interferência de políticas públicas, cuja falta, certamente, é responsável por esse índice elevado e possível agravamento da prevalência.

BACKGROUND: Literature shows that prevalence of skin diseases in children and adolescents aged 7-14 years is very significant, as well as lack of treatment worsening the situation. OBJECTIVES: An investigative analysis was conducted to determine the prevalence of skin diseases in individuals 714 years and focus on whether or not they are related directly to their respective socio-economic status. METHODS: 200 children and adolescents were examined aged 7-14 years,between August and November 2006,100 children in two public schools located in the periphery and 100 in two private schools located in upper middleclass neighborhood in Santo André,located in São Paulo.Investigative method used was the clinical examination of the whole skin, mucous areas and palpable ganglia,and the population sample analyzed according to the chi-square. RESULTS: 87.5 percent of children had some skin disease.46 dermatoses were found,the most important:a)melanocytic nevi (p <0.001);b)acne grade II (p = 0.004);c)pityriasis alba (p <0.001);d)livedo reticularis (p = 0.025); e)pediculosis (p <0.001);f)asteatosis (p <0.001);g) frictional dermatitis (p = 0.007).Small prevalence of skin diseases was observed in children in public schools (53.14 percent). CONCLUSIONS: This population sample indicated that 87.5 percent of children had skin diseases,which prevalence was much higher than those found in the literature(30-50 percent),showing a lightly enhanced prevalence in public schools.The study showed the neglect of parents and caregivers,indicating the need for interference from public policy,which lack certainly is responsible for high rate and can increase it.

Prevalência de dermatoses pediátricas em um hospital universitário na região sudeste do Brasil / Prevalence of pediatric dermatoses in a university hospital in southeastern Brazil

FUNDAMENTOS: Numerosas dermatoses afetam crianças, dependendo da idade, da região e da classe socioeconômica. OBJETIVO: Determinar a prevalência de dermatoses pediátricas em um hospital universitário, considerando-se o diagnóstico, a idade e o sexo. MÉTODOS: Estudo epidemiológico transversal realizado de julho de 2006 a dezembro de 2007. Análise dos prontuários de 264 pacientes do Ambulatório de Dermatologia Pediátrica de um hospital universitário nesse período. A variável dependente foi a existência ou não de dermatoses em crianças até os 19 anos de idade. Entre as variáveis independentes obtiveram-se: diagnóstico clínico, sexo e idade. RESULTADOS: Dos 264 prontuários analisados, observou-se maior prevalência de dermatoses alérgicas em 74 casos (28,0 por cento), seguidas por dermatoses inflamatórias em 49 casos (18,6 por cento), dermatoses pigmentares em 42 casos (15,9 por cento), dermatoses infecciosas em 38 casos (14,4 por cento), tumores benignos em 25 casos (9,5 por cento), miscelânea em 14 casos (5,3 por cento), genodermatoses em 12 casos (4,5 por cento) e afecções de anexos cutâneos em dez casos (3,8 por cento). Os lactentes perfizeram 11,3 por cento do total, os pré-escolares, 15,9 por cento, os escolares, 48,8 por cento e os adolescentes, 23,8 por cento. Observou-se maior incidência de dermatoses alérgicas em pré-escolares em 15 casos (35,7 por cento), em lactentes em dez casos (33,3 por cento) e em escolares em 39 casos (30,2 por cento). Entre os adolescentes destacaram-se as dermatoses inflamatórias. O estudo não mostrou diferenças estatísticas entre sexo e faixa etária. CONCLUSÕES: O estudo do perfil epidemiológico facilita o diagnóstico das dermatoses pediátricas, incentivando a boa anamnese e a busca da prevenção.

BACKGROUND: Numerous dermatoses affects children, depending on age, region and socioeconomic status. OBJECTIVE: To determine the prevalence of pediatric dermatoses at the Dermatology Department of a University Hospital, involving the diagnosis, age and sex. METHODS: Epidemiologic cross-sectional study carried out in the period between July 2006 and December 2007. There were reviewed the handbooks of 264 patients from the Pediatric Dermatology Department of a University Hospital in this period. The dependent variable was the existence or not of dermatoses in children of age up to 19 years. Independent variables were: clinical diagnosis, sex and age. RESULTS: Of the 264 handbooks reviewed, there was a higher prevalence of allergic dermatoses in 74 cases (28,0 percent), followed by inflammatory dermatoses in 49 cases (18,6 percent), pigmentary dermatoses in 42 cases (15,9 percent), infectious dermatoses with 38 cases (14,4 percent), benign tumors in 25 cases (9,5 percent), miscellaneous in 14 cases (5,3 percent), genodermatosis with 12 cases (4,5 percent) and skin annexes disorders with 10 cases (3,8 percent). The infants represented 11,3 percent of the total, the pre-school 15,9 percent, the schoolboys 48,8 percent, and the adolescents 23,8 percent. There was greater prevalence of allergic dermatoses in pre-school with 15 cases (35,7 percent), infants with 10 cases (33,3 percent) and schoolboys with 39 cases (30,2 percent). Among adolescents are highlighted inflammatory dermatoses. The study showed no statistical differences between sex and age. CONCLUSIONS: The study of the epidemiological profile makes easy the diagnosis of pediatric dermatoses encouraging good history and search for prevention.

Manifestações cutâneas na doença renal terminal / Cutaneous manifestations in end-stage renal disease

A prevalência da doença renal crônica aumentou nos últimos anos. Os efeitos dessa doença são complexos e podem levar à disfunção de múltiplos órgãos, entre eles, a pele. A maioria dos pacientes apresenta pelo menos uma alteração dermatológica. Algumas vezes, esses sintomas podem ser o primeiro sinal evidente de doença renal. Este artigo aborda as manifestações cutâneas relacionadas a disfunção renal grave ou doença renal terminal, divididas em não específicas e específicas, revisando quadro clínico, etiopatogenia e opções terapêuticas dessas dermatoses. Seu reconhecimento e trata mento precoces diminuem a morbidade, melhorando a qualidade de vida desses doentes.

The prevalence of chronic kidney disease has increased over the last years. The effects of this disease are complex and may lead to dysfunction of multiple organs, including the skin, with most patients presenting with at least one dermatologic alteration. Sometimes these symptoms can be the first clear sign of kidney disease. This article discusses the skin manifestations related to severe renal impairment or end-stage renal disease (ESRD), which are divided into nonspecific and specific, and reviews the clinical features, etiopathogenesis and therapeutic options for these dermatoses. Early recognition and treatment reduce morbidity and improve these patients' quality of life.

Morbilidad dermatológica en interconsultas de pacientes hospitalizados en el Complejo Asistencial Barros Luco / Dermatologic morbidity in consultations of patients at the Complejo Asistencial Barros Luco

Las patologías dermatológicas comunes y los signos cutáneos de enfermedades sistémicas están habitualmente presentes en los pacientes hospitalizados. El objetivo de este estudio fue analizar las interconsultas derivadas al Servicio de Dermatología y evaluar el perfil del paciente, el patrón de referencia y la precisión diagnóstica de los médicos no dermatólogos. Se realizó un estudio retrospectivo, se revisaron todas las interconsultas de pacientes hospitalizados durante el período comprendido entre abril del 2006 y diciembre del 2009 en el Complejo Asistencial Barros Luco. En 1.009 interconsultas se analizaron las variables de edad, género, fecha de derivación, Servicios Clínicos y la concordancia diagnóstica. La edad media de los pacientes derivados fue de 53,73 años (+/- -19.24 SD) con un 45,39 por ciento de mujeres y 56,61 por ciento de hombres. Los Servicios Clínicos con mayor frecuencia de solicitudes de interconsultas fueros: Hospital Infecccioso (37,80 por ciento), Medicina Interna (27,50 por ciento), Neurología (6,90 por ciento) y UCI (6,30 por ciento). La concordancia diagnóstica general fue de 48,75 por ciento y varía por cada grupo de enfermedades dermatológicas (inflamatorias: 54,90 por ciento, infecciosas: 22,25 por ciento; neoplasias benignas y malignas: 13,8 por ciento y otros diagnósticos: 9,07 por ciento). El perfil de interconsultas es diferente al de los pacientes ambulatorios, el diagnóstico específico que presentó el mayor porcentaje de derivaciones fueron las reacciones adversas medicamentosas, lo que se explica por la gran cantidad de fármacos usados a nivel hospitalario a diferencia del nivel ambulatorio donde éstas no son un diagnóstico significante. La concordancia diagnóstica respecto al diagnóstico dermatológico no supera el 50 por ciento en forma global y la tumoral solo presenta un 42,99 por ciento de asertividad, por lo que sería importante mejorar la educación dermatológica de pregrado especialmente en patologías de mayor...

Common dermatologic conditions and skin signs of systemic diseases are routinely present in hospitalized patients. The objective of this study was to analize the patient profile and the referral pattern of the in - patient dermatology consultation and evaluate the diagnostic accuracy of non dermatologist. This was retrospective study reviewing all inpatient referrals during a period (April 2006. December 2009) at the Barros Luco Hospital. 1009 dermatological consultations were analized by age, sex, date, clinical service and diagnostic correlation. The average age of the patients was 53.73 years old (+/-19.24DS) with a 45.39 percent of female and 56.61 percent of males. The Clinical services that most require consultations were infetious diseases (37.80 percent), internal medicine (27.50 percent), Neurology (6.90 percent) and ICU (6.30 percent). The total correlation diagnosis was 48.75 percent and this percentage was analized per dermatological disease (inflammatory 54.90 percent, infectious diseases 22.25 percent, benign and malignant neoplasias 13.8 percent and other diagnosis 9.07 percent). The inpatients consultation profile is different from the outpatient, the specific diagnosis that had the highest percentage of referrals were "adverse drug reactions" which can be explained by the large number of drugs used the hospital level opposed to an outpatient setting where adverse drug reactions do not represent a significant diagnosis. The diagnostic correlation was less than 50 percent globally compared with the dermatologic diagnosis; in tumors a 42.99 percent of concordance was found. It would be important to improve undergraduate education, especially in the most important dermatological diseases.

Aplicación de la teledermatología asincrónica en usuarios de la comuna de Yerbas Buenas, Región del Maule, Chile / Effectiveness of asynchronous teledermatology in users of the rural health center in Chile

La teledermatología (TD) revoluciona la atención en dermatología, facilitando su acceso a regiones remotas. La TD asincrónica (TDA), utilizada para el diagnóstico dermatológico a través del envío de información mediante e-mail, ha sido implementada en forma limitada en Chile. El objetivo de este estudio fue analizar la efectividad y la satisfacción usuaria (SU) de la TDA en un centro de salud rural de Chile. Se diseño un sistema de teleconsultas, capacitando a los médicos generales en patología dermatológica más frecuente y se realizó contrarreferencia. Se analizaron 172 teleconsultas. Las patologías más frecuentes fueron: acné (11,1 por ciento), onicomicosis (8,7 por ciento), psoriasis (4,1 por ciento), dermatitis de contacto (4,1 por ciento) y verrugas (4,1 por ciento), Se encontró alta concordancia diagnóstica (CD) entre médicos generales y especialista (88,3 por ciento). La SU general alcanzó un 97 por ciento y se logró la resolución del 99,4 por ciento de las teleconsultas. La TDA permite proporcionar atención dermatológica a distancia, lo que permitiría favorecer a diversas localidades rurales de Chile.

Teledermatology (TD) revolutionizes the delivery of dermatology services by facilitating the access to specialist services at a distance. Asynchronous TD (ATD) is used for skin diseases diagnosis by sending information and images through e-mail. Its implementation in Chile has been limited. The purpose of this study was to analize the effectiveness and the user satisfaction (US) of the application of ATD in a rural helath center in Chile. A teleconsultation system was designed, primary care general practitioners were trained in dermatological diagnosis and implementation of the cross-refertence was developed. We assessed 172 teleconsultations. The most frequent pathologies were acne (11,1 percent), onychomycosis (8,7 percent), psoriasis (4,1 percent), contact dermatitis (4,1 percent) and warts (4,1 percent). The diagnosis concordance (DC) was 88,3 percent and the general US reached 97 percent. Diagnostic and therapeutic resolution was achieved in 99,4 percent of the teleconsultations. ATD was able to provide a distant dermatological assistance, helping several rural areas of Chile.