A cross-sectional questionnaire study in a phototherapy unit during COVID-19.

BACKGROUND: In March 2020, social isolation measures were imposed in Brazil to contain the spread of the novel coronavirus (SARS-CoV-2), requiring health services to implement contingency plans. The main objective of the study was to verify the status of the disease, self-reported by patients who discontinued phototherapy, during a period of social isolation. METHODS: All patients receiving phototherapy at the Santa Casa de Porto Alegre, Brazil, prior to the implementation of social distancing measures were eligible for inclusion in the study. 86 patients answered a questionnaire during a medical evaluation. RESULTS: 95% of patients who stopped phototherapy reported a worsening of disease status. Only 19% of patients continued to attend phototherapy sessions during the social isolation period. CONCLUSION: The COVID-19 pandemic led most patients to stop phototherapy, resulting in the perception of increased disease severity in an outpatient sample in southern Brazil.

Ecthyma-like phaeohyphomycosis caused by Cladosporium cladosporioides.

A case of cutaneous phaeohyphomycosis caused by Cladosporium cladosporioides in a 50-year-old housewife is described. The clinical presentation was an ecthyma-like crusted lesion on the back of her left hand. Scanning electron microscopy of the culture showed the conidiophores and the limoniform or ellipsoidal conidia, with a slightly verrucous surface. The lesion was removed surgically, with no relapses after 6-month follow up.

Cutaneous phaeohyphomycosis caused by Exophiala xenobiotica: A case report.

We report a case of phaeohyphomycosis that affected the leg of a 45-year-old Brazilian man, car mechanic and renal transplanted. The direct mycological examination evidenced dematiaceous septated hyphae. The pathogenic fungal species was identified as Exophiala xenobiotica. Antifungal activity in vitro revealed terbinafine as the best antifungal. For treatment, it was chosen surgical excision of the entire lesion and used systemic itraconazole. Phaeohyphomycosis caused by Exophiala xenobiotica is extremely rare and is closely related to transplant patients.

[Epidemiology of elevated triciptal and subscapular skinfolds in adolescents]. / Epidemiologia das pregas cutâneas triciptal e subescapular elevadas em adolescentes.

The objective of this study was to describe and compare the tricipital (TSF) and subscapular skinfold (SSF) thickness according to demographic, socioeconomic, behavioral, and biological characteristics in adolescents from Pelotas, Rio Grande do Sul State, Brazil. A cross-sectional study nested in a birth cohort (n = 4,452; mean age = 11 years) was conducted. The outcomes were defined as skinfold thickness >or= 90th percentile of the National Center for Health Statistics reference curve. The prevalence rates for elevated TSF and SSF were 20.2% and 17.3%, respectively, in boys and 14.2% and 10.5% in girls. The strongest factor associated with adiposity in boys was socioeconomic status (p < 0.001), whereas among girls it was maternal body mass index (p < 0.001). Low physical activity (< 300 minutes/week) was associated with elevated SSF only among girls, while schooling was associated with increased TSF and SSF only among boys. Diet, skin color, and sedentary behavior were not associated with any of the outcomes. We concluded that the main predictors of adiposity were maternal and socioeconomic characteristics. We recommend that further studies on this issue apply other methods to estimate body composition in order to confirm our results.

Prevalence and associated factors with sunscreen use in Southern Brazil: A population-based study.

BACKGROUND: Sunscreen use is important for the prevention of skin cancer, but population-based information about its prevalence and associated factors are scarce in Brazil. OBJECTIVE: We sought to evaluate the prevalence and associated factors with sunscreen use among Brazilian adults. METHODS: We conducted a cross-sectional population-based study with a representative sample of adults aged 20 years or older living in the urban area of the city of Pelotas, Southern Brazil. We evaluated sunscreen use at the beach, at work, and during outdoor sports, for at least 20 minutes between 10 am and 4 Pm, from December 2004 to March 2005. The outcome measure was dichotomized in individuals who never used sunscreen, and those who used sunscreen, regardless of frequency. RESULTS: Prevalence of sunscreen use at the beach, work, and outdoor sports was 60.8% (95% confidence interval 55.6-66.0), 13.7% (95% confidence interval 10.7-16.6%), and 30.2% (95% confidence interval 24.1-36.3), respectively. At work, the median number of days of exposure was 70 days, whereas at the beach it was 10, and for sports it was 16. Women, whites, those with higher educational achievement, and those with higher income were more likely to use sunscreen. LIMITATIONS: No data on adequacy of sunscreen use were gathered. CONCLUSION: Our data show that the individuals most exposed to sunlight are those who use sunscreen the least. Interventions targeting this group are required, because this is also the population with the lowest socioeconomic level.

Efficacy of Immunobiologic and Small Molecule Inhibitor Drugs for Psoriasis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

BACKGROUND: Psoriasis is an immune-mediated inflammatory disease for which treatment has evolved over the past few years due to the introduction of immunobiologic and small molecule inhibitor medications. A better understanding of the comparative efficacies of drugs may help doctors to choose the most appropriate treatment for patients. OBJECTIVE: The aim of this study was to conduct a systematic review and meta-analysis to assess the efficacy of immunobiologic and small molecule inhibitor drugs for patients with moderate to severe psoriasis. DATA SOURCES: The EMBASE, PUBMED, LILACS, Web of Science and ClinicalTrials.org databases were searched for trials published to 21 July 2016. STUDY SELECTION: Only randomized, double-blind, placebo-controlled clinical trials that evaluated the efficacy of immunobiologics or small molecule inhibitors for moderate to severe plaque-type psoriasis were selected by two independent authors. No restrictions were used. DATA EXTRACTION AND SYNTHESIS: Two authors independently extracted the data and a random-effects model meta-analysis was performed. MAIN OUTCOMES AND MEASURES: The Psoriasis Area and Severity Index (PASI) 75 was considered the primary outcome, measured at the primary endpoint of each study. RESULTS: Thirty-eight studies were included in our analysis. The overall pooled effect favored biologics and small molecule inhibitors over placebo (risk difference [RD] 0.59, 95% confidence interval [CI] 0.58-0.60). Ixekizumab at a dose of 160 mg on week 0 and then every 2 weeks (RD 0.84, 95% CI 0.81-0.88), brodalumab 210 mg (RD 0.79, 95% CI 0.76-0.82), infliximab 5 mg/kg (RD 0.76, 95% CI 0.73-0.79), and secukinumab 300 mg (RD 0.76, 95% CI 0.71-0.81) showed a greater chance of response (PASI 75) when compared with placebo. LIMITATIONS: The methodology of a traditional meta-analysis does not allow for drugs to be ranked. Included studies used short-term endpoints (10-16 weeks) to evaluate the primary outcome, therefore long-term efficacy could not be determined. CONCLUSIONS AND RELEVANCE: The anti-IL-17 drugs brodalumab, ixekizumab and secukinumab showed an equal or greater chance of helping patients achieve a 75% improvement on PASI compared with other reviewed drugs.

Recurrent aphthous stomatitis in 18-year-old adolescents - Prevalence and associated factors: a population-based study.

BACKGROUND: Recurrent aphthous stomatitis is a painful disorder of unknown etiology. It is among the most common oral mucosal lesions with high prevalence among young adults. OBJECTIVES: To conduct a population-based study with 18-year-old army recruiters to assess its prevalence and associated factors in male adolescents. METHODS: Interview during clinical examination in the army. RESULTS: In this group (2,427 interviewed adolescents) there was a RAS prevalence of 24.9%. Smoking, herpes labialis and socioeconomic status correlated with the outcome. STUDY LIMITATIONS: only male adolescents were interviewed. CONCLUSIONS: Our results showed high prevalence of RAS; association with higher economic level and herpes simplex was found. Protective effect of smoking was confirmed.

Describing numerical variables: which are the most appropriate parameters to describe the data?

The proper description of numerical variables is very important when presenting a set of data. Measures of central tendency and dispersion are used to adequately understand a set of numerical variables. Knowledge of the properties of these measures and their adequate use provide the reader with a better understanding of the results of a study.

Cutaneous metastasis of pheochromocytoma in multiple endocrine neoplasia IIB.

Pheochromocytoma is a rare tumor originating from neuroectodermic cells. Only 10% of these tumors are malignant. There are many familial forms of this tumor, including multiple endocrine neoplasia type II, Von Hippel-Lindau syndrome, and neurofibromatosis type I. Skin manifestations of pheochromocytoma are rare, and cutaneous metastasis in patients with multiple endocrine neoplasia IIB has never been described. The case of a patient with multiple endocrine neoplasia IIB who presented malignant pheochromocytoma with multiple cutaneous metastasis is described.

Sampling: how to select participants in my research study?

BACKGROUND: In this paper, the basic elements related to the selection of participants for a health research are discussed. Sample representativeness, sample frame, types of sampling, as well as the impact that non-respondents may have on results of a study are described. The whole discussion is supported by practical examples to facilitate the reader's understanding. OBJECTIVE: To introduce readers to issues related to sampling.

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.

Acne scars in 18-year-old male adolescents: a population-based study of prevalence and associated factors.

BACKGROUND: Acne vulgaris is a pilosebaceous follicle disorder affecting over 85% of adolescents to some degree. It frequently causes psychological distress that may persist into adulthood due to scarring. Little information about post-acne scarring epidemiology is available. OBJECTIVES: To describe prevalence, distribution patterns and associated factors of acne scarring in young males, drawing on a representative population sample from a southern Brazilian city. METHODS: A cross-sectional study was undertaken during presentation for military service, which is compulsory for all 18-year-old males. A questionnaire was applied, covering topics like diet, smoking habits, ethnicity, family structure, socio-economic level, as well as specific questions about active acne and resulting scars. Dermatologists conducted the clinical examination. RESULTS: A total of 2,201 male adolescents were interviewed and examined. The overall prevalence of acne scarring was 22%. The malar region was the most frequently involved, present in 80% of affected individuals, followed by the frontal region (31.5%), back (17%), anterior chest (8.2%) and mentonian region (6.4%). Correlation between the intensity of clinical acne and the presence of scars was found, but no association was observed with educational level, smoking, ethnicity, obesity or socio-economic status. CONCLUSIONS: There is a high prevalence of acne scars among this population. This is the first study to ascertain a correlation between acne scarring and factors such as socio-economic status and educational level. The direct relation between acne severity and scarring indicates that prompt and effective treatment is the best way to reduce scarring.

Test of association: which one is the most appropriate for my study?

BACKGROUND: Hypothesis tests are statistical tools widely used for assessing whether or not there is an association between two or more variables. These tests provide a probability of the type 1 error (p-value), which is used to accept or reject the null study hypothesis. OBJECTIVE: To provide a practical guide to help researchers carefully select the most appropriate procedure to answer the research question. We discuss the logic of hypothesis testing and present the prerequisites of each procedure based on practical examples.

Emotional impact of halitosis.

OBJECTIVE: To evaluate the emotional impact of halitosis on 18-year-old men using a self-reported questionnaire. METHOD: A total of 2,224 participants underwent dental and medical examinations in the army medical services in the city of Pelotas, southern Brazil, in July 2008. RESULTS: In this sample, 12% of respondents expressed concern about their oral malodor, which had a strong emotional impact on their quality of life. CONCLUSIONS: The individuals reporting halitosis showed a higher degree of concern with their oral malodor. Low educational level and low income were associated with psychological impact and halitosis in this population.

Field work I: selecting the instrument for data collection.

The selection of instruments that will be used to collect data is a crucial step in the research process. Validity and reliability of the collected data and, above all, their potential comparability with data from previous investigations must be prioritized during this phase. We present a decision tree, which is intended to guide the selection of the instruments employed in research projects. Studies conducted along these lines have greater potential to broaden the knowledge on the studied subject and contribute to addressing truly socially relevant needs.

Presenting data in tables and charts.

The present paper aims to provide basic guidelines to present epidemiological data using tables and graphs in Dermatology. Although simple, the preparation of tables and graphs should follow basic recommendations, which make it much easier to understand the data under analysis and to promote accurate communication in science. Additionally, this paper deals with other basic concepts in epidemiology, such as variable, observation, and data, which are useful both in the exchange of information between researchers and in the planning and conception of a research project.

Sample size: how many participants do I need in my research?

The importance of estimating sample sizes is rarely understood by researchers, when planning a study. This paper aims to highlight the centrality of sample size estimations in health research. Examples that help in understanding the basic concepts involved in their calculation are presented. The scenarios covered are based more on the epidemiological reasoning and less on mathematical formulae. Proper calculation of the number of participants in a study diminishes the likelihood of errors, which are often associated with adverse consequences in terms of economic, ethical and health aspects.