Assuntos
Filariose Linfática , Filaricidas , Wuchereria bancrofti , Animais , Humanos , Masculino , Filariose Linfática/complicações , Filariose Linfática/diagnóstico , Filariose Linfática/tratamento farmacológico , Filaricidas/administração & dosagem , Filaricidas/uso terapêutico , Wuchereria bancrofti/isolamento & purificação , Idoso , Resultado do Tratamento , Doxiciclina/uso terapêutico , Albendazol/administração & dosagem , Albendazol/uso terapêutico , Dietilcarbamazina/administração & dosagem , Dietilcarbamazina/uso terapêutico , Edema/etiologia , Edema/parasitologia , Pênis , Escroto , Perna (Membro) , Imageamento por Ressonância MagnéticaRESUMO
Dehydrated human amnion/chorion membrane allograft (dHACM) derived from placenta is increasingly used for skin and soft tissue repair in several medical specialties. Promising effects of dHACM were also reported in chronic venous and diabetic leg ulcers. However, dHACM is cost-intensive and its effect on chronic leg ulcers of other etiologies and pain reduction is unknown. Clinical predictors of a favorable response to dHACM during the early treatment period could help to limit unnecessary costs. In our case series with six patients suffering from chronic lower leg ulcers of various etiology, the effect of dHACM once per week on reduction of pain and wound size during a 5-week period was examined. dHACM resulted in effective pain reduction and improved wound healing in three patients with chronic leg ulcers due to calciphylaxis, chronic venous disease and reactive angioendotheliomatosis. Pain reduction after 1 to 2 applications of dHACM predicted a favorable healing response. Hence, our observation indicates that assessment of pain 3 weeks after initiation of dHACM may be a clinical predictor to justify dis-/continuation of dHACM and thereby may help to limit costs.
Assuntos
Âmnio , Úlcera da Perna , Aloenxertos , Córion , Humanos , Úlcera da Perna/diagnóstico , Úlcera da Perna/etiologia , DorRESUMO
Itch is the commonest skin-related symptom and can be influenced by visual cues as exemplified by the phenomenon of "contagious itch." Colors are visual cues able to modify somatosensory inputs. We explored the relationship of colors and itch and the impact of color viewing on itch intensity. In this cross-sectional study, patients suffering from itch with a mean intensity of ≥2 on a Numerical Rating Scale during the last 7 days were evaluated. The study consisted of a questionnaire-based part using The Manchester Color Wheel and the ItchyQoL, followed by an interventional part. All 72 itch patients were able to match their itchy sensation with a color: In 68 patients (94.4%) this "pruritic" basic color was red. Likewise, all patients were able to define a subjective "antipruritic" color: The leading basic color choice was blue (31/72, 43.0%) followed by green (21/72, 29.1%), yellow (7/72,9.7%) and others. The impairment of the itch-related quality of life (as measured by the ItchyQoL) correlated with the brightness and saturation of the pruritic and antipruritic colors. Ten patients were visually exposed to their subjective antipruritic and pruritic color during 10 minutes resulting in a significant decrease and increase of itch intensity compared to baseline (5.1 ± 1.52 vs. 2.8 ± 1.47 [0-10 Numerical Rating Scale, NRS], p=0.0004 and 4.9 ± 1.66 vs. 6.8± 2.09 NRS, p=0.0009). These results indicate that itch can be modified by color viewing and colors matter when treating itch patients. However, further investigations are required to elucidate the therapeutic potential of colors in itch patients.
Assuntos
Antipruriginosos , Qualidade de Vida , Cor , Estudos Transversais , Humanos , Projetos Piloto , Prurido/diagnósticoRESUMO
Itch is the commonest skin-related symptom, associated with a high psychosocial and economic burden. While the main focus of itch research lies on a few chronic skin diseases, only little is known about the perception of itch, itch-aggravating/-relieving factors and treatment preferences in patients with acute and chronic itch of various etiology. In this cross-sectional study, we assessed these aspects in 126 patients (mean age 61.7 ± 18.4 years, 67 females, median itch duration 3.9 years) using a 78-item questionnaire. The diseases were categorized into 11 diagnostic groups for descriptive analysis; the three most frequent groups ("atopic dermatitis," "nonatopic eczema," "inflammatory dermatoses") were statistically compared. Itch was most often perceived as localized 42.9%, burning (40.5%), and worrying (39.7%) with worsening in the evening (49.2%), due to warmth (42.1%) and sweating (26.2%). While itch perception, itch-aggravating factors and treatment preferences differed broadly among patients, the itch-relieving personal strategies were more uniform ("scratching by hand 70.6%, applying topicals 57.9%). Also, 69.8% of patients suffered from itch-related sleep disturbance, consequently affecting their relatives in 30.0%. Subgroup comparisons revealed significant differences regarding itch-aggravating factors (P = .0012) and itch duration (P = .0082). Patients rated the antipruritic effectiveness of phototherapy, "complementary and alternative medicine" and "other tablets" as high, but oral antihistamines, "cortisone tablets" and any topical as only moderately efficacious. The preferred administration of an ideal itch treatment was "creams/ointments" (51.6%) or "tablets" (35.7%), only few patients preferred "injections" or "patches." Consideration of such differences and similarities in itch characteristics and treatment preferences could help to better tailor treatment in itch patients.
Assuntos
Dermatite Atópica , Eczema , Adulto , Idoso , Idoso de 80 Anos ou mais , Antipruriginosos , Estudos Transversais , Dermatite Atópica/diagnóstico , Dermatite Atópica/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Prurido/diagnóstico , Prurido/etiologia , Prurido/terapiaRESUMO
BACKGROUND AND OBJECTIVES: Anogenital warts (AGWs) are most commonly caused by low-risk human papillomavirus (HPV) types, and although they are the most frequent viral sexually transmitted infections (STIs), little is known about STI coinfections in affected patients. We therefore sought to assess STI coinfection rates in patients with AGW, specify STI coinfections and calculate the number needed to screen (NNS) for each STI. METHODS: A retrospective cross-sectional study analyzing data sets from AGW patients treated in our clinic between 2008-2016. RESULTS: 142/196 (72 %) patients had been variably screened for infections with HIV, HBV and HCV, Treponema pallidum, Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium and HSV. The STI coinfection rate in all tested patients was 24.6 %, yielding an NNS of 4.1 to detect any STI. Of note, the coinfection rate did not differ significantly between heterosexual men, homosexual men and women, respectively. The NNS for syphilis was 8.4, for HIV 14.0, for HCV 28.5 and for HBV 39.0. The NNS for asymptomatic patients tested for HSV, Chlamydia trachomatis and Mycoplasma genitalium were 1.4, 5.3 and 12.0, respectively. CONCLUSION: Due to the high prevalence of STI coinfections, AGW patients should be screened for other STIs.
Assuntos
Coinfecção/epidemiologia , Condiloma Acuminado/epidemiologia , Infecções Sexualmente Transmissíveis/epidemiologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos RetrospectivosRESUMO
Ichthyosis with confetti (IWC) is a genodermatosis associated with dominant-negative variants in keratin 10 (KRT10) or keratin 1 (KRT1). These frameshift variants result in extended aberrant proteins, localized to the nucleus rather than the cytoplasm. This mislocalization is thought to occur as a result of the altered carboxy (C)-terminus, from poly-glycine to either a poly-arginine or -alanine tail. Previous studies on the type of C-terminus and subcellular localization of the respective mutant protein are divergent. In order to fully elucidate the pathomechanism of IWC, a greater understanding is critical. This study aimed to establish the consequences for localization and intermediate filament formation of altered keratin 10 (K10) C-termini. To achieve this, plasmids expressing distinct KRT10 variants were generated. Sequences encoded all possible reading frames of the K10 C-terminus as well as a nonsense variant. A keratinocyte line was transfected with these plasmids. Additionally, gene editing was utilized to introduce frameshift variants in exon 6 and exon 7 at the endogenous KRT10 locus. Cellular localization of aberrant K10 was observed via immunofluorescence using various antibodies. In each setting, immunofluorescence analysis demonstrated aberrant nuclear localization of K10 featuring an arginine-rich C-terminus. However, this was not observed with K10 featuring an alanine-rich C-terminus. Instead, the protein displayed cytoplasmic localization, consistent with wild-type and truncated forms of K10. This study demonstrates that, of the various 3' frameshift variants of KRT10, exclusively arginine-rich C-termini lead to nuclear localization of K10.
Assuntos
Arginina/genética , Núcleo Celular/genética , Eritrodermia Ictiosiforme Congênita/genética , Queratina-10/genética , Mutação , Transporte Ativo do Núcleo Celular/genética , Alanina/genética , Alanina/metabolismo , Arginina/metabolismo , Linhagem Celular , Núcleo Celular/metabolismo , Éxons/genética , Mutação da Fase de Leitura , Proteínas de Fluorescência Verde/genética , Proteínas de Fluorescência Verde/metabolismo , Humanos , Eritrodermia Ictiosiforme Congênita/metabolismo , Eritrodermia Ictiosiforme Congênita/patologia , Queratina-10/química , Queratina-10/metabolismo , Queratinócitos/metabolismo , Microscopia ConfocalRESUMO
Itch is the commonest skin-related symptom, and sex differences are increasingly recognised as important determinants in stratified medicine, but only little is known about sex differences in itch. Questionnaire-based studies indicated that women perceive itch as more intensive and bothersome in comparison with men. However, data of studies using standardised itch models to objectify sex differences are scarce and inconsistent. To determine sex differences in intensity, skin flares and central processing of histaminergic itch, we compared 15 female and 15 male healthy subjects in a double-blinded, within-subject, placebo-controlled study using a histamine skin prick itch model (histamine 1% applied onto the volar forearm) and functional MRI. We found trends in higher mean itch intensity (0.58 VAS, CI 95% 0.004-1.19, P = .056) and maximum itch intensity (men 3.93 VAS ± 0.39 SD at 3 minutes, women 4.73 VAS ± 0.31 SD at 4 minutes, P = .073) in women paralleled by a trend in a stronger positive correlation between itch intensity and blood oxygen level-dependent (BOLD) activity in brain structures identified during itch in comparison with men (rs in women: .46, P = .08, rs in men: .07, P = .79). The erythema and wheal following histamine skin pricking were (non-significantly) larger in men, indicating that higher mean itch intensities on the right volar forearm in women may not be explained by more intense flares. The comparison of the activation patterns between the sexes revealed increased activity in men compared to women in the left middle temporal gyrus (temporooccipital part)/lateral occipital cortex. Thus, our findings indicate that histaminergic itch perception and central itch processing differ between the sexes under standardised conditions.
Assuntos
Encéfalo/fisiopatologia , Prurido/fisiopatologia , Caracteres Sexuais , Pele/fisiopatologia , Adulto , Encéfalo/diagnóstico por imagem , Feminino , Histamina , Humanos , Imageamento por Ressonância Magnética , Masculino , Projetos Piloto , Prurido/diagnóstico por imagem , Adulto JovemRESUMO
Mechanically induced itch is an important cofactor in many patients with chronic itch. However, studying mechanical itch in a controlled environment is challenging because it is difficult to evoke. We investigated the use of whole body vibration (WBV) exercise, a training method used for musculoskeletal rehabilitation, to experimentally evoke mechanical itch. Mild to severe itch ascending from the soles to the groins was evoked in 16 of 20 healthy participants. We observed a characteristic on/off itch crescendo pattern reflecting the alternating intervals of vibration and no vibration. Wheals or an angioedema was absent, and serum mast cell tryptase was not increased by the exercise. Participants described the evoked sensation primarily as "itching" with some nociceptive components. Itch intensity correlated with the intensity of a concomitant erythema (R = 0.45, P = 0.043) and with the rise in skin temperature (R = 0.54, P = 0.017). Hence, WBV can be used as an easily applicable, noninvasive, investigator- and user-friendly framework for studying mechanical itch. Moreover, WBV allows to "switch itch on and off" rapidly and to simultaneously study interactions between itch, skin blood flow and skin temperature.
Assuntos
Prurido/etiologia , Vibração/efeitos adversos , Adulto , Estudos Transversais , Eritema , Feminino , Voluntários Saudáveis , Humanos , Percepção , Prevalência , Prurido/sangue , Prurido/epidemiologia , Temperatura Cutânea , Suíça/epidemiologia , Triptases/sangueRESUMO
BACKGROUND: Infestations with scabies mites are a global burden affecting individuals of all ages, classes and ethnicities. As poor sanitation and overcrowding favor the transmission of this highly contagious disease, epidemic outbreaks are frequently observed among displaced persons and asylum seekers. Due to the growing influx of refugees during the last years, public health authorities in host countries are frequently confronted with the challenge to treat individuals with diagnosed or suspected scabies promptly and effectively to avoid further spreading of the infestation. This study aimed to establish a straightforward and efficient algorithm for rapid screening and treatment of large numbers of patients with confirmed or suspected scabies infestations. METHODS: Forty-eight individuals (58% males, mean age 22.4 yrs.) from Syria with suspected scabies infestation were allocated to 3 colour-coded groups: (1) no signs or symptoms of infestation, (2) itch only, and (3) itch and typical skin lesions. Patients were treated with a single (group 1) or two doses of oral ivermectin at an interval of 7 days (group 2), or with a combination of 2 doses of ivermectin plus 2 applications of permethrin ointment at an interval of 7 days (group 3). Follow-ups were performed 4 weeks after initial treatments. RESULTS: All individuals with signs and/or symptoms of infestation had improved skin lesion; in 10/11 (90.9%) lesion had completely resolved. All individuals with initial itch only (n = 32) reported improvement of its intensity or complete resolution. None of the patients of group 1 developed itch or skin lesions. The algorithm was reapplied in 4 individuals (8.3%) after 4 weeks and the outbreak was completely controlled after 8 weeks. Colour-coding ensured fast flow of information between health-care providers at the interfaces of the algorithm. CONCLUSIONS: Our algorithm proved to be both highly efficient for treatment of large numbers of patients with suspected or diagnosed scabies infestation as well as for prevention of spreading of the disease. Hence, this algorithm is well suited for the management of scabies mass outbreaks.
Assuntos
Algoritmos , Escabiose/diagnóstico , Escabiose/tratamento farmacológico , Adolescente , Adulto , Idoso , Animais , Antiparasitários/administração & dosagem , Antiparasitários/uso terapêutico , Surtos de Doenças , Feminino , Pessoal de Saúde , Humanos , Lactente , Ivermectina/administração & dosagem , Ivermectina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Permetrina/administração & dosagem , Permetrina/uso terapêutico , Refugiados , Escabiose/epidemiologia , Suíça/epidemiologia , SíriaRESUMO
Psoriasis can involve the skin, joints, nails and cardiovascular system and result in a significant impairment in quality of life. Studies have shown a lower response rate to systemic anti-psoriatic therapies in smokers, and smoking is a trigger factor for psoriasis. The aim of this study was therefore to analyse the response to systemic therapies for psoriasis, with a focus on smoking. Prospectively collected data from patients with moderate to severe psoriasis included in the national psoriasis registries for Germany and Switzerland (PsoBest and SDNTT) were analysed. Therapy response was defined as reaching a Psoriasis Area and Severity Index (PASI) reduction of 75%, PASI ≤ 3 or Dermatology Life Quality Index (DLQI) ≤ 1. Out of 5,346 patients included in these registries, 1,264 met the inclusion criteria for this study. In the smoking group, 715 (60.6%) reached therapy response at month 3, compared with 358 (63.7%) in the non-smoking group (p ≤ 0.269), 659 (74.1%) vs. 330 (77%) reached therapy response at month 6 (p ≤ 0.097), and 504 (76.6%) vs. 272 (79.0%) at month 12 (p ≤ 0.611). Therefore, these data do not show that smoking affects the response rate of anti-psoriatic therapy after 3, 6 and 12 months.
Assuntos
Fármacos Dermatológicos/administração & dosagem , Psoríase/tratamento farmacológico , Fumar , Adulto , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Psoríase/diagnóstico , Qualidade de Vida , Sistema de Registros , Indução de Remissão , Índice de Gravidade de Doença , Suíça , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Approximately 80% of internet users access health information online and patients with chronic illnesses especially rely on internet-based resources. YouTube ranks second among the most accessed websites worldwide and hosts an increasing number of videos with medical information. However, their quality is sometimes unscientific, misleading, or even harmful. OBJECTIVE: As little is known about YouTube as a source of information on psoriasis, we aimed to investigate the quality of psoriasis-related videos and, if necessary, point out strategies for their improvement. METHODS: The quality of the 100 most viewed psoriasis-related videos was assessed using the DISCERN instrument and the Global Quality Scale (GQS) by categorizing the videos into useful, misleading, and dangerous and by evaluating the reception of the videos by users. RESULTS: Evaluation of the videos exhibited a total of 117,221,391 views and a total duration of 10:28 hour. The majority of clips contained anecdotal personal experiences with complementary and alternative psoriasis treatments, topical treatments, and nutrition and diets being the most frequently addressed topics. While advertisements accounted for 26.0% (26/100) of the videos, evidence-based health information amounted to only 20.0% (20/100); 32.0% (32/100) of the videos were classified as useful, 52.0% (52/100) as misleading, and 11.0% (11/100) as even dangerous. The quality of the videos evaluated by DISCERN and GQS was generally low (1.87 and 1.95, respectively, on a 1 to 5 scale with 5 being the maximum). Moreover, we found that viewers rated poor-quality videos better than higher quality videos. CONCLUSIONS: Our in-depth study demonstrates that nearly two-thirds of the psoriasis-related videos we analyzed disseminate misleading or even dangerous content. Subjective anecdotal and unscientific content is disproportionately overrepresented and poor-quality videos are predominantly rated positively by users, while higher quality video clips receive less positive ratings. Strategies by professional dermatological organizations are urgently needed to improve the quality of information on psoriasis on YouTube and other social media.
Assuntos
Coleta de Dados/métodos , Estilo de Vida Saudável/fisiologia , Psoríase/epidemiologia , Mídias Sociais/normas , Gravação em Vídeo/métodos , Estudos Transversais , Humanos , InternetRESUMO
The Interdisciplinary Stomatology Service at the Department of Oral Surgery and Dental Imaging, University Center for Dental Medicine and the University Hospital Basel, Switzerland - Results from 2003 - 2013 Abstract. Stomatological problems are common, but rarely diagnosed in private dental practice. Even for oral surgeon's diagnosis and therapy of these disorders could be challenging. Stomatological problems can indicate general health problems. Hence, the oral cavity is also known as the «mirror of systemic diseases¼. To tackle this problem, an interdisciplinary stomatological service in a specialized dental clinic was established in 1999 at the Center for Dental Medicine, University of Basel, Switzerland. A board of specialists (Dermatologists, Otorhinolaryngologists, Oral- and Maxillofacial surgeons) was summoned monthly to perform interdisciplinary consultations of selected patients with complex oral and medical disorders. The specific knowledge of each specialist helped to ensure a diagnosis, even of rare systemic disorders and symptoms. Networking with a variety of specialists built the foundation for synoptic therapy approaches. Thus, the center was able to provide appropriate care for patients suffering from severe, chronic and complex stomatological findings. The results presented in this article are part of a dissertation based on the analysis of 154 patients who were seen in the interdisciplinary consultations in 2003 - 2013.
Assuntos
Medicina Bucal , Hospitais Universitários , Humanos , Encaminhamento e Consulta , SuíçaRESUMO
Adams-Oliver syndrome (AOS) is a rare developmental disorder, characterized by scalp aplasia cutis congenita (ACC) and transverse terminal limb defects (TTLD). Autosomal dominant forms of AOS are linked to mutations in ARHGAP31, DLL4, NOTCH1 or RBPJ, while DOCK6 and EOGT underlie autosomal recessive inheritance. Data on the frequency and distribution of mutations in large cohorts are currently limited. The purpose of this study was therefore to comprehensively examine the genetic architecture of AOS in an extensive cohort. Molecular diagnostic screening of 194 AOS/ACC/TTLD probands/families was conducted using next-generation and/or capillary sequencing analyses. In total, we identified 63 (likely) pathogenic mutations, comprising 56 distinct and 22 novel mutations, providing a molecular diagnosis in 30% of patients. Taken together with previous reports, these findings bring the total number of reported disease variants to 63, with a diagnostic yield of 36% in familial cases. NOTCH1 is the major contributor, underlying 10% of AOS/ACC/TTLD cases, with DLL4 (6%), DOCK6 (6%), ARHGAP31 (3%), EOGT (3%), and RBPJ (2%) representing additional causality in this cohort. We confirm the relevance of genetic screening across the AOS/ACC/TTLD spectrum, highlighting preliminary but important genotype-phenotype correlations. This cohort offers potential for further gene identification to address missing heritability.
Assuntos
Displasia Ectodérmica/genética , Deformidades Congênitas dos Membros/genética , Dermatoses do Couro Cabeludo/congênito , Proteínas rho de Ligação ao GTP/genética , Displasia Ectodérmica/fisiopatologia , Extremidades/fisiopatologia , Feminino , Estudos de Associação Genética , Humanos , Deformidades Congênitas dos Membros/fisiopatologia , Masculino , Mutação , Linhagem , Receptores Notch/genética , Couro Cabeludo/fisiopatologia , Dermatoses do Couro Cabeludo/genética , Dermatoses do Couro Cabeludo/fisiopatologiaRESUMO
Adams-Oliver syndrome (AOS) is a rare developmental disorder characterized by the presence of aplasia cutis congenita (ACC) of the scalp vertex and terminal limb-reduction defects. Cardiovascular anomalies are also frequently observed. Mutations in five genes have been identified as a cause for AOS prior to this report. Mutations in EOGT and DOCK6 cause autosomal-recessive AOS, whereas mutations in ARHGAP31, RBPJ, and NOTCH1 lead to autosomal-dominant AOS. Because RBPJ, NOTCH1, and EOGT are involved in NOTCH signaling, we hypothesized that mutations in other genes involved in this pathway might also be implicated in AOS pathogenesis. Using a candidate-gene-based approach, we prioritized DLL4, a critical NOTCH ligand, due to its essential role in vascular development in the context of cardiovascular features in AOS-affected individuals. Targeted resequencing of the DLL4 gene with a custom enrichment panel in 89 independent families resulted in the identification of seven mutations. A defect in DLL4 was also detected in two families via whole-exome or genome sequencing. In total, nine heterozygous mutations in DLL4 were identified, including two nonsense and seven missense variants, the latter encompassing four mutations that replace or create cysteine residues, which are most likely critical for maintaining structural integrity of the protein. Affected individuals with DLL4 mutations present with variable clinical expression with no emerging genotype-phenotype correlations. Our findings demonstrate that DLL4 mutations are an additional cause of autosomal-dominant AOS or isolated ACC and provide further evidence for a key role of NOTCH signaling in the etiology of this disorder.
Assuntos
Displasia Ectodérmica/genética , Displasia Ectodérmica/patologia , Peptídeos e Proteínas de Sinalização Intercelular/genética , Deformidades Congênitas dos Membros/genética , Deformidades Congênitas dos Membros/patologia , Mutação/genética , Dermatoses do Couro Cabeludo/congênito , Transdução de Sinais/genética , Proteínas Adaptadoras de Transdução de Sinal , Sequência de Aminoácidos , Sequência de Bases , Proteínas de Ligação ao Cálcio , Heterozigoto , Humanos , Dados de Sequência Molecular , Linhagem , Receptores Notch/genética , Dermatoses do Couro Cabeludo/genética , Dermatoses do Couro Cabeludo/patologia , Análise de Sequência de DNARESUMO
The skin and brain have a close bi-directional anatomical and functional connection. Historically, the skin-brain axis and the brain-skin axis have been well described. However, brain function in this context has only recently been demystified with the introduction of functional neuroimaging in dermatology. Functional neuroimaging, especially functional magnetic resonance imaging (fMRI), allows indirect visualisation of brain function. This review looks back to the beginnings of functional neuroimaging in dermatology, summarises the currently available dermatology-related fMRI studies and discusses the potential future role of fMRI as a stratifying tool in clinical dermatology and in the development of novel therapies. According to the main body of research made in this field, the focus is placed on experimental itch studies, which described the brain structures involved in itch processing, the regulation of the scratch response, contagious itch and itch suppression.
Assuntos
Encéfalo/diagnóstico por imagem , Neuroimagem Funcional , Imageamento por Ressonância Magnética , Prurido/tratamento farmacológico , Prurido/fisiopatologia , Encéfalo/fisiologia , Delírio de Parasitose/diagnóstico por imagem , Humanos , Prurido/psicologia , Psoríase/diagnóstico por imagem , Psoríase/psicologia , Fenômenos Fisiológicos da PeleRESUMO
Proteases are important for wound healing, but in excessive amounts or left uncontrolled, they may cause healing impairment or other severe wound complications. Point-of-care testing for protease activities in wounds may be useful for monitoring the effectiveness of treatment, and for early identification of wounds that potentially fail to heal. Here we describe an easy, noninvasive method to collect wound fluid for evaluating the protease milieu of wounds. Wound fluids were collected using sterile sponges applied between wound surface and normal wound dressing. Wound fluid could be easily squeezed or centrifuged out of the sponges and was tested for gelatinase (MMP-2 and MMP-9) activities by gel zymography. In addition, we measured polymorphonuclear granulocyte elastase levels by ELISA. Both gelatinases were remarkably stable in sponge derived fluids, as no significant loss was observed even when samples were stored for 3 days at room temperature. Protease levels were highly diverse amongst patients and, in some cases, showed substantial variations in the course of the treatment. The here described wound sponge approach represents a patient-friendly and reliable method to collect wound fluid for evaluating wound healing relevant biomarkers, such as matrix metalloproteinases.
Assuntos
Exsudatos e Transudatos/enzimologia , Peptídeo Hidrolases/metabolismo , Tampões de Gaze Cirúrgicos , Úlcera/enzimologia , Cicatrização/fisiologia , Idoso , Idoso de 80 Anos ou mais , Eletroforese em Gel de Poliacrilamida , Exsudatos e Transudatos/metabolismo , Feminino , Humanos , Masculino , Metaloproteinase 2 da Matriz , Metaloproteinase 9 da Matriz , Pessoa de Meia-Idade , Reprodutibilidade dos TestesRESUMO
BACKGROUND/AIMS: Topical corticosteroid concerns (TCC) are an important issue in patients with atopic dermatitis, leading to non-adherence with poor disease control and increased health care costs. However, neither the prevalence of TCC in a more comprehensible dermatological population nor the impact of patient information on topical corticosteroids given by clinicians is known. Therefore, we assessed the prevalence, characteristics, and sources of TCC in a dermatological population and the impact of written and oral patient information on TCC. METHODS: A total of 643 outpatients with various skin diseases answered a 12-item questionnaire while waiting for the doctor's visit. Patients with TCC quantified their concerns on a discrete visual analogue scale before and after patient information, which consisted of written and oral information about topical corticosteroids (TCS) given by dermatologists. RESULTS: The prevalence of TCC was 41.5%, and that of TCC-related non-adherence was 28.3%. TCC was positively associated with age <60 years, female gender, use of complementary and alternative medicine (CAM) and non-physician health care profession. The leading concerns were skin atrophy, systemic effects, and impairment of the immune system. The most frequent sources of TCC were negative reports by media, family, or friends. Both written and oral patient information significantly reduced TCC. The number needed to benefit from patient information was approximately 2. Non-responders were more often female, TCS-inexperienced, and users of CAM with an intermediate level of education. CONCLUSIONS: TCC are highly prevalent in dermatological patients. Patient information may lower TCC in almost every second patient.
Assuntos
Dermatite Atópica/tratamento farmacológico , Glucocorticoides/administração & dosagem , Cooperação do Paciente , Pele/patologia , Administração Tópica , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos Transversais , Dermatite Atópica/diagnóstico , Dermatite Atópica/epidemiologia , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Inquéritos e Questionários , Suíça/epidemiologia , Fatores de Tempo , Adulto JovemRESUMO
Psoriasis vulgaris is a common, chronic inflammatory skin disease with a prevalence of 1.5-2% in Western industrialized countries. A relevant percentage of patients suffer from moderate-to-severe psoriasis and experience a significant reduction in quality of life. The choice of an adequate therapy could help to prevent disease and exacerbation of comorbidity, which could increase quality of life, avoid hospitalization and avoid reduction of working days. The present guidelines are focused on the initiation and management of systemic therapies in cases of moderate-to-severe plaque-type psoriasis in adults to optimize treatment response, adherence and quality of life. This first version of the Swiss S1 guidelines presents therapeutic recommendations which are based on a systematic literature search as well as an informal expert consensus of dermatologists in Switzerland.
Assuntos
Fatores Biológicos/uso terapêutico , Dermatologia/normas , Glucocorticoides/uso terapêutico , Imunossupressores/uso terapêutico , Psoríase/tratamento farmacológico , Sociedades Médicas , Acitretina/uso terapêutico , Ciclosporina/uso terapêutico , Fumaratos/uso terapêutico , Humanos , Suíça , Talidomida/análogos & derivados , Talidomida/uso terapêuticoRESUMO
BACKGROUND: The Swiss psoriasis registry SDNTT (Swiss Dermatology Network for Targeted Therapies) records the long-term safety and effectiveness of systemic treatment regimens for psoriasis. PATIENTS AND METHODS: Patients with moderate to severe psoriasis are included in the SDNTT when treatment with a conventional systemic agent or biologic is initiated that was not previously used by the respective patient. Patients are followed over a 5-year period. Clinical data are obtained every 3-6 months using standardized case report forms. Here, baseline data and follow-up data for 1 year of patients included from October 2011 until December 2014 were analyzed. RESULTS: Within 39 months, 323 patients from 7 tertiary dermatology centers in Switzerland were recruited in the SDNTT; 165 patients received biologics and 158 conventional systemic therapies. Patients treated with biologics had a significantly higher severity (PASI 11.3 vs. 9.2, BSA 15.6 vs.11.9, psoriatic arthritis 36.4 vs. 10.8%; p ≤ 0.005, p ≤ 0.013, p ≤ 0.001) and a longer duration of illness (19.2 vs. 14.4 years, p ≤ 0.003) compared to patients starting a conventional systemic treatment. PASI reduction was satisfying in both treatment groups, with 60.6% of patients treated with biologics achieving PASI75 after 1 year compared to 54.2% of patients receiving conventional systemic drugs (nonsignificant). On average, the drug survival in patients receiving a biologic therapy was significantly longer than those receiving conventional systemic treatments (30.5 vs. 19.2 months, p ≤ 0.001). CONCLUSIONS: In the real-world setting of a prospective national therapy registry, the application of current therapeutic guidelines for patients with moderate to severe psoriasis resulted in a PASI reduction of approximately 70% within the first year of treatment, but current therapeutic targets of PASI75 and PASI90 were reached in only 58 and 36% of patients, respectively, at 1 year, highlighting a gap in efficacy between selective clinical trials and the real-world setting.