RESUMO
INTRODUCTION: The Psoriasis Area Severity Index (PASI) is the most widely used scale for assessing the severity of psoriasis and for therapeutic decision making. On the basis of the PASI score, patients have been stratified into 2 groups: mild disease and moderate-to-severe disease. OBJECTIVE: To draft a proposal for the definition and characterization of moderate psoriasis based on PASI and Dermatology Life Quality Index (DLQI) scores. MATERIAL AND METHODS: A group of 6 dermatologists with experience in the treatment of psoriasis undertook a critical review of the literature and a discussion of cases to draft a proposal. RESULTS: In order of priority, PASI, DLQI, and body surface area (BSA) are the parameters to be used in daily practice to classify psoriasis as mild, moderate, or severe. Severity should be assessed on the basis of a combined evaluation and interpretation of the PASI and DLQI. And 3, PASI and DLQI should carry equal weight in the determination of disease severity. On this basis, psoriasis severity was defined using the following criteria: mild, PASI<7 and DLQI<7; moderate, PASI=7-15 and DLQI=5-15 (classified as severe when difficult-to-treat sites are affected or when there is a significant psychosocial impact); severe, PASI >15, independently of the DLQI score. CONCLUSIONS: A more precise classification of psoriasis according to disease severity will improve the risk-benefit assessment essential to therapeutic decision making in these patients.
Assuntos
Psoríase , Índice de Gravidade de Doença , Consenso , Humanos , Psoríase/classificação , Psoríase/patologia , Psoríase/psicologia , Qualidade de Vida , Medição de Risco , Inquéritos e Questionários , Avaliação de SintomasAssuntos
Anticorpos Monoclonais Humanizados/administração & dosagem , Conjuntivite/epidemiologia , Dermatite Atópica/tratamento farmacológico , Prurido/tratamento farmacológico , Adolescente , Adulto , Idoso , Anticorpos Monoclonais Humanizados/efeitos adversos , Conjuntivite/induzido quimicamente , Conjuntivite/imunologia , Dermatite Atópica/complicações , Dermatite Atópica/diagnóstico , Dermatite Atópica/imunologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prurido/diagnóstico , Prurido/imunologia , Qualidade de Vida , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto JovemAssuntos
Fármacos Dermatológicos/administração & dosagem , Fibromatose Agressiva/tratamento farmacológico , Metotrexato/administração & dosagem , Psoríase/complicações , Adolescente , Feminino , Fibromatose Agressiva/complicações , Humanos , Psoríase/tratamento farmacológico , Indução de Remissão/métodosRESUMO
Secukinumab, an immunoglobulin G1/κ monoclonal antibody that selectively targets interleukin 17a, is used to treat moderate to severe plaque psoriasis in adults who are eligible for systemic treatment. Indirect comparisons of the efficacy of secukinumab, ustekinumab, and anti-tumor necrosis factor agents have found lower drug survival rates for patients on secukinumab, in spite of that biologic's rapid onset of action and efficacy as demonstrated by the large number of patients reaching a Psoriasis Area and Severity Index of 90 or 100. We present data from a retrospective study of 171 patients treated with doses of 300mg or 150mg of secukinumab every 4 weeks in 5 hospitals in the Spanish autonomous community of Andalusia. Eighty-seven percent continued on treatment at 132 weeks, contrasting with reports from previously published case series.
Assuntos
Anticorpos Monoclonais Humanizados , Preparações Farmacêuticas , Adulto , Humanos , Estudos Retrospectivos , Índice de Gravidade de DoençaRESUMO
Tineabarbae is a rare form of dermatophytosis that affects hair follicles of the beard and moustache. Dermoscopy could prove useful to identify parasitism of hair of the beard, just as it has proven useful in the diagnosis of Tineacapitis. We present the first fully documented case series of T. barbae with clinical, dermoscopic and mycological features.
Assuntos
Dermoscopia/métodos , Dermatoses Faciais/diagnóstico , Microscopia/métodos , Tinha/diagnóstico , Adulto , Dermoscopia/normas , Diagnóstico Diferencial , Face , Dermatoses Faciais/microbiologia , Cabelo/microbiologia , Humanos , Masculino , Microscopia/normas , Pessoa de Meia-Idade , Couro Cabeludo/microbiologia , Tinha/microbiologiaRESUMO
INTRODUCTION: Clinical expression of psoriasis is in part dependent on external factors, such as drugs, microorganisms or stress. However convincing evidence of the role of Malassezia species in the pathogenesis of the psoriasis is still lacking. PATIENTS AND METHODS: Samples taken from scalp skin of 40 psoriatic patients and the same number of healthy individuals were observed under direct microsocopic examination and cultured on modified Dixon agar. RESULTS: Direct microscopy examination of psoriatic scalp scales was positive in 30 (75%) patients; while it was positive in only 12 (30%) healthy subjects (P=0.003). Half of the cultures from healthy subjects showed no growth of colonies, but only 8 (15%) of psoriatic patients were negative. When an exacerbation has occurred in the previous weeks, pseudohyphaes were observed in 12 (40%) patients, Malassezia globosa was isolated in 18 (45%) patients and Malassezia restricta was isolated in 12 (30%) patients. In the group of patients having stable lesion, without any exacerbation in the previous weeks, no pseudohypahes were observed, M. globosa was not isolated, M. restricta was isolated in 4 (10%), and cultures were negative in 6 of them (15%). CONCLUSIONS: Malassezia species form an integral part of normal cutaneous microflora in humans, however we found that during the episodes of exacerbation of the disease the presence of these yeasts, and particularly M. globosa, was increased.
Assuntos
Dermatomicoses/complicações , Malassezia/fisiologia , Psoríase/microbiologia , Couro Cabeludo/microbiologia , Adolescente , Adulto , Idoso , Dermatomicoses/epidemiologia , Dermatomicoses/microbiologia , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psoríase/epidemiologia , Psoríase/patologia , Couro Cabeludo/patologia , Adulto JovemAssuntos
Neurofibroma Plexiforme/diagnóstico , Neurofibromatose 1/diagnóstico , Neoplasias Cutâneas/diagnóstico , Neoplasias de Tecidos Moles/diagnóstico , Adolescente , Feminino , Humanos , Perna (Membro) , Neurofibroma Plexiforme/complicações , Neurofibroma Plexiforme/patologia , Neurofibromatose 1/complicações , Neurofibromatose 1/patologia , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/patologia , Neoplasias de Tecidos Moles/complicações , Neoplasias de Tecidos Moles/patologiaRESUMO
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Humanos , Vitamina B 12/sangue , Dermatite Esfoliativa/sangue , Síndromes Paraneoplásicas/sangue , Fatores de Risco , Biomarcadores Tumorais/sangueRESUMO
INTRODUCCIÓN: El Psoriasis Area Severity Index (PASI) es la escala de medida más utilizada para la valoración de la gravedad de la psoriasis y la toma de decisión para la indicación de tratamiento. Atendiendo a su valor se han diferenciado 2 grupos de pacientes: psoriasis leve y moderada-grave. OBJETIVO: Elaborar una propuesta para la definición y caracterización de la psoriasis moderada mediante el PASI y el DLQI. Material y métodos Un grupo de 6 dermatólogos con experiencia en tratar psoriasis planteó la revisión crítica de la literatura y discusión de casos clínicos para elaborar una propuesta. RESULTADOS: 1) PASI, DLQI y BSA son, en orden de prioridad, los parámetros a emplear en la práctica clínica para la clasificación de la psoriasis leve, moderada y grave; 2) la evaluación de la gravedad debe incluir la evaluación e interpretación conjunta del PASI y del DLQI; y 3) la evaluación del PASI y del DLQI debería tener igual relevancia a la hora de determinar la gravedad de la psoriasis. Conforme a esto, se definieron los siguientes criterios de caracterización de psoriasis: a) leve: PASI<7 y DLQI<7; b) moderada: PASI 7-15 y DLQI 5-15 (grave en caso de localizaciones de difícil acceso para tratamientos o que supongan impacto psicosocial importante); y c) grave: PASI>15, independientemente de la puntuación DLQI. CONCLUSIONES: Una mejor caracterización de los pacientes en función de su gravedad permitirá una mejora del balance de riesgos y beneficios en el que se fundamente la toma de decisiones terapéuticas
INTRODUCTION: The Psoriasis Area Severity Index (PASI) is the most widely used scale for assessing the severity of psoriasis and for therapeutic decision making. On the basis of the PASI score, patients have been stratified into 2 groups: mild disease and moderate-to-severe disease. OBJECTIVE: To draft a proposal for the definition and characterization of moderate psoriasis based on PASI and Dermatology Life Quality Index (DLQI) scores. MATERIAL AND METHODS: A group of 6 dermatologists with experience in the treatment of psoriasis undertook a critical review of the literature and a discussion of cases to draft a proposal. RESULTS: In order of priority, PASI, DLQI, and body surface area (BSA) are the parameters to be used in daily practice to classify psoriasis as mild, moderate, or severe. Severity should be assessed on the basis of a combined evaluation and interpretation of the PASI and DLQI. And 3, PASI and DLQI should carry equal weight in the determination of disease severity. On this basis, psoriasis severity was defined using the following criteria: mild, PASI<7 and DLQI<7; moderate, PASI=7-15 and DLQI=5-15 (classified as severe when difficult-to-treat sites are affected or when there is a significant psychosocial impact); severe, PASI >15, independently of the DLQI score. CONCLUSIONS: A more precise classification of psoriasis according to disease severity will improve the risk-benefit assessment essential to therapeutic decision making in these patients
Assuntos
Humanos , Psoríase/classificação , Índice de Gravidade de Doença , Reprodutibilidade dos Testes , Qualidade de Vida , Perfil de Impacto da Doença , Técnicas de Apoio para a DecisãoRESUMO
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