Body dysmorphic disorder among dermatologic patients: Prevalence and clinical features.

BACKGROUND: An impairing preoccupation with a nonexistent or slight defect in appearance is the core symptom of body dysmorphic disorder (BDD), a psychiatric condition common in dermatology settings. OBJECTIVE: We sought to determine the prevalence of BDD in dermatologic patients, comparing general and cosmetic settings, and describing some demographic and clinical characteristics. METHODS: In all, 300 patients were consecutively assessed. Screening and diagnoses were performed with validated instruments plus a best estimate diagnosis procedure. The final sample comprised 150 patients in the cosmetic group, 150 patients in the general dermatology group, and 50 control subjects. Standard statistical analyses were performed (chi(2), nonparametric tests, logistic regression). RESULTS: The current prevalence was higher in the cosmetic group (14.0%) compared with general (6.7%) and control (2.0%) groups. No patient had a previous diagnosis. Frequently the reason for seeking dermatologic treatment was not the main BDD preoccupation. Patients with BDD from the cosmetic group were in general unsatisfied with the results of dermatologic treatments. LIMITATIONS: Cross-sectional study conducted in a university hospital is a limitation. It is uncertain if the findings can be generalized. Retrospective data regarding previous treatments are not free from bias. CONCLUSIONS: BDD is relatively common in a dermatologic setting, especially among patients seeking cosmetic treatments. These patients have some different features compared with general dermatology patients. Dermatologists should be aware of the clinical characteristics of BDD to identify and refer these patients to mental health professionals.

Atopic dermatitis in adults: evaluation of peripheral blood mononuclear cells proliferation response to Staphylococcus aureus enterotoxins A and B and analysis of interleukin-18 secretion.

BACKGROUND: Atopic dermatitis (AD) is a chronic, inflammatory skin disease with a high prevalence and complex pathogenesis. The skin of AD patients is usually colonized by Staphylococcus aureus (S. aureus); its exotoxins may trigger or enhance the cutaneous inflammation. Several mediators are related to the AD immune imbalance and interleukin-18 (IL-18), an inflammatory cytokine, may play a role in the atopic skin inflammation. AIMS: To evaluate peripheral blood mononuclear cells (PBMC) proliferation response to staphylococcal enterotoxins A (SEA) and B (SEB) and the levels of IL-18 in adults with AD. METHODS: Thirty-eight adult patients with AD and 33 healthy controls were analysed. PBMC were stimulated with SEA and SEB, phytohemaglutinin (PHA), pokeweed (PWM), tetanus toxoid (TT) and Candida albicans (CMA). IL-18 secretion from PBMC culture supernatants and sera were measured by ELISA. RESULTS: A significant inhibition of the PBMC proliferation response to SEA, PHA, TT and CMA of AD patients was detected (P < or = 0.05). Furthermore, increased levels of IL-18 were detected both in sera and non-stimulated PBMC culture supernatants from AD patients (P < or = 0.05). CONCLUSIONS: A decreased PBMC proliferation response to distinct antigens and mitogens (TT, CMA, SEA and PHA) in adults with AD suggest a compromised immune profile. IL-18 secretion from AD upon stimulation was similar from controls, which may indicate a diverse mechanism of skin inflammation maintained by Staphylococcus aureus. On the other hand, augmented IL-18 secretion from AD sera and non-stimulated cell culture may enhance the immune dysfunction observed in AD, leading to constant skin inflammation.

Increased circulating pro-inflammatory cytokines and imbalanced regulatory T-cell cytokines production in chronic idiopathic urticaria.

The immunologic characterization of chronic idiopathic urticaria (CIU), mainly regarding cytokine profile needs more investigation. We examined circulating inflammatory cytokine levels, T-cell induced secretion, and cytokine mRNA expression in patients with CIU subjected to the intradermal autologous serum skin test (ASST). Increased levels of circulating pro-inflammatory cytokines, such as TNF-alpha, IL-1beta, IL-12p70, and IL-6 have been observed in most of patients with CIU, together with an enhancement of IL-2 secretion following T-cell stimulation. Highlighting the inflammatory profile in CIU found in ASST positive, is the enhanced B-cell proliferative responsiveness and increased IL-17 secretion levels. ASST-positive patients also exhibited impaired IL-4 secretion associated with increased IL-10 production. Altered cytokine expression in patients with ASST-negative, was the down-modulation of spontaneous IL-10 mRNA expression levels in peripheral blood mononuclear cells. Our findings support the concept of immunologic dysregulation in CIU, revealing a systemic inflammatory profile associated with disturbed cytokine production by T cells, mainly related to IL-17 and IL-10 production.

Oral lesions in lupus erythematosus: correlation with cutaneous lesions.

Oral lesions in the context of lupus erythematosus (LE) have long been described. However, definitive agreement on about the exact nature and correct classification of these manifestations is lacking in published studies. Controversy exists on the significance of oral LE lesions regarding patient outcome. In this article, medical and dental literature on clinical and histopathological aspects of oral LE lesions are reviewed and critically discussed. A clinico-pathological correlation of oral lesions (interface mucositis-lupus mucositis) with cutaneous lesions (interface dermatitis-lupus dermatitis) is established, for those represent the mucosal counterparts of cutaneous LE. Validity about widely used but imprecise terms such as "oral ulcers", "ulcerative plaques", and others, in the context of LE, is discussed, and the uncertain relationship of these alterations to systemic disease with a worse outcome is commented. Furthermore, insights about the nature, differential diagnosis, and prognosis of oral lesions in LE patients are presented.

Prevalence of depression and anxiety disorders in hospitalized patients at the dermatology clinical ward of a university hospital.

BACKGROUND: The objective of this study was to estimate the prevalence of depression and anxiety disorders in hospitalized patients at the dermatology ward at a university hospital in São Paulo, Brazil. OBJECTIVE: To assess the prevalence of mood and anxiety disorders in hospitalized patients at the dermatology ward at a university hospital in São Paulo. METHOD: A total of 75 patients, men and women, aged between 18 and 76 years, took part in the research. The study employed a descriptive, cross sectional and correlational method. The data was collected by means of a social demographic questionnaire and the PRIME-MD. RESULTS: It was found that 45.3 percent of the subjects presented with depressive symptoms, and 52 percent presented with symptoms of anxiety and that this survey showed moderate and high significant correlations (p<0,01; r= 0,616) for depression and anxiety. CONCLUSION: These facts could evidence the relationship between physical and psyche, just as the literature presents.

Livedoid vasculopathy as a coagulation disorder.

Livedoid vasculopathy is an occlusive cutaneous disease of the dermal vessels with pauci-inflammatory or non-inflammatory histopathology findings. It is characterized by the presence of macules or papules, erythemato-purpuric lesions located on the legs, especially on the ankles and feet, which produce ulcerations that are intensely painful and originate ivory atrophic scars called "atrophie blanche". In this review article, studies on LV from the literature are analyzed, and their etiopathogenic associations, particularly those related to the thrombophilic states, as well as the pathologic findings and therapeutic approaches applied in the difficult clinical management of these cases, are evaluated.

Livedoid vasculopathy: an intringuing cutaneous disease.

Livedoid vasculopathy is a skin disease that occludes the blood vessels of the dermis. It has a pauciinflammatory or non-inflammatory nature. It is characterized by the presence of macular or papular, erythematous-purpuric lesions affecting the legs, especially the ankles and feet, and producing intensely painful ulcerations, which cause white atrophic scars called "atrophie blanche". This review includes studies and case reports found in the medical literature regarding the etiopathogenic associations of the disease, particularly those related to thrombophilia, their histopathological findings and the therapeutic approaches used in the difficult clinical management of these cases.

Prevalence of depression and anxiety disorders in hospitalized patients at the dermatology clinical ward of a university hospital / Prevalência de depressão e ansiedade em pacientes hospitalizados na enfermaria da clínica de dermatologia de um hospital universitário

BACKGROUND: The objective of this study was to estimate the prevalence of depression and anxiety disorders in hospitalized patients at the dermatology ward at a university hospital in São Paulo, Brazil. OBJECTIVE: To assess the prevalence of mood and anxiety disorders in hospitalized patients at the dermatology ward at a university hospital in São Paulo. METHOD: A total of 75 patients, men and women, aged between 18 and 76 years, took part in the research. The study employed a descriptive, cross sectional and correlational method. The data was collected by means of a social demographic questionnaire and the PRIME-MD. RESULTS: It was found that 45.3 percent of the subjects presented with depressive symptoms, and 52 percent presented with symptoms of anxiety and that this survey showed moderate and high significant correlations (p<0,01; r= 0,616) for depression and anxiety. CONCLUSION: These facts could evidence the relationship between physical and psyche, just as the literature presents.

FUNDAMENTOS: O presente estudo teve como objetivo verificar a freqüência de depressão e ansiedade em pacientes internados na Divisão da Clínica de Dermatologia de um hospital universitário de São Paulo. OBJETIVO: Avaliar a prevalência de depressão e ansiedade em pacientes hospitalizados na enfermaria da clínica de dermatologia de um hospital universitário em São Paulo. MÉTODO: Participaram da pesquisa 75 sujeitos, homens e mulheres, entre 18 e 76 anos. O delineamento do estudo foi transversal e descritivo. Os instrumentos utilizados foram Entrevista Sócio Demográfica e PRIME-MD. RESULTADOS: Identificou-se a presença de depressão em 45,3% e de ansiedade em 52% dos pacientes avaliados. CONCLUSÃO: Verificou-se correlação moderada e altamente significativa (p<0,01; r =0,616) para os índices de depressão e ansiedade, que pode evidenciar a relação entre adoecimento físico e psíquico muito encontrada na literatura.

Vasculopatia livedoide: uma doença cutânea intrigante / Livedoid vasculopathy: an intringuing cutaneous disease

A vasculopatia livedoide é uma afecção cutânea oclusiva dos vasos sanguíneos da derme, de caráter pauci-inflamatório ou não-inflamatório. Caracteriza-se pela presença de lesões maculosas ou papulosas, eritêmato-purpúricas, nas pernas, especialmente nos tornozelos e pés, as quais produzem ulcerações intensamente dolorosas, que originam cicatrizes atróficas esbranquiçadas, denominadas "atrofia branca". Nesta revisão, abordamos os estudos e relatos de caso da literatura médica referentes às associações etiopatogênicas da doença, particularmente as que se referem aos estados de trombofilia, seus achados histopatológicos e abordagens terapêuticas empregadas na difícil condução clínica destes casos.

Livedoid vasculopathy is a skin disease that occludes the blood vessels of the dermis. It has a pauciinflammatory or non-inflammatory nature. It is characterized by the presence of macular or papular, erythematous-purpuric lesions affecting the legs, especially the ankles and feet, and producing intensely painful ulcerations, which cause white atrophic scars called "atrophie blanche". This review includes studies and case reports found in the medical literature regarding the etiopathogenic associations of the disease, particularly those related to thrombophilia, their histopathological findings and the therapeutic approaches used in the difficult clinical management of these cases.

Avaliação da circulação arterial pela medida do índice tornozelo/braço em doentes de úlcera venosa crônica / Evaluation of arterial circulation using the ankle/brachial blood pressure index in patients with chronic venous ulcers

FUNDAMENTOS: As úlceras venosas dos membros inferiores são freqüentes e têm grande impacto na qualidade de vida e produtividade do indivíduo, além de alto custo para a saúde pública. OBJETIVOS: Detecção de alterações arteriais em pacientes de úlcera venosa crônica dos membros inferiores com emprego de método não invasivo, de modo a discriminar aqueles em que estaria contra-indicado o tratamento compressivo. MÉTODOS: Foram estudados 40 doentes portadores de úlcera venosa crônica, com o intuito de se avaliar a presença de doença arterial periférica pela medida do índice tornozelo/braço por doppler-ultra-som. RESULTADOS: O índice tornozelo/braço mostrou-se alterado (menor que 1) em 9/22 (40,9 por cento) doentes com úlcera venosa crônica e hipertensão arterial concomitante, e apenas em 1/13 (7,7 por cento) doentes de úlcera venosa crônica sem hipertensão arterial. CONCLUSÕES: Doentes de úlcera venosa crônica e hipertensão arterial concomitantes devem ser submetidos rotineiramente à medida do índice tornozelo/braço para detecção de possível insuficiência arterial periférica associada.

Anatomopatologia e imunofluorescencia direta e indireta das lesoes de penfigo foliaceo endemico resistentes a corticoterapia / Anatomophatology and direct and indirect immunofluorescence of lesions of pemphigus foliaceous endemic resistent to corticoid therapy

Sao estudados 16 doentes de penfigo foliaceo endemico (PFE), sob tratamento com corticosteroides, que ainda apresentavam lesoes eritemato-papulo-verrucosas, geralmente hiperpigmentadas, que foram caracterizadas como lesoes resistentes a corticoterapia (LRC). O estudo destas lesoes foi feito atraves de anatomopatologia de imunofluorescencia direta (IFD). Anatomopatologicamente essas lesoes mostraram tendencia a hiperplasia epitelial e clivagem em niveis variaveis na epiderme o que difere dos achados nas lesoes recentes do PFE e coincide com os achados nas lesoes cronicas do PFE da era pre-corticoide. A IFD da pele lesada foi positivada para IgG em 93,75 por cento dos casos, como ocorre nas fases iniciais do PFE, tendo sido negativa no unico caso em que nao houve clivagem. Adicionalmente, em oito desses doentes, foram estudados a IFD da pele sa e a imunofluorescencia indireta (IFI). A IFD foi positiva em tres destes casos e a IFI foi negativa nos oito.

Histoplasmin reaction: comparison of a polysaccharide antigen to the filtrate antigen

O estudo envolve a comparaçäo entre o antigeno polissacaridico de Histoplasma capsulatum com a histoplasmina classica em inquerito epidemiologico, atraves de provas intradermicas de hipersensibilidade do tipo tardio, realizado em 115 individuos da regiäo de Santo Amaro. Os resultados revelaram 46 por cento de provas positivas com a histoplasmina classica e 51,30 por cento de resultados positivos com o antigeno polissacaridico em sua maior concentraçäo. A principal conclusao da pesquisa: e possível utilizar o antigeno polissacaridico como histoplasmina, em substituiçäo ao antigeno filtrado

Departamento de Dermatologia: historico, seus professores e suas contribuicoes cientificas / Department of Dermatology: history, professors and their scientific contributions

O primeiro professor da entao catedra de clinica dermatologica e sifiligrafia da Faculdade de Medicina da Universidade de Sao Paulo foi o Prof. Adolpho Carlos Lindenberg (foto 1) um dos pioneiros da Dermatologia no Brasil. O Prof. Lindenberg ministrou a primeira aula de Dermatologia em 26 de fevereiro de 1916 para os alunos do ...

Imunidade celular inespecífica na leishmaniose tegumentar americana / Nonspecific cellular immunity in American cutaneous leishmaniasis

Foram estudados 42 doentes de leishmaniose tegumentar americana observados na Clínica Deramtológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de Säo Paulo (Serviço do Prof. Sebastiäo a. P. Sampaio) com idades entre 3 e 70 anos, compreendendo 36 homens e 6 mulheres. Tratavam-se de doentes com tempo de evoluçäo variavel de 2 meses a 47 anos e compreendiam 29 doentes brancos, 11 pardos e 2 pretos. Estes doentes distribuiram-se quanto à forma clínica em: formas cutâneas puras 21 doentes; formas cutâneos-mucosas 8 doentes; formas mucosas 13 doentes. Os doentes foram estudados imunologicamente por método "in vivo" e "in vitro. I. Metodos "in vivo": 1. Intradermorreaçöes com antigenos de Montenegro, PPD, levedurina, tricofitina e varidase. As mesmas reaçöes foram realizadas em grupo controle de 23 individuos normais. 2. Sensibilizaçäo ao DNCB. II. Métodos "in vitro": 1. determinaçäo dos linfócitos T e B no sangue periférico. 2. Transformaçäo blástica frente a fitohemaglutinina com soro autólogo e hemólogo. 3. Determinaçäo de anticorpos circulantes pela I.F.I.. Os resultados obtidos permitem as seguintes conclusöes: 1. Registraram-se baixos índices de positividade às intradermorreaçöes de leitura tardia particularmente com dois dos quatro antígenos testados, levedurina e varidase, nos doentes de leishmaniose cutâneo-mucosa comparativamente a controles normais. Verifiacaram-se: a) baixos índices de positividade à varidase no total dos doentes com formas exclusivamente cutâneas e nos doentes com lesöes mucosas, b) baixos índices de resposta à levedurina nas formas com participaçä mucosa, c) comparativamente ao grupo control, nos doentes predominaram, considerando-se o número de reaçöes positivas apresentadas, os casos co, todas as reaçöes negativas, uma das reaçöes positivas ou, no máximo duas reaçöes positivas enquanto que a positividade de três reaçöes ou quatro reaçöes predominou nitidamente entre controles. Estes resultados indicam certo grau de depressäo da imunidade celular inespecífica especialmente nos doentes com acometimento mucoso...