Perfil Epidemiológico dos Pacientes em Tratamento na Unidade de Fototerapia do Serviço Dermatologia de um Hospital Universitário

Introduction: Phototherapy is a therapeutic modality used to treat various dermatoses. It consists of exposure to non-ionizing radiation, classified as UVA or UVB according to its wavelength. Material and Methods: This is an observational, cross-sectional and descriptive study carried out in the phototherapy sector of the Dermatology Service of a university hospital with the objective of characterizing the population under treatment and their degree of satisfaction. Results: Fifty-one individuals were included of whom 69% were female, with a mean age of 49 years. The most prevalent dermatoses under treatment during the research were: vitiligo (62.5%), and mycosis fungoides (13.73%). Regarding the level of satisfaction with treatment, more than 90% declared themselves satisfied/very satisfied. Discussion: The prevalence of women and lower phototypes was consistent with the literature. The predominance of the elderly in this study corroborated by other studies may be justified by the presence of comorbidities, and contraindication to conventional treatments beside more time available for the treatment. In some cases, the most prevalent dermatosis was psoriasis, differing from our study. The second most prevalent dermatosis in our study was mycosis fungoides, which also differs from the studies found that described psoriasis or vitiligo as the second most prevalent dermatosis. Conclusion: Studies such as this one are necessary for the planning both the departments that already have this therapeutic modality and those that wish to implement it. Our results are not fully convergent with those of the literature as nowadays there are new options for the treatment of psoriasis.Introdução: A fototerapia é uma modalidade terapêutica empregada para tratamento de várias dermatoses. Consiste em exposição à radiação não ionizante, classificada em UVA ou UVB segundo seu comprimento de onda. Material e Métodos: Efectuámos um estudo observacional, transversal e descritivo no setor de fototerapia do Serviço de Dermatologia de um hospital universitário com o objectivo de avaliar os dados epidemiológicos e o grau de satisfação dos doentes. Resultados: Foram incluídos 51 indivíduos, 69% eram do sexo feminino com uma idade média de 49 anos. As dermatoses em tratamento mais prevalentes durante a pesquisa foram: o vitiligo, com 62,5% dos pacientes, e em segundo lugar a micose fungoide, com 13,73%. Em relação ao nível de satisfação com o tratamento, mais de 90% se declararam satisfeitos/muito satisfeitos. Discussão: A prevalência de mulheres e fototipos mais baixos foi concordante com a literatura. A predominância de idosos nesse estudo corroborada com outros trabalhos e pode ser justificada pela presença de comorbidades, e assim contraindicações aos tratamentos convencionais além de maior disponibilidade de tempo do paciente. Em alguns casos a dermatose mais prevalente foi a psoríase, diferindo do nosso estudo. A segunda dermatose mais prevalente em nosso estudo foi a micose fungoide, o que difere de outros estudos nos quais a segunda dermatose mais prevalente foi a psoríase ou o vitiligo. Conclusão: Estudos como este são necessários para o planejamento tanto dos serviços que já dispõem dessa modalidade terapêutica quanto das unidades que desejam implantá-la. Nossos resultados não são integralmente convergentes com os da literatura publicada já que atualmente existem novas opções para o tratamento da psoríase

IMMUNE RECONSTITUTION INFLAMMATORY SYNDROME: A POTENTIAL PITFALL IN THE MANAGEMENT OF KAPOSI’S SARCOMA IN HIV POSITIVE PATIENTS? – A CASE REPORT

A diversidade de apresentações clínicas da síndrome de reconstituição imune faz da mesma um desafio clínico, na medida em que é difícil o manejo de infecções oportunistas e outras condições clínicas relacionadas com tal síndrome. A relevância da mencionada síndrome o Sarcoma de Kaposi após o início da terapia antiretroviral é notável, principalmente em países que possuem altos níveis de transmissão de doenças sexualmente transmissíveis e HIV. Desta forma, clínicos e dermatologistas devem estar atentos para identificar sinais e sintomas dessa progressão neoplásica e diferenciá-los do Sarcoma de Kaposi relacionado à síndrome de reconstituição imune de acordo com os critérios de classificação recentes da doença. Vital mencionar que terapia anti-retroviral não deve ser interrompida na maioria dos casos.The variety of immune reconstitution inflammatory syndrome’s (IRIS) clinical presentations makes this syndrome a challenge, in that it is difficult to manage opportunistic infections and other serious clinical conditions related to the manifestation of this syndrome. The relevance of immune reconstitution inflammatory syndrome – associated with Kaposi sarcoma (IRIS-KS) after initiation of highly active antiretroviral therapy (HAART) is noteworthy, mainly in coun tries that still have high levels of transmission of sexually transmitted diseases and HIV. Clinicians and dermatologists should be aware to identify signs and symptoms of this neoplasm progression and to differentiate them from KS related IRIS according to the recent classification criteria of this disease and antiretroviral therapy should not be discontinued in the most cases

Peeling Skin Syndrome - Relato de Caso

Peeling skin syndrome (PSS) is a rare genodermatosis of autosomal recessive inheritance caused by mutations in CDSN, TGM5 or CHST8, depending on the type of disease. It is characterized by localized or generalized superficial peeling of the skin, with or without erythema and itching. Concerning to the generalized form, Heiko Traupe proposed distinction between noninflammatory (type A) and associated with congenital erythroderma (type B). Mevorah described the type C, with features similar to type B. Noninflammatory type is characterized for continuous spontaneous clearance areas of stratum corneum, which begins at birth or during childhood. We describe a 19 year’s old male patient, with skin peeling of the neck, trunk and upper limbs since childhood and a similar dermatoses in the family.Peeling skin syndrome (PSS) é uma genodermatose rara, de herança autossômica recessiva causada por mutações nos genes CDSN, TGM5 ou CHTS8 dependendo do tipo da doença. É caracterizada por descamação superficial da pele, localizada (acral) ou generalizada, com ou sem eritema e prurido. Relativamente à forma generalizada, Heiko Traupe propôs distinção entre o tipo A, não inflamatório, e o tipo B, associado à eritrodermia congênita (inflamatória). Mevorah descreveu o tipo C que possui características mais próximas ao B. O tipo generalizado não inflamatório é caracterizado por áreas de eliminação espontânea e contínua do estrato córneo, com início no nascimento ou durante a infância. Descrevemos o caso de um paciente masculino de 19 anos, com descamação no pescoço, tronco e membros superiores desde a infância e história de patologia semelhante na família

Humanistic and economic impact of moderate to severe plaque psoriasis in Brazil

Introduction Psoriasis is an immune-mediated, chronic, inflammatory disease, which has a substantial humanistic and economic burden. This study aimed to assess the impact of this disease on health-related quality of life (HRQoL), work productivity, and direct and indirect costs from a societal perspective among Brazilian patients. Methods This is a cross-sectional, observational, multicenter study, enrolling patients with moderate to severe plaque psoriasis according to physician evaluation. Data collection was performed from December 2015 to November 2016 through face-to-face interviews using a structured questionnaire and five standardized patient-reported outcomes instruments. Direct costs were estimated by multiplying the amount of resources used (12-month recall period) by the corresponding unit cost. Indirect costs were grouped in two time horizons: annual costs (income reduction and absenteeism) and lifetime costs (demission and early retirement). Results A total of 188 patients with moderate to severe plaque psoriasis were included, with mean age of 48.0 (SD 13.1). “Anxiety and depression” and “pain and discomfort” were the most impaired dimensions, according to the EuroQol Five-Dimension-Three-Level (EQ-5D-3L). The highest effect was found for “symptoms and feelings” [mean (SD) 2.4 (1.7)] Dermatology Life Quality Index (DLQI) subscale. Psoriatic arthritis (PsA) presence and biologic-naïve status were associated with worse HRQoL. Presenteeism was more frequent than absenteeism, according to the Work Productivity and Activity Impairment questionnaire-General Health (WPAI-GH) [17.4% vs. 6.3%], while physical demands and time management were the most affected Work Limitations Questionnaire (WLQ) subscales [means (SD) 23.5 (28.5) and 17.7 (24.9), respectively]. The estimated annual cost per patient was USD 4034. Direct medical costs accounted for 87.7% of this estimate, direct non-medical costs for 2.4%, and indirect costs for 9.9%. Conclusions Results evidenced that moderate to severe plaque psoriasis imposes substantial costs to society. Our data showed that this disease negatively affects both work productivity and HRQoL of Brazilian patients. Subgroups with PsA and biologic-naïve patients presented lower HRQoL, showing the impact of this comorbidity and the relevance of biologics in psoriasis treatment