The worldwide epidemiology of rosacea

Department of Dermatovenerology Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020Introduction. Rosacea is a common, chronic disorder that can present with a variety of cutaneous or ocular manifestations. Skin involvement primarily affects the central face, with findings such as persistent centrofacial redness, papules, pustules, flushing, telangiectasia, and phymatous skin changes. Ocular involvement may also occur, manifesting with lid margin telangiectases, conjunctival injection, ocular irritation, or other signs and symptoms. The worldwide epidemiology of rosacea remains unknown, although it is a common condition associated with other diseases outside the skin. Aim of the study. To perform a review of the published literature to examine the global epidemiology of rosacea. Materials and methods. A systematic review of population‐based and dermatological outpatient studies reporting frequency of rosacea was performed using three electronic medical databases: PubMed (7), Embase (5) and Web of Science (4) Results. Rosacea affects mainly adults around the age of 30 years and classically predominates in females. Recent Estonian and Irish studies suggest that the female predominance may not be as high as previously believed. However, prevalence does increase with age. The prevalence statistics published in Europe and the United States are highly variable, ranging from less than 1% to more than 20% of the adult population. Rosacea has been reported in countries whose populations have significant proportions of people with skin of color throughout Africa, Asia, and South America, with rates up to 10%.Although only 15 cases of rosacea were observed in a South African dermatology clinic over an 8-year period, during which 6700 patients were examined, all of these cases occurred in patients with Fitzpatrick skin phototype V( Dlova, N.C. and Mosam, Clin Exp Dermatol. 2017) Likewise, an epidemiologic study in Colombia reported a rosacea prevalence of <3%, but ∼12% of the 291 patients with rosacea had Fitzpatrick skin phototype IV or V (Rueda, L.J., Motta, A., Pabon, Int J Dermatol. 2017) . An even greater percentage was revealed in a study of 168 Korean patients with rosacea; nearly 40% of these patients had Fitzpatrick skin phototype IV or V (Bae, Y.I., Yun, S.J., Lee, J.B., Kim, S.J., Won, Y.H., and Lee, S.C. Ann Dermatol. 2009). Rosacea diagnosis in patients with darker skin has also been reported in European countries. An analysis of 348 workers in Estonia showed a 20% prevalence of rosacea, with 55% of cases occurring in patients with Fitzpatrick skin phototypes I and II, as would be expected.Also, the Estonian study also showed that ∼38% of the patients had Fitzpatrick skin phototype III and 7% had phototype IV. Conclusions. Estimated worldwide epidemiology of rosacea based on published data and found that 5-46% of the adult population is affected. However, the prevalence of rosacea depended on the diagnostic method, with higher estimates in questionnaire studies of rosacea symptoms and lower estimates in health registries with International Classification of Diseases codes

XeraCalm AD creme as adjuvant treatment in patients with atopic dermatitis

Obiectiv. Urmărirea eficienţei XeraCalm AD cremă în tratamentul complex al bolnavilor cu dermatită atopică (DA). Material şi metode. Lotul de studiu a cuprins 25 de pacienţi cu DA, cu vârste cuprinse între 2 şi 16 ani. La 15 pacienţi (lotul I) s-a constatat o formă uşoară de DA (media SCORAD – 10,5), ceilalţi 10 au constituit lotul II cu formă moderată de DA (media SCORAD – 25,4). Crema XeraCalm AD a fost aplicată de 2 ori în zi ca un adjuvant la terapia de bază (dermatocorticoizi şi antihistaminice), pe arii de xeroză cutanată pronunţată şi plăci cu aspect eritemato-scuamos. Durata tratamentului a constituit 2 săptămâni, urmat de un tratament anti-recidivă, aplicat de 2-3 ori pe săptămână, pe parcursul următoarelor 2 luni. Rezultate. La 14 (93,3%) pacienţi din lotul I, peste 5-7 zile s-a constatat dispariţia xerozei şi instalarea remisiunii clinice (efect foarte bun). La 6 (60%) bolnavi din lotul II, s-a stabilit involuţia eritemului şi păstrarea xerozei discrete la a 8 – a 10 zi, media SCORAD reducându-se de 2 ori (efect bun). Evoluţie stagnantă s-a raportat la 5 (20%) din totalul pacienţilor din lotul de studiu (efect insuficient). Recurenţele pe parcursul a 2 luni de tratament s-au observat în 7 (28%) cazuri. Concluzii. XeraCalm AD cremă este eficientă în tratamentul adjuvant de combatere a xerozei la atopici, facilitează reducerea indicelui SCORAD, având contribuţie anti-recidivă majoră în menţinerea remisiunii clinice.Objectives. To follow up the efficacy of XeraCalm AD crème, a part of adjuvant complex treatment for patients with atopic dermatitis. Materials and methods. A total number of 25 patients with atopic dermatitis aged from 2 till 16 years were included in the research. In 15 patients (the 1st group) a mild form of atopic dermatitis was established (SCORAD mean – 10.5), another 10 (the 2nd group) presented a moderate form (SCORAD mean – 25.4). The XeraCalm AD crème was applied twice per day on sights with marked xerosis and erythematosquamous lesions as an adjuvant therapy for basic treatment (dermatocorticosteroids and antihistamines). Therapy lasted for 2 weeks, then antirecurrent treatment was made 2-3 times per week during the following 2 months. Results. In 14 (93.3%) patients from the 1st group, after 5-7 days of treatment, xerosis has disappeared completely and clinical remission occurred (a very good effect). In 6 (60%) patients from the 2nd group an erythema involution was observed, although a discrete xerosis was still present at 8-10 days of treatment, SCORAD mean decreased 2 times (a good effect). A stagnant evolution was reported in 5 (20%) out of all the number of patients included in the study (insufficient result). In 7 (28%) patients recurrence has developed during first 2 months of the treatment. Conclusions. XeraCalm AD crème is efficient adjuvant remedy for xerosis treatment in patients with atopic dermatitis, which facilitates decrease of SCORAD index, as well as represents a major antirecurrent effect

Mucocutaneous manifestations in patients with HIV/AIDS infection

Generalităţi. Procesul epidemic al infecţiei HIV/SIDA, în Republica Moldova (RM), se află în continuă ascensiune. Astfel, conform datelor statistice, la 01.01.2015, în RM, au fost înregistrate 10 213 cazuri de HIV infectaţi, dintre care diagnosticaţi cu SIDA – 3130 şi deja decedaţi – 2892 de persoane. Ţinând cont de faptul că manifestările cutaneo-mucoase sunt frecvent întâlnite la persoanele HIV infectate, ne-am propus ca scop evaluarea frecvenţei şi particularităţilor clinico-evolutive ale leziunilor dermatologice la pacienţii cu infecţie HIV/SIDA. Material şi metode. Studiul retrospectiv a cuprins 2244 de fişe ale pacienţilor cu diagnosticul HIV/SIDA, internaţi în Spitalul Dermatologie şi Maladii Comunicabile pentru perioada 2011-2014. De asemenea, au fost înregistrate o serie de cazuri clinice mai relevante. Rezultate. Pe parcursul perioadei de referinţă, au fost înregistraţi 1886 de pacienţi cu manifestări cutaneo-mucoase, dintre care valoarea CD4+ sub 200 cel/mmc a fost inregistrată la 881 de pacienţi. Afectarea solitară a mucoaselor a fost estimată la 1383 de pacienţi, afectarea solitară a pielii la 92 de pacienţi şi afectarea combinată cutaneo-mucoasă – la 411 pacienţi. Atingerea mucoasei cavităţii bucale a fost raportată în 96% din cazuri, cu prevalenţa incontestabilă a infecţiei provocate de C. albicans, exprimată prin candidoză orofaringiană sau esofagiană. Evaluarea ponderii atingerilor cutanate la pacienţii HIV infectaţi a evidenţiat prezenţa manifestărilor cutanate infecţioase în 52% cazuri, al manifestărilor non-infecţioase - în 45% cazuri (dintre care mai mult de 2/3 au fost cu dermatoze alergice) şi doar la 3% din cazuri – manifestări neoplazice. Formele clinice ale atingerilor cutaneo-mucoase şi evoluţia lor au corelat cu valoarea numerică a celulelor CD4. Concluzii. Manifestările cutaneo-mucoase se întâlnesc la persoanele HIV-infectate în 84% din cazuri. Mai frecvent, se afectează mucoasa cavităţii bucale. Severitatea şi forma clinică a atingerilor cutaneo-mucoase corelează cu valoarea limfocitelor CD4. În majoritatea cazurilor, leziunile cutaneo-mucoase la pacienţii HIV-infectaţi, apar în urma imunităţii scăzute şi pot fi considerate ca semne revelatoare ale imunosupresiei legate de HIV, fapt care permite identificarea precoce a acestei infecţii.Overview. Epidemic evolution of HIV/AIDS in the Republic of Moldova is in a permanent progression. Thus, in accordance with statistic data on 01.01.2015 in the Republic of Moldova 10213 cases of HIV/AIDS were registered, among those 3130 people were identified with AIDS and 2892 have already died. It is well known that mucocutaneous manifestations are not rare in patients with HIV/AIDS this is why authors’ aim was to evaluate frequency and clinico-evolutive peculiarities of skin lesions in patients with HIV/AIDS. Materials and methods. A retrospective research was done, which included 2244 medical files of patients with HIV/AIDS, who have been treated at the Hospital of Dermatology and Communicable Diseases during 2011-2014. A number of relevant clinical cases were described as well. Results. 1886 patients with HIV/AIDS, who have shown mucocutaneous involvement, have been registered during present research, in 881 of them CD4+ count was less than 200cells/mmc. Involvement of mucous membranes was established only in 1383 cases, of the skin only in 92 cases and both mucocutaneous manifestations in 411 patients. Mucous membrane affection was reported in 96% of cases with incontestable prevalence of C. albicans infection manifested by oropharyngeal or esophageal candidiasis. Evaluation of cutaneous involvement in patients with HIV has shown as follows: presence of skin infections in 52% of cases, non-infectious dermatoses in 45% of cases (2/3 of which were allergic skin disorders) and skin tumors in 3% of patients only. Clinical forms of skin diseases and their evolution was in strong correlation with CD4+ cells count. Conclusions. Mucocutaneous manifestations affect patients with HIV/AIDS in 84% of cases. The most frequent target is oral cavity. Severity and clinical forms of mucocutaneous involvement have a strong correlation with CD4+ cell count. In majority of cases, mucocutaneous lesions in patients with HIV occur because of decreased immune response and might be considered relevant signs of immunosupression induced by HIV, as well as comprehensive tool for HIV/AIDS early detection

Generalized granuloma anullare – a case report

Generalităţi. Granulomul inelar (GI) este o dermatoză inflamatorie benignă, care se caracterizează prin papule și plăci inelare. Examenul histopatologic relevă o degenerescenţă a colagenului din dermul superficial și profund, înconjurată de un infiltrat granulomatos. Sunt cunoscute următoarele forme clinice: localizată, generalizată, subcutanată, perforantă, eritematoasă. Mecanismele patogenetice propuse includ: o reacţie de hipersensibilitate de tip IV, degenerarea primară a ţesutului conjunctiv, care duce la inflamaţie granulomatoasă, reacţia imună mediată de limfocite cu activarea macrofagilor etc. Granulomul inelar generalizat este o formă mai rară (2,8-15% din cazuri), intâlnită în special la adulţi, mult mai frecventă la femei decât la barbaţi (raport = 6/1). Prezentare de caz. Un bărbat în vârstă de 71 de ani, prezenta, timp de o lună, papule eritematoase diseminate, dispuse relativ simetric, pe trunchi și membre, care s-au extins rapid în plăci și placarde eritematoase, infiltrate, cu centrul plăcilor ușor hipopigmentat, fără atrofie cutanată, cu periferia papuloasă arciformă. Examenul histopatologic a constatat în dermul mijlociu și profund, zone de necroză a fibrelor de colagen, înconjurate de reacţie granulomatoasă giganto-celulară. A fost stabilit diagnosticul de granulom inelar generalizat. Radiografia cutiei toracice a confirmat un desen pulmonar obișnuit. Ecografia abdominală a evidenţiat semne de colecistită cronică. Explorările de laborator, inclusiv testele de glicemie, colesterol și trigliceride, au fost în limitele normale. Tratamentul sistemic a inclus glucocorticoizi (metilprednisolon 32 mg), timp de 2 săptamani, cu scădere graduală, antibiotice (ofloxacină 400 mg/zi) – 10 zile și preparate antihistaminice. Tratamentul topic s-a limitat la corticoizi de potenţă medie. La control repetat, după o lună de terapie, s-a consemnat o dinamică pozitivă a procesului cu regresiunea a 60% din leziunile cutanate. Concluzii. Reieșind din faptul că granulomul inelar generalizat este mai rezistent la tratamentul topic, am optat pentru o corticoterapie sistemică, potenţată de ofloxacină.Overview. Granuloma annulare (GA) is a benign inflammatory dermatosis, characterized by papules and annular plaques. Histopathological examination reveals degeneration of collagen in the deep and superficial dermis, surrounded by a granulomatous infiltrate. The following clinical forms are recognized: localized GA, generalized GA, perforating GA, arcuate dermal erythema. Pathogenetic mechanism of granuloma annulare formation includes cell-mediated immunity (type IV) reaction, primary degeneration of connective tissue leading to granulomatous inflammation, lymphocyte mediated immune reaction with macrophage activation. Generalized/disseminated GA represents between 2.8% and 15% of all cases, occurs more frequently in adults, with higher prevalence in women vs. men (sex/ratio= 6/1). A case report. A 71-year old man, presented for a month erythematous disseminated papules relatively symmetrically arranged on the trunk and limbs. These lesions have rapidly developed in erythematous plaques and placards, with slightly hypopigmented center, arcued plaques with pappular periphery and without skin atrophy. Histopathological examination discovered areas of necrosis in the middle and deep dermis, surrounded by giant cells of granulomatous reaction. Established dermatological diagnosis is generalized granuloma annulare. Chest X-ray was of normal appearance. Abdominal ultrasound examination described chronic cholecystitis. Laboratory tests showed normal values. All laboratory tests inclusive the glucose, triglycerides and cholesterol test showed normal values. The patient received systemic treatment with corticosteroids (methylprednisolone 32 mg/ daily) during 2 weeks with graduate decreases of antibiotic dose (ofloxacin 400mg/day) for 10 days and antihistaminic drugs. Topical treatment has been done by middle-potent corticosteroids. A favorable clinical evolution (60% regression of cutaneous lesions) has been noted after the first month of therapy. Conclusion. Proceeding from the fact that generalized annular granuloma is more resistant to topical treatment in comparison with the localized form, we opted for a systemic corticosteroids in combination with ofloxacin

Psoriazis: protocol clinic naţional (ediția III) PCN-122

Protocolul naţional este elaborat în conformitate cu ghidurile internaţionale actuale privind psoriazisul şi va servi drept bază pentru elaborarea protocoalelor instituţionale, în baza posibilităţilor reale ale fiecărei instituţii în anul curent. La recomandarea MS, pentru monitorizarea protocoalelor instituţionale pot fi folosite formulare suplimentare, care nu sunt incluse în protocolul clinic naţional