Oral lichen planus

O líquen plano da mucosa oral (LPO) é afecção relativamente comum, que pode aparecer isolado ou associado ao líquen plano cutâneo, havendo, no entanto, significantes diferenças clínicoevolutivas: o LPO tende a ser crônico, recidivante e de difícil tratamento, levando a importante morbidade, principalmente em sua forma erosiva. Novas formas clínicas agressivas têm sido salientadas na literatura, como a forma gingivo-vulvar. Este artigo revisa a etiopatogenia, as formas clínicas, a diagnose diferencial e laboratorial, a prognose e o tratamento do LPO, além de mencionar, brevemente, a experiência dos autores com esta enfermidade, vivida no Ambulatório de Estomatologia da Divisão de Dermatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloOral lichen planus (OLP) is a relatively common mucosal disease that can present isolated or associated with cutaneous lichen planus. Contrarily to its cutaneous counterpart, though, OLP tends to be chronic, relapsing, and difficult to treat. Severe morbidity is related to erosive forms, and more aggressive presentations have been described, such as the "gingivo-vulvar syndrome". This article reviews the current knowledge about the pathogenesis, clinical picture, differential and laboratorial diagnosis, prognosis, and treatment of OL

Pathogenesis of napkin dermatitis: part I

A dermatite da área da fralda irritativa primária é a dermatite da área da fralda mais prevalente, sendo provavelmente a afecção cutânea mais freqüente na primeira infância, constituindo fonte significativa de desconforto para a criança. O uso da fralda ocasiona aumento da temperatura e da umidade locais. Há conseqüente maceração da pele, que se torna mais susceptível à irritação ocasionada pelo contato prolongado da urina e das fezes com a pele da região coberta pelas fraldas. Freqüentemente surge infecção secundária por Candida ou por bactérias como Bacillos faecallis, Proteus, Pseudomonas, Staphylococcus e Streptococcus. O uso de pós, óleos, sabões e pomadas irritantes agravam o quadro clínico. Diante disso, é importante que se conheça a fisiopatologia da doença para que se possa fazer correta prevenção e tratamento apropriado.Irritant contact dermatitis is the most prevalent diaper dermatitis and, probably, the most common cause of skin disease in infancy. The wearing of diaper leads to overhydration, increased local temperature and humidity. Constant maceration and prolonged contact with urine and stools makes the skin under the diaper more susceptible. There is often secondary infection due to Candida or bacteria, such as Bacillus faecallis, Proteus, Pseudomonas, Staphylococcus e Streptococcus. Oils, soaps, powders and ointments can be irritants and aggravate the rash. It is important to know the pathophysiology of the disease for appropriate treatment and preventio

Scientific research published on the Anais Brasileiros de Dermatologia (2003-2007)

FUNDAMENTOS - A produção científica da dermatologia brasileira, quantitativa e qualitativamente, é pouco conhecida e pouco estudada. OBJETIVO - Analisar características da produção científica da dermatologia brasileira segundo o publicado nos Anais Brasileiros de Dermatologia entre 2003 e 2007. MÉTODOS - Realizou-se estudo transversal através análise dos artigos publicados nas seções de "investigação clínica, epidemiológica, laboratorial e terapêutica"; "caso clínico"e "comunicação"dos Anais Brasileiros de Dermatologia entre 2003 e 2007. As variáveis de interesse foram: objeto temático, delineamento utilizado e grupo de enfermidades nas seções de investigação e caso clínico e o enfoque quanto à seção "comunicação". RESULTADOS - Entre os artigos de investigação predominaram os trabalhos clínicos (60,3%); os com temática cirúrgica ou cosmiátrica somaram 13%. Delineamento descritivo/observacional prevaleceu (81,9%), sendo a "série de casos"o mais utilizado (50%). Predominaram enfermidades infecciosas (33,6%) entre os de investigação e inflamatórias (28,6%) entre os casos relatados. Relato de casos (54,3%) foi o principal enfoque dado às comunicações CONCLUSÃO - Predominou a tradição descritiva nos artigos publicados no período. Delineamentos mais elaborados e sofisticados foram incomuns. O método científico e a análise crítica da literatura devem fazer parte do currículo da pós-graduação em dermatologia, stricto e lato sensu.BACKGROUND - The scientific production of dermatology is not very known and studied in quantitative and qualitative aspects in Brazil. OBJECTIVE - To study the characteristics of the Brazilian scientific production published on the Anais Brasileiros de Dermatologia from 2003 to 2007. METHODS - A transversal study of articles published on the "clinical, epidemiological, laboratory and therapeutic investigation"; "case report"and "communication"sections of the Anais Brasileiros de Dermatologia, from 2003 to 2007, were reviewed. The variables studied were: the dermatological subspecialty focused; methodological analysis used; diseases or disorders investigated and the understanding of authors related to the "communication"section. RESULTS - Among investigational manuscripts, clinical studies prevailed (60.3%), those with surgical or cosmetic interest accounted for 13%. Descriptive and observational studies were the most common (81.9%), particularly the "case series"(50%). Infectious (33.6%) and inflammatory disease (28.6%) was the subject of investigation or case report, respectively. "Case report"was the most common subject on the "communication"section. CONLUSION - Descriptive methods were predominant among the research articles published in the studied period. More sophisticated and elaborated methods were uncommon. Research designs and critical analysis of the scientific literature must be part of the curriculum of the graduate and residency programs in dermatology

Revista da Escola de Enfermagem da USP

P. 34-42.Este estudo consiste num espaço de reflexão sobre a questão da cidadania e qualidade de vida dos portadores de transtornos psíquicos, tomando como eixo as transformações ocorridas na relação da sociedade com esses indivíduos, explicitando suas contradições e racionalidade. Aponta os desafios a serem superados na construção da cidadania e qualidade de vida dessas pessoas.São Paul

Revista Latino-Americana de Enfermagem

p. 803-811This text is a revision of the most important theoretical approaches that fundament the studies about Mental Health and Work, pointing to the basic concepts, categories of analyses and respective limits. The objective is to underline some conceptions about the theme, in the attempt to contribute with a way to face the problems, questions and difficulties imposed by the construction of this object of study. Thus, the text is based on the critical review of theoretical paradigms that predominate in studies about Mental Health and Work. Finally, it indicates some important theoretical questions about the relation between mental health and work

CORRELATION BETWEEN PLASMA TAMOXIFEN CONCENTRATION AND TUMOR RESPONSE IN PATIENTS WITH BREAST CANCER: AT NEOADJUVANT TREATMENT WITH TAMOXIFEN

Objective: to determine a possible correlation between the tumor response in patients suffering from breast cancer, initially treated with tamoxifen, and plasma concentration of this drug.Methods: we studied 27 elderly patients (age range: 62 to 82 y) with advanced breast carcinoma who were treated with a daily dose of 20 mg of oral tamoxifen, for 3 mo. Responders were followed-up for 19 mo, and nonresponders for 21 mo. We measured plasma tamoxifen citrate levels in order to determine their possible correlation with objective remission of the disease.Results: the correlation was found to be significant among responders (37%), whose median plasma tamoxifen level was 187.40ng. ml-1, when comparing to non-responders, whose median plasma tamoxifen level was 99.52ng. ml-1. The frequency distribution of patients in both groups with concentration of tamoxifen lower and higher than 182.60ng. ml-1 was significant (fisher's test p-value<0,0011).Conclusion: considering the results herein, we suggest that patients whose plasma tamoxifen levels reach 182.60ng. ml-1 after 3 mo of treatment, with no tumor response, may not benefit from this treatment, and an alternative therapy should be regarded

British Journal of Dermatology

Texto completo. Acesso restrito. p. 257-264Background Desquamative gingivitis refers to a clinical manifestation associated with several mucocutaneous disorders. The most common are mucous membrane pemphigoid, pemphigus vulgaris and lichen planus. Their specific diagnosis is better established by histopathological and immunofluorescence evaluation. Objectives To examine cases of desquamative gingivitis using reflectance confocal microscopy (RCM) and compare the findings with those of normal gingiva. To compare RCM findings in desquamative gingivitis with conventional histopathology of the biopsied lesions, in order to establish criteria for this noninvasive diagnostic technique. Methods A total of 25 cases of suspected mucous membrane pemphigoid, pemphigus vulgaris and lichen planus were included. RCM was performed on the gingiva of a healthy person and on gingival lesions. All lesions were biopsied in order to perform a RCM–histopathological correlation. Results Reflectance confocal microscopy examination of the gingival lesions suspected to be mucous membrane pemphigoid revealed a separation at the level of the dermal–epidermal junction, filled with small, bright structures interpreted as blood cells. Histopathological and immunofluorescence findings confirmed the diagnosis. For pemphigus vulgaris, RCM features were intraepithelial clefts with round, detached cells interpreted as acantholytic keratinocytes, similar to the histopathological features. Hyperkeratosis and spongiosis associated with infiltration of inflammatory cells, seen as small, bright cells intermingling with the honeycomb keratinocyte epithelial structure, were seen in lichen planus. Mildly bright, round structures interpreted as necrotic keratinocytes and mildly bright, stellate structures, interpreted as melanophages, were also seen in the dermis. These features were present on histopathology, confirming the diagnosis of lichen planus. Conclusion We propose that RCM is a useful tool to help distinguish between the three most common causes of desquamative gingivitis