RESUMEN
Background: Scalp pruritus is a common symptom in Dermatomyositis (DM) patients. There are indications that small nerve fibers neuropathy could be involved in this symptom, however the etiology of scalp pruritus is not fully understood. Objectives: To assess epidermal nerve fiber (ENF) density of dermatomyositis patients with scalp pruritus by biopsy by confocal microscopy and immunohistochemistry with subsequent imaging analysis. Methods: DM patients with severe scalp pruritus from the dermatology outpatient clinic were compared to healthy volunteers. Two 4-mm scalp skin biopsies were obtained above the right ear in the parietal region and below the occipital protuberance in the occipital region. Biopsy specimens were incubated with primary antibodies to protein gene product (PGP 9.5), calcitonin gene-related peptide (CGRP), substance P (SP) were used to visualize nerve fibers (ENF) and collagen IV was used to label the epidermal basement membrane. The number of ENFs per millimeter was counted and recorded as the mean of ± SD of counts in 16 images at two micrometer increments/sections, two from each of the samples. ENF densities were compared between groups and a multiple linear regression model was applied to associated factors with ENF density. Results: Fifteen DM patients with severe scalp pruritus and 12 healthy volunteers were included in the study. The mean number of ENF/mm in occipital region of DM group was 16.0 ± 13.9 while the control group in the same region was 99.8 ± 33.1. In parietal region the number of ENF/mm of DM group was 18.0 ± 20.7 while in control group was 50.4 ± 17.4 (p < 0.001). Conclusion: DM patients with pruritus could have some impairment of small nerve fiber density that could explain their recalcitrant scalp pruritus.
RESUMEN
94 children and 25 adolescents, 42% male and 58% female, aged predominantly between six and ten years old (40%) were studied at the Martagão Gesteira Childcare and Pediatrics Institute (Rio de Janeiro Federal University) between 2005 and 2011. The prevalent clinical form of vitiligo was the generalized type (34%). Although the clinical response was similar between the treatment modalities, we decided for low and high power topical steroids in our routine. Halo nevi were found in seven (5.9%) cases. Thirty (25%) patients underwent specialized evaluation and 18 (60%) reported some relevant psychological situation.
Asunto(s)
Vitíligo/epidemiología , Adolescente , Distribución por Edad , Edad de Inicio , Brasil/epidemiología , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Nevo con Halo/epidemiología , Prevalencia , Estudios Retrospectivos , Distribución por Sexo , Resultado del Tratamiento , Vitíligo/tratamiento farmacológicoRESUMEN
O Acinetobacter baumanni é patógeno oportunista antigamente considerado de baixa virulência. Atualmente está envolvido em processos infecciosos que acometem pacientes imunocomprometidos,grandes queimados e pacientes em unidades de terapia intensiva que fazem uso de ventilação mecânica. Esse relato de caso chama atenção para infecção cutânea rara por essa bactéria em paciente imunocompetente.
Acinetobacter baumannii is an oportunistic pathogen that used to be considered as having low virulence; however, it is currently known to be involved in infectious processes in patients with immunosuppression, large burns and those under mechanical ventilation in intensive care units. This case report emphasizes the possibility of cutaneous infection by A. baumanni in immunocompetent patients.