RESUMEN
Atopic dermatitis is a chronic inflammatory skin disorder, for which it is difficult to obtain epidemiologic findings. In a previous study, we suggested the following diagnostic criteria for atopic dermatitis in the adult Thai population: visible flexural dermatitis, a history of flexural dermatitis, a rash of more than six months duration and visible dry skin. However these criteria were not validated against physicians' diagnoses. In the present study, we validated these diagnostic criteria for atopic dermatitis in the Thai population in a clinical setting. A case-controlled study was performed on a total of 259 patients; 33 subjects with active atopic dermatitis, 26 with inactive atopic dermatitis, 100 controls presenting with an inflammatory skin disorder other than atopic dermatitis and 100 controls without any skin disease. Each patient was examined according to the above criteria. Sensitivity, specificity, relative value, positive predictive value, and negative predictive value were calculated for each individual criterion and for composite criteria. Our data confirmed that in order to achieve satisfactory sensitivity and specificity for diagnosing atopic dermatitis in Thai people older than 13 years, a patient must have a history of flexural dermatitis plus two or more of the other mentioned criteria.
Asunto(s)
Dermatitis Atópica/diagnóstico , Adulto , Estudios de Casos y Controles , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , TailandiaRESUMEN
BACKGROUND: Acquired bilateral nevus of Ota-like macules (Hori's nevus) is a dermal pigmented lesion commonly seen in middle-aged women of Asian descent. The Q-switched ruby laser (QSRL) has been used successfully to treat a variety of benign pigmented lesions. Multiple, sequential treatments are typically required for complete clearance of the dermal pigmented dermatoses. OBJECTIVE: The purpose of this study was to determine the efficacy of QSRL in the treatment of Hori's nevus and the beneficial effect of epidermal ablation using the scanned carbon dioxide (CO(2)) laser before QSRL. METHODS: A total of 13 women from Thailand with Hori's nevus were randomly treated with the scanned CO(2) laser followed by QSRL on one side of their face, and QSRL alone on the other side. The same fluence of QSRL was used on both sides in individual patients. The treatment response was objectively evaluated by measuring the melanin index using a Mexameter (Courage & Khazaka Electronic GmbH, Köln, Germany), and subjectively assessed by the patients before treatment and 3 and 16 months after treatment. Adverse sequelae of the treatment and the patients' tolerance were also evaluated at the same follow-up visit. RESULTS: The 3- and 16-month posttreatment melanin index was significantly decreased compared with that of pretreatment on both treated sites and this corresponded to the patients' subjective evaluations. The response rate, defined as "the percentage of reduction in melanin index," was significantly higher on the sides treated with scanned CO(2) laser followed by QSRL, compared with the sides irradiated with QSRL alone at both follow-up visits. At the 3-month follow-up, the most common adverse effect was hypopigmentation, found in 15% (2 of 13) of the patients on the sites treated with QSRL alone, and on the sites treated with scanned CO(2) laser followed by QSRL (8%, 1/13). Erythema was observed in 15% (2/13) of the patients only on the sites that received combination treatment. However, no adverse sequelae were observed at the 16-month posttreatment follow-up. CONCLUSION: Epidermal ablation with scanned CO(2) laser before the use of the pigment-specific laser may be an effective technique for increasing therapeutic efficacy in the treatment of dermal pigmented dermatoses.
Asunto(s)
Neoplasias Faciales/terapia , Terapia por Láser , Terapia por Luz de Baja Intensidad , Nevo de Ota/terapia , Neoplasias Cutáneas/terapia , Adulto , Terapia Combinada/efectos adversos , Neoplasias Faciales/patología , Femenino , Humanos , Terapia por Láser/efectos adversos , Terapia por Luz de Baja Intensidad/efectos adversos , Persona de Mediana Edad , Nevo de Ota/patología , Piel/patología , Neoplasias Cutáneas/patologíaRESUMEN
A rare simultaneous occurrence of multicentric Castleman's disease, non-Hodgkin's lymphoma, and Kaposi's sarcoma was diagnosed in a 70-year-old man who presented with fever, polyarthralgia, weight loss, vascular purpura, anemia, generalized lymphadenopathy, and hepatosplenomegaly. He had no risk of HIV infection and serological tests for HIV were negative twice, but a low number of T-cells and a reversed CD4/CD8 ratio were observed. During hospitalization, he developed Kaposi's sarcoma at the right sole. Lymph node biopsies revealed multicentric Castleman's disease together with a large B-cell lymphoma, which showed monotypic IgM-lambda lymphocytes. To our knowledge, this is the first report in which systemic manifestations of all three diseases occurred simultaneously prior to any specific treatment. The altered immune status and human herpesvirus-8 infection might have played a role in the pathogenesis of this occurrence.
Asunto(s)
Enfermedad de Castleman/diagnóstico , Linfoma no Hodgkin/diagnóstico , Sarcoma de Kaposi/diagnóstico , Neoplasias Cutáneas/diagnóstico , Anciano , Biopsia , Enfermedad de Castleman/patología , Humanos , Linfoma no Hodgkin/patología , Masculino , Neoplasias Primarias Múltiples/diagnóstico , Neoplasias Primarias Múltiples/patología , Sarcoma de Kaposi/patología , Piel/patología , Neoplasias Cutáneas/patologíaRESUMEN
BACKGROUND: There have been reports concerning an association between human immunodeficiency virus (HIV) infection and autoimmune and rheumatic diseases. OBJECTIVE: The purpose of this study was to examine autoimmune and rheumatic manifestations in HIV-infected patients and their correlation with antinuclear antibody (ANA) tests. METHODS: The clinical and laboratory results of HIV-infected patients attending the Department of Dermatology, Siriraj Hospital, Bangkok, Thailand, from February 1999 to January 2000, were analyzed. Laboratory studies included serum CD4 lymphocyte count and ANA tests. RESULTS: Sixty-two patients were enrolled prospectively in the study. Myalgia was the most common clinical presentation (50%). Others included photosensitivity (on history) (39%), arthralgia (26%), vasculitis (18%), sicca complex (10%), arthritis (7%), and Reiter's syndrome (2%). A history of hair loss was given by 23% of patients. A positive ANA test was detected in 3%. No cases of systemic lupus erythematosus, scleroderma, or dermatomyositis were seen. CONCLUSIONS: Autoimmune and rheumatic manifestations were not uncommonly detected in patients with HIV infection. HIV infection may sometimes mimic systemic lupus erythematosus clinically.