RESUMO
BACKGROUND: Actinic prurigo is an idiopathic photodermatosis, the pathophysiology of which has been hypothesized to involve subtype IV type b (Th2) hypersensitive response, whereby IL4, IL5, and IL13 are secreted and mediate the production of B cells, IgE, and IgG4. OBJECTIVES: To examine the association of serum IgE levels and the clinical severity of injuries. METHODS: This case-control study comprised patients with a clinical and histopathological diagnosis of actinic prurigo, as well as clinically healthy subjects, from whom 3cc of peripheral blood was taken for immunoassay. Cases were classified by lesion severity as mild, moderate, and severe. Descriptive statistics were analyzed, and chi-square test was performed. RESULTS: We included 21 actinic prurigo patients and 21 subjects without disease; 11 patients with actinic prurigo had elevated serum IgE levels, and 10 had low serum levels. Six actinic prurigo (AP) patients with elevated serum levels of IgE had moderate injuries, 4 had severe injuries, and 1 had minor injuries. Eight out of 10 patients with normal IgE levels presented with minor injuries in the clinical evaluation. The 21 controls did not have increased serum IgE levels. CONCLUSIONS: Elevated IgE levels are associated with moderate to severe clinical lesions, suggesting that actinic prurigo entails a type IV subtype b hypersensitivity response in which Th2 cells predominate.
Assuntos
Imunoglobulina E/sangue , Transtornos de Fotossensibilidade/sangue , Transtornos de Fotossensibilidade/fisiopatologia , Dermatopatias Genéticas/sangue , Dermatopatias Genéticas/fisiopatologia , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Feminino , Humanos , Imunoensaio , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Transtornos de Fotossensibilidade/patologia , Valores de Referência , Índice de Gravidade de Doença , Dermatopatias Genéticas/patologia , Talidomida/uso terapêutico , Adulto JovemRESUMO
Abstract BACKGROUND: Actinic prurigo is an idiopathic photodermatosis, the pathophysiology of which has been hypothesized to involve subtype IV type b (Th2) hypersensitive response, whereby IL4, IL5, and IL13 are secreted and mediate the production of B cells, IgE, and IgG4. OBJECTIVES: To examine the association of serum IgE levels and the clinical severity of injuries. METHODS: This case-control study comprised patients with a clinical and histopathological diagnosis of actinic prurigo, as well as clinically healthy subjects, from whom 3cc of peripheral blood was taken for immunoassay. Cases were classified by lesion severity as mild, moderate, and severe. Descriptive statistics were analyzed, and chi-square test was performed. RESULTS: We included 21 actinic prurigo patients and 21 subjects without disease; 11 patients with actinic prurigo had elevated serum IgE levels, and 10 had low serum levels. Six actinic prurigo (AP) patients with elevated serum levels of IgE had moderate injuries, 4 had severe injuries, and 1 had minor injuries. Eight out of 10 patients with normal IgE levels presented with minor injuries in the clinical evaluation. The 21 controls did not have increased serum IgE levels. CONCLUSIONS: Elevated IgE levels are associated with moderate to severe clinical lesions, suggesting that actinic prurigo entails a type IV subtype b hypersensitivity response in which Th2 cells predominate.
Assuntos
Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Imunoglobulina E/sangue , Transtornos de Fotossensibilidade/sangue , Transtornos de Fotossensibilidade/fisiopatologia , Dermatopatias Genéticas/sangue , Dermatopatias Genéticas/fisiopatologia , Estudos de Casos e Controles , Imunoensaio , Imunossupressores/uso terapêutico , Transtornos de Fotossensibilidade/patologia , Valores de Referência , Índice de Gravidade de Doença , Dermatopatias Genéticas/patologia , Talidomida/uso terapêuticoRESUMO
With the emergence of medical specialties in different areas of medicine, assessment of patients became narrow and specialized. There is also the perception that some specialties are more difficult than others. Dermatology has long been seen by most physicians non dermatologists as a relaxed area, without real emergencies or requirement of great intellectual effort. Some specialists, erroneously think that everything can be cured with topical steroids and/or antifungal creams. Although several skin diseases are common complains seen by the general practitioner, very few time and credits are granted to cover these diseases during the years of undergraduate training. Thus, the primary care physicians and others medical specialists believe that skin diseases are not life threatening and hence irrelevant. Nonetheless, they feel competent enough to prescribe a variety of treatments for skin diseases that may lead to iatrogenesis.
Con la aparición de las especialidades en las diferentes áreas de la medicina se comenzó a notar una "fragmentación" en la forma de evaluar al paciente; también surgió la percepción de que existen algunas más difíciles que otras. La Dermatología ha sido vista durante mucho tiempo por la mayor parte de los médicos no dermatólogos como una área relajada, sin guardias, sin urgencias y que no requiere gran ejercicio intelectual. Algunos especialistas piensan que todo se "cura" con esteroides tópicos y/o antimicóticos. A pesar de que varias dermatosis son motivo frecuente de consulta para el médico general, durante los años de pregrado se concede poco tiempo y, consecuentemente, escasos créditos a esta materia, dando como resultado que los médicos y otros especialistas no den la importancia debida a las enfermedades de la piel, al no ser estas riesgosas para la salud del paciente. Sin embargo sí se atreven a tratar dichas enfermedades con tal displicencia que terminan por generar iatrogenia de todo tipo.
Assuntos
Atitude do Pessoal de Saúde , Competência Clínica , Dermatologia , Atenção Primária à Saúde , Encaminhamento e Consulta , Dermatopatias , Humanos , Atenção Primária à Saúde/organização & administração , Dermatopatias/diagnóstico , Dermatopatias/terapiaRESUMO
BACKGROUND: Actinic prurigo (AP) is an idiopathic photodermatosis that usually onsets during childhood and predominates in women. It is characterized by the symmetrical involvement of sun-exposed areas of the skin, lips, and conjunctiva. OBJECTIVES: This study aimed to analyze the risk factors associated with AP using a case-control design. METHODS: All patients diagnosed with AP during 1990-2006 at Dr. Manuel Gea González General Hospital in Mexico City were included. Respective controls were recruited. Race, demographic, geographic, socioeconomic, environmental, clinical, and nutritional risk factors were assessed. RESULTS: A total of 132 persons were enrolled. These included 44 cases and two control groups comprising, respectively, dermatology and non-dermatology outpatients without AP or any autoimmune disease. Distribution by gender, age, place of birth, place of residence, and economic status did not differ significantly among the three groups. A total of 256 variables were analyzed. Only 19 variables were found to be statistically significant (P < 0.05). These were: use of a boiler; use of firewood; car ownership; use of earthenware; mixed material housing; socioeconomic level 1; sun exposure; use of soap; lemon consumption; use of moisturizing hair cream; living with pets in the house; living with farm animals; age; having a family member with AP; having had surgery; having had trauma; having been hospitalized; use of oral medication; and use of herbal medication. Of 40 macro- and micronutrients analyzed, 11 were found to have statistically significant effects (P < 0.05). CONCLUSIONS: Multiple epidemiologic, geographic, clinical, and immunologic factors are involved in the etiology of AP. This study proposes a clear line for research directed at specific risk factors that refer to an individual's clinical, allergic, health, and socioeconomic status. Further study should also investigate the etiologic role of diet in AP and the molecular mechanisms behind the development of AP to establish whether AP is caused by exposure to polycyclic aromatic hydrocarbons.
Assuntos
Transtornos de Fotossensibilidade/etiologia , Dermatopatias Genéticas/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Estudos de Casos e Controles , Criança , Feminino , Incêndios , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estado Nutricional , Animais de Estimação , Fatores de Risco , Madeira , Adulto JovemRESUMO
Lichen planus is a disease generally considered uncommon in children. Our objective was to obtain epidemiologic data retrospectively and determine the clinical characteristics of lichen planus in Mexican children seen in our dermatology department. We found 235 patients with the clinical and histologic diagnosis of lichen planus seen over a period of 22 years and 7 months. Twenty-four (10.2%) of these patients were children (15 years of age or younger). The ratio of male to female was 1:1.2. The main clinical pattern was classic lichen planus (43.5%). Mucous membrane and nail involvement were uncommon. No family history of lichen planus or systemic disease was noted. In the international literature, the frequency of lichen planus varied from 2.1% to 11.2% of the pediatric population. In the majority of studies no significant gender predominance was identified. Most patients had the classic variety of lichen planus. Reported mucosal involvement was rare, except in India and Kuwait. Frequency of nail involvement ranged from 0% to 16.6%. Little evidence of systemic disease or family history was found.
Assuntos
Líquen Plano/epidemiologia , Adolescente , Corticosteroides/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Ceratolíticos/uso terapêutico , Líquen Plano/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Doenças da Unha/tratamento farmacológico , Doenças da Unha/epidemiologia , Transtornos de Fotossensibilidade/tratamento farmacológico , Transtornos de Fotossensibilidade/epidemiologia , Estudos RetrospectivosRESUMO
BACKGROUND: Actinic prurigo (AP) is a photodermatosis with a restricted ethnic distribution, mainly affecting Mestizo women (mixed Indian and European). The lesions are polymorphic and include macules, papules, crusts, hyperpigmentation and lichenification. Thalidomide, an effective immunomodulatory drug, was first used successfully to treat AP in 1973. In this work we describe the effect that thalidomide had on TNF-alpha sera levels and on IL-4- and IFN gamma (IFNgamma)-producing lymphocytes of actinic prurigo (AP) patients. METHODS: Actinic prurigo patients were analyzed before and after thalidomide treatment. The percentage of IL-4+ or IFNgamma+ CD3+ lymphocytes was analyzed in eight of them by flow cytometry. TNFalpha in sera was measured by ELISA in 11 patients. RESULTS: A direct correlation was observed between resolution of AP lesions and an increase in IFNgamma+ CD3+ peripheral blood mononuclear cells (P < or = 0.001) and a decrease in TNFalpha serum levels (no statistical difference). No IL-4+ CD3+ cells were detected. CONCLUSIONS: Our findings confirm that AP is a disease that has an immunological component and that thalidomide clinical efficacy is exerted not only through inhibition of TNFalpha synthesis, but also through modulation of INFgamma-producing CD3+ cells. These cells could be used as clinical markers for recovery.
Assuntos
Imunossupressores/uso terapêutico , Prurigo/imunologia , Talidomida/uso terapêutico , Adolescente , Adulto , Complexo CD3/imunologia , Feminino , Seguimentos , Humanos , Interferon gama/sangue , Interleucina-4/sangue , México , Pessoa de Meia-Idade , Transtornos de Fotossensibilidade/tratamento farmacológico , Transtornos de Fotossensibilidade/etnologia , Transtornos de Fotossensibilidade/imunologia , Estudos Prospectivos , Prurigo/tratamento farmacológico , Prurigo/etnologia , Indução de Remissão , Linfócitos T/efeitos dos fármacos , Linfócitos T/imunologia , Fator de Necrose Tumoral alfa/análise , Fator de Necrose Tumoral alfa/antagonistas & inibidoresRESUMO
Actinic prurigo (AP) is an idiopathic photodermatosis that affects mainly the mestizo population in Latin America. It has an early onset, a slight predominance in women, and affects the sun-exposed areas of the skin, causing erythematous papules and lichenified plaques secondary to intense and chronic pruritus. Lesions can be induced by both ultraviolet A (UVA) and ultraviolet B (UVB). An association with several human leukocyte antigen (HLA) alleles has been reported. AP is unique among all photodermatoses in its remarkable response to thalidomide. In the past the microscopic features of AP have been considered as nonspecific; however, the constant finding of dense lymphocytic inflammatory infiltrates and the immunogenetic features of AP support the existence of an immunologic mechanism in its pathogenesis.
Assuntos
Transtornos de Fotossensibilidade/diagnóstico , Prurigo/diagnóstico , Fármacos Dermatológicos/uso terapêutico , Diagnóstico Diferencial , Humanos , Transtornos de Fotossensibilidade/tratamento farmacológico , Transtornos de Fotossensibilidade/imunologia , Prurigo/tratamento farmacológico , Prurigo/imunologia , Talidomida/uso terapêuticoRESUMO
Objective. This study describes the clinicopathologic features and therapeutic results of 116 patients with actinic prurigo cheilitis seen over an 11-year period. Study Design. A retrospective study was carried out with hospital records and a microscopic slide review from a large dermatology department in Mexico City, Mexico. Results. The study consisted of 42 male (36.2%) and 74 female (63.8%) patients, with a male to female ratio of 1:1.7. Age ranged from 9 to 82 years (mean, 27.9 years; standard deviation, 14.2). Thirty-two cases (27.6%) were found in which cheilitis was the only manifestation of this condition. Pruritus, tingling, and pain of the vermilion were recorded in 96 cases (82.7%). Typical histopathologic findings included in most cases the presence of acanthosis, spongiosis, basal cell vacuolation, ulceration with serohematic crust formation, edema of the lamina propria, lymphocytic inflammatory infiltrate with well-defined lymphoid follicles, and variable numbers of eosinophils and melanophages. Improvement of the symptoms was obtained in 112 cases (96.5%) with sun-protective measures and diverse antiinflammatory agents. However, complete resolution of the labial lesions were more frequently achieved with the combination of topical steroids, thalidomide, and sun-protective measures (42.2%) as compared with topical steroid therapy plus sun-protection measures (16.3%; P <.005). Conclusion. Our findings confirm that lip lesions may appear as the only manifestations of this photodermatosis and that it has typical clinical and microscopic features and should therefore be considered a specific form of cheilitis.
Assuntos
Queilite/etiologia , Queilite/patologia , Transtornos de Fotossensibilidade/patologia , Prurigo/etiologia , Administração Tópica , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios/uso terapêutico , Queilite/complicações , Queilite/tratamento farmacológico , Distribuição de Qui-Quadrado , Criança , Fármacos Dermatológicos/uso terapêutico , Combinação de Medicamentos , Feminino , Glucocorticoides , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Fotossensibilidade/tratamento farmacológico , Prurigo/complicações , Prurigo/tratamento farmacológico , Prurigo/patologia , Análise de Regressão , Estudos Retrospectivos , Luz Solar/efeitos adversos , Protetores Solares/uso terapêutico , Talidomida/uso terapêuticoRESUMO
Los pénfigos son un grupo de enfermedades ampollosas de piel y mucosas que histológicamente presentan ampollas intraepidérmicas por acantólisis y anticuerpos fijos y circulantes dirigidos contra la superficie celular de los queratinocitos. En pacientes mexicanos que padecen pénfigo, no se han determinado desequilibrios de presentación de antígenos del HLA, como se ha estudiado en otras poblaciones, por lo que se efectuó un estudio comparativo, prospectivo, transversal y observacional en 25 pacientes; 18 de ellos con pénfigo vulgar y 7 con pénfigo foliáceo a quienes se les tomó muestra de sangre periférica para la extracción de DNA, con el método de expulsión salina ("salting out"). Se realizó determinación de HLA-DR, amplificando la región HLA-DRB1, mediante la técnica de reacción de polimerasa en cadena (PCR) y se determi-naron cada uno de los alelos con oligonucleótidos específicos de alelos (ASO), utilizando el kit Amplicor Hoffman La Roche Basilea, Suiza.Los resultados mostraron que el HLA-DR14 (DR6) es más común en los pacientes con pénfigo, sobre todo pénfigo vulgar, que en la población sana control, esto concuerda con lo descrito en la literatura universal. Por otra parte, el HLA-DR1 representa un riesgo relativo mayor para el desarrollo de pénfigo foliáceo en nuestra población.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Antígenos HLA-DR/análise , México , Pênfigo/imunologia , Doenças Autoimunes , Antígenos de HistocompatibilidadeRESUMO
La dermatosis cenicienta es un padecimiento inflamatorio de la piel que, en su fase tardía, muestra manchas hiperpigmentadas de color gris-parduzco ("cenicientas") muy características. Es un padecimiento que tiende a la cronicidad y cursa de manera asintomática; se le observa predominantemente en población mestiza de Latinoamérica. La mayoría de los enfermos responden bien al tratamiento con 50 mg/día de clofazimina durante varios meses. Estudios recientes sugieren que se trata de un padecimiento de base inmunológica (AU)
Assuntos
Humanos , Clofazimina/uso terapêutico , Dermatopatias/diagnóstico , Clofazimina/efeitos adversos , Líquen Plano/diagnóstico , Diagnóstico Diferencial , Moléculas de Adesão Celular/efeitos adversos , Queratinócitos/patologia , Complexo Principal de HistocompatibilidadeRESUMO
La dermatosis cenicienta es un padecimiento inflamatorio de la piel que, en su fase tardía, muestra manchas hiperpigmentadas de color gris-parduzco ("cenicientas") muy características. Es un padecimiento que tiende a la cronicidad y cursa de manera asintomática; se le observa predominantemente en población mestiza de Latinoamérica. La mayoría de los enfermos responden bien al tratamiento con 50 mg/día de clofazimina durante varios meses. Estudios recientes sugieren que se trata de un padecimiento de base inmunológica
Assuntos
Humanos , Clofazimina/uso terapêutico , Dermatopatias/diagnóstico , Clofazimina/efeitos adversos , Diagnóstico Diferencial , Queratinócitos/patologia , Líquen Plano/diagnóstico , Complexo Principal de Histocompatibilidade , Moléculas de Adesão Celular/efeitos adversosRESUMO
Se reportan los resultados de un estudio inmunohistoquímico del infiltrado inflamatorio de biopsias de la piel, el labio y la conjuntiva de pacientes con prurigo actínico (PA), donde se aplicaron anticuerpos monoclonales contra vimentina (para saber si el tejido necesitaba recuperación antigénica), contra antígeno común leucocitario (CD45), UCHL-1 (anti-CD45RO) marcador de linfocitos T, L-26 (anti-CD20) marcador de linfocitos B. Se demostró la presencia de linfocitos B y T en los infiltrados inflamatorios; cuando éstos se disponen en folículos linfoides los linfocitos B se encuentran al centro y los T en la periferia
Assuntos
Anticorpos Monoclonais , Linfócitos B/citologia , Biópsia , Imuno-Histoquímica , Inflamação/imunologia , Prurigo/imunologia , Linfócitos T/citologiaRESUMO
Se estudiaron 20 pacientes portadores de granuloma piógeno en diversas topografías. Se asignaron a ser manejados mediante excisión en huso de la lesión con cierre primario de la herida, o bien rasurado de la lesión con legrado y electrofulguración del lecho. Los resultados en ambos grupos fueron similares. Ningún granuloma piógeno recidivó y el dolor ocasionado por cualquiera de los métodos fue leve y pasajero
Assuntos
Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Eletrocoagulação , Granuloma Piogênico/cirurgia , Granuloma Piogênico/patologiaRESUMO
Se comunican 8 casos de enfermedad de Paget estudiados en la consulta dermatológica del Hospital General "Dr. Manuel Gea González", de 1980 a 1993. Cinco casos se presentaron en mama y el tiempo de evolución varió de 6 meses a un año. Tres fueron extramamarios de 1 a 6 años de evolución. Clínicamente presentaron placas eritemato-escamosas con eccema y en genitales eritema y descamación con aspecto de candidosis. Cinco pacientes fueron tratados con mastectomia radical y quimioterapia. Un caso extramamario falleció por asociación con otro carcinoma y metástasis del mismo