RESUMO
BACKGROUND: In recent years, the need for international, objective, patient-reported outcomes measures has grown as international collaboration has increased. As most quality-of-life scales have been developed in English, there is a growing need to adapt them transculturally to obtain equivalence between the original instrument and the adapted scale. OBJECTIVES: To assess the construct and convergent-discriminant validity and responsiveness of the Colombian version of Skindex-29. METHODS: The cross-sectional and longitudinal validity and responsiveness were tested in both healthy and dermatology patients. Construct validity was tested through a confirmatory factor analysis. The convergent-discriminant validity was assessed by examining the Spearman correlation coefficient. Change sensitivity was tested by means of the standardized response mean. The effect size and the minimum detectable change were also assessed. RESULTS: A total of 265 participants were included; 21·1% were healthy individuals, and 78·9% patients had either inflammatory or noninflammatory skin diseases. Confirmatory factor analysis showed an adequate comparative fit index and Tucker-Lewis index adjustment for the root mean square error of approximation. Convergent validity showed moderate correlations between the emotions, functioning and physical function or physical role domains. Discriminant validity showed low correlations between overall domains for both scales. Sensitivity to change at the first and third month showed effect sizes in global Skindex scores of 0·92 and 0·82, respectively. CONCLUSIONS: The Colombian version of Skindex-29 is a valid and clinically sensitive instrument, which can be used for clinical practice and for research to measure the impact of skin diseases on the quality of life of dermatology patients.
Assuntos
Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Dermatopatias/diagnóstico , Adolescente , Adulto , Idoso , Colômbia , Estudos Transversais , Feminino , Voluntários Saudáveis , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Psicometria/métodos , Reprodutibilidade dos Testes , Dermatopatias/psicologia , Traduções , Adulto JovemAssuntos
Farmacogenética , Testes Farmacogenômicos , Fatores Biológicos , Produtos Biológicos , Humanos , PsoríaseRESUMO
BACKGROUND: Improvement in the morphological appearance of collagen and elastic fibres has been reported after the use of trichloroacetic acid, dermabrasion and laser therapy, but the histopathological changes occurring after photodynamic therapy are less understood. AIM: To assess the histological changes that occur after methyl aminolevulinate (MAL) plus red-light therapy for facial photodamage. METHODS: This was a prospective, double-blind, double-arm, randomized, placebo-controlled trial of MAL plus red light in patients with facial photodamage. A 3-mm punch biopsy was taken from each side of the face before randomization and start of therapy. A dermatopathologist blinded to the treatment assessed epidermal and dermal layer thickness, perivascular inflammation, solar elastosis, perifollicular fibrosis, telangiectasias, number of elastic and collagen fibres, and grade of reticular degeneration. RESULTS: In total, 65 women were initially screened for eligibility, but skin samples from only 38 of these were analysed. The change in dermal thickness from baseline to postintervention was significant (P < 0.01, Wilcoxon signed rank test). Although there was a trend for the epidermis to be thinner after MAL plus red light vs. placebo plus red light (46.25 µm vs. 55.50 µm, respectively), the difference was not significant (P = 0.64, Mann-Whitney U-test). Similarly, the changes in dermal thickness obtained with the two treatments were not significant (P = 0.99, Mann-Whitney test). Histological improvement was seen using stains for collagen, elastic tissue, and perifollicular fibrosis after MAL plus red light therapy. DISCUSSION: Dermal thickness increased after the use of MAL plus red light, and there was improvement in collagen, elastic tissue and perifollicular fibrosis. Although these differences were not significant, most of the histopathological features examined in our study improved after treatment with MAL plus red light. The lack of significance might be due either to the low power of this study or to the failure of our scoring method to detect significant histopathological differences.
Assuntos
Ácido Aminolevulínico/análogos & derivados , Dermatoses Faciais/tratamento farmacológico , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/uso terapêutico , Envelhecimento da Pele/efeitos dos fármacos , Envelhecimento da Pele/efeitos da radiação , Adulto , Idoso , Ácido Aminolevulínico/uso terapêutico , Colágeno , Método Duplo-Cego , Tecido Elástico , Face/efeitos da radiação , Dermatoses Faciais/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
BACKGROUND: To date, there is no gold standard therapy for skin photoageing. In the last decade, laser technologies have offered great promise among skin-rejuvenation therapies; however, both non-ablative and ablative fractional resurfacing modalities have their own benefits and drawbacks. More recently, open-label studies and few controlled trials have suggested that photodynamic therapy may have therapeutic potential in photodamage. OBJECTIVE: To assess the efficacy of methyl aminolevulinate + red-light on facial photodamage in a double-blind split-face randomized placebo-controlled trial. METHODS: Subjects had initially two split-face treatments 2-3 weeks apart in which half of the face was treated with MAL + red-light compared with placebo + red-light. Primary outcome was the assessment of global photodamage 1 month after session 2. Secondary outcomes included the assessment of fine lines, mottled pigmentation, tactile roughness, sallowness, erythema and telangiectasia 1 month after session 2, according to severity scores rated as failure, improvement or success. RESULTS: Based on the intention-to-treat analysis, a total of 48 patients (96 split-faces) were included. Facial global photodamage success or improvement had occurred in 94 split-faces and in no split-faces receiving placebo (RR: 0.02; 95% confidence interval, 0.0-0.14; P = 0.0000). One patient had an adverse event that led to the discontinuation of the therapy after session 1. CONCLUSIONS: Methyl aminolevulinate + red-light demonstrated significantly superior efficacy in global facial photodamage compared with placebo. This therapy was also useful for all other specific secondary outcomes, except for telangiectasia. Overall, MAL + red-light sessions were well tolerated and resulted in high/total patient satisfaction in the majority of subjects (80.4%).
Assuntos
Ácido Aminolevulínico/análogos & derivados , Face , Fototerapia , Envelhecimento da Pele/efeitos dos fármacos , Adulto , Ácido Aminolevulínico/efeitos adversos , Ácido Aminolevulínico/farmacologia , Ácido Aminolevulínico/uso terapêutico , Método Duplo-Cego , Feminino , Humanos , Pessoa de Meia-Idade , Fototerapia/efeitos adversos , Placebos , Estudos Prospectivos , Envelhecimento da Pele/efeitos da radiaçãoRESUMO
BACKGROUND: Onychomycosis is one of the commonest dermatological diseases worldwide. The antifungal activity of current medications varies, and treatment failure occurs in 25-40% of treated patients. AIMS: To evaluate the in vitro antifungal activity of itraconazole, fluconazole, terbinafine and voriconazole against isolates taken from patients with onychomycosis. METHODS: Nail isolates were evaluated according to methods described in the protocols of the Antifungal Susceptibility Testing Subcommittee of the European Committee on Antimicrobial Susceptibility Testing (AFST-EUCAST) and the Clinical and Laboratory Standards Institute (CLS M38-A), and a CLSI M38-A modified technique for dermatophytes. Antifungal agents tested included terbinafine, itraconazole, voriconazole and fluconazole. RESULTS: In total, 103 isolates of Candida species (n = 58), Fusarium species (n = 10), Fusicoccum dimidiatum (n = 4), Scytalidium hyalinum (n = 1) and dermatophytes (n = 30) were evaluated. Itraconazole and voriconazole were the most active agents against Candida species, whereas terbinafine and voriconazole were most potent against dermatophytes. Fusarium species had the highest minimum inhibitory concentration (MIC) values with all antifungal agents. CONCLUSIONS: The aetiological agents of onychomycosis that we found differ from those found in other countries, suggesting that the heat and humidity of the Colombian climate could favour yeast nail infections. The lowest MICs for Candida species (obtained with voriconazole, followed by itraconazole) may be explained by emerging resistant strains. Against dermatophytes, the lowest MICs were obtained with terbinafine, followed by voriconazole. MIC values for the evaluated agents were higher for non-dermatophyte filamentous fungi than for other fungi. As MIC breakpoints have not yet been established for onychomycosis therapies, it remains unclear if in vitro activities of antifungal drugs are predictive of clinical outcome. Well-designed clinical studies are necessary to assist clinicians in choosing the best antifungal agents.
Assuntos
Antifúngicos/farmacologia , Fungos/efeitos dos fármacos , Onicomicose/tratamento farmacológico , Análise de Variância , Arthrodermataceae/efeitos dos fármacos , Candida/efeitos dos fármacos , Colômbia , Relação Dose-Resposta a Droga , Fluconazol/farmacologia , Fusarium/efeitos dos fármacos , Humanos , Itraconazol/farmacologia , Testes de Sensibilidade Microbiana , Naftalenos/farmacologia , Onicomicose/microbiologia , Pirimidinas/farmacologia , Terbinafina , Triazóis/farmacologia , VoriconazolRESUMO
BACKGROUND: Among all the topical immunomodulators, vitiligo's mainstay therapy includes topical corticosteroids. Many other non-immune theories have also been suggested for vitiligo's pathogenesis, but the role of oxidative stress has gained more importance in recent years. OBJECTIVE: To compare the effect of topical 0.05% betamethasone vs. catalase/dismutase superoxide (C/DSO). STUDY DESIGN: Randomized, matched-paired, double-blind trial. SETTING: Dermatology Section, University of Antioquia, Medellín, Colombia. SUBJECTS: Patients (aged > 18 years or between 12 and 18 years) with parent's informed consent, with stable or active bilateral vitiligo. INTERVENTION: Topical 0.05% betamethasone or C/DSO. METHODS: Two lesions similar to each other in size were chosen. All assessments were made by two blinded investigators, and photographs were subjected to morphometry analysis. MAIN OUTCOME: Skin repigmentation by digital morphometry. RESULTS: Twenty-five patients were enrolled in the study (21 women and 4 men). Mean age of participants was 40 years (range: 12-74 years). One patient on C/DSO experienced a mild local erythematous papular rash that self-resolved. At 4 months of therapy, there was no statistical difference on the percentage of repigmentation between betamethasone and C/DSO (5.63% +/- 27.9 vs. 3.22% +/- 25.8, respectively, P = 0.758). After 10 months of therapy, the percentage of skin repigmentation increased to 18.5 +/- 93.14% with betamethasone and to 12.4 +/- 59% with C/DSO, but again, we found no statistical differences (P = 0.79). DISCUSSION AND CONCLUSIONS: Few studies have described objective methods to evaluate repigmentation among vitiligo patients. Digital morphometry provides an objective assessment of repigmentation in vitiligo. Objective vitiligo repigmentation with topical C/DSO at 10 months is similar to topical 0.05% betamethasone. Although a mild adverse effect was related to the use of C/DSO, such finding was not severe enough to discontinue treatment.
Assuntos
Betametasona/uso terapêutico , Catalase/uso terapêutico , Superóxido Dismutase/uso terapêutico , Vitiligo/tratamento farmacológico , Administração Tópica , Adolescente , Adulto , Idoso , Betametasona/administração & dosagem , Catalase/administração & dosagem , Criança , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Superóxido Dismutase/administração & dosagemRESUMO
OBJECTIVE: To evaluate the efficacy of 5% imiquimod in HIV-positive male patients with anogenital warts or anal intraepithelial neoplasia (AIN), and to elucidate whether human papillomavirus (HPV) type and viral load were important for clinical outcome and recurrences. METHODS: Thirty-seven patients with histologically proven anogenital warts or AIN were enrolled. Topical 5% imiquimod was applied three times per week for more than 8 h overnight for 16 weeks, although patients were allowed to continue therapy for 4 more weeks if they did not have complete clearance of lesions. RESULTS: Mean age was 34 years. The perianal area was the main lesion location. Thirty-three patients had CD4 counts of < 500 cells/mm(3). Eighteen patients had a histopathological diagnosis of AIN-1. Main HPV types detected corresponded to low-risk HPV types. At 20 weeks of therapy, 46% patients achieved total clearance whereas 14 patients had > 50% clearance. Recurrence was observed in 5 of 17 patients who cleared. Clearance was not influenced by patients' CD4 counts, wart location, HIV viral load or HPV viral load. CONCLUSIONS: The assumption that visible perianal warts are benign lesions in HIV-positive patients has to be reevaluated since an important number of such lesions could correspond to low-grade anal disease, which in turn could progress to high-grade anal disease or cancer. In addition, our results in this preliminary study indicate that imiquimod appears to be effective in treating AIN in HIV-positive patients. Further studies are needed to document its utility to prevent high-grade dysplasia and/or anal cancer.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Adjuvantes Imunológicos/uso terapêutico , Aminoquinolinas/uso terapêutico , Doenças do Ânus/tratamento farmacológico , Neoplasias do Ânus/tratamento farmacológico , Condiloma Acuminado/tratamento farmacológico , Doenças dos Genitais Masculinos/tratamento farmacológico , Infecções por Papillomavirus/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/virologia , Adjuvantes Imunológicos/administração & dosagem , Administração Tópica , Adulto , Aminoquinolinas/administração & dosagem , Doenças do Ânus/virologia , Neoplasias do Ânus/virologia , Carcinoma in Situ/tratamento farmacológico , Carcinoma in Situ/virologia , Condiloma Acuminado/virologia , Doenças dos Genitais Masculinos/virologia , Humanos , Imiquimode , Masculino , Pessoa de Meia-Idade , Papillomaviridae/classificação , Infecções por Papillomavirus/virologia , Reação em Cadeia da Polimerase , Resultado do Tratamento , Carga ViralRESUMO
Human papillomavirus (HPV) infection is the most common sexually transmitted disease in the world and accounts for an estimated 11% of the global cancer incidence in women. HPV-16 is the most prevalent type detected in cervical cancer and along with types 18, 31, 33 and 45 has been classified as a class I carcinogen. In addition to cervical cancer, HPVs are also associated with the malignant transformation of other mucosal and skin cancers. Thus, the combination of the malignant potential of HPV and its high prevalence of infection confers to it an importance of generalized clinical and virological significance. The natural history of HPV infection with or without treatment varies from spontaneous regression to persistence. The most important mechanism for wart regression appears to be cell-mediated immunity. Cytokines released by keratinocytes or cells of the immune system may play a part in the induction of an effective immune response against HPV infection and the subsequent regression of lesions. This review discusses the molecular biology, pathogenesis and immunology of HPV infections.
Assuntos
Papillomaviridae/fisiologia , Infecções por Papillomavirus/imunologia , Humanos , Infecções por Papillomavirus/epidemiologiaRESUMO
OBJECTIVE: To characterize the epidemiological, clinical, and histopathological features of patients with cancer who develop widespread polymorphic and pruritic skin lesions following radiotherapy. PATIENTS, DESIGN, AND INTERVENTIONS: During phase 1, epidemiological and clinical features of 103 patients with cancer, 83 treated with radiotherapy (71 women and 12 men) and 20 controls who did not undergo radiotherapy (16 women and 4 men), were explored during 3 months (October 1995 to January 1996). During phase 2, in 30 additional patients with cancer who were treated with telecobalt or linear accelerator, 18 with skin lesions (15 women and 3 men) and 12 without lesions (10 women and 2 men), the following were investigated: (1) hematoxylin-eosin-stained sections for routine histopathological examination and direct immunofluorescence, and lymphocytic markers; (2) blood, skin, and primary tumor eosinophilia; and (3) the presence of antiepidermal autoantibodies. Patients were examined during 5 months (February 1996 to June 1996). SETTING: A dermatology department at a university hospital. RESULTS: During phase 1, 14 (17%) of the 83 patients undergoing radiotherapy developed an eruption. Acral excoriations, erythematous papules, vesicles, and bullae were the most frequent lesions. During phase 2, in 18 patients, a superficial and deep lymphocytic perivascular infiltrate with numerous eosinophils, intraepidermal and interstitial eosinophilic infiltrates, eosinophilic panniculitis, IgM and C3 perivascular deposits, and slightly predominant CD4+ cells were observed. No antiepidermal autoantibodies were found. CONCLUSIONS: The clinical, histopathological, and immunopathologic features in patients with cancer undergoing radiotherapy are described. To our knowledge, this condition has not been well characterized. Because of its unique presentation, the denomination "eosinophilic, polymorphic, and pruritic eruption associated with radiotherapy" is suggested.