RESUMO
Vitiligo is an acquired depigmenting disorder. To date, there is no predictive model for its response rate to narrowband ultraviolet B (NBUVB) phototherapy. The aim of this study was to investigate the different types of response of patients with non-segmental vitiligo undergoing NBUVB 3 times a week. Many patients who were previously considered non-responders were given the opportunity to continue the treatment. Long-term maintenance of treatment and follow-up of a cohort of 579 patients enabled different subtypes of response (very rapid, rapid, average, slow and "non-responders") to be described for the first time, and a predictive model of response to be constructed based on repigmentation rate in the first 48 sessions of NBUVB. Among those patients who did not respond during the first 48 sessions, a new subgroup of patients was found, termed "very-slow" responders, who achieved a low, but significant, level of repigmentation after 96 sessions of NBUVB.
Assuntos
Pigmentação da Pele/efeitos da radiação , Pele/efeitos da radiação , Terapia Ultravioleta , Vitiligo/radioterapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Fotografação , Valor Preditivo dos Testes , Indução de Remissão , Estudos Retrospectivos , Índice de Gravidade de Doença , Pele/fisiopatologia , Terminologia como Assunto , Fatores de Tempo , Resultado do Tratamento , Terapia Ultravioleta/efeitos adversos , Vitiligo/classificação , Vitiligo/diagnóstico , Vitiligo/fisiopatologia , Adulto JovemRESUMO
Objetivo: Analisar a presença de autoanticorpos antitireoidianos (anti-TPO) no soro de pessoas acometidas por vitiligo. Métodos: Estudo do tipo caso-controle retrospectivo realizado em serviço de dermatologia de referência na Amazônia, com amostra constituída por dois grupos: Grupo Vitiligo (n=56), com diagnóstico clínico de vitiligo, e Grupo Controle (n=30), que se declarou sadio, não portador de vitiligo, de outra dermatose e/ou doença autoimune diagnosticada. O registro dos dados foi feito pelo preenchimento de protocolo específico usado em entrevista para ambos os grupos, além de coleta de sangue para dosagem de autoanticorpos anti-TPO para os dois grupos. O teste qui quadrado e a odds ratio (OR) foram utilizados para variáveis qualitativas; para as quantitativas, foi utilizado o teste t de Student, e o nível de significância foi de p≤5%. Resultados: A história pessoal de doença autoimune esteve presente em 7,14% dos portadores versus 0% dos controles. Não houve diferenças estatisticamente relevantes com relação aos antecedentes familiares entre os grupos (OR: 0,5704; p=0,4146). Quanto à positividade para os autoanticorpos anti-TPO (níveis superiores ao ponto de corte), não houve relevância estatística (qui quadrado 2,844; p=0,229). Entretanto, na comparação dos níveis séricos absolutos de autoanticorpos anti-TPO entre os grupos, foram obtidos 129,49±323,88 para o portador da doença e 35,85±13,16 para o controle, com t=2,1602 e p=0,0351. Conclusão: Embora não tenha sido relevante a diferença entre os Grupo Vitiligo e Controle quanto à positividade para o autoanticorpos anti-TPO, ao se considerar a comparação com os valores séricos absolutos do Grupo Vitiligo, estes foram maiores que os apresentados pelos controles, sendo esta diferença estatisticamente relevante.(AU)
Objective: To analyze the presence of antithyroid autoantibodies (anti-TPO) in the serum of people affected by vitiligo. Methods: This is a study of retrospective casecontrol, performed in a reference dermatological center in Amazonia, with a sample consisting of two groups: Vitiligo group (n=56), with clinical diagnosis of vitiligo, and the Control Group (n=30), who was self-declared as healthy, nonvitiligo carrier, with no other dermatosis and/or diagnosed autoimmune disease. The data recording was made with specific protocol completion in an interview for both groups, and blood collection for antithyroid autoantibodies dosage for both groups. Chi-square and odds ratio (OR) tests were used for qualitative variables; for the quantitative ones, t-Student test, and significance level of p≤5%. Results: The personal history of autoimmune disease was present in 7.14% of patients compared to 0% of controls. There were no statistically significant differences in relation to family history between the groups (odds ratio: 0.5704; p=0.4146). As for the positivity for antithyroid autoantibodies (levels above the cutoff point), there was no statistical significance (chi-square=2.844, p=0.229). However, when comparing the absolute serum levels of antithyroid autoantibodies between the groups, 129.49±323.88 was obtained for the carrier of the disease, and 35.85±13:16 to controls, with t=2.1602, and p=0.0351. Conclusion: Although the difference between vitiligo and control groups were not significant regarding positivity for antithyroid autoantibodies, when the comparison with the absolute serum levels of the group with vitiligo was considered, they were higher than those presented by the controls, with this difference being statistically significant.(AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Autoanticorpos/análise , Doenças Autoimunes/complicações , Glândula Tireoide , Vitiligo/fisiopatologia , Estudos de Casos e ControlesRESUMO
Abstract: Background: The onset of vitiligo during childhood is common. Limited data exist that compare the clinical associations of prepubertal and postpubertal vitiligo in Arabs. Objective: To compare the clinical profile of pre and postpubertal onset vitiligo. Methods: A cross-sectional observational study was conducted. The Vitiligo European Task Force questionnaire was completed for each patient. Results: A total of 375 patients were included; 199 had postpubertal vitiligo (>12 years), and 176 had prepubertal onset vitiligo (<12years). There were more females in the prepubertal group (49%) than in the postpubertal group (29%), p-value <0.001. The prepubertal group has had more involvement than the postpubertal group (45% vs 30%, p=0.004). Only 8 cases of segmental vitiligo were observed; five were observed in the prepubertal group of patients. Female gender (OR=2.3; 95% CI:1.5, 3.5), presence of halo nevus (OR=2.2; 95% CI:1.1, 4.4) and face involvement (OR=1.9; 95% CI:1.2, 2.9) were positively associated with prepubertal vitiligo. Stress, as an onset factor, was positively associated (OR=0.51; 95% CI:0.3, 0.8) with postpubertal onset vitiligo. Study limitations: A possible selection bias toward more severe vitiligo cases can be a limitation, because the study was conducted in a clinic specialized in vitiligo. Moreover, a likelihood of false recall bias cannot be excluded. Conclusions: Our data present clinical evidence that vitiligo behaves mostly the same way in the prepubertal group as in the postpubertal group. However, female over-representation, more face involvement and more halo nevi were observed in prepubertal vitiligo, while stress was more prevalent as an aggravating factor in postpubertal vitiligo patients.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Vitiligo/fisiopatologia , Puberdade/fisiologia , Estresse Psicológico/fisiopatologia , Índice de Gravidade de Doença , Modelos Logísticos , Fatores Sexuais , Estudos Transversais , Análise Multivariada , Inquéritos e Questionários , Idade de Início , Nevo com Halo/fisiopatologiaRESUMO
The aim of this study is to evaluate the use of fractional carbon dioxide laser (CO2 ) with betamethasone and salicylic acid solution in the treatment of patients with refractory vitiligo in hands. Each hand of the patient was randomly assigned to one of two groups: lesion treated with fractional carbon dioxide laser associated with betamethasone and salicylic acid solution administration or lesion treated only with betamethasone and salicylic acid solution. We conclude that combined treatment with fractional carbon dioxide laser and betamethasone associated with salicylic acid solution could effectively and safely be used in the treatment of refractory vitiligo.
Assuntos
Betametasona/uso terapêutico , Glucocorticoides/uso terapêutico , Lasers de Gás/uso terapêutico , Terapia com Luz de Baixa Intensidade/instrumentação , Ácido Salicílico/uso terapêutico , Pigmentação da Pele/efeitos dos fármacos , Pigmentação da Pele/efeitos da radiação , Vitiligo/terapia , Adulto , Brasil , Terapia Combinada , Combinação de Medicamentos , Humanos , Pessoa de Meia-Idade , Soluções Farmacêuticas , Resultado do Tratamento , Vitiligo/diagnóstico , Vitiligo/fisiopatologia , Adulto JovemRESUMO
BACKGROUND: The onset of vitiligo during childhood is common. Limited data exist that compare the clinical associations of prepubertal and postpubertal vitiligo in Arabs. OBJECTIVE: To compare the clinical profile of pre and postpubertal onset vitiligo. METHODS: A cross-sectional observational study was conducted. The Vitiligo European Task Force questionnaire was completed for each patient. RESULTS: A total of 375 patients were included; 199 had postpubertal vitiligo (>12 years), and 176 had prepubertal onset vitiligo (<12years). There were more females in the prepubertal group (49%) than in the postpubertal group (29%), p-value <0.001. The prepubertal group has had more involvement than the postpubertal group (45% vs 30%, p=0.004). Only 8 cases of segmental vitiligo were observed; five were observed in the prepubertal group of patients. Female gender (OR=2.3; 95% CI:1.5, 3.5), presence of halo nevus (OR=2.2; 95% CI:1.1, 4.4) and face involvement (OR=1.9; 95% CI:1.2, 2.9) were positively associated with prepubertal vitiligo. Stress, as an onset factor, was positively associated (OR=0.51; 95% CI:0.3, 0.8) with postpubertal onset vitiligo. STUDY LIMITATIONS: A possible selection bias toward more severe vitiligo cases can be a limitation, because the study was conducted in a clinic specialized in vitiligo. Moreover, a likelihood of false recall bias cannot be excluded. CONCLUSIONS: Our data present clinical evidence that vitiligo behaves mostly the same way in the prepubertal group as in the postpubertal group. However, female over-representation, more face involvement and more halo nevi were observed in prepubertal vitiligo, while stress was more prevalent as an aggravating factor in postpubertal vitiligo patients.
Assuntos
Puberdade/fisiologia , Vitiligo/fisiopatologia , Adolescente , Idade de Início , Criança , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Análise Multivariada , Nevo com Halo/fisiopatologia , Índice de Gravidade de Doença , Fatores Sexuais , Estresse Psicológico/fisiopatologia , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Vitiligo, although asymptomatic, highly compromises patients' quality of life (QoL). Therefore, an adequate evaluation of QoL is essential. OBJECTIVES: Translation, cultural adaptation and validation of VitiQol (Vitiligo-specific health-related quality of life instrument) into Brazilian Portuguese. METHODS: The study was conducted in two stages; the first stage was the translation and cultural/linguistic adaptation of the instrument; the second stage was the instrument's validation. RESULTS: The translated VitiQol showed high internal consistency (Cronbach alpha = 0.944) and high test-retest reliability and intraclass correlation coefficient=0.95 (CI 95% 0.86 - 0.98), p<0.001. There was no statistically significant difference between the means of the first completion of the VitiQoL questionnaire and the retest, p = 0.661. There was a significant correlation between VitiQoL and DLQI (r = 0.776, p <0.001) and also between VitiQoL-PB and subjects' assessment of the severity of their disease (r = 0.702, p <0.001). CONCLUSIONS: The impact of vitiligo on the QoL of Brazilian patients can be assessed by a specific questionnaire.
Assuntos
Nível de Saúde , Qualidade de Vida/psicologia , Inquéritos e Questionários/normas , Traduções , Vitiligo/psicologia , Adulto , Idade de Início , Brasil , Comparação Transcultural , Feminino , Humanos , Idioma , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Autoimagem , Índice de Gravidade de Doença , Fatores Socioeconômicos , Vitiligo/fisiopatologiaRESUMO
Abstract BACKGROUND: Vitiligo, although asymptomatic, highly compromises patients' quality of life (QoL). Therefore, an adequate evaluation of QoL is essential. OBJECTIVES: Translation, cultural adaptation and validation of VitiQol (Vitiligo-specific health-related quality of life instrument) into Brazilian Portuguese. METHODS: The study was conducted in two stages; the first stage was the translation and cultural/linguistic adaptation of the instrument; the second stage was the instrument's validation. RESULTS: The translated VitiQol showed high internal consistency (Cronbach alpha = 0.944) and high test-retest reliability and intraclass correlation coefficient=0.95 (CI 95% 0.86 - 0.98), p<0.001. There was no statistically significant difference between the means of the first completion of the VitiQoL questionnaire and the retest, p = 0.661. There was a significant correlation between VitiQoL and DLQI (r = 0.776, p <0.001) and also between VitiQoL-PB and subjects' assessment of the severity of their disease (r = 0.702, p <0.001). CONCLUSIONS: The impact of vitiligo on the QoL of Brazilian patients can be assessed by a specific questionnaire. .
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nível de Saúde , Qualidade de Vida/psicologia , Inquéritos e Questionários/normas , Traduções , Vitiligo/psicologia , Idade de Início , Brasil , Comparação Transcultural , Idioma , Reprodutibilidade dos Testes , Autoimagem , Índice de Gravidade de Doença , Fatores Socioeconômicos , Vitiligo/fisiopatologiaRESUMO
UNLABELLED: Vitiligo is a skin disease characterized by absence of melanin due to melanocytes destruction. AIM: to study the incidence of hearing alterations in patients with vitiligo. METHOD: prospective audiological evaluation, transient-evoked otoacoustic emission recordings and study the effects of suppression in 24 patients with vitiligo. Their ages ranged from 15 to 45 years. RESULTS: 21 patients (87.5%) had normal audiometry; 2 had unilateral hearing loss in the high frequencies and 1 had cochlear moderate hearing loss in the left ear. Of these 21 subjects, 66.7% had no otoacoustic emissions, suggesting cochlear dysfunction. Only 7 patients had otoacoustic emissions present in all frequencies (29.2%) and 17 (70.8%) did not have them, and the highest rate of no otoacoustic emissions happened in the right ear of males. Regarding the suppression study, 6 subjects failed, all of them were females, and their left ears were the most affected. CONCLUSION: the findings show that patients with vitiligo, particularly males, have a greater predisposition to cochlear dysfunction, especially in the right ear. As far as the suppression effect was concerned, there was a greater alteration in the female efferent system, particularly in the left ear. Hearing alterations did not vary as far as age is concerned, type of vitiligo and time of disease progression.
Assuntos
Emissões Otoacústicas Espontâneas/fisiologia , Vitiligo/fisiopatologia , Testes de Impedância Acústica , Adolescente , Adulto , Audiometria de Tons Puros , Feminino , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/etiologia , Perda Auditiva Unilateral/diagnóstico , Perda Auditiva Unilateral/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença , Fatores Sexuais , Vitiligo/complicações , Adulto JovemRESUMO
Vitiligo é uma doença cutânea, caracterizada pela ausência da melanina, por destruição de melanócitos. Objetivo: Verificar a ocorrência de alteração auditiva em indivíduos com vitiligo. Método: Avaliação audiológica, pesquisa das emissões otoacústicas evocadas transientes e do efeito de supressão em estudo prospectivo de 24 pacientes com vitiligo. A faixa etária variou de 15 a 45 anos. Resultados: 21 pacientes (87.5%) apresentaram audiometria normal; dois apresentaram perda auditiva unilateral em freqüências altas e um apresentou perda coclear de grau moderado à esquerda. Destes 21 sujeitos, 66,7% tiveram ausência de emissões, sugerindo disfunção coclear. As emissões estiveram presentes em todas as bandas de freqüência em apenas 7 pacientes (29,2%) e ausentes em 17 (70,8%), com maior ocorrência de falha no sexo masculino, na orelha direita. Na pesquisa da supressão, seis indivíduos falharam, todos do sexo feminino, sendo a orelha esquerda a mais afetada. Conclusão: Pela análise das emissões otoacústicas verificou-se que os portadores de vitiligo possuem maior predisposição à disfunção coclear, com maior ocorrência no sexo masculino na orelha direita. Quanto ao efeito de supressão, houve maior alteração no sistema eferente em mulheres, com maior ausência à esquerda. As alterações auditivas não diferiram quanto à idade, tipo de vitiligo e tempo de evolução da doença.
Vitiligo is a skin disease characterized by absence of melanin due to melanocytes destruction. Aim: to study the incidence of hearing alterations in patients with vitiligo. Method: prospective audiological evaluation, transient-evoked otoacoustic emission recordings and study the effects of suppression in 24 patients with vitiligo. Their ages ranged from 15 to 45 years. Results: 21 patients (87.5%) had normal audiometry; 2 had unilateral hearing loss in the high frequencies and 1 had cochlear moderate hearing loss in the left ear. Of these 21 subjects, 66.7% had no otoacoustic emissions, suggesting cochlear dysfunction. Only 7 patients had otoacoustic emissions present in all frequencies (29.2%) and 17 (70.8%) did not have them, and the highest rate of no otoacoustic emissions happened in the right ear of males. Regarding the suppression study, 6 subjects failed, all of them were females, and their left ears were the most affected. Conclusion: the findings show that patients with vitiligo, particularly males, have a greater predisposition to cochlear dysfunction, especially in the right ear. As far as the suppression effect was concerned, there was a greater alteration in the female efferent system, particularly in the left ear. Hearing alterations did not vary as far as age is concerned, type of vitiligo and time of disease progression.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Emissões Otoacústicas Espontâneas/fisiologia , Vitiligo/fisiopatologia , Testes de Impedância Acústica , Audiometria de Tons Puros , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/etiologia , Perda Auditiva Unilateral/diagnóstico , Perda Auditiva Unilateral/etiologia , Estudos Prospectivos , Índice de Gravidade de Doença , Fatores Sexuais , Vitiligo/complicações , Adulto JovemRESUMO
Ankylosing spondylitis (AS) is a disabling disease affecting the enthesis and joints of the spine and peripheral sites. Tumour necrosis factor alpha (TNF-alpha) is a proinflammatory mediator which plays a significant role in the pathogenesis of AS. Infliximab (a chimeric monoclonal antibody which blocks the activity of TNF-alpha) is one of the most effective therapies of AS thus far. Vitiligo is a depigmenting disorder of the skin of unknown aetiology affecting 0.5-1% of the population. Here we describe the effect of infliximab on vitiligo in a patient with AS.
Assuntos
Anticorpos Monoclonais/uso terapêutico , Fatores Imunológicos/uso terapêutico , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Vitiligo/tratamento farmacológico , Adulto , Humanos , Infliximab , Masculino , Espondilite Anquilosante/complicações , Espondilite Anquilosante/tratamento farmacológico , Vitiligo/complicações , Vitiligo/fisiopatologiaAssuntos
Humanos , Lúpus Vulgar/diagnóstico , Lúpus Vulgar/fisiopatologia , Lúpus Vulgar/terapia , Pele/anatomia & histologia , Pele/fisiopatologia , Pele/lesões , Vitiligo/diagnóstico , Vitiligo/fisiopatologia , Vitiligo/terapia , Urticária/diagnóstico , Urticária/fisiopatologia , Urticária/terapiaAssuntos
Pele/enzimologia , Pele/química , Congressos como Assunto , Dermatite/diagnóstico , Dermatite/fisiopatologia , Dermatite/prevenção & controle , Eczema/fisiopatologia , Eczema/prevenção & controle , Eczema/reabilitação , Eventos Científicos e de Divulgação , Vitiligo/fisiopatologia , Vitiligo/prevenção & controle , Vitiligo/reabilitaçãoRESUMO
Objetivo: identificar el comportamiento clínico y la terapéutica aplicada en los pacientes con diagnóstico de vitiligo en la primera consulta. Material y método: Estudio descriptivo, restrospectivo, transversal. La recolección de la información fue obtenida de los expedientes clínicos evaluándose a través de una ficha de recolección de datos; las caractrísticas sociodemográficas, de evolución, las manifestaciones clínicas y el tratamiento indicado a estos pacientes. Resultados: Se revisaron 205 expedientes de pacientes con Vitiligo: la edad promedio fue de 24 años más o menos 18.5, el sexo más afectado fue el femenino con 61.9 por ciento (n=127) y la procedencia más frecuente fue de 75.6 por ciento (n=155) el área urbana. Al determinar la edad de inicio más frecuente oscilo entre 5-9 años con 26.8 por ciento (n= 55), 10-14 años 15.6 por ciento (n=32), 20 años a más. El tiempo de evolución de la enfermedad a la primera consulta se encontró que la mayoría tenía menos de un año 53.6 por ciento (n=110). Se consiguió este dato en el expediente clínico. La forma clínica más común fue el Vitiligo diseminado 52.6 por ciento (n=108), seguido de la forma focal 37.5 por ciento (n=77). Las terapias más utilizadas fueron el esteroides tópicos más 8-metoxipsoraleno tópico 39.5 por ciento (n=81), seguido de esteroides tópicos 15.12 por ciento (n=31)...
Assuntos
Transtornos da Pigmentação/diagnóstico , Transtornos da Pigmentação/fisiopatologia , Transtornos da Pigmentação/patologia , Vitiligo , Vitiligo/diagnóstico , Vitiligo/fisiopatologia , Vitiligo/psicologia , Vitiligo/terapia , NicaráguaRESUMO
A 3-year-old boy with segmental vitiligo, poliosis, and alopecia over the right side of the scalp developed epilepsia partialis continua involving the left side of the body and progressive atrophy of the right cerebral hemisphere. There was a right ear dysacusia and a perilimbal vitiligo associated with an area of iris depigmentation in the right eye. Pleocytosis and hypergammaglobulin were detected in cerebrospinal fluid. Because medical treatment that included phenobarbital, phenytoin, carbamazepine, oxcarbazepine, benzodiazepines, corticosteroids, gamma-globulin, and a ketogenic diet was ineffective, he underwent a right hemispherectomy. Neuropathologic examination showed a widespread scattered inflammatory process with numerous microglial nodules and perivascular lymphocytic cuffing associated with degenerative changes with severe neuronal loss, loosening of the neuropil, and microcystic changes with tissue collapse. The coexistence of vitiligo and possibly Vogt-Koyanagi-Harada syndrome in this child reinforces the autoimmune theory as the pathogenesis of Rasmussen syndrome.
Assuntos
Encefalite/complicações , Vitiligo/complicações , Vitiligo/fisiopatologia , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Pré-Escolar , Eletroencefalografia , Encefalite/diagnóstico , Lateralidade Funcional/fisiologia , Transtornos da Audição/complicações , Transtornos da Audição/diagnóstico , Humanos , Imageamento por Ressonância Magnética , Masculino , Degeneração Neural/fisiopatologia , Couro Cabeludo , Tomografia Computadorizada por Raios XRESUMO
La psico-neuro-inmuno-endocrino-dermatología es una especialidad relativamente nueva dentro de la medicina, que emparenta la parte psíquica y el estrés con diversas ramas de la medicina como son la neurología, endocrinología, dermatología e inmunología. En este artículo se trata de explicar, en forma breve y clara, la etiopatogenia de las dermatosis inducidas por el estrés, desde que el estímulo es captado en el sistema nervioso central hasta el desarrollo de la dermatosis (AU)
Assuntos
Humanos , Doenças do Colágeno/psicologia , Estresse Psicológico/complicações , Dermatopatias/psicologia , Psoríase/fisiopatologia , Vitiligo/fisiopatologia , Alopecia em Áreas/fisiopatologia , Dermatite Atópica/psicologia , Estresse Psicológico/fisiopatologia , Acontecimentos que Mudam a Vida , Estresse Fisiológico/fisiopatologia , Dermatopatias/etiologiaRESUMO
La psico-neuro-inmuno-endocrino-dermatología es una especialidad relativamente nueva dentro de la medicina, que emparenta la parte psíquica y el estrés con diversas ramas de la medicina como son la neurología, endocrinología, dermatología e inmunología. En este artículo se trata de explicar, en forma breve y clara, la etiopatogenia de las dermatosis inducidas por el estrés, desde que el estímulo es captado en el sistema nervioso central hasta el desarrollo de la dermatosis