Flávio Barbosa Luz

The psychiatric facet of hyperhidrosis: demographics, disability, quality of life, and associated psychopathology.

We compared the sociodemographic and psychiatric features of treatment-seeking patients with (n=17) and without (n=29) primary hyperhidrosis (HYH) attending an outpatient dermatological clinic. Subjects were assessed with a structured clinical questionnaire, the Mini International Neuropsychiatric Interview, as well as the Screening for Abnormal Olfactory Experiences (to assess for symptoms of olfactory reference syndrome), the Obsessive-Compulsive Inventory-Revised, the Social Phobia Inventory, the Beck Depression and Anxiety Inventories, the Skindex-16 (a quality of life measure for patients with skin diseases), and the Sheehan Disability Scale. Patients with HYH were more frequently younger (p=0.003), unmarried (p=0.004), employed (p=0.019), more educated (p<0.0001), and better paid (p=0.001) than non-HYH patients. However, they also reported greater disabilities and impairments in work/school (p=0.05) and social life (p=0.014) domains, worse quality of life in emotional (p=0.003) and functioning (p>0.001) dimensions, and they had a greater frequency of comorbid social anxiety disorder (p=0.019). Conversely, non-HYH patients had greater severity of obsessive-compulsive neutralization symptoms (repeating compulsions, counting, and having lucky/unlucky numbers) (p=0.034). In conclusion, patients with HYH are characterized by differential sociodemographic and psychopathological characteristics, with major disability, marked impairment in quality of life, and increased rates of social anxiety disorder. (Journal of Psychiatric Practice 2014;20:316–323)

Surgical treatment of axillary hyperhidrosis by suction-curettage of sweat glands

Suction curettage is a dermatologic surgery technique for the treatment of axillary hyperhidrosis, which is becoming more popular. Objective: The purpose of this study is to describe the current technique of removal of axillary sweat glands, and evaluate its efficacy and safety. Conclusion: Suction-curettage of sweat glands is a minimally invasive surgical technique that is easy to perform, safe, has high rates of success and relatively few side-effects. It is generally well tolerated by patients and requires shorter time away from daily activities, when compared with other surgical modalities.

Surgical treatment of basal cell carcinoma: an algorithm based on the literature

Although basal cell carcinoma can be effectively managed through surgical excision, the most suitable surgical margins have not yet been fully determined. Furthermore, micrographic surgery is not readily available in many places around the world. A review of the literature regarding the surgical treatment of basal cell carcinoma was conducted in order to develop an algorithm for the surgical treatment of basal cell carcinoma that could help the choice of surgical technique and safety margins, considering the major factors that affect cure rates. Through this review, it was found that surgical margins of 4mm seem to be suitable for small, primary, well-defined basal cell carcinomas, although some good results can be achieved with smaller margins and the use of margin control surgical techniques. For treatment of high-risk and recurrent tumors, margins of 5-6 mm or margin control of the surgical excision is required. Previous treatment, histological subtype, site and size of the lesion should be considered in surgical planning because these factors have been proven to affect cure rates. Thus, considering these factors, the algorithm can be a useful tool, especially for places where micrographic surgery is not widely available.

Phylogenetic and structural analysis of merkel cell polyomavirus VP1 in Brazilian samples

Our understanding of the phylogenetic and structural characteristics of the Merkel Cell Polyomavirus (MCPyV) is increasing but still scarce, especially in samples originating from South America. In order to investigate the properties of MCPyV circulating in the continent in more detail, MCPyV Viral Protein 1 (VP1) sequences from five basal cell carcinoma (BCC) and four saliva samples from Brazilian individuals were evaluated from the phylogenetic and structural standpoint, along with all complete MCPyV VP1 sequences available at Genbank database so far. The VP1 phylogenetic analysis confirmed the previously reported pattern of geographic distribution of MCPyV genotypes and the complexity of the South-American clade. The nine Brazilian samples were equally distributed in the South-American (3 saliva samples); North American/European (2 BCC and 1 saliva sample); and in the African clades (3 BCC). The classification of mutations according to the functional regions of VP1 protein revealed a differentiated pattern for South-American sequences, with higher number of mutations on the neutralizing epitope loops and lower on the region of C-terminus, responsible for capsid formation, when compared to other continents. In conclusion, the phylogenetic analysis showed that the distribution of Brazilian VP1 sequences agrees with the ethnic composition of the country, indicating that VP1 can be successfully used for MCPyV phylogenetic studies. Finally, the structural analysis suggests that some mutations could have impact on the protein folding, membrane binding or antibody escape, and therefore they should be further studied.

Merkel cell carcinoma in an immunosuppressed patient

Merkel cell carcinoma is an uncommon neuroendocrine carcinoma with a rising incidence and an aggressive behavior. It predominantly occurs in older patients, with onset occurring at a mean age of 75-80 years. Recognized risk factors are ultraviolet sunlight exposure, immunosuppression, and, more recently, Merkel cell polyomavirus. We report a case of Merkel cell carcinoma in a young HIV positive patient with Merkel Cell polyomavirus detected in the tumor.

Analysis of effectiveness of a surgical treatment algorithm for basal cell carcinoma

BACKGROUND Surgical excision is the treatment of choice for basal cell carcinoma and micrographic surgery considered the gold standard, however not yet used routinely worldwide available, as in Brazil. Considering this, a previously developed treatment guideline, which the majority of tumors were treated by conventional technique (not micrographic) was tested. OBJECTIVE To establish the recurrence rate of basal cell carcinomas treated according to this guideline. METHOD Between May 2001 and July 2012, 919 basal cell carcinoma lesions in 410 patients were treated according to the proposed guideline. Patients were followed-up and reviewed between September 2013 and February 2014 for clinical, dermatoscopic and histopathologic detection of possible recurrences. RESULTS After application of exclusion criteria, 520 lesions were studied, with 88.3% primary and 11.7% recurrent tumors. Histological pattern was indolent in 85.5%, 48.6% were located in high risk areas and 70% small tumors. Only 7.3% were treated by Mohs micrographic surgery. The recurrence rate, in an average follow-up period of 4.37 years, was 1.3% for primary and 1.63% for recurrent tumors. Study limitations: unicenter study, with all patients operated on by the same surgeon. CONCLUSION The treatment guideline utilized seems a helpful guide for surgical treatment of basal cell carcinoma, especially if micrographic surgery is not available.

Demographics and spatial distribution of the Brazilian dermatologists

The medical-dermatological demographics favors health planning and guides expansion of the specialty. We conducted an ecological study of dermatologists members of the Brazilian Society of Dermatology (SBD). We evaluated: gender, age, address; which were compared with population and human development index indicators of municipalities. We evaluated 8384 members, distributed in 527 (9.5%) municipalities throughout Brazil. The female sex represented 78.4% of the members and the median age was 43 (36-54) years. The median density of dermatologists was 0.35 (0.21-0.37) per 10,000 inhabitants. The correlation (Spearmans rho) between density of dermatologists and human development index was 0.39 (p <0.01). The Brazilian dermatologist is characterized as: female, age <50 years and presenting an heterogeneous distribution throught the country.The medical-dermatological demographics favors health planning and guides expansion of the specialty. We conducted an ecological study of dermatologists members of the Brazilian Society of Dermatology (SBD). We evaluated: gender, age, address; which were compared with population and human development index indicators of municipalities. We evaluated 8384 members, distributed in 527 (9.5%) municipalities throughout Brazil. The female sex represented 78.4% of the members and the median age was 43 (36-54) years. The median density of dermatologists was 0.35 (0.21-0.37) per 10,000 inhabitants. The correlation (Spearmans rho) between density of dermatologists and human development index was 0.39 (p <0.01). The Brazilian dermatologist is characterized as: female, age <50 years and presenting an heterogeneous distribution throught the country.

Drug delivery of topical anesthetics as an effective technique for reducing pain in microneedling: a pilot study

Introduction: Microneedling, also known as percutaneous collagen induction therapy, is a safe and effective procedure, mostly used for rejuvenation, treatment of scars, melasma, alopecia, and other conditions, as well as for drug delivery. Despite the safety and benefits of this technique, the control of pain during the procedure is its major limiting factor. Objectives: To assess whether the drug delivery system for topical anesthesia immediately before a microneedling session is capable of reducing the pain. Methods: A split-face pilot study was carried out with nine consecutive cases of microneedling that had been indicated for the treatment of acne scars, rejuvenation and collagen induction. All patients underwent cleansing of the skin followed by the application of topical anesthetics on the entire face, and drug delivery with a 0.5mm roller only on the left hand side of the face. Next, all anesthetics were removed and microneedling with a 1.0mm roller was performed on both sides of the face. Results: There was a significant reduction of the pain on the left hand side of the face, where the drug delivery was carried out (p <0.01), with a mean value of 3.33 (± 1.49) on the Visual Analogue Scale as compared to the right hand side, which yielded a mean value of 5.22 (± 1.74). Conclusion: The topical anesthetic drug delivery technique was effective and successful in reducing the pain during microneedling procedures carried out in the study’s patients group.

Molecular prevalence of Merkel cell polyomavirus in nonmelanoma skin cancer in a Brazilian population

Merkel cell polyomavirus (MCPyV), a newly described oncogenic virus, has been found in association with tumours other than Merkel cell carcinoma (MCC). As yet, little is known about the involvement or influence of MCPyV on the development of these tumours and its prevalence in various populations.

Post-Therapeutic Hypochromia after Fractional CO2 Laser treated withBromisum Gaudchii trecul

Hypochromia secondary to the use of CO2 fractional laser, although common, is seldom reported in the medical literature, as well as how to proceed in such cases. We report a patient who was submitted to the procedure for treatment of diffuse atrophic striae in the lower limbs. She noted new lesions more evident than the original, as soon as the post-procedure crusts came off. She was treated with a progressive improvement after 3 months with oral therapy of Brosimum gaudichaudii Trecul, topical psoralen, and a not frequent sun exposure (UVA).