Iphis Campbell

HLA antigens and risk for development of pemphigus foliaceus (fogo selvagem) in endemic areas of Brazil

Endemic pemphigus foliaceus (EPF), is an autoimmune disease associated with production of IgG antibodies against epidermal antigens. We have tested 38 patients and 50 control subjects living in endemic areas to investigate whether HLA genes are associated with host factors that determine whether or not exposed individuals will develop this disease. A variant of HLA-DR1, an antigen common in Blacks (DRB1*0102), was found to be the main susceptibility factor (relative risk=7.3, P<0.0002). Two amino acids, in positions 85 and 86 of DRB1, distinguish DRB1*0102 from DRB1*0101. These residues appear to be involved in the formation of a functional epitope that causes T cell recognition and determines disease susceptibility. Moreover, subjects having DQw2 did not develop the disease, while the frequency of DQw2 in controls was 22% (RR=0.04, P<0.006). Thus HLA genes appear to play a crucial role in the response to an environmental factor which in this setting frequently leads to the development of autoimmune disease. An HLA-DQ allele, DQw2, appears to be associated with factors that prevent the development of the disease in exposed individuals.

Endemic pemphigus foliaceus (fogo selvagem) in Native Americans from Brazil

BACKGROUND Fogo selvagem (FS) is an autoimmune disease that is endemic in certain regions of Brazil and appears to be precipitated by an environmental factor. OBJECTIVE Our purpose was to confirm the occurrence and prevalence of FS in a population of Xavante Indians living in an endemic region of central Brazil. METHODS Clinical, anthropologic, and immunologic studies were carried out in patients and in normal inhabitants of the Pimentel Barbosa Indian Reservation, Mato Grosso, Brazil. RESULTS FS was identified and confirmed in 10 patients from a patient pool of 295 with various skin diseases. The Xavante settlement has a total population of 746. Anti-desmoglein 1 autoantibodies were detected in all patients with FS and were absent from more than 300 serum samples collected from randomly selected unaffected persons. CONCLUSION FS is strongly linked to outdoor activities and is largely restricted to immunogenetically predisposed persons. FS appears to have been endemic in certain regions of South America for several centuries.

The profile of fogo selvagem (endemic pemphigus foliaceus) at the University Hospital of Brasilia–Brazil. Epidemiological and clinical considerations

Background  Endemic pemphigus foliaceus (EPF) or fogo selvagem (FS) is an endemic autoimmune disease, characterized by flaccid bullae induced by IgG4 subclass antibodies. The authors demonstrate the epidemiological and clinical status of patients who have been followed at the University Hospital of Brasília (HUB) for more than 15 years.

Efficacy and safety of itraconazole pulse therapy: Brazilian multicentric study on toenail onychomycosis caused by dermatophytes

BACKGROUND Itraconazole is a large spectrum triazole with known efficacy in both continuous and pulse therapy for various mycoses. OBJECTIVES Evaluate the efficacy and tolerability of itraconazole pulse therapy for onychomycosis of the toenails due to dermatophytes, in a prospective, open, non-comparative and multicentric investigation. Patients and methods The trial was completed by 72 patients of an initial total of 89. Treatment consisted of four cycles of itraconazole, 200 mg twice a day, for seven consecutive days each month. Patients were evaluated clinically, mycologically and biochemically before, during and at the end of the investigation, and were divided into two groups according to the measure of normal portion of the most affected nail (target nail), as follows: Group 1: 0-5.9 mm; and Group 2: more than 6 mm. RESULTS Improvement was satisfactory and progressive. Results were statistically significant, when comparing the three moments of the study: pre-treatment, end of therapy (fourth month) and follow-up (ninth month) in both groups. CONCLUSIONS Itraconazole pulse therapy was efficient and safe for the treatment of onychomycosis caused by dermatophytes, although a much higher daily dosage than the known continuous administration was used. Group 1, with nails initially more extensively affected, had a more evident improvement, by the mean variation in millimeters of normal portion of the target nail. This group showed a very satisfactory response, although not reaching total cure, thus demonstrating the great importance of early treatment of this disease. A residual therapeutic effect is maintained even after suspension of the drug. Group 2 obtained better total cure rates, and four pulses were, in general, sufficient, whereas more cycles would have been beneficial for the Group 1 patients with more extensive involvement.

HLA in Brazilian Ashkenazic Jews with chronic dermatophytosis caused by Trichophyton rubrum

The frequency of HLA (Human Leucocyte Antigens) was analyzed in 25 non-consanguineous Brazilian Ashkenazic Jews, resident in the city of Sao Paulo, Brazil, suffering from chronic dermatophytosis caused by T. rubrum, and in 25 non-infected individuals belonging to the same ethnic group. Statistically significant values (p<0.05) were observed for HLA-B14 associated with resistance to chronic dermatophytosis and HLA-DQB1*06 (p=0.05) possibly related to susceptibility. These findings suggest that genes on the chromosome 6, in the region of the major histocompatibility complex, may influence the development of chronic dermatophytosis.

Pênfigo foliáceo endêmico (fogo-selvagem) no grupo indígena Xavánte, Mato Grosso, Brasil

Foi realizado inquerito soro-epidemiologico atraves de testes de imunofluorescencia indireta e imunoprecipitacao visando determinar a prevalencia do penfigo foliaceo endemico (PFE) na populacao indigena Xavante do Brasil Central. Do total de 163 amostras de soro testadas, 5 (3,1%) foram positivas a imunofluorescencia. Todos os soros positivos procediam de individuos com sintomas clinicos da doenca. Nao foram observadas diferencas do PFE entre os Xavante e a populacao em geral sob o ponto de vista imunologico, ja que se verificou uma predominância da IgG4 entre os anticorpos nos pacientes indigenas.

Dermatoses entre os Xavánte da área indígena Pimentel Barbosa, Mato Grosso (Brasil)

The authors present the results of a dermatological survey conducted among the Xavánte Indians from the Pimentel Barbosa Reservation, state of Mato Grosso, Brazil Scabies, pediculosis, and pioderma were the most frequent diseases, clearly related to poor hygiene. The finding of perleche indicates the presence of nutritional deficiency. Endemic pemphigus foliaceus (fogo selvagem) was the most serious dermatological affection found in this population.

Estudo clínico aberto multicêntrico da efetividade e tolerabilidade do gel de adapaleno a 0,1%* em pacientes com acne vulgar

BACKGROUND: Adapalene, a naftoic acid derivative with biological properties similar to those of the retinoic acid, is indicated in the treatment of acne vulgaris. OBJECTIVES: The present study was carried out to evaluate the therapeutic action of adapalene 0.1% gel and its tolerability in the treatment of mild to moderate acne vulgaris in patients living in Brazil. MATERIAL AND METHODS: Patients applied the gel at night for 12 weeks; and were evaluated regarding the efficacy and tolerability of the product according to the number of lesions observed at each of the 2-week and 12-week visits. RESULTS: Out of 125 patients, 81.6% completed 12 weeks of therapy and 10.4% of the cases left the study before week 12 because they were found to be lesion-free. Results allow us to confirm its effect upon keratinocyte cellular differentiation with antiinflammatory and antiproliferative properties. Adapalene induces a marked decrease in comedos and inflammatory lesions. Mild adverse events were reported in less than 10% of patients. CONCLUSION: Adapalene has been shown to be one of the best topical therapies for mild or moderate acne both in the present study and in previous studies.

Endemic pemphigus foliaceus (fogo selvagem)

Endemic pemphigus foliaceus (PF), or fogo selvagem (FS), is an autoimmune bullous disease that is endemic in Brazil and in other South American countries, such as Paraguay, Bolivia, Peru, and Colombia. It is characterized histologically by acantholytic intraepidermal blisters, and immunologically by circulating immunoglobulin G (IgG) autoantibodies that exhibit the same speci®city against the desmosomal glycoproteins of the cells of strati®ed squamous epithelium as in PF. A remarkable characteristic of FS is its epidemiology. The unique features of FS include the fact that the disease is endemic to certain states of Brazil, that there is an increased number of familial cases, and that the number of cases in children and young adults dedicated to farming activities is high. These ®ndings led Brazilian investigators to postulate that FS is precipitated by exposure to an environmental factor or factors. This striking epidemiology differentiates FS from the nonendemic form of PF, which occurs sporadically throughout the world. FS is now endemic in central Brazil where new cases have been reported. The migratory characteristics of this disease, following waves of colonization, demonstrate the potential for new cases in Amazonia, where, indeed, such cases have started to appear. Finally, the fact that this disease is the only endemic autoimmune disease makes FS of particular scienti®c interest, and opens up enormous perspectives for the investigation of etiopathogenic factors in other autoimmune diseases.

Sun Education in Brazil

patients after a television program has been screened about skin cancer. The high general awareness of the need for protection against UVR is seen in the increased marketing of sun screens with high SPFs, even in the black community. Sunproofed clothing is becoming more readily available. Well-known clothing manufacturers and popular stores are supplying an increasing range of sun protective clothing. CANSA envisages that in three years all items of clothing will have a UPF label. Many schools have adopted regulations aimed at sun protection, some are even buying sunscreens in bulk from the manufacturers for sale to pupils at a reduced cost. On the negative side, some schools are known to resist measures such as the compulsory wearing of hats, on the grounds that they are too difficult to enforce. An interesting observation has been made in the tyrosinase-positive albino population in Johannesburg. The number of individuals with sun-induced dendritic freckles has declined over a period of several years, possibly because they have been using sunscreens regularly during this time. 3