Magda Blessmann Weber

Tratamento da doença de Hailey-Hailey com toxina botulínica tipo A

Two sisters with recurrent lesions, one on axillae and other on the groin, and with limited response to classical treatments were treated with injections botulinum toxin type A. We observed marked improvement in the patient treated in the groin and complete remission in the patient treated in the axillae. It was possible to spare the use of systemic antibiotics and topical corticosteroids. The high cost is a restrictive factor to routine use and large studies are necessary to access efficacy and cost benefit profile.

Epidemiology of melasma in Brazilian patients: a multicenter study

Melasma is an acquired, irregularly patterned, light to dark‐brown hypermelanosis, with symmetric distribution mostly over the face. The aim of this study was to evaluate clinical characteristics and factors related to melasma in Brazilian patients.

Assessment of the quality of life of pediatric patients at a center of excellence in dermatology in southern Brazil

BACKGROUNDnSkin diseases cause negative impact on the emotional state, social relationships and daily activities, due to the stigma caused by the appearance of the lesions.nnnOBJECTIVEnThis study aimed to assess the quality of life of pediatric patients with skin diseases attending a dermatology service, compare the scores obtained among the dermatoses found in the sample and associate them to the variables, in addition to observing how the skin disease specifically affects quality of life.nnnMETHODSnCross-sectional study, with patients between 5 and 16 years attending the Dermatology Service of the University of Health Sciences of Porto Alegre, Brazil, between July 2010 and February 2011. The data collection instruments were the Childrens Dermatology Life Quality Index questionnaire and the AUEQI questionnaire.nnnRESULTSnA total of 161 patients were interviewed, with mean age of 9,66 years. The main dermatoses were atopic dermatitis (29.8%), warts (13%) and molluscum contagiosum (7.5%). Chronic diseases (73.9%) were the most prevalent. The overall mean Childrens Dermatology Life Quality Index score was 5.01 for chronic dermatoses and 2.07 for acute illnesses, indicating a compromised quality of life among chronically ill patients. The comparison between the scores obtained with the AUEQI scale and the Childrens Dermatology Life Quality Index scores indicates that the overall quality of life is less affected than the specific quality of life related to the dermatosis.nnnCONCLUSIONSnThe data presented reinforce how important it is that the patients, their families and caregivers understand the symptoms, triggers and treatment of the skin disease in question. This information facilitates adherence to the treatment and justifies the conduct adopted by the dermatologist.

Assessment of the quality of life of pediatric patients with the major chronic childhood skin diseases

BACKGROUNDnThe skin is the primary interface of the human being with the external environment and the presence of skin diseases can have substantial effects on the quality of life.nnnOBJECTIVEnThis study aims to make a comparative evaluation of the quality of life of pediatric patients with atopic dermatitis, psoriasis and vitiligo and correlate the findings with the total body surface and the areas with the disease exposed to view.nnnMETHODSnThe sample consisted of 118 patients with atopic dermatitis, vitiligo and psoriasis, aged between 5 and 16 years, who were asked to answer the Childrens Dermatology Life Quality Index (CDLQI) questionnaire. A dermatological examination for the measurement of total body surface affected by the disease was performed.nnnRESULTSnThe three groups showed an impaired quality of life. Patients with atopic dermatitis and psoriasis showed a significantly greater impact on the QoL than the group with vitiligo. There is a trend towards impaired quality of life in patients from the three groups of dermatoses, which is related to increments in both the total affected area and affected area exposed to view (r = 0.428 and p <0.001, r = 0.381 and p <0.001, respectively).nnnCONCLUSIONnThe assessed children had impaired quality of life. However, there is a significantly greater impact in the groups with atopic dermatitis and psoriasis than in the group with vitiligo. This may be due to lack of symptoms in vitiligo and the fact this group presented a statistically smaller affected body surface than the other two groups.

Avaliação da associação entre as alterações no metabolismo mineral e o prurido nos pacientes em hemodiálise

BACKGROUNDnUremic pruritus is the most frequent symptom in long-term hemodialysis patients. Abnormal laboratory parameters have been found with conflicting data.nnnOBJECTIVEnTo correlate the prevalence of pruritus with alterations in mineral metabolism in hemodialysis patients.nnnMETHODSnThis was a case-control study. A hundred and five patients on maintenance hemodialysis were evaluated: a group of patients with pruritus and a control group. They answered a research protocol questionnaire; laboratory data were collected from medical records and the patients with pruritus filled out a visual analogue scale (VAS) to measure pruritus level.nnnRESULTSnThe mean age was 51.9 years; 59% of the patients were men and 43% of the patients had pruritus. Xeroderma occurred in 45% of the patients. High levels of calcium were demonstrated in 55% of the patients and 47% had pruritus. 60% of the patients had high phosphorus levels and 43% had pruritus. The Ca/P ratio was normal for all the patients. Parathyroid hormone was high in 95% of the patients, all of them referring pruritus.nnnCONCLUSIONnThere was a statistically significant association between the group of patients with pruritus and xeroderma. Serum calcium and phosphorus levels, Ca/P ratio, PTHi and size of the dialyzer did not show a statistically significant association with pruritus. Therefore, we found an important relationship between xeroderma and pruritus, with no relation with the assessed laboratory parameters.

Relação entre de prurido e qualidade de vida de pacientes em hemodiálise

FUNDAMENTOS: O prurido e um sintoma frequente nos pacientes em hemodialise. Tem etiologia nao totalmente esclarecida e dificil manejo, o que piora de modo consideravel a qualidade de vida dos doentes. OBJETIVOS: Avaliar o grau de prurido e sua influencia na qualidade de vida dos pacientes renais cronicos em hemodialise. METODOS: Estudo transversal com pacientes renais cronicos em hemodialise no Complexo Hospitalar Santa Casa de Porto Alegre, que apresentassem prurido sem outras dermatoses. Utilizou-se a escala analoga visual para mensuracao do grau de prurido e o questionario do Indice de Qualidade de Vida para Dermatologia. RESULTADOS: Dos 200 pacientes avaliados, 69 (34,5%) apresentaram prurido, dos quais 16 (23%) de grau leve, 39 (56,5%) moderado e 14 (20,2%) grave. Quando analisada a qualidade de vida, verificou-se que em 14 (20,3%) nao houve influencia do prurido na qualidade de vida. Entretanto, para 26 pacientes (37,4%), o prurido teve um pequeno efeito, em nove (13%) houve efeito moderado, 13 (18,8%) foram afetados de maneira grave e em sete (10,1%) houve influencia extremamente grave. CONCLUSOES: Neste estudo, 57% dos individuos nao demonstraram alteracoes importantes na qualidade de vida relacionadas ao prurido, mas um numero significativo estava na faixa de muito e extremamente alterado, o que denota a necessidade de atencao ao tratamento deste sintoma neste grupo de pacientes.

Treatment of Granulosis Rubra Nasi with Botulinum Toxin Type A

e report on the case of a 16-year-old boy whopresented with a 12-year history of erythemaand hyperhidrosis of the nose; signs, symptoms, andhistological findings were consistent with granulosisrubra nasi. The treatment of granulosis rubra nasiwith botulinum toxin type A resulted in significantimprovement of clinical symptoms and psychosocialcomplications.

Staphylococcus aureus resistance to topical antimicrobials in atopic dermatitis

Background Topical antimicrobial drugs are indicated for limited superficial pyodermitis treatment, although they are largely used as self-prescribed medication for a variety of inflammatory dermatoses, including atopic dermatitis. Monitoring bacterial susceptibility to these drugs is difficult, given the paucity of laboratory standardization. Objective To evaluate the prevalence of Staphylococcus aureus topical antimicrobial drug resistance in atopic dermatitis patients. Methods We conducted a cross-sectional study of children and adults diagnosed with atopic dermatitis and S. aureus colonization. We used miscellaneous literature reported breakpoints to define S. aureus resistance to mupirocin, fusidic acid, gentamicin, neomycin and bacitracin. Results A total of 91 patients were included and 100 S. aureus isolates were analyzed. All strains were methicillin-susceptible S. aureus. We found a low prevalence of mupirocin and fusidic acid resistance (1.1% and 5.9%, respectively), but high levels of neomycin and bacitracin resistance (42.6% and 100%, respectively). Fusidic acid resistance was associated with more severe atopic dermatitis, demonstrated by higher EASI scores (median 17.8 vs 5.7, p=.009). Our results also corroborate the literature on the absence of cross-resistance between the aminoglycosides neomycin and gentamicin. Conclusions Our data, in a southern Brazilian sample of AD patients, revealed a low prevalence of mupirocin and fusidic acid resistance of S. aureus atopic eczema colonizer strains. However, for neomycin and bacitracin, which are commonly used topical antimicrobial drugs in Brazil, high levels of resistance were identified. Further restrictions on the use of these antimicrobials seem necessary to keep resistance as low as possible.

Skin changes after bariatric surgery

Today, obesity is considered an epidemic all over the world and it is recognized as one of the major public health problems. Bariatric surgery is considered an appropriate therapeutic option for obesity with progressively increasing demands. The changes resulting from massive weight loss after bariatric surgery are related to numerous complications. This article will present the dermatological alterations that can be found after bariatric surgery. They will be subdivided into dermatoses that are secondary to metabolic and nutritional disorders, those derived from cutaneous structural modifications after major weight loss and the influence the latter may have in improving of certain dermatoses.

Translation into Brazilian portuguese and validation of the psoriasis family index

Psoriasis Family Index is a quality of life instrument for family members of patients with psoriasis developed in English. The aims of this study were to translate the Psoriasis Family Index into Brazilian Portuguese, culturally adapt it and verify its reliability and validity. The study followed these two steps: 1) Translation, linguistic and cultural adaptation, 2) Validation. The translated Psoriasis Family Index showed high internal consistency and high test-retest reliability, confirming its reproducibility. The Portuguese version of the Psoriasis Family Index was validated for our population and can be recommended as a reliable instrument to assess the QoL of family members and partners of patients with psoriasis.