Vitória Regina Pedreira de Almeida Rêgo

Psoriasis and uveitis: a literature review

Psoriasis is a systemic, chronic, immunologically mediated disease, with significant genetic and environmental influences. It affects from 1 to 3% of the world population. Recently, the relation between psoriasis and different comorbidities, particularly metabolic syndrome, has become extremely relevant. Uveitis is characterized by a process of intraocular inflammation resulting from various causes. Considering psoriasis and uveitis as immune-mediated diseases, this study aims to evaluate the possible association of psoriasis and/or psoriatic arthritis with uveitis and its subtypes. Few studies have evaluated the association of uveitis and psoriasis without joint involvement. It seems that psoriasis without arthropathy is not a risk factor for the development of uveitis. Uveitis tends to develop more frequently in patients with arthropathy or pustular psoriasis than in patients with other forms of psoriasis. Ophthalmic examination should be performed periodically in patients with psoriasis and uveitis. If ophthalmopathy is diagnosed, the patient should receive adequate treatment with anti-inflammatory drugs or immunomodulators to prevent vision loss.

Brazilian Consensus on Photoprotection

Brazil is a country of continental dimensions with a large heterogeneity of climates and massive mixing of the population. Almost the entire national territory is located between the Equator and the Tropic of Capricorn, and the Earth axial tilt to the south certainly makes Brazil one of the countries of the world with greater extent of land in proximity to the sun. The Brazilian coastline, where most of its population lives, is more than 8,500 km long. Due to geographic characteristics and cultural trends, Brazilians are among the peoples with the highest annual exposure to the sun. Epidemiological data show a continuing increase in the incidence of non-melanoma and melanoma skin cancers. Photoprotection can be understood as a set of measures aimed at reducing sun exposure and at preventing the development of acute and chronic actinic damage. Due to the peculiarities of Brazilian territory and culture, it would not be advisable to replicate the concepts of photoprotection from other developed countries, places with completely different climates and populations. Thus the Brazilian Society of Dermatology has developed the Brazilian Consensus on Photoprotection, the first official document on photoprotection developed in Brazil for Brazilians, with recommendations on matters involving photoprotection.

Características da reação tipo 1 e associação com vírus B e C da hepatite na hanseníase

Type 1 reaction or reversal reaction is an acute inflammatory episode in the skin and peripheral nerves that is found in up to 30% of leprosy patients and commonly causes physical disabilities. Multidrug chemotherapy and viral infections are associated risk factors. In this study, 620 leprosy patients were evaluated. Reversal reactions were diagnosed in 121 cases (19.5%) and were most frequently found in borderline patients (48%). Starting on multidrug chemotherapy was considered to be a risk factor for reversal reaction: 52% of the cases presented their first episode at this time. Neuritis was found in 73% of the cases. The presence of hepatitis B or C virus was documented in 9% of the 55 patients with reversal reaction, while it was not detected in any of the 57 patients without reaction (p = 0.026, Fishers exact test). This suggests that these agents may have a role as risk factors for developing reversal reactions.

Refractory erythrodermic psoriasis in a child with an excellent outcome by using etanercept

Psoriasis affects 0.12% to 0.71% of all children. Erythrodermic psoriasis is an uncommon but serious disorder, occurring in less than 1.5% of cases. Tumor necrosis factor-alpha blockers (TNF-α) are a new class of drugs used to treat moderate to severe psoriasis refractory to conventional therapies. Etanercept is a TNFα receptor fusion protein, approved by the FDA for treating juvenile rheumatoid arthritis. We present the case of a 7-year-old suffering from plaque psoriasis since 8 months old which evolved into erythroderma refractory to cyclosporine and methotrexate. Patient responded excellently to etanercept, with no adverse side effects.

Inherited epidermolysis bullosa: clinical and therapeutic aspects

Inherited epidermolysis bullosa (EB) is a heterogeneous group of genetic disorders that present with skin and, in some cases, mucosal fragility, predisposing patients to the development of blisters and/or erosions after minimal trauma or friction. Children with a recurrent history of these kinds of lesions or neonates that present them in the absence of another reasonable explanation should be investigated. Diagnosis must be based on clinical and histopathological findings. To date, management of inherited EB basically consists in avoiding traumas that trigger lesions, as well as preventing infection and facilitating healing of the wounds with the systematic use of bandages.

Anti-TNFα therapy in the management of psoriasis: experience of a state referral center

BACKGROUND Psoriasis is a chronic immune-mediated disease, characterized by increased levels of TNFα. Anti-TNFα agents have revolutionized the treatment of severe psoriasis by targeting an important molecule involved in its pathogenesis. OBJECTIVES We report the experience of a state referral center that uses anti-TNFα agents for psoriasis. METHODS We conducted a retrospective case series. Seventy-four out of 120 patients met the inclusion criteria. Clinical and laboratory data was analyzed using the chi-squared, Wicoxon and McNemars tests. Associations were considered statistically significant when p-value<0.05. RESULTS Forty-one subjects (55.40%) were male, with a mean age of 47.69±14.99 years. Median disease duration and pre-treatment PASI were 14.0 months (IQR 9.0-20.0), and 13.55 points (IQR 8.5-20.32). Sixty patients (81.10%) had arthropathic psoriasis. Forty-six subjects (62.20%) had comorbidities; the most frequent was dyslipidemia (25.70%). In 55.40% of patients, insufficient response to conventional therapies was the principal indication for using anti-TNFα drugs. Clinical improvement occurred in 93.20% of cases, and the post-treatment PASI median was 0.0 points (IQR 0.0-0.0). Adverse effects occurred in 6.80% of patients. Infections and elevation of transaminases occurred in 28.40% and 8.10% of cases, respectively. CONCLUSION Post-treatment reduction in PASI was satisfactory and the occurrence of adverse effects was minor, mostly mild infusion effects and local reactions at drug administration sites.

Você conhece esta síndrome

Congenital Hypertrichosis Lanugionsa is a rare autosomal dominant genetic disorder, with fewer than 50 cases reported in the literature. It is characterized by excessive lanugo hair, sparing only the mucous membranes, palms and soles. It may be associated with other organic abnormalities and should form part of the dermatologists current knowledge. We discuss some aspects of the syndrome in question arising from the case report of a 2-year-old female patient, black, with classic clinical presentation, with no other associated congenital abnormalities.

Papillon-Lefèvre syndrome

Dear Editor, Papillon-Lefèvre syndrome is a rare, autosomal recessive genodermatosis with an estimated prevalence of one to four cases per million people, without sexual or racial predominance.1 It is clinically characterized by diffuse palmaoplantar keratoderma, associated with a severe periodontopathology, with premature loss of deciduous and permanent teeth.1 The cutaneous changes commonly begin during the first four years of life, and the severe destruction of periodontal regions results in loss of the primary teeth within these first four years, as well as premature loss of the permanent teeth.1 The syndrome is caused by a mutation in the gene that encodes the protein cathepsin C, a lysosomal protease known as dipeptidyl-peptidase 1, present in the epithelial regions commonly affected by the syndrome, as well as in cells of the immune system, including polymorphonuclear leukocytes, macrophages and their precursors.1 This case is reported because of the rarity of its pathology and to highlight the importance of the presence of extracutaneous manifestations in diffuse palmoplantar keratodermas, which are often erroneously diagnosed as psoriasis. This case involves a 17-year-old male patient with a history of gingival and periodontal changes since the age of three. The patient mentioned softening and breakage of the teeth, accompanied by halitosis, since the age of eight. In the last three years, exuberant asymptomatic palmoplantar keratoderma has evolved, accompanied by diffuse palmoplantar hyperhydrosis, requiring the continuous use of socks to reduce the discomfort of humidity. He presented a history of multiple hospitalizations for pneumonia and gastroenteritis during infancy, as well as a report of consanguinity. In the dermatological exam, the patient presented accentuated palmoplantar hyperkeratosis on the hands and feet (Figure 1). The oral cavity showed edema and gingival erythema, with bleeding upon manipulation, and the presence of purulent secretion from the lower gingiva (Figure 2). Panoramic radiography of the dental arch revealed areas of alveolar bone loss and ridge resorption (Figure 3). Treatment with acitrentin, emollients and keratolytics was initiated, with satisfactory improvement in the keratoderma and the odontological condition. The

Erythematous, yellowish plaque on the face of a child

What is your diagnosis?

Etiopathogenesis of acne

Acne is a chronic hormonal–genetic disorder; the genetic basis is characterized by numerous transmission patterns, probably related to its wide spectrum of variation. The main factors involved in its etiopathogenesis are hyperkeratinization of the upper portion of the hair follicle, increase in sebaceous production, bacterial colonization of the follicles, and inflammatory processes in the follicles and the surrounding areas. This paper presents an updated review of these etiopathogenetic factors.