25-Hydroxyvitamin D as a biomarker of vitamin D status in plaque psoriasis and other dermatological diseases: a cross-sectional study

ABSTRACT BACKGROUND: Hypovitaminosis D is a public health problem associated with several chronic inflammatory and immunological diseases, including psoriasis. OBJECTIVES: This study aimed to determine the prevalence of hypovitaminosis D in patients with plaque psoriasis. A comparison was made between vitamin D levels in patients with psoriasis and those with other non-inflammatory dermatoses without photosensitivity. In addition, it evaluated the effects of the patients' Fitzpatrick skin phototype and the season of the year on the serum levels of vitamin D. DESIGN AND SETTINGS: A retrospective cross-sectional study was conducted at an outpatient clinic in a university center in Juiz de Fora (MG), Brazil. METHODS: A review of dermatology patients' demographic data, including skin phototype and serum levels of 25-hydroxyvitamin D [25(OH)D], over 12 months in 2016. RESULTS: This study included 554 patients: 300 patients allocated to the plaque psoriasis group and 254 control patients with other dermatological diseases. Regarding the season of the year, 229, 132, 62, and 131 participants were evaluated in summer, autumn, winter, and spring, respectively. As for the skin phototype, 397, 139, and 18 patients had phototypes III, IV, and V, respectively. The serum levels of 25(OH)D were significantly lower in the psoriasis group (24.91 ± 7.16 ng/mL) than in the control group (30.37 ± 8.14 ng/mL). CONCLUSIONS: Hypovitaminosis D (< 30 ng/mL) was present in 76.66% of patients with psoriasis versus 53.94% of control patients. Vitamin D deficiency (< 20 ng/mL) was observed in 25% of the patients with psoriasis versus 8.66% in the control group (P < 0.001). The season and patient's skin phototype were independent predictors of serum vitamin D levels.

Is vitamin D status relevant to psoriasis and psoriatic arthritis? A retrospective cross-sectional study

Abstract BACKGROUND: Psoriasis is a systemic, immune-mediated disease characterized by inflammatory manifestations in the skin and joints. Vitamin D deficiency is currently considered a pandemic and is associated with comorbidities including psoriasis and psoriatic arthritis (PsA). OBJECTIVES: To determine the prevalence of hypovitaminosis D [25(OH)D] in patients with plaque psoriasis, with and without PsA, and of independent predictors of serum 25(OH)D levels. DESIGN AND SETTING: Retrospective cross-sectional study conducted among 300 patients at an outpatient clinic in a university center in Juiz de Fora, Minas Gerais, Brazil. METHODS: Demographic and clinical data (psoriasis area and severity index [PASI], family history, age at onset, disease duration, and the presence of PsA according to Classification Criteria for Psoriatic Arthritis), skin phototype, and season of the year were reviewed. RESULTS: Hypovitaminosis D (< 30 ng/mL) was highly prevalent in patients with psoriasis with and without PsA (82.2% and 74.9%, respectively). An inverse correlation between PASI and vitamin D was found (without PsA r = -0.59 and, PsA r = -0.52, P < 0.001), and multivariate regression revealed that hypovitaminosis D was associated with disease severity, season, and phototype. It was confirmed by binary logistic regression between PASI and vitamin D deficiency (< 30 ng/mL), (odds ratio, OR 1.78 CI: -0.20-0.53, P < 0.001). CONCLUSION: Hypovitaminosis D (< 30 ng/mL) was highly prevalent in psoriatic patients with and without PsA. Season and skin phototype were associated with 25(OH)D levels. An inverse association between PASI and serum 25(OH)D levels was established.

Prevalence of psoriatic arthritis among patients with plaque psoriasis: a Brazilian retrospective study

ABSTRACT BACKGROUND: Psoriatic arthritis is the most frequent and impactful comorbidity among psoriatic patients and appears in most cases after skin disease. Dermatologists play a key role in its early diagnosis and treatment. OBJECTIVE: To determine the prevalence of psoriatic arthritis and associated variables among patients with plaque psoriasis seen at a reference center for treating psoriasis. DESIGN AND SETTING: Retrospective cross-sectional study conducted among 300 patients at an outpatient clinic in a university center in Juiz de Fora, MG, Brazil. METHODS: Standardized records of 300 patients with plaque psoriasis were examined. Demographic data and medical variables relating to psoriasis (Psoriasis Area and Severity Index (PASI), family history, age at onset and disease progression) and psoriasis arthritis (CASPAR criteria) were evaluated. Laboratory and radiographic tests in the medical records were reviewed. RESULTS: Seventy-three (24.3%) of these 300 patients with plaque psoriasis had psoriatic arthritis. Asymmetric oligoarthritis (58.9%) was the most common clinical form, followed by polyarthritis (20.5%), distal interphalangeal arthritis (15.2%) and spondyloarthritis (5.4%). Dactylitis was present in 21.9% and enthesitis in 35.6% of patients. Compared with patients without arthritis, patients with arthritis had higher average age, higher frequency of positive family history of psoriasis, longer duration of evolution and higher PASI rates. CONCLUSION: Psoriatic arthritis is often underdiagnosed. Since dermatologists perform the initial approach, these professionals need to be trained to diagnose this comorbidity and treat it, together with rheumatologists.

Successful therapeutic approach in a patient with elephantiasic pretibial myxedema

Abstract Localized pretibial myxedema is a dermopathy whose treatment is a challenge in dermatology, occurring in 0.5-4% of patients with Graves' disease. This autoimmune thyroid condition stimulates the production of hyaluronic acid and glycosaminoglycans that are deposited particularly in the pretibial region. Clinically, it presents as a localized, circumscribed, and non-depressible infiltrate in plaques. Several treatment modalities have been proposed, and their results vary, with worse response observed in severe cases. This report presents the case of a patient with elephantiasic pretibial myxedema who was subjected to intralesional corticosteroid applications, resulting in an excellent and encouraging therapeutic response that was maintained.

Excision of furuncular myiasis larvae using a punch: a simple, practical and aesthetic method

Abstract: Myiasis refers to Diptera larvae infesting vertebrate animals. There are two forms of the disease: primary and secondary. In primary myiasis, fly larvae invade and develop in healthy tissue; in secondary myiasis, flies lay their eggs in skin ulcerations, and the larvae develop in tissue necrosis products. Furuncular myiasis is a type of primary myiasis. Treatment for it consists of techniques such as the production of localized hypoxia to force the emergence of the larvae, and mechanical or surgical removal of the maggots. These techniques, however, are painful and often unsuccessful. We propose a new technique for extraction of myiasis larvae, which might facilitate the surgical procedure and constitute a virtually painless and aesthetic option for the patient.

Perfil dos usuários do ambulatório de dermatologia antroposófica - HU/CAS- UFJF, Juiz de Fora - MG / The patient´s profile of the anthroposophic dermatology service - HU/CAS - UFJF, Juiz de Fora - MG

Este trabalho busca demonstrar o perfil do usuário da Medicina Antroposófica (MA) no Ambulatório de Dermatologia do Hospital Universitário ? Centro de Atenção à Saúde da Universidade Federal de Juiz de Fora (HU/CAS-UFJF), assim como avaliar sua aceitação pela comunidade.O ambulatório surgiu dentro de uma visão mais abrangente da Medicina, em conformidade com a Organização Mundial de Saúde, que vem estimulando o uso da Medicina Tradicional e Complementar/Alternativa nos Sistemas de Saúde de forma integrada às técnicas modernas da medicina ocidental; e visa difundir a prática Médica Antroposófica em Juiz de Fora demonstrando sua eficácia e qualidade.Para tal feito, foi realizado um estudo retrospectivo, quali-quantitativo, através da coleta de dados, a partir de prontuários de 2008 e 2009 do HU/CAS-UFJF, seguida da análise das informações.O resultado demonstrou que a MA foi eficaz em mais de 75% dos tratamentos propostos, com média de cura/melhora completa em 40% dos casos analisados. Discute-se então, sobre os resultados encontrados e percebe-se que têm semelhanças com os da literatura em relação à frequência das doenças dermatológicas. As conclusões são positivas e contribuem para a legitimidade da Medicina Antroposófica.

This paper seeks to demonstrate the patients’ profile of the Anthroposophical Medicine (AM) in the Dermatology Clinic of the Hospital Undergraduate / Secondary Service Center, Federal University of Juiz de Fora - MG (HU / CAS-UFJF) as well as evaluate its acceptance by the community. This Clinic of AM emerged within a more comprehensive vision of medicine in accordance with the World Health Organization which has encouraged the use of Traditional Medicine and Complementary / Alternative Systems in an integrated manner with the modern Western medicine techniques, and aims to spread the Anthroposophical Medicine experience in Juiz de Fora and demonstrate its effectiveness and quality. For this, it was performed a retrospective study and quali-quantitative data collection made in the period of June- December 2009 from medical files of the HU/ CAS - UFJF, followed by analysis of the collected data. The findings were that the AM was effective in more than 75% of the proposed treatments, with healing / improvement average of 100% in 40% of cases. It is argued then about the results and perceives that has similarities with the literature in relation to frequency. The conclusions are positive and contribute to the legitimacy of Medicine Antroposófica.

Estudo descritivo das dermatoses bolhosas no serviço de dermatologia do HU - UFJF / A study about bullous diseases in the service of dermatology of the University Hospital of UFJF

Os autores apresentam um estudo descritivo das dermatoses bolhosas no Serviço de Dermatologia do Hospital Universitário da UFJF. Foram cadastrados 27 pacientes no período de abril de 1997a abril de 2003. As buloses de maior prevalência foram avaliadas e relacionadas com a idade do início das manifestações da doença, sintomatologia, localização inicial da lesão, tempo de evolução da mesma e influência de certas drogas tanto no desenvolvimento como na evoluçãoda doença. Correlacionou-se, também, o diagnóstico clínico e o histopatológico. ÁPos término do estudo, observou-se um maior número de casos de pênfigo foliáceo, mostrando uma inversão na prevalência dessa dermatose no nosso serviço. Cocluiu-se que o diagnóstico da doença deve ser baseado em critérios clínicos e histopatológicos, sendo a imunofluorescência direta relevante nos casos em que o exame histopatológico mostra-se inconclusivo, mesmo quando associado à clínica.

Exostose subungueal: estudo clínico-patológico e análise de uma técnica cirúrgica / Subungual exostosis: a clinical and pathological study and a surgical technique analysis

No período de 1996 a 2000 foram atendidos 2000 pacientes no Ambulatório de Unhas do Hospital Universitário da Universidade Federal de Juiz de Fora; deste total, 12 eram portadores de exostose subungueal. No presente trabalho foram incluídos os 12 pacientes em um estudo prospectivo (grupo A) e acrescentados 51 casos oriundos de outros serviços nacionais de Dermatologia (grupo B) em um estudo transversal, totalizando 63 casos de exostose subungueal. A afecção foi analisada quanto ao sexo, idade, cor, e localização das lesões, além da possível existência de traumas anteriores. Neste trabalho foi descrita, detalhadamente, a técnica operatória utilizada nos 12 pacientes (grupo A), a qual foi avaliada quanto aos seus resultados estéticos, índices de recorrências e complicações, comparando-os aos de outros autores. Na descrição da cirurgia excisional da lesão, buscou-se enfatizar seus aspectos práticos, desde a forma de se utilizar o anestésico, até os cuidados indispensáveis para se evitar recidivas. O procedimento realizado buscou preservar ao máximo a lâmina ungueal, obtendo resultados funcionais e estéticos. As etapas cirúrgicas foram fotografadas e anexadas a este estudo, para visualização dos procedimentos descritos, bem como seus aspectos radiológicos e histopatológicos. Diagnósticos diferenciais foram destacados com a intenção de evitar erros, para que a exostose subungueal não fosse confundida com outras doenças ungueais. São apresentados os resultados da avaliação clínica e cirúrgica, em tabelas e fotografias, obtidas no pós-operatório dos casos acompanhados. Nenhuma recorrência foi detectada e os resultados estéticos das unhas tratadas foi excelente, num período médio de seguimento de 2 anos