ABSTRACT
Abstract: Psoriasis is a chronic inflammatory disease that affects 1.3% of the Brazilian population. The most common clinical manifestations are erythematous, scaling lesions that affect both genders and can occur on any anatomical site, preferentially involving the knees, elbows, scalp and genitals. Besides the impact on the quality of life, the systemic nature of the disease makes psoriasis an independent risk factor for cardiovascular disease, especially in young patients with severe disease. By an initiative of the Brazilian Society of Dermatology, dermatologists with renowned clinical experience in the management of psoriasis were invited to form a work group that, in a partnership with the Brazilian Medical Association, dedicated themselves to create the Plaque Psoriasis Diagnostic and Treatment Guidelines. The relevant issues for the diagnosis (evaluation of severity and comorbidities) and treatment of plaque psoriasis were defined. The issues generated a search strategy in the Medline-PubMed database up to July 2018. Subsequently, the answers to the questions of the recommendations were devised, and each reference selected presented the respective level of recommendation and strength of scientific evidence. The final recommendations for making up the final text were worded by the coordinators.
Subject(s)
Humans , Male , Female , Psoriasis/diagnosis , Psoriasis/therapy , Phototherapy/methods , Psoriasis/epidemiology , Societies, Medical , Time Factors , Vitamin D/analysis , Severity of Illness Index , Brazil , Comorbidity , Anthralin/therapeutic use , Methotrexate/therapeutic use , Cyclosporine/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Dermatologic Agents/therapeutic use , Dermatology , Drug Combinations , Calcineurin Inhibitors/therapeutic use , Antibodies, Monoclonal/therapeutic useABSTRACT
A acne é uma das dermatoses mais frequentes entre adolescentes e adultos jovens. As lesões podem causar cicatrizes inestéticas e grande prejuízo à qualidade de vida do paciente. Atualmente há um grande arsenal terapêutico disponível, o que nos permite obter sucesso no tratamento quase que na totalidade dos casos, evitando a formação das cicatrizes quando o tratamento é instituído precocemente...
Subject(s)
Humans , Male , Female , Acne VulgarisABSTRACT
Piloleiomyoma, a benign smooth-muscle tumor arising from the arrectores pilorum muscles of the skin, affects males and females in the third decade of life. It presents as asymmetrical, reddish-brown nodules or papules with a firm consistency, predominantly located on the limbs. When multiple lesions are present, they may be tender or painful. Their association with uterine fibroids, referred to as Reed syndrome or familial leiomyomatosis cutis et uteri, is rare and may be associated with renal cell carcinoma. The approach consists of surgical excision in cases presenting few lesions and pharmacological treatment if symptomatic. The present paper describes a case of Reed syndrome in which a decision was made to monitor the patient in view of the absence of symptoms.
Tumor benigno de tecido muscular, o piloleiomioma tem origem no músculo eretor do pelo, atingindo ambos os sexos geralmente na terceira década de vida. Apresenta-se como nódulo-pápulas assimétricas nas extremidades, de cor eritêmato-acastanhada e de consistência firme. As lesões, quando múltiplas, podem ser sensíveis ou dolorosas. Sua associação com miomas uterinos, denominada de síndrome de Reed ou leiomiomatose cutis et uteri, é apresentação rara, podendo estar associada a carcinoma de células renais. A abordagem é cirúrgica em casos isolados e medicamentosa se houver sintomas. Relatamos um caso de síndrome de Reed em que se optou por acompanhamento pela ausência de sintomatologia.
Subject(s)
Female , Humans , Middle Aged , Leiomyoma/pathology , Skin Neoplasms/pathology , Uterine Neoplasms/pathology , Leiomyomatosis/pathology , SyndromeABSTRACT
O líquen plano hipertrófico é uma variante do líquen plano, com pronunciada hiperplasia epidérmica em resposta à coçadura persistente. Clinicamente, caracterizam-se por placas hiperceratósicas, simétricas, de coloração cinza-violácea, com predileção pela região pré-tibial. O prurido intenso, a refratariedade aos tratamentos convencionais e a possibilidade de associação de um carcinoma epidermoide às lesões de longa duração impõem um tratamento eficaz. Os corticoides são considerados o tratamento de primeira linha e podem ser aplicados topicamente ou empregados de forma sistêmica. Outras modalidades terapêuticas propostas são a fototerapia com UVB-NB ou PUVA, imunossupressores e retinoides sistêmicos, com destaque para a acitretina. Relatamos um caso com apresentação clínica exuberante e excelente resposta à acitretin, totalizando um seguimento de nove meses.
Hyperthrofic lichen planus is considered a variant of lichen planus with marked epidermal hyperplasia in response to persistent itch. It is clinically, characterized by symmetric hyperkeratotic plaques, of purplish-grey color, often located in the pretibial region. Intense pruritus, refractoriness to conventional treatments and the possibility of association of the long-term injuries with squamous cell carcinoma requires an effective treatment. The first-line treatment is corticosteroids which can be applied either topically or systemically. Other therapeutic modalities proposed are: NB-UVB phototherapy or PUVA, immunosuppressive drugs and systemic retinoids, notably acitretin. We report a case with exuberant clinical presentation of hyperthrofic lichen planus with excellent response to acitretin after nine months of treatment.
Subject(s)
Female , Humans , Middle Aged , Acitretin/therapeutic use , Hand Dermatoses/drug therapy , Keratolytic Agents/therapeutic use , Lichen Planus/drug therapy , Hand Dermatoses/pathology , Lichen Planus/pathologyABSTRACT
A mucinose papulosa ou líquen mixedematoso é doença idiopática, manifestada por pápulas, nódulos ou placas por depósito de mucina na derme, na ausência de doença tireoidiana. Apresentamos um caso atípico, com lesões exuberantes em placas, associado ao hipotireoidismo subclínico. Nas mucinoses cutâneas há quantidade anormal de mucina na pele. Tradicionalmente as classificações consideram critério diagnóstico para mucinose papulosa a ausência de doença tireoidiana. Poucos casos associados ao hipotireoidismo são descritos e, assim como o nosso, constituem líquen mixedematoso atípico, sugerindo que a presença de doença tireoidiana não deva ser critério de exclusão para essa doença.
Papular mucinosis or lichen myxedematosus is an idiopathic disorder characterized by papules, nodules or plaques caused by mucin deposition in the dermis, in the absence of thyroid disease. The present report describes an atypical case with exuberant lesions in the form of plaques, associated with subclinical hypothyroidism. In cutaneous mucinosis, there is an abnormal quantity of mucin in the dermis. In traditional classifications of papular mucinosis, an absence of thyroid disease constitutes a diagnostic criterion. A few cases of the disease have been reported in association with hypothyroidism constituting, as in the present case, atypical lichen myxedematosus. It is therefore suggested that the presence of thyroid disease should not be considered an exclusion criterion for the diagnosis of this condition.