Graft-versus-host disease and other cutaneous manifestations in pediatric patients transplanted for Fanconi anemia / Doença do enxerto contra o hospedeiro e outras manifestações cutâneas em pacientes pediátricos transplantados por anemia de Fanconi

ABSTRACT Objective: The aim of this study was to elaborate a specific protocol for the assessment and early identification of skin lesions in pediatric patients with Fanconi anemia undergoing hematopoietic stem cell transplantation. Methods: This is a longitudinal, retrospective, and descriptive study. The medical records of 136 pediatric patients with Fanconi anemia who underwent hematopoietic stem cell transplantation between 2008 and 2018 at the Clinical Hospital of the Federal University of Paraná were reviewed. A specific protocol was created for data collection, which included age, sex, skin color, age at diagnosis of Fanconi anemia, transplantation data, family history of consanguinity, and pre- and post-transplant complications. In addition, the data included the presence of graft-versus-host disease of the skin and other organs, its classification, type of lesion, location, and also skin lesions not related to graft-versus-host disease. Results: Among the skin manifestations in pre-transplant period, café-au-lait spots stood out (32.4%). At least one organ was affected by graft-versus-host disease in 55.1% of patients; the most common involvement being the mouth, followed by the skin. Rash and erythema were the most frequently observed cutaneous manifestations of graft-versus-host disease. Conclusion: A high prevalence of cutaneous manifestations of the disease was observed, as well as cutaneous manifestations of graft-versus-host disease. The protocol developed gathers relevant and standardized information for the follow-up of patients with Fanconi anemia undergoing hematopoietic stem cell transplantation, ensuring greater reliability of the information, and its implementation will allow the prospective evaluation of patients.

RESUMO Objetivo: Elaborar um protocolo específico para a avaliação e identificação precoces de lesões de pele em pacientes pediátricos com anemia falciforme submetidos ao transplante de células-tronco hematopoiéticas. Métodos: Estudo longitudinal, retrospectivo e descritivo. Foram revisados os prontuários dos pacientes pediátricos com anemia de Fanconi submetidos a transplante de células-tronco hematopoiéticas entre os anos de 2008 e 2018 no Hospital de Clínicas da Universidade Federal do Paraná, totalizando 136 pacientes. Foi criado um protocolo específico para a coleta de dados, que incluiu: idade, sexo, cor, idade ao diagnóstico da anemia de Fanconi, dados do transplante, história familiar de consanguinidade e complicações pré e pós-transplante. Além disso, foram verificados a presença de doença do enxerto contra o hospedeiro da pele e de outros órgãos, sua classificação, tipo de lesão, localização e, também, lesões de pele não relacionadas à doença. Resultados: Entre as manifestações de pele no período pré-transplante, destacaram-se as manchas café com leite (32,4%). Pelo menos um órgão foi afetado pela doença do enxerto contra o hospedeiro em 55,1% dos pacientes, sendo o acometimento mais comum o de boca, seguido pelo de pele. Exantema e eritema foram as manifestações cutâneas mais frequentemente observadas. Conclusões: Observou-se alta prevalência de manifestações cutâneas próprias da doença, bem como de manifestações cutâneas de doença do enxerto contra o hospedeiro. O protocolo elaborado reúne informações relevantes e padronizadas para o acompanhamento dos pacientes com anemia de Fanconi submetidos ao transplante, garantindo maior confiabilidade das informações, e sua implementação permitirá a avaliação prospectiva dos pacientes.

Randomized trial with soaps - what happens to a newborn baby's skin?

Abstract Objective: Evaluate the effectiveness of a children's soap with physiological pH in maintaining cutaneous pH and moisture of the newborn (NB)'s skin after the first bath. Methods: Randomized, controlled and double-blind clinical trial in a rooming-in of a tertiary maternity hospital in southern Brazil with 204 newborns > 34 gestational weeks. Gestational and obstetric history was evaluated, and newborns were randomized into two groups according to the product applied in the bath: the control group (CG), which used common liquid soap with pH 7.0 and experimental group (EG), which used children's liquid soap with pH 5.8. Evaluation was made immediately before and after bath with skin pH measurement, corneometry and clinical parameters (erythema, scaling and moisture), on the forehead, abdomen and thigh. Results: There was no difference between groups regarding gestational, obstetric and family history (p > 0.05). In CG, skin pH increased in the abdomen and thigh (p < 0.05). In EG there was an improvement in clinical parameters after bathing with: increased moisture, less erythema and less scaling (p < 0.05). On the forehead, there was a significant increase in pH after bathing (p < 0.001) similar in both groups, although no use of soap. There was no difference in corneometry between groups after bathing. Conclusions: Children's liquid soap with physiological pH maintained the acidic skin pH and moisture of the newborn's skin after the first bath, which reinforces the importance of using products with physiological pH in the hygiene of newborns. Registration number RBR-9ky84vd.

Photoprotection in adolescents: what they know and how they behave

Abstract: Background: The greatest sun exposure occurs until adolescence and this is the only factor involved in photocarcinogenesis subject to modification with photoprotection. Objective: The objective of this study was to evaluate the habits and knowledge of adolescents regarding photoprotection. Method: Cross-sectional study that included 512 students from primary and high school. Data were collected by questionnaires with questions about habits and knowledge on sun protection. For data analysis, Pearson's Chi-square test and Yates test were applied, with 5% level of significance. Results: We evaluated 512 students, with a mean age of 14 years old. The teenagers agreed that ultraviolet rays cause skin cancer and aging (96% and 70%, respectively). Knowledge about the occurrence of burns even on cloudy days was recorded in 68% of cases, as well as the need for photoprotection for sports in 72%. The source of information about sun protection were by parents in 55%. In 70% was observed previous occurrence of sunburn, the daily use of sunscreens was found in 15% and 67% used only at the beach. of sunscreens with SPF higher than 30 was reported by 70% of students and 57% reported going to the beach between 10h and 16h. In 68% of cases it was registered insufficient sun protection, attributed, in 57% of the time to forgetfulness. Study limitations: The sample refers to two schools of Curitiba (PR), Brazil. Conclusion: Teenagers know the risks of sun exposure, but they do not adopt the practices for adequate protection.

Critical assessment of the pH of children's soap / Avaliação crítica do pH dos sabonetes infantis

Abstract Objective: To evaluate the pH value of children's antibacterial soaps and syndets used in children's baths and verify whether there is information regarding pH on the product label. Methods: Quantitative, cross-sectional, analytical observational study that included ninety soap samples, both in bar and liquid presentations, as follows: 67 children's soap (group 1), 17 antibacterial soaps (group 2), and 6 syndets (group 3). Each sample had its pH measured after 1% dilution. In addition to descriptive statistics, the Pearson-Yates chi-squared test and Student's t-tests were applied, considering the minimal significance level of 5%. The Wilcoxon-Mann-Whitney test, Fisher's exact test, and the Kruskal-Wallis test were used for inferential statistics. Results: The pH levels varied considerably between liquid and bar presentations, with lower levels (4.4-7.9) found for the liquids (p < 0.05). Syndets showed pH levels close to the ideal (slightly acid) and the antibacterial soaps showed the highest pH levels (up to 11.34) (p < 0.05). Only two of the soaps included in the study had information about their pH levels on the product packaging. Conclusions: Knowledge of the pH of children's soap by doctors and users is important, considering the great pH variability found in this study. Moreover, liquid soaps, and especially syndets, are the most recommended for the sensitive skin of neonates and infants, in order to guarantee skin barrier efficacy.

Resumo Objetivos: Avaliar o pH dos sabonetes infantis, antibacterianos e sindets (syntetic detergents) habitualmente usados em crianças, bem como verificar se há no rótulo desses produtos informação sobre seu pH. Métodos: Estudo observacional, analítico, transversal e quantitativo, que incluiu 90 sabonetes nas apresentações em barra e líquida, 67 infantis (grupo 1), 17 antibacterianos (grupo 2) e 6 sindets (grupo 3). Procedeu-se à mensuração do pH das amostras após diluição a 1%. Além da estatística descritiva, foram usados os testes de qui-quadrado Persons/Yates e t de Student, com nível de significância mínimo de 5%. Para a estatística inferencial, foram usados os testes de Wilcoxon-Mann-Whitney, exato de Fisher e Kruskal-Wallis. Resultados: O pH variou consideravelmente entre as formas líquida e em barra, com pHs menores (de 4,4 a 7,9) nos líquidos (p < 0,05). Os sindets mostraram pHs próximos ao ideal (levemente ácidos) e os antibacterianos apresentaram os maiores pHs (até 11,34) (p < 0.05). Apenas dois dos sabonetes analisados apresentavam no rótulo a indicação do pH. Conclusões: A observação do pH dos sabonetes infantis pelos médicos e usuários é importante, haja vista a grande variabilidade de valores de pH encontrados. Além disso, os sabonetes líquidos, e especialmente os sindets, são os mais recomendados para uso em recém-nascidos e lactentes com pele sensível, de forma a garantir a eficácia da barreira cutânea.

Granuloma anular: aspectos clínicos y evolutivos de 52 pacientes / Granuloma annulare: clinical and developmental aspects of 52 patients

Introducción: El granuloma anular (GA) es una dermatosis benigna autolimitada. Se observa con mayor frecuencia en la edad escolar y, si bien la causa es desconocida, se postula que puede ser una reacción inmune de hipersensibilidad tardía a diversos antígenos. El diagnóstico es clínico y se basa en la presencia de placas de centro hipercrómico o color piel normal y límites papulares arciformes. La asociación con diabetes mellitus en los pacientes en la franja etaria pediátrica aún es controvertida. El objetivo de este trabajo es evaluar las características clínicas y evolutivas del GA en la infancia. Materiales y métodos: Estudio retrospectivo y descriptivo de pacientes de hasta 15 años de edad que tuvieron diagnóstico de GA, entre los años 1990 y 2008 en el servicio de atención terciaria de la ciudad de Curitiba, Brasil. Resultados: Fueron evaluados 52 casos de GA. La edad media de inicio fue de 4,5 años (14 meses a 12 años). En el 88% de los casos, las lesiones fueron asintomáticas. La forma localizada ocurrió en 39 (75%) pacientes, la profunda en 9 (17%) y las formas generalizada y perforante en 2 casos respectivamente. De los 33 pacientes con seguimiento, el 78,7% presentó mejoría de las lesiones en un período medio de 8 meses (1 a 35 meses). La glucemia en ayunas fue normal en los 18 (34%) casos evaluados. Un paciente tenía diagnóstico previo de diabetes mellitus tipo 1. Discusión: En esta población el GA afectó predominantemente al sexo femenino, con lesiones circinadas y localizadas en el dorso de los pies. La forma clínica más común fue la localizada, no hubo alteración de la glucemia y la resolución espontánea ocurrió en la mayoría de los casos.

Introduction: Granuloma annulare (GA) is a self-limited dermatosis. It is observed at school age the cause is unknown, it is believed to be an immune reaction of delayed hypersensitivity to various antigens. The diagnosis is clinical and based on the presence of arciform plaques with Introduction: Granuloma annulare (GA) is a self-limited dermatosis. It is observed at school age and hyperpigmented or flesh-coloured skin center. The association with diabetes mellitus in the pediatric population remains controversial. The objective of this work is to evaluate the clinical features and outcome of granuloma annulare in childhood. Materials and methods: Retrospective descriptive study of patients up to 15 years of age diagnosed with GA, between 1990 and 2008, in a tertiary care center of the city of Curitiba, Brasil. Results: We evaluated 52 cases of GA. The average age of onset was 4.5 years (14 months to 12 years). In 88% of cases the lesions were asymptomatic. The localized type was observed in 39 (75%) patients, deep lesions in 9 (17%) and generalized and perforating type in 2 cases each. Of the 33 patients with follow-up, 78.7% showed improvement in the lesions over an average period of 8 months (1 to 35 months). Glycemia was normal in the 18 cases evaluated. One patient had a previous diagnosis of type 1 diabetes mellitus. Discussion: We found, among the studied population, that GA occurred predominantly in females, with localized circinate lesions occurring mainly in the dorsal region of the feet. There was no increase in blood glucose and the spontaneous resolution occurred in most of the cases.

Paraqueratose granular: relato de seis casos em crianças / Granular parakeratosis: a report of six cases in children

A paraqueratose granular é alteração da queratinização, primeiramente descrita em adultos, caracterizada por pápulas e placas hiperqueratósicas nas áreas intertriginosas. Os autores descrevem seis casos de paraqueratose granular em crianças. Um paciente apresentava lesões nas regiões glúteas, dois em ambas as axilas e região cervical (apresentações inéditas na literatura). Três pacientes apresentavam lesões em pregas inguinais. Realizam também revisão da literatura e discutem a possível etiologia dessa rara dermatose.