ABSTRACT
RESUMEN Introducción: desde el inicio de la pandemia declarada en marzo del 2020 por la Organización Mundial de la Salud, la piel no se ve excluida de esta afectación, al inicio descripta como hallazgo poco frecuente, actualmente se estima que un 20 % de los pacientes con COVID-19 presentan algún tipo de manifestación dermatológica que se presenta durante la fase aguda de la enfermedad o durante la convalecencia. Las lesiones cutáneas son diversas, entre ellas llama la atención por su importancia y severidad las acroisquémicas. Objetivo: describir las características demográficas, clínicas, laboratoriales y evolutivas de 6 casos de COVID-19 con lesiones acroisquémicas severas. Metodología: estudio retrospectivo, descriptivo y observacional de casos de COVID-19 confirmados por pruebas laboratoriales con lesiones acroisquémicas severas interconsultados en el Servicio de Dermatología del Hospital Nacional o de la consulta privada en el periodo julio 2020 a julio 2021. Resultados: se analizaron 6 casos, 3 mujeres y 3 varones, con promedio de edad de 61.6 años, todos con diagnóstico confirmado de COVID-19. Los patrones clínicos de lesiones acroisquémicas observados fueron 2 isquemias microcirculatorias severas y 4 gangrenas secas. Todos los pacientes presentaron alguna comorbilidad y dímero D elevado. Uno recibió tratamiento ambulatorio, 4 en sala de internados y 1 en unidad de cuidados intensivos. Todos recibieron anticoagulación. La evolución fue satisfactoria en 2 de ellos, en 2 fue necesaria la amputación parcial o total de los miembros afectados y 1 obitó. Conclusión: las lesiones cutáneas acroisquémicas en pacientes que cursan o han cursado con COVID-19 son poco frecuentes, se presentan por lo general en personas mayores y están asociados a un peor pronóstico en cuanto a morbimortalidad.
ABSTRACT Introduction: since the beginning of the pandemic declared in March 2020 by the World Health Organization, the skin is not excluded from this affectation, initially described as a rare finding, currently it is estimated that 20% of patients with COVID-19 present some type of dermatological manifestation that manifests itself during the acute phase of the disease or during convalescence. Skin lesions are diverse, among them acroischemic ones are striking for their importance and severity. Objective: to describe the demographic, clinical, laboratory and evolutionary characteristics of 6 cases of COVID-19 with severe acroischemic lesions. Methodology: Retrospective, descriptive and observational study of COVID-19 cases confirmed by laboratory tests with severe acroischemic lesions consulted in the "Servicio de Dermatología" del "Hospital Nacional" or the private practice in the period July 2020 to July 2021. Results: 6 cases were analyzed, 3 women and 3 men, with an average age of 61.6 years, all with a confirmed diagnosis of COVID-19. The clinical patterns of acroischemic lesions observed were 2 severe microcirculatory ischemia and 4 dry gangrene. All patients had some comorbidity and elevated D-dimer. One received outpatient treatment, 4 in the inpatient ward and 1 in the intensive care unit. All received anticoagulation. The evolution was satisfactory in 2 of them, in 2 it was necessary the partial or total amputation of the affected limbs and 1 died. Conclusion: acroischemic skin lesions in patients with or who have had COVID-19 are rare, generally occur in older people, and are associated with a worse prognosis in terms of morbidity and mortality.
ABSTRACT
O censo dermatológico das diversas regiões brasileiras apresenta inegável importância para a Sociedade Brasileira de Dermatologia no intuito de se priorizar também seu papel social, assim como sua função no desenvolvimento da política de saúde do país. O objetivo do trabalho é o levantamento nosológico das dermatoses mais freqüentes de uma ampla região que abrange parte do Estado de Minas Gerais e do Estado do Rio de Janeiro, com a finalidade de fornecer dados para posteriores trabalhos e iniciativas afins específicas. Foram avaliados 14.784 prontuários dermatológicos referentes ao período de 02 de fevereiro de 2003 a 02 de fevereiro de 2006. Deste total, ao excluírem-se os retornos, obtiveram-se um total de 9.031 pacientes atendidos, valor referente ao número de patologias diagnosticadas e tratadas no Serviço de Dermatologia do Hospital Universitário da Universidade Federal de Juiz de Fora. Os diagnósticos foram subdivididos de forma compacta e didática. Os resultados mais frequentes foram Tumores Cutâneos com 19,9% do total; Infecções Cutâneas com 19,89%; Eczemas com 13,56% e Afecções dos Anexos com 10,56%. Quanto às infecções, estas representam um grande percentual dos casos analisados, o que se deve provavelmente ao baixo nível socioeconômico dos pacientes em estudo. O presente Censo Dermatológico fornece subsídios para as diversas instâncias governamentais no planejamento das políticas de saúde na área da dermatologia, assim como para os programas de formação em dermatologia.
A dermatological survey of the different Brazilian regions provides scope for the Brazilian Dermatology Society to both play its social role and influence the national health policies. The objective of this study is the data-gathering nosological survey of the most frequently diagnosed dermatological conditions in a region comprising part of the states of Minas Gerais and Rio de Janeiro, Brazil. 14.784 medical records of Dermatology from the period February 2, 2003 to February 2, 2006 were assessed.After exclusion of follow-up visits, 9.031 patients were seen at the Dermatology Clinic. Diagnoses were clustered in a compact and didatic way. The results were that 19.9% of the patients were diagnosed with skin tumors, 19.89% with skin infections, 13.56% with eczema, and 10.56% with infection of the skin annexes. The low socioeconomic status of the patients is likely to account for the high percentage of skin infections. This dermatological census informs different government levels about priorities for health policies and professional education.