Patrón cutáneo pigmentario de disposición lineal en un niño, vitíligo segmentario vs. hipomelanosis de Ito / Linear disposition pigmentary skin pattern in a child, segmental vitiligo vs. Hypomelanosis of Ito

Introducción: algunas enfermedades dermatológicas siguen disposición con patrones lineales. Con hipopigmentación en la infancia se encuentran el vitíligo segmentario, que sigue los dermatomas, aunque puede seguir las líneas de Blaschko y la hipomelanosis de Ito, que a su vez sigue las líneas de Blaschko. Estas dermatosis son infrecuentes en la práctica dermatólogica. Objetivo: profundizar en los elementos diagnósticos que permiten diferenciar dos dermatosis clínicamente caracterizadas por hipopigmentación segmentaria lineal de tipo blaschkoide y el tratamiento. Presentación del caso: a la consulta de Genodermatosis en Las Tunas acude un niño con máculas acrómicas en hemicuerpo izquierdo, sin otras alteraciones. Después de ser evaluado por varias especialidades (Dermatología, Genética, Pediatría, Oftalmología y Neurología), se determina que solo presentaba afectación cutánea, se le realizó biopsia de piel, que corroboró el diagnóstico de vitíligo segmentario. Conclusiones: se presenta el caso porque el vitíligo segmentario es infrecuente, sigue un patrón lineal que puede ser diferenciado de otra dermatosis infrecuente, como la hipomelanosis de Ito, y en el tratamiento es importante brindar apoyo psicológico al paciente para favorecer la obtención de mejores resultados con la Melagenina Plus(AU)

Introduction: some dermatological diseases are still available with linear patterns. In childhood with hypopigmentation can be found segmental vitiligo (which follows the dermatomes although it can follow the lines of Blaschko), and Hypomelanosis of Ito (which in turn follows the lines of Blaschko). These dermatoses are infrequent in dermatological practice. Objective: to deepen into the diagnostic elements that allows the differentiation of two dermatoses clinically characterized by linear segmental hypopigmentation of blaschkoid type and treatment. Case presentation: a child attends to the consultation of Genodermatoses in Las Tunas presenting acromic macules in left half of the body, without other alterations. After being evaluated by several specialties (Dermatology, Genetics, Pediatrics, Ophthalmology and Neurology), it was determined that only skin affectation was present. A skin biopsy was performed, which corroborated the diagnosis of segmental vitiligo. Conclusions: The case is presented because segmental vitiligo is infrequent, it follows a linear pattern that can be differentiated from another uncommon dermatosis, such as Hypomelanosis of Ito, and in the treatment it is important to provide psychological support to the patient to favor obtaining better results with Melagenina Plus(AU)

Vitiligo as a psychosocial disease: apprehensions of patients imprinted by the white / O vitiligo como uma doença psicossocial: apreensões de pacientes marcados pelo branco / El vitíligo como una enfermedad psicosocial: comprensión de pacientes marcados por lo blanco

This study aimed to show the comprehension that patients bearing vitiligo have over their condition, also assessing the association with their health and disease concepts. It is a qualitative research with descriptive and exploratory purposes, carried out from an epidemiological survey throughout the years of 2010-2013, with records from a dermatology outpatient care sector of a seminal hospital located in the city of Campina Grande - Paraíba, Brazil. It was identified that from the 832 existing records, 13 were of vitiligo patients and, from them, eight agreed to be part of this study, answering a semi-structured questionnaire. Data examination was made using the Thematic Content Analysis technique, identifying four categories. Results indicated that the process of being stricken with the disease is directly related to social practices that target the "stained" subject, over whom vitiligo has imprinted its patches.(AU)

O presente estudo teve por objetivo apresentar a compreensão de sujeitos portadores de vitiligo sobre sua afecção, avaliando também a associação com a concepção de saúde-doença. Trata-se de uma pesquisa qualitativa de caráter descritivo e exploratório, realizada a partir de um levantamento epidemiológico do período de 2010-2013, em prontuários do ambulatório de dermatologia de um hospital de referência localizado na cidade de Campina Grande - Paraíba, Brasil. Identificou-se que de 832 prontuários existentes, 13 pacientes possuíam vitiligo e, destes, apenas oito aceitaram participar do estudo, respondendo a um questionário semiestruturado. O tratamento dos dados ocorreu por meio da técnica de análise de conteúdo temática, identificando quatro categorias. Os resultados indicaram que o processo de adoecimento está diretamente ligado às práticas sociais que são direcionadas ao sujeito "manchado", sobre o qual o vitiligo imprimiu suas marcas.(AU)

El objetivo de este estudio fue presentar la comprensión de sujetos portadores de vitíligo sobre su afección, evaluando también la asociación con el concepto de salud-enfermedad. Se trata de una investigación cualitativa de carácter descriptivo y exploratorio, realizada a partir de un levantamiento epidemiológico del período de 2010-2013, en fichas del ambulatorio de dermatología de un hospital de referencia localizado en la ciudad de Campina Grande - estado de Paraíba, Brasil. Se identificó que, de las 832 fichas existentes, 13 pacientes sufrían de vitíligo y de ellos solamente ocho aceptaron participar en el estudio, respondiendo un cuestionario semi-estructurado. El tratamiento de los datos se realizó por medio de la técnica de análisis de contenido temático, identificando cuatro categorías. Los resultados indicaron que el proceso de enfermedad está directamente vinculado a las prácticas sociales que se dirigen al sujeto "manchado", sobre el cual el vitíligo imprimió sus marcas.(AU)

"Mata de tristeza!&": representações sociais de pessoas com vitiligo atendidas na Farmácia Universitária da Universidade Federal do Rio de Janeiro, Brasil / "Sadness kills!": Social representations of people who have vitiligo assisted in the pharmacy of the Federal University of Rio de Janeiro, Brazil / "Mata de tristeza!": representaciones sociales de personas que tienen vitiligo y son atendidas en la Farmacia Universitaria de la Universidade Federal do Rio de Janeiro, Brasil

Vitiligo é caracterizado por manchas brancas na pele. Na dispensação do metoxisaleno utilizado para tratá-lo, na Farmácia Universitária/UFRJ, os portadores relatavam mal-estares devido à terapia e à doença. A busca pela compreensão da experiência do adoecer conduziu este estudo que adota perspectiva teórico-metodológica socioantropológica. A apreensão da visão de mundo dos sujeitos foi captada em entrevistas entre usuários da FU/UFRJ. A partir do diagnóstico, os sujeitos consideram o vitiligo "um castigo" sentem-se alvo de "chacotas", "preconceito", "discriminações". A experiência da doença impõe rever seus conceitos e filiação religiosa. O fato de o vitiligo não ser concebido como doença grave estabelece um não-lugar para o sofrimento dos portadores. Aspectos simbólicos, emocionais e socioculturais que circunscrevem a doença devem ser considerados para melhorar a atenção à saúde e vida desses sujeitos. Os profissionais de saúde precisam concebê-los para além de suas "manchas".

Vitiligo is characterized by white spots on the skin. During the dispensation of Methoxypsoralen, a drug used for treating it, patients reported discomfort regarding such therapy and their disease. Thus, the study has the motivation of seeking to understand the experience of being ill, using a socio-anthropological, theoretical and methodological approach. Subjects' worldview after the diagnosis of vitiligo was apprehended by interviews with UFRJ pharmacy users. The subjects tend to consider having vitiligo "punishment", and they feel like a target of "mockery", "prejudice" and "discrimination". It is a fact that vitiligo is not taken as a severe condition, and this establishes a "non-place" for the suffering of its bearers. Symbolic, emotional, and socio-cultural aspects of the disease must be taken into account, in order to improve health care for these subjects and their lives. Health professionals need to perceive vitiligo bearers beyond their "spots".

El vitiligo se caracteriza por manchas blancas en la piel. En el momento de la entrega del medicamento correspondiente a esta enfermedad en la farmacia, los pacientes nos informaron sobre incomodidades por que pasaron. La incomodidad en la cosmovisión de los sujetos fue capturada en entrevistas. A partir del diagnóstico médico, los sujetos comenzaron a considerar al vitiligo como "un castigo", blanco de "burlas", 'prejuicios" y "discriminación". Así mismo, la experiencia de la enfermedad les condujo a revisar sus conceptos y religiones. El hecho de que el vitiligo no se considera una enfermedad graveparece establecer un "no lugar" para el sufrimiento y el "dolor espiritual" de sus portadores. Los aspectos simbólicos, emocionales y socioculturales que circunscriben esta enfermedad deben considerarse para mejorar la atención de la salud y la vida de estos sujetos. Por su parte, los profesionales de la salud deben aprender a concebirlos más allá de sus "manchas".

Knowledge, beliefs, and perceptions of Turkish vitiligo patients regarding their condition

Abstract BACKGROUND: Vitiligo is an acquired pigmentary skin disorder that affects 0.5% to 2.0% of the population. OBJECTIVE: Patients' knowledge, opinions, and attitudes about vitiligo were evaluated. METHODS: The team conducted a cross-sectional, descriptive, prospective study between June 2014 and May 2015. The study included 100 patients aged over 12 years who were diagnosed with vitiligo. A questionnaire including items on knowledge, opinions, and beliefs about vitiligo and the Illness Perception Questionnaire (IPQ) were filled out by the patients, and the results were analyzed. RESULTS: In total, 100 (58 female, 42 male) patients were included in the study. Of them, 74% knew the name of their disease, 90% thought that vitiligo was not contagious, 48% reported that they obtained information on the disease from a doctor, and 69% believed they had adequate information on vitiligo. Eighty percent reported no negative effects from vitiligo on relationships with friends or family. It was believed that stress, excessive sun exposure, and heredity were causes of vitiligo, according to 84%, 37%, and 22% of the patients, respectively. Thirty-six patients (36%) believed that their illness was a serious disease and 35% deemed that it did not have a major impact on their lives. CONCLUSIONS: Our results show that vitiligo patients were generally highly aware of their condition. The disease did not negatively affect patient opinions or attitudes about vitiligo. The authors believe that improving patient-physician communication will impact positively on the course of the disease.

Psicodermatología en la atención primaria / Psychodermatology in primary care

The skin has the distinction of being the largest, visible and accessible part of the human body, and it hides a close and old relationship with the human psyche, and so has been demonstrated in the last years, where more elements of the Mental Health are elucidated playing a role in the pathogenesis of skin diseases, as well as there are some descriptions of the inverse relationship, this is, on how the skin diseases affect Mental Health of the individual. In this paper we propose to emphasize the importance of the issue, to consider a comprehensive approach to everyday Dermatology in Primary Care Medicine.

Translation, cross-cultural adaptation and validation of the vitiligo-specifi c health-related quality of life instrument (VitiQoL) into Brazilian Portuguese

Abstract BACKGROUND: Vitiligo, although asymptomatic, highly compromises patients' quality of life (QoL). Therefore, an adequate evaluation of QoL is essential. OBJECTIVES: Translation, cultural adaptation and validation of VitiQol (Vitiligo-specific health-related quality of life instrument) into Brazilian Portuguese. METHODS: The study was conducted in two stages; the first stage was the translation and cultural/linguistic adaptation of the instrument; the second stage was the instrument's validation. RESULTS: The translated VitiQol showed high internal consistency (Cronbach alpha = 0.944) and high test-retest reliability and intraclass correlation coefficient=0.95 (CI 95% 0.86 - 0.98), p<0.001. There was no statistically significant difference between the means of the first completion of the VitiQoL questionnaire and the retest, p = 0.661. There was a significant correlation between VitiQoL and DLQI (r = 0.776, p <0.001) and also between VitiQoL-PB and subjects' assessment of the severity of their disease (r = 0.702, p <0.001). CONCLUSIONS: The impact of vitiligo on the QoL of Brazilian patients can be assessed by a specific questionnaire. .

Perfil clínico e epidemiológico do vitiligo infantil: análise de 113 casos diagnosticados em um centro de referência em dermatologia de 2004 a 2014 / Clinical and epidemiological profile of childhood vitiligo: analysis of 113 cases diagnosed at a dermatology referral center from 2004 to 2014

Introdução: O vitiligo é forma adquirida autoimune de hipopigmentação ou despigmentação, iniciando-se na infância metade de seus casos. Objetivos: Traçar o perfil clínico e epidemiológico do vitiligo infantil em um centro de referência em dermatologia. Métodos: Estudo transversal e descritivo com análise dos prontuários de pacientes com menos de 13 anos diagnosticados como portadores de vitiligo entre 2004 e 2014. Resultados: Dos 113 casos identificados, 54% eram do sexo feminino e 46% do sexo masculino; a idade variou de zero a 12 anos com a maioria dos pacientes (54,8%) no subgrupo de quatro a oito anos. Em 59% dos prontuários não havia registro sobre fatores desencadeantes do vitiligo; 31% dos pacientes associaram o início da doença a estresse emocional, 3% a trauma físico, e 7% não associaram a fator desencadeante. Conclusões: A discreta prevalência no sexo feminino também foi descrita em outros estudos. O comportamento do vitiligo na criança é diferente daquele observado nos adultos. A influência dos fatores psicológicos como desencadeantes e os potenciais efeitos duradouros na autoestima devem ser levados em consideração na abordagem do paciente. Os resultados deste trabalho foram semelhantes aos relatos existentes sobre o vitiligo nessa faixa etária, que são, aliás, poucos na literatura

Introduction: Vitiligo is an acquired autoimmune form of hypopigmentation or depigmentation in which half of the cases begins in childhood. Objectives: To describe the clinical and epidemiological profile of childhood vitiligo in a referral center for dermatology. Methods: A cross-sectional, descriptive study was carried out based on the analysis of medical records of patients younger than 13 years diagnosed with vitiligo from 2004 to 2014. Results: Of the 113 cases identified, 54% were female and 46% male, the age ranged from 0 to 12 years, with most patients in the 4-8 years-old subgroup (54.8%). In 59% of the medical records there was no record of triggering factors of vitiligo; 31% of patients associated the onset of the illness to emotional stress, 3% to physical trauma and 7% did not associate it to any triggering factor. Conclusions: The discreet prevalence in women has also been reported in other studies. Vitiligo behavior in children is different from that observed in adults. The influence of psychological factors as triggers and potential lasting effects on self-esteem should be considered in the approach of the patient. Although studies on vitiligo in this age group are scarce in the literature, the results of the present study were similar to the reports already available in the literature

Vitiligo impact scale: An instrument to assess the psychosocial burden of vitiligo.

Background : Vitiligo is a disease that significantly impairs quality of life. Previous studies have shown that vitiligo has an impact that may not correlate with the size and extent of depigmentation, indicating a need for an independent measure of the psychosocial burden. Aims : To develop a rating scale to assess the psychosocial impact of vitiligo. Methods : The study was undertaken in three broad phases: item generation, pre- and pilot testing, and test administration. Items were generated largely from a qualitative study using semi-structured interviews of patients. Face and content validity were assessed through pre- and pilot testing in 80 patients and the final version was administered to 100 patients who also received the Dermatology Life Quality Index (DLQI) and the Skindex-16. Each patient also underwent a physician global assessment (PGA) of the impact of vitiligo. Test-retest reliability was assessed in 20 patients. Results: Of 72 items initially generated for the scale, 27 were retained in the final version. Subjects were able to comprehend the items and took about 5-7 min to complete the instrument. The scale was internally consistent (Cronbach's α = 0.85). Scores on the scale correlated moderately well with the DLQI and the Skindex (Spearman rank correlation: 0.51 and 0.65, respectively). The scale was able to discriminate between patients having mild and those having moderate and severe impact as assessed by PGA. The test-retest reliability coefficient (Spearman rank correlation) was 0.80. Conclusion: The Vitiligo Impact Scale appears to be a valid measure of the psychosocial impact of vitiligo and this instrument may be useful both in the clinic and in clinical trials.

Assessment of the quality of life of pediatric patients at a center of excellence in dermatology in southern Brazil / Avaliação da qualidade de vida dos pacientes pediátricos de um centro de referência em dermatologia no sul do Brasil

BACKGROUND: Skin diseases cause negative impact on the emotional state, social relationships and daily activities, due to the stigma caused by the appearance of the lesions. OBJECTIVE: This study aimed to assess the quality of life of pediatric patients with skin diseases attending a dermatology service, compare the scores obtained among the dermatoses found in the sample and associate them to the variables, in addition to observing how the skin disease specifically affects quality of life. METHODS: Cross-sectional study, with patients between 5 and 16 years attending the Dermatology Service of the University of Health Sciences of Porto Alegre, Brazil, between July 2010 and February 2011. The data collection instruments were the Children's Dermatology Life Quality Index questionnaire and the AUEQI questionnaire. RESULTS: A total of 161 patients were interviewed, with mean age of 9,66 years. The main dermatoses were atopic dermatitis (29.8%), warts (13%) and molluscum contagiosum (7.5%). Chronic diseases (73.9%) were the most prevalent. The overall mean Children's Dermatology Life Quality Index score was 5.01 for chronic dermatoses and 2.07 for acute illnesses, indicating a compromised quality of life among chronically ill patients. The comparison between the scores obtained with the AUEQI scale and the Children's Dermatology Life Quality Index scores indicates that the overall quality of life is less affected than the specific quality of life related to the dermatosis. CONCLUSIONS: The data presented reinforce how important it is that the patients, their families and caregivers understand the symptoms, triggers and treatment of the skin disease in question. This information facilitates adherence to the treatment and justifies the conduct adopted by the dermatologist.

FUNDAMENTOS: Doenças dermatológicas, em razão dos estigmas pela aparência das lesões, são fonte de impacto negativo no estado emocional, relações sociais e atividades cotidianas. OBJETIVOS: Este estudo objetiva avaliar a qualidade de vida nos pacientes dermatológicos pediátricos em um centro de referência em dermatologia, comparar os índices de qualidade de vida entre as dermatoses e associá-los às variáveis, além de avaliar de que forma as dermatoses afetam a qualidade de vida especificamente. MÉTODOS: Estudo analítico transversal, pacientes entre 5 e 16 anos, do Serviço de Dermatologia da Universidade Federal de Ciências da Saúde de Porto Alegre, entre julho de 2010 e fevereiro de 2011. Instrumentos utilizados: questionário Índice Pediátrico de Qualidade de Vida em Dermatologia e escala AUQEI. RESULTADOS: Um total de 161 pacientes, média de idade de 9,66 anos. As principais dermatoses foram dermatite atópica (29,8%), verrugas vulgares (13%) e molusco contagioso (7,5%). Doenças crônicas (73,9%) foram mais prevalentes. A média do Índice Pediátrico de Qualidade de Vida em Dermatologia de 5,01 para dermatoses crônicas, e de 2,07 em agudas, indicando maior comprometimento da qualidade de vida entre os pacientes cronicamente enfermos. A comparação entre os escores obtivos com a escala AUEQI e o Índice Pediátrico de Qualidade de Vida em Dermatologia indicam que a qualidade de vida global é afetada com menor intensidade do que a relacionada especificamente à dermatose. CONCLUSÃO: Os dados obtidos reforçam a importância do entendimento dos sintomas, desencadeantes e da terapêutica da dermatose em questão pelos pacientes, por seus familiares e por seus cuidadores. Tais infomações facilitam a aderência ao tratamento e justificam a conduta adotada pelo dermatologista.

Assessment of the quality of life of pediatric patients with the major chronic childhood skin diseases / Avaliação da qualidade de vida em pacientes pediátricos com as principais dermatoses crônicas da infância

BACKGROUND: The skin is the primary interface of the human being with the external environment and the presence of skin diseases can have substantial effects on the quality of life. OBJECTIVE: This study aims to make a comparative evaluation of the quality of life of pediatric patients with atopic dermatitis, psoriasis and vitiligo and correlate the findings with the total body surface and the areas with the disease exposed to view. METHODS: The sample consisted of 118 patients with atopic dermatitis, vitiligo and psoriasis, aged between 5 and 16 years, who were asked to answer the Children's Dermatology Life Quality Index (CDLQI) questionnaire. A dermatological examination for the measurement of total body surface affected by the disease was performed. RESULTS: The three groups showed an impaired quality of life. Patients with atopic dermatitis and psoriasis showed a significantly greater impact on the QoL than the group with vitiligo. There is a trend towards impaired quality of life in patients from the three groups of dermatoses, which is related to increments in both the total affected area and affected area exposed to view (r = 0.428 and p <0.001, r = 0.381 and p <0.001, respectively). CONCLUSION: The assessed children had impaired quality of life. However, there is a significantly greater impact in the groups with atopic dermatitis and psoriasis than in the group with vitiligo. This may be due to lack of symptoms in vitiligo and the fact this group presented a statistically smaller affected body surface than the other two groups.

FUNDAMENTOS: A pele é a principal interface do ser humano com o meio externo e a presença de doenças cutâneas pode levar a repercussões importantes na qualidade de vida. OBJETIVOS: O presente estudo tem como objetivo fazer uma avaliação comparativa entre a qualidade de vida dos pacientes pediátricos com dermatite atópica, vitiligo e psoríase e correlacioná-la à superfície corporal total e às áreas expostas à visualização acometidas pela doença. MÉTODOS: Amostra composta por 118 pacientes com dermatite atópica, vitiligo e psoríase na faixa etária entre 5 a 16 anos para a aplicação do questionário Índice de Qualidade de Vida para Dermatologia em Crianças (CDLQI). Realizado exame dermatológico para a aferição da superfície corporal total acometida pela doença. RESULTADOS: Os três grupos de pacientes pediátricos demonstraram ter redução na qualidade de vida. Os pacientes com dermatite atópica e psoríase apresentaram um impacto na QoL significativamente maior que o grupo com vitiligo. Há uma tendência na redução da qualidade de vida dos pacientes dos três grupos de dermatoses relacionado ao aumento tanto da superfície total quanto da superfície exposta à visualização (r=0,428 e p<0,001; r=0,381 e p<0,001, respectivamente). CONCLUSÃO: As crianças avaliadas com dermatite atópica, psoríase e vitiligo apresentaram redução na qualidade de vida. Porém, há um impacto significativamente maior nos grupos de pacientes com dermatite atópica e psoríase em relação ao grupo com vitiligo. Este fato pode dever-se a ausência de sintomas no vitiligo e ao grupo ter apresentado uma superfície corporal comprometida estatisticamente menor que outros dois grupos.

Abordagem multiprofissional na visão integral do paciente com vitiligo / Multidisciplinary approach in the patient's integral vision with vitiligo

A psicodermatologia é uma área que estuda e integra o trabalho de médicos e psicólogos, objetivando um melhor entendimento das doenças cutâneas. O vitiligo, caracterizado por máculas acrômicas, é causado por destruição adquirida de melanócitos, sendo associado com fatores emocionais. Há três teorias para explicar a destruição dos melanócitos no vitiligo: a imunológica, a citotóxica e a neural. Independentemente da origem, existe a percepção nítida da sua relação com aspectos emocionais. O aparecimento e o alastramento da doença cursam com o aumento das frustrações e preocupações. Vários doentes relatam o aparecimento após traumas emocionais significativos. Quanto maior a área corporal afetada, maior o nível de estresse, depressão e tensão emocional. Provavalmente, alterações emocionais desequilibram o organismo, favorecendo alterações hormanais e imunológicas, podendo desencadear e piorar o vitiligo. A pessoa deve ser vista com um todo, constituída de outras dimensões, como a psíquica, social, econômica e cultural. Este trabalho objetiva demonstrar a visão de homem integral, considerando as influências biopsicossociais e aimportância do trabalho multiprofissional.

Tha Psychodermatology is an area that studies and integrate the doctor's work, psychologists, looking for a better understanding of skin diseases. The vitiligo, marked by achromatic maculates, is caused because there is an adquire destruction of melanocytes, so related with emotional components. There are three theories that explain the destruction of the melanocytes in vitiligo: an immunological response, one that is citolitic and the last one, neural. Causes apart, that is a clear perception about the relation with emotional aspects. The beginning and spreading of the disease courses with frustrations and concerns, both always increasing. A lot of sick people relates the beginning of the disease after some important emotional stress. The higher is the body area affected, higher is the leval of stress, depression and emotional tension. Probably, emotional changing unbalance the organism, favoring hormonal and immunological changes, and it may trigger de vitiligo. The person must be seen as a whole person, consists of other dimensions, such as psychological, social, economic and cultural. This work shows the integral vision of man, considering the influences biopsychosocial and the importance of multidisciplinary working.

Vitiligo e emoções / Vitiligo and emotions

FUNDAMENTOS: O vitiligo acomete, em média, 1% da população mundial. Mais de 75% dos pacientes têm autoimagem depreciativa em relação à doença. Seu impacto emocional é muitas vezes negligenciado pelo cuidador, influenciando negativamente o prognóstico. OBJETIVO - Verificar o efeito do vitiligo sobre as emoções e discutir as últimas descobertas sobre a interação mente? corpo e seu desdobramento sobre a doença. MÉTODOS - Cem pacientes com diversas formas de vitiligo responderam, na primeira consulta, a uma pergunta sobre as emoções que a presença das manchas lhes provocava. RESULTADOS - Entre os que apresentavam manchas em áreas expostas, 80% queixaram-se de emoções desagradáveis, em contraposição a 37% dos que tinham manchas em áreas não expostas. As emoções mais referidas foram medo (71%), vergonha (57%), insegurança (55%), tristeza (55%) e inibição (53%). CONCLUSÃO - Qualquer doença crônica produz nos seres humanos uma vivência negativa propiciada pela expectativa de sofrimento. O vitiligo é um desafio à autoestima. Além de uma orientação científica adequada, o paciente de vitiligo carece de conforto emocional. A resposta e a adesão ao tratamento e até mesmo a resiliência diante de eventuais falhas terapêuticas dependem da boa relação médico-paciente. Numa época em que dispomos de respeitável terapêutica, torna-se indispensável que o dermatologista se mostre apto a avaliar seu paciente holisticamente.

BACKGROUND: On average, vitiligo affects one percent of the world population. More than 75% of the patients have negative self-image on account of the disease. The emotional impact of the dermatosis is frequently neglected by the caretaker, which has negative influence on therapy and prognosis. OBJECTIVE - To check the effect of vitiligo on patients’ emotions and discuss the mind-body interaction and its impact on the disease. METHODS - In their first medical visit, one hundred patients with various forms of vitiligo answered a question about which emotions were elicited by the presence of the spots. RESULTS - Eighty-eight percent of the patients with spots in exposed areas complained of unpleasant emotions versus twenty-seven percent of those with spots in unexposed areas. The most frequently referred emotions were fear, specifically of expansion of the spots (71%), shame (57%), insecurity (55%), sadness (55%) and inhibition (53%). CONCLUSION - Chronic illnesses generate in human beings a negative experience propitiated by the expectation of suffering. Besides appropriate scientific guidance, vitiligo patients need emotional comfort. Treatment outcomes and patients’ compliance to it, and even their resilience to face occasional therapeutic failures, rely on good physician-patient relationship. At a time when doctors make use of reputable therapeutic resources, it is indispensable that dermatologists become able to evaluate the patient in an integrative fashion.

Factores psicobiológicos en vitiligo infantil: Posible rol en su génesis e impacto en la calidad de vida / Possible role of psychological and environmental factors in the genesis of chilhood vitiligo

Background: The exposure to stressing situations may play a role in the appearance of vitiligo. Patients with the disease have a greater sensitivity to environmental stress and a lower threshold to generate catecholamine mediated responses. Aim: To evaluate the temperament and character of patients with vitiligo and explore the relationship of the disease withnegative life events and life quality impairment. Material and methods: The study population were 21 patients with vitiligo aged 5 to 12 years, and two control groups (G1 and G2). G1 was composed by 14 healthy siblings of vitiligo patients. G2 was composed by 21 age and gender matched healthystudents from two schools in Santiago, Chile. The Junior Temperament and Character Inventory (JTCI), the Qualitative Psychosocial Development Survey (QPDS), the Life Event Checklist (LEC) and the Childrens’ Life Quality Index (CDLQI) were applied (LEC only to vitiligo patients). Results: On thetemperament dimensions, vitiligo patients scored high on the “harm avoidance“ scale in comparison toG2 (13.7 v/s 10.6). Compared with G1, QPDS showed in vitiligo patients a higher frequency of fear to strangers (71% and 36%, respectively) and a predominant feeling of fear and shyness in response to changes in a close relative (80% and 8%, respectively). There was a negative correlation (protective factor) between the character dimension “self-directedness“ and CDLQI score (r =–0.703). Conclusions: In this group of patients, we found a possible relationship between a specific temperament dimension, vitiligo and its impact on life quality.

Vitiligo y temperamento / Vitiligo and tempetament

A la fecha no existe ningún trabajo que explore la relación entre vitíligo y temperamento, salvo algunos que intentan buscar posibles causas. Menos aún trabajos desde una perspectiva del desarrollo que indaguen diversos factores psicobiológicos asociados a la génesis de este compromiso. Objetivo: Estudiar el temperamento, carácter y el respectivo desarrollo de pacientes con vitíligo, además de eventos vitales y calidad de vida. Método: Se analizaron 21 pacientes con diagnóstico de vitiligo infantil (G0), comparándolos con dos grupos controles,(G1) 14 hermanos sanos y (G2) 21 escolares sanos. Se utilizaron los siguientes instrumentos: 1.- JTCI ( Junior Temperament and Character Inventory) 2.- EDC ( Encuesta de Desarrollo Cualitativo) 3.- LEC ( Life Event Checklist) 4.- CDLQI ( Children’s Life Quality Index ). Resultados: Mediante el JTCI se encontró una frecuencia estadísticamente signifi cativa de dimensión Evitación del Daño (ED) en G0 vs G2 (13.6 v/s 10.6, p=0.037). En la EDC encontramos una mayor frecuencia de temor frente a extraños (71.4 por ciento v/s 35.7 por ciento) y una respuesta predominante de retraimiento y temor frente a cambios emocionales en figuras de apego (79,8 por ciento v/s 8,3 por ciento) G0 vs G1. En la LEC se encontró una relación en los eventos vitales del tipo situaciones de distanciamiento de figuras significativas. Conclusión: Al encontrar mayor frecuencia de ED en los niños con vitíligo más el resultado en la EDC, se corrobora la impresión clínica anterior, que estos niños tienen una especial sensibilidad que se asociaría a la génesis de este cuadro. Se inicia así, una línea de investigación, la perspectiva del desarrollo, para entender estos cuadros psico-somáticos de manera más integrada.

There is a lack for studies exploring the relationship between vitiligo and temperament, except those searching for possible causes. Yet, no study from a developmental view investigates different psychobiological factors related to the origin of this condition. Objective: to study the temperament, character and the respective development of vitiligo patients, the vital events and the life quality. Method: 21 patients with a diagnosis of childhood vitiligo (G0) were analyzed and compared to two control groups, 14 healthy brothers or sisters (G1) and 21 healthy school-aged children (G2). Instruments: 1. Junior Temperament and Character Inventory (JTCI), 2. Qualitative Psychosocial Development Survey (QPDS), 3. Life Event Checklist (LEC), 4.Children`s life quality index (CDLQI). Results: the JTCI revealed a significant statistics association between the harm avoidance dimension in the G0 group vs G2 (13.6 vs 10.6, p=0.037). The QPDS showed a higher frequency in fear to strangers(71.4 percent vs 35.7 percent) and a significant responsive fear- withdrawn pattern to the emotional variations of the attachment figure (G0 vs G1: 79.8 percent vs 8.3 percent).The LEC revealed an association between life events and …. Situations. Conclusions: the present study revealed a higher frequency for harm avoidance at the vitiligo group and by considering the QPDS results, the clinical impression was corroborate by suggesting the special sensitivity of this group of children in the origin of this pathology. An investigation line may start with a developmental and integrated view for the understanding of psychosomatic disorders.

Associação de eventos estressores ao surgimento ou agravamento de vitiligo e psoríase / Perceptions of patients with vitiligo and psoriasis about the existence of association between stressfull events and dermatosis

O presente artigo busca identificar os motivos relacionados à presença de vitiligo e psoríase, através da análise qualitativa de 103 fichas de triagem do serviço de psicologia do ambulatório de dermatologia sanitária do Rio Grande do Sul realizadas entre janeiro de 2000 a dezembro de 2003. Os resultados indicam que os fatores mencionados como desencadeantes ou agravantes das doenças de pele remetem a situações de estresse, estando a maior parte destes relacionados à perda e à separação em todas as áreas de vida.

The proposal of this article was to understand the factors in relation to presence of vitiligo and psoriasis, using a qualitative analysis of 103 trial forms presents at the Psychological Service of the Ambulatório de Dermatologia Sanitária, in Rio Grande do Sul State – Brazil, in the period from January 2000 to December of 2003. The results indicate that the factors mentioned as giving rise or aggravating the lesions of the skin involve stress situations and are relationed, at the majority, to loss and separation in all areas of life.

Análise do conceito de estigma em crianças com dermatoses crônicas / Analysis of stigma concept in children with chronic skin disease

Dermatite atópica, psoríase e vitiligo são doenças de pele crônicas em que o prognóstico, a evolução, os tipos de cuidados requeridos e a visibilidade da condição constituem fatores que afetam o comportamento do paciente e de seus familiares. A principal dificuldade enfrentada pelo portador de uma destas doenças é o fato de se tornar alvo constante de discriminação e preconceito. Este estudo visa demonstrar alguns efeitos de comportamentos estigmatizantes sobre o relato verbal de crianças portadoras de dermatoses crônicas, a partir de personagens de uma história infantil. Para este fim, seis crianças entre sete e oito anos de idade, com doenças crônicas da pele criaram, individualmente, um texto para as personagens de uma estória infantil. Os resultados mostraram que o preconceito e a estigmatização estão presentes em diferentes contextos sociais e que existem dificuldades tanto das crianças quanto de sua família para enfrentarem de modo mais adequado estas situações

[Prevalence of depression in vitiligo patients]

Vitiligo is a acquired skin disease with prevalence of 1% in the community. In spite of existing different options in its treatment, commonly the course is progressive and the prognosis is unpredictable. In our community with a negative attitude of people to the disease, great burdens of social and familial problems are caused to the patient and these may bring about Psychological disorders. The object of this study is to evaluate the prevalence and severity of depression in vitiligo patients and comparison with normal population according to Hamilton Rating Score for Depression. This is a cross-sectional descriptive Analytical study. 52 vitiligo patients presenting to dermatology clinic of Imam Reza Hospital agreed to participate in this study. The dissemination and extent of their skin disease was determined and their demographic identification recorded. Then, the 24 item questionnaire of HRSD completed. The same was performed for the control group, which were healthy in general and dermatology examination and the same as examination group in demographic identification. In the vitiligo patient group 24 patients [46.2%] and in the control group 3 [5.8%] were depressed. Mean depression score in the vitiligo patients was 17.48 and in the control 5.6. 7.6% of vitiligo patients had a history of suicidal attempt. Also, in vitiligo patients no significant statistical relationship was found between depression score and age, sex, marital state, extent of skin involvement with vitiligo, expose or non-expose skin lesions, and history of consullation with psychiatrist [P> 0.05]. High prevalence of depression in these patients is indicator of an insistent need to collaboration of psychiatrists with dermatologists in the management of this disease

Psicodermatologia: uma interface entre psicologia e dermatologia / Psychodermatology: an interface between psychology and dermatology

O objetivo deste artigo é apresentar alguns resultados importantes provenientes da tese de doutorado da primeira autora, orientado pela segunda. O tema da tese foi um estudo com pacientes de vitiligo, através da abordagem analítica, buscando compreender o vitiligo como possibilidade de manifestação simbólica da relação psique/corpo. Treze mulheres fizeram parte do estudo, sendo que dez receberam acompanhamento médico e psicológico por seis meses. Destas, cinco receberam acompanhamento psicológico grupal e cinco, acompanhamento psicológico individual. Três pacientes receberam só acompanhamento médico por igual período. Buscou-se, com esse atendimento diferenciado, avaliar se haveria diferença à resposta clínica (condição de repigmentação) das pacientes. Os resultados indicam que o modelo analítico permitiu a compreensão simbólica da doença vitiligo como manifestação de conteúdos inconscientes que necessitavam ser integrados à consciência. As pacientes que receberam tratamento conjunto médico e psicológico apresentaram um percentual de repigmentação de até 80%, enquanto as que receberam exclusivamente tratamento médico obtiveram um percentual de repigmentação de até 20%. Esse dado demonstra a importância de um trabalho integrado no tratamento das doenças de manifestação psicossomática.

The aim of this article is to present some results of the author’s doctorate thesis. The theme of the thesis was a study with patients suffering from vitiligo, through the analytic approach, in order to see vitiligo as a possibility of symbolic manifestation of the psyche/body relation. Thirteen women were part of the study, whereas ten were given medical and psychological assistance for six months. Among these women, five were given group psychological therapy, and five received individual psychological therapy. Three patients were given only medical assistance for the same period. This differentiated assistance aimed at assessing if there would be any difference to the patients’ clinical answer (condition of repigmentation). The results indicate that the analytical model allowed the symbolic comprehension of the vitiligo disease as a manifestation of unaware contents which needed to be integrated to consciousness. Those patients who received both medical and psychological treatment presented a higher percentage of up to 80% of repigmentation while the ones who were under medical assistance presented only 20% of repigmentation. This results showed the importance of a joint work in the psychosomatic manifestation diseases.