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J. coloproctol. (Rio J., Impr.) ; 40(3): 261-264, July-Sept. 2020. ilus
Article in English | LILACS | ID: biblio-1135000


Abstract The Buschke-Lowenstein tumor, known as the giant condyloma acuminatum, is a rare lesion of the anorectal and PerianaL region; it is sexually transmitted and associated with human papilloma virus, types 6 and 11. Histologically, it is a benign tumor, but it can reach big proportions and may behave aggressively. The purpose of this study is to report the case of a patient diagnosed with HIV and psoriasis 14 years ago, associated with Buschke-Lowenstein tumor and other diffuse condylomatous lesions in the body.

Resumo O tumor de Buschke-Lowenstein, também conhecido como condiloma acuminado gigante, é uma lesão rara da região anorretal e perianal, sexualmente transmitida, associada ao papiloma vírus humano, Tipos 6 e 11. Histologicamente, trata-se de um tumor benigno, mas clinicamente atinge grandes proporções e pode se comportar de forma agressiva. O objetivo deste estudo é relatar o caso de um paciente com diagnóstico de HIV e psoríase há 14 anos, associado ao tumor de Buschke-Lowenstein e outras lesões condilomatosas difusas no corpo.

Humans , Male , Psoriasis/complications , HIV Infections/complications , Buschke-Lowenstein Tumor/pathology , Papillomaviridae
An. bras. dermatol ; 95(2): 150-157, Mar.-Apr. 2020. tab
Article in English | ColecionaSUS, LILACS, ColecionaSUS | ID: biblio-1130840


Abstract Background: Psoriasis is associated with atherosclerosis and increased cardiovascular risk. Currently, an automated ultrasound, called quantitative intima media thickness, has proven to be a useful method to evaluate subclinical atherosclerosis. Objectives: To compare increased cardiovascular risk in psoriasis patients receiving two types of treatments: Methotrexate and tumor necrosis factor inhibitor and to evaluate the correlation between the Framingham score and quantitative intima media thickness. Methods: Fifty patients with plaque psoriasis were selected from June 2017 to July 2018, divided into two groups, receiving methotrexate and tumor necrosis factor inhibitor. Measurement of abdominal circumference, blood pressure, body mass index and presence of metabolic syndrome were performed. Afterwards, the patients were evaluated for increased cardiovascular risk with the Framingham score and for the quantitative intima media thickness of the carotid arteries. Results: The mean age was 54.8 (±12.5) with a slight male predominance (58%). Overall, 84% of the patients had elevated waist circumference, 82% had a body mass index above ideal, and 50% had a metabolic syndrome. For the correlation between quantitative intima media thickness and Framingham Score, Pearson's linear correlation coefficient was 0.617 (p < 0.001), indicating a moderate to strong positive association. Study limitations: The protective effect of the therapies cited in relation to the increased cardiovascular risk was not evaluated. Conclusions: A moderate to strong positive association was found correlating the Framingham Score values with the quantitative intima media thickness measurement and it is not possible to state which drug has the highest increased cardiovascular risk.

Humans , Male , Female , Adult , Aged , Psoriasis/complications , Psoriasis/drug therapy , Cardiovascular Diseases/chemically induced , Methotrexate/adverse effects , Dermatologic Agents/adverse effects , Carotid Intima-Media Thickness , Tumor Necrosis Factor Inhibitors/adverse effects , Psoriasis/epidemiology , Reference Values , Severity of Illness Index , Brazil/epidemiology , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/diagnostic imaging , Body Mass Index , Comorbidity , Cross-Sectional Studies , Risk Factors , Risk Assessment , Waist Circumference , Middle Aged
An. bras. dermatol ; 95(1): 40-45, Jan.-Feb. 2020. tab
Article in English | LILACS | ID: biblio-1088733


Abstract Background: Psoriasis is a chronic immune-mediated inflammatory skin disease that is associated with cardiovascular comorbidities. Objectives: The objective of this retrospective study is to assess the C-reactive protein, monocyte-to-high-density-lipoprotein ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio as inflammatory markers in patients with psoriasis and to search for a relationship between these parameters and psoriasis severity, as defined by the psoriasis area and severity index. Methods: There were 94 patients with psoriasis and 118 healthy controls enrolled in the study. The C-reactive protein, monocyte-to-high-density-lipoprotein ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio values of two groups were retrospectively evaluated. Results: Statistically significant differences were observed in terms of C-reactive protein, monocyte-to-high-density-lipoprotein ratio, neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio between the patient and control groups (p = 0.001, p = 0.003, p = 0.038, and p = 0.007, respectively). Positive correlations were found between the psoriasis area and severity index and the values of C-reactive protein, monocyte-to-high-density-lipoprotein ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio (r: 0.381; p < 0.01, r: 0.203; p < 0.05, r: 0.268; p < 0.01, r: 0.374; p < 0.01, r: 0.294; p < 0.01, respectively). Study limitations: The small sample size and the retrospective design of the study are limitations. Conclusion: Elevated C-reactive protein, monocyte-to-high-density-lipoprotein ratio, neutrophil-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio were significantly associated with psoriasis. A positive correlation between C-reactive protein and monocyte-to-high-density-lipoprotein ratio leads to the suggestion that monocyte-to-high-density-lipoprotein ratio might be a reliable parameter in psoriasis during the follow-up. The relationship between the diasease and inflammatory parameters might provide early detection of cardiovascular morbidities in psoriasis patients.

Humans , Male , Female , Adult , Young Adult , Psoriasis/blood , Blood Platelets , C-Reactive Protein/analysis , Lymphocytes , Monocytes , Lipoproteins, HDL/blood , Neutrophils , Platelet Count , Psoriasis/complications , Reference Values , Severity of Illness Index , Biomarkers/blood , Cardiovascular Diseases/etiology , Cardiovascular Diseases/blood , Case-Control Studies , Retrospective Studies , Risk Factors , Analysis of Variance , Statistics, Nonparametric , Leukocyte Count , Middle Aged
An. bras. dermatol ; 94(6): 691-697, Nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1054897


Abstract Background: Different strategies have been proposed for the cardiovascular risk management of patients with psoriasis. Objective: To estimate the cardiovascular risk and evaluate two cardiovascular prevention strategies in patients with psoriasis, analyzing which proportion of patients would be candidates to receive statin therapy. Methods: A retrospective cohort was selected from a secondary database. All patients >18 years with psoriasis without cardiovascular disease or lipid-lowering treatment were included. The atherosclerotic cardiovascular disease calculator (2018 American College of Cardiology/American Heart Association guidelines) and the Systematic Coronary Risk Evaluation risk calculator (2016 European Society of Cardiology/European Society of Atherosclerosis guidelines) were calculated. The SCORE risk value was adjusted by a multiplication factor of 1.5. The recommendations for the indication of statins suggested by both guidelines were analyzed. Results: A total of 892 patients (mean age 59.9 ± 16.5 years, 54.5% women) were included. The median atherosclerotic cardiovascular disease calculator and Systematic Coronary Risk Evaluation values were 13.4% (IQR 6.1-27.0%) and 1.9% (IQR 0.4-5.2), respectively. According to the atherosclerotic cardiovascular disease calculator, 20.1%, 11.0%, 32.9%, and 36.4% of the population was classified at low, borderline, moderate, or high risk. Applying the Systematic Coronary Risk Evaluation, 26.5%, 42.9%, 20.8%, and 9.8% of patients were stratified as having low, moderate, high, or very high risk, respectively. The proportion of subjects with statin indication was similar using both strategies: 60.1% and 60.9% for the 2018 American College of Cardiology/American Heart Association and 2016 European Society of Cardiology/European Society of Atherosclerosis guidelines, respectively. Study limitations: This was a secondary database study. Data on the severity of psoriasis and pharmacological treatments were not included in the analysis. Conclusion: This population with psoriasis was mostly classified at moderate-high risk and the statin therapy indication was similar when applying the two strategies evaluated.

Humans , Male , Female , Adult , Middle Aged , Aged , Psoriasis/prevention & control , Cardiovascular Diseases/prevention & control , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Anticholesteremic Agents/therapeutic use , Psoriasis/complications , Triglycerides/blood , Cardiovascular Diseases/etiology , Sex Factors , Cholesterol/blood , Retrospective Studies , Risk Factors , Practice Guidelines as Topic , Risk Assessment , Diabetes Complications
Arq. bras. cardiol ; 113(2): 242-249, Aug. 2019. tab
Article in English | LILACS | ID: biblio-1019386


Abstract Background: Psoriasis correlates with metabolic disorders, early atheromatosis and increased cardiovascular risk. Objectives: To assess markers of cardiovascular disease in psoriatic patients. Methods: Cross-sectional, observational study involving 11 psoriatic participants and 33 controls. Anthropometric, biochemical, hemodynamic and imaging parameters were evaluated. Arterial stiffness was assessed by oscillometric measurement of the brachial artery. Intima-media thickness (IMT) and left ventricular diastolic function were assessed by Doppler echography and echocardiography. Between-group comparisons of numerical variables were performed by the Student's t-test or Wilcoxon Mann-Whitney test for independent samples. Significance level was set at 5%. Results: Psoriatic patients showed increased pulse wave velocity (PWV) (9.1 ± 1.8 vs 8.0 ± 2 m/s, p = 0.033), IMT of the left common carotid artery (p = 0.018) and a higher percentage of patients above the 75th percentile according to the ELSA table when compared with controls (54.5 vs 18.2%, p = 0.045). Psoriatic patients also showed an increase in peripheral/central systolic blood pressure (137.1 ± 13.2 vs 122.3 ± 11.6 mmHg, p = 0.004)/(127 ± 13 vs 112.5 ± 10.4 mmHg, p = 0.005), peripheral/central diastolic blood pressure (89.9 ± 8.9 vs 82.2 ± 8, p = 0.022)/(91 ± 9.3 vs 82.2 ± 8.3, p = 0.014), total cholesterol (252 ± 43.5 vs 198 ± 39.8 mg/dL, p < 0.001), LDL cholesterol (167 ± 24 vs 118 ± 40.8 mg/dL, p < 0.001) and C-reactive protein (7.6 ± 35.4 vs 1 ± 1.2 mg/L p < 0.001) compared with controls. Conclusion: Psoriasis patients show increased PWV, IMT, peripheral and central blood pressures, and serum cholesterol and C-reactive protein levels, denoting a higher cardiovascular risk.

Resumo Fundamento: A psoríase correlaciona-se a distúrbios metabólicos, ateromatose precoce e aumento do risco cardiovascular. Objetivos: Avaliar marcadores de doença cardiovascular na população psoriásica. Métodos: Estudo observacional transversal, envolvendo 11 participantes psoriásicos e 33 controles. Foram avaliados parâmetros antropométricos, laboratoriais, hemodinâmicos e de imagem. A rigidez arterial foi avaliada por oscilometria da artéria braquial. A espessura médio-intimal (EMI) e a função diastólica do ventrículo esquerdo foram avaliadas por meio da ecografia e ecocardiografia Doppler. As comparações de variáveis numéricas entre grupos foram realizadas por teste t-Student e Wilcoxon Mann-Whitney para amostras independentes, adotando-se o nível de significância de 5%. Resultados: Os pacientes psoriásicos apresentaram aumento de VOP (9,1 ± 1,8 e 8 ± 2 m/s, p = 0,033), EMI da artéria carótida comum esquerda (p = 0,018) e maior proporção de percentil > 75 pela tabela ELSA (54,5 e 18,2%, p = 0,045) e) quando comparados aos controles. Pacientes psoriásicos também mostraram aumento nos seguintes parâmetros em relação ao grupo controle, respectivamente: pressão arterial sistólica periférica/central (137,1 ± 13,2 e 122,3 ± 11,6 mmHg, p = 0,004)/(127 ± 13 e 112,5 ± 10,4 mmHg, p = 0,005), pressão arterial diastólica periférica/central (89,9 ± 8,9 e 82,2 ± 8 mmHg, p = 0,022) / (91 ± 9,3 e 82,2 ± 8,3 mmHg, p = 0,014), colesterol total (252 ± 43,5 e 198 ± 39,8 mg/dL, p < 0,001), colesterol LDL (167 ± 24 e 118 ± 40,8 mg/dL, p < 0,001) e proteína C reativa (7,6 ± 35,4 e 1 ± 1,2 mg/L, p<0,001). Conclusão: Pacientes psoriásicos apresentam elevações de VOP e EMI, além de maiores pressões arteriais periféricas e centrais, níveis séricos de colesterol e de proteína C reativa, denotando maior risco cardiovascular.

Humans , Male , Adult , Middle Aged , Aged , Psoriasis/complications , Psoriasis/physiopathology , Cardiovascular Diseases/etiology , Cardiovascular Diseases/physiopathology , Oscillometry/methods , Reference Values , Severity of Illness Index , Blood Pressure/physiology , Brachial Artery/physiopathology , C-Reactive Protein/analysis , Echocardiography, Doppler , Case-Control Studies , Cholesterol/blood , Cross-Sectional Studies , Risk Factors , Statistics, Nonparametric , Risk Assessment , Carotid Intima-Media Thickness , Vascular Stiffness , Pulse Wave Analysis
Medisan ; 23(3)mayo.-jun. 2019. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1091094


Se realizó un estudio descriptivo, transversal y prospectivo de 114 pacientes con diagnóstico de psoriasis, atendidos en la consulta de Dermatología del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, desde enero de 2014 hasta marzo del 2016, con vistas a identificar los factores de riesgo y las comorbilidades en ellos. La mayoría de los integrantes de la casuística correspondieron al grupo etario de 30 a 45 años y al sexo femenino; de igual modo, predominaron el hábito de fumar, el sedentarismo y el sobrepeso como factores de riesgo, y la hipertensión arterial, la esteatosis hepática, las alteraciones psiquiátricas y cardiovasculares como morbilidades asociadas. Pudo concluirse que los pacientes con psoriasis requieren una atención integral y multidisciplinaria por la gran frecuencia de comorbilidades, las que limitan aún más su calidad de vida.

A descriptive, cross-sectional and prospective study of 114 patients with diagnosis of psoriasis, assisted in the Dermatology Service of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba was carried out from January, 2014 to March, 2016, with the aim of identifying the risk factors and the comorbidities in them. Most of the members of the case material corresponded to the age group 30 to 45 years and to the female sex; in a same way, the smoking habit, sedentarism and the overweight prevailed as risk factors, and hypertension, hepatic esteatosis, psychiatric and cardiovascular changes as associate morbidities. It could be concluded that patients with psoriasis require a comprehensive and multidisciplinary care due to the great comorbidities frequency, which limit even more their life quality.

Psoriasis , Comorbidity , Risk Factors , Psoriasis/complications , Hospital Care
An. bras. dermatol ; 94(2): 224-226, Mar.-Apr. 2019. graf
Article in English | LILACS | ID: biblio-1001141


Abstract Psoriasis has been associated with various autoimmune diseases, however, its relation to bullous diseases is infrequent. Of these, bullous pemphigoid appears as the main associated entity, even though both conditions differ considerably in demographic and clinical aspects. We report the case of a 42-year-old female patient, with long-standing psoriasis who consulted due to the exacerbation of psoriatic plaques associated with generalized bullous lesions on the skin and oral mucosa, with one-week duration. With clinical signs and histopathological findings compatible with bullous pemphigoid associated with psoriasis, we decided to treat her with methotrexate 10mg a week. The patient had an excellent response after two months of treatment.

Humans , Adult , Psoriasis/drug therapy , Methotrexate/therapeutic use , Pemphigoid, Bullous/drug therapy , Dermatologic Agents/therapeutic use , Psoriasis/complications , Psoriasis/diagnosis , Pemphigoid, Bullous/complications , Pemphigoid, Bullous/diagnosis , Treatment Outcome , Fluorescent Antibody Technique, Direct
Rev. chil. dermatol ; 35(3): 90-94, 2019. tab
Article in Spanish | LILACS | ID: biblio-1116406


INTRODUCCIÓN: La eritrodermia es un síndrome inflamatorio cutáneo infrecuente caracterizado por compromiso eritematoso generalizado y descamación, de más del 90% de superficie cutánea total. OBJETIVO: Caracterizar clínica e histopatológicamente a los pacientes con eritrodermia en un hospital universitario chileno. METODOLOGÍA: Estudio retrospectivo, realizado en el Hospital Clínico Universidad de Chile, basado en revisión de fichas clínicas e informes histopatológicos de pacientes con eritrodermia, entre 2005 y 2018. Se evaluó edad, sexo y variables clínicas (co-morbilidades, síntomas, días de evolución, ingreso hospitalario, informe histopatológico, diagnóstico y evolución). RESULTADOS: Total de 28 pacientes, 18 hombres (64%), edad promedio 59 años. Causa más frecuente de eritrodermia fue dermatosis pre-exis-tentes, con 15 casos (54%), que incluyen: psoriasis 9 (32%), dermatitis de contacto 3 (11%), PRP 2 (7%), dermatitis atópica 1 (4%). A estas le siguen: reacción adversa medicamentosa 6 (21%), idiopática 6 (21%) y Síndrome de Sezary 1 (4%). CONCLUSIÓN: El presente estudio corresponde a la primera serie de eritrodermias realizada en Chile. Destacan las dermatosis preexistentes como la principal causa, lo que se correlaciona con la literatura.

INTRODUCTION: Erythroderma is an infrequent cutaneous inflammatory disorder characterized by generalized erythematous compromise and desquamation, of more than 90% of total cutaneous surface. OBJECTIVE: Clinical and histopathological cha-racterization of patients with erythroderma in a Chilean university hospital. METHODOLOGY: Retrospective study, performed at the University of Chile Clinical Hospital, based on review of clinical records and histopatho-logical reports of patients with erythroderma, between 2005 and 2018. Age, sex and clinical variables were evaluated (co-morbidities, symp-toms, days of evolution, hospital admission, histopathological report, diagnosis and evolu-tion). RESULTS: A total of 28 patients, 18 were men (64%), average age 59 years. Most frequent cause of erythroderma was pre-existing dermatosis, with 13 cases (52%), which included: psoriasis 9 (32%), contact dermatitis 3 (11%), PRP 2 (7%), atopic dermatitis 1 (4%). These are followed by adverse drug eruption 6 (21%), idiopathic 6 (21%) and Sezary syndrome 1 (4%). CONCLUSION: The present study corresponds to the first series of erythrodermas performed in Chile. The pre-existing dermatoses were the main cause of erythroderma, which coincides with other reports.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Dermatitis, Exfoliative/etiology , Dermatitis, Exfoliative/pathology , Dermatitis, Exfoliative/epidemiology , Psoriasis/complications , Psoriasis/epidemiology , Clinical Evolution , Chile , Cross-Sectional Studies , Retrospective Studies , Drug Eruptions/complications , Drug Eruptions/epidemiology , Dermatitis, Atopic/complications , Dermatitis, Atopic/epidemiology , Dermatitis, Contact/complications , Dermatitis, Contact/epidemiology
An. bras. dermatol ; 93(6): 801-806, Nov.-Dec. 2018. tab
Article in English | LILACS | ID: biblio-973637


Abstract: Background: Psoriasis has a significant impact on quality of life (QoL). Sexual life can also be affected, with sexual dysfunction being reported by 25-70% of patients. Objectives: To determine the occurrence of sexual dysfunction and evaluate QoL in women with psoriasis. Methods: This case-control study included women aged 18-69 years. The validated Brazilian Portuguese versions of the Female Sexual Function Index (FSFI) and of the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) were administered to all participants to assess sexual function and QoL, respectively. Patients with psoriasis underwent clinical evaluation for the presence of comorbidities, especially psoriatic arthritis and other rheumatic manifestations. Location of lesions and the extent of skin involvement were also assessed. Results: The sample consisted of 150 women, 75 with diagnosis of psoriasis and 75 healthy controls. Prevalence of sexual dysfunction was high in women with psoriasis (58.6% of the sample). Prevalence was statistically higher in women with psoriasis than in controls (P = 0.014). The SF-36 domain scores were also lower in women with psoriasis, with role limitations due to physical health, limitations due to emotional problems, and mental health being the most affected domains. Study limitations: Sample size was calculated to evaluate the association between the occurrence of sexual dysfunction and psoriasis, but it did not include the determination of the possible causes of this dysfunction. Conclusions: QoL and sexual function were altered in women with psoriasis and should be taken into consideration when assessing disease severity.

Humans , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Psoriasis/psychology , Quality of Life/psychology , Sexual Dysfunctions, Psychological/psychology , Psoriasis/complications , Psoriasis/epidemiology , Severity of Illness Index , Brazil/epidemiology , Case-Control Studies , Prevalence , Surveys and Questionnaires , Sexual Dysfunctions, Psychological/epidemiology
Arq. bras. oftalmol ; 81(3): 219-225, May-June 2018. tab, graf
Article in English | LILACS | ID: biblio-950445


ABSTRACT Purpose: We aimed to report the ocular manifestations observed in patients with psoriasis. Methods: Patients were included and referred to our ophthalmology clinic from dermatology clinics of Universidade do Estado do Pará between October 2013 and August 2014. Clinical interviews were conducted to identify relevant epidemiological data, clinical features, and treatment details, and data were recorded using the same protocol. Subsequent dermatological examinations were performed and disease severity was rated using the Psoriasis Area and Severity Index and the Dermatological Life Quality Index. Complete eye examination was conducted, including visual acuity, biomicroscopy, tonometry, fundoscopy, Schirmer I test, tear breakup time, rose bengal staining, ocular surface disease index, and glaucoma tests. Results: In total, we included 43 patients with psoriasis and 86 controls. Patients with psoriasis had statistically higher incidences of dry eye (16.28%), likely dry eye (32.56%), and blepharitis (16.28%). Furthermore, the rose bengal and ocular surface disease tests were more abnormal in patients with psoriasis (p<0.05). Conclusions: Patients with psoriasis should undergo regular eye exams, regardless of risk factors, to monitor for the progression of symptomatic or asymptomatic ocular manifestations.

RESUMO Objetivos: Relatar as manifestações oculares observadas em pacientes com psoríase atendidos no Ambulatório de Dermatologia da X e encaminhados ao Y, no período de outubro de 2013 a agosto de 2014. Métodos: A amostra foi constituída por um grupo composto por 43 pacientes com psoríase e um grupo controle com 86 pacientes sem psoríase. Foi realizada uma entrevista clínica com dados epidemiológicos, aspectos clínicos da doença e terapia empregada, sendo todas as informações registradas em protocolo próprio. Posteriormente, realizou-se o exame dermatológico, no qual foi avaliado o índice de gravidade da Psoríase por área (PASI) e índice dermatológico de qualidade de vida (DLQI), e o exame oftalmológico completo, incluindo: Acuidade Visual, Biomicroscopia, Tonometria, Fundoscopia, Teste de Schirmer I, Tempo de Ruptura do Filme Lacrimal (TBUT), rosa bengala, índice de doença da superfície ocular (OSDI) e exames para glaucoma. Resultados: Observou-se que nos pacientes com psoríase houve frequência estatisticamente maior de envolvimento ocular, como olho seco (16,28%), provável olho seco (32,56%) e blefarite (16,28%). Além disso, os valores do rosa bengala e do OSDI apresentaram-se mais alterados nos pacientes com psoríase (p<0,05). Conclusão: Dessa forma, sugere-se que esses pacientes realizem exames oftalmológicos periódicos, já que as manifestações oculares podem progredir sem sintomatologia e ocorrer independentemente de fatores de risco.

Humans , Male , Female , Middle Aged , Psoriasis/complications , Eye Diseases/etiology , Tonometry, Ocular , Severity of Illness Index , Visual Acuity , Case-Control Studies , Microscopy, Acoustic , Eye Diseases/diagnosis
Rev. medica electron ; 40(2): 471-479, mar.-abr. 2018. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-902300


RESUMEN El síndrome de Sézary constituye la fase leucémica de la micosis fungoide caracterizado por eritrodermia, adenopatías superficiales y células atípicas en sangre. Predomina en los hombres con una proporción 2/1 respecto a las mujeres, y en las edades entre los 60 y 70 años de edad. La enfermedad es de difícil tratamiento, con un pronóstico reservado por su baja supervivencia. Por ser infrecuente y su posible similitud con otras dermatosis, se presenta un caso con antecedentes de psoriasis vulgar con 5 años de evolución, que hacía aproximadamente 6 meses, se encontraba sin mejoría en brote de agudización a pesar de los tratamientos indicados (AU).

ABSTRACT Sezary syndrome is the leukemic part of the fungoid mycosis, characterized by erythroderma, surface adenopathies and atypical cells in blood. It predominates in men with a 2/1 proportion in respect to women, and in ages ranging from 60 to 70 years. It is a difficult treated disease, with a reserved prognosis because of the low survival. Due to its infrequency and possible similarity to other dermatosis, it is presented a case with antecedents of vulgar psoriasis of 5 years evolution, without improvement for around 6 months, in acute outbreak in spite of the indicated treatments (AU).

Humans , Male , Aged , Psoriasis/complications , Psoriasis/drug therapy , Skin Neoplasms , Sezary Syndrome/complications , Sezary Syndrome/diagnosis , Sezary Syndrome/etiology , Sezary Syndrome/mortality , Sezary Syndrome/pathology , Sezary Syndrome/epidemiology , Physical Examination , Skin Diseases , Therapeutics , Secondary Care , Biopsy/methods , Mycosis Fungoides/complications , Mycosis Fungoides/epidemiology , Oncology Service, Hospital , Diagnostic Tests, Routine
Rev. Assoc. Med. Bras. (1992) ; 64(4): 368-373, Apr. 2018. tab
Article in English | LILACS | ID: biblio-956460


SUMMARY BACKGROUND: Psoriasis is associated with higher prevalence of metabolic syndrome (MS). The prevalence of MS varies according to the studied population as it suffers influence of genetics, aging, sedentary behaviour and diet. OBJECTIVE: To study the prevalence of MS in local psoriasis patients and the influence of psoriasis variables on its appearance. METHODS: A group of 97 psoriasis patients were studied for MS and compared with 97 controls. Psoriasis type, nail involvement, psoriasis extension measured by PASI (Psoriasis Area and Severity Index) were obtained through physical examination and history of previous myocardial infarction, angina and stroke were obtained through chart review. RESULTS: Comparison of MS prevalence in psoriasis patients (49.4%) with controls (35.0%) showed difference with p=0.04; OR=1.8 (95%CI=1.02-3.23). Patients with psoriasis had higher body mass index (p=0.02), higher systolic blood pressure (p=0.007), lower HDL cholesterol (p=0.01), higher glucose (p=0.04), higher waist circumference (p=0.003) and more angina pectoris (p=0.03;OR=2.5; 95% 0=1.04-6.15) than controls. When psoriasis sample with and without MS were compared, those with MS were older (p=0.0004), had disease onset at older age (p=0.02), more tobacco exposure (p=0.02), and a tendency to have less scalp involvement (p=0.06) in univariate analysis. Logistic regression showed that only age and scalp involvement were independently associated with MS in the psoriasis sample. CONCLUSION: In our psoriasis sample, MS prevalence is high and the items that deserve more attention are central obesity, low HDL, hypertension and smoking habits. In the psoriasis group, MS was associated independently with older age and less scalp involvement.

RESUMO OBJETIVO: Estudar a prevalência de SM (Síndrome metabólica) em pacientes com psoríase de nossa localidade, assim como a influência das variáveis da psoríase no seu aparecimento. MÉTODOS: Noventa e sete pacientes com psoríase foram estudados para SM e comparados com 97 controles. Dados sobre o tipo de psoríase, envolvimento de unhas e extensão da lesão cutânea medida pelo PASI (Psoriasis Area and Severity Index) foram obtidas por meio de exame físico. Dados de infarto do miocárdio, angina pectoris e acidente vascular cerebral prévios foram coletados por meio de revisão de prontuários e questionamento direto. RESULTADOS: A comparação da prevalência de SM em pacientes com psoríase (49,4%) com controles (35,0%) apresentou diferença com p = 0,04; OR = 1,8 (IC95% = 1,02-3,23). Pacientes com psoríase apresentaram maior índice de massa corporal (p = 0,02), maior pressão arterial sistólica (p = 0,007), menor colesterol HDL (p = 0,01), maiores valores de glicose (p = 0,04), maior circunferência da cintura (p = 0,003) e mais angina pectoris (p = 0,03; OR = 2,5; IC95% = 1,04-6,15) do que controles. Quando os pacientes de psoríase com e sem SM foram comparados entre si, aqueles com SM eram mais velhos (p = 0,0004), apresentaram início da doença em idade mais avançada (p = 0,02), tinham maior exposição ao fumo (p = 0,02) e tendência a ter menor envolvimento no couro cabeludo (p = 0,06) quando comparados com os sem SM na análise univariada. A regressão logística mostrou que apenas a idade e o envolvimento do couro cabeludo foram independentemente associados à SM na amostra de psoríase. CONCLUSÃO: Na presente amostra de pacientes com psoríase, a prevalência de SM é alta e os itens que merecem mais atenção são obesidade central, baixo HDL, hipertensão e hábito de fumar. No grupo da psoríase, a SM foi associada de forma independente com idade mais avançada e menor envolvimento no couro cabeludo.

Humans , Male , Female , Adult , Aged , Aged, 80 and over , Young Adult , Psoriasis/epidemiology , Metabolic Syndrome/epidemiology , Psoriasis/complications , Triglycerides/blood , Severity of Illness Index , Blood Glucose/analysis , Blood Pressure/physiology , Brazil/epidemiology , Case-Control Studies , Logistic Models , Prevalence , Cross-Sectional Studies , Age Factors , Statistics, Nonparametric , Metabolic Syndrome/complications , Waist Circumference , Obesity, Abdominal/complications , Obesity, Abdominal/epidemiology , Cholesterol, HDL/blood , Middle Aged
An. bras. dermatol ; 93(2): 222-228, Mar.-Apr. 2018. tab
Article in English | LILACS | ID: biblio-887185


Abstract: Background: Psoriasis has been associated with co-morbidities and elevated cardiovascular risk. Objectives: To analyze the relationships among metabolic syndrome, cardiovascular risk, C-reactive protein, gender, and Psoriasis severity. Methods: In this cross-sectional study, plaque Psoriasis patients (n=90), distributed equally in gender, were analyzed according to: Psoriasis Area and Severity Index, cardiovascular risk determined by the Framingham risk score and global risk assessment, C-reactive protein and metabolic syndrome criteria (NCEPT-ATP III). Results: Metabolic syndrome frequency was 43.3% overall, without significance between genders (P=0.14); but women had higher risk for obesity (OR 2.56, 95%CI 1.02-6.41; P=0.04) and systemic arterial hypertension (OR 3.29, 95%CI 1.39-7.81; P=0.006). The increase in the Psoriasis Area and Severity Index also increased the risk for metabolic syndrome (OR 1.060, 95%CI 1.006-1.117; P=0.03). Absolute 10-year cardiovascular risk was higher in males (P=0.002), but after global risk assessment, 51.1% patients, 52.2% women, were re-classified as high-intermediate cardiovascular risk; without significance between genders (P=0.83). C-reactive protein level was elevated nearly six-fold overall, higher in metabolic syndrome (P=0.05), systemic arterial hypertension (P=0.004), and high-intermediate 10-year cardiovascular risk patients (P<0.001); positively correlated to: Framingham risk score (P<0.001; r=0.60), absolute 10-year cardiovascular risk (P<0.001; r=0.58), and age (P=0.001; r=0.35); but not to Psoriasis Area and Severity Index (P=0.14; r=0.16); increased the 10-year cardiovascular risk (R2=33.6; P<0.001), MetS risk (OR 1.17, 95%CI 0.99-1.37; P=0.05) and with age (P=0.001). HDL-cholesterol level was higher in normal C-reactive protein patients (t=1.98; P=0.05). Study limitations: Restricted sample, hospital-based and representative of a single center and no specification of psoriatic arthritis. Conclusions: Psoriasis, metabolic syndrome, systemic arterial hypertension and age share the increase in C-reactive protein, which could implicate in additional burden for increasing the cardiovascular risk and be an alert for effective interventions.

Humans , Male , Female , Adult , Middle Aged , Psoriasis/complications , Psoriasis/epidemiology , C-Reactive Protein/analysis , Cardiovascular Diseases/etiology , Metabolic Syndrome/complications , Metabolic Syndrome/epidemiology , Psoriasis/metabolism , Reference Values , Severity of Illness Index , Brazil/epidemiology , Comorbidity , Sex Factors , Anthropometry , Prevalence , Cross-Sectional Studies , Multivariate Analysis , Risk Factors , Sex Distribution , Risk Assessment , Hypertension/complications , Hypertension/epidemiology , Obesity/complications , Obesity/epidemiology
An. bras. dermatol ; 93(2): 205-211, Mar.-Apr. 2018. tab
Article in English | LILACS | ID: biblio-887203


Abstract: Background: Coexistence of obesity, hypertension, insulin resistance and dyslipidemia is defined as metabolic syndrome (MBS), which is among the important risk indicators for cardiovascular diseases, diabetes and stroke. Smoking and alcohol consumption are the other factors which lead to an increase in the risk of cardiovascular disease. Objective: To investigate the prevalence of metabolic syndrome, smoking and alcohol consumption in psoriasis patients and the relationship between disease severity and these factors. Methods: This cross-sectional study enrolled 563 patients with chronic plaque-type psoriasis, all of which completed a questionnaire and underwent a complete physical examination. Data about MBS components, psoriasis severity/duration, smoking and alcohol consumption, and cardiovascular diseases were recorded. Results: A total of 563 patients with ages ranging from 18 to 78 years were evaluated. Metabolic syndrome was found in 12.6% of the patients [central obesity (38.7%), hypertension (14.3%), dyslipidemia (18.6%), diabetes (9.2%)], while 50.3% had smoking, and 3.3% had alcohol consumption. Patients with metabolic syndrome were older and more likely to have a longer disease duration than those without metabolic syndrome (p<0.05 for each). The prevalence of metabolic syndrome was higher in women than in men. Psoriasis was more severe in patients with central obesity, diabetes and smoking than in those without (p<0.05 for each). Study Limitations: Retrospective design. Conclusions: Our results indicate that MBS is a risk factor for psoriasis patients with advanced age. The relationship between disease severity and obesity, diabetes, and smoking in psoriasis patients indicates that the patients should be informed about the potential metabolic risks and receive therapies for behavioral changes besides anti-psoriatic treatment in order to minimize these risks.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Psoriasis/epidemiology , Alcohol Drinking/epidemiology , Smoking/epidemiology , Metabolic Syndrome/epidemiology , Psoriasis/complications , Time Factors , Turkey/epidemiology , Alcohol Drinking/adverse effects , Cardiovascular Diseases/etiology , Smoking/adverse effects , Sex Factors , Epidemiologic Methods , Risk Factors , Age Factors , Sex Distribution , Age Distribution , Metabolic Syndrome/complications , Diabetes Mellitus/epidemiology , Dyslipidemias/complications , Dyslipidemias/epidemiology , Obesity, Abdominal/complications , Obesity, Abdominal/epidemiology , Hypertension/complications , Hypertension/epidemiology
An. bras. dermatol ; 92(6): 826-829, Nov.-Dec. 2017. tab
Article in English | LILACS | ID: biblio-887130


Abstract: Psoriasis is a chronic disease, characterized by erythematous scaly lesions, presented in eight different forms: plaques, guttate, pustular, erythrodermic, inverse, nail and scalp psoriasis, and psoriatic arthritis. Its development depends on genetic factors, external stimulus and immune response alteration.1 Proinflammatory cytokines such as TNF-alpha, IL-12 and 23 may also be involved. In the worst cases, systemic complications linked to endothelial alterations may occur. A literature review was conducted for a better understanding of what roles VEGF (vascular endothelial growth factor) and ICAM-1 (intercellular adhesion molecule) have, among other cytokines, in systemic capillary leak syndrome, involved in erythrodermic and pustular psoriasis, the most unstable forms of the disease.

Humans , Psoriasis/complications , Psoriasis/pathology , Intercellular Adhesion Molecule-1/analysis , Capillary Leak Syndrome/etiology , Capillary Leak Syndrome/pathology , Vascular Endothelial Growth Factor A/analysis , Psoriasis/physiopathology , Cytokines/analysis , Capillary Leak Syndrome/physiopathology
An. bras. dermatol ; 92(4): 470-473, July-Aug. 2017. tab
Article in English | LILACS | ID: biblio-887017


Abstract: Background: Pruritus is the most commonly occurring subjective symptom of dermatological disease. Published data on both prevalence and intensity of pruritus in psoriasis is limited. Objective: In this study we aimed to investigate the prevalence of pruritus and its relation with psoriasis area severity index, body mass index and presence of systemic disease in patients with psoriasis. Methods: We analyzed data of psoriatic patients diagnosed in our psoriasis outpatient clinic between March 2013 and June 2014 collected retrospectively from PSR-TR registration system. Results: In total, 880 patients were analyzed. Pruritus was more prominent in female patients. This difference was statistically significant. No significant associations were found between age of patients, clinical type of disease and pruritus. The itching was more common in patients with higher body mass index. Presence of pruritus was correlated significantly with severity of psoriasis. Five hundred and sixty of 880 patients had no systemic disease. The presence of pruritus was not related with presence of systemic disease. Existence of systemic disease with psoriasis has minimal effect on pruritus. Study Limitations: We did not evaluate intensity of pruritus. Conclusions: Pruritus is not mentioned within the classical symptoms of psoriasis. Pruritus in psoriasis is a very unpleasant symptom with great potential to impair patient's quality of life and may exacerbate psoriasis as a Koebner phenomenon.

Humans , Male , Female , Adult , Middle Aged , Pruritus/epidemiology , Psoriasis/complications , Pruritus/etiology , Pruritus/psychology , Psoriasis/psychology , Quality of Life , Turkey/epidemiology , Severity of Illness Index , Body Mass Index , Prevalence , Cross-Sectional Studies , Regression Analysis
An. bras. dermatol ; 92(1): 104-106, Jan.-Feb. 2017. graf
Article in English | LILACS | ID: biblio-838022


Abstract: Psoriasis is a chronic inflammatory disease of multifactorial etiology influenced by genetic, immunological, and environmental factors. We report the case of a patient with psoriasis for more than 25 years who developed hyperuricemia and chronic tophaceous gout with unusual appearance. In psoriasis, hyperuricemia may occur by increased epidermal cell turnover, which accelerates purine metabolism and has uric acid as the product of its catabolism. The association of psoriasis with hyperuricemia can trigger the onset of gouty arthritis, and pose a greater risk of developing other inflammatory comorbidities. Therefore, it is important to periodically investigate uric acid levels in order to treat changes triggered by hyperuricemia.

Humans , Male , Middle Aged , Psoriasis/complications , Hyperuricemia/etiology , Gout/etiology , Chronic Disease , Gout/pathology
An. bras. dermatol ; 92(1): 21-25, Jan.-Feb. 2017. tab
Article in English | LILACS | ID: biblio-838033


Abstract: BACKGROUND: The nail involvement in psoriasis is related to psoriatic arthritis and may represent a predictor of the disease. OBJECTIVES: To analyze, through nail clipping, clinically normal and dystrophic nails of patients with cutaneous psoriasis and psoriatic arthritis. METHODS: This is a cross-sectional multicenter study, conducted between August 2011 and March 2012. Patients were divided into four groups: patients with cutaneous psoriasis and onychodystrophy, patients with cutaneous psoriasis and clinically normal nails, patients with psoriatic arthritis and onychodystrophy and patients with psoriatic arthritis and clinically normal nails. We calculated NAPSI (Nail Psoriasis Severity Index) of the nail with more clinically noticeable change. After collection and preparation of the nail clipping, the following microscopic parameters were evaluated: thickness of the nail plate and subungual region, presence or absence of parakeratosis, serous lakes, blood, and fungi. RESULTS: There were more layers of parakeratosis (p=0.001) and a greater thickness of the subungual region in patients with cutaneous psoriasis and onychodystrophy (p=0.002). Serous lakes were also more present in the same group (p=0.008) and in patients with psoriatic arthritis and normal nails (p=0.047). The other microscopic parameters showed no significant difference between normal and dystrophic nails or between patients with psoriatic arthritis or cutaneous psoriasis. STUDY LIMITATIONS: Small sample size and use of medications. CONCLUSIONS: Nail clipping is a simple and quick method to assess the nails of patients with nail psoriasis although does not demonstrate difference between those with joint changes or exclusively cutaneous psoriasis.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Psoriasis/complications , Psoriasis/pathology , Nail Diseases/etiology , Nail Diseases/pathology , Nails, Malformed/etiology , Nails, Malformed/pathology , Arthritis, Psoriatic/complications , Arthritis, Psoriatic/pathology , Case-Control Studies , Cross-Sectional Studies