Clinical characterization, physical frailty, and depression in elderly patients with psoriasis from a reference center in Brazil: a cross-sectional study

Abstract Background: There are few studies dedicated to the characterization of the geriatric population with psoriasis, which has particularities in terms of clinical manifestations and therapeutic limitations. As psoriasis is a chronic disease, presenting a higher prevalence with age, the increase in life expectancy in Brazil demands knowledge about the behavior of the disease among the elderly. Objectives: To characterize elderly people with psoriasis from a tertiary service, from the clinical-epidemiological point of view, presence of comorbidities, physical frailty, and affective impact, and to compare these aspects with adults with psoriasis and elderly people without the disease. Methods: Cross-sectional study of 64 elderly patients with psoriasis, 64 adults with psoriasis, and 64 elderly patients without the disease. Clinical-demographic aspects, the Beck depression scale, and Skindex-16 were evaluated. Indicators of physical frailty were evaluated in elderly patients: handgrip, sit-to-stand test, fatigue, and weight loss >5%. Results: In the elderly, the mean age (SD) of psoriasis onset was 44 (10) years, men represented 47% of the sample, the prevalence of arthritis was 22%, and ungual involvement occurred in 72%. Topical corticosteroids were used more often among elderly people with psoriasis (100%) than among adults with the disease (86%), with no difference among other systemic treatments. Diabetes mellitus occurred in 30% of the elderly. Hypertension (59%), dyslipidemia (52%), depression (34%), and fatigue (59%) were more prevalent among the elderly with psoriasis than among the healthy controls.

Intestinal microbiome characterization of adult Brazilian men with psoriasis compared to omnivore and vegetarian controls

Abstract Background Psoriasis is a chronic inflammatory disease associated with systemic inflammation and comorbidities. Changes in the composition of the intestinal microbiome are involved in the pathogenesis of inflammatory diseases and metabolic syndrome. Characterizing the intestinal microbiome of patients with psoriasis may be relevant for the understanding of its clinical course and comorbidity prevention. Objective To characterize the intestinal microbiome of men with psoriasis compared to omnivore and vegetarian controls (without psoriasis). Method Cross-sectional study of 42 adult males: 21 omnivores with psoriasis; and controls: 14 omnivores and 7 vegetarian individuals. The characterization of the intestinal microbiome was performed by metagenomic analysis. Serum levels of lipopolysaccharide-binding protein (LPB) and C-reactive protein (CRP) were evaluated. Results The groups differed from each other regarding nutritional aspects and microbiome; individuals with psoriasis had a higher consumption of protein and lower consumption of fibers. Levels of LPB, CRP, and the Firmicutes/Bacteroidetes ratio were higher in the group with psoriasis than in the vegetarian group (p < 0.05). The genera Prevotella, Mogibacterium, Dorea, Bifidobacterium and Coprococcus, differed in the group with psoriasis compared to vegetarians; the genera Mogibacterium, Collinsella and Desulfovibrio differed from omnivores. A microbiome pattern linked to psoriasis (plsPSO) was identified, which was associated with higher LPB levels (rho = 0.39; p = 0.02), and lower dietary fiber intake (rho = −0.71; p < 0.01). Study limitations Only adult men were evaluated. Conclusion A difference was identified in the intestinal microbiome of adult men with psoriasis when compared to healthy omnivores and vegetarian controls. The identified microbiome pattern was correlated with dietary fiber intake and serum levels of LPB.

Histological changes in facial melasma after treatment with triple combination cream with or without oral tranexamic acid and/or microneedling: A randomised clinical trial

Background: Melasma is an acquired dyschromia with several histologic alterations in the epidermis, basement membrane and upper dermis. The treatment of melasma is challenging due to the irregular response and chronicity of the disease. To date, there are no curative strategies, largely due to the limited understanding of the intrinsic effects of each treatment. Objectives: The objective of the study was to evaluate the histological changes promoted by triple combination cream, with or without complementary treatment with microneedling and oral tranexamic acid, in the treatment of melasma. Methods: A factorial, randomised, controlled and evaluator-blinded clinical trial was performed involving 64 women with facial melasma, divided in four groups, who underwent 60 days of treatment with triple combination cream alone (control group) or combined with two monthly microneedling sessions (microneedling group), TA 250 mg twice daily (tranexamic acid group), or both tranexamic acid group and microneedling group. The participants underwent biopsy of the area with melasma at inclusion (D1) and D60. The primary outcomes were the variation (D1 × D60) between the variables: Thickness of the epidermis and stratum corneum, stratum corneum compaction and solar elastosis; melanin density in the epidermis and upper dermis; proportion between the extension of the nonintact and intact basement membrane zone; mast cell count in the upper dermis; melanocyte count in the basal layer, pendulum melanocyte count and melanocyte area; immunostaining density of vascular endothelial growth factor; stem cell factor and keratinocyte growth factor. Results: One participant in the TG discontinued tranexamic acid due persistent headache; and herpes simplex occurred in three patients after microneedling. The groups showed a 24% (CI95%: 17–35%; P < 0.01) reduction in epidermal melanin density. There was no change in dermal melanin density or the area of melanocytes after treatment. There was an overall 25% (CI95%: 7–42%; P < 0.01) reduction in the number of pendulum melanocytes, especially in the microneedling and tranexamic acid group, that presented a 41% (CI95%: 7–73%; P < 0.01) reduction. The extension of the nonintact basal membrane relative to the intact basal membrane decreased after treatment, especially in microneedling group and microneedling and tranexamic acid group. There was an increase of 13% (CI95%: 5–21%; P = 0.02) in epidermal thickness and 6% (CI95%: 0–22%; P = 0.04) thinning of the stratum corneum in the groups. All groups showed stratum corneum compaction. Solar elastosis improved only in the microneedling group and microneedling and tranexamic acid group. Vascular endothelial growth factor immunostaining increased 14% (CI95%: 4–24%; P = 0.03) in the groups; and stem cell factor increased only in microneedling group. There was no change in the number of mast cells, CD34 and keratinocyte growth factor immunostaining. Limitations: The site of biopsy may not represent all of the facial melasma and the immunohistochemical sensitivity of the cytokines does not have a stoichiometric relationship with proteins. Conclusion: A greater thickness of the epidermis is associated with melasma bleaching. Dermal melanin seems to have no impact on melasma prognosis. Damage to the skin barrier and stimulus of angiogenesis should be avoided in the treatment of melasma. Microneedling complements the topical treatment of melasma by improving patterns of skin photoaging. Oral tranexamic acid complements the topical treatment of melasma by inhibiting the stem cell factor.

Pigmented eccrine poroma in an atypical location

Abstract Eccrine poroma is the term that includes benign neoplasms of the terminal duct of the eccrine sweat glands, which may clinically and dermoscopically resemble other melanoma and non-melanoma skin tumors. They are often located on the extremities (especially palms and soles), presenting as normochromic or erythematous papules and nodules, measuring up to 2 cm. Pigmented variants are uncommon, accounting for less than 20% of cases. This report describes a 37-year-old man who developed a large pigmented eccrine poroma on his right shoulder, causing diagnostic difficulty. Histopathological examination revealed a nodular neoplasm consisting of small, monomorphic, cuboidal cells, with ample, eosinophilic cytoplasm and well-defined borders, in addition to conspicuous intercellular bridges, with melanin deposits diffusely distributed inside them. The absence of cytological atypia, cellular pleomorphism, increased mitotic activity, and necrosis foci corroborated the diagnostic exclusion of porocarcinoma, which can develop from eccrine poroma.

Fibroblast morphology, growth rate and gene expression in facial melasma

Abstract Background: In addition to melanocytic hyperfunction, changes are observed in the upper dermis of melasma, and fibroblasts play a central role in collagen synthesis and pigmentation induction. Objective: To explore the morphology, growth rate, and gene expression profile of fibroblasts from the skin with melasma in comparison to fibroblasts from the adjacent healthy skin. Methods: Ten women with facial melasma were biopsied (lesion and adjacent healthy skin), and the fragments were processed for fibroblast culture. Samples from five participants were seeded to evaluate growth (days 2, 5 and 8) and senescence (SA-β-gal) curves. The samples from the other participants were submitted to real-time PCR to comparatively evaluation of the expression of 39 genes. Results: Cultured fibroblasts from melasma skin were morphologically less fusiform in appearance and on average a 34% (95% CI 4%-63%) greater proportion of cells labeled with SA-β-gal than the fibroblasts from the adjacent skin. The cell growth rate was lower for the melasma samples after eight days (p < 0.01). The WNT3A, EDN3, ESR2, PTG2, MMP1, and SOD2 genes were up-regulated, whereas the COL4A1, CSF2, DKK3, COL7A1, TIMP4, CCL2, and CDH11 genes were down-regulated in melasma skin fibroblasts when compared to the ones from adjacent healthy skin. Study limitations: Small sample size; absence of functional tests. Conclusions: Fibroblasts from the skin with melasma showed a lower growth rate, less fusiform morphology and greater accumulation of SA-β-gal than those from adjacent photo exposed skin. Moreover, their gene expression profile comprised factors that may contribute to upper dermis damage and sustained melanogenesis.

Case for diagnosis. Noninfectious suppurative panniculitis induced by mesotherapy with deoxycholate

Abstract A 28-year-old white female patient presented with multiple erythematous-to-violaceous, painful, suppurative nodules on the buttocks and thighs that appeared after two weeks of mesotherapy with deoxycholate, caffeine, sunflower liposomes, and sinetrol for localized fat. She was treated for atypical mycobacteriosis, but with no satisfactory response after antibiotic therapy. Bacterial, mycobacterial, and fungal culture were all negative. Histopathologic examination of the biopsy showed noninfectious suppurative panniculitis. It resolved after treatment with methotrexate, prednisone, and hydroxychloroquine. This report highlights the rarity of this complication, the importance of its early recognition, and differentiation with atypical fast growing mycobacterioses.

Development and validation of a multidimensional questionnaire for evaluating quality of life in melasma (HRQ-melasma)

Abstract: BACKGROUND: Melasma has a major impact on quality of life. MELASQoL is the only validated specific psychometric instrument to evaluate melasma QoL. OBJECTIVE: To develop and validate a multidimensional questionnaire for evaluating quality of life related to facial melasma. METHODS: Cross-sectional study performed in 2 institutions (public and private) from Brazil. Two focus groups were carried out: 5 board-certified dermatologists and 10 melasma patients, indicating the dimensions and significant units of melasma QoL. The preliminary questionnaire with 49 itens was applied to 154 facial melasma patients. Item reduction was performed by Rasch analysis. Parallel evaluations of clinical (MASI), demographic, and QoL aspects (MELASQoL, DLQI) were performed. The dimensional structure was assessed by confirmatory factor analysis. Temporal stability was tested in a subgroup of 42 individuals within 7-14 days. RESULTS: The mean (SD) age of the 154 interviewed subjects was 39±8 years, and 87% were females. The median (p25-p75) DLQI and MELASQoL were: 2 (1-6) and 30 (17-44). HRQ-Melasma consisted of 19 items distributed in 4 dimensions: Physical/Appearance, Social/Professional, Psychological, and Treatment. Cronbach's alpha for HRQ-Melasma was 0.96, and >0.74 for each dimension. There was high correlation between HRQ-Melasma and DLQI and MELASQoL (rho=0.80 and 0.83), but modest with MASI (rho=0.35). Dimensional structure of HRQ-Melasma was stated by confirmatory factor analysis coefficients. Test-retest analysis disclosed an intraclass correlation coefficient of 0.91 (p<0.01). STUDY LIMITATIONS: Single-center study. CONCLUSIONS: A specific instrument to evaluate QoL in melasma with multidimensional characteristics was developed and validated, with appropriate psychometric performance.

Psychometrican analysis and dimensional structure of the Brazilian version of melasma quality of life scale (MELASQoL-BP)

Abstract: Background: Although asymptomatic, melasma inflicts significant impact on quality of life. MELASQoL is the main instrument used to assess quality of life associated with melasma, it has been validated in several languages, but its latent dimensional structure and psychometric properties haven´t been fully explored. Objectives: To evaluate psychometric characteristics, information and dimensional structure of the Brazilian version of MELASQoL. Methods: Survey with patients with facial melasma through socio-demographic questionnaire, DLQI-BRA, MASI and MELASQoL-BP, exploratory and confirmatory factor analysis, internal consistency of MELASQoL and latent dimensions (Cronbach's alpha). The informativeness of the model and items were investigated by the Rasch model (ordinal data). Results: We evaluated 154 patients, 134 (87%) were female, mean age (± SD) of 39 (± 8) years, the onset of melasma at 27 (± 8) years, median (p25-p75) of MASI scores , DLQI and MELASQoL 8 (5-15) 2 (1-6) and 30 (17-44). The correlation (rho) of MELASQoL with DLQI and MASI were: 0.70 and 0.36. Exploratory factor analysis identified two latent dimensions: Q1-Q3 and Q4-Q10, which had significantly more adjusted factor structure than the one-dimensional model: Χ2 / gl = 2.03, CFI = 0.95, AGFI = 0.94, RMSEA = 0.08. Cronbach's coefficient for the one-dimensional model and the factors were: 0.95, 0.92 and 0.93. Rasch analysis demonstrated that the use of seven alternatives per item resulted in no increase in the model informativeness. Conclusions: MELASQoL-BP showed good psychometric performance and a latent structure of two dimensions. We also identified an oversizing of item alternatives to characterize the aggregate information to each dimension.

Melasma: a clinical and epidemiological review

Melasma is a chronic acquired hypermelanosis of the skin, characterized by irregular brown macules symmetrically distributed on sun-exposed areas of the body, particularly on the face. It is a common cause of demand for dermatological care that affects mainly women (especially during the menacme), and more pigmented phenotypes (Fitzpatrick skin types III-V). Due to its frequent facial involvement, the disease has an impact on the quality of life of patients. Its pathogeny is not yet completely understood, although there are some known triggering factors such as sun exposure, pregnancy, sexual hormones, inflammatory processes of the skin, use of cosmetics, steroids, and photosensitizing drugs. There is also a clear genetic predisposition, since over 40% of patients reported having relatives affected with the disease. In this manuscript, the authors discuss the main clinical and epidemiological aspects of melasma.

Psoriasis: correlation between severity index (PASI) and systemic treatment / Psoriase: correlacao entre gravidade clinica (PASI) e qualidade de vida (DLQI) em pacientes avaliados antes e depois de tratamento sistemico

BACKGROUND: Psoriasis is a chronic inflammatory disease of the skin that affects patients of all ages andboth genders. The impact of the disease on quality of life is greater among patients with moderate to severe psoriasis. OBJECTIVE: to establish a correlation between the psoriasis area and severity index (PASI) and theDermatology Life Quality Index (DLQI) based on a quality of life questionnaire adapted to the Brazilian contextfor patients with plaque psoriasis before and after systemic treatment. METHODS: This was a cross-sectional, descriptive study of psoriasis patients who did not undergo treatment or who manifested clinical activity of the disease. Patients were evaluated according to the PASI and the quality of life questionnaire adapted to theBrazilian context before and 60 days after systemic treatment. RESULTS: Thirty-five patients participated in thestudy. Twenty-six were men, with a mean age of 46 years. There was no correlation between the PASI and thequality of life questionnaire adapted to the Brazilian context, but there was a correlation between the PASI andsome items of the quality of life questionnaire adapted to the Brazilian context, such as jobs involving public contact. CONCLUSION: The non-correlation between the PASI and the quality of life questionnaire adapted to the Brazilian context in this work may be associated with a history of chronic disease, which implies greater acceptance of the illness, or may be related to the low income and social status of the patients studied. The correlationobserved among patients with careers involving public contact suggests that some professions are more impacted by the disease. It may be necessary to adapt the quality of life questionnaire to patients with a low income andcultural and social limitations. The small sample size (n=35 patients) and the short follow-up period of 60 dayswere some of the limitations of this work. .

FUNDAMENTOS: Psoríase é doença inflamatória crônica da pele que afeta pacientes de todas as idades eambos os gêneros. O impacto negativo na qualidade de vida é mais importante naqueles pacientes com psoríasemoderada a grave. OBJETIVO: Correlacionar o índice de gravidade e extensão da psoríase e o índice de qualidadede vida, segundo questionário de qualidade de vida adaptado ao Brasil, em pacientes de psoríase em placas antes e depois de tratamento sistêmico. MÉTODO: Estudo transversal, descritivo, de pacientes de psoríase, virgens detratamento ou em atividade clinica, submetidos a avaliação do índice de gravidade e extensão da psoríase e aoquestionário de qualidade de vida adaptado ao Brasil antes e após 60 dias de tratamento com medicação sistêmica. RESULTADOS: Trinta e cinco pacientes foram estudados, 26 homens, com idade média de 46 anos. Não houvecorrelação entre índice de gravidade e extensão da psoríase e questionário de qualidade de vida adaptado aoBrasil. Mas, houve correlação entre índice de gravidade e extensão da psoríase e itens do questionário de qualidade de vida adaptado ao Brasil, tal como "atividade profissional com público". CONCLUSÃO: A não correlação entre índice de gravidade e extensão da psoríase e questionário de qualidade de vida adaptado ao Brasil nessainvestigação pode estar relacionada com história crônica de psoríase, o que implicaria em melhor aceitação dadoença ao longo do tempo ou às condições sociais e de baixa renda dos pacientes estudados. A correlação observada entre aqueles com atividade pública sugere que algumas profissões podem sofrer maior impacto da enfermidade. ...

Time needed to schedule dermatological consultations in Brazil / Tempo para agendamento de consultas dermatologicas no Brasil

BACKGROUND: It is not clear what the population's demand for dermatologists is, nor how many professionals are needed in order to provide adequate care in this area of expertise. Knowledge of the flow of patients at dermatological clinics throughout the country allows for the formation of expansion and distribution policies regarding professionals, and provides backing for the decision to increase medical residency places. OBJECTIVES: To evaluate the time it takes to schedule a private dermatological consultation in Brazil, and other factors concerning consultations. METHODS: Survey with a random sample of 14% of Brazilian dermatologists, simulating the scheduling of emergency clinical and cosmetic consultations, and botulinum toxin procedures. Also, details relating to cost and professionals, were studied. Data were adjusted for each region of the country. RESULTS: A total of 873 dermatologists were evaluated. Full SBD members represented 85%, and 66% were women. The median time to schedule a consultation ranged from 6 (out-of-pocket payment) to 7 (medical insurance) consecutive working days. Times varied depending on the region. A multivariate analysis showed that out-of-pocket consultations and procedures were scheduled sooner than with medical insurance, regardless of whether they were clinical or cosmetic. CONCLUSION: The characteristics of dermatologists are varied throughout regions of the country. Private ...

FUNDAMENTOS: Não é clara a demanda populacional dermatológica, assim como a proporção de profissionais adequada para a cobertura de saúde na especialidade. O conhecimento da realidade de fluxo de atendimentos nos consultórios dermatológicos do País permite a formação de políticas de expansão e distribuição de profissionais, além de subsidiar a decisão de ampliação das vagas de residência médica. OBJETIVOS: Avaliar o tempo para agendamento de consulta dermatológica privada no Brasil e características ligadas à consulta. MÉTODOS: Inquérito populacional com amostra probabilística de 14% dos consultórios dermatológicos brasileiros, simulando o agendamento de consulta clínica de urgência, cosmiátrica e aplicação de toxina botulínica. Avaliaram-se também aspectos ligados ao custo e ao profissional. Dados foram ajustados para cada região do País. RESULTADOS: Foram avaliados 873 dermatologistas brasileiros. Sócios titulares da SBD foram 85% e mulheres, 66%. O tempo mediano para agendamento de consulta variou de 6 (particulares) a 7 (convênios) dias úteis consecutivos, esse valores variaram entre as regiões do País. A análise multivariada demonstrou que atendimentos e procedimentos particulares foram agendados mais rapidamente que os de convênios, independentemente, se clínico ...

Techniques of digital image analysis for histological quantification of melanin / Técnicas de análise de imagem digital para quantificação histológica da melanina

Morphometric analysis of tissue melanin may quantitatively contribute to research on pigmentation disorders. The authors present three methods for image analysis, which allow for identification of melanin-equivalent pixels in the epidermis using Fontana-Masson stain and, therefore, for the calculation of its percentage in the different epidermal layers. Moreover, they discuss the main elements related to the analysis and the need for rigorous standardization of the process.

A análise morfométrica da melanina tecidual pode subsidiar quantitativamente a pesquisa em discromias. Os autores demonstram três técnicas de análise de imagem digital que permitem a identificação dos pixels equivalentes à melanina na epiderme pela coloração de Fontana-Masson, possibilitando o cálculo da sua porcentagem nas diferentes camadas da epiderme, e discutem os principais elementos relacionados à análise e a necessidade de rigorosa padronização do processo.

Psoríase associada à infecção pelo HIV/aids / Psoriasis associated with HIV / AIDS

Psoríase é enfermidade inflamatória crônica, de alta prevalência e mediada por fenômenos imunes. A ocorrência da psoríase associada à infecção pelo HIV é relatada com frequência maior do que na população geral.A psoríase pré-existente pode se tornar mais grave ou se tornar mais resistente à terapêutica na medida em que agrava a depleção imune no paciente infectado pelo HIV.A psoríase pode se manifestar desde o início como quadro grave e atípico em paciente infectado pelo HIV. A psoríase grave e rapidamente evolutiva pode ser a manifestação clínica sugestiva de infecção pelo HIV subjacente e insuspeita.O tratamento antirretroviral e a consequente recuperação imune contribuem para melhoria clínica da psoríase associada à infecção pelo HIV.

Associação entre acrocórdons e resistência à insulina / Association between skin tags and insulin resistance

FUNDAMENTOS: Acrocórdons são lesões dermatológicas comuns na população e estão associados ao diabetes mellitus, à obesidade, à resistência insulínica e à aterosclerose. A identificação precoce de pacientes com resistência insulínica pode ter papel preventivo primário. OBJETIVO: Avaliar a associação entre presença de acrocórdons cervicais ou axilares e resistência insulínica. MÉTODOS: Estudo transversal com pacientes dermatológicos adultos atendidos em hospital universitário. Casos foram definidos como portadores de mais de cinco acrocórdons cervicais e/ou axilares. A resistência insulínica foi estimada pelo índice HOMA-IR. Resultados foram ajustados pelas demais covariáveis de risco para resistência insulínica conhecidos, a partir de regressão logística múltipla. RESULTADOS: Avaliaram-se 98 casos e 103 controles, que não diferiram entre si quanto à idade ou ao gênero. Acrocórdons se associaram diretamente aos valores de HOMA-IR (Odds Ratio = 1,4), hipertrigliceridemia e índice de massa corpórea, independentemente do ajuste por diabetes mellitus, idade, fototipo, gênero, história de diabetes mellitus familiar e relação cintura/quadril. Níveis qualitativamente elevados de HOMA-IR (> 3,8) também evidenciaram associação significativa (Índice de probabilidade = 7,5). CONCLUSÕES: Presença de múltiplos acrocórdons se associou à resistência insulínica, independentemente dos demais fatores de risco.

BACKGROUND: Skin tags are dermatological lesions commonly found in the general population and have been associated with diabetes mellitus, obesity, insulin resistance and atherosclerosis. Early detection of patients with insulin resistance may play an important preventive role. OBJECTIVE: To evaluate the association between skin tags in the neck or axillary regions and insulin resistance. METHODS: A cross-sectional study involving adult patients receiving care at a university teaching hospital. Cases were defined as patients with > 5 skin tags in the neck region and/or axillae. Insulin resistance was estimated using the HOMA-IR index. Results were adjusted for the other known covariates of risk for insulin resistance using a multiple logistic regression model. RESULTS: Ninety-eight cases and 103 controls were evaluated. There was no difference between the groups with respect to age or gender. Skin tags were directly associated with HOMA-IR values (odds ratio = 1.4), hypertriglyceridemia and body mass index, irrespective of adjustment for diabetes mellitus, age, skin phototype, gender, family history of diabetes mellitus or hip/waist ratio. Qualitatively elevated HOMA-IR levels (>3.8) were also significantly associated (odds ratio = 7.5). CONCLUSIONS: The presence of multiple skin tags was strongly associated with insulin resistance irrespective of other risk factors.

Fisiopatologia do melasma: [revisão] / Physiopathology of melasma: [review]

Melasma é uma dermatose comum que cursa com alteração da cor da pele normal, resultante da hiperatividade melanocítica focal epidérmica de clones de melanócitos hiperfuncionantes, com consequente hiperpigmentação melânica induzida, principalmente, pela radiação ultravioleta. Clinicamente, caracteriza-se por manchas acastanhadas, localizadas preferencialmente na face, embora possa acometer também região cervical, torácica anterior e membros superiores.Mulheres em período fértil e de fototipos intermediários representam as populações mais acometidas. Grande parte de sua fisiopatogenia permanece desconhecida, havendo relação com fatores genéticos, hormonais, uso de medicamentos, cosméticos, endocrinopatias e fotoexposição. Os autores discutem os principais elementos relacionados à pigmentação da pele e ao desenvolvimento do melasma.

Melasma is a common dermatosis that involves changes in normal skin pigmentation, resulting from the hyperactivity of epidermal melanocytes. The consequent hyperpigmentation is mostly induced by ultraviolet radiation. Clinically, melasma is characterized by light to dark brown macules that usually occur on the face, although they can also affect the cervical and anterior thoracic regions and upper members.Fertile age women and those with intermediate skin phototypes are most likely to develop melasma. Most of its physiopathogenics is not yet fully understood, but there is a relation with genetic and hormonal factors, drugs and cosmetics use, endocrinopathies and sun exposure. The authors discuss the main aspects associated with skin pigmentation and the development of melasma.

Estudo comparativo morfofuncional de melanócitos em lesões de melasma / Morphological and functional comparative study of melanocytes in melasma lesions

FUNDAMENTOS - Melasma é hipermelanose comum caracterizada por máculas acastanhadas em áreas fotoexpostas, cuja fisiopatogenia não é totalmente esclarecida. OBJETIVOS - Caracterizar e comparar morfologica e funcionalmente os melanócitos da epiderme sã com os da pele afetada por melasma. MÉTODOS - Avaliaram-se 12 pacientes portadores de melasma facial, sendo realizadas biópsias da pele lesada e pele sã adjacente. Os cortes foram corados por hematoxilina-eosina, Fontana-Masson, marcados pelo Melan-A e submetidos à microscopia eletrônica. A quantificação epidérmica de melanina e melanócitos foi estimada a partir de análise citomorfométrica digital. RESULTADOS - Todas as pacientes eram mulheres com média de idade 41,3±2,8 anos. Ao Fontana-Masson evidenciou-se importante aumento da melanina epidérmica na pele lesada em relação à pele sã. A marcação pelo Melan-A demonstrou melanócitos maiores com dendritos proeminentes na pele lesada. Observou-se maior densidade de melanina epidérmica na pele lesada, e a análise digital do número de melanócitos da epiderme não demonstrou diferença significativa entre pele lesada e sã. À microscopia eletrônica, observaram-se número aumentado de melanossomas maduros nos ceratinócitos e melanócitos com organelas citoplasmáticas proeminentes na pele lesada. CONCLUSÕES - Melanogênese aumentada na epiderme com melasma em relação à epiderme normal adjacente.

BACKGROUND - Melasma is a common hypermelanosis characterized by symmetric brownish macules on photoexposed areas, most frequently on the face of women. Its pathophysiology is still unknown. OBJECTIVES - To morphologically and functionally characterize and compare melanocytes of normal skin and of melasma. METHODS - Twelve patients with facial melasma were assessed and biopsies of lesions and adjacent healthy skin were performed. The slices were stained with hematoxylin-eosin and Fontana-Masson, immunohistochemically marked for Melan-A and evaluated by electronic microscopy. Quantification of epidermal melanin and melanocytes was estimated by digital cytomorphometric analysis. RESULTS - All patients were female, mean age of 41.3±2.8 years. The Fontana-Masson staining showed an important increase in epidermal melanin as compared to normal skin. The Melan-A staining demonstrated larger and intensely marked melanocytes and more prominent dendrites in the damaged skin. Greater epidermal melanin density was observed in melasma lesions and the digital analysis of number of epidermal melanocytes did not show a significant difference between damaged and normal skin. Electronic microscopy analysis revealed an increased number of mature melanosomes in keratinocytes and melanocytes, with marked cytoplasmic organelles in melasma skin. CONCLUSIONS - Melanogenesis is increased on melasma epidermis as compared to adjacent normal skin.

Avaliação do efeito antiparasitário do omeprazol na prevenção do desenvolvimento de lesões cutâneas em hamsters infectados por Leishmania brasiliensis / Evaluation of omeprazole's antiparasitary effect preventing the development of cutaneous lesions due to Leishmania brasiliensis in hamsters

FUNDAMENTOS: A leishmaniose tegumentar americana permanece doença endêmica em diversas regiões brasileiras. A sobrevivência do parasita no interior dos macrófagos se deve, em parte, pela atividade de uma K+/H+-ATPase de membrana que pode ser inibida pelo omeprazol. OBJETIVOS: Avaliar a eficácia do omeprazol na prevenção do desenvolvimento de lesões de leishmaniose em hamsters. MÉTODOS: Empregaram-se 18 hamsters, divididos em três grupos: o grupo L recebeu apenas a inoculação de L. brasiliensis na pata anterior direita, o grupo O recebeu apenas doses diárias de 0,4mg de omeprazol subcutâneo, e o grupo L+O recebeu o inóculo de leishmanias e o tratamento com omeprazol desde o dia da inoculação. O estudo foi conduzido por 42 dias, realizaram-se medidas dos diâmetros das patas semanalmente, e, ao final do estudo, foram realizados esfregaços das lesões para verificação dos parasitas. RESULTADOS: Os hamsters dos grupos L e L+O desenvolveram lesões de leishmaniose tegumentar havendo ulceração em duas patas do grupo L e uma do grupo L+O. Ao final do estudo, a mobilidade e vitalidade no grupo L foram menores que em L+O, e estas menores que no grupo O. Os diâmetros das patas inoculadas nos grupos L e L+O foram significativamente maiores que no início do estudo (p<0.05). Não houve diferença significativa entre os diâmetros das patas dos grupos L e L+O ao final do estudo (p0,05), sendo detectados parasitas no esfregaço das lesões dos dois grupos. CONCLUSÕES: Omeprazol, no protocolo utilizado, não evitou o desenvolvimento de lesões de leishmaniose tegumentar em hamsters.

BACKGROUND: Cutaneous leishmaniasis remains an endemic disease in several brazilian regions. The parasite survival in macrophages is due to a membrane K+/H+-ATPase that can be inhibited by omeprazole. OBJECTIVES: Evaluate omeprazoles efficacy preventing the development of cutaneous leishmaniasis in hamsters. METHODS: Eighteen hamsters were divided in 3 groups: the L group received an inoculation of L. brasiliensis on right paw, the O group received daily 0,4mg omeprazole subcutaneously, and L+O group received both omeprazole and the inocule. The study was performed in 42 days, and the measurements of the diameter of paws were done weekly. At the end of the study was carried out a smear to verify the presence of parasites. RESULTS: Hamsters fitted in L and L+O groups have developed cutaneous leishmaniasis lesions, there were ulcerations in 2 hamsters from L group and 1 from L+O group. At the end of the study, the vitality and mobility of animals from L group were less prominent than L+O and O groups. Diameters of inoculated paws in L and L+O groups were significantly larger in comparison to begin of the study (p<0,05). There were no statistical difference between diameters of the paws from L and L+O groups at the end of study (p0,05). Parasites were detected at microscopic smears of lesions from both groups. CONCLUSIONS: HamstersÆ cutaneous lesions due to Leishmania sp. inoculation couldnÆt be prevented by omeprazole, using this protocol.

Comparative study of the topical effectiveness of the andiroba oil (Carapa guianensis) and DEET 50 percent as repellent for Aedes sp

O DEET (N, N-dietil-3-metilbenzamida) é hoje o repelente mais efetivo disponível, porém, seu uso pode apresentar importantes efeitos colaterais tópicos e sistêmicos. Alguns compostos botânicos, como a Andiroba (Carapa guianensis), têm demonstrado propriedades repelentes a um baixo custo e baixa toxicidade. Quatro voluntários hígidos submeteram seus antebraços recobertos com óleo de Andiroba a 100%, DEET 50% (controle positivo), óleo de soja refinado, óleo de Andiroba 15% e na ausência de produtos (controles negativos), diretamente a picadas de fêmeas saudáveis de Aedes sp. Foram aferidos os tempos da primeira e terceira picadas. Os resultados mostraram que a mediana da primeira picada nos antebraços sem produto foi 17.5s e a terceira picada, 40.0s. No óleo de soja, as picadas ocorreram em 60.0s e 101.5s. No óleo de Andiroba 100%, em 56.0s e 142.5s. Com Andiroba 15%, em 63.0s e 97.5s. Usando DEET 50% não houve picadas após 3600s na maioria dos experimentos (p < 0.001 Wilcoxon). O óleo de Andiroba 100% comparado ao óleo de soja, antebraço sem produto e óleo de Andiroba 15%, mostrou discreta superioridade (p < 0.001 Wilcoxon). Concluímos que o óleo puro de Andiroba apresenta efeito repelente discreto contra picada de Aedes sp., sendo significativamente inferior ao DEET 50%.