Melasma and assessment of the quality of life in Brazilian women

BACKGROUND: Melasma is a chronic, acquired hyperpigmentation disease on sun-exposed areas of the skin, which affects patients' quality of life. OBJECTIVE: To assess the impact on the quality of life of women living in Florianópolis, Brazil, through questionnaire (MelasQol), and investigate the clinical aspects and risk factors for melasma, correlating them with the MelasQol scores. METHODS: This study was performed on 51 melasma patients cared for at the University Hospital of the Universidade Federal de Santa Catarina. The variables included were: age, gender, age of onset of melasma, Fitzpatrick phototype (I-VI), duration and family history of melasma, onset of melasma during pregnancy, use of hormonal contraceptive, thyroid disorder and distribution of melasma. The MelasQoL questionnaire, validated for Brazilian Portuguese (MelasQoL-BP), was applied. RESULTS: The mean age was 38.43±6.75 years. All patients were women. The most common Fitzpatrick skin phototypes were III (49.02%) and IV (33.33%). Melasma had a mean age of onset of 29.18±7.05 years and a mean duration of 9.25±6.18 years. The majority of patients did not have familial history of melasma (50.98%). Melasma onset was associated with pregnancy (45.10%). The MelasQoL-BP analysis revealed significant emotional impact on patients, such as feeling bothered (94.11%), frustrated and embarrassed (64.71%), and depressed (52.94%) about their skin appearance, as well as unattractive (78.43%). No social impact was observed (P>0.05). CONCLUSION: Melasma has a strong emotional impact on quality of life, resulting especially from feelings about skin appearance. .

Indeterminate leprosy and lepromatous index case: four cases in the same family / Hanseniase indeterminada e caso indice virchowiano: 4 casos na mesma familia

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, which primarily affects the skin and peripheral nerves. Brazil remains as the country with the second largest number of cases in the world. We report the case of three patients diagnosed with indeterminate leprosy in the same family. Two patients were HIV positive. An active search led to the discovery of the index case. It was crucial to persist in the search of the index case. This report shows how important it is to teach physicians and the general population about the signs and symptoms of leprosy. Early diagnosis and treatment are necessary to prevent sequelae and to eliminate the disease as a public health problem.

A hanseníase é uma doença infecciosa crônica causada pelo Mycobacterium leprae, que afeta principalmente a pele e nervos periféricos. O Brasil continua sendo o segundo país do mundo com maior número de casos. Aqui relatamos três pacientes diagnosticados com hanseníase indeterminada, pertencentes à mesma família, cuja busca ativa levou à descoberta do caso índice. Dois pacientes eram HIV positivos. Foi de imensa importância a insistência na procura pelo caso índice. Este relato ilustra a importância do ensino sobre sinais e sintomas de hanseníase na formação médica e à população. O pronto reconhecimento e tratamento são necessários para prevenir sequelas e eliminar a doença como problema de saúde pública.

Dermoscopic features of thin melanomas: a comparative study of melanoma in situ and invasive melanomas smaller than or equal to 1mm / Caracteristicas dermatoscopicas de melanomas finos: estudo comparativo entre melanomas in situ e melanomas invasivos menores ou iguais a 1mm

BACKGROUND: Dermoscopy allows the early detection of melanomas. The preoperative determination of Breslow index by dermoscopy could be useful in planning the surgical approach and in selecting patients for sentinel lymph node biopsy. OBJECTIVES: This study aims at describing the dermoscopic features of thin melanomas and comparing melanomas in situ with invasive melanomas less than or equal to 1 mm thick. METHODS: This was an observational retrospective study in which the dermoscopy photographs of 41 thin melanomas were evaluated. Three observers evaluated together 14 dermoscopic criteria. RESULTS: Among thin melanomas, the most frequent criteria were presence of asymmetry in two axes in 95% of cases (39 cases), 3 or more colors in 80.4% of cases (33 cases), atypical dots or globules in 58.5% of cases (24 cases) and atypical network or streaks in 53.6% of cases (22 cases). The group of invasive melanomas presented with a higher frequency and statistical significance (p <0.05) 3 or more colors (OR: 16.1), milky red areas (OR: 4.8) and blue-white veil (OR: 20.4), and a greater tendency to have streaks or atypical network (OR: 3.66). CONCLUSIONS: Thin melanomas tend to have asymmetry in the two axes, 3 or more colors, atypical dots or globules and atypical network or streaks. Melanomas in situ tend to have up to 2 colors, no blue-white veil and no milky red area. Invasive melanomas tend to have 3 or more colors, a milky red area, blue-white veil, and atypical network or streaks. Further studies are needed to confirm these findings. .

FUNDAMENTOS: A dermatoscopia propicia o diagnóstico mais precoce do melanoma. A estimativa préoperatória da espessura de Breslow através da dermatoscopia poderia ser útil no planejamento da conduta cirúrgica e seleção dos pacientes para a biópsia de linfonodo sentinela. OBJETIVOS: Este estudo objetiva descrever as características dermatoscópicas encontradas em melanomas finos e comparar melanomas in situ com melanomas invasivos menores ou iguais a 1 mm. MÉTODOS: Trata-se de estudo observacional, retrospectivo, no qual avaliouse o registro fotográfico da dermatoscopia de 41 melanomas finos. Três observadores avaliaram em conjunto 14 critérios dermatoscópicos. RESULTADOS: Dentre os melanomas finos, os critérios mais encontrados foram: presença de assimetria nos dois eixos em 95% (39 casos), 3 ou mais cores em 80,4% (33 casos), pontos ou glóbulos atípicos em 58,5% (24 casos) e rede atípica ou estrias radiadas em 53,6% (22 casos). O grupo dos melanomas invasivos apresentou com maior frequência e significância estatística (p<0,05) a presença de 3 ou mais cores (OR: 16,1), áreas vermelho-leitosas (OR: 4,8) e véu (OR: 20,4), além de uma maior tendência em apresentar rede atípica ou estrias radiadas (OR: 3,66). CONCLUSÕES: Os melanomas finos tendem a apresentar assimetria nos dois eixos, 3 ou mais cores, pontos ou glóbulos atípicos e rede atípica ou estrias radiadas. Os melanomas in situ tendem a apresentar até 2 cores, ausência de véu e de área vermelho-leitosa. Os melanomas invasivos tendem a exibir 3 cores ou mais, área vermelho-leitosa, véu, rede atípica ou estrias radiadas. Outros estudos são necessários para a confirmação dos achados. .