Estratégias terapêuticas e atualizações no tratamento de vitiligo / Therapeutic strategies and updates for treatment of vitiligo

O vitiligo é uma desordem dermatológica complexa, cuja patogênese ainda não é totalmente esclarecida. Apesar de não apresentar complicações funcionais no organismo dos pacientes acometidos, o vitiligo pode resultar em um grande impacto psicossocial. Desse modo, é importante que os médicos saibam como conduzir o tratamento dessa patologia. O objetivo deste estudo foi documentar as terapias disponíveis para o tratamento do vitiligo, assim como apontar pesquisas que relataram a utilização dessas opções terapêuticas e os dados resultantes. As terapias abordadas foram corticoides tópicos e sistêmicos, fototerapia e fotoquimioterapias, antioxidantes, imunomoduladores, fenilalanina, despigmentação, procedimentos cirúrgicos e novas abordagens. A monoterapia parece ser menos eficaz no tratamento do vitiligo. A associação de medicação tópica e/ou sistêmica com o uso da fototerapia ultravioleta B de banda estreita parece ser o padrão-ouro para a repigmentação da pele dos pacientes. Medicamentos novos estão em estudo, porém sua eficácia e o estudo dos possíveis efeitos colaterais, principalmente a longo prazo, têm que ser melhores investigados. É necessário que o médico dermatologista, em conjunto com o paciente, escolha a melhor terapia dentre as disponíveis, de acordo com critérios clínicos e a possibilidade de acesso ao tratamento pelo portador. O acompanhamento e a abordagem por uma equipe multiprofissional também são importantes. (AU)

Vitiligo is a complex dermatological disorder, whose pathogenesis has not yet been fully elucidated. Although it does not present functional complications in the affected patients' body, vitiligo can result in a great psychosocial impact. Therefore, it is important that physicians know how to conduct its treatment. This study aimed at documenting the available therapies for the treatment of vitiligo, as well as pointing out studies reporting the use of these therapeutic options and their resulting data. The therapies addressed were topical and systemic corticosteroids, phototherapy, and photochemotherapies, antioxidants, immunomodulators, phenylalanine, depigmentation, surgical procedures, and new approaches. Monotherapy appears to be less effective in the treatment of vitiligo. The combination of topical and/or systemic medication with the use of narrowband ultraviolet B phototherapy seems to be the gold standard for the patients' skin repigmentation. New drugs are under study, but their effectiveness and study of possible side effects, especially in the long run, have to be better investigated. It is necessary that the dermatologist, together with the patient, choose the best therapy among those available, according to clinical criteria and the possibility of access to treatment by the patient. Monitoring and approach by a multiprofessional team is also important. (AU)

Arquitectura y anatomía foliar del complejo Polypodium plesiosorum sensu Moran (Polypodiaceae)

Architecture and leaf anatomy of the Polypodium plesiosorum sensu Moran complex (Polypodiaceae). The Polypodium plesisorum complex is a heterogeneous morphology group. We studied leaf architecture and anatomy of 12 species of this group, in addition to other 23 species of Polypodium (P. dulce, P. polypodioides and P. vulgare complex sensu Moran) and related genera (Goniophlebium, Phlebodium, Pleopeltis, Serpocaulon, Synammia), for comparative purposes. Two homogeneous groups of species were established in P. plesiosorum complex. One of them is recognized based on the type of anastomosis of the veins (Type III): Polypodium conterminans (originally considered in the group of P. dulce with free venation by Moran), P. hispidulum, P. plesiosorum and P. rhodopleuron. The second group with Polypodium arcanum, P. castaneum, P. colpodes, P. eatonii, and P. flagellare were recognized based on the type of anastomosis of the veins (Type IV) and how vascular strands fuse along the petiole-leaf rachis. Characters studied helped to group the remaining species with other groups outside the complex under study. Rev. Biol. Trop. 58 (3): 955-976. Epub 2010 September 01.

El complejo Polypodium plesisorum es un grupo de morfología heterogénea. Se estudió la arquitectura y anatomía foliar de 12 especies que constituyen el complejo de Polypodium plesiosorum reconocidas por Moran, y otras 23 especies de Polypodium (complejos P. dulce, P. polypodioides y P. vulgare sunsu Moran) y géneros relacionados taxonómicamente (Goniophlebium, Phlebodium, Pleopeltis, Serpocaulon, Synammia) con fines comparativos. Dos grupos de especies homogéneas fueron establecidos en el complejo P. plesisorum. Uno de ellos se reconoce por el tipo de anastomosis de las venas (tipo III): Polypodium conterminans (originalmente considerado en el grupo de P. dulce de venación libre según Moran), P. hispidulum, P. plesiosorum y P. rhodopleuron. El segundo grupo formado por Polypodium arcanum, P. castaneum, P. colpodes, P. eatonii y P. flagellare, se reconoce por el tipo de anastomosis de las venas (tipo IV) y la forma en que se fusionan los cordones vasculares a lo largo del eje pecíoloraquis de la hoja. Los caracteres estudiados ayudaron a relacionar las especies restantes con otros grupos fuera del complejo estudiado.

Antioxidantes / Antioxidants

Nuestra piel está constantemente expuesta al estrés oxidativo endógeno y exógeno, el cual juega un papel fundamental tanto en el envejecimiento intrínseco como extrínseco. El estrés oxidativo se debe a la producción de especies reactivas de oxígeno, también conocidas como radicales libres. Las estructuras vitales que se ven afectadas por este proceso son el ADN, elementos del citoesqueleto, proteínas celulares y membranas celulares. El cuerpo posee mecanismos de defensa contra los radicales libres, denominados antioxidantes, los cuales son capaces de reducirlos y neutralizarlos. Sin embargo, como parte natural del proceso de envejecimiento, no sólo la producción de especies reactivas de oxígeno aumenta, sino que los mecanismos endógenos de defensa disminuyen, resultando en un desbalance con predominio de radicales libres no neutralizados que dañan las estructuras del organismo. Aunque el cuerpo posee antioxidantes endógenos y ciertos alimentos son ricos en antioxidantes, muchos creen que niveles más altos de estas sustancias pueden obtenerse con suplementos alimentarios. En consecuencia, ha llegado a ser muy popular el uso de antioxidantes en suplementos orales o en forma tópica, los cuales podrían potencialmente aminorar los efectos adversos de las especies reactivas de oxígeno. En esta revisión se analizan los antioxidantes más conocidos que se encuentran incorporados en los productos cosméticos o que son administrados por vía oral en los pacientes interesados en la cosmética personal.

Our skin is constantly exposed to endogenous and exogenous oxidative stress, which plays a pivotal role in intrinsic and extrinsic aging. Oxidative stress is delivered by the creation of reactive oxygen species also known as free radicals. Vital structures that can be adversely affected by this process are DNA, cytoskeletal elements, cellular proteins, and cellular membranes. The body possesses defense mechanisms against free radicals, which are called antioxidants, and are able to reduce and neutralize them. However, as part of the natural aging process, not only does the production of reactive oxygen species increase, but our endogenous defense mechanisms decrease resulting in an imbalance and increased number of unchecked free radicals damaging vital structures of the body. Although the body possesses endogenous antioxidants and certain foods are rich in antioxidants, many believe that higher levels can be achieved by supplementation. Consequently, the use of antioxidants as oral supplements or topical formulation should be able to lessen the harmful adverse effects induced by reactive oxygen species and has thus become popular. This review discusses the most popular types of antioxidants found in cosmetic products or taken orally by cosmetic patients.