Suppression of wheal and flare in histamine test by the main H1 antihistamines commercialized in Brazil

Abstract: Background: Several dermatoses are mediated by histamine, such as urticaria, angioedema, and papular urticaria. There are no Brazilian studies comparing the potency of antihistamines. Objectives: To evaluate the tolerability and efficacy of the main commercial brand and generic H1 antihistamines, regarding the suppression of the wheal and flare to the histamine test. Methods: A quasi-experimental, open study with 10 healthy adults submitted to the histamine test on the ventral aspect of the forearms. After 20 minutes, wheal and flares were measured. The tests were performed after two hours of intake of dexchlorpheniramine, hydroxyzine, levocetirizine, fexofenadine, cetirizine, loratadine, ebastine, desloratadine, epinastine and rupatadine, as well as generics of loratadine, cetirizine and fexofenadine. Results: All antihistamines presented a reduction in the wheal compared to the control (p <0.02), as well as in the flare, except for rupatadine (p = 0.70). In the internal comparison, cetirizine, fexofenadine, epinastine, levocetirizine, dexchlorpheniramine and hydroxyzine were the most potent, with no difference between them (p > 0.1). As for halo, cetirizine, epinastine, hydroxyzine and fexofenadine were the most potent, with no difference between them (p > 0.1). The most common adverse effect was drowsiness, which was more prevalent among first-generation drugs (p < 0.01). Generic loratadine, fexofenadine and cetirizine halos were higher than their controls (p <0.03).. Study limitations: A single-center study evaluating only aspects related to histamine. Conclusions: Brazilian commercial antihistamines presented different profiles of inhibition of wheal and flares in the histamine test, as well as adverse effects. Generic loratadine, fexofenadine and cetirizine presented larger flares than brand drugs.

Melanoma primário múltiplo sincrônico em mulher jovem: relato de caso e revisão da literatura / Multiple synchronous primary melanoma in young women: case report and literature review

Contexto: Melanoma corresponde a apenas 3% dos cânceres da pele, porém, tem alta letalidade. Pacientes diagnosticados com melanoma têm risco de 1% a 8% de desenvolver um segundo melanoma, o que se denomina de melanoma primário múltiplo (MPM). Até 30% dos casos de MPM são sincrônicos. Descrição do caso: Mulher, de 39 anos, com duas lesões melanocíticas no membro inferior. Exame histopatológico evidenciou serem ambos melanomas primários, sendo, portanto, diagnosticados como MPM sincrônicos. Discussão: MPM sincrônico é raro e há poucos relatos na literatura, sendo as características da doença pouco conhecidas pelos dermatologistas. Principais fatores de risco para desenvolvimento de MPM são história pessoal de nevo displásico e antecedente familiar de melanoma. Conclusões: Pacientes com MPM devem ter seguimento clínico regular minucioso, por apresentarem maior risco que a população geral de desenvolver outros melanomas. Com o aumento da incidência do melanoma, casos de MPM devem tornar-se mais frequentes na prática clínica.

Quality of life index in autoimmune bullous dermatosis patients

BACKGROUND: Autoimmune bullous dermatoses are complex diseases triggered by autoantibodies action against epidermal antigens or the dermoepidermal junction. Blisters and vesicles that evolve with erosion areas characterize them. Although rare, they present high morbidity, affecting the quality of life of patients. OBJECTIVES: To assess the magnitude of autoimmune bullous dermatoses on life quality of patients treated in a public university service in countryside of Brazil. METHODS: This cross-sectional study was based on an inquiry with autoimmune bullous dermatoses patients assisted at outpatient university referral service. Elements related to quality of life were evaluated by the Dermatology Life Quality Index, as well as clinical and demographic data. RESULTS: The study evaluated 43 patients with pemphigus foliaceus, 32 with pemphigus vulgaris, 6 with bullous pemphigoid and 3 with dermatitis herpetiformis. The average age was 48 ± 16 years and 34 (40%) were female. The median score (p25-p75) of the Dermatology Life Quality Index was 16 (9-19), classified as "severe impairment" of life quality, in which the greater impact was related to symptoms and feelings, daily and leisure activities. CONCLUSIONS: Autoimmune bullous dermatoses inflict severe impairment of quality of life for patients followed by a public outpatient clinic in the countryside of Brazil. .

Dimensioning the fear of dermatologic diseases / Dimensionando o medo de doenças dermatológicas

The symbolic representation of a disease is related to personal perceptions and cultural background. In the present study, the authors evaluate the population knowledge and fears related to skin and other prevalent or severe diseases. This survey was based on a semi-structured form to investigate demographic aspects, dermatologic consultations, fears and knowledge of 19 dermatoses and 11 prevalent or severe diseases. We interviewed 302 people, of which 54% were women and the mean age was 39 years. Some fears of dermatoses surpass those of severe diseases. Skin cancer and total alopecia disclosed fears similar to that of myocardial infarction. - fundament, fundamentals - objective, objectives - method, methods - result, results - conclusion, conclusions.

A representação simbólica de doenças é ligada a percepções pessoais e raízes culturais. Neste estudo os autores avaliam o conhecimento e temores relacionados a dermatoses e outras doenças prevalentes ou graves na população. Este inquérito foi baseado em formulário semiestruturado para avaliar aspectos demográficos, consulta a dermatologistas, temores e conhecimento sobre 19 dermatoses e 11 doenças prevalentes ou graves. Foram entrevistadas 302 pessoas, sendo 54% do sexo feminino e a idade média, 39 anos. Certos temores de dermatoses superaram os de doenças graves, além disso, câncer de pele e alopecia total representaram temores semelhantes ao infarto do miocárdio. Fundamentos Objetivos Métodos Resultados Conclusões.