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. .

Psychogenic purpura: a case series and brief clinical review

Psychogenic purpura or Diamond-Gardner Syndrome Is associated with painful bruising and purpura following an auto-sensitization to red blood cells along with imminent psychological and psychosocial factors. Patients with this disorder may present to the dermatologist from where they may be referred to the psychiatrist. A history of psychological stress may be elicited in some cases and psychiatric comorbidity may be seen in others. The psychiatrist, dermatologist and haematologist may have to assess the patient together to reach a diagnosis after a thorough evaluation. The treatment of this condition often involves a team approach involving various medical specialties. We present a series of three cases of psy-chogenic purpura and review the relevant literature

Patologías auto-agresivas: una reflexión psicoanalítica actual sobre el significado de las relaciones intersubjetivas primitivas en su configuración / Self aggressive pathologies: a psychoanalytic reflection about the meaning of primitive intersubjective relationships' configuration

El autor propone una reflexión sobre las patologías auto-inmunes, tomando como punto de partida su idea de que el estrés durante el embarazo de los padres de pacientes con trastornos inmunológicos pueda ser responsable, en parte, de la configuración de las patologías. Conceptos contemporáneos de las neurociencias, sobre el tema estrés y embarazo, dan soporte a sus ideas. Propone poner mayor atención a los embarazos, usando el concepto winnicottiano de medio ambiente facilitador, antes del nacimiento. Incluye, además de las teorías de Winnicott sobre el desarrollo primitivo, conceptos de los psicoanalistas de la Escuela Americana de la Intersubjetividad y aquellos de los neurocientíficos

The author proposes a reflection on the auto-inmunes pathologies, taking as a starting point the idea that stress during mothers pregnancy in patients with immune disorders, may be responsible, in part, on the configuration of pathologies. Contemporary concepts of neuroscience, on the theme of stress and pregnancy, support his ideas. He proposed to pay more attention to pregnancies, using the winnicottian concept of faciliting environment, before birth. Includes Winnicott theories of primitive development, psychoanalysts of the American School of intersubjectivity and those of the neurociences concepts

Síndrome catatônica por doença auto-imune: recuperaçäo espontânea / Catatonic syndrome caused by autoimmune disease: spontaneous remission

O conhecimento das manifestaçöes psiquiátricas do Lúpus Eritematoso Sistêmico (LES) e de outras doenças auto-imunes é importante, tanto para o clínico como para o psiquiatra, uma vez que elas podem preceder de muitos anos as manifestaçöes sistémicas. Neste estudo é apresentada uma paciente com síndrome catatónica näo associada a distúrbios metabólicos e cuja evoluçäo näo foi de uma doença esquizofrênica. A paciente apresentava imunocomplexos liquóricos durante a crise e as provas imunológicas mostravam a presença de imunocomplexos circulantes, FAN positivo (1/800) com padräo nucleolar a imunofluorescência. O quadro clínico regrediu concomitantemente com a negativaçäo dos imunocomplexos liquóricos e com a acentuaçäo dos imunocomplexos circulantes, sem o uso de imunossupressores. A síndrome cataônica é uma manifestaçäo rara em pacientes com doença auto-imune e poucos säo os casos relatados sem manifestaçöes sistêmicas concomitantes. Este estudo clínico mostra que devemos estar atentos para as manifestaçöes psiquiátricas das doenças auto-imunes e que alguns marcadores como imunocomplexos liquóricos säo de grande valia para o seu diagnóstico e poderäo revelar que este tipo de manifestaçäo é mais freqüente do que revela a literatura