Caracterización clínico-epidemiológica de pacientes con daño actínico crónico. Cochabamba, Bolivia / Clinical-epidemiological characterization of patients with chronic actinic damage. Cochabamba, Bolivia

RESUMEN Introducción: el daño actínico crónico es un grupo de alteraciones en la estructura, función y apariencia de la piel como resultado de la exposición no controlada a las radiaciones ultravioletas. Puede provocar el cáncer de piel. Objetivo: caracterizar a los pacientes con daño actínico crónico, atendidos en la consulta de Dermatología del Hospital Comunitario Valle Hermoso, en el departamento de Cochabamba, Bolivia. Materiales y métodos: se realizó un estudio clínico descriptivo, prospectivo, en un universo de 1 833 pacientes diagnosticados con daño actínico crónico, atendidos en la consulta de Dermatología del Hospital Comunitario Valle Hermoso, en Cochabamba, entre septiembre de 2017 y septiembre de 2018. Se evaluaron las variables edad, sexo, color y fototipo de piel, ocupación, uso de medios de protección solar, exposición a otro tipo de radiaciones, manifestaciones clínicas de fotodaño y altitud del lugar de residencia. Resultados: predominaron el grupo de edad de 25 a 59 años, el sexo femenino, el color de piel mestizo (77,08 %), el fototipo de piel IV (76,98 %) y la ocupación comerciante (72,56 %). La mayoría de los pacientes (82,7 %) no utilizaron medios de protección solar, y el 99,8 % no tuvieron exposición a otro tipo de radiaciones. Las lesiones por fotodaño que prevalecieron fueron melasma (83,03 %) y lentigos (12,22 %). El 99,29 % vivían en zonas de gran altitud. Conclusiones: se caracterizaron los pacientes con daño actínico crónico, obteniendo en algunas variables estudiadas resultados similares a los mencionados por otros investigadores (AU).

ABSTRACT Introduction: chronic actinic damage is a group of alterations in the structure, function, and appearance of the skin as a result of uncontrolled exposure to ultraviolet radiation. It can cause skin cancer. Objective: to characterize the patients with chronic actinic damage, treated at the Dermatology consultation of Valle Hermoso Community Hospital, in the department of Cochabamba, Bolivia. Materials and methods: a descriptive, prospective clinical study was conducted in a universe of 1,833 patients diagnosed with chronic actinic damage, treated at the Dermatology clinic of the Valle Hermoso Community Hospital, Cochabamba, between September 2017 and September 2018. The variables age, sex, skin color, skin phototype, occupation, use of sun protectors, exposure to other types of radiation, clinical manifestations of photodamage and altitude of the place of residence were evaluated. Results: the age group from 25 to 59 years, the female sex, mestizo skin color (77.08 %), the IV skin phototype (76.98 %) and merchant occupation (72.56 %) predominated. Most patients (82.7 %) did not use sun protection means, and 99.8 % had no other radiation exposure. The prevailing photodamage lesions were melasma (83.03 %) and lentigo (12.22 %). 99.29 % lived in high altitude areas. Conclusions: the patients with chronic actinic damage were characterized, obtaining in some variables studied results similar to those mentioned by other researchers (AU).

Dermatitis actínica crónica / Chronic actinic dermatitis

RESUMEN La dermatitis actínica crónica (DAC) - dermatitis por fotosensibilidad, reacción solar persistente o su variante extrema el reticuloide actínico- es una fotodermatosis crónica, propia del adulto más frecuente en el sexo masculino provocada por rayos ultravioletas (UVB), (UVA) y luz visible. El diagnóstico es clínico, caracterizado por placas eccematosas y liquenificadas pruriginosas en aéreas expuestas al sol. Se cree que el DAC se debe a la fotosensibilización secundaria de un antígeno endógeno de la piel.

ABSTRACT Chronic actinic dermatitis (ACD) - photosensitivity dermatitis, persistent solar reaction or its extreme variant actinic reticuloid - is a chronic photodermatosis, typical of the adult male caused by ultraviolet (UVB), (UVA) and visible light. The diagnosis suggested by clinical researchers, characterized by eczematous and lichenified pruritic plaques in areas exposed to the sun. It is believed that DAC is due to the secondary photosensitization of an endogenous skin antigen.

Incapacitating solar urticaria: successful treatment with omalizumab

Abstract: Solar urticaria is a rare form of physical urticaria mediated by immunoglobulin E. The lesions appear immediately after the sun exposure, interfering with the patient's normal daily life. Omalizumab, a monoclonal anti-IgE antibody, has been recently approved for the treatment of chronic spontaneous urticaria, and the latest reports support its role also in the treatment of solar urticaria. Hereby, we report a case of solar urticaria refractory to conventional treatment strategies, with an excellent response to treatment with omalizumab and phototesting normalization.

Llega la primavera y florecen los eritemas polimorfos solares / Spring arrives and with it the polymorphous light eruption

El eritema polimorfo solar es la fotodermatosis más frecuente y suele aparecer en primavera con la primera exposición intensa al sol. Sus manifestaciones cutáneas son variadas y el diagnóstico se basa en la clínica junto al antecedente de exposición solar. En los casos leves, la fotoprotección suele ser suficiente para el control de la enfermedad, pero en formas más graves se requieren otras terapéuticas, como corticoides, antihistamínicos, o fototerapia, que genera una "fotoadaptación" de las áreas de piel afectadas. Presentamos un caso típico de erupción polimorfa solar que respondió de forma adecuada a medidas de fotoprotección. (AU)

The polymorphic solar eruption is the most frequent photodermatosis, and usually appears in spring with the first intense exposure to the sun. It has multiple cutaneous manifestations, and its diagnosis is based on the clinic and the antecedent of solar exposition. In mild cases, photoprotection is usually enough to control the disease, but in more severe forms, other therapies are required, such as corticosteroids, antihistamines, or phototherapy to generate a "photo-adaptation" of the affected skin areas. We present a typical case of polymorphic solar eruption that responded adequately to photoprotection measurements. (AU)

Protocolo para dispensação de protetor solar destinado a pacientes lúpicos com definida fotossensibilidade / Protocol for dispensing sunscreen for lupus patients with defined photosensitivity

Objetivo Geral: oferecer aos profissionais da saúde orientações de acesso e condutas adotadas para dispensação de protetor solar para pacientes lúpicos no âmbito do Sistema Único de Saúde (SUS) no estado de Mato Grosso.(AU)

Dermatitis actínica crónica: reticuloide actínico / Chronic actinic dermatitis: actinic reticuloid

El reticuloide actínico (RA) es una fotodermatosis crónica grave propia del adulto masculino provocada por los rayos ultravioletas y la luz visible. Sus semejanzas clínicas e histológicas con el linfoma de células T, lo han encuadrado dentro de los pseudolinfomas T. Se loconsidera en el espectro de las dermatitis actínicas crónicas (DAC) el polo más severo. A pesar de que el riesgo de desarrollar malignidad no está evidenciado, suele traer grandesmorbilidades para los pacientes y se le otorga poco valor y estudio en la consulta diaria dermatológica...

Kindler's syndrome: a report of five cases in a family

Kindler's Syndrome [KS] is a rare genodermatosis with autosomal recessive mode of inheritance. The disease results from homozygous mutations on both alleles of the FERMT-1 gene [also known as KIND-1 gene] that encodes the protein Kindlin-1 [kindlerin]. Clinical features include a constellation of early infantile skin blistering and mild photosensitivity, which improves with age, and progressive poikiloderma with widespread cutaneous atrophy. The differential diagnosis of Kindler syndrome include other congenital poikilodermatous and photosensitive conditions including Bloom syndrome, Cockayne syndrome, dyskeratosis congenita, epidermolysis bullosa, Rothmund-Thomson syndrome and xeroderma pigmentosum. We herein, report the presence of the Kindler's syndrome in 5 out of 7 children of consanguineous parents. To authors' knowledge, this is the first report of Kindler's syndrome involving 5 members of a family

Granuloma actínico / Actinic granuloma

El granuloma actínico es una rara afección de la piel que se desarrolla en general en áreas expuestas al sol. Su patogénesis no es clara.La teoría más aceptada es la implicancia de la radiación solar como factor disparador. Típicamente la enfermedad se presenta en individuos mayores de 30 años con historia de exposición solar. Se manifiesta con lesiones anulares de bordes elevados y atrofia central,asintomáticas, con poca tendencia a la involución. Se han probado múltiples terapéuticas con éxito variado. Esta entidad poco frecuente fue descripta por primera vez en 1975 por O`Brien. Presentamos dos pacientes con granuloma actínico. El primero correspondió a una mujer de 83 años de edad con una lesión en pómulo izquierdo. El segundo a un varón de 70 años con una gran lesión que se extendía desde el epigastrio hasta las clavículas.

Actinic granuloma is a rare skin disorder usually developing uponsun-exposed areas. While its pathogenesis is unclear, the acceptedhypothesis maintains that solar radiation is the triggering factor.Typically the disease develops in individuals over 30 years of age witha history of sun exposure, showing annular lesions with raised bordersand central atrophy, asymptomatic, with little tendency to regression.Multiple therapies have been tested with variable response. Thisuncommon entity was described for the first time in 1975 by O’Brien.We present two patients with actinic granuloma. The first onecorresponded to an 83 years-old woman with a lesion on the leftcheek. The second one was a 70 years-old male with a large lesion thatextended from the epigastrium to the collar bones.

Kindler syndrome: 2 case reports from India

Kindler syndrome [KS] is a rare autosomal recessive genodermatosis. We report two cases of KS with classical clinical presentations involving skin and mucus membranes. Clinically, both patients had four major features of KS in the form of acral skin blistering, photosensitivity, progressive poikiloderma, and diffuse cutaneous atrophy. Case 1 had associated features in the form of urethral stenosis, skin fragility and palmoplantar keratoderma with extension of the scaling onto the flexor aspect of the wrist and loss of palmar creases. Case 2 had associated features in form of anal stenosis, oesophageal stenosis, skin fragility and palmoplantar keratoderma with loss of palmar creases. An Interesting finding in our report is that both cases have prominent telengectasia involving face and neck regions

Evaluation and management of photosensitivity in children.

Photosensitive disorders in children are not uncommon in our country. It is often difficult to establish the diagnosis, either due to confusing presentation or ignorance by the parents. We review the presentation and management of photosensitive disorders in children.Detailed history and thorough clinical examination is essential in arriving at a particular diagnosis. Photosensitive disorders in children are idiopathic, or related to nutritional, genetic, metabolic or connective tissue diseases. Most photosensitive disorders begin in infancy or childhood and persist for invariable period during adulthood. However, their severity decreases with age. As there is no definitive treatment in most of the cases, the only treatment is prevention from further exposure to sunlight. Our aim should be to minimize the photo damage which can be achieved by adopting different methods of photoprotection. Photoprotection can be achieved by using adequate sunscreens, proper clothing and avoidance of sun exposure. It is recommended that these children and their parents should be adequately counseled about the disease and different methods of photoprotection. This article describes how to diagnose photosensitive disorders in children and its management.

Fotossensibilização primária em eqüídeos e ruminantes no semi-árido causada por Froelichia humboldtiana (Amaranthaceae) / Primary photosensitization in equidae and ruminants in the Brazilian semi-arid caused by Froelichia humboldtiana (Amaranthaceae)

Fotossensibilização é freqüente em eqüinos no semi-árido da região Nordeste, mas jumentos, mulas, ovinos e bovinos são, também, afetados. A dermatite afeta, principalmente, áreas de pele despigmentadas e os animais se recuperam após serem retirados das pastagens. Para comprovar a etiologia da enfermidade Froelichia humboldtiana (Roem. et Schult.) Seub., coletada no campo foi administrada no mesmo dia da colheita ou após ser mantida em refrigerador por 1-4 dias, por períodos de 30 ou mais dias, ad libitum como único alimento, a 2 jumentos e um ovino branco e, como único alimento volumoso, a um eqüino branco. Esses animais não manifestaram sinais clínicos e as atividades séricas de gama-glutamiltransferase (GGT), aspartato-aminotransferase (AST) e alanino-aminotransferase (ALT) ficaram dentro dos valores normais. Em outro experimento, um ovino foi colocado a pastar diariamente, durante o dia, preso por uma corda em uma área que tinha exclusivamente F. humboldtiana, por um período de 26 dias. Lesões características de fotossensibilização foram observadas 4-5 dias após o início do experimento. Após cessar o consumo da planta, no 26º dia, o ovino recuperou-se totalmente em 30 dias. Em outro experimento, 4 ovinos foram também colocados, presos por cordas, na mesma área. Outros 4 permaneceram como controles em uma pastagem vizinha, mas sem F. humboldtiana. Lesões de pele, características de fotossensibilização foram observadas após 11-25 dias de consumo de F. humboldtiana. As atividades séricas de AST e GGT, e os níveis de bilirrubina sérica permaneceram dentro dos valores normais. No final do período de permanência em pastagens de F. humboldtiana, 2 ovinos foram abatidos e 2 foram retirados da pastagem. Os que foram abatidos não apresentaram lesões macroscópicas nem histológicas do fígado; os outros dois se recuperaram das lesões da pele 17 e 20 dias após o fim do pastejo. Uma égua e seu potro foram colocados na mesma pastagem com F. humboldtiana...

Photosensitization is common in the Brazilian semiarid, affecting mainly horses, but also donkeys, mules, sheep and cattle. The dermatitis affects mainly non pigmented skin, and the animals recover after being withdrawn from the pastures. To demonstrate the etiology of the disease, Froelichia humboldtiana (Roem. et Schult.) Seub., collected in the field one or two times a week and kept in the refrigerator for 1-4 days, was administered for 30 or more days as the only food ad libitum to 2 donkeys and one white sheep, and as the only forage ad libitum, to one white horse. No clinical signs were observed in those animals, and serum activities of aspartate-aminotransferase (AST), alanine-aminotransferase (AST), and gamma-glutamyltransferase (GGT) were within normal ranges. In another experiment, one sheep was tied by a rope, during the day, in a pasture of exclusively F. humboldtiana for a 26 days period. Skin lesions characteristic of photosensitization appeared 4-5 days after the start of the experiment and became severe until day 26. After the withdrawal of the animal from the pasture on day 26 it fully recovered within 30 days. In another experiment, 4 sheep were tied by ropes in the same pasture, during the day, for a 29 days period. Another 4 control sheep were maintained in a neighboring pasture without F. humboldtiana. Skin lesions characteristic of photosensitization were observed after 11-25 days of F. humboldtiana grazing. Serum activities of AST and GGT, and serum levels of bilirubin were within normal ranges. At the end of the 29 days grazing F. humboldtiana, 2 sheep were euthanized, and 2 were withdrawn from the pastures. No gross or histologic liver lesions were observed on the 2 sheep euthanized; the other 2 sheep recovered within 17 and 20 days after the end of grazing. One mare and its foal grazed in the same pasture during 44 days. The mare that had a pigmented skin had no dermatitis, but the foal showed dermatitis on the...

Crystal-associated cholangiopathy in sheep grazing Brachiaria decumbens containing the saponin protodioscin

An outbreak of hepatogenous photosensitization is reported in a flock of 28 sheep grazing Brachiaria decumbens in Mato Grosso do Sul State, Central-Western Brazil. Seven lambs and an adult sheep were affected and 6 of them died. Two surviving affected lambs and one lamb without clinical signs had increased serum values of gamma glutamyltransferase, bilirubin, and cholesterol. In two adult unaffected sheep those parameters were within normal values. An adult sheep submitted to necropsy presented moderate body condition, unilateral corneal opacity, drying of the muzzle, moderate jaundice, increased lobular pattern of the liver, and a distended gallbladder. Histological lesions were epithelial degeneration, necrosis, and hyperplasia of small bile ducts. Mild amounts of foamy macrophages were observed, mainly in the centroacinar zone. Diffuse swelling and vacuolation were observed in hepatocytes. Crystal negative images were found within bile ducts, foamy macrophages, and the lumen of some renal tubules. The heart showed multifocal areas of degeneration and necrosis of the muscle fibers. Pasture samples (Brachiaria decumbens) contained 2.36 percent of protodioscin. No Pithomyces chartarum spores were found in the pasture. Samples from a similar neighboring B. decumbens pasture grazed by cattle without photosensitization contained 1.63 percent of protodioscin isomers. Outbreaks of photosensitization caused by Brachiaria spp. are common in cattle in the Brazilian Cerrado (savanna) with about 51 million hectares of Brachiaria spp pastures. Sheep farming has been recently developed in this region, and the number of sheep is increasing significantly. Because sheep are more susceptible than cattle to lithogenic saponins, poisoning by Brachiaria should be an important limiting factor for the sheep industry.

Um surto de fotossensibilização hepatógena é descrito em um rebanho de 28 ovinos mantidos em pastagem de Brachiaria decumbens no Estado de Mato Grosso do Sul, região Centro-Oeste do Brasil. Sete cordeiros e uma ovelha adulta foram afetados e seis deles morreram. Dois cordeiros com sinais clínicos e um cordeiro, aparentemente sem sinais clínicos, apresentaram elevação na atividade sérica de gama glutamil-transferase, e nos valores de bilirrubina e colesterol. Em dois animais adultos que não apresentavam sinais clínicos, esses parâmetros estavam dentro dos valores normais. Uma ovelha adulta submetida à necropsia apresentou moderada condição corporal, opacidade de córnea unilateral, focinho ressecado, moderada icterícia, padrão lobular hepático evidente e vesícula biliar acentuadamente distendida e repleta. As lesões histológicas consistiram de degeneração epitelial, necrose e hiperplasia de ductos biliares. Havia discreta quantidade de macrófagos espumosos, principalmente na região centroacinar, e tumefação e vacuolização difusas dos hepatócitos. Foram observadas imagens negativas de cristais dentro dos ductos biliares, macrófagos espumosos e lúmen de alguns túbulos renais. O coração apresentou áreas multifocais de degeneração e necrose de fibras musculares. Amostras da pastagem (B. decumbens) apresentaram 2,36 por cento de protodioscina e nenhum esporo de Pithomyces chartarum foi encontrado na pastagem. Amostras de uma pastagem vizinha semelhante (B. decumbens), que havia sido pastejada por bovinos que não desenvolveram fotossensibilização, apresentaram 1,63 por cento de protodioscina. Surtos de fotossensibilização causados por espécies de Brachiaria são comuns em bovinos no Cerrado brasileiro onde há aproximadamente 51 milhões de hectares plantados com essa gramínea. A criação de ovinos nesta região ganhou recente impulso e o número de ovinos vem aumentando significativamente. Como os ovinos são mais suscetíveis que os bovinos à intoxicação...

Fotossensibilização hepatógena em eqüinos pela ingestão de Brachiaria humidicola (Gramineae) no Estado do Pará / Hepatogenous photosensitization in horses caused by Brachiaria humidicola (Gramineae) in the State of Pará

São apresentados os aspectos clínico-patológicos e epidemiológicos de doença, caracterizada por fotossensibili-zação, que ocorre em eqüinos no nordeste do Estado do Pará. De um total de 40 animais examinados clinicamente, sete foram necropsiados, e tiveram fragmentos de órgãos examinados microscopicamente. Em virtude das lesões características encontradas, sobretudo nas partes despigmentadas da pele, das le-sões hepáticas macro e microscópicas, e sabendo-se que as brachiárias, de uma maneira geral, encerram saponinas com propriedades tóxicas, que causam alterações hepáticas e fo-tossensibilização em bovinos e ovinos, conclui-se, que essa doença fotossensibilizante foi determinada pelo pastoreio de Brachiaria humidicola, alimentação exclusiva dos animais enfermos.

Data on the clinical-pathological aspects and on the epidemioloy of a disease in horses, characterized by phototsensitization, which occurs in northeastern of Pará, Brazil, are presented. Of a total of 40 horses examined clinically, post-mortem examination was performed on seven. Due to the characteristic lesions found on the non-pigmented skin, the macroscopic and histological alterations in the liver, and knowing that Brachiaria grasses contain saponins with toxic properties, which cause liver lesions and photosensitization in cattle and sheep, it is concluded that this disease in horses is caused by grassing exclusively Brachiaria humidicola.

Photosensitivity in children: an approach to diagnosis and management.

Photosensitivity disorders in children include a wide array of conditions, many of which are unique to this age group. Prompt diagnosis of these disorders becomes difficult at times because of the overlapping clinical pictures. Genodermatoses and metabolic disorders may have associated systemic involvement, which may lead to these children presenting to pediatricians who may overlook the photosensitivity. A dermatologist's consultation is essential in such cases for specific instructions and counseling of parents regarding photoprotection in these children. This intervention may improve the quality of life by reducing the morbidity and chances of early mortality. This review includes a comprehensive discussion of the distinguishing clinical features of childhood photodermatoses along with general guidelines regarding their investigation and treatment.

Reticulóide actínico / Actinic reticuloide syndrome

Os autores relatam caso de reticulóide actínico, fazem uma revisäo bibliográfica sobre o tema, incluindo prognóstico e tratamento(au)