Subject(s)
COVID-19 , Psoriasis , COVID-19/prevention & control , Follow-Up Studies , Hospitals , Humans , Patient Isolation , Policy , Psoriasis/drug therapy , Psoriasis/epidemiologyABSTRACT
Aim of study: identify consultation reasons, experiences with seeking dermatological assistance and skin care strategies within neighbours from an urban deprived settlement in Buenos Aires province, Argentina. This setting lies onto a sanitary landfill with a high index of environmental contamination. Materials and methods: a dermatological health care team from the main local hospital designed a dermatological assistance device (DAD), in cooperation with social leaders and institutions of the neighborhood. The DADs included walks around the neighborhood for attending those who could not get a consultation. The experiences were evaluated through a qualitative research strategy, developed from the theoretical framework of Sociocultural Epidemiology. Those who attended the DADs were interviewed. Ethnographic field notes were also recorded. Multiple accessibility barriers to the public health care system were identified and self care practices were also recognized. Results: The most frequent consultations to the DADs were for "pimples", "stains'' and "lumps" on exposed areas of the skin. These lesions generated discomfort or pain, or even affected the interviewees aesthetically or emotionally. Most of them were associated to extremely dry skin and a high sun exposure, in connection with the lack of shade in the neighbourhood. An initiative to plant trees was promoted in order to prevent sun radiation-induced dermatoses. Conclusion: the reflective immersion of the dermatology team in the realm of the neighborhood daily life enabled the development of attention strategies grounded on the perceived needs of the population.
Objetivo: analizar motivos de consulta, experiencias y formas de atención de las afecciones dermatológicas de la población de un asentamiento de la Provincia de Buenos Aires, ubicado sobre un relleno sanitario con altos índices de contaminación ambiental. Materiales y métodos: investigación cualitativa, mediante entrevistas en profundidad a vecinos/as y elaboración de registros etnográficos de las recorridas. La investigación se realizó en el contexto de un dispositivo de atención dermatológica, planificado en conjunto con referentes barriales, bajo el marco teórico de la Epidemiología Sociocultural. Resultados: se identificaron múltiples barreras de accesibilidad a la atención dermatológica en el sistema público de salud, y prácticas de autoatención como el uso de cremas, medidas de higiene y uso de elementos de protección personal para trabajos que significaban un riesgo para la salud. Las consultas al dispositivo más frecuentes fueron "granos", "manchas", "bultitos" en zonas visibles del cuerpo, que generaban molestia, dolor y/o afectaban estética y emocionalmente a lo/as entrevistado/as. Estas consultas se relacionaban principalmente con piel extremadamente seca y patologías por alta exposición solar, coincidiendo con la escasez de sombra en el barrio. Para prevenir patologías relacionadas a la exposición solar, se impulsó una iniciativa para plantar árboles. Conclusión: a partir de la inmersión reflexiva del equipo de atención, en las experiencias de atención de lo/as habitantes del barrio, se desplegaron estrategias según las necesidades percibidas por la población.
Subject(s)
Delivery of Health Care , Referral and Consultation , Hospitals , Humans , Patient Care Team , Qualitative ResearchABSTRACT
La fibrosis pulmonar a causa del metotrexato es un efecto adverso infrecuente, observado principalmente en los pacientes con artritis reumatoide, aunque también se vio, de manera escasa, en el tratamiento de la psoriasis. Se presenta el caso de un paciente con psoriasis que desarrolló fibrosis pulmonar por metotrexato.
Pulmonary fibrosis due to methotrexate is an infrequent adverse event, observed mainly in patients with rheumatoid arthritis, although it has also been poorly described in the treatment of psoriasis. We present the case of a patient with psoriasis who developed pulmonary fibrosis due to methotrexate.
Subject(s)
Humans , Male , Aged , Psoriasis/drug therapy , Pulmonary Fibrosis/chemically induced , Methotrexate/adverse effects , Dermatologic Agents/adverse effects , Phototherapy , Pulmonary Fibrosis/diagnostic imaging , Tomography, X-Ray Computed , Interleukin-17/therapeutic use , Adalimumab/therapeutic use , Interleukin Inhibitors/therapeutic use , Anti-Inflammatory Agents/therapeutic useABSTRACT
OBJECTIVE: To describe dermatologists' methotrexate (MTX) prescription trends for the treatment of psoriasis, and to identify variables associated with suboptimal MTX use. METHODS: Cross-sectional study of dermatologists from Argentina who completed a pre-designed survey focussed on MTX prescription characteristics. A multiple logistic regression model was used to identify variables independently associated with suboptimal MTX use (when less than 12 weeks and less than 15 mg/week were administrated in patients with monotherapy before discontinuing or adding a second drug). RESULTS: Two hundred and twenty-one dermatologists participated in the study. Median time of practice in dermatology: 10 (IQR 3-15) years. MTX initial dose: 2.5-7.5, 10-15 and 20-30 mg/week in 52%, 41% and 7% of the participants, respectively. Suboptimal MTX use was observed in 76% of the participants. Thirty per cent of the participants responded that they considered MTX to be an ineffective drug. The only variable that was independently associated with suboptimal MTX use was the prescriber's personal consideration of MTX to be an ineffective drug (OR 2.29; 95%CI 1.05-5.00). CONCLUSION: A wide heterogeneity in the prescribing profile of MTX for the treatment of psoriasis was observed among Argentinean dermatologists. Suboptimal MTX use was identified in the majority of the prescribers.
Subject(s)
Methotrexate/therapeutic use , Psoriasis/drug therapy , Argentina , Cross-Sectional Studies , Drug Administration Routes , Drug Administration Schedule , Humans , Odds Ratio , Surveys and Questionnaires , Treatment OutcomeABSTRACT
Los nevos epidérmicos son disembrioplasias cutáneas de aparición congénita o durante los primeros años de vida. Clínicamente son lesiones hiperqueratósicas y verrugosas que pueden asociarse a manifestaciones esqueléticas, neurológicas y oftalmológicas, conformando el síndrome del nevo epidérmico.Presentamos 133 casos entre los cuales la forma clínica más frecuente fue el nevo simple seguido del NEVIL; el patrón histológico predominante fue el clásico, seguido del de hiperqueratosis epidermolítica, y la prevalencia del síndrome del nevo epidérmico fue del 2,21%.
Epidermal nevi are common skin lesions that may be present al birth or develop during earlychildhood. Clinically they are hyperkeratotic and verrucous lesions, and they may be associatedwith skeletal, neurologic and ophtalmic abnormalities.We present 133 patients among whom the most frequent clinical presentation was nevus simplexfollowed by ILVEN. The predominant histological feature was the classic pattern, followed by theepidermolytic hyperkeratosis pattern. The prevalence of the epidermal nevus syndrome was 2.21%.
Subject(s)
Humans , Adolescent , Skin Neoplasms/diagnosis , Skin Neoplasms/pathology , Nevus/diagnosis , Nevus/pathology , Skin/pathologyABSTRACT
Los mosaicismos pigmentarios son enfermedades névicas caracterizadas por la presencia en piel de máculas híper o hipopigmentadas de distribución según patrones clínicos preestablecidos. En ocasiones presentan asociaciones extracutáneas que alteran el desarrollo normal del individuo. Presentamos una recopilación de todos los casos de mosaicismos pigmentarios evaluados en nuestro Servicio en laúltima década
