What the skin of 341 premature newborns says - a transversal study.

OBJECTIVES: Determine the frequency of dermatological diagnoses in preterm newborns up to 28 days of life and associated perinatal factors. METHOD: a cross-sectional analytical study with a convenience sample and prospective data collection, was conducted between November 2017 and August 2019. Overall, 341 preterm newborns who had been admitted to a University hospital - including those admitted to the Neonatal Intensive Care Unit - were evaluated. RESULTS: 61 (17.9%) had less than 32 weeks gestational age (GA), with a mean GA and birth weight of 33.9 ± 2.8 weeks and 2107.8 ± 679.8g (465 to 4230g), respectively. The median age at the time of evaluation was 2.9 days (4 h to 27 days). The frequency of dermatological diagnoses was 100% and 98.5% of the sample had two or more, with an average of 4.67+1.53 dermatoses for each newborn. The 10 most frequent diagnoses were lanugo (85.9%), salmon patch (72.4%), sebaceous hyperplasia (68.6%), physiological desquamation (54.8%), dermal melanocytosis (38.7%), Epstein pearls (37.2%), milia (32.2%), traumatic skin lesions (24%), toxic erythema (16.7%), and contact dermatitis (5%). Those with GA< 28 weeks showed more traumatic injuries and abrasions, whereas those with ≥ 28 weeks had physiological changes more frequently, and those with GA between 34-366/7 weeks, had transient changes. CONCLUSION: Dermatological diagnoses were frequent in our sample and those with higher GA showed a higher frequency of physiological (lanugo and salmon patch) and transient changes (toxic erythema and miliaria). Traumatic lesions and contact dermatitis were among the 10 most frequent injuries, reinforcing the need to effectively implement neonatal skin care protocols, especially in preterm.

Intervenções educativas na dermatite atópica em crianças: o que há de novo? / Educational interventions for atopic dermatitis in children: what's new?

A educação dos cuidadores dos pacientes com dermatite atópica (DA) pode possibilitar a melhora da qualidade de vida e minimizar a gravidade da doença, já que esta tem um imensurável impacto emocional, social e financeiro nas famílias dos doentes. Entretanto, não há um consenso de qual o escopo ideal e frequência para a entrega das informações educativas sobre a patologia e terapêutica. Esta é uma revisão integrativa de literatura cujo objetivo foi avaliar estudos sobre a eficácia de intervenções educativas para pais e pacientes pediátricos com DA na gravidade da doença e na qualidade de vida. Foi realizada uma busca nas bases de dados do PubMed e MEDLINE, em acesso realizado em 08/08/2022, incluindo publicações de 2000 a 2022, nos idiomas português e inglês, incluindo os termos: "atopic dermatitis", "education program", "therapeutic education". Foram incluídos 15 artigos nesta revisão. As metodologias dos estudos são diversas e as ferramentas utilizadas pelos pesquisadores também são heterogêneas, o que dificulta a comparação dos resultados. Dos temas abordados, o cuidado da pele e/ou rotinas básicas foram temas sempre incluídos. E, apesar da literatura demonstrar melhora na gravidade da doença e na qualidade de vida dos cuidadores e pacientes com DA após as intervenções, isso não foi um consenso entre os autores. A educação terapêutica pode ser útil para aumentar a adesão ao tratamento e prevenção de complicações; porém, estudos prospectivos com casuística maior são primordiais para esclarecer qual o escopo ideal e frequência para a entrega destas informações.

Educating the caregivers of patients with atopic dermatitis may lead to improved quality of life and help minimize disease severity, since the pathology has an immeasurable emotional, social, and financial impact on the patient's families. However, there is no consensus on the ideal scope and frequency for providing educational information about atopic dermatitis and its treatment. The purpose of this integrative literature review was to evaluate studies on the effectiveness of educational interventions for parents and pediatric patients with atopic dermatitis regarding disease severity and quality of life. On August 8, 2022, we searched the PubMed and MEDLINE databases for studies published between 2000 and 2022 in Portuguese or English that included the terms: "atopic dermatitis", "education program", and/or "therapeutic education". A total of 15 articles were included in this review. The studies' methodologies and tools were heterogeneous, impeding comparison of the results. Of the covered topics, skin care and/ or basic routines were always included. Although the literature showed that therapeutic education improved disease severity and quality of life for both caregivers and patients, there was no consensus among the authors. Therapeutic education may help increase treatment adherence and prevent complications. However, prospective studies with larger populations are essential for clarifying the ideal scope and frequency of education programs.

What the skin of 341 premature newborns says - a transversal study

Abstract Objectives: Determine the frequency of dermatological diagnoses in preterm newborns up to 28 days of life and associated perinatal factors. Method: a cross-sectional analytical study with a convenience sample and prospective data collection, was conducted between November 2017 and August 2019. Overall, 341 preterm newborns who had been admitted to a University hospital - including those admitted to the Neonatal Intensive Care Unit - were evaluated. Results: 61 (17.9%) had less than 32 weeks gestational age (GA), with a mean GA and birth weight of 33.9 ± 2.8 weeks and 2107.8 ± 679.8g (465 to 4230g), respectively. The median age at the time of evaluation was 2.9 days (4 h to 27 days). The frequency of dermatological diagnoses was 100% and 98.5% of the sample had two or more, with an average of 4.67 +1.53 dermatoses for each newborn. The 10 most frequent diagnoses were lanugo (85.9%), salmon patch (72.4%), sebaceous hyperplasia (68.6%), physiological desquamation (54.8%), dermal melanocytosis (38.7%), Epstein pearls (37.2%), milia (32.2%), traumatic skin lesions (24%), toxic erythema (16.7%), and contact dermatitis (5%). Those with GA< 28 weeks showed more traumatic injuries and abrasions, whereas those with ≥ 28 weeks had physiological changes more frequently, and those with GA between 34-366/7 weeks, had transient changes. Conclusion: Dermatological diagnoses were frequent in our sample and those with higher GA showed a higher frequency of physiological (lanugo and salmon patch) and transient changes (toxic erythema and miliaria). Traumatic lesions and contact dermatitis were among the 10 most frequent injuries, reinforcing the need to effectively implement neonatal skin care protocols, especially in preterm.

Dermatite atópica grave: guia prático de tratamento da Associação Brasileira de Alergia e Imunologia e Sociedade Brasileira de Pediatria / Severe atopic dermatitis: a practical treatment guide from the Brazilian Association of Allergy and Immunology and the Brazilian Society of Pediatrics

A dermatite atópica (DA) é uma doença cutânea inflamatória, crônica, comum, complexa e de etiologia multifatorial, que se manifesta clinicamente com prurido muitas vezes incapacitante, lesões recorrentes do tipo eczema, xerose e que pode evoluir para liquenificação. Embora o conhecimento sobre a sua fisiopatologia venham crescendo nos últimos anos, ainda as formas graves são frequentes e representam um desafio para o clínico. Para o presente guia realizou-se revisão não sistemática da literatura relacionada à DA grave refratária aos tratamentos habituais com o objetivo de elaborar um documento prático e que auxilie na compreensão dos mecanismos envolvidos na DA, assim como dos possíveis fatores de risco associados à sua apresentação. A integridade da barreira cutânea é um dos pontos fundamentais para a manutenção da homeostase da pele. Além dos cuidados gerais: evitação dos agentes desencadeantes e/ou irritantes, o uso de hidratantes, suporte emocional, entre outros, o uso de agentes anti-inflamatórios/imunossupressores de uso tópico e/ou sistêmico também foi revisado. A aquisição de novos agentes, os imunobiológicos e as pequenas moléculas, melhorou a terapêutica para os pacientes com formas graves de DA, sobretudo as refratárias aos tratamentos convencionais.

Atopic dermatitis is a chronic, common, and complex inflammatory skin disease with a multifactorial etiology. It manifests clinically with often disabling pruritus, recurrent eczema-like lesions, and xerosis, and can progress to lichenification. Although understanding of the disease's pathophysiology has been growing in recent years, severe forms are still frequent and represent a challenge for clinicians. A non-systematic review of the literature on severe atopic dermatitis refractory to conventional treatment was conducted to develop the present guide, whose purpose is to help clarify the mechanisms involved in the disease and possible risk factors. The integrity of the skin barrier is fundamental for maintaining skin homeostasis. In addition to general care, patients should avoid triggering and/or irritating agents and moisturizers and seek emotional support, etc.; the use of topical and/or systemic anti-inflammatory/immunosuppressive agents was also reviewed. New agents, immunobiologicals, and small molecules have led to a broader range of therapies for patients with severe forms of the disease, especially cases refractory to conventional treatment.

Randomized trial with soaps - what happens to a newborn baby's skin?

Abstract Objective: Evaluate the effectiveness of a children's soap with physiological pH in maintaining cutaneous pH and moisture of the newborn (NB)'s skin after the first bath. Methods: Randomized, controlled and double-blind clinical trial in a rooming-in of a tertiary maternity hospital in southern Brazil with 204 newborns > 34 gestational weeks. Gestational and obstetric history was evaluated, and newborns were randomized into two groups according to the product applied in the bath: the control group (CG), which used common liquid soap with pH 7.0 and experimental group (EG), which used children's liquid soap with pH 5.8. Evaluation was made immediately before and after bath with skin pH measurement, corneometry and clinical parameters (erythema, scaling and moisture), on the forehead, abdomen and thigh. Results: There was no difference between groups regarding gestational, obstetric and family history (p > 0.05). In CG, skin pH increased in the abdomen and thigh (p < 0.05). In EG there was an improvement in clinical parameters after bathing with: increased moisture, less erythema and less scaling (p < 0.05). On the forehead, there was a significant increase in pH after bathing (p < 0.001) similar in both groups, although no use of soap. There was no difference in corneometry between groups after bathing. Conclusions: Children's liquid soap with physiological pH maintained the acidic skin pH and moisture of the newborn's skin after the first bath, which reinforces the importance of using products with physiological pH in the hygiene of newborns. Registration number RBR-9ky84vd.

Randomized trial with soaps - what happens to a newborn baby's skin?

OBJECTIVE: Evaluate the effectiveness of a children's soap with physiological pH in maintaining cutaneous pH and moisture of the newborn (NB)'s skin after the first bath. METHODS: Randomized, controlled and double-blind clinical trial in a rooming-in of a tertiary maternity hospital in southern Brazil with 204 newborns > 34 gestational weeks. Gestational and obstetric history was evaluated, and newborns were randomized into two groups according to the product applied in the bath: the control group (CG), which used common liquid soap with pH 7.0 and experimental group (EG), which used children's liquid soap with pH 5.8. Evaluation was made immediately before and after bath with skin pH measurement, corneometry and clinical parameters (erythema, scaling and moisture), on the forehead, abdomen and thigh. RESULTS: There was no difference between groups regarding gestational, obstetric and family history (p > 0.05). In CG, skin pH increased in the abdomen and thigh (p < 0.05). In EG there was an improvement in clinical parameters after bathing with: increased moisture, less erythema and less scaling (p < 0.05). On the forehead, there was a significant increase in pH after bathing (p < 0.001) similar in both groups, although no use of soap. There was no difference in corneometry between groups after bathing. CONCLUSION: Children's liquid soap with physiological pH maintained the acidic skin pH and moisture of the newborn's skin after the first bath, which reinforces the importance of using products with physiological pH in the hygiene of newborns. Registration number RBR-9ky84vd.

Educational intervention and atopic dermatitis: impact on quality of life and treatment.

BACKGROUND: Educational intervention (EI) could improve understanding of atopic dermatitis (AD) and adherence to treatment, decreasing severity, and improving quality of life (QoL). OBJECTIVE: This study aims to evaluate the influence of an EI on the severity of the disease and on the QoL in children with AD. METHODS: A controlled clinical trial was performed, including children up to 14 years of age with AD. Patients were allocated into control group (CG), which received usual guidelines on AD during the outpatient visit, and a study group (SG) that, in addition to the usual guidelines, participated in the EI. The severity of AD was assessed by Scoring Atopic Dermatitis (SCORAD) and Eczema Area and Severity Index (EASI). QoL was assessed by the Children's Dermatology Life Quality Index and the Dermatitis Family Impact Questionnaire. RESULTS: Twenty-seven participants were included in the CG and 21 in the SG. There was a decrease in the median value for the QoL of children in the SG after the intervention (p = 0.04), as well as in the caregiver's (p = 0.04). In the CG, the median QoL of children and caregivers remained unaltered, for caregivers the median value for the QoL was equal throughout first and second evaluation (p = 0.32). In the SG, EASI values decreased after the intervention (p = 0.04), as well as SCORAD (p = 0.04). The CG did not show any decrease in the values of EASI (p = 0.88) scores nor of SCORAD scores (p = 0.82). CONCLUSION: The EI rendered a decrease in severity of the disease and improvement in the QoL of patients and their caregivers.

Vitamin D supplementation and severity of atopic dermatitis: pre-post assessment

Background/objectives There is evidence that vitamin D (VD) supplementation may help in the management of atopic dermatitis (AD). The aim of this study was to assess the influence of VD supplementation on the severity of AD. Methods Pre–post interventional study with prospective data collection in patients younger than 14 years. The severity of AD was determined through SCORAD (SCORing Atopic Dermatitis) and classified as mild (SCORAD < 25), moderate (≥25 and <50), and severe (≥50). Skin prick test was performed in all patients. Serum VD levels were classified as sufficient (≥30 ng/mL), insufficient (29 to 21 ng/mL), and deficient (≤20 ng/mL); and those with inadequate levels received oral supplementation of VD for 3 months, and were reassessed after treatment. Results A total of 152 patients were included. Patients with sufficient vitamin levels had lower SCORAD values (p = 0.04). Further, 116 patients (76.3%) received VD supplementation and after 3 months, VD levels were significantly higher (35.9 ng/mL) compared to baseline levels (23.7 ng/mL, p < 0.001). At the same time, a reduction in the SCORAD index was observed (19.4 before vs 12.3 after supplementation, p < 0.001). Considering other factors that could influence the decrease in AD severity after VD supplementation, female gender was associated with a worse treatment response (p = 0.02). Conclusion Vitamin D supplementation could be an adjuvant in reducing the severity of atopic dermatitis (AU)

Vitamin D supplementation and severity of atopic dermatitis: pre-post assessment.

BACKGROUND/OBJECTIVES: There is evidence that vitamin D (VD) supplementation may help in the management of atopic dermatitis (AD). The aim of this study was to assess the influence of VD supplementation on the severity of AD. METHODS: Pre-post interventional study with prospective data collection in patients younger than 14 years. The severity of AD was determined through SCORAD (SCORing Atopic Dermatitis) and classified as mild (SCORAD < 25), moderate (≥25 and <50), and severe (≥50). Skin prick test was performed in all patients. Serum VD levels were classified as sufficient (≥30 ng/mL), insufficient (29 to 21 ng/mL), and deficient (≤20 ng/mL); and those with inadequate levels received oral supplementation of VD for 3 months, and were reassessed after treatment. RESULTS: A total of 152 patients were included. Patients with sufficient vitamin levels had lower SCORAD values (p = 0.04). Further, 116 patients (76.3%) received VD supplementation and after 3 months, VD levels were significantly higher (35.9 ng/mL) compared to baseline levels (23.7 ng/mL, p < 0.001). At the same time, a reduction in the SCORAD index was observed (19.4 before vs 12.3 after supplementation, p < 0.001). Considering other factors that could influence the decrease in AD severity after VD supplementation, female gender was associated with a worse treatment response (p = 0.02). CONCLUSION: Vitamin D supplementation could be an adjuvant in reducing the severity of atopic dermatitis.

Mental disorders and atopic dermatitis in children and adolescents.

INTRODUCTION: Some authors point to a relationship between mental disorders (MD) and atopic dermatitis (AD), but few determine which MD these are, and none of them evaluate the impact of AD on their healthy siblings. AIM: To determine which MD affect children and adolescents with AD and compare it with the risk of their healthy siblings. MATERIAL AND METHODS: This is a cross-sectional, prospective study with the application of a risk assessment instrument for Mental Disorders in paediatric patients with AD and their siblings from September 2016 to June 2018. The evaluation instrument used to assess the risk of MD was the Child Behaviour Checklist (CBCL). The Wilcoxon-Mann-Whitney, Pearson's χ2 test with Yates correction and Fisher's exact test were used, considering a significance level of 5%. RESULTS: The risk of MD in participants with AD was 63.0%, and in the healthy siblings, 36.0% (p < 0.01). The risk was higher in participants with AD when compared to their siblings for the syndromes "Sleep Problems", "Thought Problems" and "Somatic Complaints". Parental concerns on socialization/bullying were also more frequent for participants with AD when compared to siblings. CONCLUSIONS: Children and adolescents with AD present a high risk of MD, and their healthy siblings also present impairment in their mental health. In both cases, this impairment is higher than the one expected in the Brazilian general paediatric population (24.6%) and global paediatric population (22.4%).

Parry Romberg disease with En Coup de Sabre Scleroderma: Effect of tocilizumab on periodontal bone inflammation.

Parry Romberg disease and En Coupe de Sabre Scleroderma are frequently associated disorders that affect the face and can cause severe aesthetic and functional impairment. Systemic immunosuppression is the gold standard of first-line treatment in the pediatric rheumatology standpoint although it is often delayed in the pediatric dermatology clinics and more often used in cases of refractory neurological impairment. We report on a case with dental root resorption and severe periodontal bone inflammation detected on magnetic resonance imaging, which was successfully treated with the anti-IL-6 agent tocilizumab.

The musculoskeletal impairment negatively impacts the quality of life of children and adolescents with psoriasis.

BACKGROUND: The severity of nail disease, the presence of arthralgia and fatigue are predictors of development of psoriatic arthritis (PsA) in patients with psoriasis (Pso). In children, little is known about the musculoskeletal (MSK) impairment in patients with Pso and its effect on health-related quality of life (HRQoL). OBJECTIVES: To determine the frequencies of pain and MSK inflammation (i.e., arthritis, enthesitis, and sacroiliitis) among children and adolescents with Pso and its relationship to HRQoL and fatigue. METHODS: Pediatric patients with Pso underwent a rheumatologic physical examination to evaluate synovitis, enthesalgia, sacroiliac joint (SIJ) pain and tender points of fibromyalgia. The core set of domains recommended by the GRAPPA - OMERACT to be measured in PsA studies was assessed. Ultrasound (US) was performed in clinical cases of enthesitis, and magnetic resonance imaging (MRI) was performed in cases of SIJ pain. RESULTS: Forty-three participants (10 ± 2.9 years old) were evaluated. Pain on palpation of the entheses was observed in 10 (23.2%) patients and pain on SIJ palpation was observed in 3 (7%). No patient presented with synovitis; one presented with enthesitis on US, but MRI did not confirm sacroiliitis in any case. Patients with MSK pain had greater skin disease severity (PASI 5.4 vs. 2, p <  0.01), worse fatigue, and lower HRQoL scores on all instruments used. The estimated risk of HRQoL impairment was eight times higher in the presence of MSK pain, which was an independent predictive factor. With a NAPSI greater than 30, the probability of pain was greater than 80%. CONCLUSION: MSK pain is frequent among children with Pso, related to the severity of skin and nail disease, and negatively affects HRQoL. The typically used complementary exams might not detect the inflammatory process caused by Pso.

BATHING, MAKE-UP, AND SUNSCREEN: WHICH PRODUCTS DO CHILDREN USE?

OBJECTIVE: To evaluate the hygiene practices and frequency of use of personal hygiene products, cosmetics, and sunscreen among children and adolescents. METHODS: Cross-sectional study with interviews about skincare conducted with caregivers through closed-ended questions. We included patients up to 14 years of age waiting for consultation in pediatric outpatient clinics of a tertiary hospital. We performed a descriptive statistical analysis and applied the Kruskal-Wallis test and Fisher's exact test to compare the practices according to maternal schooling. RESULTS: We conducted 276 interviews. The median age of the participants was age four, and 150 (54.3%) were males. A total of 143 (51.8%) participants bathed once a day and 128 (46.3%) bathed two or more times a day, lasting up to ten minutes in 132 (47.8%) cases. Adult soap was used by 103 (37.3%) children and bar soap by 220 (79.7%). Fifty-three (19.2%) participants used sunscreen daily. Perfume was used by 182 (65.9%) children, hair gel by 98 (35.5%), nail polish by 62 (22.4%), and some type of make-up by 71 (25.7%) - eyeshadow by 30 (10.8%), lipstick by 52 (18.8%), face powder and mascara by 13 (4.7%). Make-up use started at a median age of 4 years. Henna tattoo was done in eight children. CONCLUSIONS: The children studied used unsuitable products for their skin, such as those intended for adults, used sunscreen inadequately, and started wearing make-up early, evidencing the need for medical orientation.

Colorimetric analysis of images in the follow-up of infantile hemangiomas.

BACKGROUND/OBJECTIVES: Infantile hemangiomas (IH) are common vascular tumors that appear early in life, have a rapid proliferative phase and slowly involute. There are no standardized ways to evaluate the regression of these lesions. We propose a colorimetric analysis of photographs to allow a more precise determination of IH treatment response and involution. METHODS: Patients 1-10 months of age with superficial or mixed IH were included. The lesions were managed with 0.5% topical timolol ophthalmic solution. Patients were followed for 16 weeks with 6 evaluations each. Photographic images were taken with a red and green circle placed beside each hemangioma. The photographs were treated as to equalize the size, color, and brightness among them based on the colors of the two circles. A grading scale was established based on the color of the patient skin (0) and the color of the hemangioma at the beginning of treatment (100) by pixel analysis using Adobe Photoshop® software. RESULTS: A total of 17 patients 1 to 10 months of age were included, of whom 16 were girls (94%). Fourteen lesions were superficial, and 3 were mixed IH. The median time prior to initiation of treatment was 105 days (44-232). All lesions showed some degree of clearing. The mean of lightening of color intensity observed was of 45% (17%-74%) over the period of follow-up. CONCLUSIONS: The colorimetric analysis of the digital images allowed an accurate and objective evaluation of IH clearing.

Bathing, make-up, and sunscreen: which products do children use? / Banho, maquiagem e protetor solar: o que as crianças usam?

ABSTRACT Objective: To evaluate the hygiene practices and frequency of use of personal hygiene products, cosmetics, and sunscreen among children and adolescents. Methods: Cross-sectional study with interviews about skincare conducted with caregivers through closed-ended questions. We included patients up to 14 years of age waiting for consultation in pediatric outpatient clinics of a tertiary hospital. We performed a descriptive statistical analysis and applied the Kruskal-Wallis test and Fisher's exact test to compare the practices according to maternal schooling. Results: We conducted 276 interviews. The median age of the participants was age four, and 150 (54.3%) were males. A total of 143 (51.8%) participants bathed once a day and 128 (46.3%) bathed two or more times a day, lasting up to ten minutes in 132 (47.8%) cases. Adult soap was used by 103 (37.3%) children and bar soap by 220 (79.7%). Fifty-three (19.2%) participants used sunscreen daily. Perfume was used by 182 (65.9%) children, hair gel by 98 (35.5%), nail polish by 62 (22.4%), and some type of make-up by 71 (25.7%) - eyeshadow by 30 (10.8%), lipstick by 52 (18.8%), face powder and mascara by 13 (4.7%). Make-up use started at a median age of 4 years. Henna tattoo was done in eight children. Conclusions: The children studied used unsuitable products for their skin, such as those intended for adults, used sunscreen inadequately, and started wearing make-up early, evidencing the need for medical orientation.

RESUMO Objetivo: Avaliar os hábitos de higiene e a frequência do uso de produtos de higiene pessoal, cosméticos e protetor solar nas crianças e adolescentes. Métodos: Estudo transversal com entrevistas para cuidadores sobre cuidados com a pele, por meio de perguntas fechadas. Incluídos pacientes de até 14 anos que consultavam nos ambulatórios pediátricos de um hospital terciário. Realizada estatística descritiva e aplicados os testes de Kruskal-Wallis e exato de Fisher para comparar os hábitos conforme a escolaridade materna. Resultados: Foram realizadas 276 entrevistas. A mediana de idade foi de 4 anos, sendo 150 (54,3%) crianças do sexo masculino. O número de banhos por dia foi de um em 143 (51,8%) casos e dois ou mais por parte de 128 (46,3%) indivíduos, com duração de até dez minutos em 132 (47,8%) dos participantes. O sabonete destinado a adultos era utilizado por 103 (37,3%) crianças e o sabonete em barra por 220 (79,7%) delas. Protetor solar era utilizado diariamente por 53 (19,2%) participantes. Perfume foi utilizado por 182 (65,9%) integrantes da amostra, gel de cabelo por 98 (35,5%), esmalte por 62 (22,4%) e algum tipo de maquiagem por 71 (25,7%) - sombra em 30 (10,8%), batom em 52 (18,8%), pó facial e rímel em 13 (4,7%). A mediana de idade de início do uso de maquiagem foi de 4 anos. Tatuagem de hena foi realizada em oito crianças. Conclusões: As crianças estudadas utilizavam produtos inadequados para a sua pele, como os destinados à pele do adulto, e faziam uso incorreto do protetor solar e uso precoce de maquiagem, mostrando a importância da orientação médica.

The musculoskeletal impairment negatively impacts the quality of life of children and adolescents with psoriasis

Abstract Background The severity of nail disease, the presence of arthralgia and fatigue are predictors of development of psoriatic arthritis (PsA) in patients with psoriasis (Pso). In children, little is known about the musculoskeletal (MSK) impairment in patients with Pso and its effect on health-related quality of life (HRQoL). Objectives To determine the frequencies of pain and MSK inflammation (i.e., arthritis, enthesitis, and sacroiliitis) among children and adolescents with Pso and its relationship to HRQoL and fatigue. Methods Pediatric patients with Pso underwent a rheumatologic physical examination to evaluate synovitis, enthesalgia, sacroiliac joint (SIJ) pain and tender points of fibromyalgia. The core set of domains recommended by the GRAPPA - OMERACT to be measured in PsA studies was assessed. Ultrasound (US) was performed in clinical cases of enthesitis, and magnetic resonance imaging (MRI) was performed in cases of SIJ pain. Results Forty-three participants (10 ± 2.9 years old) were evaluated. Pain on palpation of the entheses was observed in 10 (23.2%) patients and pain on SIJ palpation was observed in 3 (7%). No patient presented with synovitis; one presented with enthesitis on US, but MRI did not confirm sacroiliitis in any case. Patients with MSK pain had greater skin disease severity (PASI 5.4 vs. 2, p < 0.01), worse fatigue, and lower HRQoL scores on all instruments used. The estimated risk of HRQoL impairment was eight times higher in the presence of MSK pain, which was an independent predictive factor. With a NAPSI greater than 30, the probability of pain was greater than 80%. Conclusion MSK pain is frequent among children with Pso, related to the severity of skin and nail disease, and negatively affects HRQoL. The typically used complementary exams might not detect the inflammatory process caused by Pso.(AU)

Metabolomic profiling suggests systemic signatures of premature aging induced by Hutchinson-Gilford progeria syndrome.

INTRODUCTION: Hutchinson-Gilford Progeria Syndrome (HGPS) is an extremely rare genetic disorder. HGPS children present a high incidence of cardiovascular complications along with altered metabolic processes and an accelerated aging process. No metabolic biomarker is known and the mechanisms underlying premature aging are not fully understood. OBJECTIVES: The present work aims to evaluate the metabolic alterations in HGPS using high resolution mass spectrometry. METHODS: The present study analyzed plasma from six HGPS patients of both sexes (7.7 ± 1.4 years old; mean ± SD) and eight controls (8.6 ± 2.3 years old) by LC-MS/MS in high-resolution non-targeted metabolomics (Q-Exactive Plus). Targeted metabolomics was used to validate some of the metabolites identified by the non-targeted method in a triple quadrupole (TSQ-Quantiva). RESULTS: We found several endogenous metabolites with statistical differences between control and HGPS children. Multivariate statistical analysis showed a clear separation between groups. Potential novel metabolic biomarkers were identified using the multivariate area under ROC curve (AUROC) based analysis, showing an AUC value higher than 0.80 using only two metabolites, and tending to 1.00 when increasing the number of metabolites in the AUROC model. Taken together, changed metabolic pathways involve sphingolipids, amino acids, and oxidation of fatty acids, among others. CONCLUSION: Our data show significant alterations in cellular energy use and availability, in signal transduction, and lipid metabolites, adding new insights on metabolic alterations associated with premature aging and suggesting novel putative biomarkers.