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1.
J Am Acad Dermatol ; 89(4): 795-801, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-35283243

RESUMO

The literature on hidradenitis suppurativa in sexual and gender minorities remains sparse. This review article aims to discuss critical factors for providers to consider in lesbian, gay, bisexual, transgender, queer, intersex, and asexual patients with hidradenitis suppurativa, including associated comorbidities, gender-affirming hormonal therapy, squamous cell carcinoma, infections in HIV-positive patients, and creating a welcoming clinic for sexual and gender minority patients.


Assuntos
Hidradenite Supurativa , Homossexualidade Feminina , Minorias Sexuais e de Gênero , Pessoas Transgênero , Feminino , Humanos , Hidradenite Supurativa/complicações , Hidradenite Supurativa/epidemiologia , Hidradenite Supurativa/terapia , Comportamento Sexual
2.
J Am Acad Dermatol ; 80(3): 581-589, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30744874

RESUMO

More than 10 million lesbian, gay, bisexual, and transgender (LGBT) persons live in the United States. Improving their health is a public health priority. LGBT persons have specific health concerns and face health care disparities. Awareness of those issues and disparities can enable dermatologists to provide medically appropriate and culturally competent care to LGBT patients. This review highlights terminology important in caring for LGBT persons, LGBT demographics in the United States, health care disparities faced by LGBT persons, and approaches to caring for LGBT patients.


Assuntos
Dermatologia/métodos , Disparidades em Assistência à Saúde , Assistência ao Paciente , Minorias Sexuais e de Gênero , Demografia , Identidade de Gênero , Disparidades nos Níveis de Saúde , Humanos , Comportamento Sexual , Terminologia como Assunto , Estados Unidos
3.
J Am Acad Dermatol ; 80(3): 591-602, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30744875

RESUMO

Lesbian, gay, bisexual, and transgender (LGBT) persons face important health issues relevant to dermatologists. Men who have sex with men (MSM) are at higher risk of certain infectious diseases, including HIV, syphilis and other sexually transmitted diseases (STDs), methicillin-resistant Staphylococcus aureus infections, and invasive meningococcal disease, and might be at higher risk of non-infectious conditions, including skin cancer. Recommendations for preventive health care, including screening for HIV and other STDs, sexual health-related vaccinations, and HIV pre-exposure prophylaxis, differ for MSM compared with non-MSM. Women who have sex with women experience disparities in STDs, including chlamydia and HPV. Transgender patients have unique, and often unmet, dermatologic needs during gender transition (also called gender affirmation), related to hormonal therapy and gender-affirming surgery. Familiarity with LGBT health issues and disease-prevention guidelines can enable dermatologists to provide medically appropriate and culturally competent care to LGBT persons.


Assuntos
Dermatologia/métodos , Homossexualidade Feminina , Homossexualidade Masculina , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/epidemiologia , Dermatopatias/diagnóstico , Dermatopatias/epidemiologia , Pessoas Transgênero , Feminino , Humanos , Masculino , Guias de Prática Clínica como Assunto , Infecções Sexualmente Transmissíveis/prevenção & controle , Dermatopatias/prevenção & controle
4.
Pediatr Dermatol ; 36(1): 169-171, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30318854

RESUMO

As the transgender community has become increasingly visible in public life, a greater awareness of this group's unique health needs and obstacles to optimal medical care has developed. Unfortunately, transgender youth face multiple barriers within the health care system, including access to equitable and gender-affirming care. As dermatologists who care for children and adolescents, we must be aware of the challenges facing transgender youth and work to correct the disparities that exist for this vulnerable group. An initial step in supporting our transgender patients is to advocate for changes to the iPLEDGE system for prescribing isotretinoin (and other Risk Evaluation and Mitigation Strategy systems), specifically requesting a change to its gender-binary categorization model that compromises an individual's right to self-identify. By promoting a gender-neutral patient categorization that is based instead upon reproductive potential, a simple change to the iPLEDGE program allows us to safely treat all of our patients requiring isotretinoin, while preserving our transgender patients' rights to self-determination and self-identification.


Assuntos
Acne Vulgar/tratamento farmacológico , Fármacos Dermatológicos/uso terapêutico , Isotretinoína/uso terapêutico , Padrões de Prática Médica , Pessoas Transgênero , Adolescente , Criança , Atenção à Saúde , Feminino , Identidade de Gênero , Disparidades em Assistência à Saúde/normas , Humanos , Masculino , Pediatras , Melhoria de Qualidade
5.
Aesthet Surg J ; 39(5): NP123-NP137, 2019 04 08.
Artigo em Inglês | MEDLINE | ID: mdl-30383180

RESUMO

BACKGROUND: Transgender patients may seek nonsurgical methods for facial masculinization and feminization as an adjunct or alternative to undergoing surgical procedures. OBJECTIVES: The authors reviewed the existing literature regarding this topic and provided an overview of nonsurgical techniques for facial masculinization and feminization. METHODS: A comprehensive literature search of the PubMed and MedLine databases was conducted for studies published through December 2017 for techniques and outcomes of nonsurgical facial masculinization and feminization. Keywords were used in performing the search. Data on techniques, outcomes, complications, and patient satisfaction were collected. RESULTS: Four articles fit our inclusion criteria. Given the lack of published literature describing facial injectables in transgender patients, data from the literature describing techniques in cisgender patients were utilized to supplement our review. CONCLUSIONS: Facial feminization can be achieved through injectables such as neurotoxin and fillers for lateral brow elevation, lip augmentation, malar augmentation, and improvement of rhytids. Facial masculinization can be achieved with injectables used for genioplasty, jawline augmentation, and supraorbital ridge augmentation. One must develop best practices for these techniques in the transgender patient population and increase awareness regarding nonsurgical options.


Assuntos
Preenchedores Dérmicos , Face/anatomia & histologia , Feminização , Pessoas Transgênero , Feminino , Humanos , Masculino
6.
J Am Acad Dermatol ; 74(2): 303-8, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26669479

RESUMO

BACKGROUND: There are an estimated 700,000 or more transgender people in the United States, however their dermatologic needs are not fully established in the medical literature. Unique needs relate to hormone therapy, prior surgeries, and other aspects of physical transitioning. OBJECTIVES: By examining attitudes and practices of transgender individuals, we aimed to identify areas for which dermatologists could contribute to their physical transformation. METHODS: This cross-sectional study used an anonymous online survey, distributed via lesbian, gay, bisexual, and transgender organizations; social media; and at targeted locations and events. RESULTS: A total of 327 people completed the survey (63% men, 29% women, 9% other). Most transgender women indicated that their face was most imperative to have changed, whereas men noted their chest, in turn influencing procedures. Of women's facial procedures, hair removal predominated, followed by surgery then injectables, mostly performed by plastic surgeons. Hormone-induced facial effects varied, usually taking over 2 years for maximal effect. When choosing procedures, money was the major barrier and good aesthetic outcome the primary concern. Participants did not think that facial procedures necessitate the currently accepted prerequisites for chest and genital surgery. LIMITATIONS: This study has limited size and convenience sampling. CONCLUSION: Dermatologists could contribute to the physical transformation of transgender patients through noninvasive procedures.


Assuntos
Técnicas Cosméticas , Dermatologia , Conhecimentos, Atitudes e Prática em Saúde , Papel do Médico , Procedimentos de Readequação Sexual , Pessoas Transgênero/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Técnicas Cosméticas/economia , Estudos Transversais , Estética , Face , Feminino , Guias como Assunto , Remoção de Cabelo , Hormônios/uso terapêutico , Humanos , Masculino , Mamoplastia , Pessoa de Meia-Idade , Procedimentos de Readequação Sexual/economia , Inquéritos e Questionários , Adulto Jovem
7.
Dermatol Online J ; 20(12)2014 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-25526340

RESUMO

A 67-year-old man with a three-year history of non-scarring alopecia that progressed to alopecia totalis despite intralesional glucocorticoid injections is presented. He developed 20-nail dystrophy that was recalcitrant to antifungal and anti-inflammatory treatments. Biopsy of the nail matrix showed histopathologic features of lichen planus. Alopecia totalis and isolated lichen planus of the nails are uncommon subtypes of common dermatologic disorders. Rarely reported concurrently, we provide a review of the literature of their association, which is most likely attributed to their autoimmune pathogeneses.


Assuntos
Alopecia/complicações , Líquen Plano/complicações , Doenças da Unha/complicações , Idoso , Humanos , Líquen Plano/patologia , Masculino , Doenças da Unha/patologia
8.
Proc Natl Acad Sci U S A ; 108(40): 16723-8, 2011 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-21933959

RESUMO

Ipilimumab, a monoclonal antibody against cytotoxic T lymphocyte antigen 4 (CTLA-4), has been shown to improve survival in patients with advanced metastatic melanoma. It also enhances immunity to NY-ESO-1, a cancer/testis antigen expressed in a subset of patients with melanoma. To characterize the association between immune response and clinical outcome, we first analyzed NY-ESO-1 serum antibody by ELISA in 144 ipilimumab-treated patients with melanoma and found 22 of 140 (16%) seropositive at baseline and 31 of 144 (22%) seropositive following treatment. These NY-ESO-1-seropositive patients had a greater likelihood of experiencing clinical benefit 24 wk after ipilimumab treatment than NY-ESO-1-seronegative patients (P = 0.02, relative risk = 1.8, two-tailed Fisher test). To understand why some patients with NY-ESO-1 antibody failed to experience clinical benefit, we analyzed NY-ESO-1-specific CD4(+) and CD8(+) T-cell responses by intracellular multicytokine staining in 20 NY-ESO-1-seropositive patients and found a surprising dissociation between NY-ESO-1 antibody and CD8 responses in some patients. NY-ESO-1-seropositive patients with associated CD8(+) T cells experienced more frequent clinical benefit (10 of 13; 77%) than those with undetectable CD8(+) T-cell response (one of seven; 14%; P = 0.02; relative risk = 5.4, two-tailed Fisher test), as well as a significant survival advantage (P = 0.01; hazard ratio = 0.2, time-dependent Cox model). Together, our data suggest that integrated NY-ESO-1 immune responses may have predictive value for ipilimumab treatment and argue for prospective studies in patients with established NY-ESO-1 immunity. The current findings provide a strong rationale for the clinical use of modulators of immunosuppression with concurrent approaches to favor tumor antigen-specific immune responses, such as vaccines or adoptive transfer, in patients with cancer.


Assuntos
Anticorpos Monoclonais/farmacologia , Antígenos de Neoplasias/imunologia , Linfócitos T CD8-Positivos/imunologia , Antígeno CTLA-4/imunologia , Melanoma/imunologia , Proteínas de Membrana/imunologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais/imunologia , Ensaio de Imunoadsorção Enzimática , Humanos , Imuno-Histoquímica , Ipilimumab , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Análise de Sobrevida
9.
Clin Cancer Res ; 16(15): 4057-65, 2010 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-20647477

RESUMO

PURPOSE: Prior studies show that i.m. injection of xenogeneic orthologues of melanosomal antigens (tyrosinase, gp100) induces CD8(+) T-cell responses to the syngeneic protein. To further define the optimal vaccination strategy, we conducted a pilot clinical trial comparing i.m. injection with particle-mediated epidermal delivery (PMED). EXPERIMENTAL DESIGN: Human leukocyte antigen (HLA)-A*0201(+) disease-free melanoma patients were randomized to the PMED or i.m. arm, receiving eight vaccinations over 4 months. Patients received 4 microg or 2,000 microg per injection, respectively, of mouse gp100 DNA. Peripheral blood mononuclear cells were collected, cultured with gp100 peptides, and analyzed by tetramer and intracellular cytokine staining for responses to HLA-A*0201-restricted gp100 epitopes [gp100(209-217) (ITDQVPFSV) and gp100(280-288) (YLEPGPVTA)]. RESULTS: Twenty-seven patients with stage IIB-IV melanoma were analyzable for immune response. The only common toxicity was grade 1 injection site reaction in nine patients with no intergroup difference, and one dose-limiting toxicity of acute hypersensitivity occurred in a PMED patient with undiagnosed gold allergy. Four of 27 patients produced gp100 tetramer(+)CD8(+) T cells, all carrying the CCR7(lo)CD45RA(lo) effector-memory phenotype. Five of 27 patients generated IFN-gamma(+)CD8(+) T cells, one who was also tetramer-positive. Overall, vaccination induced a response in 30% of patients, which was not significantly associated with study arm or clinical outcome. However, the PMED group showed a trend toward increased IFN-gamma(+)CD8(+) T-cell generation (P = 0.07). CONCLUSION: A comparable efficacy and safety profile was shown between the i.m. and PMED arms, despite a significantly decreased dose of DNA used for PMED injection.


Assuntos
Biolística , Vacinas Anticâncer/administração & dosagem , Vacinas Anticâncer/imunologia , Melanoma/terapia , Glicoproteínas de Membrana/administração & dosagem , Administração Intranasal , Adulto , Idoso , Animais , Antígenos Heterófilos/administração & dosagem , Antígenos Heterófilos/efeitos adversos , Linfócitos T CD8-Positivos/imunologia , Vacinas Anticâncer/efeitos adversos , DNA/administração & dosagem , DNA/efeitos adversos , DNA/imunologia , Feminino , Antígenos HLA-A , Antígeno HLA-A2 , Humanos , Estimativa de Kaplan-Meier , Masculino , Melanoma/mortalidade , Melanoma/patologia , Glicoproteínas de Membrana/efeitos adversos , Glicoproteínas de Membrana/imunologia , Camundongos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Fragmentos de Peptídeos , Peptídeos , Projetos Piloto , Vacinas de DNA/administração & dosagem , Vacinas de DNA/efeitos adversos , Vacinas de DNA/imunologia , Antígeno gp100 de Melanoma
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