36 results on '"Mario Cezar Pires"'
Search Results
2. Clinical Features and Disease Management in Adult Patients With Atopic Dermatitis Receiving Care at Reference Hospitals in Brazil: the ADAPT Study
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Ariana Campos Yang, D Richman, Mario Cezar Pires, V Aoki, O Lupi, R Fj Criado, Luisa Karla de Paula Arruda, S Silvi, and L Hz Fabricio
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Adult ,Male ,medicine.medical_specialty ,Immunology ,Comorbidity ,Omalizumab ,Disease ,Dermatitis, Atopic ,Tertiary Care Centers ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Adjuvant therapy ,Humans ,Immunology and Allergy ,030212 general & internal medicine ,Family history ,Disease burden ,Demography ,Asthma ,business.industry ,Pruritus ,Atopic dermatitis ,Immunoglobulin E ,medicine.disease ,Eosinophils ,Hospitalization ,030228 respiratory system ,Erythema ,Hypertension ,Disease Progression ,Female ,business ,Brazil ,Follow-Up Studies ,medicine.drug - Abstract
Background and objectives Atopic dermatitis is a chronic inflammatory skin disease with a prevalence of 0.02% to 8.1% in adults. Adult patients with moderate-to-severe atopic dermatitis have frequent relapses and significant disease burden. Objectives: Characterize clinical, immunological and therapeutic features of Brazilian adults with atopic dermatitis. Methods A multicenter, observational, retrospective, descriptive registry-based study, conducted at reference hospitals, between December 2016 and October 2017. Demographics, personal and family history of atopic diseases, clinical manifestations, laboratory tests, disease severity and management were collected. Results From the 187 subjects included in the analysis, 56.1% were female and 71.7% were Caucasian, with a mean age of 24.7 years. Mean follow-up duration was 9 years. Asthma or other allergic diseases were reported by 80.2% of the patients. The main comorbidity was hypertension (10.2%) and common disease manifestations included pruritus and erythema. Lesions were generally distributed in non-flexural and flexural areas, with typical morphology. Around 83% of patients had moderate to severe disease and 8.6% reported at least one hospitalization. Most patients received topical and/or systemic pharmacological therapies, including omalizumab (5.9%); 4.3% received phototherapy. Moreover, 66.8% of patients received adjuvant therapy and 79.1% changed or discontinued treatment for atopic dermatitis due to remission (46.5%), poor effectiveness (33.7%) or lack of therapeutic adherence (12.9%). Most patients presented characteristics of type 2 inflammation, with immunoglobulin E levels above 100 IU/mL (94.4%) and peripheral blood eosinophils above 5% (55.9%). Conclusion Brazilian adult patients with severe atopic dermatitis need treatments to efficiently control the disease and improve quality of life.
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- 2021
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3. Evaluation of depression, stress and quality of life indexes in patients with atopic dermatitis
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Cleide Rodrigues de Castro, Maria Elisa Bertocco Andrade, Renata Marli Gonçalves Pires, and Mario Cezar Pires
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medicine.medical_specialty ,Depression ,business.industry ,Eczema ,MEDLINE ,Dermatology ,Atopic dermatitis ,Anxiety ,medicine.disease ,Dermatitis, Atopic ,Quality of life ,RL1-803 ,Internal medicine ,Quality of Life ,Research Letter ,medicine ,Humans ,In patient ,business ,Depression (differential diagnoses) - Published
- 2021
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4. Consensus on the therapeutic management of atopic dermatitis - Brazilian Society of Dermatology*
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Zilda Najjar Prado de Oliveira, Valeria Aoki, Cláudia Márcia de Resende Silva, Roberto Takaoka, Daniel Lorenzini, Ana Maria Mosca de Cerqueira, Maria Cecília Rivitti-Machado, Silvia Souto-Mayor, Mariana Colombini Zaniboni, Mario Cezar Pires, Silmara da Costa Pereira Cestari, Magda Blessmann Weber, Cristina Marta Maria Laczynski, Francisca Regina Oliveira Carneiro, Raquel Leão Orfali, Andrea Machado Coelho Ramos, Tania F. Cestari, and Bernardo Gontijo
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Keratinocytes ,Skin barrier ,medicine.medical_specialty ,Venereology ,Consensus ,Administration, Topical ,Calcineurin Inhibitors ,MEDLINE ,Anti-Inflammatory Agents ,Atopic Dermatitis ,Dermatology ,Systemic therapy ,Ultraviolet therapy ,Severity of Illness Index ,Dermatitis, Atopic ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Anti-Infective Agents ,Adrenal Cortex Hormones ,Severity of illness ,medicine ,Humans ,Societies, Medical ,Atopic dermatitis ,Inflammation ,business.industry ,Interleukins ,General Medicine ,medicine.disease ,body regions ,030220 oncology & carcinogenesis ,RL1-803 ,Etiology ,Ultraviolet Therapy ,business ,Brazil - Abstract
BACKGROUND: Atopic dermatitis is a highly prevalent inflammatory and pruritic dermatosis with a multifactorial etiology, which includes skin barrier defects, immune dysfunction, and microbiome alterations. Atopic dermatitis is mediated by genetic, environmental, and psychological factors and requires therapeutic management that covers all the aspects of its complex pathogenesis. OBJECTIVES: The aim of this article is to present the experience, opinions, and recommendations of Brazilian dermatology experts regarding the therapeutic management of atopic dermatitis. METHODS: Eighteen experts from 10 university hospitals with experience in atopic dermatitis were appointed by the Brazilian Society of Dermatology to organize a consensus on the therapeutic management of atopic dermatitis. The 18 experts answered an online questionnaire with 14 questions related to the treatment of atopic dermatitis. Afterwards, they analyzed the recent international guidelines on atopic dermatitis of the American Academy of Dermatology, published in 2014, and of the European Academy of Dermatology and Venereology, published in 2018. Consensus was defined as approval by at least 70% of the panel. RESULTS/CONCLUSION: The experts stated that the therapeutic management of atopic dermatitis is based on skin hydration, topical anti-inflammatory agents, avoidance of triggering factors, and educational programs. Systemic therapy, based on immunosuppressive agents, is only indicated for severe refractory disease and after failure of topical therapy. Early detection and treatment of secondary bacterial and viral infections is mandatory, and hospitalization may be needed to control atopic dermatitis flares. Novel target-oriented drugs such as immunobiologicals are invaluable therapeutic agents for atopic dermatitis.
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- 2019
5. Clinical Characteristics of Frontal Fibrosing Alopecia in Brazil: A Series of 59 Patients
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Priscila Kakizaki, Carla Jorge Machado, Vanessa Barreto Rocha, Cidia Vasconcellos, Leticia Arse Contin, and Mario Cezar Pires
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Autoimmune disease ,medicine.medical_specialty ,Lichen planus pigmentosus ,business.industry ,Frontal fibrosing alopecia ,Medical record ,Brasil ,Eyebrow ,Lichen Planus ,Disease ,lcsh:RL1-803 ,medicine.disease ,Dermatology ,Pathophysiology ,Líquen Plano ,Body hair ,lcsh:Infectious and parasitic diseases ,medicine.anatomical_structure ,lcsh:Dermatology ,Medicine ,Alopecia/epidemiologia ,lcsh:RC109-216 ,business ,Brazil ,Alopecia/epidemiology - Abstract
Introduction: Clinical characteristics of frontal fibrosing alopecia (FFA) have been studied since its description in 1994 in Europe, North America and Australia, and the present study is the largest on FFA features in Latin America. Methods: This study, through questionnaire and medical records, describes characteristics of a Brazilian population of 59 patients with FFA, concerning clinical forms, individual features and use of cosmetic products. Results: Mean patients’ age was 58.4 years (range 35-84y). Duration of disease varied from six months to 20y (median 5y). Most women were postmenopausal (83.1%) and non-smokers (83.1%). Five percent had at least one associated autoimmune disease, most commonly hypothyroidism (13.6%). Six of 40 patients (15%) had lichen planus pigmentosus and ten had facial papules (25%). Eyebrow alopecia occurred in 50 (84.7%), and body hair loss in 47 (79.7%). Facial papules were more prevalent in premenopausal women. Conclusion: Studying FFA epide- miology may help understanding the pathophysiology of this epidemic disease and this study highlights similarities and differences to previously published studies in FFA, such as greater frequency in postmenopausal women, association with hypothyroidism and facial irritation with cosmetic products.
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- 2020
6. Consensus on the diagnostic and therapeutic management of chronic spontaneous urticaria in adults - Brazilian Society of Dermatology
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Andrea Machado Coelho Ramos, Celina Wakisaka Maruta, Luis Eduardo Agner Machado Martins, Bernardo Gontijo, Maria Cecília Rivitti-Machado, Alice de Oliveira de Avelar Alchorne, Patricia Karla de Souza, Mario Cezar Pires, Roberta Buense Bedrikow, Josemir Belo dos Santos, Raquel Leão Orfali, Maria Regina Cavariani Silvares, Renan Rangel Bonamigo, Zilda Najjar Prado de Oliveira, Roberta Fachini Jardim Criado, Paulo Ricardo Criado, Universidade de São Paulo (USP), Fac Med ABC, Universidade Federal de Pernambuco (UFPE), Univ Nove Julho, Universidade Federal de Minas Gerais (UFMG), Fac Evangel Curitiba, Universidade Estadual Paulista (Unesp), Hosp Padre Bento Guarulhos, Hosp Serv Publ Estadual Sao Paulo, Universidade Federal de São Paulo (UNIFESP), Univ Fed Rio Grande do Sul, Ambulatorio Dermatol Sanitaria, Santa Casa Porto Alegre, Santa Casa Misericordia Sao Paulo, and Santa Casa Misericardia Sao Paulo
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Adult ,medicine.medical_specialty ,Histamine H1 Antagonists, Non-Sedating ,Consensus ,Urticaria ,Antagonistas dos receptores histamínicos ,Population ,MEDLINE ,Cyclosporins ,Omalizumab ,Dermatology ,Urticaria/etiology ,Severity of Illness Index ,Histamine antagonists ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Severity of illness ,Anti-Allergic Agents ,medicine ,Humans ,Urticarial vasculitis ,Intensive care medicine ,education ,Societies, Medical ,Urticaria/therapy ,education.field_of_study ,business.industry ,Public health ,General Medicine ,Guideline ,medicine.disease ,Work-up ,Methotrexate ,030220 oncology & carcinogenesis ,RL1-803 ,Chronic Disease ,Cyclosporine ,business ,Dapsone ,Brazil ,Immunosuppressive Agents ,medicine.drug - Abstract
Made available in DSpace on 2019-10-04T12:38:20Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-03-01. Added 1 bitstream(s) on 2019-10-09T18:34:12Z : No. of bitstreams: 1 S0365-05962019000700056.pdf: 486399 bytes, checksum: a2e0a3f4581e4f634c104b420135972a (MD5) Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) BACKGROUND: Urticarias are frequent diseases, with 15% to 20% of the population presenting at least one acute episode in their lifetime. Urticaria are classified in acute ( 6 weeks). They may be induced or spontaneous. OBJECTIVES: To verify the diagnostic and therapeutic recommendations in chronic spontaneous urticaria (CSU), according to the experience of Brazilian experts, regarding the available guidelines (international and US). Methods: A questionnaire was sent to Brazilian experts, with questions concerning diagnostic and therapeutic recommendations for CSU in adults. RESULTS: Sixteen Brazilian experts answered the questionnaire related to diagnosis and therapy of CSU in adults and data were analyzed. Final text was written, considering the available guidelines (International and US), adapted to the medical practices in Brazil. Diagnostic work up in CSU is rarely necessary. Biopsy of skin lesion and histopathology may be indicated to rule out other diseases, such as, urticarial vasculitis. Other laboratory tests, such as complete blood count, CRP, ESR and thyroid screening. Treatment of CSU includes second-generation anti-histamines (sgAH) at licensed doses, sgAH two, three to fourfold doses (non-licensed) and omalizumab. Other drugs, such as, cyclosporine, immunomodulatory drugs and immunosuppressants may be indicated (non-licensed and with limited scientific evidence). CONCLUSIONS: Most of the Brazilian experts in this study partially agreed with the diagnostic and therapeutic recommendations of the International and US guidelines. They agreed with the use of sgAH at licensed doses. Increase in the dose to fourfold of sgAH may be suggested with restrictions, due to its non-licensed dose. Sedating anti-histamines, as suggested by the US guideline, are indicated by some of the Brazilian experts, due to its availability. Adaptations are mandatory in the treatment of CSU, due to scarce or lack of other therapeutic resources in the public health system in Brazil, such as omalizumab or cyclosporine. Univ Sao Paulo, Dermatol, Fac Med, Sao Paulo, SP, Brazil Fac Med ABC, Postgrad Program, Sao Paulo, SP, Brazil Univ Sao Paulo, Dept Dermatol, Fac Med, Sao Paulo, SP, Brazil Univ Fed Pernambuco, Recife, PE, Brazil Univ Nove Julho, Dermatol, Sao Paulo, SP, Brazil Univ Fed Minas Gerais, Dermatol Serv, Hosp Clin, Belo Horizonte, MG, Brazil Univ Fed Minas Gerais, Dermatol, Fac Med, Belo Horizonte, MG, Brazil Univ Fed Pernambuco, Dept Dermatol, Ctr Ciencias Med, Fac Med, Recife, PE, Brazil Fac Evangel Curitiba, Dermatol Serv, Curitiba, Parana, Brazil Univ Sao Paulo, Div Dermatol, Hosp Clin, Fac Meclicina, Sao Paulo, SP, Brazil Univ Estadual Paulista, Dept Dermatol & Radiotherapy, Botucatu, SP, Brazil Hosp Padre Bento Guarulhos, Training & Improvement Management, Sao Paulo, SP, Brazil Hosp Serv Publ Estadual Sao Paulo, Dermatol Serv, Sao Paulo, SP, Brazil Univ Fed Sao Paulo, Urticaria Outpatient Clin, Dept Dermatol, Sao Paulo, SP, Brazil Univ Fed Rio Grande do Sul, Dermatol Serv, Hosp Clin Porto Alegre, Fac Med, Porto Alegre, RS, Brazil Ambulatorio Dermatol Sanitaria, Porto Alegre, RS, Brazil Santa Casa Porto Alegre, Dermatol Serv, Porto Alegre, RS, Brazil Santa Casa Misericordia Sao Paulo, Dermatol Clin, Sao Paulo, SP, Brazil Santa Casa Misericardia Sao Paulo, Dermatol, Fac Ciencias Med, Sao Paulo, SP, Brazil Fac Med ABC, Sao Paulo, SP, Brazil Univ Estadual Paulista, Dept Dermatol & Radiotherapy, Botucatu, SP, Brazil CAPES: 001
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- 2019
7. Familial fibrosing frontal alopecia in six sisters
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Vanessa Barreto Rocha, Mario Cezar Pires, and Leticia Arsie Contin
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business.industry ,Biopsy ,Siblings ,Lichen Planus ,Alopecia ,Dermatology ,Middle Aged ,Fibrosis ,RL1-803 ,Medicine ,Humans ,Female ,Case Letter ,business ,Aged - Published
- 2018
8. Photopatch and patch testing in 63 patients with frontal fibrosing alopecia: a case series
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F.F. Brito, P. Moraes, Leticia Arsie Contin, Juliana Mariotti Guerra, Vanessa Barreto Rocha, Carla Jorge Machado, Priscila Kakizaki, D. Claudino, Mario Cezar Pires, and Aline Donati
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Adult ,Male ,medicine.medical_specialty ,Dermatology ,Cosmetics ,Patch testing ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Cicatrix ,0302 clinical medicine ,medicine ,Humans ,Photosensitivity Disorders ,Aged ,Skin ,business.industry ,Frontal fibrosing alopecia ,Alopecia ,Middle Aged ,Patch Tests ,medicine.disease ,Fibrosis ,030220 oncology & carcinogenesis ,Sunlight ,Female ,Eyebrows ,business - Abstract
Fund for Dermatology of Sao Paulo - Sebastiao Sampaio (FUNADERSP) from the Brazilian Society of Dermatology - Region of Sao Paulo State
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- 2018
9. Diphenciprone as a therapeutic alternative to exuberant periungual warts
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Caroline Paias Ribeiro, Bethânia Cabral Cavalli Swiczar, Mario Cezar Pires, and Bruno de Castro e Souza
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Cyclopropanes ,medicine.medical_specialty ,Adolescent ,business.industry ,Treatment outcome ,MEDLINE ,General Medicine ,Dermatology ,Fingers ,Nail Diseases ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Treatment Outcome ,0302 clinical medicine ,Text mining ,030220 oncology & carcinogenesis ,RL1-803 ,Humans ,Immunologic Factors ,Medicine ,Female ,Letters ,Warts ,business - Published
- 2018
10. Metástase cutânea de carcinoma folicular de tireóide mimetizando granuloma piogênico
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F. O. da Silva, Mario Cezar Pires, Neusa Yuriko Sakai Valente, Ticiana de Andrade Castelo Branco Diniz, and C. P. Ribeiro
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Pathology ,medicine.medical_specialty ,Pyogenic granuloma ,business.industry ,Dermatology ,medicine.disease ,Thyroid carcinoma ,Granuloma ,Follicular phase ,medicine ,Carcinoma ,Surgery ,Cutaneous metastasis ,business - Published
- 2018
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11. Lichen planopilaris-like eruption during treatment with tyrosine kinase inhibitor nilotinib
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Juliana Ribeiro Leitão, Priscila Kakizaki, Mario Cezar Pires, Isis Suga Veronez, and Neusa Yuriko Sakai Valente
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business.industry ,medicine.drug_class ,Myeloid leukemia ,Case Report ,Alopecia ,Imatinib ,Dermatology ,Protein-tyrosine kinases ,Tyrosine-kinase inhibitor ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Imatinib mesylate ,Nilotinib ,Mechanism of action ,RL1-803 ,Toxicity ,Cancer research ,Medicine ,030212 general & internal medicine ,medicine.symptom ,Lichen planus ,business ,Tyrosine kinase ,medicine.drug - Abstract
Tyrosine kinase inhibitors are effective as a target therapy for malignant neoplasms. Imatinib was the first tyrosine kinase inhibitor used. After its introduction, several other drugs have appeared with a similar mechanism of action, but less prone to causing resistance. Even though these drugs are selective, their toxicity does not exclusively target cancer cells, and skin toxicity is the most common non-hematologic adverse effect. We report an eruption similar to lichen planopilaris that developed during therapy with nilotinib, a second generation tyrosine kinase inhibitor, in a patient with chronic myeloid leukemia resistant to imatinib. In a literature review, we found only one report of non-scarring alopecia due to the use of nilotinib.
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- 2016
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12. Primary cutaneous aspergillosis and idiopathic bone marrow aplasia
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Juliana Cabral Nunes Chartuni, Neusa Yuriko Sakai Valente, Mario Cezar Pires, Karina Furlan, and Priscila Kakizaki
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0301 basic medicine ,medicine.medical_specialty ,Fatal outcome ,Anemia ,030106 microbiology ,Bone Marrow Aplasia ,Dermatology ,Skin infection ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Biopsy ,medicine ,Aspergillosis ,Bone marrow ,Severe neutropenia ,medicine.diagnostic_test ,business.industry ,medicine.disease ,Spores, fungal ,Surgery ,RL1-803 ,Images in Dermatology ,Primary cutaneous aspergillosis ,business ,Immunosuppression - Abstract
We describe the case of a 9-year-old boy with idiopathic bone marrow aplasia and severe neutropenia, who developed skin ulcers under cardiac monitoring electrodes. The diagnosis of primary cutaneous aspergillosis was made after the second biopsy and culture. Imaging investigation did not reveal internal fungal infection. The child was treated, but did not improve and died 3 months after admission. The report highlights and discusses the preventable risk of aspergillus skin infection in immunocompromised patients.
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- 2016
13. Clinical evaluation of the efficacy and safety of an active moisturizer-barrier repairer as an adjuvant treatment in atopic dermatitis in children
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Natalia Ivanoff dos Reis, Anita Rotter, Liliana Bechelli de Oliveira Torloni, Maria do Rosario Vidigal, Lucia Romanó Santos, and Mario Cezar Pires
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Skin barrier ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Dermatology ,Atopic dermatitis ,medicine.disease ,body regions ,Desquamation ,Dexchlorpheniramine ,medicine ,Surgery ,Objective evaluation ,Moisturizer ,medicine.symptom ,business ,Adjuvant ,Hydrocortisone ,medicine.drug - Abstract
The use of moisturizers improves the skin barrier’s function and might be useful in atopic dermatitis. Objectives: To assess the efficacy and safety of an active moisturizer-barrier repairer based on glycerin, erythritol, Imperata cylindrica and homarine as an adjuvant treatment in atopic dermatitis. Methods: Application of the moisturizer in children with mild to moderate atopic dermatitis for 1 month, with subjective and objective evaluations after 15 and 30 days. Results: Data from 35 children – 20 girls (57.15%), 15 boys (42.86%) / 26 Caucasians (74.29%), 6 mulattos (17.14%), 3 dark skinned (8.57%) – aged 1 to 10 years (mean age = 5.6) were analyzed. The values of the variables sleeping disorders, dryness, desquamation, pruritus and softness of the skin had significantly decreased on the 30th day of treatment as compared to the baseline. The objective evaluation of the severity using the Scoring Atopic Dermatitis severity index revealed a decrease to 9.30 from 25.27 (p
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- 2017
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14. Atopy patch test with Aleuroglyphus ovatus antigen in patients with atopic dermatitis
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Daniel Lorenzini, Cidia Vasconcellos, Mario Cezar Pires, Roberto Takaoka, Valeria Aoki, and R. L. Souza
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Dermatology ,Dermatitis, Atopic ,Aleuroglyphus ovatus ,Atopy ,Young Adult ,Antigen ,Respiratory Hypersensitivity ,medicine ,Mite ,Animals ,Humans ,In patient ,Antigens ,Respiratory system ,Child ,Acaridae ,biology ,business.industry ,Patch test ,Atopic dermatitis ,Patch Tests ,biology.organism_classification ,medicine.disease ,body regions ,Infectious Diseases ,Case-Control Studies ,Child, Preschool ,Immunology ,Female ,business - Abstract
Background Epicutaneous test made with dust mite antigens. Objective Evaluation of the response of the epicutaneous test with Aleuroglyphus ovatus antigen in atopic patients. Methods We patch tested 119 individuals, 48 with atopic dermatitis, 50 with respiratory allergy and 21 healthy controls. We compare the positive response frequency to a closed patch test using Aleuroglyphus ovatus antigen in different concentrations and 48 and 96h reading times among those individuals. Results Six patients with atopic dermatitis (12.5%) and 4 with respiratory atopy (8.0%) had positive reactions. None of the non-atopic controls had a positive response. As the antigen concentration raised, the number of positive reactions to epicutaneous test raised as well. Conclusion Our data suggest a positive relation between Atopy Patch Test positive responses and Aleuroglyphus ovatus antigen concentration, no matter the kind of the atopic clinical expression.
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- 2014
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15. Evaluation of dental material series from patients with dental prostheses and suspicion of delayed hypersensitivity
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Mario Cezar Pires, Victor do Espirito Santo Cunha, Fernanda Cortinhas Yoshimura, and Ruppert Ludwig Hahnstadt
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Adult ,Male ,Time Factors ,Erythema ,Dental prosthesis ,Dentistry ,Dermatology ,Patch tests ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Dental Materials ,0302 clinical medicine ,Predictive Value of Tests ,Prostheses and implants ,medicine ,Hypersensitivity ,Humans ,In patient ,Allergic contact dermatitis ,Aged ,Investigation ,Aged, 80 and over ,business.industry ,Patch test ,Reproducibility of Results ,030206 dentistry ,Allergens ,Middle Aged ,Patch Tests ,medicine.disease ,stomatognathic diseases ,Delayed hypersensitivity ,Predictive value of tests ,RL1-803 ,Dermatitis, Allergic Contact ,Etiology ,Female ,medicine.symptom ,business ,Skin tests ,Contact dermatitis ,Brazil - Abstract
BACKGROUND: Patients with oral sensitivity are common in our practice. Allergic contact dermatitis is one of the most frequent etiologies. OBJECTIVES: Evaluate oral contact dermatitis using the Brazilian standard series and complementary dental series in patients using dental prostheses, with or without oral complaints. Determine specific dental Brazilian series. METHODS: Patients using dental prostheses with or without oral complaints realized patch tests. Brazilian standard series and complementary dental series were used according to ICDRG recommendations. The results were analysed according to age, sex, race, atopic conditions and symptoms associated. RESULTS: From 54 patients tested, 34 (63%) were positive at least to one substance. Nineteen had oral complaints, such as burning mouth, itch or oral erythema. There was no association between atopic condition and tests results. Without the oral series, just 23(42,6%) patients had a positive result. Using the Brazilian standard series with the complementary dental series we improved the positivity of the patch test to 47%. CONCLUSION: In patients using prostheses and with oral complaints, patch tests with Brazilian standard series with complementary dental series improve the tests positivity.
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- 2016
16. Unusual manifestation of the yellow nail syndrome - Case report
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Jeane Jeong Hoon Yang, Francine Papaiordanou, Mario Cezar Pires, Mariana Yumi Miyaoka, and Marina Gabrielle Epstein
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Male ,Pathology ,medicine.medical_specialty ,Pleural effusion ,Case Report ,Dermatology ,medicine ,Nail diseases ,Humans ,Lymphedema ,Dystrophic nails ,skin and connective tissue diseases ,Skin ,integumentary system ,business.industry ,Yellow nail syndrome ,Abdominal Wall ,Middle Aged ,medicine.disease ,Pleural Effusion ,body regions ,medicine.anatomical_structure ,Nail disease ,RL1-803 ,Abdomen ,Lymph ,Tomography, X-Ray Computed ,business - Abstract
The yellow nail syndrome is a rare disorder characterized by the classic triad of yellow and dystrophic nails, lymphedema and pleural effusion. We report in this paper a case of yellow nail syndrome, presenting the classic triad of the disease, associated with an unusual lymph accumulation in the abdomen region.
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- 2014
17. Avaliação da eficácia e segurança do tacrolimo pomada 0,03% no tratamento da dermatite atópica em pacientes pediátricos
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Roberto Takaoka, Ida Duarte, Cintia Sayuri Kurokawa La Scala, Tania F. Cestari, Bernardo Gontijo, José Alexandre de Souza Sittart, Mario Cezar Pires, Wilson Tartuce Aun, Silmara da Costa Pereira Cestari, and Zilda Najjar Prado de Oliveira
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Body surface area ,medicine.medical_specialty ,business.industry ,Dermatology ,Atopic dermatitis ,medicine.disease ,Tacrolimus ,medicine ,Severe atopic dermatitis ,Itching ,medicine.symptom ,Adverse effect ,business - Abstract
FUNDAMENTOS - Tacrolimo pomada é eficaz no tratamento da dermatite atópica. OBJETIVOS - Avaliar a eficácia e segurança do tacrolimo pomada 0,03% (Protopic®) no tratamento de pacientes pediátricos com dermatite atópica. MÉTODOS - Estudo multicêntrico, aberto e não comparativo. Incluídos 174 pacientes (dois a 10 anos)com dermatite atópica. Utilizou-se tacrolimo duas vezes ao dia, por seis semanas. O critério primário de eficácia foi a melhora clínica > a 90% avaliada pelo médico (Escala de Avaliação Global da Resposta Clínica). Outros critérios de eficácia foram a redução no índice de área e gravidade do eczema (EASI), a redução do percentual de superfície corporal afetada (%BSA) e a avaliação do prurido pelo paciente (escala analógica visual). Segurança foi avaliada pela ocorrência de eventos adversos relatados pelos pais e pacientes ou pelos investigadores. RESULTADOS - Trinta e três por cento dos pacientes apresentaram melhora clínica >90%. Quando avaliado o escore EASI, houve redução de 45,5% (primeira semana) e 61,8% (sexta semana) quando comparado com o basal (p
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- 2008
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18. Comparative study of patch test using traditional method vs. prior skin abrading
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Mario Cezar Pires, Maria de Fátima M. Fernandes, J F de Mello, and M C M Vizeu
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Adult ,Male ,medicine.medical_specialty ,Pathology ,Adolescent ,Relevance analysis ,Concordance ,Dermatology ,Dermatitis, Contact ,Nickel sulphate ,Sensitivity and Specificity ,Gastroenterology ,Statistical significance ,Internal medicine ,Humans ,Medicine ,Surgical Tape ,Child ,Allergic contact dermatitis ,Aged ,Chi-Square Distribution ,business.industry ,Significant difference ,Patch test ,Middle Aged ,Patch Tests ,medicine.disease ,Infectious Diseases ,Female ,business ,Chi-squared distribution - Abstract
Summary Background The patch test is an essential procedure for the investigation of aetiologic diagnosis of allergic contact dermatitis, although it is not yet able to fully reproduce the events of the initial site of contact with the allergen. Objectives The aims of the present study are (i) to assess whether removal of the superficial corneous layer results in test positivity differences vs. the traditional technique, (ii) to assess the probable and/or possible and past and/or present sensitivity and relevance for each method, and (iii) to compare specific relevance of nickel sulphate for each method. Results Concordance of positive reactions was 75.9% (66 of 87), with 21.8% (19 of 87) positivity results on the abraded side only and 2.3% (2 of 87) on the unabraded side (P
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- 2007
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19. Epidermodysplasia Verruciformis in a young man with HIV since birth - Case report*
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Sônia Maria Fonseca de Andrade, Sheila Itamara Ferreira do Couto Meireles, Cristiano Luiz Horta de Lima Júnior, and Mario Cezar Pires
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Male ,Cellular immunity ,Human immunodeficiency virus (HIV) ,Case Report ,HIV Infections ,Dermatology ,medicine.disease_cause ,Virus ,DNA probes, HPV ,Young Adult ,medicine ,Humans ,In patient ,Skin ,Hpv types ,business.industry ,Transmission (medicine) ,Immunity, cellular ,Genodermatosis ,virus diseases ,HIV ,Epidermodysplasia verruciformis ,medicine.disease ,Virology ,female genital diseases and pregnancy complications ,RL1-803 ,Epidermodysplasia Verruciformis ,business - Abstract
Epidermodysplasia Verruciformis is a genodermatosis characterized by susceptibility to infection by specific HPV types (HPV 3/10 and beta-HPVs). It is considered to be the first model in human carcinogenesis induced by HPV. In this report we present a rare case of Epidermodysplasia Verruciformis associated with vertical transmission of HIV. Although most patients with HIV present infections by HPV virus, the frequency of Epidermodysplasia Verruciformis is no greater in patients with HIV because in EV there is a deficiency of specific cellular immunity to infection by some types of HPV, called HPV-related Epidermodysplasia Verruciformis.
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- 2013
20. Severe Darier's disease in a psychiatric patient
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Mario Cezar Pires, Medéia Carolina Fernandes Pereira, Roberta Simão Lopes, Jeane Jeong Hoon Yang, and Antônio José Tebcherani
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medicine.medical_specialty ,Bipolar Disorder ,Case Report ,Disease ,Dermatology ,Gene mutation ,Mental disorders ,Severity of Illness Index ,Darier Disease ,medicine ,Darier's disease ,Humans ,Bipolar disorder ,Genetic pleiotropy ,Darier’s disease ,Psychiatry ,Depression (differential diagnoses) ,Skin ,business.industry ,Genodermatosis ,Middle Aged ,medicine.disease ,medicine.anatomical_structure ,Scalp ,RL1-803 ,Mutation ,Female ,business - Abstract
Darier’s disease is characterized by dense keratotic lesions in the seborrheic areas of the body such as scalp, forehead, nasolabial folds, trunk and inguinal region. It is a rare genodermatosis, an autosomal dominant inherited disease that may be associated with neuropsichiatric disorders. It is caused by ATPA2 gene mutation, presenting cutaneous and dermatologic expressions. Psychiatric symptoms are depression, suicidal attempts, and bipolar affective disorder. We report a case of Darier’s disease in a 48-year-old female patient presenting severe cutaneous and psychiatric manifestations.
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- 2014
21. Systemic antibiotics in acne
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Mario Cezar Pires and José Alexandre de Souza Sittart
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medicine.medical_specialty ,medicine.drug_class ,business.industry ,Antibiotics ,Dermatology ,Inflammatory acne ,Pharmacology ,Super infection ,medicine.disease ,Antibiotic resistance ,Systemic antibiotics ,medicine ,business ,Acne - Abstract
Systemic antibiotics have bacteriostatic and anti-inflammatory effects and are mainly indicated in cases of moderate or severe inflammatory acne, and papulopustulous and conglobate acne. Tetracyclines are the preferred choice, followed by macrolides. Other options include sulfonamides and quinolones. It is important that systemic antibiotics are selected and used according to strict criteria in order to avoid the development of super-infection and bacterial resistance.
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- 2006
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22. Atrophia maculosa varioliformis cutis: a case with extrafacial involvement and familial facial lesions
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JR Pegas, A Tebecherani, Mario Cezar Pires, M Sueto, Paulo Ricardo Criado, and AC Souza
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medicine.medical_specialty ,Infectious Diseases ,Atrophia maculosa varioliformis cutis ,business.industry ,medicine ,Dermatology ,business ,medicine.disease - Published
- 2005
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23. Avaliação do teste de contato com aeroalérgenos em pacientes com dermatite atópica
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João Ferreira Melo, Ruppert Ludwig Hahnstadt, Mario Cezar Pires, F. Montealegre, and Rosana Neves dos Santos Rodrigues
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Gynecology ,medicine.medical_specialty ,business.industry ,Dermatophagoides pteronyssinus ,medicine ,Patch test ,In patient ,Dermatite atópica ,Dermatology ,Atopic dermatitis ,medicine.disease ,business ,Hipersensibilidade - Abstract
FUNDAMENTOS: a dermatite atópica é uma doença inflamatória cutânea que apresenta múltiplos fatores desencadeantes. Há vários relatos de autores que confirmaram os aeroalérgenos como fatores agravantes ou desencadeantes. O teste de contato com aeroalérgenos ou teste de contato atópico foi proposto para avaliar a participação destes alérgenos na dermatite atópica. OBJETIVO: objetivo deste estudo foi avaliar a positividade do teste de contato atópico em pacientes com dermatite atópica. MÉTODOS: Avaliamos 50 pacientes com dermatite atópica e 45 do grupo com rinite alérgica, nos quais realizamos teste de contato atópico com extratos de Dermatophagoides pteronissynus, Dermatophagoides farinae e Blomia tropicalis, além de testes cutâneos de leitura imediata para os mesmos alérgenos, acrescidos de epitélio de cão e gato e fungos. RESULTADOS: verificamos que o teste de contato atópico com ácaros apresentou maior positividade nos indivíduos do grupo de dermatite atópica quando comparado ao grupo de rinite alérgica. CONCLUSÕES: o teste de contato atópico apresenta resultados estatisticamente significativos quando realizado com ácaros, em pacientes com dermatite atópica, com p=0,035, OR (odds ratio) = 3,35 e IC(95%) = [ 1,18; 9,47].
- Published
- 2011
24. Rhinofacial zygomycosis caused by Conidiobolum coronatus
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José Roberto Pereira Pegas, V M dos Reis, Luiz Carlos Cucé, Alexandra R. Costa, Helena Muller, E. Porto, C. Da S. Lacaz, Maria Conceição Rodrigues, and Mario Cezar Pires
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medicine.medical_specialty ,Veterinary (miscellaneous) ,Conidiobolus coronatus ,Nose ,Applied Microbiology and Biotechnology ,Microbiology ,Recurrence ,medicine ,Edema ,Humans ,Fluconazole ,Mycosis ,Aged ,biology ,business.industry ,Fungi ,medicine.disease ,biology.organism_classification ,Dermatology ,Agricultural Workers' Diseases ,Ketoconazole ,medicine.anatomical_structure ,Mycoses ,Face ,Order Entomophthorales ,Female ,Zygomycosis ,business ,Agronomy and Crop Science ,Brazil ,medicine.drug - Abstract
A case of rhinofacial zygomycosis with of years duration, caused by Conidiobolus coronatus is described. The patient, a 72-years-old woman, presented with a bilateral distortion of the subcutaneous tissue and disfigurement of the face. Treatment with ketoconazole and potassium iodide did not prevent several relapses. At present she is still under treatment with fluconazole with clinical healing. Histopathological and mycological examination confirmed the dermatological diagnosis. An increasing number of cases of zygomycosis caused by fungi of the order Entomophthorales have also been reported in the Northern and Northeastern States of Brazil.
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- 1991
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25. Alergia ao látex em profissionais de saúde de São Paulo, Brasil
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Mario Cezar Pires, Leticia Nunes Montalvão, and João Ferreira de Mello
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Pediatrics ,medicine.medical_specialty ,Allergy ,Latex ,Epidemiology ,Population ,Frequency of use ,Dermatology ,Látex ,Hipersensibilidade imediata ,Atopy ,Environmental health ,Medicine ,Statistical analysis ,education ,Epidemiologia ,education.field_of_study ,business.industry ,Hipersensibilidade ao látex ,medicine.disease ,Hypersensitivity, immediate ,Past history ,Latex hypersensitivity ,Specific antibody ,Latex allergy ,business - Abstract
FUNDAMENTOS: Alergia ao látex é comum em trabalhadores da saúde, resultando em absenteísmo e afastamento das atividades profissionais. Há no Brasil poucos estudos publicados sobre o assunto. Enquanto na população geral a prevalência de alergia ao látex é menor que 2%, nos profissionais de saúde pode chegar a 30%. OBJETIVO: Estudar a prevalência de alergia ao látex em profissionais de saúde do Hospital do Servidor Público Estadual de São Paulo. MÉTODOS: Foi aplicado questionário aberto a profissionais que têm contato com luvas de borracha em todos os serviços do hospital. Foi colhido sangue daqueles que referiram sintomas e dosado anticorpo IgE específico por meio do ImmunoCAP. Para análise estatística utilizaram-se porcentagens, tabelas e teste qui-quadrado. RESULTADOS: Foram distribuídos 2.349 questionários, e respondidos 1.045, dos quais 129 referiram correlação entre uso de látex e sintomas sugestivos de alergia, e 54 permitiram a coleta de sangue para determinação de IgE específica. Neste grupo houve dois casos em que foi demonstrado anticorpo específico, estabelecendo-se prevalência de 3,7% de alergia ao látex. Fatores como gênero, profissão, freqüência de contato com luvas, setor de trabalho e antecedentes de atopia foram relacionados com maior prevalência de alergia ao látex. CONCLUSÃO: A prevalência de alergia ao látex encontrada foi de 3,7%. BACKGROUND: Latex allergy is common among healthcare workers and leads to absence from work and withdraw from professional activities. There are few studies published in Brazil on this subject. In the general population the prevalence of allergy to latex is less than 2%, whereas in healthcare workers it may reach 30%. OBJECTIVE: To study the prevalence of latex allergy in healthcare workers at the Hospital do Servidor Público Estadual de São Paulo. METHODS: A self-administered questionnaire was distributed to healthcare professionals from any sector of the hospital who have contact with rubber gloves. Blood was drawn from those who referred symptoms, for analyses of serum antilatex IgE antibody by Immunocap assay. Percentages, tables and the chi-square test were used for statistical analysis. RESULTS: A total of 2349 questionnaires were distributed, and 1045 were answered. In that, 129 reported association between latex and allergy symptoms and 54 out of them agreed to blood collection for specific IgE determination. Specific antibody was demonstrated in tow cases, determining a prevalence of 3.7% of latex allergy. Gender, occupation, frequency of use of gloves, work sector and past history of atopy were related to greater prevalence of latex allergy. CONCLUSION: The prevalence of latex allergy found was 3.7%.
- Published
- 2008
26. Epidermodisplasia verruciforme: tratamento combinado com acitretina e interferon alfa-2a
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Cristiana Silveira Silva, Mario Cezar Pires, Rodrigo de Oliveira Ramos, and José Alexandre de Souza Sittart
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medicine.medical_specialty ,Epidermodisplasia verruciforme ,business.industry ,Acitretina ,Interferon alfa-2a ,Dermatology ,Epidermodysplasia verruciformis ,Histopathological examination ,medicine.disease ,Acitretin ,Combined treatment ,Interferon ,Medicine ,business ,Interferon Alpha 2a ,medicine.drug - Abstract
We report the result of a treatment with acitretin and alpha-2a interferon in a 16-year-old boy with epidermodysplasia verruciformis. Diagnosis was based on clinical features, histopathological examination and positivity for in situ HPV. The affection was extensive and resistant to other treatment modalities, with a high risk of development of neoplasias. Treatment with oral acitretin associated with subcutaneous recombinant interferon alpha-2a three times per week induced improvement, which was sustained for 16 months of follow-up.
- Published
- 2006
27. Ceratodermia palmoplantar de Unna-Thost associada a pseudo-ainhum: relato de um caso
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José Roberto Pereira Pegas, Luciana Valentini de Melo Cesarini, Helena Muller, Vitor Manuel Silva dos Reis, Marco Antônio de Oliveira, and Mario Cezar Pires
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medicine.medical_specialty ,ceratodermia palmar e plantar ,business.industry ,keratoderma, palmoplantar ,Medicine ,Dermatology ,ainhum ,business ,Hereditary palmoplantar keratoderma - Abstract
Os autores relatam um caso de ceratodermia palmoplantar hereditária de Unna-Thost, de apresentação clínica atípica, bem como complicação do tipo estrangulamento ainhumóide no quinto dedo de ambos os pés. Os autores citam ainda outras ceratodermias palmoplantares hereditárias que podem cursar com pseudo-ainhum, bem como os critérios clínicos básicos que diferenciam essas manifestações. The authors report a case of hereditary palmoplantar keratoderma, Unna-Thost type, demonstrating some atypical features when compared to descriptions found in the literature. The case study also includes pseudoainhum on both fifth toes. The authors describe other hereditary palmoplantar keratodermas that may also present with pseudoainhum, and demonstrate the basic clinical criteria that they share.
- Published
- 2004
28. Urticária e doenças sistêmicas
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Roberta Fachini Jardim Criado, Mario Cezar Pires, J. F. de Mello, Paulo Ricardo Criado, Wilson Tartuce Aun, and J. A. De Souza Sittart
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Disease ,medicine.disease_cause ,Autoimmunity ,Pathogenesis ,immune system diseases ,Urticária crônica ,Medicine ,Systemic diseases ,skin and connective tissue diseases ,Urticária ,Chronic urticaria ,lcsh:R5-920 ,Doenças sistêmicas ,biology ,Angioedema ,business.industry ,General Medicine ,Helicobacter pylori ,biology.organism_classification ,Immunology ,Etiology ,medicine.symptom ,lcsh:Medicine (General) ,business - Abstract
Chronic urticaria and concurrent angioedema are disappoiting problems for both physicians and patients. The disease can result from multiple causes and probably does not have a single etiology. Several factors have been identified that appear to be important in the pathogenesis of individual cases, some drugs, food additives, physical factors and internal diseases. In some cases no pathogenesis are identified and those cases are classified as idiopathic. In recent years several articles has emphasized autoimmunity and infections due to Helicobacter pylori. Our article reviewed the etiology of chronic urticaria at current concepts.
- Published
- 1999
29. Pigmented contact dermatitis due to Plathymenia foliosa dust
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Mario Cezar Pires, Renata Mitelmann, Vitor Manoel Silva dos Reis, and Fatima Moreira
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Adult ,Male ,medicine.medical_specialty ,Allergy ,Dermatology ,Immunopathology ,Occupational Exposure ,Immunology and Allergy ,Medicine ,Humans ,Plathymenia ,Plants, Medicinal ,biology ,business.industry ,Dust ,Fabaceae ,Patch Tests ,biology.organism_classification ,medicine.disease ,Wood ,Surgery ,Dermatitis, Occupational ,Toxicity ,Dermatitis, Allergic Contact ,Occupational exposure ,business ,Phototoxicity ,Contact dermatitis ,Pigmentation Disorders - Published
- 1999
30. CONTACT DERMATITIS IN CHILDREN
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Rosana Neves dos Santos Rodrigues and Mario Cezar Pires
- Subjects
medicine.medical_specialty ,business.industry ,medicine ,Immunology and Allergy ,Dermatology ,medicine.disease ,business ,Contact dermatitis - Published
- 2005
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31. Nonoccupational Allergic Contact Dermatitis to Cashew Nut Simulating Photosensitivity Eczema
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Mario Cezar Pires, W. T. Aun, Roberta Fachini Jardim Criado, J. F. Mello, Cidia Vasconcellos, Paulo Ricardo Criado, F. Malamam, and Luis Felipe Ensina
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medicine.medical_specialty ,Photosensitivity ,business.industry ,Immunology and Allergy ,Medicine ,Dermatology ,Cashew nut ,business ,medicine.disease ,Allergic contact dermatitis - Published
- 2002
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32. CONTACT DERMATITIS TO LATANOPROST
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Rosana Neves dos Santos Rodrigues and Mario Cezar Pires
- Subjects
medicine.medical_specialty ,chemistry.chemical_compound ,chemistry ,business.industry ,Immunology and Allergy ,Medicine ,Dermatology ,Latanoprost ,business ,medicine.disease ,Contact dermatitis - Published
- 2005
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33. Epitope spreading\' phenomena: clínical and immunopathological characterization in patients with bullous dermatosis
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Livia Delgado, Valeria Aoki, Zilda Najjar Prado de Oliveira, Mario Cezar Pires, Mirian Nacagami Sotto, and Neusa Yuriko Sakai Valente
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business.industry ,Medicine ,business - Abstract
INTRODUÇÃO: As dermatoses bolhosas autoimunes são um grupo heterogêneo de afecções da pele e/ou mucosas associadas à produção de autoanticorpos dirigidos às moléculas de adesão epitelial. Podem ser classificadas em dermatoses bolhosas intraepidérmicas (pênfigos) ou subepidérmicas (penfigóides, epidermólise bolhosa adquirida). Nos últimos anos, a transição entre dermatoses bolhosas autoimunes ou coexistência de autoanticorpos de diferentes dermatoses têm sido relatadas em alguns pacientes e atribuída ao fenômeno de epitope spreading (ES): a diversificação de epítopos reconhecidos pelo sistema imune evocaria uma reação secundária a antígenos distintos e não relacionados aos da doença primária. Neste trabalho avaliamos a ocorrência de fenômenos de ES em pacientes portadores de pênfigo. CASUÍSTICA E MÉTODOS: Inicialmente, foi realizada análise de dados clínicos e laboratoriais (exame histopatológico, de imunofluorescência direta-IFD, indireta IFI e ELISA) de 351 pacientes portadores de pênfigos acompanhados no Ambulatório de dermatoses bolhosas autoimunes do Departamento de Dermatologia da Faculdade de Medicina da Universidade de São Paulo no período de dezembro de 2002 a dezembro de 2012. Foram selecionados pacientes com quadro sugestivo de conversão à dermatose bolhosa distinta da doença primária. RESULTADOS: Nove pacientes apresentaram sinais sugestivos de fenômeno de ES e foram incluídos no estudo: 8 com a conversão de Pênfigo vulgar (PV) a foliáceo (PF) 2,3% (grupo1) e um de PF a Epidermólise bolhosa adquirida (EBA) 0,3% (grupo 2). No grupo 1 o intervalo mediano para a conversão foi de 3,5 anos. Cinco pacientes apresentaram modificação histopatológica de clivagem intraepidérmica na camada suprabasal para clivagem na camada subcórnea durante a suspeita de ES; 2 apresentaram clivagem na camada epidérmica média durante a transição e um manteve clivagem suprabasal, apesar de quadro clínico sugestivo de PF. Todos os pacientes apresentavam depósitos intercelulares de IgG e/ou C3 durante o diagnóstico de PV e PF à IFD. Títulos de IFI variaram de 1:160 a 1:5120. Os valores de ELISA para Dsg1 variaram de 22 a 319; e para Dsg3 de 0.4 a 224 (positivo se > 20). A relação Dsg1/Dsg3 correspondeu à mudança PV-PF. No grupo 2, o ES para EBA ocorreu sete anos após o diagnóstico de inicial de PF. No momento da suspeita de ES o paciente apresentava-se em remissão clínica do quadro de pênfigo folíaceo. A avaliação laboratorial mostrou clivagem subepidérmica neutrofílica, IFD com IgG intercelular intraepidérmica e depósitos de IgM, IgA, IgG e C3 na zona da membrana basal. IFI com técnica de salt split skin revelou depósitos de IgG do lado dérmico. Ao immunobloting houve reconhecimento de colágeno VII e ELISA para Dsg1 foi positivo. CONCLUSÃO: A frequência de ES em pacientes portadores de pênfigo foi de 2,6%. Estudos serão necessários para elucidar a patogênese deste evento e sua importância na progressão dos pênfigos BACKGROUND: Autoimmune bullous skin diseases represent a heterogeneous group of disorders of skin and mucosa associated with autoantibodies against distinct adhesion molecules. They can be classified, based on the level of loss of adhesion in intraepidermal and sub epidermal dermatosis. The shift from an autoimmune blistering disease to another has been recently described and attributed to the \"epitope spreading\" (ES) phenomena. It occurs when a primary inflammatory/autoimmune process releases \"hidden\" epitopes which are recognized by the lymphocytes and evoke a secondary reaction to antigens distinct from, and non-cross-reactive, with the disease causing-epitope. This study attempted to characterize the occurrence of ES in pemphigus patients. METHODS: We analyzed data from 351 pemphigus patients treated ambulatorially at the Department of Dermatology, Faculty of Medicine, University of São Paulo, from December 2002 to December 2012. A careful search for clinical and laboratorial (histopathology, direct-DIF and indirect-IIF immunofluorescence, ELISA) changes suggestive of shift to a secondary bullous disease was performed. RESULTS: Nine out of 351 patients presented clínical shift and were included in the study: eight from pemphigus vulgaris (PV) to foliaceus (PF) 2.3% (group 1) and one from PF to epidermolysis bullosa acquisita (EBA) 0.3% (group 2). In group 1, median interval of disease shift was 3.5 years. Of 8 patients with clinical PF, five showed change of histopathology pattern from suprabasilar cleavage to subcorneal acantholysis, two had cleavage within the middle epidermal layer, and one sustained the suprabasilar acantholysis. One shifted back to PV after clinical and histopatological changes of PF. All patients showed intercellular IgG and/or C3 deposits during PV and PF diagnosis by DIF. IIF titers varied from 1:160 to 1:5120. ELISA index for Dsg1 varied from 22 to 319; and for Dsg3 from 0.4 to 224 (positive if > 20). Dsg1/Dsg3 indexes corresponded to the clinical PV-PF changes. In group 2, onset of PF occurred at the age of 25, and ES to EBA 7 years later in the absence of PF lesions. Laboratory evaluation showed sub epidermal cleavage with neutrophils, IgG intercellular staining in the epidermis and IgM, IgA, IgG and C3 deposits at BMZ by DIF, IgG deposits by indirect salt-split, recognition of collagen VII by immunoblotting, and positive ELISA for Dsg1. CONCLUSIONS: Intermolecular ES occurred in 2.6% (9/351) of pemphigus patients. Futures studies will be necessary to elucidate the pathogenesis of this event and its significance in pemphigus progression
- Published
- 2016
34. Painel imunoistoquímico para distinção entre tricoepitelioma e carcinoma basocelular desenvolvido utilizando a técnica do TMA
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Antonio José Tebcherani, Mirian Nacagami Sotto, Cyro Festa Neto, Mario Cezar Pires, Sheila Aparecida Coelho Siqueira, and Cidia Vasconcellos
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business.industry ,Medicine ,business - Abstract
O diagnóstico das neoplasias cutâneas do folículo piloso, particularmente do tricoepitelioma (TE), frequentemente representa dificuldade diagnóstica com o carcinoma basocelular (CBC). As semelhanças clínicas e histopatológicas somadas aos artefatos de amostragem (amostras exíguas por biopsias incisionais ou parcialmente danificadas por esmagamento ou fulguração) podem provocar situações de dificuldade na diagnose diferencial entre as duas neoplasias. O diagnóstico de certeza é importante, pois o CBC tem caráter agressivo local e, quando não totalmente excisado, infiltra os tecidos adjacentes. O TE é uma lesão benigna, sem capacidade de invasão local, não havendo recomendação de excisão com margem cirúrgica. Vários marcadores imunoistoquímicos têm sido propostos na literatura médica para auxiliar no diagnóstico diferencial entre o TE e o CBC. Esses estudos, entretanto, têm resultados conflitantes que podem estar relacionados à pequena casuística avaliada, que geralmente não excede 50 casos de TE. A técnica do arranjo em matriz de amostras teciduais, tissue microarray (TMA), permite a avaliação de um número grande de amostras teciduais, que podem ser submetidas de modo simultâneo aos procedimentos das reações imunoistoquímicas. O objetivo do presente estudo foi o de submeter uma ampla amostra de TE e CBC, obtida através da técnica de TMA, aos marcadores imunoistoquímicos descritos, com a finalidade de identificar um marcador, ou painel de marcadores, capaz de auxiliar a diferenciação do TE do CBC. Cortes histológicos de quatro blocos de TMA representando espécimes de 162 TE e 328 CBC foram submetidos às reações imunoistoquímicas com os anticorpos CD34, BCL-2, CD 10, antígeno de membrana epitelial (EMA), citoqueratinas (CK) 20 e 15, D2-40 e 34 E12. A fim de facilitar a avaliação dos resultados e padrões de expressão antigênica, os espécimes foram digitalizados para obtenção de lâminas histológicas virtuais. Estas foram analisadas por meio de um programa de computador. Fez-se inicialmente a análise dos resultados de 85 TE e 62 CBC representados no primeiro bloco de TMA. Esta verificação identificou a expressão dos marcadores CD34, CD10, EMA, CK15, CK20 e D2-40 com diferença significativa entre os TE e os CBC. Procedeu-se a seguir a avaliação da imunomarcação de toda a casuística. As análises estatísticas de regressão linear multifatorial e regressão logística multifatorial indicaram os marcadores e padrões de expressão em ordem decrescente de importância: D2 40 positivo em células tumorais periféricas, CK 15 positivo em células tumorais periféricas, CD10 positivo no estroma tumoral, CK 20 positivo em células tumorais periféricas e positividade estromal de CD 34. A regressão logística evidenciou ainda que, na amostra examinada, a presença de três ou quatro desses marcadores, com exceção do CD 34, pode identificar 35,9% dos TE. Nossos resultados, obtidos pelo estudo de casuística expressiva, são concordantes com os achados de outros trabalhos que sugerem que o TE e o CBC são neoplasias que estão em diferentes pontos da mesma linhagem de diferenciação dos tumores basalóides foliculares e que, por este motivo, podem expressar os mesmos marcadores/perfil antigênico epitelial e estromal. Embora o painel de quatro anticorpos acima relatado possa ser de grande ajuda, e até mesmo identificar 35,9% dos TE, os critérios histopatológicos clássicos e clínicos ainda devem ser os principais guias para o diagnóstico diferencial entre o TE e o CBC Trichoepithelioma is a benign neoplasm that shares both clinical and histological features with basal cell carcinoma. It is important to distinguish these neoplasms because they have different clinical behavior and require proper therapeutic planning. Many studies have addressed the use of immunohistochemistry to improve the differential diagnosis of these tumors. These studies present conflicting results when addressing the same markers, probably due to the small number of basaloid tumors that comprised their studies, which generally did not exceed 50 cases. We built a tissue microarray with 162 trichoepithelioma and 328 basal cell carcinoma biopsies and tested a panel of immune markers composed of CD34, CD10, epithelial membrane antigen, BCL-2, cytokeratins 15 and 20 and D2-40. The results were analyzed using multiple linear and logistic regression models. This analysis revealed a model that could differentiate trichoepithelioma from basal cell carcinoma in 35,9% of the cases. The panel of immunohistochemical markers required to differentiate between these tumors was composed of CD10, cytokeratin 15, cytokeratin 20 and D2-40. The results obtained in this work were generated from a large number of biopsies and resulted in the confirmation of overlapping epithelial and stromal immunohistochemical profiles from these basaloid tumors. The results also corroborate the point of view that trichoepithelioma and basal cell carcinoma tumors represent two different points in the same line of differentiation. Despite the use of panels of immune markers, histopathological criteria associated with clinical data certainly remain the best guideline for the differential diagnosis of trichoepithelioma and basal cell carcinoma
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- 2015
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35. Perfil imunoistoquímico de linfócitos T regulatórios no pênfico foliáceo endêmico através da expressão do marcador Foxp3
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Fernanda Lago, Valeria Aoki, Fernando Augusto de Almeida, Mario Cezar Pires, Vitor Manoel Silva dos Reis, and Mirian Nacagami Sotto
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business.industry ,Medicine ,business - Abstract
Introdução: Os linfócitos T regulatórios CD4+CD25+Foxp3+ (Tregs) desempenham um papel fundamental na manutenção da tolerância aos antígenos próprios e no controle da magnitude da resposta imunológica. Alterações quantitativas ou funcionais foram descritas em diversos distúbios auto-imunes. O pênfigo foliáceo endêmico (PFE) é uma doença bolhosa cutânea de natureza auto-imune, que compartilha características clínicas e imunopatológicas com o pênfigo foliáceo clássico, mas apresenta achados epidemiológicos próprios. Auto-anticorpos circulantes e teciduais da classe IgG dirigidos contra caderinas desmossômicas (desmogleína 1), levam à perda de adesão entre os queratinócitos. Objetivo: O objetivo deste estudo foi avaliar se a perda de tolerância é associada com alterações quantitativas nos linfócitos Tregs CD4+CD25+Foxp3+ na pele de pacientes com PFE. Métodos: Amostras de pele de 22 pacientes e 10 controles saudáveis foram submetidos à análise imunoistoquímica com anti-CD4, anti-CD25 e anti-Foxp3. Fotomicrografias foram obtidas de campos consecutivos ao longo de toda epiderme e derme. A seguir, foi realizada quantificação dos linfócitos Foxp3+, CD4+, CD25+, CD4+Foxp3+ e CD25+Foxp3+ em cada compartimento, considerando-se a respectiva área de cada campo (m2). Valores significantemente estatísticos foram considerados como p
- Published
- 2015
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36. Testes de contato em crianças com eczema
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Clarice Marie Kobata, Ida Alzira Gomes Duarte, Valeria Aoki, and Mario Cezar Pires
- Subjects
business.industry ,Medicine ,business - Abstract
Introdução: Eczemas são manifestações inflamatórias da pele. Na infância se destacam a dermatite atópica (DA) e a dermatite de contato (DC). Os testes de contato correspondem a um método auxiliar para diferenciar a dermatite de contato por irritante primário (DCIP) da dermatite de contato alérgica (DCA) e definir a etiologia da DCA. Nos pacientes com DA, têm a faculdade de também auxiliar na identificação de substâncias que possam estar contribuindo para a piora do quadro. Objetivos: verificar a frequência de testes de contato positivos em crianças com hipóteses diagnósticas de DC e de DA associada ou não à DC; obter os principais sensibilizantes nessa faixa etária e comparar os dados obtidos entre os grupos de pacientes com DC e DA. Métodos: Durante o período entre julho de 2007 e agosto de 2009, 62 crianças com idades entre 2 e 12 anos foram submetidas aos testes de contato com a bateria padrão e/ou bateria de cosméticos de testes de contato padronizadas pelo Grupo Brasileiro de Estudos em Dermatite de Contato. As leituras foram realizadas em 48 e 96 horas. Resultados: Entre os 62 pacientes submetidos aos testes de contato, 38 pacientes apresentaram pelo menos um teste de contato positivo e 24, todos negativos. Entre os 44 pacientes com hipótese diagnóstica inicial de DA, 19 tinham DA associada à DCA. Entre os 18 pacientes com hipótese diagnóstica inicial de DC, 12 apresentavam DCA. No total, foram encontrados 76 testes positivos, sendo 53 (70%) relevantes, e 23 (30%) não relevantes com a história clínica do paciente. Os pacientes com DA apresentaram mais testes positivos não relevantes do que os pacientes com hipótese diagnóstica apenas de DC, e essa diferença foi estatisticamente significativa.( 2 = 6,55 e p = 0,01 ). Considerando os testes relevantes com a história clínica, o sulfato de níquel foi o principal sensibilizante com 14 (22,6%) testes positivos, a neomicina foi o segundo sensibilizante mais comum com sete testes positivos (11,3%), e a terceira substância mais comum foi o cloreto de cobalto com quatro (6,4%) testes positivos. Testes não relevantes foram encontrados em 30% do total de substâncias com testes positivos. O timerosol foi positivo em 11 casos, porém em oito pacientes com DA não foram relevantes com a história clínica. Conclusões: Pacientes na faixa etária entre 2 e 12 anos com DA e DC apresentaram testes de contato positivos, e não houve diferenças quanto à frequência dos testes positivos entre esses dois grupos. Os principais sensibilizantes relevantes com a história clínica foram o sulfato de níquel, a neomicina e o cloreto de cobalto, o que está de acordo com vários estudos na literatura. Pacientes com DA apresentaram mais testes falso-positivos que os pacientes com DC, possivelmente por um defeito da barreira cutânea dos pacientes com DA, e maior exposição precoce aos medicamentos tópicos ou emolientes para o controle da DA. Teste de contato em crianças pode ser considerado importante ferramenta para auxiliar no diagnóstico dos eczemas, identificando o agente causador da DC ou de piora nos casos de DA, e deve ser levado em conta em todos esses pacientes Eczema is a cutaneous inflammatory manifestation in some dermatosis. In children, we highlight atopic dermatitis (AD) and contact dermatitis (CD). Patch tests help to differentiate irritative contact dermatitis (ICD) from allergic contact dermatitis (ACD), and define the etiology of allergic contact dermatitis. In patients with AD, it may also help to identify substances that may contribute to the worsening of this dermatosis. Objectives: To determine the frequency of positive patch tests in children with diagnosis of CD and AD with or without CD; to detect the main sensitizers in this group and compare the results between the groups of patients with CD and AD. Methods: From July 2007 to August 2009, 62 children aged between 2 to 12 years old were patch tested with the Brazilian standard battery of patch tests and cosmetic series. The readings were taken at 48 and 96 hours. Results: Thirty-eight patients had at least one positive patch test reactions and 24, all negative. Among the 44 patients with initial diagnosis of AD, 19 were associated with ACD. Among the 18 patients with initial diagnosis of CD, 12 had ACD. In total, there were 76 positive tests, 53 (70%) relevant, and 23 (30%) not relevant to the patient\'s clinical history. Patients with AD showed more positive tests not relevant than patients with diagnosis of CD only, and this difference was statistically significant. (2 = 6.55 and p = 0.01). Considering the relevant tests, nickel sulphate was the main allergen with 14 (22.6%) positive tests, neomycin was the second with seven positive tests (11.3%), and the third substance was cobalt chloride with four (6.4%) positive tests. Tests not relevant were found in 30% of the total of the positive tests. Thimerosol was positive in 11 cases, but in eight patients with AD were not relevant to the clinical history. Conclusions Patients aged between 2 to 12 years old with AD and CD had positive tests, and there were no differences in the frequency of positive tests between these two groups. The main sensitizers, relevant to the clinical history were nickel sulfate, neomycin and cobalt chloride. This result is consistent with several studies in the literature. Patients with AD showed more false-positive tests than patients with CD, possibly due to a defective skin barrier of AD patients, and earlier exposure to topical emollients and treatments for the control of AD. Patch test in children can be considered an important tool for the diagnosis of eczema, identifying the causative agent of CD or worsening cases of AD, and should be performed in all these patients. The correct interpretation of the patch tests is essential to evaluate the association of ACD in patients with AD and to identify the causative agent of the ACD
- Published
- 2015
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