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Background Nail psoriasis occurs frequently in patients with psoriatic disease, it can lead to functional impairment, pain, discomfort, decreased quality of life and can also be a predictor for the development of arthritis. Early recognition of this condition can provide early and effective treatment and prevent structural impairment. This study aims to identify nail ultrasonographic characteristics in three groups: psoriasis (PsO), psoriatic arthritis (PsA) and controls patients, to determine if the ultrasonography (US) can identify early signs of nail psoriatic impairment or local inflammation. We conducted nail US to determine nail matrix resistance index (NMRI), nail bed resistance index (NBRI), and power Doppler (PD) and grayscale (GS) parameters in these 3 groups. Methods Single-center, cross-sectional study. GS, PD, and spectral doppler images of bilateral 2nd and 3rd fingernails were acquired from 35 PsO, 31 PsA, and 35 controls patients. An US equipment with an 18 MHz linear transducer for GS and 8.0 MHz for PD was used. PD, NMRI, NBRI, nail plate thickness (NPT), nail bed thickness (NBT), nail matrix thickness (NMT), and morphostructural characteristics of the trilaminar structure (TS) were evaluated in saved images, blind. Results Mean NMRI and NBRI did not differ between groups. Linear regression analysis detected no relationships between PsO or PsA and NMRI or NBRI. Nail PD grade did not differ between groups. Type I and IV TS changes were more frequent in PsO; types II and III changes were more frequent in PsA (p p = 0.001). Conclusion Echographic TS characteristics of the nail plate and NPT evaluated by GS are useful and can distinguish PsO and PsA nails from controls. NMRI, NBRI, and US nail microcirculation parameters could not distinguish psoriatic nails. Trial registration 72762317.4.0000.5327 (Certificate of Presentation of Ethical Appreciation – CAAE - Plataforma Brasil) Avaiable in https://plataformabrasil.saude.gov.br/login.jsf.

Although the Psoriasis Epidemiology Screening Tool (PEST) questionnaire is a useful tool for screening patients for psoriatic arthritis (PsA), it has not been validated in Portuguese. Our aim was to perform a cross-cultural validation of the PEST for Brazilian Portuguese, as well as to analyse its psychometric properties and to test the association of PEST scores with patient clinical characteristics. The first step was the translation and cross-cultural adaptation of the PEST questionnaire into Brazilian Portuguese, which included forward translation, synthesis, back translation, consolidation with an expert panel and cognitive debriefing with pilot testing. The second step was validation and psychometric testing, in which 124 dermatology patients with no previous PsA diagnosis completed the new adapted questionnaire (PEST-bp). Patients were initially assessed by a dermatologist for clinical characteristics, then they answered the Dermatology Life Quality Index (DLQI) and PEST-bp questionnaires. Afterwards, a rheumatologist, blind to former tests, evaluated the presence of PsA according to CASPAR criteria. The PEST-bp proved to be 0.81 accurate (95% CI: 0.73-0.88) in the ROC curve, indicating a cutoff score ≥ 3 as suggestive of PsA (sensitivity = 84.6%, specificity = 63.3%). The assessment of internal consistency, via the Cronbach test, presented a coefficient of 0.72 (acceptable). A higher PEST-bp score was positively associated with lower quality of life scores and with male patients. In conclusion, the PEST-bp questionnaire proved to be suitable as a screening tool for PsA in patients with psoriasis. Elevated PEST-bp scores are associated with decreased patient quality of life.

Introdução: A relação entre doença cardiovascular, resistência à insulina e vitiligo tem sido avaliada em estudos. No entanto, ainda não há consenso sobre o assunto. Objetivos: Avaliar a relação entre resistência à insulina e vitiligo, além da prevalência de fatores de risco para doença cardiovascular em adultos com vitiligo quando comparados ao grupo controle. Métodos: Estudo transversal com grupo controle. Foi utilizada uma amostra de conveniência de pacientes consecutivos com 14 anos ou mais. Pacientes e controles foram investigados com exames laboratoriais e medidas antropométricas. Foram calculados os índices LAP, HOMA-IR, e HOMAβ. Resultados: Foram incluídos 130 pacientes, 73 com diagnóstico de vitiligo e 57 controles. Não houve diferença significativa entre os grupos quando avaliadas as medidas do LAP, HOMA-IR, e HOMAβ. Dentre os fatores de risco para doença cardiovascular, a pressão arterial sistólica foi significativamente maior nos pacientes com vitiligo. Conclusões: Não foi observada maior prevalência de resistência à insulina entre pacientes com vitiligo. Quanto aos fatores de risco para doenças cardiovasculares, apenas a pressão arterial sistólica foi maior nos pacientes com vitiligo. Novos estudos são necessários para elucidar a prevalência de resistência à insulina e fatores de risco cardiovascular em pacientes com vitiligo.

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.

Interest has increased in comorbidities associated with psoriasis and their effects on health‐related quality of life (HRQoL). This study aimed to evaluate the prevalence of metabolic syndrome (MetS) and psoriatic arthritis (PsA) and to investigate HRQoL and the prevalence of hypertension, type 2 diabetes mellitus (T2DM), obesity and dyslipidemia. In a cross‐sectional design, patients diagnosed with plaque psoriasis answered an interview and standardized questionnaires (Dermatology Life Quality Index questionnaire [DLQI], 36‐Item Short Form Health Survey [SF‐36] and EuroQol Five‐Dimension Questionnaire Three‐Level version [EQ‐5D‐3L]). Physical examination and several tests to assess desired outcomes were performed by a dermatologist and a rheumatologist during three visits. The prevalence of MetS and PsA was 50.0% and 41.8%, respectively. Dyslipidemia was the most prevalent (74.5%) secondary comorbidity, followed by hypertension (61.8%), obesity (52.5%) and T2DM (30.9%). The mean (standard deviation) DLQI score was 6.5 (6.9), and mean physical and mental SF‐36 measures were 45.2 (10.4) and 45.5 (12.3), respectively, and for EQ‐5D‐3L, mean utility index and EQ‐VAS scores were 0.68 (0.27) and 72.7 (19.7), respectively. PsA and MetS are important comorbidities; a reduced HRQoL is noted among plaque psoriasis patients with these comorbidities, emphasizing the relevance of diagnosis and treatment beyond the care of skin lesions.

INTRODUCTION Periorbital hyperchromia (POH) is a multifactorial condition, precipitated or aggravated by sleep disorders, which negatively affects quality of life (QoL). The aim of this study was to evaluate the impact of POH on QoL, sleep quality, and dissatisfaction of affected patients. METHODS In this cross-sectional study of male and female patients over 18 years, participants were examined, their demographic data were registered, and Dermatology Quality of Life Index (DLQI), Pittsburgh Sleep Quality Index (PSQI-BR), and Visual Analogue Scale (VAS) were used to assess dissatisfaction. RESULTS Patients (n = 100) were mostly women (91%) with a mean age of 36.9 years and POH duration of 18.32 years. Phototypes II (24%) and III (60%) were predominant. A total of 33% reported 4-6 hours and 66% reported over 6 hours of sleep per night. POH was classified as mild (59%), moderate (37%), or severe (4%). Mean dissatisfaction with POH was 6.9, PSQI was 6.04, and DLQI was 4.92. There was a significant difference in the dissatisfaction scale (P

BACKGROUND: Global concern about vitamin D deficiency has fuelled debates on photoprotection and the importance of solar exposure to meet vitamin D requirements. OBJECTIVES: To review the published evidence to reach a consensus on the influence of photoprotection by sunscreens on vitamin D status, considering other relevant factors. METHODS: An international panel of 13 experts in endocrinology, dermatology, photobiology, epidemiology and biological anthropology reviewed the literature prior to a 1-day meeting in June 2017, during which the evidence was discussed. Methods of assessment and determining factors of vitamin D status, and public health perspectives were examined and consequences of sun exposure and the effects of photoprotection were assessed. RESULTS: A serum level of ≥ 50 nmol L-1 25(OH)D is a target for all individuals. Broad-spectrum sunscreens that prevent erythema are unlikely to compromise vitamin D status in healthy populations. Vitamin D screening should be restricted to those at risk of hypovitaminosis, such as patients with photosensitivity disorders, who require rigorous photoprotection. Screening and supplementation are advised for this group. CONCLUSIONS: Sunscreen use for daily and recreational photoprotection does not compromise vitamin D synthesis, even when applied under optimal conditions. What's already known about this topic? Knowledge of the relationship between solar exposure behaviour, sunscreen use and vitamin D is important for public health but there is confusion about optimal vitamin D status and the safest way to achieve this. Practical recommendations on the potential impact of daily and/or recreational sunscreens on vitamin D status are lacking for healthy people. What does this study add? Judicious use of daily broad-spectrum sunscreens with high ultraviolet (UV) A protection will not compromise vitamin D status in healthy people. However, photoprotection strategies for patients with photosensitivity disorders that include high sun-protection factor sunscreens with high UVA protection, along with protective clothing and shade-seeking behaviour are likely to compromise vitamin D status. Screening for vitamin D status and supplementation are recommended in patients with photosensitivity disorders. ispartof: BRITISH JOURNAL OF DERMATOLOGY vol:181 issue:5 pages:916-931 ispartof: location:England status: published

BACKGROUND Periorbital hyperchromia (POH), popularly known as "dark circles," is a very frequent complaint in dermatological appointments. It affects all phototypes, genders, and ages, and it is associated with a tired and aged aspect to the face, which may lead to esthetic concerns and impairments in the quality of life. Its etiology is multifactorial, and it is believed that sleep disorders may be considered as precipitating or aggravating factors. AIMS Our objective is to compare sleep quality (using the Pittsburgh Sleep Quality Index-PSQI) of patients with POH to patients without this complaint. METHODS A single-center, case-control study. Patients from both genders were included. Cases were patients with POH, and controls had no POH. Demographic data, Dermatology Life Quality Index (DLQI), and PSQI were collected. A power of 80% and statistical significance when a P-value was lower than .05 were stipulated. RESULTS Out of 303 patients, 149 cases and 154 controls, with a mean age of 35.83 ± 11.38 for cases and 37.52 ± 14.89 for controls, there was no significant difference between groups. The DLQI revealed a mean of 4.86 ± 4.89 for cases and 2.25 ± 3.73 for controls (P

Background The early diagnosis of psoriatic arthritis (PsA) on patients with psoriasis (PsO) is challenging, but may prevent functional impairment. Patients with nail psoriasis have an odds ratio of nearly 3.0 of developing psoriatic arthritis. Ultrasonography is a replicable, radiation-free method that could be used to identify nail changes before clinical manifestations. Objectives To verify if nail changes identified via ultrasonography can differentiate between PsA and PsO patients as well as between PsA/PsO patients and a control group. Methods Single-center, cross-sectional study. PsA patients were consecutively enrolled, PsO and controls were matched by age and gender with the PsA group. PsO patients must have had the diagnosis of psoriasis of any subtypes. PsA patients had to fulfill the CASPAR criteria. Exclusion criteria, for all groups included: other joint inflammatory disease; dermatological or systemic disease that could modify the nail structure. Ultrasound examination was performed using a MyLab 50 system (Esaote Biomedica, Genova, Italy), equipped with a linear probe of 18 MHz in greyscale (GS) and 8.0 MHz in power doppler (PD). The exams were performed in a room with temperature between 22°C and 26°C, after a 10 minutes rest period. Patients were seated, with hands and fingers in a neutral position over the table. The nails were scanned on a longitudinal plane. The 2nd and 3rd fingernails of both hands were examined. Through GS, the following characteristics were assessed: 1) the trilaminar appearance of the nail plate (NP), that was classified according to Wortsman characterization of changes on psoriatic nails (I – IV), 2) the nail plate thickness (NPT), 3) the nail bed thickness (NBT), and 4) the nail matrix thickness (NMT). The signal of PD in the nail matrix and in the nail bed were evaluated together and classified according to Gutierrez et al.’s score (1-3). Comparisons between independent means were analyzed using ANOVA or Kruskal-Wallis test. The association between categorical variables was calculated by chi-squared test or Fisher’s exact test. Results In the trilaminar structure (TS) evaluation, 137(99.3%) of the nails from control group had no change in the TS; for PsO group, 32 of the analyzed nails presented TS alterations, as follows: 9 type I, 5 type II, 7 type III and 11 type IV. For PsA group, there were also 32 of the analyzed nails that presented TS changes; 4 type I, 15 type II, 9 type III and 4 type IV. The mean NPT± SD (mm) was higher on both PsA and PsO groups when compared to the control group: 0.73 ±0.14 and 0.72 ±0.15 vs.0.67±0.10 (p=0.001), respectively. NBT and NMT means did not differ among groups. There was also no statistical difference between groups regarding the degree of nail PD, as well as no difference in the grayscale and PD evaluated parameters between PsA/PsO nails both with or without clinical involvement. Conclusion Alterations of the trilaminar structure of the NP and the NPT show differentiation between psoriatic nails and the control group, but no differentiation between PsO and PsA nails. PD, NMT and NBT means also had no differences between groups. Studies with larger sample sizes are necessary to clarify the utility of these parameters in the evaluation of psoriatic patients. References [1] Wortsman C X, Holm EA, Jemec GB, Gniadecka M, Wulf HC. Ultrasonido de Alta Resolucion en el estudio de la una psoriatica. Rev Chil Radiol.2004;10(1). [2] Gutierrez M, Di Geso L, Salaffi F, Bertolazzi C, Tardella M, Filosa G, Filippucci E, Grassi W. Development of a preliminary US power Doppler composite score for monitoring treatment in PsA. Rheumatology. 2012Jul;51(7):1261-8. Disclosure of Interests None declared

Introduction Psoriasis is an immune-mediated, chronic, inflammatory disease, which has a substantial humanistic and economic burden. This study aimed to assess the impact of this disease on health-related quality of life (HRQoL), work productivity, and direct and indirect costs from a societal perspective among Brazilian patients. Methods This is a cross-sectional, observational, multicenter study, enrolling patients with moderate to severe plaque psoriasis according to physician evaluation. Data collection was performed from December 2015 to November 2016 through face-to-face interviews using a structured questionnaire and five standardized patient-reported outcomes instruments. Direct costs were estimated by multiplying the amount of resources used (12-month recall period) by the corresponding unit cost. Indirect costs were grouped in two time horizons: annual costs (income reduction and absenteeism) and lifetime costs (demission and early retirement). Results A total of 188 patients with moderate to severe plaque psoriasis were included, with mean age of 48.0 (SD 13.1). “Anxiety and depression” and “pain and discomfort” were the most impaired dimensions, according to the EuroQol Five-Dimension-Three-Level (EQ-5D-3L). The highest effect was found for “symptoms and feelings” [mean (SD) 2.4 (1.7)] Dermatology Life Quality Index (DLQI) subscale. Psoriatic arthritis (PsA) presence and biologic-naïve status were associated with worse HRQoL. Presenteeism was more frequent than absenteeism, according to the Work Productivity and Activity Impairment questionnaire-General Health (WPAI-GH) [17.4% vs. 6.3%], while physical demands and time management were the most affected Work Limitations Questionnaire (WLQ) subscales [means (SD) 23.5 (28.5) and 17.7 (24.9), respectively]. The estimated annual cost per patient was USD 4034. Direct medical costs accounted for 87.7% of this estimate, direct non-medical costs for 2.4%, and indirect costs for 9.9%. Conclusions Results evidenced that moderate to severe plaque psoriasis imposes substantial costs to society. Our data showed that this disease negatively affects both work productivity and HRQoL of Brazilian patients. Subgroups with PsA and biologic-naïve patients presented lower HRQoL, showing the impact of this comorbidity and the relevance of biologics in psoriasis treatment. Funding Novartis Biociências S.A. Electronic supplementary material The online version of this article (10.1007/s12325-019-01049-7) contains supplementary material, which is available to authorized users.

Striae distensae (SD), an unsightly cutaneous condition characterized by epidermal atrophy, can affect the quality of life of women. The aim of our study was to compare the efficacy of a neodymium:yttrium–aluminum–perovskite 1340 nm non-ablative fractional laser (NAFL) and the microneedling (MN) technique to treat striae alba (SA). NAFL and MN were used to treat striae on the longitudinally divided abdominal surface of 20 women classified as Fitzpatrick skin type III or IV (five sessions at monthly intervals). Photographs and skin biopsies were obtained during pretreatment and after the third and fifth treatment sessions for all patients. Patients and two independent evaluators assessed the clinical response using the Global Aesthetic Improvement Scale. Patient-reported evaluation showed improvement of striae using both modalities, with no statistically significant difference between the groups. Collagen and elastic fibers were significantly increased (p

The efficacy and safety of nonablative fractional laser for acne scars treatment has been described in several studies. Recently, microneedling treatment has been showing promising results with lower costs, quick healing time, and low risk of postinflammatory hyperpigmentation (PIH).To compare the effectiveness and safety of nonablative fractional erbium laser 1,340 nm and microneedling for the treatment of facial atrophic acne scars.Forty-six patients with atrophic facial acne scars were randomized to microneedling and laser groups, receiving 3 sessions performed monthly. Two blinded dermatologists applied the validated "Quantitative Global Grading System for Postacne Scarring" scale, before, 2 months, and 6 months after the treatment. Side effects were recorded at each follow-up visit and patient's satisfaction was evaluated.Both groups showed a significant improvement, and there was no statistically significant difference between results of both therapies (p = .264). The erythema after each session was longer in the laser group and 13.6% subjects experienced PIH. No PIH was observed in the microneedling group.This study shows that both nonablative fractional laser 1,340 nm and microneedling are comparable and effective in the treatment of atrophic acne scars. Microneedling is well tolerated, with fewer side effects and lower down time.

Data on chronic plaque psoriasis severity and its potential clinical and lifestyle implications in the Brazilian population are limited. The primary aim of this study was to assess the clinical severity of plaque psoriasis in Brazil. Further objectives included evaluating potential associations between disease severity and demographic, lifestyle, and clinical characteristics, health-related quality of life (HRQOL), and work productivity.This observational (non-interventional) cross-sectional study was conducted in 26 dermatologic clinics across 11 Brazilian states. Psoriasis severity was assessed using investigator judgment and Finlay's Rule of Tens: a Psoriasis Area and Severity Index (PASI) score10, a Body Surface Area (BSA) 10%, or a Dermatology Life Quality Index (DLQI) score10.Among 1125 patients, 205 (18.2%) had moderate-to-severe disease. On multiple regression analyses, psoriasis severity was significantly (directly) associated with the presence of physical inactivity and comorbid pain, anxiety, and depression; and significantly (inversely) associated with HRQOL and work productivity.Cross-sectional studies cannot assess temporal trends, and observational studies cannot conclusively determine causality or exclude biases and confounding due to unmeasured variables.Among Brazilian patients with moderate-to-severe psoriasis, disease severity had far-reaching adverse impacts on lifestyle, comorbidities, HRQOL, and work productivity.

Background: The worldwide incidence of cutaneous melanoma (CM) has been continuously increasing over the last decades. Primary and secondary prevention, with attention to risk factors and early diagnosis, remain the cornerstone for reducing the burden of cutaneous melanoma. Detailed information with respect to clinical and pathological data on cutaneous melanoma is scarce in Brazil. Objective: The purpose of our study was to analyze epidemiological and pathological characteristics of primary cutaneous melanoma in Joinville, southern Brazil. Methods: Observational, cross-sectional, retrospective study in which 893 reports of primary cutaneous melanoma from the local population were analyzed in the period 2003-2014. The study was approved by the local Ethics and Research Committee. Results: We observed a female predominance of cutaneous melanoma (56.3%). The age standardized incidence rate of primary cutaneous melanoma for the world population in the period 2003-06 was 11.8 per 100,000 population (CI 95%, 10.3-13.4), and 17.5 (CI 95%, 15.7-19.3) in 2011-14, revealing a significant increase of 48.3% (p < 0,05). Six and a half percent of patients had multiple cutaneous melanomas (mean 2.2 years and a maximum of 10.0 years between diagnoses). We observed significant differences between the location head/neck and cutaneous melanoma in situ, lower limb with Breslow depth S III and upper limb with Breslow depth S I. The comparison of the characteristics of cutaneous melanoma in the elderly and non-elderly (< 60 years old) showed significant differences with respect to all the variables studied. Study limitations: Using secondary data source. Conclusion: Joinville has high incidence coefficients for Brazilian standards, showing an increase in the incidence of cutaneous melanoma.

BACKGROUND: Vitiligo, although asymptomatic, highly compromises patients' quality of life (QoL). Therefore, an adequate evaluation of QoL is essential. OBJECTIVES: Translation, cultural adaptation and validation of VitiQol (Vitiligo-specific health-related quality of life instrument) into Brazilian Portuguese. METHODS: The study was conducted in two stages; the first stage was the translation and cultural/linguistic adaptation of the instrument; the second stage was the instrument's validation. RESULTS: The translated VitiQol showed high internal consistency (Cronbach alpha = 0.944) and high test-retest reliability and intraclass correlation coefficient=0.95 (CI 95% 0.86 - 0.98), p

Background/Objectives Erythema toxicum neonatorum (ETN) and transient neonatal pustular melanosis (TNPM) are benign pustular skin conditions that are relatively common in newborns, but the predisposing factors for these conditions are unknown. Our goal was to verify the prevalence of ETN and TNPM and their predisposing factors in a large sample of neonates. Methods In this prospective 1-year multicenter study, 2,831 neonates (age ≤72 hours) born in southern Brazil were randomized to undergo skin examination by a dermatologist. Results Most were Caucasian (of European descent). There were 602 cases of ETN (21.3% prevalence) and 97 cases of TNPM (3.4% prevalence). ETN was more prevalent in Caucasian neonates, male neonates, those with 1-minute Apgar scores from 8 to 10, those who had no gestational risk factors, and those not admitted to a neonatal intensive care unit (NICU). Positive correlations were observed between ETN and gestational age and birthweight. ETN was least frequent in the winter. No NICU admission or birth during the spring was associated with TNPM. Conclusions At least in the region where this study was conducted, seasonality affects these benign pustular skin conditions. The health of the child at birth, gestational age, and birthweight influenced the development of ETN. This finding may indicate a role of immune system maturity in ETN, but additional studies are needed to confirm this.

Nail changes are present in about 50% of psoriasis patients and tend to be refractory to conventional treatments. Pulsed dye laser has emerged as an alternative therapy. Our aim is to evaluate the efficacy of pulsed dye laser in nail psoriasis and the impact of treatment on quality of life. Fourteen patients were treated in monthly sessions for three months. The outcome assesment was made by the Nail Psoriasis Severity Index (NAPSI). The median improvement in the scores of the overall NAPSI, nail bed NAPSI, and nail matrix NAPSI were 44.2% (P = 0.002), 50% (P = 0.033) and 65.1% (P = 0.024), respectively.

Background Melasma is an acquired, irregularly patterned, light to dark-brown hypermelanosis, with symmetric distribution mostly over the face. The aim of this study was to evaluate clinical characteristics and factors related to melasma in Brazilian patients. Methods This was a cross-sectional, multicenter study performed in Brazil. Investigators examined and questioned 953 patients over 18 years of age on clinical characteristics and other factors related to their melasma. Results Melasma was more prevalent in women (97.5%) and in Fitzpatrick skin phototypes II (12.8%), III (36.3%), and IV (39.7%). Skin phototypes II and III and family history of melasma had early onset of the disorder when compared with skin phototypes IV, V, and VI (P

Improved education on appropriate photoprotection in children is vital. Photoprotection for these individuals should include seeking shade, the use of physical agents (clothing, hat, sunglasses), and application of sunscreens on exposed areas. Avoidance of the use of tanning beds is an important component of education for teenagers. Ultraviolet radiation exposure induces DNA damage and photoaging in all skin types, including people of color. The extent of such damage is inversely related to constitutive skin pigmentation. Therefore, personalized photoprotection recommendations concerning skin cancer risk factors, desired treatment outcomes, health needs (eg, vitamin D), and photoaging based on the needs and preferences of the patient are essential. It is clear that additional research is needed on optimal levels of protection against ultraviolet radiation for people of color.

The neonatal period comprises the first four weeks of life. It is a period of adaptation where the skin often presents several changes: transient lesions, resulting from a physiological response, others as a consequence of transient diseases and some as markers of severe disorders. The presence of pustules in the skin of the newborn is always a reason for the family and for the assisting doctor to be worried, since the newborn is especially vulnerable to bacterial, viral or fungal infection. However, the majority of neonatal skin pustules is not infectious, comprising the benign neonatal pustulosis. Benign neonatal pustuloses are a group of clinical disease characterized by pustular eruptions in which a contagious agent is not responsible for its etiology. The most common ones are erythema toxicum neonatorum, the transient neonatal pustular melanosis and the benign cephalic pustulosis. These dermatoses are usually benign, asymptomatic and self-limited. It is important that the dermatologist and the neonatologist can identify benign and transient lesions, those caused by genodermatoses, and especially differentiate between neonates with systemic involvement from those with benign skin lesions, avoiding unnecessary diagnostic tests and worries.

Acne fulminans is a rare and serious condition characterized by the sudden onset of nodular and ulcerative acne lesions associated with systemic symptoms. It has been recognized a subset of patients with a sudden worsening of acne, often during treatment with oral isotretinoin, but without the strong presence of systemic involvement. Recognized by some authors as "pseudo-acne fulminans" or " acne fulminans sine fulminans," we report a case with these features in order to draw attention to the recognition and early management of this manifestation.

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

Dark circles under the eyes (DC) are defined as bilateral, round, homogeneous pigment macules on the infraorbital regions. Despite its significant prevalence, there are a few published studies about its pathogenesis. DC are caused by multiple etiologic factors that include dermal melanin deposition, postinflammatory hyperpigmentation secondary to atopic or allergic contact dermatitis, periorbital edema, superficial location of vasculature, and shadowing due to skin laxity. The purpose of this review is to discuss some of the available evidences about the anatomic features that could explain dark circles and the proposed treatments for this unpleasant condition.

Adolescents constitute an important audience for photoprotection programs. Sun exposure and sun protection habits acquired during adolescence have a significant impact on skin cancer incidence. We administered a questionnaire to 724 students about ultraviolet radiation effects, opinions about tanning, total time of sun exposure per day, photoprotection and activities in the sun. About 90% were aware of the association between sun exposure and skin cancer, and mass media was the main source of information. However, the great majority believed that tanning improved their appearance, and that it was worth taking the risk. The most prevalent outdoor activity among boys was sports; girls preferred walks and sunbathing. Sun exposure was significantly longer in summer, when 90% of the students went to the beach. About 47% reported sunscreen use in summer and only 3% reported using sunscreen during winter. These results emphasize the need for the promotion of photoprotective habits in our population and the importance of engaging physicians and school teachers in developing campaigns directed at this issue to achieve effective, long-lasting results. Adolescents are aware of the effects of ultraviolet radiation on the skin but campaigns have not successfully changed their sun exposure habits.

The aim of this study was to compare the efficacy and safety of a triple combination (TC) cream and monotherapy with hydroquinone (HQ) cream in the treatment of moderate to severe facial melasma. A total of 120 patients applied TC cream once daily or HQ cream twice daily for 8 weeks. Evaluations included static global severity assessment of melasma, improvement of melasma over time, local tolerability, and adverse events. TC cream was significantly more effective than HQ cream from week 4 onwards: lesions were approximately equivalent to the surrounding skin in 35% of all TC-treated patients, compared to 5% of those who used HQ cream (P = 0.0001). Improvement of more than 75% was achieved by 73% of TC cream patients and 49% of HQ cream patients (P = 0.007). The incidence of adverse events (erythema, burning sensation, and desquamation) was similar in both groups. No patient dropped out of the study because of drug-related adverse events. TC cream was more effective than the HQ cream for the treatment of moderate to severe facial melasma. Both products had similar safety profiles.

This chapter examines tungiasis and bed bugs. In recent years, increased ecotourism and international travel to tropical countries has produced a growing incidence of infestations formerly limited to certain regions. Tungiasis is a common ectoparasitic infestation that occurs mainly in the tropics, particularly where poverty and poor standards of basic hygiene exist. Despite recent progress in the treatment and prevention of tungiasis, diagnosis can present a challenge to those unfamiliar with the disorder, especially when happening in nonendemic countries. Standard therapy for tungiasis consists of surgical extraction of the embedded parasite under sterile conditions, followed by appropriate care of the resulting wound. Meanwhile, many physicians are unfamiliar with bedbugs and their bites. Awareness of the possibility of infestation is important to institute correct medication and parasite control measures.

Summary Background Pigmentation disorders, such as melasma, greatly influence the quality of life (QoL) of affected individuals who usually consider the disorder to be more severe than the objective clinical scores. Several instruments have been successfully developed to evaluate QoL. However, they must be adapted to the target population in terms of language and cultural diversity. The first, specific QoL questionnaire for melasma (MelasQoL) was developed for English speaking patients. Objectives To validate the Brazilian Portuguese version of the MelasQoL evaluation questionnaire for patients with melasma (MelasQoL-BP) and to assess the impact of treatment with a triple combination cream (hydroquinone, fluocinolone acetonide and tretinoin) on the QoL of patients with moderate-to-severe melasma. Methods and Results Three hundred individuals from the five Brazilian geographic regions took part in this multicentre study. Their mean age was 42 years and skin phototype distribution was: type II 7AE0% of patients, III 23AE7%, IV 42AE7% and V 22AE7%. Melasma Area and Severity Index (MASI), MelasQoL-BP and the short version of the QoL assessment instrument from the World Health Organization (WHOQOL-BREF) were used to assess melasma severity and QoL at baseline. MelasQoL-BP was previously translated and culturally adapted from the English version, with participation of the authors and according to the standards of the World Health Organization (WHO). From the original sample, we randomized150 volunteers to treat melasma and repeated the evaluation after 8 weeks. The analysis of the MelasQoL-BP baseline answers demonstrated an important impact of the disease on skin appearance (65% of patients were bothered all the time or most of the time), frustration (55%), embarrassment (57%) and influence of the disease on interpersonal relationships (42%). Forty-three per cent of patients felt not attractive or even dirty due to their skin condition. MelasQoL-BP results showed significant internal consistency (Cronbach’s alpha coefficient 0AE919; P

A pele é a nossa fronteira com o mundo, fazendo trocas e contato com o meio ambiente. Sendo assim, não seria ela capaz de sinalizar, através de suas alterações, o nosso anseio pelo outro, a necessidade de "trocas afetivas"? Os autores apresentam a observação da evolução clínica e emocional de uma criança de 2 anos de idade, portadora de dermatite atópica, participante do Grupo de Apoio à Dermatite Atópica, com sua formação pioneira interdisciplinar, durante 9 meses de acompanhamento da criança no grupo. Como resultados, foram evidenciadas mudanças no comportamento da criança frente ao livre brincar, uma interação social mais concreta, com diminuição da irritabilidade e agressividade e, principalmente, maior e melhor vinculação entre a dupla mãe-criança, assim como marcada melhora do quadro dermatológico. Conclui-se que a abrangência, proporcionada pelo atendimento interdisciplinar, possibilita uma intervenção precoce na relação mãe-criança, podendo ser considerada como uma estratégia de prevenção em saúde mental materno-infantil, evitando possíveis patologias futuras.

The advent of organ transplantation identified a new group of diseases. Dermatologists are studying transplant-associated diseases along with the atypical behavior of already known dermatoses. Pediatric patients have been treated as an extension of adult population, but unique aspects of age required clarification. A prospective cohort was studied including patients from both genders up to 17 yr of age who were recipients of kidney, liver or BMT during 2003 in Porto Alegre, Brazil. Regular skin examinations were performed up to the sixth month after the procedure, and an analysis was determined by ID (i.e. = number of skin changes/number of patients-month x 100). Thirty-nine patients were examined: 20 were kidney transplant recipients; 11 were BMT recipients (10 autologous transplants and 1 allogeneic transplant); and 8 were liver transplant recipients. Skin changes result primarily from the use of medication (87.2). Individually, kidney transplant patients presented the highest ID of skin changes because of medications (104.1). BMT recipients presented the highest ID of alterations occurring on skin appendages (85.4) and liver transplant recipients had the highest ID of vascular changes (94.9). In conclusion, this study shows that cutaneous alterations in pediatric transplant recipients present some particularities not described in adult recipients, such as ichthyosiform xerosis in renal recipients and skin scaling with pellagroid appearance in bone marrow recipients. Also, dermatoses secondary to medication use were the main finding in pediatric population.

Resumo: FUNDAMENTOS – Pacientes portadores de dermatite atópica apresentam freqüentemente níveis séricos elevados de IgE, e o prurido é uma das manifestações cardinais da doença. OBJETIVOS – Descrever as características do prurido nos pacientes com dermatite atópica (DA) e correlacionar a gravidade do eczema com os níveis plasmáticos de imunoglobulina E (IgE). MÉTODOS – Os pacientes com dermatite atópica atendidos no Serviço de Dermatologia do Hospital de Clínicas de Porto Alegre e nos Serviços de Pediatria e Dermatologia da Universidade Luterana do Brasil responderam a um questionário sobre sintomas da dermatite atópica e deles foi coletado sangue para dosagem da IgE sérica. A gravidade da dermatose foi calculada conforme critérios sugeridos por Rajka et al. Os dados foram analisados no programa SPSS. RESULTADOS – Oitenta e nove pacientes completaram o estudo. A média de idade foi de 9,6 + 9 anos, e 51% dos pacientes eram do sexo feminino. Quando analisada a freqüência de prurido de acordo com a gravidade do quadro clínico, foi encontrada uma relação significativa (p = 0,003). Os pacientes com quadro leve de dermatite atópica tinham coceira diária em 45% dos casos; aqueles com quadro grave tinham 90,9% de sintomas diários; e apenas 4,5% tinham mais de sete dias de intervalo entre os episódios de coceira. A mediana dos níveis de IgE sérica foi de 347UI\ml. As medianas da IgE sérica nos pacientes com eczema leve, moderado e grave foram 279UI\ml, 347UI/ml e 952UI/ml, respectivamente (p = 0,699). Pacientes do sexo feminino apresentaram níveis de IgE menores do que os do sexo masculino (212UI/ml and 2067UI/ml, p= 0,004). CONCLUSÃO – Pacientes com quadros graves de dermatite atópica apresentam prurido mais freqüente do que aqueles com manifestações mais leves. Na avaliação dos níveis séricos de IgE em relação à gravidade da DA, apesar de os valores serem mais altos nos pacientes mais graves, não se encontrou relação estatística significativa. Pacientes do sexo masculino têm níveis séricos de IgE significativamente mais altos do que os do sexo feminino. A freqüência do prurido está relacionada com a gravidade da dermatite atópica. BACKGROUND - Atopic dermatitis patients often have high serum immunoglubulin E (IgE) levels and pruritus is a major symptom of the disorder. OBJECTIVE - To describe the characteristics of pruritus in atopic dermatitis (AD) patients and to correlate severity of eczema with plasma IgE levels METHODS - Patients with atopic dermatitis seen at the Dermatology Service of Hospital de Clínicas de Porto Alegre and at the Dermatology and Pediatrics Service of Universidade Luterana do Brasil filled out a questionnaire on AD symptoms and had their blood collected for serum IgE levels. Severity of dermatitis was assessed according to criteria adopted by Rajka et al. Data were analyzed by SPSS program. RESULTS: Eighty-nine patients completed the study. The mean age was 9.6 + 9 years and 51% were female. The relation between frequency of pruritus and severity of dermatitis was significant (p=0.003). Forty-five percent of patients with mild atopic dermatitis presented pruritus every day, 90.9% of severe patients showed daily symptoms, and only 4.5% remained symptom-free for more than seven days. The median serum IgE level was 347 UI/ml. The median serum IgE levels for mild, moderate and severe cases was 279 UI/ml, 347 UI/ml and 952UI/ml, respectively (p=0.699). Females showed significantly lower serum IgE levels when compared to males (212 UI/ml vs. 2067 UI/ml, p=0.004). CONCLUSIONS - Although IgE levels were higher in severe patients, this study did not demonstrate a trend toward greater levels in patients with severe eczema as compared with mild eczema. Males have significantly higher serum IgE levels than females.

Introduction: Organ transplant is an example of the great progression achieved by the current medicine, along with its benefits and problems concerning to this advance. Many of these consequences have important cutaneous manifestations which should be known and studied. Methods: The authors present three clinical cases of pediatric transplant - bone marrow, liver and kidney – with its dermatological manifestations observed within the first six months post transplant. Further, a review of the literature on dermatological manifestations in pediatric transplant is carried through. Conclusions: Face to the increasing number of transplant patients and their life perspectives, a large number of cutaneous diseases in this group is found. Controversially, there is a little literary subsidy concerning dermatological manifestations in pediatric transplant. For this reason, we should have better knowledge of the great variety of disorders to provide an adequate prevention and therapeutic guidance to the pediatric transplant patient.

Objective: mastocytosis comprises a group of diseases characterized by accumulation of mast cells on the skin, with the possibility of affecting other systems. Symptoms can be exclusively cutaneous, associated with symptoms of the organs involved or even systemic, due to the release of chemical mediators. Three cases of systemic mastocytosis are described, each case presenting different manifestations of the disorder. Description: the first report is about a patient with urticaria pigmentosa that presented persistent lesions until puberty when systemic manifestations initiated with lymphoreticular involvement, splenomegaly and bone marrow infiltration. In the second case, the child had bullous mastocytosis associated with gastrointestinal symptoms, whose investigation showed mast cell infiltration in the intestinal wall. The third patient presented an early and extensive cutaneous manifestation of mastocytosis, with a dramatic evolution to shock and posterior death.Discussion: clinical aspects, treatment and prognosis of such forms of the disease are discussed.

The "Quantitative Global Scarring Grading System for Postacne Scarring" was developed in English for acne scar grading, based on the number and severity of each type of scar. The aims of this study were to translate this scale into Brazilian Portuguese and verify its reliability and validity. The study followed five steps: Translation, Expert Panel, Back Translation, Approval of authors and Validation. The translated scale showed high internal consistency and high test-retest reliability, confirming its reproducibility. Therefore, it has been validated for our population and can be recommended as a reliable instrument to assess acne scarring.

Psoriasis is a chronic disease with worldwide prevalences of 0.6-4.8%. Its inherent chronic inflammatory component predisposes patients to cardiovascular and metabolic diseases.This study aimed to evaluate the associations of psoriasis with comorbidities and health risk factors such as smoking and alcohol intake, and to examine demographic differences in its occurrence in a southern Brazil population.A case-control study was conducted at the Hospital de Clínicas de Porto Alegre between April 2009 and March 2011. The sample comprised 350 patients with psoriasis and 346 healthy control subjects. Data were collected using a standardized questionnaire. Tobacco load and alcohol consumption per person were investigated. Physical examination included blood pressure, waist circumference (WC), and body mass index (BMI) calculation. Clinical evaluation investigated whether psoriasis was localized or widespread and the percentage of body surface area (BSA) affected.Psoriasis patients exhibited an increased WC (P 0.01) and BMI (P = 0.01) and higher incidences of smoking (P 0.01) and depression (P 0.01) than control subjects. A comparison of patients with involvement of20% and20% of BSA revealed significant differences in prevalences of hypertension (P = 0.03) and diabetes (P 0.01).The present study demonstrated higher incidences of depression, increased WC, overweight, obesity, and smoking in psoriasis patients compared with controls. Patients with20% of BSA affected were 1.69 times more likely to have hypertension and 2.9 times more likely to have diabetes. Healthcare providers should be alert to the increased cardiovascular risk and metabolic specificities of patients with psoriasis. Appropriate information on healthy lifestyle habits, including maintenance of a healthy weight and participation in physical exercise, and avoidance of alcohol and smoking are fundamental.

Made available in DSpace on 2016-04-01T18:43:04Z (GMT). No. of bitstreams: 0 Previous issue date: 2014. Added 1 bitstream(s) on 2016-04-01T18:49:06Z : No. of bitstreams: 1 S0365-05962014000700001.pdf: 893660 bytes, checksum: 33d5d1cafa189cbffb22d67fb608fb0c (MD5) Brazil is a country of continental dimensions with a large heterogeneity of climates and massive mixing of the population. Almost the entire national territory is located between the Equator and the Tropic of Capricorn, and the Earth axial tilt to the south certainly makes Brazil one of the countries of the world with greater extent of land in proximity to the sun. The Brazilian coastline, where most of its population lives, is more than 8,500 km long. Due to geographic characteristics and cultural trends, Brazilians are among the peoples with the highest annual exposure to the sun. Epidemiological data show a continuing increase in the incidence of non-melanoma and melanoma skin cancers. Photoprotection can be understood as a set of measures aimed at reducing sun exposure and at preventing the development of acute and chronic actinic damage. Due to the peculiarities of Brazilian territory and culture, it would not be advisable to replicate the concepts of photoprotection from other developed countries, places with completely different climates and populations. Thus the Brazilian Society of Dermatology has developed the Brazilian Consensus on Photoprotection, the first official document on photoprotection developed in Brazil for Brazilians, with recommendations on matters involving photoprotection. Brazil is a country of continental dimensions with a large heterogeneity of climates and massive mixing of the population. Almost the entire national territory is located between the Equator and the Tropic of Capricorn, and the Earth axial tilt to the south certainly makes Brazil one of the countries of the world with greater extent of land in proximity to the sun. The Brazilian coastline, where most of its population lives, is more than 8,500 km long. Due to geographic characteristics and cultural trends, Brazilians are among the peoples with the highest annual exposure to the sun. Epidemiological data show a continuing increase in the incidence of non-melanoma and melanoma skin cancers. Photoprotection can be understood as a set of measures aimed at reducing sun exposure and at preventing the development of acute and chronic actinic damage. Due to the peculiarities of Brazilian territory and culture, it would not be advisable to replicate the concepts of photoprotection from other developed countries, places with completely different climates and populations. Thus the Brazilian Society of Dermatology has developed the Brazilian Consensus on Photoprotection, the first official document on photoprotection developed in Brazil for Brazilians, with recommendations on matters involving photoprotection. University of Mogi das Cruzes (UMC) - São Paulo (SP), Brazil ProMatre and Santa Joana Hospitals - São Paulo (SP), Brazil Hospital of the Military Police of Minas Gerais - Belo Horizonte (MG), Brazil Charity Hospital (Santa Casa de Misericórdia) - São Paulo (SP), Brazil Center of Dermatology Prof. Rene Garrido Neves - City Health Foundation - Rio de Janeiro (RJ), Brazil MEDCIN Skin Institute - São Paulo (SP), Brazil Universidade Estadual Paulista Júlio de Mesquita Filho, Departamento de Dermatologia e Radioterapia, Faculdade de Medicina (FMB), Botucatu, Campus Universitário de Rubião Jr, Rubião Jr, CEP 18618-970, SP, Brasil Federal University of Rio Grande do Sul (UFRGS) - Porto Alegre (RS), Brazil Fluminense Federal University (UFF) - Niterói (RJ), Brazil Teaching Hospital of Porto Alegre (HCPA) - Porto Alegre (RS), Brazil University of São Paulo (USP) - São Paulo (SP), Brazil Federal University of Itajubá (UNIFEI) - Itajubá (MG), Brazil Federal University of Santa Catarina (UFSC) - Blumenau (SC), Brazil Federal University of Campina Grande (UFCG) and College of Medical Sciences of Campina Grande - Campina Grande (PB), Brazil SQUALIS - Teaching, Research and Technology Society - João Pessoa (PB), Brazil Federal University of Bahia (UFBA) - Salvador (BA), Brazil Universidade Estadual Paulista Júlio de Mesquita Filho, Departamento de Dermatologia e Radioterapia, Faculdade de Medicina (FMB), Botucatu, Campus Universitário de Rubião Jr, Rubião Jr, CEP 18618-970, SP, Brasil

Foi desenvolvido um objeto de ensino em Dermatologia voltado para a graduação, que utiliza um web site interativo, o Cybertutor. Selecionaram-se casos clínicos didáticos, aulas teóricas e referências bibliográficas atualizadas. As fotografias das lesões foram obtidas pela seleção de pacientes atendidos no ambulatório de Dermatologia. Os temas das aulas se basearam no currículo vigente da Universidade Federal do Rio Grande do Sul (UFRGS). O Cybertutor é um objeto de ensino dinâmico, moderno e atual, que possibilita constante inovação. It was developed a teaching tool in Dermatology for undergraduate medical students, using an interactive website, the Cybertutor. Clinical cases, lectures and updated bibliography were selected. Photographies of dermatological lesions were taken from ambulatory patients. The topics of the lectures were based on the current curriculum of the Federal University of Rio Grande do Sul. The Cybertutor is a dynamic and modern teaching tool, allowing constant innovation.

Psoriasis Family Index é um instrumento para aferição da qualidade de vida em familiares de pacientes com psoríase, desenvolvido em língua inglesa. O objetivo deste estudo é traduzir o Psoriasis Family Index para o Português, adaptá-lo culturalmente e determinar sua confiabilidade e validade. Foi realizado em duas etapas: 1) tradução, adaptação cultural e linguística e 2) validação. O Psoriasis Family Index traduzido demonstrou alta consistência interna e alta confiabilidade de teste e reteste, confirmando sua reprodutibilidade. A versão brasileira do Psoriasis Family Index foi validada para nossa população e pode ser recomendada como uma ferramenta na avaliação da influência da psoríase na família dos pacientes. Psoriasis Family Index is a quality of life instrument for family members of patients with psoriasis developed in English. The aims of this study were to translate the Psoriasis Family Index into Brazilian Portuguese, culturally adapt it and verify its reliability and validity. The study followed these two steps: 1) Translation, linguistic and cultural adaptation, 2) Validation. The translated Psoriasis Family Index showed high internal consistency and high test-retest reliability, confirming its reproducibility. The Portuguese version of the Psoriasis Family Index was validated for our population and can be recommended as a reliable instrument to assess the QoL of family members and partners of patients with psoriasis.

Ultraviolet radiation (UVR) modulates cellular immunity in humans and experimental animals and can interfere with immune responses against infectious agents in animal models. We used the lepromin reaction, a cell-mediated immune response to antigens of Mycobacterium leprae, to determine whether UVR affects the cellular immune response to an infectious agent in humans. We selected 29 healthy, lepromin-positive contacts of leprosy patients and determined their minimal erythema dose (MED) of UVR. Immediately afterward, each subject was injected with 0.1 ml of lepromin in two areas of the buttocks: one at the site that had received twice the MED of UVR and the other on the contralateral, unirradiated site. The irradiated site was given twice the MED every 4 d for a total of five treatments. One week after the last irradiation, both lepromin reactions were measured and biopsied. The size of the lepromin-induced granulomas was significantly reduced in the irradiated site, as was the number of lymphocytes. Immunohistochemical analysis showed a depletion in the number of infiltrating cells and a lower percentage of T cells, particularly the CD4+ subpopulation, in granulomas formed in UV-irradiated skin. This study demonstrates that local UV irradiation reduces the granulomatous reaction to lepromin in sensitized individuals. These findings are of clinical relevance because of the fundamental role played by the delayed-type hypersensitivity response in defense against intracellular pathogens and because of potential increases in the amount of UVR in sunlight reaching the earth's surface.

BACKGROUND: The skin is the primary interface of the human being with the external environment and the presence of skin diseases can have substantial effects on the quality of life. OBJECTIVE: This study aims to make a comparative evaluation of the quality of life of pediatric patients with atopic dermatitis, psoriasis and vitiligo and correlate the findings with the total body surface and the areas with the disease exposed to view. METHODS: The sample consisted of 118 patients with atopic dermatitis, vitiligo and psoriasis, aged between 5 and 16 years, who were asked to answer the Children's Dermatology Life Quality Index (CDLQI) questionnaire. A dermatological examination for the measurement of total body surface affected by the disease was performed. RESULTS: The three groups showed an impaired quality of life. Patients with atopic dermatitis and psoriasis showed a significantly greater impact on the QoL than the group with vitiligo. There is a trend towards impaired quality of life in patients from the three groups of dermatoses, which is related to increments in both the total affected area and affected area exposed to view (r = 0.428 and p