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- Passive Smoking and Hidradenitis Suppurativa: a Retrospective Analysis.Publication . Aparício Martins, Inês; Valente, Clara; Simões Farinha, Pedro; Figueira Vilela, Beatriz; Cabete, Joana; Wiley
- Esomeprazole-Induced Lichen PlanusPublication . Santos-Coelho, M; Barbosa, J; João, A; Araújo-Carvalho, RIntroduction: Lichenoid drug eruption (LDE) is an uncommon cutaneous drug reaction (CDR) that has classically been associated with anti-hypertensive drugs, gold, and penicillamine. Case presentation: We present the case of a 63-year-old woman who developed a pruriginous disseminated dermatosis composed of violaceous polygonal flat-topped papules affecting the flexural aspects of the upper and lower limbs, abdominal flanks, and the lumbar and sacral regions. The lesions started 2 weeks after initiating esomeprazole intake. A histopathological exam of one of the lesions was compatible with LDE. The patient discontinued esomeprazole and was treated with medium potency topical corticosteroids and emollient with full resolution of symptoms. Conclusion: Even though CDRs associated with proton-pump inhibitors (PPI) are relatively common, there are only three reported cases of LDE. We report this case to highlight the importance of considering PPIs as the culprit drug in similar clinical situations.
- Radiation-Induced Morphea: An Uncommon EntityPublication . Santos-Coelho, M; Barbosa, JA; Araújo-Carvalho, R
- Atopic Dermatitis: Improving Patient Access to Health Care in DermatologyPublication . Torres, T; Gonçalo, M; Paiva-Lopes, MJ; Claro, C; Varela, P; Silva, JM; Cordeiro, A; Mendes-Bastos, PIntroduction and Objective: The present study on atopic dermatitis (AD) in Portugal aims to characterize patient needs and discuss measures to improve health care in dermatology, particularly in cases of moderate to severe disease. Methods: The study was conducted in three phases–(1) data collection on the patient access to healthcare and subsequent analysis; (2) critical evaluation of the data in individual interviews with dermatologists and one pediatrician; and lastly, (3) data discussion in consensus meetings to validate the existing care capacity in dermatology, to identify gaps in care for patients with AD and to define mitigation strategies. Results: In Portugal, it is estimated that AD affects ~ 360,000 patients, 70,000 of whom have moderate to severe disease. Healthcare capacity analysis confirmed that the private system plays an important role in the management of AD. It is estimated that 30% of patients rely solely on the Portuguese public health service. Nevertheless, patients with moderate to severe disease can only access advanced targeted therapies from public healthcare providers. Analysis of public care capacity in dermatology shows relevant gaps in the referral system, the geographical coverage of specialized centers, the number of specialists and high waiting times for first appointments. Considering the negative impact of the disease on patients’ quality of life, 86% of patients with AD use private settings to better manage their disease. Conclusion: In conclusion, private setting bridges the gaps in public health care capacity in dermatology, and therefore, it is crucial for patients with AD. However, a major limitation is the lack of reimbursement for advanced targeted therapies recommended for moderate to severe AD when they are prescribed in a private setting, thus compromising patient access to these therapies. A possible strategy could be to extend the prescription of these therapies to a private setting based on a reimbursement model similar to that outlined in Act 48/2016 of 22 March.
- Recomendações para o Diagnóstico e Tratamento da Infeção Não Complicada por Chlamydia trachomatis (Não- Linfogranuloma Venéreo) em PortugalPublication . Andrade, P; Azevedo, J; Lisboa, C; Fernandes, C; Borrego, MJ; Borges-Costa, J; Reis, J; Santiago, F; Santos, A; Alves, JChlamydia trachomatis infection is the most prevalent sexually transmitted bacterial infection in the world. Being associated with a large number of asymptomatic carriers, the diagnosis is frequently challenging and requires appropriate laboratory testing. In Portugal, the incidence of the disease has been consistently increasing in recent years, meaning that special awareness is required for case identification, contact tracing and application of appropriate treatments. These recommendations result from the adaptation of the international consensuses on the diagnosis and treatment of Chlamydia trachomatis infection to the Portuguese healthcare setting, with the aim of standardizing the clinical and laboratory approach to symptomatic and nonsymptomatic carriers of the disease.
- Trichloroacetic Acid (80%) As a Chemical Debridement Method for Chronic Venous Leg Ulcers - a Pilot StudyPublication . Alpuim Costa, R; Porfírio Costa, B; Cabete, JDebridement is essential for the optimal care of venous leg ulcers. Several debridement methods with different limitations may be deployed. Trichloroacetic acid (TCA) is used for several dermatological purposes. Its application as a chemical debridement method for leg ulcers has never been explored. We designed a prospective study to determine the role of 80% TCA solution as a chemical debridement method for leg ulcers, regarding efficacy and procedure-associated pain. Chronic venous leg ulcers were treated with 3 cycles of 80% TCA solution or curettage over 1 week. Pain and the mean percentage of fibrin and devitalized tissue covering wound bed were evaluated. At the end of the study, a trend towards larger fibrin mean reduction among the TCA treated ulcers was observed, although this difference was not statistically significant (P = .35). The mean pain score after TCA application was significantly reduced compared to pain after curettage alone (P < 0.001). TCA presented several advantages over mechanical debridement: it is a more selective debridement method, has haemostatic properties, and a simpler and faster application. The 80% TCA solution may be a cheap, simple, and considerably less-painful chemical debridement method for venous leg ulcers compared to classical mechanical debridement.
- Antibodies Towards High-Density Lipoprotein Components in Patients with PsoriasisPublication . Paiva-Lopes, MJ; Batuca, J; Gouveia, S; Alves, M; Papoila, AL; Delgado Alves, JPsoriasis is a chronic inflammatory immune disorder associated with an increased risk of atherosclerosis. This increased risk is not fully understood. High-density lipoproteins (HDL) play an important role in the prevention of atherosclerosis and any factors that may hamper HDL function such as anti-HDL antibodies (aHDL) might be associated with an increased cardiovascular risk. We aimed to determine whether anti-HDL antibodies (aHDL) are present in patients with psoriasis. Sixty-seven patients with psoriasis were compared with a healthy control group. Epidemiologic and clinical data were recorded. IgG and IgM aHDL, IgG anti-apolipoprotein A-I (aApoA-I), anti-apolipoprotein E (aApoE), and anti-paraoxonase 1 (aPON1) antibodies, as well as VCAM-1, IL-6, and TNF-α were assessed by ELISA. Apolipoprotein A-I (ApoA-I) and Apolipoprotein E (ApoE) were measured by immunoturbidimetric immunoassay. Patients with psoriasis had higher titers of IgG aHDL (p < 0.001), IgG aApoA-I (p = 0.001) and aApoE antibodies (p < 0.001). IgG aHDL and aApoE titers were higher in patients with severe psoriasis (p = 0.010 and p = 0.018, respectively). Multiple regression analysis, considering all clinical and biological variables, showed that aApoE, IL-6, and aPON1 are the biological variables that best explain aHDL variability. This is the first report showing the presence of aHDL, aApoA-I, and aApoE antibodies in patients with psoriasis. These antibodies were associated with increased disease severity and may contribute to the pathogenesis of atherosclerosis in psoriasis. They may fulfill the clinical need for biomarkers of cardiovascular risk associated with psoriasis that would help to stratify patients for prevention and therapeutic approaches.
- An Unusual Case of Extragenital Primary SyphilisPublication . Santos-Coelho, M; Alves Barbosa, J; Valejo Coelho, MM; João, A
- Atopic Dermatitis and Multilocular Alopecia Areata Simultaneously Treated With BaricitinibPublication . Pestana, M.; Brito Caldeira, M.; Duarte, B.
- Lymphogranuloma Venereum: a Retrospective Analysis of an Emerging Sexually Transmitted Disease in a Lisbon Tertiary CenterPublication . Neves, JM; Ramos Pinheiro, R; Côrte‐Real, R; Borrego, MJ; Rodrigues, A; Fernandes, CBackground: Lymphogranuloma venereum (LGV) is a sexual transmitted infection (STI), currently endemic within the population of men who have sex with men (MSM) of Western Countries. L2B variant has been reported as the predominant strain in the current LGV epidemics, although a shift towards L2-434 has been observed in some European countries. Objectives: To evaluate and characterize the population with LGV infection diagnosed in Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal. Methods: A retrospective analysis of all LGV diagnoses between 2016 and 2019 was performed. The diagnosis was established through ompA-genotyping of samples yielding a positive result to Chlamydia trachomatis (CT). All considered samples were retrieved from the clinician activity, through swabbing and urine analysis and CT infection diagnosis was obtained using real-time PCR. Results: During the period studied 16 279 CT diagnostics tests were employed, with a striking increase from 2016 (n = 467) to 2019 (n = 9362). A total of 1602 diagnoses of CT were established, from which 168 (10.5%) corresponded to LGV, with both infections showing a rising evolution, between 2016 and 2019, of 2.9 and 2.7 times, respectively. The majority of the LGV strains were genotyped as L2/434 (67.3%; n = 113). LGV predominantly affected MSM and men who have sex with men and women (97.0%; n = 163). Anorectal infection was the most prevalent one (90.5%; n = 152), being proctitis the main clinical presentation (76.2%; n = 128). Absence of symptoms was reported in almost 15% of the cases (n = 24). The presence of concomitant infection with human immunodeficiency virus was dominant (73.2%; n = 123) and the prevalence of one or more STI co-infections was about 60.1% (n = 99). Conclusions: An increasing evolution of CT and LGV testing and diagnosing was observable throughout the studied period. Characteristics of the population are similar with those described within LGV epidemics. In accordance with recent European studies, predominance towards L2 genotype was identified.