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Marques Pinto G.,Servico de Dermatologia e Venereologia | Filipe P.,Clinica Universitaria de Dermatologia
Acta Medica Portuguesa | Year: 2012

Psoriasis is an inflammatory dermatosis, affecting approximately 2% of the population, with predominantly skin and joint involvement but also associated with considerable comorbidities. Approximately 20% to 30% of patients have moderate to severe disease uncontrollable with topical therapy. Traditional systemic therapy - oral PUVA, retinoids, cyclosporin and methotrexate - may induce organ specific toxicity and a significant number of patients are unresponsive, intolerant or have specific contraindications to its use. With the increased understanding of the pathogenesis of psoriasis, multiple biologic agents have been introduced. In the last years there has been an increased utilization of these agents and several studies were designed to evaluate their efficacy and safety. Currently, four biologics have been already approved by EMEA (European Medicines Agency) for the treatment of plaque psoriasis, 3 anti-TNFα (adalimumab, etanercept and infliximab) and one anti-IL12/23p40 (ustecinumab). In the present article we update the prior published guidelines (Trabalhos da SPDV 2010;68(1):47-68 and 2011;69(4):531-553) due to the recent progress in the knowledge and therapeutic options in these area. These recommendations should be used with caution and treatment should be tailored to meet individual patient's needs and each specific clinical situation. © Ordem dos Médicos 2012. Source


Borges Da Costa J.,Clinica Universitaria de Dermatologia
Journal of the European Academy of Dermatology and Venereology | Year: 2010

Objectives To assess the prevalence of sexually transmitted infections (STI) and relationships between them and sociodemographic/behavioural data in the major Venereology Clinic in Lisbon. Methods Every patient attending this STI clinic for the first time in the first 17 weeks of 2007 was enrolled in this study. Early syphilis, Chlamydia trachomatis infection, gonorrhoea, human immunodeficiency virus (HIV) first diagnosed and genital warts were considered for the study of statistical associations with sociodemographic/behavioural variables or other STI. Data were analysed with an exact significance level of 5%. Results A total of 743 patients were included. In women (n = 296), the only significant associations found were for C. trachomatis and being non-Caucasian (OR = 2.13, CI 1.17-3.9) or being younger than 25 years (OR = 1.9, CI 1.31-2.79). Men who have sex with men (176 of the 447 male patients) contributed to 39% of the STI, although more than half of the early syphilis, gonorrhoea and HIV cases were diagnosed in this group. Conclusions Despite its limitations, our study allows some insight into the relationships between sociodemographic factors and STI in a selected population attending Lisbon's major Venereology Clinic. The results were similar to those of other European studies and to recent trends in STI, but differ in the association between C. trachomatis infection and non-Caucasian women, which is similar to cities with significant African minorities. Attention should be given to the associations found between men who have sex with men and STI such as gonorrhoea, syphilis and HIV, as these associations can lead to serious difficulties in the control of HIV infection in Portugal. © 2009 European Academy of Dermatology and Venereology. Source


Emerit I.,French National Center for Scientific Research | Antunes J.,Clinica Universitaria de Dermatologia | Silva J.M.,Clinica Universitaria de Dermatologia | Freitas J.,Clinica Universitaria de Dermatologia | And 2 more authors.
Photochemistry and Photobiology | Year: 2011

As previously described, Psoralen plus UVA (PUVA) therapy induces chromosome damage in psoriatic patients. This study evaluates whether these effects are transitory or persistent. In addition, we studied these effects after narrowband UVB (nUVB) and anti-tumor necrosis factor (TNF)-α treatments. Among 40 responder patients, 10 received PUVA, 10 nUVB, 10 Infliximab and 10 Etanercept. Disease activity was determined with Psoriasis Area and Severity Index. Chromosomal breakage was evaluated by the clastogenic factor (CF) test. Potential clastogenic agents, malondialdehyde (MDA) and TNF-α were measured. Before treatment, the plasma-adjusted clastogenic scores (ACS) of patients were increased. During treatment, a further increase in ACS was observed in both phototherapy groups. Chromosome damage persisted for PUVA patients at week 32, while it diminished after nUVB to ACS values lower than before treatment. MDA and TNF-α values were also increased at baseline. MDA decreased during treatment in all groups, but without reaching normal levels. Plasma TNF-α remained unchanged in PUVA and nUVB but decreased in both anti-TNF-α treatment groups. Psoriasis is accompanied by CF-induced chromosomal breakage that increases during PUVA and nUVB treatments. Plasma clastogenic activity persisted in the follow-up after PUVA, while after nUVB ACS returned to values even lower than baseline. Clastogenic activity during the induction phase with anti-TNF-α remained unchanged. Psoriasis is accompanied by clastogenic factor (CF)-induced chromosomal breakage that increases during Psoralen plus UVA (PUVA) and narrowband UVB (nUVB) treatments. CF+ patients were more likely to occur in patients with severe disease (Psoriasis Area and Severity Index > 20). Plasma clastogenic activity persisted in the follow-up after PUVA, while after nUVB clastogenic activity returned to values even lower than baseline. During the induction phase with anti-TNF-α treatments clastogenic activity remained unchanged. © 2011 The American Society of Photobiology. Source


Fernandes I.,Servico de Oncologia | Da Costa J.B.,Clinica Universitaria de Dermatologia | Rego F.,Clinica Universitaria de Medicina Interna | Quintela A.,Servico de Oncologia | And 3 more authors.
Skin Cancer | Year: 2010

Cowden Syndrome is an often underdiagnosed autosomal dominant disorder with multisystemic cancer predisposition. We present a 23-year-old male patient admitted to our hospital with fever and hepatic metastases from a tumour with unknown primary site. Cowden's syndrome was diagnosed and the patient died of sepsis after initiating chemotherapy for a neuroendocrine carcinoma. Cowden's syndrome is characterized by pathognomonic skin lesions, such as trichilemmomas, that develop before internal malignancies. Dermatologists should be aware of this syndrome since its early diagnosis allows cancer screening in these patients and their families and improves survival. Source


Travassos A.R.,Clinica Universitaria de Dermatologia | Travassos A.R.,Catholic University of Leuven | Claes L.,Catholic University of Leuven | Boey L.,Catholic University of Leuven | And 2 more authors.
Contact Dermatitis | Year: 2011

Objectives. Reports about the nature of the ingredients responsible for allergic contact dermatitis caused by specific cosmetic products are scarce. Methods. Between January 2000 and December 2010, the specific cosmetic products having caused allergic contact dermatitis, as well as the individual allergenic cosmetic ingredients present in them, were recorded by use of a standardized form. Results. Among 11 different categories of cosmetic product, skin care products, followed by hair care and body-cleansing products, were most often involved. The presence of the allergenic ingredient(s) in a specific cosmetic product was confirmed according to the ingredient label in 959 of 1448 records. Six hundred and twenty-one of 959 concerned non-fragrance components, preservatives being responsible for 58% of them. Reactions to formaldehyde and formaldehyde-releasers were most often correlated with body-cleansing products, particularly 2-bromo-2-nitropropane-1,3-diol and skin care products. They were followed by the methylchloroisothiazolinone/methylisothiazolinone mixture, most frequently found as allergens in hair care and intimate hygiene products, and facial cleansers (in the last category together with diazolidinyl urea). Octocrylene was by far the most frequent (photo)allergen in sun care products. Conclusions. This study provides information on the presence and frequency of allergens in specific causal cosmetic products. © 2011 John Wiley & Sons A/S. Source

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