Malignant fibrous histiocytoma (MFH) or undifferentiated pleomorphic sarcoma (UPS) is a sarcoma c... more Malignant fibrous histiocytoma (MFH) or undifferentiated pleomorphic sarcoma (UPS) is a sarcoma capable of invading adjacent structures. It is a mesenchymal neoplasia that predominates in men between the sixth and seventh decades of life. It is located mainly in the lower limbs and may affect the head and neck, trunk, and retroperitoneum, presenting a tendency to recurrence and local metastasis. This report aims to present a case of MFH in the ankle of a 49-year-old woman with an adjacent bone invasion, which evolved with transtibial amputation. Clinical, radiological, histopathological, and therapeutic aspects were addressed, highlighting the importance of early diagnosis.
Number of facial topographies affected by melasma according to schooling and skin phototypes (n =... more Number of facial topographies affected by melasma according to schooling and skin phototypes (n = 119). (DOCX 14 kb)
Melasma is a multifactorial dyschromia that results from exposure to external factors (such as so... more Melasma is a multifactorial dyschromia that results from exposure to external factors (such as solar radiation) and hormonal factors (such as sex hormones and pregnancy), as well as skin inflammation (such as contact dermatitis and esthetic procedures), in genetically predisposed individuals. Beyond hyperfunctional melanocytes, skin with melasma exhibits a series of structural and functional alterations in the epidermis, basement membrane, and upper dermis that interact to elicit and sustain a focal hypermelanogenic phenotype. Evolution in the knowledge of the genetic basis of melasma and the cutaneous response to solar radiation, as well as the roles of endocrine factors, antioxidant system, endothelium proliferation, fibroblast senescence, mast cell degranulation, autophagy deficits of the melanocyte, and the paracrine regulation of melanogenesis, will lead to the development of new treatments and preventive strategies. This review presents current knowledge on these aspects of the pathogenesis of melasma and discusses the effects of specific treatments and future research on these issues.
BACKGROUND: Psoriasis is a chronic inflammatory disease of the skin that affects patients of all ... more BACKGROUND: Psoriasis is a chronic inflammatory disease of the skin that affects patients of all ages andboth genders. The impact of the disease on quality of life is greater among patients with moderate to severe psoriasis. OBJECTIVE: to establish a correlation between the psoriasis area and severity index (PASI) and theDermatology Life Quality Index (DLQI) based on a quality of life questionnaire adapted to the Brazilian contextfor patients with plaque psoriasis before and after systemic treatment. METHODS: This was a cross-sectional, descriptive study of psoriasis patients who did not undergo treatment or who manifested clinical activity of the disease. Patients were evaluated according to the PASI and the quality of life questionnaire adapted to theBrazilian context before and 60 days after systemic treatment. RESULTS: Thirty-five patients participated in thestudy. Twenty-six were men, with a mean age of 46 years. There was no correlation between the PASI and thequality of life ...
a Departamento de Patologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, B... more a Departamento de Patologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil b Departamento de Bioestatística, Instituto de Biociências de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil c Departamento de Dermatologia e Radioterapia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil d Departamento de Enfermagem, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
Background Psoriasis is a chronic inflammatory disease with systemic repercussions and an associa... more Background Psoriasis is a chronic inflammatory disease with systemic repercussions and an association with comorbidities such as metabolic syndrome, cardiovascular diseases, and obesity. Psoriasis patients have a higher prevalence of obesity compared to the general population. Diet is a relevant environmental factor, since malnutrition, inadequate body weight, and metabolic diseases, in addition to the direct health risk, impair the treatment of psoriasis. Objectives To evaluate food intake patterns, anthropometric, and metabolic syndrome-related aspects in psoriasis patients. Methods Cross-sectional study through anthropometric assessment and food frequency questionnaire. Food frequency questionnaire items were evaluated by exploratory factor analysis and identified dietary patterns were analyzed by multivariate methods. Results This study evaluated 94 patients, 57% female, with a mean age of 54.9 years; the prevalence of obesity was 48% and of metabolic syndrome, 50%. Factor analy...
Materials and Methods: Open randomized controlled double-blinded factorial trial involving 64 wom... more Materials and Methods: Open randomized controlled double-blinded factorial trial involving 64 women randomized into 4 groups: CG received oral placebo, opaque sunscreen and a triple combination cream containing fluocinolone acetonide 0.01%, tretinoin 0.05%, and hydroquinone 2% once daily; M was submitted to 2 sessions of microneedling (roller 1,5mm, moderate injury) with interval of 30 days between then in addition to CG regimen; TA received oral tranexamic acid 250mg twice daily, in addition to CG regimen. MT group received oral tranexamic acid, 2 sessions of microneedling in addition to CG regimen. After 8 weeks, all groups were maintained using just sunscreen and triple combination cream for other 8 weeks. MELASQoL, mMASI, colorimetry (ITA) and adverse effects were evaluated at T0, T30, T60 and T120.
w c c t c t olar radiation and promotes longer-lasting pigmentation (> weeks) than UVA; howeve... more w c c t c t olar radiation and promotes longer-lasting pigmentation (> weeks) than UVA; however, only in higher phototypes (IV o VI).1 Opsin-3, also known as encephalopsin or panopsin OPN3), is a G-protein-coupled photoreceptor which prootes blue light-induced melanogenesis (420--490 nm). psins 1 to 5 have been described in the retina; howver, OPN3 is the most often expressed form in the skin, hich induces the phosphorylation of the microphthalmiassociated transcription factor (MITF) in melanocytes, esulting in tyrosinase activation.2 To date, the differential xpression of OPN3 in melasma skin compared to adjacent kin has not been investigated. In the present study, after the Ethics Committee pproval, 20 women with facial melasma (diagnosed clincally by an experienced dermatologist), without treatment or more than 30 days (except sunscreen) were submitted o two biopsies (3 mm): skin with melasma and unaffected djacent skin (< 2 cm of distance). The 40 specimens were submitted ...
The fingernail growth rate (NGR) is approximately 3 mm/month and varies according to sex, age, la... more The fingernail growth rate (NGR) is approximately 3 mm/month and varies according to sex, age, labour activities, systemic diseases, seasonality, dominant hand, and trauma.1 The slow growth of nails may have functional and cosmetic impact, such as nail fragility and delayed renewal of the nail plate.2 Few studies have evaluated pharmacological interventions to increase NGR.
BACKGROUND Skin tags are dermatological lesions commonly found in the general population and have... more BACKGROUND Skin tags are dermatological lesions commonly found in the general population and have been associated with diabetes mellitus, obesity, insulin resistance and atherosclerosis. Early detection of patients with insulin resistance may play an important preventive role. OBJECTIVE To evaluate the association between skin tags in the neck or axillary regions and insulin resistance. METHODS A cross-sectional study involving adult patients receiving care at a university teaching hospital. Cases were defined as patients with > 5 skin tags in the neck region and/or axillae. Insulin resistance was estimated using the HOMA-IR index. Results were adjusted for the other known covariates of risk for insulin resistance using a multiple logistic regression model. RESULTS Ninety-eight cases and 103 controls were evaluated. There was no difference between the groups with respect to age or gender. Skin tags were directly associated with HOMA-IR values (odds ratio = 1.4), hypertriglyceride...
Concerns on comparing drugs in dermatologic treatments from different suppliers Dear Editor, We a... more Concerns on comparing drugs in dermatologic treatments from different suppliers Dear Editor, We appreciate the opportunity to discuss crucial aspects of the role of different product suppliers for dermatologic treatments. As long as pharmaceutical technology evolves, drugs and their additives can be sourced from different suppliers. Moreover, products can be processed through different techniques by their manufacturers. The solubility, stability, absorption rate, distribution, and pharmacokinetics of the metabolites can vary among brands. This concern is a recurrent issue in dermatologic practice (e.g. botulinum toxin brands, suppliers of isotretinoin, micronized itraconazole, and biosimilars in the treatment of psoriasis). The comparison of drugs from different suppliers is not straightforward, and their clinical efficacy is not a linear result of the stoichiometric measure of drug concentration. Therefore, systematic investigation of the clinical performance of these products is mandatory. While cysteamine is a known depigmenting agent, a recent change in its formulation has reduced the sulfur odor and skin irritability. Nevertheless, it is an unstable compound with high hygroscopicity, which requires refined pharmacologic stabilization. As several suppliers worldwide are now available (e.g. Switzerland, India, China, and Brazil), concerns regarding its efficacy have emerged. We demonstrated the proper efficacy and good tolerability of a Brazilian brand 5% cysteamine gel-cream (Clarit e Cysteamin; Dermage, S~ ao Paulo-Brazil) for the treatment of melasma in women. Table 1 presents the results of published trials on topical cysteamine in facial melasma; the clinical improvement ranged from 38 to 58% after 16 weeks of treatment, regardless of the supplier. We read with consternation the correspondence from Dr. Chun-Man Lee, which reported the finding of a very low concentration of a derivative (cysteamine-NPM complex) in a sample from Clarit e Cysteamin (Brazil) through HPLC-UV performed in a Swiss laboratory. Unfortunately, Dr. Lee did not provide data regarding the analyzed lot or storage and transport conditions, nor was the sample integrity verified. Without the availability of such data, it is impossible to draw a conclusion about the test. In addition, as the quantification was performed after the formation of the cysteamine-NPM complex, it is necessary to ensure that all cysteamine in the sample was complexed to ensure that no free cysteamine was left and, therefore, not included in the quantification. The Brazilian producer warranted the tests of quality for the registration of the product with the regulatory agency of the Brazilian Ministry of Health (ANVISA; National Health Surveillance Agency). The cysteamine was quantified by ion-pair reversedphase high-performance liquid chromatography. This methodology assesses cysteamine hydrochloride in its pure form and not through a derived process, using cysteamine hydrochloride (CAS No. 156-57-0) as the quantification standard. Therefore, all the cysteamine present in the formulation was quantified. Furthermore, we believe that the clinical efficacy of the Brazilian product in comparison to other trials (Table 1) and our results comparing it to hydroquinone would be difficult to achieve if the concentration of the active ingredient was 10 times lower than the expected, as asserted by Dr. Lee. Further clinical trials on melasma using the Brazilian brand of 5%
To assess the efficacy and safety of topical 5% cysteamine versus 4% hydroquinone in the treatmen... more To assess the efficacy and safety of topical 5% cysteamine versus 4% hydroquinone in the treatment of facial melasma in women. Topical 5% cysteamine is an antioxidant and tyrosinase inhibitor that has been shown to be effective in the treatment of melasma. However, to date, no study has compared the performance of topical cysteamine to hydroquinone for facial melasma.
Background: Melasma is a chronic acquired focal hypermelanosis which pathogenesis has not been fu... more Background: Melasma is a chronic acquired focal hypermelanosis which pathogenesis has not been fully elucidated. Classical pathophysiologic studies have analysed the affected and perilesional areas, but little is known about the status of sun-protected skin, which is subjected to the same endogenous and genetic factors. Objective: To assess the histological characteristics of melasma compared to adjacent and retroauricular skin. Methods: Skin samples were collected from 10 female from: melasma, perilesional area and retroauricular. The samples were stained (haematoxylin-eosin, periodic acid-Schiff, Fontana-Masson, picrosirius red, toluidine blue and Verhoeff), immunolabelled for CD34 and Wnt1. The data from the skin sites were analysed simultaneously by a multivariate model. Results: Melasma skin exhibited noteworthy stratum corneum compaction, greater collagen heterogeneity, solar elastosis, higher number of mast cells, basement membrane zone (BMZ) damage, Wnt1 expression, pendulum melanocytes, higher cellularity and vascular proliferation at the superficial dermis. Stratum cor-neum compaction, collagen heterogeneity and BMZ abnormalities were variables associated to melasma that not follow a continuum through retroauricular to adjacent skin. Mast cell count was the variable that disclosed correlation with the most other abnormalities as well as had the greater contribution in the multivariate model. Conclusion: In addition to melanocyte hyperactivity, melasma skin exhibits alterations in the epidermal barrier, upper dermis and BMZ, which differ from the adjacent sun-exposed skin and retroauricular skin, indicating a distinct phenotype, rather than a mere extension of photoageing or intrinsic ageing. Mast cells appear to play a central role in the physiopathology of melasma.
Background: Melasma has a major impact on quality of life. MELASQoL is the only validated specifi... more Background: Melasma has a major impact on quality of life. MELASQoL is the only validated specific psychometric instrument to evaluate melasma QoL. oBjective: To develop and validate a multidimensional questionnaire for evaluating quality of life related to facial melasma. Methods: Cross-sectional study performed in 2 institutions (public and private) from Brazil. Two focus groups were carried out: 5 board-certified dermatologists and 10 melasma patients, indicating the dimensions and significant units of melasma QoL. The preliminary questionnaire with 49 itens was applied to 154 facial melasma patients. Item reduction was performed by Rasch analysis. Parallel evaluations of clinical (MASI), demographic, and QoL aspects (MELASQoL, DLQI) were performed. The dimensional structure was assessed by confirmatory factor analysis. Temporal stability was tested in a subgroup of 42 individuals within 7-14 days. results: The mean (SD) age of the 154 interviewed subjects was 39±8 years, and 87% were females. The median (p25-p75) DLQI and MELASQoL were: 2 (1-6) and 30 (17-44). HRQ-Melasma consisted of 19 items distributed in 4 dimensions: Physical/ Appearance, Social/Professional, Psychological, and Treatment. Cronbach's alpha for HRQ-Melasma was 0.96, and >0.74 for each dimension. There was high correlation between HRQ-Melasma and DLQI and MELASQoL (rho=0.80 and 0.83), but modest with MASI (rho=0.35). Dimensional structure of HRQ-Melasma was stated by confirmatory factor analysis coefficients. Test-retest analysis disclosed an intraclass correlation coefficient of 0.91 (p<0.01). study liMitations: Single-center study. conclusions: A specific instrument to evaluate QoL in melasma with multidimensional characteristics was developed and validated, with appropriate psychometric performance.
A 28-year-old white female patient presented with multiple erythematous-toviolaceous, painful, su... more A 28-year-old white female patient presented with multiple erythematous-toviolaceous, painful, suppurative nodules on the buttocks and thighs that appeared after two weeks of mesotherapy with deoxycholate, caffeine, sunflower liposomes, and sinetrol for localized fat. She was treated for atypical mycobacteriosis, but with no satisfactory response after antibiotic therapy. Bacterial, mycobacterial, and fungal culture were all negative. Histopathologic examination of the biopsy showed noninfectious suppurative panniculitis. It resolved after treatment with methotrexate, prednisone, and hydroxychloroquine. This report highlights the rarity of this complication, the importance of its early recognition, and differentiation with atypical fast growing mycobacterioses.
Objective: To exhibit the meanings attributed to quality of life by patients with facial melasma.... more Objective: To exhibit the meanings attributed to quality of life by patients with facial melasma. Methods: Qualitative research using the focal group technique, with 10 people with facial melasma from a public hospital and private clinic of a municipality in the interior of the state of São Paulo. The methodological indicative used was content analysis. Results: In the interviewees’ speech, one perceives the annoyance generated by the opinion of others, with curious and even malicious questions related to the blemish. There is difficulty to hide the injuries and the appearance of skin neglect is also cause for distress for the participants. Conclusion: Because it affects the face, which makes it easily visible, melasma is uncomfortable and has a negative impact on the quality of life, since it affects patients’ psychological and emotional well-being.
Malignant fibrous histiocytoma (MFH) or undifferentiated pleomorphic sarcoma (UPS) is a sarcoma c... more Malignant fibrous histiocytoma (MFH) or undifferentiated pleomorphic sarcoma (UPS) is a sarcoma capable of invading adjacent structures. It is a mesenchymal neoplasia that predominates in men between the sixth and seventh decades of life. It is located mainly in the lower limbs and may affect the head and neck, trunk, and retroperitoneum, presenting a tendency to recurrence and local metastasis. This report aims to present a case of MFH in the ankle of a 49-year-old woman with an adjacent bone invasion, which evolved with transtibial amputation. Clinical, radiological, histopathological, and therapeutic aspects were addressed, highlighting the importance of early diagnosis.
Number of facial topographies affected by melasma according to schooling and skin phototypes (n =... more Number of facial topographies affected by melasma according to schooling and skin phototypes (n = 119). (DOCX 14 kb)
Melasma is a multifactorial dyschromia that results from exposure to external factors (such as so... more Melasma is a multifactorial dyschromia that results from exposure to external factors (such as solar radiation) and hormonal factors (such as sex hormones and pregnancy), as well as skin inflammation (such as contact dermatitis and esthetic procedures), in genetically predisposed individuals. Beyond hyperfunctional melanocytes, skin with melasma exhibits a series of structural and functional alterations in the epidermis, basement membrane, and upper dermis that interact to elicit and sustain a focal hypermelanogenic phenotype. Evolution in the knowledge of the genetic basis of melasma and the cutaneous response to solar radiation, as well as the roles of endocrine factors, antioxidant system, endothelium proliferation, fibroblast senescence, mast cell degranulation, autophagy deficits of the melanocyte, and the paracrine regulation of melanogenesis, will lead to the development of new treatments and preventive strategies. This review presents current knowledge on these aspects of the pathogenesis of melasma and discusses the effects of specific treatments and future research on these issues.
BACKGROUND: Psoriasis is a chronic inflammatory disease of the skin that affects patients of all ... more BACKGROUND: Psoriasis is a chronic inflammatory disease of the skin that affects patients of all ages andboth genders. The impact of the disease on quality of life is greater among patients with moderate to severe psoriasis. OBJECTIVE: to establish a correlation between the psoriasis area and severity index (PASI) and theDermatology Life Quality Index (DLQI) based on a quality of life questionnaire adapted to the Brazilian contextfor patients with plaque psoriasis before and after systemic treatment. METHODS: This was a cross-sectional, descriptive study of psoriasis patients who did not undergo treatment or who manifested clinical activity of the disease. Patients were evaluated according to the PASI and the quality of life questionnaire adapted to theBrazilian context before and 60 days after systemic treatment. RESULTS: Thirty-five patients participated in thestudy. Twenty-six were men, with a mean age of 46 years. There was no correlation between the PASI and thequality of life ...
a Departamento de Patologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, B... more a Departamento de Patologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil b Departamento de Bioestatística, Instituto de Biociências de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil c Departamento de Dermatologia e Radioterapia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil d Departamento de Enfermagem, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
Background Psoriasis is a chronic inflammatory disease with systemic repercussions and an associa... more Background Psoriasis is a chronic inflammatory disease with systemic repercussions and an association with comorbidities such as metabolic syndrome, cardiovascular diseases, and obesity. Psoriasis patients have a higher prevalence of obesity compared to the general population. Diet is a relevant environmental factor, since malnutrition, inadequate body weight, and metabolic diseases, in addition to the direct health risk, impair the treatment of psoriasis. Objectives To evaluate food intake patterns, anthropometric, and metabolic syndrome-related aspects in psoriasis patients. Methods Cross-sectional study through anthropometric assessment and food frequency questionnaire. Food frequency questionnaire items were evaluated by exploratory factor analysis and identified dietary patterns were analyzed by multivariate methods. Results This study evaluated 94 patients, 57% female, with a mean age of 54.9 years; the prevalence of obesity was 48% and of metabolic syndrome, 50%. Factor analy...
Materials and Methods: Open randomized controlled double-blinded factorial trial involving 64 wom... more Materials and Methods: Open randomized controlled double-blinded factorial trial involving 64 women randomized into 4 groups: CG received oral placebo, opaque sunscreen and a triple combination cream containing fluocinolone acetonide 0.01%, tretinoin 0.05%, and hydroquinone 2% once daily; M was submitted to 2 sessions of microneedling (roller 1,5mm, moderate injury) with interval of 30 days between then in addition to CG regimen; TA received oral tranexamic acid 250mg twice daily, in addition to CG regimen. MT group received oral tranexamic acid, 2 sessions of microneedling in addition to CG regimen. After 8 weeks, all groups were maintained using just sunscreen and triple combination cream for other 8 weeks. MELASQoL, mMASI, colorimetry (ITA) and adverse effects were evaluated at T0, T30, T60 and T120.
w c c t c t olar radiation and promotes longer-lasting pigmentation (> weeks) than UVA; howeve... more w c c t c t olar radiation and promotes longer-lasting pigmentation (> weeks) than UVA; however, only in higher phototypes (IV o VI).1 Opsin-3, also known as encephalopsin or panopsin OPN3), is a G-protein-coupled photoreceptor which prootes blue light-induced melanogenesis (420--490 nm). psins 1 to 5 have been described in the retina; howver, OPN3 is the most often expressed form in the skin, hich induces the phosphorylation of the microphthalmiassociated transcription factor (MITF) in melanocytes, esulting in tyrosinase activation.2 To date, the differential xpression of OPN3 in melasma skin compared to adjacent kin has not been investigated. In the present study, after the Ethics Committee pproval, 20 women with facial melasma (diagnosed clincally by an experienced dermatologist), without treatment or more than 30 days (except sunscreen) were submitted o two biopsies (3 mm): skin with melasma and unaffected djacent skin (< 2 cm of distance). The 40 specimens were submitted ...
The fingernail growth rate (NGR) is approximately 3 mm/month and varies according to sex, age, la... more The fingernail growth rate (NGR) is approximately 3 mm/month and varies according to sex, age, labour activities, systemic diseases, seasonality, dominant hand, and trauma.1 The slow growth of nails may have functional and cosmetic impact, such as nail fragility and delayed renewal of the nail plate.2 Few studies have evaluated pharmacological interventions to increase NGR.
BACKGROUND Skin tags are dermatological lesions commonly found in the general population and have... more BACKGROUND Skin tags are dermatological lesions commonly found in the general population and have been associated with diabetes mellitus, obesity, insulin resistance and atherosclerosis. Early detection of patients with insulin resistance may play an important preventive role. OBJECTIVE To evaluate the association between skin tags in the neck or axillary regions and insulin resistance. METHODS A cross-sectional study involving adult patients receiving care at a university teaching hospital. Cases were defined as patients with > 5 skin tags in the neck region and/or axillae. Insulin resistance was estimated using the HOMA-IR index. Results were adjusted for the other known covariates of risk for insulin resistance using a multiple logistic regression model. RESULTS Ninety-eight cases and 103 controls were evaluated. There was no difference between the groups with respect to age or gender. Skin tags were directly associated with HOMA-IR values (odds ratio = 1.4), hypertriglyceride...
Concerns on comparing drugs in dermatologic treatments from different suppliers Dear Editor, We a... more Concerns on comparing drugs in dermatologic treatments from different suppliers Dear Editor, We appreciate the opportunity to discuss crucial aspects of the role of different product suppliers for dermatologic treatments. As long as pharmaceutical technology evolves, drugs and their additives can be sourced from different suppliers. Moreover, products can be processed through different techniques by their manufacturers. The solubility, stability, absorption rate, distribution, and pharmacokinetics of the metabolites can vary among brands. This concern is a recurrent issue in dermatologic practice (e.g. botulinum toxin brands, suppliers of isotretinoin, micronized itraconazole, and biosimilars in the treatment of psoriasis). The comparison of drugs from different suppliers is not straightforward, and their clinical efficacy is not a linear result of the stoichiometric measure of drug concentration. Therefore, systematic investigation of the clinical performance of these products is mandatory. While cysteamine is a known depigmenting agent, a recent change in its formulation has reduced the sulfur odor and skin irritability. Nevertheless, it is an unstable compound with high hygroscopicity, which requires refined pharmacologic stabilization. As several suppliers worldwide are now available (e.g. Switzerland, India, China, and Brazil), concerns regarding its efficacy have emerged. We demonstrated the proper efficacy and good tolerability of a Brazilian brand 5% cysteamine gel-cream (Clarit e Cysteamin; Dermage, S~ ao Paulo-Brazil) for the treatment of melasma in women. Table 1 presents the results of published trials on topical cysteamine in facial melasma; the clinical improvement ranged from 38 to 58% after 16 weeks of treatment, regardless of the supplier. We read with consternation the correspondence from Dr. Chun-Man Lee, which reported the finding of a very low concentration of a derivative (cysteamine-NPM complex) in a sample from Clarit e Cysteamin (Brazil) through HPLC-UV performed in a Swiss laboratory. Unfortunately, Dr. Lee did not provide data regarding the analyzed lot or storage and transport conditions, nor was the sample integrity verified. Without the availability of such data, it is impossible to draw a conclusion about the test. In addition, as the quantification was performed after the formation of the cysteamine-NPM complex, it is necessary to ensure that all cysteamine in the sample was complexed to ensure that no free cysteamine was left and, therefore, not included in the quantification. The Brazilian producer warranted the tests of quality for the registration of the product with the regulatory agency of the Brazilian Ministry of Health (ANVISA; National Health Surveillance Agency). The cysteamine was quantified by ion-pair reversedphase high-performance liquid chromatography. This methodology assesses cysteamine hydrochloride in its pure form and not through a derived process, using cysteamine hydrochloride (CAS No. 156-57-0) as the quantification standard. Therefore, all the cysteamine present in the formulation was quantified. Furthermore, we believe that the clinical efficacy of the Brazilian product in comparison to other trials (Table 1) and our results comparing it to hydroquinone would be difficult to achieve if the concentration of the active ingredient was 10 times lower than the expected, as asserted by Dr. Lee. Further clinical trials on melasma using the Brazilian brand of 5%
To assess the efficacy and safety of topical 5% cysteamine versus 4% hydroquinone in the treatmen... more To assess the efficacy and safety of topical 5% cysteamine versus 4% hydroquinone in the treatment of facial melasma in women. Topical 5% cysteamine is an antioxidant and tyrosinase inhibitor that has been shown to be effective in the treatment of melasma. However, to date, no study has compared the performance of topical cysteamine to hydroquinone for facial melasma.
Background: Melasma is a chronic acquired focal hypermelanosis which pathogenesis has not been fu... more Background: Melasma is a chronic acquired focal hypermelanosis which pathogenesis has not been fully elucidated. Classical pathophysiologic studies have analysed the affected and perilesional areas, but little is known about the status of sun-protected skin, which is subjected to the same endogenous and genetic factors. Objective: To assess the histological characteristics of melasma compared to adjacent and retroauricular skin. Methods: Skin samples were collected from 10 female from: melasma, perilesional area and retroauricular. The samples were stained (haematoxylin-eosin, periodic acid-Schiff, Fontana-Masson, picrosirius red, toluidine blue and Verhoeff), immunolabelled for CD34 and Wnt1. The data from the skin sites were analysed simultaneously by a multivariate model. Results: Melasma skin exhibited noteworthy stratum corneum compaction, greater collagen heterogeneity, solar elastosis, higher number of mast cells, basement membrane zone (BMZ) damage, Wnt1 expression, pendulum melanocytes, higher cellularity and vascular proliferation at the superficial dermis. Stratum cor-neum compaction, collagen heterogeneity and BMZ abnormalities were variables associated to melasma that not follow a continuum through retroauricular to adjacent skin. Mast cell count was the variable that disclosed correlation with the most other abnormalities as well as had the greater contribution in the multivariate model. Conclusion: In addition to melanocyte hyperactivity, melasma skin exhibits alterations in the epidermal barrier, upper dermis and BMZ, which differ from the adjacent sun-exposed skin and retroauricular skin, indicating a distinct phenotype, rather than a mere extension of photoageing or intrinsic ageing. Mast cells appear to play a central role in the physiopathology of melasma.
Background: Melasma has a major impact on quality of life. MELASQoL is the only validated specifi... more Background: Melasma has a major impact on quality of life. MELASQoL is the only validated specific psychometric instrument to evaluate melasma QoL. oBjective: To develop and validate a multidimensional questionnaire for evaluating quality of life related to facial melasma. Methods: Cross-sectional study performed in 2 institutions (public and private) from Brazil. Two focus groups were carried out: 5 board-certified dermatologists and 10 melasma patients, indicating the dimensions and significant units of melasma QoL. The preliminary questionnaire with 49 itens was applied to 154 facial melasma patients. Item reduction was performed by Rasch analysis. Parallel evaluations of clinical (MASI), demographic, and QoL aspects (MELASQoL, DLQI) were performed. The dimensional structure was assessed by confirmatory factor analysis. Temporal stability was tested in a subgroup of 42 individuals within 7-14 days. results: The mean (SD) age of the 154 interviewed subjects was 39±8 years, and 87% were females. The median (p25-p75) DLQI and MELASQoL were: 2 (1-6) and 30 (17-44). HRQ-Melasma consisted of 19 items distributed in 4 dimensions: Physical/ Appearance, Social/Professional, Psychological, and Treatment. Cronbach's alpha for HRQ-Melasma was 0.96, and >0.74 for each dimension. There was high correlation between HRQ-Melasma and DLQI and MELASQoL (rho=0.80 and 0.83), but modest with MASI (rho=0.35). Dimensional structure of HRQ-Melasma was stated by confirmatory factor analysis coefficients. Test-retest analysis disclosed an intraclass correlation coefficient of 0.91 (p<0.01). study liMitations: Single-center study. conclusions: A specific instrument to evaluate QoL in melasma with multidimensional characteristics was developed and validated, with appropriate psychometric performance.
A 28-year-old white female patient presented with multiple erythematous-toviolaceous, painful, su... more A 28-year-old white female patient presented with multiple erythematous-toviolaceous, painful, suppurative nodules on the buttocks and thighs that appeared after two weeks of mesotherapy with deoxycholate, caffeine, sunflower liposomes, and sinetrol for localized fat. She was treated for atypical mycobacteriosis, but with no satisfactory response after antibiotic therapy. Bacterial, mycobacterial, and fungal culture were all negative. Histopathologic examination of the biopsy showed noninfectious suppurative panniculitis. It resolved after treatment with methotrexate, prednisone, and hydroxychloroquine. This report highlights the rarity of this complication, the importance of its early recognition, and differentiation with atypical fast growing mycobacterioses.
Objective: To exhibit the meanings attributed to quality of life by patients with facial melasma.... more Objective: To exhibit the meanings attributed to quality of life by patients with facial melasma. Methods: Qualitative research using the focal group technique, with 10 people with facial melasma from a public hospital and private clinic of a municipality in the interior of the state of São Paulo. The methodological indicative used was content analysis. Results: In the interviewees’ speech, one perceives the annoyance generated by the opinion of others, with curious and even malicious questions related to the blemish. There is difficulty to hide the injuries and the appearance of skin neglect is also cause for distress for the participants. Conclusion: Because it affects the face, which makes it easily visible, melasma is uncomfortable and has a negative impact on the quality of life, since it affects patients’ psychological and emotional well-being.
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Papers by Luciane Miot