Coexistência de Morfeia, Vitíligo e Diabetes Auto-Imune Latente do Adulto

Cerca de 30% dos adultos com morfeia apresentam simultaneamente outras doenças auto-imunes, o que suporta a presença de mecanismos de auto-imunidade na patogénese desta doença fibrosante da pele e tecidos subjacentes. Os autores descrevem o caso de um doente do sexo masculino, 27 anos, que notou o aparecimento na região abdominal,cerca de 1 ano antes da observação, de placa eritematosa, ovalada, endurada,assintomática, com crescimento progressivo. Referiu vitiligo acro-facial desde os 12 anos de idade e antecedentes maternos de vitiligo e tiroidite de Hashimoto. A avaliação histopatológica evidenciou escasso infiltrado inflamatório perivascular e espessamento das fibras de colagénio, suportando o diagnóstico clínico de morfeia. Na avaliação laboratorial destacou-se a marcada elevação no título do auto-anticorpo anti-descarboxilase do ácido glutâmico, permitindo o diagnóstico de diabetes auto-imune latente do adulto (LADA), uma forma de diabetes tipo 1 de início tardio. A morfeia e o vitiligo são dermatoses raramente descritas em simultâneo, apesar da sua provável etiologia auto-imune. Neste doente, a investigação de outras doenças auto-imunes permitiu o diagnóstico de LADA. Esta associação, raramente descrita, favorece a hipótese auto-imune.

Syndrome In Question

Multiple autoimmune syndrome is a rare condition, described by Humbert and Dupond in 1988. It is defined by the association of at least 3 autoimmune diseases in the same patient. Vitiligo is the most common skin condition in this syndrome. This article presents the case of a 31-year-old male with vitiligo, alopecia areata, Crohn's disease, psoriasis vulgaris and oral lichen planus. The rarity of this case is highlighted by the coexistence of four autoimmune skin diseases in association with Crohn's disease, never described in the literature.

Hanseníase no Município de Buriticupu, Estado do Maranhão: busca ativa de casos na população adulta

INTRODUÇÃO: O estudo foi desenvolvido com o objetivo de avaliar a situação da hanseníase na população adulta do Município de Buriticupu, MA. MÉTODOS: Foi empregado o método de busca ativa na identificação de casos novos, no período de 2005 a 2007. Baciloscopia de raspado intradérmico foi feita em todos os pacientes com lesões de pele compatíveis com hanseníase, enquanto exame histopatológico foi feito naqueles em que havia dúvidas na definição da forma clínica. RESULTADOS: Participaram do estudo 15.409 indivíduos, tendo o exame clínico definido o diagnóstico de hanseníase em 62 pacientes, o que representa um coeficiente de detecção de 40,23/10.000. A baciloscopia foi positiva em seis pacientes, sendo predominante a forma clínica tuberculóide, em 31 casos, seguida da forma indeterminada em 20, dimorfa em 10 e virchowiana em um. O estudo permitiu, ainda, a identificação de outras doenças da pele, tais como pitiríase versicolor, dermatofitose, escabiose, vitiligo e carcinoma de pele. CONCLUSÕES: O elevado coeficiente de detecção define o município como hiperendêmico para a hanseníase. A busca ativa de casos é um método importante para o controle da doença.

Leprosy in Buriticupu, state of Maranhão: active search in the general population

INTRODUCTION: This study was developed to evaluate the situation of leprosy in the general population of the municipality of Buriticupu, State of Maranhão, Brazil. METHODS: We used the method of active search to identify new cases from 2008 to 2010. Bacilloscopy of intradermal scrapings was performed in all patients with skin lesions compatible with leprosy, and histopathological examination in those who had doubts on the definition of the clinical form. RESULTS: The study included 19,104 individuals, with 42 patients diagnosed with leprosy after clinical examination, representing a detection rate of 219.84 per 100,000 inhabitants. The predominant clinical presentation was tuberculoid with 24 (57.1%) cases, followed by borderline with 11, indeterminate with four, and lepromatous with three cases. The study also allowed the identification of 81 patients with a history of leprosy and other skin diseases, such as pityriasis versicolor, dermatophytosis, scabies, vitiligo, and skin carcinoma. The binomial test showed that the proportion of cases in the headquarters was significantly higher than that in the villages (p = 0.04), and the generalized exact test showed that there was no association between age and clinical form (p = 0.438) and between age and gender (p = 0.083). CONCLUSIONS: The elevated detection rate defines the city as hyperendemic for leprosy; the active search for cases, as well as the organization of health services, is an important method for disease control.

Increased numbers of circulating polyfunctional Th17 memory cells in patients with seronegative spondylarthritides

OBJECTIVE: A distinct subset of proinflammatory CD4+ T cells that produce interleukin-17 was recently identified. These cells are implicated in different autoimmune disease models, such as experimental autoimmune encephalomyelitis and collagen-induced arthritis, but their involvement in human autoimmune disease has not yet been clearly established. The purpose of this study was to assess the frequency and functional properties of Th17 cells in healthy donors and in patients with different autoimmune diseases. METHODS: Peripheral blood was obtained from 10 psoriatic arthritis (PsA), 10 ankylosing spondylitis (AS), 10 rheumatoid arthritis (RA), and 5 vitiligo patients, as well as from 25 healthy donors. Synovial tissue samples from a separate group of patients were also evaluated (obtained as paraffin-embedded sections). Peripheral blood cells were analyzed by multiparameter flow cytometry and immunohistochemistry. Cytokine production was examined by enzyme-linked immunosorbent assay and intracellular cytokine staining using specific monoclonal antibodies. Synovial tissue was examined for infiltrating T cells by immunohistochemical analysis. RESULTS: We found increased numbers of circulating Th17 cells in the peripheral blood of patients with seronegative spondylarthritides (PsA and AS), but not in patients with RA or vitiligo. In addition, Th17 cells from the spondylarthritis patients showed advanced differentiation and were polyfunctional in terms of T cell receptor-driven cytokine production. CONCLUSION: These observations suggest a role of Th17 cells in the pathogenesis of certain human autoimmune disorders, in particular the seronegative spondylarthritides.

Scientific production on the applicability of phenytoin in wound healing

Phenytoin is an anticonvulsant that has been used in wound healing. The objectives of this study were to describe how the scientific production presents the use ofphenytoinas a healing agent and to discuss its applicability in wounds. A literature review and hierarchy analysis of evidence-based practices was performed. Eighteen articles were analyzed that tested the intervention in wounds such as leprosy ulcers, leg ulcers, diabetic foot ulcers, pressure ulcers, trophic ulcers, war wounds, burns, preparation of recipient graft area, radiodermatitis and post-extraction of melanocytic nevi. Systemic use ofphenytoinin the treatment of fistulas and the hypothesis of topical use in the treatment of vitiligo were found. In conclusion, topical use ofphenytoinis scientifically evidenced. However robust research is needed that supports a protocol for the use ofphenytoinas another option of a healing agent in clinical practice.

Genotoxicity of Brosimum gaudichaudii measured by the Salmonella/microsome assay and chromosomal aberrations in CHO cells

The root bark of Brosimum gaudichaudii Trecul (Moraceae) is popularly used for treatment of vitiligo. In the present study the mutagenic activity of the aqueous and methanolic extract as well as of the n-butanolic fraction of this medicinal plant were evaluated using Salmonella typhimurium assays, TA100, TA98, TA102 and TA97a strains, while the clastogenic effect in Chinese hamster ovary (CHO) cells in the G(1)/S, S and G(2)/S phases of the cell cycle. The results showed mutagenic activity of the aqueous extract against TA102 in the presence of S9, and of methanolic extract, with and without metabolic activation. TA100 mutagenicity was only observed for the methanolic extract in the absence of S9. The n-butanolic fraction did not present mutagenic activity. In CHO cells only the methanolic extract induced a significant increase of chromosomal aberrations in the G(1)/S and S phases, whereas a decrease in the mitotic index was observed in the G(1)/S and G(2)/S phases. No clastogenicity was observed for the aqueous extract. The furocoumarins (psoralen and bergapten) presented in the extracts might contribute to the mutagenicity. The lower activity of the aqueous extract was probably due to the presence of smaller amount of furocoumarins compared to the methanolic extract. (C) 2002 Elsevier B.V. Ireland Ltd. All rights reserved.

Morfoanatomia e histoquímica de Brosimum gaudichaudii Trécul (Moraceae)

Brosimum gaudichaudii, conhecida como mamacadela, é espécie comum nos cerrados, com grande valor na medicina popular e na indústria de medicamentos. A casca da raiz e do caule é empregada no tratamento do vitiligo, sendo o bergapteno e psoraleno, duas furanocumarinas, responsáveis pela ação farmacológica. Neste trabalho são apresentadas a caracterização morfoanatômica e a histoquímica de órgãos vegetativos de B. gaudichaudii, com informações sobre o embrião e o desenvolvimento pós-seminal. Amostras foram processadas segundo técnicas usuais em anatomia e ultra-estrutura vegetal. O embrião é do tipo total e invaginado, a plântula cripto-hipogéia e o sistema radicular do tirodendro é composto por raiz primária pouco desenvolvida em relação às raízes laterais. Plantas adultas apresentam raízes gemíferas longas, plagiotrópicas originando ramos caulinares aéreos; tais raízes possuem periderme com súber desenvolvido e floema secundário abundante em relação ao xilema, sendo facilmente destacados quando manipulados. O caule jovem e a folha apresentam epiderme unisseriada, grande densidade de tricomas tectores unicelulares e tricomas glandulares. Laticíferos não-articulados ramificados ocorrem em todos os órgãos, podendo invadir os elementos de vaso. Idioblastos fenólicos ocorrem em abundância em todos tecidos e órgãos analisados. O valor das características anatômicas observadas no controle de qualidade da droga é discutido.

Avaliação do potencial genotóxico do extrato bruto de Pyrostegia venusta (Ker Gawl.) Miers, Bignoneaceae, em medula óssea de camundongos

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Rapid determination of furanocoumarins in creams and pomades using SPE and GC

A solid-phase extraction and chromatography-flame ionization detection (GC-FID) method has been developed for the routine analysis of psoralen, bergapten, isopimpinellin and pimpinellin in creams and pomades employed in Brazil for the treatment of vitiligo. The calibration curve for psoralen was linear in the range 10-100 mu g ml(-1), for bergapten 5-90 mu g ml(-1), for pimpinellin 10-90 mu g ml(-1) and for isopimpinellin 5-100 mu g ml(-1). The best recoveries of the furanocoumarins in the creams analysed were 94-97%, whereas in the pomades, recoveries were 94-96%. The R.S.D. of the quantitative analysis of the furanocoumarins in the products analyses were within 5%. (C) 2000 Elsevier B.V. B.V. All rights reserved.

Simultaneous determination of furanocoumarins in infusions and decoctions from Carapia (Dorstenia species) by high-performance liquid chromatography

The use of furanocoumarins, which are photosensitizing compounds, combined with exposure to UV-A radiation is a common treatment for vitiligo, psoriasis, and a number of other skin diseases. Although furanocoumarins plus UV-A treatment is highly effective, several studies have shown that exposure to high doses increases the risk to development of cutaneus carcinoma. Several Dorstenia species are used in folk medicine, mainly against skin diseases, because of the presence of biologically active compounds. We present here analysis of the chemical composition of furanocoumarins from infusion and decoction of Carapia (Dorstenia species), which is used in Brazil against several diseases. We have employed high-performance liquid chromatography (HPLC) procedures for the quantitative determination of psoralen, bergapten, and isopimpinellin. The contents of furanocoumarins revealed an insignificant difference between infusion and decoction. Dorstenia tubicina and D. asaroides contained psoralen and bergapten only in the rhizomes, whereas D. vitifolia shows solely isopimpinellin in both rhizomes and aerial parts.

Biodegradable Nanoparticles Containing Benzopsoralens: An Attractive Strategy for Modifying Vascular Function in Pathological Skin Disorders

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Morfoanatomia e histoquímica de órgãos vegetativos e reprodutivos de Brosimum gaudichaudii Trecul (Moraceae)

Pós-graduação em Ciências Biológicas (Botânica) - IBB

Estudo comparativo dos constituintes químicos de Brosimum gaudichaudii Trécul e do medicamento V

Pós-graduação em Química - IQ