Fototerapia: aplicações clínicas

Nanoemulsion containing 8-methoxypsoralen for topical treatment of dermatoses: Development, characterization and ex vivo permeation in porcine skin

Oral therapy with 8-methoxypsoralen (8-MOP) may cause major side effects, whereas the topical treatment might not be much effective due to the low penetration induced by typical formulations. Therefore, the objectives of this work are the development and characterization of a nanoemulsion (NE) containing 8-MOP together with an ex vivo permeation study, monitored by a validated HPLC-Fluo method, to determine the amount of drug retained in viable skin (epidermis (E) and dermis (D)) and in stratum corneum (SC). The optimized conditions for NE formulation were achieved by full factorial designs (2⁵ and 3²): 60 s and 60% of ultrasound time and potency, respectively; 10 mL of final volume; 2% v/v of oil phase (clove essential oil); and 10% m/v of Poloxamer 407. The NE showed mean droplet diameter of 24.98 ± 0.49 nm, polydispersity index (PDI) of 0.091 ± 0.23, pH values of 6.54 ± 0.06, refractive index of 1.3525 ± 0.0001 and apparent viscosity of 51.15 ± 3.66 mPa at 20 °C. Droplets with nanospherical diameters were also observed by transmission electron microscopy (TEM). Ex vivo permeation study showed that 8.5% of the applied 8-MOP dose permeated through the biological membranes, with flux (J) of 1.35 μg cm^-2 h^-1. The drug retention in E + D and in SC was 10.15 ± 1.36 and 1.95 ± 0.71 µg cm^-2, respectively. Retention in viable skin induced by the NE was almost two-fold higher than a compounded cream (5.04 ± 0.30 μg cm^-2). These results suggested that the developed NE is a promising alternative for 8-MOP topical therapy when compared to commercial formulations.

“Mata de tristeza!”: representações sociais de pessoas com vitiligo atendidas na Farmácia Universitária da Universidade Federal do Rio de Janeiro, Brasil

Vitiligo é caracterizado por manchas brancas na pele. Na dispensação do metoxisaleno utilizado para tratá-lo, na Farmácia Universitária/UFRJ, os portadores relatavam mal-estares devido à terapia e à doença. A busca pela compreensão da experiência do adoecer conduziu este estudo que adota perspectiva teórico-metodológica socioantropológica. A apreensão da visão de mundo dos sujeitos foi captada em entrevistas entre usuários da FU/UFRJ. A partir do diagnóstico, os sujeitos consideram o vitiligo “um castigo”, sentem-se alvo de “chacotas”, “preconceito”, “discriminações”. A experiência da doença impõe rever seus conceitos e filiação religiosa. O fato de o vitiligo não ser concebido como doença grave estabelece um não-lugar para o sofrimento dos portadores. Aspectos simbólicos, emocionais e socioculturais que circunscrevem a doença devem ser considerados para melhorar a atenção à saúde e vida desses sujeitos. Os profissionais de saúde precisam concebê-los para além de suas “manchas”.

An evaluation of the treatment of parapsoriasis with phototherapy

Whether parapsoriasis represents an early stage of T-cell cutaneous lymphoma is still the subject of controversy. We evaluated the efficacy of phototherapy in the treatment of parapsoriasis and its relation with TCCL. Patients diagnosed with parapsoriasis and treated with phototherapy PUVA or UVB-NB were selected. Between 1 to 8 years following treatment the evolution of their disease was evaluated. In 62 patients the cure rate was 79.3% and 17.2% showed improvement of the lesions. Only two patients developed full blown T-cell cutaneous lymphoma. Phototherapy is an excellent treatment for parapsoriasis, with high cure rates, regardless of the type of phototherapy employed. Of the 62 patients under study, parapsoriasis showed no general tendency to progress to T-cell cutaneous lymphoma.

Tacrolimus 0,1% ointment in the treatment of vitiligo: a series of cases

Vitiligo is a dermatosis of difficult treatment and significant psychosocial impact. The objective of this study was to evaluate the response to tacrolimus 0,1% ointment for vitiligo treatment. Ten patients took part in the present study: six patients with lesions on the cephalic and cervical regions had more than 75% of repigmentation. As for extremities and trunk results varied from good to excellent in 27% of the cases. The association with other therapeutic options could possibly increase the efficacy of the treatment.