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Olsen EA, Harries M, Tosti A, Bergfeld W, Blume-Peytavi U, Callender V, Chasapi V, Correia O, Cotsarelis G, Dhurat R, Dlova N, Doche I, Enechukwu N, Grimalt R, Itami S, Hordinsky M, Khobzei K, Lee WS, Malakar S, Messenger A, McMichael A, Mirmirani P, Ovcharenko Y, Papanikou S, Pinto GM, Piraccini BM, Pirmez R, Reygagne P, Roberts J, Rudnicka L, Saceda-Corralo D, Shapiro J, Silyuk T, Sinclair R, Soares RO, Souissi A, Vogt A, Washenik K, Zlotogorski A, Canfield D, Vano-Galvan S. Guidelines for clinical trials of frontal fibrosing alopecia: consensus recommendations from the International FFA Cooperative Group (IFFACG). Br J Dermatol 2021; 185:1221-1231. [PMID: 34105768 DOI: 10.1111/bjd.20567] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Frontal fibrosing alopecia (FFA) has become one of the most common causes of cicatricial alopecia worldwide. However, there is a lack of clear aetiology and robust clinical trial evidence for the efficacy and safety of agents currently used for treatment. OBJECTIVES To enable data to be collected worldwide on FFA using common criteria and assessment methods. METHODS A multicentre, international group of experts in hair loss was convened by email to create consensus recommendations for clinical trials. Consensus was defined at > 90% agreement on each recommended part of these guidelines. RESULTS Standardized diagnostic criteria, severity rating, staging, and investigator and patient assessment of scalp hair loss and other clinical features of FFA were created. CONCLUSIONS These guidelines should allow the collection of reliable aggregate data on FFA and advance efforts in both clinical and basic research to close knowledge gaps in this condition.
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Affiliation(s)
- E A Olsen
- Duke University Medical Center, Durham, NC, USA
| | - M Harries
- University of Manchester, MAHSC and NIHR Manchester Biomedical Research Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - A Tosti
- University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - V Callender
- Callender Dermatology & Cosmetic Center and Howard University College of Medicine, Washington, DC, USA
| | - V Chasapi
- Andreas Sygros Hospital, Athens, Greece
| | - O Correia
- Centro Dermatologia Epidermis, Porto, Portugal
| | - G Cotsarelis
- University of Pennsylvania, Philadelphia, PA, USA
| | - R Dhurat
- LTM Medical College & Hospital Sion, Mumbai, India
| | - N Dlova
- University of KwaZulu Natal, Durban, South Africa
| | - I Doche
- University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | - N Enechukwu
- Nnamdi Azikiwe University Awka, Anambra State, Nigeria
| | - R Grimalt
- Universitat Internacional de Catalunya, Barcelona, Spain
| | - S Itami
- Oita University, Oita, Japan
| | - M Hordinsky
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - K Khobzei
- Kyiv Medical University, Kyiv, Ukraine
| | - W-S Lee
- Yonsei University, Wonju College of Medicine, Wonju, Gangwon-do, Republic of Korea
| | - S Malakar
- Rita Skin Foundation, Kolkata, West Bengal, India
| | | | - A McMichael
- Wake Forest School of Medicine, Winston Salem, NC, USA
| | - P Mirmirani
- Kaiser Permanente Northern California, Vallejo, CA, USA
| | - Y Ovcharenko
- V.N. Karazin Kharkiv National University, Kharkiv, Ukraine
| | | | - G M Pinto
- University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - R Pirmez
- Instituto de Dermatologia Professor Rubem David Azulay - Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - P Reygagne
- Centre Sabouraud, Hôpital Saint Louis, Paris, France
| | - J Roberts
- Northwest Dermatology Institute, Portland, OR, USA
| | - L Rudnicka
- Medical University of Warsaw, Warsaw, Poland
| | - D Saceda-Corralo
- Ramón y Cajal Hospital, IRYCIS, University of Alcala, Madrid, Spain
| | - J Shapiro
- New York University Grossman School of Medicine, New York, NY, USA
| | - T Silyuk
- Hair Treatment and Transplantation Center Private Practice, Saint Petersburg, Russia
| | - R Sinclair
- University of Melbourne and Sinclair Dermatology, Melbourne, VIC, Australia
| | - R O Soares
- Cuf Descobertas Hospital, Lisbon, Portugal
| | - A Souissi
- Department of Dermatology, University of Tunis El Manar, Tunis, Tunisia
| | - A Vogt
- Charité-Universitaetsmedizin, Berlin, Germany
| | - K Washenik
- Bosley Medical Group, Beverly Hills, CA and New York University Grossman School of Medicine, New York, NY, USA
| | - A Zlotogorski
- Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - D Canfield
- Canfield Scientific, Inc, Parsippany, NJ, USA
| | - S Vano-Galvan
- Ramón y Cajal Hospital, IRYCIS, University of Alcala, Madrid, Spain
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Oksuz DP, Aguiar CA, Tápia S, Llop E, Lopes P, Serrano AR, Leal AI, Correia O, Matos P, Rainho A, Branquinho C, Correia RA, Palmeirim JM. The contribution of small shrubby patches to the functional diversity of wood-pastures. Acta Oecologica 2020. [DOI: 10.1016/j.actao.2020.103626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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3
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Duarte A, Mota I, Campo M, Correia O. Skin Cancer and UV Literacy - Outdoor Workers Study. Actas Dermo-Sifiliográficas (English Edition) 2020. [DOI: 10.1016/j.adengl.2018.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Correia O, Duarte A, Picoto A. Green, yellow and red hours to go to the beach. Actas Dermo-Sifiliográficas (English Edition) 2019. [DOI: 10.1016/j.adengl.2018.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Suppa M, Gandini S, Njimi H, Bulliard JL, Correia O, Duarte AF, Peris K, Stratigos AJ, Nagore E, Longo MI, Bylaite-Bucinskiene M, Karls R, Helppikangas H, Del Marmol V. Prevalence and determinants of sunbed use in thirty European countries: data from the Euromelanoma skin cancer prevention campaign. J Eur Acad Dermatol Venereol 2019; 33 Suppl 2:13-27. [PMID: 30811698 DOI: 10.1111/jdv.15311] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 09/20/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although considered as a first-group carcinogen, indoor tanning is a common practice in Europe. Euromelanoma is a pan-European skin cancer prevention campaign. OBJECTIVES To compare several European countries in terms of the prevalence and determinants of sunbed use. METHODS Participants in the Euromelanoma campaigns filled in questionnaires containing demographics and risk factors, including type/duration of sunbed use. Multivariate analyses adjusted for age, gender, education, skin type and year of survey were employed to assess factors independently associated with sunbed use in each country. RESULTS In total, 227 888 individuals (67.4% females, median age 44, 63.4% highly educated, 71.9% skin types III-VI) from 30 countries participated. Overall, the prevalence of sunbed ever use was 10.6% (≤19-year-olds: 5.9%; 20 to 35-year-olds: 17.0%; >35-year-olds: 8.3%). Females displayed a higher prevalence than males in all countries. Balkan countries displayed the highest female/male ratios (≥4). Sunbed use was significantly more prevalent among skin type III-VI (14/30 countries) and highly educated participants (11/30 countries). Significant correlations were found between sunbed use prevalence and countries' latitude (P < 0.001) and sunshine (P = 0.002); Italy and Spain represented exceptions towards excessive exposure. Very different prevalence rates were found for Spain (19.3%) and Portugal (2.0%). Scandinavian countries ranked highest in sunbed use among ≤19-year-olds, Baltic countries among 20 to 35-year-olds. CONCLUSIONS Sunbed use prevalence was higher in northern, sun-deprived countries, with the exception of Italy and Spain. The main determinants of sunbed use were age (young adults) and gender (females), whereas education and skin type had a less relevant effect. Geographic particularities were found in four regions: Iberian (prevalence ten times higher in Spain than Portugal), Balkan (prevalence disproportionately higher among women), Baltic (highest prevalence among young adults) and Scandinavian (highest prevalence among adolescents). These data have public health relevance for future interventions aimed at reducing sunbed use in Europe.
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Affiliation(s)
- M Suppa
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - S Gandini
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - H Njimi
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - J L Bulliard
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - O Correia
- Centro de Dermatologia Epidermis, Instituto CUF, Porto, Portugal.,Portuguese Skin Cancer Association, Lisbon, Portugal.,Center for Health Technology and Services Research (CINTESIS), Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - A F Duarte
- Centro de Dermatologia Epidermis, Instituto CUF, Porto, Portugal.,Portuguese Skin Cancer Association, Lisbon, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - K Peris
- Institute of Dermatology, Catholic University, Rome, Italy
| | - A J Stratigos
- First Department of Dermatology, National and Kapodistrian University of Athens School of Medicine, Andreas Sygros Hospital, Athens, Greece
| | - E Nagore
- Department of Dermatology, Instituto Valenciano de Oncología, Universidad Católica de València San Vicente Ferrer, Valencia, Spain
| | - M I Longo
- Department of Dermatology, University of Florida College of Medicine, Gainesville, FL, USA
| | - M Bylaite-Bucinskiene
- Clinic of Infectious, Chest Diseases, Dermatovenereology and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - R Karls
- Department of Infectiology and Dermatology, Riga Stradins University, Riga, Latvia
| | - H Helppikangas
- Dermatology Department, Clinical Center, University of Sarajevo, Sarajevo, Bosnia & Herzegovina
| | | | - V Del Marmol
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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6
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Suppa M, Gandini S, Njimi H, Bulliard JL, Correia O, Duarte AF, Peris K, Stratigos AJ, Nagore E, Longo MI, Bylaite-Bucinskiene M, Karls R, Helppikangas H, Del Marmol V. Association of sunbed use with skin cancer risk factors in Europe: an investigation within the Euromelanoma skin cancer prevention campaign. J Eur Acad Dermatol Venereol 2019; 33 Suppl 2:76-88. [PMID: 30811689 DOI: 10.1111/jdv.15307] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 09/20/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Sunbed use has been significantly associated with increased risk of melanoma and non-melanoma skin cancer (NMSC), but its relationship with melanoma's risk factors such as high nevus count, atypical nevi and lentigines is poorly studied. Euromelanoma is a skin cancer prevention campaign conducted all over Europe. It offers a once-a-year screening during which participants' data, including sunbed use and phenotype, are collected via questionnaires. OBJECTIVES To investigate the association of sunbed use with nevus count, atypical nevi, lentigines and suspicion of skin cancer. METHODS To ensure reliability of the data, we defined inclusion and exclusion criteria for countries' eligibility for the risk analysis. Multivariate logistic regression models (including age, gender, education, skin type, family history of melanoma, personal history of skin cancer, any sun exposure and any sunscreen use) were used to calculate summary odds ratios (SORs) of each clinical endpoint for ever sunbed use. RESULTS Overall, 227 888 individuals from 30 countries completed the Euromelanoma questionnaire. After the data quality check, 16 countries were eligible for the multivariate analysis, for a total of 145 980 participants (64.8% females; median age 43 years; 62.3% highly educated; 28.5% skin type I-II; 11.0% ever sunbed use). Ever sunbed use was independently associated with nevus count >50 [SOR = 1.05 (1.01-1.10)], atypical nevi [SOR = 1.04 (1.00-1.09)], lentigines [SOR = 1.16 (1.04-1.29)] and suspicion of melanoma [SOR = 1.13 (1.00-1.27)]. Conversely, no significant association was found between ever sunbed use and suspicion of NMSC [SOR = 1.00 (0.91-1.10)]. CONCLUSIONS Indoor tanning is significantly associated with well-recognized risk factors for melanoma (including high nevus count, presence of atypical nevi and lentigines) as well as suspicion of melanoma within the Euromelanoma screenees. In order to reduce the prevalence of melanoma risk factors, avoidance/discontinuation of sunbed use should always be encouraged, especially but not exclusively for individuals with high-risk phenotypes.
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Affiliation(s)
- M Suppa
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - S Gandini
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - H Njimi
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - J L Bulliard
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - O Correia
- Centro de Dermatologia Epidermis, Instituto CUF, Porto, Portugal.,Portuguese Skin Cancer Association, Lisbon, Portugal.,Center for Health Technology and Services Research (CINTESIS), Porto, Portugal.,Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - A F Duarte
- Centro de Dermatologia Epidermis, Instituto CUF, Porto, Portugal.,Portuguese Skin Cancer Association, Lisbon, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - K Peris
- Institute of Dermatology, Catholic University, Rome, Italy
| | - A J Stratigos
- First Department of Dermatology, National and Kapodistrian University of Athens School of Medicine, Andreas Sygros Hospital, Athens, Greece
| | - E Nagore
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain.,Universidad Católica de València San Vicente Ferrer, Valencia, Spain
| | - M I Longo
- Department of Dermatology, University of Florida College of Medicine, Gainesville, FL, USA
| | - M Bylaite-Bucinskiene
- Clinic of Infectious, Chest diseases, Dermatovenereology and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - R Karls
- Department of Infectiology and Dermatology, Riga Stradins University, Riga, Latvia
| | - H Helppikangas
- Dermatology Department, Clinical Center, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - V Del Marmol
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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Cariñanos P, Grilo F, Pinho P, Casares-Porcel M, Branquinho C, Acil N, Andreucci MB, Anjos A, Bianco PM, Brini S, Calaza-Martínez P, Calvo E, Carrari E, Castro J, Chiesura A, Correia O, Gonçalves A, Gonçalves P, Mexia T, Mirabile M, Paoletti E, Santos-Reis M, Semenzato P, Vilhar U. Estimation of the Allergenic Potential of Urban Trees and Urban Parks: Towards the Healthy Design of Urban Green Spaces of the Future. Int J Environ Res Public Health 2019; 16:E1357. [PMID: 30991765 PMCID: PMC6517926 DOI: 10.3390/ijerph16081357] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/07/2019] [Accepted: 04/09/2019] [Indexed: 11/17/2022]
Abstract
The impact of allergens emitted by urban green spaces on health is one of the main disservices of ecosystems. The objective of this work is to establish the potential allergenic value of some tree species in urban environments, so that the allergenicity of green spaces can be estimated through application of the Index of Urban Green Zones Allergenicity (IUGZA). Multiple types of green spaces in Mediterranean cities were selected for the estimation of IUGZ. The results show that some of the ornamental species native to the Mediterranean are among the main causative agents of allergy in the population; in particular, Oleaceae, Cupressaceae, Fagaceae, and Platanus hispanica. Variables of the strongest impact on IUGZA were the bioclimatic characteristics of the territory and design aspects, such as the density of trees and the number of species. We concluded that the methodology to assess the allergenicity associated with urban trees and urban areas presented in this work opens new perspectives in the design and planning of urban green spaces, pointing out the need to consider the potential allergenicity of a species when selecting plant material to be used in cities. Only then can urban green areas be inclusive spaces, in terms of public health.
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Affiliation(s)
- Paloma Cariñanos
- Department of Botany, University of Granada, 18071 Granada, Spain.
- Andalusian Institute for Earth System Research (IISTA-CEAMA), University of Granada, 18071 Granada, Spain.
| | - Filipa Grilo
- Centre for Ecology, Evolution and Environmental Changes (cE3c), Faculdade de Ciencias da Universidade de Lisboa, 1749-016 Lisbon, Portugal.
| | - Pedro Pinho
- Centre for Ecology, Evolution and Environmental Changes (cE3c), Faculdade de Ciencias da Universidade de Lisboa, 1749-016 Lisbon, Portugal.
| | | | - Cristina Branquinho
- Centre for Ecology, Evolution and Environmental Changes (cE3c), Faculdade de Ciencias da Universidade de Lisboa, 1749-016 Lisbon, Portugal.
| | - Nezha Acil
- School of Geography, Earth and Environmental Science and Birmingham Institute of Forest Research, University of Birmingham, Birmingham, B15 2TT, UK.
| | | | - Andreia Anjos
- Centre for Ecology, Evolution and Environmental Changes (cE3c), Faculdade de Ciencias da Universidade de Lisboa, 1749-016 Lisbon, Portugal.
| | | | - Silvia Brini
- Institute for Environmental Protection and Research (ISPRA), 00144 Rome, Italy.
| | - Pedro Calaza-Martínez
- Spanish Association for Public Parks and Gardens, 28223 Pozuelo de Alarcón, Madrid, Spain.
| | - Enrico Calvo
- Regional Agency for the Service of Agricultural and Forest (ERSAF), 2014 Milano, Italy.
| | | | - José Castro
- Centro de Investigação da Montanha (CIMO), Instituto Politécnico de Bragança, 5300-253 Bragança, Portugal.
| | - Anna Chiesura
- Institute for Environmental Protection and Research (ISPRA), 00144 Rome, Italy.
| | - Otilia Correia
- Centre for Ecology, Evolution and Environmental Changes (cE3c), Faculdade de Ciencias da Universidade de Lisboa, 1749-016 Lisbon, Portugal.
| | - Artur Gonçalves
- Centro de Investigação da Montanha (CIMO), Instituto Politécnico de Bragança, 5300-253 Bragança, Portugal.
| | - Paula Gonçalves
- Centre for Ecology, Evolution and Environmental Changes (cE3c), Faculdade de Ciencias da Universidade de Lisboa, 1749-016 Lisbon, Portugal.
| | - Teresa Mexia
- Centre for Ecology, Evolution and Environmental Changes (cE3c), Faculdade de Ciencias da Universidade de Lisboa, 1749-016 Lisbon, Portugal.
| | - Marzia Mirabile
- Institute for Environmental Protection and Research (ISPRA), 00144 Rome, Italy.
| | | | - Margarida Santos-Reis
- Centre for Ecology, Evolution and Environmental Changes (cE3c), Faculdade de Ciencias da Universidade de Lisboa, 1749-016 Lisbon, Portugal.
| | - Paolo Semenzato
- Department of Land and Agro-Forestry Systems, University of Padova, 35020 Legnano, Italy.
| | - Ursa Vilhar
- Slovenian Forestry Institute, 1000 Ljubljana, Slovenia.
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Longo M, Bulliard J, Correia O, Maier H, Magnússon S, Konno P, Goad N, Duarte A, Oláh J, Nilsen L, Peris K, Karls R, Forsea A, del Marmol V. Sunbed use legislation in Europe: assessment of current status. J Eur Acad Dermatol Venereol 2019; 33 Suppl 2:89-96. [DOI: 10.1111/jdv.15317] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 09/20/2018] [Indexed: 12/17/2022]
Affiliation(s)
- M.I. Longo
- Department of Dermatology; University of Florida College of Medicine; Gainesville FL USA
| | - J.L. Bulliard
- Institute of Social and Preventive Medicine (IUMSP); Lausanne University Hospital; Lausanne Switzerland
| | - O. Correia
- Centro Dermatologia Epidermis; Instituto CUF; Porto Portugal
| | - H. Maier
- Department of Dermatology; Medical University of Vienna; Vienna Austria
| | | | - P. Konno
- Department of Dermatology; East Tallinn Central Hospital; Tallinn Estonia
| | - N. Goad
- British Association of Dermatologists; London UK
| | - A.F. Duarte
- Centro Dermatologia Epidermis; Instituto CUF; Porto Portugal
| | - J. Oláh
- Department of Dermatology and Allergology; University of Szeged; Szeged Hungary
| | - L.T.N. Nilsen
- Norwegian Radiation Protection Authority; Østerås Norway
| | - K. Peris
- Department of Dermatology; Catholic University of the Sacred Heart; Milano Italy
| | - R. Karls
- Department of Infectology and Dermatology; Riga Stradins University; Riga Latvia
| | - A.M. Forsea
- Department of Dermatology; Elias University Hospital; Carol Davila University of Medicine and Pharmacy; Bucharest Romania
| | - V. del Marmol
- Department of Dermatology; Hôpital Erasme; Université Libre de Bruxelles; Brussels Belgium
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Duarte AF, Sousa-Pinto B, Freitas A, Delgado L, Costa-Pereira A, Correia O. Skin cancer healthcare impact: A nation-wide assessment of an administrative database. Cancer Epidemiol 2018; 56:154-160. [PMID: 30179829 DOI: 10.1016/j.canep.2018.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 08/04/2018] [Accepted: 08/13/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Skin cancer is an important health concern, with an increasing incidence worldwide. OBJECTIVE To assess the clinical and economic burden of melanoma (MM) and non-melanoma skin cancer (NMSC) at public hospitals in mainland Portugal. METHODS We used an administrative database containing a registration of all hospitalizations and ambulatory episodes occurred in Portuguese public hospitals between 2011 and 2015. We assessed all episodes with associated diagnoses of MM or NMSC regarding neoplasm location, metastases occurrence, length of stay, in-hospital mortality and hospital costs. RESULTS We assessed 15,913 MM and 72,602 NMSC episodes. 14.3% of MM episodes presented with metastases, compared to 1.9% of NMSC episodes. Patients' median age was lower for MM (66 years) than NMSC (76 years). The trunk was the most common location for MM (32.5%), followed by the lower limbs (26.5%). NMSC presented with higher length of stay than MM (median 5 versus 4 days; p < 0.001), but with lower in-hospital mortality (7.3% versus 11.9%; p < 0.001). MM episodes had higher average hospital costs than NMSC episodes (1197.7 versus 1113.5 €; p < 0.001). Overall, NMSC episodes amounted a total of 80.8 million € in hospital costs versus 19.1 million € for MM episodes. CONCLUSION Skin neoplasms have substantial impact on healthcare services. NMSC is an important contributor to this burden. NMSC underreporting should be tackled and it should not be downplayed in skin cancer preventative strategies.
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Affiliation(s)
- A F Duarte
- Centro de Dermatologia Epidermis, Instituto CUF, Porto, Portugal; MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Portugal.
| | - B Sousa-Pinto
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, Porto, Portugal; Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Portugal
| | - A Freitas
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - L Delgado
- CINTESIS - Center for Health Technology and Services Research, Porto, Portugal; Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Portugal
| | - A Costa-Pereira
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - O Correia
- Centro de Dermatologia Epidermis, Instituto CUF, Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, Porto, Portugal; Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Portugal
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Correia O, Duarte AF, Picoto A. Green, yellow and red hours to go to the beach. Actas Dermosifiliogr (Engl Ed) 2018; 110:610-612. [PMID: 29859619 DOI: 10.1016/j.ad.2018.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 01/20/2018] [Indexed: 11/26/2022] Open
Affiliation(s)
- O Correia
- Centro de Dermatología Epidermis, Instituto CUF, Sra da Hora, Portugal; Asociación Portuguesa de Cáncer de Piel, Oporto, Portugal; Unidad de Inmunología, Facultad de Medicina, Universidad de Oporto, Oporto, Portugal; CINTESIS, Center for Health Technology and Services Research, Universidad de Oporto, Oporto, Portugal
| | - A F Duarte
- Centro de Dermatología Epidermis, Instituto CUF, Sra da Hora, Portugal; Asociación Portuguesa de Cáncer de Piel, Oporto, Portugal.
| | - A Picoto
- Asociación Portuguesa de Cáncer de Piel, Oporto, Portugal
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Duarte A, Maia Silva J, Costa Pereira A, Nagore E, Picoto A, Correia O. Sunbed use among Portuguese beach goers: a crave group while waiting sunbeds to be abolished. J Eur Acad Dermatol Venereol 2016; 31:e294-e295. [DOI: 10.1111/jdv.14070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A.F. Duarte
- Centro Dermatologia Epidermis; Instituto CUF; Porto Portugal
- Portuguese Skin Cancer Association; Lisboa Portugal
| | | | - A. Costa Pereira
- Center for Health Technology and Services Research (CINTESIS) and Department of Health Information and Decision Sciences; Faculty of Medicine; University of Porto; Porto Portugal
| | - E. Nagore
- Department of Dermatology; Instituto Valenciano de Oncologia; Valencia Spain
| | - A. Picoto
- Portuguese Skin Cancer Association; Lisboa Portugal
| | - O. Correia
- Centro Dermatologia Epidermis; Instituto CUF; Porto Portugal
- Portuguese Skin Cancer Association; Lisboa Portugal
- Faculty of Medicine; University of Porto; Porto Portugal
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12
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Duarte AF, Correia B, Picoto A, Costa Pereira A, Nagore E, Correia O. Behaviour towards sun exposure, skin self-examination and skin cancer knowledge of educators, health professionals and the general population - cross-sectional study. J Eur Acad Dermatol Venereol 2016; 31:e132-e135. [PMID: 27520118 DOI: 10.1111/jdv.13878] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A F Duarte
- Centro Dermatologia Epidermis, Instituto CUF, Porto, Portugal.,Portuguese Skin Cancer Association, Porto, Portugal
| | - B Correia
- Portuguese Skin Cancer Association, Porto, Portugal
| | - A Picoto
- Portuguese Skin Cancer Association, Porto, Portugal
| | - A Costa Pereira
- Center for Health Technology and Services Research (CINTESIS) and Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - E Nagore
- Department of Dermatology, Instituto Valenciano de Oncologia, Valencia, Spain
| | - O Correia
- Centro Dermatologia Epidermis, Instituto CUF, Porto, Portugal.,Portuguese Skin Cancer Association, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
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Diaz-Barradas M, Costa C, Correia O, León-González A, Navarro-Zafra I, Zunzunegui M, Alvarez-Cansino L, Martín-Cordero C. Pentacyclic triterpenes responsible for photoprotection of Corema album (L.) D.Don white berries. BIOCHEM SYST ECOL 2016. [DOI: 10.1016/j.bse.2016.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lopes C, Rocha L, Sokhatska O, Soares J, Tavaria F, Correia O, Pintado M, Fernandes S, Delgado L, Moreira A. Filaggrin Polymorphism Pro478Ser Is Associated With the Severity of Atopic Dermatitis and Colonization by Staphylococcal aureus. J Investig Allergol Clin Immunol 2016; 26:70-72. [PMID: 27012026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
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15
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Ventura F, Correia O, Duarte AF, Barros AM, Haneke E. "Retronychia--clinical and pathophysiological aspects". J Eur Acad Dermatol Venereol 2015; 30:16-9. [PMID: 26435476 DOI: 10.1111/jdv.13342] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 07/03/2015] [Indexed: 11/28/2022]
Abstract
Retronychia represents proximal ingrowth of the nail that occurs when the nail embeds backwards into the proximal nail fold. It is suspected when there is a persistent paronychia, particularly in the setting of trauma. Important clinical criteria for diagnosis are inflammation of the proximal nail fold, granulation tissue emerging from under the nail fold, thickening of the proximal portion of the nail plate and interruption of nail growth. The condition is rarely diagnosed and often misinterpreted, and is therefore unnecessarily treated with systemic antibiotics and antifungals. Avulsion of the nail confirms the diagnosis and it is the curative treatment. Conservative treatment with an adhesive technique is a valid option in early cases. We report 20 cases of retronychia diagnosed in our department between 2010 and 2013.
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Affiliation(s)
- F Ventura
- Centro de Dermatologia Epidermis, Instituto CUF, Porto, Portugal
| | - O Correia
- Centro de Dermatologia Epidermis, Instituto CUF, Porto, Portugal
| | - A F Duarte
- Centro de Dermatologia Epidermis, Instituto CUF, Porto, Portugal
| | - A M Barros
- Centro de Dermatologia Epidermis, Instituto CUF, Porto, Portugal
| | - E Haneke
- Centro de Dermatologia Epidermis, Instituto CUF, Porto, Portugal.,Hospital Isla, University of Bern, Switzerland
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Gilaberte Y, Aguilar M, Almagro M, Correia O, Guillén C, Harto A, Pérez-García B, Pérez-Pérez L, Redondo P, Sánchez-Carpintero I, Serra-Guillén C, Valladares L. Spanish-Portuguese Consensus Statement on the Use of Daylight Photodynamic Therapy With Methyl Aminolevulinate in the Treatment of Actinic Keratosis. Actas Dermo-Sifiliográficas (English Edition) 2015. [DOI: 10.1016/j.adengl.2015.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Werner R, Stockfleth E, Connolly S, Correia O, Erdmann R, Foley P, Gupta A, Jacobs A, Kerl H, Lim H, Martin G, Paquet M, Pariser D, Rosumeck S, Röwert-Huber HJ, Sahota A, Sangueza O, Shumack S, Sporbeck B, Swanson N, Torezan L, Nast A. Evidence- and consensus-based (S3) Guidelines for the Treatment of Actinic Keratosis - International League of Dermatological Societies in cooperation with the European Dermatology Forum - Short version. J Eur Acad Dermatol Venereol 2015; 29:2069-79. [DOI: 10.1111/jdv.13180] [Citation(s) in RCA: 188] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 04/02/2015] [Indexed: 12/22/2022]
Affiliation(s)
- R.N. Werner
- Division of Evidence Based Medicine (dEBM), Department of Dematology, Venerology and Allergology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - E. Stockfleth
- Department of Dermatology, Venerology and Allergology; Skin Cancer Center (HTCC); Charité - Universitätsmedizin Berlin; Berlin Germany
| | - S.M. Connolly
- Department of Dermatology; Mayo Clinic; Scottsdale Arizona USA
| | - O. Correia
- Centro Dermatologia Epidermis; Instituto CUF and Faculty of Medicine of University of Porto; Porto Portugal
| | - R. Erdmann
- Division of Evidence Based Medicine (dEBM), Department of Dematology, Venerology and Allergology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - P. Foley
- Skin and Cancer Foundation Victoria; Carlton Victoria Australia
- St. Vincent's Hospital Melbourne; Fitzroy Victoria Australia
- The University of Melbourne; Melbourne Victoria Australia
| | - A.K. Gupta
- Division of Dermatology; Department of Medicine; University of Toronto; Toronto Ontario Canada
- Mediprobe Research Inc.; London Ontario Canada
| | - A. Jacobs
- Division of Evidence Based Medicine (dEBM), Department of Dematology, Venerology and Allergology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - H. Kerl
- Department of Dermatology; Medical University of Graz; Graz Austria
| | - H.W. Lim
- Department of Dermatology; Henry Ford Hospital; Detroit Michigan USA
| | - G. Martin
- Dermatology Laser Center of Maui; Kihei Hawaii USA
| | - M. Paquet
- Mediprobe Research Inc.; London Ontario Canada
| | - D.M. Pariser
- Division of Dermatology and Virginia Clinical Research Inc; Eastern Virginia Medical School; Norfolk Virginia USA
| | - S. Rosumeck
- Division of Evidence Based Medicine (dEBM), Department of Dematology, Venerology and Allergology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - H.-J. Röwert-Huber
- Division of Dermatopathology; Department of Dermatology, Venerology and Allergology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - A. Sahota
- Department of Dermatology; Whipps Cross University Hospital; London UK
| | - O.P. Sangueza
- Department of Pathology; Wake Forest Baptist Medical Center; Winston-Salem North Carolina USA
- Department of Dermatology; Wake Forest Baptist Medical Center; Winston-Salem North Carolina USA
| | - S. Shumack
- Department of Dermatology; Northern Medical School; University of Sydney; Sydney New South Wales Australia
| | - B. Sporbeck
- Division of Evidence Based Medicine (dEBM), Department of Dematology, Venerology and Allergology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - N.A. Swanson
- Dermatology, Surgery, and Otolaryngology; Oregon Health and Science University; Portland Oregon USA
- Surgical and Cosmetic Dermatology and Clinical Operations; Oregon Health and Science University Knight Cancer Institute; Portland Oregon USA
| | - L. Torezan
- Faculty of Medicine; Hospital das Clínicas; Universidade de São Paulo; São Paulo Brazil
| | - A. Nast
- Division of Evidence Based Medicine (dEBM), Department of Dematology, Venerology and Allergology; Charité - Universitätsmedizin Berlin; Berlin Germany
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18
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Gilaberte Y, Aguilar M, Almagro M, Correia O, Guillén C, Harto A, Pérez-García B, Pérez-Pérez L, Redondo P, Sánchez-Carpintero I, Serra-Guillén C, Valladares LM. Spanish-Portuguese consensus statement on use of daylight-mediated photodynamic therapy with methyl aminolevulinate in the treatment of actinic keratosis. Actas Dermosifiliogr 2015; 106:623-31. [PMID: 26115793 DOI: 10.1016/j.ad.2015.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 05/28/2015] [Accepted: 06/01/2015] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION Daylight-mediated photodynamic therapy (PDT) is a new type of PDT that is as effective as conventional PDT in grade 1 and 2 actinic keratosis but with fewer adverse effects, resulting in greater efficiency. The climatic conditions in the Iberian Peninsula require an appropriately adapted consensus protocol. OBJECTIVE We describe a protocol for the treatment of grade 1 and 2 actinic keratosis with daylight-mediated PDT and methyl aminolevulinate (MAL) adapted to the epidemiological and clinical characteristics of Spanish and Portuguese patients and the climatic conditions of both countries. METHODS Twelve dermatologists from different parts of Spain and Portugal with experience in the treatment of actinic keratosis with PDT convened to draft a consensus statement for daylight-mediated PDT with MAL in these countries. Based on a literature review and their own clinical experience, the group developed a recommended protocol. RESULTS According to the recommendations adopted, patients with multiple grade 1 and 2 lesions, particularly those at risk of developing cancer, are candidates for this type of therapy. Daylight-mediated PDT can be administered throughout the year, although it is not indicated at temperatures below 10°C or at excessively high temperatures. Likewise, therapy should not be administered when it is raining, snowing, or foggy. The procedure is simple, requiring application of a sunscreen with a protection factor of at least 30 based exclusively on organic filters, appropriate preparation of the lesions, application of MAL without occlusion, and activation in daylight for 2hours. CONCLUSION This consensus statement represents a practical and detailed guideline to achieve maximum effectiveness of daylight-mediated PDT with MAL in Spain and Portugal with minimal adverse effects.
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Affiliation(s)
- Y Gilaberte
- Unidad de Dermatología, Hospital San Jorge, Huesca, España.
| | - M Aguilar
- Servicio de Dermatología, Hospital Costa del Sol, Marbella, Málaga, España
| | - M Almagro
- Servicio de Dermatología, Complejo Hospitalario Universitario, La Coruña, España
| | - O Correia
- Centro de Dermatología Epidermis, Instituto CUF, Oporto y Facultad de Medicina, Universidad de Oporto, Oporto, Portugal
| | - C Guillén
- Servicio de Dermatología, Instituto Valencia de Oncología, Valencia, España
| | - A Harto
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - B Pérez-García
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - L Pérez-Pérez
- Servicio de Dermatología, Estructura Organizativa de Gestión Integrada (EOXI) de Vigo, Clínica Pérez & Gavín dermatólogos, Vigo, España
| | - P Redondo
- Servicio de Dermatología, Clínica Universitaria de Navarra, Pamplona, España
| | | | - C Serra-Guillén
- Servicio de Dermatología, Instituto Valencia de Oncología, Valencia, España
| | - L M Valladares
- Servicio de Dermatología, Complejo Asistencial Universitario de León, León, España
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Munzi S, Correia O, Silva P, Lopes N, Freitas C, Branquinho C, Pinho P. Lichens as ecological indicators in urban areas: beyond the effects of pollutants. J Appl Ecol 2014. [DOI: 10.1111/1365-2664.12304] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Silvana Munzi
- Centro de Biologia Ambiental; Faculdade de Ciências; Universidade de Lisboa; Bloco C2, 5° Piso, sala 2.5.14 1749-016 Lisboa Portugal
| | - Otilia Correia
- Centro de Biologia Ambiental; Faculdade de Ciências; Universidade de Lisboa; Bloco C2, 5° Piso, sala 2.5.14 1749-016 Lisboa Portugal
| | - Patricia Silva
- Sustainable Environmental Management and Planning Department; Municipality of Almada; Almada Portugal
| | - Nuno Lopes
- Sustainable Environmental Management and Planning Department; Municipality of Almada; Almada Portugal
| | - Catarina Freitas
- Sustainable Environmental Management and Planning Department; Municipality of Almada; Almada Portugal
| | - Cristina Branquinho
- Centro de Biologia Ambiental; Faculdade de Ciências; Universidade de Lisboa; Bloco C2, 5° Piso, sala 2.5.14 1749-016 Lisboa Portugal
| | - Pedro Pinho
- Centro de Biologia Ambiental; Faculdade de Ciências; Universidade de Lisboa; Bloco C2, 5° Piso, sala 2.5.14 1749-016 Lisboa Portugal
- Centre for Natural Resources and the Environment; Instituto Superior Técnico; University of Lisbon; Lisbon Portugal
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Stratigos A, Forsea A, van der Leest R, de Vries E, Nagore E, Bulliard JL, Trakatelli M, Paoli J, Peris K, Hercogova J, Bylaite M, Maselis T, Correia O, del Marmol V. Euromelanoma: a dermatology-led European campaign against nonmelanoma skin cancer and cutaneous melanoma. Past, present and future. Br J Dermatol 2012; 167 Suppl 2:99-104. [DOI: 10.1111/j.1365-2133.2012.11092.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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21
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van der Leest RJT, de Vries E, Bulliard JL, Paoli J, Peris K, Stratigos AJ, Trakatelli M, Maselis TJEML, Situm M, Pallouras AC, Hercogova J, Zafirovik Z, Reusch M, Olah J, Bylaite M, Dittmar HC, Scerri L, Correia O, Medenica L, Bartenjev I, Guillen C, Cozzio A, Bogomolets OV, del Marmol V. The Euromelanoma skin cancer prevention campaign in Europe: characteristics and results of 2009 and 2010. J Eur Acad Dermatol Venereol 2011; 25:1455-65. [PMID: 21951235 DOI: 10.1111/j.1468-3083.2011.04228.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Euromelanoma is a skin cancer education and prevention campaign that started in 1999 in Belgium as 'Melanoma day'. Since 2000, it is active in a large and growing number of European countries under the name Euromelanoma. OBJECTIVE To evaluate results of Euromelanoma in 2009 and 2010 in 20 countries, describing characteristics of screenees, rates of clinically suspicious lesions for skin cancer and detection rates of melanomas. METHODS Euromelanoma questionnaires were used by 20 countries providing their data in a standardized database (Belgium, Croatia, Cyprus, Czech Republic, FYRO Macedonia, Germany, Greece, Hungary, Italy, Lithuania, Luxembourg, Malta, Moldavia, Portugal, Serbia, Slovenia, Spain, Sweden, Switzerland and Ukraine). RESULTS In total, 59,858 subjects were screened in 20 countries. Most screenees were female (64%), median ages were 43 (female) and 46 (male) and 33% had phototype I or II. The suspicion rates ranged from 1.1% to 19.4% for melanoma (average 2.8%), from 0.0% to 10.7% for basal cell carcinoma (average 3.1%) and from 0.0% to 1.8% for squamous cell carcinoma (average 0.4%). The overall positive predictive value of countries where (estimation of) positive predictive value could be determined was 13.0%, melanoma detection rates varied from 0.1% to 1.9%. Dermoscopy was used in 78% of examinations with clinically suspected melanoma; full body skin examination was performed in 72% of the screenees. CONCLUSION Although the population screened during Euromelanoma was relatively young, high rates of clinically suspected melanoma were found. The efficacy of Euromelanoma could be improved by targeting high-risk populations and by better use of dermoscopy and full body skin examination.
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Affiliation(s)
- R J T van der Leest
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands.
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Stanganelli I, Argenziano G, Sera F, Blum A, Ozdemir F, Karaarslan IK, Piccolo D, Peris K, Kirchesch H, Bono R, Pizzichetta MA, Gasparini S, Braun RP, Correia O, Thomas L, Zaballos P, Puig S, Malvehy J, Scalvenzi M, Rabinovitz H, Bergamo A, Pellacani G, Longo C, Pavlovic M, Rosendahl C, Hofmann-Wellenhof R, Cabo H, Marghoob AA, Langford D, Astorino S, Manganoni AM, Gourhant JY, Keir J, Grichnik JM, Fumo G, Dong H, Sortino Rachou AM, Ferrara G, Zalaudek I. Dermoscopy of scalp tumours: a multi-centre study conducted by the international dermoscopy society. J Eur Acad Dermatol Venereol 2011; 26:953-63. [PMID: 21790795 DOI: 10.1111/j.1468-3083.2011.04188.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known about the dermoscopic features of scalp tumours. Objective To determine the dermoscopic features of scalp tumours. METHODS Retrospective analysis of dermoscopic images of histopathologically diagnosed scalp tumours from International Dermoscopy Society members. RESULTS A total of 323 tumours of the scalp from 315 patients (mean age: 52 years; range 3-88 years) were analysed. Scalp nevi were significantly associated with young age (<30 years) and exhibited a globular or network pattern with central or perifollicular hypopigmentation. Melanoma and non-melanoma skin cancer were associated with male gender, androgenetic alopecia, age >65 years and sun damage. Atypical network and regression were predictive for thin (≤1 mm) melanomas, whereas advanced melanomas (tumour thickness > 1 mm) revealed blue white veil, unspecific patterns and irregular black blotches or dots. CONCLUSIONS The data collected provide a new knowledge regarding the clinical and dermoscopy features of pigmented scalp tumours.
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Affiliation(s)
- I Stanganelli
- Skin Cancer Unit, Istituto Tumori Romagna (IRST), Meldola (FC), Italy
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Hellmann C, Sutter R, Rascher KG, Máguas C, Correia O, Werner C. Impact of an exotic N2-fixing Acacia on composition and N status of a native Mediterranean community. Acta Oecologica 2011. [DOI: 10.1016/j.actao.2010.11.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Mrowietz U, Kragballe K, Reich K, Spuls P, Griffiths CEM, Nast A, Franke J, Antoniou C, Arenberger P, Balieva F, Bylaite M, Correia O, Daudén E, Gisondi P, Iversen L, Kemény L, Lahfa M, Nijsten T, Rantanen T, Reich A, Rosenbach T, Segaert S, Smith C, Talme T, Volc-Platzer B, Yawalkar N. Definition of treatment goals for moderate to severe psoriasis: a European consensus. Arch Dermatol Res 2010; 303:1-10. [PMID: 20857129 PMCID: PMC3016217 DOI: 10.1007/s00403-010-1080-1] [Citation(s) in RCA: 545] [Impact Index Per Article: 38.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 08/23/2010] [Accepted: 08/26/2010] [Indexed: 02/08/2023]
Abstract
Patients with moderate to severe psoriasis are undertreated. To solve this persistent problem, the consensus programme was performed to define goals for treatment of plaque psoriasis with systemic therapy and to improve patient care. An expert consensus meeting and a collaborative Delphi procedure were carried out. Nineteen dermatologists from different European countries met for a face-to-face discussion and defined items through a four-round Delphi process. Severity of plaque psoriasis was graded into mild and moderate to severe disease. Mild disease was defined as body surface area (BSA) ≤10 and psoriasis area and severity index (PASI) ≤10 and dermatology life quality index (DLQI) ≤10 and moderate to severe psoriasis as (BSA > 10 or PASI > 10) and DLQI > 10. Special clinical situations may change mild psoriasis to moderate to severe including involvement of visible areas or severe nail involvement. For systemic therapy of plaque psoriasis two treatment phases were defined: (1) induction phase as the treatment period until week 16; however, depending on the type of drug and dose regimen used, this phase may be extended until week 24 and (2) maintenance phase for all drugs was defined as the treatment period after the induction phase. For the definition of treatment goals in plaque psoriasis, the change of PASI from baseline until the time of evaluation (ΔPASI) and the absolute DLQI were used. After induction and during maintenance therapy, treatment can be continued if reduction in PASI is ≥75%. The treatment regimen should be modified if improvement of PASI is <50%. In a situation where the therapeutic response improved ≥50% but <75%, as assessed by PASI, therapy should be modified if the DLQI is >5 but can be continued if the DLQI is ≤5. This programme defines the severity of plaque psoriasis for the first time using a formal consensus of 19 European experts. In addition, treatment goals for moderate to severe disease were established. Implementation of treatment goals in the daily management of psoriasis will improve patient care and mitigate the problem of undertreatment. It is planned to evaluate the implementation of these treatment goals in a subsequent programme involving patients and physicians.
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Affiliation(s)
- U Mrowietz
- Department of Dermatology, University Medical Center Schleswig-Holstein, Kiel, Germany.
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Palmares J, Correia O, Delgado L, Vazsilva M, Mesquita-Guimaraes J, Castro-Correia J. Ocular involvement in toxic epidermal necrolysis. Ocul Immunol Inflamm 2009; 1:171-8. [DOI: 10.3109/09273949309086556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
OBJECTIVES To review methodological approaches used in recent publications in onychomycosis clinical research. To identify key methodological criteria to ensure conclusive and reliable clinical results. METHODS A Medline search for recent articles on onychomycosis treatment revealed considerable variation in inclusion criteria, definitions and methodology, rendering comparisons difficult. RESULTS Careful diagnosis at trial entry is critical and predisposing factors affecting overall results are rarely considered at enrolment. Clear definitions are required, notably for the terms mycological, clinical and total cure. A consensus was reached that only studies that are evidence-based, controlled and double-blind with less than 10-15% of patients lost to follow-up should be accepted. Results should be interpreted with caution if a given treatment is found to be less effective than previously reported, even if the results are published in a recognized journal. It was agreed that an explanatory/pilot study should be done initially to determine whether there is a reason to believe that a new therapy is effective. If promising results are obtained, a double-blind, randomized study comparing the new therapy with either an existing therapy (preferably) or a placebo may be initiated. CONCLUSIONS Sample size, and inclusion and exclusion criteria should be clearly determined. Efficacy criteria should include mycological, clinical and total cure rates. Finally, studies of toenail and fingernail onychomycosis must last at least 18 and 9 months, respectively.
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Affiliation(s)
- O Correia
- Centro Dermatologia Epidermis, Porto, Portugal
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Abstract
BACKGROUND There are numerous factors that predispose to onychomycosis including genetic predisposition, diabetes mellitus, immunosuppression, vascular disease and psoriasis. OBJECTIVES The aims of this workshop were to discuss current knowledge of genetic risk factors and the approaches that should be used to investigate underlying mechanisms. RESULTS The high prevalence of onychomycosis within certain families was initially attributed to intrafamilial transmission. However, the low prevalence of infection in people marrying into infected families together with the high prevalence among their offspring suggested a genetic basis. The state-of-the-art pedigree study by Zaias et al. suggested that Trichophyton rubrum infection shows an autosomal dominant pattern of inheritance. A consensus was reached that epidemiological and genetic studies are required to investigate this issue further. For epidemiological studies, families in which two or three generations are infected with T. rubrum should be selected. Patients with T. rubrum on different body sites should be included, and the presence of associated diseases or other common features in these individuals should be investigated to identify trigger factors. CONCLUSION Genetic studies should explore the mode of inheritance of onychomycosis and look for the disease gene(s). Serum samples from patients and age-sex matched controls must be analysed centrally. The results of these studies will make it possible to develop therapeutic, preventive and prophylatic measures and to provide patients and their families with information.
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Affiliation(s)
- J Faergemann
- Department of Dermatology, Sahlgrenska University Hospital, SE Göteborg, Sweden.
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Clemente AS, Werner C, Maguas C, Cabral MS, Martins-Loucao MA, Correia O. Restoration of a Limestone Quarry: Effect of Soil Amendments on the Establishment of Native Mediterranean Sclerophyllous Shrubs. Restor Ecol 2004. [DOI: 10.1111/j.1061-2971.2004.00256.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Correia O, Delgado L, Barbosa IL, Domingues JC, Azevedo R, Vaz CP, Pimentel P. CD8+ lymphocytes in the blister fluid of severe acute cutaneous graft-versus-host disease: further similarities with toxic epidermal necrolysis. Dermatology 2002; 203:212-6. [PMID: 11701973 DOI: 10.1159/000051751] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Graft-versus-host disease (GvHD) remains the major toxicity of allogeneic bone marrow transplantation (BMT). In the acute form of the disease, the differential diagnosis includes viral rash and drug eruptions. METHODS We report two patients with chronic myeloid leukemia submitted to allogeneic BMT who developed a severe form of acute cutaneous GvHD, with clinical and histological pictures mimicking toxic epidermal necrolysis (TEN). RESULTS We found a predominance of peripheral CD8+ T lymphocytes and, at the same time, studying the cellular profile of the blister fluid, just in the beginning of blister eruption, we also found a high proportion of CD8+ T lymphocytes, mainly CD8+CD57-. CONCLUSION These data are in agreement with previous reports of the presence of CD8+ T cells in the blister fluid of patients with TEN, further emphasizing similar immunoinflammatory pathways in both diseases.
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Affiliation(s)
- O Correia
- Department of Dermatology, Instituto Português Oncologia, Porto, Portugal.
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Correia O, Lomba Viana H, Azevedo R, Delgado L, Polónia J. Possible phototoxicity with subsequent progression to discoid lupus following pantoprazole administration. Clin Exp Dermatol 2001; 26:455-6. [PMID: 11488838 DOI: 10.1046/j.1365-2230.2001.00857.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Correia O, Ribas F, Azevedo R, Rodrigues H, Delgado L. Gangrene of the fingertips after bleomycin and methotrexate. Cutis 2000; 66:271-2, 274. [PMID: 11109149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
The increased use of cytostatic drugs, which are sometimes used in combination chemotherapy, may result in new and unusual cutaneous side effects. We describe a 57-year-old man with acral erythrocyanosis progressing to acute digital ischemia and gangrene that developed after combined chemotherapy (bleomycin and methotrexate) used to treat a metastatic squamous cell carcinoma of the hypopharynx. A leukocytoclastic vasculitis was found in both the acute phase and in the amputated fingertips. This supports the well-reported potential of bleomycin to trigger acral vascular toxicity.
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Affiliation(s)
- O Correia
- Department of Dermatology, Instituto Português de Oncologia, Porto, Portugal
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Abstract
Docetaxel is a new taxoid antineoplastic drug widely used for advanced breast cancer. Skin and nail toxicity are one of the more frequent nonhematologic adverse reactions. Besides dark pigmentations and Beau's lines, subungual hemorrhage, orange discoloration, acute painful paronychia, onycholysis, subungual hyperkeratosis and transverse loss of the nail plate are described. The type of nail alteration is related with the number of cycles administered and there are no efficacious preventive measures to avoid its development. Clinicians should recognize the clinical picture of these adverse nail reactions because docetaxel is used for several neoplastic disorders.
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Affiliation(s)
- O Correia
- Department of Dermatology, Instituto Português de Oncologia, Porto, Portugal
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Rzany B, Correia O, Kelly JP, Naldi L, Auquier A, Stern R. Risk of Stevens-Johnson syndrome and toxic epidermal necrolysis during first weeks of antiepileptic therapy: a case-control study. Study Group of the International Case Control Study on Severe Cutaneous Adverse Reactions. Lancet 1999; 353:2190-4. [PMID: 10392983 DOI: 10.1016/s0140-6736(98)05418-x] [Citation(s) in RCA: 185] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is still controversy about whether all antiepileptic drugs are associated with the severe cutaneous reactions Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). We have studied the role of antiepileptic drugs in SJS and TEN, taking into account potential cofactors that might confound or modify the risk. METHODS The case-control study in France, Italy, Germany, and Portugal identified cases of SJS/TEN that developed when the patient was not in hospital and were validated by an expert committee. Controls were patients admitted to the same hospital as the case for an acute illness or an elective procedure. FINDINGS 73 (21%) of the 352 SJS/TEN cases and 28 (2%) of the 1579 controls reported intake of antiepileptic drugs. Among the 73 exposed SJS and TEN patients, 36 reported intake of phenobarbital, 14 of phenytoin, 21 of carbamazepine, 13 of valproic acid, and three of lamotrigine. Risk was highest in the first 8 weeks after onset of treatment. For individual antiepileptic drugs the univariate relative risk of SJS/TEN for 8 weeks or less of use was 57 (95% CI 16-360; multivariate risk 59 [12-302]) for phenobarbital; 91 (26-infinity) for phenytoin; 120 (34-infinity) for carbamazepine; 25 (5.6-infinity) for lamotrigine, and 24 (5.9-infinity) for valproic acid. The result for valproic acid was based on four case users, all of whom reported concurrent use of other associate drugs. The univariate relative risk for more than 8 weeks of use was 6.2 (2.4-17.0; multivariate risk 2.1 [0.5-9.3]) for phenobarbital, 1.2 (0-5.4) for phenytoin, 0.4 (0.02-2.1) for carbamazepine, and 7.0 (2.4-21.0; multivariate risk 2.0 [0.3-15.0]) for valproic acid. INTERPRETATION SJS and TEN are associated with short-term therapy with phenytoin, phenobarbital, and carbamazepine. The association with valproic acid seems to be confounded by concomitant short-term therapy with other causal drugs. Lamotrigine also has the potential for severe skin reactions. The period of increased risk is largely confined to the first 8 weeks of treatment.
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Affiliation(s)
- B Rzany
- Department of Dermatology, Fakultät für Klinische Medizin Mannheim der Universität Heidelberg, Mannheim, Germany.
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Werner C, Correia O, Beyschlag W. Two different strategies of Mediterranean macchia plants to avoid photoinhibitory damage by excessive radiation levels during summer drought. Acta Oecologica 1999. [DOI: 10.1016/s1146-609x(99)80011-3] [Citation(s) in RCA: 147] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Roujeau JC, Kelly JP, Naldi L, Rzany B, Stern RS, Anderson T, Auquier A, Bastuji-Garin S, Correia O, Locati F, Mockenhaupt M, Paoletti C, Shapiro S, Shear N, Schöpf E, Kaufman DW. Medication use and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis. Am J Ophthalmol 1996. [DOI: 10.1016/s0002-9394(14)70298-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Roujeau JC, Kelly JP, Naldi L, Rzany B, Stern RS, Anderson T, Auquier A, Bastuji-Garin S, Correia O, Locati F. Medication use and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis. N Engl J Med 1995; 333:1600-7. [PMID: 7477195 DOI: 10.1056/nejm199512143332404] [Citation(s) in RCA: 850] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Toxic epidermal necrolysis and Stevens-Johnson syndrome are rare, life-threatening, drug-induced cutaneous reactions. We conducted a case-control study to quantify the risks associated with the use of specific drugs. METHODS Data were obtained through surveillance networks in France, Germany, Italy, and Portugal. Drug use before the onset of disease was compared in 245 people who were hospitalized because of toxic epidermal necrolysis or Stevens-Johnson syndrome and 1147 patients hospitalized for other reasons (controls). Crude relative risks were calculated and adjusted for confounding by multivariate methods when numbers were large enough. RESULTS Among drugs usually used for short periods, the risks were increased for trimethoprim-sulfamethoxazole and other sulfonamide antibiotics (crude relative risk, 172; 95 percent confidence interval, 75 to 396), chlormezanone (crude relative risk, 62; 21 to 188), aminopenicillins (multivariate relative risk, 6.7; 2.5 to 18), quinolones (multivariate relative risk, 10; 2.6 to 38), and cephalosporins (multivariate relative risk, 14; 3.2 to 59). For acetaminophen, the multivariate relative risk was 0.6 (95 percent confidence interval, 0.2 to 1.3) in France but 9.3 (3.9 to 22) in the other countries. Among drugs usually used for months or years, the increased risk was confined largely to the first two months of treatment, when crude relative risks were as follows: carbamazepine, 90 (95 percent confidence interval, 19 to infinity); phenobarbital, 45 (19 to 108); phenytoin, 53 (11 to infinity); valproic acid, 25 (4.3 to infinity); oxicam nonsteroidal antiinflammatory drugs (NSAIDs), 72 (25 to 209); allopurinol, 52 (16 to 167); and corticosteroids, 54 (23 to 124). For many drugs, including thiazide diuretics and oral hypoglycemic agents, there was no significant increase in risk. CONCLUSIONS The use of antibacterial sulfonamides, anticonvulsant agents, oxicam NSAIDs, allopurinol, chlormezanone, and corticosteroids is associated with large increases in the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis. But for none of the drugs does the excess risk exceed five cases per million users per week.
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Affiliation(s)
- J C Roujeau
- Department of Dermatology, Université Paris XII, Créteil, France
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Kelly JP, Auquier A, Rzany B, Naldi L, Bastuji-Garin S, Correia O, Shapiro S, Kaufman DW. An international collaborative case-control study of severe cutaneous adverse reactions (SCAR). Design and methods. J Clin Epidemiol 1995; 48:1099-108. [PMID: 7636511 DOI: 10.1016/0895-4356(95)00004-n] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A multicenter international case-control study has been designed to elucidate the etiology of Stevens-Johnson syndrome and toxic epidermal necrolysis (TEN). Although these diseases occur rarely, the morbidity is high and the mortality for TEN is of the order of 30%. These serious dermatologic conditions have often been linked to exposure to drugs. Infective and autoimmune diseases, as well as other non-drug risk factors, have also been postulated to be of importance in increasing the risk. The design and methods are described, with particular attention to the unique challenges for an epidemiologic study of these conditions.
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Affiliation(s)
- J P Kelly
- Slone Epidemiology Unit, Boston University School of Medicine, Brookline, Massachusetts, USA
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Correia O, Delgado L, Ramos JP, Resende C, Torrinha JA. Cutaneous T-cell recruitment in toxic epidermal necrolysis. Further evidence of CD8+ lymphocyte involvement. Arch Dermatol 1993; 129:466-468. [PMID: 8466217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
BACKGROUND Toxic epidermal necrolysis (TEN) is a life-threatening disease with severe mucocutaneous shedding. Although it is widely accepted that immune mechanisms are at play, the pathophysiology of TEN is still unknown. We studied the blister fluid inflammatory cells in three drug-related cases to further define the suspected T-cell involvement in TEN. OBSERVATIONS A peripheral blood lymphopenia, especially of CD4+ T lymphocytes, was associated with a high lymphocytic cellularity of the blister fluid. In two cases, immunophenotyping of blister fluid lymphocytes showed a predominance of the CD8 phenotype. Furthermore, using two-color flow cytometry in one patient, we could show the predominance of CD8+ CD29+ lymphocytes and CD45RA- negative cells. CONCLUSIONS Our findings point to a cutaneous recruitment of antigen-primed and cytotoxic T cells in TEN, further supporting the involvement of CD8+ lymphocytes in TEN pathogenesis and its immune mediation.
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Affiliation(s)
- O Correia
- Department of Immunology, Faculty of Medicine, Hospital S João, Porto, Portugal
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Abstract
A series of 90 consecutive cases of toxic epidermal necrolysis (TEN) observed in a single center between 1985 and March 1991 was compared to a previous series from the same institution in order to look for changes in the characteristics of the patients and in the drug etiology. The most salient change was the high prevalence of human immunodeficiency virus (HIV) infection among patients with TEN (20/90). This high rate of HIV infection was linked to two other changes: higher number of male patients leading to an equilibrated sex ratio and an increased role of sulfonamides-mainly sulfadiazine-as etiologic agents.
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Affiliation(s)
- O Correia
- Department of Dermatology, Hôpital Henri-Mondor, Université Paris-XII, Créteil, France
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Correia O, Nunes JP, Vaz-da-Silva MJ, Pires S, Brandão F, Mesquita-Guimarães J. Acute exanthematous pustular dermatitis after pneumococcal vaccine. Dermatology 1993; 187:217. [PMID: 8219429 DOI: 10.1159/000247249] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Affiliation(s)
- O Correia
- Serviço de Dermatologia e Venereologia, Hospital de S. João, Porto, Portugal
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Abstract
The classical treatment of severe forms of dermatomyositis includes high doses of steroids and/or cytotoxic agents. Acute forms are frequently life threatening. Because cyclosporine is a fast-acting immunosuppressive drug, it appears to be a good candidate for the treatment of refractory forms of acute dermatomyositis. We report a dramatic improvement of a severe, acute, steroid-resistant adult form after cyclosporine administration. A rapid clinical and biochemical improvement is reported, and the reversibility of immunologic abnormalities is emphasized.
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Affiliation(s)
- O Correia
- Department of Dermatology, Oporto Medical School, Hospital S. João, Porto, Portugal
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