Patients and Methods This parallel‐group, double‐blind trial compared the efficacy and tolerability of topical prednicarbate, 0.25% ointment, with that of fluocortin butyl ester, 0.75% ointment. The trial included 79 outpatients at three participating centers. All patients had a diagnosis of atopic dermatitis on the basis of Hanifin and Rajka's criteria.1 Other inclusion criteria were: age ≥ 18 years and stability or worsening of the condition for at least 1 week in the current episode. Patients were required to have been treatment‐free for minimum periods of: 7 days if previously treated with other topical corticosteroids; 1 month if previously treated with systemic corticosteroids; 3 days if previously treated with shortacting antihistamines; 2 months if previously treated with astemizole. Exclusion criteria were: severe incapacitating dermatitis; infectious processes or association with other skin changes; need for the concomitant administration of antihistamines or antimicrobials; serious concurrent illness. Women not using adequate contraception were also excluded. A thin layer of topical prednicarbate (N = 42) or fluocortin butyl ester (N = 37) was applied to the affected area of skin twice daily, without occlusion. The duration of treatment was set at 21 days, but it could be interrupted earlier, at the discretion of the investigator, on the grounds of total disappearance of the condition, inefficacy, or the appearance of any adverse reaction. A daily application of an emollient oil and/or a cleaning or emollient aqueous cream could be used at the investigator's discretion. At the start of treatment and at 4, 7, 14, and 21 days, each of the following features was rated on a scale of 0 to 3 (0; absent, 1: mild, 2: moderate, 3: severe): pruritus; excoriations; erythema; scaling; lichenification; vesiculation; hyper‐keratosis. On the basis of these scores, the overall efficacy of treatment was rated as: improvement > improvement of > 50 to 75%; improvement of > 25 to 50%; improvement < 25%; no improvement; worsening. If the treatment ended before 21 days, owing to either cure or inefficacy, the score for the last evaluation was used for all subsequent followup points. At the end of treatment the investigator and the patient rated treatment as excellent, good, fair, or poor. Cosmetic acceptance by the patient was evaluated in the same terms.
A "Deus" e aos seus mensageiros que certamente me impulsionam a cada dia para prosseguir com confiança, disposição e amor em tudo que eu me comprometo a fazer.Ao meu amor Alexandre Merlo, por todo o apoio, incentivo e colaboração essenciais neste projeto. Obrigada por me fazer tão feliz, por ser paciente, compreensivo e pelo amor incondicional que demonstra ter por mim.Aos meus pais, Edson e Leda, pelo apoio, dedicação e paciência durante todo o período de estudo na minha vida, por me ensinarem a ser forte, dedicada e persistente.Aos principais colaboradores deste projeto, os doadores das amostras, pela receptividade sempre gentil e pela tolerância nas inúmeras colheitas realizadas, que os fazem nobres. Sem a colaboração de cada um de vocês Paixão, Didi, Moreno, Miau-Miau....., as informações contidas aqui não seriam concluídas. Agradeço....A Deus por colocar mais esse aprendizado na minha vida e, principalmente, por ter criado os seres mais verdadeiros e apaixonantes da Natureza, os animais.Ao meu orientador Archivaldo Reche Jr., pela oportunidade de tornar esse meu sonho concretizado, pelo incentivo e paciência em todos os momentos de insegurança. Pela confiança e orientações na idealização deste projeto. Às Prof as Márcia Mery Kogika e Mitika Kuribayashi Hagiwara, pelas dicas e sugestões ao longo das incansáveis e motivadoras discussões. À Carmem Salas, proprietária do gatil, que sempre nos recebeu com respeito e confiança para realização das colheitas. A todos os professores do Departamento de Clínica Médica da FMVZ-USP, que se mostraram sempre empenhados e disponíveis em doarem seus conhecimentos. Às funcionárias dos laboratórios pertencentes ao Departamento da Clínica Médica, especialmente Samantha Ive Myashiro, Clara S. Mori e Marli Elizabete Ferreira de Castro, pela disposição e paciência com que me orientaram na rotina do laboratório. Aos meus colegas pós-graduandos por colaborarem na obtenção das minhas amostras e no árduo trabalho em laboratório: Bruno Marques Teixeira, Carlos Collaciopo, pelo apoio, desabafos e risadas durante os momentos difíceis e engraçados ao longo de todos esses anos de verdadeira amizade e afeto. Aos meus colegas de trabalho, especialmente Letícia Lavans e Viviane Higuchi Imagawa, que tiveram disponibilidade e sempre boa vontade para trocas de plantão, me permitindo frequentar as aulas e o laboratório. Aos veterinários Mário Marcondes dos Santos e Fernanda da Silva Fragata, que me incentivaram e foram compreensíveis nos momentos em que precisei recorrer de trocas de plantão ou me ausentar do trabalho.À Prof que me recebeu pronta e gentilmente no laboratório de pesquisa de nefrologia da FM-USP. Aos enfermeiros do HOVET-USP, especialmente ao Milton Gregório dos Santos, pela disposição durante as colheitas das amostras. Aos meus familiares, em especial meu irmão Anderson, Tia Ana e Ana Prima pelo amor que nos une e a elas por toda a dedicação no trato dos nossos animais. Aos meus queridos e saudosos animaizinhos: Fuffy, Maguila, Thor e Felicidade que me proporcionaram alegria de vi...
Background Artificial intelligence (AI) has emerged in dermatology with some studies focusing on skin disorders such as skin cancer, atopic dermatitis, psoriasis, and onychomycosis. Alopecia areata (AA) is a dermatological disease whose prevalence is 0.7%-3% in the United States, and is characterized by oval areas of nonscarring hair loss of the scalp or body without evident clinical variables to predict its response to the treatment. Nonetheless, some studies suggest a predictive value of trichoscopic features in the evaluation of treatment responses. Assuming that black dots, broken hairs, exclamation marks, and tapered hairs are markers of negative predictive value of the treatment response, while yellow dots are markers of no response to treatment according to recent studies, the absence of these trichoscopic features could indicate favorable disease evolution without treatment or even predict its response. Nonetheless, no studies have reportedly evaluated the role of AI in AA on the basis of trichoscopic features. Objective This study aimed to develop an AI algorithm to predict, using trichoscopic images, those patients diagnosed with AA with a better disease evolution. Methods In total, 80 trichoscopic images were included and classified in those with or without features of negative prognosis. Using a data augmentation technique, they were multiplied to 179 images to train an AI algorithm, as previously carried out with dermoscopic images of skin tumors with a favorable response. Subsequently, 82 new images of AA were presented to the algorithm, and the algorithm classified these patients as responders and non-responders; this process was reviewed by an expert trichologist observer and presented a concordance higher than 90% with the algorithm identifying structures described previously. Evolution of the cases was followed up to truly determine their response to treatment and, therefore, to assess the predictive value of the algorithm. Results In total, 32 of 40 (80%) images of patients predicted as nonresponders scarcely showed response to the treatment, while 34 of 42 (81%) images of those predicted as responders showed a favorable response to the treatment. Conclusions The development of an AI algorithm or tool could be useful to predict AA evolution and its response to treatment. However, further research is needed, including larger sample images or trained algorithms, by using images previously classified in accordance with the disease evolution and not with trichoscopic features. Conflicts of Interest None declared.
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