Brazil is a country of continental dimensions with a large heterogeneity of climates and massive mixing of the population. Almost the entire national territory is located between the Equator and the Tropic of Capricorn, and the Earth axial tilt to the south certainly makes Brazil one of the countries of the world with greater extent of land in proximity to the sun. The Brazilian coastline, where most of its population lives, is more than 8,500 km long. Due to geographic characteristics and cultural trends, Brazilians are among the peoples with the highest annual exposure to the sun. Epidemiological data show a continuing increase in the incidence of non-melanoma and melanoma skin cancers. Photoprotection can be understood as a set of measures aimed at reducing sun exposure and at preventing the development of acute and chronic actinic damage. Due to the peculiarities of Brazilian territory and culture, it would not be advisable to replicate the concepts of photoprotection from other developed countries, places with completely different climates and populations. Thus the Brazilian Society of Dermatology has developed the Brazilian Consensus on Photoprotection, the first official document on photoprotection developed in Brazil for Brazilians, with recommendations on matters involving photoprotection.

Obesity is strongly related to several skin alterations that could be considered as markers of excessive weight. Skin care of obese patients deserves particular attention, not only because of the high prevalence of cutaneous alteration but mainly because many of these disorders are preventable and could be treated, improving patient's quality of life.

Cutaneous hyperpigmentations are frequent complaints, motivating around 8.5% of all dermatological consultations in our country. They can be congenital, with different patterns of inheritance, or acquired in consequence of skin problems, systemic diseases or secondary to environmental factors. The vast majority of them are linked to alterations on the pigment melanin, induced by different mechanisms. This review will focus on the major acquired hyperpigmentations associated with increased melanin, reviewing their mechanisms of action and possible preventive measures. Particularly prominent aspects of diagnosis and therapy will be emphasized, with focus on melasma, post-inflammatory hyperpigmentation, periorbital pigmentation, dermatosis papulosa nigra, phytophotodermatoses, flagellate dermatosis, erythema dyschromicum perstans, cervical poikiloderma (Poikiloderma of Civatte), acanthosis nigricans, cutaneous amyloidosis and reticulated confluent dermatitis

OBJECTIVE -To evaluate the impact of masked hypertension in normotensive type 2 diabetic patients on microvascular complications and echocardiographic parameters. RESEARCH DESIGN AND METHODS-A cross-sectional study was conducted in 135 normotensive patients with type 2 diabetes. Patients underwent urinary albumin excretion rate (UAER) measurement, echocardiography, and 24-h ambulatory blood pressure monitoring (ABPM). Patients with increased daytime blood pressure levels (Ն135/85 mmHg) were classified as having masked hypertension.RESULTS -The prevalence of masked hypertension was 30% (n ϭ 41). Normotensive and masked hypertensive subjects, based on ambulatory blood pressure, were not different in terms of age, diabetes duration, smoking status, BMI, waist circumference, serum creatinine, glycemic, or lipid profiles. The office systolic blood pressure was higher in those with masked hypertension (127.8 Ϯ 7.5 vs. 122.9 Ϯ 10.2 mmHg, P ϭ 0.003) than in the normotensive group. UAER also was increased in the group with masked hypertension (21.3 g/min [range 2.5-1,223.5] vs. 8.1 g/min [1.0 -1,143.0], P ϭ 0.001), as was the interventricular septum (1.01 Ϯ 0.15 vs. 0.94 Ϯ 0.13 cm, P ϭ 0.015) and posterior wall (0.96 Ϯ 0.12 vs. 0.90 Ϯ 0.10 cm, P ϭ 0.006) thickness. After adjustments for diabetes duration, sex, smoking, LDL cholesterol, and A1C values, all associations were sustained for daytime systolic blood pressure but not for office systolic blood pressure.CONCLUSIONS -Type 2 diabetic patients with masked hypertension have higher UAER as well as enlargement of ventricular walls compared with the normotensive patients, according to ABPM. Therefore, ABPM is important to identify this high-risk group so as to be able to take interventionist measures. Diabetes Care 30:1255-1260, 2007H ypertension is a major risk factor for the development and progression of chronic complications in type 2 diabetes (1,2). Blood pressure evaluation over a 24-h ambulatory blood pressure monitoring (ABPM) period correlates better with outcomes than ordinary office blood pressure measurements in both hypertensive subjects (3) and the general population (4). In addition, systolic ambulatory blood pressure is associated with the urinary albumin excretion rate (UAER), even in normoalbuminuric type 2 diabetic patients (5). The ABPM also allows the analysis of other blood pressure parameters, otherwise not documented by the office blood pressure evaluation, such as nocturnal dipping patterns, presence of white-coat hypertension, blood pressure loads, and a novel subgroup of patients with masked hypertension (6).Masked hypertension is defined by elevated mean daytime blood pressure levels at 24-h ABPM (blood pressure Ն135/85 mmHg) in office normotensive individuals (blood pressure Ͻ140/90 mmHg). In a population-based study, it was detected in 9% of the individuals tested (7). Before the ABPM became available, these patients were not detected and were believed to have the same risk for cardiovascular events as the normotensive population. However, e...

Background: Vitiligo can negatively affect a patient's quality of life (QoL). A specific questionnaire has been developed and validated in the English language: the vitiligo-specific quality-of-life instrument (VitiQoL). The instrument was translated, culturally adapted and validated into Brazilian Portuguese (VitiQoL-PB). Objective: The aim of this study was to assess the QoL in adult patients through the VitiQoL and Dermatology Life Quality Index (DLQI) and in pediatric patients through the Children's Dermatology Life Quality Index (CDLQI) in a sample of patients with vitiligo. Methods: Subjects were selected from a dermatological outpatient clinic and from a private practice in Porto Alegre. The QoL of pediatric patients was evaluated using the CDLQI questionnaire. In adult patients we used the VitiQoL-PB and the DLQI. Results: A strong correlation between the scores of the total VitiQoL and DLQI was observed (r = 0.81; p < 0.001). The factor that most contributed to the final score of VitiQoL was stigma. In our sample, women had higher scores than men (p < 0.05). Psychiatric problems were associated with lower QoL. In the pediatric population, the median score of the CDLQI was 3 (interquartile range 1.3-7.3). There was a statistically significant correlation between the child's age and the CDLQI score (r_s = 0.41, p = 0.044). Conclusion: This study confirms that the VitiQoL is easy to administer and adds important information about the impact of vitiligo on a South American population. Stigmatization is very present in the disease. There are groups of patients that are more vulnerable, like women, patients with psychiatric diseases and adolescents.

It was developed a teaching tool in Dermatology for undergraduate medical students, using an interactive website, the Cybertutor. Clinical cases, lectures and updated bibliography were selected. Photographies of dermatological lesions were taken from ambulatory patients. The topics of the lectures were based on the current curriculum of the Federal University of Rio Grande do Sul. The Cybertutor is a dynamic and modern teaching tool, allowing constant innovation. Keywords: Dermatology; E-learning; MedicalEducation; Telemedicine Resumo: Foi desenvolvido um objeto de ensino em Dermatologia voltado para a graduação, que utiliza um web site interativo, o Cybertutor. Selecionaram-se casos clínicos didáticos, aulas teóricas e referências bibliográficas atualizadas. As fotografias das lesões foram obtidas pela seleção de pacientes atendidos no ambulatório de Dermatologia. Os temas das aulas se basearam no currículo vigente da Universidade Federal do Rio Grande do Sul (UFRGS). O Cybertutor é um objeto de ensino dinâmico, moderno e atual, que possibilita constante inovação. Palavras-chave: Dermatologia; Educação a distância; Educação médica; Telemedicina ©2010 by Anais Brasileiros de Dermatologia COMUNICATIONTelemedicine is defined as the use of telecommunications technology applied to the medical practice.1 In especial, to Teledermatology, an area of Telemedicine that studies the application of telecommunications technology and information technology to dermatological practice. Teledermatology has been presenting an important increase all over the world. [2][3][4] One of the most promising and versatile applications of Teledermatology is the development of distance learning projects, training and even tutorials and assessment of learning. This occurs because it is possible to integrate texts, images (still or dynamic), virtual reality models or sounds in distance learning programs about health with pedagogic structures and communication strategies 1 Besides that, some articles show that e-learning has been lately considered an important part of medical education.5 E-learning can be understood as the use of Internet technologies to increase the knowldge and performance as it allows students to have more control about content, timing, sequencing and rithm of learning. The current teaching model for medical students based on traditional theoretical lectures 7 is being discussed as the retention of knowledge and the level of interest of students seem to be decreasing. Studies show that multimedia programs have many advantages in relation to traditional teaching. 8 So, it was developed an object for medical teaching in Dermatology, using the educational platform named Cybertutor. This study was carried out in the dermatological service of the University Hospital An Bras Dermatol. 2010;85(3):400-2.

BACKGROUND:Vitiligo, although asymptomatic, highly compromises patients' quality of life (QoL). Therefore, an adequate evaluation of QoL is essential.OBJECTIVES:Translation, cultural adaptation and validation of VitiQol (Vitiligo-specific health-related quality of life instrument) into Brazilian Portuguese.METHODS:The study was conducted in two stages; the first stage was the translation and cultural/linguistic adaptation of the instrument; the second stage was the instrument's validation.RESULTS:The translated VitiQol showed high internal consistency (Cronbach alpha = 0.944) and high test-retest reliability and intraclass correlation coefficient=0.95 (CI 95% 0.86 - 0.98), p<0.001. There was no statistically significant difference between the means of the first completion of the VitiQoL questionnaire and the retest, p = 0.661. There was a significant correlation between VitiQoL and DLQI (r = 0.776, p <0.001) and also between VitiQoL-PB and subjects' assessment of the severity of their disease (r = 0.702, p <0.001).CONCLUSIONS:The impact of vitiligo on the QoL of Brazilian patients can be assessed by a specific questionnaire.

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