Objective To identify the prevalence and factors associated with depression and anxiety in patients with psoriasis. Background Psoriasis is a chronic, non‐contagious, autoimmune inflammatory skin disease associated with psychological comorbidities. Design A cross‐sectional study conducted between March 2017–December 2018 in a dermatology infirmary and outpatient clinic of a public hospital in the inner State of São Paulo (Brazil). Methods We used questionnaires with sociodemographic data and clinical history, the HADS (Hospital Anxiety and Depression Scale), DLQI‐BRA (Dermatology Life Quality Index) and PASI (Psoriasis Area Severity Index). The correlations between variables were explored using multivariate techniques. STROBE checklist was applied as the reporting guideline for this study (File S1). Results A total of 281 participants were included, of which the majority were female 146 (52%), with a mean age of 52.1 years (SD: 13.8), elementary school 154 (55%), married/cohabiting 209 (74%) and with low income 201 (72%). The median (p25–p75) time with the disease was 14 years (7–23). Regarding the quality of life, 31% of respondents reported being little affected by the disease. The prevalence of depression was 19% and that of anxiety was 36%. The multivariate analysis showed that the variables that influenced the anxiety and depression scores were as follows: DLQI‐BRA, income, female sex, illness length and age. For the multiple correspondence analysis, the highest levels of anxiety and depression referred to women, middle age, lower income and low PASI. Conclusion The prevalence of anxiety and depression symptoms was low. Female sex, income, age, illness length and quality of life were associated with anxiety and depression scores in patients with psoriasis. Relevance to clinical practice Due to the scarcity of studies in the field of nursing with psoriasis patients, we believe these findings contribute to the reorganisation of the care provided, allowing nurses to timely identify mood disorders such as anxiety and depression and adopt the necessary measures to a service and/or specialised referral.

Epidemiology of diseases is influenced by population socio-demographic circumstances. Therefore it can be modified along the time. There are no studies exploring epidemiological transition in dermatology. This study investigated the incidence of dermatoses in new patients from a Brazilian country town public service in 2003 and 2014. There was a significant increase in the incidence of sexually transmitted diseases, leprosy, melasma, pruritus and hidradenitis suppurativa. However, a prominent reduction in scheduling of appointments for surgeries of benign lesions, drug reactions, urticaria and superficial mycoses was detected. The identification of epidemiological trends guides the dimensioning of health system and professional qualification policies.

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BackgroundSeveral dermatoses are mediated by histamine, such as urticaria, angioedema, and papular urticaria. There are no Brazilian studies comparing the potency of antihistamines.ObjectivesTo evaluate the tolerability and efficacy of the main commercial brand and generic H1 antihistamines, regarding the suppression of the wheal and flare to the histamine test.MethodsA quasi-experimental, open study with 10 healthy adults submitted to the histamine test on the ventral aspect of the forearms. After 20 minutes, wheal and flares were measured. The tests were performed after two hours of intake of dexchlorpheniramine, hydroxyzine, levocetirizine, fexofenadine, cetirizine, loratadine, ebastine, desloratadine, epinastine and rupatadine, as well as generics of loratadine, cetirizine and fexofenadine.ResultsAll antihistamines presented a reduction in the wheal compared to the control (p <0.02), as well as in the flare, except for rupatadine (p = 0.70). In the internal comparison, cetirizine, fexofenadine, epinastine, levocetirizine, dexchlorpheniramine and hydroxyzine were the most potent, with no difference between them (p > 0.1). As for halo, cetirizine, epinastine, hydroxyzine and fexofenadine were the most potent, with no difference between them (p > 0.1). The most common adverse effect was drowsiness, which was more prevalent among first-generation drugs (p < 0.01). Generic loratadine, fexofenadine and cetirizine halos were higher than their controls (p <0.03)..Study limitationsA single-center study evaluating only aspects related to histamine.ConclusionsBrazilian commercial antihistamines presented different profiles of inhibition of wheal and flares in the histamine test, as well as adverse effects. Generic loratadine, fexofenadine and cetirizine presented larger flares than brand drugs.

Background: The Dermatology Life Quality Index (DLQI) is the most commonly used instrument for clinical evaluation of the impact on health-related quality of life (HRQOL) in dermatological research protocols. The DLQI's classical psychometric properties have been considered adequate in validation studies from several countries. However, the structure of the DLQI is a matter of discussion, especially concerning the dimensionality and informative properties of its questions according to the item response theory (IRT). Methods: Pooled data from studies in Brazil that utilized the DLQI to assess HRQOL in 14 dermatoses were reanalyzed. Classical psychometrical analysis, dimensionality assessment through parallel analysis and IRT (Samejima's ordinal model) analysis were performed. Results: The sample consisted of 1286 patients with a mean age of 47 years (SD = 16), and the proportion of women was 59% (765). The DLQI scores ranged from 0 to 29, with a median (p 25-p 75) of 5 (2-11). All items indicated significant correlations with the total DLQI score (rho > 0.54). The Cronbach's alpha result was 0.90 (CI 95% 0.89-0.91). Parallel analysis indicated a unidimensional factor structure. According to IRT analysis, items q6 (sports) and q7 (work/study) exhibited insufficient fit to the model (p < 0.01), while the items that indicated the best discrimination and information functions were q2 (embarrassment), q3 (shopping/gardening), q4 (clothing) and q5 (social/leisure). The ordination of the scores was confirmed for all items. Most items revealed non-uniform behavior according to sex, age and type of disease. Conclusions: The DLQI exhibits adequate psychometric reliability and a unidimensional structure for assessing HRQOL in Brazilian dermatological patients. The DLQI's performance varies in the assessment of HRQOL in heterogeneous samples.

Milker's nodule is an occupational dermatovirose caused by Parapoxvirus, which is self-limited and, due to the lack of information of health professionals, may lead to underdiagnosis. We present two cases with exuberant manifestations and classic histopathologic findings. Case 1: Male, 19 years of age, milker, presented nodules and blisters on his palm for 15 days. Case 2: Male, 33 years of age, administrative assistant, presented erythematous nodules on his palms with lymphangitis for 5 days. He had milked a cow one week before the onset of the lesions. In both cases, the histopathology was representative and coincident with the clinical hypothesis. The lesions have presented complete involution. Milker's nodule diagnosis is based on clinical presentation, epidemiology, and histopathology. The knowledge of this disease is essential for its correct diagnosis, as well as to guide the implementation of public health measures and the appropriate treatment of sick cattle.

Molecular studies have shown more than one species of the genus Paracoccidioides to be the causal agent of paracoccidioidomycosis. Efforts have been made to correlate the identified species with epidemiological and clinical data of patients, aiming to determine the real meaning and impact of new species. Bearing this objective in mind, the authors report a clinical case of paracoccidioidomycosis, from São Paulo state, Brazil, that manifested as uncommon sarcoid-like cutaneous lesions and was caused by Paracoccidioides brasiliensis sensu stricto (S1a). The patient was treated with itraconazole 200mg/day for 12 months, with complete clinical remission.

Amicrobial pustulosis of the folds is a chronic relapsing neutrophilic dermatosis characterized by sterile pustules compromising skin folds, scalp, face and periorificial regions. It predominantly affects women. Demodicosis is an inflammatory disease associated with cutaneous overpopulation of the mite Demodex spp., the pathogenesis of which is not completely established, but is frequently related to local immunodeficiency. A case of a young woman with amicrobial pustulosis of the folds, and isolated worsening of facial lesions, is reported; investigation revealed overlapping demodicosis. There was complete regression of lesions with acaricide and cyclin treatment. This case warns of a poorly diagnosed but disfiguring and stigmatizing disease, often associated with underlying dermatoses or inadvertent treatments on the face.