Generalized Pustular Psoriasis Brazilian Experts Survey: Challenges in Disease Management.

IF 3.5 3区 医学 Q1 DERMATOLOGY
Ricardo Romiti, André V E de Carvalho, Cinara P C C Soares, Gleison Duarte
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Abstract

Introduction: Generalized pustular psoriasis (GPP) is a rare and severe form of psoriasis. Diagnosis involves several steps due to its rarity and the similarity to other pustular skin conditions. There is a lack of standardized guidelines for managing patients. The objective of this survey was to understand how Brazilian dermatologists manage GPP.

Methods: Three dermatologists, authors of this study, compiled a list of 57 Brazilian dermatologists who had treated patients with GPP in the last 5 years. A questionnaire composed of 28 questions about diagnosis, treatment, and follow-up of patients with GPP was sent to all dermatologists listed.

Results: A total of 32 dermatologists answered the survey. Most were female, had more than 15 years of clinical practice, and had treated at least 3 patients in the last 5 years. The diagnosis was based on the presence of pustules, worsening skin lesions, and erythema. More than half of the participants cited inflammatory markers used for screening. Triggering factors for flares included steroid withdrawal, infection, and stress. Most of them reported that their patients experienced at least one flare per year, lasting 2-4 weeks. Pustules are the first sign of resolution and scaling skin could last more than 6 months. Hospitalization was considered common or very common, often lasting more than 1 week. During GPP flares, the most recommended treatments were cyclosporine. For residual disease treatment, retinoids were the most cited. In addition, 63% of dermatologists think that the options to resolve flares are too slow and 66% consider that options do not prevent new flares.

Conclusions: GPP is a challenging disorder. In Brazil, Brazilian patients with GPP often require longer hospitalization when compared with Europe and USA. A local consensus on GPP management is urgently needed to establish the goals and the standard of care for these patients.

广泛性脓疱性牛皮癣巴西专家调查:疾病管理的挑战。
简介:广泛性脓疱性牛皮癣(GPP)是一种罕见而严重的牛皮癣。由于其罕见性和与其他脓疱性皮肤状况的相似性,诊断涉及几个步骤。目前缺乏管理病人的标准化指南。这项调查的目的是了解巴西皮肤科医生如何管理GPP。方法:三名皮肤科医生,本研究的作者,编制了过去5年中治疗过GPP患者的57名巴西皮肤科医生的名单。一份由28个问题组成的关于GPP患者的诊断、治疗和随访的问卷被发送给所有列出的皮肤科医生。结果:共有32名皮肤科医生回答了调查。多数为女性,临床执业15年以上,近5年至少治疗3例患者。诊断是基于存在脓疱,恶化的皮肤损伤和红斑。超过一半的参与者提到了用于筛查的炎症标志物。引发耀斑的因素包括类固醇停药、感染和压力。他们中的大多数报告他们的患者每年至少经历一次持续2-4周的耀斑。脓疱是消退的第一个迹象,皮肤上的鳞屑可能持续6个月以上。住院治疗被认为是常见的或非常常见的,通常持续1周以上。在GPP发作期间,最推荐的治疗方法是环孢素。对于残留疾病的治疗,类维生素a被引用最多。此外,63%的皮肤科医生认为解决耀斑的选择太慢,66%的人认为这些选择不能预防新的耀斑。结论:GPP是一种具有挑战性的疾病。在巴西,与欧洲和美国相比,巴西GPP患者往往需要更长的住院时间。迫切需要在GPP管理方面达成当地共识,以建立这些患者的目标和护理标准。
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来源期刊
Dermatology and Therapy
Dermatology and Therapy Medicine-Dermatology
CiteScore
6.00
自引率
8.80%
发文量
187
审稿时长
6 weeks
期刊介绍: Dermatology and Therapy is an international, open access, peer-reviewed, rapid publication journal (peer review in 2 weeks, published 3–4 weeks from acceptance). The journal is dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of dermatological therapies. Studies relating to diagnosis, pharmacoeconomics, public health and epidemiology, quality of life, and patient care, management, and education are also encouraged. Areas of focus include, but are not limited to all clinical aspects of dermatology, such as skin pharmacology; skin development and aging; prevention, diagnosis, and management of skin disorders and melanomas; research into dermal structures and pathology; and all areas of aesthetic dermatology, including skin maintenance, dermatological surgery, and lasers. The journal is of interest to a broad audience of pharmaceutical and healthcare professionals and publishes original research, reviews, case reports/case series, trial protocols, and short communications. Dermatology and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an International and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of quality research, which may be considered of insufficient interest by other journals. The journal appeals to a global audience and receives submissions from all over the world.
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