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El objetivo de este estudio fue investigar la QoL y el alcance de las psicopatolog&#237;as en los pacientes iran&#237;es con AM&#46; Los resultados de este estudio pueden ser de particular inter&#233;s&#44; ya que la cultura &#250;nica y el c&#243;digo de vestimenta de Ir&#225;n hacen que las lesiones cut&#225;neas est&#233;n normalmente cubiertas en p&#250;blico&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Contexto y aprobaci&#243;n del estudio</span><p id="par0015" class="elsevierStylePara elsevierViewall">Este estudio transversal de dos grupos fue realizado de 2018 a 2020 en la cl&#237;nica ambulatoria de Dermatolog&#237;a del Hospital Imam Reza de Mashhad&#44; obteni&#233;ndose consentimiento informado escrito de todos los participantes&#44; y garantiz&#225;ndose la confidencialidad&#46; El Comit&#233; de &#201;tica de la Universidad de Ciencias M&#233;dicas de Mashhad aprob&#243; este estudio &#40;C&#243;digo&#58; IRAN&#46;MUMS&#46;MEDICAL&#46;REC&#46;1397&#46;125&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Participantes</span><p id="par0020" class="elsevierStylePara elsevierViewall">La muestra de conveniencia dio como resultado 20 participantes con AM&#44; que cumplieron los criterios de inclusi&#243;n&#58; diagn&#243;stico confirmado de AM mediante histopatolog&#237;a&#44; y examen f&#237;sico por parte de un dermat&#243;logo&#44; &#60;<span class="elsevierStyleHsp" style=""></span>65 a&#241;os de edad y alfabetizaci&#243;n&#46; Utilizando el muestreo disponible&#44; se seleccionaron 20 voluntarios sanos pareados por edad y sexo de la poblaci&#243;n general mediante una invitaci&#243;n online&#44; como grupo control&#46; No se incluy&#243; a los pacientes con situaciones mentales mayores preexistentes &#40;previas a la AM&#41;&#44; amiloidosis sist&#233;mica y enfermedades f&#237;sicas cr&#243;nicas no relacionadas&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Recopilaci&#243;n de los datos</span><p id="par0025" class="elsevierStylePara elsevierViewall">El grupo de casos complet&#243; tres cuestionarios&#58; el formulario breve de 36 &#237;tems &#40;SF-36&#41;&#44; el <span class="elsevierStyleItalic">test</span> de los 90 s&#237;ntomas revisados &#40;SCL-90-R&#41; y el &#237;ndice de calidad de vida dermatol&#243;gica &#40;DLQI&#41;&#46; El grupo control solo complet&#243; SF-36 y SCL-90-R&#46; Se utiliz&#243; la versi&#243;n persa validada de los tres cuestionarios<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">6&#8211;8</span></a>&#46; El <span class="elsevierStyleItalic">test</span> SCL-90-R es una encuesta autoreportada de nueve dimensiones&#44; en la que las puntuaciones mayores representan m&#225;s situaciones severas&#44; midi&#233;ndose tambi&#233;n tres variables globales&#58; el &#237;ndice de severidad global &#40;GSI&#41; mide el alcance de las situaciones psiqui&#225;tricas del individuo&#59; el total de s&#237;ntomas positivos &#40;TSP&#41; indica el n&#250;mero total de cuestiones con puntuaci&#243;n mayor a cero&#44; y el &#237;ndice de distr&#233;s de s&#237;ntomas positivos &#40;PSDI&#41; se calcula dividiendo la suma de todos los &#237;tems por TPS<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">DLQI es un cuestionario autoadministrado que mide los impactos de la enfermedad cut&#225;nea en la QoL&#44; centr&#225;ndose en seis dimensiones&#44; donde las mayores puntuaciones significan mayores deterioros de la QoL<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">6</span></a>&#46; SF-36 es un cuestionario autoreportado&#44; que mide la QoL a lo largo de ocho subescalas&#44; donde las mayores puntuaciones indican una mejor QoL<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Adem&#225;s&#44; se registraron para cada participante los datos que incluyeron edad&#44; sexo&#44; estado civil&#44; educaci&#243;n&#44; empleo&#44; duraci&#243;n de la enfermedad&#44; localizaci&#243;n de las lesiones&#44; severidad del prurito &#40;basada en la escala visual anal&#243;gica &#91;EVA&#93;&#41;&#44; historia de enfermedad psiqui&#225;trica u hospitalizaci&#243;n&#44; abuso de sustancias y enfermedades f&#237;sicas&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">An&#225;lisis estad&#237;stico</span><p id="par0040" class="elsevierStylePara elsevierViewall">Todos los datos fueron analizados utilizando SPSS versi&#243;n 22 &#40;IBM Statistics&#44; Chicago&#44; IL&#41;&#46; Se utilizaron medidas y desviaciones est&#225;ndar para describir los datos&#44; y las pruebas <span class="elsevierStyleItalic">t</span>&#44; de Mann&#8211;Whitney y <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span> para comparar las variables&#46; Tambi&#233;n se utilizaron las pruebas Shapiro&#8211;Wilk de normalidad&#44; de Spearman y de Pearson&#46; El nivel alfa fue de 0&#44;05 para todas las pruebas&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Resultados</span><p id="par0045" class="elsevierStylePara elsevierViewall">En total&#44; se incluyeron 40 participantes femeninas &#40;20 en cada grupo de estudio&#41; con una edad media de 36&#44;80<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;19 a&#241;os &#40;rango de 13 a 53 a&#241;os&#41;&#46; Sobre la base de las pruebas <span class="elsevierStyleItalic">t</span> y <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span>&#44; los grupos de casos y controles no fueron estad&#237;sticamente diferentes en t&#233;rminos de edad &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;668&#41;&#44; estado civil&#44; educaci&#243;n&#44; empleo&#44; o antecedentes familiares de enfermedades similares&#46; La duraci&#243;n media de la enfermedad fue de 5&#44;05<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;30 a&#241;os &#40;rango de uno a 12 a&#241;os&#41;&#46; En cuanto a la localizaci&#243;n de la lesi&#243;n en el grupo de casos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&#44; ocho &#40;40&#37;&#41; eran cubiertas &#40;espalda o torso&#41;&#44; cuatro &#40;20&#37;&#41; descubiertas &#40;cabeza&#44; cuello&#44; o miembros superiores&#41;&#44; y ocho &#40;40&#37;&#41; eran de ambos tipos&#46; La severidad media del prurito fue de 5&#44;30<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;46&#58; puntuaci&#243;n-0 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44; 15&#37;&#41;&#59; puntuaci&#243;n-1 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44; 10&#37;&#41;&#59; puntuaci&#243;n-2 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44; 5&#37;&#41;&#59; puntuaci&#243;n-6 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#44; 20&#37;&#41;&#59; puntuaci&#243;n-7 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#44; 35&#37;&#41;&#59; puntuaci&#243;n-8 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44; 10&#37;&#41;&#59; puntuaci&#243;n-10 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44; 5&#37;&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">De acuerdo con la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#44; la puntuaci&#243;n SF-36 fue significativamente mayor en el grupo control&#59; total &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y en las tres subescalas&#58; limitaci&#243;n del rol debido a la salud emocional &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; funcionamiento social &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; y bienestar emocional &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#46; En cuanto a las puntuaciones SCL-90-R&#44; el grupo de casos tuvo mayores puntuaciones totales&#44; as&#237; como puntuaciones dimensionales de &#171;depresi&#243;n&#187;&#44; &#171;obsesi&#243;n-compulsi&#243;n&#187; y &#171;sensibilidad interpersonal&#187; &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Adem&#225;s&#44; las puntuaciones GSI&#44; PSDI y TSP fueron significativamente mayores en el grupo de casos &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">El grupo de casos respondi&#243; a la encuesta DLQI &#40;<a class="elsevierStyleCrossRef" href="#sec0055">tabla Suplementaria 1</a>&#41; con una puntuaci&#243;n media de 10&#44;95<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;60 &#40;rango de tres a 19&#41;&#46; Por tanto&#44; el efecto en la QoL en este grupo &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41; fue muy amplio en 10 casos &#40;50&#37;&#41;&#44; moderado en nueve &#40;45&#37;&#41;&#44; y leve en uno &#40;5&#37;&#41;&#46; La <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> muestra los resultados de los modelos de regresi&#243;n lineal&#44; lo cual indica que la edad puede predecir significativamente la puntuaci&#243;n DLQI&#46; Adem&#225;s&#44; tras ajustarse&#44; la severidad del prurito&#44; la localizaci&#243;n de las lesiones y el estado civil podr&#237;an predecir significativamente DLQI en 78&#37;&#46; La regresi&#243;n lineal no encontr&#243; relaciones significativas entre las puntuaciones de SCL-90-R y SF-36 y las caracter&#237;sticas demogr&#225;ficas o sintom&#225;ticas&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">La edad guard&#243; una correlaci&#243;n positiva con la puntuaci&#243;n DLQI &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;048&#59; r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;447&#41;&#44; y la subescala de dolor de SF-36 se correlacion&#243; con la severidad del prurito &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;018&#59; r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;521&#41; y la puntuaci&#243;n DLQI &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;044&#59; r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;455&#41;&#46; Adem&#225;s de esto&#44; la severidad del prurito se correlacion&#243; negativamente con la ideaci&#243;n paranoide &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;027&#59; r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;521&#41; y positivamente con la puntuaci&#243;n DLQI &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#59; r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;776&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">De acuerdo con el an&#225;lisis de varianza unidireccional&#44; la puntuaci&#243;n DLQI no fue diferente entre los grupos de individuos casados y solteros &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;236&#41;&#44; siendo significativamente diferente &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; entre los tres grupos de localizaci&#243;n de la lesi&#243;n &#40;cubierta&#44; descubierta&#44; y ambas&#41;&#46; La prueba de Tukey reflej&#243; que los pacientes con lesiones cubiertas ten&#237;an una mayor QoL&#44; en comparaci&#243;n con los otros dos grupos &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Discusi&#243;n</span><p id="par0070" class="elsevierStylePara elsevierViewall">En los &#250;ltimos a&#241;os&#44; se ha reconocido que el control de los s&#237;ntomas som&#225;ticos y las comorbilidades psicol&#243;gicas asociadas son elementos importantes para el manejo de la enfermedad&#46; Nosotros utilizamos m&#250;ltiples cuestionarios para investigar el impacto de la AM en la salud mental y la QoL&#46; De manera similar a nuestros hallazgos&#44; Fang et al&#46; descubrieron bajas puntuaciones de SF-36 en las dimensiones de bienestar emocional&#44; funcionamiento social y limitaci&#243;n del rol&#44; debido a la salud emocional&#44; entre los pacientes de ACNP<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">5</span></a>&#46; La puntuaci&#243;n DLQI media en nuestro estudio fue m&#225;s alta que la reportada por Fang et al&#46; &#40;9&#44;05<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;88&#41; Sin embargo&#44; esto no es sorprendente&#44; ya que nosotros solo investigamos un subtipo de ACNP y&#44; comparativamente&#44; nuestro tama&#241;o muestral fue m&#225;s peque&#241;o<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">En pocos estudios se ha reportado la puntuaci&#243;n DLQI entre los pacientes de ACNP&#46; Un estudio registr&#243; la puntuaci&#243;n DLQI preliminar entre los pacientes de AM y liquen simple como resultado secundario&#44; reportando una puntuaci&#243;n media de 8&#44;25<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;5<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">10</span></a>&#46; Un estudio sobre DLQI entre las mujeres con pigmentaciones cut&#225;neas adquiridas reflej&#243; que 40&#37; de los pacientes de AM estuvo ampliamente afectado&#44; mientras que 33&#44;3&#37; estuvo moderadamente afectado<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">11</span></a>&#46; Nosotros encontramos que la puntuaci&#243;n DLQI media entre los pacientes de AM fue de 10&#44;95<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;60&#44; mientras que los estudios en poblaciones similares indican que esta puntuaci&#243;n en pacientes con psoriasis&#44; vit&#237;ligo&#44; acn&#233; y lesiones por quemaduras es de 6&#44;46<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">12</span></a>&#44; 7&#44;05<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">6</span></a>&#44; 6&#44;42<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">13</span></a> y 17&#44;7<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">14</span></a>&#44; respectivamente&#46; Esto demuestra que la AM tiene comparativamente m&#225;s impacto en la QoL&#46; Sin embargo&#44; cabe resaltar que&#44; sobre la base de las puntuaciones DLQI&#44; muchos pacientes de nuestro estudio &#40;&#62;<span class="elsevierStyleHsp" style=""></span>90&#37;&#41; experiment&#243; efectos de muy grandes a moderados&#46; Adem&#225;s&#44; nuestros hallazgos de la puntuaci&#243;n DLQI indicaron un mayor deterioro de la QoL en los pacientes con lesiones no cubiertas&#44; lo cual concuerda con los hallazgos de informes previos<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">15</span></a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Ning&#250;n estudio ha investigado previamente la escala SCL-90-R en los pacientes de AM&#46; Sin embargo&#44; en comparaci&#243;n con una poblaci&#243;n sana&#44; se ha reportado que la puntuaci&#243;n SCL-90-R es mayor en los pacientes afectados de lesiones cut&#225;neas prur&#237;ticas cr&#243;nicas&#44; con una diferencia m&#225;s prominente en las dimensiones &#171;obsesi&#243;n-compulsi&#243;n&#187; y &#171;depresi&#243;n&#187;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">16</span></a>&#46; La AM es una situaci&#243;n que viene frecuentemente acompa&#241;ada de prurito cr&#243;nico y&#44; como tal&#44; nuestros hallazgos concuerdan con los estudios sobre situaciones prur&#237;ticas<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">4&#44;17</span></a>&#46; El prurito es comparable al dolor cr&#243;nico<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">3</span></a>&#44; pudiendo originar trastornos del sue&#241;o&#44; los cuales pueden causar s&#237;ntomas de depresi&#243;n y ansiedad&#44; reduciendo en &#250;ltimo caso la QoL<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Aun as&#237;&#44; encontramos que los pacientes mayores experimentan un mayor impacto en su QoL&#44; y los estudios con poblaciones m&#225;s diversas han concluido que la edad m&#225;s temprana est&#225; asociada a un mayor impacto sobre la QoL entre los pacientes con ACNP y otras situaciones cut&#225;neas<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">5&#44;19</span></a>&#46; Las personas m&#225;s j&#243;venes&#44; y en particular las mujeres&#44; parecen ser m&#225;s autoconscientes de su imagen f&#237;sica&#44; en comparaci&#243;n con las personas mayores&#44; pudiendo emplear m&#225;s tiempo para encarar esta situaci&#243;n&#44; lo cual significa la importancia del enfoque psiqui&#225;trico y sintom&#225;tico simult&#225;neos&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Este estudio fue el primero que evalu&#243; en la regi&#243;n las implicaciones en la salud mental de la ACNP&#44; aunque se presentaron ciertas limitaciones&#46; Utilizamos un muestreo de conveniencia y no incorporamos el progreso terap&#233;utico ni el estadio de la enfermedad como variables en nuestro an&#225;lisis&#46; Adem&#225;s&#44; debido a nuestro tama&#241;o muestral limitado&#44; no fue factible examinar adecuadamente las variables predicativas del impacto de la QoL en la AM&#44; utilizando la regresi&#243;n log&#237;stica&#46; Sin embargo&#44; nuestro estudio indic&#243; que los pacientes de AM tienen deterioro de la QoL&#44; lo cual puede estar influido por factores tales como la edad&#44; severidad del prurito&#44; y localizaci&#243;n de las lesiones cut&#225;neas &#40;cubiertas o descubiertas&#41;&#46; Nuestros hallazgos pueden significar el valor de un enfoque multidisciplinar para los pacientes con AM&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Financiaci&#243;n</span><p id="par0095" class="elsevierStylePara elsevierViewall">Este estudio fue respaldado por la <span class="elsevierStyleGrantSponsor" id="gs1">Universidad de Ciencias M&#233;dicas de Mashhad</span> &#40;n&#250;mero de subvenci&#243;n <span class="elsevierStyleGrantNumber" refid="gs1">970178</span>&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflicto de intereses</span><p id="par0100" class="elsevierStylePara elsevierViewall">Los autores declaran la ausencia de conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La amiloidosis macular &#40;AM&#41; es una situaci&#243;n cut&#225;nea con predominancia en mujeres j&#243;venes&#46; Nuestro objetivo fue evaluar la calidad de vida &#40;QoL&#41; y las psicopatolog&#237;as en estos pacientes&#46; En este estudio transversal se incluy&#243; a pacientes con AM derivados al Hospital Imam Reza&#44; de Mashhad&#44; de 2018 a 2020&#44; as&#237; como a sus controles pareados&#46; Los participantes completaron la encuesta SF-36 &#40;formulario breve de 36 &#237;tems&#41;&#44; el <span class="elsevierStyleItalic">test</span> de los 90 s&#237;ntomas revisado &#40;SCL-90-R&#41; y el &#237;ndice de calidad de vida dermatol&#243;gica &#40;DLQI&#41;&#46; A nivel global se estudi&#243; a 40 mujeres con una edad media de 36&#44;80<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;19 a&#241;os&#46; En el grupo AM&#44; la puntuaci&#243;n SF-36 fue m&#225;s baja &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; siendo m&#225;s alta la puntuaci&#243;n SCL-90-R &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; La puntuaci&#243;n DLQI se correlacion&#243; con la edad &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;447&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;048&#41; y con la severidad del prurito &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;776&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; siendo m&#225;s baja en las pacientes con lesiones sin cubrir &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41;&#46; La AM estuvo asociada a un deterioro de la QoL&#44; que vino determinada por la severidad del prurito y la localizaci&#243;n de la lesi&#243;n&#46; A este respecto&#44; dichas pacientes pueden beneficiarse de intervenciones psiqui&#225;tricas&#46;</p></span>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Macular amyloidosis &#40;MA&#41; is a skin condition with predominance in young women&#46; We aimed to evaluate quality of life &#40;QoL&#41; and psychopathologies in these patients&#46; In this cross-sectional study&#44; patients with MA referring to the Imam Reza Hospital&#44; Mashhad during 2018&#8211;2020&#44; and their matched controls were included&#46; Participants completed the 36-item short form survey &#40;SF-36&#41;&#44; the revised symptom checklist-90 &#40;SCL-90-R&#41;&#44; and the dermatology life quality index &#40;DLQI&#41;&#46; Overall&#44; 40 women with a mean age of 36&#46;80<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;19 years were studied&#46; In the MA group&#44; the SF-36 score was lower &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; and the SCL-90-R score was higher &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; The DLQI score was correlated with age &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;447&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;048&#41; and pruritus severity &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;776&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; and was lower in patients with uncovered lesions &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#41;&#46; MA was associated with impaired QoL&#44; which was determined by pruritus severity and lesion location&#59; these patients can benefit from psychiatric interventions in this regard&#46;</p></span>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0115" class="elsevierStylePara elsevierViewall">Datos suplementarios al presente art&#237;culo&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Anexo A"
            "titulo" => "Material adicional"
            "identificador" => "sec0060"
          ]
        ]
      ]
    ]
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          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">SF-36&#58; formulario breve de 36 &#237;tems&#59; SCL-90-R&#58; test de los 90 s&#237;ntomas revisado&#59; IQR&#58; rango intercuart&#237;lico&#59; DE&#58; desviaci&#243;n est&#225;ndar&#59; QoL&#58; calidad de vida&#59; GSI&#58; &#237;ndice de s&#237;ntomas globales&#59; PSDI&#58; &#237;ndice de distr&#233;s de s&#237;ntomas positivos&#59; TSP&#58; total de s&#237;ntomas positivos&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Funcionamiento f&#237;sico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">57&#44;50 &#40;100&#8211;50&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">62&#44;50 &#40;100&#8211;25&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Limitaci&#243;n del rol debido a salud emocional&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">73&#44;75 &#40;90&#8211;45&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">60&#44;00 &#40;80&#8211;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">60&#44;00 &#40;80&#8211;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#44;640<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">00&#44;00 &#40;100&#8211;00&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">100&#44;00 &#40;100&#8211;33&#44;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#44;002<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">51&#44;97<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;19&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">69&#44;65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sensibilidad interpersonal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;00 &#40;1&#44;07&#8211;0&#44;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;08<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;20&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hostilidad&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;05<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;42&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;799<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t">0&#44;965<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>GSI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Edad&nbsp;\t\t\t\t\t\t\n
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