Psoriasis affects individuals of African descent and white Brazilians similarly

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López-Estebaranz, E. Cuerda" "autores" => array:2 [ 0 => array:2 [ "nombre" => "J.L." "apellidos" => "López-Estebaranz" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Cuerda" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731010000839?idApp=UINPBA000044" "url" => "/00017310/0000010100000003/v1_201304241229/S0001731010000839/v1_201304241229/es/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Psoriasis affects individuals of African descent and white Brazilians similarly" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "230" "paginaFinal" => "234" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "C. Porto Ferreira, C.J. Martins, P.R. Issa, R. de Vasconcellos Carvalhaes de Oliveira, A.M. Da-Cruz" "autores" => array:5 [ 0 => array:4 [ "nombre" => "C." "apellidos" => "Porto Ferreira" "email" => array:1 [ 0 => "drcassioferreira@yahoo.com.br" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff2" ] 2 => array:2 [ "etiqueta" => "¿" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "C.J." "apellidos" => "Martins" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff3" ] ] ] 2 => array:3 [ "nombre" => "P.R." "apellidos" => "Issa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff3" ] ] ] 3 => array:3 [ "nombre" => "R." "apellidos" => "de Vasconcellos Carvalhaes de Oliveira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff2" ] ] ] 4 => array:3 [ "nombre" => "A.M." "apellidos" => "Da-Cruz" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "d" "identificador" => "aff4" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Laboratório de Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz/FIOCRUZ, Rio de Janeiro, Brasil" "etiqueta" => "a" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Instituto de Pesquisa Clínica Evandro Chagas/FIOCRUZ, Rio de Janeiro, Brasil" "etiqueta" => "b" "identificador" => "aff2" ] 2 => array:3 [ "entidad" => "Serviço de Dermatologia, Hospital Universitário Gaffré e Guinle, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Brasil" "etiqueta" => "c" "identificador" => "aff3" ] 3 => array:3 [ "entidad" => "Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Brasil" "etiqueta" => "d" "identificador" => "aff4" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La psoriasis afecta de forma similar a los pacientes brasileños de ascendencia africana y caucásica" ] ] "textoCompleto" => "IntroductionPsoriasis is a chronic inflammatory disease that affects skin and joints<a class="elsevierStyleCrossRef" href="#bib1">1</a>. Estimates of prevalence are relatively high, varying from 0.5 to 4.6%, depending on the geographic location, but especially affecting Caucasians<a class="elsevierStyleCrossRefs" href="#bib1">1,2</a>. The etiology of the disease is unknown, but genetic predisposition and environmental factors can influence the occurrence and severity of the disease<a class="elsevierStyleCrossRefs" href="#bib1">1,3,4</a>. Epidermal proliferation is a key feature of psoriasis although immune mediated mechanisms are crucial for maintaining the inflammatory lesions<a class="elsevierStyleCrossRefs" href="#bib5">5,6</a>. Plaque psoriasis is the most frequent clinical form of the disease, affecting up to 80% of patients<a class="elsevierStyleCrossRefs" href="#bib3">3,4</a>. The onset of symptoms can be divided into two periods, teenagers (type 1) or individuals in the fifth decade of life (type 2), without distinct sex prevalence<a class="elsevierStyleCrossRef" href="#bib7">7</a>. Most studies concerning epidemiology and clinical aspects of psoriasis focus on European and North American populations. However, very few reports address the epidemiological and clinical features of psoriasis in developing regions such as South America<a class="elsevierStyleCrossRefs" href="#bib8">8,9</a>. In Brazil, miscegenation, besides the typical tropical climate and sun exposure, can have a beneficial impact such as delayed onset and progression of psoriatic lesions. Here we describe the main clinical aspects of psoriasis in Brazilian patients that were evaluated in a public dermatological outpatient care unit in Rio de Janeiro state. We also investigate whether any particular feature can distinguish the disease occurring among Brazilian patients from that occurring among patients from other countries.MethodologyWe carried out a retrospective analysis of selected records of 151 patients that have been seen at the public dermatological outpatient care unit of the Hospital Gaffrée-Guinle/UNIRIO from April 2006 to September 2008. Demographic data such as age, sex, race, and geographic origin were considered. Patients were submitted to dermatological examination, and clinical aspects such as duration of illness before diagnosis and lesion features (clinical form, distribution and shape of lesions) were also investigated. All patients fulfilled the inclusion criteria for the diagnosis of psoriasis, which were based on established clinical parameters<a class="elsevierStyleCrossRef" href="#bib1">1</a> and histopathological criteria<a class="elsevierStyleCrossRef" href="#bib6">6</a>. The severity of psoriasis was assessed. To measure the activity and severity of psoriasis we used the Physician Global Assessment (PGA). The PGA is one of the most commonly used tools for assessing psoriasis activity and for following clinical response to treatment. There are two main forms of assessment completed by a physician: a static and a dynamic one, in which the physician assesses the global improvement compared to baseline; the latter is hardly reproducible and is based on the observer's memory, so the static assessment has been generally made to assess overall psoriasis, using a score between 0 and 6 (0=clear [no signs of psoriasis], 1=almost clear [minimal], 2=mild [slight plaque elevation, scaling and/or erythema], 3=mild to moderate [intermediate between mild and moderate], 4=moderate [moderate plaque elevation, scaling and/or erythema], 5=moderate to severe [marked plaque elevation, scaling and/or erythema] and 6=severe [very marked plaque elevation, scaling and/or erythema])<a class="elsevierStyleCrossRefs" href="#bib10">10–18</a>. In this period, the new dermatological outpatients were evaluated to estimate the prevalence of psoriasis in the Department of Dermatology. Prevalence is usually defined as the proportion of individuals in a given population with a disease in a specified time period.This study was approved by the Ethical Committee of the Escola de Medicina e Cirurgia (UNIRIO, MEC, Brazil).ResultsThe new dermatological outpatients in the general clinic were analyzed for skin color and were reported as follows: interracial individuals (mixed race): 61.2%, whites: 37%, blacks: 1.9%, and 78.2% of the patients were primarily from Rio de Janeiro state. Psoriasis was responsible for 5.2% (95% confidence interval: 3.1–7.6%) of consultations at the Department of Dermatology in this period of 17 months. Among the 151 psoriatic patients selected for the study, the disease was equally distributed between males (71 cases, 46.3%) and females (80 cases, 53.6%). The mean age±standard deviation was 42.1±20.9 years (median 44 years, ranging from 3 to 83 years) for males and 35.8±20.8 years (median 36 years; ranging from 3 to 80 years) for females. Patients aged between 51–60 years (19.9%), 41–50 years (17.6%) and 31–40% (14%) accounted for the majority of cases, followed by patients aged between 0–10 years (16.2%). The period in which women reached medical care for the first consultation after the onset of symptoms was more precocious (3.6±5.4 years; median 1 year, ranging from one month to 25 years) than for men (4.7±6.9 years; median 2 years, ranging from two months to 33 years). One hundred thirteen cases were analyzed for skin color and were reported as follows: whites, 47 cases (41.6%), interracial individuals (mixed race), 42 cases (37.2%) and blacks, 24 (21.2%). No significant difference in terms of race was observed among males and females (<a class="elsevierStyleCrossRef" href="#tbl1">Table 1</a>). The most frequent clinical forms of psoriasis are recorded (<a class="elsevierStyleCrossRef" href="#tbl1">Table 1</a>), but chronic plaque psoriasis was the most prevalent (110 cases, 72.8%). Indeed, palm and sole involvement accounted for 13.9% of cases. The mean age of chronic plaque patients at the onset of symptoms was 39.8±20.6 years, with no sex differences. The majority of patients were also interracial individuals or blacks (66 cases). Patients usually exhibited single lesions (46 in 133 cases), but two (30 in 133 cases) or three lesions (20 in 133 cases) were equally very common. The affected body regions were mainly the scalp (28 cases, 21%), elbows (25 cases, 18.8%), and knees (21 cases, 15.8%). Other locations such as nails, face, back, abdomen, and chest were referred in less than 1% of cases. Only two cases of psoriatic arthritis, and no cases of inverse psoriasis or generalized pustular psoriasis were found. One hundred twenty two cases were analyzed for the severity of psoriasis (PGA score) and are reported as follows: 0 (none of the patients), 1 (9 in 122 cases), 2 (32 in 122 cases), 3 (33 in 122 cases), 4 (21 in 122 cases), 5 (13 in 122 cases) and 6 (14 in 122 cases). The reported associated diseases were hypertension (9), atopy (7), HIV/AIDS (2), hepatitis (2), diabetes mellitus (3), and hyperthyroidism (1). Only five patients referred a family history of psoriasis.<elsevierMultimedia ident="tbl1"></elsevierMultimedia>DiscussionPsoriasis affects people worldwide<a class="elsevierStyleCrossRefs" href="#bib1">1–3</a>; however, cultural, socio-demographic, and environmental factors could have an impact on the incidence or clinical course of the disease in some geographic regions. Here we analyzed psoriasis cases from an outpatient care unit located in Rio de Janeiro, Brazil. We demonstrated that the clinical form of the disease was similar to that observed in other countries, but interracial and black populations were affected as much as whites. No difference regarding gender was observed in the present study, even after taking into account different races. Considering the mean age of the onset of symptoms, our patients were equally distributed into type I and type II<a class="elsevierStyleCrossRef" href="#bib7">7</a>. As expected, chronic plaque psoriasis was the most common clinical presentation with no difference for gender or skin color. Conversely, psoriatic arthritis was rarely reported, probably because these patients were mainly seen by Rheumatology services. Interracial and black subjects did not present a more severe clinical form of the disease, as has been suggested by previous authors<a class="elsevierStyleCrossRef" href="#bib19">19</a>. The low intensity and severity of psoriasis in this sample (PGA score 5 [13 in 122 cases] and 6 [14 in 122 cases]) could be attributed to the tropical climate in Brazil, a country located close to the equator. The country is exposed to high levels of ultraviolet radiation from intense sunlight throughout the year, which leads to a much better prognosis of the disease<a class="elsevierStyleCrossRefs" href="#bib20">20,21</a>. In a Colombian study, 18.6% of 86 patients presented severe psoriasis<a class="elsevierStyleCrossRef" href="#bib22">22</a>.In our study, blacks comprised 18% of patients seen in our care unit, and our results indicate that psoriasis also affects an Afro-descendant population. Such percentage is high considering the official data showing that the Brazilian population consists of 38.2% of interracial individuals and 5.9% of blacks<a class="elsevierStyleCrossRef" href="#bib23">23</a>, which include Afro-descendants. These data are surprising as psoriasis is classically considered a Caucasian disease that affects less than 0.1% of Asians and is considered rare among Africans<a class="elsevierStyleCrossRefs" href="#bib1">1–3,24</a>. Note that two Latin Americans studies led to different findings. Gonzalez et al analyzed 86 patients and reported that race distribution was as follows: interracial individuals (85%), whites (14%) and blacks (1%)<a class="elsevierStyleCrossRef" href="#bib22">22</a>. Trujillo et al analyzed 200 patients and reported the following distribution: interracial individuals (10.5%), whites (85.5%), blacks (3.5%) and unknown (0.5%)<a class="elsevierStyleCrossRef" href="#bib20">20</a>. Yet, population-based studies showed that psoriasis affects a significant fraction of African-Americans, although it was observed a reduction in the prevalence of approximately 52% compared to Caucasians<a class="elsevierStyleCrossRef" href="#bib19">19</a>.In contrast, whites predominated in a previous Brazilian study, though it also included patients seen in a private dermatology practice<a class="elsevierStyleCrossRef" href="#bib9">9</a>. In this study, we hypothesize that blacks may have inherited Caucasian genes associated with psoriasis<a class="elsevierStyleCrossRef" href="#bib25">25</a> because of the high number of interracial populations in Brazil. In fact, this hypothesis is consistent with the literature. Green reported that psoriasis among indigenous Australians of “full-blood” descent may be rare or non-existent; minimal cases haved been reported among Aborigines, and psoriasis diagnoses were associated with Aboriginal people of mixed descent<a class="elsevierStyleCrossRef" href="#bib26">26</a>. Further research indicated that the condition appeared to be relatively uncommon among Nigerians and Mongolians, and more common among Kenyans and people from the Faroe Islands<a class="elsevierStyleCrossRefs" href="#bib27">27–29</a>. It is worth noting that the different methodology employed in research design, such as population-based research compared with hospital-based research, makes it difficult to conclude whether these differences were indeed a result of racial variation<a class="elsevierStyleCrossRef" href="#bib30">30</a>.Indeed, other factors such as behavior and environmental conditions can also influence the development of the disease<a class="elsevierStyleCrossRefs" href="#bib24">24,31</a>. Perhaps a major component of regional variation in the frequency, severity and morbidity of psoriasis is climate variation. A population-based study reported a seasonal variation in psoriasis diagnoses, in which over 65% of the cases were diagnosed in winter and spring, as opposed to approximately 30% of cases diagnosed in summer and autumn<a class="elsevierStyleCrossRef" href="#bib32">32</a>. Farber and Nail reported that almost 90% of the respondents indicated that cold weather made their psoriasis worse, approximately 80% claimed that hot weather made their psoriasis better, and 80% stated that sunlight made their psoriasis better<a class="elsevierStyleCrossRef" href="#bib33">33</a>. With respect to geographical or climatic features, an author recorded the highest prevalence level of the disease in the central area of Spain, whose weather is drier and colder than in the northern and southern/Mediterranean regions of Spain<a class="elsevierStyleCrossRef" href="#bib34">34</a>.In country-specific studies, the estimated prevalence of psoriasis ranges from 0% in Australian Aborigines and Andean Indians to 11.8% in the inhabitants of Kazakhstan (an Arctic region of the Soviet Union)<a class="elsevierStyleCrossRef" href="#bib35">35</a>. More comprehensive studies reported that the prevalence of psoriasis was 1.4% in Spain<a class="elsevierStyleCrossRef" href="#bib34">34</a>, 1.5% in the United Kingdom<a class="elsevierStyleCrossRef" href="#bib36">36</a> and 2.9% in South Africa<a class="elsevierStyleCrossRef" href="#bib37">37</a> and Italy<a class="elsevierStyleCrossRef" href="#bib38">38</a>. The present study analyzed the epidemiology of psoriasis, but the prevalence of psoriasis (5.2%) was estimated for new dermatological outpatients in a limited clinical setting, with a small population. Therefore, it does not reflect the true prevalence of this specific disease in the Brazilian population. We believe that larger population-based studies should provide a broader picture of the incidence and/or prevalence of psoriasis in Brazil. Trujillo et al reported that psoriasis represents 6% of the dermatologic consultations in Cuba<a class="elsevierStyleCrossRef" href="#bib20">20</a>. This large number is justified because the health system in Cuba<a class="elsevierStyleCrossRef" href="#bib20">20</a>, as well as in Brazil<a class="elsevierStyleCrossRef" href="#bib39">39</a>, is free, allowing easy access to data concerning the entire population.Although this study was not designed to estimate the race prevalence of psoriasis, our results suggest that this disease is common in the African-descendant Brazilian population. Different ethnic backgrounds can mirror the health-related quality of life, and African-Brazilians are more likely to have a low social status compared to that of Caucasians<a class="elsevierStyleCrossRef" href="#bib40">40</a>. Indeed, poor socio-economic factors can limit African-Brazilian patients’ possibilities of receiving adequate treatments, and such factors can have an effect on these patients’ health-related quality of life. Accordingly, these results should be considered in health care policy making in Brazil, particularly when developing policies in public health programs for psoriasis patients.Conflict of interestAuthors have no conflict of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres95333" "titulo" => array:5 [ 0 => "Abstract" 1 => "Introduction" 2 => "Material and methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec82493" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres95334" "titulo" => array:5 [ 0 => "Resumen" 1 => "Introducción" 2 => "Material y métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec82494" "titulo" => "Palabras clave" ] 4 => array:1 [ "titulo" => "Introduction" ] 5 => array:1 [ "titulo" => "Methodology" ] 6 => array:1 [ "titulo" => "Results" ] 7 => array:1 [ "titulo" => "Discussion" ] 8 => array:1 [ "titulo" => "Conflict of interest" ] 9 => array:2 [ "identificador" => "xack35187" "titulo" => "Acknowledgments" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2009-04-20" "fechaAceptado" => "2009-09-03" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec82493" "palabras" => array:5 [ 0 => "Psoriasis" 1 => "Clinical features" 2 => "Afro-descendants" 3 => "Brazilian population" 4 => "Blacks" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec82494" "palabras" => array:5 [ 0 => "Psoriasis" 1 => "Características clínicas" 2 => "Afrodescendientes" 3 => "Población brasileña" 4 => "Negros" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "IntroductionCultural, socio-demographic and environmental factors such as tropical climate and exposure to sun could have an impact on the incidence or clinical course of psoriasis. Here we describe the main clinical aspects of psoriasis in Brazilian patients and also investigate whether any particular feature can distinguish the disease occurring in Brazil from that occurring in other countries. Material and methodsWe recorded the clinical features of 151 psoriasis patients seen in a Brazilian public dermatological care unit between 2006 and 2008. ResultsMales and females were similarly affected. The reported races were as follows: whites, 47 cases (41.6%), interracial individuals (mixed race), 42 cases (37.2%) and blacks, 24 cases (21.2%). Chronic plaque-type psoriasis was the most prevalent clinical form (110 cases, 72.8%) followed by palm and sole involvement (21 cases, 13.9%). ConclusionsWe demonstrated that psoriasis in these Brazilian subjects was similar to that observed in subjects from other countries, but interracial and black populations were affected as much as whites. Considering the high rate of interracial populations among Brazilians we cannot exclude the possibility that Afro-descendants may have inherited Caucasian genes associated with psoriasis. Poor socio-economic conditions of Afro-descendants can limit their possibilities of receiving adequate treatments, impairing their health-related quality of life." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "IntroducciónLos factores culturales, sociodemográficos y ambientales tales como el clima tropical o la exposición solar pueden tener un impacto en la incidencia o el curso clínico de la psoriasis. En este artículo describimos los principales aspectos clínicos de la psoriasis en pacientes brasileños e investigamos si existe alguna característica que permita distinguir la enfermedad que ocurre en Brasil de la que se encuentra en otros países. Material y métodosSe recogieron las características clínicas de 151 pacientes con psoriasis evaluados en un centro dermatológico público de Brasil entre 2006 y 2008. ResultadosLos hombres y las mujeres estaban afectados de forma similar. La frecuencia de afectación según la raza era la siguiente: blancos 47 casos (41,6%), mestizos 42 casos (37,2%) y negros 24 casos (21,2%). Las formas clínicas más prevalentes fueron la psoriasis crónica en placas (110 casos, 72,8%) seguida de la psoriasis palmoplantar (21 casos, 13,9%). ConclusionesDemostramos que la psoriasis en estos sujetos brasileños es similar a la que se observa en sujetos de otros países, pero los mestizos y los negros están afectados tanto como los blancos. Teniendo en cuenta la elevada proporción de población mestiza entre los brasileños, no podemos descartar la posibilidad de que los descendientes africanos hayan podido heredar los genes caucásicos asociados a la psoriasis. Las pobres condiciones socioeconómicas de los descendientes africanos pueden limitar sus posibilidades para recibir tratamientos adecuados, lo que altera su calidad de vida." ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "tbl1" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "F: female. M: male." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " rowspan="2" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clinical forms of psoriasis</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " rowspan="2" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Frequency of cases</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " rowspan="2" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years)<a class="elsevierStyleCrossRef" href="#tblfn1a">a</a></td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " rowspan="2" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sex (M/F)</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " rowspan="2" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Period of illness (years)<a class="elsevierStyleCrossRef" href="#tblfn1a">a</a></td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Race<a class="elsevierStyleCrossRef" href="#tblfn1b">b</a></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">White \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Interracial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Black \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chronic plaque \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 \t\t\t\t\ttop\n \t\t\t\t">110 (72.8%) \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 \t\t\t\t\ttop\n \t\t\t\t">39.8±20.6 \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 \t\t\t\t\ttop\n \t\t\t\t">55/55 \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 \t\t\t\t\ttop\n \t\t\t\t">4.2±6.0 \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 \t\t\t\t\ttop\n \t\t\t\t">34 \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 \t\t\t\t\ttop\n \t\t\t\t">30 \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 \t\t\t\t\ttop\n \t\t\t\t">14 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Palm and sole \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 \t\t\t\t\ttop\n \t\t\t\t">21 (13.9%) \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 \t\t\t\t\ttop\n \t\t\t\t">24.7±20.4 \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 \t\t\t\t\ttop\n \t\t\t\t">6/15 \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 \t\t\t\t\ttop\n \t\t\t\t">2.1±3.0 \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 \t\t\t\t\ttop\n \t\t\t\t">7 \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 \t\t\t\t\ttop\n \t\t\t\t">7 \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 \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Erythrodermic \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 \t\t\t\t\ttop\n \t\t\t\t">8 (5.3%) \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 \t\t\t\t\ttop\n \t\t\t\t">61.0±13.1 \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 \t\t\t\t\ttop\n \t\t\t\t">5/3 \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 \t\t\t\t\ttop\n \t\t\t\t">4.7±8.6 \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 \t\t\t\t\ttop\n \t\t\t\t">2 \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 \t\t\t\t\ttop\n \t\t\t\t">2 \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 \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pustular \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 \t\t\t\t\ttop\n \t\t\t\t">7 (4.6%) \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 \t\t\t\t\ttop\n \t\t\t\t">42.3±9.1 \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 \t\t\t\t\ttop\n \t\t\t\t">2/5 \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 \t\t\t\t\ttop\n \t\t\t\t">4.8±7.1 \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 \t\t\t\t\ttop\n \t\t\t\t">1 \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 \t\t\t\t\ttop\n \t\t\t\t">2 \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 \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Psoriatic arthritis \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 \t\t\t\t\ttop\n \t\t\t\t">3 (2.0%) \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 \t\t\t\t\ttop\n \t\t\t\t">56.3±10.2 \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 \t\t\t\t\ttop\n \t\t\t\t">2/1 \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 \t\t\t\t\ttop\n \t\t\t\t">12.3±11.2 \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 \t\t\t\t\ttop\n \t\t\t\t">1 \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 \t\t\t\t\ttop\n \t\t\t\t">1 \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 \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Guttata \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 \t\t\t\t\ttop\n \t\t\t\t">2 (1.3%) \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 \t\t\t\t\ttop\n \t\t\t\t">28.5±3.5 \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 \t\t\t\t\ttop\n \t\t\t\t">1/1 \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 \t\t\t\t\ttop\n \t\t\t\t">2.2±2.6 \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 \t\t\t\t\ttop\n \t\t\t\t">2 \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 \t\t\t\t\ttop\n \t\t\t\t">0 \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 \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab181770.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn1a" "etiqueta" => "a" "nota" => "Results are expressed as mean±standard deviation." ] 1 => array:3 [ "identificador" => "tblfn1b" "etiqueta" => "b" "nota" => "Data were not available for 38 cases." ] ] ] "descripcion" => array:1 [ "en" => "Main patients’ demographic characteristics related to clinical forms of psoriasis observed in a Brazilian population" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:40 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Psoriasis--epidemiology and clinical spectrum" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "E. 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Estadísticas

Original article

Psoriasis affects individuals of African descent and white Brazilians similarly

La psoriasis afecta de forma similar a los pacientes brasileños de ascendencia africana y caucásica

C. Porto Ferreiraa,b,

Autor para correspondencia

drcassioferreira@yahoo.com.br

Corresponding author.

, C.J. Martinsc, P.R. Issac, R. de Vasconcellos Carvalhaes de Oliveirab, A.M. Da-Cruza,d

a Laboratório de Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz/FIOCRUZ, Rio de Janeiro, Brasil

b Instituto de Pesquisa Clínica Evandro Chagas/FIOCRUZ, Rio de Janeiro, Brasil

c Serviço de Dermatologia, Hospital Universitário Gaffré e Guinle, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Brasil

d Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Brasil

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    "textoCompleto" => "<span class="elsevierStyleSections"><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p class="elsevierStylePara elsevierViewall">Psoriasis is a chronic inflammatory disease that affects skin and joints<a class="elsevierStyleCrossRef" href="#bib1"><span class="elsevierStyleSup">1</span></a>&#46; Estimates of prevalence are relatively high&#44; varying from 0&#46;5 to 4&#46;6&#37;&#44; depending on the geographic location&#44; but especially affecting Caucasians<a class="elsevierStyleCrossRefs" href="#bib1"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; The etiology of the disease is unknown&#44; but genetic predisposition and environmental factors can influence the occurrence and severity of the disease<a class="elsevierStyleCrossRefs" href="#bib1"><span class="elsevierStyleSup">1&#44;3&#44;4</span></a>&#46; Epidermal proliferation is a key feature of psoriasis although immune mediated mechanisms are crucial for maintaining the inflammatory lesions<a class="elsevierStyleCrossRefs" href="#bib5"><span class="elsevierStyleSup">5&#44;6</span></a>&#46; Plaque psoriasis is the most frequent clinical form of the disease&#44; affecting up to 80&#37; of patients<a class="elsevierStyleCrossRefs" href="#bib3"><span class="elsevierStyleSup">3&#44;4</span></a>&#46; The onset of symptoms can be divided into two periods&#44; teenagers &#40;type 1&#41; or individuals in the fifth decade of life &#40;type 2&#41;&#44; without distinct sex prevalence<a class="elsevierStyleCrossRef" href="#bib7"><span class="elsevierStyleSup">7</span></a>&#46; Most studies concerning epidemiology and clinical aspects of psoriasis focus on European and North American populations&#46; However&#44; very few reports address the epidemiological and clinical features of psoriasis in developing regions such as South America<a class="elsevierStyleCrossRefs" href="#bib8"><span class="elsevierStyleSup">8&#44;9</span></a>&#46; In Brazil&#44; miscegenation&#44; besides the typical tropical climate and sun exposure&#44; can have a beneficial impact such as delayed onset and progression of psoriatic lesions&#46; Here we describe the main clinical aspects of psoriasis in Brazilian patients that were evaluated in a public dermatological outpatient care unit in Rio de Janeiro state&#46; We also investigate whether any particular feature can distinguish the disease occurring among Brazilian patients from that occurring among patients from other countries&#46;</p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Methodology</span><p class="elsevierStylePara elsevierViewall">We carried out a retrospective analysis of selected records of 151 patients that have been seen at the public dermatological outpatient care unit of the Hospital Gaffr&#233;e-Guinle&#47;UNIRIO from April 2006 to September 2008&#46; Demographic data such as age&#44; sex&#44; race&#44; and geographic origin were considered&#46; Patients were submitted to dermatological examination&#44; and clinical aspects such as duration of illness before diagnosis and lesion features &#40;clinical form&#44; distribution and shape of lesions&#41; were also investigated&#46; All patients fulfilled the inclusion criteria for the diagnosis of psoriasis&#44; which were based on established clinical parameters<a class="elsevierStyleCrossRef" href="#bib1"><span class="elsevierStyleSup">1</span></a> and histopathological criteria<a class="elsevierStyleCrossRef" href="#bib6"><span class="elsevierStyleSup">6</span></a>&#46; The severity of psoriasis was assessed&#46; To measure the activity and severity of psoriasis we used the Physician Global Assessment &#40;PGA&#41;&#46; The PGA is one of the most commonly used tools for assessing psoriasis activity and for following clinical response to treatment&#46; There are two main forms of assessment completed by a physician&#58; a static and a dynamic one&#44; in which the physician assesses the global improvement compared to baseline&#59; the latter is hardly reproducible and is based on the observer&#39;s memory&#44; so the static assessment has been generally made to assess overall psoriasis&#44; using a score between 0 and 6 &#40;0&#61;clear &#91;no signs of psoriasis&#93;&#44; 1&#61;almost clear &#91;minimal&#93;&#44; 2&#61;mild &#91;slight plaque elevation&#44; scaling and&#47;or erythema&#93;&#44; 3&#61;mild to moderate &#91;intermediate between mild and moderate&#93;&#44; 4&#61;moderate &#91;moderate plaque elevation&#44; scaling and&#47;or erythema&#93;&#44; 5&#61;moderate to severe &#91;marked plaque elevation&#44; scaling and&#47;or erythema&#93; and 6&#61;severe &#91;very marked plaque elevation&#44; scaling and&#47;or erythema&#93;&#41;<a class="elsevierStyleCrossRefs" href="#bib10"><span class="elsevierStyleSup">10&#8211;18</span></a>&#46; In this period&#44; the new dermatological outpatients were evaluated to estimate the prevalence of psoriasis in the Department of Dermatology&#46; Prevalence is usually defined as the proportion of individuals in a given population with a disease in a specified time period&#46;</p><p class="elsevierStylePara elsevierViewall">This study was approved by the Ethical Committee of the Escola de Medicina e Cirurgia &#40;UNIRIO&#44; MEC&#44; Brazil&#41;&#46;</p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStylePara elsevierViewall">The new dermatological outpatients in the general clinic were analyzed for skin color and were reported as follows&#58; interracial individuals &#40;mixed race&#41;&#58; 61&#46;2&#37;&#44; whites&#58; 37&#37;&#44; blacks&#58; 1&#46;9&#37;&#44; and 78&#46;2&#37; of the patients were primarily from Rio de Janeiro state&#46; Psoriasis was responsible for 5&#46;2&#37; &#40;95&#37; confidence interval&#58; 3&#46;1&#8211;7&#46;6&#37;&#41; of consultations at the Department of Dermatology in this period of 17 months&#46; Among the 151 psoriatic patients selected for the study&#44; the disease was equally distributed between males &#40;71 cases&#44; 46&#46;3&#37;&#41; and females &#40;80 cases&#44; 53&#46;6&#37;&#41;&#46; The mean age&#177;standard deviation was 42&#46;1&#177;20&#46;9 years &#40;median 44 years&#44; ranging from 3 to 83 years&#41; for males and 35&#46;8&#177;20&#46;8 years &#40;median 36 years&#59; ranging from 3 to 80 years&#41; for females&#46; Patients aged between 51&#8211;60 years &#40;19&#46;9&#37;&#41;&#44; 41&#8211;50 years &#40;17&#46;6&#37;&#41; and 31&#8211;40&#37; &#40;14&#37;&#41; accounted for the majority of cases&#44; followed by patients aged between 0&#8211;10 years &#40;16&#46;2&#37;&#41;&#46; The period in which women reached medical care for the first consultation after the onset of symptoms was more precocious &#40;3&#46;6&#177;5&#46;4 years&#59; median 1 year&#44; ranging from one month to 25 years&#41; than for men &#40;4&#46;7&#177;6&#46;9 years&#59; median 2 years&#44; ranging from two months to 33 years&#41;&#46; One hundred thirteen cases were analyzed for skin color and were reported as follows&#58; whites&#44; 47 cases &#40;41&#46;6&#37;&#41;&#44; interracial individuals &#40;mixed race&#41;&#44; 42 cases &#40;37&#46;2&#37;&#41; and blacks&#44; 24 &#40;21&#46;2&#37;&#41;&#46; No significant difference in terms of race was observed among males and females &#40;<a class="elsevierStyleCrossRef" href="#tbl1">Table 1</a>&#41;&#46; The most frequent clinical forms of psoriasis are recorded &#40;<a class="elsevierStyleCrossRef" href="#tbl1">Table 1</a>&#41;&#44; but chronic plaque psoriasis was the most prevalent &#40;110 cases&#44; 72&#46;8&#37;&#41;&#46; Indeed&#44; palm and sole involvement accounted for 13&#46;9&#37; of cases&#46; The mean age of chronic plaque patients at the onset of symptoms was 39&#46;8&#177;20&#46;6 years&#44; with no sex differences&#46; The majority of patients were also interracial individuals or blacks &#40;66 cases&#41;&#46; Patients usually exhibited single lesions &#40;46 in 133 cases&#41;&#44; but two &#40;30 in 133 cases&#41; or three lesions &#40;20 in 133 cases&#41; were equally very common&#46; The affected body regions were mainly the scalp &#40;28 cases&#44; 21&#37;&#41;&#44; elbows &#40;25 cases&#44; 18&#46;8&#37;&#41;&#44; and knees &#40;21 cases&#44; 15&#46;8&#37;&#41;&#46; Other locations such as nails&#44; face&#44; back&#44; abdomen&#44; and chest were referred in less than 1&#37; of cases&#46; Only two cases of psoriatic arthritis&#44; and no cases of inverse psoriasis or generalized pustular psoriasis were found&#46; One hundred twenty two cases were analyzed for the severity of psoriasis &#40;PGA score&#41; and are reported as follows&#58; 0 &#40;none of the patients&#41;&#44; 1 &#40;9 in 122 cases&#41;&#44; 2 &#40;32 in 122 cases&#41;&#44; 3 &#40;33 in 122 cases&#41;&#44; 4 &#40;21 in 122 cases&#41;&#44; 5 &#40;13 in 122 cases&#41; and 6 &#40;14 in 122 cases&#41;&#46; The reported associated diseases were hypertension &#40;9&#41;&#44; atopy &#40;7&#41;&#44; HIV&#47;AIDS &#40;2&#41;&#44; hepatitis &#40;2&#41;&#44; diabetes mellitus &#40;3&#41;&#44; and hyperthyroidism &#40;1&#41;&#46; Only five patients referred a family history of psoriasis&#46;</p><elsevierMultimedia ident="tbl1"></elsevierMultimedia></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p class="elsevierStylePara elsevierViewall">Psoriasis affects people worldwide<a class="elsevierStyleCrossRefs" href="#bib1"><span class="elsevierStyleSup">1&#8211;3</span></a>&#59; however&#44; cultural&#44; socio-demographic&#44; and environmental factors could have an impact on the incidence or clinical course of the disease in some geographic regions&#46; Here we analyzed psoriasis cases from an outpatient care unit located in Rio de Janeiro&#44; Brazil&#46; We demonstrated that the clinical form of the disease was similar to that observed in other countries&#44; but interracial and black populations were affected as much as whites&#46; No difference regarding gender was observed in the present study&#44; even after taking into account different races&#46; Considering the mean age of the onset of symptoms&#44; our patients were equally distributed into type I and type II<a class="elsevierStyleCrossRef" href="#bib7"><span class="elsevierStyleSup">7</span></a>&#46; As expected&#44; chronic plaque psoriasis was the most common clinical presentation with no difference for gender or skin color&#46; Conversely&#44; psoriatic arthritis was rarely reported&#44; probably because these patients were mainly seen by Rheumatology services&#46; Interracial and black subjects did not present a more severe clinical form of the disease&#44; as has been suggested by previous authors<a class="elsevierStyleCrossRef" href="#bib19"><span class="elsevierStyleSup">19</span></a>&#46; The low intensity and severity of psoriasis in this sample &#40;PGA score 5 &#91;13 in 122 cases&#93; and 6 &#91;14 in 122 cases&#93;&#41; could be attributed to the tropical climate in Brazil&#44; a country located close to the equator&#46; The country is exposed to high levels of ultraviolet radiation from intense sunlight throughout the year&#44; which leads to a much better prognosis of the disease<a class="elsevierStyleCrossRefs" href="#bib20"><span class="elsevierStyleSup">20&#44;21</span></a>&#46; In a Colombian study&#44; 18&#46;6&#37; of 86 patients presented severe psoriasis<a class="elsevierStyleCrossRef" href="#bib22"><span class="elsevierStyleSup">22</span></a>&#46;</p><p class="elsevierStylePara elsevierViewall">In our study&#44; blacks comprised 18&#37; of patients seen in our care unit&#44; and our results indicate that psoriasis also affects an Afro-descendant population&#46; Such percentage is high considering the official data showing that the Brazilian population consists of 38&#46;2&#37; of interracial individuals and 5&#46;9&#37; of blacks<a class="elsevierStyleCrossRef" href="#bib23"><span class="elsevierStyleSup">23</span></a>&#44; which include Afro-descendants&#46; These data are surprising as psoriasis is classically considered a Caucasian disease that affects less than 0&#46;1&#37; of Asians and is considered rare among Africans<a class="elsevierStyleCrossRefs" href="#bib1"><span class="elsevierStyleSup">1&#8211;3&#44;24</span></a>&#46; Note that two Latin Americans studies led to different findings&#46; Gonzalez et al analyzed 86 patients and reported that race distribution was as follows&#58; interracial individuals &#40;85&#37;&#41;&#44; whites &#40;14&#37;&#41; and blacks &#40;1&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib22"><span class="elsevierStyleSup">22</span></a>&#46; Trujillo et al analyzed 200 patients and reported the following distribution&#58; interracial individuals &#40;10&#46;5&#37;&#41;&#44; whites &#40;85&#46;5&#37;&#41;&#44; blacks &#40;3&#46;5&#37;&#41; and unknown &#40;0&#46;5&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib20"><span class="elsevierStyleSup">20</span></a>&#46; Yet&#44; population-based studies showed that psoriasis affects a significant fraction of African-Americans&#44; although it was observed a reduction in the prevalence of approximately 52&#37; compared to Caucasians<a class="elsevierStyleCrossRef" href="#bib19"><span class="elsevierStyleSup">19</span></a>&#46;</p><p class="elsevierStylePara elsevierViewall">In contrast&#44; whites predominated in a previous Brazilian study&#44; though it also included patients seen in a private dermatology practice<a class="elsevierStyleCrossRef" href="#bib9"><span class="elsevierStyleSup">9</span></a>&#46; In this study&#44; we hypothesize that blacks may have inherited Caucasian genes associated with psoriasis<a class="elsevierStyleCrossRef" href="#bib25"><span class="elsevierStyleSup">25</span></a> because of the high number of interracial populations in Brazil&#46; In fact&#44; this hypothesis is consistent with the literature&#46; Green reported that psoriasis among indigenous Australians of &#8220;full-blood&#8221; descent may be rare or non-existent&#59; minimal cases haved been reported among Aborigines&#44; and psoriasis diagnoses were associated with Aboriginal people of mixed descent<a class="elsevierStyleCrossRef" href="#bib26"><span class="elsevierStyleSup">26</span></a>&#46; Further research indicated that the condition appeared to be relatively uncommon among Nigerians and Mongolians&#44; and more common among Kenyans and people from the Faroe Islands<a class="elsevierStyleCrossRefs" href="#bib27"><span class="elsevierStyleSup">27&#8211;29</span></a>&#46; It is worth noting that the different methodology employed in research design&#44; such as population-based research compared with hospital-based research&#44; makes it difficult to conclude whether these differences were indeed a result of racial variation<a class="elsevierStyleCrossRef" href="#bib30"><span class="elsevierStyleSup">30</span></a>&#46;</p><p class="elsevierStylePara elsevierViewall">Indeed&#44; other factors such as behavior and environmental conditions can also influence the development of the disease<a class="elsevierStyleCrossRefs" href="#bib24"><span class="elsevierStyleSup">24&#44;31</span></a>&#46; Perhaps a major component of regional variation in the frequency&#44; severity and morbidity of psoriasis is climate variation&#46; A population-based study reported a seasonal variation in psoriasis diagnoses&#44; in which over 65&#37; of the cases were diagnosed in winter and spring&#44; as opposed to approximately 30&#37; of cases diagnosed in summer and autumn<a class="elsevierStyleCrossRef" href="#bib32"><span class="elsevierStyleSup">32</span></a>&#46; Farber and Nail reported that almost 90&#37; of the respondents indicated that cold weather made their psoriasis worse&#44; approximately 80&#37; claimed that hot weather made their psoriasis better&#44; and 80&#37; stated that sunlight made their psoriasis better<a class="elsevierStyleCrossRef" href="#bib33"><span class="elsevierStyleSup">33</span></a>&#46; With respect to geographical or climatic features&#44; an author recorded the highest prevalence level of the disease in the central area of Spain&#44; whose weather is drier and colder than in the northern and southern&#47;Mediterranean regions of Spain<a class="elsevierStyleCrossRef" href="#bib34"><span class="elsevierStyleSup">34</span></a>&#46;</p><p class="elsevierStylePara elsevierViewall">In country-specific studies&#44; the estimated prevalence of psoriasis ranges from 0&#37; in Australian Aborigines and Andean Indians to 11&#46;8&#37; in the inhabitants of Kazakhstan &#40;an Arctic region of the Soviet Union&#41;<a class="elsevierStyleCrossRef" href="#bib35"><span class="elsevierStyleSup">35</span></a>&#46; More comprehensive studies reported that the prevalence of psoriasis was 1&#46;4&#37; in Spain<a class="elsevierStyleCrossRef" href="#bib34"><span class="elsevierStyleSup">34</span></a>&#44; 1&#46;5&#37; in the United Kingdom<a class="elsevierStyleCrossRef" href="#bib36"><span class="elsevierStyleSup">36</span></a> and 2&#46;9&#37; in South Africa<a class="elsevierStyleCrossRef" href="#bib37"><span class="elsevierStyleSup">37</span></a> and Italy<a class="elsevierStyleCrossRef" href="#bib38"><span class="elsevierStyleSup">38</span></a>&#46; The present study analyzed the epidemiology of psoriasis&#44; but the prevalence of psoriasis &#40;5&#46;2&#37;&#41; was estimated for new dermatological outpatients in a limited clinical setting&#44; with a small population&#46; Therefore&#44; it does not reflect the true prevalence of this specific disease in the Brazilian population&#46; We believe that larger population-based studies should provide a broader picture of the incidence and&#47;or prevalence of psoriasis in Brazil&#46; Trujillo et al reported that psoriasis represents 6&#37; of the dermatologic consultations in Cuba<a class="elsevierStyleCrossRef" href="#bib20"><span class="elsevierStyleSup">20</span></a>&#46; This large number is justified because the health system in Cuba<a class="elsevierStyleCrossRef" href="#bib20"><span class="elsevierStyleSup">20</span></a>&#44; as well as in Brazil<a class="elsevierStyleCrossRef" href="#bib39"><span class="elsevierStyleSup">39</span></a>&#44; is free&#44; allowing easy access to data concerning the entire population&#46;</p><p class="elsevierStylePara elsevierViewall">Although this study was not designed to estimate the race prevalence of psoriasis&#44; our results suggest that this disease is common in the African-descendant Brazilian population&#46; Different ethnic backgrounds can mirror the health-related quality of life&#44; and African-Brazilians are more likely to have a low social status compared to that of Caucasians<a class="elsevierStyleCrossRef" href="#bib40"><span class="elsevierStyleSup">40</span></a>&#46; Indeed&#44; poor socio-economic factors can limit African-Brazilian patients&#8217; possibilities of receiving adequate treatments&#44; and such factors can have an effect on these patients&#8217; health-related quality of life&#46; Accordingly&#44; these results should be considered in health care policy making in Brazil&#44; particularly when developing policies in public health programs for psoriasis patients&#46;</p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interest</span><p class="elsevierStylePara elsevierViewall">Authors have no conflict of interest to declare&#46;</p></span></span>"
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            0 => "Psoriasis"
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            2 => "Afrodescendientes"
            3 => "Poblaci&#243;n brasile&#241;a"
            4 => "Negros"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p class="elsevierStyleSimplePara elsevierViewall">Cultural&#44; socio-demographic and environmental factors such as tropical climate and exposure to sun could have an impact on the incidence or clinical course of psoriasis&#46; Here we describe the main clinical aspects of psoriasis in Brazilian patients and also investigate whether any particular feature can distinguish the disease occurring in Brazil from that occurring in other countries&#46;</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p class="elsevierStyleSimplePara elsevierViewall">We recorded the clinical features of 151 psoriasis patients seen in a Brazilian public dermatological care unit between 2006 and 2008&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">Males and females were similarly affected&#46; The reported races were as follows&#58; whites&#44; 47 cases &#40;41&#46;6&#37;&#41;&#44; interracial individuals &#40;mixed race&#41;&#44; 42 cases &#40;37&#46;2&#37;&#41; and blacks&#44; 24 cases &#40;21&#46;2&#37;&#41;&#46; Chronic plaque-type psoriasis was the most prevalent clinical form &#40;110 cases&#44; 72&#46;8&#37;&#41; followed by palm and sole involvement &#40;21 cases&#44; 13&#46;9&#37;&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">We demonstrated that psoriasis in these Brazilian subjects was similar to that observed in subjects from other countries&#44; but interracial and black populations were affected as much as whites&#46; Considering the high rate of interracial populations among Brazilians we cannot exclude the possibility that Afro-descendants may have inherited Caucasian genes associated with psoriasis&#46; Poor socio-economic conditions of Afro-descendants can limit their possibilities of receiving adequate treatments&#44; impairing their health-related quality of life&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p class="elsevierStyleSimplePara elsevierViewall">Los factores culturales&#44; sociodemogr&#225;ficos y ambientales tales como el clima tropical o la exposici&#243;n solar pueden tener un impacto en la incidencia o el curso cl&#237;nico de la psoriasis&#46; En este art&#237;culo describimos los principales aspectos cl&#237;nicos de la psoriasis en pacientes brasile&#241;os e investigamos si existe alguna caracter&#237;stica que permita distinguir la enfermedad que ocurre en Brasil de la que se encuentra en otros pa&#237;ses&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">Se recogieron las caracter&#237;sticas cl&#237;nicas de 151 pacientes con psoriasis evaluados en un centro dermatol&#243;gico p&#250;blico de Brasil entre 2006 y 2008&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Los hombres y las mujeres estaban afectados de forma similar&#46; La frecuencia de afectaci&#243;n seg&#250;n la raza era la siguiente&#58; blancos 47 casos &#40;41&#44;6&#37;&#41;&#44; mestizos 42 casos &#40;37&#44;2&#37;&#41; y negros 24 casos &#40;21&#44;2&#37;&#41;&#46; Las formas cl&#237;nicas m&#225;s prevalentes fueron la psoriasis cr&#243;nica en placas &#40;110 casos&#44; 72&#44;8&#37;&#41; seguida de la psoriasis palmoplantar &#40;21 casos&#44; 13&#44;9&#37;&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Demostramos que la psoriasis en estos sujetos brasile&#241;os es similar a la que se observa en sujetos de otros pa&#237;ses&#44; pero los mestizos y los negros est&#225;n afectados tanto como los blancos&#46; Teniendo en cuenta la elevada proporci&#243;n de poblaci&#243;n mestiza entre los brasile&#241;os&#44; no podemos descartar la posibilidad de que los descendientes africanos hayan podido heredar los genes cauc&#225;sicos asociados a la psoriasis&#46; Las pobres condiciones socioecon&#243;micas de los descendientes africanos pueden limitar sus posibilidades para recibir tratamientos adecuados&#44; lo que altera su calidad de vida&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleBold">Clinical forms of psoriasis</span></td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Period of illness &#40;years&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn1a"><span class="elsevierStyleSup">a</span></a></td><td class="td" title="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">Race</span><a class="elsevierStyleCrossRef" href="#tblfn1b"><span class="elsevierStyleSup">b</span></a></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">Guttata&nbsp;\t\t\t\t\t\t\n
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                  """
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        "titulo" => "Acknowledgments"
        "texto" => "<p class="elsevierStylePara elsevierViewall">We are grateful to Dr R&#46; Vieira-Gon&#231;alves for the valuable suggestions&#44; to Sonia Maria Ramos Vasconcelos for the linguistic revision and to the clinical staff of the Servi&#231;o de Dermatologia-HUGG&#47;UNIRIO&#46; C&#46; Porto-Ferreira is a graduate student at Programa de P&#243;s-Gradua&#231;&#227;o em Ci&#234;ncias M&#233;dicas&#44; FCM-UERJ&#46; A&#46;M&#46; Da-Cruz is a research fellow from FAPERJ&#46;</p>"
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Información del artículo

ISSN: 00017310
Idioma original: Inglés

DOI:10.1016/j.ad.2009.09.008

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2018 Septiembre	3	0	3
2018 Marzo	3	0	3
2018 Febrero	18	7	25
2018 Enero	18	6	24
2017 Diciembre	39	7	46
2017 Noviembre	17	7	24
2017 Octubre	34	5	39
2017 Septiembre	21	15	36
2017 Agosto	22	16	38
2017 Julio	32	5	37
2017 Junio	40	30	70
2017 Mayo	25	18	43
2017 Abril	31	14	45
2017 Marzo	32	27	59
2017 Febrero	17	6	23
2017 Enero	21	11	32
2016 Diciembre	34	10	44
2016 Noviembre	28	7	35
2016 Octubre	40	20	60
2016 Septiembre	42	12	54
2016 Agosto	59	16	75
2016 Julio	37	49	86
2016 Junio	7	25	32
2016 Mayo	4	20	24
2016 Abril	9	2	11
2016 Marzo	10	3	13
2016 Febrero	7	3	10
2016 Enero	8	24	32
2015 Diciembre	9	23	32
2015 Noviembre	17	23	40
2015 Octubre	13	7	20
2015 Septiembre	21	10	31
2015 Agosto	28	4	32
2015 Julio	53	1	54
2015 Junio	64	7	71
2015 Mayo	83	13	96
2015 Abril	79	11	90
2015 Marzo	155	4	159
2015 Febrero	92	1	93
2015 Enero	107	2	109
2014 Diciembre	124	0	124
2014 Noviembre	118	0	118
2014 Octubre	126	1	127
2014 Septiembre	113	1	114
2014 Agosto	120	0	120
2014 Julio	138	1	139
2014 Junio	123	0	123
2014 Mayo	142	1	143
2014 Abril	119	0	119
2014 Marzo	128	21	149
2014 Febrero	116	24	140
2014 Enero	131	35	166
2013 Diciembre	117	25	142
2013 Noviembre	83	29	112
2013 Octubre	124	37	161
2013 Septiembre	103	31	134
2013 Agosto	114	49	163
2013 Julio	104	30	134
2013 Junio	97	29	126
2013 Mayo	106	21	127
2013 Abril	107	33	140
2013 Marzo	78	19	97
2013 Febrero	52	15	67
2013 Enero	47	12	59
2012 Diciembre	45	16	61
2012 Noviembre	20	8	28
2012 Octubre	15	6	21
2012 Septiembre	5	3	8
2011 Mayo	3	0	3
2011 Abril	6	0	6
2011 Marzo	16	0	16
2011 Febrero	8	0	8
2011 Enero	8	0	8
2010 Diciembre	14	0	14
2010 Noviembre	14	0	14
2010 Octubre	3	0	3
2010 Septiembre	15	0	15
2010 Agosto	3	0	3
2010 Julio	5	0	5
2010 Junio	6	0	6
2010 Mayo	33	0	33
2010 Abril	19	0	19

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