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On-line version ISSN 1806-4841
An. Bras. Dermatol. vol.85 no.2 Rio de Janeiro Mar./Apr. 2010
Lauro Rodolpho Soares LopesI; Débora KundmanI; Ida Alzira Gomes DuarteII
Resident Physician in Dermatology at Irmandade da Santa Casa de Sao Paulo (ISCMSP)
- Sao Paulo (SP), Brazil
IIProfessor of Dermatology, Ph.D, at Irmandade da Santa Casa de Misericordia de Sao Paulo (ISCMSP) - Sao Paulo (SP), Brazil
The objective was to evaluate the prevalence of skin diseases in patients seen at the Dermatology outpatients' clinic of the Santa Casa de São Paulo during the period from June to October 2005, comparing the results with a similar survey conducted at the same center in 1977. During the period of study, the electronic medical charts of 3011 patients seen in a first visits were analyzed.
Keywords: Prevalence; Skin diseases; Statistics
An up-to-date statistical analysis of the frequency of skin disorders in a specialized Dermatology clinic in Brazil is necessary, since the last work of this type was conducted in 1977.1 This investigation is important because it promotes the establishment of a more effective prevention policy, geared towards the most prevalent diseases.1
The objective of this work was to evaluate the prevalence of non-inflammatory skin disorders in patients seen at the Dermatology Outpatients Clinic of Santa Casa de Sao Paulo. The diagnoses of 3,011 electronic and manual medical charts of new patients seen from June 1st to October 31st of 2005 were analyzed.1
Data from the statistical analysis performed in 1977 show that 3,005 new patients were seen at the clinic during that year. In the current study, 3,109 new cases were recorded in the period of five months, of which 3,011 were evaluated. Based on this comparison, we can infer that the demand for dermatologic services at the clinic has grown over the past years.
Women predominated in the study: 1,683 (56%), with an average age of 36 years.
In decreasing order, relative to the frequency of skin diseases, the following were diagnosed: cutaneous tumors were present in 672 (22.32%) patients; infectious dermatosis, in 652 (21.65%); eczemas, in 441 (14.65%); erythematous-scaly lesions, in 283 (9.40%); benign tumors and cysts, in 260 (8.64%); dyschromias, in 222 (7.37%), malignant tumors, in 178 (5.91%); folliculitis, in 153 (5.08%); mesenchymal tumors, in 132 (4.38%); trichosis, in 114 (3.79%); premalignant tumors, in 102 (3.39%); urticaria, in 48 (1.59%); lichen disorders, in 44 (1.46%); connective tissue diseases, in 41 (1.36%); pruritus, in 38 (1.26%); pharmacodermias, in 35 (1.16%); onychocryptoses, in 35 (1.16%); granulomatosis, in 31 (1.03%); papular pruritic eruptions, in 24 (0.39%); papular nodular eruptions, in 20 (0.66%); ulcers, in 18 (0.6%); hydrosis, in 17 (0.56%); vesicular bullous dermatosis, in 17 (0.56%); blood vessel diseases, in 15 (0.5%); purpuric diseases, in 13 (0.43%); atrophic sclerotic lesions, in 8 (0.27%), followed by other skin diseases in 54 (1.78%) patients (Table 1).
Skin tumors were the primary cause of medical assistance in our study, with a total of 672 cases (22.32%). This contrasts with the results obtained in the 1977 study, in which eczemas predominated (40.35%).1 At that time, skin cancer represented the second most frequent disorder, totaling 14. 65%. The authors of the 1977 study questioned the discrepancy between their results and the percentage of carcinoma cases in statistical analyses performed in the United States. The results obtained in this work are similar to those found in current statistical analyses in the US. This can be explained by incentives for knowledge about skin cancer promoted by prevention campaigns about the issue in our country.1-5 Zooparasitic diseases are currently the ninth most prevalent disorder. In 1977 they were ranked second. This may be explained by basic sanitation improvements over the last 30 years and greater access to better hygiene and cleaning products. The same can be said of pyodermitis, a disease whose frequency went from the sixth to the twelfth position.1,6,7
Pityriasis versicolor was the main dermatosis among superficial mycoses1, but tineas are currently more frequent due to an increase in the incidence of onychomycosis, with 114 diagnoses of the disease. Even with the high interest of the population in aesthetics, diagnoses related to this condition were not prevalent in our sample (Graph 1).
Regarding deep mycoses, three cases of chromomycosis and two cases of paracoccidioidomycosis were observed. Three new cases of leishmaniasis and 26 new cases of leprosy were diagnosed, showing that Brazil is still an endemic country for the disease.
The incidence of sexually transmitted diseases, especially syphilis, has decreased significantly (5.40% then and 1.96% now; syphilis, 1.96% then and 0.53% now) due to instruction campaigns and the widespread adoption of prevention methods.1,6
It is relevant to mention that some diseases, absent in the 1977 investigation, have now been diagnosed, such as dyschromias and erythematous-scaly eruptions (Table 1).
There were few cases of acne in our study (3.62%) and in the 1977 analysis (2.89%), which goes against the expected prevalence for the population.1
Regarding gender distribution, few skin diseases were more prevalent in women than in men: dyschromias (2:1) and vasculitis and purpuric lesions (3:1). A lower incidence of malignant tumors in women was confirmed (1.5:1). This fact may be a reflection of better skin care by women.8,9 (Table 1).
1. Zaitz C, Proença NG, Ferreira AM, Arns VL. Estatísticas do ambulatório de dermatologia da Santa Casa de São Paulo, 1977. An Bras Dermatol. 1979;54:311-24. [ Links ]
4. Sampaio SAP, Rivitti EA. Dermatologia. 3 ed. São Paulo: Artes Médicas; 2007. [ Links ]
6. Ministério da Saúde. Guia de vigilância epidemiológica. Brasília: Ministério da Saúde; 2003. [ Links ]
7. Cucé LC, Neto CF. Manual de dermatologia. 2 ed. São Paulo: Atheneu; 2001. p.451-5. [ Links ]
8. Sociedade Brasileira de Dermatologia. Perfil nosológico das consultas dermatológicas no Brasil. An Bras Dermatol. 2006;81:549-58. [ Links ]
9. Santos Júnior A, Andrade MGG, Zeferino AB, Monte Alegre S, Moraes AM, Velho PENF. Prevalência das dermatoses na rede básica de saúde de Campinas, São Paulo - Brasil. An Bras Dermatol. 2007;82:419-24. [ Links ]
Mailing Address: Received on January
7th, 2008. * Work conducted
at the Dermatology Clinic of Irmandade da Santa Casa de Misericordia de Sao
Paulo - Sao Paulo (SP), Brazil.
Lauro Rodolpho Soares Lopes
Av. Marechal Castelo Branco 670 Apt.1600 Ilhotas
64001 810 Teresina, PI
Tel./fax: 86 94240202 86 32215631 86 3221 5631
Approved by the Peer Review Board and accepted for publication on December 18th, 2008.
Conflict of interest: None
Financial funding: None
Received on January
* Work conducted at the Dermatology Clinic of Irmandade da Santa Casa de Misericordia de Sao Paulo - Sao Paulo (SP), Brazil.