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Abstract This publication is an update of the “Consensus on the therapeutic management of atopic dermatitis - Brazilian Society of Dermatology” published in 2019, considering the novel, targeted-oriented systemic therapies for atopic dermatitis. The initial recommendations of the current consensus for systemic treatment of patients with atopic dermatitis were based on a recent review of scientific published data and a consensus was reached after voting. The Brazilian Society of Dermatology invited 31 experts from all regions of Brazil and 2 international experts on atopic dermatitis who fully contributed to the process. The methods included an e-Delphi study to avoid bias, a literature search and a final consensus meeting. The authors added novel approved drugs in Brazil and the indication for phototherapy and systemic therapy for AD. The therapeutical response to systemic treatment is hereby reported in a suitable form for clinical practice and is also part of this updated manuscript.

https://doi.org/10.1016/j.abd.2023.04.003

Lucius phenomenon: the importance of a primary dermatological care
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Pinheiro, Juliana Viana

; Pontes, Maria Araci de Andrade

; Medeiros Neto, José Urbano de

; Gonçalves, Heitor de Sá

Anais Brasileiros de Dermatologia

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feb 2022, Volume 97 N. 1 Pages 54 - 57

Abstract: En | Text: En | PDF: En

Abstract Leprosy presents a varied clinical spectrum. Lucius phenomenon is a rare leprosy reaction characterized by erythematous, painful, slightly infiltrated macules and hemorrhagic bullae that progress to ulceration. This case report describes a patient whose diagnosis of leprosy occurred in the presence of Lucius phenomenon. Late diagnosis and delay in the implementation of specific therapy contributed to an unfavorable outcome, highlighting the importance of early identification and treatment of this disease, as well as its complications.

https://doi.org/10.1016/j.abd.2020.08.033

Unanswered questions on the safety of MDT-U - Reply
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Penna, Gerson Oliveira

; Gonçalves, Heitor de Sá

; Pontes, Maria Araci de Andrade

Anais Brasileiros de Dermatologia

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aug 2019, Volume 94 N. 4 Pages 500 - 500

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/abd1806-4841.201985641 221 downloads

Clinical trial for uniform multidrug therapy for leprosy patients in Brazil (U-MDT/CT-BR): adverse effects approach
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Cruz, Rossilene Conceição da Silva

; Bührer-Sékula, Samira

; Penna, Gerson Oliveira

; Moraes, Maria Elisabete Amaral de

; Gonçalves, Heitor de Sá

; Stefani, Mariane Martins de Araújo

; Penna, Maria Lúcia Fernandes

; Pontes, Maria Araci de Andrade

; Talhari, Sinésio

Anais Brasileiros de Dermatologia

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jun 2018, Volume 93 N. 3 Pages 377 - 384

Abstract: En | Text: En | PDF: En

Abstract: BACKGROUND: The Clinical Trial for Uniform Multidrug Therapy for Leprosy Patients in Brazil (U-MDT/CT-BR), designed to evaluate the effectiveness of a six-months regimen, assessed the adverse effects caused by the drugs. OBJECTIVE: Describe adverse effects due to MDT in U-MDT/CT-BR, comparing the uniform regimen (U-MDT) to the current WHO regimen (R-MDT). Patients and methods: After operational classification, patients were randomly allocated to the study groups. U-MDT PB and U-MDT MB groups, received the U-MDT regimen, six doses of MB-MDT (rifampicin, dapsone and clofazimine). R-MDT PB and R-MDT MB groups, received the WHO regimens: six doses (rifampicin and dapsone) for PB and 12 doses (rifampicin, dapsone and clofazimine) for MB. During treatment, patients returned monthly for clinical and laboratorial evaluation. Patients with single lesion were not included in this trial. RESULTS: Skin pigmentation (21.7%) and xerosis (16.9%) were the most frequent complaints among 753 patients. Laboratory exams showed hemoglobin concentration lower than 10g/dL in 23.3% of the patients, glutamic oxaloacetic transaminase (GOT) above 40U/L in 29.5% and glutamic pyruvic transaminase (GPT) above 40U/L in 28.5%. Twenty-four patients (3.2%) stopped dapsone intake due to adverse effects, of whom 16.6% due to severe anemia. One case of sulfone syndrome was reported. STUDY LIMITATIONS: Loss of some monthly laboratory sample collection. CONCLUSIONS: There was no statistical difference regarding adverse effects in the R-MDT and U-MDT groups but anemia was greater in patients from R-MDT/MB group, therefore adverse effects do not represent a constraint to recommend the six-month uniform regimen of treatment for all leprosy patients.

https://doi.org/10.1590/abd1806-4841.20186709 1503 downloads

Daylight photodynamic therapy - Experience and safety in treatment of actinic keratoses of the face and scalp in low latitude and high brightness region
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Galvão, Luiz Eduardo Garcia

; Gonçalves, Heitor de Sá

; Botelho, Karine Paschoal

; Caldas, Juliana Chagas

Anais Brasileiros de Dermatologia

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feb 2017, Volume 92 N. 1 Pages 142 - 144

Abstract: En | Text: En | PDF: En

ABSTRACT Daylight photodynamic therapy has been used in countries with high latitudes during the summer for actinic keratoses treatment with reports of similar efficacy to conventional photodynamic therapy. We evaluate its safety in 20 patients in the city of Fortaleza, a local with low latitude and high brightness. Sixteen patients did not report any discomfort due to the procedure. Daylight photodynamic therapy is an easy application method with great tolerability by the patient and has the possibility of being performed throughout the year in these regions. It can mean a promising tool in the control of skin cancer.

https://doi.org/10.1590/abd1806-4841.20175175 1335 downloads

Widespread nasal carriage of Mycobacterium lepraeamong a healthy population in a hyperendemic region of northeastern Brazil
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Lima, Luana Nepomuceno Gondim Costa

; Frota, Cristiane Cunha

; Mota, Rosa Maria Salani

; Almeida, Rosa Livia Freitas

; Pontes, Maria Araci de Andrade

; Gonçalves, Heitor de Sá

; Rodrigues, Laura Cunha

; Kendall, Carl

; Kerr, Ligia

Memórias do Instituto Oswaldo Cruz

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nov 2015, Volume 110 N. 7 Pages 898 - 905

Abstract: En | Text: En | PDF: En

A case-control study was conducted to determine the presence ofMycobacterium leprae DNA in nasal secretions of leprosy cases and nonleprosy individuals in Fortaleza, Brazil. It included 185 cases identified by physicians at the Dona Libânia National Reference Centre for Sanitary Dermatology (CDERM). A control group (Co) (n = 136) was identified among individuals from CDERM not diagnosed as leprosy cases. To augment the spatial analysis of M. leprae specific repetitive element (RLEP) positive prevalence, an external group (EG) (n = 121), a convenience sample of healthy students, were included. Polymerase chain reaction for the RLEP sequence was conducted for all participants. Prevalence of RLEP positivity for cases and Co were 69.2% and 66.9%, respectively, significantly higher than for EG (28.1%), and reported elsewhere. Male sex, belonging to a lower socioeconomic status (D/E), history of a previous contact with a case and being older, were associated with being a leprosy case. Our geographical analysis demonstrated that the bacillus is widespread among the healthy population, with clusters of RLEP positive multibacillary cases concentrated in distinct areas of the city. Our results suggest that in endemic areas, as in Fortaleza, surveillance for both nonhousehold leprosy contacts and members of the general population living in cluster areas should be implemented.

https://doi.org/10.1590/0074-02760150178 1647 downloads

Piloleiomyoma with segmental distribution - Case report
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Albuquerque, Melina Maria de Sousa

; Rocha, Camila Farias

; Costa, Igor Santos

; Maia, Rodger da Rocha

; Branco, Francisco José Dias

; Gonçalves, Heitor de Sá

Anais Brasileiros de Dermatologia

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jun 2015, Volume 90 N. 3 Pages 178 - 180

Abstract: En | Text: En | PDF: En

Abstract Piloleiomyoma is an uncommon benign neoplasm arising from the erector pilorum muscle. It presents as reddish-brown papules or nodules, in general located on the limbs or trunk, often painful. The present paper describes a case of piloleiomyoma with segmental distribution on left trunk, with an important expression of pain.

https://doi.org/10.1590/abd1806-4841.20153769 2128 downloads

Rosai-Dorfman disease presenting with extensive cutaneous manifestation - Case report
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Leal, Paula Azevedo Borges

; Adriano, Adrilena Lopes

; Breckenfeld, Marcelle Parente

; Costa, Igor Santos

; Sousa, Antônio Renê Diógenes de

; Gonçalves, Heitor de Sá

Anais Brasileiros de Dermatologia

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apr 2013, Volume 88 N. 2 Pages 256 - 259

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

A doença de Rosai-Dorfman é uma desordem benigna, autolimitada, idiopática, decorrente da proliferação de histiócitos. Foi descrita pela primeira vez por Rosai e Dorfman em 1969. Tipicamente, a doença se caracteriza por extensa linfadenopatia cervical, febre, gamopatia monoclonal e leucocitose com neutrofilia. Manifestações extranodais são encontradas em 43% dos casos, sendo a pele o sítio extranodal mais comumente afetado. No trabalho, apresentamos um caso de doença de Rosai-Dorfman com apresentação cutânea exuberante na coxa direita e discreto comprometimento linfonodal limitado à cadeia regional.

Rosai-Dorfman disease is a benign, self-limited, idiopathic proliferative histiocytic disorder. It was first described in 1969 by Rosai and Dorfman. In its typical form the disease is characterized by extensive cervical lymphadenopathy associated with fever, polyclonal gammopathy and leukocytosis with neutrophilia. The skin is the most common site affected. Extranodal manifestations have been reported in 43% of cases. In this study, we report an atypical case of Rosai-Dorfman disease in a female with massive cutaneous manifestation on the thigh, associated with a minimal lymphadenopathy limited to the regional inguinal lymph nodes.

https://doi.org/10.1590/S0365-05962013000200014 3142 downloads

Genotyping of Mycobacterium leprae present on Ziehl-Neelsen-stained microscopic slides and in skin biopsy samples from leprosy patients in different geographic regions of Brazil
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Fontes, Amanda Nogueira Brum

; Gomes, Harrison Magdinier

; Araujo, Marcelo Ivens de

; Albuquerque, Edson Cláudio Araripe de

; Baptista, Ida Maria Foschiani Dias

; Moura, Maria Manuela da Fonseca

; Rezende, Denise Silva

; Pessolani, Maria Cristina Vidal

; Lara, Flávio Alves

; Pontes, Maria Araci de Andrade

; Gonçalves, Heitor de Sá

; Lucena-Silva, Norma

; Sarno, Euzenir Nunes

; Vissa, Varalakshmi D

; Brennan, Patrick J

; Suffys, Philip Noel

Memórias do Instituto Oswaldo Cruz

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dec 2012, Volume 107 Suppl. 1 Pages 143 - 149

Abstract: En | Text: En | PDF: En

We analysed 16 variable number tandem repeats (VNTR) and three single-nucleotide polymorphisms (SNP) in Mycobacterium leprae present on 115 Ziehl-Neelsen (Z-N)-stained slides and in 51 skin biopsy samples derived from leprosy patients from Ceará (n = 23), Pernambuco (n = 41), Rio de Janeiro (n = 22) and Rondônia (RO) (n = 78). All skin biopsies yielded SNP-based genotypes, while 48 of the samples (94.1%) yielded complete VNTR genotypes. We evaluated two procedures for extracting M. leprae DNA from Z-N-stained slides: the first including Chelex and the other combining proteinase and sodium dodecyl sulfate. Of the 76 samples processed using the first procedure, 30.2% were positive for 16 or 15 VNTRs, whereas of the 39 samples processed using the second procedure, 28.2% yielded genotypes defined by at least 10 VNTRs. Combined VNTR and SNP analysis revealed large variability in genotypes, but a high prevalence of SNP genotype 4 in the Northeast Region of Brazil. Our observation of two samples from RO with an identical genotype and seven groups with similar genotypes, including four derived from residents of the same state or region, suggest a tendency to form groups according to the origin of the isolates. This study demonstrates the existence of geographically related M. leprae genotypes and that Z-N-stained slides are an alternative source for M. leprae genotyping.

3142 downloads

10.

Mycobacterium leprae virulence-associated peptides are indicators of exposure to M. leprae in Brazil, Ethiopia and Nepal
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Bobosha, Kidist

; Tang, Sheila Tuyet

; van der Ploeg-van Schip, Jolien J

; Bekele, Yonas

; Martins, Marcia VSB

; Lund, Ole

; Franken, Kees LMC

; Khadge, Saraswoti

; Pontes, Maria Araci de Andrade

; Gonçalves, Heitor de Sá

; Hussien, Jemal

; Thapa, Pratibha

; Kunwar, Chhatra B

; Hagge, Deanna A

; Aseffa, Abraham

; Pessolani, Maria Cristina Vidal

; Pereira, Geraldo MB

; Ottenhoff, Tom HM

; Geluk, Annemieke

Memórias do Instituto Oswaldo Cruz

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dec 2012, Volume 107 Suppl. 1 Pages 112 - 123

Abstract: En | Text: En | PDF: En

Silent transmission of Mycobacterium leprae, as evidenced by stable leprosy incidence rates in various countries, remains a health challenge despite the implementation of multidrug therapy worldwide. Therefore, the development of tools for the early diagnosis of M. leprae infection should be emphasised in leprosy research. As part of the continuing effort to identify antigens that have diagnostic potential, unique M. leprae peptides derived from predicted virulence-associated proteins (group IV.A) were identified using advanced genome pattern programs and bioinformatics. Based on human leukocyte antigen (HLA)-binding motifs, we selected 21 peptides that were predicted to be promiscuous HLA-class I T-cell epitopes and eight peptides that were predicted to be HLA-class II restricted T-cell epitopes for field-testing in Brazil, Ethiopia and Nepal. High levels of interferon (IFN)-γ were induced when peripheral blood mononuclear cells (PBMCs) from tuberculoid/borderline tuberculoid leprosy patients located in Brazil and Ethiopia were stimulated with the ML2055 p35 peptide. PBMCs that were isolated from healthy endemic controls living in areas with high leprosy prevalence (EChigh) in Ethiopia also responded to the ML2055 p35 peptide. The Brazilian EChigh group recognised the ML1358 p20 and ML1358 p24 peptides. None of the peptides were recognised by PBMCs from healthy controls living in non-endemic region. In Nepal, mixtures of these peptides induced the production of IFN-γ by the PBMCs of leprosy patients and EChigh. Therefore, the M. leprae virulence-associated peptides identified in this study may be useful for identifying exposure to M. leprae in population with differing HLA polymorphisms.

5808 downloads

11.

Brazilian clinical trial of uniform multidrug therapy for leprosy patients: the correlation between clinical disease types and adverse effects
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Gonçalves, Heitor de Sá

; Pontes, Maria Araci de Andrade

; Bührer-Sékula, Samira

; Cruz, Rossilene

; Almeida, Paulo Cesar

; Moraes, Maria Elisabete Amaral de

; Penna, Gerson Oliveira

Memórias do Instituto Oswaldo Cruz

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dec 2012, Volume 107 Suppl. 1 Pages 74 - 78

Abstract: En | Text: En | PDF: En

This study sought to verify the correlation between leprosy types and the adverse effects of treatment drugs. This quantitative, prospective, nested study was developed at the Dona Libânia Dermatology Centre in Fortaleza, Brazil. Data were collected from November 2007-November 2008. During this period, 818 leprosy patients were diagnosed and began treatment. Forty patients with tuberculoid leprosy (TT) were selected. Twenty patients followed a standard therapy of dapsone and rifampicin and 20 were administered dapsone, rifampicin and clofazimine (U-MDT). Twenty patients with borderline lepromatous (BL) and lepromatous leprosy (LL) were also selected and treated with U-MDT. All of the subjects received six doses. With the exception of haemolytic anaemia, there was a low incidence of adverse effects in all the groups. We did not observe any differences in the incidence of haemolytic anaemia or other side effects across groups of patients with TT, BL or LL treated with U-MDT.

2897 downloads Cited 1 time in SciELO

12.

A clinical trial for uniform multidrug therapy for leprosy patients in Brazil: rationale and design
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Penna, Gerson Oliveira

; Pontes, Maria Araci de Andrade

; Cruz, Rossilene

; Gonçalves, Heitor de Sá

; Penna, Maria Lúcia Fernandes

; Bührer-Sékula, Samira

Memórias do Instituto Oswaldo Cruz

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dec 2012, Volume 107 Suppl. 1 Pages 22 - 27

Abstract: En | Text: En | PDF: En

Leprosy will continue to be a public health problem for several decades. The World Health Organization (WHO) recommends that, for treatment purposes, leprosy cases be classified as either paucibacillary or multibacillary (MB). A uniform leprosy treatment regimen would simplify treatment and halve the treatment duration for MB patients. The clinical trial for uniform multidrug therapy (U-MDT) for leprosy patients (LPs) in Brazil is a randomised, open-label clinical trial to evaluate if the effectiveness of U-MDT for leprosy equals the regular regimen, to determine the acceptability of the U-MDT regimen and to identify the prognostic factors. This paper details the clinical trial methodology and patient enrolment data. The study enrolled 858 patients at two centres and 78.4% of participants were classified as MB according to the WHO criteria. The main difficulty in evaluating a new leprosy treatment regimen is that no reliable data are available for the current treatment regimen. Relapse, reaction and impaired nerve function rates have never been systematically determined, although reaction and impaired nerve function are the two major causes of nerve damage that lead to impairments and disabilities in LPs. Our study was designed to overcome the need for reliable data about the current treatment and to compare its efficacy with that of a uniform regimen.

3775 downloads Cited 2 times in SciELO

13.

Neuropatia silenciosa em portadores de hanseníase na cidade de Fortaleza, Ceará, Brasil
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Leite, Vyna Maria Cruz

; Lima, José Wellington de Oliveira

; Gonçalves, Heitor de Sá

Cadernos de Saúde Pública

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apr 2011, Volume 27 N. 4 Pages 659 - 665

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Uma das formas da hanseníase é a neuropatia silenciosa que consiste em perda progressiva da função motora ou sensorial na ausência de dor e hipersensibilidade dos nervos. Realizou-se um estudo transversal em Fortaleza, Ceará, Brasil, o qual estimou a proporção de neuropatia silenciosa e fatores associados. O paciente foi interrogado sobre a presença de dor, dormência, alteração da sensibilidade, e foi realizada palpação de nervos para identificar espessamento, abscesso e dor. Amostras de linfa foram obtidas para exames parasitológicos. Foi medida a força de músculos voluntários dos membros e a sensibilidade de pontos das mãos e dos pés por meio de monofilamentos de Semmes-Weinstein. De uma amostra de 233 portadores de hanseníase, a proporção de pacientes com neuropatia silenciosa foi 5,6% (IC95%: 3,0-9,4), e a ocorrência de neuropatia silenciosa esteve significativamente associada à idade (p = 0,011) e à incapacidade (p < 0,000). Esses resultados poderão ajudar a identificar casos de neuropatia silenciosa, focalizando pacientes com maior probabilidade de desenvolver a doença.

One of the clinical forms of Hansen's disease is silent neuropathy, which consists of progressive nerve damage in the absence of pain and hypersensitivity to palpation. This study estimated the proportion of silent neuropathy and associated factors. A cross-sectional study was performed in Fortaleza, Ceará State, Brazil. Patients were asked about the presence of decreased sensation involving touch, heat, pain, and numbness. Nerves were palpated to identify thickness, abscess, and pain. Lymph samples were drawn for parasitological tests. Strength of voluntary muscles in the feet and hands was evaluated. The sensitivity of specific points on the feet and hands was measured using Semmes-Weinstein monofilament. The sample included 233 patients. The proportion of silent neuropathy was 5.6% (95%CI: 3.0-9.4), and factors significantly associated with silent neuropathy were: age (p = 0.011) and disability (p < 0.000). These results will help identify cases of silent neuropathy, targeting patients at higher risk.

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14.

Neuropatia silenciosa em portadores de hanseníase na cidade de Fortaleza, Ceará, Brasil
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Leite, Vyna Maria Cruz

; Lima, José Wellington de Oliveira

; Gonçalves, Heitor de Sá

Cadernos de Saúde Pública

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apr 2011, Volume 27 N. 4 Pages 659 - 665

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

8470 downloads

15.

Hanseníase simulando erupção liquenóide: relato de caso e revisão de literatura
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Sousa, Antônio Renê Diógenes de

; Costa, Carolina Oliveira

; Queiroz, Hercilia Maria Carvalho

; Gonçalves, Paulo Eduardo de Sá

; Gonçalves, Heitor de Sá

Anais Brasileiros de Dermatologia

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apr 2010, Volume 85 N. 2 Pages 224 - 226

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

A hanseníase relaciona-se à formação de grande variedade de lesões cutâneas, desde manchas, pápulas, placas e nódulos, até infiltração difusa, dependendo da resposta imune do indivíduo. A apresentação clínica foge, muitas vezes, do padrão habitual, fazendo com que especialistas confundam o diagnóstico. O artigo descreve um caso raro de hanseníase, simulando erupção liquenoide, abordando os diferentes aspectos das manifestações clínicas, do diagnóstico e do tratamento desta entidade nosológica.

Leprosy is associated with the occurrence of various skin lesions such as macules, papules, plaques, nodules, and even diffused infiltration, depending on the patient's immune response. Its clinical presentation is often different from the usual pattern, leading to confusion in diagnosis. The present article describes a rare case of leprosy simulating lichenoid eruption and explores different aspects of the clinical manifestations, diagnosis, and treatment of this nosologic entity.

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