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Methotrexate for refractory adult atopic dermatitis leads to alterations in cutaneous IL-31 and IL-31RA expression IL31 IL 31 IL-3 IL31RA ILRA 31RA RA IL3 3 IL-
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Samorano, Luciana Paula

; Manfrere, Kelly Cristina Gomes

; Pereira, Naiura Vieira

; Takaoka, Roberto

; Valente, Neusa Yuriko Sakai

; Sotto, Mirian Nacagami

; Silva, Luiz Fernando Ferraz

; Sato, Maria Notomi

; Aoki, Valeria

Anais Brasileiros de Dermatologia

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jan 2024, Volume 99 N. 1 Pages 72 - 79

Abstract: En | Text: En | PDF: En

Abstract Background: Methotrexate (MTX) is an alternative treatment for patients with moderate/severe atopic dermatitis (AD). Objective: The authors evaluated the effect of MTX on the cutaneous expression of cytokines and chemokines that are involved in the inflammatory response in adult AD patients who received treatment with methotrexate for 24 weeks. Methods: The authors conducted a prospective single-institution cohort study with 12 adults with moderate/severe AD who received oral MTX (15 mg/wk for 24 wks) and 10 non-atopic matched controls. The comparison was made of skin biopsies of lesional and non-lesional skin, pre- and post MTX treatment. The authors analyzed mean epidermal thickness and expression of IL-31, IL-31RA, OSMR, TSLP, Ki67, IL-4 mRNA, IL-6, IL-10, TNF-α, IFN-γ, TARC, and CCL-22. Results: There was a reduction in mean epidermal thickness (p = 0.021), an increase in IL-31RA expression (immunohistochemistry) in the epidermis (p = 0.016) and a decrease in IL-31 gene expression (p = 0.019) on lesional AD skin post-MTX treatment. No significant changes in the cutaneous expression of the other evaluated markers were identified. Study limitations: Small sample size and limited length of follow-up. Conclusions: Treatment with MTX in adults with moderate/severe AD reduced epidermal hyperplasia and changed the cutaneous expression of inflammatory cytokines and receptors that are mainly related to pruritus, including IL-31 and IL-31RA. Background (MTX moderatesevere moderate severe AD. . (AD) Objective 2 weeks Methods singleinstitution single institution 1 15 (1 mgwk mg wk wks nonatopic non controls nonlesional pre IL31, IL31 IL 31, 31 IL31RA, IL31RA ILRA 31RA, 31RA RA OSMR TSLP Ki67 Ki IL4 4 IL- mRNA IL6, IL6 6, 6 IL-6 IL10, IL10 10, IL-10 TNFα, TNFα TNF α, α TNF-α IFNγ, IFNγ IFN γ, γ IFN-γ TARC CCL22. CCL22 CCL 22. 22 CCL-22 Results p 0.021, 0021 0.021 , 0 021 0.021) immunohistochemistry (immunohistochemistry 0.016 0016 016 IL-3 0.019 0019 019 postMTX identified limitations followup. followup follow up. up follow-up Conclusions pruritus IL31RA. 31RA. (AD ( IL3 3 Ki6 IL1 IL-1 CCL2 CCL-2 002 0.02 02 0.01 001 01 CCL- 00 0.0 0.

https://doi.org/10.1016/j.abd.2023.01.002

Correlation between skin patch testing and clinical outcome in total knee arthroplasty, a serial prospective study arthroplasty
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Tirico, Maria Claudia Carvas Passarelli

; Reis, Vitor Manuel da Silva

; Aoki, Valeria

; Demange, Marco Kawamura

; Tirico, Luis Eduardo Passarelli

Anais Brasileiros de Dermatologia

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apr 2023, Volume 98 N. 2 Pages 224 - 226

Abstract: En | Text: En | PDF: En

https://doi.org/10.1016/j.abd.2022.04.007

Consensus on the therapeutic management of atopic dermatitis ‒ Brazilian Society of Dermatology: an update on phototherapy and systemic therapy using e-Delphi technique Dermatology eDelphi e Delphi
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Orfali, Raquel Leao

; Lorenzini, Daniel

; Bressan, Aline

; Tanaka, Anber Ancel

; Cerqueira, Ana Maria Mósca de

; Hirayama, André da Silva

; Ramos, Andréa Machado Coelho

; Proença, Carolina Contin

; Silva, Claudia Marcia de Resende

; Laczynski, Cristina Marta Maria

; Carneiro, Francisca Regina

; Duarte, Gleison

; Hans Filho, Gunter

; Gonçalves, Heitor de Sá

; Melo, Ligia Pessoa de

; Azulay-Abulafia, Luna

; Weber, Magda Blessmann

; Rivitti-Machado, Maria Cecília

; Zaniboni, Mariana Colombini

; Ogawa, Marília

; Pires, Mario Cezar

; Ianhez, Mayra

; Felix, Paulo Antonio Oldani

; Bonamigo, Renan

; Takaoka, Roberto

; Lazzarini, Rosana

; Cestari, Silmara

; Mayor, Silvia Assumpção Soutto

; Cestari, Tania

; Oliveira, Zilda Najjar Prado de

; Spuls, Phyllis I.

; Gerbens, Louise A.A.

; Aoki, Valeria

Anais Brasileiros de Dermatologia

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2023, Volume 98 N. 6 Pages 814 - 836

Abstract: En | Text: En | PDF: En

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. Consensus 2019 targetedoriented targeted oriented voting 3 process eDelphi e Delphi bias meeting AD manuscript 201 20

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

Autoimmune bullous diseases in pregnancy: clinical and epidemiological characteristics and therapeutic approach,
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Fagundes, Patrícia Penha Silveira

; Santi, Claudia Giuli

; Maruta, Celina Wakisaka

; Miyamoto, Denise

; Aoki, Valeria

Anais Brasileiros de Dermatologia

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oct 2021, Volume 96 N. 5 Pages 581 - 590

Abstract: En | Text: En | PDF: En

Abstract Autoimmune bullous dermatoses are a heterogeneous group of diseases with autoantibodies against structural skin proteins. Although the occurrence of autoimmune bullous dermatoses during pregnancy is low, this topic deserves attention, since the immunological and hormonal alterations that occur during this period can produce alterations during the expected course of these dermatoses. The authors review the several aspects of autoimmune bullous dermatoses that affect pregnant women, including the therapeutic approach during pregnancy and breastfeeding. Gestational pemphigoid, a pregnancy-specific bullous disease, was not studied in this review.

https://doi.org/10.1016/j.abd.2020.10.007 51 downloads

Plasmacytoid dendritic cells in dermatology,
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Dias de Oliveira, Natasha Favoretto

; Santi, Claudia Giuli

; Maruta, Celina Wakisaka

; Aoki, Valeria

Anais Brasileiros de Dermatologia

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feb 2021, Volume 96 N. 1 Pages 76 - 81

Abstract: En | Text: En | PDF: En

Abstract Plasmacytoid dendritic cells are part of the dendritic cells family and are a relevant link between innate and adaptive immunity. They are the most potent producers of type 1 interferon, generating antiviral response, stimulating macrophages and dendritic cells and inducing activation and migration of natural killer cells. Plasmacytoid dendritic cells also exert a role as antigen-presenting cells, promote T-lymphocyte responses, immunoregulation, plasma cells differentiation and antibody secretion. Even though plasmacytoid dendritic cells are not usually present in normal skin, their presence is detected in healing processes, viral infections, and inflammatory, autoimmune, and neoplastic diseases. In recent years, the presence of plasmacytoid dendritic cells in several dermatological diseases has been described, enhancing their potential role in the pathogenesis of such conditions. Future studies on the role of plasmacytoid dendritic cells in dermatology may lead to new therapeutic targets.

https://doi.org/10.1016/j.abd.2020.08.006 245 downloads

Paraneoplastic pemphigus: a clinical, laboratorial, and therapeutic overview
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Maruta, Celina Wakisaka

; Miyamoto, Denise

; Aoki, Valeria

; Carvalho, Ricardo Gomes Ribeiro de

; Cunha, Breno Medeiros

; Santi, Claudia Giuli

Anais Brasileiros de Dermatologia

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aug 2019, Volume 94 N. 4 Pages 388 - 398

Abstract: En | Text: En | PDF: En

Abstract: Paraneoplastic pemphigus is a rare and severe autoimmune blistering disease characterized by mucocutaneous lesions associated with benign and malignant neoplasms. Diagnostic criteria include the presence of chronic mucositis and polymorphic cutaneous lesions with occult or confirmed neoplasia; histopathological analysis exhibiting intraepidermal acantholysis, necrotic keratinocytes, and vacuolar interface dermatitis; direct immunofluorescence with intercellular deposits (IgG and C3) and at the basement membrane zone (IgG); indirect immunofluorescence with intercellular deposition of IgG (substrates: monkey esophagus and simple, columnar, and transitional epithelium); and, autoreactivity to desmogleins 1 and 3, desmocollins 1, 2, and 3, desmoplakins I and II, envoplakin, periplakin, epiplakin, plectin, BP230, and α-2-macroglobulin-like protein 1. Neoplasias frequently related to paraneoplastic pemphigus include chronic lymphocytic leukemia, non-Hodgkin lymphoma, carcinomas, Castleman disease, thymoma, and others. Currently, there is no standardized treatment for paraneoplastic pemphigus. Systemic corticosteroids, azathioprine, mycophenolate mofetil, cyclosporine, rituximab, cyclophosphamide, plasmapheresis, and intravenous immunoglobulin have been used, with variable outcomes. Reported survival rates in 1, 2, and 5 years are 49%, 41%, and 38%, respectively.

https://doi.org/10.1590/abd1806-4841.20199165 3055 downloads

Consensus on the therapeutic management of atopic dermatitis - Brazilian Society of Dermatology
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Aoki, Valeria

; Lorenzini, Daniel

; Orfali, Raquel Leão

; Zaniboni, Mariana Colombini

; Oliveira, Zilda Najjar Prado de

; Rivitti-Machado, Maria Cecília

; Takaoka, Roberto

; Weber, Magda Blessmann

; Cestari, Tania

; Gontijo, Bernardo

; Ramos, Andrea Machado Coelho

; Silva, Claudia Marcia de Resende

; Cestari, Silmara da Costa Pereira

; Souto-Mayor, Silvia

; Carneiro, Francisca Regina

; Cerqueira, Ana Maria Mosca de

; Laczynski, Cristina

; Pires, Mario Cezar

Anais Brasileiros de Dermatologia

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apr 2019, Volume 94 N. 2 Pages 67 - 75

Abstract: En | Text: En | PDF: En

Abstract: BACKGROUND: Atopic dermatitis is a highly prevalent inflammatory and pruritic dermatosis with a multifactorial etiology, which includes skin barrier defects, immune dysfunction, and microbiome alterations. Atopic dermatitis is mediated by genetic, environmental, and psychological factors and requires therapeutic management that covers all the aspects of its complex pathogenesis. OBJECTIVES: The aim of this article is to present the experience, opinions, and recommendations of Brazilian dermatology experts regarding the therapeutic management of atopic dermatitis. METHODS: Eighteen experts from 10 university hospitals with experience in atopic dermatitis were appointed by the Brazilian Society of Dermatology to organize a consensus on the therapeutic management of atopic dermatitis. The 18 experts answered an online questionnaire with 14 questions related to the treatment of atopic dermatitis. Afterwards, they analyzed the recent international guidelines on atopic dermatitis of the American Academy of Dermatology, published in 2014, and of the European Academy of Dermatology and Venereology, published in 2018. Consensus was defined as approval by at least 70% of the panel. RESULTS/CONCLUSION: The experts stated that the therapeutic management of atopic dermatitis is based on skin hydration, topical anti-inflammatory agents, avoidance of triggering factors, and educational programs. Systemic therapy, based on immunosuppressive agents, is only indicated for severe refractory disease and after failure of topical therapy. Early detection and treatment of secondary bacterial and viral infections is mandatory, and hospitalization may be needed to control atopic dermatitis flares. Novel target-oriented drugs such as immunobiologicals are invaluable therapeutic agents for atopic dermatitis.

https://doi.org/10.1590/abd1806-4841.2019940210 4086 downloads

Vasculopatia livedoide: uma doença cutânea intrigante
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Criado, Paulo Ricardo

; Rivitti, Evandro Ararigboia

; Sotto, Mirian Nacagami

; Valente, Neusa Yuriko Sakai

; Aoki, Valeria

; Carvalho, Jozelio Freire de

; Vasconcellos, Cidia

Anais Brasileiros de Dermatologia

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oct 2011, Volume 86 N. 5 Pages 961 - 977

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

A vasculopatia livedoide é uma afecção cutânea oclusiva dos vasos sanguíneos da derme, de caráter pauci-inflamatório ou não-inflamatório. Caracteriza-se pela presença de lesões maculosas ou papulosas, eritêmato-purpúricas, nas pernas, especialmente nos tornozelos e pés, as quais produzem ulcerações intensamente dolorosas, que originam cicatrizes atróficas esbranquiçadas, denominadas "atrofia branca". Nesta revisão, abordamos os estudos e relatos de caso da literatura médica referentes às associações etiopatogênicas da doença, particularmente as que se referem aos estados de trombofilia, seus achados histopatológicos e abordagens terapêuticas empregadas na difícil condução clínica destes casos.

Livedoid vasculopathy is a skin disease that occludes the blood vessels of the dermis. It has a pauciinflammatory or non-inflammatory nature. It is characterized by the presence of macular or papular, erythematous-purpuric lesions affecting the legs, especially the ankles and feet, and producing intensely painful ulcerations, which cause white atrophic scars called "atrophie blanche". This review includes studies and case reports found in the medical literature regarding the etiopathogenic associations of the disease, particularly those related to thrombophilia, their histopathological findings and the therapeutic approaches used in the difficult clinical management of these cases.

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Barreira cutânea na dermatite atópica
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Addor, Flavia Alvim Sant'Anna

; Aoki, Valeria

Anais Brasileiros de Dermatologia

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apr 2010, Volume 85 N. 2 Pages 184 - 194

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

O estudo da barreira cutânea e de suas propriedades ganhou impulso a partir da década de 60, com estudos que apontaram sua resistência de forma isolada e suas propriedades com relação à permeação cutânea. Paralelamente, a descrição dos corpos de Odland auxiliou a compreensão da manutenção da estabilidade da camada córnea. O modelo brick & mortar, em que os corneócitos são os tijolos e o cimento são os lipídeos intercelulares, é o mais aceito, até o momento. Atualmente, há evidências consistentes de que o estrato córneo é uma estrutura metabolicamente ativa e exerce funções adaptativas. A barreira cutânea também tem um papel na resposta inflamatória, com ativação de melanócitos, angiogênese e fibroplasia, cuja intensidade depende, basicamente, da intensidade da agressão. As anormalidades da barreira cutânea da dermatite atópica são clinicamente observáveis pela presença de pele seca, achado muito frequente e significativo, que constitui parâmetro iagnóstico e de acompanhamento. O grau de hidratação da camada córnea, assim como a perda de água transepidérmica (transepidermal water loss - TEWL), estão relacionados com o grau de dano à barreira, constituindo parâmetros biofísicos que permitem acompanhar os pacientes de maneira não invasiva e com maior grau de sensibilidade.

Research about the skin barrier and its properties has increased significantly since the 60s, with studies that indicated its resistance when isolated, as well as its particularities in relation to skin permeability. At the same time, description of Odland bodies helped to understand how stratum corneum stability is maintained. The â€œbrick and mortarâ€� model is the most accepted so far. In this analogy, the corneocytes are the bricks and the intercellular lipids are the mortar. Currently, there is concrete evidence that the stratum corneum is an active metabolic structure that holds adaptive functions, interacting dynamically with the underlying epidermal layers. The skin barrier also plays a role in the inflammatory response through melanocyte activation, angiogenesis, and fibroplasia. The intensity of this response will essentially depend on the severity of the injury. Skin barrier abnormalities in atopic dermatitis are clinically observed by the presence of dry skin, a common and significant symptom which constitutes a diagnostic and monitoring parameter. The stratum corneum hydration level and transepidermal water loss are associated with the level of damage to the barrier, representing biophysical parameters. These parameters help doctors monitor patients in a less invasive and more sensitive manner.

46748 downloads

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Quality of life is severely compromised in adult patients with atopic dermatitis in Brazil, especially due to mental components
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Coghi, Silvana

; Bortoletto, Maria Cecilia

; Sampaio, S.A.P.

; Andrade Junior, Heitor Franco de

; Aoki, Valeria

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2007, Volume 62 N. 3 Pages 235 - 242

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

OBJETIVOS: Medir a qualidade de vida (QoL), por questionários tanto genéricos como dermatológicos específicos, em pacientes adultos brasileiros com dermatite atópica, procurando por grupos afetados selecionados. MÉTODOS: Nós estudamos a qualidade de vida em 75 pacientes brasileiros adultos em tratamento ambulatorial de dermatite atópica, usando dois tipos de questionários de auto-resposta, previamente padronizados: um questionário genérico de qualidade de vida de 36 questões (SF-36) e um questionário de 10 questões para determinação do índice dermatológico de qualidade de vida (DLQI). Todos os pacientes estavam em tratamento por pelo menos seis meses e o seu estágio de doença clinico definido quantitativamente pelo índice padronizado de gravidade e áreas de eczema (EASI). RESULTADOS: A QoL e o controle da doença estavam relacionados mas com baixa relação tanto avaliados pelo DLQI (r²=0.26) ou pelo SF-36 (r²=0.20), mas com maiores relações com os componentes emocionais do SF-36. Usando a distribuição do percentil 75% para o SF36 e os valores de 75% do escore de gravidade clínica EASI, os pacientes foram distribuídos em quatro grupos: I que referia boa QoL e doença atópica leve (14/75), II referindo má QoL e doença atópica leve (19/75), III referindo boa QoL apesar de doença atópica mais grave (5/75) e IV concordando uma má QoL referida e uma doença atópica mais grave (37/75); todos os grupos apresentavam mesma distribuição etária, educação e nível social, renda familiar e tempo de doença. Havia uma maior freqüência de mulheres no grupo II, mas sem distúrbios de sono ou prurido intenso, fatores presentes intensamente no grupo IV. Dissecando os componentes físicos e emocionais do SF36, os grupos discrepantes II e II apresentavam maior diferença relativa aos componentes emocionais do teste, que também estavam relacionados aos valores do teste DLQI, o qual apresentava uma distribuição similar entre os grupos e maior relação aos componentes emocionais do teste genérico. CONCLUSÕES: A qualidade de vida é afetada em pacientes adultos com dermatite atópica, relacionada tanto com a gravidade da doença clinica como com os componentes emocionais, que são diferentes em subgrupos de pacientes. Estes dados mostram componentes que podem mascarar o exato impacto da severidade da doença sobre a qualidade de vida destes pacientes.

PURPOSE: to measure the quality of life (QoL), either by a specific dermatology or generic self applied questionnaire, in Atopic dermatitis adult Brazilian patients, looking for selected affected groups. METHODS: We studied the quality of life of 75 Brazilian ambulatory adults with atopic dermatitis using two types of self-answered instruments: a quality of life generic questionnaire (SF-36) and a 10-item Dermatology Life Quality Index (DLQI) questionnaire. All patients had been treated for at least 6 months, and their disease status was determined by Eczema Area and Severity Index scores. RESULTS: Quality of life and disease control were found to be related but with low scores both in DLQI (r²=0.26) and in SF-36 (r²=0.20), but with greater correlation for SF-36 mental components. Using the 75% percentile distribution of SF36 mean score and the 75% value of disease severity score, we sorted patients into four groups: I, referring good QoL and mild atopic disease (14/75), II, referring bad QoL and with mild atopic disease (19/75), III referring good QoL despite severe atopic disease (5/75) and IV referring bad QoL and severe atopic disease (37/75); all groups presented similar age, education, family income and time of disease progression. There was a higher frequency of women in group II, but without sleep disturbance or increased pruritus, which was present in group IV, with intense itching and sleep disturbances. Analyzing the physical or mental components of the SF36 generic test, discrepant groups II and III presented higher differences related to the mental components of the test, which was also related to DLQI scores, with a similar distribution for the 2 groups and a higher relation to the mental component of the generic test. CONCLUSION: The quality of life is affected in adult atopic patients, both related to disease severity and also to mental components, but with diverse effects in patient subgroups. Our data show some components that may mask the exact relationship between QoL results and disease severity.

4402 downloads Cited 6 times in SciELO

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