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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. 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

Phototherapy
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Barros, Norami de Moura

; Sbroglio, Lissiê Lunardi

; Buffara, Maria de Oliveira

; Baka, Jessica Lana Conceição e Silva

; Pessoa, Allen de Souza

; Azulay-Abulafia, Luna

Anais Brasileiros de Dermatologia

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aug 2021, Volume 96 N. 4 Pages 397 - 407

Abstract: En | Text: En | PDF: En

Abstract Of all the therapeutic options available in Dermatology, few of them have the history, effectiveness, and safety of phototherapy. Heliotherapy, NB-UVB, PUVA, and UVA1 are currently the most common types of phototherapy used. Although psoriasis is the most frequent indication, it is used for atopic dermatitis, vitiligo, cutaneous T-cell lymphoma, and cutaneous sclerosis, among others. Before indicating phototherapy, a complete patient assessment should be performed. Possible contraindications should be actively searched for and it is essential to assess whether the patient can come to the treatment center at least twice a week. One of the main method limitations is the difficulty that patients have to attend the sessions. This therapy usually occurs in association with other treatments: topical or systemic medications. Maintaining the regular monitoring of the patient is essential to identify and treat possible adverse effects. Phototherapy is recognized for its benefits and should be considered whenever possible.

https://doi.org/10.1016/j.abd.2021.03.001 19 downloads

Tinea corporis by Nannizia gypsea: delayed diagnosis due to unusual presentation,
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Soares, Juliana de Jesus

; Sousa, Nathalie Andrade

; Azulay-Abulafia, Luna

; Costa, Rosane Orofino

Anais Brasileiros de Dermatologia

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feb 2021, Volume 96 N. 1 Pages 91 - 93

Abstract: En | Text: En | PDF: En

Abstract Fungal infections by dermatophytes can present with unusual clinical manifestations, which can cause diagnostic difficulties. The authors present the case of a patient with cutaneous infection by Nanizzia gypsea, initially treated erroneously with topical corticosteroids due to a wrong diagnosis. It was cured after antifungal treatment.

https://doi.org/10.1016/j.abd.2020.05.012 262 downloads

Perfil Epidemiológico dos Pacientes em Tratamento na Unidade de Fototerapia do Serviço Dermatologia de um Hospital Universitário
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Baka, Jessica Lana Conceição e Silva

; Barros, Norami de Moura

; Pessoa, Allen de Souza

; Azulay-Abulafia, Luna

Revista da Sociedade Portuguesa de Dermatologia e Venereologia

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sep 2020, Volume 78 N. 3 Pages 19 - 23

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

RESUMO Introdução: A fototerapia é uma modalidade terapêutica empregada para tratamento de várias dermatoses. Consiste em exposição à radiação não ionizante, classificada em UVA ou UVB segundo seu comprimento de onda. Material e Métodos: Efectuámos um estudo observacional, transversal e descritivo no setor de fototerapia do Serviço de Dermatologia de um hospital universitário com o objectivo de avaliar os dados epidemiológicos e o grau de satisfação dos doentes. Resultados: Foram incluídos 51 indivíduos, 69% eram do sexo feminino com uma idade média de 49 anos. As dermatoses em tratamento mais prevalentes durante a pesquisa foram: o vitiligo, com 62,5% dos pacientes, e em segundo lugar a micose fungoide, com 13,73%. Em relação ao nível de satisfação com o tratamento, mais de 90% se declararam satisfeitos/muito satisfeitos. Discussão: A prevalência de mulheres e fototipos mais baixos foi concordante com a literatura. A predominância de idosos nesse estudo corroborada com outros trabalhos e pode ser justificada pela presença de comorbidades, e assim contraindicações aos tratamentos convencionais além de maior disponibilidade de tempo do paciente. Em alguns casos a dermatose mais prevalente foi a psoríase, diferindo do nosso estudo. A segunda dermatose mais prevalente em nosso estudo foi a micose fungoide, o que difere de outros estudos nos quais a segunda dermatose mais prevalente foi a psoríase ou o vitiligo. Conclusão: Estudos como este são necessários para o planejamento tanto dos serviços que já dispõem dessa modalidade terapêutica quanto das unidades que desejam implantá-la. Nossos resultados não são integralmente convergentes com os da literatura publicada já que atualmente existem novas opções para o tratamento da psoríase.

ABSTRACT Introduction: Phototherapy is a therapeutic modality used to treat various dermatoses. It consists of exposure to non-ionizing radiation, classified as UVA or UVB according to its wavelength. Material and Methods: This is an observational, cross-sectional and descriptive study carried out in the phototherapy sector of the Dermatology Service of a university hospital with the objective of characterizing the population under treatment and their degree of satisfaction. Results: Fifty-one individuals were included of whom 69% were female, with a mean age of 49 years. The most prevalent dermatoses under treatment during the research were: vitiligo (62.5%), and mycosis fungoides (13.73%). Regarding the level of satisfaction with treatment, more than 90% declared themselves satisfied/very satisfied. Discussion: The prevalence of women and lower phototypes was consistent with the literature. The predominance of the elderly in this study corroborated by other studies may be justified by the presence of comorbidities, and contraindication to conventional treatments beside more time available for the treatment. In some cases, the most prevalent dermatosis was psoriasis, differing from our study. The second most prevalent dermatosis in our study was mycosis fungoides, which also differs from the studies found that described psoriasis or vitiligo as the second most prevalent dermatosis. Conclusion: Studies such as this one are necessary for the planning both the departments that already have this therapeutic modality and those that wish to implement it. Our results are not fully convergent with those of the literature as nowadays there are new options for the treatment of psoriasis.

https://doi.org/10.29021/spdv.78.3.1240 16 downloads

Analysis of filaggrin 2 gene polymorphisms in patients with atopic dermatitis,
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Hertz, Amanda

; Azulay-Abulafia, Luna

; Nascimento, Adriana Paulino do

; Ohara, Cintya Yumi

; Kuschnir, Fabio Chigres

; Porto, Luís Cristovão

Anais Brasileiros de Dermatologia

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mar 2020, Volume 95 N. 2 Pages 173 - 179

Abstract: En | Text: En | PDF: En

Abstract Background: Polymorphisms of the filaggrin 2 gene (rs 12568784 and rs 16899374) are associated with persistent atopic dermatitis in African American patients. Filaggrin 2 is a protein with a function similar to filaggrin and also encoded in the epidermal differentiation complex on chromosome 1q21. Objective: To evaluate the polymorphisms in the filaggrin 2 gene (rs 12568784 and rs 16899374) in children and adults with atopic dermatitis and to verify the association of these with the severity of the clinical picture, presence of other allergic diseases, and socio-demographic factors. Method: The study was carried out with patients and control group. Questionnaires were used to evaluate ethnicity, sex, age, family history, scoring, atopic dermatitis (SCORAD), among other parameters. Genotyping of the filaggrin 2 gene was performed by real-time polymerase chain reaction. Results: Forty-eight patients and 83 controls were evaluated. No correlation was found between the variables studied in patients with atopic dermatitis and polymorphisms, no significant difference between the prevalence of polymorphisms in the patients and in the control group p > 0.05. Study limits: The exclusive use of self-reported ethnicity information and the sample size. Results: The results of this work can be an incentive for the study of the polymorphisms in atopic dermaititis, considering the characteristic of the Brazilian multi ethnic population. Conclusion: This is an unpublished work in Brazil and the first study in the world to have a control group to evaluate alterations in the gene of filaggrin 2.

https://doi.org/10.1016/j.abd.2019.07.002 228 downloads

Diagnostic and therapeutic guidelines for plaque psoriasis - Brazilian Society of Dermatology
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Arnone, Marcelo

; Takahashi, Maria Denise Fonseca

; Carvalho, André Vicente Esteves de

; Bernardo, Wanderley Marques

; Bressan, Aline Lopes

; Ramos, Andrea Machado Coelho

; Terena, Aripuanã Cobério

; Souza, Cacilda da Silva

; Nunes, Daniel Holthausen

; Bortoletto, Maria Cecília de Carvalho

; Oliveira, Maria de Fátima Santos Paim de

; Neffá, Jane Marcy

; Fieri, Luciana Cristina

; Azulay-Abulafia, Luna

; Felix, Paulo Antônio Oldani

; Magalhaes, Renata Ferreira

; Romiti, Ricardo

; Jaime, Tatiana Jerez

Anais Brasileiros de Dermatologia

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apr 2019, Volume 94 N. 2 Pages 76 - 107

Abstract: En | Text: En | PDF: En

Abstract: Psoriasis is a chronic inflammatory disease that affects 1.3% of the Brazilian population. The most common clinical manifestations are erythematous, scaling lesions that affect both genders and can occur on any anatomical site, preferentially involving the knees, elbows, scalp and genitals. Besides the impact on the quality of life, the systemic nature of the disease makes psoriasis an independent risk factor for cardiovascular disease, especially in young patients with severe disease. By an initiative of the Brazilian Society of Dermatology, dermatologists with renowned clinical experience in the management of psoriasis were invited to form a work group that, in a partnership with the Brazilian Medical Association, dedicated themselves to create the Plaque Psoriasis Diagnostic and Treatment Guidelines. The relevant issues for the diagnosis (evaluation of severity and comorbidities) and treatment of plaque psoriasis were defined. The issues generated a search strategy in the Medline-PubMed database up to July 2018. Subsequently, the answers to the questions of the recommendations were devised, and each reference selected presented the respective level of recommendation and strength of scientific evidence. The final recommendations for making up the final text were worded by the coordinators.

https://doi.org/10.1590/abd1806-4841.2019940211 3381 downloads

How relevant are vascular endothelial growth factor and intercellular adhesion molecule in the systemic capillary leak syndrome of psoriasis?
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Bressan, Aline Lopes

; Pereira, Daniele

; Medeiros, Paula Mota

; Carneiro, Sueli

; Azulay-Abulafia, Luna

Anais Brasileiros de Dermatologia

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dec 2017, Volume 92 N. 6 Pages 826 - 829

Abstract: En | Text: En | PDF: En

Abstract: Psoriasis is a chronic disease, characterized by erythematous scaly lesions, presented in eight different forms: plaques, guttate, pustular, erythrodermic, inverse, nail and scalp psoriasis, and psoriatic arthritis. Its development depends on genetic factors, external stimulus and immune response alteration.1 Proinflammatory cytokines such as TNF-alpha, IL-12 and 23 may also be involved. In the worst cases, systemic complications linked to endothelial alterations may occur. A literature review was conducted for a better understanding of what roles VEGF (vascular endothelial growth factor) and ICAM-1 (intercellular adhesion molecule) have, among other cytokines, in systemic capillary leak syndrome, involved in erythrodermic and pustular psoriasis, the most unstable forms of the disease.

https://doi.org/10.1590/abd1806-4841.20175994 905 downloads

Agminated blue nevus - Case report
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Lisboa, Alice Paixão

; Silvestre, Keline Jácome

; Pedreira, Renata Leite

; Alves, Natália Ribeiro de Magalhães

; Obadia, Daniel Lago

; Azulay-Abulafia, Luna

Anais Brasileiros de Dermatologia

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oct 2016, Volume 91 N. 5 Pages 658 - 660

Abstract: En | Text: En | PDF: En

Abstract: Blue nevi are benign melanocytic lesions located in the deeper reticular dermis, consequence of failure of melanocytic migration into the dermal-epidermal junction from the neural crest. Lesions are usually asymptomatic and solitary, but may present in a multiple or agminated (grouped) pattern. The agminated subtype is formed when bluish-pigmented lesions cluster together in a well-defined area. Lesions can be flat or raised. We report the case of a patient who presented multiple bluish macules (1-3 mm in diameter) grouped on the left upper back. Dermoscopy and anatomic pathological examination were consistent with blue nevus.

https://doi.org/10.1590/abd1806-4841.20164448 933 downloads

10.

Nursing diagnoses in patients with immune-bullous dermatosis
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Brandão, Euzeli da Silva

; Santos, Iraci dos

; Lanzillotti, Regina Serrão

; Ferreira, Adriano Menis

; Gamba, Mônica Antar

; Azulay-Abulafia, Luna

Revista Latino-Americana de Enfermagem

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2016, Volume 24 elocation e2766

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

Resumo Objetivo: identificar diagnósticos de enfermagem em clientes com dermatoses imunobolhosas. Método: pesquisa quantitativa e descritiva, realizada em três instituições localizadas no Rio de Janeiro e no Mato Grosso do Sul-Brasil, aplicando o Protocolo de Avaliação do Cliente em Dermatologia, durante consulta de enfermagem. Utilizou-se a estatística descritiva simples para análise dos dados. Resultados: participaram do estudo 14 sujeitos, nove com diagnóstico médico de pênfigo vulgar, dois de foliáceo e três de penfigoide bolhoso. A idade variou entre 27 e 82 anos, predominando 11 pessoas do sexo feminino. Foram discutidos 14 diagnósticos de enfermagem identificados a partir do raciocínio clínico, em todos os participantes do estudo, representando as respostas humanas mais frequentes nesta amostra. A aplicação do Protocolo de Avaliação do Cliente em Dermatologia facilitou a avaliação integral, além de propiciar a identificação dos diagnósticos de acordo com a North American Nursing Diagnosis Association International. Conclusão: os diagnósticos de enfermagem apresentados ratificam a necessidade do trabalho interdisciplinar durante atendimento a esta clientela. Para melhor descrição dos fenômenos relacionados à clientela em questão, sugere-se a inclusão de dois fatores de risco/relacionados em três diagnósticos desta taxonomia. Cabe ressaltar a contribuição dos achados para o cuidar/educar/pesquisar em enfermagem em dermatologia.

ABSTRACT Objective: identify nursing diagnoses in patients with immune-bullous dermatosis. Method: a quantitative and descriptive research, carried out in three institutions located in Rio de Janeiro and Mato Grosso do Sul, Brazil, using the Client Assessment Protocol in Dermatology during a nursing consultation. Simple descriptive statistics was used for data analysis. Results: 14 subjects participated in the study, nine with a diagnosis of pemphigus vulgaris, pemphigus two and three of bullous pemphigoid. The age ranged between 27 and 82 years, predominantly females (11). 14 nursing diagnoses were discussed and identified from a clinical rationale in all study participants, representing the most common human responses in this sample. The application of the Assessment Protocol in Dermatology facilitated the comprehensive assessment, in addition to providing the identification of diagnostics according to the North American Nursing Diagnosis Association International. Conclusion: the nursing diagnoses presented confirm the necessity of interdisciplinary work during the care for this clientele. For better description of the phenomena related to the client in question, it is suggested the inclusion of two risk factors related in three diagnoses of this taxonomy. It is worth noting the contribution of the findings for the care, education and research in nursing in dermatology.

RESUMEN Objetivo: identificar los diagnósticos de enfermería en pacientes con inmuno dermatosis ampollosa. Método: investigación cuantitativa y descriptiva, realizada en tres instituciones ubicadas en Río de Janeiro y Mato Grosso do Sul, Brasil, utilizando el Protocolo de Evaluación del Cliente en Dermatología en la consulta de enfermería. Se utilizó estadística descriptiva simples para el análisis de datos. Resultados: 14 sujetos participaron en el estudio, nueve con diagnóstico de pénfigo vulgar, dos de pénfigo foliáceo y tres de penfigoide ampolloso. La edad osciló entre 27 y 82 años, predominio femenino con 11 mujeres. Se discutieron 14 diagnósticos de enfermería identificados desde el razonamiento clínico, en todos los participantes en el estudio, que representa las respuestas humanas más comunes en esta muestra. La aplicación del Protocolo de Evaluación de Dermatología facilitó la evaluación global, además de proporcionar la identificación de los diagnósticos de acuerdo con la North American Nursing Diagnosis Association International. Conclusión: los diagnósticos de enfermería presentados confirman la necesidad del trabajo interdisciplinario en el servicio a estos clientes. Para una mejor descripción de los fenómenos relacionados con los clientes en cuestión, se sugiere la inclusión de dos factores de riesgo/relacionados en tres diagnósticos de esta taxonomía. Vale la pena señalar la contribución de los hallazgos para el cuidado/educación/investigación en enfermería en dermatología.

https://doi.org/10.1590/1518-8345.0424.2766 18254 downloads

11.

Nursing diagnoses in patients with immune-bullous dermatosis
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Brandão, Euzeli da Silva

; Santos, Iraci dos

; Lanzillotti, Regina Serrão

; Ferreira, Adriano Menis

; Gamba, Mônica Antar

; Azulay-Abulafia, Luna

Revista Latino-Americana de Enfermagem

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2016, Volume 24 elocation e2766

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

https://doi.org/10.1590/1518-8345.0424.2766 38 downloads

12.

Multicenter study for efficacy and safety evaluation of a fixeddose combination gel with adapalen 0.1% and benzoyl peroxide 2.5% (Epiduo® for the treatment of acne vulgaris in Brazilian population
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Sittart, José Alexandre de Souza

; Costa, Adilson da

; Mulinari-Brenner, Fabiane

; Follador, Ivonise

; Azulay-Abulafia, Luna

; Castro, Lia Cândida Miranda de

Anais Brasileiros de Dermatologia

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dec 2015, Volume 90 N. 6 Pages 1 - 16

Abstract: En | Text: En | PDF: En

Abstract: BACKGROUND: The current options for the treatment of acne vulgaris present many mechanisms of action. For several times, dermatologists try topical agents combinations, looking for better results. OBJECTIVES: To evaluate the efficacy, tolerability and safety of a topical, fixed-dose combination of adapalene 0.1% and benzoyl peroxide 2.5% gel for the treatment of acne vulgaris in the Brazilian population. METHODS: This is a multicenter, open-label and interventionist study. Patients applied 1.0 g of the fixed-dose combination of adapalene 0.1% and benzoyl peroxide 2.5% gel on the face, once daily at bedtime, during 12 weeks. Lesions were counted in all of the appointments, and the degree of acne severity, overall improvement, tolerability and safety were evaluated in each visit. RESULTS: From 79 recruited patients, 73 concluded the study. There was significant, fast and progressive reduction of non-inflammatory, inflammatory and total number of lesions. At the end of the study, 75.3% of patients had a reduction of >50% in non-inflammatory lesions, 69.9% in inflammatory lesions and 78.1% in total number of lesions. Of the 73 patients, 71.2% had good to excellent response and 87.6% had satisfactory to good response. In the first week of treatment, erythema, burning, scaling and dryness of the skin were frequent complaints, but, from second week on, these signals and symptoms have reduced. CONCLUSION: The fixed-dose combination of adapalene 0.1% and benzoyl peroxide 2.5% gel is effective, safe, well tolerated and apparently improves patient compliance with the treatment.

https://doi.org/10.1590/abd1806-4841.20153969 2423 downloads

13.

Clinical exuberance of classic Kaposi's sarcoma and response to radiotherapy
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Trujillo, Jeniffer Muñoz

; Alves, Natália Ribeiro de Magalhães

; Medeiros, Paula Mota

; Azulay-Abulafia, Luna

; Alves, Maria de Fátima Guimarães Scotelaro

; Gripp, Alexandre Carlos

Anais Brasileiros de Dermatologia

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dec 2015, Volume 90 N. 6 Pages 883 - 886

Abstract: En | Text: En | PDF: En

Abstract: Kaposi's sarcoma (KS) is a multicentric vascular neoplasm, with cutaneous and extracutaneous involvement. Different clinical and epidemiological variants have been identified. The classic form is manifested mainly in elderly men with indolent and long-term evolution, with lesions localized primarily in the lower extremities. We present two cases of classic Kaposi's sarcoma (CKS) in two female patients with extensive, exuberant skin involvement and rapid evolution, with good response to radiotherapy.

https://doi.org/10.1590/abd1806-4841.20153877 2717 downloads

14.

Dapsone in the treatment of pemphigus vulgaris: adverse effects and its importance as a corticosteroid sparing agent
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Quaresma, Maria Victória

; Bernardes Filho, Fred

; Hezel, Janaína

; Peretti, Murilo Calvo

; Kac, Bernard Kawa

; Azulay-Abulafia, Luna

Anais Brasileiros de Dermatologia

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jun 2015, Volume 90 N. 3 Pages 51 - 54

Abstract: En | Text: En | PDF: En

Abstract Pemphigus vulgaris is an autoimmune disease characterized by suprabasal blisters with acantholysis, which has a fatal course in a large number of untreated patients. Systemic corticosteroid therapy is considered first-line therapy. Adjuvant treatment with the goal of sparing corticosteroids include, among others, dapsone. This drug is not without side effects and its use requires clinical and laboratory control. We present a patient with PV initially managed with suboptimal dose of prednisone, evolving into drug-induced hepatitis after introduction of dapsone.

https://doi.org/10.1590/abd1806-4841.20153408 2084 downloads

15.

Bed bug dermatitis, description of two cases in Rio de Janeiro, Brazil
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Bernardes Filho, Fred

; Quaresma, Maria Victória

; Avelleira, João Carlos Regazzi

; Azulay, David Rubem

; Azulay-Abulafia, Luna

; Bastos, Amanda Queiroz

; Gonçalves, Teresa Cristina Monte

Anais Brasileiros de Dermatologia

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apr 2015, Volume 90 N. 2 Pages 240 - 243

Abstract: En | Text: En | PDF: En

Bed bugs are hematophagous insects which due to their morphological and biological characteristics are able to easily adapt themselves to human households. The authors describe two cases of dermatitis caused by bed bug bites in the city of Rio de Janeiro, Brazil. Patients presented linear lesions in the usual "breakfast, lunch and dinner" arrangement, suggesting this diagnosis. A visit to their dwellings showed infestation of insects identified as Cimex hemipterus. The knowledge of these insects by the dermatological community will contribute to an accurate diagnosis as well as subsidize the dissemination of information aiming for prevention.

https://doi.org/10.1590/abd1806-4841.20153214 2294 downloads

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