Abstract Background The effects of chemical straighteners on the scalp and hair shaft are not fully known, although such substances are widely used. Hair straightening became popular in Brazil with the use of formaldehyde and its derivatives, despite the prohibition by the current legislation. Objective To identify changes in hair shaft and scalp caused by the use of chemical straighteners. Methods A search was performed using keywords in three databases from 03/16/2020 to 05/20/2020, with publications between the years 2000 to 2020. After applying the inclusion and exclusion criteria, 33 articles were selected for review. Results In some studies, hair relaxers were associated with eczema, desquamation, pain, burns, and inflammation in the scalp. Hair loss, damage to the shaft, alteration in the color of the hairs and in the composition of their amino acids were observed. Findings are variable across the studies. Study limitations The search was restricted to three databases, in two languages, different study designs were accepted. Conclusions Straightening techniques can have side effects, including scalp inflammation, damage to the shaft, and hair loss. Its long-term effects remain unknown and further studies are necessary.

Abstract Background: Alopecia areata is a highly frequent disease with an impact on quality of life and several treatment options with little clinical confirmatory evidence. Objective: To disseminate the recommendations of Brazilian dermatologists with expertise in the treatment of alopecia areata. Methods: Eight specialists with expertise in alopecia areata from different university centers were appointed by the Brazilian Society of Dermatology to reach a consensus on its treatment. Based on the adapted DELPHI methodology, the relevant elements were considered; then, an analysis of recent literature was carried out and the consensus was written down. Consensus on the management of alopecia areata was defined with the approval of at least 70% of the panel. Results/Conclusions: Intralesional injectable corticotherapy was considered the first option for localized disease in adults. In extensive cases with signs of activity, systemic corticosteroid therapy should be considered and can be used together with immunosuppressants (corticosteroid-sparing agents). The use of an immunosensitizer (diphencyprone) is an option for stable long-term cases. Evaluation of side effects is as important as the rate of hair regrowth.

Abstract Frontal fibrosing alopecia is a variant of lichen planopilaris with marginal progressive hair loss on the scalp, eyebrows and axillae. We report a case of frontal fibrosing alopecia and lichen planus pigmentosus in a postmenopausal woman, that started with alopecia on the eyebrows and then on the frontoparietal region, with periocular and cervical hyperpigmentation of difficult management. The condition was controlled with systemic corticosteroid therapy and finasteride. Lichen planus pigmentosus is an uncommon variant of lichen planus frequently associated with frontal fibrosing alopecia in darker phototipes. It should be considered in patients affected by scarring alopecia with a pattern of lichen planopilaris and areas of skin hyperpigmentation revealing perifollicular hyperpigmentation refractory to multiple treatments. This case illustrates diagnostic and therapeutic challenge in face of scarring alopecia and perifollicular hyperpigmentation.

Abstract: Due to mounting evidences of interaction between Hansen's bacilli with endothelial cells and the paucity of studies addressing the presence of nailfold capillaroscopic alterations in patients with Hansen's disease, a study was carried out in order to verify the presence of capillaroscopic alterations in patients with leprosy in its various forms and its correlation with clinical parameters. Ten patients were evaluated at a specialized university service. Sixty percent of those had some capillaroscopic change, such as micro-hemorrhages, ectatic, bushy and corkscrew capillaries. Such changes were unspecific, which suggests there is not a specific pattern for this disease.

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.

AbstractBACKGROUND:Leprosy is an infectious disease that may lead to irreversible nerve damage, compromising patient's quality of life and leading to loss of working years.OBJECTIVES:To evaluate the epidemiological profile of patients followed at a University Hospital.MATERIALS AND METHODS: This is a retrospective observational study, based on a review of medical records. We studied the clinical and epidemiological features of patients with leprosy monitored at the Hospital de Clínicas of the Federal University of Paraná between January 2005 and January 2010.RESULTS:The mean age was 47.51, while 35.94% of patients were aged 41-60. The male:female rate was 1.8:1. The most prevalent occupations were: retired, students or rural workers. Patients came mainly from Curitiba or nearby areas, but there were also patients from the countryside. The mean diagnostic delay was 24.57 months. Multibacillary forms prevailed, with the lepromatous variety being the most common, closely followed by the borderline type. Neural enlargement was found in more than 50% of the patients and 48.44% of them developed reactional states. Hemolysis was the most commonly detected drug side effect. Initial functional evaluation was possible in 70% of patients, 55% of whom had disabilities upon diagnosis. The most prevalent associated disease was hypertension.CONCLUSIONS:This study showed an important diagnostic delay and a high rate of sequelae in this specific population. Brazil is one of the few remaining countries that has not yet eradicated leprosy and it is important to improve health policies in order to prevent sequelae and achieve eradication.

AbstractBACKGROUND:Lichen planopilaris is a frequent presentation of primary cicatricial alopecia. Scalp distribution characterizes the main clinical presentations: classic lichen planopilaris, frontal fibrosing alopecia and Graham-Little Piccardi-Lassueur Syndrome (GLPLS).OBJECTIVE:Description of the clinical, dermoscopic and histopathological findings of Lichen planopilaris in public and private practices.METHOD:A retrospective observational study was performed by reviewing medical records of patients with lichen planopilaris.RESULTS:Eighty patients were included, 73 (91,25%) were female. Prototype II was seen in 53 (66,25%) patients. Classic lichen planopilaris was seen in 62,5% of the cases. Frontal fibrosing alopecia was seen in 31% of the patients and only one patient presented Graham-Little Piccardi-Lassueur Syndrome (GLPLS). Scalp lesions were scattered throughout the scalp in 47 (58,75%) of the patients, while 24 (30%) presented mainly central scalp lesions, 29 (36,25%) presented marginal lesions and only 4 (5%) patents had vertex lesions.CONCLUSIONS:Clinical presentation of Lichen planopilaris varies. To recognize the heterogeneity of the clinical appearance in lichen planopilaris is important for differential diagnosis.

Abstract Dermatosis neglecta is the name of a skin condition characterized by papules and polygonal plaques, which are sometimes warty, brownish and hyperpigmented, adherent and symmetric, though removable with ethyl or isopropyl alcohol. It occurs due to inadequate skin cleansing causing accumulation of sebum, sweat, keratin and impurities. Its occurrence, though little reported, is frequent. The main differential diagnosis is the Terra fi rma-forme dermatosis. The treatment is simple, with exfoliation, moisturizing and even rubbing of alcohol. Causes of negligence on the patient’s side, which can range from hygiene carelessness to psychiatric disorders, local hypersensitivity, limbs negligence or motor paralysis, should be investigated. We illustrate the case of dermatosis neglecta in a 45-years old patient admitted with pulmonary sepsis.

BACKGROUND: Alopecia areata is a chronic disorder of the hair follicles and nails, of unknown etiology, with clear autoimmune components and genetic factors. Several therapeutic options have been suggested; however, no treatment is able to modify the disease course. Methotrexate is an immunosuppressant used in various dermatoses and recently introduced as a therapeutic option for alopecia areata. OBJECTIVES: To evaluate the efficacy and safety of methotrexate in alopecia areata. METHODS: In a retrospective, non-controlled study, we evaluated 31 patients with alopecia areata in current or prior treatment with methotrexate to assess the therapeutic response according to sex, age, pattern of alopecia areata, disease duration, cumulative dose of methotrexate, use of systemic corticosteroids or other treatments, and drug safety. RESULTS: Regrowth greater than 50% was observed in 67.7% of patients, with the best responses observed in those with <5 years of disease progression (79%), age over 40 years (73.3%), male patients (72.8%), cumulative dose of methotrexate 1000-1500 mg, and multifocal alopecia areata (93%). Among patients receiving systemic corticosteroids in combination with methotrexate, 77.3% had greater than 50% regrowth, compared with 44.4% in those who used methotrexate alone. The therapeutic dose ranged from 10-25 mg/week. No patient had serious adverse effects. Relapse was observed in 33.3% of patients with more than 50% regrowth. CONCLUSION: Methotrexate appears to be a promising and safe medication for the treatment of severe alopecia areata when used alone or in combination with corticosteroids.

A dermatose pustular erosiva do couro cabeludo é uma doença inflamatória rara do couro cabeludo, de ocorrência preferencial em pacientes idosos após trauma local e com evolução para alopecia cicatricial. O caso relatado é de uma paciente idosa feminina que iniciou com pústulas dolorosas em região parietal bilateral com aumento das lesões e exulceração local. Após o diagnóstico histológico de dermatose pustular erosiva do couro cabeludo, foi iniciada prednisona 40 mg/dia e tacrolimus 0,1% tópico. Após 10 semanas evoluiu com cicatrização completa das áreas erosadas e alopecia cicatricial.

Erosive pustular dermatosis of the scalp is a rare inflammatory disorder of the scalp, affecting elderly patients after local trauma and leading to scarring or cicatricial alopecia. Case Report: An elderly female patient complained of painful pustules on the parietal region bilaterally with progressive enlargement and ulceration. A biopsy suggested erosive pustular dermatosis of the scalp and the patient was treated with prednisone 40 mg/day and 0.1% topical tacrolimus. After 10 weeks complete closure of the eroded areas was observed and a stable scarring alopecia developed.

Ictioses são distúrbios da queratinização que se expressam com descamação cutânea generalizada persistente não inflamatória. Os pacientes que apresentam essa doença possuem aumentada renovação celular, maior espessura da camada córnea e alterações funcionais de glândulas sebáceas e sudoríparas, aspectos que parecem favorecer a infecção por dermatófitos. Dermatofitoses são infecções causadas por fungos ceratinofílicos, que acometem pele, pelos e unhas. Um dos gêneros mais prevalentes é o Trichophyton rubrum. Apesar das infecções fúngicas por dermatófitos e os quadros clínicos de ictiose serem muito comuns, são raros em literatura os relatos de associações dessas duas entidades. Apresentamos os relatos de três casos de ictiose associada a dermatofitose por T. rubrum. A ausência de resposta aos antifúngicos leva à piora clínica da ictiose.

Ichthyoses are a common group of keratinization disorders. A non-inflammatory generalized persistent skin desquamation is observed. It is characterized by increased cell turnover, thickening of the stratum corneum and functional changes of sebaceous and sweat glands. All of these favor fungal proliferation. Dermatophytes may infect skin, hair and nails causing ringworm or tinea. They have the ability to obtain nutrients from keratinized material. One of its most prevalent genera is Trichophyton rubrum. Although tineas and ichthyoses are quite common, the association of the two entities is rarely reported in the literature. Three cases of ichthyosis associated with widespread infection by T. rubrum are presented. Resistance to several antifungal treatments was responsible for worsening of ichthyosis signs and symptoms.

A alopecia difusa tem como principais causas eflúvio telógeno, alopecia androgenética difusa (alopecia androgenética de padrão feminino) e alopecia areata difusa. Em muitas ocasiões o diagnóstico diferencial entre as três entidades é difícil. Na segunda parte deste artigo se discute em mais detalhes as características clínicas, dermatoscópicas e histológicas do eflúvio telógeno crônico e da alopecia areata difusa. Uma maneira prática e objetiva de abordagem diagnóstica da alopecia difusa é apresentada através de um fluxograma.

Diffuse alopecia is mainly caused by telogen effluvium, diffuse androgenetic alopecia (femalepattern hair loss) and diffuse alopecia areata. Differential diagnosis between the three disorders may be difficult in several occasions. In this second part of our study, chronic telogen effluvium and diffuse alopecia areata are discussed in detail, including clinical, dermoscopic and histological aspects. A flowchart presents a practical and objective differential diagnostic approach to diffuse alopecia.