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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

Evaluation of depression, stress and quality of life indexes in patients with atopic dermatitis,
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Castro, Cleide Rodrigues de

; Andrade, Maria Elisa Bertocco

; Pires, Renata Marli Gonçalves

; Pires, Mario Cezar

Anais Brasileiros de Dermatologia

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oct 2021, Volume 96 N. 5 Pages 627 - 629

Abstract: En | Text: En | PDF: En

https://doi.org/10.1016/j.abd.2020.09.010 20 downloads

Randomized controlled study comparing the use of diphencyprone and anthralin in the treatment of extensive chronic alopecia areata
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Rocha, Vanessa Barreto

; Kakizaki, Priscila

; Donati, Aline

; Machado, Carla Jorge

; Pires, Mario Cezar

; Contin, Leticia Arsie

Anais Brasileiros de Dermatologia

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jun 2021, Volume 96 N. 3 Pages 372 - 376

Abstract: En | Text: En | PDF: En

https://doi.org/10.1016/j.abd.2020.06.018 80 downloads

Familial fibrosing frontal alopecia in six sisters,
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Rocha, Vanessa Barreto

; Pires, Mario Cezar

; Contin, Leticia Arsie

Anais Brasileiros de Dermatologia

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feb 2020, Volume 95 N. 1 Pages 125 - 128

Abstract: En | Text: En | PDF: En

https://doi.org/10.1016/j.abd.2019.02.009 252 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

Consensus on the diagnostic and therapeutic management of chronic spontaneous urticaria in adults - Brazilian Society of Dermatology
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Criado, Paulo Ricardo

; Maruta, Celina Wakisaka

; Alchorne, Alice de Oliveira de Avelar

; Ramos, Andréa Machado Coelho

; Gontijo, Bernardo

; Santos, Josemir Belo dos

; Martins, Luis Eduardo Agner Machado

; Rivitti-Machado, Maria Cecília

; Silvares, Maria Regina Cavariani

; Pires, Mario Cezar

; Souza, Patricia Karla de

; Orfali, Raquel Leão

; Bonamigo, Renan Rangel

; Bedrikow, Roberta Buense

; Criado, Roberta Fachini Jardim

; Oliveira, Zilda Najjar Prado de

Anais Brasileiros de Dermatologia

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apr 2019, Volume 94 N. 2 Pages 56 - 66

Abstract: En | Text: En | PDF: En

Abstract: Background: Urticarias are frequent diseases, with 15% to 20% of the population presenting at least one acute episode in their lifetime. Urticaria are classified in acute ( ≤ 6 weeks) or chronic (> 6 weeks). They may be induced or spontaneous. Objectives: To verify the diagnostic and therapeutic recommendations in chronic spontaneous urticaria (CSU), according to the experience of Brazilian experts, regarding the available guidelines (international and US). Methods: A questionnaire was sent to Brazilian experts, with questions concerning diagnostic and therapeutic recommendations for CSU in adults. Results: Sixteen Brazilian experts answered the questionnaire related to diagnosis and therapy of CSU in adults and data were analyzed. Final text was written, considering the available guidelines (International and US), adapted to the medical practices in Brazil. Diagnostic work up in CSU is rarely necessary. Biopsy of skin lesion and histopathology may be indicated to rule out other diseases, such as, urticarial vasculitis. Other laboratory tests, such as complete blood count, CRP, ESR and thyroid screening. Treatment of CSU includes second-generation anti-histamines (sgAH) at licensed doses, sgAH two, three to fourfold doses (non-licensed) and omalizumab. Other drugs, such as, cyclosporine, immunomodulatory drugs and immunosuppressants may be indicated (non-licensed and with limited scientific evidence). Conclusions: Most of the Brazilian experts in this study partially agreed with the diagnostic and therapeutic recommendations of the International and US guidelines. They agreed with the use of sgAH at licensed doses. Increase in the dose to fourfold of sgAH may be suggested with restrictions, due to its non-licensed dose. Sedating anti-histamines, as suggested by the US guideline, are indicated by some of the Brazilian experts, due to its availability. Adaptations are mandatory in the treatment of CSU, due to scarce or lack of other therapeutic resources in the public health system in Brazil, such as omalizumab or cyclosporine.

https://doi.org/10.1590/abd1806-4841.2019940209 3823 downloads

PERFIL EPIDEMIOLÓGICO DE MULHERES COM PAPILOMAVÍRUS HUMANO QUE UTILIZAM O SERVIÇO PÚBLICO DE SAÚDE
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Machado, Lígia Souza

; Pires, Mario Cezar

Revista Baiana de Enfermagem

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2017, Volume 31 N. 4 elocation e22135

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

Objective To get to know the profile of women with genital human papillomavirus and to investigate the knowledge about the infection and its prevention. Method Descriptive study based on the application of a structured form to a sample of 49 women. All patients had pap smear results showing low-grade intraepithelial lesions. The data were treated by means of a descriptive statistical analysis using the EPI-INFO® 7.1.4 software. Results Most of the women studied were young, single adults with a high school education. The infection occurred in participants with family incomes of less than five minimum wages per month. More than 70 percent of them reported taking pap smear tests and test periodicity. Conclusion The data showed the occurrence of human papillomavirus in women aged 20 and 40 years, and the infection was more frequent among those who became sexually active after 15 years of age.

Objetivo conocer el perfil de mujeres con papiloma virus humano genital e investigar el conocimiento sobre la infección y su prevención. Método estudio descriptivo a través de la aplicación de formulario estructurado para una muestra de 49 mujeres. Todas presentaron resultado de Papanicolaou con lesión intraepitelial de bajo grado. Los datos fueron tratados mediante análisis estadístico descriptivo utilizando el programa EPI-INFO® 7.1.4. Resultados las mujeres estudiadas, en su mayoría, eran adultas jóvenes, solteras y con enseñanza media. La incidencia de la infección ocurrió en participantes con ingreso familiar inferior a cinco salarios mínimos por mes. La realización del examen de Papanicolaou y su periodicidad fue referida por más del 70% de ellas. Conclusión los datos apuntaron la ocurrencia del papiloma virus humano en mujeres entre 20 y 40 años de edad, con mayor frecuencia en aquellas que iniciaron la actividad sexual después de los 15 años de edad.

Objetivo conhecer o perfil de mulheres com papilomavírus humano genital e investigar o conhecimento sobre a infecção e sua prevenção. Método estudo descritivo através da aplicação de formulário estruturado para uma amostra de 49 mulheres. Todas apresentaram resultado de papanicolaou com lesão intraepitelial de baixo grau. Os dados foram tratados por meio de análise estatística descritiva utilizando o programa EPI-INFO® 7.1.4. Resultados as mulheres estudadas, em sua maioria, eram adultas jovens, solteiras e com ensino médio. A incidência da infecção ocorreu em participantes com renda familiar inferior a cinco salários mínimos por mês. A realização do exame de papanicolaou e sua periodicidade foi referida por mais de 70% delas. Conclusão os dados apontaram ocorrência do papilomavírus humano em mulheres entre 20 e 40 anos de idade, com maior frequência naquelas que iniciaram a atividade sexual após os 15 anos de idade.

https://doi.org/10.18471/rbe.v31i4.22135 178 downloads

Lichen planopilaris-like eruption during treatment with tyrosine kinase inhibitor nilotinib
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Leitão, Juliana Ribeiro

; Valente, Neusa Yuriko Sakai

; Kakizaki, Priscila

; Veronez, Isis Suga

; Pires, Mario Cezar

Anais Brasileiros de Dermatologia

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oct 2016, Volume 91 N. 5 Pages 45 - 47

Abstract: En | Text: En | PDF: En

Abstract Tyrosine kinase inhibitors are effective as a target therapy for malignant neoplasms. Imatinib was the first tyrosine kinase inhibitor used. After its introduction, several other drugs have appeared with a similar mechanism of action, but less prone to causing resistance. Even though these drugs are selective, their toxicity does not exclusively target cancer cells, and skin toxicity is the most common non-hematologic adverse effect. We report an eruption similar to lichen planopilaris that developed during therapy with nilotinib, a second generation tyrosine kinase inhibitor, in a patient with chronic myeloid leukemia resistant to imatinib. In a literature review, we found only one report of non-scarring alopecia due to the use of nilotinib.

https://doi.org/10.1590/abd1806-4841.20164724 814 downloads

Primary cutaneous aspergillosis and idiopathic bone marrow aplasia
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Furlan, Karina Colossi

; Pires, Mario Cezar

; Kakizaki, Priscila

; Chartuni, Juliana Cabral Nunes

; Valente, Neusa Yuriko Sakai

Anais Brasileiros de Dermatologia

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jun 2016, Volume 91 N. 3 Pages 381 - 383

Abstract: En | Text: En | PDF: En

Abstract: We describe the case of a 9-year-old boy with idiopathic bone marrow aplasia and severe neutropenia, who developed skin ulcers under cardiac monitoring electrodes. The diagnosis of primary cutaneous aspergillosis was made after the second biopsy and culture. Imaging investigation did not reveal internal fungal infection. The child was treated, but did not improve and died 3 months after admission. The report highlights and discusses the preventable risk of aspergillus skin infection in immunocompromised patients.

https://doi.org/10.1590/abd1806-4841.20164889 1371 downloads

10.

Unusual manifestation of the yellow nail syndrome - Case report
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Papaiordanou, Francine

; Epstein, Marina Gabrielle

; Miyaoka, Mariana Yumi

; Yang, Jeane Jeong Hoon

; Pires, Mario Cezar

Anais Brasileiros de Dermatologia

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jun 2014, Volume 89 N. 3 Pages 490 - 492

Abstract: En | Text: En | PDF: En

The yellow nail syndrome is a rare disorder characterized by the classic triad of yellow and dystrophic nails, lymphedema and pleural effusion. We report in this paper a case of yellow nail syndrome, presenting the classic triad of the disease, associated with an unusual lymph accumulation in the abdomen region.

https://doi.org/10.1590/abd1806-4841.20142936 1491 downloads

11.

Epidermodysplasia verruciformis in a young man with HIV since birth - case report
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Meireles, Sheila Itamara Ferreira do Couto

; Andrade, Sônia Maria Fonseca de

; Lima Júnior, Cristiano Luiz Horta de

; Pires, Mario Cezar

Anais Brasileiros de Dermatologia

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dec 2013, Volume 88 N. 6 Pages 190 - 192

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

A Epidermodisplasia Verruciforme é uma genodermatose que se caracteriza pela susceptibilidade à infecção por tipos específicos de HPV (HPVs 3 e 10 e os beta-HPVs) e é considerada o primeiro modelo no homem de carcinogênese induzida pelo HPV. Neste artigo apresenta-se um caso raro de Epidermodisplasia Verruciforme em um paciente com HIV desde o nascimento. Apesar dos doentes com HIV apresentarem mais infecções pelos vírus HPVs, existem poucos relatos na literatura de Epidermodisplasia Verruciforme no doente com HIV. Isso se explica, pois a Epidermodisplasia Verruciforme é consequência de uma deficiência celular específica à infecção por alguns tipos distintos de HPVs, ditos HPVs relacionados a Epidermodisplasia Verruciforme.

Epidermodysplasia Verruciformis is a genodermatosis characterized by susceptibility to infection by specific HPV types (HPV 3/10 and beta-HPVs). It is considered to be the first model in human carcinogenesis induced by HPV. In this report we present a rare case of Epidermodysplasia Verruciformis associated with vertical transmission of HIV. Although most patients with HIV present infections by HPV virus, the frequency of Epidermodysplasia Verruciformis is no greater in patients with HIV because in EV there is a deficiency of specific cellular immunity to infection by some types of HPV, called HPV-related Epidermodysplasia Verruciformis.

https://doi.org/10.1590/abd1806-4841.20132328 2672 downloads

12.

Avaliação do teste de contato com aeroalérgenos em pacientes com dermatite atópica
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Rodrigues, Rosana Neves Dos Santos

; Melo, João Ferreira

; Montealegre, Federico

; Hahnstadt, Ruppert Ludwig

; Pires, Mario Cezar

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feb 2011, Volume 86 N. 1 Pages 37 - 43

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

FUNDAMENTOS: a dermatite atópica é uma doença inflamatória cutânea que apresenta múltiplos fatores desencadeantes. Há vários relatos de autores que confirmaram os aeroalérgenos como fatores agravantes ou desencadeantes. O teste de contato com aeroalérgenos ou teste de contato atópico foi proposto para avaliar a participação destes alérgenos na dermatite atópica. OBJETIVO: objetivo deste estudo foi avaliar a positividade do teste de contato atópico em pacientes com dermatite atópica. MÉTODOS: Avaliamos 50 pacientes com dermatite atópica e 45 do grupo com rinite alérgica, nos quais realizamos teste de contato atópico com extratos de Dermatophagoides pteronissynus, Dermatophagoides farinae e Blomia tropicalis, além de testes cutâneos de leitura imediata para os mesmos alérgenos, acrescidos de epitélio de cão e gato e fungos. RESULTADOS: verificamos que o teste de contato atópico com ácaros apresentou maior positividade nos indivíduos do grupo de dermatite atópica quando comparado ao grupo de rinite alérgica. CONCLUSÕES: o teste de contato atópico apresenta resultados estatisticamente significativos quando realizado com ácaros, em pacientes com dermatite atópica, com p=0,035, OR (odds ratio) = 3,35 e IC(95%) = [ 1,18; 9,47].

BACKGROUND: Atopic dermatitis is an inflammatory skin disease that can be triggered by many factors. Several reports confirm the role of airborne allergic agents as aggravating or triggering factors. The patch test with airborne allergic agents or the atopy patch test was suggested to evaluate the role of these allergens in atopic dermatitis. OBJECTIVE: This study aimed at evaluating the positivity of the atopy patch test in patients with atopic dermatitis. METHODS: We evaluated 50 patients with atopic dermatitis and 45 with allergic rhinitis, the atopy patch test was performed in these patiennts with extracts of Dermatophagoides pteronissynus, Dermatophagoides farinae and Blomia tropicalis, as well as immediate skin prick tests for the same allergens with cat and dog epithelia and fungi. RESULTS: It was found that the atopy patch test with dust mites showed higher positivity in individuals with atopic dermatitis when compared to those with allergic rhinitis. CONCLUSIONS: The atopy patch test shows statistically significant results when performed with dust mites in patients with atopic dermatitis, p = 0.035, odds ratio (OR) = 3.35 and CI (95%) = [1.18, 9, 47].

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13.

Queilite actínica: avaliação comparativa estética e funcional entre as vermelhectomias clássica e em W-plastia
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Rossoe, Ed Wilson Tsuneo

; Tebcherani, Antonio José

; Sittart, José Alexandre

; Pires, Mario Cezar

Anais Brasileiros de Dermatologia

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feb 2011, Volume 86 N. 1 Pages 65 - 73

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

FUNDAMENTO: A queilite actínica crônica é a ceratose actínica localizada no vermelhão labial. O tratamento é de crucial importância, devido ao potencial de transformação maligna. OBJETIVO: Avaliar os resultados estéticos e funcionais das vermelhectomias clássica e em W-plastia na queilite actínica. Na técnica clássica, a cicatriz é linear; na W-plastia, em linha quebrada. MÉTODOS: Foram tratados 32 pacientes com diagnóstico clínico e histopatológico de queilite actínica. Quinze deles foram submetidos à técnica em W-plastia e 17, à técnica clássica. Avaliaram-se parâmetros como retração cicatricial e alterações funcionais. RESULTADOS: Houve associação estatisticamente significativa entre a técnica utilizada e a presença de retração cicatricial, sendo a associação positiva com a clássica (p=0,01 com correção de Yates). O risco relativo (odds ratio - OR) calculado foi de 11,25, ou seja, houve maior chance de retração nos pacientes submetidos à técnica clássica. Nenhuma das técnicas apresentou alterações funcionais. Avaliaram-se complicações pós-operatórias como presença de crostas, lábios secos, parestesia e deiscência de sutura. Não houve associação estatisticamente significante entre as complicações e a técnica utilizada (p=0,69). CONCLUSÃO: Concluiu-se que a vermelhectomia em W-plastia oferece melhores resultados estéticos e índices de complicações semelhantes.

BACKGROUND: Chronic actinic cheilitis is actinic keratosis located on the vermilion border. Treatment is essential because of the potential for malignant transformation. OBJECTIVE: To evaluate the aesthetic and functional results of vermilionectomy using the classic and Wplasty techniques in actinic cheilitis. In the classic technique, the scar is linear and in the W-plasty one, it is a broken line. METHODS: 32 patients with clinical and histopathological diagnosis of actinic cheilitis were treated. Out of the 32 patients, 15 underwent the W-plasty technique and 17 underwent the classic one. We evaluated parameters such as scar retraction and functional changes. RESULTS: A statistically significant association between the technique used and scar retraction was found, which was positive when using the classic technique (p = 0.01 with Yates' correction). The odds ratio was calculated at 11.25, i.e., there was a greater chance of retraction in patients undergoing the classic technique. Both techniques revealed no functional changes. We evaluated postoperative complications such as the presence of crusts, dry lips, paresthesia, and suture dehiscence. There was no statistically significant association between complications and the technique used (p = 0.69). CONCLUSION: We concluded that vermilionectomy using the W-plasty technique shows better cosmetic results and similar complication rates.

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14.

Avaliação do método de disco-difusão para determinação da eficácia da terbinafina in vitro em agentes de micoses superficiais e subcutâneas
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Diogo, Hilda Conceição

; Melhem, Márcia

; Sarpieri, Aldo

; Pires, Mario Cezar

Anais Brasileiros de Dermatologia

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jun 2010, Volume 85 N. 3 Pages 324 - 330

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

FUNDAMENTOS: As micoses superficiais e subcutâneas têm alta prevalência e, muitas vezes, caráter crônico, necessitando tratamentos tópicos e/ou sistêmicos com antifúngicos. As drogas de escolha são azóis e alilaminas (terbinafina). É necessário avaliar a eficácia das drogas para tratamento em humanos e em animais. Estudos para avaliar in vitro a ação dos antimicóticos são raros, especialmente, contra fungos filamentosos. OBJETIVO: Avaliar a eficácia in vitro da terbinafina pelo método de disco-difusão contra fungos filamentosos e leveduras agentes de micoses. MÉTODOS: Avaliou-se a ação da terbinafina (0,125µg-100µg) contra dez espécies fúngicas pelos métodos discodifusão e microdiluição/referência, para determinar a concentração inibitória mínima (MIC). RESULTADOS: Observou-se alta sensibilidade à terbinafina em: T. rubrum, M. gypseum, T. mentagrophytes, T. tonsurans, M. canis, C. carrionii e E. floccosum (halo ≥ 40mm com disco de 0,125µg). S. hyalinum e C. parapsilosis foram considerados sensíveis, mas com halos menores. Fusarium spp. apresentou menor sensibilidade (halo=12mm com disco de 2µg; MIC 8µg/mL). CONCLUSÕES: Os resultados reiteram estudos anteriores quanto à alta eficácia da terbinafina em relação a dermatófitos. A técnica de disco-difusão foi de fácil aplicação e adequada na rotina de laboratórios clínicos.

BACKGROUND: Superficial and subcutaneous mycoses have a high prevalence and, often, chronic evolution. Therefore, they need extensive treatment with topic and/or systemic antifungal agents. Azoles and alilamines (terbinafine) are first-choice drugs to treat human and animal infections. Thus, evaluation of the efficacy of these drugs is important for a successful treatment. However, there are few studies that evaluate the in vitro activity of antifungal agents. OBJECTIVE: To evaluate the in vitro efficacy of terbinafine activity against filamentous fungi and yeasts that cause mycoses. METHOD: The in vitro activity of terbinafine (0.125-100µg) against 10 fungi species was evaluated by the diskdiffusion and microdilution/reference methods to determine the Minimum Inhibitory Concentration (MIC). RESULTS: We found a high susceptibility to terbinafine in: T. rubrum, M. gypseum, T. mentagrophytes, T. tonsurans, M. canis, C. carrionii and E. floccosum (halo ≥ 40mm with 0.125µg disk). S. hyalinum and C. parapsilosis were considered susceptible, but less than the others. Fusarium spp. showed the lowest susceptibility (halo=12mm with 2µg disk; MIC 8µg/mL). CONCLUSIONS: The results of this research confirm previous findings about the efficacy of terbinafine. The drug was shown to be highly effective to treat dermatophyte infections. The disk-diffusion method was easy to use and is a suitable technique for routine use in clinical laboratories.

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15.

Avaliação da eficácia e segurança do tacrolimo pomada 0,03% no tratamento da dermatite atópica em pacientes pediátricos
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Gontijo, Bernardo

; Duarte, Ida A. Gomes

; Sittart, José Alexandre de Souza

; Pires, Mario Cezar

; Takaoka, Roberto

; Cestari, Silmara da Costa P.

; Cestari, Tania Ferreira

; Aun, Wilson Tartuce

; Oliveira, Zilda Najjar P. de

; La Scala, Cintia S. Kurokawa

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dec 2008, Volume 83 N. 6 Pages 511 - 519

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

FUNDAMENTOS - Tacrolimo pomada é eficaz no tratamento da dermatite atópica. OBJETIVOS - Avaliar a eficácia e segurança do tacrolimo pomada 0,03% (Protopic®) no tratamento de pacientes pediátricos com dermatite atópica. MÉTODOS - Estudo multicêntrico, aberto e não comparativo. Incluídos 174 pacientes (dois a 10 anos)com dermatite atópica. Utilizou-se tacrolimo duas vezes ao dia, por seis semanas. O critério primário de eficácia foi a melhora clínica > a 90% avaliada pelo médico (Escala de Avaliação Global da Resposta Clínica). Outros critérios de eficácia foram a redução no índice de área e gravidade do eczema (EASI), a redução do percentual de superfície corporal afetada (%BSA) e a avaliação do prurido pelo paciente (escala analógica visual). Segurança foi avaliada pela ocorrência de eventos adversos relatados pelos pais e pacientes ou pelos investigadores. RESULTADOS - Trinta e três por cento dos pacientes apresentaram melhora clínica >90%. Quando avaliado o escore EASI, houve redução de 45,5% (primeira semana) e 61,8% (sexta semana) quando comparado com o basal (p<0,001). Em relação a %BSA, houve redução de 30,4% e 55,5%, na primeira e na sexta semana. Houve redução do prurido em relação ao basal (p<0,001).Os eventos adversos mais comuns foram - queimação e prurido localizados. CONCLUSÃO - Tacrolimo pomada 0,03% é terapia segura e efetiva no tratamento da dermatite atópica leve a grave em pacientes pediátricos.

BACKGROUND: Tacrolimus ointment has been shown to be effective in treatment of atopic dermatitis. OBJECTIVES: To evaluate the efficacy and safety of 0.03% tacrolimus ointment (Protopic®) in pediatric patients with mild, moderate and severe atopic dermatitis. METHODS: Open, non-comparative, multicentric study carried out in Brazil. 174 patients (ages from two to 10) with mild to severe atopic dermatitis were included. Patients were instructed to apply Protopic® twice a day for six weeks. Primary efficacy criterion was clinical improvement > 90% assessed by the physician (Clinical Response Global Evaluation Scale). Other efficacy criteria included reduction of the Eczema Area Severity Index (EASI), decrease of the affected body surface area (%BSA) and evaluation of the itching by the patients or their guardians (visual analogical scale). Safety was evaluated by adverse events reported by patients and/or guardians or by investigators. RESULTS: Thirty-three percent of patients showed clinical improvement > 90%. 45.5% of patients (1st week) decreased EASI and 61.8% (6th week) (p<0,001). %BSA decreased 30.4% and 55.5% in the first and sixth week. Improvement was also significant when measured by itching (p<0,001). Most frequentadverse effects were: burning and itching. CONCLUSION: 0.03% tacrolimus ointment is a safe and effective therapy for mild to severe atopic dermatitis in pediatric patients.

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