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.
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.
Abstract: We report a case of a 76-year-old patient with a history of recent weight loss and ulcerated umbilical nodular lesion. Initially, we considered the diagnostic hypothesis of Sister Mary Joseph's nodule. However, histopathological evaluation revealed that it was an ulcerated intradermal nevus. We perform a brief review of umbilical nodules.
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.
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.
Abstract: BACKGROUND: Patients with oral sensitivity are common in our practice. Allergic contact dermatitis is one of the most frequent etiologies. OBJECTIVES: Evaluate oral contact dermatitis using the Brazilian standard series and complementary dental series in patients using dental prostheses, with or without oral complaints. Determine specific dental Brazilian series. METHODS: Patients using dental prostheses with or without oral complaints realized patch tests. Brazilian standard series and complementary dental series were used according to ICDRG recommendations. The results were analysed according to age, sex, race, atopic conditions and symptoms associated. RESULTS: From 54 patients tested, 34 (63%) were positive at least to one substance. Nineteen had oral complaints, such as burning mouth, itch or oral erythema. There was no association between atopic condition and tests results. Without the oral series, just 23(42,6%) patients had a positive result. Using the Brazilian standard series with the complementary dental series we improved the positivity of the patch test to 47%. CONCLUSION: In patients using prostheses and with oral complaints, patch tests with Brazilian standard series with complementary dental series improve the tests positivity.
AbstractDarier’s disease is characterized by dense keratotic lesions in the seborrheic areas of the body such as scalp, forehead, nasolabial folds, trunk and inguinal region. It is a rare genodermatosis, an autosomal dominant inherited disease that may be associated with neuropsichiatric disorders. It is caused by ATPA2 gene mutation, presenting cutaneous and dermatologic expressions. Psychiatric symptoms are depression, suicidal attempts, and bipolar affective disorder. We report a case of Darier’s disease in a 48-year-old female patient presenting severe cutaneous and psychiatric manifestations.
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.
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.
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].
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.
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.
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.