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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

Pediatric dermatoses pattern at a Brazilian reference center
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Miotto, Isadora Zago

; Bessa, Vanessa Rolim

; Vasconcelos, Luana Barreto de Almeida

; Samorano, Luciana Paula

; Rivitti-Machado, Maria Cecília

; Oliveira, Zilda Najjar Prado de

Jornal de Pediatria

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Abr 2021, Volume 97 Nº 2 Páginas 211 - 218

Resumo: En | Texto: En | PDF: En

Abstract Objective: The aim of this study was to identify the pattern of pediatric dermatoses of patients evaluated at a dermatologic clinic of a reference center in Brazil and to compare these results to similar surveys conducted in other countries. Methods: A retrospective study was performed of patients up to 18 years old, evaluated at a dermatologic clinic between January 1, 2017 and December 31, 2017. Variables collected for analysis included age, gender, dermatological diagnosis, multidisciplinary follow-up, hospitalization, and complementary exams. Results: A total of 2330 patients were included for analysis, with a mean age of 9.7 years. 295 patients were diagnosed with more than one skin disease, leading to a total of 2668 diagnoses. Skin diseases were organized into categories and inflammatory dermatoses corresponded to the largest group (31.2%), mostly due to atopic dermatitis (18.3%). The other main categories were: genodermatoses (14.2%), infectious diseases (12.6%), adnexal disorders (12.5%), cysts and neoplasms (10.7%), and vascular disorders (7.0%). Fifty-six patients needed to be admitted to the dermatology ward; 25 of them (44.6%) for management of worsening of the skin disease, mainly atopic dermatitis, psoriasis, and drug reactions. There were 885 biopsies performed in 38.0% of the subjects and 751 patients (32.2%) required multidisciplinary care; most of them had some genodermatoses. Conclusions: Dermatologic disorders are very common in the pediatric age group and differ from those in adults, suffering influence from cultural, ethnic, socioeconomic, and environmental factors. Knowing the magnitude and distribution of these dermatoses is important to better plan healthcare policies.

https://doi.org/10.1016/j.jped.2020.02.002 150 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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Abr 2019, Volume 94 Nº 2 Páginas 67 - 75

Resumo: En | Texto: 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 treatment of hidradenitis suppurativa - Brazilian Society of Dermatology
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Magalhães, Renata Ferreira

; Rivitti-Machado, Maria Cecília

; Duarte, Gleison Vieira

; Souto, Roberto

; Nunes, Daniel Holthausen

; Chaves, Mario

; Hirata, Sérgio Henrique

; Ramos, Andrea Machado Coelho

Anais Brasileiros de Dermatologia

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Abr 2019, Volume 94 Nº 2 Páginas 7 - 19

Resumo: En | Texto: En | PDF: En

Abstract: Hidradenitis suppurativa is a chronic immune mediated disease of universal distribution that causes great damage to the quality of life of the affected individual, whose prevalence is estimated at 0.41% in the Brazilian population. The objective of this work was update on physiopathogenesis, diagnosis and classification of hidradenitis suppurativa and to establish therapeutic recommendations in the Brazilian reality. It was organized as a work group composed of eight dermatologists from several institutions of the country with experience in the treatment of hidradenitis suppurativa and carried out review on the topic. Recommendations were elaborated and voted by modified Delphi system and statistical analysis of the results was performed. The Brazilian consensus on the clinical approach of hidradenitis suppurativa had the support of the Brazilian Society of Dermatology.

https://doi.org/10.1590/abd1806-4841.20198607 6229 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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Abr 2019, Volume 94 Nº 2 Páginas 56 - 66

Resumo: En | Texto: 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

PHACE syndrome: clinical manifestations, diagnostic criteria, and management
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Rotter, Anita

; Samorano, Luciana Paula

; Rivitti-Machado, Maria Cecília

; Oliveira, Zilda Najjar Prado

; Gontijo, Bernardo

Anais Brasileiros de Dermatologia

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Jun 2018, Volume 93 Nº 3 Páginas 405 - 411

Resumo: En | Texto: En | PDF: En

Abstract: Infantile hemangioma can be linked to other organ malformations. In 1996, PHACE syndrome was first defined as the association of large and segmental infantile hemangioma, usually on the face, head, or cervical region, with malformations of the posterior fossa of the brain, arterial anomalies of the central nervous system, coarctation of the aorta, cardiac defects, and ocular abnormalities. Over 300 cases of PHACE syndrome have been reported, and it is cconsidered one of the most common neurocutaneous vascular disorders in childhood. Knowledge of the features and locations of lesions that imply a greater risk of systemic involvement is crucial for the diagnosis and proper management of PHACE syndrome patients. This review highlights the diagnostic criteria for PHACE syndrome, the imaging workup for extracutaneous involvement, the treatment of infantile hemangioma, and the importance of a multidisciplinary approach in the management of these patients.

https://doi.org/10.1590/abd1806-4841.20187693 3381 downloads

Tuberous sclerosis complex: review based on new diagnostic criteria
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Portocarrero, Larissa Karine Leite

; Quental, Klícia Novais

; Samorano, Luciana Paula

; Oliveira, Zilda Najjar Prado de

; Rivitti-Machado, Maria Cecília da Matta

Anais Brasileiros de Dermatologia

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Jun 2018, Volume 93 Nº 3 Páginas 323 - 331

Resumo: En | Texto: En | PDF: En

Abstract: Tuberous sclerosis complex is a multisystemic, autosomal dominant genetic disorder with complete penetrance, that can evolve with hamartomas in multiple organs, such as skin, central nervous system, kidney and lung. Due to the wide phenotypic variability, the disease is often not recognized. Tuberous sclerosis complex affects one in 10,000 newborns and most patients are diagnosed during the first 15 months of life. The diagnostic criteria for tuberous sclerosis were reviewed in 2012, at the second International Tuberous Sclerosis Complex Consensus Conference. The diagnosis is based on genetic criteria, by the identification of inactivating pathogenic mutation of tumor suppressor genes TSC1 and TSC2, and clinical criteria, including cutaneous, renal, pulmonary, cardiac and neurological manifestations. The treatment of tuberous sclerosis complex consists, mainly, in management of the symptoms caused by hamartomas and in prevention of organ failure. Multidisciplinary approach is recommended, in order to obtain better clinical outcomes.

https://doi.org/10.1590/abd1806-4841.20186972 5473 downloads

Propranolol for treatment of infantile hemangiomas
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Melo, Juliana Nakano de

; Rotter, Anita

; Rivitti-Machado, Maria Cecília

; Oliveira, Zilda Najjar Prado de

Anais Brasileiros de Dermatologia

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Dez 2013, Volume 88 Nº 6 Páginas 220 - 223

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

O hemangioma da infância é o tumor vascular mais comum nessa faixa etária. Mais recentemente, propranolol oral tem sido usado com sucesso em um número limitado de crianças com hemangioma da infância. Nós apresentamos 6 casos de hemangioma da infância, provenientes de um único centro dermatológico, que apresentaram boa resposta ao tratamento com propranolol oral.

Infantile hemangioma is the most common vascular tumor in early childhood. Propranolol has been successfully used recently in a limited number of children with Infantile hemangioma. We present 6 cases of Infantile hemangioma, at a single dermatological center, which responded to oral propranolol with good results.

https://doi.org/10.1590/abd1806-4841.20131699 8817 downloads

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