Abstract Ischemic ulcers due to compromised microcirculation of the lower limbs cause painful ulcers that represent a challenge for the correct diagnosis and treatment. Livedoid vasculopathy, calciphylaxis, and Martorell’s hypertensive ischemic ulcer are part of this group and present some similarities due to microvascular occlusive impairment. They are often misdiagnosed as inflammatory ulcers such as pyoderma gangrenosum and vasculitis. This review discusses the pathophysiology, risk factors, clinical aspects, differential diagnoses, histopathology, and presents a therapeutic update of livedoid vasculopathy, calciphylaxis, and Martorell’s ulcer. Although they are less frequent causes of chronic ulcers, a correct diagnosis is essential to reduce the chance of erroneous therapies that may impact morbidity and mortality related to these conditions.

RESUMEN Objetivo: Realizar la adaptación transcultural de CALCULATE al portugués brasileño. Método: Un estudio metodológico llevado a cabo de enero a diciembre de 2021, dividido en seis etapas: traducción, síntesis, retrotraducción, comité de expertos con aplicación del índice de validez de contenido, preprueba en 40 pacientes adultos y envío a las autoras. El estudio se realizó en las unidades de cuidados intensivos de un hospital público de enseñanza terciaria en el interior del estado de São Paulo, Brasil. El CALCULATE original tiene ocho ítems de evaluación (factores de riesgo) y se estratifica con un puntaje de 0-3 (alto riesgo) y 4-8 (riesgo muy alto). Resultados: Después de la evaluación de los expertos, la validez de contenido final fue de 0,9. Sugirieron palabras y frases que debían cambiar en cuanto a equivalencias textuales, así como definiciones de siglas y terminologías. En la preprueba, los ítems se evaluaron como adecuados para la comprensión; solo un ítem requirió una explicación adicional para su adecuación. Conclusión: Se realizó con éxito la adaptación transcultural de CALCULATE al portugués brasileño, revelando un buen índice de validez de contenido, confirmando la relevancia y adecuación de sus ítems. CALCULATE es adecuado para su uso en unidades de cuidados intensivos y centros de investigación y enseñanza.

RESUMO Objetivo: Realizar a adaptação transcultural do CALCULATE para o português brasileiro. Método: Estudo metodológico, desenvolvido de janeiro a dezembro de 2021 e dividido em seis etapas: tradução, síntese, retrotradução, comitê de especialistas com aplicação de índice de validade de conteúdo, pré-teste em 40 pacientes adultos e envio às autoras. O estudo ocorreu nas unidades de terapia intensiva em hospital público de ensino de nível terciário no interior do estado de São Paulo, Brasil. O CALCULATE original tem oito itens de avaliação (fatores de risco) e é estratificado com escore 0-3 (alto risco) e 4-8 (risco muito alto). Resultados: Após avaliação dos especialistas, a validade de conteúdo final foi de 0,9. Eles sugeriram palavras e frases que deveriam sofrer alterações quanto às equivalências textuais, assim como definições de siglas e terminologias. No pré-teste, os itens foram avaliados como adequados na compreensão; apenas um item precisou de explicação complementar para adequação. Conclusão: Foi realizada a adaptação transcultural do CALCULATE para o português do Brasil, a qual revelou ter bom índice de validade de conteúdo, sendo verificada a pertinência e relevância de seus itens. O CALCULATE está adequado para utilização em unidades de terapia intensiva e centros de pesquisa e ensino.

ABSTRACT Objective: To perform the cross-cultural adaptation of CALCULATE for Brazilian Portuguese. Method: A methodological study conducted from January to December 2021, divided into six stages: translation, synthesis, back-translation, expert committee with the application of the content validity index, pre-testing in 40 adult patients, and submission to the authors. The study took place in the intensive care units of a public tertiary teaching hospital in the interior of the state of São Paulo, Brazil. The original CALCULATE has eight risk assessment items and is stratified with a score of 0-3 (high risk) and 4-8 (very high risk). Results: After expert evaluation, the final content validity was 0.9. They suggested words and phrases that should undergo changes regarding textual equivalences, as well as definitions of acronyms and terminologies. In the pre-test, the items were assessed as suitable for understanding; only one item required additional explanation for adequacy. Conclusion: The cross-cultural adaptation of CALCULATE for Brazilian Portuguese was successfully performed, revealing a good content validity index, confirming the relevance and appropriateness of its items. CALCULATE is suitable for use in intensive care units and research and teaching centers.

ABSTRACT Objective: To perform the cross-cultural adaptation of CALCULATE for Brazilian Portuguese. Method: A methodological study conducted from January to December 2021, divided into six stages: translation, synthesis, back-translation, expert committee with the application of the content validity index, pre-testing in 40 adult patients, and submission to the authors. The study took place in the intensive care units of a public tertiary teaching hospital in the interior of the state of São Paulo, Brazil. The original CALCULATE has eight risk assessment items and is stratified with a score of 0-3 (high risk) and 4-8 (very high risk). Results: After expert evaluation, the final content validity was 0.9. They suggested words and phrases that should undergo changes regarding textual equivalences, as well as definitions of acronyms and terminologies. In the pre-test, the items were assessed as suitable for understanding; only one item required additional explanation for adequacy. Conclusion: The cross-cultural adaptation of CALCULATE for Brazilian Portuguese was successfully performed, revealing a good content validity index, confirming the relevance and appropriateness of its items. CALCULATE is suitable for use in intensive care units and research and teaching centers.

RESUMO Objetivo: Realizar a adaptação transcultural do CALCULATE para o português brasileiro. Método: Estudo metodológico, desenvolvido de janeiro a dezembro de 2021 e dividido em seis etapas: tradução, síntese, retrotradução, comitê de especialistas com aplicação de índice de validade de conteúdo, pré-teste em 40 pacientes adultos e envio às autoras. O estudo ocorreu nas unidades de terapia intensiva em hospital público de ensino de nível terciário no interior do estado de São Paulo, Brasil. O CALCULATE original tem oito itens de avaliação (fatores de risco) e é estratificado com escore 0-3 (alto risco) e 4-8 (risco muito alto). Resultados: Após avaliação dos especialistas, a validade de conteúdo final foi de 0,9. Eles sugeriram palavras e frases que deveriam sofrer alterações quanto às equivalências textuais, assim como definições de siglas e terminologias. No pré-teste, os itens foram avaliados como adequados na compreensão; apenas um item precisou de explicação complementar para adequação. Conclusão: Foi realizada a adaptação transcultural do CALCULATE para o português do Brasil, a qual revelou ter bom índice de validade de conteúdo, sendo verificada a pertinência e relevância de seus itens. O CALCULATE está adequado para utilização em unidades de terapia intensiva e centros de pesquisa e ensino.

RESUMEN Objetivo: Realizar la adaptación transcultural de CALCULATE al portugués brasileño. Método: Un estudio metodológico llevado a cabo de enero a diciembre de 2021, dividido en seis etapas: traducción, síntesis, retrotraducción, comité de expertos con aplicación del índice de validez de contenido, preprueba en 40 pacientes adultos y envío a las autoras. El estudio se realizó en las unidades de cuidados intensivos de un hospital público de enseñanza terciaria en el interior del estado de São Paulo, Brasil. El CALCULATE original tiene ocho ítems de evaluación (factores de riesgo) y se estratifica con un puntaje de 0-3 (alto riesgo) y 4-8 (riesgo muy alto). Resultados: Después de la evaluación de los expertos, la validez de contenido final fue de 0,9. Sugirieron palabras y frases que debían cambiar en cuanto a equivalencias textuales, así como definiciones de siglas y terminologías. En la preprueba, los ítems se evaluaron como adecuados para la comprensión; solo un ítem requirió una explicación adicional para su adecuación. Conclusión: Se realizó con éxito la adaptación transcultural de CALCULATE al portugués brasileño, revelando un buen índice de validez de contenido, confirmando la relevancia y adecuación de sus ítems. CALCULATE es adecuado para su uso en unidades de cuidados intensivos y centros de investigación y enseñanza.

Abstract Background Several treatments are available for skin with advanced photodamage, which is characterized by the presence of actinic keratoses (AK). Objectives Evaluate the efficacy of using sunscreen with photolyase compared to regular sunscreen, as well as to compare the combination of a topical formulation of antioxidants versus placebo in the treatment of advanced photodamage. Methods This was a randomized, double-blind, factorial clinical trial. Participants with AKs on their forearms were randomized to apply regular sunscreen (SC) or sunscreen with photolyase (SC+P) on both forearms during the day. One of the forearms in each group was randomized again to receive topical antioxidants (AOx), and the other forearm received a placebo cream (both for night application). The four groups were SC/AOx, SC/placebo, SC+P/AOx, and SC+P/placebo. The duration of treatment was 8 weeks. Primary outcomes were total AK clearance, decrease in Forearm Photoaging Scale (FPS), and AK severity scores. Secondary outcomes were reduction in AK count, partial clearance rate, and safety. Results Forty participants (80 forearms) were included. All groups showed significant improvement in outcomes at week eight. There were no significant differences between SC and SC+P for either outcome. AOx led to a significant reduction in AK count (22%; p < 0.05). Partial clearance was obtained in 18 (47.4%) forearms treated with AOx and in 9 (23.7%) treated with placebo (p < 0.05). All groups reduced the FPS score, without significant differences among them. Conclusions There is no difference in the treatment of advanced photodamage skin when comparing the use of sunscreen with photolyase and regular sunscreen, and topical antioxidants were more efficient in reducing AK count than placebo. Study limitations Short interval of follow-up and absence of re-evaluation in the absence of treatment were limitations of the present study.

Objetivo: descrever o processo metodológico de adaptação cultural da Glamorgan Scale para o português do Brasil. Método: estudo metodológico de tradução e adaptação cultural da Glamorgan Scale, seguindo as seis etapas: tradução inicial, síntese das traduções, retrotradução, comitê de especialistas, pré-teste e envio da versão adaptada para aprovação ao autor do instrumento original. O comitê de especialistas foi composto por cinco doutores e, durante sua avaliação, foi realizada análise semântica, idiomática, cultural e conceitual. A concordância e a representatividade dos itens foram avaliadas por meio do Índice de Validade de Conteúdo. Considerou-se o valor mínimo de 80% de concordância. Resultados: todas as etapas do processo de tradução e adaptação transcultural foram satisfatórias. Na avaliação realizada pelo comitê de especialistas, todos os itens obtiveram concordância superior a 80% na primeira rodada de avaliação. A etapa do pré-teste permitiu uma visão crítica geral do instrumento, onde foram sugeridas pequenas modificações pelos participantes. Conclusão: a Escala de Glamorgan foi traduzida e adaptada culturalmente para o português do Brasil. Estudos psicométricos futuros são necessários para validação da escala.

Objective: to describe the methodological process of cultural adaptation of the Glamorgan Scale to Brazilian Portuguese. Method: a methodological study of translation and cultural adaptation of the Glamorgan Scale, following the six stages: initial translation, synthesis of translations, back-translation, committee of experts, pre-test, and submission of the adapted version to the author for approval. The committee of experts was composed of five physicians and, during evaluation, a semantic, idiomatic, cultural and conceptual analysis was carried out. The agreement and representativeness of the items were assessed using the Content Validity Index. A minimum value of 80% agreement was considered. Results: all stages of the translation and cross-cultural adaptation process were satisfactory. In the evaluation made by the committee of experts, all items obtained an agreement greater than 80% in the first evaluation round. The pre-test stage allowed for a critical overview of the instrument, where few modifications were suggested by the participants. Conclusion: the Glamorgan Scale was translated and culturally adapted to Brazilian Portuguese. Future psychometric studies are necessary to validate the scale.

Objetivo: describir el proceso metodológico de adaptación cultural de la Escala de Glamorgan al portugués de Brasil. Método: estudio metodológico de traducción y adaptación cultural de la Escala de Glamorgan siguiendo seis etapas: traducción inicial, síntesis de las traducciones, retrotraducción, comité de especialistas, prueba previa y envío de la versión adaptada para aprobación del autor. El comité de especialistas está formado por cinco médicos y, durante su evaluación, se realizó un análisis semántico, idiomático, cultural y conceptual. Se evaluó la concordancia y la representatividad de los ítems a través del Índice de Validez del Contenido. Se consideró un valor mínimo del 80% de concordancia. Resultados: todas las etapas del proceso de traducción y adaptación transcultural fueron satisfactorias. En la evaluación realizada por el comité de especialistas, todos los ítems obtuvieron un nivel de concordancia superior al 80 % en la primera etapa de evaluación. La etapa de la prueba previa permitió una visión crítica general del instrumento, en la cual los participantes sugirieron pocas modificaciones. Conclusión: se tradujo y se adaptó culturalmente la Escala de Glamorgan al portugués de Brasil. Se requieren estudios psicométricos futuros para validar la escala.

Abstract Background: Chronic leg ulcers affect a large portion of the adult population and cause a significant social and economic impact, related to outpatient and hospital care, absence from work, social security expenses, and reduced quality of life. The correct diagnosis and therapeutic approach are essential for a favorable evolution. Objective: To gather the experience of Brazilian dermatologists, reviewing the specialized literature to prepare recommendations for the diagnosis and treatment of the main types of chronic leg ulcers. Methods: Seven specialists from six university centers with experience in chronic leg ulcers were appointed by the Brazilian Society of Dermatology to reach a consensus on the diagnosis and therapeutic management of these ulcers. Based on the adapted DELPHI methodology, relevant elements were considered in the diagnosis and treatment of chronic leg ulcers of the most common causes; then, the recent literature was analyzed using the best scientific evidence. Results: The following themes were defined as relevant for this consensus - the most prevalent differential etiological diagnoses of chronic leg ulcers (venous, arterial, neuropathic, and hypertensive ulcers), as well as the management of each one. It also included the topic of general principles for local management, common to chronic ulcers, regardless of the etiology. Conclusion: This consensus addressed the main etiologies of chronic leg ulcers and their management based on scientific evidence to assist dermatologists and other health professionals and benefit the greatest number of patients with this condition.

Abstract Venous ulcers are the main causes of chronic lower-limb ulcers. The healing difficulties encourage the research and development of new products in order to achieve better therapeutic results. Fibrin sealant is one of these alternatives. Besides being a validated scaffold and drug delivery system, it possesses excellent healing properties. This review covered the last 25 years of the literature and showed that the fibrin sealant is used in various clinical situations to promote the healing of different types of ulcers, especially chronic ones. These are mostly venous in origin and usually does not respond to conventional treatment. Commercially, only the homologous fibrin sealants obtained from human blood are available, which are highly efficient but very expensive. The heterologous fibrin sealant is a non-commercial experimental low-cost product and easily produced due to the abundance of raw material. The phase I/II clinical trial is already completed and showed that the product is safe and promisingly efficacious for the treatment of chronic venous ulcers. In addition, clinical proteomic strategies to assess disease prognosis have been increasingly used. By analyzing liquid samples from the wounds through proteomic strategies, it is possible to predict before treatment which ulcers will evolve favorably and which ones will be difficult to heal. This prognosis is only possible by evaluating the expression of isolated proteins in exudates and analysis using label-free strategies for shotgun. Multicentric clinical trials will be required to evaluate the efficacy of fibrin sealant to treat chronic ulcers, as well as to validate the proteomic strategies to assess prognosis.

Abstract: Ulcers or wounds can be classified as acute or chronic. Their treatment involves overall assessment of the patient and choice of suitable local therapy, and the appropriate indication and use of products. Technological progress in the field of wound treatment has increased rapidly. Constant updating, with emphasis on available scientific evidence, is necessary to offer the best approaches to patients with acute and chronic wounds. A qualitative analysis of literature was conducted to identify scientific publications that update the concepts involved in local wound treatment, to present some resources that can aid the healing process and describe the different types of dressings available. This review includes wound assessment using the acronym TIME (tissue, infection/inflammation, moisture balance and edge of wound), cleaning and debridement, infection/inflammation control, exudate control, dressing types and main indications.

Abstract: Background: Venous ulcers represent 70% of the lower limb ulcers. They are difficult to heal, requiring a correct diagnostic and therapeutic approach. Many products have been developed to healing, such as homologous platelet gel obtained from the platelet concentrate exceeding from blood transfusion. Objective: To evaluate the safety and efficacy of homologous platelet gel in venous ulcers compared with hydrocolloid dressing. Method: A pilot randomized clinical trial in patients with venous ulcers. Randomized groups (homologous platelet gel and hydrocolloid groups) were followed for 90 days and were assessed through the evolution of ulcerated area, qualitative analysis of vascularization and adverse events. Both groups used elastic compression. Results: We included 16 participants, with a total of 21 venous ulcers. Both treatments promoted a reduction of the areas of the ulcers in 90 days (mean 69%), there was significant difference between the groups concerning the gradual reduction of the ulcers areas, favorably to the hydrocolloid (70% vs 64%; p <0.01). There were some mild adverse events in both groups. Study limitations: Single-center study with a small number of patients, preventing more accurate assessment of the effects of platelet gel. Conclusion: The homologous platelet gel associated with the elastic compression can be an alternative to the venous ulcer treatment and is safe due to the occurrence of a few mild local adverse events and no serious adverse events. Clinical trials with larger numbers of patients must be performed to maintain the indication of this treatment for venous ulcer.

BACKGROUND: squamous cell carcinoma is the second most common type of skin malignancy and may evolve to regional lymph node and distant metastases. OBJECTIVE: The objective of this study was to evaluate patients with head and neck cutaneous squamous cell carcinoma to identify its clinical and histopathological characteristics, as well as the frequency of local recurrence and metastasis. METHODS: A retrospective cohort of patients with head and neck cutaneous squamous cell carcinoma. Inclusion criteria: histopathological confirmation, follow-up for longer than one year after diagnosis. Exclusion criteria: immunosuppression; lip and oral cavity squamous cell carcinoma; and non-surgical resection of the lesion. We evaluated demographic, clinical and anatomopathologic findings and explored their associations. RESULTS: Sixty-one patients with 79 tumors and followed by 4.8±3.0 years were selected. The average age was 67.1 years, and 63% of tumors had up to two centimeters. Seven tumors (8.9%) recurred and two of them had positive margins. Recurrence was associated with higher Broders' grade (p<0.01). Two patients (3.3%) had regional lymph node metastases. There were no distant metastases. Seventy tumors were considered to be usual tumors (89.7%), and 68 (87.2%) were classified as Broders' grade 1 and 2. Additionally, 64.1% of tumors had a depth of invasion below four millimeters. Thirteen tumors (16.7%) had positive histological margins. CONCLUSIONS: Most patients had good prognosis in the first year of follow-up, confirming that head and neck cutaneous squamous cell carcinoma has a better prognosis than squamous cell carcinoma of other regions such as mucosa, oral cavity, and internal organs.

BACKGROUND:Venous ulcers have a significant impact on patient quality of life, and constitute a worldwide public health problem. Treatment is complex, with high failure rates.OBJECTIVES:To identify clinical and therapeutic factors that influence healing of venous ulcers.METHODS:Retrospective cohort study of patients with venous ulcers. Ulcer area was measured at the first visit (T0) and after 6 months (T6) and 1 year (T12). A reduction in ulcer area of 50% or more at T6 and T12 was the outcome of interest, weighted by clinical, demographic and treatment aspects.RESULTS:Ninety-four patients were included (137 ulcers). A reduction in ulcer area of 50% or more was seen in 40.1% of patients (95%CI 31.9 to 48.4%) at T6 and 49.6% (95%CI 41.2 to 58.1%) at T12. Complete healing occurred in 16.8% (95%CI 10.5 to 23.1%) at T6 and 27% (95%CI 19.5 to 39.5%) at T12. The lowest ulcer area reductions at T6 were associated with longstanding ulcer (RR=0.95; 95%CI 0.91 to 0.98), poor adherence to compression therapy (RR=4.04; 95%CI 1.31 to 12.41), and infection episodes (RR= 0.42; 95%CI 0.23 to 0.76). At T12, lower reductions were associated with longstanding ulcer (RR=0.95; 95%CI 0.92 to 0.98), longer topical antibiotic use (RR=0.93; 95%CI 0.87 to 0.99), and systemic antibiotic use (RR=0.63; 95%CI 0.40 to 0.99).CONCLUSIONS:Longstanding ulcer, infection, poor adherence to compression therapy, and longer topical and systemic antibiotic use were independently correlated with worse healing rates.

Hay-Wells syndrome or AEC (Ankyloblepharon, Ectodermal dysplasia and Cleft lip and palate syndrome) is a rare ectodermal disorder. The treatment is aimed to prevent clinical complications. We describe the case of a four-month old male patient with erosions on the scalp, trunk and arms, trachyonychia, deformity of the ears, micropenis, cleft palate, decreased eyebrow and eyelash hairs, in addition to antecedents of surgical correction of ankyloblepharon. The importance of the correct diagnosis is emphasized, besides the investigation of the associated diseases, treatment of complications and genetic counseling of the parents.

O artigo revisa os conceitos diagnósticos e de classificação da micose fungóide e da síndrome de Sézary a luz das publicações normativas mais recentes. Descreve a grande variabilidade de expressão clinica da micose fungóide em seus estágios iniciais assim como os aspectos histopatológicos e imuno-histoquímicos auxiliares ao diagnóstico. São descritos os critérios de diagnósticos exigidos para que se caracterize a síndrome de Sézary e o sistema de estadiamento, utilizado para ambas, micose fungóide e síndrome de Sézary.

This paper reviews the diagnostic and classificatory concepts of mycosis fungoides and Sézary syndrome in light of the latest normative publications. It describes the great variability of the clinical expression of mycosis fungoides in its early stages as well as the histopathological and immunohistochemical aspects that help with diagnosis. The diagnostic criteria required for characterizing Sézary syndrome and the staging system used for both mycosis fungoides and Sézary syndrome are described.