Resumo em Inglês:

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.

Resumo em Inglês:

Abstract Background: Linear IgA bullous dermatosis (LABD) is an uncommon disease with only a few reported studies in large series with long follow-up periods. Objectives: To evaluate the clinical presentation, immunopathological features, management, and disease course in LABD patients. Methods: Data including demographics, clinical features, histopathological and immunofluorescence findings of LABD patients, in addition to the preferred treatments and responses to treatments were evaluated. Results: Among 26 patients diagnosed with LABD, 17 (65.4%) were female. The mean age was 40.3 ± 22.4 (6-80) years of whom 21 were adults. The most common mucosal involvement was oral (n = 9, 34.6%). Continuous linear IgA deposition was present on the basement membrane zone of all patients in addition to C3 (n = 13), IgG (n = 9), IgM (n = 4), and fibrinogen (n = 4). Three patients were lost to follow-up without any treatment. Dapsone was the treatment of choice in most (n = 21, 91.3%) patients in addition to systemic corticosteroids (n = 17), azathioprine (n = 3), tetracycline and nicotinamide (n = 2). Complete and partial remissions were achieved in 11 (47.8%) and 12 (52.2%) patients, respectively, in a mean follow-up period of 45.9 ± 43.9 (3-158) months. Furthermore, 17 patients were still under treatment at the end of the follow-up period. Study limitations: Retrospective study conducted in a single center. Conclusions: LABD may occur at two separate peaks, one in the second and the other in the sixth decade of life with a female predominance. Other immunoglobulins may be associated with dominant IgA antibody deposition and the most commonly used therapeutic option for LABD patients was oral dapsone.

Resumo em Inglês:

Abstract Background: The positioning of substances, which are co-sensitizers and/or with a tendency to cross-react, is not considered in the technique when applying patch tests (PT). Objective: To investigate the interference of the positioning of nickel (Ni), chromium (Cr) and cobalt (Co) in patch tests (PT) results, when applied close or distant from each other. Methods: PT were performed in patients suspected of allergic contact dermatitis (ACD), using the standard battery (SB), with substances showing a tendency towards cross-react and cosensitizers applied far apart, and an additional battery (AB) with the metals placed close to each other. For tabulation purposes, only the 96-h reading was considered. Results: Of the 86 tested patients, 33 (38%) had negative testing for metals and 53 (62%) had one or more positive (+) tests for Ni, Cr and/or Co. Concordant results in both tests (SB/ AB) occurred in 18/53 (34%) and 35/53 (66%) had discordant results. Regarding the SB, of the 159 tests with metals (53 patients, three metals), 57 tests were (+) and 102 (-). In the AB, 87 tests were (+) and 72 (-), a statistically significant difference (p < 0.05). Of the 57 (+) tests in the SB, 35 were for Ni, 18 for Co and four for Cr. In AB the number of (+) tests was 87, with 45 (+) tests for Ni, 35 for Co and seven for Cr. The difference in the number of positive tests between the two batteries was statistically significant for Co and Ni. Study limitations: The number of cases. Conclusion: The results showed that the positioning of the metals interferes with the PT results and should be considered as part of the PT application technique.

Resumo em Inglês:

Abstract Background: Eccrine porocarcinoma (EPC) is a rare cutaneous neoplasm, commonly arising from its benign counterpart, eccrine poroma (EP), but potential unrevealed clinicopathological differences between them are not well understood. Objectives: This study aimed to identify clinicopathological features of EP and EPC and describe the factors that may be associated with the malignant transformation of EP by comparing the two groups. Methods: A total of 37 cases of EP and 22 cases of EPC diagnosed between January 2017 and June 2023 were retrospectively reviewed, and the clinical and histopathological characteristics were compared using statistical methods. Results: Clinical and histopathologic data such as age, gender, site, clinical presentation, and histopathologic characteristics were collected. The EPC group was more common in older patients, with more cases located in exposed areas, and the patients with EPC had larger lesions with a higher incidence of ulceration. Histopathological features showed significant differences in tumor architecture, ulceration, squamous differentiation, spindle cell changes, central necrosis, and diffuse inflammatory infiltration between the two groups. Study limitations: This study has limitations due to a small number of cases with potential experimental bias. Conclusion: The clinicopathological features of EP and EPC were compared in this study and the results may assist clinicians in diagnosis and management of these tumors by helping to identify potential factors associated with the malignant transformation of EP.

Resumo em Inglês:

Abstract Background: There are few studies in the literature comparing the effectiveness of topical treatments in early-stage mycosis fungoides (MF). Objectives: It was aimed to evaluate the clinical efficacy, side effects and topical treatment compliance with bexarotene or clobetasol propionate in early-stage MF. Methods: A total of 40 patients with stage IA-IB MF were enrolled in the study. Twenty patients were treated with 1% bexarotene gel and 20 patients were treated with 0.05% clobetasol propionate ointment. Results: In the bexarotene group, 11 patients (55%) had complete clinical response (CCR) and 5 patients (25%) had partial response (PR) while in the clobetasol propionate group, 10 patients (50%) had CCR and 9 patients (45%) had PR. The median duration of remission was 10.5 months in the bexarotene group and 4 months in the clobetasol propionate group. The remission period was statistically significantly longer in the bexarotene group (p = 0.032). Irritation symptoms were statistically significantly more common in the bexarotene group (p = 0.001). Study limitations: The limitation of the study was its retrospective design. Conclusion: Both topical bexarotene and topical clobetasol propionate were found to be effective in MF. Irritation symptoms were more common with topical bexarotene. Moreover, the remission period with topical bexarotene was significantly longer.

Resumo em Inglês:

Abstract Background: Conventional systemic corticosteroid therapy for bullous pemphigoid (BP) has been challenged due to severe adverse events. Dupilumab has emerged as an alternative therapeutical option of BP patients. Objectives: To evaluate the efficacy of dupilumab monotherapy and the combination with medium/low-dose corticosteroids for BP treatment. Methods: Thirteen, twenty-four and thirty-two BP patients treated with Dupilumab monotherapy (Dupi group), dupilumab combined with corticosteroids (Dupi + CS group), and corticosteroid monotherapy (CS group), respectively, were retrospectively analyzed for various clinical and laboratory parameters. Results: In the Dupi group, the total Bullous Pemphigoid Disease Area Index (BPDAI) Total, Erosion/Blister, Urticaria/Erythema and Itching NRS scores were all reduced significantly after 2-4 weeks of treatment, but the BPDAI Mucosal Score was not changed significantly at the end of the overextended time of treatment. All the above clinical parameters and many laboratory parameters (including the serum anti-BP180 autoantibodies [IgG] level, blood eosinophil count, and percentage) were significantly reduced in both Dupi + CS and CS groups after treatment, but no statistical differences were found in the reduction rates of these parameters between the two groups. However, the Dupi + CS group had less baseline dose and cumulative dosage of prednisone at the time of disease control, and fewer adverse effects were reported than the CS group. Study limitations: The retrospective design and small clinical sample size of the Dupi group. Conclusions: For BP patients, dupilumab monotherapy based on the treatment of atopic dermatitis can significantly improve skin lesions and pruritus symptoms but may be ineffective for oral mucosal lesions. The combination of dupilumab and medium/low-dose corticosteroids can achieve the same effect of corticosteroid therapy with superior safety.

Resumo em Inglês:

Abstract Background: Psoriasis is a chronic inflammatory skin disease with a genetic predisposition and autoimmune component, often treated with immunomodulators such as biologic therapies. Objectives: In this study, the authors evaluated the effectiveness and safety of two of these over a 52-week treatment period. Methods: A double-center retrospective cohort study was conducted, enrolling patients with moderate to severe psoriasis who received either guselkumab or risankizumab at dermatology clinics for a minimum of 52-weeks. Result: Out of the 90 patients enrolled in the study, 49 (54.4%) received guselkumab, while 41 (45.6%) received risankizumab. Regarding therapy efficiency, there was no statistically significant difference in PASI90 and PASI100 at week 4 between the two groups (p = 0.428, p = 0.750, respectively). By week 16, PASI90 responses were higher in the guselkumab group (p = 0.039). However, there was no difference in PASI100 response at week 16 (p = 0.957). At weeks 24 and 52, PASI90 and PASI100 responses were similar in both groups. Our results demonstrated that both guselkumab and risankizumab were effective in patients who had previously failed other biologics. Clinical outcomes in both the guselkumab and risankizumab groups had remained unaffected during prior biologic treatments, including anti-TNF, anti-IL17, and/or anti-IL12/23. Treatments yielded consistent outcomes regardless of factors such as obesity, gender, and comorbidities. Study limitations: The small sample size. Conclusions: Our results demonstrated that both guselkumab and risankizumab were effective in patients who had previously failed other biologics. Clinical outcomes in both the guselkumab and risankizumab groups had remained unaffected during prior biologic treatments, including anti-TNF, anti-IL17, and/or anti-IL12/23. Treatments yielded consistent outcomes regardless of factors such as obesity, gender, and comorbidities.

Resumo em Inglês:

Abstract Background: Cutaneous tuberculosis is a rare form of the disease that defies diagnosis due to the diversity of clinical presentations. This study was based on the reality of a dermatology referral center in the Brazilian Amazon region to detail several characteristics of this disease. Objective: To describe a series of cases of cutaneous tuberculosis treated at a dermatology service in the Brazilian Amazon region, addressing epidemiological aspects, clinical forms, diagnostic methods, treatment, and outcomes. Methods: This is a descriptive and observational study of the case series type, including eight patients with a confirmed diagnosis of cutaneous tuberculosis seen between 2021 and 2023. A standardized protocol was used to collect data from patients’ medical records. Results: Among the eight cases of cutaneous tuberculosis, there were four cases of erythema induratum of Bazin, one case of tuberculosis verrucosa cutis, two cases of scrofuloderma, and one case of lupus vulgaris. Erythema induratum of Bazin, the most common form in the study, occurred predominantly in women, presenting as infiltrated plaques and erythematous nodules. All eight cases were treated with the standard therapeutic regimen of the Brazilian Ministry of Health (rifampicin, isoniazid, pyrazinamide, and ethambutol). Study limitations: They include the small sample size, making generalizations difficult. Conclusions: The study addressed the clinical diversity of cutaneous tuberculosis, with erythema induratum of Bazin as the most common form. The importance of the socioeconomic context in the prevalence of the disease and the need for more comprehensive epidemiological studies to improve the understanding of cutaneous tuberculosis, especially in endemic regions, are highlighted.

Resumo em Inglês:

Abstract Background: Skin cancer is the most common neoplasm among Brazilians, accounting for 31.3% of all cancer cases in the country. Objectives: To analyze the longitudinal morbimortality of skin cancer and compare it with the latitude and the prevalence of white skin color in each federative unit of the country. Methods: An ecological observational study was carried out using data from the Hospital Information System (SIH) and the Mortality Information System (SIM). Results: In Brazil, morbidity rates (per 100,000 inhabitants) increased from 14.88 to 27.69(p < 0.05) when comparing the years 2012 and 2022, whereas the mortality rates (per 100,000 inhabitants) increased from 0.35 to 0.54 (p < 0.05) during the same period. Furthermore, most states showed an increase in morbimortality rates. Concerning race/ethnicity, individuals with white skin had the highest morbimortality rates. Regarding the age groups, individuals over 50 years old had the highest morbidity rates, while patients over 80 years old had the highest mortality rates, at 23.29%. Finally, the latitude showed a negative correlation, meaning that lower latitudes presented higher rates of morbidity and mortality from skin cancer. Study limitations: Self-reporting of skin color by participants, which may not fully correspond to phototypes. Data was analyzed exclusively from hospitalizations through the Unified Health System (SUS) and severe cases of the disease, as this study focused on hospitalizations and mortality, considering that the main treatment for skin cancer is carried out on an outpatient basis. Conclusions: The majority of Brazilian states showed rising morbimortality rates during the period, with the white-skinned population being the most affected. Additionally, a negative correlation with latitude was observed.

Resumo em Inglês:

Abstract: Background: Psoriasis, a chronic, inflammatory skin disease, requires long-term therapy. Risankizumab is a humanized immunoglobulin G1 monoclonal antibody that specifically inhibits interleukin 23 by binding to its p19 subunit. Objective: The authors assessed the efficacy and safety of risankizumab compared with methotrexate in adults with moderate-to-severe plaque psoriasis. Methods: IMMbrace was a phase 3, multicenter, randomized, double-blind, double-dummy, active-controlled study. Patients received subcutaneous risankizumab 150 mg at weeks 0, 4, and 16 plus oral placebo weekly, or oral methotrexate 5 mg weekly (with dose escalation up to 25 mg based on response and tolerability) plus subcutaneous placebo at weeks 0, 4, and 16. Primary efficacy endpoints were the proportions of patients who achieved ≥ 90% improvement in Psoriasis Area and Severity Index (PASI90) and static Physician’s Global Assessment of clear/almost clear (sPGA 0/1) at week 28. Safety was also assessed. Results: Among 98 patients randomized (risankizumab, n = 50; methotrexate, n = 48), 95 completed the double-blind period. At week 28, significantly higher proportions of patients treated with risankizumab versus methotrexate achieved PASI90 (84.0% vs. 35.4%; p < 0.001); sPGA 0/1 was achieved by 90.0% and 64.6% of patients in the risankizumab and methotrexate groups(p ≤ 0.001). Risankizumab efficacy was maintained throughout week 112. Adverse event rates were similar in the two groups. Study limitations: The sample size was small due to the difficulty of recruiting patients without methotrexate use. Conclusions: Risankizumab demonstrated superior efficacy over methotrexate at week 28; efficacy was maintained, and no new safety findings were observed through week 112.

Resumo em Inglês:

Abstract Keloid is a common fibrotic disease, which is difficult to treat. It often causes itching and pain, which greatly disturbs patients in their work and daily life and causing difficulties in social interaction. Its pathogenesis is not clear, but may be related to several aspects: genetic susceptibility, environmental, immunological and endocrine factors, trauma and tension. The central point of its pathogenesis is the excessive proliferation of fibroblasts, with excessive synthesis and secretion of extracellular matrix such as collagen. However, the cause of fibroblast excessive proliferation and differentiation is not clear. Immune abnormalities may play an important role, with cytokines, chemokines, growth factors, and other important immune molecules acting on fibroblasts. This paper presents a detailed and comprehensive literature review on this subject.

Resumo em Inglês:

Abstract Male androgenetic alopecia (MAA) is quite common and worsens with age, with a significant impact on quality of life, and is increasingly a reason for consultation with a dermatologist. The etiopathogenesis of MAA is multifactorial and genetic and hormonal influences stand out. MAA starts with the process of follicular miniaturization in diverse phenotypic patterns. The diagnosis of MAA is basically clinical and currently corroborated by well-established trichoscopic findings. Despite this, therapeutic options are limited, especially when one considers medications with a high level of scientific evidence. This review aims to help the general dermatologist towards a better understanding of MAA providing a basis for good individualized and judicious therapeutic decisions.

Resumo em Inglês:

Abstract Hair holds a significance that surpasses mere aesthetics, as it plays a pivotal role in our social interactions and contributes significantly to the definition of our self-esteem. Central to this understanding is the concept of the exposome, which encompasses intrinsic elements like genetics and physiological changes, as well as extrinsic factors such as UV radiation, pollution, lifestyle choices, and chemical treatments. These factors may significantly impact hair health and hair aging. Expanding upon the groundwork laid by the first part of this research (Cedirian et al., 2024), this study aims to deepen our understanding of exposome influence on hair. Specifically, through a narrative review of current literature, this second part endeavors to provide non-pharmacological treatment solutions and effective strategies to mitigate the negative impact of the exposome on hair health.

Resumo em Inglês:

Abstract Background: Alopecia areata is a highly frequent disease with great variability in clinical presentation, severity, and prognosis. It has a significant negative impact on quality of life, especially in the moderate and severe forms. Objective: To disseminate guidelines, prepared by a group of Brazilian experts, for the treatment and follow-up of patients with alopecia areata. Methods: Eight specialists from different university centers with experience in alopecia areata were appointed by the Brazilian Society of Dermatology to reach a consensus on its treatment. Using the adapted DELPHI methodology, relevant elements were considered and then an analysis of the recent literature was carried out and the text produced. Consensus on the guidelines was defined with the approval of at least 70% of the panel of experts. Results/Conclusions: Treatments vary according to patient age and disease severity. Intralesional injectable corticosteroid therapy was considered the first option for localized disease in adults. In severe cases, Janus Kinase inhibitors are the treatment with the highest levelof evidence. Systemic corticosteroid therapy and immunosuppressants (corticosteroid-sparing agents) are also options in these cases. Contact immunotherapy (diphencyprone) is an alternative for stable extensive cases. The assessment of side effects is as important as the hair regrowth rate.