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Abstract Syphilis, an infection caused by Treponema pallidum, transmitted predominantly through sexual contact, affects several organs, causing skin, mucous membranes and systemic lesions. Despite being a secular disease, it still poses a major challenge for the public health system, since the number of cases continues to increase after years of warnings from the scientific community. Recognizing the clinical manifestations is essential for formulating the clinical hypothesis and diagnostic confirmation with complementary exams. However, recognizing skin lesions is not always simple, given the diversity of clinical manifestations which resemble other diseases. This review presents an overview of the disease, with current epidemiological data, a representation of the various clinical manifestations, a description of the pertinent diagnostic methods for laboratory confirmation, and appropriate therapeutic approaches for each clinical form.

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Abstract: Background: Atopic dermatitis (AD) burden increases with disease severity. Objective: Characterize the real-world burden of AD in Brazil, Mexico, and Argentina. Methods: MEASURE-AD enrolled patients (≥12-years old) with moderate to severe AD receiving or candidates for systemic therapy between December 2019-December 2020. Patient characteristics, treatments, and outcomes were recorded during one office visit. Primary outcome measures included worst itch/past 24 hours (Worst Pruritus Numerical Rating Scale [WP-NRS]), quality of life (QoL, Dermatology Life Quality Index [DLQI] and Children’s DLQI [CDLQI]). Results: Of 180 patients (adults, n = 157; adolescents, n = 23), 52.2% were male, the mean (SD) age was 33.8 (17.0) years, and all were receiving AD treatment (65.6% systemic therapy). Severe pruritus (WP-NRS ≥ 7) was reported by 54.4% (adults, 57.3%; adolescents, 34.8%). A very/extremely large effect on QoL (DLQI/CDLQI ≥ 11) was reported among 50.0% of patients ≥ 16 years old and 42.9% of patients 12-15 years old. The mean Eczema Area Severity Index (EASI) was 17.0 (adults, 17.7; adolescents, 12.4); 3.9% of patients had clear skin (EASI 0) and 26.7% had severe AD (EASI 23-72). Over the previous 6 months, 0, 1-2, 3-4, 5-6, and > 6 flares were reported by 8.3%, 27.2%, 31.1%, 11.7%, and 15.6% of patients, respectively. On average, flares lasted 15.2 days (adults, 15.9 days; adolescents, 11.1 days). Study limitations: Patient self-reported information and recall during one office visit. Conclusions: Despite treatment, disease severity and impact on QoL were high, suggesting that AD is not adequately controlled in all patients, highlighting a considerable unmet need for effective treatments to reduce AD burden.

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Abstract Background: Psoriasis is an inflammatory skin disease associated with Metabolic Syndrome (MetS), Steatotic Liver Disease (SLD) and cardiovascular risk. However, the effect of antiinflammatory therapy on cardiovascular risk is uncertain. Objectives: To determine the relationship between anti-inflammatory therapy and subclinical atherosclerosis in individuals with psoriasis, using the gold standard carotid-femoral Pulse Wave Velocity (cf-PWV) measurement. Additionally, to evaluate the association between cf-PWV, steatosis and Advanced Fibrosis (AF) using Transient Elastography (TE) by Fibroscan®. Methods: Cross-sectional study including psoriasis patients submitted to cf-PWV and TE. Steatosis was defined as a controlled attenuation parameter ≥ 275 dB/m, AF as liver stiffness measurement ≥ 10 kPa, and increased Aortic Stiffness (AoS) as cf-PWV ≥ 10 m/s. Significant cumulative methotrexate dose was ≥ 1500 mg (MTX1500). Logistic regression analysis evaluated the independent variables associated with increased AoS. Results: Eighty patients were included (mean age 56.2 ± 11.5-years, 57.5% female, BMI 28.6 ± 5.3 kg/m2). Prevalences of MetS, diabetes mellitus, dyslipidemia, systemic arterial hypertension, steatosis and AF were 57.5%, 40.0%, 67.5%, 70.0%, 50.0% and 16.3%, respectively. MTX1500 was present in 45%, immunobiological treatment in 33.8%, and cf-PWV ≥ 10 m/s in 21.2%. On logistic regression analysis, age was independently related to cf-PWV ≥ 10 m/s (OR = 1.21; 95% CI 1.06-1.38; p = 0.003) and MTX1500 was a protective cardiovascular factor (OR = 0.18; 95% CI 0.038-0.87; p = 0.033). No association was observed between steatosis, AF or immunobiological therapy and cf-PWV ≥10 m/s. Study limitations: Sample size. Conclusion: In patients with psoriasis, increased AoS was associated with age, but not with steatosis or AF. A protective cardiovascular effect of MTX was found in a psoriasis population with a high prevalence of MetS and its components.

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Abstract Background: Pyoderma gangrenosum (PG) is a rare dermatosis often associated with systemic diseases. There are autoinflammatory mechanisms with neutrophilic infiltrate and necrosis. Due to the high morbidity, variable response to therapy and lack of treatment standardization, PG constitutes a highly burdensome condition. Objectives: To evaluate the epidemiological, clinical and laboratory features and response to therapy of patients with PG followed at HCFMUSP. Methods: This retrospective and descriptive study included patients with confirmed PG under follow-up at HCFMUSP from January 2000 to August 2021. Data were retrieved from medical records. Results: Fifty patients were included. The mean time from the onset of symptoms to diagnosis was 26.5 months. Lesions predominated on the lower extremity in 72% (n = 36/50), and the ulcerative type was the most common (n = 43/50; 86%). Local pain was mentioned in 39/50 (78%) and 12/50 (24%) presented pathergy. The most frequently associated diseases were inflammatory bowel disease (n = 10/20; 20%) and hidradenitis suppurativa (n = 10/20; 20%). High-dose systemic corticosteroid was mostly the first therapy (88%), either alone (n = 7/50; 14%) or in association with classic immunosuppressants or immunobiologicals (n = 37; 74%). Most patients (n = 32/50; 64%) had at least one hospitalization. Disease control was achieved in 44/50 (88%), with recurrences in 48% (n = 24/50) and total healing without medication in 24% (n = 12). Sixteen patients (32%) were treated with at least 1 immunobiological agent in addition to classic drugs. Study limitations: Retrospective, descriptive design and number of patients. Conclusions: There was delay in diagnosis, association with systemic and cutaneous conditions, and the need for prolonged immunomodulatory or immunosuppressive therapy (classic agents and also biologic agents) to control PG.

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Abstract Background: Renal transplant recipients (RTRs) use a combination of immunosuppressive agents: a corticosteroid; a calcineurin inhibitor (cyclosporine or tacrolimus) and an antimetabolic agent (azathioprine [AZA] or a mycophenolic acid precursor [MPA] - Mycophenolate mofetil or sodium) or an mTOR inhibitor (mTORi) - sirolimus or everolimus. These treatments increase the incidence of various neoplasms, especially non-melanoma skin cancers (NMSCs). Objectives: To evaluate the histopathological alterations in the skin of the RTRs under three different immunosuppressive regimens: one mTORi (sirolimus or everolimus); or one antimetabolic agent (MPA or AZA), comparing them by groups and with healthy controls. Methods: This was a cross-sectional comparative study of 30 patients selected from the Renal Transplant Service and divided into three groups: mTORi (n = 10), MPA (n = 10), and AZA (n = 10). The control group consisted of 10 immunocompetent non-transplanted volunteers. All RTRs were using tacrolimus and prednisone. Each participant underwent two biopsies of intact skin: one in a sun-protected and another in a sun-exposed area. The specimens were analyzed without previous information on which group they belonged to. Results: The most significant histopathological change was thinning of the epidermis in the mTORi group, both in photoexposed and photoprotected skin. Study limitations: The study was conducted on a limited number of patients, which may influence the representativeness of the results. Conclusions: Only RTRs treated with mTORi presented interruption of epidermal proliferation. These findings help to understand the influence of these different types of immunosuppressive regimens and their subsequent potential effects on carcinogenesis.

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Abstract Background: Life expectancy is rising in developed countries. The impact of age on melanoma characteristics is unclear, but it seems that melanomas in the elderly have distinct features affecting management and outcomes. Objectives: To compare clinical and histopathological melanoma characteristics and management in elderly and younger patients. Methods: A retrospective population-based study analyzed melanomas observed between 2007 and 2022 was made in the southern Seville health area (Spain). Patients were divided into two age groups: <65 and ≥65. Data were collected from clinical histories. Results: Among 431 primary cutaneous melanomas, 33% were in patients ≥65-years. Elderly patients had more head and neck melanomas (37.8% vs. 14.9%; p < 0.001), larger lesions (1.3 vs. 0.9 cm; p < 0.001), more ulcerated melanomas (17.8% vs. 8.8%; p < 0.012), and higher Breslow thickness (1.03 vs. 0.65 mm; p < 0.01) than younger patients. No differences were found in the number of mitoses or histopathological invasions. Stage 0 and more advanced stages (II/III/IV) were observed more frequently in ≥65-years (29.3% vs. 23% and 27.1% vs. 15.7%, p < 0.001 respectively). Fewer wide excisions (28.4% vs. 5.6%, p < 0.001), sentinel lymph node biopsy (17.6% vs. 2.4%, p < 0.001), and adjuvant therapy (11.9% vs. 2.1%, p < 0.001) were performed in patients ≥ 65-years. Study limitations: The study was retrospective, primarily covering the last 10-years, with older data missing. Key risk factors like the number of nevi and family history of melanoma were not collected. Conclusions: Melanomas in the elderly were diagnosed more frequently at initial and advanced stages despite having worse prognostic characteristics compared melanomas occurring in younger people.

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Abstract Objective: Evaluate the safety and efficacy of dupilumab in treating moderate-to-severe bullous pemphigoid. Methods: The authors performed a systematic review and meta-analysis of comparative studies of Dupilumab combined with corticosteroids and conventional corticosteroid therapy alone in patients with moderate-to-severe bullous pemphigoid. PubMed, Embase and Cochrane databases were searched for studies published up to December 2023. Data were extracted from published reports and quality assessment was performed according to Cochrane recommendations. Results: A total of four studies involving 127 patients were included, of which 53 received Dupilumab combined with corticosteroids, while the other 74 were administered corticosteroids alone. Regarding efficacy, Dupilumab the time before new blister formation stopped (MD = -5.13 days; 95% CI -7.12 to -3.15; p < 0.0001) and demonstrated a greater reduction in Bullous Pemphigoid Disease Area Index (MD = -3.90; 95% CI -5.52 to -2.27; p < 0.0001) and Numeric Rating Scale for Pruritus (SMD = -1.37; 95% CI -2.02 to -0.72; p < 0.0001) compared with patients who received conventional therapy. However safety endpoints, adverse events (RR = 0.78; 95% CI 0.58 to 1.05; p = 0.10) and relapses (RR = 0.50; 95% CI 0.19 to 1.36; p = 0.17) showed no significance. The main limitations were retrospective studies with small samples and limited results in clinical practice and a moderate overall risk of bias. Conclusion: Compared with conventional therapy, Dupilumab decreased the time before new blister formation stopped in 5.13 days, as well as Disease Area Index and Pruritus, without interfering with adverse events and relapse.

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Abstract Background: Hand dermatitis (HD) is a prevalent inflammatory skin disease with a significant socioeconomic impact. Objectives: To characterize the population of HD patients followed up at the Department of Dermatology of a tertiary hospital. Methods: A cross-sectional, retrospective and descriptive study was carried out through the analysis of medical records of HD patients assisted at the Allergy Clinic of the Department of Dermatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, between March 1, 2016 and August 31, 2022. Results: Of the 175 patients, 73.3% were women, and the mean age at the onset of the condition was 41.7 years. There was a statistically significant association between occupation categories and the presence of occupational dermatitis. Cases were classified as irritant contact dermatitis (49.7%), allergic contact dermatitis (57.1%) and endogenous vesicular HD (3.4%). It was observed a statistically significant higher frequency of patch tests positivity for methylchloroisothiazolinone and methylisothiazolinone (MCI/MI) and nickel sulfate in women and for potassium bichromate and carba mix in men. DLQI was assessed in 77 patients, and the average score was 7.8 points. Study limitations: As limitations, the authors point out data collection from medical records, which lacked some information. Furthermore, as this was a cross-sectional study, it was not possible to assess cause-and-effect relationships between the variables. Conclusions: The present data reinforces the importance of patch tests in HD investigation and highlights the high sensitivity rates to MCI/MI and nickel sulfate in Brazilian women and to potassium bichromate and carba mix in Brazilian men patients.

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Abstract Background: Pemphigus is an autoimmune blistering disease where autoantibodies target desmoglein (Dsg) antigens on keratinocytes, triggering the p38 MAPK pathway, Dsg internalization, desmosomal dissolution, and keratinocyte apoptosis, are essential for blister formation. Recent research indicates keratinocyte pyroptosis may exacerbate acantholysis and delay wound healing. Current treatments, including corticosteroids and immunosuppressants, are effective but have significant side effects, such as prolonged wound healing and increased infection risk. Understanding these inflammatory processes is crucial for developing effective treatments for pemphigus. Methods: The authors conducted a comprehensive review of the literature, analyzing recent findings regarding the upregulation of pyroptosis-related proteins in pemphigus. Results: The present findings highlight a significant upregulation of pyroptosis-related proteins, which play a crucial role in the inflammatory response and blister formation characteristic of pemphigus. Key proteins such as cytokines IL-113, IL-18, High Mobility Group Box-1 (HMGB1), and Parkin, along with NOD-like receptors and P2 × 7 receptors, were identified as pivotalin facilitating pyroptosis. The study also discusses potential therapeutic approaches targeting these proteins to modulate the disease pathway effectively. Study limitations: This study aimed to investigate the role of pyroptosis in the pathogenesis of pemphigus, focusing on its potential as a novel therapeutic target. Conclusions: Pyroptosis significantly contributes to the pathogenesis of pemphigus and presents a promising target for therapy. Targeting specific molecules involved in the pyroptosis pathway offers the potential for developing more precise and less toxic treatments, allowing the shift from traditional therapies towards targeted therapeutic strategies.

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Abstract Chronic pruritus encompasses a manifestation of several cutaneous, allergic, infectious, neurological, psychological, and systemic conditions, whose etiological investigation and therapeutic strategy can be challenging. This comprehensive review aims to enhance the understanding of pruritus by highlighting important elements in its pathogenesis, including keratinocytes, Merkel cells and mast cells, nerve fibers, histaminergic and nonhistaminergic pathways, and the interaction of itch signals with the central nervous system. Diagnostic evaluation of chronic pruritus may require a meticulous approach, guided by the identification of skin lesions or signs/symptoms of underlying systemic diseases. A comprehensive evaluation, including a detailed medical history, thorough physical examination, and appropriate laboratory and imaging tests, often supplemented by skin biopsy and direct immunofluorescence, is essential. Treatment strategies for chronic pruritus should be individualized based on the etiology identified. General measures, such as emollients, serve as initial interventions, followed by targeted approaches. Topical corticosteroids, calcineurin inhibitors, phototherapy, and systemic immunosuppressants address cutaneous inflammation. Antihistamines, antidepressants, and immunosuppressants may be employed based on the specific etiology. Emerging therapies, including biologic drugs and JAK inhibitors, have potential in refractory cases.

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Abstract: Background: There are different classifications of psoriasis based on its clinical presentation, impact on quality of life, requirements for specific treatments, and other patientor physicianreported outcomes. However, the lack of unified definitions has led to the severity of the disease being underestimated. Standardizing the classification of psoriasis will promote a better approach to the disease and facilitate care by professionals. Objective: To present a consensus of experts in Latin America regarding the classification of psoriasis severity, based on the best available evidence and applicable to current medical practice in the region. Methods: An independent methodological team, together with a group of clinical dermatologists representatives from different Latin American countries, developed a consensus witha modified Delphi methodology based on a systematic review of the literature. This consensus includes the classification of psoriasis, tools to define the severity of psoriasis, and other considerations in evaluating patients with psoriasis. Results: Fifteen statements were formulated aimed at classifying the severity of cutaneous psoriasis and other forms of the disease, as well as tools to assess and define the severityof psoriasis and therapy considerations. Additionally, the consensus addresses implementation considerations. Conclusion: The results of this consensus constitute a solid basis for a standard classification terminology for the varied clinical forms of psoriasis and their therapeutic implications. The importance of maintaining a personalized therapeutic approach, adjusted to each country’s available resources and administrative realities, is highlighted.

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Abstract Background: The skin is the first organ of the human body to be exposed to flood water,with local and possibly systemic consequences. There are no Brazilian data on dermatological diseases during recent climate catastrophes related in the country. Objectives: To assess the demographic profile and dermatological diagnoses in people displaced from their homes and sheltered in collective housing and among rescue workers during the extreme climate crisis in the state of Rio Grande do Sul, Brazil, in 2024. Methods: This was a cross-sectional and observational study. Information was collected in person or through records, retrospectively. Results: Data were collected from 371 people with dermatological complaints, and a total of 423 dermatoses were diagnosed. The most prevalent dermatological diseases were dermatoparasitosis, pyoderma, and skin conditions due to trauma and/or injuries. The male gender was statistically associated with traumatic dermatoses/injuries, and females with pyoderma (p < 0.05). Conclusion: In the recent episode of extreme climate crisis in Brazil, infectious and traumatic dermatoses were the most prevalent among the affected persons. The role of dermatologists in providing care for this population, as well as guiding other colleagues in the management of skin diseases during the floods is highlighted. Study limitations: The study was conducted in shelters, and some data were evaluated retrospectively. No complementary exams were used for diagnosis.

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Abstract The Anais Brasileiros de Dermatologia (ABD), an official publication of the Brazilian Society of Dermatology, has been published since 1925. ABD is considered the most influential dermatological journal in Latin America. By 2025, the journal will mark a significant milestone, celebrating a century of history. Over this time, it has published 99 volumes and 6,299 contributions from more than 10,800 authors. To analyze the trajectory of the journal, this study employs an applied research approach characterized by descriptive objectives and a quantitative nature. This research was based on a documentary procedure that encompassed all contributions already published in the journal. The main goal of the work was to identify the most prominent authors who have contributed to the journal and to map the largest coauthorship communities. The authors hope that this research serves as a formal recognition of the researchers who have written the history of the ABD.