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Abstract Lipedema is a chronic and progressive disorder characterized by disproportionate fat accumulation, mainly affecting the lower extremities of women, and commonly accompanied by sensations of heaviness, tenderness, and discomfort. While its pathogenesis remains largely unknown, genetic, hormonal, and microvascular factors have been implicated. The condition often coexists with psychological distress, which significantly detracts from the quality of life of affected individuals. Diagnosis is primarily clinical, as no specific biomarkers or imaging modalities have been proven sufficiently reliable for identification. Proposed managements are controversial, although current treatment focuses on symptom management and disease control through conservative methods such as compression and non-invasive device therapies, specialized diets, and physical rehabilitation or surgical treatments. Psychological support is vital in addressing the emotional challenges of the condition. Despite recent advancements in the understanding and management of lipedema, there remains a critical need for further research to establish standardized diagnostic criteria and targeted therapeutic strategies for this debilitating condition.

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Abstract Background Cutaneous leishmaniasis (CL) affects up to 1.2 million people annually, mainly in resource-limited regions. Meglumine antimoniate, the standard treatment, is limited by systemic toxicity, injectable administration, and increasing resistance. Miltefosine, an oral alternative, offers practical advantages, although comparative efficacy and safety data remain inconsistent. Objective To compare the efficacy and safety of miltefosine versus meglumine antimoniate for New World CL. Methods The authors systematically searched PubMed, Embase, Scopus, and the Cochrane Library for randomized controlled trials directly comparing miltefosine and meglumine antimoniate. Risk Ratios (RRs) with 95% Confidence Intervals (95% CIs) were calculated using random-effects models. Heterogeneity was assessed with the I² statistic. Risk of bias was evaluated using the Cochrane RoB-2 tool. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Results Eight trials involving 898 patients (502 treated with miltefosine, 396 with meglumine antimoniate) were included. Miltefosine showed significantly higher cure rates at two months (RR = 0.83; 95% CI: 0.71-0.98; I2 = 0%). Differences at six months were not statistically significant. Gastrointestinal side effects were more frequent with miltefosine, whereas hepatic enzyme elevations, arthralgia (RR = 10.08; 95% CI: 2.36-43.12), and fever (RR = 2.98; 95% CI: 1.53-5.80) were more common with meglumine antimoniate. Study Limitations High heterogeneity, short follow-up, small sample sizes, and interstudy variability may limit precision. Conclusion Miltefosine shows superior early response and a safer systemic profile. However, the certainty of evidence, as assessed by GRADE, ranged from very low to high across outcomes, and long-term data remain limited, highlighting the need for further high-quality studies with extended follow-up.

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Abstract Background Mucous membrane pemphigoid (MMP) is an autoimmune blistering disease with heterogeneous clinical manifestations that is hard to diagnose. Direct immunofluorescence (DIF) is critical, but its role in multimodal frameworks is unclear. Objective To assess DIF's diagnostic performance in MMP and explore factors affecting its positivity patterns in multimodal workflows. Methods We retrospectively analyzed 79 suspected MMP patients, categorizing them into confirmed and non-confirmed groups based on clinical, histopathological, and serological criteria. DIF of perilesional mucosal biopsies showed linear deposits of IgG, IgA, IgM, C3, and fibrinogen along the basement membrane zone (BMZ). Diagnostic efficacy was assessed via ROC curve analysis. Results 55 cases were confirmed. Histopathology demonstrated subepithelial blisters in 51, with 100% specificity, 92.73% sensitivity (AUC = 0.964, p < 0.05). DIF identified 47 cases, with C3 (63.64%) and IgG (60.00%) most common, showing 85.45% sensitivity, 100% specificity, and 97.87% concordance with histopathology. Disease duration independently predicted positive IgM (p = 0.023). Study limitations This study is a single-center retrospective study with a limited sample size, which has certain limitations. Conclusion DIF, 100% specific, aids histopathology in MMP diagnosis, especially with C3/IgG linear BMZ deposition. Notably, IgM positivity correlates with prolonged disease duration, suggesting DIF efficiency may link to disease stage.

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Abstract Background Psoriatic arthritis (PsA) remains diagnostically challenging in clinical practice. The Psoriasis Epidemiology Screening Tool - Brazilian Portuguese version (PEST-BP) offers a potential solution for simplified case identification. Objective To evaluate the diagnostic accuracy of PEST-BP in detecting PsA among patients with psoriasis in a novel Southern Brazilian population. Methods In this cross-sectional study, psoriasis patients from a dermatology clinic underwent dual assessment: PEST-BP screening and gold-standard rheumatologic evaluation using CASPAR criteria for PsA diagnosis. Statistical analyses included sensitivity, specificity, and ROC curve determination. Results Among 100 patients, 21 (21%) met the CASPAR criteria for PsA. A PEST-BP score ≥ 3 showed the best diagnostic performance with 81% sensitivity, 79.7% specificity, and 80% overall accuracy (AUC = 0.845, p < 0.001). Patients with PsA had a significantly higher prevalence of dactylitis (38.1% vs. 11.4%; p = 0.004), nail psoriasis (66.7% vs. 35.4%; p = 0.01), and Psoriasis Area and Severity Index (PASI) ≥ 10 (42.9% vs. 19%; p = 0.023). In multivariate analysis, a PEST-BP score ≥ 3 (OR = 32.43; p < 0.001) and PASI ≥ 10 (OR = 9.26; p = 0.007) were independently associated with PsA. Study limitations Single-center design in a tertiary care hospital and small sample size may overrepresent patients with severe disease. Conclusion The PEST-BP is a reliable and accurate tool for PsA screening in Brazilian dermatology settings. Its simplicity and strong diagnostic performance support its integration into routine clinical practice for early PsA detection.

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Abstract Background Psoriasis is a chronic, immune-mediated disease with a significant genetic component. The HLA-C*06:02 allele is one of the most strongly associated with the disease, particularly influencing early onset and severity. There are few current data on genetics in a Brazilian population with psoriasis. Objective This study aimed to investigate the genetic associations between human leucocyte antigen (HLA) alleles and psoriasis in a Brazilian admixed population. Methods We conducted HLA class I and II genotyping in 144 patients with psoriasis and compared the results with those of 720 controls. Additionally, we calculated the Psoriasis Area and Severity Index (PASI) and recorded whether the patient had current or previous systemic treatment for psoriasis and the age of disease onset. Results HLA-B*13:02g, B*15:01g, B*37:01g, B*38:01g, B*57:01g, B*57:02g, B*13:02g, C*01:02g, C*06:02g, C*12:03g, C*18:01g, DRB1*01:02g, DRB1*04:08g and DPB1*04:01g alleles were associated with an increased risk of psoriasis (after the Bonferroni correction factor, only the HLA-C*06:02 remained significant). And HLA-DRB1*15:03g conferred protection against psoriasis after Bonferroni correction. Alleles significantly associated with PASI score < 10 were A*34:02g (p = 0.037) and B*50:01g (p = 0.037), while the allele related to PASI > 10 was DRB1*01:01g (p = 0.049). When comparing the age of disease onset, the following alleles were significantly associated with early onset psoriasis (before 30 years of age): B*44:03g (p = 0.010) and C*07:02g (p = 0.022). Study limitations The sample size was small compared with other international publications, and the subgroup of patients with mild disease was less represented; however, the combination of analytical approaches (univariate tests, PCA, and correction for multiple comparisons) reinforces the robustness of the work. Conclusion The present findings highlight the genetic complexity of psoriasis in a diverse population and suggest that it may not be directly linked to specific genetic factors. Further research is required to explore the environmental and genetic interactions that contribute to psoriasis pathogenesis.

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Abstract Background Chronic urticaria (CU) compromises quality of life, requiring escalated treatment with second-generation H1 antihistamines, omalizumab, and, in refractory cases, cyclosporine. Predictors of therapeutic response are not yet well established. Objective To evaluate clinical and laboratory factors associated with treatment response in patients with CU. Methods Cross-sectional study of 175 patients with CU followed at the Urticaria Reference Center (UCARE) of Complexo Hospitalar Universitário Professor Edgard Santos (HUPES/UFBA) between 2023 and 2024. Sociodemographic, clinical, and laboratory data were analyzed. Treatment response was assessed using the Urticaria Control Test (UCT), with responders being those with a score ≥12 or Angioedema Control Test (AECT) ≥10. Results Most patients were female (80.6%), with a mean age of 45.3 years. Chronic spontaneous urticaria (CSU) was predominant (86.3%). Higher body mass index (BMI), early onset, longer disease duration, and psychiatric disorders were associated with poorer response to second-generation H1 antihistamines. Responders to these drugs had shorter disease duration and a lower proportion of women compared to those requiring omalizumab. In omalizumab users, mental disorders remained associated with refractoriness. Total IgE, eosinophils, CRP, ESR, D-dimer, and anti-TPO did not correlate with therapeutic response. Study limitations Cross-sectional study and reliance on clinical records, information bias, and selection bias. Conclusions High BMI, female gender, early symptom onset, prolonged disease duration, and mental disorders were associated with poorer response to CU treatment. The evaluated laboratory tests did not demonstrate predictive value for treatment response.

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Abstract Acne vulgaris is a chronic inflammatory condition with multifactorial pathogenesis. Despite the availability of numerous treatment options, there remains a need for safe, well-tolerated, and microbiome-preserving therapies. This narrative review explores recent advances in non-pharmacological acne treatments, focusing on various microbiome modulation strategies. It highlights emerging therapeutic modalities and their potential impact on clinical practice. Key findings from recent studies are summarized, providing insights for future research and practical applications in dermatology.

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Abstract Background Phototherapy is one of the widely used therapeutic options in dermatology, and it has proven effective for many dermatological conditions. It includes various modalities such as heliotherapy, broad-band UVB, narrow-band UVB, excimer laser, UVA1, UVA with Psoralens (PUVA), among others. The mechanisms behind phototherapy's efficacy include proapoptotic, immunomodulatory, propigmenting, antifibrotic, and antipruritic effects. In this context, the effectiveness of this modality has been demonstrated in pediatric patients with various conditions; however, no consensus has yet been established regarding its use in this population. Methods A comprehensive literature review was conducted to identify the most recent studies and advancements in the use of phototherapy in the pediatric population. Results Phototherapy is a safe and effective therapeutic modality that can be used in multiple conditions, such as psoriasis, vitiligo, atopic dermatitis, mycosis fungoides, pityriasis lichenoides, and actinic prurigo, among others. The therapeutic outcomes depend on the condition being treated, the type of phototherapy used, and the appropriate selection of patients. Conclusions The phototherapy with NB-UVB is the most commonly use and preferred modality due to its efficacy and lower risk associated. Careful monitoring is recommended to assess long-term safety and optimize pediatric treatment protocols.

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Abstract Tirzepatide, a dual Glucose-dependent Insulinotropic Polypeptide (GIP) and Glucagon-Like Peptide-1 (GLP-1) receptor agonist. Tirzepatide was first approved by the FDA for type 2 diabetes in May 2022 and subsequently for obesity in November 2023, and has demonstrated significant efficacy in glycemic control and weight reduction. Beyond its metabolic benefits, recent evidence highlights its relevance in dermatology. This review explores the dermatologic implications of tirzepatide, including its cutaneous adverse effects, therapeutic potential in inflammatory skin diseases, and cosmetic benefits. Cutaneous side effects such as hypersensitivity reactions, injection-site reactions, and rare severe dermatologic events have been documented. Across the SURPASS clinical trials, injection-site reactions occurred slightly more frequently, comparable to other GLP-1 receptor agonists as semaglutide. Meanwhile, tirzepatide's immunomodulatory properties suggest potential therapeutic roles in conditions like psoriasis and hidradenitis suppurativa; however, current evidence is limited to case reports and small studies. Additionally, its profound effects on fat distribution raise interest in its cosmetic implications. Tirzepatide's induced rapid weight loss may lead to aesthetic changes, including facial volume loss, which warrants cautious interpretation. This narrative review summarizes current data from clinical trials, case reports, and pharmacovigilance sources, based on a literature search of PubMed, Scopus, and Google Scholar up to May 2025, focusing on skin-related adverse events, therapeutic effects, and cosmetic outcomes of tirzepatide.