ABSTRACT
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.
ABSTRACT
ABSTRACT Introduction: Systemic Mastocytosis comprises a group of neoplastic diseases characterized by clonal expansion and infiltration of mast cells into several organs. The diagnosis and treatment of this disease may be challenging for non-specialists. Objective: Make suggestions or recommendations in Systemic Mastocytosis based in a panel of Brazilian specialists. Method and results: An online expert panel with 18 multidisciplinary specialists was convened to propose recommendations on the diagnosis and treatment of Systemic Mastocytosis in Brazil. Recommendations were based on discussions of topics and multiple-choice questions and were graded using the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence Chart. Conclusion: Twenty-two recommendations or suggestions were proposed based on a literature review and graded according to the findings.
Subject(s)
Mastocytosis, Systemic/diagnosis , Mastocytosis, Systemic/therapy , Child , AdultABSTRACT
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.
Subject(s)
Humans , Consensus , Dermatitis, Atopic/drug therapy , Societies, Medical , Ultraviolet Therapy , Severity of Illness Index , Brazil , Administration, Topical , Adrenal Cortex Hormones/therapeutic use , Dermatology , Calcineurin Inhibitors/therapeutic use , Anti-Infective Agents/therapeutic use , Anti-Inflammatory Agents/therapeutic useABSTRACT
AbstractSweet syndrome or acute febrile neutrophilic dermatosis is a recurrent and rare skin disease caused by the release of cytokines, with diverse possible etiologic causes. It presents clinically with polymorphic skin lesions, fever, arthralgia, and peripheral leukocytosis. In general, it is associated with infections, malignancy and drugs. It usually regresses spontaneously and treatment is primarily to control the basic disease. The authors report the case of a child of 1 year and 11 months who developed Sweet syndrome.
Subject(s)
Humans , Female , Infant , Sweet Syndrome/pathology , Skin/pathology , Biopsy , Sweet Syndrome/complications , Rare Diseases , Fever/etiology , Fever/pathologyABSTRACT
We report the case of a three-year-old child who, following long term treatment with topical corticosteroids and their associations for a case of ringworm on the face developed a form of folliculitis known as Majocchi's Granuloma. Treatment with oral Griseofulvin was successful.
Subject(s)
Humans , Female , Child, Preschool , Tinea/pathology , Facial Dermatoses/pathology , Granuloma/pathology , Skin/pathology , Tinea/drug therapy , Biopsy , Treatment Outcome , Facial Dermatoses/drug therapy , Folliculitis/pathology , Granuloma/drug therapy , Griseofulvin/therapeutic use , Immunocompetence , Antifungal Agents/therapeutic useABSTRACT
We report the case of an 11-year-old male patient with a histopathological and immunohistochemical diagnosis of dermatofibroma with an atypical clinical presentation on the right forearm. Although dermatofibroma is considered a benign skin tumor, some of its differential diagnoses, such as dermatofibrosarcoma protuberans and malignant fibrous histiocytoma, are truly aggressive. Lesions with atypical clinical aspects and topology associated with specific histopathological variants are some of the criteria for complete tumor excision.
Subject(s)
Humans , Male , Child , Skin/pathology , Skin Neoplasms/pathology , Histiocytoma, Benign Fibrous/pathology , Biopsy , Diagnosis, Differential , Forearm/pathologyABSTRACT
Os autores fazem uma revisäo literária de 10 anos sobre a dermatite das fraldas que, dentro da Saúde Comunitária, assume importância vital para o conhecimento médico devido à sua elevada freqüência. Objetiva-se com este trabalho o reconhecimento da doença em seus diversos graus de acometimento, as medidas básicas de tratamento e principalmente, os aspectos fisiológicos reconhecidos até hoje como responsáveis pela dermatose. Conclui-se qu, apesar das utilizaçöes de diversas medidas preventivas e terapêuticas, a dermatite das fraldas continua sendo uma queixa freqüentíssima das mäes nos ambulatórios de pediatria e de dermatologia; e que o tratamento tradicional, instituído há muitos anos, continua sendo o mais eficaz e o de menor custo