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Article in Portuguese, English | LILACS-Express | LILACS | ID: biblio-1411988


Objetivo: Os agentes biológicos representam um grande avanço no tratamento da psoríase em placas moderada a grave. No entanto, variações de eficácia, segurança e custos dos tratamentos podem dificultar a escolha do agente terapêutico. Este estudo teve como objetivo atualizar o custo por resposta dos agentes biológicos disponíveis para psoríase no ROL de Procedimentos e Eventos em Saúde (ROL) da Agência Nacional de Saúde Suplementar (ANS). Métodos: Uma análise de custo por resposta foi utilizada para avaliar a razão de custo pelo desfecho Índice de Gravidade e Área da Psoríase (PASI) 90. Os resultados foram apresentados para o primeiro ano (ano I), que compreende a fase de indução e a fase manutenção até completar 52 semanas e foi realizada uma análise da efetividade do tratamento num cenário de orçamento fixo. Os custos dos tratamentos foram calculados com base nos preços de fábrica (PF18%) da Tabela da Câmara de Regulação do Mercado de Medicamentos de junho de 2021. Resultados: Para o ano I, o guselcumabe apresentou melhor resultado para custo por resposta (R$ 130.467) PASI 90, seguido por ixequizumabe, ustequinumabe, secuquinumabe, adalimumabe, infliximabe e etanercepte. No cenário com orçamento fixo, o guselcumabe demonstrou ser o agente capaz de tratar com sucesso (PASI 90) o maior número de pacientes. Atualização do custo-efetividade por resposta para psoríase em placas moderada a grave. Conclusão: Sob a perspectiva do Sistema de Saúde Suplementar do Brasil, o guselcumabe apresentou o melhor custo por resposta PASI 90, sendo, assim, a terapia com melhor custo-efetividade no tratamento da psoríase em placas moderada a grave disponível no ROL.

Objective: Biological agents represent a major advance in the treatment of moderate-to-severe plaque psoriasis. However, variations of efficiency, safety and costs of treatments make it difficult to select the drug. This study aims to update the cost per response of biological agents available in the Health Procedures and Events Roll (ROL) of the National Supplementary Health Agency (ANS). Methods: A cost-per-response analysis was used to assess the cost per outcome of Psoriasis Area and Severity Index (PASI) 90. Results were presented for the first year (I), which comprises induction and maintenance for 52 weeks and a fixed budget scenario analysis. Treatment costs were calculated based on the prices of the 2021 Medicines Market Regulation Chamber Table. Results: Analysis of year I, guselkumab showed the best result for cost per cost (R$ 130,467) PASI 90, followed by ixekizumab, ustekinumab, secukinumab, adalimumab, infliximab, and etanercept. In the fixedbudget analysis, guselkumab is the therapy capable of successfully treating (PASI 90) the largest number of patients. Conclusion: From the perspective of the Supplementary Health System in Brazil, guselkumab showed the best cost per response PASI 90, thus being the most cost-effective therapy in the treatment of moderate to severe plaque psoriasis available in the Brazilian ROL.

An. bras. dermatol ; 97(1): 63-74, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1360091


Abstract Generalized pustular psoriasis (von Zumbusch) is a rare and acute eruption characterized by multiple sterile pustules over an erythematous and edematous background, eventually associated with psoriasis vulgaris. Classically, it manifests as a potentially severe systemic picture and demands prompt diagnosis and intervention. The duration of each flare-up and intervals between the pustular episodes is extremely variable. Recently, genetic abnormalities have been identified mainly in the familial and early variants of this disease. The therapeutic arsenal is limited; however, new drugs being evaluated aim to control both pustular flare-ups and disease recurrences.

Humans , Psoriasis/diagnosis , Psoriasis/drug therapy , Skin Diseases, Vesiculobullous , Exanthema , Acute Disease , Chronic Disease
An. bras. dermatol ; 97(3): 348-357, 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1383581


Abstract Lichen planopilaris and frontal fibrosing alopecia are primary scarring alopecias where diagnosis can be suggested by clinical and trichoscopy features, especially in the early stages, but scalp biopsy is the standard exam for definitive diagnosis. Frontal fibrosing alopecia is considered a variant of lichen planopilaris, as the histopathological findings are similar, with a perifollicular lymphohistiocytic infiltrate, sometimes with a lichenoid pattern. A thorough clinical examination, trichoscopy and photographic documentation are essential to assess the evolution and therapeutic response. To date, there are no validated treatments or guidelines for these diseases, but there are recommendations that vary with the individual characteristics of each patient. This article presents a comprehensive review of the literature, including an update on topics related to the diagnosis, follow-up, histopathological aspects and available treatments for lichen planopilaris and frontal fibrosing alopecia, highlighting their similarities, differences and peculiarities.

An. bras. dermatol ; 96(3): 324-327, May-June 2021. graf
Article in English | LILACS | ID: biblio-1285063


Abstract Systemic amyloidosis secondary to psoriatic arthritis is rare, and published data are based mainly on case reports and are associated with increased mortality. This is the report of a patient with long-term psoriatic arthritis and chronic sialadenitis, who showed an inadequate response to therapy. The diagnosis of secondary amyloidosis was attained through biopsies of genital skin lesions. Although very rare, it is important that dermatologists and general practitioners consider the possibility of amyloidosis in patients with chronic inflammatory diseases, since an early intervention can be implemented, and thus, the prognosis of this condition can be improved.

Humans , Psoriasis , Arthritis, Psoriatic/complications , Immunoglobulin Light-chain Amyloidosis , Amyloidosis/complications , Amyloidosis/diagnosis , Skin
An. bras. dermatol ; 94(2,supl.1): 76-107, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1011088


Abstract: Psoriasis is a chronic inflammatory disease that affects 1.3% of the Brazilian population. The most common clinical manifestations are erythematous, scaling lesions that affect both genders and can occur on any anatomical site, preferentially involving the knees, elbows, scalp and genitals. Besides the impact on the quality of life, the systemic nature of the disease makes psoriasis an independent risk factor for cardiovascular disease, especially in young patients with severe disease. By an initiative of the Brazilian Society of Dermatology, dermatologists with renowned clinical experience in the management of psoriasis were invited to form a work group that, in a partnership with the Brazilian Medical Association, dedicated themselves to create the Plaque Psoriasis Diagnostic and Treatment Guidelines. The relevant issues for the diagnosis (evaluation of severity and comorbidities) and treatment of plaque psoriasis were defined. The issues generated a search strategy in the Medline-PubMed database up to July 2018. Subsequently, the answers to the questions of the recommendations were devised, and each reference selected presented the respective level of recommendation and strength of scientific evidence. The final recommendations for making up the final text were worded by the coordinators.

Humans , Male , Female , Psoriasis/diagnosis , Psoriasis/therapy , Phototherapy/methods , Psoriasis/epidemiology , Societies, Medical , Time Factors , Vitamin D/analysis , Severity of Illness Index , Brazil , Comorbidity , Anthralin/therapeutic use , Methotrexate/therapeutic use , Cyclosporine/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Dermatologic Agents/therapeutic use , Dermatology , Drug Combinations , Calcineurin Inhibitors/therapeutic use , Antibodies, Monoclonal/therapeutic use
Adv Rheumatol ; 59: 3, 2019. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1088594


Abstract Objective: To evaluate prevalence, clinical manifestations, laboratory abnormalities, treatment and outcome in a multicenter cohort of childhood-onset systemic lupus erythematosus (cSLE) patients with and without panniculitis. Methods: Panniculitis was diagnosed due to painful subcutaneous nodules and/or plaques in deep dermis/subcutaneous tissues and lobular/mixed panniculitis with lymphocytic lobular inflammatory infiltrate in skin biopsy. Statistical analysis was performed using Bonferroni correction(p < 0.004). Results: Panniculitis was observed in 6/847(0.7%) cSLE. Painful subcutaneous erythematosus and indurated nodules were observed in 6/6 panniculitis patients and painful subcutaneous plaques in 4/6. Generalized distribution was evidenced in 3/6 and localized in upper limbs in 2/6 and face in 1/6. Cutaneous hyperpigmentation and/or cutaneous atrophy occurred in 5/6. Histopathology features showed lobular panniculitis without vasculitis in 5/6(one of them had concomitant obliterative vasculopathy due to antiphospholipid syndrome) and panniculitis with vasculitis in 1/6. Comparison between cSLE with panniculitis and 60 cSLE without panniculitis with same disease duration [2.75(0-11.4) vs. 2.83(0-11.8) years,p = 0.297], showed higher frequencies of constitutional involvement (67% vs. 10%,p = 0.003) and leukopenia (67% vs. 7%,p = 0.002). Cutaneous atrophy and hyperpigmentation occurred in 83% of patients. Conclusions: Panniculitis is a rare skin manifestation of cSLE occurring in the first three years of disease with considerable sequelae. The majority of patients have concomitant mild lupus manifestations.

An. bras. dermatol ; 93(6): 813-818, Nov.-Dec. 2018. tab
Article in English | LILACS | ID: biblio-973641


Abstract: Background: The Simplified Psoriasis Index is a tool that assesses the current severity, psychosocial impact, past history and interventions in patients with psoriasis through separate components. Two versions are available, one in which the current severity of the disease is evaluated by the patient themselves and another by the physician. Objectives: Translate the Simplified Psoriasis Index into Brazilian Portuguese and verify its validity. Methods: The study was conducted in two stages; the first stage was the translation of the instrument; the second stage was the instrument's validation. Results: We evaluated 62 patients from Complexo Hospitalar Santa Casa de Porto Alegre and Hospital Universitário de Brasília. The Simplified Psoriasis Index translated into Portuguese showed high internal consistency (Cronbach test 0.68). Study limitations: Some individuals, because of poor education, might not understand some questions of the Simplified Psoriasis Index. Conclusions: The Brazilian Portuguese version of the Simplified Psoriasis Index was validated for our population and can be recommended as a reliable instrument to assess the patients with psoriasis.

Humans , Male , Female , Adult , Middle Aged , Psoriasis/diagnosis , Psoriasis/classification , Translations , Severity of Illness Index , Brazil , Predictive Value of Tests , Surveys and Questionnaires , Reproducibility of Results , Sensitivity and Specificity , Cultural Characteristics , Language
An. bras. dermatol ; 91(6): 781-789, Nov.-Dec. 2016.
Article in English | LILACS | ID: biblio-837982


Abstract During the last decade, different studies have converged to evidence the high prevalence of comorbidities in subjects with psoriasis. Although a causal relation has not been fully elucidated, genetic relation, inflammatory pathways and/or common environmental factors appear to be underlying the development of psoriasis and the metabolic comorbidities. The concept of psoriasis as a systemic disease directed the attention of the scientific community in order to investigate the extent to which therapeutic interventions influence the onset and evolution of the most prevalent comorbidities in patients with psoriasis. This study presents scientific evidence of the influence of immunobiological treatments for psoriasis available in Brazil (infliximab, adalimumab, etanercept and ustekinumab) on the main comorbidities related to psoriasis. It highlights the importance of the inflammatory burden on the clinical outcome of patients, not only on disease activity, but also on the comorbidities. In this sense, systemic treatments, whether immunobiologicals or classic, can play a critical role to effectively control the inflammatory burden in psoriatic patients.

Humans , Psoriasis/drug therapy , Antibodies, Monoclonal/therapeutic use , Cardiovascular Diseases/drug therapy , Comorbidity , Risk Factors , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Metabolic Syndrome/drug therapy , Diabetes Mellitus/drug therapy , Dyslipidemias/drug therapy , Obesity, Abdominal/drug therapy , Non-alcoholic Fatty Liver Disease/drug therapy , Hypertension/drug therapy
An. bras. dermatol ; 90(1): 62-73, Jan-Feb/2015. tab, graf
Article in English | LILACS | ID: lil-735732


Scleroderma is a rare connective tissue disease that is manifested by cutaneous sclerosis and variable systemic involvement. Two categories of scleroderma are known: systemic sclerosis, characterized by cutaneous sclerosis and visceral involvement, and localized scleroderma or morphea which classically presents benign and self-limited evolution and is confined to the skin and/or underlying tissues. Localized scleroderma is a rare disease of unknown etiology. Recent studies show that the localized form may affect internal organs and have variable morbidity. Treatment should be started very early, before complications occur due to the high morbidity of localized scleroderma. In this review, we report the most important aspects and particularities in the treatment of patients diagnosed with localized scleroderma.

Female , Humans , Male , Scleroderma, Localized/pathology , Scleroderma, Localized/therapy , Skin/pathology , Biopsy , Scleroderma, Localized/classification , Scleroderma, Localized/etiology , Scleroderma, Systemic/pathology
An. bras. dermatol ; 89(4): 685-687, Jul-Aug/2014. graf
Article in English | LILACS | ID: lil-715530


Alopecia areata is a common autoimmune disorder that leads to nonscarring hair loss. Black dots, also called comedo-like cadaver hairs, can be found in almost 50% of alopecia areata patients and indicate disease activity. Trichostasis spinulosa is a follicular disorder resulting from the retention of numerous hairs surrounded by a keratinous sheath in dilated follicles. Trichostasis spinulosa is a relatively common but underdiagnosed disorder of hair follicles. Here, we describe a man with alopecia areata of the eyebrows, androgenetic alopecia and trichostasis spinulosa at the vertex and show how dermoscopy can be useful in distinguishing black dots from Trichostasis spinulosa lesions.

Humans , Male , Middle Aged , Alopecia Areata/pathology , Hair Diseases/pathology , Keratosis/pathology , Pruritus/pathology , Scalp Dermatoses/pathology , Biopsy , Dermoscopy , Diagnosis, Differential , Scalp/pathology
An. bras. dermatol ; 89(2): 236-240, Mar-Apr/2014. tab, graf
Article in English | LILACS | ID: lil-706969


BACKGROUND: Genital warts are caused by human papillomavirus infection and represent one of the most common sexually transmitted diseases. Many infections are transient but the virus may recur, persist, or become latent. To date, there is no effective antiviral treatment to eliminate HPV infection and most therapies are aimed at the destruction of visible lesions. Potassium hydroxide is a strong alkali that has been shown to be safe and effective for the treatment of genital warts and molluscum contagiosum. Cryotherapy is considered one of the most established treatments for genital warts. No comparative trials have been reported to date on the use of potassium hydroxide for genital warts. OBJECTIVE: A prospective, open-label, randomized clinical trial was conducted to compare topical potassium hydroxide versus cryotherapy in the treatment of genital warts affecting immunocompetent, sexually active men. METHODS: Over a period of 10 months, 48 patients were enrolled. They were randomly divided into two groups and selected on an alternative basis for either potassium hydroxide therapy or cryotherapy. While response to therapy did not differ substantially between both treatment modalities, side effects such as local pain and post-treatment hypopigmentation were considerably more prevalent in the groups treated using cryotherapy. Result: In our study, potassium hydroxide therapy proved to be at least as effective as cryotherapy and offered the benefit of a better safety profile. CONCLUSION: Topical 5% potassium hydroxide presents an effective, safe, and low-cost treatment modality for genital warts in men and should be included in the spectrum of therapies for genital warts. .

Adolescent , Adult , Aged , Humans , Male , Middle Aged , Young Adult , Condylomata Acuminata/therapy , Cryotherapy/methods , Dermatologic Agents/administration & dosage , Genital Diseases, Male/therapy , Hydroxides/administration & dosage , Potassium Compounds/administration & dosage , Administration, Topical , Chi-Square Distribution , Dose-Response Relationship, Drug , Dermatologic Agents/therapeutic use , Follow-Up Studies , Hydroxides/therapeutic use , Prospective Studies , Potassium Compounds/therapeutic use , Reproducibility of Results , Treatment Outcome
An. bras. dermatol ; 88(6,supl.1): 29-31, Nov-Dec/2013. graf
Article in English | LILACS | ID: lil-696789


Psoriasis is a relatively frequent inflammatory dermatosis. Scarring alopecia due to scalp psoriasis was first reported in 1972, but few reports have been written since then, showing that this is a very rare complication of a common disorder. We report a young Brazilian woman with longstanding scalp psoriasis, which progressed to scaring alopecia.

A psoríase é uma dermatose inflamatória que atinge com relativa frequência o couro cabeludo. Alopecia cicatricial devido à psoríase do couro cabeludo foi publicada pela primeira vez em 1972, mas poucos relatos foram escritos desde então. Aqui nós relatamos uma jovem brasileira com psoríase do couro cabeludo de longa data, que evoluiu para alopecia cicatricial.

Adult , Female , Humans , Alopecia/pathology , Psoriasis/pathology , Scalp Dermatoses/pathology , Alopecia/etiology , Biopsy , Cicatrix/pathology , Dermoscopy , Disease Progression , Psoriasis/complications , Scalp Dermatoses/complications
An. bras. dermatol ; 86(2): 352-354, mar.-abr. 2011. ilus
Article in Portuguese | LILACS | ID: lil-587675


Molusco contagioso é uma dermatovirose causada por poxvírus e caracterizada por erupção benigna e autolimitada de uma ou múltiplas pápulas esféricas e brilhantes. A transmissão habitualmente ocorre por contato direto com indivíduos infectados. Relata-se caso de doente masculino, 22 anos, com história de surgimento de numerosas pápulas umbilicadas localizadas estritamente sobre a região de uma tatuagem. Exame histopatológico de uma das pápulas confirmou a hipótese clínica de molusco contagioso. Os autores descrevem uma manifestação pouco frequente da disseminação desse vírus em tatuagens e apresentam uma revisão da literatura, enfatizando as vias de transmissão e a terapêutica do molusco contagioso.

Molluscum contagiosum is a disease caused by a poxvirus characterized by benign self-limited eruption of single or multiple cutaneous spherical and pearly papules. Transmission usually occurs by direct contact with infected hosts. It is reported the case of a 22-year-old Caucasian male who presented characteristic pearly and umbilicated papules strictly located on the region of a tattoo. Histopathologic exam confirmed the diagnosis of molluscum contagiosum. The authors describe an uncommomn manifestation of dissemination of this virus in tattoos and also present a literature review emphasizing the transmission pathways and treatment of Molluscum contagiosum.

Humans , Male , Young Adult , Molluscum Contagiosum/diagnosis , Tattooing/adverse effects , Curettage , Molluscum Contagiosum/surgery
s.l; s.n; 2011. 7 p. ilus.
Non-conventional in Portuguese | LILACS, SES-SP, SESSP-ILSLACERVO, SES-SP | ID: biblio-1243004
Rio de Janeiro; Elsevier; 2010. 252 p. ilus, tab.
Monography in Portuguese | LILACS | ID: lil-573537

Humans , Psoriasis