Consensus on the treatment of autoimmune bullous dermatoses: bullous pemphigoid, mucous membrane pemphigoid and epidermolysis bullosa acquisita - Brazilian Society of Dermatology

Abstract: Bullous pemphigoid, mucous membrane pemphigoid and epidermolysis bullosa acquisita are subepidermal autoimmune blistering diseases whose antigenic target is located at the basement membrane zone. Mucous membrane pemphigoid and epidermolysis bullosa acquisita can evolve with cicatricial mucosal involvement, leading to respiratory, ocular and/or digestive sequelae with important morbidity. For each of these dermatoses, a literature review covering all therapeutic options was performed. A flowchart, based on the experience and joint discussion among the authors of this consensus, was constructed to provide treatment orientation for these diseases in Brazil. In summary, in the localized, low-risk or non-severe forms, drugs that have immunomodulatory action such as dapsone, doxycycline among others may be a therapeutic option. Topical treatment with corticosteroids or immunomodulators may also be used. Systemic corticosteroid therapy continues to be the treatment of choice for severe forms, especially those involving ocular, laryngeal-pharyngeal and/or esophageal mucosal involvement, as may occur in mucous membrane pemphigoid and epidermolysis bullosa acquisita. Several immunosuppressants are used as adjuvant alternatives. In severe and recalcitrant cases, intravenous immunoglobulin is an alternative that, while expensive, may be used. Immunobiological drugs such as rituximab are promising drugs in this area. Omalizumab has been used in bullous pemphigoid.

Granuloma annulare on the palms in an elderly patient

Abstract: Granuloma annulare is a relatively common, idiopathic, benign inflammatory dermatosis, with a varied clinical presentation that often makes diagnosis difficult. It mainly affects the extremities, such as the dorsa of the hands and feet, forearms and legs. Palmar and plantar regions are generally spared. It occurs mainly in young female patients. The presentation of the palmar variant in an elderly patient is a rarity.

Púrpura de Doucas e Kapetanakis / Purpura of Doucas and Kapetanakis

A púrpura pigmentosa de Doucas e Kapetanakis é um tipo de dermatose purpúrica pigmentosa, que possui etiologia desconhecida e pode estar relacionada com uma série de fatores desencadeantes, como medicamentos, infecção local e doenças sistêmicas. Esta dermatose purpúrica atinge preferencialmente adultos jovens do sexo masculino, porém pode atingir qualquer sexo e idade. Clinicamente as lesões se localizam quase que exclusivamente nos membros inferiores e podem apresentar-se como máculas, petéquias, lesões eritêmato-purpúricas, lesões telangiectásicas e lesões eczematosas. É uma dermatose de caráter crônico, benigno e recidivante. O presente trabalho tem como objetivo realizar uma breve revisão na literatura sobre a púrpura pigmentosa de Doucas e Kapetanakis e relatar o caso de uma paciente do sexo feminino, com apresentação atípica.