Consensus on the therapeutic management of atopic dermatitis ‒ Brazilian Society of Dermatology: an update on phototherapy and systemic therapy using e-Delphi technique

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.

Lucius phenomenon: the importance of a primary dermatological care

Abstract Leprosy presents a varied clinical spectrum. Lucius phenomenon is a rare leprosy reaction characterized by erythematous, painful, slightly infiltrated macules and hemorrhagic bullae that progress to ulceration. This case report describes a patient whose diagnosis of leprosy occurred in the presence of Lucius phenomenon. Late diagnosis and delay in the implementation of specific therapy contributed to an unfavorable outcome, highlighting the importance of early identification and treatment of this disease, as well as its complications.

Clinical trial for uniform multidrug therapy for leprosy patients in Brazil (U-MDT/CT-BR): adverse effects approach

Abstract: BACKGROUND: The Clinical Trial for Uniform Multidrug Therapy for Leprosy Patients in Brazil (U-MDT/CT-BR), designed to evaluate the effectiveness of a six-months regimen, assessed the adverse effects caused by the drugs. OBJECTIVE: Describe adverse effects due to MDT in U-MDT/CT-BR, comparing the uniform regimen (U-MDT) to the current WHO regimen (R-MDT). Patients and methods: After operational classification, patients were randomly allocated to the study groups. U-MDT PB and U-MDT MB groups, received the U-MDT regimen, six doses of MB-MDT (rifampicin, dapsone and clofazimine). R-MDT PB and R-MDT MB groups, received the WHO regimens: six doses (rifampicin and dapsone) for PB and 12 doses (rifampicin, dapsone and clofazimine) for MB. During treatment, patients returned monthly for clinical and laboratorial evaluation. Patients with single lesion were not included in this trial. RESULTS: Skin pigmentation (21.7%) and xerosis (16.9%) were the most frequent complaints among 753 patients. Laboratory exams showed hemoglobin concentration lower than 10g/dL in 23.3% of the patients, glutamic oxaloacetic transaminase (GOT) above 40U/L in 29.5% and glutamic pyruvic transaminase (GPT) above 40U/L in 28.5%. Twenty-four patients (3.2%) stopped dapsone intake due to adverse effects, of whom 16.6% due to severe anemia. One case of sulfone syndrome was reported. STUDY LIMITATIONS: Loss of some monthly laboratory sample collection. CONCLUSIONS: There was no statistical difference regarding adverse effects in the R-MDT and U-MDT groups but anemia was greater in patients from R-MDT/MB group, therefore adverse effects do not represent a constraint to recommend the six-month uniform regimen of treatment for all leprosy patients.

Daylight photodynamic therapy - Experience and safety in treatment of actinic keratoses of the face and scalp in low latitude and high brightness region

ABSTRACT Daylight photodynamic therapy has been used in countries with high latitudes during the summer for actinic keratoses treatment with reports of similar efficacy to conventional photodynamic therapy. We evaluate its safety in 20 patients in the city of Fortaleza, a local with low latitude and high brightness. Sixteen patients did not report any discomfort due to the procedure. Daylight photodynamic therapy is an easy application method with great tolerability by the patient and has the possibility of being performed throughout the year in these regions. It can mean a promising tool in the control of skin cancer.

Carcinoma basocelular desenvolvido sobre nevo sebáceo: tratamento com terapia fotodinâmica abordando campo de cancerização / Basal cell carcinoma growth over a nevus sebaceous: treatment of the field cancerization with photodynamic therapy

Nevo sebáceo de Jadassohn é hamartoma congênito que pode apresentar evolução para neoplasia cutânea maligna. A terapia fotodinâmica é utilizada para tratamento de ceratoses actínicas e carcinomas basocelulares superficiais ou nodulares, podendo-se observar o campo de cancerização cutâneo através da lâmpada de Wood, durante a realização da técnica. Relata-se um caso do uso da terapia fotodinâmica para o tratamento de um carcinoma basocelular, que se desenvolveu sobre nevo sebáceo, demonstrando-se o campo cancerizável através do uso da lâmpada de Wood. O procedimento consistiu em alternativa de tratamento não cirúrgico para o carcinoma basocelular, com excelente resultado estético. A paciente encontra-se em seguimento clínico, não apresentando recidiva da neoplasia 18 meses após o tratamento.

The sebaceous nevus of Jadassohn is a congenital hamartoma that may develop into a malignant cutaneous neoplasia. Photodynamic therapy is used to treat actinic keratoses and superficial or nodular basal cell carcinomas, and the cutaneous field cancerization can be observed using the Wood's lamp during the performance of the technique. This article describes a case of photodynamic therapy used in the treatment of a basal cell carcinoma, which developed on a sebaceous nevus, where the field cancerization was demonstrated through the use of Wood's lamp. The procedure is a non-surgical alternative for the treatment of the basal cell carcinoma, with excellent aesthetic outcome. The patient is on clinical follow-up, with absence of recurrence of the neoplasia 18 months after the treatment.

Terapia fotodinâmica com luz do dia: farmacoeconomia no uso do creme de metilaminolevulinato para ceratoses actínicas faciais / Daylight photodynamic therapy: pharmacoeconomics of methyl aminolevulinate cream use for facial actinic keratoses

Introdução: As ceratoses actínicas são as lesões pré-malignas de pele mais comuns, apresentando caráter crônico e recorrente. A terapia fotodinâmica com luz do dia tem sido utilizada no tratamento de ceratoses actínicas de face e couro cabeludo. Objetivo: Demonstrar a possibilidade da realização da terapia fotodinâmica com luz do dia em serviço público para o tratamento de ceratoses actínicas em face, utilizando um tubo de creme de metilaminolevulinato em até quatro pacientes. Métodos: Foram selecionados 10 pacientes para a realização de terapia fotodinâmica com luz do dia, realizando-se curetagem das ceratoses actínicas seguidas da aplicação de filtro químico e creme de metilaminolevulinato em toda a face. Resultados: um tubo de creme de metilaminolevulinato, foi suficiente para tratar até quatro pacientes com múltiplas ceratoses actínicas de face, enquanto os estudos sugerem o uso de pelo menos 1g para tratar uma face completa. Conclusões: O resultado nos leva a afirmar que na terapia fotodinâmica com luz do dia, a utilização de quantidade inferior a 1 grama de creme de metilaminolevulinato no tratamento de ceratoses actínicas de face é posologia factível para obtenção de efetiva resposta clínica.

Introduction: Actinic keratoses are the most common premalignant skin lesions, with a chronic and recurrent nature. Daylight photodynamic therapy has been used in the treatment of actinic keratoses of the face and scalp. Objective: To demonstrate the possibility of implementing daylight photodynamic therapy at a public service, for the treatment of facial actinic keratosis, using one tube of methyl aminolevulinate cream for up to four patients. Methods: Ten patients were selected to undergo daylight photodynamic therapy at the Centro de Dermatologia Dona Libânia, located in the city of Fortaleza (CE), Brazil. Curettage was performed on the actinic keratosis and a methyl aminolevulinate cream based chemical filter was applied across the face. Results: One tube of methyl aminolevulinate cream was enough for treating up to four patients with multiple facial actinic keratoses, whereas studies suggest the use of at least one gram to treat one face completely. Conclusion: It was possible to conclude when administering daylight photodynamic therapy, an amount of less than one gram of methyl aminolevulinate cream in the treatment of facial actinic keratoses is a dosage sufficient to obtain an effective clinical response.

Widespread nasal carriage of Mycobacterium lepraeamong a healthy population in a hyperendemic region of northeastern Brazil

A case-control study was conducted to determine the presence ofMycobacterium lepraeDNA in nasal secretions of leprosy cases and nonleprosy individuals in Fortaleza, Brazil. It included 185 cases identified by physicians at the Dona Libânia National Reference Centre for Sanitary Dermatology (CDERM). A control group (Co) (n = 136) was identified among individuals from CDERM not diagnosed as leprosy cases. To augment the spatial analysis of M. leprae specific repetitive element (RLEP) positive prevalence, an external group (EG) (n = 121), a convenience sample of healthy students, were included. Polymerase chain reaction for the RLEP sequence was conducted for all participants. Prevalence of RLEP positivity for cases and Co were 69.2% and 66.9%, respectively, significantly higher than for EG (28.1%), and reported elsewhere. Male sex, belonging to a lower socioeconomic status (D/E), history of a previous contact with a case and being older, were associated with being a leprosy case. Our geographical analysis demonstrated that the bacillus is widespread among the healthy population, with clusters of RLEP positive multibacillary cases concentrated in distinct areas of the city. Our results suggest that in endemic areas, as in Fortaleza, surveillance for both nonhousehold leprosy contacts and members of the general population living in cluster areas should be implemented.

Piloleiomyoma with segmental distribution - Case report

Piloleiomyoma is an uncommon benign neoplasm arising from the erector pilorum muscle. It presents as reddish-brown papules or nodules, in general located on the limbs or trunk, often painful. The present paper describes a case of piloleiomyoma with segmental distribution on left trunk, with an important expression of pain.

Rosai-Dorfman disease presenting with extensive cutaneous manifestation - Case report / Doença de Rosai-Dorfman com manifestação cutânea extensa - Relato de caso

Rosai-Dorfman disease is a benign, self-limited, idiopathic proliferative histiocytic disorder. It was first described in 1969 by Rosai and Dorfman. In its typical form the disease is characterized by extensive cervical lymphadenopathy associated with fever, polyclonal gammopathy and leukocytosis with neutrophilia. The skin is the most common site affected. Extranodal manifestations have been reported in 43% of cases. In this study, we report an atypical case of Rosai-Dorfman disease in a female with massive cutaneous manifestation on the thigh, associated with a minimal lymphadenopathy limited to the regional inguinal lymph nodes.

A doença de Rosai-Dorfman é uma desordem benigna, autolimitada, idiopática, decorrente da proliferação de histiócitos. Foi descrita pela primeira vez por Rosai e Dorfman em 1969. Tipicamente, a doença se caracteriza por extensa linfadenopatia cervical, febre, gamopatia monoclonal e leucocitose com neutrofilia. Manifestações extranodais são encontradas em 43% dos casos, sendo a pele o sítio extranodal mais comumente afetado. No trabalho, apresentamos um caso de doença de Rosai-Dorfman com apresentação cutânea exuberante na coxa direita e discreto comprometimento linfonodal limitado à cadeia regional.

A clinical trial for uniform multidrug therapy for leprosy patients in Brazil: rationale and design

Leprosy will continue to be a public health problem for several decades. The World Health Organization (WHO) recommends that, for treatment purposes, leprosy cases be classified as either paucibacillary or multibacillary (MB). A uniform leprosy treatment regimen would simplify treatment and halve the treatment duration for MB patients. The clinical trial for uniform multidrug therapy (U-MDT) for leprosy patients (LPs) in Brazil is a randomised, open-label clinical trial to evaluate if the effectiveness of U-MDT for leprosy equals the regular regimen, to determine the acceptability of the U-MDT regimen and to identify the prognostic factors. This paper details the clinical trial methodology and patient enrolment data. The study enrolled 858 patients at two centres and 78.4% of participants were classified as MB according to the WHO criteria. The main difficulty in evaluating a new leprosy treatment regimen is that no reliable data are available for the current treatment regimen. Relapse, reaction and impaired nerve function rates have never been systematically determined, although reaction and impaired nerve function are the two major causes of nerve damage that lead to impairments and disabilities in LPs. Our study was designed to overcome the need for reliable data about the current treatment and to compare its efficacy with that of a uniform regimen.

Brazilian clinical trial of uniform multidrug therapy for leprosy patients: the correlation between clinical disease types and adverse effects

This study sought to verify the correlation between leprosy types and the adverse effects of treatment drugs. This quantitative, prospective, nested study was developed at the Dona Libânia Dermatology Centre in Fortaleza, Brazil. Data were collected from November 2007-November 2008. During this period, 818 leprosy patients were diagnosed and began treatment. Forty patients with tuberculoid leprosy (TT) were selected. Twenty patients followed a standard therapy of dapsone and rifampicin and 20 were administered dapsone, rifampicin and clofazimine (U-MDT). Twenty patients with borderline lepromatous (BL) and lepromatous leprosy (LL) were also selected and treated with U-MDT. All of the subjects received six doses. With the exception of haemolytic anaemia, there was a low incidence of adverse effects in all the groups. We did not observe any differences in the incidence of haemolytic anaemia or other side effects across groups of patients with TT, BL or LL treated with U-MDT.

Mycobacterium leprae virulence-associated peptides are indicators of exposure to M: leprae in Brazil, Ethiopia and Nepal

Silent transmission of Mycobacterium leprae, as evidenced by stable leprosy incidence rates in various countries, remains a health challenge despite the implementation of multidrug therapy worldwide. Therefore, the development of tools for the early diagnosis of M. leprae infection should be emphasised in leprosy research. As part of the continuing effort to identify antigens that have diagnostic potential, unique M. leprae peptides derived from predicted virulence-associated proteins (group IV.A) were identified using advanced genome pattern programs and bioinformatics. Based on human leukocyte antigen (HLA)-binding motifs, we selected 21 peptides that were predicted to be promiscuous HLA-class I T-cell epitopes and eight peptides that were predicted to be HLA-class II restricted T-cell epitopes for field-testing in Brazil, Ethiopia and Nepal. High levels of interferon (IFN)-γ were induced when peripheral blood mononuclear cells (PBMCs) from tuberculoid/borderline tuberculoid leprosy patients located in Brazil and Ethiopia were stimulated with the ML2055 p35 peptide. PBMCs that were isolated from healthy endemic controls living in areas with high leprosy prevalence (EChigh) in Ethiopia also responded to the ML2055 p35 peptide. The Brazilian EChigh group recognised the ML1358 p20 and ML1358 p24 peptides. None of the peptides were recognised by PBMCs from healthy controls living in non-endemic region. In Nepal, mixtures of these peptides induced the production of IFN-γ by the PBMCs of leprosy patients and EChigh. Therefore, the M. leprae virulence-associated peptides identified in this study may be useful for identifying exposure to M. leprae in population with differing HLA polymorphisms.

Genotyping of Mycobacterium leprae present on Ziehl-Neelsen-stained microscopic slides and in skin biopsy samples from leprosy patients in different geographic regions of Brazil

We analysed 16 variable number tandem repeats (VNTR) and three single-nucleotide polymorphisms (SNP) in Mycobacterium leprae present on 115 Ziehl-Neelsen (Z-N)-stained slides and in 51 skin biopsy samples derived from leprosy patients from Ceará (n = 23), Pernambuco (n = 41), Rio de Janeiro (n = 22) and Rondônia (RO) (n = 78). All skin biopsies yielded SNP-based genotypes, while 48 of the samples (94.1%) yielded complete VNTR genotypes. We evaluated two procedures for extracting M. leprae DNA from Z-N-stained slides: the first including Chelex and the other combining proteinase and sodium dodecyl sulfate. Of the 76 samples processed using the first procedure, 30.2% were positive for 16 or 15 VNTRs, whereas of the 39 samples processed using the second procedure, 28.2% yielded genotypes defined by at least 10 VNTRs. Combined VNTR and SNP analysis revealed large variability in genotypes, but a high prevalence of SNP genotype 4 in the Northeast Region of Brazil. Our observation of two samples from RO with an identical genotype and seven groups with similar genotypes, including four derived from residents of the same state or region, suggest a tendency to form groups according to the origin of the isolates. This study demonstrates the existence of geographically related M. leprae genotypes and that Z-N-stained slides are an alternative source for M. leprae genotyping.

Neuropatia silenciosa em portadores de hanseníase na cidade de Fortaleza, Ceará, Brasil / Silent neuropathy in patients with leprosy in the city of Fortaleza, Ceará State, Brazil

Uma das formas da hanseníase é a neuropatia silenciosa que consiste em perda progressiva da função motora ou sensorial na ausência de dor e hipersensibilidade dos nervos. Realizou-se um estudo transversal em Fortaleza, Ceará, Brasil, o qual estimou a proporção de neuropatia silenciosa e fatores associados. O paciente foi interrogado sobre a presença de dor, dormência, alteração da sensibilidade, e foi realizada palpação de nervos para identificar espessamento, abscesso e dor. Amostras de linfa foram obtidas para exames parasitológicos. Foi medida a força de músculos voluntários dos membros e a sensibilidade de pontos das mãos e dos pés por meio de monofilamentos de Semmes-Weinstein. De uma amostra de 233 portadores de hanseníase, a proporção de pacientes com neuropatia silenciosa foi 5,6 por cento (IC95 por cento: 3,0-9,4), e a ocorrência de neuropatia silenciosa esteve significativamente associada à idade (p = 0,011) e à incapacidade (p < 0,000). Esses resultados poderão ajudar a identificar casos de neuropatia silenciosa, focalizando pacientes com maior probabilidade de desenvolver a doença.

One of the clinical forms of Hansen's disease is silent neuropathy, which consists of progressive nerve damage in the absence of pain and hypersensitivity to palpation. This study estimated the proportion of silent neuropathy and associated factors. A cross-sectional study was performed in Fortaleza, Ceará State, Brazil. Patients were asked about the presence of decreased sensation involving touch, heat, pain, and numbness. Nerves were palpated to identify thickness, abscess, and pain. Lymph samples were drawn for parasitological tests. Strength of voluntary muscles in the feet and hands was evaluated. The sensitivity of specific points on the feet and hands was measured using Semmes-Weinstein monofilament. The sample included 233 patients. The proportion of silent neuropathy was 5.6 percent (95 percentCI: 3.0-9.4), and factors significantly associated with silent neuropathy were: age (p = 0.011) and disability (p < 0.000). These results will help identify cases of silent neuropathy, targeting patients at higher risk.

Angiossarcoma primário em couro cabeludo e hanseníase virchowiana: associação incomum em paciente idosa / Primary angiosarcoma of the scalp and lepromatous leprosy: an uncommon combination in an elderly patient

Introdução: Os sarcomas cutâneos primários são neoplasias mesenquimais raras e de grande heterogeneidade histopatológica. O angiossarcoma é um subtipo de sarcoma cutâneo maligno pouco comum, que atinge preferencialmente homens idosos. De localização típicamente cefálica, apresenta-se como lesões multifocais que levam a edema, sangramento e ulceração locais. São agressivos, de crescimento rápido e difícil delimitação de margens cirúrgicas, o que explica altas taxas de recorrência. Descreve-se caso de angiossarcoma primário em couro cabeludo de paciente idosa em uso de poliquimioterapia para hanseníase virchowiana. Associação de angiossarcoma e hanseníase é incomum. A ausência de relatos semelhantes na literatura motivou a descrição do caso.

Hanseníase simulando erupção liquenóide: relato de caso e revisão de literatura / Leprosy simulating lichenoid eruption: case report and literature review

A hanseníase relaciona-se à formação de grande variedade de lesões cutâneas, desde manchas, pápulas, placas e nódulos, até infiltração difusa, dependendo da resposta imune do indivíduo. A apresentação clínica foge, muitas vezes, do padrão habitual, fazendo com que especialistas confundam o diagnóstico. O artigo descreve um caso raro de hanseníase, simulando erupção liquenoide, abordando os diferentes aspectos das manifestações clínicas, do diagnóstico e do tratamento desta entidade nosológica.

Leprosy is associated with the occurrence of various skin lesions such as macules, papules, plaques, nodules, and even diffused infiltration, depending on the patient's immune response. Its clinical presentation is often different from the usual pattern, leading to confusion in diagnosis. The present article describes a rare case of leprosy simulating lichenoid eruption and explores different aspects of the clinical manifestations, diagnosis, and treatment of this nosologic entity.

Experiência na terapia fotodinâmica com cloridrato de aminolevulinato de metila para queratose actínica e neoplasia cutânea não melanocítica / Photodynamic therapy with methyl-aminolevulinate hydrochloride for actinic keratosis anda non-melanocytic cutaneous neoplasia

Introdução: A terapia fotodinâmica (TFD) é uma opção de tratamento baseada na utilização de substâncias fotoquímicas que, ao impregnarem seletivamente o tecido anormal, agem como sensibilizadores para a atuação de radiação luminosa. Objetivos: Avaliar a resposta clínica, o resultado estético e efeitos colaterais da aplicação de TFD utilizando o fotosensibilizante cloridrato de aminolevulinato de metila (MAL) em lesões de queratose actínica (QA), carcinoma basocelular (CBC) e doença de Bowen (DB). Métodos: Após remoção de escamas ou crostas e impregnação da lesão com MAL, foi realizada a exposição à radiação de luz vermelha de 632nm (37 j/cm2),por 8 minutos, entre 5 e 8 cm de distancia da pele. Resultados: Foram analisados 102 pacientes, sendo que 59 eram portadores de QAs, 32 de CBC e 11 de DB. Houve resposta completa na maioria dos pacientes após 12 semanas, excetuando-se 14 pacientes: 6 com QA, 2 com DB, 6 com CBC. O tratamento demonstrou excelente resultado estético. As principais complicações foram 1 caso de eritema severo e 1 de pústulas e edema importantes. Conclusões: O presente trabalho, em consonância com a literatura, confirma a eficácia da TDF-MAL no tratamento de lesões de QA e neoplasias cutâneas não melanocíticas (NCNM), com semelhantes taxas de recidiva e melhores resultados estéticos em comparação com as terapias convencionais.

Introduction: Photodynamic therapy uses photochemical substances that selectively impregnate abnormal tissue and act as a sensitizing agent for the light. Objective: To evaluate the clinical response, aesthetic results and side effects of applying photodynamic therapy using the photosensitizer methyl-aminolevulinate hydrochloride in actinic keratosis lesions, basal cell carcinomas, and Bowen’s disease. Methods: After removing scales or crusts and impregnating the lesion with methyl- aminolevulinate hydrochloride, 632 nm (37 j/cm2) red light radiation was applied, at a distance of 5 to 8 cm from the skin, for 8 minutes. Results: 102 patients (59 with actinic keratosis, 32 with basal cell carcinoma, and 11 with Bowen’s disease) were studied. After 12 weeks, only 14 patients (6 actinic keratosis, 6 basal cell carcinoma, and 2 Bowen’s disease) had incomplete results.The treatment yielded excellent aesthetic results. The main complications were 1 case of severe erythema and 1 case of important pustules and edema. Conclusions: Consistent with the literature, this study confirms the efficacy of photodynamic therapy with methyl-aminolevulinate hydrochloride in the treatment of actinic keratosis lesions and nonmelanocytic cutaneous neoplasias, with similar recurrence rates and better aesthetic results than conventional therapies.

Estudo clínico observacional de eficácia e segurança do uso de extratos de Imperata cylindrica e de Triticum vulgare... / Surveillance clinical trial for efficacy and safety uses of extracts of Imperata cylindrica and Triticum vulgare...

A hidratação cutânea é, sem dúvida alguma, uma das modalidades terapêuticas mais empregadas pelos dermatologistas em sua prática clínica diária. Neste artigo se apresenta o resultado clínico de um estudo fase IV, aberto, multicêntrico, prospectivo, de uso de extratos de Imperata cylindrica e de Triticum vulgare ceramidas vitaminas A, C, E e F silanol (Epidrat® Ultra) em 168 voluntários portadores de xerose cutânea associada a causas específicas (dermatite atópica, psoríase, xerose senil, hanseníase, climatério e senilidade, diabetes mellitus ou hipotireoismo). Após 30 dias de uso do produto houve alívio, médio, de 40,38% dos sinais (p<0,0001) e 37,08% dos sintomas (p<0,0001) de xerose entre os voluntários (redução média da soma dos sinais e sintomas foi de 40,51% p<0,0001). Antes do uso do produto 61,3% dos voluntários possuíam xerose moderada/grave/muito grave, o que involuiu para 23,2% dos mesmos ao final da avaliação (p<0,0001) inversamente, dos 38,7% dos voluntários considerados com xerose ausente/leve no início do estudo, a porcentagem dos mesmos subiu para 76,2% (p<0,0001, para ambos os comportamentos). Segundo os investigadores, o alívio completo/acentuado da xerose notado foi de 57,1% e, para os voluntários, de 60,7% (p<0,0001). Além do mais, o produto apresentou boa tolerabilidade de uso, com incidência reduzida de eventos adversos realmente relacionados ao seu uso (13,8%) que, em última análise, poderia ser da própria evolução clínica adaptativa da terapêutica tópica, talvez, observada com o uso de qualquer produto tópico, cosmecêutico ou farmacológico. Estes dados, portanto, estabelecem Epidrat® Ultra como uma boa opção terapêutica para abordagem de quadros graves de xerose cutânea.

Perfil clínico-epidemiológico dos pacientes diagnosticados com hanseníase em um centro de referência na região nordeste do Brasil / Clinical and epidemiological profile of patients diagnosed with leprosy in a reference center in the notheast of Brazil

FUNDAMENTOS: A hanseníase permanece sério problema de saúde pública mundial. O conhecimento das características epidemiológicas da doença é importante ferramenta para o controle da endemia. OBJETIVO: Descrever as características clínicas e epidemiológicas dos pacientes diagnosticados com hanseníase no ano de 2004 em um centro de referência da Região Nordeste do Brasil. MÉTODO: Foram avaliados prontuários de pacientes que deram entrada no registro ativo do Centro de Dermatologia Dona Libânia, em Fortaleza, Ceará, no período de janeiro a dezembro de 2004. RESULTADOS: dos 967 casos que deram entrada nesse Centro naquele ano, 909 foram casos novos. Cerca de 7,7 por cento eram pacientes entre zero e 14 anos de idade, e a distribuição por gênero foi de 483 (49,95 por cento) homens e 484 (50,05 por cento) mulheres. A maioria apresentava a forma clínica dimorfa (54,6 por cento), sendo 82,2 por cento dos pacientes provenientes de Fortaleza, CE. Foi realizada a avaliação do grau de incapacidades no diagnóstico em 94,2 por cento dos pacientes, com 21,7 por cento apresentando grau diferente de zero no diagnóstico. CONCLUSÃO: Com base nos resultados obtidos, constatou-se a presença de elevado percentual (7,7 por cento) de casos detectados em menores de 15 anos, associado a baixo percentual (5,8 por cento) de pacientes diagnosticados na forma indeterminada e elevado percentual (21,7 por cento) de casos com incapacidade ao diagnóstico.

BACKGROUND: Leprosy continues to represent a serious public health problem worldwide. Knowledge of epidemiological characteristics of the disease is an important tool for the endemy control. OBJECTIVES: To describe the clinical and epidemiological characteristics of patients diagnosed with leprosy during 2004, in a Reference Center in the Northeast of Brazil. METHODS: We analyzed the records referring to patients who entered de active register of the Center of Dermatology Dona Libânia, in Fortaleza, Ceará, from January to december 2004. RESULTS: Out of 967 cases that entered this Center in this year, 909 were new detected cases. About 7,7 percent were between zero e 14 years old, and distribution per gender was of 483(49,95 percent) men and 484(50,05 percent) women. Most of them presented the borderline clinical form (54,6 percent), and 82,2 percent resided in the city of Fortaleza/CE. Measurement of disabilities degree in diagnosis was made in 94,2 percent of the patients, and 21,7 percent of total showed a degree different from zero. CONCLUSION: Based in the results, we noted a high percentual (7,7 percent) of patients under fifteen years old, associated with low percentual of indeterminate forms and a high percentual of cases with disabilities at diagnosis. These factors are expressive enough to make the authorities consider the difficulties to reach the goal of eliminating leprosy by the end of 2005, and the necessity of new approaches and strategies to control leprosy endemy.