Bibliometric evaluation of Anais Brasileiros de Dermatologia (2013-2022)

Abstract The Anais Brasileiros de Dermatologia, published since 1925, is the most influential dermatological journal in Latin America, indexed in the main international bibliographic databases, and occupies the 50th position among the 70 dermatological journals indexed in the Journal of Citations Reports, in 2022. In this article, the authors present a critical analysis of its trajectory in the last decade and compare its main bibliometric indices with Brazilian medical and international dermatological journals. The journal showed consistent growth in different bibliometric indices, which indicates a successful editorial policy and greater visibility in the international scientific community, attracting foreign authors. The increases in citations received (4.1 ×) and in the Article Influence Score (2.9×) were more prominent than those of the main Brazilian medical and international dermatological journals. The success of Anais Brasileiros de Dermatologia in the international scientific scenario depends on an assertive editorial policy, on promptly publication of high-quality articles, and on institutional stimulus to encourage clinical research in dermatology.

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.

JAK-STAT pathway inhibitors in dermatology

Abstract The JAK-STAT signaling pathway mediates important cellular processes such as immune response, carcinogenesis, cell differentiation, division and death. Therefore, drugs that interfere with different JAK-STAT signaling patterns have potential indications for various medical conditions. The main dermatological targets of JAK-STAT pathway inhibitors are inflammatory or autoimmune diseases such as psoriasis, vitiligo, atopic dermatitis and alopecia areata; however, several dermatoses are under investigation to expand this list of indications. As JAK-STAT pathway inhibitors should gradually occupy a relevant space in dermatological prescriptions, this review presents the main available drugs, their immunological effects, and their pharmacological characteristics, related to clinical efficacy and safety, aiming to validate the best dermatological practice.

Accuracy of direct examination and culture as compared to the anatomopathological examination for the diagnosis of chromoblastomycosis: a systematic review

Abstract Background: Chromoblastomycosis is a skin infection caused by dematiaceous fungi that take the form of muriform cells in the tissue. It mainly manifests as verrucous plaques on the lower limbs of rural workers in tropical countries. Objectives: The primary objective of this review is to evaluate the accuracy of diagnostic methods for the identification of chromoblastomycosis, considering the histopathological examination as the reference test. Methods: MEDLINE, LILACS and Scielo databases were consulted using the terms ‟chromoblastomycosis" AND ‟diagnosis". The eligibility criteria were: studies that evaluated the accuracy of tests for the diagnosis of chromoblastomycosis. Eleven studies were selected. Statistical analysis included the calculation of sensitivity and specificity of the diagnostic methods. Results: Considering the histopathological examination as the reference test, the culture showed a sensitivity (S) of 37.5% - 90.9% and a specificity (Sp) of 100%; while direct mycological examination showed S = 50% - 91.6% and Sp of 100% . Considering the culture as the reference test, the serology (precipitation techniques) showed S of 36% - 99%; and Sp of 80% - 100%; while the intradermal test showed S of 83.3% - 100% and Sp of 99.4% - 100%. Study limitations: The small number of studies and very discrepant sensitivity results among them do not allow the calculation of summary measures through a meta-analysis. Conclusions: Direct mycological examination, culture, intradermal test and serology show sensitivity and specificity values for the diagnosis of chromoblastomycosis with no significant difference between the studies.

Diagnosis of chromoblastomycosis: an historical review

Chromoblastomycosis is a skin infection caused by dematiaceous fungi, characterized by a verrucous plaque on the limbs. It mainly affects rural workers in tropical countries. The purpose of this review is to identify how the diagnostic methods used in the propaedeutic of chromoblastomycosis emerged and were developed. The MeSH terms "chromoblastomycosis" or "chromomycosis" or "verrucous dermatitis" and "diagnosis" were used to search articles indexed in MEDLINE and LILACS databases. The description of a first-time-used method in diagnosing chromoblastomycosis or modifications and innovations in an existing technique was the criteria used to deem the article eligible. The first methods described in diagnosing chromoblastomycosis were histopathological examination and culture, which characterizes and defines the disease in the early 20th century. Subsequently, they were described as direct microscopic examination, fine needle aspiration for cytology, electron microscopy, serology, molecular tests, scintigraphy, nuclear magnetic resonance and dermoscopy. Tests based on the direct identification of the fungus through biopsy, culture, or direct microscopy are the oldest and more employed methods for diagnosing chromoblastomycosis. The polymerase chain reaction was introduced in the last few decades and is a promising technique. Dermoscopy of chromoblastomycosis shows blackish red dots and white and pink areas along with scaling. Other techniques, such as serology and skin testing for delayed-type hypersensitivity, have not been incorporated into clinical practice

Cost-effectiveness of moderate-to-severe psoriasis biologic treatments in Brazilian private healthcare system: cost-per-responder results derived from a network metanalysis / Custo-efetividade do tratamento biológico para psoríase moderada a grave no sistema brasileiro de saúde suplementar: resultados de custo por resposta obtidos por meio de uma metanálise em rede

Objective: To assess the cost-per-responder (CpR) of biologic therapies available in Brazil to treat moderate-to-severe plaque psoriasis (PsO) from the private healthcare system's perspective. Methods: Number needed to treat (NNT) and (CpR) analyses were performed to evaluate biologic therapies' cost-effectiveness for moderate-to-severe PsO available in Brazil. The effectiveness of biologic treatments for moderate-to-severe PsO was assessed based on a previously published metanalysis, which included studies considering PsO patients and outcomes of interest (PASI 75, 90, and 100). The clinical efficacy data in terms of estimated NNT based on the network metanalysis (NMA) results were combined with drug treatment costs to determine the CpR for each treatment arm in 3-time horizons: the primary response period, 1-year, and 2-years. Results: Risankizumab was the most cost-effective option when NMA base case scenario data was used to calculate NNT in all PASI response for both the primary response period and 1- and 2-years follow-up durations. Differences in CpR between risankizumab and other biologic drugs increased with more significant PASI improvements. CpR sensitivity analysis also confirmed these findings, indicating that risankizumab has a better performance for PASI 100, and both risankizumab and guselkumab are very similar in terms of cost per additional PASI 75 and PASI 90 responder. Conclusions: Risankizumab was estimated to have a lower cost per PASI 75, 90, and 100 responders in most simulated scenarios (primary response period [12-16 weeks], 1-year and 2-years), among the evaluated biologic therapies.

Objetivo: Avaliar o custo por respondedor (CpR) das terapias biológicas disponíveis no Brasil para tratamento da psoríase em placas (PsO) moderada a grave, na perspectiva do sistema brasileiro de saúde suplementar. Métodos: Foram realizadas análises de número necessário para tratar (NNT) e CpR para avaliar o custo-efetividade das terapias biológicas para PsO moderada a grave disponíveis no Brasil. A eficácia foi avaliada por meio de dados de uma metanálise em rede (NMA), que incluiu estudos considerando pacientes com PsO moderada a grave e os desfechos de interesse (PASI 75, 90 e 100). Dados de eficácia em termos de NNT foram combinados com custos do tratamento medicamentoso para determinar o CpR para cada braço de tratamento em três horizontes temporais: período de resposta primária, 1 ano e 2 anos. Resultados: Risanquizumabe foi mais econômico quando utilizados os dados do caso-base para calcular o NNT, considerando todos os escores PASI para o período de resposta primária e em 1 e 2 anos. As diferenças no CpR entre o risanquizumabe e os outros medicamentos biológicos aumentaram com maiores ganhos de PASI. O CpR calculado pela análise de sensibilidade confirmou esses achados, indicando que risanquizumabe tem um melhor desempenho para PASI 100, e risanquizumabe e guselcumabe são muito semelhantes em termos de CpR por PASI 75 e PASI 90 adicionais. Conclusões: Risanquizumabe apresentou um custo mais baixo por respondedor PASI 75, 90 e 100 na maioria dos cenários analisados (período de resposta primária [12-16 semanas], 1 ano e 2 anos), entre as terapias biológicas avaliadas.

Consensus on the use of oral isotretinoin in dermatology - Brazilian Society of Dermatology

Abstract Background: Isotretinoin is a synthetic retinoid, derived from vitamin A, with multiple mechanisms of action and highly effective in the treatment of acne, despite common adverse events, manageable and dose-dependent. Dose-independent teratogenicity is the most serious. Therefore, off-label prescriptions require strict criteria. Objective: To communicate the experience and recommendation of Brazilian dermatologists on oral use of the drug in dermatology. Methods: Eight experts from five universities were appointed by the Brazilian Society of Dermatology to develop a consensus on indications for this drug. Through the adapted DELPHI methodology, relevant elements were listed and an extensive analysis of the literature was carried out. The consensus was defined with the approval of at least 70% of the experts. Results: With 100% approval from the authors, there was no doubt about the efficacy of oral isotretinoin in the treatment of acne, including as an adjunct in the correction of scars. Common and manageable common adverse events are mucocutaneous in nature. Others, such as growth retardation, abnormal healing, depression, and inflammatory bowel disease have been thoroughly investigated, and there is no evidence of a causal association; they are rare, individual, and should not contraindicate the use of the drug. Regarding unapproved indications, it may represent an option in cases of refractory rosacea, severe seborrheic dermatitis, stabilization of field cancerization with advanced photoaging and, although incipient, frontal fibrosing alopecia. For keratinization disorders, acitretin performs better. In the opinion of the authors, indications for purely esthetic purposes or oil control are not recommended, particularly for women of childbearing age. Conclusions: Approved and non-approved indications, efficacy and adverse effects of oral isotretinoin in dermatology were presented and critically evaluated.

Case for diagnosis

A 6 year-old patient began to experience localized hairloss in the right temporal region three years ago. During the first appointment, diagnoses of alopecia areata and congenital triangular alopecia were made. After one year, there was no change. Upon dermatological examination, non-scarring alopecia was noted in the right temporal region, revealing extremely fine and fair hair follicles. A dermoscopy revealed only thin vellus-type hairs. Congenital triangular alopecia is a condition commonly confused with alopecia areata and is thus underdiagnosed. However, well-established clinical parameters and dermoscopic criteria can be used to distinguish skin diseases that affect hair and define the diagnosis.

Granuloma faciale: a rare disease from a dermoscopy perspective / Granuloma facial: uma doenca rara sob uma perspectiva dermatoscopica

The granuloma faciale is a rare and benign skin disease of unknown etiology, characterized by chronic leukocitoclastic vasculitis. It is characterized by skin lesions predominantly facial whose course is chronic and slowly progressive. The diagnosis is based on clinical features, histopathology and, more recently, in dermoscopy. We describe the case of a male patient, 40 years old, with a sarcoid lesion on the malar site, whose histopathological examination revealed a mixed inflammatory infiltrate with presence of Grenz zone. Dermoscopy revealed a pink background with white striations. The definitive diagnosis is made by histopathologic evaluation, and dermatoscopy can be helpful. It is known to be resistant to therapy, oral medications, intralesional and surgical procedures are options.

O granuloma facial é doença cutânea rara e benigna, de etiologia desconhecida, caracterizado por vasculite leucocitoclástica crônica. Caracteriza-se por lesões cutâneas predominantemente faciais, tem curso crônico e lentamente progressivo. O diagnóstico é baseado na clínica, histopatologia e, mais recentemente, na dermatoscopia. Relatamos o quadro de um paciente masculino, 40 anos de idade, com lesão sarcoídea na face malar, cujo exame histopatológico revelou infiltrado inflamatório misto com presença de zona de Grenz. A dermatoscopia revelou um fundo rosado com estrias brancas. O diagnóstico definitivo é feito pela avaliação histopatológica, sendo que a dermatoscopia pode ser útil. É conhecida por ser resistente à terapêutica, sendo propostas medicações orais, intralesionais e procedimentos cirúrgicos.

Retinoids for prevention and treatment of actinic keratosis / Retinoides para a prevencao e tratamento das queratoses actinicas

Actinic keratosis is a common cause of dermatological consultations and it presents a strong association with squamous cell carcinoma. Many substances are used for treatment and prevention, such as retinoids. Nevertheless, many studies on retinoids emphasize their application in treating and preventing non melanoma skin cancers. In this article, we reviewed studies about systemic and topical retinoids used with immunocompetent patients and organ transplant recipients with actinic keratosis, as primary or secondary outcomes. The majority of these papers pointed to a reduction in actinic keratosis count after treatment with retinoids. However, studies need to be better-defined in order to address the lack of a standardized dose, the absence of control groups, the low number of patients and short follow-up periods. Blind, randomized and controlled clinical trials with adequate sample sizes, specifically focused on actinic keratosis, are needed to clarify the real benefit of topical and/or oral retinoids. Comparison of efficacy and safety between oral and topical retinoids in the prevention and treatment of non-melanoma skin cancers and actinic keratosis is an essential pre requisite to establish new strategies to control these conditions. .

A queratose actínica é uma causa comum de consultas dermatológicas e apresenta forte associação com o carcinoma espinocelular. Muitas substâncias são utilizadas para seu tratamento e prevenção, assim como os retinoides. Entretanto, muitos estudos sobre retinoides salientam seu uso no tratamento e prevenção de cânceres de pele não melanoma. Neste artigo, nós revisamos estudos que avaliam o uso dos retinoides sistêmicos e tópicos para pacientes imunocompetentes e imunossuprimidos com queratoses actínicas, como desfechos primários e secundários. A maioria destes estudos mostra redução na contagem das queratoses actínicas após o tratamento com retinóides. Além disso, ajustes no delineamento dos estudos deveriam ser feitos quanto à falta de padronização da dose, ausência de grupos controle, número pequeno de pacientes e tempo curto de seguimento. Ensaios clínicos cegos, randomizados e controlados com tamanho amostral adequado tendo como alvo específico as queratoses actínicas são necessários para esclarecer o real benefício dos retinoides tópicos e/ou orais. A comparação da eficácia e segurança entre os retinoides orais e tópicos na prevenção e tratamento dos cânceres de pele não melanoma e queratoses actínicas é um pré-requisito essencial para o estabelecimento de novas estratégias para o controle destas condições.

Estudo da correlação entre molusco contagioso e dermatite atópica em crianças / A study of the correlation between molluscum contagiosum and atopic dermatitis in children

FUNDAMENTOS: É bastante divulgado, sem a fundamentação científica necessária, que a infecção por molusco contagioso tende a ser mais frequente e de maior intensidade nos pacientes acometidos por dermatite atópica. Tal fato motivou a realização deste trabalho. OBJETIVOS: Avaliar a prevalência de associação de dermatite atópica e molusco contagioso; avaliar se, nos pacientes com dermatite atópica, a infecção por molusco contagioso é mais recorrente e/ou disseminada e se a ocorrência de eczema perimolusco, prurido e/ou infecção é mais prevalente que nos pacientes sem dermatite atópica. MÉTODOS: Avaliaram-se 284 crianças de ambos os sexos, com diagnóstico de molusco contagioso e/ ou dermatite atópica. RESULTADOS: Apenas 13,4 por cento dos pacientes apresentavam ambas as doenças. O número de áreas anatômicas afetadas por molusco contagioso, a ocorrência de eczema perimolusco e prurido foram maiores nos pacientes com dermatite atópica associada. Não houve diferença significativa de frequência de infecção secundária associada às lesões de molusco contagioso nos pacientes com e sem dermatite atópica. CONCLUSÃO: A prevalência da ocorrência de dermatite atópica e molusco contagioso associados foi baixa. Não houve diferença significativa na recorrência da infecção por molusco contagioso e na quantidade de lesões nos pacientes com e sem dermatite atópica. O número de áreas anatômicas afetadas por lesões de molusco contagioso, a presença de eczema perimolusco e de prurido foram maiores nos pacientes com dermatite atópica. Não houve diferença significativa na ocorrência de infecção bacteriana secundária nos grupos com e sem dermatite atópica.

BACKGROUND: Although no scientific evidence has yet been published, it is widely understood that molluscum contagiosum tends to be more common and more intense in patients with atopic dermatitis. This lack of evidence led to the development of the present study. OBJECTIVES: To evaluate the prevalence of the association between atopic dermatitis and molluscum contagiosum; to evaluate whether molluscum contagiosum is more likely to be recurrent and/or disseminated in patients with atopic dermatitis and whether the occurrence of eczema surrounding the molluscum contagiosum lesions, pruritus and/or infection is more prevalent in these patients compared to patients without atopic dermatitis. METHODS: A total of 284 children of both sexes with a diagnosis of molluscum contagiosum and/or atopic dermatitis were evaluated. RESULTS: Only 13.4 percent of the patients had both conditions. The number of anatomical areas affected by molluscum contagiosum and the occurrence of surrounding eczema and pruritus was greater in the patients who also had atopic dermatitis. There was no statistically significant difference in the frequency of secondary infection associated with the molluscum contagiosum lesions between the patients who had atopic dermatitis and those who did not. CONCLUSION: The prevalence of atopic dermatitis associated with molluscum contagiosum was low. There was no statistically significant difference in the recurrence rates associated with molluscum contagiosum or in the number of lesions between the patients who had atopic dermatitis and those who did not. The number of anatomical areas affected by the molluscum contagiosum lesions and the presence of surrounding eczema and pruritus were higher in the patients with atopic dermatitis. There was no statistically significant difference in the occurrence of secondary bacterial infection between the groups with and without atopic dermatitis.

Padrões dermatoscópicos do molusco contagioso: estudo de 211 lesões confirmadas por exame histopatológico / Dermoscopic patterns of molluscum contagiosum: a study of 211 lesions confirmed by histopathology

FUNDAMENTOS: Embora de fácil diagnóstico, o molusco contagioso pode apresentar-se como lesões inflamadas, únicas ou pequenas de difícil diagnóstico. OBJETIVO: Descrever características dermatoscópicas do molusco contagioso e comparar achados do exame clínico e dermatoscópico. MÉTODOS: Avaliou-se clínica e dermatoscopicamente lesões confirmadas pela histopatologia em 57 pacientes. RESULTADOS: Nos exames clínico e dermatoscópico de 211 lesões, foram visualizados orifícios em 50,24 por cento e 96,68 por cento das lesões e vasos em 6,16 por cento e 89,10 por cento delas, respectivamente. Os padrões vasculares encontrados em 188 lesões que apresentaram vasos à dermatoscopia foram coroa (72,34 por cento), radial (54,25 por cento) e puntiforme (20,21 por cento). Metade das 188 lesões apresentou padrão vascular combinado, sendo o padrão em flor (novo padrão vascular) responsável por 19,68 por cento. Foram identificados mais orifícios e vasos no exame dermatoscópico que no clínico, inclusive naquelas com inflamação, eczema perilesional e de tamanho pequeno. Vasos puntiformes relacionaram-se com inflamação, escoriação e eczema perilesional. CONCLUSÕES: A dermatoscopia das lesões de molusco mostrou-se superior ao exame dermatológico mesmo quando seu diagnóstico clínico torna-se difícil. A presença de orifícios, vasos e padrões vasculares específicos auxilia no seu diagnóstico e na diferenciação de outras lesões de pele.

BACKGROUNDS: Although easily diagnosed, molluscum contagiosum may present as a single lesion or as several small, inflamed lesions of difficult diagnosis. OBJECTIVE: To describe the dermoscopic characteristics of molluscum contagiosum and to compare the findings from clinical examination and dermoscopy. METHODS: Histopathologically confirmed lesions were evaluated clinically and dermoscopically in 57 patients. RESULTS: At clinical examination and dermoscopy of 211 lesions, orifices were visualized in 50.24 percent and 96.68 percent of the lesions, and vessels in 6.16 percent and 89.10 percent, respectively. The vascular patterns found in the 188 lesions in which vessels were found at dermoscopy were the crown (72.34 percent), radial (54.25 percent) and punctiform patterns (20.21 percent). Half of the 188 lesions had a combination of vascular patterns, with the flower pattern (a new vascular pattern) being found in 19.68 percent of cases. More orifices and vessels were identified at dermoscopy than at clinical examination, including cases with inflammation or perilesional eczema and small lesions. Punctiform vessels were associated with inflammation, excoriation and perilesional eczema. CONCLUSIONS: Dermoscopy performed on molluscum contagiosum lesions proved superior to dermatological examination even in cases in which clinical diagnosis was difficult. The presence of orifices, vessels and specific vascular patterns aids diagnosis, including differential diagnosis with other types of skin lesion.

Dificuldade diagnóstica e mau prognóstico associados à regressão de melanoma cutâneo primário / Difficulty in the diagnosis and bad prognosis associated with the regression of primary cutaneous melanoma

O melanoma cutâneo primário em regressão (melanoma em regressão) espontânea parcial é frequente, porém a regressão completa é rara. O diagnóstico é difícil, principalmente na regressão completa. Relatam-se três casos de melanoma em regressão nos quais a biópsia inicial não revelou melanoma, e o diagnóstico foi obtido pelas metástases. Não há consenso sobre o significado prognóstico da regressão. Nos casos descritos, o melanoma em regressão associou-se a pior prognóstico, pela própria característica do tumor ou dificuldade no diagnóstico precoce e estadiamento. Conclui-se que a regressão no melanoma primário pode conferir maior dificuldade ao diagnóstico e estadiamento, com consequente pior prognóstico. Deve-se indicar biópsia excisional de lesão suspeita sempre que possível.

The partial regression of cutaneous melanoma is a frequent event. Nevertheless, complete regression is a rare and difficult to diagnose condition.We report three cases of regressed cutaneous melanoma (RCM) whose initial biopsies did not reveal melanoma and in which the diagnosis was based on the presence of metastasis. There is no consensus about the prognosis of RCMs. Some authors relate a higher prevalence of metastasis, coinciding with our cases' outcomes, where the RCM had the worst prognosis due to the tumors' aggressiveness or to the difficulty in establishing an early diagnosis and staging. We have concluded that the regression of melanoma complicates the diagnosis, staging and formulation of a worst-case scenario prognosis. Excisional biopsy should always be the first choice.

Urticária aquagênica familiar: relato de dois casos e revisão da literatura / Familial aquagenic urticaria: report of two cases and literature review

Urticária aquagênica é forma rara de urticária física caracterizada por aparecimento de urticas após o contato com água, independente da temperatura. Há poucos casos descritos de urticária aquagênica e, destes, somente cinco da forma familiar. Apresentamos o primeiro relato de urticária aquagênica familiar no Brasil, acometendo mãe e filha. Ambas apresentavam urticas, principalmente após banho de chuveiro, independentemente da temperatura da água. A mãe referia ter o quadro há quatro anos, e a filha, desde o nascimento. Para diagnóstico, foram realizados testes de provocação com água, com aparecimento de lesões em ambas, e testes com dermografômetro, com cubo de gelo envolvido em plástico e de provocação para urticária colinérgica, sem o aparecimento de lesões, excluindo assim outras formas de urticária física.

Aquagenic urticaria is a rare form of physical urticaria, characterized by pruritic wheals that appear following contact with water, independently of its temperature. There are few reports of cases of aquagenic urticaria, and only five include the familial form. We present the first case of familial aquagenic urticaria in Brazil (mother and daughter). Both patients presented wheals following contact with water, especially when showering, regardless of its temperature. The mother reported onset of urticaria four years before and the daughter presented wheals since birth. For diagnostic purposes, they were submitted to a challenge test with water, and both subjects presented wheals, as well as to tests using ice cubes in plastic bag with dermographometer and challenge tests for cholinergic urticaria, with no appearance of lesions, excluding other forms of physical urticaria.