Diagnostic and therapeutic guidelines for plaque psoriasis - Brazilian Society of Dermatology

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.

Moderate to severe plaque psoriasis - treatment with drugs of the classic scheme

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.

Psoriasis in moderate grave plaque - immunobiological treatment

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.

Psoríase na infância e na adolescência / Psoriasis in childhood and adolescence

A psoríase é doença inflamatória crônica, imunologicamente mediada, recorrente e de caráter universal. Aproximadamente um terço dos adultos acometidos refere início da doença antes dos 16 anos de idade. Quanto mais precoce, mais grave tende a ser a evolução do quadro. Em crianças, as lesões podem ser fisicamente desfigurantes, causando prejuízos psicológicos e evidente comprometimento da qualidade de vida. As medicações sistêmicas utilizadas na psoríase, bem como a fototerapia, têm indicação limitada na infância, devido aos efeitos cumulativos das drogas, à baixa aceitação e ao risco de teratogenicidade. Nesta seção, discutiremos as principais manifestações clínicas da psoríase na infância e na adolescência, bem como os diagnósticos diferenciais, opções terapêuticas e prognóstico.

Psoriasis is a chronic, immunologically mediated, recurrent and universal inflammatory disorder. Approximately one third of adults refer onset before 16 years of age. The sooner the onset, the worse is the prognosis. In children, lesions may be physically disfiguring, leading to psychological impairment and evident loss of quality of life. Systemic therapy used in psoriasis, as well as phototherapy, has limited use in children due to accumulative effects of drugs, low acceptance, and risk of teratogenicity. In this section, we discuss the main clinical aspects of psoriasis in childhood and adolescence, differential diagnosis, therapeutic options, and prognosis.

African histoplasmosis. Report of the first case in Brazil and treatment with itraconazole

We report the first case of African histoplasmosis diagnosed in Brazil. The patient was an immigrant from Angola who had come to Brazil six months after the appearance of the skin lesion. The skin of the right retroauricular area was the only site of involvement. The diagnosis was established by direct mycologic examination, culture and by histopathologic examination of the lesion. The patient was successfully treated with Itraconazole 100mg a day for 52 days. No recurrent skin lesions were observed during the ten month follow-up period.

Calcipotriol no tratamento da psoríase vulgar / Calcipotriol in the treatment of psoriasis vulgaris

Estudou-se a açäo calcipotriol em 20 doentes portadores de psoríase vulgar estável, examinados no Departamento de Dermatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de Säo Paulo. Trata-se de um novo análogo da vitamina D3, que teria açäo na inibiçäo da proliferaçäo celular e diferenciaçäo terminal dos queratinócitos, o que explicaria o efeito terapêutico na psoríase. Aplicado topicamente, à concentraçäo de 50*/g, o calcipotriol mostrou ser eficaz e bem tolerado

Hanseníase indeterminada: evoluçao clínico-patológica / ?

Foi estudada, em um período de 2 meses a 24 anos, a evoluçao de 51 doentes de hanseníase indeterminada, para formas pauci ou multibacilares da moléstia. O objetivo do estudo foi o de procurar critérios para facilitar a comprovaçao diagnóstica das formas iniciais e o de buscar parâmetros - clínicos, histopatológicos e imunohistoquímicos - que permitissem inferir, desde o início dos sintomas, o sentido evolutivo da doença. Foram examinados os prontuários dos doentes, analisando-se, em relaçao ao quadro inicial da moléstia, o número e características morfológicas das lesoes, a história pregressa, a reaçao de Mitsuda e o tratamento recebido. Nos exames histopatológicos, na coloraçao pela hematoxilina-eosina, foram estudadas as alteraçoes epidérmicas e o infiltrado dermico - sua intensidade, constituiçao e localizaçao

Pênfigo folliaceus endêmico na infância: estudo evolutivo / Endemic pemphigus foliáceo in children: study of the evaluation

Foram estudados 21 doentes de PFE que adoeceram antes dos 14 anos de idade. O objetivo primordial do estudo foi verificar a evoluçäo sob tratamento. Näo obstante sua gravidade potencial, a doença teve evoluçäo favorável sob corticoterapia. Nos doentes estudados verificou-se somente um óbito, um permanece fora de controle após três anos de observaçäo, 13 dos doentes estäo controlados com doses baixas de corticosteróides e em três foi possível suspender a medicaçäo. Em três casos näo foi possível o seguimento clínico após a alta hospitalar

Manifestaçöes cutaneomucosas em doentes de AIDS / Skin and mucocutaneous manifestations in AIDS

Foram examinados, em relaçäo a manifestaçöes dermatológicas, 55 doentes de AIDS, num período de 20 meses. As dermatoses mais freqüentes foram: candidíase, sarcoma de Kaposi, herpes simples, herpes zoster, dermatofitoses, asteatose e dermatite seborréica