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Thien CI, Bessa VR, Miotto IZ, Samorano LP, Rivitti-Machado MC, Oliveira ZNPD. Hereditary epidermolysis bullosa: clinical-epidemiological profile of 278 patients at a tertiary hospital in São Paulo, Brazil. An Bras Dermatol 2024; 99:380-390. [PMID: 38403552 DOI: 10.1016/j.abd.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/17/2023] [Accepted: 06/23/2023] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Epidermolysis bullosa (EB) is a group of rare hereditary diseases, characterized by fragility of the skin and mucous membranes. Epidemiological data on EB in Brazil are scarce. OBJECTIVES To describe epidemiological aspects of patients with EB diagnosed in the Dermatology Department of a tertiary hospital, from 2000 to 2022. METHODS An observational and retrospective study was conducted through the analysis of medical records. The evaluated data included clinical form, sex, family history, consanguinity, age at diagnosis, current age, time of follow-up, comorbidities, histopathology and immunomapping, presence of EB nevi and squamous cell carcinomas (SCC), cause of and age at death. RESULTS Of 309 patients with hereditary EB, 278 were included. The most common type was dystrophic EB (DEB), with 73% (28.4% dominant DEB, 31.7% recessive DEB and 12.9% pruriginous DEB). Other types were junctional EB with 9.4%, EB simplex with 16.5% and Kindler EB with 1.1%. Women accounted for 53% and men for 47% of cases. Family history was found in 35% and consanguinity in 11%. The mean age at diagnosis was 10.8 years and the current age was 26 years. The mean time of follow-up was nine years. Esophageal stenosis affected 14%, dental alterations affected 36%, malnutrition 13% and anemia 29%. During diagnostic investigation, 72.6% underwent histopathological examination and 92% underwent immunomapping. EB nevi were identified in 17%. Nine patients had SCC. Eleven patients died. STUDY LIMITATIONS Insufficient data included to medical records, loss to follow-up, and unavailability of genetic testing. CONCLUSIONS In this study, dystrophic EB predominated and the need for multidisciplinary care for comorbidities and complications was highlighted.
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Affiliation(s)
- Chan I Thien
- Department of Dermatology, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Vanessa Rolim Bessa
- Department of Dermatology, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Isadora Zago Miotto
- Department of Dermatology, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Luciana Paula Samorano
- Department of Dermatology, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Maria Cecília Rivitti-Machado
- Department of Dermatology, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
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Kelmann SV, Stephan BDO, Barbosa SMDM, Polastrini RTV, Oliveira ZNPD, Rivitti-Machado MC, Spolador GM, Honjo RS, Saida K, Matsumoto N, Kim CA. Advantages of whole-exome sequencing over immunomapping in 67 Brazilian patients with epidermolysis bullosa. An Bras Dermatol 2024; 99:350-356. [PMID: 38368142 DOI: 10.1016/j.abd.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/29/2023] [Accepted: 07/21/2023] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Epidermolysis bullosa (EB) is characterized by skin fragility and blistering. In Brazil, the diagnosis is usually obtained through immunomapping, which involves a skin biopsy. Most recently, whole exome sequencing (WES) has become an important tool for the diagnosis of the subtypes of EB, providing information on prognosis as well as allowing appropriate genetic counseling for the families. OBJECTIVE To compare the results of immunomapping and molecular analysis and to describe the characteristics of a Brazilian cohort of patients with EB. METHODS Patients were submitted to clinical evaluation and WES using peripheral blood samples. WES results were compared to those obtained from immunomapping testing from skin biopsies. RESULTS 67 patients from 60 families were classified: 47 patients with recessive dystrophic EB (DEB), 4 with dominant DEB, 15 with EB simplex (EBS), and 1 with junctional EB (JEB). Novel causative variants were: 10/60 (16%) in COL7A1 associated with recessive DEB and 3 other variants in dominant DEB; one homozygous variant in KRT5 and another homozygous variant in PLEC, both associated with EBS. Immunomapping was available for 59 of the 67 patients and the results were concordant with exome results in 37 (62%), discordant in 13 (22%), and inconclusive in 9 patients (15%). STUDY LIMITATIONS Even though EB is a rare disease, for statistical purposes, the number of patients evaluated by this cohort can still be considered limited; other than that, there was a significant difference between the proportion of types of EB (only one case with JEB, against more than 50 with DEB), which unfortunately represents a selection bias. Also, for a small subset of families, segregation (usually through Sanger sequencing) was not an option, usually due to deceased or unknown parent status (mostly the father). CONCLUSION Although immunomapping has been useful in services where molecular studies are not available, this invasive method may provide a misdiagnosis or an inconclusive result in about 1/3 of the patients. This study shows that WES is an effective method for the diagnosis and genetic counseling of EB patients.
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Affiliation(s)
- Samantha Vernaschi Kelmann
- Genetics Unit, Instituto da Criança, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Bruno de Oliveira Stephan
- Genetics Unit, Instituto da Criança, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Silvia Maria de Macedo Barbosa
- Pain and Palliative Care Unit, Instituto da Criança, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Rita Tiziana Verardo Polastrini
- Pain and Palliative Care Unit, Instituto da Criança, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Maria Cecília Rivitti-Machado
- Department of Dermatology, Hospital das Clinicas, Faculty of Medicine, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Gustavo Marquezani Spolador
- Genetics Unit, Instituto da Criança, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Rachel Sayuri Honjo
- Genetics Unit, Instituto da Criança, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ken Saida
- Department of Human Genetics, Yokohama City University, Graduate School of Medicine Yokohama, Yokohama, Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Yokohama City University, Graduate School of Medicine Yokohama, Yokohama, Japan
| | - Chong Ae Kim
- Genetics Unit, Instituto da Criança, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
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Doche I, Valente N, Sotto MN, Rivitti-Machado MC, Aoki V, Gerlero P, Hordinsky MK. Correlation of clinical, histopathologic, and direct immunofluorescence findings in lesional and nonlesional scalp of frontal fibrosing alopecia and lichen planopilaris - An observational study. JAAD Int 2023; 13:7-9. [PMID: 37575512 PMCID: PMC10413340 DOI: 10.1016/j.jdin.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Affiliation(s)
- Isabella Doche
- Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - Neusa Valente
- Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - Mirian N. Sotto
- Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
- Department of Pathology, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Valéria Aoki
- Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - Paula Gerlero
- Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - Maria K. Hordinsky
- Department of Dermatology, University of Minnesota Medical School, Minneapolis
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Orfali RL, Lorenzini D, Bressan A, Tanaka AA, Cerqueira AMMD, Hirayama ADS, Ramos AMC, Proença CC, Silva CMDR, Laczynski CMM, Carneiro FR, Duarte G, Hans Filho G, Gonçalves HDS, Melo LPD, Azulay-Abulafia L, Weber MB, Rivitti-Machado MC, Zaniboni MC, Ogawa M, Pires MC, Ianhez M, Felix PAO, Bonamigo R, Takaoka R, Lazzarini R, Cestari S, Mayor SAS, Cestari T, Oliveira ZNPD, Spuls PI, Gerbens LAA, Aoki V. Consensus on the therapeutic management of atopic dermatitis ‒ Brazilian Society of Dermatology: an update on phototherapy and systemic therapy using e-Delphi technique. An Bras Dermatol 2023; 98:814-836. [PMID: 37302894 PMCID: PMC10589461 DOI: 10.1016/j.abd.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/04/2023] [Accepted: 04/09/2023] [Indexed: 06/13/2023] Open
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.
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Affiliation(s)
- Raquel Leao Orfali
- Department of Dermatology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Daniel Lorenzini
- Department of Dermatology, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Aline Bressan
- Department of Dermatology, Hospital Universitário Pedro Ernesto, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Anber Ancel Tanaka
- Department of Dermatology, Hospital Universitário Evangélico Mackenzie, Curitiba, PR, Brazil
| | | | - André da Silva Hirayama
- Department of Dermatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Andréa Machado Coelho Ramos
- Department of Dermatology, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Carolina Contin Proença
- Dermatology Clinic, Irmandade Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Gleison Duarte
- Department of Dermatology, Instituto Bahiano de Imunoterapia, Salvador, BH, Brazil
| | - Gunter Hans Filho
- Department of Dermatology, Hospital Universitário Maria Aparecida Pedrossian, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Heitor de Sá Gonçalves
- Department of Health, National Reference Center in Sanitary Dermatology Dona Libânia, Fortaleza, CE, Brazil
| | - Ligia Pessoa de Melo
- Department of Dermatology, Instituto de Medicina Integral Professor Fernando Figueira, Recife, PE, Brazil; Health Department, Hospital Otávio de Freitas, Recife, PE, Brazil
| | - Luna Azulay-Abulafia
- Department of Dermatology, Hospital Universitário Pedro Ernesto, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Professor Rubem David Azulay Institute of Dermatology, Santa Casa de Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Maria Cecília Rivitti-Machado
- Department of Dermatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; Department of Dermatology, Universidade Metropolitana de Santos, Santos, SP, Brazil
| | - Mariana Colombini Zaniboni
- Department of Dermatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marília Ogawa
- Department of Dermatology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Mario Cezar Pires
- Department of Dermatology, Complexo Hospitalar Padre Bento, Guarulhos, SP, Brazil; Department of Dermatology, State Public Servant Hospital, São Paulo, SP, Brazil
| | - Mayra Ianhez
- Department of Dermatology, Hospital for Tropical Diseases, Goiânia, GO, Brazil; Department of Dermatology, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | | | - Renan Bonamigo
- Department of Dermatology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Roberto Takaoka
- Department of Dermatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Rosana Lazzarini
- Dermatology Clinic, Irmandade Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Silmara Cestari
- Department of Dermatology, Teaching and Research Institute of Hospital Sírio-Libanês, São Paulo, SP, Brazil
| | | | - Tania Cestari
- Department of Dermatology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Phyllis I Spuls
- Department of Dermatology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, The Netherlands
| | - Louise A A Gerbens
- Department of Dermatology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, The Netherlands
| | - Valeria Aoki
- Department of Dermatology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Doche I, Gerlero P, Magalhães T, Thien CI, Macedo T, Rivitti-Machado MC. Multivariate analysis of clinical characteristics and prognostic factors in early-onset alopecia areata: a retrospective study with 82 Brazilian patients. An Bras Dermatol 2023; 98:681-684. [PMID: 37164790 PMCID: PMC10404497 DOI: 10.1016/j.abd.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 05/12/2023] Open
Affiliation(s)
- Isabella Doche
- Department of Dermatology, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Paula Gerlero
- Department of Dermatology, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Tiara Magalhães
- Department of Dermatology, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Chan I Thien
- Department of Dermatology, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Thalita Macedo
- Department of Dermatology, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
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Mendonça LO, Toledo-Barros MAM, Leal VNC, Roa MEGV, Cambuí RAG, Toledo E, Barros SF, de Oliveira AM, Rivitti-Machado MC, Francescantonio ICM, Grumach AS, de Oliveira Penido N, Castro FFM, Kalil J, Pontillo A. In-vitro NLRP3 functional test assists the diagnosis of cryopyrin-associated periodic syndrome (CAPS) patients: A Brazilian cooperation. Clin Immunol 2022; 245:109159. [DOI: 10.1016/j.clim.2022.109159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/04/2022] [Accepted: 10/07/2022] [Indexed: 11/03/2022]
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Doche I, Romiti R, Rivitti-Machado MC, Gorbatenko-Roth K, Freese RL, Hordinsky MK. Quality-of-life impairment is not related to disease activity in lichen planopilaris and frontal fibrosing alopecia. Results of a preliminary cross-sectional study. J Eur Acad Dermatol Venereol 2021; 36:e288-e290. [PMID: 34753220 DOI: 10.1111/jdv.17798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/03/2021] [Indexed: 11/29/2022]
Affiliation(s)
- I Doche
- Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - R Romiti
- Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - M C Rivitti-Machado
- Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - K Gorbatenko-Roth
- Department of Psychology, University of Wisconsin-Stout, Menomonie, WI, USA
| | - R L Freese
- Clinical and Translational Science Institute, Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis, MN, USA
| | - M K Hordinsky
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, MN, USA
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Doche I, Hordinsky MK, Valente NS, Sotto MN, Miotto I, Rebeis M, Rivitti-Machado MC. Evidence for lymphocytic inflammation in non-lesional scalp of folliculitis decalvans: an observational study of 25 patients. J Eur Acad Dermatol Venereol 2021; 36:e109-e111. [PMID: 34510547 DOI: 10.1111/jdv.17649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/02/2021] [Indexed: 02/04/2023]
Affiliation(s)
- I Doche
- Department of Dermatology, University of Sao Paulo Medical School, São Paulo, Brazil
| | - M K Hordinsky
- Department of Dermatology, University of Minnesota Medical School, São Paulo, Brazil
| | - N S Valente
- Department of Dermatology, University of Sao Paulo Medical School, São Paulo, Brazil
| | - M N Sotto
- Department of Pathology, University of Sao Paulo Medical School, São Paulo, Brazil
| | - I Miotto
- Department of Dermatology, University of Sao Paulo Medical School, São Paulo, Brazil
| | - M Rebeis
- Department of Dermatology, University of Sao Paulo Medical School, São Paulo, Brazil
| | - M C Rivitti-Machado
- Department of Dermatology, University of Sao Paulo Medical School, São Paulo, Brazil
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Doche I, Rebeis M, Valente N, Rivitti-Machado MC. Occipital Fibrosing Alopecia in a Young Male: A Case Report. Skin Appendage Disord 2021; 7:71-74. [PMID: 33614725 DOI: 10.1159/000512034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/24/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Lichen planopilaris (LPP) is a primary lymphocytic cicatricial alopecia with 3 recognized clinical variants. Lately, LPP clinical spectrum has expanded with new and overlapping clinical variants. First considered as a subtype of LPP affecting postmenopausal women, the increasing worldwide incidence of FFA including atypical lesions in young female and male suggests a different pathomechanism for this disease. Although LPP-spectrum disorders may share similar histopathological findings, clinical features and prognosis are different. Case Report A 26-year-old Caucasian male presented with occipital scarring alopecia and pruritus for the last 6 months. The patient had been treated for an associated androgenetic alopecia and superficial recurrent scalp folliculitis over the vertex scalp for the last 5 years. Trichoscopy of the occipital scalp showed mild diffuse erythema, moderate peripilar scaling, and absence of follicular openings, suggestive of a scarring process. The patient underwent an occipital scalp biopsy that confirmed the diagnosis of a LPP-spectrum disorder. Discussion/Conclusion Both LPP and FFA mostly affect the anterior-mid scalp of females. However, recent reports on FFA also in premenopausal women and men should make physicians aware of atypical features of this disease and unusual clinical presentation.
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Affiliation(s)
- Isabella Doche
- Department of Dermatology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Marina Rebeis
- Department of Dermatology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Neusa Valente
- Department of Dermatology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
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Doche I, Rebeis MM, Gerlero P, Valente NYS, Rivitti-Machado MC. Novel blue blotch lesions in folliculitis decalvans - a clinical, histopathological and immunohistochemical study of seven cases. J Eur Acad Dermatol Venereol 2020; 35:e203-e205. [PMID: 32885877 DOI: 10.1111/jdv.16919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/12/2020] [Accepted: 08/26/2020] [Indexed: 11/26/2022]
Affiliation(s)
- I Doche
- Department of Dermatology, Hospital das Clínicas, University of São Paulo Medical School, Sao Paulo, Brazil
| | - M M Rebeis
- Department of Dermatology, Hospital das Clínicas, University of São Paulo Medical School, Sao Paulo, Brazil
| | - P Gerlero
- Department of Dermatology, Hospital Nacional de Clínicas, Córdoba, Argentina
| | - N Y S Valente
- Department of Dermatology, Hospital das Clínicas, University of São Paulo Medical School, Sao Paulo, Brazil
| | - M C Rivitti-Machado
- Department of Dermatology, Hospital das Clínicas, University of São Paulo Medical School, Sao Paulo, Brazil
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Criado PR, Maruta CW, Alchorne ADODA, Ramos AMC, Gontijo B, Santos JBD, Martins LEAM, Rivitti-Machado MC, Silvares MRC, Pires MC, Souza PKD, Orfali RL, Bonamigo RR, Bedrikow RB, Criado RFJ, Oliveira ZNPD. Consensus on the diagnostic and therapeutic management of chronic spontaneous urticaria in adults - Brazilian Society of Dermatology. An Bras Dermatol 2019; 94:56-66. [PMID: 31166404 PMCID: PMC6544033 DOI: 10.1590/abd1806-4841.2019940209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 12/07/2018] [Indexed: 11/22/2022] Open
Abstract
Background Urticarias are frequent diseases, with 15% to 20% of the population
presenting at least one acute episode in their lifetime. Urticaria are
classified in acute ( ≤ 6 weeks) or chronic (> 6 weeks). They may
be induced or spontaneous. Objectives To verify the diagnostic and therapeutic recommendations in chronic
spontaneous urticaria (CSU), according to the experience of Brazilian
experts, regarding the available guidelines (international and US). Methods A questionnaire was sent to Brazilian experts, with questions concerning
diagnostic and therapeutic recommendations for CSU in adults. Results Sixteen Brazilian experts answered the questionnaire related to diagnosis and
therapy of CSU in adults and data were analyzed. Final text was written,
considering the available guidelines (International and US), adapted to the
medical practices in Brazil. Diagnostic work up in CSU is rarely necessary.
Biopsy of skin lesion and histopathology may be indicated to rule out other
diseases, such as, urticarial vasculitis. Other laboratory tests, such as
complete blood count, CRP, ESR and thyroid screening. Treatment of CSU
includes second-generation anti-histamines (sgAH) at licensed doses, sgAH
two, three to fourfold doses (non-licensed) and omalizumab. Other drugs,
such as, cyclosporine, immunomodulatory drugs and immunosuppressants may be
indicated (non-licensed and with limited scientific evidence). Conclusions Most of the Brazilian experts in this study partially agreed with the
diagnostic and therapeutic recommendations of the International and US
guidelines. They agreed with the use of sgAH at licensed doses. Increase in
the dose to fourfold of sgAH may be suggested with restrictions, due to its
non-licensed dose. Sedating anti-histamines, as suggested by the US
guideline, are indicated by some of the Brazilian experts, due to its
availability. Adaptations are mandatory in the treatment of CSU, due to
scarce or lack of other therapeutic resources in the public health system in
Brazil, such as omalizumab or cyclosporine.
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Affiliation(s)
| | - Celina Wakisaka Maruta
- Department of Dermatology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Andréa Machado Coelho Ramos
- Dermatology Service, Hospital das Clinicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Bernardo Gontijo
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Josemir Belo Dos Santos
- Centro de Ciências Médicas, Faculdade de Medicina, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | | | | | | | | | - Patricia Karla de Souza
- Urticaria Outpatient Clinic, Department of Dermatology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Raquel Leão Orfali
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Renan Rangel Bonamigo
- Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Magalhães RF, Rivitti-Machado MC, Duarte GV, Souto R, Nunes DH, Chaves M, Hirata SH, Ramos AMC. Consensus on the treatment of hidradenitis suppurativa - Brazilian Society of Dermatology. An Bras Dermatol 2019; 94:7-19. [PMID: 31166401 PMCID: PMC6544037 DOI: 10.1590/abd1806-4841.20198607] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 09/13/2018] [Indexed: 12/27/2022] Open
Abstract
Hidradenitis suppurativa is a chronic immune mediated disease of universal
distribution that causes great damage to the quality of life of the affected
individual, whose prevalence is estimated at 0.41% in the Brazilian population.
The objective of this work was update on physiopathogenesis, diagnosis and
classification of hidradenitis suppurativa and to establish therapeutic
recommendations in the Brazilian reality. It was organized as a work group
composed of eight dermatologists from several institutions of the country with
experience in the treatment of hidradenitis suppurativa and carried out review
on the topic. Recommendations were elaborated and voted by modified Delphi
system and statistical analysis of the results was performed. The Brazilian
consensus on the clinical approach of hidradenitis suppurativa had the support
of the Brazilian Society of Dermatology.
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Affiliation(s)
| | | | | | - Roberto Souto
- Dermatology Service, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Daniel Holthausen Nunes
- Dermatology Service, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Mario Chaves
- Dermatology Service, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Aoki V, Lorenzini D, Orfali RL, Zaniboni MC, de Oliveira ZNP, Rivitti-Machado MC, Takaoka R, Weber MB, Cestari T, Gontijo B, Ramos AMC, Silva CMDR, Cestari SDCP, Souto-Mayor S, Carneiro FR, de Cerqueira AMM, Laczynski C, Pires MC. Consensus on the therapeutic management of atopic dermatitis - Brazilian Society of Dermatology. An Bras Dermatol 2019; 94:67-75. [PMID: 31166406 PMCID: PMC6544038 DOI: 10.1590/abd1806-4841.2019940210] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/13/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Atopic dermatitis is a highly prevalent inflammatory and pruritic dermatosis with a multifactorial etiology, which includes skin barrier defects, immune dysfunction, and microbiome alterations. Atopic dermatitis is mediated by genetic, environmental, and psychological factors and requires therapeutic management that covers all the aspects of its complex pathogenesis. OBJECTIVES The aim of this article is to present the experience, opinions, and recommendations of Brazilian dermatology experts regarding the therapeutic management of atopic dermatitis. METHODS Eighteen experts from 10 university hospitals with experience in atopic dermatitis were appointed by the Brazilian Society of Dermatology to organize a consensus on the therapeutic management of atopic dermatitis. The 18 experts answered an online questionnaire with 14 questions related to the treatment of atopic dermatitis. Afterwards, they analyzed the recent international guidelines on atopic dermatitis of the American Academy of Dermatology, published in 2014, and of the European Academy of Dermatology and Venereology, published in 2018. Consensus was defined as approval by at least 70% of the panel. RESULTS/CONCLUSION The experts stated that the therapeutic management of atopic dermatitis is based on skin hydration, topical anti-inflammatory agents, avoidance of triggering factors, and educational programs. Systemic therapy, based on immunosuppressive agents, is only indicated for severe refractory disease and after failure of topical therapy. Early detection and treatment of secondary bacterial and viral infections is mandatory, and hospitalization may be needed to control atopic dermatitis flares. Novel target-oriented drugs such as immunobiologicals are invaluable therapeutic agents for atopic dermatitis.
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Affiliation(s)
- Valeria Aoki
- Department of Dermatology, Faculdade de Medicina, Universidade de
São Paulo, São Paulo (SP), Brazil
| | - Daniel Lorenzini
- Dermatology Service, Irmandade Santa Casa de Misericórdia de
Porto Alegre, Porto Alegre (RS), Brazil
| | - Raquel Leão Orfali
- Department of Dermatology, Faculdade de Medicina, Universidade de
São Paulo, São Paulo (SP), Brazil
| | | | | | | | - Roberto Takaoka
- Department of Dermatology, Faculdade de Medicina, Universidade de
São Paulo, São Paulo (SP), Brazil
| | - Magda Blessmann Weber
- Dermatology Service, Universidade Federal de Ciências da
Saúde de Porto Alegre, Porto Alegre (RS), Brazil
| | - Tania Cestari
- Dermatology Service, Hospital de Clínicas de Porto Alegre,
Universidade Federal do Rio Grande do Sul, Porto Alegre (RS), Brazil
| | - Bernardo Gontijo
- Dermatology Service, Hospital das Clínicas, Universidade
Federal de Minas Gerais, Belo Horizonte (MG), Brazil
| | - Andrea Machado Coelho Ramos
- Dermatology Service, Hospital das Clínicas, Universidade
Federal de Minas Gerais, Belo Horizonte (MG), Brazil
| | | | | | - Silvia Souto-Mayor
- Clinic of Dermatology, Department of Medicine, Faculdade de
Medicina da Santa Casa de São Paulo, São Paulo (SP), Brazil
| | | | | | - Cristina Laczynski
- Dermatology Outpatient Clinic, Discipline of Dermatology,
Faculdade de Medicina do ABC, Santo André (SP), Brazil
| | - Mario Cezar Pires
- Dermatology Service, Hospital do Servidor Público Estadual,
São Paulo (SP), Brazil
- Dermatology Service, Complexo Hospitalar Padre Bento, Guarulhos
(SP), Brazil
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Rotter A, Samorano LP, Rivitti-Machado MC, Oliveira ZNP, Gontijo B. PHACE syndrome: clinical manifestations, diagnostic criteria, and management. An Bras Dermatol 2018; 93:405-411. [PMID: 29924216 PMCID: PMC6001075 DOI: 10.1590/abd1806-4841.20187693] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 01/07/2018] [Indexed: 11/25/2022] Open
Abstract
Infantile hemangioma can be linked to other organ malformations. In 1996, PHACE syndrome was first defined as the association of large and segmental infantile hemangioma, usually on the face, head, or cervical region, with malformations of the posterior fossa of the brain, arterial anomalies of the central nervous system, coarctation of the aorta, cardiac defects, and ocular abnormalities. Over 300 cases of PHACE syndrome have been reported, and it is cconsidered one of the most common neurocutaneous vascular disorders in childhood. Knowledge of the features and locations of lesions that imply a greater risk of systemic involvement is crucial for the diagnosis and proper management of PHACE syndrome patients. This review highlights the diagnostic criteria for PHACE syndrome, the imaging workup for extracutaneous involvement, the treatment of infantile hemangioma, and the importance of a multidisciplinary approach in the management of these patients.
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Affiliation(s)
- Anita Rotter
- Dermatology Department, Hospital das Clínicas, Faculdade de
Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Luciana Paula Samorano
- Dermatology Department, Hospital das Clínicas, Faculdade de
Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Maria Cecília Rivitti-Machado
- Dermatology Department, Hospital das Clínicas, Faculdade de
Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Zilda Najjar Prado Oliveira
- Dermatology Department, Hospital das Clínicas, Faculdade de
Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Bernardo Gontijo
- Dermatology Unit. Hospital das Clínicas, Universidade
Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
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Rivitti-Machado MC, Toma JT, Pompeu VM, Valente NY, Doche I. Epidermolysis Bullosa Pruriginosa Associated with Folliculitis Decalvans: Case Report and Review of the Literature. Skin Appendage Disord 2018; 4:339-341. [DOI: 10.1159/000485521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 11/20/2017] [Indexed: 11/19/2022] Open
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Rotter A, Samorano LP, de Oliveira Labinas GH, Alvarenga JG, Rivitti-Machado MC, Bouer M, Santos PCC, Silvestre DAM, de Oliveira ZNP. Ultrasonography as an objective tool for assessment of infantile hemangioma treatment with propranolol. Int J Dermatol 2016; 56:190-194. [DOI: 10.1111/ijd.13442] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 05/22/2016] [Accepted: 07/11/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Anita Rotter
- Department of Dermatology; University of São Paulo Medical School; São Paulo Brazil
| | | | | | | | | | - Márcio Bouer
- Department of Radiology; University of São Paulo Medical School; São Paulo Brazil
| | - Paulo C. C. Santos
- Department of Laboratory of Medical Investigation; University of São Paulo Medical School; São Paulo Brazil
| | - Daniel A. M. Silvestre
- Department of Laboratory of Medical Investigation; University of São Paulo Medical School; São Paulo Brazil
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Kelmann SV, Quaio CRDC, Honjo RS, Bertola DR, Rosa Neto NS, Lourenço CM, d'Almeida V, Lellis RF, Rivitti-Machado MC, Enokihara MMSES, Michalany NS, Kim CA. Multicentric study on the diagnosis of Fabry's disease using angiokeratoma biopsy registries. Int J Dermatol 2015; 54:e241-4. [DOI: 10.1111/ijd.12713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 02/17/2014] [Accepted: 03/08/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Samantha Vernaschi Kelmann
- Genetics Unit; Instituto da Criança da Faculdade de Medicina da Universidade de São Paulo; São Paulo SP Brazil
| | | | - Rachel Sayuri Honjo
- Genetics Unit; Instituto da Criança da Faculdade de Medicina da Universidade de São Paulo; São Paulo SP Brazil
| | - Debora Romeo Bertola
- Genetics Unit; Instituto da Criança da Faculdade de Medicina da Universidade de São Paulo; São Paulo SP Brazil
| | | | - Charles Marques Lourenço
- Serviço de Genética da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo; São Paulo SP Brazil
| | - Vânia d'Almeida
- Departamento de Psicologia da Universidade Federal de São Paulo; São Paulo SP Brazil
| | - Rute Facchini Lellis
- Serviço de Patologia do Hospital Santa Casa de Misericórdia de São Paulo; São Paulo SP Brazil
| | | | | | - Nilceo S Michalany
- Departamento de Patologia da Universidade Federal de São Paulo; São Paulo SP Brazil
| | - Chong Ae Kim
- Unidade de Genética - ICr; Av. Dr. Enéas Carvalho de Aguiar; 647 São Paulo SP CEP: 05403-000 Brazil
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Melo JND, Rotter A, Rivitti-Machado MC, Oliveira ZNPD. Propranolol for treatment of infantile hemangiomas. An Bras Dermatol 2014; 88:220-3. [PMID: 24346925 PMCID: PMC3875975 DOI: 10.1590/abd1806-4841.20131699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 01/13/2013] [Indexed: 12/22/2022] Open
Abstract
Infantile hemangioma is the most common vascular tumor in early childhood.
Propranolol has been successfully used recently in a limited number of children with
Infantile hemangioma. We present 6 cases of Infantile hemangioma, at a single
dermatological center, which responded to oral propranolol with good results.
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Affiliation(s)
| | - Anita Rotter
- University of São Paulo, FM, Teaching Hospital, São PauloSP, Brazil
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