Anais brasileiros de dermatologia最新文献

Background: There are few studies in the literature comparing the effectiveness of topical treatments in early-stage mycosis fungoides (MF).

Objectives: It was aimed to evaluate the clinical efficacy, side effects and topical treatment compliance with bexarotene or clobetasol propionate in early-stage MF.

Methods: A total of 40 patients with stage IA-IB MF were enrolled in the study. Twenty patients were treated with 1% bexarotene gel and 20 patients were treated with 0.05% clobetasol propionate ointment.

Results: In the bexarotene group, 11 patients (55%) had complete clinical response (CCR) and 5 patients (25%) had partial response (PR) while in the clobetasol propionate group, 10 patients (50%) had CCR and 9 patients (45%) had PR. The median duration of remission was 10.5 months in the bexarotene group and 4 months in the clobetasol propionate group. The remission period was statistically significantly longer in the bexarotene group (p = 0.032). Irritation symptoms were statistically significantly more common in the bexarotene group (p = 0.001).

Study limitations: The limitation of the study was its retrospective design.

Conclusion: Both topical bexarotene and topical clobetasol propionate were found to be effective in MF. Irritation symptoms were more common with topical bexarotene. Moreover, the remission period with topical bexarotene was significantly longer.

Background: Conventional systemic corticosteroid therapy for bullous pemphigoid (BP) has been challenged due to severe adverse events. Dupilumab has emerged as an alternative therapeutical option of BP patients.

Objectives: To evaluate the efficacy of dupilumab monotherapy and the combination with medium/low-dose corticosteroids for BP treatment.

Methods: Thirteen, twenty-four and thirty-two BP patients treated with Dupilumab monotherapy (Dupi group), dupilumab combined with corticosteroids (Dupi + CS group), and corticosteroid monotherapy (CS group), respectively, were retrospectively analyzed for various clinical and laboratory parameters.

Results: In the Dupi group, the total Bullous Pemphigoid Disease Area Index (BPDAI) Total, Erosion/Blister, Urticaria/Erythema and Itching NRS scores were all reduced significantly after 2-4 weeks of treatment, but the BPDAI Mucosal Score was not changed significantly at the end of the overextended time of treatment. All the above clinical parameters and many laboratory parameters (including the serum anti-BP180 autoantibodies [IgG] level, blood eosinophil count, and percentage) were significantly reduced in both Dupi + CS and CS groups after treatment, but no statistical differences were found in the reduction rates of these parameters between the two groups. However, the Dupi + CS group had less baseline dose and cumulative dosage of prednisone at the time of disease control, and fewer adverse effects were reported than the CS group.

Study limitations: The retrospective design and small clinical sample size of the Dupi group.

Conclusions: For BP patients, dupilumab monotherapy based on the treatment of atopic dermatitis can significantly improve skin lesions and pruritus symptoms but may be ineffective for oral mucosal lesions. The combination of dupilumab and medium/low-dose corticosteroids can achieve the same effect of corticosteroid therapy with superior safety.

Background: Eccrine porocarcinoma (EPC) is a rare cutaneous neoplasm, commonly arising from its benign counterpart, eccrine poroma (EP), but potential unrevealed clinicopathological differences between them are not well understood.

Objectives: This study aimed to identify clinicopathological features of EP and EPC and describe the factors that may be associated with the malignant transformation of EP by comparing the two groups.

Methods: A total of 37 cases of EP and 22 cases of EPC diagnosed between January 2017 and June 2023 were retrospectively reviewed, and the clinical and histopathological characteristics were compared using statistical methods.

Results: Clinical and histopathologic data such as age, gender, site, clinical presentation, and histopathologic characteristics were collected. The EPC group was more common in older patients, with more cases located in exposed areas, and the patients with EPC had larger lesions with a higher incidence of ulceration. Histopathological features showed significant differences in tumor architecture, ulceration, squamous differentiation, spindle cell changes, central necrosis, and diffuse inflammatory infiltration between the two groups.

Study limitations: This study has limitations due to a small number of cases with potential experimental bias.

Conclusion: The clinicopathological features of EP and EPC were compared in this study and the results may assist clinicians in diagnosis and management of these tumors by helping to identify potential factors associated with the malignant transformation of EP.

Background: The positioning of substances, which are co-sensitizers and/or with a tendency to cross-react, is not considered in the technique when applying patch tests (PT).

Objective: To investigate the interference of the positioning of nickel (Ni), chromium (Cr) and cobalt (Co) in patch tests (PT) results, when applied close or distant from each other.

Methods: PT were performed in patients suspected of allergic contact dermatitis (ACD), using the standard battery (SB), with substances showing a tendency towards cross-react and co-sensitizers applied far apart, and an additional battery (AB) with the metals placed close to each other. For tabulation purposes, only the 96-h reading was considered.

Results: Of the 86 tested patients, 33 (38%) had negative testing for metals and 53 (62%) had one or more positive (+) tests for Ni, Cr and/or Co. Concordant results in both tests (SB/ AB) occurred in 18/53 (34%) and 35/53 (66%) had discordant results. Regarding the SB, of the 159 tests with metals (53 patients, three metals), 57 tests were (+) and 102 (-). In the AB, 87 tests were (+) and 72 (-), a statistically significant difference (p < 0.05). Of the 57 (+) tests in the SB, 35 were for Ni, 18 for Co and four for Cr. In AB the number of (+) tests was 87, with 45 (+) tests for Ni, 35 for Co and seven for Cr. The difference in the number of positive tests between the two batteries was statistically significant for Co and Ni.

Study limitations: The number of cases.

Conclusion: The results showed that the positioning of the metals interferes with the PT results and should be considered as part of the PT application technique.

Background: Linear IgA bullous dermatosis (LABD) is an uncommon disease with only a few reported studies in large series with long follow-up periods.

Objectives: To evaluate the clinical presentation, immunopathological features, management, and disease course in LABD patients.

Methods: Data including demographics, clinical features, histopathological and immunofluorescence findings of LABD patients, in addition to the preferred treatments and responses to treatments were evaluated.

Results: Among 26 patients diagnosed with LABD, 17 (65.4%) were female. The mean age was 40.3 ± 22.4 (6‒80) years of whom 21 were adults. The most common mucosal involvement was oral (n = 9, 34.6%). Continuous linear IgA deposition was present on the basement membrane zone of all patients in addition to C3 (n = 13), IgG (n = 9), IgM (n = 4), and fibrinogen (n = 4). Three patients were lost to follow-up without any treatment. Dapsone was the treatment of choice in most (n = 21, 91.3%) patients in addition to systemic corticosteroids (n = 17), azathioprine (n = 3), tetracycline and nicotinamide (n = 2). Complete and partial remissions were achieved in 11 (47.8%) and 12 (52.2%) patients, respectively, in a mean follow-up period of 45.9 ± 43.9 (3‒158) months. Furthermore, 17 patients were still under treatment at the end of the follow-up period.

Study limitations: Retrospective study conducted in a single center.

Conclusions: LABD may occur at two separate peaks, one in the second and the other in the sixth decade of life with a female predominance. Other immunoglobulins may be associated with dominant IgA antibody deposition and the most commonly used therapeutic option for LABD patients was oral dapsone.

Background: Psoriasis, a chronic, inflammatory skin disease, requires long-term therapy. Risankizumab is a humanized immunoglobulin G1 monoclonal antibody that specifically inhibits interleukin 23 by binding to its p19 subunit.

Objective: The authors assessed the efficacy and safety of risankizumab compared with methotrexate in adults with moderate-to-severe plaque psoriasis.

Methods: IMMbrace was a phase 3, multicenter, randomized, double-blind, double-dummy, active-controlled study. Patients received subcutaneous risankizumab 150 mg at weeks 0, 4, and 16 plus oral placebo weekly, or oral methotrexate 5 mg weekly (with dose escalation up to 25 mg based on response and tolerability) plus subcutaneous placebo at weeks 0, 4, and 16. Primary efficacy endpoints were the proportions of patients who achieved ≥ 90% improvement in Psoriasis Area and Severity Index (PASI90) and static Physician's Global Assessment of clear/almost clear (sPGA 0/1) at week 28. Safety was also assessed.

Results: Among 98 patients randomized (risankizumab, n = 50; methotrexate, n = 48), 95 completed the double-blind period. At week 28, significantly higher proportions of patients treated with risankizumab versus methotrexate achieved PASI90 (84.0% vs. 35.4%; p < 0.001); sPGA 0/1 was achieved by 90.0% and 64.6% of patients in the risankizumab and methotrexate groups (p ≤ 0.001). Risankizumab efficacy was maintained throughout week 112. Adverse event rates were similar in the two groups.

Study limitations: The sample size was small due to the difficulty of recruiting patients without methotrexate use.

Conclusions: Risankizumab demonstrated superior efficacy over methotrexate at week 28; efficacy was maintained, and no new safety findings were observed through week 112.

Background: Alopecia areata is a highly frequent disease with great variability in clinical presentation, severity, and prognosis. It has a significant negative impact on quality of life, especially in the moderate and severe forms.

Objective: To disseminate guidelines, prepared by a group of Brazilian experts, for the treatment and follow-up of patients with alopecia areata.

Methods: Eight specialists from different university centers with experience in alopecia areata were appointed by the Brazilian Society of Dermatology to reach a consensus on its treatment. Using the adapted DELPHI methodology, relevant elements were considered and then an analysis of the recent literature was carried out and the text produced. Consensus on the guidelines was defined with the approval of at least 70% of the panel of experts.

Results/conclusions: Treatments vary according to patient age and disease severity. Intralesional injectable corticosteroid therapy was considered the first option for localized disease in adults. In severe cases, Janus Kinase inhibitors are the treatment with the highest level of evidence. Systemic corticosteroid therapy and immunosuppressants (corticosteroid-sparing agents) are also options in these cases. Contact immunotherapy (diphencyprone) is an alternative for stable extensive cases. The assessment of side effects is as important as the hair regrowth rate.