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.
BackgroundAcne in women is often associated with anxiety and depression, and may
persist from adolescence as well as manifest for the first time in
adulthood. Genetic and hormonal factors contribute to its etiopathogenesis,
and maintenance treatment is required, usually for years, due to its
clinical evolution.ObjectiveTo develop a guide for the clinical practice of adult female acne.MethodsA team of five experts with extensive experience in acne conducted a
literature review of the main scientific evidence and met to discuss the
best practices and personal experiences to develop a guide containing
recommendations for the clinical practice of adult female acne.ResultsThe group of specialists reached consensus on the main guidelines for
clinical practice, providing detailed recommendations on clinical picture,
etiopathogenesis, laboratory investigation and treatment of adult female
acne.ConclusionDifferent from teenage acne, adult female acne presents some characteristics
and multiple etiopathogenic factors that make its management more complex.
This guide provides recommendations for best clinical practices and
therapeutic decisions. However, the authors consider that additional studies
are needed in order to provide more evidence for adult female acne to be
better understood.
Tuberous sclerosis complex is a multisystemic, autosomal dominant genetic
disorder with complete penetrance, that can evolve with hamartomas in multiple
organs, such as skin, central nervous system, kidney and lung. Due to the wide
phenotypic variability, the disease is often not recognized. Tuberous sclerosis
complex affects one in 10,000 newborns and most patients are diagnosed during
the first 15 months of life. The diagnostic criteria for tuberous sclerosis were
reviewed in 2012, at the second International Tuberous Sclerosis Complex
Consensus Conference. The diagnosis is based on genetic criteria, by the
identification of inactivating pathogenic mutation of tumor suppressor genes
TSC1 and TSC2, and clinical criteria, including cutaneous, renal, pulmonary,
cardiac and neurological manifestations. The treatment of tuberous sclerosis
complex consists, mainly, in management of the symptoms caused by hamartomas and
in prevention of organ failure. Multidisciplinary approach is recommended, in
order to obtain better clinical outcomes.
Neonatal skin suffers a progressive adaptation to the extrauterine environment and special care is needed during this period. This skin is very sensitive, thin and fragile. Immaturity of the epidermal barrier reduces the defense against the excessive proliferation of microbes and makes the skin more vulnerable to trauma and percutaneous drug toxicity. Because of the peculiar characteristics of newborn, infant and children's skin, the use of cosmetic products designed for hygiene and protection requires caution. In order to preserve the integrity of neonatal and child's skin, this article reviewed basic preventive care practices in relation to hygiene, bathing, cleansing agents, topical products and their percutaneous toxicity.
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.
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.
After resolution of melasma with TC, maintenance therapy over 6 months was successful in preventing relapse in over half of the patients who entered maintenance phase. Prescribing medicines should be adapted to patients based on melasma severity.
Epidermolysis bullosa has marked impacts on the lives of EB patients and their families, which are strongly correlated with disease severity. The Brazilian Portuguese version of the QoLEB is validated and can be recommended for use in subsequent studies.
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