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.
A case of rhinofacial zygomycosis with of years duration, caused by Conidiobolus coronatus is described. The patient, a 72-years-old woman, presented with a bilateral distortion of the subcutaneous tissue and disfigurement of the face. Treatment with ketoconazole and potassium iodide did not prevent several relapses. At present she is still under treatment with fluconazole with clinical healing. Histopathological and mycological examination confirmed the dermatological diagnosis. An increasing number of cases of zygomycosis caused by fungi of the order Entomophthorales have also been reported in the Northern and Northeastern States of Brazil.
Quinze deles foram submetidos à técnica em W-plastia e 17, à técnica clássica. Avaliaram-se parâmetros como retração cicatricial e alterações funcionais. RESULTADOS: Houve associação estatisticamente significativa entre a técnica utilizada e a presença de retração cicatricial, sendo a associação positiva com a clássica (p=0,01 com correção de Yates). O risco relativo (odds ratio -OR) calculado foi de 11,25, ou seja, houve maior chance de retração nos pacientes submetidos à técnica clássica. Nenhuma das técnicas apresentou alterações funcionais. Avaliaram-se complicações pós-operatórias como presença de crostas, lábios secos, parestesia e deiscência de sutura. Não houve associação estatisticamente significante entre as complicações e a técnica utilizada (p=0,69). CONCLUSÃO: Concluiu-se que a vermelhectomia em W-plastia oferece melhores resultados estéticos e índices de complicações semelhantes.
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