Dry skin or xerosis is a common condition triggered by many factors—non-pathological, such as climate and age, and pathological, such as skin diseases as well as systemic conditions, like diabetes and kidney disease. Since dry skin can have a relevant influence on a patient's quality of life and may contribute to the recurrence or worsening of other existing skin conditions, proper management of xerosis is crucial for good health and proper self-care. An expert panel collaborated on a review of xerosis management in clinical practice and the literature on moisturization ingredients, with the aim of creating an algorithm to help healthcare professionals make efficient and appropriate recommendations to their patients. This review encompasses an investigation of common moisturizer ingredients and vehicles, their mechanisms of action on the skin barrier, considering climate variations and clinical experiences. The resulting materials provide tools that may improve the way healthcare professionals help their patients understand how to manage their dry skin, thus positively impacting therapeutic clinical results.

BACKGROUND:Atopic dermatitis (AD) burden increases with disease severity. OBJECTIVE:Characterize the real-world burden of AD in Brazil, Mexico, and Argentina. METHODS:MEASURE-AD enrolled patients (≥12-years old) with moderate to severe AD receiving or candidates for systemic therapy between December 2019-December 2020. Patient characteristics, treatments, and outcomes were recorded during one office visit. Primary outcome measures included worst itch/past 24hours (Worst Pruritus Numerical Rating Scale [WP-NRS]), quality of life (QoL, Dermatology Life Quality Index [DLQI] and Children's DLQI [CDLQI]). RESULTS:Of 180 patients (adults, n=157; adolescents, n=23), 52.2% were male, the mean (SD) age was 33.8 (17.0) years, and all were receiving AD treatment (65.6% systemic therapy). Severe pruritus (WP-NRS ≥ 7) was reported by 54.4% (adults, 57.3%; adolescents, 34.8%). A very/extremely large effect on QoL (DLQI/CDLQI≥11) was reported among 50.0% of patients ≥ 16 years old and 42.9% of patients 12-15 years old. The mean Eczema Area Severity Index (EASI) was 17.0 (adults, 17.7; adolescents, 12.4); 3.9% of patients had clear skin (EASI 0) and 26.7% had severe AD (EASI 23-72). Over the previous 6 months, 0, 1-2, 3-4, 5-6, and > 6 flares were reported by 8.3%, 27.2%, 31.1%, 11.7%, and 15.6% of patients, respectively. On average, flares lasted 15.2 days (adults, 15.9 days; adolescents, 11.1 days). STUDY LIMITATIONS:Patient self-reported information and recall during one office visit. CONCLUSIONS:Despite treatment, disease severity and impact on QoL were high, suggesting that AD is not adequately controlled in all patients, highlighting a considerable unmet need for effective treatments to reduce AD burden.

Atopic dermatitis (AD) is an inflammatory skin condition with a complex pathogenesis associated with skin dryness and increased Staphylococcus aureus skin colonization. Treatments aim to control the disease, reducing crisis and improving quality of life. This clinical study evaluated tolerance and efficacy of a recovering cream (RC) composed of 1% colloidal prebiotic oatmeal, lipid technology, and beta glucan active, applied on 30 Brazilian multi-ethnic mild to moderate AD patients for 21 days. Clinical efficacy was evaluated by complementary methodologies: Scoring Atopic Dermatitis (SCORAD), Patient Oriented Eczema Measure (POEM), instrumental measurements, AD images, microbiome analysis, and patient's self-assessment, evaluated at different timepoints (baseline and after 5, 7, 14, and 21 days). SCORAD reduced in 100% of patients since D5 (p<0.001), with visible reduction on AD extent and severity. POEM showed improvement (74%) in eczema severity since Week 1 (p<0.001) and continued improving through D21; 83% of patients completed D21 classified as clear or almost clear compared to the 3% of patients at baseline. Hydration increased after RC usage (p<0.001). Relative abundance of S. aureus decreased from 40% (baseline) to 22% (D21). All patients agreed RC improved their quality of life and relieved uncomfortable sensations from 1st application. Patients emotional verbatims corroborate clinical results: Moisturizer solved my problem; Lesion improved very quickly; Relieves gray skin; Improved sleep. This clinical study brings tolerance and efficacy in a diverse population with atopic dermatitis, showing effectiveness of RC as an adjuvant in AD treatment from dermatologist and patients' perspectives, corroborating the importance of moisturization.

Abstract The burden of atopic dermatitis (AD), a chronic, relapsing inflammatory skin disease, increases with disease severity and is associated with multiple flares per year over many years. We characterized the real-world burden of disease, including flares, in patients with AD enrolled in MEASURE-AD from Latin America. Patients (aged ≥12 years) with physician-confirmed AD receiving or eligible for systemic therapy were enrolled in MEASURE-AD between December 2019 and June 2020. Patient characteristics, treatments and outcomes were recorded during a single office visit. Primary outcome measures included worst itch within the past 24 h (Worst Pruritus Numerical Rating Scale [WP-NRS]) and quality of life (QoL; Dermatology Life Quality Index [DLQI] and cDLQI). Among secondary outcomes, the frequency and duration of disease flares within the last 6 months were assessed. Herein result from the Latin American (Brazil, Mexico and Argentina) population (N = 180; adults (≥18 years), n = 157; adolescents, n = 23). Analyses were based on observed data; only descriptive statistics were presented. The mean (SD) age was 33.8 (17.0) years, 52.2% were males and all patients were receiving AD treatment, including 65.6% receiving systemic therapy alone or in combination. Severe pruritus (WP-NRS ≥7) was reported by 54.4% of patients (adults, 57.3%; adolescents, 34.8%). A very or extremely large effect on QoL (DLQI or cDLQI ≥11) was reported among 50.0% of patients ≥16 years and 42.9% of patients 12–15 years. Over the previous 6 months, 0, 1–2, 3–4, 5–6 and >6 flares were reported by 8.3%, 27.2%, 31.1%, 11.7% and 15.6% of patients, respectively. On average, flares lasted 15.2 days (adults, 15.9 days; adolescents, 11.1 days). Although all patients received treatment and two-thirds received systemic therapies, severity scores and impact on QoL and itch were extremely high, suggesting that AD is not adequately controlled in all patients.

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.

Objetivo: Estimar a soropositividade do VORL e prevalência da infecção pelo HIV em mulheres no momento do parto como população sentinela. O Hospital Materno-infantil Presidente Vargas (HMIPV) faz parte do programa de vigilância sentinela anônimo e não vinculado da infecção pelo HIV proposto pela Coordenação Nacional OST/Aids do Ministério da Saúde. Os esforços deste programa foram aproveitados para obter dados sobre sífilis na população em estudo. Métodos: Estudo transversal vinculado e confidêncial acompanhado de aconselhamento pré e pós teste. Foi utilizada uma amostragem consecutiva das pacientes que buscaram a matemida de para realização do parto durante dois períodos de 20 dias em março de 1997 e abril de 1998. No segundo inquérito transversal, foi obtido consentimento livre e esclarecido para a realização dos testes anti-HIV e um questionário foi aplicado. Resultados: Das duzentas amostra s testadas pelo VORL em março d e 1997, sete resultaram positivas (3,5% - IC (95%) 1.42 -7.09). Em abril d e 1998, tressoros resultaram reagentes para o VORL dos 200 testados (1,5% - IC (95%) 0,31-4,68). Nesta segunda amostra dos 200 testes anti-HIV realizados, 3 resultaram reagentes (1 ,5%-IC (95%) 0,31-4 ,68). A prevalência de gestantes com menos de 6 consultas pré-natal foi de 45% (90 gestantes). O teste anti-HIV foi oferecido durante o pré-natal para 103 gestantes (55,4%). Após aconselhamento, todas as 200 gestantes concordaram em realizar o teste. Conclusão: Os resultados a pontam que ambas as infecções são prevalentes em nosso estado. Apontam ainda a necessidade de reforço e/ou estabelecimento dos programas para a revenção e tratamento da sililis congênita bem como para diagnóstico da infecção pelo HIV e prevenção de sua transmissão vertical. É necessário o envolvimento de todos os níveis de atenção (saúde da mulher, prê-natal, maternidades e saúde da criança).

Abstract Background Nail psoriasis occurs frequently in patients with psoriatic disease, it can lead to functional impairment, pain, discomfort, decreased quality of life and can also be a predictor for the development of arthritis. Early recognition of this condition can provide early and effective treatment and prevent structural impairment. This study aims to identify nail ultrasonographic characteristics in three groups: psoriasis (PsO), psoriatic arthritis (PsA) and controls patients, to determine if the ultrasonography (US) can identify early signs of nail psoriatic impairment or local inflammation. We conducted nail US to determine nail matrix resistance index (NMRI), nail bed resistance index (NBRI), and power Doppler (PD) and grayscale (GS) parameters in these 3 groups. Methods Single-center, cross-sectional study. GS, PD, and spectral doppler images of bilateral 2nd and 3rd fingernails were acquired from 35 PsO, 31 PsA, and 35 controls patients. An US equipment with an 18 MHz linear transducer for GS and 8.0 MHz for PD was used. PD, NMRI, NBRI, nail plate thickness (NPT), nail bed thickness (NBT), nail matrix thickness (NMT), and morphostructural characteristics of the trilaminar structure (TS) were evaluated in saved images, blind. Results Mean NMRI and NBRI did not differ between groups. Linear regression analysis detected no relationships between PsO or PsA and NMRI or NBRI. Nail PD grade did not differ between groups. Type I and IV TS changes were more frequent in PsO; types II and III changes were more frequent in PsA (p < 0.001). NPT was greater in PsA and PsO groups than controls: PsA 0.73 ± 0.14 mm, PsO 0.72 ± 0.15 mm, Controls 0.67 ± 0.10 mm (p = 0.001). Conclusion Echographic TS characteristics of the nail plate and NPT evaluated by GS are useful and can distinguish PsO and PsA nails from controls. NMRI, NBRI, and US nail microcirculation parameters could not distinguish psoriatic nails. Trial registration 72762317.4.0000.5327 (Certificate of Presentation of Ethical Appreciation – CAAE - Plataforma Brasil) Avaiable in https://plataformabrasil.saude.gov.br/login.jsf.

International Journal of DermatologyEarly View Case report Trichoscopy in acrodermatitis enteropathica Lucas Samuel Perinazzo Pauvels MD, Corresponding Author Lucas Samuel Perinazzo Pauvels MD dermatolucas@gmail.com orcid.org/0000-0002-3672-7426 Dermatology Department, Hospital de Clínicas de Porto Alegre, Brazil Correspondence Lucas Samuel Perinazzo Pauvels, md Ramiro Barcelos Street 2350, Hospital de Clínicas de Porto Alegre Zona 13: Serviço de Dermatologia Porto Alegre Rio Grande do Sul Postal Code 90035-903 Brazil E-mail: dermatolucas@gmail.comSearch for more papers by this authorTimotio Dorn MD, Timotio Dorn MD Dermatology Department, Hospital de Clínicas de Porto Alegre, BrazilSearch for more papers by this authorAndré Cartell MD, André Cartell MD Pathology Department, Hospital de Clínicas de Porto Alegre, BrazilSearch for more papers by this authorJuliana Catucci Boza MD, Msc, Juliana Catucci Boza MD, Msc Dermatology Department, Hospital de Clínicas de Porto Alegre, BrazilSearch for more papers by this authorTania Ferreira Cestari MD, PhD, Tania Ferreira Cestari MD, PhD Dermatology Department, Hospital de Clínicas de Porto Alegre, BrazilSearch for more papers by this author Lucas Samuel Perinazzo Pauvels MD, Corresponding Author Lucas Samuel Perinazzo Pauvels MD dermatolucas@gmail.com orcid.org/0000-0002-3672-7426 Dermatology Department, Hospital de Clínicas de Porto Alegre, Brazil Correspondence Lucas Samuel Perinazzo Pauvels, md Ramiro Barcelos Street 2350, Hospital de Clínicas de Porto Alegre Zona 13: Serviço de Dermatologia Porto Alegre Rio Grande do Sul Postal Code 90035-903 Brazil E-mail: dermatolucas@gmail.comSearch for more papers by this authorTimotio Dorn MD, Timotio Dorn MD Dermatology Department, Hospital de Clínicas de Porto Alegre, BrazilSearch for more papers by this authorAndré Cartell MD, André Cartell MD Pathology Department, Hospital de Clínicas de Porto Alegre, BrazilSearch for more papers by this authorJuliana Catucci Boza MD, Msc, Juliana Catucci Boza MD, Msc Dermatology Department, Hospital de Clínicas de Porto Alegre, BrazilSearch for more papers by this authorTania Ferreira Cestari MD, PhD, Tania Ferreira Cestari MD, PhD Dermatology Department, Hospital de Clínicas de Porto Alegre, BrazilSearch for more papers by this author First published: 17 August 2021 https://doi.org/10.1111/ijd.15864 Conflict of interest: None. Funding source: None. Consent: The patient and her mother signed a consent form in their mother language (Portuguese) regarding the publication of case details and clinical pictures. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

Introduction: several guidelines emphasize the advantages of multidisciplinary management of patients with psoriasis (PSO) or psoriatic arthritis (PSA). Early diagnosis of PSA relates to better outcomes in 5 years. However, early diagnosis of PSA remains a challenge. Methods: retrospective cohort of patients with previous or suspect diagnosis of PSO and/or PSA who were cared for in the combined dermatology and rheumatology clinic from January 2013 to January 2017. Results: among the 55 patients previously diagnosed with PSO, 30.9% (n=17) were diagnosed with PSA. Changes in medical therapy were made for 58.5% (n = 48) of patients, mainly due to poor cutaneous or articular disease control. Imunobiologicals were the most commonly initiated class of medicine, corresponding to 35.4% (n = 17) of changes in medical therapy. Methotrexate was the second most initiated medicine (18.7%; n = 9), or with changes in its dosage or route of administration (20.8%; n = 10), totaling 39.5% (n = 19) of changes in medical therapy. There was an increase in the proportions of patients undergoing systemic therapies (79.2%; n = 65). Conclusions: this study reenforces the importance of a multidisciplinary approach in the early diagnosis of PSA and demonstrates that a combined approach between dermatology and rheumatology is feasible in Brazil, with similar outcomes to those reported in international literature.

Background: Vitiligo is a muco-cutaneous, autoimmune, localized, or disseminated disease, which manifests through hypochromic or achromic macules, with loss in quality of life. The prevalence of vitiligo in Brazil was determined to be 0.54%. There is no on-label medication for its treatment. To date, no Brazilian consensus on the treatment of vitiligo had been written. Objectives: The objective of this group of Brazilian dermatologists with experience in the treatment of this disease was to reach a consensus on the clinical and surgical treatment of vitiligo, based on articles with the best scientific evidence. Methods: Seven dermatologists were invited, and each was assigned two treatment modalities to review. Each treatment (topical, systemic, and phototherapy) was reviewed by three experts. Two experts reviewed the surgical treatment. Subsequently, the coordinator compiled the different versions and drafted a text about each type of treatment. The new version was returned to all experts, who expressed their opinions and made suggestions for clarity. The final text was written by the coordinator and sent to all participants to prepare the final consensus. Results/Conclusion: The experts defined the following as standard treatments of vitiligo: the use of topical corticosteroids and calcineurin inhibitors for localized and unstable cases; corticosteroid minipulse in progressive generalized vitiligo; narrowband UVB phototherapy for extensive forms of the disease. Surgical modalities should be indicated for segmental and stable generalized vitiligo. Topical and systemic anti-JAK drugs are being tested, with promising results. (C) 2020 Sociedade Brasileira de Dermatologia. Published by Elsevier Espana, S.L.U.

Background Periorbital hyperchromia (POH), popularly known as "dark circles," is a very frequent complaint in dermatological appointments. It affects all phototypes, genders, and ages, and it is associated with a tired and aged aspect to the face, which may lead to esthetic concerns and impairments in the quality of life. Its etiology is multifactorial, and it is believed that sleep disorders may be considered as precipitating or aggravating factors. Aims Our objective is to compare sleep quality (using the Pittsburgh Sleep Quality Index-PSQI) of patients with POH to patients without this complaint. Methods A single-center, case-control study. Patients from both genders were included. Cases were patients with POH, and controls had no POH. Demographic data, Dermatology Life Quality Index (DLQI), and PSQI were collected. A power of 80% and statistical significance when a P-value was lower than .05 were stipulated. Results Out of 303 patients, 149 cases and 154 controls, with a mean age of 35.83 +/- 11.38 for cases and 37.52 +/- 14.89 for controls, there was no significant difference between groups. The DLQI revealed a mean of 4.86 +/- 4.89 for cases and 2.25 +/- 3.73 for controls (P < .0001), which translates into a modest effect in life quality. The PSQI mean was 5.93 +/- 2.52 for cases and 6.14 +/- 3.58 for controls (P = .633), which characterizes the poor quality of sleep. Conclusions Dark circles impact negatively on the quality of life of affected patients, especially in women. Contrary to what has been believed, sleep alone does not seem to influence the appearance of POH. NCT03393624.

Dr Lia Dantas and Dr Tania Cestari work as researchers for Abbvie. The other authors have no conflicts of interest to state.

As dermatoses podem ter um significativo impacto na vida social, familiar e profissional dos pacientes. Além da avaliação objetiva dos resultados das intervenções terapêuticas, a medida da influência das doenças na qualidade de vida é considerada com relevância similar, sendo medida por questionários validados para tal. Este estudo revisa e descreve as escalas utilizadas na dermatologia. Unitermos: Qualidade de vida, escalas, dermatologia.

Striae distensae (SD), an unsightly cutaneous condition characterized by epidermal atrophy, can affect the quality of life of women.