Resumo em Inglês:

Abstract Pressure injuries must be identified and managed early to prevent them from becoming difficult to heal. In this review, the main complications inherent to pressure injuries will be highlighted, as well as the expected prognosis for patients with this health condition. Furthermore, the most current preventive measures are emphasized and supported by robust references from systematic reviews and guidelines. In the treatment section, an updated and comprehensive conceptual model is presented to guide dermatologists and healthcare professionals in assessing injuries in general, as well as pressure injuries. The focus on the debridement and management of infections and biofilm is emphasized. The importance of preparing the wound bed and the peri-wound area will also be addressed, unifying concepts with the best scientific evidence.

Resumo em Inglês:

Abstract Background Patient satisfaction is a key indicator of healthcare quality and plays a crucial role in strengthening the physician-patient relationship. In dermatology, it contributes to greater treatment adherence and improved clinical outcomes, particularly in chronic skin conditions. However, limited studies have comprehensively evaluated the factors influencing satisfaction in outpatient dermatological settings, especially in academic institutions. Objective To identify factors associated with patient satisfaction during in-person dermatology visits at two tertiary care hospitals with postgraduate training programs and measure global satisfaction. Methods A cross-sectional analytical study was conducted using a structured survey assessing six domains of care: physician interaction, verbal and non-verbal communication, consult timing, privacy, teaching activity, and infrastructure. A multivariate logistic regression model was used to determine variables associated with overall satisfaction, adjusting for potential confounders. Results Most patients reported high satisfaction ([90.5%]), particularly with physician interaction. Key predictors of dissatisfaction included: inadequate bedside manner (Aor = 0.01 [95% CI 0.00-0.04], p < 0.001), discomfort during physical examination (aOR = 0.17 [95% CI 0.05-0.60], p = 0.006), presence of students during medical interview (aOR = 0.13 [95% CI 0.04-0.42], p < 0.001), and not use of white lab coat (aOR = 0.06 [95% CI 0.02-0.25], p < 0.001). Study limitations The cross-sectional design prevents causal inference, and subjective responses may be influenced by social desirability bias. Context-specific findings may limit generalizability. Conclusions Physician bedside manners, communication, and teaching dynamics significantly affect patient satisfaction. Targeted interventions in medical training and institutional policies may improve patient-centered care outcomes. Associations observed were statistically robust, minimizing the risk of spurious conclusions.

Resumo em Inglês:

Abstract Background Misconceptions about psoriasis can negatively influence attitudes toward people diagnosed with the condition as in other developing countries. Health literacy is known to be low, which may further exacerbate negative attitudes toward psoriasis patients. Objectives The study aimed to evaluate the attitudes and knowledge levels and associated factors regarding psoriasis among adults in a community-based sample. Methods This cross-sectional study was conducted among 715 individuals (aged ≥ 18 years) who presented to a university hospital. Results Approximately 60% of the participants in the study did not have sufficient knowledge about psoriasis, and approximately half of them had a negative attitude according to the attitude scale. A moderate negative correlation was found between the psoriasis knowledge score and the psoriasis attitude scale score. According to the multivariate linear regression model, predictors of a positive attitude toward psoriasis were identified as having an income-generating job (Beta; 95% CI: -1.812; -3.052 to -0.572), having heard of psoriasis in medical terminology (-3.946; -5.374 to -2.518), being aware of psoriasis (-3.961; -5.518 to -2.404), having a family member or close individual with a psoriasis diagnosis (-3.961; -4.637 to -1.694), and having an adequate knowledge level regarding psoriasis (-2.880; -4.072 to -1.687) (F = 22.921, p ≤ 0.001, R2 = 0.206). Study limitations Due to its cross-sectional design, causality could not be established. Additionally, the study was single-centered and based on self-reported data. Conclusions The most significant predictor of attitudes toward people with psoriasis was identified as knowledge adequacy.

Resumo em Inglês:

Abstract Background Topical calcineurin inhibitors (TCIs) are commonly used in the treatment of pediatric vitiligo; however, limited studies have specifically examined their efficacy in this patient population. Objective This study aims to evaluate the efficacy of TCI therapy in the treatment of childhood vitiligo. Methods A comprehensive search was conducted in MEDLINE, EMBASE, and Web of Science to identify prospective cohort studies and randomized controlled trials (RCT) evaluating the efficacy of TCI therapy for childhood vitiligo. The primary outcome was treatment success, defined as ≥50% repigmentation. A meta-analysis was performed when appropriate. And the certainty of evidence was graded based on the GRADE (grading of recommendations assessment, development and evaluation) approach. Results Nine studies involving a total of 636 patients were included in this review. Five studies were included in the meta-analysis, and 2 RCTs met eligibility criteria with medium-quality results. The efficacy of TCI therapy for childhood vitiligo was comparable to that of topical corticosteroid (TCS) therapy (Risk Ratio [RR = 0.70], 95% Confidence Interval [95% CI 0.39‒1.25]). Additionally, low-certainty evidence indicates that the combination of TCI therapy with phototherapy demonstrated superior results compared to phototherapy alone (RR = 1.32, 95% CI 1.01‒1.73). Study limitations The findings are based on a limited number of studies and patients. Conclusion TCI therapy for childhood vitiligo appears to be non-inferior to TCS therapy. Moreover, the combination of TCI and phototherapy may offer superior results compared to phototherapy alone; however, this conclusion should be interpreted with caution due to the low certainty of evidence as assessed by GRADE.

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Abstract Background Recurrent nevi (RN) arise from the incomplete removal of a benign melanocytic lesion. They may present with clinical and dermoscopic characteristics similar to melanomas and are a potential mimic of neoplasia. Objective To describe histopathological and immunohistochemical findings of recurrent nevi, including BRAF immunoexpression. Methods A cross-sectional study was conducted on 58 recurrent nevi obtained from a previous prospective study. RN were submitted to histopathological and immunohistochemical analysis. The markers HMB-45, Tyrosinase, Ki-67, and BRAF V-600E were used. Results A trizonal pattern was observed in 84.5% of cases and is defined by the presence of junctional melanocytic proliferation, scar tissue, and residual dermal nests. Furthermore, architectural asymmetry (56.9%), lentiginous hyperplasia (75.9%), fibrosis (98.4%), lymphocytic infiltrate (96.5%), and melanophages (79.2%) were identified. Dropping off was observed in 1.7%, adnexal involvement in 22.3%, a pagetoid distribution in 30%, and cell atypia in 15%. HMB-45 and tyrosinase were expressed in a gradient and were identified in 98.3% and 91.4%, respectively. Ki-67 was positive in all cases, and the mean proliferative index was 2.83%. BRAF expression was positive in 72.4%. Study limitations Limited sample size, evaluation by a single dermatopathologist, targeted immunohistochemical profiling, and the lack of red counterstaining could be potential limitations of the study. Conclusions RN are characterized by architectural asymmetry and a trizonal pattern. Nuclear atypia and a pagetoid distribution may be observed. RN cells have a low proliferative index and are positive for HMB-45 and tyrosinase. BRAF expression occurs in most recurrences and is heterogeneous in RN melanocytes.

Resumo em Inglês:

Abstract Background Publications on vertical ex vivo dermoscopy of skin lesions are sporadic and present only as case reports. Objectives This study defines, describes, and determines the importance of structures visible by vertical ex vivo dermoscopy in the diagnosis of pigmented, benign skin lesions and their distinction between themselves, and in relation to other skin lesions. Methods The prospective, descriptive study was conducted in two University centers. Digital images of completely excised skin lesions, fixed in formalin before further processing, were evaluated dermoscopically. For the analysis of horizontal ex vivo dermoscopy, pattern analysis was used, while for the vertical section, a description of the visible structures was made. Results The research sample consisted of 80 benign pigmented skin lesions obtained from 73 patients. Histopathological diagnosis of the evaluated lesions included 59 nevi, 17 seborrheic keratoses, 3 angiomas and 1 clear cell acanthoma. Seborrheic keratosis had the most variable presentation on vertical ex vivo dermoscopy. By analyzing the vertical section of the evaluated skin lesions, the importance of vertical ex vivo dermoscopy in the diagnosis and/or differentiation of blue nevus, seborrheic keratosis and angioma from other skin lesions was noted. Study limitations Small number of analyzed lesions, and inclusion of Caucasian patients only. Conclusions Vertical ex vivo dermoscopy can contribute to the distinction between different pigmented benign skin lesions, as well as to their differentiation from other skin lesions. Furthermore, vertical section enables more accurate assessment of additional, descriptive lesional characteristics.

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Abstract Background Melanoma is an aggressive skin cancer with a high metastatic potential and mortality risk. Identifying risk factors for distant metastasis is crucial for optimizing surveillance strategies. The authors aimed to evaluate the predictors of distant metastasis in early-stage cutaneous melanoma within a Turkish patient cohort. Methods A retrospective cohort study was conducted on patients with stage I-II melanoma, diagnosed between 2004 and 2024 at the Department of Dermatology, Dokuz Eylul University. A minimum follow-up period of five years was ensured. Demographic, clinical, and histopathological variables were analyzed for their association with distant metastasis using univariate and multivariate statistical models. Results Among 148 patients, distant metastasis occurred in 36 (24.3%) during follow-up. Multivariate analysis identified age (HR = 1.03 per year, p = 0.050), Breslow thickness (HR = 1.19 per mm, p = 0.008), ulceration (HR = 3.05, p = 0.028), and Lymphovascular Invasion (LVI) (HR = 4.20, p = 0.002) as significant independent predictors of distant metastasis. The risk was found to increase markedly, particularly after the age of 40. Additionally, the optimal cut-off value for Breslow thickness was determined to be 2.73 mm, with a sensitivity of 69% and a specificity of 71% based on ROC curve analysis. Conclusion Increasing age, Breslow thickness, ulceration, and LVI were identified as independent risk factors for distant metastasis in early-stage cutaneous melanoma. Notably, patients over 40-years and those with Breslow thickness >2.73 mm were at significantly higher risk. Further studies are warranted to validate these results and facilitate their integration into clinical practice.

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Abstract Background Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous sarcoma characterized by slow growth, a high local recurrence rate, and low metastatic potential. Objective: To characterize the clinicopathological features and the treatment outcomes of patients diagnosed with DFSP. Methos Retrospective study of patients with a histopathological diagnosis of DFSP between 1997 and 2022. Results Data from 42 patients with DFSP were included. The majority were female (69%) with a mean age of 49.1 years. The trunk (52%) and extremities (40%) were the most common tumor sites. Classic histologic pattern was observed in 90% of cases, while rare variants, including fibrosarcomatous, pigmented, and myxoid subtypes, were also identified. Wide local excision was the primary treatment (95%), achieving clear margins in 71% of patients. Local recurrence occurred in 4.8% and adjuvant radiotherapy was employed in 19% of cases. Two patients developed pulmonary metastases with disease progression despite treatment with imatinib. Study limitations Retrospective study based on medical and pathological records. Conclusions Cutaneous DFSP in this series demonstrated clinicopathologic features consistent with those reported in the literature, including a predilection for the trunk and middle-aged females. Histologically, most cases exhibited the classic storiform pattern with strong CD34 positivity. Wide local excision was the primary treatment modality, with a relatively low recurrence rate compared to the literature, possibly influenced by the use of adjuvant radiotherapy in select patients. Although uncommon, metastasis occurred in cases with recurrent disease and fibrosarcomatous transformation. Ongoing research into systemic therapies and molecularly targeted treatments is needed to improve outcomes in advanced DFSP.

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Abstract Teledermatology services in Brazil have a rich history, with several ongoing projects boosting academic research and providing efficiency gains by reducing waste, humanizing healthcare, and ensuring greater quality and speed in patient assistance. Reviewing the fundamentals and history of Teledermatology, along with the continuing evolution of Telemedicine services in Brazil and its practical aspects and future prospects, might bring better comprehension of how to further develop and improve these services.

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Abstract Background Prurigo nodularis (PN) is a chronic, debilitating inflammatory skin disorder characterized by persistent itching, firm pruritic nodular lesions, and evidence of frequent scratching, like excoriation, and lichenification. Nemolizumab, a monoclonal antibody targeting IL-31, has shown significant improvements in skin lesions, itching, and sleep disturbances by reducing type 2 immune responses in PN. Objectives Evaluate the efficacy and safety of nemolizumab in treating PN by systematically analyzing randomized controlled trials (RCTs). Methods: The authors conducted a systematic review and meta-analysis by searching Pubmed, Embase, Cochrane Central and Scopus for RCTs comparing nemolizumab to placebo for PN. Statistical analysis usedR Studio 4.3.2. Results Three trials, involving 630 patients, were included. Nemolizumab significantly reduced pruritus at week-4 (MD = −32.04; 95% CI: −38.47, −25.62) and at week-16 (MD = −347.34; 95% CI: −1039.71, 345.04). Investigator’s Global Assessment (IGA) success favored Nemolizumab at week-16 (RR = 3.50; 95% CI: 2.18, 5.63). No significant differences were observed in adverse events (RR = 1.10; 95% CI: 0.97, 1.25) or serious adverse events (RR = 0.77; 95% CI: 0.43, 1.39). Nemolizumab also significantly reduced neurodermatitis. Study limitations Limitations include variability in treatment duration, small sample sizes, and the lack of direct comparisons with other biologics. Conclusion Our meta-analysis shows that Nemolizumab significantly improves pruritus, IGA success rates, and PAS > 75% in treating patients with moderate to severe PN. Its safety profile is favorable, with no significant differences in adverse events compared to placebo. These findings support Nemolizumab as a viable treatment for moderate to severe PN.

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Abstract The 2024 Brazilian Consensus on Psoriasis and Treatment Algorithm of the Brazilian Society of Dermatology (SBD, Sociedade Brasileira de Dermatologia) comes four years after the release of the last Consensus, published in 2020. This new consensus now includes 43 chapters and has the participation of 85 professionals from across Brazil, including dermatologists and rheumatologists working in university hospitals, research centers, and public and private healthcare systems. The concept of Cumulative Life Course Impairment (CLCI), the inclusion of new biologics approved in Brazil after 2020, the update on psoriasis treatment in specific situations (such as pregnancy and surgery), and the discussion on "Response Predictors" are examples of updates addressed in this Consensus. The updated treatment algorithm used experts’ responses through the Delphi method and, among other modifications, removed acitretin from the plaque psoriasis treatment sequence, defined treatment lines for choosing immunobiologicals in both adult and pediatric populations, and included spesolimab and cyclosporine as first-line treatments for generalized pustular psoriasis. Finally, the new Consensus addresses the place of small molecule inhibitors in the algorithm and discusses future treatment options for plaque psoriasis.