Publications by authors named "Jose Antonio Sanches"

49 Publications

Cutaneous adverse events to systemic antineoplastic therapies: a retrospective study in a public oncologic hospital.

An Bras Dermatol 2021 Nov 26. Epub 2021 Nov 26.

Department of Dermatology, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil.

Background: Mucocutaneous adverse events are common during anticancer treatment, with variable consequences for the patient and their therapeutic regimen.

Objective: To evaluate the most common adverse events, as well as the drugs associated with their appearance and the consequences for cancer treatment.

Methods: A retrospective study was carried out through the analysis of patients treated at the Clinical Dermatology Unit of a public oncologic hospital.

Results: A total of 138 patients with 200 adverse events were evaluated. The most commonly identified adverse events were nail and periungual changes (20%), papulopustular eruptions (13%), acneiform eruptions (12%), hand-foot syndrome (6.5%), hand-foot skin reaction (6%), and xerosis (6%). The most frequently associated antineoplastic treatment groups were classical chemotherapy (46.2%), target therapy (32.3%), and other non-antineoplastic drugs used in neoplasia protocols (16.5%). Of the total number of patients, 17.4% had their treatment suspended or changed due to a dermatological adverse event.

Study Limitations: Retrospective study and analysis of patients who were referred for specialized dermatological examination only, not allowing the assessment of the actual incidence of adverse events.

Conclusion: A wide variety of dermatological manifestations are secondary to antineoplastic treatment with several different drugs resulting, not rarely, in the interruption or modification of therapeutic regimens.
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http://dx.doi.org/10.1016/j.abd.2021.05.007DOI Listing
November 2021

Primary Cutaneous Lymphoma: Recommendations for Clinical Trial Design and Staging Update from the ISCL, USCLC, and EORTC.

Blood 2021 Nov 10. Epub 2021 Nov 10.

Leiden University Medical Center, Leiden, Netherlands.

The number of patients with primary cutaneous lymphoma (PCL) relative to other non-Hodgkin lymphomas (NHLs) is small and the number of subtypes large. Although clinical trial guidelines have been published for mycosis fungoides/Sézary syndrome (MF/SS), the most common type of PCL, none exist for the other PCLs. In addition, staging in the PCLs has been evolving based on new data on potential prognostic factors, diagnosis, and assessment methods of both skin and extracutaneous disease and a desire to align the latter with the Lugano guidelines for all NHLs. The International Society for Cutaneous Lymphomas (ISCL), the United States Cutaneous Lymphoma Consortium (USCLC), and the Cutaneous Lymphoma Task Force of the European Organization for the Research and Treatment of Cancer (EORTC) now propose updated staging and guidelines for the study design, assessment, endpoints and response criteria in clinical trials for all the PCLs in alignment with that of the Lugano guidelines. These recommendations provide standardized methodology that should facilitate planning and regulatory approval of new treatments for these lymphomas worldwide, encourage cooperative investigator-initiated trials, and help to assess the comparative efficacy of therapeutic agents tested across sites and studies.
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http://dx.doi.org/10.1182/blood.2021012057DOI Listing
November 2021

Taxane-induced scleroderma. Report of two cases.

Rev Med Chil 2021 May;149(5):807-809

Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil.

Taxanes are a class of chemotherapeutic agents with common associated dermatologic adverse events, such as skin hyperpigmentation, hand-foot skin syndrome, paronychia and onycholysis. Taxane-induced scleroderma is rare. Few cases with skin findings resembling systemic sclerosis, have been reported after the administration of these agents. We report two cases with stage IV breast cancer, aged 66 and 71 years, who developed sclerodermic skin lesions in their extremities after starting treatment with placlitaxel and nabplaclitaxel respectively.
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http://dx.doi.org/10.4067/s0034-98872021000500807DOI Listing
May 2021

Reasons we should not exclude the term parapsoriasis from the medical vocabulary.

J Cutan Pathol 2021 Nov 13;48(11):1436-1437. Epub 2021 Oct 13.

Dermatological Outpatient Clinic, Hospital das Clínicas, Medical School of the University of São Paulo, São Paulo, Brazil.

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http://dx.doi.org/10.1111/cup.14140DOI Listing
November 2021

Randomized phase 3 ALCANZA study of brentuximab vedotin vs physician's choice in cutaneous T-cell lymphoma: final data.

Blood Adv 2021 Sep 10. Epub 2021 Sep 10.

Peter MacCallum Cancer Centre, Melbourne, Australia.

The primary analysis of the phase 3 ALCANZA trial showed significantly-improved objective responses lasting ≥4 months (ORR4; primary endpoint) and progression-free survival (PFS) with brentuximab vedotin vs physician's choice (methotrexate or bexarotene) in CD30-expressing mycosis fungoides (MF) or primary cutaneous anaplastic large-cell lymphoma (C-ALCL). Cutaneous T-cell lymphomas often cause pruritus and pain; brentuximab vedotin improved skin symptom burden with no negative effects on quality of life. We report final data from ALCANZA (median follow-up 45.9 months). Adults with previously treated CD30-expressing MF/C-ALCL were randomized to brentuximab vedotin (n = 64) or physician's choice (n = 64). Final data demonstrated improved responses per independent review facility with brentuximab vedotin vs physician's choice: ORR4, 54.7% vs 12.5% (P < .001); complete response, 17.2% vs 1.6% (P = .002). Median PFS with brentuximab vedotin vs physician's choice was 16.7 months vs 3.5 months (P< .001). Median time to next treatment was significantly longer with brentuximab vedotin than with physician's choice (14.2 vs 5.6 months; hazard ratio, 0.27; 95% CI, 0.17-0.42; P < .001). Of 44 patients in the brentuximab vedotin arm who experienced any-grade peripheral neuropathy (PN), (grade 3, n = 6; grade 4, n = 0), 86% (38/44) had complete resolution (26/44) or improvement to grade 1-2 (12/44). PN was ongoing in 18 patients (all grade 1-2). These final analyses confirm improved, clinically meaningful, durable responses and longer PFS with brentuximab vedotin vs physician's choice in CD30-expressing MF or C-ALCL. This trial was registered at https://www.clinicaltrials.gov/ct2/show/NCT01578499 as #NCT01578499.
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http://dx.doi.org/10.1182/bloodadvances.2021004710DOI Listing
September 2021

Different aspects and variants of mycosis fungoides in a single patient.

Indian J Dermatol Venereol Leprol 2021 [SEASON];87(4):565-568

Department of Dermatology, Hospital das Clínicas, Medical School of the University of São Paulo, São Paulo, Brazil.

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http://dx.doi.org/10.25259/IJDVL_787_20DOI Listing
June 2020

Mycosis fungoides and Sézary syndrome: focus on the current treatment scenario.

An Bras Dermatol 2021 Jul-Aug;96(4):458-471. Epub 2021 May 28.

Hematology Clinic Division, Faculty of Medicine, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil.

Cutaneous T-cell lymphomas are a heterogeneous group of lymphoproliferative disorders, characterized by infiltration of the skin by mature malignant T cells. Mycosis fungoides is the most common form of cutaneous T-cell lymphoma, accounting for more than 60% of cases. Mycosis fungoides in the early-stage is generally an indolent disease, progressing slowly from some patches or plaques to more widespread skin involvement. However, 20% to 25% of patients progress to advanced stages, with the development of skin tumors, extracutaneous spread and poor prognosis. Treatment modalities can be divided into two groups: skin-directed therapies and systemic therapies. Therapies targeting the skin include topical agents, phototherapy and radiotherapy. Systemic therapies include biological response modifiers, immunotherapies and chemotherapeutic agents. For early-stage mycosis fungoides, skin-directed therapies are preferred, to control the disease, improve symptoms and quality of life. When refractory or in advanced-stage disease, systemic treatment is necessary. In this article, the authors present a compilation of current treatment options for mycosis fungoides and Sézary syndrome.
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http://dx.doi.org/10.1016/j.abd.2020.12.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8245718PMC
July 2021

Primary cutaneous CD30-positive T cell lymphoproliferative disorders associated with polymethylmethacrylate: An unfortunate coincidence or a causal relationship?

Dermatol Ther 2021 03 4;34(2):e14824. Epub 2021 Feb 4.

Dermatological Outpatient Clinic, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.

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http://dx.doi.org/10.1111/dth.14824DOI Listing
March 2021

Development of a clinical scale to assess the severity of striae distensae.

Skin Res Technol 2021 Jul 27;27(4):627-631. Epub 2020 Dec 27.

Department of Dermatology, UNIFESP, São Paulo, Brazil.

Background And Objective: There is no validated instrument to assess the clinical severity of striae distensae. Here, we aimed to develop a striae distensae severity scale.

Material And Methods: After a Delphi-based consensus, 15 items related to striae severity were assessed in 110 areas (breasts, abdomen, and buttocks) from 45 participants. The items were analyzed through a partial least squares model to select the most important variables. To assess the reliability of the scale, 43 areas were retested.

Results: Of the 110 areas evaluated, 34 were breasts, 24 abdomens, and 52 buttocks. Striae were considered mild in 30% of the evaluations, moderate in 33%, severe in 21%, and extremely severe in 16%. The final model was composed by: width of the widest striae, width of the striae with the most frequent pattern, atrophy, number of affected quadrants, distribution (multiple or isolated), hypo or hyperchromia and topography. The scores of the scale demonstrated a high correlation with the clinical classification (rho = 0.77). There was a high agreement in the scores from the reassessed areas (intraclass correlation coefficient = 0.90).

Conclusion: An objective and reliable scale to assess the clinical severity of striae distensae on the breasts, abdomen, and buttocks was developed.
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http://dx.doi.org/10.1111/srt.12995DOI Listing
July 2021

Trends in Melanoma Mortality in Brazil: A Registry-Based Study.

JCO Glob Oncol 2020 11;6:1766-1771

Dermatology Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.

Purpose: A substantial increase in melanoma incidence has been consistently observed worldwide over the past decades. However, melanoma mortality rates have remained stable or declined over the past years in most regions. Given the paucity of melanoma mortality data for different Brazilian regions, we sought to describe melanoma mortality trends in southeastern Brazil and their relationship with demographic variables.

Materials And Methods: A cross-sectional registry-based analysis was conducted to describe melanoma mortality trends in the state of São Paulo, Brazil, from 1996 to 2016. Demographic information from melanoma-related death records, including sex and age, was collected from the Fundação Sistema Estadual de Análise de Dados database. The annual percentage change (APC) was calculated to identify mortality trends over the period.

Results: An increasing melanoma mortality trend was detected among males, regardless of age (APC, 1.72%; < .001), and was more pronounced for men ≥ 60 years old (APC, 2.63%; < .001). Melanoma mortality rates have also increased for patients ≥ 60 years old, regardless of sex (APC, 1.11%; < .001). A non-statistically significant increase in the overall melanoma mortality rate was observed over the 20-year period analyzed (APC, 0.36%; = .4).

Conclusion: Our data suggest a stable melanoma mortality over the past two decades for the overall population studied; however, a significant increase in melanoma mortality rates has been demonstrated among males and in the population ≥ 60 years old, emphasizing the need to implement prevention strategies and expand access to effective therapies for this population.
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http://dx.doi.org/10.1200/GO.20.00426DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7713536PMC
November 2020

Extensive cutaneous involvement by dermatomyositis: Report of six cases and review of the literature.

Autoimmun Rev 2020 Dec 22;19(12):102680. Epub 2020 Oct 22.

Department of Dermatology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.

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http://dx.doi.org/10.1016/j.autrev.2020.102680DOI Listing
December 2020

Progression of mycosis fungoides after treatment with dupilumab: A case report.

Dermatol Ther 2020 11 12;33(6):e13880. Epub 2020 Jul 12.

Department of Dermatology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.

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http://dx.doi.org/10.1111/dth.13880DOI Listing
November 2020

Erythroderma: a prospective study of 309 patients followed for 12 years in a tertiary center.

Sci Rep 2020 06 17;10(1):9774. Epub 2020 Jun 17.

Division of Clinical Dermatology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.

Erythroderma is characterized by erythema and scaling affecting more than 80% of the body surface area. It is potentially life-threatening, and diagnosis of the underlying disease is a challenge. Despite laboratory improvements, many cases remain idiopathic. We aimed to analyze clinical and laboratory findings of 309 erythrodermic patients to find clues to the etiologic diagnosis. We performed a prospective study at the University of São Paulo Medical School, from 2007 to 2018, with patients with acquired erythroderma. Clinical, laboratory, histology, and molecular biology data were collected. The median age at diagnosis was 57 years, with a male-to-female ratio of 2.2. Eczema was the most frequent etiology (20.7%), followed by psoriasis (16.8%), Sézary syndrome (12.3%), drug eruption (12.3%), atopic dermatitis (8.7%), and mycosis fungoides (5.5%). Other diagnoses (6.8%) included pemphigus foliaceous, paraneoplastic erythroderma, adult T-cell leukemia/lymphoma, dermatomyositis, pityriasis rubra pilaris, lichen planus, bullous pemphigoid, and leprosy. In 52 patients (16.8%), it was not possible to elucidate erythroderma etiology. Atopic dermatitis developed erythroderma at an earlier age (median 25 years; P = 0.0001). Acute onset was associated with drug reactions and atopic dermatitis (median time from erythroderma to diagnosis of 1 and 1.5 months, respectively; P = 0.0001). Higher immunoglobulin E levels were observed in atopic dermatitis (median 24,600 U/L; P = 0.0001). Histopathology was helpful and was consistent with the final diagnosis in 72.4%. Monoclonal T-cell proliferation in the skin was observed in mycosis fungoides (33.3%) and Sézary syndrome (90.9%). At the last assessment, 211 patients (69.3%) were alive with disease, 65 (21.7%) were alive without disease, and 27 (9.1%) died with active disease. Erythroderma is a challenging syndrome with a difficult diagnostic approach. Younger age and higher immunoglobulin E levels are associated with atopic dermatitis; acute onset is observed in drug eruptions and atopic dermatitis. Histopathology and molecular biology tests are essential tools in the investigation of erythroderma.
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http://dx.doi.org/10.1038/s41598-020-66040-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7300014PMC
June 2020

Management of dermatologic adverse events from cancer therapies: recommendations of an expert panel.

An Bras Dermatol 2020 Mar - Apr;95(2):221-237. Epub 2020 Feb 15.

Department of Dermatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.

With the development of new cancer therapies, systemic toxicity profile and effects on survival achieved an important improvement. However, a constellation of toxicities has emerged, even more remarkably, cutaneous adverse events. This report, developed by a board of Brazilian experts in oncodermatology, aims to establish a guideline for the dermatological care of oncologic patients. When possible, evidence-based recommendations were made, but in many cases, when strong evidence was not available, a consensus was reached, based on some data supporting therapies combined with personal experiences.
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http://dx.doi.org/10.1016/j.abd.2020.01.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7175407PMC
May 2020

Worse survival of invasive melanoma patients in men and "de novo" lesions.

An Bras Dermatol 2020 Mar - Apr;95(2):158-164. Epub 2020 Jan 23.

Department of Data Information Analysis and Dissemination, Fundação Sistema Estadual de Análise de Dados, São Paulo, SP, Brazil.

Background: The incidence and mortality of melanoma is increasing in many countries, including Brazil. Survival studies are still scarce in our country, but much needed to know and address this problem better.

Objective: To analyze the disease-specific survival of patients with invasive melanoma and to correlate it with clinical and histopathological variables.

Methods: Retrospective cohort analysis of 565 cases of invasive melanoma in a tertiary hospital with the objective of testing variables that could be associated with a worse prognosis, such as gender, phototype, thickness, histological type and presence of pre-existing clinical lesion at the site of the tumor.

Results: The worst survival rates were significantly associated with thicker tumors (p<0.001), male sex (p=0.014), high phototype (p=0.047), nodular melanoma (p=0.024) and "de novo" lesions (p=0.005). When all variables were adjusted for melanoma thickness, male patients (p=0.011) and "de novo" melanomas (p=0.025) remained associated with worse survival.

Study Limitations: Retrospective study of a single tertiary hospital.

Conclusions: Although the causes are still unknown, melanoma-specific survival was statistically worse for males and for "de novo" melanomas even after adjustment of tumor thickness.
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http://dx.doi.org/10.1016/j.abd.2019.07.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7175044PMC
May 2020

Leprosy elimination - Still a long way to go.

Sao Paulo Med J 2019 Nov-Dec;137(6):552-554

MD, PhD. Full Professor, Dermatology Department, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo (SP), Brazil.

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http://dx.doi.org/10.1590/1516-3180.2018.0345021019DOI Listing
May 2020

Clinicopathologic and microenvironmental analysis of primary cutaneous CD30-positive lymphoproliferative disorders: a 26 year experience from an academic medical center in Brazil.

Diagn Pathol 2019 Oct 22;14(1):115. Epub 2019 Oct 22.

Department of Pathology, Stanford University School of Medicine, Stanford, CA, 94305, USA.

Background: Primary cutaneous CD30+ lymphoproliferative disorders (pc-CD30-LPD) are a group of clonal T cell lymphoproliferative disorders that despite very similar tumor histology follow different and characteristic clinical courses, suggesting a homeostatic role of the tumor microenvironment. Little is known about tumor microenvironment and there is almost no literature about PD-L1 expression in pc-CD30-LPD.

Methods: This retrospective study presents a fully clinicopathologically characterized series of pc-CD30-LPDs from an academic medical center in Brazil, including 8 lymphomatoid papulomatosis (LyP), 9 primary cutaneous anaplastic large cell lymphoma (pcALCL) and 4 borderline lesions. All the cases were scored for FOXP3+ regulatory T-cells (Treg) and CD8+ cytotoxic tumor infiltrating lymphocytes (TIL) densities, as well as PD-L1 expression in tumor cells and tissue associated macrophages. The CD8+/FOXP3+ ratio was also evaluated.

Results: Among the 21 cases of pc-CD30-LPD, PD-L1 expression is frequent in both tumor cells and tissue associated macrophages in pc-CD30-LPD across categories, suggesting that the PD-L1 axis may be a common feature of pc-CD30-LPDs. While reactive T cell infiltrates vary widely from case to case, a common feature across pc-CD30-LPDs is higher density of CD8 than FOXP3 + T cells. The distribution of T cells within the lesions however differed between LyP and pcALCL: we found that LyP lesions tend to be permeated by CD8+ and FOXP3+ T cells, whereas pcALCL tend to be surrounded by a rim of CD8+ TIL and FOXP3+ Tregs with relatively lower density infiltrates in the center of the lesion.

Conclusions: LyP has a trend to have denser immune cells throughout the lesion, with higher FOXP3+ Treg and CD8+ TIL in the center than the edge comparing with pcALCL. PD-L1+ is frequent in tumor cells and tissue associated macrophages in pc-CD30-LPD. The differential distribution of CD8+ and FOXP3+ TILs in LyP as compared to pcALCL could provide a clue to the relapsing/remitting course of LyP as compared to the less frequent spontaneous regression of pcALCL.
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http://dx.doi.org/10.1186/s13000-019-0900-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6805531PMC
October 2019

Poikilodermatous Mycosis Fungoides: Comparative Study of Clinical, Histopathological and Immunohistochemical Features.

Dermatology 2020 24;236(2):117-122. Epub 2019 Sep 24.

Department of Dermatology, School of Medicine, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil.

Background: Poikilodermatous mycosis fungoides (pMF) is characterized by poikiloderma areas, typically involving the major flexural areas and trunk. Its presentation can be generalized or admixed with other forms of MF. Previous studies fail to correlate the clinical presentation with prognosis and laboratory findings. Some reports show pityriasis lichenoides chronica (PLC) preceding the poikiloderma.

Objectives: Correlate prognostic, histopathological and molecular aspects of pMF with its clinical presentation.

Methods: Retrospective analysis of 14 cases of generalized pMF (GpMF), 22 of localized pMF (LpMF) and 17 of pMF admixed with other forms of MF (mix-pMF).

Results: Female predominance and lower age at diagnosis was found in all groups compared to classic MF, a high prevalence of PLC-like lesions in the GpMF group and a high rate of hypopigmented lesions in the mix-pMF group. There were 2 deaths within the GpMF group. Histology was similar to previously reported findings, as was the prevalence of CD4 T-cell infiltrate, compared to CD8. The T-cell clonality positivity was lower in the GpMF group, compared to other groups (27% GpMF, 80% LpMF and 100% mix-pMF).

Discussion: This is the first article to categorize the different forms of pMF and correlate them with clinical and laboratory findings. The dermatological presentation differs among the groups. There was a high frequency of PLC-like lesions within the GpMF group and of hypopigmented lesions in mix-pMF. The histological and immunohistochemical findings were similar to those previously reported. Aggressive treatments are not recommended due to the good prognosis of all pMF forms. The low positivity of T-cell clonality in the GpMF group should be investigated.
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http://dx.doi.org/10.1159/000502027DOI Listing
February 2021

Cutaneous manifestations of adult T-cell leukemia/lymphoma.

Semin Diagn Pathol 2020 Mar 30;37(2):81-91. Epub 2019 Jul 30.

Department of Dermatology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil. Electronic address:

Adult T-cell leukemia/lymphoma (ATLL) is an aggressive peripheral T-cell lymphoma caused by the human T-lymphotropic virus type-1 (HTLV-1). The skin is affected in approximately half of ATLL patients, and it may be the first manifestation of the disease. The skin lesions of ATLL are polymorphous, and depending on the type of skin eruption, it is possible to predict the prognosis of the disease. Besides specific skin lesions, other non-specific lesions and increased risk of cutaneous and systemic infections are observed. In this article, we describe the different skin lesions of ATLL patients (specific, non-specific, and infectious lesions), the different histopathological patterns, and the association of clinicopathological characteristics with prognosis. Recognition of ATLL skin lesions is essential for the correct management and the search for the virus, even in non-endemic regions, where global migration may bring HTLV-1 infected individuals.
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http://dx.doi.org/10.1053/j.semdp.2019.07.010DOI Listing
March 2020

Consensuses, guidelines and position papers: the role of the Brazilian Society of Dermatology in the contribution to the best practice of Dermatology.

An Bras Dermatol 2019 Apr 3;94(2 Suppl 1). Epub 2019 Jun 3.

Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Brazil.

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http://dx.doi.org/10.1590/abd1806-4841.2019940205DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6544035PMC
April 2019

Atypical herpes vasculitis in a leukemic patient: An unusual presentation.

Hematol Transfus Cell Ther 2019 Jan-Mar;41(1):95-98. Epub 2018 Aug 7.

Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HC FMUSP), São Paulo, SP, Brazil.

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http://dx.doi.org/10.1016/j.htct.2018.07.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6371409PMC
August 2018

Participation and responsibility.

An Bras Dermatol 2019 Jan-Feb;94(1)

Department of Dermatology, University of Sao Paulo, Brazil. President of Brazilian Society of Dermatology 2017-2018.

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http://dx.doi.org/10.1590/abd1806-4841.201994101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6360966PMC
March 2019

Zwei Fälle perforierender Dermatosen bei Therapie mit Multikinase-Inhibitoren, einer davon assoziiert mit Lenvatinib.

J Dtsch Dermatol Ges 2018 Dec;16(12):1486-1489

Department of Dermatology, University of Sao Paulo Medical School, Sao Paulo, Brazil.

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http://dx.doi.org/10.1111/ddg.13704_gDOI Listing
December 2018

Dermoscopic findings of perifollicular pigmentation associated with vandetanib.

Dermatol Pract Concept 2018 Oct 31;8(4):340-341. Epub 2018 Oct 31.

Department of Dermatology, University of São Paulo, São Paulo, Brazil.

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http://dx.doi.org/10.5826/dpc.0804a20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6246057PMC
October 2018

Perforating dermatosis associated with multikinase inhibitors: report of two cases, including one associated with lenvatinib.

J Dtsch Dermatol Ges 2018 Dec 22;16(12):1486-1489. Epub 2018 Nov 22.

Department of Dermatology, University of Sao Paulo Medical School, Sao Paulo, Brazil.

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http://dx.doi.org/10.1111/ddg.13704DOI Listing
December 2018

A case report of erythroderma in a patient with borderline leprosy on reversal reaction: a result of the exacerbated reaction?

BMC Dermatol 2017 Dec 20;17(1):16. Epub 2017 Dec 20.

Clinical and Experimental Allergy and Immunology Laboratory LIM-56, University of São Paulo Medical School, São Paulo, Brazil.

Background: Erythroderma is characterized by erythema and scaling affecting more than 90% of the body surface area. Inflammatory, neoplastic and, more rarely, infectious diseases may culminate with erythroderma. Diagnosis of the underlying disorder is therefore crucial to institute the appropriate therapy. Leprosy is a chronic infectious disease that is endemic in Brazil. Here we present an unusual case of leprosy and reversal reaction causing erythroderma, and we discuss the underlying immunological mechanisms which could contribute to the generalized skin inflammation.

Case Presentation: We report a case of a patient with reversal reaction (RR) in borderline borderline leprosy presenting with erythroderma and neural disabilities. Histopathology of the skin showed regular acanthosis and spongiosis in the epidermis and, in the dermis, compact epithelioid granulomas as well as grouped and isolated bacilli. This duality probably reflects the transition from an anergic/multibacillary state to a state of more effective immunity and bacillary control, typical of RR. Leprosy was successfully treated with WHO's multidrug therapy, plus prednisone for controlling the RR; the erythroderma resolved in parallel with this treatment. Immunologic studies showed in situ predominance of IFNγ + over IL-4+ lymphocytes and of IL-17+ over Foxp3+ lymphocytes, suggesting an exacerbated Th-1/Th-17 immunoreactivity and poor Th-2 and regulatory T-cell responses. Circulating Tregs were also diminished. We hypothesize that the flare-up of anti-mycobacteria immunoreactivity that underlies RR may have triggered the intense inflammatory skin lesions that culminated with erythroderma.

Conclusions: This case report highlights the importance of thorough clinical examination of erythrodermic patients in search for its etiology and suggests that an intense and probably uncontrolled leprosy RR can culminate in the development of erythroderma.
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http://dx.doi.org/10.1186/s12895-017-0068-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5738805PMC
December 2017

Double-positive CD4 and CD8 Sézary syndrome.

JAAD Case Rep 2017 Nov 23;3(6):485-488. Epub 2017 Sep 23.

Department of Dermatology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.

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http://dx.doi.org/10.1016/j.jdcr.2017.06.036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5614634PMC
November 2017

Angiosarcoma in HIV-negative patients is not associated with HHV-8.

An Bras Dermatol 2016 Nov-Dec;91(6):738-741

Universidade de São Paulo (USP) - São Paulo (SP), Brazil.

Background:: Angiosarcoma is an aggressive, malignant neoplasm of vascular or lymphatic origin. Herpes virus 8 (HHV-8) is a member of the herpes family with a tropism for endothelial cells and it has been proven to induce vascular neoplasms, such as Kaposi's sarcoma. The role of HHV-8 in the pathogenesis of angiosarcoma has not been well defined.

Objective:: To investigate the relationship between the presence of HHV-8 and angiosarcoma.

Methods:: In this study, the team investigated the relationship between the presence of HHV-8, as determined by polymerase chain reaction, and angiosarcoma, using samples from patients with epidemic Kaposi's sarcoma as controls.

Results:: While all control cases with epidemic Kaposi's sarcoma were positive for HHV-8, none of the angiosarcoma cases was.

Conclusion:: These findings support most previous studies that found no association between HHV-8 and angiosarcoma.
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http://dx.doi.org/10.1590/abd1806-4841.20164730DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5193183PMC
May 2017

Indeterminate cell histiocytosis successfully treated with phototherapy.

Autops Case Rep 2016 Apr-Jun;6(2):33-8. Epub 2016 Jun 30.

Dermatology Department - Faculty of Medicine - Hospital das Clínicas - University of São Paulo, São Paulo/SP - Brazil .

First described in 1985, intermediate cell histiocytosis is a rare disorder of the cutaneous dendritic cell group with a varied clinical presentation and evolution. The pathologic substrate is constituted by the proliferation of indeterminate cells (ICs) that are immunophenotypically characterized by the positivity of CD1a, CD68, and faint/focal S100, plus the negativity for CD207 (langerin). The authors present the case of a healthy elderly woman who presented generalized dome-shaped reddish cutaneous nodules over her trunk, neck, face, and extremities over a period of 18 months. A laboratory and imaging work-up ruled out internal involvement. The skin biopsy was consistent with IC histiocytosis. The patient was treated with narrowband ultraviolet B phototherapy, which resulted in an excellent short-term outcome.
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http://dx.doi.org/10.4322/acr.2016.038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4982782PMC
August 2016
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