Publications by authors named "Paulo Ricardo Criado"

105 Publications

What lessons can we learn? Clinical and epidemiological retrospective analysis of 267 patients with urticaria in a Brazilian tertiary center.

An Bras Dermatol 2021 May 21. Epub 2021 May 21.

Department of Dermatology, Centro Universitário Saúde ABC, Santo André, SP, Brazil.

Background: There are few epidemiological studies of urticaria, published in the indexed literature (PubMed/Medline).

Objective: The study aimed to evaluate the epidemiological and clinical data among patients with urticaria/angioedema attending a reference clinic in Brazil.

Methods: Two hundred sixty-seven patients were evaluated retrospectively considering demographic data, time course of the disease, triggering symptoms, the presence of angioedema, complementary laboratory tests including total blood count, reactive-C protein, erythrocyte sedimentation rate, IgE serum levels, and other, as necessary.

Results: The most commonly diagnosed type of urticaria was chronic spontaneous urticaria (56.93%). Angioedema was associated with chronic urticaria in 108 patients (40.08%).

Study Limitations: Unicentered and retrospective.

Conclusion: Some relevant findings in this study are the observation of a female prevalence of cases (4-females: 1-man), a result more elevated than demonstrated in previous studies in Europe and Asia, the median age was 43-years old and the delay of time between the diagnosis of urticaria and the admission for treatment in a specialized center was approximately 2-years. Other multicenter studies can better establish these differences in Brazilian patients.
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http://dx.doi.org/10.1016/j.abd.2020.12.003DOI Listing
May 2021

M2 macrophage polarization in chronic spontaneous urticaria refractory to antihistamine treatment.

Allergol Int 2021 May 11. Epub 2021 May 11.

Department of Collective Health, Discipline of Sexual and Reproductive Health and Population Genetics, Faculdade de Medicina do ABC, Santo André, Brazil.

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http://dx.doi.org/10.1016/j.alit.2021.03.005DOI Listing
May 2021

International registry of dermatological manifestations secondary to COVID-19 infection in 347 Hispanic patients from 25 countries.

Int J Dermatol 2021 May 8. Epub 2021 May 8.

Departamento de Dermatología, Instituto de Biomedicina, Universidad Central de Venezuela, Hospital Vargas Clínica El Ávila, Caracas, Venezuela.

Background: The infection by coronavirus disease 2019 (COVID-19) has been associated with multiple cutaneous manifestations, although characterization of them in Hispanic patients with darker skin phototypes is lacking. The objective of this study is to characterize the clinical dermatological manifestations associated with COVID-19 infection in cases with few or without general symptoms in patients from Latin America.

Methods: Cross-sectional study using a questionnaire that was made for health professionals (physicians with a specialty in dermatology) to investigate dermatological lesions associated with COVID-19 infection in patients from 25 countries of Latin America. The survey was active from June 9 to July 30, 2020.

Results: In this study, information was collected from a total of 347 patients. We found a female gender predominance: 179/347 (51.6%). The mean age at presentation was 40.87 years. The most frequent dermatological manifestations were maculopapular rash and urticarial lesions, followed by papulovesicular lesions, vesicular lesions, chilblain-like lesions, papular lesions, ecchymosis, petechial purpura, pityriasis rosea-like lesions, pruritus, palmoplantar dysesthesias, transient livedo, acral necrosis, palpable purpura, livedo racemosa, and retiform purpura. As far as we know, there are no previous reports of pruritus and palmoplantar dysesthesias.

Conclusions: This registry emphasizes skin manifestations as an important criterion for establishing the diagnosis of COVID-19 infection in Latin American countries. This information will be useful for the early identification of suspected cases by health professionals (dermatologists and nondermatologists) and will allow contact tracing to mitigate the impact on health systems at different levels.
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http://dx.doi.org/10.1111/ijd.15632DOI Listing
May 2021

Axillary papules: an uncommon location of lichen nitidus.

An Bras Dermatol 2021 May-Jun;96(3):381-383. Epub 2021 Mar 16.

Faculdade de Medicina do ABC, São Paulo, SP, Brazil; Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil. Electronic address:

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http://dx.doi.org/10.1016/j.abd.2020.04.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8178568PMC
March 2021

First report of cutaneous mycetoma by Paecilomyces variotii and the successful treatment with combined itraconazole and terbinafine along with resection surgeries.

Australas J Dermatol 2021 Mar 24. Epub 2021 Mar 24.

Laboratory of Pathology of Infectious Diseases (LIM-50), Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil.

Mycetoma is a progressively mutilating infectious disease of the subcutaneous tissue that affects the skin and deep structures, which is poorly responsive to chemotherapy. Here, we report a skin mycetoma caused by Paecilomyces variotii, an uncommon fungus of human infections, and the therapeutic approach that resulted in a complete cure of the patient.
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http://dx.doi.org/10.1111/ajd.13592DOI Listing
March 2021

Evaluation of serum levels of C-reactive protein, D-Dimer and Autologous Serum Skin Test in patients with Chronic Spontaneous Urticaria in a Brazilian tertiary center : a cross-sectional study.

An Bras Dermatol 2021 Mar-Apr;96(2):148-154. Epub 2021 Feb 1.

Department of Dermatology, Faculdade de Medicina do ABC, Santo André, SP, Brazil.

Background: The pathophysiology of urticaria is still poorly understood. Recent studies demonstrate that the activation of coagulation is correlated with the clinical activity of Chronic Spontaneous Urticaria. Coagulation and inflammation are strongly linked.

Objectives: To correlate the severity and activity of Chronic Spontaneous Urticaria with the levels of D-dimer, C-reactive protein, and autologous serum test in patients with Chronic Spontaneous Urticaria.

Methods: The study included 55 patients diagnosed with chronic spontaneous urticaria. D-dimer levels were measured using enzyme-linked fluorescent assay and C-reactive protein levels were measured using the nephelometric method; autologous serum testing was performed on patients who discontinued antihistamine therapy. The severity of the disease was assessed using the urticaria activity score.

Results: patients with severe, spontaneous, and difficult-to-control chronic urticaria had elevated serum levels of D-dimer, as well as a positive autologous serum test. Little correlation was demonstrated between the severity of chronic spontaneous urticaria and the levels of C-reactive protein.

Conclusion: The authors concluded that patients with severe Chronic Spontaneous Urticaria showed signs of activated fibrinolysis. Most patients with high clinical scores had high D-dimer values. Patients with positive results for the autologous serum test also had more severe Chronic Spontaneous Urticaria and needed more drugs to control the disease. Finally, little correlation was found between C-reactive protein levels and disease severity.

Study Limitations: The main limitation was the small sample of patients. In the present patients, it was demonstrated that serum D-dimer levels and the autologous serum test can act as predictive markers of severity and activity of Chronic Spontaneous Urticaria.
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http://dx.doi.org/10.1016/j.abd.2020.07.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8007487PMC
March 2021

A late diagnosis of hyperhomocysteinemia with probable evolution to verrucous elephantiasis nostra and leg ulcers.

An Bras Dermatol 2021 Mar-Apr;96(2):253-255. Epub 2021 Jan 31.

Department of Dermatology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; Centro Universitário Saúde ABC, Santo André, SP, Brazil.

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http://dx.doi.org/10.1016/j.abd.2020.04.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8007548PMC
April 2021

Socioeconomic impact of high-cost drugs in Brazilian dermatology. Legal and financial aspects, and impact on clinical practice.

An Bras Dermatol 2021 Mar-Apr;96(2):200-209. Epub 2021 Jan 30.

Dermatology Course, Centro Universitário FMABC, Santo André, SP, Brazil.

The technological advancement of the pharmaceutical industry, resulting from the techniques of molecular biology and expansion of the knowledge of immunopathogenesis, has modified the therapeutic arsenal used in dermatology. Scientific research and regulatory standards cause drug costs to rise, thus making their use impossible in most public policies. In order to make high-cost drugs viable in the public health network, the Specialized Pharmaceutical Assistance Component was created. However, despite the frequent incorporation of medications, the constant requirement of drugs through lawsuits leads to exorbitant costs to the state budget. The present work analyzed through a descriptive observational study, the current situation of the Specialized Component and the involvement of medicines used in dermatology, through legal reviews, financial analyses, and medical articles, aiming at future incorporations for the specialty. When assessing the legal demands for dermatological drugs in the state of São Paulo, the specialty still has a low participation and psoriasis is the main disease involved in requiring drugs through the judicial system in the state. New methods of access to raw materials must be created to reduce legal issues. Cost-effectiveness and public planning studies are mandatory for incorporating new dermatological therapies.
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http://dx.doi.org/10.1016/j.abd.2020.08.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8007493PMC
March 2021

Livedoid vasculopathy in 75 Brazilian patients in a single-center institution: Clinical, histopathological and therapy evaluation.

Dermatol Ther 2021 03 7;34(2):e14810. Epub 2021 Feb 7.

Department of Pathology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.

This study presents a single center experience with livedoid vasculopathy (LV). A rare disease that can lead to severe quality of life impairment. Characterize clinical data of LV patients at the Dermatology Division at the University of São Paulo. A retrospective and transversal study was conducted, from 1 January 2005 to 31 December 2019. About 75 patients diagnosed as LV and confirmed by skin biopsy were included. Epidemiology, clinical appearance, histopathology data, and treatment history were observed. There were 78.66% Caucasian women, with a mean age of 39.9 years. Frequent cutaneous manifestations were ulcers, atrophic blanche-like scars, hyperpigmentation, purpuras, telangiectasias, and livedo racemosa. Pain, pruritus, and hypoesthesia were the main symptoms. After treatment, almost 40% of cases relapsed during spring and summer months. About 66% of cases had thrombophilia factors associated, such as high levels of lipoprotein(a). Frequent treatments included acetylsalicylic acid, pentoxifylline, and diosmin with hesperidin. Not being a prospective study. This research provides useful data on Latin American LV patients, indicating multifactorial conditions involved in LV pathogenesis. An extensive work-up including autoimmune laboratory tests, thrombophilia factors, and other conditions associated with venous stasis should be part of LV investigation and controlled to improve treatment response.
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http://dx.doi.org/10.1111/dth.14810DOI Listing
March 2021

The global impact of the COVID-19 pandemic on the management and course of chronic urticaria.

Allergy 2021 03 29;76(3):816-830. Epub 2020 Dec 29.

Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology and Venereology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Introduction: The COVID-19 pandemic dramatically disrupts health care around the globe. The impact of the pandemic on chronic urticaria (CU) and its management are largely unknown.

Aim: To understand how CU patients are affected by the COVID-19 pandemic; how specialists alter CU patient management; and the course of CU in patients with COVID-19.

Materials And Methods: Our cross-sectional, international, questionnaire-based, multicenter UCARE COVID-CU study assessed the impact of the pandemic on patient consultations, remote treatment, changes in medications, and clinical consequences.

Results: The COVID-19 pandemic severely impairs CU patient care, with less than 50% of the weekly numbers of patients treated as compared to before the pandemic. Reduced patient referrals and clinic hours were the major reasons. Almost half of responding UCARE physicians were involved in COVID-19 patient care, which negatively impacted on the care of urticaria patients. The rate of face-to-face consultations decreased by 62%, from 90% to less than half, whereas the rate of remote consultations increased by more than 600%, from one in 10 to more than two thirds. Cyclosporine and systemic corticosteroids, but not antihistamines or omalizumab, are used less during the pandemic. CU does not affect the course of COVID-19, but COVID-19 results in CU exacerbation in one of three patients, with higher rates in patients with severe COVID-19.

Conclusions: The COVID-19 pandemic brings major changes and challenges for CU patients and their physicians. The long-term consequences of these changes, especially the increased use of remote consultations, require careful evaluation.
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http://dx.doi.org/10.1111/all.14687DOI Listing
March 2021

Keep it simple. A ten-year experience in reconstructions after Mohs micrographic surgery.

An Bras Dermatol 2020 Nov - Dec;95(6):714-720. Epub 2020 Sep 17.

Dermatology Department, Centro Universitário Saúde ABC, Santo André, SP, Brazil.

Background: Mohs micrographic surgery is worldwide used for treating skin cancers. After obtaining tumor-free margins, choosing the most appropriate type of closure can be challenging.

Objectives: Our aim was to associate type of surgical reconstructions after Mohs micrographic surgery with the characteristics of the tumors as histological subtype, anatomical localization and especially number of surgical stages to achieve complete excision of the tumour.

Methods: Transversal, retrospective analyses of medical records. Compilation of data such as gender, age, tumor location, histological subtype, number of stages to achieve clear margins and type of repair used.

Results: A total of 975 of facial and extra-facial cases were analyzed. Linear closure was the most common repair by far (39%) and was associated with the smallest number of Mohs micrographic surgery stages. This type of closure was also more common in most histological subtypes and anatomical locations studied. Using Poisson regression model, nose defects presented 39% higher frequency of other closure types than the frequency of primary repairs, when compared to defects in other anatomic sites (p < 0.05). Tumors with two or more stages had a 28.6% higher frequency of other closure types than those operated in a single stage (p < 0.05).

Study Limitations: Retrospective study with limitations in obtaining information from medical records. The choice of closure type can be a personal choice.

Conclusions: Primary closure should not be forgotten especially in surgical defects with fewer stages and in non-aggressive histological subtypes in main anatomic sites where Mohs micrographic surgery is performed.
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http://dx.doi.org/10.1016/j.abd.2020.05.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7672493PMC
December 2020

From dermatological conditions to COVID-19: Reasoning for anticoagulation, suppression of inflammation, and hyperbaric oxygen therapy.

Dermatol Ther 2021 Jan 30;34(1):e14565. Epub 2020 Nov 30.

Department of Pathology and Forensic Medicine, Faculdade de Medicina de Ribeirão Preto da USP, São Paulo, Brazil.

COVID-19 generates a complex systemic inflammatory response that can lead to death due to wide macrophage activation, endothelial damage, and coagulation in critically ill patients. SARS-CoV-2-induced lung injury due to inflammatory mediated thrombosis could be similar to the livedoid vasculopathy in the skin, supporting a translational comparison of these clinical settings. In this article, we discuss anticoagulation, suppression of inflammatory response, and hyperbaric oxygen therapy in the context of severe COVID-19 and livedoid vasculopathy.
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http://dx.doi.org/10.1111/dth.14565DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7744832PMC
January 2021

Potential interactions of SARS-CoV-2 with human cell receptors in the skin: Understanding the enigma for a lower frequency of skin lesions compared to other tissues.

Exp Dermatol 2020 10;29(10):936-944

LIM-50, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) represents a new public health problem, with a total of 10.577.263 documented COVID-19 cases worldwide and 513.441 deaths up to the present date. Few cases of disease-related cutaneous manifestations have been reported in the literature, and such manifestations are scarce. Integumentary manifestations from COVID-19 include exanthemas and papular dermatoses, urticarial eruptions, atopic dermatitis, vesiculobullous lesions and skin signs of hypercoagulable states, such as acral ischaemia, livedo and retiform purpura. Most common extracutaneous manifestations from the disease include headache, cough, anosmia, ageusia, fever, dyspnoea, nausea, diarrhoea and cardiovascular events. The objectives of this review were to discuss the role of human cell receptors described as interaction targets of SARS-CoV-2, as well to understand the current state of knowledge on skin expression of these receptors, in order to substantiate future research. The authors present a thorough literature review on SARS-CoV-2 and its possible interaction with cell receptors and human tissues including the skin. They discuss a molecular hypothesis to explain the lower prevalence of dermatological manifestations from direct SARS-CoV-2 infection. Distinct human cell receptors binding the virus appear to be less expressed in the skin compared to other organs. Additionally, the presence of resolvins and the disintegrin metalloprotease ADAM17 provide a putative protection to the skin, explaining the majority of COVID-19 manifestations to be extracutaneous. This review represents an excellent opportunity for future studies using skin biopsies from COVID-19 patients to investigate molecular expression in the pathophysiology of cutaneous manifestations of the disease.
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http://dx.doi.org/10.1111/exd.14186DOI Listing
October 2020

Case Report: Treatment of Chromoblastomycosis with Combinations including Acitretin: A Report of Two Cases.

Am J Trop Med Hyg 2020 11;103(5):1852-1854

Institute for Advanced Studies of Ocean, São Paulo State University (UNESP), São Vicente, Brazil.

Chromoblastomycosis is a cutaneous fungal infection caused by dematiaceous fungi that belong to the order and family . This infection is prevalent in tropical and subtropical areas and has been designated as a neglected tropical disease according to the WHO. Chromoblastomycosis infection is difficult to treat, and there are limited therapeutic options, making urgent the characterization of new medicines or approaches to treat such infection. In the present case report, two patients with extensive chromoblastomycosis lesions were treated with the combination of itraconazole, acitretin, and imiquimod. In the fourth month of treatment, both patients showed improvement of verrucous plates, suggesting that acitretin combined with drugs already used in chromoblastomycosis therapy can decrease the time of treatment, improving patient's quality of life.
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http://dx.doi.org/10.4269/ajtmh.20-0471DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7646813PMC
November 2020

Case Report: An Uncommon Clinical Case of Fatal Adult T-Cell Leukemia/Lymphoma Associated with HTLV-1 and Suspected due to Cutaneous Lesions and Epidemiologic Data.

Am J Trop Med Hyg 2020 11;103(5):2113-2115

Department of Dermatology, Faculdade de Medicina do ABC, São Paulo, Brazil.

Adult T-cell leukemia/lymphoma (ATLL) is a peripheral T-cell neoplasm caused by the human T-cell leukemia virus type 1 (HTLV-1). It is characterized by a short survival time and lack of response to chemotherapy. We report a case of a 56-year-old woman, from the Brazilian northeast state of Bahia, who presented with a 2-month history of infiltrated papular and nodular skin lesions, especially on her forehead and also on her lower and upper limbs. Laboratory tests revealed positive serology for HTLV-1. Histopathological findings and the immunohistochemical profile confirmed the diagnosis of adult T-cell lymphoma/leukemia. A month after the diagnosis, the patient presented acute fatigue and pronounced paleness of the skin, dying of septic shock after her first chemotherapy cycle. The aim of this case report was to emphasize the importance of maintaining high clinical suspicion for ATLL, considering the epidemiological profile of the disease, especially for patients whose only early symptoms are cutaneous lesions.
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http://dx.doi.org/10.4269/ajtmh.20-0420DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7646774PMC
November 2020

What the physicians should know about mast cells, dendritic cells, urticaria, and omalizumab during COVID-19 or asymptomatic infections due to SARS-CoV-2?

Dermatol Ther 2020 11 13;33(6):e14068. Epub 2020 Aug 13.

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

Coronavirus disease (COVID-19) pandemic presents several dermatological manifestations described in the present indexed literature, with around 700 cases reported until May 2020, some described as urticaria or urticarial rashes. Urticaria is constituted by evanescent erythematous-edematous lesions (wheals and flare), which does not persist in the same site for more than 24 to 48 hours and appears in other topographic localization, resolving without residual hyper pigmentation. During the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, some cytokines are synthesized, including Interferon (IFN) type I, TNF-α, and chemokines which may induce mast cells (MCs) and basophils degranulation by mechanisms similar to the autoinflammatory monogenic or polygenic diseases. In this article, we discuss the spectrum of the urticaria and urticarial-like lesions in the COVID-19's era, besides other aspects related to innate and adaptative immune response to viral infections, interactions between dermal dendritic cells and MCs, and degranulation of MCs by different stimuli. Plasmacytoid dendritic cells share, in allergic patients, expression of the high-affinity IgE receptors on cell membranes and demonstrated a low pattern of type I IFN secretion in viral infections. We discuss the previous descriptions of the effects of omalizumab, a monoclonal antibody directed to IgE and high-affinity IgE receptors, to improve the IFN responses and enhance their antiviral effects.
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http://dx.doi.org/10.1111/dth.14068DOI Listing
November 2020

Unilateral verrucous plaque in a 14-year-old child.

Pediatr Dermatol 2020 07;37(4):734-735

Department of Dermatology, Faculdade de Medicina do ABC, Santo André, Brazil.

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http://dx.doi.org/10.1111/pde.14205DOI Listing
July 2020

Lessons from dermatology about inflammatory responses in Covid-19.

Rev Med Virol 2020 09 12;30(5):e2130. Epub 2020 Jul 12.

Center of Biological and Health Sciences, State University of Pará, Belém, Brazil.

The SARS-Cov-2 is a single-stranded RNA virus composed of 16 non-structural proteins (NSP 1-16) with specific roles in the replication of coronaviruses. NSP3 has the property to block host innate immune response and to promote cytokine expression. NSP5 can inhibit interferon (IFN) signalling and NSP16 prevents MAD5 recognition, depressing the innate immunity. Dendritic cells, monocytes, and macrophages are the first cell lineage against viruses' infections. The IFN type I is the danger signal for the human body during this clinical setting. Protective immune responses to viral infection are initiated by innate immune sensors that survey extracellular and intracellular space for foreign nucleic acids. In Covid-19 the pathogenesis is not yet fully understood, but viral and host factors seem to play a key role. Important points in severe Covid-19 are characterized by an upregulated innate immune response, hypercoagulopathy state, pulmonary tissue damage, neurological and/or gastrointestinal tract involvement, and fatal outcome in severe cases of macrophage activation syndrome, which produce a 'cytokine storm'. These systemic conditions share polymorphous cutaneous lesions where innate immune system is involved in the histopathological findings with acute respiratory distress syndrome, hypercoagulability, hyperferritinemia, increased serum levels of D-dimer, lactic dehydrogenase, reactive-C-protein and serum A amyloid. It is described that several polymorphous cutaneous lesions similar to erythema pernio, urticarial rashes, diffuse or disseminated erythema, livedo racemosa, blue toe syndrome, retiform purpura, vesicles lesions, and purpuric exanthema or exanthema with clinical aspects of symmetrical drug-related intertriginous and flexural exanthema. This review describes the complexity of Covid-19, its pathophysiological and clinical aspects.
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http://dx.doi.org/10.1002/rmv.2130DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7404593PMC
September 2020

Atypical clinical presentation of an Arthroderma gypseum infection in a renal transplant recipient.

Rev Inst Med Trop Sao Paulo 2020 22;62:e42. Epub 2020 Jun 22.

Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório de Investigação Médica (LIM-50), São Paulo, São Paulo, Brazil.

Dermatophytes are known as a common cause of superficial mycosis, but atypical presentations in immunosuppressed patients make the diagnosis more challenging. Here, we report a case of a 39-year-old patient, a renal transplant recipient from a living donor, who presented with atypical cutaneous lesions of lower extremities caused by Arthroderma gypseum (Nannizzia gypsea), four months after receiving a renal transplant. It is important to highlight the importance of the early detection of fungal infections in immunosuppressed patients. Clinicians should have a high degree of suspicion for the early detection and treatment of the cases.
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http://dx.doi.org/10.1590/S1678-9946202062042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7310607PMC
June 2020

Update on vasculitis: overview and relevant dermatological aspects for the clinical and histopathological diagnosis - Part II.

An Bras Dermatol 2020 Jul - Aug;95(4):493-507. Epub 2020 May 24.

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

Vasculitis is a group of several clinical conditions in which the main histopathological finding is fibrinoid necrosis in the walls of blood vessels. This article assesses the main dermatological aspects relevant to the clinical and laboratory diagnosis of small- and medium-vessel cutaneous and systemic vasculitis syndromes. The most important aspects of treatment are also discussed.
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http://dx.doi.org/10.1016/j.abd.2020.04.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7335877PMC
August 2020

Are the cutaneous manifestations during or due to SARS-CoV-2 infection/COVID-19 frequent or not? Revision of possible pathophysiologic mechanisms.

Inflamm Res 2020 Aug 2;69(8):745-756. Epub 2020 Jun 2.

Department of Dermatology, Faculdade de Medicina do ABC, Príncipe de Gales, Avenida Príncipe de Gales, 821, Santo André, SP, 09060-650, Brazil.

Background: SARS-Cov-2 is a single-stranded RNA virus, a Betacoronavirus, composed of 16 non-structural proteins, with specific roles in replication of coronaviruses. The pathogenesis of COVID-19 is not yet fully understood. The virus and host factors interplay among distinct outcomes of infected patients.

Methods: Using MeSH (Medical Subject Headings) in PubMed, authors searched for articles cotaining information on COVID-19 and the skin.

Results: The pathophysiology of the disease is multifactorial: association with innate immune response, hypercoagulability state, lung tissue damage, neurological and/or gastrointestinal tract involvement, monocytic/macrophage activation syndrome, culminating in exaggerated cytokine secretion, called "cytokine storm", which leads to worsening and death. These systemic conditions may be associated with cutaneous lesions, that have polymorphic aspects, where at histopathological level show involvement in different skin changes. These lesions may be associated with multisystemic manifestations that could occur due to angiotensin-converting enzyme 2 receptor and transmembrane serine protease action, allowing the pulmonary infection and possibly skin manifestation. Several reports in literature show cutaneous lesions similar to chilblain, urticarial eruptions, diffuse or disseminated erythema, livedo racemosa, blue toe syndrome, retiform purpura, vesicle trunk, purpuric exanthema or exanthema with clinical aspects of symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) and others.

Conclusions: This review describes the complexity of Covid-19, pathophysiological and clinical aspects, dermatological finding and other dermatological conditions associated with SARS-CoV-2 infection or COVID-19.
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http://dx.doi.org/10.1007/s00011-020-01370-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7266387PMC
August 2020

Multinucleate cell angiohistiocytoma: an uncommon cutaneous tumor.

An Bras Dermatol 2020 Jul - Aug;95(4):480-483. Epub 2020 May 11.

Department of Dermatology, Faculdade de Medicina do ABC, Santo André, SP, Brazil.

Multinucleate cell angiohistiocytoma is a rare, benign vascular proliferation of unknown etiology. It occurs mainly in middle-aged women and usually affects the acral regions; the lesions appear as discrete, grouped, and asymptomatic violaceous papules. Histopathology shows proliferation and dilated small vessels in the papillary dermis, fibrous stroma with thickened collagen bundles, and multinucleated giant cells. To date, there are approximately 140 cases described in the indexed literature. This report presents the case of a 62-year-old woman with a typical clinical condition, who chose not undergo treatment, considering the benign character of her illness. The clinical and immunohistological aspects of this unusual dermatological entity are emphasized.
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http://dx.doi.org/10.1016/j.abd.2019.10.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7335878PMC
August 2020

Panniculitis as main clinical manifestation of alpha-1 antitrypsin deficiency revealing a SerpinA1 gene mutation.

Australas J Dermatol 2020 Nov 19;61(4):e470-e471. Epub 2020 May 19.

Department of Dermatology, Faculdade de Medicina do ABC, Santo André, Brazil.

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http://dx.doi.org/10.1111/ajd.13332DOI Listing
November 2020

Update on vasculitis: an overview and dermatological clues for clinical and histopathological diagnosis - part I.

An Bras Dermatol 2020 May - Jun;95(3):355-371. Epub 2020 Mar 26.

Discipline of Dermatology, Faculdade de Medicina do ABC, Santo André, SP, Brazil; Postgraduate Program, Faculdade de Medicina do ABC, Santo André, SP, Brazil.

The term vasculitis refers to the inflammation of vessel walls. It may range in severity from a self-limited disorder in one single organ to a life-threatening disease due to multiple organ failure. It has many causes, although they result in only a few histological patterns of vascular inflammation. Vessels of any type and in any organ can be affected, a fact that results in a broad variety of signs and symptoms. Different vasculitides with indistinguishable clinical presentations have quite different prognosis and treatments. This condition presents many challenges to physicians in terms of classification, diagnosis, appropriate laboratory workup, and treatment. Moreover, it compels a careful follow-up. This article reviews the Chapel-Hill 2012 classification, etiology, recent insights in pathophysiology, some important dermatological clues for the diagnosis and summarizes treatment of some of these complex vasculitis syndromes.
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http://dx.doi.org/10.1016/j.abd.2020.01.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7253914PMC
June 2020

Livedo Racemosa: Clinical, Laboratory, and Histopathological Findings in 33 Patients.

Int J Low Extrem Wounds 2021 Mar 29;20(1):22-28. Epub 2020 Jan 29.

Federal University of Bahia, Hospital Universitario Prof. Edgard Santos, Salvador BA, Brazil.

Livedo racemosa is a cutaneous finding characterized by a persistent, erythematous, or violaceous discoloration of the skin, in a broken, branched, discontinuous, and irregular pattern. A retrospective review of 33 cases with clinical diagnosis of livedo racemosa over the past 6 years was evaluated in the dermatology department of a tertiary care hospital. We found predominance in Caucasian women (78.8%); age ranged from 8 to 81 years, with a mean age of 36 years. Livedo racemosa was described as generalized in 12 patients (36.4%), although the main localization was on lower limbs (42%). After laboratory testing and histopathological examinations, 12 patients (36.4%) were classified with idiopathic livedo racemosa; secondary diseases were diagnosis in 21 patients (63.6%), including Sneddon's syndrome, cutaneous polyarteritis nodosa, systemic lupus erythematosus, and others. Medical history of thrombotic events was described in 8 (24.2%) patients, and also 8 (24.2%) patients had abnormal results for 2 or more thrombophilia laboratory tests. Skin biopsy showed no histological abnormalities in 11 cases (33.3%), thrombosis of dermal blood vessels in 10 (30.3%), intimal/subintimal thickening in 7 (21.2%), and vasculitis in 5 (15.2%). In conclusion, livedo racemosa is a clinical feature that might be correlated to vascular disorders, such as thrombotic and/or hypercoagulable states, autoimmune diseases, and neoplastic diseases, or it can be secondary to specific medications. It is essential to establish a correct approach in cases of livedo racemosa, which includes anamnesis, physical examination, laboratory test, histological examination, and complementary examination according to clinical findings, in order to diagnosis underlying causes.
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http://dx.doi.org/10.1177/1534734619896938DOI Listing
March 2021

Early diagnosis and treatment of Leukocytoclastic Vasculitis: case report.

J Vasc Bras 2020 Jan 7;19:e20180072. Epub 2020 Jan 7.

Faculdade de Medicina do ABC, Santo André, SP, Brasil.

A 46-year-old female patient presented at the emergency department of a Municipal University Hospital with necrotic lesions in lower limbs associated with wasting syndrome. She was diagnosed with leukocytoclastic vasculitis after physical examination and history-taking in a fast and cost-effective manner, using an algorithm specifically for primary vasculitis, enabling early and appropriate treatment. The good clinical outcome demonstrates the need to quickly make a definitive diagnosis and start treatment.
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http://dx.doi.org/10.1590/1677-5449.190072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6956624PMC
January 2020

Successful treatment of chromoblastomycosis caused by Fonsecaea pedrosoi using imiquimod.

J Dermatol 2020 Apr 21;47(4):409-412. Epub 2020 Jan 21.

Institute of Biosciences, São Paulo State University (UNESP), São Vicente, Brazil.

Chromoblastomycosis (CBM) is a fungal infection caused by fungi belonging to the order Chaetothyriales, and caused mainly by Fonsecaea pedrosoi. The classic treatment, based on itraconazole and/or terbinafine as well as physical approaches, is considered complex and ineffective due to the high rate of relapses. Thus, new strategies are needed to manage CBM; in this regard, the present work reports the evolution of lesions in patients successfully treated with imiquimod. Of note, classic treatment was not effective in healing the lesions of two of them, but single topical treatment with imiquimod healed the lesions.
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http://dx.doi.org/10.1111/1346-8138.15225DOI Listing
April 2020