An Bras Dermatol
· 2025 · PMID 40857991
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Phenol, or carbolic acid, is an organic compound with caustic and antiseptic properties widely used in dermatology. Since its introduction as an antiseptic in the 19 century, its use has expanded to various areas of medi...Phenol, or carbolic acid, is an organic compound with caustic and antiseptic properties widely used in dermatology. Since its introduction as an antiseptic in the 19 century, its use has expanded to various areas of medicine, including the treatment of dermatological conditions such as vitiligo, warts, guttate leukoderma, hidradenitis suppurativa, angiosarcoma, acne scars, alopecia areata, onychocryptosis, and actinic keratoses. In deep peels, phenol stands out for its effectiveness in skin rejuvenation, promoting intense and sustained neocollagenesis, with unparalleled results. Its ability to alter dermal structure makes it an essential therapeutic tool in various dermatological approaches. However, its use requires extreme caution due to its rapid cutaneous absorption and unique toxicokinetic profile. The substance can induce serious complications, such as cardiac arrhythmias, renal failure, neurotoxicity, and multiple organ failure, especially when applied to large areas or with inadequate techniques and formulations. Historical and contemporary studies report cases of fatal poisoning due to cutaneous exposure to phenol, highlighting the need for strict precautions in its use. To minimize these risks, it is essential that procedures be performed by highly trained physicians, with constant monitoring and controlled application, to ensure safety and maximize the therapeutic benefits of this substance, whose efficacy is widely recognized.
Criado PR, Criado RFJ, Miot HA
… +3 more, Abdalla BMZ, Marchioro HZ, Bonamigo RR
An Bras Dermatol
· 2025 · PMID 40845419
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BACKGROUND: The understanding of chronic spontaneous urticaria pathogenesis has been increasing recently. The central role of mast cells is being reinforced, but multiple cells, pathways, and mediators are involved in a...BACKGROUND: The understanding of chronic spontaneous urticaria pathogenesis has been increasing recently. The central role of mast cells is being reinforced, but multiple cells, pathways, and mediators are involved in a complex interrelationship. Modern therapies for its management reflect the need to encompass different mechanisms and promise to alter the course of urticaria and the long journey of those with refractory disease. Continuous updating of these aspects is necessary to optimize patient care. OBJECTIVES: To review concepts and advances in the pathogenesis of chronic spontaneous urticaria, in addition to contextualizing promising drug options for its management. METHOD: A narrative review was conducted between 1977 and 2024, including relevant articles published in the scientific literature, indexed in the PubMed system. RESULTS: A total of 25,732 articles were found. Inclusion criteria were determined by the authors' decision regarding their level of importance for furthering knowledge in the areas of pathogenesis and treatment of chronic spontaneous urticaria, with preference given to meta-analyses, systematic reviews, and randomized trials. Regarding therapeutics, 138 articles from the last 15 years were prioritized, in addition to records on ClinicalTrials.gov, and the drugs could be in the clinical trial phase. Immunobiologicals and small molecules hold promise for future treatment regimens for chronic spontaneous urticaria. STUDY LIMITATIONS: Narrative reviews do not provide statistical value to the results and outcomes studied. CONCLUSION: A review of the pathogenesis of chronic spontaneous urticaria was conducted, contextualizing these aspects with promising drug options for its treatment, particularly immunobiologicals and small molecules.
Velozo BC, Hong MV, Bernardo LC
… +3 more, E Castro MCN, Contreras-Ruiz J, Abbade LPF
An Bras Dermatol
· 2025 · PMID 40829307
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Pressure injuries remain a significant challenge in healthcare services. They negatively impact these services by increasing workload, financial burden, and direct and indirect costs related to detection, prevention, tre...Pressure injuries remain a significant challenge in healthcare services. They negatively impact these services by increasing workload, financial burden, and direct and indirect costs related to detection, prevention, treatment, and rehabilitation. It is of utmost importance that dermatologists and other healthcare professionals are knowledgeable about these lesions. The first part of this review discusses the history and terminology of pressure injuries, epidemiology in different settings, from adults to pediatric and neonatal patients; etiopathogenesis, demonstrating the current scheme of the vicious cycle of ischemia and tissue death; associated risk factors, both intrinsic and extrinsic; classification of all stages of pressure injuries with clinical images; and the main anatomical areas at risk in each position ‒ lateral, seated, supine, prone, and with medical devices. Differential diagnoses were detailed, including incontinence-associated dermatitis, and the "Kennedy terminal ulcer", providing support for proper evaluation and guidance on preventive measures and treatment, which will be further detailed in Part II of this review. The primary focus was to provide resources for healthcare professionals to holistically assess, prescribe, and monitor patients at risk for or with pressure injuries.
Brito Cipriano R, Falco Neto W, Barcellos Filho FN
… +1 more, Dias Porto Chiavegatto Filho A
An Bras Dermatol
· 2025 · PMID 40812227
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BACKGROUND: Accurate diagnoses in dermatology can be challenging for general practitioners. In this context, the support of artificial intelligence tools can be beneficial in the Brazilian primary care setting. OBJECTIVE...BACKGROUND: Accurate diagnoses in dermatology can be challenging for general practitioners. In this context, the support of artificial intelligence tools can be beneficial in the Brazilian primary care setting. OBJECTIVES: To develop an interpretable machine-learning algorithm capable of assisting in the diagnosis of erythematous-squamous dermatological diseases through clinical data, without histopathological support. METHODS: The random-forest algorithm was trained with the public Dermatology database of 366 patients diagnosed with: chronic dermatitis, lichen planus, pityriasis rosea, pityriasis rubra pilaris, psoriasis, or seborrheic dermatitis. The model was evaluated by performance metrics and interpretability techniques. RESULTS: The model showed good predictive performance, with ROC-AUC ranging from 0.89 to 1.00, and overall accuracy of 0.86. The best results were for the diagnosis of pityriasis rubra pilaris (f1-score: 1.00) and the worst for chronic and seborrheic dermatitis (f1-score: 0.77 and 0.76, respectively). The clinical characteristics that most influenced the model's decision were, in decreasing order: involvement of knees and elbows, involvement of scalp, Koebner phenomenon, polygonal papules, and involvement of oral mucosa. STUDY LIMITATIONS: The model was not validated with Brazilian data. CONCLUSION: The developed technology obtained good predictive performance and clinical coherence. There is a need for adaptation for implementation, using national data. The results indicate the potential for similar models to be improved and adapted to clinical practice for the benefit of the Unified Heath System.
An Bras Dermatol
· 2025 · PMID 40812223
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BACKGROUND: Xeroderma pigmentosum (XP) is an autosomal recessive genetic disorder characterized by a defect in the nucleotide excision repair (NER) pathway, responsible for repairing DNA damage induced by ultraviolet ray...BACKGROUND: Xeroderma pigmentosum (XP) is an autosomal recessive genetic disorder characterized by a defect in the nucleotide excision repair (NER) pathway, responsible for repairing DNA damage induced by ultraviolet rays. The most common symptom in affected patients is an increased photosensitivity associated with early development of cutaneous and internal malignancies. OBJECTIVE: To describe whether the follow-up of xeroderma pigmentosum patients using total body mapping (TBM) with digital dermoscopy (DD) and in vivo reflectance confocal microscopy (RCM) increases early detection of melanoma and reduces unnecessary biopsies of benign melanocytic lesions. METHODS: Twelve XP patients were followed-up with TBM and DD from February 2008 until March 2020. The number of melanocytic lesions excised (NNE) was counted before and after the surveillance with TBM, DD, and RCM. RESULTS: In the 12-year surveillance period, twelve XP patients were followed-up with TBM, DD, and RCM. The proportion of thinner and in situ melanomas diagnosed increased after the implementation of TBM and DD in the follow-up of this group (from 67% to 82%). The association of technologies caused a reduction in the NNE from 4.02 to 2.88 and promoted early detection of melanoma. STUDY LIMITATIONS: Maintaining regular follow-up with some XP patients can be challenging due to comorbidities and social issues. Although XP is a rare disease, this represents an especially small number of cases. CONCLUSION: XP patients are generally submitted to multiple surgical excisions, with high morbidity. Based on this experience, TBM, DD and RCM have improved the early detection of melanoma and reduced the NNE with a positive impact on health and quality of life.