An Bras Dermatol
· 2026 Jun · PMID 42235132
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BACKGROUND: Bullous Pemphigoid (BP) and Atrial Fibrillation (AF) share common underlying mechanisms involving chronic inflammation, but their relationship was unclear. OBJECTIVE: To assess the risk of incident AF in indi...BACKGROUND: Bullous Pemphigoid (BP) and Atrial Fibrillation (AF) share common underlying mechanisms involving chronic inflammation, but their relationship was unclear. OBJECTIVE: To assess the risk of incident AF in individuals with BP. METHODS: This nationwide cohort study utilized Taiwan's National Health Insurance Research Database from 2011 to 2019. Adults newly diagnosed with BP were identified and initially matched by age and sex to controls without BP. Stabilized inverse probability weighting was applied to balance baseline characteristics between cohorts. Cox proportional hazards models were used to estimate Hazard Ratios (HRs) and 95% Confidence Intervals (95% CIs) for incident AF. Subgroup analyses were performed by age and sex, along with several sensitivity analyses. RESULTS: During the follow-up period, AF occurred in 510 of the 9,554 patients in the BP group and 1,902 of the 52,015 individuals in the non-BP group, corresponding to an incidence of 15.03 and 7.99 per 1,000 person-years, respectively. BP was associated with an increased risk of incident AF (HR 1.83; 95% CI 1.66-2.02). This association persisted across analyses stratified by age and sex. The findings were consistent across multiple sensitivity analyses. STUDY LIMITATIONS: The unavailability of data on potential confounders such as lifestyle factors (smoking, alcohol, obesity) and disease severity. CONCLUSIONS: BP is linked to a heightened risk of AF. Prompt recognition of AF and timely cardiology referrals may be warranted in BP patients presenting with suggestive symptoms.
An Bras Dermatol
· 2026 Jun · PMID 42235131
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BACKGROUND: Isotretinoin is an effective therapy for acne vulgaris, but its impact on thyroid function remains uncertain, with existing studies reporting inconsistent biochemical changes. OBJECTIVE: To assess the effects...BACKGROUND: Isotretinoin is an effective therapy for acne vulgaris, but its impact on thyroid function remains uncertain, with existing studies reporting inconsistent biochemical changes. OBJECTIVE: To assess the effects of oral isotretinoin on serum thyroid function parameters and thyroid antibody levels in patients with acne vulgaris. METHODS: A systematic review and meta-analysis of observational studies was conducted according to PRISMA guidelines and prospectively registered (INPLASY202560049). PubMed, Scopus, Embase, and Web of Science were searched from January 1980 to September 2025. Studies reporting serum thyroid parameters before and during isotretinoin therapy were included. Random-effects meta-analyses were performed for parameters reported in more than three studies. Heterogeneity was assessed using the I statistic, and risk of bias using NIH tools. RESULTS: Fifteen studies were included. Meta-analysis showed a small statistically significant increase in thyroid-stimulating hormone after isotretinoin treatment (MD = 0.03, 95% CI 0.02‒0.05, p < 0.001), with significant decreases in thyroxine (MD = -0.19, 95% CI -0.24 to -0.15, p < 0.001) and triiodothyronine (MD = -0.62, 95% CI-0.76 ‒ -0.48, p < 0.001). Heterogeneity was substantial for thyroid-stimulating hormone (I = 85%) and triiodothyronine (I = 86%), and moderate for thyroxine (I = 60%). Evidence regarding thyroid antibodies was limited and inconsistent. STUDY LIMITATIONS: Included studies were observational, predominantly single-centre, and heterogeneous in dosing, duration, and laboratory assessments. CONCLUSIONS: Isotretinoin is associated with statistically significant alterations in serum thyroid function parameters, though the clinical significance of these changes remains uncertain.
Calderón Quiroz ER, Torres Guerrero E, Proy Trujillo H
… +2 more, Vega Memije ME, Atoche Diéguez C
An Bras Dermatol
· 2026 Jun · PMID 42235130
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BACKGROUND: Chromoblastomycosis is a chronic granulomatous fungal infection of the skin and subcutaneous tissue caused by dematiaceous fungi of the family Herpotrichiellaceae. It is considered an occupational disease, pr...BACKGROUND: Chromoblastomycosis is a chronic granulomatous fungal infection of the skin and subcutaneous tissue caused by dematiaceous fungi of the family Herpotrichiellaceae. It is considered an occupational disease, predominantly affecting male agricultural workers, with a worldwide distribution, especially in tropical and subtropical regions. Fonsecaea pedrosoi accounts for approximately 90% of reported cases. OBJECTIVE: To describe the etiological agents, clinical features, and major complications associated with chromoblastomycosis. METHODS: A retrospective, descriptive, and observational study presenting a case series was conducted, focusing on the pathogenesis, clinical presentation, disease course, and reported complications of chromoblastomycosis. RESULTS: A total of 131 cases of chromoblastomycosis were documented; 10 patients (7.65%) developed squamous cell carcinoma. The mean age was 65.8-years, and the mean disease duration prior to malignant transformation was 17.4-years. The most frequently affected site was the upper limb (70%), followed by the lower limb (20%) and the trunk (10%). STUDY LIMITATIONS: The descriptive nature of this review limits causal inference and precise estimation of malignant transformation rates. CONCLUSION: Chromoblastomycosis is a chronic, polymorphic cutaneous infection often diagnosed late, leading to long-standing disease and disabling sequelae. Malignant transformation to squamous cell carcinoma represents one of its most severe complications and may occur even in residual scars. Early diagnosis and prolonged follow-up are essential to reduce morbidity and prevent malignant progression.
An Bras Dermatol
· 2026 · PMID 42150335
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BACKGROUND: The Disease Activity Index for Psoriatic Arthritis (DAPSA) is a widely used tool to assess joint involvement in Psoriatic Arthritis (PsA), but its ability to reflect skin disease severity remains unclear. OBJ...BACKGROUND: The Disease Activity Index for Psoriatic Arthritis (DAPSA) is a widely used tool to assess joint involvement in Psoriatic Arthritis (PsA), but its ability to reflect skin disease severity remains unclear. OBJECTIVE: This study aimed to investigate the association between DAPSA scores and skin disease severity in patients with PsA. METHODS: This single-center, cross-sectional study included PsA patients meeting the CASPAR classification criteria at Xiangya Hospital from April 2019 to February 2025. Skin disease severity was assessed using the Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI), while disease activity was assessed with the DAPSA. Propensity Score Matching (PSM) was applied to adjust for musculoskeletal disease activity. RESULTS: Among the 646 PsA patients (median age 46.0 years; 41.0% male), DAPSA scores increased from 12.6 (SD = 13.2) in patients with no skin disease (PASI = 0) to 20.4 (SD = 16.9) in those with severe skin disease (PASI > 10). Patient global assessment, patient pain assessment scores and C-reactive protein levels also rose with PASI severity (all p < 0.001). After PSM, patients with PASI ≥ 10 had significantly higher DAPSA scores than those with PASI < 10 (25.4 vs. 16.9, p < 0.001). A weak but statistically significant positive correlation was observed between DAPSA and PASI scores (Spearman's rho = 0.256, p = 0.003). STUDY LIMITATIONS: Cross-sectional design, single-center setting and potential residual confounding limit causal inference and generalizability. CONCLUSION: Although not designed to assess skin disease, DAPSA may partially capture skin-related burden through its inflammatory and patient-reported components. In the absence of dedicated skin assessments, DAPSA could serve as a practical and holistic tool for initial disease activity evaluation in PsA.
An Bras Dermatol
· 2026 · PMID 42150334
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Psoriasis in individuals with Skin of Color (SOC) shows distinctive clinical features and particularities that require careful consideration for accurate recognition and care. Erythema is often less apparent, and plaques...Psoriasis in individuals with Skin of Color (SOC) shows distinctive clinical features and particularities that require careful consideration for accurate recognition and care. Erythema is often less apparent, and plaques may appear violaceous or dark brown. These features, together with limited discussion of these nuances in textbooks and articles, contribute to delayed diagnosis, greater reliance on skin biopsy, and reduced diagnostic accuracy. Although overall prevalence may be lower than in White populations, SOC patients frequently present with greater body-surface involvement, thicker scale, and a disproportionate impact on quality of life. Early, effective control is critical not only to limit systemic comorbidities and quality of life impairment but also to prevent post-inflammatory dyspigmentation, which can persist for years after clinical resolution and substantially affect psychosocial well-being. Despite major advances in psoriasis research, important gaps remain regarding genetic drivers, immunopathogenesis, and the comparative effectiveness and safety of therapies across diverse populations, gaps compounded by the persistent underrepresentation of SOC in clinical trials. This review synthesizes current evidence on epidemiology, clinical presentation, diagnostic pitfalls, pigmentary sequelae, psychosocial dimensions, and therapeutic options so as to support equitable, patient-centred outcomes for SOC patients living with psoriasis.