Nadir U, Scaburi IR, Cerci FB
… +2 more, Jeha GM, Tolkachjov SN
An Bras Dermatol
· 2026 · PMID 42107926
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BACKGROUND: Local anesthesia is essential in common procedures in dermatology, but injection and infiltration of anesthetic often cause significant pain, reducing patient comfort and satisfaction. OBJECTIVE: To review ev...BACKGROUND: Local anesthesia is essential in common procedures in dermatology, but injection and infiltration of anesthetic often cause significant pain, reducing patient comfort and satisfaction. OBJECTIVE: To review evidence-based techniques to reduce pain associated with local anesthetic injection and infiltration. METHODS AND MATERIALS: A narrative review of the literature was performed, and techniques were summarized for clinicians to reference. RESULTS: Technical methods to reduce pain include using smaller-gauge needles (30-33G), smaller syringes (1‒3 mL), buffering lidocaine with sodium bicarbonate, inserting the needle at 90 degrees, slow infusion, subcutaneous delivery, and pore-guided injection. Adjuncts such as warming anesthetic, vibration, ice, music, and verbal distraction ("talkesthesia") also reduce patient perception of pain. STUDY LIMITATIONS: Limitations include heterogeneity in study designs, outcomes measures, and clinical contexts across the included literature, precluding quantitative synthesis or direct comparison of individual techniques. Additionally, several recommendations are based on expert opinion or limited evidence. CONCLUSION: A multimodal approach using both technical refinements and adjunctive measures can make local anesthetic administration less painful. Dermatologists may routinely implement these strategies to improve patient experience and satisfaction.
An Bras Dermatol
· 2026 · PMID 42107925
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The Varicella-zoster virus (VZV) is a prevalent human pathogen that links dermatology, virology, and immunology. Following primary varicella infection, the virus establishes lifelong latency in the sensory ganglia, with...The Varicella-zoster virus (VZV) is a prevalent human pathogen that links dermatology, virology, and immunology. Following primary varicella infection, the virus establishes lifelong latency in the sensory ganglia, with reactivation manifesting as herpes zoster. The clinical spectrum ranges from typical dermatomal vesicular eruptions to atypical or disseminated presentations in older adults or immunocompromised patients, often posing diagnostic challenges. Early recognition and prompt initiation of antiviral therapy are essential to limit lesion progression, reduce viral shedding, and prevent complications. Dermatologists are uniquely positioned to identify these manifestations and distinguish VZV infection from its clinical mimics. Advances in molecular diagnostics have improved the detection of atypical cases, while the introduction of the attenuated-virus vaccine for varicella and recombinant glycoprotein E-based vaccine for herpes zoster has transformed prevention, providing durable protection even in older adults and immunosuppressed populations. Beyond therapy, dermatologists play a key role in integrating vaccination assessment and patient education into routine care. Understanding the biological continuum of VZV (from latency to reactivation) enhances diagnostic precision, guides evidence-based treatment, and supports immunization strategies against VZV. As VZV continues to impose a substantial burden of cutaneous and neuropathic morbidity, an integrated dermatological approach that combines early therapeutic intervention with preventive counseling represents the most effective strategy to reduce its clinical and public health impact.
Valenzuela F, Benavides E, Echeverry EV
… +2 more, Hartmann D, Bilicic D
An Bras Dermatol
· 2026 · PMID 42070323
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BACKGROUND: Psoriasis is a chronic immune-mediated inflammatory disease linked to systemic comorbidities such as obesity, diabetes, cardiovascular disease, and inflammatory bowel disease. Non-pharmacological intervention...BACKGROUND: Psoriasis is a chronic immune-mediated inflammatory disease linked to systemic comorbidities such as obesity, diabetes, cardiovascular disease, and inflammatory bowel disease. Non-pharmacological interventions, such as dietary modifications, nutritional supplementation, exercise, and psychological interventions, have emerged as complementary therapies in the management of psoriasis. OBJECTIVES: Review the current and recent evidence and the role of trace elements, vitamins, diet, exercise, and psychological interventions as complementary approaches in the management of patients with psoriasis. MATERIALS AND METHODS: A narrative review was conducted, analyzing clinical trials, meta-analyses, and cohort studies from major databases. RESULTS: Trace elements such as zinc, copper, and selenium, and vitamins including D, E, B-complex, and A, play roles in oxidative stress modulation, immune regulation, and keratinocyte biology. However, the clinical efficacy of micronutrient supplementation remains uncertain due to inconsistent and conflicting findings. Dietary interventions, particularly Mediterranean diet adherence and weight loss through caloric restriction or bariatric surgery, have been associated with reductions in psoriasis severity, although clear clinical protocols are lacking. Aerobic exercise appears beneficial but is underutilized, partially due to psychological and disease-related barriers. Furthermore, psoriasis is associated with a high prevalence of psychological disorders, with the necessity to integrate psychological interventions to optimize disease management. STUDY LIMITATIONS: The available evidence is limited and with heterogeneity in study design, with small sample sizes, observational methodologies, and inconsistent intervention protocols, restricting causal inference and generalizability. CONCLUSION: While non-pharmacological strategies show promise as complementary interventions in psoriasis management, they cannot replace conventional therapy. Further studies are required to confirm their clinical impact. These approaches should be considered as complementary strategies, with individualized patient assessments and continuous follow-up being essential.
Gontijo JRV, Bittencourt FV, Nelson JH
… +2 more, Garcia LC, Leachman SA
An Bras Dermatol
· 2026 · PMID 42066632
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BACKGROUND: Thin melanoma (TM, ≤1.0 mm Breslow thickness) and Melanoma In Situ (MIS) constitute the majority of melanoma diagnoses worldwide and are responsible for melanoma-related deaths in these early-stage tumors. De...BACKGROUND: Thin melanoma (TM, ≤1.0 mm Breslow thickness) and Melanoma In Situ (MIS) constitute the majority of melanoma diagnoses worldwide and are responsible for melanoma-related deaths in these early-stage tumors. Despite their favorable prognosis, MIS and TM represent an opportunity for improving patient outcomes through early detection, accurate risk stratification, and long-term surveillance for metastasis and new skin neoplasms. OBJECTIVE: Provide an update of current evidence regarding epidemiology, risk factors, prognostic indicators, genetic background, and clinical management of MIS and TM. METHODS: A comprehensive review of the literature and international guidelines was conducted, integrating epidemiologic data, clinical prognostic parameters, and molecular insights relevant to MIS and TM. RESULTS: MIS and TM account for over 80% of all melanomas, with increasing incidence and relatively stable mortality rates. Prognosis is primarily determined by Breslow depth and ulceration, while factors such as mitotic rate, anatomic site, and age further refine risk assessment. Genetic alterations contribute to tumorigenesis but are not yet integrated into routine management. Long-term dermatological surveillance is needed, as new neoplasms, recurrence, and metastasis can develop during follow-up. CONCLUSIONS: MIS and TM are increasingly diagnosed, and dermatologists need to be a part of early detection, multidisciplinary management, and lifelong surveillance, which remain the cornerstone of reducing melanoma-related mortality. STUDY LIMITATIONS: The substantial heterogeneity among the included studies limits direct comparison and quantitative synthesis of the available data.
An Bras Dermatol
· 2026 · PMID 42061337
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BACKGROUND: Cutaneous melanoma remains the leading cause of skin cancer-related mortality worldwide. Despite national awareness campaigns launched by the Brazilian Society of Dermatology since 1999, morbidity and mortali...BACKGROUND: Cutaneous melanoma remains the leading cause of skin cancer-related mortality worldwide. Despite national awareness campaigns launched by the Brazilian Society of Dermatology since 1999, morbidity and mortality in Brazil remain substantially high. METHODS: We conducted an ecological study using secondary data from DATASUS (Hospital Information System – SIH/SUS, Mortality Information System – SIM/SUS, and population estimates from IBGE). Melanoma cases were identified using ICD-10 code C43 between 2013 and 2023. Incidence rates were calculated per 100,000 inhabitants. RESULTS: A total of 20,087 melanoma cases were reported during the study period. Men accounted for 57.5% of cases, a proportion that remained stable throughout the decade. Annual case counts increased from 1,547 in 2013 to 2,047 in 2023, representing a 32% rise. The South and Southeast regions — historically shaped by European immigration and concentrating the majority of White individuals — reported the highest incidence and mortality, consistent with prior population-based cohort data from southern Brazil. CONCLUSIONS: These findings highlight a multifactorial scenario in which demographic, behavioral, biological, and structural healthcare determinants converge to shape melanoma burden in Brazil. Sex-specific behavioral factors (lower photo protection adherence, delayed dermatological evaluation among men) and biological differences may contribute to male predominance. Expanding access to early-detection strategies and equitable resource allocation remains essential in a country marked by vast territorial, climatic, and socioeconomic heterogeneity.