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Abstract Prurigo is a reactive, hyperplastic skin condition characterized by pruritic papules, plaques, and/or nodules. The temporal classification includes acute/subacute and chronic disease (≥ 6 weeks), with different clinical variants, synonymies, and underlying etiological factors. The immunology of chronic prurigo shows similarities with atopic dermatitis due to the involvement of IL-4 and IL-13, IL-22, and IL-31. Treatment includes antihistamines, topical steroids, dupilumab, and JAK inhibitors. Several conditions manifest clinically as prurigo-like lesions, and the correct clinical diagnosis must precede correct treatment. Furthermore, chronic prurigos represent a recalcitrant and distressing dermatosis, and at least 50% of these patients have atopic diathesis, the treatment of which may induce adverse effects, especially in the elderly. The quality of life is significantly compromised, and topical treatments are often unable to control symptoms and skin lesions. Systemic immunosuppressants, immunobiologicals, and JAK inhibitors, despite the cost and potential adverse effects, may be necessary to achieve clinical improvement and quality of life. This manuscript reviews the main types of prurigo, associated diseases, their immunological bases, diagnosis, and treatment.

Abstract Background The treatment for atopic dermatitis (AD) has been the focus of clinical research, and behavioral intervention is considered an indispensable treatment method. To our knowledge, no relevant meta-analysis has evaluated the effects of behavioral interventions on atopic dermatitis. Objectives To evaluate the effects of behavioral interventions on atopic dermatitis. Methods The authors searched PubMed, EMBASE, and Cochrane CENTRAL to retrieve relevant RCTs (up to Feb 2022). The search strategy involved a combination of related keywords. The Cochrane Q and I2 statistics were used to assess heterogeneity. Results Six RCTs involving seven reports with 246 patients were included. The results suggested that behavioral interventions could relieve eczema severity (correlation coefficient [r = −0.39]; p < 0.001) and scratching severity significantly (r = −0.19; p = 0.017), while not affect itching intensity (r = −0.02; p = 0.840). A sensitivity analysis confirmed the robustness of the results. Study limitations An important limitation of this study was the insufficient number of RCTs and the limited sample size. In addition, the study lacked a control group receiving a type of intervention other than the experimental protocol. Another limitation was the short duration of follow-up. Conclusions This study suggests that behavioral interventions could be effective in treating atopic dermatitis by reducing eczema and scratching severity. Additionally, habit-reversal behavioral therapy may be more effective for treating atopic dermatitis.

Abstract Background: Methotrexate (MTX) is an alternative treatment for patients with moderate/severe atopic dermatitis (AD). Objective: The authors evaluated the effect of MTX on the cutaneous expression of cytokines and chemokines that are involved in the inflammatory response in adult AD patients who received treatment with methotrexate for 24 weeks. Methods: The authors conducted a prospective single-institution cohort study with 12 adults with moderate/severe AD who received oral MTX (15 mg/wk for 24 wks) and 10 non-atopic matched controls. The comparison was made of skin biopsies of lesional and non-lesional skin, pre- and post MTX treatment. The authors analyzed mean epidermal thickness and expression of IL-31, IL-31RA, OSMR, TSLP, Ki67, IL-4 mRNA, IL-6, IL-10, TNF-α, IFN-γ, TARC, and CCL-22. Results: There was a reduction in mean epidermal thickness (p = 0.021), an increase in IL-31RA expression (immunohistochemistry) in the epidermis (p = 0.016) and a decrease in IL-31 gene expression (p = 0.019) on lesional AD skin post-MTX treatment. No significant changes in the cutaneous expression of the other evaluated markers were identified. Study limitations: Small sample size and limited length of follow-up. Conclusions: Treatment with MTX in adults with moderate/severe AD reduced epidermal hyperplasia and changed the cutaneous expression of inflammatory cytokines and receptors that are mainly related to pruritus, including IL-31 and IL-31RA.

Atopic dermatitis (AD) is a chronic skin disease whose hallmark is a deficient skin barrier. Current treatment consists of restoring this barrier using emollients, reported corticosteroids, and systemic medications in severe cases. This study aimed to evaluate the subdermal hyaluronic acid (HA) injection to treat AD. We applied HA to plaques of atopic dermatitis, and there was a global improvement in the lesions and skin elasticity after two weeks. There was no complete regression of the plaques; however, HA can be proposed as an adjuvant treatment option for key areas.

Abstract Immunobiologicals are a reality in current clinical practice and have increasingly gained space in the inflammatory disease scenario, especially in dermatology, with approved drugs for psoriasis, atopic dermatitis, and hidradenitis suppurativa, in addition to many others undergoing study. It is important for dermatologists to have knowledge of the medications approved in Brazil, for the best management of dermatoses, in addition to the fact that they represent hope for improvement in patients with chronic diseases.

Abstract Atopic dermatitis predisposes to skin infections, and on the other hand, some therapies used for atopic dermatitis may worsen viral infections whose lesions may be more diffuse and resistant to treatment. The authors present a patient with severe atopic dermatitis and disseminated molluscum contagiosum infection. The molluscum contagiosum did not clear with topical treatment, and it worsened her atopic dermatitis even more, so the authors started treatment with dupilumab. After two months, the patient's dermatitis went into clinical remission and there was resolution of the infection with no recurrence at the 12-month follow-up. Dupilumab is nowadays a promising treatment for severe atopic dermatitis. To our knowledge, only four reports of molluscum contagiosum during dupilumab therapy have been reported in the literature, with contrasting effects. According to the authors’ experience, treatment with dupilumab appears to be a safe alternative for patients with severe atopic dermatitis who are also infected with molluscum contagiosum, as opposed to other treatments such as systemic corticosteroids or cyclosporine.

Abstract Background Atopic dermatitis is the most common inflammatory skin disease in childhood and has an important impact on quality of life, especially severe cases or those that are recalcitrant to treatments. Sensitization to allergens with the potential for allergic contact dermatitis is a factor associated with cases of recalcitrant atopic dermatitis. Understanding the relationship between atopic dermatitis, allergens, and allergic contact dermatitis is essential. In Brazil, there are no studies on sensitization to allergens found in patch tests with pediatric batteries in patients with atopic dermatitis. Objectives To verify the main sensitizing agents, the prevalence of allergic contact dermatitis and the epidemiological and clinical profile of children and adolescents with atopic dermatitis. Methods Cross-sectional, prospective study in patients between 4 and 18 years of age, with recalcitrant atopic dermatitis, treated at the Sanitary Dermatology Outpatient Clinic (RS). All patients underwent patch tests with a battery of pediatric allergens. Results The prevalence of sensitization and allergic contact dermatitis in the evaluated patients was 37.07% (20/54) and 27.7% (15/54), respectively. The most frequent allergens were: nickel sulfate (16.7%), disperse blue (5.6%), and fragrance mix I (5.6%). Nickel was associated with the female sex (p = 0.019). Study limitations Sample size and selection, absence of a control group. Conclusions A proportion of patients with recalcitrant atopic dermatitis may be sensitized to different allergens and may even have developed allergic contact dermatitis. Recognizing this context is important in the prevention strategy and management of the disease.

Background: Atopic dermatitis (AD) is a chronic, recurrent, inflammatory skin condition that is associated with detrimental effects on the lives of patients and their families, including an impact on quality of life (QOL). Studies about QOL on Latin American AD patients are scarce and have generally included few patients. Objective: describing AD impact on the QOL in a large cohort in Argentina. Methods: a structured web-based survey including 1,650 AD pediatric and adult patients was performed. Results: according to retrieved data, AD symptoms onset started during childhood in most patients, but 20 % of participants reported that manifestations of AD were initially perceived during late adolescence and adulthood. Important differences were observed among country regions, with a shorter time-to-diagnosis in most populated and richer districts. Main affected domains included frustration, anger, mood alterations, stress, sleep alterations, routine alterations, pain and economic impact of AD. Limitations: biases inherent to survey design. Conclusions: we consider that our study contributes to a better understanding of AD in Argentina, as well as its physical, social and financial impact on affected patients.

Abstract Background: Higher skin pH in atopic dermatitis contributes to impaired epidermal barrier. A moisturizer compatible with physiological pH could improve atopic dermatitis. Objective: To determine the effect of a physiologically compatible pH moisturizer in atopic dermatitis. Methods: A randomized half body, double blind, controlled trial involving patients with stable atopic dermatitis was performed. pH-modified moisturizer and standard moisturizer were applied to half body for 6 weeks. Results: A total of 6 (16.7%) males and 30 (83.3%) females participated. Skin pH reductions from week 0, week 2 and 6 were significant at the forearms (5.315 [0.98] to 4.85 [0.54] to 5.04 [0.78], p = 0.02) and abdomen (5.25 [1.01], 4.82 [0.64], 5.01 [0.59], p = 0.00) but not at the shins (5.01 [0.80], 4.76 [0.49], 4.85 [0.79], p = 0.09) with pH-modified moisturizer. Transepidermal water loss (TEWL) at the forearms decreased (4.60 [2.55] to 3.70 [3.10] to 3.00 [3.55], p = 0.00), abdomen (3.90 [2.90] to 2.40 [3.45] to 2.70 [2.25], p = 0.046). SCORAD improved from 14.1 ± 12.75 to 10.5 ± 13.25 to 7 ± 12.25, p = 0.00. In standard moisturizer group, pH reductions were significant at the forearms (5.29 [0.94] to 4.84 [0.55] to 5.02 [0.70], p = 0.00) and abdomen (5.25 [1.09], 4.91 [0.63], 5.12 [0.66], p = 0.00). TEWL at the forearm were (4.80 [2.95], 4.10 [2.15], 4.60 [3.40], p = 0.67), shins (3.80 [1.40], 3.50 [2.35], 4.00 [2.50], p = 0.91) and abdomen (3.70 [2.45], 4.10 [3.60], 3.40 [2.95], p = 0.80). SCORAD improved from 14.2 ± 9.1 to 10.9 ± 10.65 to 10.5 ± 11, p = 0.00. Reduction in pH was observed with both moisturizers while TEWL significantly improved with pH-modified moisturizer. pH-modified moisturizer resulted in greater pH, TEWL and SCORAD improvements however the differences were not significant from standard moisturizer. Study limitation: Skin hydration was not evaluated. Conclusion: Moisturization is beneficial for atopic dermatitis; use of physiologically compatible pH moisturizer is promising.

Abstract Background: Polymorphisms of the filaggrin 2 gene (rs 12568784 and rs 16899374) are associated with persistent atopic dermatitis in African American patients. Filaggrin 2 is a protein with a function similar to filaggrin and also encoded in the epidermal differentiation complex on chromosome 1q21. Objective: To evaluate the polymorphisms in the filaggrin 2 gene (rs 12568784 and rs 16899374) in children and adults with atopic dermatitis and to verify the association of these with the severity of the clinical picture, presence of other allergic diseases, and socio-demographic factors. Method: The study was carried out with patients and control group. Questionnaires were used to evaluate ethnicity, sex, age, family history, scoring, atopic dermatitis (SCORAD), among other parameters. Genotyping of the filaggrin 2 gene was performed by real-time polymerase chain reaction. Results: Forty-eight patients and 83 controls were evaluated. No correlation was found between the variables studied in patients with atopic dermatitis and polymorphisms, no significant difference between the prevalence of polymorphisms in the patients and in the control group p > 0.05. Study limits: The exclusive use of self-reported ethnicity information and the sample size. Results: The results of this work can be an incentive for the study of the polymorphisms in atopic dermaititis, considering the characteristic of the Brazilian multi ethnic population. Conclusion: This is an unpublished work in Brazil and the first study in the world to have a control group to evaluate alterations in the gene of filaggrin 2.

Impaired skin barrier is one of the hallmarks of atopic dermatitis (AD), with abnormalities in the cornified envelope, lipid lamellae, tight junctions and cutaneous microbiome. These findings are also present in nonlesional skin of AD individuals, suggesting that epidermal barrier defects may be the initial step towards the development of AD and eventually other atopic diseases (atopic march). It is currently known that pathophysiology of AD involves an interplay between this dysfunctional skin barrier and a predominantly type 2 skewed innate and adaptive immune responses, which further disrupt the skin barrier through type 2 cytokines. In this setting, there is enhanced penetration of environmental and food allergens through a deficient barrier, leading to an increased susceptibility to sensitization. During the sensitization process, thymic stromal lymphopoietin (TSLP) polarizes skin dendritic cells to a T-helper 2 response, and TSLP seems to be a key cytokine in the sensitization of food allergy, allergic asthma and rhinitis. In this review, the authors describe the current knowledge of the pathophysiology of the epidermal barrier, its disruption in AD and how it may be involved in the development of atopic comorbidities and the role of barrier repair therapy on the prevention of the atopic march progression.

Introduction: Atopic dermatitis (AD) is a chronic inflammatory disease that affects both children and adults. The main symptom is pruritus, which has an important impact on quality of life (QoL). The objective of our study was to assess the impact of AD on the quality of life of children through the CDLQI score. Population and Methods: We performed a cross-sectional survey, with descriptive and analytical aims, carried out on the basis of prospective recruitment, carried out over a period of 7 months from December 2017 to June 2018. The study included children (5-16 years) with AD selected during dermatology consultations at the Centre Hospitalier Universitaire of Treichville. Data collected included the socio-demographic characteristics of patients and their AD and the results of a questionnaire on the severity score (SCORAD) and the quality of life index in these children (CDLQI). Results: We included 60 children, mainly within the group from 05 to 09 years (57%). CDLQI average score was 9.9 and mean SCORAD 24. Pruritus, insomnia and sadness had more impact on QoL. We found a strong association between the severity of AD objectified by SCORAD and the CDLQI. Conclusion: The study reveals a high impact of AD on the QoL of children in Abidjan mainly through pruritus, insomnia and sadness. It opens up reflection on the need for education for AD management and the prospect of creating an atopy school in Côte d’Ivoire.

Abstract: Background: Current data regarding the associated factors of prurigo nodularis are still uncertain, except for atopic predisposition. Objectives: The purposes of this study were to (1) determine the frequencies of xerosis and other accompanying diseases of female patients with prurigo nodularis; (2) compare the demographic, clinical and accompanying disease characteristics by grouping these patients according to whether they have associated xerosis (who were subsequently subgrouped as atopic or non-atopic) or not. Methods: In this retrospective descriptive study, 80 females with PN were categorized according to the accompanying diseases (dermatological, systemic, neurological, psychogenic, mixed, or undetermined origin). Results: A total of 45 associated co-factors including dermatological in 63 (78.8%), systemic in 57 (71.3%), psychological in 33 (41.3%) and neurological co-factors in 14 (17.5%) of all patients with prurigo nodularis were detected. Xerosis was observed in 48 (60%) patients (non-atopic co-factors in 66.7% of them). The ratio of patients with mixed co-factors, dermatological+systemic co-factors and dermatological+systemic+psychological co-factors were found to be significantly higher in patients with xerosis compared to those without xerosis. Study limitations: Our study has certain limitations such as the absence of an age-matched control group, absence of follow-up data and the fact that the diagnosis of xerosis has not been based on objective methods. Conclusions: Xerosis has been identified in more than half of the patients with PN and it has been determined that in most patients xerosis is associated especially with diabetes mellitus and other conditions related to prurigo nodularis.

Abstract: Atopic dermatitis is a common inflammatory skin disease. New understanding in disease pathogenesis has led to a considerable number of promising new drugs in development. New topical agents can be especially helpful for children, providing an alternative to the need for chronic topical corticosteroid use. While many patients with mild or moderate disease can be managed with topical treatments, there are unmet needs for recalcitrant and severe cases. New and developing therapies hold promise for real advances in management of this complex disease.

Abstract: Background: Narrow-band UVB is the most innovative steroid sparing treatment in atopic dermatitis. There are studies showing efficacy of Narrow-band UVB in childhood atopic dermatitis, but there is lack of clinical trials in the literature determining the length of remission. Therefore, we sought to highlight its efficacy, safety and its post-treatment efficacy in childhood atopic dermatitis. Objective: To assess the clinical efficacy, safety of Narrow-band UVB in the treatment of paediatric atopic dermatitis and length of remission during 2 years of post-treatment follow-up. Methods: Thirty children (4-14 years) having moderate to severe AD (SCORAD index > 25) were enrolled for 12 weeks. Narrow-band UVB phototherapy was administered twice a week on non-consecutive days for three months. SCORAD index was calculated by the same dermatologist at baseline, 6th, 12th, 18th and 24th treatment session. Secondary outcomes were measured using visual analog scale for pruritus and sleep loss. Patients were also followed-up for 2 years to know the length of remission after end of therapy. Results: There was a significant reduction in SCORAD index at 6th, 12th, 18th and 24th treatment session in comparison to baseline. This improvement in SCORAD was also maintained during the 2 years of post-treatment follow-up period. Consequently, pruritus and sleep loss improved significantly from baseline to end of therapy and even during the 1st and 2nd year of follow-up. Study limitation: Open-label trial without control group. Conclusions: Narrow-band UVB is an efficacious and safe modality of treatment in childhood atopic dermatitis with good therapeutic index and minimal side effects.

Abstract: Background: Atopic dermatitis is a prevalent health problem in the world. Allergic sensitization is an important risk factor, but the roles of other factors, inherent in tropic region, are unknown. Objective: A cohort study was designed in a tropical city to investigate molecular and environmental risk factors for eczema, considering as particular features perennial exposure to mites, poor living conditions and others tropical characteristics. Methods: 433 patients were included at baseline and biological samples were collected during 24 months of follow-up. Clinical information was collected using questionnaires (SCORAD, DLQI and a subjective scale) during each clinical assessment. Results: The prevalence of atopic eczema was 93%, with similar frequency between children and adults; parents history of eczema and polysensitization to mites, dogs, cats, cockroaches and birds, were risk factors for severe and persistent eczema and allergic comorbidities. Food sensitization was present in 16% of patients but food-induced allergies were scarce. Psychiatric, dental and ocular disorders were the most frequent non-allergic comorbidities. Study limitations: selection bias. Conclusion: We presented a tropical cohort of patients with eczema and we identified some risk factors for severe and persistent dermatitis. Some patterns of sensitization were associated with severe eczema and respiratory symptoms, and the natural history of "atopic march" is different to that described in some industrialized countries. The collection of biological samples will contribute to the understanding of the gene/environment interactions leading to allergy inception and evolution.

Abstract: Background: Topical antimicrobial drugs are indicated for limited superficial pyodermitis treatment, although they are largely used as self-prescribed medication for a variety of inflammatory dermatoses, including atopic dermatitis. Monitoring bacterial susceptibility to these drugs is difficult, given the paucity of laboratory standardization. Objective: To evaluate the prevalence of Staphylococcus aureus topical antimicrobial drug resistance in atopic dermatitis patients. Methods: We conducted a cross-sectional study of children and adults diagnosed with atopic dermatitis and S. aureus colonization. We used miscellaneous literature reported breakpoints to define S. aureus resistance to mupirocin, fusidic acid, gentamicin, neomycin and bacitracin. Results: A total of 91 patients were included and 100 S. aureus isolates were analyzed. All strains were methicillin-susceptible S. aureus. We found a low prevalence of mupirocin and fusidic acid resistance (1.1% and 5.9%, respectively), but high levels of neomycin and bacitracin resistance (42.6% and 100%, respectively). Fusidic acid resistance was associated with more severe atopic dermatitis, demonstrated by higher EASI scores (median 17.8 vs 5.7, p=.009). Our results also corroborate the literature on the absence of cross-resistance between the aminoglycosides neomycin and gentamicin. Conclusions: Our data, in a southern Brazilian sample of AD patients, revealed a low prevalence of mupirocin and fusidic acid resistance of S. aureus atopic eczema colonizer strains. However, for neomycin and bacitracin, which are commonly used topical antimicrobial drugs in Brazil, high levels of resistance were identified. Further restrictions on the use of these antimicrobials seem necessary to keep resistance as low as possible.

Abstract: Advances in knowledge of neurocellulars relations have provided new directions in the understanding and treatment of numerous conditions, including atopic dermatitis. It is known that emotional, physical, chemical or biological stimuli can generate more accentuated responses in atopic patients than in non-atopic individuals; however, the complex network of control covered by these influences, especially by neuropeptides and neurotrophins, and their genetic relations, still keep secrets to be revealed. Itching and airway hyperresponsiveness, the main aspects of atopy, are associated with disruption of the neurosensory network activity. Increased epidermal innervation and production of neurotrophins, neuropeptides, cytokines and proteases, in addition to their relations with the sensory receptors in an epidermis with poor lipid mantle, are the aspects currently covered for understanding atopic dermatitis.

Abstract: Atopic dermatitis is a chronic inflammatory skin disease with a complex pathogenesis, where changes in skin barrier and imbalance of the immune system are relevant factors. The skin forms a mechanic and immune barrier, regulating water loss from the internal to the external environment, and protecting the individual from external aggressions, such as microorganisms, ultraviolet radiation and physical trauma. Main components of the skin barrier are located in the outer layers of the epidermis (such as filaggrin), the proteins that form the tight junction (TJ) and components of the innate immune system. Recent data involving skin barrier reveal new information regarding its structure and its role in the mechanic-immunological defense; atopic dermatitis (AD) is an example of a disease related to dysfunctions associated with this complex.

Abstract BACKGROUND: The role played by vitamin D in atopic dermatitis is controversial and has been the focus of many studies. The ultraviolet index has not been considered in this type of research. OBJECTIVES: The objectives of the study were to assess 25-hydroxy vitamin D [25(OH)D] serum level in atopic dermatitis patients and control group, to investigate the association between atopic dermatitis clinical severity (using the SCORing Atopic Dermatitis index - SCORAD) and 25(OH)D serum levels, and to evaluate the independent predictors, including Ultraviolet index, SCORAD and 25(OH)D. METHODS: We conducted a cross-sectional study of 106 atopic dermatitis patients. A control group was matched with a subsample of 54 participants with atopic dermatitis. SCORAD index, laboratory tests, and local Ultraviolet index were assessed. RESULTS: The atopic dermatitis patients had serum 25(OH)D levels and mean UVI significantly higher than the control group. Immunoglobulin E and Ultraviolet index were associated with the SCORAD index. Skin type, age and Ultraviolet index were independent predictors of 25(OH)D. CONCLUSIONS: Although statistically significant, the different levels of 25(OH)D between the paired groups may be attributed to the higher mean Ultraviolet index in atopic dermatitis patients. Since Ultraviolet index is an independent predictor of SCORAD index and of 25(OH)D level, it may work as a confounding factor in studies involving atopic dermatitis and 25(OH)D and must be considered in this kind of research.

Abstract: The pH of the skin is slightly acidic (4.6 to 5.8) which is important for appropriate antibacterial, antifungal, constitution of barrier function, as well as structuring and maturation of the stratum corneum. This study aimed to evaluate the pH of the main commercial moisturizers and liquid soaps in Brazil. Thus, pH of the products was quantified by pH meter in three measurements. A total of 38 moisturizers and six commercial liquid soaps were evaluated. Mean pH of 63% and 50% of the moisturizing and liquid soaps presented results above 5.5, disfavoring repair, function, and synthesis of dermal barrier.

BACKGROUND: atopic dermatitis is directly related to psychological stress, reduced quality of life and psychosomatic symptoms. The Psychosomatic Scale for Atopic Dermatitis is the only questionnaire developed specifically for assessment of psychosomatization in atopic dermatitis. OBJECTIVES: the objective of this study was to cross-culturally adapt and validate a Brazilian-Portuguese version of the Psychosomatic Scale for Atopic Dermatitis. METHODS: adaptation consisted of independent translation and backtranslation by three bilingual translators, followed by a pre-test. The Psychosomatic Scale for Atopic Dermatitis and the Dermatology Life Quality Index were self-administered to 47 patients with atopic dermatitis. Disease severity was evaluated using the Eczema Area and Severity Index. Factor analysis was used to identify the dimensions of the Brazilian Portuguese version of the Psychosomatic Scale for Atopic Dermatitis. Internal consistency and convergence validity were also analyzed. Reproducibility was assessed using the Kappa coefficient. RESULTS: factor analysis revealed a two-dimensional structure: stress/laziness/insecurity (I) and maladjustment/social relationships (II), explaining 54.4% of total variance. All dimensions revealed excellent internal consistency. External construct validity was confirmed by positive correlations between the Psychosomatic Scale for Atopic Dermatitis and the Dermatology Life Quality Index. Test-retest reliability was excellent, with k>0.7 for all questions. CONCLUSIONS: the Brazilian Portuguese version of the Psychosomatic Scale for Atopic Dermatitis demonstrated acceptable psychometric properties and can be used for the evaluation of psychosomatic symptoms in patients with atopic dermatitis and as a tool in clinical and epidemiological research.

BACKGROUND: Pityriasis alba affects 1% of the world population and about 9.9% of the children in Brazil. However, its etiology remains uncertain. OBJECTIVE: The objective of the present study was to evaluate the immunoexpression of factor XIIIa in dermal dendrocytes of skin lesions of pityriasis alba. METHOD: Twenty patients with pityriasis alba and 20 patients with atopic dermatitis underwent biopsy. The dermal dendrocytes marked by factor XIIIa were counted by means of immunohistochemical analysis. RESULTS: The mean amount of dermal dendrocytes found in the patients with pityriasis alba was 2, whereas in the patients with atopic dermatitis it was 4, with a statistically significant difference between them. A cutoff point of 3 cells/square inch was established to differentiate pityriasis alba from atopic dermatitis, with 80% sensibility and 90% specificity. CONCLUSION: We believe that pityriasis alba and atopic dermatitis should be considered different clinical forms within the spectrum of atopic disease, in which sun radiation plays an important role by modulating the progression of the disease.

Patients with atopic dermatitis have genetically determined risk factors that affect the barrier function of the skin and immune responses that interact with environmental factors. Clinically, this results in an intensely pruriginous and inflamed skin that allows the penetration of irritants and allergens and predisposes patients to colonization and infection by microorganisms. Among the various etiological factors responsible for the increased prevalence of atopic diseases over the past few decades, the role of vitamin D has been emphasized. As the pathogenesis of AD involves a complex interplay of epidermal barrier dysfunction and dysregulated immune response, and vitamin D is involved in both processes, it is reasonable to expect that vitamin D's status could be associated with atopic dermatitis' risk or severity. Such association is suggested by epidemiological and experimental data. In this review, we will discuss the evidence for and against this controversial relationship, emphasizing the possible etiopathogenic mechanisms involved.

BACKGROUND: The literature has shown that the presence of emotional disturbances in caregivers of children with skin diseases affects the course and treatment of the disease. Anxiety and depression are among the most frequently reported psychiatric diagnoses related to this fact. OBJECTIVE: To evaluate the presence of anxiety and depression in caregivers of pediatric patients with chronic skin disorders, exemplified by atopic dermatitis, psoriasis and vitiligo, and correlate them to the quality of life of the patients. METHODS: The sample consisted of 118 patients with atopic dermatitis, vitiligo and psoriasis, monitored by their main caregiver. The levels of anxiety and depression in the caregivers were assessed using the Hamilton Anxiety Scale and the Beck Depression Inventory, respectively. The Children's Dermatology Life Quality Index was applied. RESULTS: Anxiety was observed in 36% of the caregivers of the patients with atopic dermatitis, in 36% of those of children affected by psoriasis, and in 42% of those responsible for pediatric patients with vitiligo. Depression occurred in 36% of the caregivers of patients with atopic dermatitis, in 36% of those of children affected by psoriasis and in 26% of those responsible for pediatric patients with vitiligo. There was a significant correlation between poor quality of life scores in patients with vitiligo and the presence of depression and anxiety in their caregivers. CONCLUSION: Emotional disorders tend to be present among close family members of children with the chronic skin diseases studied and their prevention can help in controlling and treating these diseases.

BACKGROUND:Atopic dermatitis leads to epidermal barrier dysfunction and bacteria colonization. The relationship of the last factor with the severity of the disease and the frequency of exacerbation is not fully known.OBJECTIVES:Verify the severity of the atopic dermatitis and the number of appointments generated by dermatosis, comparing patients colonized with patients not colonized by S. aureus. Verify the frequency of colonization by methicillin resistant Staphylococcus aureus acquired in the community.METHODS:Cohort study with a 12 months follow-up, in a sample of patients from Porto Alegre, RS public network. Cultures in active injuries and nasal cavities were carried out as well as methicillin sensitivity tests to S. aureus.The severity of atopic dermatitis was defined by Eczema Area and Severity Index (EASI).RESULTS:We included 93 patients, 43% female and 56% male, 26 colonized by S. aureusin the nasal orifices, 56 in the skin damage. The mean of initial Eczema Area and Severity Index was 5.5 and final 3.9. The initial Eczema Area and Severity Index of patients colonized by S. aureusin the skin and nasal cavity was larger than the number of patients without colonization(p< 0.05). During the period of one year, in average, there were six appointments/patient. There was linear correlation between the number of appointments during one year and the inicial Eczema Area and Severity Index (r = 0,78). There were no patients with methicillin resistant Staphylococcus aureus acquired in the community.CONCLUSION:There is a relevant influence of staphylococcal colonization on the severity of atopic dermatitis and the number of appointments required by its exacerbation. Methicillin resistance among those affected by S. aureusdoes not seem to be an emergent problem, in this Brazilian sample.

Atopic Dermatitis is a chronic inflammatory skin disease that affects a large number of children and adults. The disease results from an interaction between genetic predisposition, host environment, skin barrier defects, and immunological factors. A major aggravating factor associated with Atopic Dermatitis is the presence of microorganisms on the patient's skin surface. Staphylococcus aureus and Streptococcus pyogenes, for instance, can exacerbate chronic skin inflammation. As a result, antimicrobials have often been prescribed to control the acute phase of the disease. However, increased bacterial resistance to antimicrobial agents has made it difficult for dermatologists to prescribe appropriate medication. In the presence of disseminated dermatitis with secondary infection, systemic antibiotics need to be prescribed; however, treatment should be individualized, in an attempt to find the most effective antibiotic with fewer side effects. Also, the medication should be used for as short as possible in order to minimize bacterial resistance.A dermatite atópica é uma doença inflamatória crônica da pele que afeta um grande número de crianças e adultos. A doença resulta da interação entre predisposição genética, fatores ambientais, defeitos da barreira cutânea e fatores imunológicos. Um dos grandes fatores agravantes associados à dermatite atópica é a presença de microorganismos na superfície cutânea desses pacientes. Staphylococcus aureus e Streptococcus pyogenes, por exemplo, podem exacerbar a inflamação crônica da pele. Como resultado, antimicrobianos são prescritos para controlar a fase aguda da doença. O constante crescimento da resistência bacteriana aos antimicrobianos tem tornado a escolha do mais adequado medicamento uma difícil decisão para os dermatologistas. Na presença de dermatite disseminada com infecção secundaria, antibióticos sistêmicos necessitam ser prescritos; no entanto, o tratamento deve ser individualizado, de forma a encontrar o antimicrobiano mais eficaz e com menores efeitos colaterais. Além disso, esse medicamento deve ser utilizado pelo menor tempo possível, a fim de minimizar a resistência bacteriana.

BACKGROUND: Atopic Dermatitis is a chronic inflammatory skin disease. Food allergens are important in the pathogenesis in 1/3 of the cases. Several mechanisms are involved in the pathogenesis of Atopic Dermatitis. Immediate reactions are identified by both measurement of specific IgE and skin prick test. Atopy Patch Test seems to be relevant in the investigation of patients with suspected delayed-type reactions. OBJECTIVES: To evaluate the standardization of this method concerning allergen concentration, occlusion time and interpretation, and determine the specificity and sensitivity of the Atopy Patch Test according to the skin prick test and specific IgE levels in food allergy diagnosis in children with Atopic Dermatitis. METHODS: Seventy-two children, aged 2-12 years were selected and followed at the allergy clinic of the Hospital São Zacharias. Skin prick test, specific IgE and food Atopy Patch Test (cow's milk, egg, soy and wheat) were carried out. Three groups were submitted to the Atopy Patch Test: (1) Atopic Dermatitis with or without Rhinitis and Asthma; (2) Rhinitis and or Asthma without AD; (3) Healthy individuals. RESULTS: In group 1, 40% of the patients presented positive reactions. The longer the exposure time (48h and 72h), the higher the sensitivity. In group 2, the test was more specific than sensitive for all the extracts, with increased sensitivity the longer the time of exposure (72h). In group 3, 8.3% presented positive tests. CONCLUSION: APT evidenced a great diagnostic value in late-phase reactions to food, with high specificity. It showed to be a specific and reliable tool in comparison with the healthy group's results.FUNDAMENTOS: A Dermatite Atópica é uma doença inflamatória crônica da pele. Os alimentos são importantes na patogênese da doença em 1/3 dos casos. Diversos mecanismos estão envolvidos na fisiopatogenia da dermatite Atópica. As reações imediatas são identificadas pela dosagem de IgE específica e teste de puntura. O teste de contato atópico parece ter relevância na investigação de pacientes com suspeita de reação tardia. OBJETIVOS: Avaliar a padronização do método com relação à concentração do alérgeno, tempo de oclusão e de interpretação; e determinar a especificidade e a sensibilidade do teste de contato atópico em relação ao teste de puntura e a dosagem de IgE específica, no diagnóstico de alergia alimentar em crianças com dermatite Atópica. MÉTODOS: Setenta e duas crianças com 2 a 12 anos foram submetidas a teste de puntura e dosagem de IgE específicas para alimentos (leite de vaca, ovo, soja, trigo). O teste de contato atópico foi aplicado em 3 grupos: (1) Dermatite Atópica com ou sem Rinite e Asma; (2) Rinite e ou Asma sem Dermatite Atópica; (3) Saudáveis. RESULTADOS: No grupo 1, 40% dos pacientes apresentaram reação positiva. Quanto maior o tempo de exposição, maior foi a sensibilidade. No grupo 2, o teste foi mais específico que sensível para todos os extratos; com aumento da sensibilidade com maior tempo de exposição (72h). No grupo 3, 8.3% apresentaram testes positivos. CONCLUSÃO: O teste de contato atópico mostrou ter valor diagnóstico em relação às reações de fase tardia a alimentos, com elevada especificidade. Mostrou-se um teste específico e confiável ao comparar com os resultados do grupo controle.

Abstract: Infective dermatitis associated with HTLV-1 (IDH) is the main cutaneous marker of HTLV-1 infection. This disease occurs primarily in children and should be differentiated from other eczemas, especially from atopic dermatitis. The largest series of IDH are from Jamaica and Brazil. There are an estimated 15 to 20 million infected people in the world, and Brazil is one of the endemic regions. Studies suggest that IDH in children may be a marker for the development of T-cell leukemia/lymphoma (ATL) or myelopathy associated with HTLV-1/tropical spastic paraparesis (HAM / TSP) in adulthood.

FUNDAMENTOS: É bastante divulgado, sem a fundamentação científica necessária, que a infecção por molusco contagioso tende a ser mais frequente e de maior intensidade nos pacientes acometidos por dermatite atópica. Tal fato motivou a realização deste trabalho. OBJETIVOS: Avaliar a prevalência de associação de dermatite atópica e molusco contagioso; avaliar se, nos pacientes com dermatite atópica, a infecção por molusco contagioso é mais recorrente e/ou disseminada e se a ocorrência de eczema perimolusco, prurido e/ou infecção é mais prevalente que nos pacientes sem dermatite atópica. MÉTODOS: Avaliaram-se 284 crianças de ambos os sexos, com diagnóstico de molusco contagioso e/ ou dermatite atópica. RESULTADOS: Apenas 13,4% dos pacientes apresentavam ambas as doenças. O número de áreas anatômicas afetadas por molusco contagioso, a ocorrência de eczema perimolusco e prurido foram maiores nos pacientes com dermatite atópica associada. Não houve diferença significativa de frequência de infecção secundária associada às lesões de molusco contagioso nos pacientes com e sem dermatite atópica. CONCLUSÃO: A prevalência da ocorrência de dermatite atópica e molusco contagioso associados foi baixa. Não houve diferença significativa na recorrência da infecção por molusco contagioso e na quantidade de lesões nos pacientes com e sem dermatite atópica. O número de áreas anatômicas afetadas por lesões de molusco contagioso, a presença de eczema perimolusco e de prurido foram maiores nos pacientes com dermatite atópica. Não houve diferença significativa na ocorrência de infecção bacteriana secundária nos grupos com e sem dermatite atópicaBACKGROUND: Although no scientific evidence has yet been published, it is widely understood that molluscum contagiosum tends to be more common and more intense in patients with atopic dermatitis. This lack of evidence led to the development of the present study. OBJECTIVES: To evaluate the prevalence of the association between atopic dermatitis and molluscum contagiosum; to evaluate whether molluscum contagiosum is more likely to be recurrent and/or disseminated in patients with atopic dermatitis and whether the occurrence of eczema surrounding the molluscum contagiosum lesions, pruritus and/or infection is more prevalent in these patients compared to patients without atopic dermatitis. METHODS: A total of 284 children of both sexes with a diagnosis of molluscum contagiosum and/or atopic dermatitis were evaluated. RESULTS: Only 13.4% of the patients had both conditions. The number of anatomical areas affected by molluscum contagiosum and the occurrence of surrounding eczema and pruritus was greater in the patients who also had atopic dermatitis. There was no statistically significant difference in the frequency of secondary infection associated with the molluscum contagiosum lesions between the patients who had atopic dermatitis and those who did not. CONCLUSION: The prevalence of atopic dermatitis associated with molluscum contagiosum was low. There was no statistically significant difference in the recurrence rates associated with molluscum contagiosum or in the number of lesions between the patients who had atopic dermatitis and those who did not. The number of anatomical areas affected by the molluscum contagiosum lesions and the presence of surrounding eczema and pruritus were higher in the patients with atopic dermatitis. There was no statistically significant difference in the occurrence of secondary bacterial infection between the groups with and without atopic dermatitis

FUNDAMENTOS: Não há consenso quanto ao efeito do aleitamento materno no desenvolvimento da dermatite atópica. É necessário aprofundar conhecimentos sobre possíveis fatores envolvidos nessa relação, como a influência do aleitamento materno na colonização do paciente atópico pelo Staphylococcus aureus (S. aureus). OBJETIVO: Avaliar uma potencial associação entre aleitamento materno e colonização pelo S. aureus nas crianças atópicas. MÉTODOS: Estudo transversal envolvendo 79 crianças atópicas de 4-24 meses, de ambos os sexos, em acompanhamento no Ambulatório de Dermatologia Sanitária de Porto Alegre, e 72 mães. Registraram-se dados clinicoepidemiológicos e de alimentação das crianças. Pesquisou-se a presença do S. aureus em swab nasal e cutâneo nas crianças e swab nasal das respectivas mães. Para análise dos dados, realizaram-se os testes qui-quadrado de Pearson e exato de Fischer. RESULTADOS: Entre as crianças amamentadas, S. aureus foi encontrado nas cavidades nasais de oito (25,8%) e na pele (fossas cubitais) de quatro (12,9%). Entre as não amamentadas, encontrou-se S. aureus nas cavidades nasais de dez (20,8%) e na pele de 11 (22,9%). Entre as mães, 16 (22,2%) apresentaram crescimento de S. aureus no material proveniente do swab nasal. Não se observou associação significativa entre aleitamento materno e colonização pelo S. aureus das cavidades nasais ou da pele das crianças. Entretanto, houve concordância entre a colonização pelo S. aureus nas cavidades nasais das mães e nas cavidades nasais e/ou na pele dos filhos. Das 72 duplas, houve concordância em 56 (77,8%). CONCLUSÃO: O aleitamento materno parece não influenciar a colonização mucocutânea pelo S. aureus em crianças com dermatite atópicaBACKGROUND: Studies on the effects of breastfeeding on the development of Atopic Dermatitis (AD) have shown controversial results. The importance of this condition deserves further studies; in particular, it remains unclear whether colonization of atopic patients by Staphylococcus aureus (S. aureus) through breastfeeding is relevant to the development of AD. OBJECTIVE: To examine the potential relation between breastfeeding and colonization by S. aureus in atopic patients. METHOD: Transversal study of atopic patients, aged from 4 to 24 months, both genders, receiving outpatient care and 72 mothers. Data on infant breastfeeding practices and on clinical-epidemiological profile were registered. Swabs of the infants' nares and skin (cubital fossa) and swabs of the mothers' nares were collected. For univariate analysis, X2 (chi-square) and Fischer Exact's test were used. RESULTS: Among breastfed children, S. aureus was isolated from 8 (25.8%) infants' nares swabs and from 4 (12.9%) skin swabs. Among not breastfed children, S. aureus was isolated from 10 (20.8%) infants' nares swabs and from 11 (22.9%) skin swabs. Sixteen mothers (22.2%) had S. aureus isolated from their nares swabs. There was no significant association between breastfeeding and S. aureus colonization (child skin and/or nares). However, there was a degree of concordance for S. aureus carriage among mothers and infants. Among 72 pairs, 56 (77.8%) were concordant. CONCLUSION: Breastfeeding was not associated with S. aureus muco-cutaneous colonization in atopic infants

FUNDAMENTOS: a dermatite atópica é uma doença inflamatória cutânea que apresenta múltiplos fatores desencadeantes. Há vários relatos de autores que confirmaram os aeroalérgenos como fatores agravantes ou desencadeantes. O teste de contato com aeroalérgenos ou teste de contato atópico foi proposto para avaliar a participação destes alérgenos na dermatite atópica. OBJETIVO: objetivo deste estudo foi avaliar a positividade do teste de contato atópico em pacientes com dermatite atópica. MÉTODOS: Avaliamos 50 pacientes com dermatite atópica e 45 do grupo com rinite alérgica, nos quais realizamos teste de contato atópico com extratos de Dermatophagoides pteronissynus, Dermatophagoides farinae e Blomia tropicalis, além de testes cutâneos de leitura imediata para os mesmos alérgenos, acrescidos de epitélio de cão e gato e fungos. RESULTADOS: verificamos que o teste de contato atópico com ácaros apresentou maior positividade nos indivíduos do grupo de dermatite atópica quando comparado ao grupo de rinite alérgica. CONCLUSÕES: o teste de contato atópico apresenta resultados estatisticamente significativos quando realizado com ácaros, em pacientes com dermatite atópica, com p=0,035, OR (odds ratio) = 3,35 e IC(95%) = [ 1,18; 9,47].BACKGROUND: Atopic dermatitis is an inflammatory skin disease that can be triggered by many factors. Several reports confirm the role of airborne allergic agents as aggravating or triggering factors. The patch test with airborne allergic agents or the atopy patch test was suggested to evaluate the role of these allergens in atopic dermatitis. OBJECTIVE: This study aimed at evaluating the positivity of the atopy patch test in patients with atopic dermatitis. METHODS: We evaluated 50 patients with atopic dermatitis and 45 with allergic rhinitis, the atopy patch test was performed in these patiennts with extracts of Dermatophagoides pteronissynus, Dermatophagoides farinae and Blomia tropicalis, as well as immediate skin prick tests for the same allergens with cat and dog epithelia and fungi. RESULTS: It was found that the atopy patch test with dust mites showed higher positivity in individuals with atopic dermatitis when compared to those with allergic rhinitis. CONCLUSIONS: The atopy patch test shows statistically significant results when performed with dust mites in patients with atopic dermatitis, p = 0.035, odds ratio (OR) = 3.35 and CI (95%) = [1.18, 9, 47].

O estudo da barreira cutânea e de suas propriedades ganhou impulso a partir da década de 60, com estudos que apontaram sua resistência de forma isolada e suas propriedades com relação à permeação cutânea. Paralelamente, a descrição dos corpos de Odland auxiliou a compreensão da manutenção da estabilidade da camada córnea. O modelo brick & mortar, em que os corneócitos são os tijolos e o cimento são os lipídeos intercelulares, é o mais aceito, até o momento. Atualmente, há evidências consistentes de que o estrato córneo é uma estrutura metabolicamente ativa e exerce funções adaptativas. A barreira cutânea também tem um papel na resposta inflamatória, com ativação de melanócitos, angiogênese e fibroplasia, cuja intensidade depende, basicamente, da intensidade da agressão. As anormalidades da barreira cutânea da dermatite atópica são clinicamente observáveis pela presença de pele seca, achado muito frequente e significativo, que constitui parâmetro iagnóstico e de acompanhamento. O grau de hidratação da camada córnea, assim como a perda de água transepidérmica (transepidermal water loss - TEWL), estão relacionados com o grau de dano à barreira, constituindo parâmetros biofísicos que permitem acompanhar os pacientes de maneira não invasiva e com maior grau de sensibilidade.Research about the skin barrier and its properties has increased significantly since the 60s, with studies that indicated its resistance when isolated, as well as its particularities in relation to skin permeability. At the same time, description of Odland bodies helped to understand how stratum corneum stability is maintained. The “brick and mortarâ€� model is the most accepted so far. In this analogy, the corneocytes are the bricks and the intercellular lipids are the mortar. Currently, there is concrete evidence that the stratum corneum is an active metabolic structure that holds adaptive functions, interacting dynamically with the underlying epidermal layers. The skin barrier also plays a role in the inflammatory response through melanocyte activation, angiogenesis, and fibroplasia. The intensity of this response will essentially depend on the severity of the injury. Skin barrier abnormalities in atopic dermatitis are clinically observed by the presence of dry skin, a common and significant symptom which constitutes a diagnostic and monitoring parameter. The stratum corneum hydration level and transepidermal water loss are associated with the level of damage to the barrier, representing biophysical parameters. These parameters help doctors monitor patients in a less invasive and more sensitive manner.

FUNDAMENTOS - Tacrolimo pomada é eficaz no tratamento da dermatite atópica. OBJETIVOS - Avaliar a eficácia e segurança do tacrolimo pomada 0,03% (Protopic®) no tratamento de pacientes pediátricos com dermatite atópica. MÉTODOS - Estudo multicêntrico, aberto e não comparativo. Incluídos 174 pacientes (dois a 10 anos)com dermatite atópica. Utilizou-se tacrolimo duas vezes ao dia, por seis semanas. O critério primário de eficácia foi a melhora clínica > a 90% avaliada pelo médico (Escala de Avaliação Global da Resposta Clínica). Outros critérios de eficácia foram a redução no índice de área e gravidade do eczema (EASI), a redução do percentual de superfície corporal afetada (%BSA) e a avaliação do prurido pelo paciente (escala analógica visual). Segurança foi avaliada pela ocorrência de eventos adversos relatados pelos pais e pacientes ou pelos investigadores. RESULTADOS - Trinta e três por cento dos pacientes apresentaram melhora clínica >90%. Quando avaliado o escore EASI, houve redução de 45,5% (primeira semana) e 61,8% (sexta semana) quando comparado com o basal (pBACKGROUND: Tacrolimus ointment has been shown to be effective in treatment of atopic dermatitis. OBJECTIVES: To evaluate the efficacy and safety of 0.03% tacrolimus ointment (Protopic®) in pediatric patients with mild, moderate and severe atopic dermatitis. METHODS: Open, non-comparative, multicentric study carried out in Brazil. 174 patients (ages from two to 10) with mild to severe atopic dermatitis were included. Patients were instructed to apply Protopic® twice a day for six weeks. Primary efficacy criterion was clinical improvement > 90% assessed by the physician (Clinical Response Global Evaluation Scale). Other efficacy criteria included reduction of the Eczema Area Severity Index (EASI), decrease of the affected body surface area (%BSA) and evaluation of the itching by the patients or their guardians (visual analogical scale). Safety was evaluated by adverse events reported by patients and/or guardians or by investigators. RESULTS: Thirty-three percent of patients showed clinical improvement > 90%. 45.5% of patients (1st week) decreased EASI and 61.8% (6th week) (p

A dermatite atópica é doença inflamatória cutânea associada à atopia, predisposição a produzir resposta IgE a alérgenos ambientais, constituindo uma das manifestações das doenças atópicas, junto com a asma e a rinite alérgica. A dermatite atópica é caracterizada por episódios recorrentes de eczema associado a prurido, acometendo superfície cutânea geneticamente alterada, induzindo, por fenômenos imunológicos, a presença de inflamação. Trata-se de doença multifatorial, com enfoque nas alterações sistêmicas e alérgicas ou nas manifestações cutâneas, de acordo com diferentes visões da doença. A conceituação da dermatite atópica é importante, porque a conduta terapêutica pode variar segundo essas duas formas diferentes de analisá-la. Autores modernos discutem extensivamente esses aspectos sem, contudo, alcançar uma conclusão sobre a dermatite atópica como doença sistêmica ou cutânea. A procura dos conceitos sobre a doença, desde os primeiros relatos, associada à evolução do pensamento na dermatologia, poderia esclarecer a origem dessas dúvidas. Uma análise histórica demonstra que a dermatite atópica tem seus conceitos atuais oriundos dos estudos de diversos pensadores, que, em diferentes momentos históricos, descreveram a doença, e que muito do que acreditamos atualmente tem, nesses escritos, seus fundamentos.Atopic dermatitis is an inflammatory disease associated to atopy, which is a predisposition to produce an IgE response to environmental allergens and considered one of the manifestations of the atopic diseases, including asthma and allergic rhinitis. Atopic dermatitis is characterized by recurrent eczema flares, associated to pruritus, affecting a genetically disrupted skin surface, inducing, by immunological phenomena, the onset of inflammation. It is a multifactorial disease, with an emphasis on systemic and allergic alterations or skin manifestations, according to different concepts. The definition of atopic dermatitis is important, since its management may vary according to these two different points of view. Modern authors have extensively discussed these concepts, though with no conclusion as to its nature - systemic or cutaneous disease. The search for concepts about the disease, since its first descriptions, associated to the evolution of the dermatology rationale through history, may help understand the origin of these doubts. A historical analysis demonstrates that the currently accepted concepts of atopic dermatitis have their background from different researchers, who, at different historical moments, described the disease, and a great part of our beliefs about atopic dermatitis are related to these ancient writings.

This review summarizes the general approach and philosophy of managing difficult atopic dermatitis. There are as many regimens as there are physicians, but too many fail to provide patients with adequate relief. This leads to the wasteful alternative - an allergy-seeking behavior that makes caring for these patients even more complicated. If we, as dermatologists, provide rational counseling on prevention and skin care along with effective, stable, anti-inflammatory therapy, our patients may stop seeking irrational approaches. The new flood of information relating to epidermal barrier provides a basis for seeking and treating xerotic conditions earlier during infancy with the hope that the increasing problems with atopic dermatitis and asthma may be lessened with simple and safe measures.Esta revisão resume a abordagem geral e a filosofia na conduta de casos difíceis de dermatite atópica. Existe uma variedade de tratamentos, assim como de médicos, mas muitos falham e não propiciam um alívio adequado aos pacientes, o que leva a uma alternativa dispendiosa, ou seja, um atitude que visa procurar alergias e complica ainda mais o tratamento desses pacientes. Se nós, como dermatologistas, oferecermos um aconselhamento racional sobre prevenção e cuidados com a pele, junto com uma terapia antiinflamatória eficaz e estável, nossos pacientes irão parar de procurar abordagens irracionais. O novo fluxo de informações sobre a barreira epidérmica propicia uma base para investigar e tratar as doenças xeróticas em uma fase mais precoce durante o primeiro ano de vida, com a esperança de que os problemas crescentes relacionados à dermatite atópica e asma possam ser atenuados com medidas simples e seguras.

Atopic dermatitis is a chronic, non-contagious disease characterized by intense itching, dry skin and skin inflammation. Children in early life are the most affected population, especially those with a family history and with contact with triggers such as food and airborne allergens. In this sense, vitamin D appears to play a role in disease remission, because studies show an inverse relationship between micronutrient levels and exacerbation of symptoms. Research also indicates the importance of supplements intake, with a consequent benefit to the immune system. Therefore, the objective of this study is to describe the main aspects of atopic dermatitis and vitamin D, with respect to metabolic, nutritional and immune questions. [ABSTRACT FROM AUTHOR]

Medicina alternativa ou complementar é definida como forma de terapia que não possui bases científicas ou eficácia comprovadas. O objetivo deste estudo foi investigar a prevalência do uso dessas terapias por pacientes pediátricos com dermatite atópica no Hospital Universitário de Brasília, no período de março de 2007 a dezembro de 2008. Um total de 54 pacientes (63,5%) utilizou algum tipo de recurso alternativo, fitoterapia e homeopatia foram os recursos alternativos mais utilizados.Complementary or Alternative Medicine is defined as a form of therapy that has no scientific basis or proven effectiveness. The aim of this study was to investigate the prevalence of the use of such therapies for pediatric patients with atopic dermatitis at the University Hospital of Brasília, in the period between March 2007 and December 2008. A total number of 54 patients (63.5%) used some kind of alternative resource and phytotherapy and homeopathy were the most used ones.