ANAIS BRASILEIROS DE DERMATOLOGIA JANUARY/FEBRUARY 2025 V. 100 N. 1| 1–214 Official publication of the Brazilian Society of Dermatology Anais Brasileiros de Dermatologia ❑ The Brazilian Society of Dermatology on the centennial of the Anais Brasileiros de Dermatologia ❑ Anais Brasileiros de Dermatologia: 100 years of history (1925 – 2025) ❑ Primary cutaneous cryptococcosis – History, concepts, clinical and therapeutic update ❑ Adverse effects of the aesthetic use of botulinum toxin and dermal fillers in the face: a narrative review FI = 2,6 VOLUME 100 ■ NUMBER 1 ■ 2025 www.anaisdedermatologia.org.br
Volume 100. Number 1. January/February 2025 CONTENTS Editorial The Brazilian Society of Dermatology on the centennial of the Anais Brasileiros de Dermatologia ........................... 1 Heitor de Sá Gonçalves, Carlos Baptista Barcaui, Francisca Regina Oliveira Carneiro, Márcio Soares Serra, Rosana Lazzarini and Fabiane Andrade Mulinari Brenner Special Article Anais Brasileiros de Dermatologia: 100 years of history (1925–2025) .............................................................. 3 Sílvio Alencar Marques, Ana Maria Ferreira Roselino, Hiram Larangeira de Almeida Junior and Luciana Patrícia Fernandes Abbade Continuing Medical Education Primary cutaneous cryptococcosis – History, concepts, clinical and therapeutic update........................................ 12 Sílvio Alencar Marques and Rosangela Maria Pires de Camargo Original Articles Clinical and dermoscopic patterns of acquired melanocytic nevi in children and adolescents: a cross-sectional study from Turkey........................................................................................................................... 22 Zeynep Keskinkaya, Özge Kaya, Selda Işık Mermutluc, Hilay Garipcan Karaemird and Sevilay Oğuz Kılıçe Comparison of long term effi cacy and cost-effectiveness of omalizumab in 150mg and 300mg doses in patients with chronic spontaneous urticaria ...................................................................................................... 31 Fikriye Kalkan, Sait Yeşillik, Fevzi Demirel, Ezgi Sönmez,Yasemin Balaban, Mustafa İlker İnan and Özgür Kartal Effi cacy and safety of narrowband ultraviolet B phototherapy for prurigo nodularis: a tertiary center experience ....... 38 Esra Agaoglu, Hilal Kaya Erdogan, Ersoy Acer and Zeynep Nurhan Saracoglu Plantar acral melanoma: epidemiological, clinical, dermoscopic and histopathological features. A Brazilian cohort ..... 45 Lucas Campos Garcia, João Renato Vianna Gontijo and Flávia Vasques Bittencourt Red light-emitting diode on skin healing: an in vitro and in vivo experimental study........................................... 54 Tuany R. Schmidt, Belkiss C. Mármora, Fernanda T. Brochado, Lucas Gonçalves, Paloma S. Campos, Marcelo L. Lamers, Aurigena A. de Araújo, Caroline A.C.X. de Medeiros, Susana B. Ribeiro, Marco A.T. Martins, Emily F.S. Pilar, Manoela D. Martins and Vivian P. Wagner Skin cancer after heart transplantation: a systematic review....................................................................... 63 Nathalia Hoffmann Guarda Aguzzoli, Ana Laura Bueno, Yağmur Halezeroğlu and Renan Rangel Bonamigo Reviews Adverse effects of the aesthetic use of botulinum toxin and dermal fi llers on the face: a narrative review................ 87 Érico Pampado Di Santis, Sergio Henrique Hirata, Giulia Martins Di Santis and Samira Yarak DRESS syndrome: an interaction between drugs, latent viruses, and the immune system...................................... 104 Paulo Ricardo Criado, Mayra Ianhez, Hélio Amante Miot, Roberta Fachini Jardim Criado, Carolina Talhari and Paulo Müller Ramos
Exploring the reality of exosomes in dermatology..................................................................................... 121 Taciana Dal’Forno-Dini, Martina Souilljee Birck, Marco Rocha and Edileia Bagatin The exposome impact on hair health: etiology, pathogenesis and clinical features — Part I ................................... 131 Stephano Cedirian, Ludmila Prudkin, Bianca Maria Piraccini, Julia Santamaria, Jaime Piquero-Casals and David Saceda-Corralo Letter - Research Brazilian experience with oral atenolol in the treatment of infantile hemangiomas ............................................ 141 Tauana Ogata Coelho da Rocha, Beatrice Nóbrega Dantas Berenguer, Camila Barreto Vianna Martins, Vanessa Rolim Bessa, Luciana Paula Samorano, Maria Cecília Rivitti-Machado and Zilda Najjar Prado de Oliveira Clinical and epidemiological characterization of demodicosis cases in the pediatric population at the Hospital Clinic of the University of Chile (2013-2020) ........................................................................................... 145 Claudia Schroder, Matías Gárate, Diego Orlandi, Ligia Aranibar and Francisco Silva Chronic actinic dermatitis: a retrospective study of epicutaneous and photo epicutaneous tests between 2007-2023 .................................................................................................................................... 148 Maria Antonieta Rios Scherrer, Mariana David Cangussu Fernandes Ribeiro, Hannah Barbosa Lopes dos Anjos and Vanessa Barreto Rocha Dermatofi broma: clinicopathological analysis of 239 cases .......................................................................... 150 Dilara˙Ilhan Erdil, Cem Leblebici, Duygu Erdil, Vildan Manav, Vefa Aslı Erdemir and Ay¸se Esra Koku Aksu Dissecting cellulitis of the scalp: clinical characteristics and impact on quality of life of 66 Brazilian patients............ 155 Paula Gerlero, Isabela Peron, Isabella Doche, Evelyn Freitas Rodrigues, Thalita Macedo and Maria Cecília Rivitti-Machado Evaluation of how facial sunscreens are applied by the population: an approach beyond the product quantity ........... 158 Lucivaldo Fernandes Cruz, Catarina Silva Guimarães, Bianca Lemos Oliveira, Bruna Santana Neves, Caio Ferraz Cabral de Araújo, Maria Clara Botelho de Sousa, Vinicius Rosenbergre dos Santos Carmo, Juliano Geraldo Amaral and Gabriel Azevedo de Brito Damasceno Prevalence of positivity in patch tests and reactivity to substances present in the main dressings in patients with chronic leg ulcers..................................................................................................................... 162 Ísis Fiorello de Oliveira Mesquita, Larissa Pierri Carvalho Fonseca, Maria Rita Parise Fortes, Hélio Amante Miot and Luciana Patricia Fernandes Abbade Translation, cultural adaptation and validation of the Brazilian version of the Frontal Fibrosing Alopecia Quality of Life Index (FFA-QLI-BRA) ........................................................................................................................ 165 Paula Rosa Coutinho Goulart Borges Mariottoni, Leonardo Spagnol Abraham, Leopoldo Duailibe Nogueira Santos, Daniel Fernandes Melo, Rodrigo Pirmez, Paulo Müller Ramos and Hélio Amante Miot Letter – Clinical A case of segmental acquired reactive perforating collagenosis: case report and literature review of the unique presentation ................................................................................................................................. 169 Yudai Yamauchi, Noritaka Oyama and Minoru Hasegawa Allergic contact dermatitis to lettuce ................................................................................................... 172 Mariany Lima Rezende, Ana Luiza Castro Fernandes Villarinho, Maria das Graças Mota Melo and Clarissa Vita Campos Amyloidosis cutis dyschromica caused by compound heterozygous GPNMB mutations in a Chinese pedigree ............... 174 Ci-Juan Zhong, Fang-Gu Li, Wen Li and Yi-Ming Fan Bullous pemphigoid mimicking toxic epidermal necrolysis........................................................................... 178 Hiram Larangeira de Almeida Jr., Rodrigo Piltcher da Silva and Valéria Magalhães Jorge Granulomatous reaction after facial fi ller during metastatic melanoma treatment with immunotherapy: a case report.......... 181 Luana Pizarro Meneghello, Diéssica Gisele Schulz, Verônica Hamann Aita and Marcio Freitas Valle de Lemos Weber Monozygotic twins affected by SAPHO syndrome ...................................................................................... 183 Ilaria Scandagli, Elia Rosi, Gianmarco Silvi, Matteo Ruggieri, Tommaso Amadori and Francesca Prignano
Pigmented mammary Paget disease: a diagnostic challenge......................................................................... 185 Esranur Ünal, Bengü Nisa Akay and Gökçen Gündoğan Plaque psoriasis on the tongue: case report............................................................................................ 188 Lucas Campos Garcia, Nicole Vieira Schwan, Jésus Faria Rosa Júnior and Andrea Machado Coelho Ramos Vohwinkel syndrome with de novo heterozygous mutation in the GJB2 gene - c.175G>A (p. Gly59Ser) ...................... 190 María Caridad Duran-Lemarie, Luis Enrique Cano-Aguilar, Edmar Obed Benitez-Alonso, Dalia Cruz-Sotomayor, Uriel Villela-Segura and Hector Proy-Trujillo Letter - Dermatopathology Neurothecoma in the tibial region ....................................................................................................... 194 Mariana Abdo de Almeida, Neusa Yuriko Sakai Valente, Eduardo César Diniz Macêdo, Bruna Nascimento Arruda Scabello and Patrícia Porto de Oliveira Grossi Letter - Tropical/Infectious and Parasitic Dermatology Bariatric surgery complicating the treatment of choice for Sporotrichosis: report of two cases .............................. 198 Maria Eduarda Resende Melo, Melissa Orzechowski Xavier, Rossana Patricia Basso, Karine Ortiz Sanchotene, Fabiana Fedatto Bernardon and Vanice Rodrigues Poester Cutaneous amoebiasis: a dermatological rarity........................................................................................ 200 John Verrinder Veasey, Helena Pladevall Moreira, Mariana de Figueiredo Silva Hafner and Rute Facchini Lellis Letter – Therapy Facial cutaneous Rosai-Dorfman disease treated with pulsed dye laser: a case report and literature review .............. 204 Qin-Xiao Wang, Si-Yu Luo, Kai-Yi Zhou and Sheng Fang Surgical avulsion of the nail plate as therapy for resistant onychomycosis: case series and literature review.............. 207 José Antônio Jabur da Cunha, Fernanda Santana Barbosa, Gustavo de Sá Menezes Carvalho and John Verrinder Veasey Treatment of nail psoriasis with intralesional methotrexate: report of four cases demonstrating an effective and safe approach with lower doses ................................................................................................................ 211 Angélica Seidel, Marcelo Rigatti, Débora Cadore de Farias, Ana Paula Bald and José Ricardo Grams Schmitz
Anais Brasileiros de Dermatologia 2025;100(1):1--2 Anais Brasileiros de Dermatologia www.anaisdedermatologia.org.br EDITORIAL The Brazilian Society of Dermatology on the centennial of the Anais Brasileiros de Dermatologia It was the year 1925, during which many events in Brazilian economic, political and social life took place. The world was going through a period of transition and reconstruction after World War I (1914-1918). Many European countries were still recovering from the devastating effects of the war and economies were trying to stabilize and rebuild, and there was a widespread desire for stability and peace. In Brazil, the first national automobile factory, General Motors, was opened in São Paulo. In that same year, Irineu Marinho founded OGlobo, a daily newspaper, and the first São Silvestre Race was held. At the same time, thirteen years after the founding of the Brazilian Society of Dermatology (SBD), Eduardo Rabello was responsible for the first issue of Anais Brasileiros de Dermatologia, still under Fernando Terra administration at SBD. When we leaf through the first issue of Annaes Brasileiros de Dermatologia e Syphilographia, dated January 1925, kept in the largest Dermatology library in South America, at SBD headquarters in Rio de Janeiro; in addition to the peculiar smell of very old paper, it is possible to feel the enthusiasm with which Eduardo Rabello, faithful to the French Dermatology, decided to create a larger publication with a scientific purpose.1 Although it has always been a journal under the scientific supervision of the Brazilian Society of Dermatology, curiously, during its first 22 years of existence, Anais Brasileiros de Dermatologia was owned by individuals, and its first owner was Oscar Silva Araújo. It was only on October 10, 1947, that Antônio Fernandes da Costa Júnior, then President of SBD transferred the rights of Anais Brasileiros de Dermatologia to the assets of our society, according to the deed signed on that occasion at the 16th Notary Office of the City of Rio de Janeiro.2 Study conducted at the Board of Directors of the Brazilian Society of Dermatology 2023--2024 Administration, Brazilian Society of Dermatology, Rio de Janeiro, RJ, Brazil. With the exception of the year 1931, when the journal was not published due to financial constraints for the construction of Pavilhão São Miguel, Anais Brasileiros de Dermatologia has reached its centennial without publication interruption. A World War, the Cold War, the landing on the moon, the fall of the Berlin Wall, pandemics, and 21 years of military government in Brazil, none of these prevented our journal from being published, gradually gaining worldwide scientific relevance. On behalf of the SBD, we would like to thank each Chief Editor and their editorial teams since the founding of ABD for the brilliant work they have performed, as well as all the authors who submitted their scientific works to the scrutiny of our Society. We recently achieved the highest Impact Factor ever achieved by a Dermatology journal in South America. This is the result of the consistent work carried out throughout this century of existence. In the current context, the challenge remains to keep our journal relevant to the scientific community. Our greatest vocation in Brazil has always been issuing publications related to infectious and parasitic diseases, a vanguard that we can never forget. On the other hand, the number of international articles that are submitted is ever-increasing. By connecting these two realities, we have everything we need to increase the international competitiveness of ABD, always seeking excellence and honoring all those who preceded us in the running of this journal over the last one hundred years. Financial support None declared. Authors’ contributions Heitor de Sá Gon¸calves: Approval of the final version of the manuscript; drafting and editing of the manuscript. https://doi.org/10.1016/j.abd.2024.09.001 0365-0596/© 2024 Published by Elsevier Espan˜a, S.L.U. on behalf of Sociedade Brasileira de Dermatologia. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
EDITORIAL Carlos Baptista Barcaui: Approval of the final version of the manuscript; drafting and editing of the manuscript. Francisca Regina Oliveira Carneiro: Approval of the final version of the manuscript; drafting and editing of the manuscript. Márcio Soares Serra: Approval of the final version of the manuscript; drafting and editing the manuscript. Rosana Lazzarini: Approval of the final version of the manuscript; drafting and editing of the manuscript. Fabiane Andrade Mulinari Brenner: Approval of the final version of the manuscript; drafting and editing of the manuscript. Conflicts of interest None declared. References 1. Rabello E, editor. Editorial. Annaes Brasileiros de Dermatologia e Syphilographia. 1925;1:1-2. 2. Carneiro G. Anais Brasileiros de Dermatologia. In: História da Dermatologia no Brasil. Rio de Janeiro: Sociedade Brasileira de Dermatologia; 2002. p. 61--9. Heitor de Sá Gon¸calves a, Carlos Baptista Barcaui b, Francisca Regina Oliveira Carneiro c,∗, Márcio Soares Serra d, Rosana Lazzarini e, Fabiane Andrade Mulinari Brenner f a Centro de Referência Nacional em Dermatologia Sanitária Dona Libânia, Secretaria da Saúde, Governo do Estado do Ceará, Fortaleza, CE, Brazil b Instituto de Dermatologia Prof. Rubem David Azulay, Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil c Department of Dermatology, Universidade do Estado do Pará, Belém, PA, Brazil d Private Practice, RJ, Rio de Janeiro, Brazil e Dermatology Clinic, Irmandade Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil f Service of Dermatology, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil ∗Corresponding author. E-mail address: francisca.carneiro@uepa.br (F. Regina Oliveira Carneiro). Received 1 September 2024 Available online 28 October 2024 2
Anais Brasileiros de Dermatologia 2025;100(1):3--11 Anais Brasileiros de Dermatologia www.anaisdedermatologia.org.br SPECIAL ARTICLE Anais Brasileiros de Dermatologia: 100 years of history (1925--2025) Sílvio Alencar Marques a,∗, Ana Maria Ferreira Roselino b, Hiram Larangeira de Almeida Junior c,d, Luciana Patrícia Fernandes Abbade a a Department of Infectology, Dermatology, Diagnostic Imaging and Radiotherapy, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brazil b Department of Internal Medicine, Division of Dermatology, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil c Department of Dermatology, Universidade Federal de Pelotas, Pelotas, RS, Brazil d Department of Dermatology, Universidade Católica de Pelotas, Pelotas, RS, Brazil Received 30 August 2024; accepted 31 August 2024 Available online 5 November 2024 KEYWORDS Anais Brasileiros de Dermatologia; Dermatology; History Abstract The month of January 1925 marks the birth of theAnnaes Brasileiros de Dermatologia e Syphilografia and currently, 100 years later, with great merit, we celebrate its evolution into Anais Brasileiros de Dermatologia (ABD). Indeed, those few brilliant pioneers never dreamed of the strength of the Brazilian Society of Dermatology nowadays. However, perhaps they envisioned a relevant role for ABD, with a natural space for dermatoses of infectious etiology, always prevalent in tropical and subtropical regions. And thus, it was established for decades. Currently, Brazilian Dermatology and ABD are plural and open to the different facets of Dermatology. However, both the specialty, Dermatology, and its official body, ABD, value and pay homage to history, and cannot forget or stray from it. Numerous challenges have been faced over the past 100 years. Many other challenges still remain, but it is up to us, as a gift to the 100th anniversary of the Anais Brasileiros de Dermatologia, to learn about them and reflect on them. The following text provides a summary of the history of ABD over the years. We invite national and international readers to celebrate with us. © 2024 Sociedade Brasileira de Dermatologia. Published by Elsevier Espan˜a, S.L.U. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). Study conducted at the Department of Infectology, Dermatology, Diagnostic Imaging and Radiotherapy, Universidade Estadual Paulista, Botucatu, SP, Brazil. ∗ Corresponding author. E-mail: silvio.marques@unesp.br (S.A. Marques). Foundation of the Brazilian Society of Dermatology and the Bulletin in 1912 The history of Anais Brasileiros de Dermatologia(ABD) began in 1912 with the founding of the Brazilian Society of Dermatology (SBD, Sociedade Brasileira de Dermatologia) and, in the same year, the publication of the first Bulletin of the https://doi.org/10.1016/j.abd.2024.08.001 0365-0596/© 2024 Sociedade Brasileira de Dermatologia. Published by Elsevier Espan˜a, S.L.U. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
S.A. Marques, A.M. Roselino, H.L. Almeida Junior et al. Figure 1 First Bulletin of the Brazilian Society of Dermatology -- 1912. Brazilian Society of Dermatology (Fig. 1).1,2 This publication aimed to disseminate clinical cases presented at scientific meetings held at the Santa Casa de Misericórdia in Rio de Janeiro, as well as to publish discussions arising from these meetings. The predominant topics in this first bulletin were infectious diseases, particularly leishmaniasis and blastomycosis (currently, paracoccidioidomycosis). Under the initial direction of dermatologist Dr. Fernando Terra, the Bulletin was published quarterly between 1912 and 1920 and it is considered a precursor and inspiration for ABD. Annaes Brasileiros de Dermatologia e Syphilographia/Anais Brasileiros de Dermatologia e Sifilografia/Anais Brasileiros de Dermatologia (1925 to nowadays) ABD officially appeared in January 1925, through the hands of Prof. Eduardo Rabello, as Chief Editor, under the name Annaes Brasileiros de Dermatologia e Syphilographia (Fig. 2).2 The Annaes, in the editorial of its first issue, jus4
Anais Brasileiros de Dermatologia 2025;100(1):3--11 Figure 2 First issue of Annaes Brasileiros de Dermatologia e Syphilografia -- 1925. 5
S.A. Marques, A.M. Roselino, H.L. Almeida Junior et al. Figure 3 Original memoirs. Leishmaniasis. 6
Anais Brasileiros de Dermatologia 2025;100(1):3--11 Table 1 Chief Editors (1925--2004). Scientific Editors (2004--2025). Name Period Eduardo Rabello 1925--1926 Oscar da Silva Araújo 1927--1937 Eduardo Rabello 1938--1940 Oscar da Silva Araújo 1941 Francisco Eduardo Rabello 1942--1945 Hildebrando Marcondes Portugal 1946--1947 Antar Padilha-Gon¸calves 1948--1962 Demétrio Peryassu 1963--1969 Rubem David Azulay 1970--1972 Sílvio Fraga 1973 Rubem David Azulay 1974--1992 Absalom Lima Filgueira 1993--1997 Jesus Rodrigues Santamaría 1998 Leninha Valério do Nascimento 1998--2004 Bernardo Gontijo 2004--2008 Izelda Maria Carvalho Costa 2009--2015 Sinésio Talhari 2016--2020 Sílvio Alencar Marques 2021--2025 tified the initiative of creating a new scientific journal due to the growth of the specialty, the existence of Dermatology journals in other countries in South and North America, and the epidemiological relevance in Brazil of the then-called venereal diseases, particularly syphilis.3 Also, due to the increase of research into tropical diseases, including those of dermatological interest, initially under the leadership of the Instituto de Patologia Experimental de Manguinhos and, from 1917 onwards, under the definitive name of Instituto Oswaldo Cruz, both leadership centers for producing and stimulating scientific research. Just like the Bulletin that preceded them, theAnnaes published clinical cases of interest, but it already incorporated scientific studies in the form of experimental laboratory tests and relevant conceptual articles as Original Memoirs (Fig. 3).4 Over the years, the Annaes overcame periods of national and international political crises, internal conflicts, external conflicts on a global scale, and economic difficulties of all kinds. The initial proposal of being a bimonthly journal was not always feasible, and during the year 1931, for purely economic reasons, the Annaes stopped being published and, in 1932, only one issue was published. From 1933 to the present day, the publication has been uninterrupted and it published three issues a year until 1983, when they were increased to six issues a year. The Annaes preceded the idea or the holding of the Brazilian Congresses of Dermatology and, therefore, since its founding, it has been one of the main transmitters of the academic word of SBD. At least during the first half of the 20th century, due to the small number of Medical Schools, Dermatology Services, and Research Institutes with scientific production, ABD remained alive due to the dedication of a few dermatologists with an academic interest and mindset. Table 1 lists the Chief Editors of ABD from its foundation to the present day. Fig. 4 depicts different covers used over the years until they settled on the various shades of green. It should be noted that in 1933 the spelling of Annaes Brasileiros de Dermatologia e Syphilographia was changed to Anais Brasileiros de Dermatologia e Sifilografia, and in 1961 it was given its current and definitive name of Anais Brasileiros de Dermatologia. It is very important to note that there is no Brazilian Annals of Dermatology, as it is sometimes observed in articles or references. Achievement of indexing A great leap in quality and modernity of ABD occurred from 1980 onwards and, even more so, from 1983 onwards, under the coordination of the then Chief Editor, Prof. Rubem David Azulay, when bimonthly publications were consolidated and an attempt was made to prioritize research articles.5 After being included in the LILACS (Latin American and Caribbean Literature in Health Sciences) database in 1981, ABD started being indexed in SciELO (Scientific Electronic Library Online) in 2003, when Prof. Leninha Valério do Nascimento held the position of Chief Editor (1998--2004). It should be noted that efforts began, during this administration, to obtain indexing in PubMed, the search platform of the National Library of Medicine (NLM), which gathers records from the MEDLINE (Medical Literature Analysis and Retrieval System Online) database. This is the international reference database, implemented in 1997, and is extremely demanding and judicious in incorporating new journals. During this period, in addition to including new sections, with an emphasis on Continuing Medical Education, the first application for PubMed/MEDLINE indexing was made, which was unsuccessful for several reasons. However, it was a crucial step, since the reasons for the refusal were reported by the National Center for Biotechnology Information (NCBI), a division of the NLM in the United States of America. With the knowledge of these reports, the following administration (2004-2008), under Prof. Bernardo Gontijo as Chief Editor, began working to improve what had been identified as insufficient in the first application. This was clearly a difficult task since one of the assessed and criticized criteria was the low percentage of original research articles published in each issue. At the time, this situation of publishing few research articles was the result of ABD being mostly a national journal, with less power of attraction, in this regard, when compared to other national journals with greater status and tradition. In other words, the scientific production originating from postgraduate programs, research institutions, and Dermatology Services, as well as their most robust clinical cases, were directed to international journals or to the most prestigious national ones. Breaking the negative vicious cycle of publishing few research articles due to lack of status and, consequently, not attaining sufficient status due to the inability to publish a greater number of articles of higher scientific standard, was the main objective of the 20042008 management of ABD. During this administration, other initiatives were implemented, such as improved editorial and graphic techniques, greater care and demand regarding the quality of clinical and histopathological photographs, and the necessary rigor in complying with the periodicity required of high-quality journals. In 2008, confident in the good work performed, with care in providing detailed information regarding the revamped ABD, supported by the 7
S.A. Marques, A.M. Roselino, H.L. Almeida Junior et al. Figure 4 Historical covers (1912--2012). quality of the writing in the English language, a new request for indexing was submitted to NCBI/NLM. In 2009, during the following administration, under Prof. Izelda Maria Carvalho Costa (2009-2015), information was released that ABD had been formally accepted and was now included in the PubMed/MEDLINE database, an undisputed international reference. This achievement was a decisive one, constituting an essential milestone for ABD to grow and acquire the desired national and international status. Also during Prof. Izelda administration, ABD started having articles submitted to the journal and reviewed by reviewers in a completely digital, online format, which is also an essential step towards becoming a modern journal with international ambitions. Historical covers encompassing the period from 2012 to 2024 are shown in Fig. 5. It is important to emphasize that, since its first issue, ABD has been fully funded by the Brazilian Society of Dermatology, characterizing itself as one of its academic voices. Equally commendable is the SBD respect for the academic independence of ABD. An additional notable characteristic is that it has remained, to this day, an open-access journal, in the Portuguese and English languages, with no submission or publication costs for neither national nor international authors. 8
Anais Brasileiros de Dermatologia 2025;100(1):3--11 Figure 5 Historical covers (2013--2024). Growing metrics and international visibility Prof. Bernardo Gontijo requested to the Thomson-Reuters Corporation in 2008 that ABD be audited and in 2009 its first Impact Factor (IF) was reported and published by the Journal of Citation Reports. In 2010, ABD started with an IF = 0.337; in 2013, it was 0.866 and, 10 years later, in 2023, it had robust values of IF = 2.6, occupying the 34th position in the ranking of 91 journals of Dermatology and related specialties, that is, an evolution to Quartile 2 among the audited journals (Fig. 6).6 A decisive step towards this success must also be credited to the management of Chief Editor Prof. Sinésio Talhari (2016--2020), transferring all the journal procedures to Elsevier Publishers, from the submission to final publication in print and online. This decision, which was not a simple one, had the financial and logistical support of the SBD Board at the time, with undeniable gains regarding the dissemination and consequent internationalization of the journal. Another extremely important metric for scientific journals is CiteScore. While the IF counts citations received in the reference year for articles published in the two previous years and considers articles as citable according to its own criteria and a more restricted source journal database, CiteScore expands its analysis to include articles published in the four previous years. Furthermore, regardless of the section and type, all articles are counted to make up the denominator of the equation. The mathematical formulas used to arrive at the IF and CiteScore are shown in Figs. 7 and 8, respectively. Increasing national and international visibility and continuing to be an open-access journal with free publication resulted in a significant increase in the number of submissions. Consequently, it was necessary to implement a rigorous policy for selecting and accepting manuscripts, penalizing some of the sections most sought after by authors for submitting articles. The new reality and the need to maintain the growth dynamics of ABD have led the cur9
S.A. Marques, A.M. Roselino, H.L. Almeida Junior et al. Figure 6 Impact factor of Anais Brasileiros de Dermatologia (2010--2023). Figure 7 Calculation of the Impact Factor. rent management to gradually eliminate some sections and expand the ‘‘Letters’’ section, with subsections, some relevant to the interests of Dermatology at the time, such as ‘‘Letters-Therapy’’, for example.7 Challenges and proposals Anais Brasileiros de Dermatologia and the Actas DermoSifiliográficas are the only two journals from Ibero-Latin American countries indexed in the main scientific databases and, therefore, responsible for representing Ibero-Latin American Dermatology well. ABD are responsible for constantly updating and modernizing themselves, on par with journals with greater tradition and/or status. In this sense, the Deliberative Board of the Brazilian Society of Dermatology should discuss and decide on making the ABD published exclusively in English, aware that this is the international scientific language. We must be aware that even the Portuguese Society of Dermatology and Venereology has been publishing its official journal, the Portuguese Journal of Dermatology and Venereology, exclusively in English for several years. However, unlike the initiative of its sister society, the sine qua nonproposal is to continue with the current and historical name of Anais Brasileiros de Dermatologia. Another proposal to be discussed will be whether or not the journal will remain in print or be published exclusively online. This is a somewhat controversial issue, but from an economic and sustainability point of view, it is an evolution that can be considered irreversible, since this initiative is already practiced by many journals, whether in Dermatology or related specialties. The continuation of the journal as an open-access journal should also be discussed, with or without maintaining full and free access, both in terms of 10
Anais Brasileiros de Dermatologia 2025;100(1):3--11 Figure 8 CiteScore calculation. submission and publication. Aiming to honor and respect the legal representation of SBD Deliberative Board, the decisions taken therein should reflect the will of all members and, for that reason, be accepted by all. Therefore, it is intended that when the year 2026 dawns, with new practices and also a new Chief Editor and, consequently, new management, ABD will aim at higher goals with greater clarity regarding the existing base and future challenges. Last, but not least, ABD would like to express its immense gratitude to its Scientific Editors and members, over time, of the different Boards of Directors of the Brazilian Society of Dermatology, for their support, to the Authors, to the Reviewers, and to the daily and indispensable work of its Technical Collaborators. Financial support None declared. Authors’ contributions Silvio Alencar Marques: Approval of the final version of the manuscript; drafting and editing of the manuscript. Ana Maria Roselino: Approval of the final version of the manuscript; drafting and editing of the manuscript. Hiram Larangeira de Almeida Junior: Approval of the final version of the manuscript; drafting and editing of the manuscript. Luciana P. Fernandes Abbade: Approval of the final version of the manuscript; drafting and editing of the manuscript. Conflicts of interest None declared. References 1. Sociedade Brasileira de Dermatologia. Boletim da Sociedade Brasileira de Dermatologia 1912;1:(1-3). 2. Costa IMC, Bonamigo RR, Vallarelli AFA, Reis VMS. Evolu¸cão histórica dos Anais Brasileiros de Dermatologia. An Bras Dermatol. 2012;87(Supl. 1):1--192. 3. Rabello E. Editorial. An Bras Dermatol Syphilogr. 1925;1:1--2. 4. Rabello E. Contribui¸cões ao estudo da leishmaniose tegumentar no Brasil. Parte 1. História e Synonimia. An Bras Dermatol Sifilogr. 1925;1:3. 5. Azulay RD. Editorial. An Bras Dermatol. 1983;58:1. 6. Marques SA, Roselino AM, Almeida Jr HL, Abbade LPF. Anais Brasileiros de Dermatologia - Impact Factor and CiteScore for 2023. An Bras Dermatol. 2024;99(6):797--8. 7. Costa LL, Bedrikow RB, Proen¸ca CGC, Lellis RF. Successful treatment with narrowband UVB in a recalcitrant case of IgA pemphigus. An Bras Dermatol. 2023;99:730--2. 11
Anais Brasileiros de Dermatologia 2025;100(1):12--21 Anais Brasileiros de Dermatologia www.anaisdedermatologia.org.br CONTINUING MEDICAL EDUCATION Primary cutaneous cryptococcosis -- History, concepts, clinical and therapeutic update Sílvio Alencar Marques ∗, Rosangela Maria Pires de Camargo Department of Infectology, Dermatology, Diagnostic Imaging and Radiotherapy, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil Received 18 April 2024; accepted 15 July 2024 Available online 15 November 2024 KEYWORDS Clinical medicine; Cryptococcosis; Cryptococcosis/diagnosis; Cryptococcosis/therapy; Mycology Abstract Cryptococcosis is a disease caused by fungi of the genus Cryptococcus, with the speciesCryptococcus neoformansandCryptococcus gattii being recognized as pathogenic. Cutaneous cryptococcosis can be classified as ‘‘secondary’’, developing from a previous systemic disease, or, on the contrary, ‘‘primary’’, resulting from transcutaneous inoculation of the agent. It can also be classified as ‘‘disseminated cutaneous cryptococcosis’’, when there is an associated systemic disease, or ‘‘localized’’, when it is restricted to the skin. This article uses the term ‘‘primary cutaneous cryptococcosis’’ because it is the most widely used and already established in the literature. Historically, the first report of a possible case of primary cutaneous cryptococcosis (PCC) occurred in 1950 by Gancy WM and was published in the Archives of Dermatology and Syphilology. Subsequently, the rare and sporadic reports in the following decades were reviewed and reported in the 1985 publication by Baes & van Cutsen. However, the unequivocal acceptance of the existence of PCC as a distinct disease only occurred in 2003 with the publication by Neville S et al. of the French Cryptococcosis Study Group. The fundamental criterion established to consider it as PCC was the proven absence of systemic disease, whether pulmonary, in the CNS or other location at the time of diagnosis of the cutaneous condition, characterized by a single lesion and, mostly, in an exposed area. These and other clinical criteria, diagnostic confirmation, and therapeutic choice are discussed in detail in the full text. © 2024 Sociedade Brasileira de Dermatologia. Published by Elsevier Espan˜a, S.L.U. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). Study conducted at the Department of Infectology, Dermatology, Diagnostic Imaging and Radiotherapy, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil. ∗ Corresponding author. E-mail: silvio.marques@unesp.br (S.A. Marques). Cryptococcosis. Etiopathogenesis. Concepts. Classification Cryptococcosis is a human and animal disease caused by fungi of the genus Cryptococcus, an encapsulated yeast with several species, of which the recognized pathogens https://doi.org/10.1016/j.abd.2024.07.004 0365-0596/© 2024 Sociedade Brasileira de Dermatologia. Published by Elsevier Espan˜a, S.L.U. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Anais Brasileiros de Dermatologia 2025;100(1):12--21 are Cryptococcus neoformans and Cryptococcus gattii. C. neoformans is a cosmopolitan, universal fungus, frequently isolated from pigeon droppings, decaying vegetables and fruits, and causes human disease predominantly in immunocompromised patients.1,2 On the other hand, C. gattii has a more regionalized distribution, prevailing in tropical and subtropical regions, although it has been isolated in temperate regions. It should be noted that C. gattii infects both immunocompromised and immunocompetent patients.3,4 C. gattii is isolated from soil samples, decaying vegetables, and tree hollows, and has a special ecological association with Eucalyptus camaldulensis plantations.3,5 In 2015, Hagen F et al.6 published an article on sufficient molecular evidence to subdivide C. neoformans into two new species and C. gattii into four additional new species, namely: C. neoformans and C. deneoformans; and, the species C. gattii, C. deuterogattii, C. bacillosporus, C. tetragattii and C. decagattii and also the possibility of hybrid species.6 This proposal, although based on multiple molecular data, did not find support among experts, including Kwon-Chung KJ et al.7 The latter authors, under various arguments, including the lack of association of specific clinical manifestations with a particular subspecies, propose the use of the name C. neoformans complex (Cryptococcus neoformans species complex) andC. gattii complex (Cryptococcus gattii species complex).7 This suggestion has been followed by several authors in recent reports.8--10 Cutaneous cryptococcosis can be classified as ‘‘secondary’’ to dissemination from a previous systemic disease or ‘‘primary’’, by transcutaneous inoculation of the agent. Or, it can be classified as ‘‘disseminated cutaneous cryptococcosis’’, that is, resulting from systemic disease with a cutaneous lesion originating from hematogenous dissemination of the fungus. Or, on the contrary, it can be classified as ‘‘localized’’, when restricted to the skin.11 In this article, the term ‘‘primary cutaneous cryptococcosis’’ is used, following the concept of local transcutaneous inoculation, as it is more widely used and already established in the literature.12 Classically, in systemic disease, the natural history of cryptococcosis results from inhalation of the fungi and a pulmonary condition that is almost always asymptomatic or oligosymptomatic. In terms of evolution, immediate hematogenous dissemination or the permanence of a quiescent pulmonary focus and subsequent hematogenous dissemination due to an imbalance in the agent-host relationship may occur.11 It is a typical disease of immunocompromised individuals and is considered, in itself, a defining factor for AIDS in HIV-infected individuals, as well as an incidental disease in patients after solid organ transplantation or on prolonged corticosteroid therapy.13 Cryptococcosis in immunocompromised patients presents most frequently as involvement of the central nervous system (CNS), with initially indolent manifestations and progressive evolution to severe and potentially fatal meningoencephalitis. An isolated or predominant pulmonary clinical manifestation is not common, but possible. Other organs and systems may be affected, including the skin in up to 15% of AIDS cases; therefore, producing a secondary skin lesion which functions as sentinel of associated systemic involvement.11,13 The dermatological clinical presentation of a lesion associated with a systemic focus is distinct from that resulting from a primary skin lesion and therefore helps in the diagnostic differentiation between ‘‘primary’’ or ‘‘secondary’’ cutaneous cryptococcosis. When the skin lesion is secondary to systemic disease, the most frequent clinical manifestation are multiple lesions, mainly in the cephalic segment, with possible mucosal lesions, albeit uncommon.11,14,15 In contrast, the primary cutaneous lesion is a single, polymorphic lesion, most often an infiltrated plaque of varying extent, with a tendency to necrosis and no mucosal involvement.11,12 Primary cutaneous cryptococcosis History Sporotrichosis and chromoblastomycosis are mycoses classically accepted as examples of subcutaneous implantation mycoses and primary transcutaneous infection. Other mycoses, which are classically systemic and inhalationmediated infections, such as coccidioidomycosis, blastomycosis, histoplasmosis, and even paracoccidioidomycosis, may exceptionally be the result of transcutaneous inoculation.16,17 However, these events, in these circumstances, constitute rare, exceptional cases and are a clear exception to the rule. The first report of a possible case of primary cutaneous cryptococcosis (PCC) occurred in 1950 by Gancy WM and was published in the Archives of Dermatology and Sypholology.18 This report was followed by rare and sporadic publications in the following decades, with the reported cases associated or not with immunocompromised patients.18--21 These publications were reviewed and reported in detail by Baes & van Cutsen in 1985.22 However, the unequivocal acceptance of the existence of PCC as a clinical subtype distinct from classical cryptococcosis and recognized as such occurred in 2003 with the publication of Neville S et al.23 of the French Cryptococcosis Study Group. In this publication, the authors compared data from 28 patients with a presumptive diagnosis of PCC with those from 80 cases of disseminated classical cryptococcosis with skin lesions and also data from 1866 cases of disseminated cryptococcosis and involvement of organs other than the skin.23 The basic criterion for considering a presumptive diagnosis of PCC was, evidently, the proven absence of systemic disease, whether pulmonary, in the central nervous system or any other location at the time of diagnosis of the skin condition. Among the various differences observed in the groups studied above, the semiological pattern and location of the lesions were differentiated. The cases of PCC were restricted to single lesions located mainly in exposed areas, sparing the cephalic segment. On the other hand, the cutaneous lesions secondary to systemic disease were almost always multiple, papulonodular, often molluscum contagiosum-like and preferentially located in the cephalic segment. It is worth noting that the same article shows the occurrence of PCC cases in immunocompetent patients, which did not occur in the systemic disease cases studied therein. Therefore, based on this explicit demonstration that these are distinct clinical expressions, the concept of ‘‘primary cutaneous cryptococcosis’’ was consolidated.23 The criteria that favor suspicion and determine the definitive diagnosis of one or the other form of the disease are 13
S.A. Marques and R.M. Camargo Figure1 Primary cutaneous cryptococcosis (PCC): Infiltrated, erythematous plaque with raised surface, showing a tumorlike aspect. Rare ulcerated or necrotic spots. Forearm of an immunocompetent 66-year-old male patient, post-trauma. didactically and clearly demonstrated in tables in this reference article by Neville S et al.23 Diagnostic criteria. Clinical history and clinical-dermatological examination The clinical history of the current disease in PCC is variable, ranging from weeks to months. There is not always a history of trauma preceding the lesion, just as there is not always a history of exposure to bird or bat droppings or rural life. The lesions are almost always located in exposed areas subject to trauma, particularly the arm and forearm. The complaint may be of pain and/or local heat. There is no complaint of fever, systemic signs or symptoms. There is often a history of immunosuppressive medication use for different reasons: post-solid organ transplant, corticosteroid therapy for chronic obstructive pulmonary disease, autoimmune diseases, particularly rheumatic joint disease, use of biological immunosuppressants or chemotherapy. When affecting the elderly, even in the absence of medication or an evident cause of immunocompromise, immunosenescence, in itself, may be the contributing factor to be considered. Clinical suspicion of PCC arises from a single skin lesion located in an exposed area, particularly the upper limbs, with acute or subacute progression, with compatible dermatological clinical characteristics and no signs or symptoms of systemic disease. Semiologically, the lesion is polymorphic, most often infiltrative, tumor-like, ulcerated or not, occasionally leishmaniasis-like, with or without necrotic spots, and rarely cellulitis-like. The lesion diameter is variable and may affect an entire segment of the affected limb, and lesion limits are not always precise. The coloration is erythematous, erythematous-violet, or erythematous-brownish (Figs. 1--5).11,12,23--27 On palpation, the consistency may be firm or somewhat soft, gelatinous, due to the large number of fungal elements, their mucoid capsules, and the scarce inflammatory response.12 Bacterial coinfection and local inflammatory signs are not uncommon. If the diagnosis is delayed, the lesion tends to develop a large diameter, with skin surface necrosis (Figs. 6 and 7). There are multiple differential diagnoses and the use of the PLECT Figure 2 PCC: Ulceronecrotic lesion with precise limits, absence of inflammatory halo. Forearm of an immunocompetent 58-year-old male patient, post-trauma. Figure3 PCC: Ulcerated lesion, clear background, with hemorrhagic spots, islands of intact tissue and infiltrated borders. The photo was taken after debridement. Elbow of a 74-year-old male patient with COPD, on irregular corticosteroid therapy, 10 mg/day. Post-trauma lesion, which occurred during the cleaning of the attic of a Catholic church. syndromic diagnosis (paracoccidioidomycosis, leishmaniasis, sporotrichosis [Esporotricose -- portuguese language], chromoblastomycosis and cutaneous tuberculosis) is recommended as an initial guide. The hypotheses of pyoderma gangrenosum, severe bacterial infections, ecthyma gangrenosum including their possible causal agents, and herpes zoster with necrosis should be added to the clinical reasoning in immunocompromised patients. Given the acute or subacute nature of the process, neoplastic diseases are not plausible differential diagnoses. It is not unusual for the initial suspicion to be of a bacterial or even viral infectious process (herpes zoster) and only after therapeutic failure with the use of antibiotics or antivirals or even worsening while taking them, does the attending physician submit the lesion to histopathological or direct mycological examination. Once the diagnosis of cutaneous cryptococcosis has been established, confirmation of whether it is primarily cutaneous and of the infecting species must follow the academically well-established criteria and steps briefed below. 14
Anais Brasileiros de Dermatologia 2025;100(1):12--21 Figure 4 PCC: (A) Extensive plaque with necrotic, ulcerated spots and pseudovesicles crusts in a 70-year-old male patient, on irregular corticosteroid therapy 5 mg/day, due to arthritis. The patient lived in a rural area. (B) Detail: Presence of a tumor-like lesion with necrotic spots and satellite lesions with pseudovesicles. Diagnostic confirmation Diagnostic confirmation is based on the analysis of several criteria: I - Observation of the agent on direct examination (direct mycological examination). A sample obtained from the lesion by biopsy, curettage, or scraping with a blunt scalpel is gently smeared on a blood count slide, to which drops of Indian ink (or Nanking ink) are added. Or, even in the absence of Indian ink, a smear of a lesion sample treated with drops of saline solution can be used. India ink or saline solution do not penetrate the mucoid capsule of Cryptococcus sp. and, as a result, the capsule stands out, contrasting with the black of the India ink or the pink of the hemorrhagic medium (Fig. 8).28 II -- Culture with seeding on Niger seed agar or Sabouraud dextrose agar. Mycosel agar should not be used, as it contains cycloheximide (Actidione®), which inhibits the growth of several species of Cryptococcus.28,29 The lesion sample for seeding can be obtained by micro biopsy or curettage of the lesion bed. The sample must be collected with maximum antisepsis, avoiding bleeding if possible, and sent to the mycology laboratory as soon as possible in a sterile bottle containing saline solution. The seeded test tube or Petri dish should ideally be kept at 30◦--32◦C, but under routine conditions they can be kept at room temperature. The growth of Cryptococcus spp. is rapid, already visible macroscopically Figure 5 PCC: Ulcerated lesion, granular background, with borders framing the lesion in a leishmaniasis-like appearance on the deltoid region of a 31-year-old male patient, a kidney transplant recipient after seven years. The patient was receiving prednisone 5 mg and tacrolimus 0.2 mg/kg/day. Figure 6 PCC: (A) Infiltrated, extensive lesion, showing nodules, ulcerations, necrotic spots, in the distal region of the arm, forearm and dorsum of the hand of a 77-year-old male patient with COPD, on corticosteroid therapy, 10 mg/day. The patient lived in a rural area. (B) Detail: Nodules, scar retractions, ulceration spots and necrosis. 15
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