Consensus on the diagnosis and management of chronic leg ulcers - Brazilian Society of Dermatology.

BACKGROUND: Chronic leg ulcers affect a large portion of the adult population and cause a significant social and economic impact, related to outpatient and hospital care, absence from work, social security expenses, and reduced quality of life. The correct diagnosis and therapeutic approach are essential for a favorable evolution. OBJECTIVE: To gather the experience of Brazilian dermatologists, reviewing the specialized literature to prepare recommendations for the diagnosis and treatment of the main types of chronic leg ulcers. METHODS: Seven specialists from six university centers with experience in chronic leg ulcers were appointed by the Brazilian Society of Dermatology to reach a consensus on the diagnosis and therapeutic management of these ulcers. Based on the adapted DELPHI methodology, relevant elements were considered in the diagnosis and treatment of chronic leg ulcers of the most common causes; then, the recent literature was analyzed using the best scientific evidence. RESULTS: The following themes were defined as relevant for this consensus - the most prevalent differential etiological diagnoses of chronic leg ulcers (venous, arterial, neuropathic, and hypertensive ulcers), as well as the management of each one. It also included the topic of general principles for local management, common to chronic ulcers, regardless of the etiology. CONCLUSION: This consensus addressed the main etiologies of chronic leg ulcers and their management based on scientific evidence to assist dermatologists and other health professionals and benefit the greatest number of patients with this condition.

Consensus on the diagnosis and management of chronic leg ulcers - Brazilian Society of Dermatology

Abstract Background: Chronic leg ulcers affect a large portion of the adult population and cause a significant social and economic impact, related to outpatient and hospital care, absence from work, social security expenses, and reduced quality of life. The correct diagnosis and therapeutic approach are essential for a favorable evolution. Objective: To gather the experience of Brazilian dermatologists, reviewing the specialized literature to prepare recommendations for the diagnosis and treatment of the main types of chronic leg ulcers. Methods: Seven specialists from six university centers with experience in chronic leg ulcers were appointed by the Brazilian Society of Dermatology to reach a consensus on the diagnosis and therapeutic management of these ulcers. Based on the adapted DELPHI methodology, relevant elements were considered in the diagnosis and treatment of chronic leg ulcers of the most common causes; then, the recent literature was analyzed using the best scientific evidence. Results: The following themes were defined as relevant for this consensus - the most prevalent differential etiological diagnoses of chronic leg ulcers (venous, arterial, neuropathic, and hypertensive ulcers), as well as the management of each one. It also included the topic of general principles for local management, common to chronic ulcers, regardless of the etiology. Conclusion: This consensus addressed the main etiologies of chronic leg ulcers and their management based on scientific evidence to assist dermatologists and other health professionals and benefit the greatest number of patients with this condition.

Imunofluorescencia direta na pele aparentemente sã, lesada e perilesional e indireta no penfigo foliaceo endemico (Fogo selvagem) / Direct immunofluorescence on the apparently healthy, injured and perilesional and indirect skin in endemic foliaceous pemphigus (Wildfire)

As imunofluorescencias direta e indireta constituem importante diagnostico nos penfigos. Foram estudados o soro e a pele aparentemente sa, lesada, eperilesional de 47 doentes de penfigo foliaceo endemico, sendo 15 doentes nao tratados e 32 em tratamento com prednisona. Quanto a forma clinica, 29 possuiam a forma localizada e 18 a generalizada da doenca. Atraves da imunofluorescencia direta analisou-se a frequencia de deposicao de IgA, IgM, IgG e suas subclasses (IgG1, IgG2, IgG3 e IgG4) e a fracao C3 do complemento nos espacos intercelulares da epiderme nas tres peles. A imunofluorescencia indireta, analisou-se frequencia de positividade dos titulos sorologicos da IgG e suas subclasses (IgG1, IgG2, IgG3 e IgG4), assim como as medias dos titulos nos dois grupos