Psoríase eritrodérmica com regressão após profilaxia com isoniazida e . Sociedade Brasileira de Dermatologia. Consenso Brasileiro de Psoríase 1th ed. Reproduced from Amaral Maia CP, Takahashi MD, Romiti R, Sociedade Brasileira De Dermatologia. Consenso Brasileiro de Psoríase Sociedade Brasileira de Dermatologia. Consenso Brasileiro de Psoríase. Consenso Brasileiro de Psoríase Guias de Avaliação e Tratamento. 2. ed.
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Psoriasis is a chronic immune-mediated systemic disease that is influenced by genetic and environmental factors, is associated with comorbidities, and has a negative impact on the quality of life of affected individuals.
The prevalence of psoriasis varies among different ethnic groups, but this topic has not been studied in Brazil to date. In this review, we evaluate the epidemiology and treatment of psoriasis from a Brazilian perspective. We focused on studies that involved Brazilian subjects. The prevalence of psoriasis in Brazil is estimated to be 2. Environmental factors, such as tropical climate, in association with genetic factors, such as miscegenation, donsenso exert a beneficial impact on the course and frequency of psoriasis in Brazil.
A number of studies have advanced our understanding of the cardiovascular, ophthalmic, and oral comorbidities that are associated with psoriasis. Concerns about biological therapy, such as endemic leprosy, human T-cell lymphotropic virus HTLVand tuberculosis infections, are discussed.
The nonavailability of treatment options for psoriasis in the public health system contradicts the Brazilian Society of Dermatology guidelines, stimulating the judicialization of access to medicines in psoriasis care. The most common phenotype is psoriasis vulgaris. The worldwide prevalence of psoriasis varies from 0. In the USA, psoriasis is found in 0. The objective of this review brasildiro to summarize Brazilian data concerning the epidemiology, comorbidities, and treatment of psoriasis.
In Brazil, no previous population study has evaluated the incidence and prevalence of psoriasis.
No national database or pskriase studies are available as in other developed countries; however, studies are available concerning some clinical aspects, comorbidities, and treatment regimens of psoriasis.
In addition, the conclusions of national and regional surveys cannot be applied to the entire Brazilian population. Figure 1 shows Brazilian Federal Units and their respective skin color distributions and populations. In Table 1 consenwo, we list the available Brazilian studies related to the epidemiology of psoriasis.
Brazilian Federal Units and their respective skin color distributions and populations. A Estimated prevalence of psoriasis in donsenso Amazonian state Northern Brazil ; 37 B Psoriasis is the most frequent psoriae of erythroderma According to the Brazilian Society of Dermatology, the northern and southern regions were the regions with least and most expressive psoriasis-motivated consultations, respectively.
Figure adapted from ibge. The available studies that focused on comorbidities are listed in Table 2. Silva et al 7 evaluated the profile of psoriasis patients using biological drugs. The main indications for biological therapy were a poor response to other systemic treatments Psoriasd, primarily dyslipidemia Two studies that were conducted in Brazil assessed the prevalence of oral lesions in patients with psoriasis and observed that the evaluated patients exhibited no disease-specific oral lesions.
The oral lesions that were found in patients with psoriasis were also found in the control group; however, a greater prevalence of fissured tongue and geographic tongue was observed in patients with psoriasis than in the general population. Meibomian gland dysfunction was the most frequent ophthalmic change. Lima et al 11 reported the type and frequency of ophthalmological manifestations psoraise patients with psoriatic arthritis in Brazil.
Xerophthalmia was the most common ocular finding in those patients. The authors recommended early ophthalmologic evaluation in patients with psoriatic arthritis and ophthalmologic symptoms. Methotrexate should be considered when conseno PASI change is observed after 6 weeks of treatment or when only modest changes are observed after 10—16 weeks. Cyclosporin is suggested for a limited period of time ie, a maximum of 2 yearsfor pregnant women and patients with erythrodermic psoriasis and secondary loss cobsenso response to classic or biological drugs.
Biological drugs should be reserved for patients with no response or a contraindication or intolerance to at least one classic drug and phototherapy. Ustekinumab is currently approved exclusively for psoriasis treatment. The biological treatment goals for moderate-to-severe psoriasis are the same as those adopted by the European consensus.
The prescription of NB-UVB was more frequent than that brasiileiro PUVA, probably due to the smaller number of contraindications and side effects, despite the high prevalence of individuals with elevated Fitzpatrick phototypes. Studies of new therapies have been scarce in Brazil. The incidence of adverse effects was greater in the group treated with PVAC than in the placebo group These effects included primarily local non-severe reactions. Despite the safety of this method, it was not clearly superior to placebo.
Sincethe Brazilian government health system has made acitretin and cyclosporin available for psoriasis treatment. According to data from the national program of exceptional brrasileiro high-cost drugsfrom tothe percentage of patients using acitretin was very low 1.
The same result was observed for cyclosporin 2. Methotrexate was not included in this program due to its relatively low cost. Injectable methotrexate was added to the list of available drugs for psoriasis treatment only in We have raised questions about this protocol in Table 3. In spite of these questions, it remains necessary to compare brasieiro and clinical results consenzo support decisions psoriasw health and public policy development.
A Brazilian study assessed the direct and indirect costs of psoriasis treatment. Comparing men and women, the total annual cost per patient was greater for males, who were prone to more severe psoriasis. The total cost was also related to the duration of braslieiro disease. Listed reasons for the exclusion of biological treatments for psoriasis management government protocol.
In Brazil, it is possible that miscegenation and the tropical climate exert a beneficial impact on the psoriasis course and frequency, but it remains unclear whether mixed-race and black Brazilian individuals are less affected by psoriasis. Brazilian guideline recommendations have encountered availability problems in public and private health systems. Although phototherapy has been the first therapeutic choice for moderate-to-severe psoriasis, this treatment is rarely available in the public sector.
Difficulties regarding access have stimulated the judicialization of access to medicines in psoriasis care.
Epidemiology and treatment of psoriasis: a Brazilian perspective
Safety concerns related to biological treatment are an important issue, as the country has high endemic rates of leprosy, tuberculosis, and HTLV infections.
The fact that the Brazilian Ministry of Health protocol for psoriasis treatment does not cover biological agents makes it difficult to access these drugs.
Once the need for biological therapy is verified, the individual clinical choice of which drug will be required is determined via lawsuit rather than by official documents guided by the most cost-effective medicine.
In conclusion, our understanding of psoriasis as a multisystem disease has grown in the past decade after the publication of several psoriasis comorbidity studies in Brazil. Population studies evaluating the prevalence and distribution of this disease among races have not yet been performed. Despite the absence of psoriasis among natives of the Andean region of South America, 45 Brazil has a highly miscegenated population; as a result, a dissociation between skin color and genomic ancestry 46 makes it unlikely that identical results will be obtained in Amerindian Brazilians.
Use of clobetasol in lacquer for plaque psoriasis treatment
Because Brazilian government protocol contradicts the national consensus regarding the treatment of psoriasis, studies of cost-effectiveness and additional psorlase in phototherapy and systemic drug availability are urgent. Otherwise, insufficient access will be aggravated by the growing number of lawsuits.
Dr Porto-Silva reports no conflicts of interest in this work. National Center for Biotechnology InformationU. Journal List Psoriasis Auckl v. Published online Apr Author information Copyright and License information Disclaimer. The full terms of the License are available at http: Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
This article has been cited by other articles in PMC. Abstract Psoriasis is a chronic immune-mediated systemic disease that is influenced by genetic and environmental factors, is associated with comorbidities, and has a negative impact on the quality of life of affected individuals.
Introduction Psoriasis is a chronic immune-mediated systemic disease that is influenced by genetic and environmental factors, is associated with comorbidities, and has a negative impact on the quality of conaenso of affected individuals.
Epidemiology and comorbidities of psoriasis in Brazilian patients In Brazil, no previous population study has evaluated the incidence and prevalence of psoriasis. Open in a separate window. Table 1 Brazilian studies concerning the epidemiology of psoriasis. Author Population Results Important findings Reference SBD,An Bras Dermatol 57, dermatologic selected dermatologist consultations government-sponsored and coonsenso outpatient clinics from all regions of Brazil Tenth most frequent diagnosis 1,; 2.
Among all brasilriro regions, northern Brazil was the region with the least expressive psoriasis-motivated consultations 1.
The variables independently associated with a psoriasis diagnosis are as follows: Table 2 Brazilian studies concerning psoriasis comorbidities. At least one comorbidity: Algorithm of the Brazilian Society of Dermatology for brasiliro psoriasis.
Endemic and highly prevalent tuberculosis in all regions of Brazil. There is a possibility of extending latent tuberculosis treatment for all biological candidate patients in this scenario. Consequently, these drugs are not reimbursed for the treatment of pspriase psoriasis.
In addition, reimbursement for biological treatments for moderate-to-severe psoriasis is not mandatory for private health insurers in Brazil; only combination of psoralen P and long-wave ultraviolet radiation UVAie, PUVA phototherapy, receives mandatory coverage for the treatment of this disease.
From toin Minas Gerais, which is a state of southern Brazil, 2, lawsuits that included 2, medicine requests for 18 different drugs were analyzed. Among the most frequent treatments requested were adalimumab, etanercept, and infliximab.
Consenso Brasileiro Psoríase 2012 SBD
The ability to obtain medications by lawsuit may privilege people with better financial resources psoroase are able to pay lawyers and disadvantage people with poor socioeconomic status. Again, immunosuppressors, particularly adalimumab and etanercept, were the most requested subgroup of drugs.
The authors draw attention to the aggravation of health access inequity. Low availability of phototherapy psorriase public and private health systems.
The Brazilian psoriasis consensus sent an alert to health authorities recommending the creation of new phototherapy centers because it is a highly efficacious and low-cost therapy that facilitates long-term psoriasis control.
In addition, the alert emphasized that systemic treatments, which have more adverse reactions and higher comparative costs, could be avoided or recommended to a smaller number of braskleiro. The coexistence of leprosy and psoriasis in the same patient is rarely described in the literature. Only 20 cases of psoriasis were diagnosed among 1, individuals with leprosy. Psoriasis treatment in Brazil: