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Initial bullous detachment at the dermo-epidermal junction (Hematoxylin & eosin, ×40). B, The primary involvement of the skin is on the sebaceous epithelium, as shown by immunohistochemistry specific for varicella zoster virus (Hematoxylin & eosin, ×40).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Gianluca Nazzaro, Stefano Veraldi" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Gianluca" "apellidos" => "Nazzaro" ] 1 => array:2 [ "nombre" => "Stefano" "apellidos" => "Veraldi" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275220301478" "doi" => "10.1016/j.abdp.2019.07.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275220301478?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620300775?idApp=UINPBA00008Z" "url" => "/03650596/0000009500000003/v4_202007210853/S0365059620300775/v4_202007210853/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0365059620300866" "issn" => "03650596" "doi" => "10.1016/j.abd.2019.07.013" "estado" => "S300" "fechaPublicacion" => "2020-05-01" "aid" => "175" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by/4.0/" "subdocumento" => "sco" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Letter</span>" "titulo" => "Terra firma-forme dermatosis: an underdiagnosed condition" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "397" "paginaFinal" => "399" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 602 "Ancho" => 855 "Tamanyo" => 53874 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Area without lesions after rubbing the skin with gauze embedded in 70% alcohol.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Bruna Anjos Badaró, Lucia Martins Diniz, Paulo Sergio Emerich Nogueira" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Bruna Anjos" "apellidos" => "Badaró" ] 1 => array:2 [ "nombre" => "Lucia Martins" "apellidos" => "Diniz" ] 2 => array:2 [ "nombre" => "Paulo Sergio Emerich" "apellidos" => "Nogueira" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275220301570" "doi" => "10.1016/j.abdp.2019.07.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275220301570?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620300866?idApp=UINPBA00008Z" "url" => "/03650596/0000009500000003/v4_202007210853/S0365059620300866/v4_202007210853/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Letter</span>" "titulo" => "Inflammatory segmental vitiligo during oral isotretinoin use: a casual association?" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">Dear Editor</span>," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "399" "paginaFinal" => "400" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Maria Fernanda de Santana Avelar-Caggiano, Caio César Silva de Castro, Gerson Dellatorre" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Maria Fernanda de Santana" "apellidos" => "Avelar-Caggiano" "email" => array:1 [ 0 => "mafe_avelar@yahoo.com.br" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Caio César Silva de" "apellidos" => "Castro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Gerson" "apellidos" => "Dellatorre" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Service of Dermatology, Hospital Santa Casa de Misericórdia de Curitiba, Curitiba, PR, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Medical School, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1117 "Ancho" => 1583 "Tamanyo" => 74065 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Wood's light examination revealed fluoresce bright blue-white in malar and perioral right regions.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Segmental vitiligo (SV) accounts for 3–20% of all cases of vitiligo and is usually not associated with autoimmune diseases when compared to non-segmental vitiligo (NSV).<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Among the theories proposed for the path physiology of SV, it is essential to emphasize the presence of an autoimmune attack against a mosaic area.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In the literature, there are few reports on the emergence of vitiligo as a side effect of medications, especially oral isotretinoin. The objective of the present report is to demonstrate a possible new side effect of this medication since there are no descriptions of its association with SV in the literature.</p><p id="par0015" class="elsevierStylePara elsevierViewall">A 17 year-old male patient, previously healthy and without a family history of vitiligo, was diagnosed with resistant acne, previously treated with topical and systemic antibiotic therapy. During the fifth month of treatment with oral isotretinoin (0.4<span class="elsevierStyleHsp" style=""></span>mg/kg/day, cumulative dose of 5.400<span class="elsevierStyleHsp" style=""></span>mg), there were a chromic spots surrounded by an erythematous-scaling halo in malar and perioral areas, not exceeding the mid line on the right side of the face (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Wood's light examination revealed fluorescent chalky white aspect, as well as polios is in beard hair (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) favoring the SV diagnosis. After the withdrawal of isotretinoin, the patient began treatment with 0.1% tacrolimus ointment twice daily with an improvement of perilesional erythema after two months, although without improvement of achromy. Subsequently, it was submitted to 20 sessions of UVB-NB phototherapy, with little perifollicularre pigmentation.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">In the literature review, only three cases of vitiligo in the context of oral isotretinoin use are described. One report describes the case of a patient who developed vitiligo during the use of oral isotretinoin at a dose of 0.3–0.4<span class="elsevierStyleHsp" style=""></span>mg/kg/day for the treatment of moderate to severe acne.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> In another report, acrofacial vitiligo was developed only two months after the end of treatment with isotretinoin, which reduces the probability of a cause-and-effect relationship.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> There is also a report of worsening of NSV lesions in the lower lip and lower perioral region after chronic cheilitis due to the use of oral isotretinoin; a condition attributed in this case to the Koebner phenomenon.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The mechanism of action of isotretinoin in this presumed association is not yet fully elucidated, but the drug appears to play a role in triggering autoimmunity in genetically susceptible individuals.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Several reports of autoimmune diseases such as diabetes, autoimmune hepatitis, Guillain–Barré syndrome, and thyroiditis have been reported after the end of the isotretinoin regimen or during the last week of treatment.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Besides, in vitro studies have also demonstrated that retinoid may have a pro-apoptotic effect on melanocytes.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Although the cause-effect relationship of this association has not yet been proven, the increasing appearance of new cases in the literature is a warning sign for dermatologists to keep vigil on this possible new side effect.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0035" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors' contributions</span><p id="par0040" class="elsevierStylePara elsevierViewall">Maria Fernanda de Santana Avelar-Caggiano: Conception and planning of the study; elaboration and writing of the manuscript; obtaining, analysis, and interpretation of the data; critical review of the literature.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Caio César Silva de Castro: Approval of the final version of the manuscript; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the manuscript.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Gerson Dellatorre: Approval of the final version of the manuscript; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors' contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-04-01" "fechaAceptado" => "2019-07-22" "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Avelar-Caggiano MFS, Castro CCS, Dellatorre G. Inflammatory segmental vitiligo during oral isotretinoin use: a casual association? An Bras Dermatol. 2020;95:399–400.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Hospital Santa Casa de Misericórdia de Curitiba, Paraná, PR, Brazil.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 999 "Ancho" => 1500 "Tamanyo" => 123876 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Achromic spots surrounded by halo erythematosus and polios is in beard hairs in the malar and right perioral regions.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1117 "Ancho" => 1583 "Tamanyo" => 74065 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Wood's light examination revealed fluoresce bright blue-white in malar and perioral right regions.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "New insights in segmental vitiligo: case report and review of theories" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. 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2023 June | 58 | 47 | 105 |
2023 May | 48 | 34 | 82 |
2023 April | 45 | 25 | 70 |
2023 March | 54 | 57 | 111 |
2023 February | 52 | 45 | 97 |
2023 January | 48 | 55 | 103 |
2022 December | 57 | 46 | 103 |
2022 November | 71 | 68 | 139 |
2022 October | 86 | 65 | 151 |
2022 September | 44 | 79 | 123 |
2022 August | 46 | 62 | 108 |
2022 July | 40 | 67 | 107 |
2022 June | 56 | 51 | 107 |
2022 May | 37 | 57 | 94 |
2022 April | 37 | 61 | 98 |
2022 March | 44 | 74 | 118 |
2022 February | 28 | 42 | 70 |
2022 January | 38 | 73 | 111 |
2021 December | 40 | 60 | 100 |
2021 November | 51 | 60 | 111 |
2021 October | 51 | 86 | 137 |
2021 September | 33 | 45 | 78 |
2021 August | 47 | 69 | 116 |
2021 July | 41 | 50 | 91 |
2021 June | 28 | 59 | 87 |
2021 May | 44 | 92 | 136 |
2021 April | 159 | 291 | 450 |
2021 March | 76 | 60 | 136 |
2021 February | 42 | 23 | 65 |
2021 January | 36 | 21 | 57 |
2020 December | 45 | 22 | 67 |
2020 November | 42 | 11 | 53 |
2020 October | 25 | 14 | 39 |
2020 September | 72 | 16 | 88 |
2020 August | 62 | 7 | 69 |
2020 July | 52 | 10 | 62 |
2020 June | 12 | 24 | 36 |
2020 May | 19 | 11 | 30 |
2020 April | 0 | 2 | 2 |