{"id":779,"date":"2023-09-02T12:53:49","date_gmt":"2023-09-02T15:53:49","guid":{"rendered":"https:\/\/peledigital.com\/blog\/?p=779"},"modified":"2023-09-03T13:33:44","modified_gmt":"2023-09-03T16:33:44","slug":"alopecia-universal-pos-dress","status":"publish","type":"post","link":"https:\/\/peledigital.com\/blog\/alopecia-universal-pos-dress\/","title":{"rendered":"Alopecia universal p\u00f3s DRESS"},"content":{"rendered":"\n

Voc\u00ea sabia que h\u00e1 casos de alopecia universal p\u00f3s DRESS (Drug rash with eosinophilia and systemic symptoms).<\/h3>\n\n\n\n

Al\u00e9m disso, que alguns casos de DRESS est\u00e3o associados com a ativa\u00e7\u00e3o do EBV (Epstein-Barr virus) e que o v\u00edrus poderia contribuir para o desenvolvimento da Alopecia universal?<\/p>\n\n\n\n

Este post faz nossa s\u00e9rie de artigos listada no post Inibidores de JAK v\u00e3o mudar a dermatologia<\/a><\/p>\n\n\n\n

O artigo Successful treatment of alopecia universalis with abrocitinib: a case report<\/a> \u00e9 um relato de caso que nos tr\u00e1s divresos ensinamentos, dessa forma, fica a sugest\u00e3o da leitura do artigo original<\/p>\n\n\n\n

Nesse relato de caso temos uma paciente que evolui com repila\u00e7\u00e3o de uma paciente portador alopecia areata universal com o uso de Abrocitinibe.<\/p>\n\n\n\n

O t\u00edtulo do artigo, nem de longe mostra a complexidade do caso que tem algumas peculiariedades:<\/p>\n\n\n\n

    \n
  1. A alopecia universal surgiu 02 meses de um caso de DRESS em consequ\u00eancia do uso da lamotrigina<\/li>\n\n\n\n
  2. A s\u00edndrome de DRESS estava associada \u00e0 reativa\u00e7\u00e3o do EBV<\/li>\n<\/ol>\n\n\n\n

    Os portadores de s\u00edndrome DRESS, especialmente nos casos associados \u00e0 reativa\u00e7\u00e3o viral, podem desenvolver as chamadas sequela autoimune da DRESS<\/p>\n\n\n\n

    Considerado um fen\u00f4meno autoinflamat\u00f3rio, a complica\u00e7\u00e3o est\u00e1 associada \u00e0 reativa\u00e7\u00e3o viral que por mecanismos ainda n\u00e3o elucidados pode lavar a quadros de tireoidite ou LES, assim como de alopecia areata, caso da paciente relatada.<\/p>\n\n\n\n

    Olhando para o tratamento da alopecia, a principio os autores utilizaram minoxidil t\u00f3pico, cortic\u00f3ide intralesional sem resposta satisfat\u00f3ria.<\/p>\n\n\n\n

    Seguiu com uso de betametasona intramuscular (que eu particularmente n\u00e3o usaria) que tamb\u00e9m n\u00e3o mostrou resultado, desta forma os autores iniciaram tofacitinibe.<\/p>\n\n\n\n

    A paciente sem resposta ao tofacitinibe, um inibidor das JAK, sem melhora cl\u00ednica. <\/p>\n\n\n\n

    O curioso \u00e9 que mesmo na falta de resposta, os autores escolheram outro inibidor de JAK, agora mais seletivo para a JAK 1.<\/h4>\n\n\n\n

    Dessa forma, optaram por iniciar o abrocitinibe 100mg que levou a melhora parcial no per\u00edodo de 2 meses. <\/p>\n\n\n\n

    Com o intuito de acelerar e melhorar a resposta, aumentaram a dose para 200mg por mais dois meses. Como resultado da boa resposta, retornaram para a dose de 100mg. <\/p>\n\n\n\n

    Ap\u00f3s 6 meses de tratamento o paciente estava com o quadro 100% controlado<\/p>\n\n\n\n

    Vamos conctar os pontos?<\/h4>\n\n\n\n

    Este caso mostra conex\u00f5es que n\u00e3o s\u00e3o \u00f3bvias e que demandam do m\u00e9dico moderno uma cultura m\u00e9dica ampla e uma grande capacidade de integrar as informa\u00e7\u00f5es.<\/p>\n\n\n\n

    Atualmente, alguns autores consideram a reativa\u00e7\u00e3o do EBV como fator desencadeador da DRESS e al\u00e9m disso como fator associado ao surgimento da alop\u00e9cia.<\/p>\n\n\n\n

    N\u00e3o sabemos o exato mecanismo sabemos por\u00e9m, que temos disfun\u00e7\u00e3o das c\u00e9lulas T regulat\u00f3rias e que esta disfun\u00e7\u00e3o poderia influenciar na perda da toler\u00e2ncia imunol\u00f3gica e assim causar a perda do p\u00ealo.<\/p>\n\n\n\n

    Outro aspecto importante do caso \u00e9 que a n\u00e3o resposta ao tofacitinibe, n\u00e3o inibiu a tentativa de tratamento com o abrocitinibe. <\/p>\n\n\n\n

    Os inibidores de JAK s\u00e3o mol\u00e9culas complexas que vamos aprender muito ao longo destes pr\u00f3ximos meses e anos que vir\u00e3o.<\/p><\/blockquote><\/figure>\n\n\n\n

    Conta para gente o quanto voc\u00ea aprendeu com esse relato de caso, com a alopecia universal p\u00f3s DRESS<\/p>\n","protected":false},"excerpt":{"rendered":"

    Tratamento de alopecia universal induzida pela s\u00edndrome DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) tratada com abrocitinibe<\/p>\n","protected":false},"author":1,"featured_media":781,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[22],"tags":[40,30,38,41,42,39,36,24,29,35],"class_list":["post-779","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-imunologia","tag-alopecia-areata","tag-baricitinibe","tag-dress","tag-ebv","tag-epstein-barr","tag-farmacodermia","tag-inibidor-de-jak","tag-inibidores-de-jak","tag-pele-digital","tag-upadacitinibe"],"acf":[],"yoast_head":"\nAlopecia universal p\u00f3s DRESS - Pele Digital<\/title>\n<meta name=\"description\" content=\"Alopecia universal p\u00f3s DRESS considerado um fen\u00f4meno raro \u00e9 descrito pelos autores que solucionam a queda de cabelo com abrocitinibe\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/peledigital.com\/blog\/alopecia-universal-pos-dress\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Alopecia universal p\u00f3s DRESS - 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