ROBERTO TAKAOKA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
11 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 11
- Methotrexate for atopic dermatitis in adults: a prospective study from a reference center in Brazil(2021) SAMORANO, Luciana Paula; TAKAOKA, Roberto; ZANIBONI, Mariana Colombini; AOKI, Valeria
- Education of Patients with Atopic Dermatitis and Their Caregivers(2016) TAKAOKA, Roberto; AOKI, ValeriaAtopic dermatitis (AD) is the most prevalent dermatological disease in the pediatric population. It is a chronic, pruritic, and inflammatory skin disorder, with a complex etiology involving genetic predisposition, skin barrier defects, and immune dysfunction. AD can be a challenge for patients, physicians, and caregivers and has a clear impact in patients' quality of life (QoL). Educational programs for patients with AD and their caregivers are effective in improving adherence, QoL, and clinical outcomes. Different models of educational programs exist and their structures depend on cultural, social, and economic factors. To improve existing programs, the educational team should go beyond the disease and have a broader view of the many aspects involved in the pathological process. These include psychological, environmental, social, financial, and cultural aspects. Patients and their caregivers should have a more realistic expectation about the treatment. Innovative methods and approaches like design thinking can create new and effective solutions for patients with AD and their caregivers.
- Methotrexate for refractory adult atopic dermatitis leads to alterations in cutaneous IL-31 and IL-31RA expression(2024) SAMORANO, Luciana Paula; MANFRERE, Kelly Cristina Gomes; PEREIRA, Naiura Vieira; TAKAOKA, Roberto; VALENTE, Neusa Yuriko Sakai; SOTTO, Mirian Nacagami; SILVA, Luiz Fernando Ferraz; SATO, Maria Notomi; AOKI, ValeriaBackground: Methotrexate (MTX) is an alternative treatment for patients with moderate/severe atopic dermatitis (AD). Objective: The authors evaluated the effect of MTX on the cutaneous expression of cytokines and chemokines that are involved in the inflammatory response in adult AD patients who received treatment with methotrexate for 24 weeks. Methods: The authors conducted a prospective single-institution cohort study with 12 adults with moderate/severe AD who received oral MTX (15 mg/wk for 24 wks) and 10 non-atopic matched controls. The comparison was made of skin biopsies of lesional and non-lesional skin, pre- and post MTX treatment. The authors analyzed mean epidermal thickness and expression of IL-31, IL-31RA, OSMR, TSLP, Ki67, IL-4 mRNA, IL-6, IL-10, TNF-alpha, IFN-gamma, TARC, and CCL-22. Results: There was a reduction in mean epidermal thickness (p = 0.021), an increase in IL-31RA expression (immunohistochemistry) in the epidermis (p = 0.016) and a decrease in IL-31 gene expression (p = 0.019) on lesional AD skin post-MTX treatment. No significant changes in the cutaneous expression of the other evaluated markers were identified. Study limitations: Small sample size and limited length of follow-up. Conclusions: Treatment with MTX in adults with moderate/severe AD reduced epidermal hyperplasia and changed the cutaneous expression of inflammatory cytokines and receptors that are mainly related to pruritus, including IL-31 and IL-31RA. (c) 2023 Published by Elsevier Espana, 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/).
- Consensus on the therapeutic management of atopic dermatitis Brazilian Society of Dermatology(2019) AOKI, Valeria; LORENZINI, Daniel; ORFALI, Raquel Leao; ZANIBONI, Mariana Colombini; OLIVEIRA, Zilda Najjar Prado de; RIVITTI-MACHADO, Maria Cecilia; TAKAOKA, Roberto; WEBER, Magda Blessmann; CESTARI, Tania; GONTIJOS, Bernardo; RAMOSS, Andrea Machado Coelho; SILVA, Claudia Marcia de Resende; CESTARI, Silmara da Costa Pereira; SOUTO-MAYOR, Silvia; CARNEIRO, Francisca Regina; CERQUEIRA, Ana Maria Mosca de; LACZYNSKI, Cristina; PIRES, Mario CezarBACKGROUND: Atopic dermatitis is a highly prevalent inflammatory and pruritic dermatosis with a multifactorial etiology, which includes skin barrier defects, immune dysfunction, and microbiome alterations. Atopic dermatitis is mediated by genetic, environmental, and psychological factors and requires therapeutic management that covers all the aspects of its complex pathogenesis. OBJECTIVES: The aim of this article is to present the experience, opinions, and recommendations of Brazilian dermatology experts regarding the therapeutic management of atopic dermatitis. METHODS: Eighteen experts from 10 university hospitals with experience in atopic dermatitis were appointed by the Brazilian Society of Dermatology to organize a consensus on the therapeutic management of atopic dermatitis. The 18 experts answered an online questionnaire with 14 questions related to the treatment of atopic dermatitis. Afterwards, they analyzed the recent international guidelines on atopic dermatitis of the American Academy of Dermatology, published in 2014, and of the European Academy of Dermatology and Venereology, published in 2018. Consensus was defined as approval by at least 70% of the panel. RESULTS/CONCLUSION: The experts stated that the therapeutic management of atopic dermatitis is based on skin hydration, topical anti-inflammatory agents, avoidance of triggering factors, and educational programs. Systemic therapy, based on immunosuppressive agents, is only indicated for severe refractory disease and after failure of topical therapy. Early detection and treatment of secondary bacterial and viral infections is mandatory, and hospitalization may be needed to control atopic dermatitis flares. Novel target-oriented drugs such as immunobiologicals are invaluable therapeutic agents for atopic dermatitis.
conferenceObject Adult atopic dermatitis: Evaluation of TH17 and TH22 cytokines in peripheral blood mononuclear cells induced by staphylococcal enterotoxins A and B(2012) ORFALI, Raquel Lean; RIVITTI, Evandro; SATO, Maria Notomi; TAKAOKA, Roberto; AOKI, ValeriaObjective: Evaluation of interleukins (IL) 17, 22, and 23 induced by Staphylococcus aureus enterotoxin stimulation in peripheral blood mononuclear cells (PBMC) of adults with atopic dermatitis. Background: Atopic dermatitis (AD) is a chronic, inflammatory disease with a high prevalence and complex etiopathogenesis.S aureusis present in 80% to 100% of AD patients, and secretes exotoxins that might relate to its pathogenesis. TH17 has been described as playing a major role in inflammatory diseases with a close relationship to bacterial pathogens, as well as TH22 in modulating the immunopathogenesis of some skin diseases. Methods: Thirty-eight AD patients (mean age, 28.55), 19 female and 19 male, and 40 healthy controls (mean age, 34.1), 21 females and 19 males (without personal or family history of atopy and negative prick-test) were selected. Hanifin and Rajka’s criteria were used to diagnose AD. Disease severity was established according to EASI (Eczema Area and Severity Index). IL-17, IL-22, and IL-23 production from PBMC after staphylococcal enterotoxins A (SEA) and B (SEB), and phytohemaglutinin (PHA) stimuli and IL-22 serum levels were measured by ELISA. Results: In AD patients, there was increased IL-22 levels in sera as well as in vitro secretion by PBMC after SEA and SEB stimuli, when compared to healthy controls. No correlation between IL-22 levels and EASI was observed (P ≤ .05). Conclusion: These findings suggest an involvement of TH22 subtype in the pathogenesis of adults with AD, especially because of its link to S aureus enterotoxins.- Towards global consensus on outcome measures for atopic eczema research: results of the HOME II meeting(2012) SCHMITT, Jochen; SPULS, Phyllis; BOERS, Maarten; THOMAS, Kim; CHALMERS, Joanne; ROEKEVISCH, Evelien; SCHRAM, Mandy; ALLSOPP, Richard; AOKI, Valeria; APFELBACHER, Christian; BRUIJNZEEL-KOOMEN, Carla; BRUIN-WELLER, Marjolein; CHARMAN, Carolyn; COHEN, Arnon; DOHIL, Magdalene; FLOHR, Carsten; FURUE, Masutaka; GIELER, Uwe; HOOFT, Lotty; HUMPHREYS, Rosemary; ISHII, Henrique Akira; KATAYAMA, Ichiro; KOUWENHOVEN, Willem; LANGAN, Sinead; LEWIS-JONES, Sue; MERHAND, Stephanie; MUROTA, Hiroyuki; MURRELL, Dedee F.; NANKERVIS, Helen; OHYA, Yukihiro; ORANJE, Arnold; OTSUKA, Hiromi; PAUL, Carle; ROSENBLUTH, Yael; SAEKI, Hidehisa; SCHUTTELAAR, Marie-Louise; STALDER, Jean-Francois; SVENSSON, Ake; TAKAOKA, Roberto; WAHLGREN, Carl-Fredrik; WEIDINGER, Stephan; WOLLENBERG, Andreas; WILLIAMS, HywelThe use of nonstandardized and inadequately validated outcome measures in atopic eczema trials is a major obstacle to practising evidence-based dermatology. The Harmonising Outcome Measures for Eczema (HOME) initiative is an international multiprofessional group dedicated to atopic eczema outcomes research. In June 2011, the HOME initiative conducted a consensus study involving 43 individuals from 10 countries, representing different stakeholders (patients, clinicians, methodologists, pharmaceutical industry) to determine core outcome domains for atopic eczema trials, to define quality criteria for atopic eczema outcome measures and to prioritize topics for atopic eczema outcomes research. Delegates were given evidence-based information, followed by structured group discussion and anonymous consensus voting. Consensus was achieved to include clinical signs, symptoms, long-term control of flares and quality of life into the core set of outcome domains for atopic eczema trials. The HOME initiative strongly recommends including and reporting these core outcome domains as primary or secondary endpoints in all future atopic eczema trials. Measures of these core outcome domains need to be valid, sensitive to change and feasible. Prioritized topics of the HOME initiative are the identification/development of the most appropriate instruments for the four core outcome domains. HOME is open to anyone with an interest in atopic eczema outcomes research.
- Atopic dermatitis in adults: clinical and epidemiological considerations(2013) ORFALI, Raquel Leao; SHIMIZUA, Marta M.; TAKAOKA, Roberto; ZANIBONI, Mariana C.; ISHIZAKI, Aline S.; COSTA, Anderson A.; TIBA, Ana Paula L.; SATO, Maria Notomi; AOKI, ValeriaObjective: Atopic dermatitis (AD) is a chronic inflammatory disease causing intense pruritus, and with typical clinical features. There are few epidemiological studies concerning AD in adults, aswell as little information about its prognostic. The aim of this study was to evaluate the clinical and epidemiological course of adults with AD. Methods: 80 patients aged above 18 years (mean age = 29 years) were selected (30 males and 50 females) and interviewed about hospitalization, systemic corticoid usage, age of ADonset, and personal and/or familial history of atopy. Disease severity was evaluated through the Scoring Atopic Dermatitis (SCORAD) tool. Laboratory examination included IgE serum levels and eosinophil blood count. Results: 71 out of 80 patients referred association with respiratory symptoms (18 had asthma, 17 had rhinitis, and 36 had both conditions); nine out of 80 patients denied any respiratory disease. AD patients were divided in mild (n = 25), moderate (n = 30), and severe (n = 25); 56% had one or more hospitalizations due to AD. A positive association was found between IgE serum levels, eosinophil blood count, and disease severity. Conclusion: Adult AD represents a clinical challenge that needs to be better characterized, since it can be misdiagnosed and interferes with the patient's social and personal life. The association of skin and respiratory atopic disease is frequent, and laboratory parameters such as circulating IgE levels and eosinophil blood count may be helpful to assess disease severity.
- Atopic dermatitis: correlation between non-damaged skin barrier function and disease activity(2012) ADDOR, Flavia A. S.; TAKAOKA, Roberto; RIVITTI, Evandro A.; AOKI, ValeriaBackground Atopic dermatitis (AD) is a chronic dermatosis, predominant in childhood, characterized by pruritus and eczematous-type lesions with xerosis as the prominent clinical sign. Objectives To analyze the correlation between biophysical measurements of skin barrier function and other assessment criteria of clinical severity according to Rajka and Langelands criteria. Methods Biophysical measurements [transepidermal water loss (TEWL) and corneometry] were obtained from 120 patients with the diagnosis of AD. Serum levels of IgE were also evaluated. Results A significant correlation between corneometry, TEWL, and clinical severity of AD was found. Data showed an inverse correlation between corneometry, TEWL, and AD severity, and a significant difference (P < 0.001) between mean of corneometry and TEWL and AD severity (mild, moderate, and severe). As for IgE levels, corneometry had significant negative correlation, in contrast with TEWL, which showed a significant positive correlation (P < 0.001). Conclusion Biophysical measurements of skin barrier in non-lesional skin of AD may work as an evaluation factor for AD severity.
conferenceObject MCM4 DEFICIENCY: A RARE VARIANT OF IMMUNODEFICIENCY OF NK CELLS ASSOCIATED TO PROPORTIONATE NANISM AND ADRENAL INSUFFICIENCY. DESCRIPTION OF THE FIRST CASE IN BRAZIL(2016) MORAES-VASCONCELOS, Dewton; RIBEIRO, Roberto; RIGATO, Paula Ordonhez; PINICHI, Paula; AOKI, Valeria; TAKAOKA, Roberto; DUARTE, Alberto Jose da Silva; SABINO, Ester Cerdeira- Consensus on the therapeutic management of atopic dermatitis - Brazilian Society of Dermatology: an update on phototherapy and systemic therapy using e-Delphi technique(2023) ORFALI, Raquel Leao; LORENZINI, Daniel; BRESSAN, Aline; TANAKA, Anber Ancel; CERQUEIRA, Ana Maria Mosca de; HIRAYAMA, Andre da Silva; RAMOS, Andrea Machado Coelho; PROENCA, Carolina Contin; SILVA, Claudia Marcia de Resende; LACZYNSKI, Cristina Marta Maria; CARNEIRO, Francisca Regina; DUARTE, Gleison; HANS FILHO, Gunter; GONCALVES, Heitor de Sa; MELO, Ligia Pessoa de; AZULAY-ABULAFIA, Luna; WEBER, Magda Blessmann; RIVITTI-MACHADO, Maria Cecilia; ZANIBONI, Mariana Colombini; OGAWA, Marilia; PIRES, Mario Cezar; IANHEZ, Mayra; FELIX, Paulo Antonio Oldani; BONAMIGO, Renan; TAKAOKA, Roberto; LAZZARINI, Rosana; CESTARI, Silmara; MAYOR, Silvia Assumpcao Soutto; CESTARI, Tania; OLIVEIRA, Zilda Najjar Prado de; SPULS, Phyllis I.; GERBENS, Louise A. A.; AOKI, ValeriaThis publication is an update of the ""Consensus on the therapeutic management of atopic dermatitis - Brazilian Society of Dermatology"" published in 2019, considering the novel, targeted-oriented systemic therapies for atopic dermatitis. The initial recommendations of the current consensus for systemic treatment of patients with atopic dermatitis were based on a recent review of scientific published data and a consensus was reached after voting. The Brazilian Society of Dermatology invited 31 experts from all regions of Brazil and 2 international experts on atopic dermatitis who fully contributed to the process. The methods included an e-Delphi study to avoid bias, a literature search and a final consensus meeting. The authors added novel approved drugs in Brazil and the indication for phototherapy and systemic therapy for AD. The therapeutical response to systemic treatment is hereby reported in a suitable form for clinical practice and is also part of this updated manuscript. (c) 2023 Sociedade Brasileira de Dermatologia.