Repositório RCAAP

Leprosy is an infectious disease caused by Mycobacterium leprae that primarily affects the skin and/or peripheral nerves. It can have periods of acute reactions known as type 1 or reverse and type 2 or erythema nodosum. These reactions reflect the immune-mediated inflammatory process involving different mechanisms of hypersensitivity. The type 1 reaction corresponds to a sudden increase in cell-mediated immunity is more common in paucibacillary forms of the disease and type 2 reaction is recognized as changes in humoral immunity, is more common in multibacillary. This article aims to demonstrate a case of reverse reaction in a multibacillary patient. KEYWORDS – Leprosy, multibacillary; Mycobacterium leprae. 

Cryptococcosis is a systemic infection that affects mainly immunocompromised subjects, occurring in 2-10% of AIDS patients. In this population, the initial phase of respiratory infection is often unrecognized, leading to systemic dissemination and multiorganic involvement. Secondary cutaneous lesions usually occur in the terminal phases of lethally disseminated infections. The authors report the case of a 37-year-old HIV positive man that presented with a 1-week history of cutaneous lesions on the face, trunk and upper limbs, together with fever, cough and severe headache. Laboratory exams and imaging studies allowed the diagnosis of a systemic cryptococcosis with secondary cutaneous involvement and the patient started treatment with systemic amphotericin B and fluconazole, with complete resolution of the clinical picture. This case highlights the fact that cutaneous lesions are often the presenting sign of a systemic cryptococcosis. The unspecific features of these lesions imply a high index of clinical suspicion in order to establish the correct diagnosis and initiate immediate treatment. KEYWORDS – Cryptococcosis; Immunosuppression; HIV. 

We report a case of prolonged secondary syphilis with asymptomatic neurological involvement in HIV- -infected patient. A 26-year-old male patient who was diagnosed three years earlier with HIV infection presented with skin lesions on the feet and hands, alopecia, fever, arthralgia, weight loss of 8 Kg which began one year before and had a negative VDRL. During hospitalization, his VDRL was 1:1024 and a CSF-VDRL positive. The patient had an excel- lent clinical response to treatment with crystalline penicillin. The syphilis diagnosis should be considered in HIV-infected patients with severe clinical disease, even when the VDRL is negative. KEYWORDS – Sexually transmitted diseases; HIV infections; Neurosyphilis; Syphilis. 

Marjolin ́s ulcer has been described as a malignant transformation arising on chronic lesions or old scars. Some authors have considered inappropriate the use of the term Marjolin’s ulcer because the French physician descri- bed the sources of ulcers, rather than tumor. Patients with Hansen disease often have neurological sequelaes, which may predispose to the development of chronic cutaneous wounds. In strange cases, these lesions could progress to squamous cell carcinoma, sometimes of the verru- cous type, having more aggressive evolution. We report a case of patient with Hansen disease, having neurological sequelae and chronic ulcer in right calcaneus region that after many years it presented malignant transformation with rapid evolution, defining a clinical picture as a Marjolin’s ulcer, having been treating with amputation of rigth inferior member. KEYWORDS – Carcinoma, squamous cell; Leprosy; Skin neoplasms. 

Introduction: Basal cell carcinoma is the most common malignant tumors found in the human race, with an increasing incidence in recent decades. The vulva is an atypical location for this type of neoplasm, probably because the etiological factors are different from other anatomical areas. It has a non-specific and monotonous symptomatology. Case Report: A 69-year-old woman attended with a 3cm eroded plaque with small pigmented areas on the edge of the right labia majora. Histology revealed a pigmented basal cell carcinoma. The patient underwent to wide excision. After three years of follow-up there was no recurrence. Conclusion: Pigmented vulva basal cell carcinoma is a rarity. We emphasize how important is the differential diagnosis with other pigmented lesions in this area which may be neoplasm with a worst prognosis and require other kind of treatments. Periodic follow-up is required because the high rate of recurrence. KEYWORDS – Pigmentation disorders; Skin neoplasms; Vulvar neoplasms. 

Rosacea is a disease of unknown etiology which affects both the skin and the eye. There is high rate of ocular manifestations in patients with rosacea, whose signs and symptoms are related to the dysfunction of Meibomius glands. We report a case of a male child with unilateral blepharitis. Due to the injury is recurrent, childhood-onset, the patient had normal laboratory tests and in the absence of central facial lesions, biopsy was required for diagnosis. His- topathological examination revealed acanthosis, dilated capillaries and venules in the papillary and reticular dermis, perivascular and interstitial lymphocytic infiltrate. This case illustrates a subtle finding that rosacea can be extremely important for early diagnosis and monitoring. KEYWORDS – Rosacea; Eyelid diseases; Meibomian glands; Blepharitis; Child. 

Cutaneous tuberculosis is an uncommon disease, accounting for 1.5% of all types of tuberculosis. In pulmonary and cutaneous disease, infections caused by Mycobacterium africanum and Mycobacterium tuberculosis can be clinically indistinguishable. A six-year-old boy from Guinea-Bissau was hospitalized due to a right pre-auricular ulcer with two-year evolution and regional lymphadenopathy. Tuberculinic test was positive and the thoracic radiography showed a hypotransparent node on the right lower pulmonary lobe, with solid characteristics in CT scan. Skin ulcer and lymphadenopathy biopsies revealed lymphocytic infiltrate with a granulomatous reaction; the culture and PCR confirmed Mycobacterium africanum infection. Antibacillary treatment was supplied for six months, leading to significant reduction of the lesion. In developed countries it’s important to remind the several forms of cutaneous tuberculosis, which can present solely or in association with other forms of infection. In patients from endemic areas, a positive tuberculinic test should rise the suspicion of this entity. KEY-WORDS – Tuberculosis, cutaneous; Tuberculosis, pulmonary; Mycobacterium infections; Child. 

Os inibidores do receptor do fator de crescimento são uma classe de medicamentos relativamente nova que tem sido frequentemente usada em oncologia para tratar vários tipos de neoplasia. Várias manifestações tegumentares já foram descritas. Neste artigo relatamos um caso de um paciente com 55 anos de idade em uso de maleato de sunitinibe para tratamento de carcinoma renal metastático que desenvolveu manchas hipercrômicas, queilite e eritema palmar pelo uso de maleato de sunitinibe. No presente relato, discutimos as características dessas manifestações e o impacto que elas apresentam na qualidade de vida dos pacientes

O vitiligo é uma doença cutânea adquirida, idiopática, que acomete aproximadamente 1% da população mundial. O nevo acrômico é uma anomalia congênita observada em 0,2 a 0,3% dos neonatos e possui uma tendência a se manter estável ao longo do tempo. Apesar do diagnóstico de vitiligo e nevo acrômico serem baseados em características clínicas, a luz de Wood é uma ferramenta que é útil no diagnóstico destas discromias. Relatamos um caso de uma paciente de 26 anos de idade que apresentava manchas compatíveis com nevo acrômico e vitiligo na mesma região do corpo.

Introdução – Os hemangiomas são os tumores vasculares mais frequentes da infância. Em aproximadamente 10% dos casos ocorrem complicações que obrigam a intervenção. O propranolol foi recentemente adicionado aos fármacos utilizados para o seu tratamento e tem vindo a revolucionar a atitude terapêutica perante os mesmos. O objectivo deste estudo é avaliar a eficácia e segurança do propranolol no tratamento dos hemangiomas da infância.Materiais e Métodos – Efectuamos um estudo descritivo dos doentes tratados com propranolol entre Março de 2010 e Março de 2013. Foram incluídos doentes com hemangiomas em fase proliferativa que apresentassem crescimento rápido, ulceração ou risco de compromisso funcional e/ou estético. O tratamento foi realizado em ambulatório e a dose administrada foi de 2 mg/kg por dia. A resposta ao tratamento foi categorizada em completa, parcial ou ausente.Resultados – Foram tratados 22 doentes, com um total de 32 hemangiomas. As principais indicações para o tratamento foram o risco de compromisso estético (n=18) e funcional (n=9). Observou-se estabilização do crescimento dos hemangiomas em todos os casos, a regressão foi completa em 20 casos e parcial em três, o que corresponde a um sucesso terapêutico de 87%. Quatro doentes ainda se encontram em tratamento e em um caso foi necessário a interrupção precoce do fármaco por bradicardia.Discussão e Conclusão – Na grande maioria dos casos o propranolol provocou uma regressão rápida e sustentada dos hemangiomas, diminuindo assim a duração natural das lesões, com poucos efeitos secundários. Consideramos o propranolol o fármaco de primeira linha no tratamento dos hemangiomas da infância. 

O tumor glômico é um tumor mesenquimal incomum originado do glomusneuromioarterial presente na derme reticular, localizado mais frequentemente nas mãos.Relatamos um caso de mulher, 51 anos, com história de longa duração de alterações no aspecto da unha do hálux esquerdo e dor local intensa. Após diversos tratamentos, já com o diagnóstico de verruga subungueal, foi suspeitada a existência de tumor glômico pela história clínica e testes semiológicos sugestivos. Foi realizada cirurgia, com a confirmação histopatológica das duas hipóteses.O possível diagnóstico é a soma de história clínica sugestiva, testes ambulatoriais e exames de imagem, contudo somente confirmado pela histopatologia.O tratamento é cirúrgico, tratando a dor e evitando a recorrência. O presente caso relata associação de diagnósticos (tumor glômico e verruga subungueal) culminando com as importantes alterações no aspecto da unha.Enfatiza-se neste trabalho a necessidade de avaliar a dor obscura de dígitos para tumor glômico.

Em 1907 EHRMANN descreveu dois tipos diferentes de livedo: um patológico, o livedo racemoso, e um “fisiológico”, o livedo reticular. Ambos são causados pela redução do fluxo sanguíneo e pela redução da tensão de oxigênio no segmento da pele. É importante diferenciar clinicamente os dois tipos de livedo. O livedo racemoso associa-se com doenças sistêmicas como esclerodermia sistêmica. É a manifestação dermatológica mais comum da síndrome do anticorpo antifosfolipídeo.Relatamos o caso de uma paciente com livedo racemoso associado à esclerodermia cutânea

Relatamos o caso de uma criança de 7 anos que desenvolveu líquen plano cutâneo por Epstein-barr. O tratamento foi realizado com griseofulvina com boa resposta.

A variety of cutaneous lesions can mimic melanoma, such as melanocytic nevi, lentigines, seborrheic keratosis, blue nevi, pigmented basal cell carcinomas and dermatofibromas. This report describes a rare clinical case of a female patient who presented a lesion on the left thigh, which was clinically and dermoscopically compatible with melanoma. The patient underwent excision of the lesion, and histopathology confirmed a diagnosis of pigmented Bowen’s disease. The purpose of this report is to draw attention to the fact that pigmented Bowen’s disease, a rare form of squamous cell carcinoma in situ, should also be considered as a differential diagnosis of malignant melanoma.  

A hanseníase ainda constitui relevante problema de saúde pública brasileira, apesar da redução drástica no número de casos. O diagnóstico e tratamento tardios dificultam uma ação decisiva sobre a doença.Relatar o caso de uma paciente com diagnóstico e tratamento para lúpus eritematoso discóide (LED), que se tratava de hanseníase. Palavras-chave: hanseníase, lúpus eritematoso discóide, saúde pública.

Introduction: Most cases of lower eyelid reconstruction are due to defects resulting from resection of skin malignancies. The principles of eyelid reconstruction have been established, but it remains challenging to achieve good functional and aesthetic reconstruction. Material and Methods: Knowing the principles of eyelid reconstruction as well as of the basic anatomy is crucial when approaching the repair of eyelid defects. The eyelid may be divided into two lamellae: the anterior lamella includes the skin and the orbicularis muscle while the posterior lamella includes the tarsus and the conjunctiva.  Results: For reconstructive purposes the eyelid reconstruction may be divided into two main groups: (1) partial thickness defects with intact margin and (2) full-thickness defects involving the eyelid margin. Surgical closure techniques to reconstruct the anterior lamella include advancement or rotation myocutaneous flaps or full-thickness skin grafts. A graft is necessary to reconstruct the posterior lamella. Both of these lamellae must be replaced in the repair of full-thickness defects in order to restore their function. The algorithms to repair the full-thickness marginal defects are classified into: small (up to 30% of the horizontal dimension of the lid margin), medium (30%-50%), and large (upper than 50%). A small defect can usually be repaired by primary closure. In case of need, the lateral eyelid margin can be mobilized 3 to 5 mm by performing an inferior or superior cantholysis. To repair a moderately sized defect, a skin flap can be performed. For large defects, the surgeon must reconstruct the posterior lamella and rely on a combination of the previously used lower eyelid repair techniques. The authors review the methodology of reconstruction of lower eyelid defects illustrating with clinical cases from their experience.Conclusion: There are several procedures available to restore the natural eyelid contour. The appropriate reconstructive path depends on the particular clinical scenario. The dermatologic surgeon should be familiar with various reconstructive options for lower eyelid defects selecting the best option for each patient. 

Introduction: Merkel cell carcinoma is a rare, aggressive cutaneous neuroendocrine carcinoma that affects primarily elderly people. Patients present with a rapidly growing nodule, preferably located at the head, neck and limbs. Merkel cell carcinoma as a propensity for local recurrence and regional lymph node metastases and wide local excision is the initial consensual approach. The role of lymph node dissection, radiation therapy and chemotherapy is not yet clearly established. Material and Methods: The aim of this retrospective study was to evaluate Merkel cell carcinoma patients followed in our department between the years 2000 and 2009, regarding sex, age, race, clinical features, location, stage, associated malignancies, treatment and evolution.  Results: Our data are consistent with the literature, namely regarding age, associated lymphoproliferative disease and high local recurrence and mortality rates.

Background: Actinic cheilitis is a pre-malignant lesion affecting predominantly the vermilion of the inferior lip of male patients. Objectives: Our aim was compare two treatment options for Actinic cheilitis: ablation with CO2 laser and vermilionectomy.  Methods: Retrospective study of patients with Actinic cheilitis treated with CO2 laser ablation or vermilionectomy, in an 11 year period.Results: 51 caucasian patients were included, 43 (84%) of which were submitted to CO2 laser ablation and the 8 (16%) remainder to vermilionectomy. Mean follow-up time was 30,8 months (3 to 84 months). No recurrences were found in the patients submitted to vermilionectomy and in 72,5% of the patients treated with CO2 laser ablation, with no statistical significance (p>0,05). There was evolution to squamous cell carcinoma in one patient treated by CO2 laser ablation, after 50 months (surgically removed, no recurrence to date).Conclusion: Despite this reduced series, our results are similar to those available in the literature, concerning the recurrence rate after laser CO2 ablation.

Genital herpes is among the most common sexually transmitted diseases worldwide. Recurrent genital herpes is associated with major morbidity. Therefore, suppressive therapy plays an important role in the life quality of these patients. There are no established guidelines regarding the criteria for initiation of prophylactic therapy, although there is evidence for it after 6 recurrences per year. Drugs approved for this purpose are acyclovir, valacyclovir and famciclovir in different regimens with similar efficacy. In patients co-infected with human immunodeficiency virus (HIV) and herpes simplex virus (HSV), these drugs remain effective with higher doses regimens. The safety profile of this therapy has been proven in studies with follow-up times up to 18 years and the appearance of resistance although rare in the immunocompetent population (1%), is a fator of concern in immunocompromised patients reaching 10.9%. Several alternative therapies have been studied, such as therapeutic vaccine or new drugs with different action targets, but all remain under investigation.

Acute tissue expansion is a procedure widely used by Plastic Surgery for the closure of large surgical defects located in the head and the neck. We present a 61-year-old patient, with a large dimension Dermatofibrosarcoma protuberans of 45x30mm, placed in the midline of the forehead. The expected surgical defect was considerable; this combined with the anatomical situation, involved a complex reconstructive surgery, which would be resolved with the creation of a flap. Acute tissue expansion is a simple technique that can be performed in a unique surgical procedure, with good cosmetic outcome, minimizing technical difficulties and complications of invasive procedures.