Repositório RCAAP

Nevus Spilus, also known as “nevus on nevus”, speckled lentiginous or zosteriform nevus, is considered an uncommon variant of melanocytic nevus, occurring with a frequency of 1-2%. Malignant melanoma arising in nevus Spilus is a rare event with 31 reports in medical literature since 1970. Authors report a case of a 66-year-old woman with malignant melanoma arising in a congenital nevus Spilus.

Superficial disseminated porokeratosis is part of a group of diseases where there is epidermal keratinization disorder, it is characterized by numerous lesions whose boundaries are given by a wall keratotic. The description of new dermoscopic patterns has been increasingly reported and its contribution in this dermatosis is a reality. The authors describe a typical case of the disease, present their dermoscopic findings, comparing with what there is described in the literature and include the presence of enlarged pores within the lesions as an additional finding in the characterization of the disease.

We report a case of a 62-years-old male patient with pulmonary tuberculosis newly diagnosed who presented a polymorphic eruption due to an infestation by Sarcoptes scabiei. The authors demonstrate dermoscopic findings of human scabies and emphasize the importance of the use of dermoscopy as a valuable tool in non-traditional indications of its use.

Syphilis is a systemic infectious disease with particular importance in pregnant women due to placental transmission to the fetus. Untreated syphilis during pregnancy can lead to serious consequences and long-term sequelae. Congenital syphilis remains a serious public health problem in many developing countries where prenatal screening and treatment programs are not effective. The number of cases of congenital syphilis is still high in Portugal compared with other European countries, which means that this infection is also common in adults. The consequences of this infection in pregnancy can be prevented by early universal prenatal screening and treatment, therefore efforts should be made towards improving care and access to prenatal care.

Increasingly common in Services Medical Clinic, chronic kidney disease may be accompanied by deterioration in several other organ systems. In this context, the involvement of the skin can be portrayed through specific or nonspecific disorders, which may signal the level of commitment by the chronic kidney disease. The deposition of calcium salts in the skin and subcutaneous tissues, skin lesion called calcinosis, consists of a specific alteration of chronic kidney disease, which may indicate later stages of the disease. The authors describe the case of a patient with hypertension and diabetes, which develops chronic kidney disease DRC , during the illness evolves with calcinosis cutis. After supportive treatment before clinical improvement, the patient was discharged, becoming regularly followed by Clinic of Internal Medicine unit.

Epidermolytic palmoplantar keratoderma (Vörner’s keratoderma) is an autosomal dominant disorder of keratinization characterized by diffuse, non-transgredient thickening of palms and soles, without associated ectodermal features. It is generally associated with mutations of the keratin 9 gene (KRT9), and rarely with the keratin 1 gene (KRT1). We herein report a 16-month-old female patient (index case), born to nonconsanguineous parents, presenting with thick, yellow and diffuse hyperkeratosis confined to the palms and soles since her second month of age. An erythematous band was evident at the edges of the keratosis. Nails, teeth, hair and mucosae were normal, and there were no anomalies in other organ systems. A thorough investigation revealed a total of 15 family members presenting similar clinical features, being the common ancestor an Italian great-great-grandfather of patient’s mother. A lesional skin biopsy obtained from the mother revealed marked orthokeratotic hyperkeratosis with epidermolysis of upper and mid-epidermis. Both the inheritance pattern and the clinical-histological findings were consistent with hereditary palmo-plantar keratoderma of Vörner type. The patient and her mother were treated with 20% and 30-50% urea-containing creams, respectively, with satisfactory response.

The Stevens-Johnson Syndrome, responsible for severe mucocutaneous lesions, usually occurs after exposure to certain medications or after infection and may be related to autoimmune events. The authors describe the case of a patient of 47 years who presented the pathology after being subjected to therapy with amoxicillin. After hospitalization and treatment, it showed satisfactory recovery without presenting significant sequelae.

The growth factor receptor inhibitors represent a relative new class of medications which have been often used on oncology to treat various types of neoplasia. Many tegumentary manifestations have been described. On this article, we report a case of 55 year-old-male in use of sunitinib malate to treat metastatic renal carcinoma that developed hypercromic spots, perlèche and palmar erythema. On this report, we discuss the features of these manifestations and the impact that they have on the patients quality of life.

Leishmaniasis is an infectious disease caused by Leishmania species. Cutaneous leishmaniasis presents as papules that evolve to nodules/plaques that may ulcerate. The diagnosis is mainly clinical and may be confirmed by cutaneous biopsy. In HIV patients, Leishmania co-infection can lead more easily to visceral leishmaniasis and atypical cutaneous lesions. We describe a case of a patient with cutaneous leishmaniasis and pancytopenia which led to the diagnosis of a previously unknown HIV infection. A 41-year-old male patient presented with a 6 month history of 2 ulcerated nodules on the face. Cutaneous leishmaniasis was suspected and confirmed by skin biopsy. Treatment with itraconazole was performed with complete regression of the lesions. He also mentioned asthenia, anorexia and significant weight loss. Complementary study revealed pancytopenia and spleen infiltration. A myelogram and serology were performed, with a positive test for HIV1. This clinical case highlights the importance of a global evaluation of the patient.

Introduction: Squamous cell carcinoma of the scrotum is a rare tumour. It was the first cancer directly linked to occupational exposure to carcinogens (polycyclic aromatic hydrocarbons).Clinical Case: A 59-year old man was referred with a one year history of a painful scrotal ulcer, 8 cm in diameter, associated with genital lymphedema. Histological examination confirmed the diagnosis of squamous cell carcinoma. The extent of the tumor and the patient’s general condition did not allow any therapeutic approach, and death occurred 18 months after the first symptoms.

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Cow’s milk protein allergy is an increasingly prevalent and more prolonged disease. Cow’s milk protein allergy is the most common food allergy in infants with a prevalence of approximately 2% to 3%. It may develop even in exclusively breastfed infants. It can manifest through a wide variety of symptoms depending on whether the type of immune response is IgE or non-IgE mediated. Symptoms and signs related to cow’s milk protein allergy may involve many different organ systems, mostly the skin and the gastrointestinal tract. Among the skin manifestations, urticaria and angioedema are likely the most common, followed by atopic dermatitis, pruritus, diffuse erythema and maculopapular rash. Cow’s milk protein allergy is suspected clinically in a large number of children. An incorrect diagnostic workup often leads to unnecessary dietary restrictions that may affect growth and development of children. This article presents a practical approach for the diagnosis and management of suspected cow’s milk protein allergy according to age and symptom severity.

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Food additives are substances added to foods that intentionally change their properties. They include antioxidants, coloring agents, emulsifiers, thickeners, flavoring agents and spices, preservatives and stabilizers. Their frequent use in food and cosmetic industries might be responsible for dermatosis in both food and food additives’ handlers and consumers, as well as in cosmetics users. Clinical presentations due to contact include contact urticaria and allergic or irritative contact dermatitis. The culprit allergen and dermatitis location differ depending on whether these occur in cosmetic users or in a professional context. Clinical presentations due to inhalation/ingestion of food additives might present as urticaria, anaphylaxis and systemic contact dermatitis. Diagnosis is based on a thorough clinical history and clinical exam, as well as cutaneous testing.

The most important question associated with the actinic keratosis is their 5 to 10% probability to evolve to invasive squamous cell carcinoma of the skin. The progressive increase of actinic keratosis prevalence and the difficulty in predicting their evolution pattern have determined the importance of its adequate prevention and treatment. The current review describes the different treatment options for the actinic keratosis, and aims at guiding the best therapeutic choice for each patient. Currently, physicians have available multiple therapeutic options including ablative procedures for treating one or a small number of lesions and topical treatments for individual lesions and field treatment. Despite the several available therapeutic options, the decision of treating the actinic keratosis must be based not only in their clinical aspects but also in several factors associated with patients’ preferences, characteristics and specificities.

Atopic eczema is a common inflammatory skin disease, affecting up to 20% of children and 3% of adults in industrialized countries. Most cases of atopic eczema are mild to moderate and will be adequately managed with topical therapy. Persistent or severe cases may require periods of systemic treatment, which can be broadly grouped into conventional and biologic agents. Conventional systemic agents are associated with potential toxicities that limit the continued use and often do not provide adequate therapeutic responses. More recently, biologic agents have been proposed for the treatment of severe atopic eczema, holding promise for a more targeted and less toxic approach. However, none of the biologics have been approved for atopic eczema therapy yet. At present, its off-label use is advisable only in severe atopic eczema refractory to conventional treatments. In this report, the authors comprehensively review the literature regarding the use of biologic therapy in severe EA.

Background: Hemangiomas are the most common vascular tumors of infancy. In approximately 10% of patients occur complications that obligate to intervene. Propranolol was recently added to the list of drugs available to treat these patients, and has been changing the therapeutic attitude towards these lesions. This study objective is to evaluate propranolol efficacy and safety in the treatment of infantile hemangiomas.Material and Methods: This is a retrospective descriptive study of patients treated with propranolol, between March 2010 and March 2013. The candidates for treatment were patients with proliferative phase hemangiomas with rapid growth or functional or aesthetic compromise. It was performed as an ambulatory treatment and the dosage used was 2mg/kg per day. Treatment response was categorized in complete, partial or absent.Results: We treated 22 patients, with a total of 32 hemangiomas. The main indications for treatment were the aesthetic (n=18) and functional risks (n=9). We observed a growth stabilization of hemangiomas in all cases. Regression was total in 20 cases and partial in three, which corresponds to a therapeutic success of 87%. Four patients are still on therapy and in one case we had to stop the drug prematurely due to bradycardia.Discussion and Conclusion: In the majority of cases propranolol caused a rapid and maintained regression of hemangiomas, shortening the natural duration of lesions, with few side effects. We consider propranolol the first line therapy for hemangiomas in infancy.

The coexistence of more than one neoplasm in a single cutaneous specimen is uncommon and has been defined as collision or compound tumor. The authors describe a 66-year-old man who presented with a contiguous seborrheic keratosis and a basal cell carcinoma on the left malar region that had developed in about one year. The case was investigated clinically and focusing on the dermoscopic features and histopathological correlates. Dermoscopy of the lesion revealed milia-like cysts corresponding to the verrucous part of the lesion, whereas the erythema at the periphery disclosed a few arborizing vessels. Histologically the lesion was a seborrheic keratosis and a basal cell carcinoma. Hence, histopathology confirmed the dermoscopic diagnosis of a compound tumor. Dermoscopy is not only an important aid to the diagnosis of cutaneous collision tumors but might additionally turn the attention of histopathologists to any peculiar feature of a given lesion.

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.