Repositório RCAAP

The authors present the case of a 19 year old male patient, with multiple hand injuries caused by trauma with several sea urchins. Clinically, he presented erythematous violaceous nodules with keratotic surface on the dorsum of the hands and edema of the third right hand finger with a month of evolution. The biopsy of the lesions revealed granulomatous response pattern. Accidents of this nature are responsible for half of the cases related to aquatic animals in the emergency rooms of the Brazilian coast.

Sea urchin injuries are responsible for half of the cases related to aquatic animals in the emergency rooms of the Brazilian coast. Clinically it is characterized by mild to moderate pain, when there is compression, and the presence of multiple spicules fragments, which are usually difficult to remove. The authors present the case of a 17 year old male patient with multiple black sea urchin spicules on hands and feet after a fall on sea urchins colonies in the rocky hillside submerged.

Segmental neurofibromatosis type 1 (NF1) is characterized by typical features of NF1 limited to one or more body segments, and usually located unilaterally. It is caused by a somatic (rarely gonadal) postzygotic mutation in the NF1 gene, explaining why it should be regarded as a genetic mosaicism instead of a distinct entity from neurofibromatosis. We herein report two patients with segmental NF1 and give an updated overview of the disease.

Pachydermodactyly is a rare benign superficial fibromatosis, painless and asymptomatic, characterized by diffuse increase of connective tissue in the skin of the proximal interphalangeal joints of the second, third and fourth fingers, with symmetrical character, usually associated with trauma. The histopathology is non-specific, showing epidermal hyperplasia, increased collagen in the dermis and slight increase in the number of fibroblasts. The authors present the case of a 27 years old male patient with pachydermodactyly associated with repeated trauma related to their work.

A wide variety of pathogenically unrelated skin diseases may follow a zosteriform distribution pattern. Zosteriform morphea is a rare and recently described pattern of presentation of this localized sclerosis of the skin. We report the case of a 26-year old woman with morphea presenting with a zosteriform pattern without a preceding herpes zoster infection. She was treated with topical PUVA for a total of 10 sessions of treatment and a total UVA dose of 16 J/cm2. Marked softening of the sclerotic plaques was seen. This is the first report of its successfully and safe use in the rare zosteriform presentation.

In 1907 EHRMANN described two types of livedo: a pathological, livedo racemosa, and a “physiological”, livedo reticularis. Both are caused by the reduction of the blood flow and lowered oxygen tensions. It´s important to make difference between these two kinds of livedo by their clinical presentation. Livedo racemosa is associated to systemic diseases as systemic scleroderma. Is the most common dermatologic manifestation in antiphospholipid syndrome. We report a case of a female patient presenting livedo racemosa associated to cutaneous scleroderma.

Vitiligo is a acquired cutaneous disease, idiopathic, that affects approximately 1% of the world population. Nevus achromicus is a congenital anomaly observed in 0,2 to 0,3% of neonates and have a tendency to maintain itself stable in a long term. Although the diagnosis of vitiligo and nevus achromicus is based on clinical grounds, Wood´s light is a useful tool on the diagnosis of these discromic diseases. We report a case of a 26-year-old female patient that presented with spots compatible with nevus achromicus and vitiligo on the same body region.

The authors report the case of a 38-year-old woman with a history of depression medicated with fluoxetine and bromazepam for 2 years that presented a generalized and painful maculopapular rash evolving for 8 days and accompanied by fever. We found out she had been taking pills for weight loss handled in the pharmacy and started a new batch 3 weeks ago. The lesions progressed with mucosal involvement and formation of blisters and erosions covering an area of 40% of body surface, which together with the histopathology result allowed the diagnosis of Lyell syndrome. Under oral prednisolone 1.5mg/kg/day there was a complete resolution of the clinical manifestations in 15 days. We must highlight that slimming pills handled in pharmacies may become increasingly reported as triggers of Lyell syndrome. These tablets contain a miscellaneous of drugs, some understudied and with unknown pharmacokinetic interactions. Considering that these tablets are prepared in the pharmacy, we never know their exact composition or if they differ according to the batch.

Leprosy is still a relevant public health problem in Brazil, despite the drastic reduction in the number of cases. The late diagnostic and treatment hamper a decisive action about the disease. Report the case of a patient with a diagnosis and treatment for discoid lupus erythematosus (DLE), nevertheless it was leprosy.

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Introdução: A queratose actínica é a lesão pré-maligna mais frequente. A abordagem terapêutica dos doentes com múltiplas lesões envolve terapêuticas de campo.Objetivo: Avaliar a eficácia e segurança de mebutato de ingenol, um novo medicamento destinado à terapêutica tópica de campo.Desenho: Revisão sistemática e meta-análise dos ensaios clínicos controlados e aleatorizados (RCTs).Fontes bibliográficas: Medline e Cochrane Library (junho 2014). Seleção dos estudos: A seleção e avaliação dos RCTs foram feitas de forma independente.Análise quantitativa: Meta-análise de efeitos aleatórios. A heterogeneidade foi avaliada com o teste I2 .Resultados: Foram incluídos 6 ensaios (n=1.492) versus placebo. Mebutato de ingenol esteve associado a uma possibilidade de um doente ter remoção completa das lesões 17 (IC95%: 9 a 31; I2=0%) e 8,5 (IC95%: 5 a 15; I2=0%) vezes superior, comparativamente ao placebo, no rosto/couro cabeludo e no tronco/extremidades, respetivamente. A incidência de eventos adversos relacionados com o tratamento foi superior no grupo mebutato de ingenol (+23%, IC95%: 11 a 35%), sem diferenças entre grupos na taxa de abandono por eventos adversos.Conclusões: Mebutato de ingenol é eficaz no tratamento da queratose actínica. Comparativamente às restantes terapêuticas de campo disponíveis em Portugal, o seu valor terapêutico advém do favorável perfil de segurança e tolerabilidade, da simplicidade e curta duração do esquema terapêutico e da possibilidade de tratar de forma diferenciada as lesões de acordo com a localização anatómica (individualização da terapêutica).Estudos futuros deveriam comparar diretamente as diferentes opções terapêuticas e avaliar a efetividade das mesmas no mundo real.

Dermoscopy is a noninvasive, in vivo technique that increases the diagnostic accuracy in both melanocytic and nonmelanocytic skin tumors. In nonpigmented tumors allows the visualization of vascular structures not visible to the naked eye. Part I of this article discusses the dermoscopic evaluation of nonpigmented skin tumors including basic principles of specific morphologic types and architectural arrangement of vessels and the presence of additional dermoscopic clues.

Introduction: Ambulatory Surgery holds a prominent position in the elective surgery, including in Dermatology, an ambulatory medical-surgical specialty par excellence. Our service was the first to perform ambulatory surgery in Hospital de Braga.Methods: We conducted a retrospective study of patients with dermatological pathology who underwent surgery/laser in ambulatory setting between January 2002 and December 2011. Epidemiological and clinical-surgical characteristics were analyzed.Results: Were performed 1494 interventions with exponential growth since 2009 (N=641). Over 40% applied to malignant tumors (95 melanoma, 366 basal cell carcinomas, 141 squamous cell carcinomas, one dermatofibrosarcoma; one atypical fibroxanthoma and one cutaneous lymphoma). Regarding melanoma, the female gender was the most affected (74.7%) and the majority occurred in the lower limbs (39.4%). In cases of non-melanoma skin cancer, 60.6% were female and the majority occurred in the face (83.4%).Conclusion: The epidemiological knowledge of cutaneous tumors makes it necessary to renew the concept of Ambulatory Surgery in the management of dermatology services to ensure an efficient, safe and on time response.

Men who have sex with men are a diverse population, defined by gender and type of sexual practices, encompassing men with different sexual orientations. The authors conducted a review of epidemiologic , etiopathogenic, clinical, diagnostic and therapeutic aspects of the most prevalent sexually transmitted diseases in this population which include human immunodeficiency virus, syphilis, gonorrhea, lymphogranuloma venereum, sexually transmitted enteric infections, human papilloma virus, herpes virus or human hepatitis B.Improvements in health of men who have sex with men may be accomplished by gathering a complete sexual history in order to identify this population or in the evaluation of risk factors for acquisition of sexually transmitted infections. Recently published guidelines made changes in medical treatments, which vary according to the clinical syndrome presented and it´s causative agent.The recognition of this population and their specificities can improve their access to health care and prevent epidemiological spreads of some of the diseases lectured.

Introduction: In recent years there has been a resurgence of syphilis. Infection by Treponema pallidum is mainly associated with inconsistent condom use and high number of sexual partners in the months preceding the diagnosis. Following the increase number of diagnosed cases, it is important to have a greater awareness of the clinical and pathological features of the disease. This article describes and correlates the clinical and histopathological features of secondary syphilis in 7 patients seen at the Department of Dermatology, Hospital Santa Maria, Lisbon, Portugal.Material and Methods: Nine biopsies of mucocutaneous lesions from seven patients with secondary syphilis, observed between 2009 and 2013. The histopathologic and clinical findings were correlated and studied.Results: This study revealed a broad spectrum of histopathological changes ranging from an inflammatory infiltrate of the superficial dermis with location to an extent perivascular in the deep dermis. Although there is some correlation between different patterns of inflammation and type of skin lesions, the macular lesions were associated with a superficial inflammatory infiltrate as papular, maculopapular , and nodular lesions were associated with a profound inflammatory process. The predominant infiltrate was plasmacytic. Neutrophils were observed only in the case of condylomata lata.Conclusions: The histopathological features of secondary syphilis appear to be as varied as the clinical ones. It is the responsibility of the professionals who deal with these patients being particularly alert to the wide range of manifestations in this disease, remember this clinical diagnosis and be aware of the need for close interaction with dermatopathologists. The collaboration between pathologists and clinicians allows a correct correlation between clinical, serology and histopathological findings in order to establish a more plausibly diagnosis of syphilis.

Dermatitis herpetiformis is an autoimmune skin disease characterized by symmetrical and pruritic vesicular and papular lesions, that occur with herpetiformis layout. The disease pathogenesis is multifactorial, depending on genetic, environmental and immunological components. There are evidence wich suggest that the hormonal factors may play a role in disease. The authors report the case of a 28 year old female patient with dermatitis herpetiformis and gluten-sensitive enteropathy, whose the skin lesions were exacerbate monthly during the menstrual period after stopping use of oral anovulatory.

Pseudoxanthoma elasticum-like papillary dermal elastolysis (PXE-PDE) is an acquired clinical entity, of unknown etiology, characterized by partial or total absence of elastic fibers in the papillary dermis. We describe the case of a 62-year-old Caucasian woman, Fitzpatrick III skin phototype, with a dermatosis characterized by multiple, asymptomatic, yellowish, monomorphic, rounded papules, with 2-3mm in diameter, located on the posterior and lateral sides of the neck with 2 years of evolution. Histopathological examination revealed a marked reduction of elastic fibres in the papillary dermis confirming PXE-PDE diagnosis. We consider that this entity, exclusively cutaneous, is under-diagnosed because it is an asymptomatic disease, in which histopathological diagnosis is difficult, if it is not clinically considered.

The authors report a case of a young male patient who presented with erythematous and descamative lesions, with maceration, in the axillary and inguinal region, associated with erythematous ulcerated plaques in the perianal region. Histopathological examination was compatible with Langerhans cell histiocytosis, with immunohistochemical positivity for CD1a and S100, thus confirming the diagnosis. Systemic investigation revealed an extra-axial mass in supra-sellar region; he underwent chemotherapy, with a significant improvement of the cutaneous lesions. He keeps his follow-up by the Dermatology, Hematology and Endocrinology Units.

Lassueur Graham-Little-Piccardi syndrome is a rare dermatosis of unknown etiology that affects mainly women between 30 and 60 years old. It is characterized by the triad of multifocal scarring alopecia of the scalp, lichenoid follicular eruption and hypotrichosis of axillary and pubic regions. Anatomopathological examination revealed decrease in the number of hair follicles, upper perifollicular infiltrate and areas with fibrosis. Therapy is a challenge, with frequent relapses after local and systemic treatments. We report a typical case of this rare syndrome in a male patient of 46 years.