RCAAP Repository

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Introduction: The Skin Pathology Laboratory of the Department of Dermatology of Hospital de Santa Maria, Lisbon, has been operating continuously since its creation. Material and Methods: A retrospective study was conducted through the analysis of the histological exams of the tumoral skin pathology of the Laboratory between January 2008 and December 2019. Results: In the period 2008-2019 the Skin Pathology Laboratory performed 60 741 histological exams, of which 80% were tumoral lesions. Of these, malignant tumors represented about one third of the sample, essentially constituted by basal cell carcinomas (53%), squamous cell carcinomas (23%) and melanomas (8%). Other malignant tumors were lymphomas (3%), Kaposi's sarcoma (1%) and skin disorders due to extracutaneous malignancies (2%). The group of benign neoplasms (68% of the total number of tumors) included melanocytic nevi (50%), seborrheic keratosis (16%) and cysts (6%). Conclusion: Comparing with former casuistic studies, a steady and regular increase in the general activity of the Laboratory of Cutaneous Histopathology at the Dermatology Service of Hospital de Santa Maria has been observed in the past 12 years. This has been reflected in an increase in the number of diagnoses of malignant skin tumors. We highlight the value of histological examination as a central component in the diagnosis and subsequent treatment of neoplastic skin conditions.

Fibrosing alopecia in a pattern distribution is a recently recognized type of scarring alopecia, with hair loss in androgens- dependent area. Loss of follicular openings, perifollicular erythema, perifollicular hyperkeratosis and anisotriquia are the trichoscopic clues and follicular lichenoid inflammatory infiltrate the important finding in histopathology. It shares features of androgenetic alopecia and lichen planopilaris. Dermatologists should be familiarized with this entity in order to optimize the diagnosis and provide early treatment to prevent irreversible follicular damage.

Introduction: Psoriasis is a chronic inflammatory multisystemic disease with several comorbidities, namely anxiety and depression disorders. Methods: In this study, the prevalence of these psychiatric entities was investigated by the PHQ-9 and GAD-7 questionnaries and related to the socio-demographic variables and to the forms of clinical treatment. Results: A total of 90 patients (56 females) were analyzed. Of these, 41 patients (45.56%) used topical treatment only, 28 patients (31.11%) used oral methotrexate and 21 patients (23.33%) used immunobiological agents (anti-TNF-alfa agents). It was observed that 47 patients (52.23%) presented some degree of depression (mild, moderate or severe) and 53 patients (58.89%) presented some degree of anxiety disorder (mild, moderate or severe). There was no statistical relationship between the anxiety and depression scores and the PASI score, as well as age, employability or schooling. There was a statistical association between psychiatric comorbidities and the female gender (p <0.0001). It was also observed a lower prevalence of depression (p = 0.0336) on patients using immunobiological treatments. Conclusion: The findings confirm published data, showing association of psychiatric conditions with psoriasis, especially in relation to TNF-alpha, so that anti-TNF therapies may become an alternative for the treatment of depression or anxiety disorders associated with psoriasis.

Adolescents (between 10 and 19 years old) are an age group with a high prevalence of sexually transmitted infections (STI), due to biological and socio-behavioural factors. In Portugal, adolescents show poor condom adherence, have multiple sexual partners, poor sex education and high reinfection rates. In this age group, genital infection by Chlamydia trachomatis is the most prevalent STI, whose asymptomatic course makes diagnosis and epidemiological control difficult. The aim of this study is to review the published data on prevalence of genital infection by Chlamydia trachomatis in Portuguese adolescents. In the Portuguese population studies, which are highly heterogeneous, a prevalence of between 2.23%-18.2% was found. Portuguese notification rates are lower than in other European countries. Moreover, national official data do not discriminate adolescents in their age ranges. Between 15-24 years old, 41 cases were identified in 2015 and 56 cases in 2016. According to the European Center for Disease Control, 116 and 167 cases from this age group were reported in Portugal in 2017 and 2018, respectively. Understanding the epidemiology of genital CT infection in Portuguese adolescents is almost impossible due to underdiagnosis, underreporting and non-isolation of adolescents in studied groups. A concerted effort at clinical and political level is therefore needed to devise an effective strategy to combat this infection in adolescents.

Urticaria multiforme is an acute hypersensitivity reaction which can be considered a morphological subtype of urticaria. It is more common in children and as its clinical presentation resembles other pathologies such as erythema multiforme, urticarial vasculitis and serum-sickness-like reaction, it has been often underdiagnosed. We report a case of a 1-year and 9-month-old child with exuberant skin lesions associated with systemic manifestations with complete and quick recovery after H1-antihistamines and iv steroids in an intensive care unit.

Introduction: Hidradenitis suppurativa (HS) is a chronic dermatosis with a large impact in patients’ quality of life and an estimated 7-year delay in diagnosis. The General Practitioner (GP) is usually the first doctor to assist the HS patient. The primary objective of this study is to describe the knowledge and clinical approach of HS by GPs. Material and Methods: A cross-sectional study was conducted, based on the GPs answers to a questionnaire designed to evaluate their knowledge on HS. Results: One hundred eighty seven questionnaires were considered valid for inclusion in the study. The majority (97.3%) of GPs correctly identified HS as the most likely diagnosis when confronted with a typical clinical history of the disease, and 84.5% associated HS with chronicity. The majority (84.0%) of GPs refers these patients, mostly to Dermatology (89.3%). The majority of GPs also considered that a surgical approach may not be curative (94.1%) and 15.0% considered that biological agents might be indicated. We compared the answers of 2 groups: group A, n=100, with <5 years of clinical practice and group B, n=84, with ≥5 years. Group A associated more HS with tobacco use and obesity than group B (p=0.013 and p=0.006, respectively). A multidisciplinary approach was also more frequently selected by group A (p=0.004). Conclusion: This pilot study shows that the view of Portuguese GPs about HS can be improved. There are significant differences concerning knowledge on HS between GPs with less than 5 years of clinical practice and the more experienced ones. This study can help to direct differential future educational actions.

Dyskeratosis Congenita (DC) is a hereditary and multisystemic syndrome, with heterogeneous clinical and genetic manifestations, characterized as a disease associated with maintenance of defects and early telomere shortening. It is a rare condition, with an estimated annual incidence of 1 in 1 million individuals, and is more common in males than females, with an approximate ratio of 10:1. The main initial clinical manifestations are disorders of cutaneous pigmentation, nail dystrophy and abnormalities in the oropharynx, usually occurring between five and twelve years of age. Bone marrow failure (BMF) is the leading cause of death related to this disease. We present a case report of a child, female, two years old, who presented the cardinal signs and symptoms of DC at an early age, and we emphasize the importance of multidisciplinary monitoring of the patient.

Introduction: Acne is an extremely prevalent condition. The healing of active acne lesions may result in the development of scars. Atrophic scars are the main scars caused by acne and result from the degradation of collagen fibers. Carboxytherapy is a minimally invasive method that involves the application of carbon dioxide subcutaneously through small infiltrations in the skin, which improves scar tissue by increasing collagen's deposition and reorganization. The aim of this study is to review the role of carboxytherapy in the treatment of atrophic facial scars, alone or in combination with other techniques. Methods: A literature search was conducted on several databases using MeSH terms “carboxytherapy”, “carbon dioxide/therapy” and “wounds” for guidelines, systematic reviews, randomized controlled trials, and observational studies, published over the last 20 years in Portuguese, English or Spanish languages. Results: A total of 129 articles were retrieved, of which four experimental studies and one case series were selected. Comparing the techniques of microneedling and carboxytherapy, both were considered non-invasive treatment modalities with equal effectiveness, tolerability and safety, resulting in similar histopathological changes. On the other hand, despite the improvement of acne scars in both treatment modalities, the results were significantly better in favor of carbon dioxide fractional laser, despite having more side effects than carboxytherapy. When these techniques are combined and carboxytherapy is used as a subcision method, there is a more marked and rapid improvement in the appearance of acne scars. Discussion: Carboxytherapy is a promising modality in the treatment of atrophic acne scars, alone or in combination with other techniques.

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Introduction: Phototherapy is a therapeutic modality used to treat various dermatoses. It consists of exposure to non-ionizing radiation, classified as UVA or UVB according to its wavelength. Material and Methods: This is an observational, cross-sectional and descriptive study carried out in the phototherapy sector of the Dermatology Service of a university hospital with the objective of characterizing the population under treatment and their degree of satisfaction. Results: Fifty-one individuals were included of whom 69% were female, with a mean age of 49 years. The most prevalent dermatoses under treatment during the research were: vitiligo (62.5%), and mycosis fungoides (13.73%). Regarding the level of satisfaction with treatment, more than 90% declared themselves satisfied/very satisfied. Discussion: The prevalence of women and lower phototypes was consistent with the literature. The predominance of the elderly in this study corroborated by other studies may be justified by the presence of comorbidities, and contraindication to conventional treatments beside more time available for the treatment. In some cases, the most prevalent dermatosis was psoriasis, differing from our study. The second most prevalent dermatosis in our study was mycosis fungoides, which also differs from the studies found that described psoriasis or vitiligo as the second most prevalent dermatosis. Conclusion: Studies such as this one are necessary for the planning both the departments that already have this therapeutic modality and those that wish to implement it. Our results are not fully convergent with those of the literature as nowadays there are new options for the treatment of psoriasis.

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Angiomatoid Spitz nevus is a rare tumor that combines the classic aspects of Spitz nevus with a prominent vascular component. Clinically, it presents as a pink or brownish papule, usually solitary, in the extremities of young adults. On histology, it is characterized by a proliferation of epithelioid or spindle cell melanocytes embedded in a fibrous stroma, where a dense proliferation of small vessels is evident. The differential diagnosis with malignant melanoma can be difficult, particularly with the desmoplastic variant or with those with marked regression. Its behavior is benign, as suggested by the absence of local recurrences or distant metastases during long-term follow-up.

Multinucleated cell angiohistiocytoma (MCAH) is a rare clinical entity whose pathogenesis is not fully understood. It is more common in middle-aged women and is characterized by erythematoviolaceous papules or nodules, usually asymptomatic and predominantly located in the extremities. Histopathology is essential for making the diagnosis, consisting of typical alterations in the dermis, namely the proliferation of small vessels and the presence of multinucleated giant cells. Evolution is benign, although persistent, with few reported cases of spontaneous remission. We present the case of a 48-year-old man with MCAH, who exhibited asymptomatic papules and nodules grouped on the back of both hands, with a year of evolution. The diagnosis was made after histopathology, which excluded other differential diagnoses. With this case report, we intend to contribute to the knowledge about this entity and highlight the interconnection of clinical observation and histopathologic analysis.

We report a case of a 84-year-old male hospitalized for bacterial pneumonia who, during hospitalization, developed a flexural exanthema in parallel with a positive swab for SARS-CoV-2. Supportive therapy was instituted, the rash disappeared in 7 days and the patient fully recovered. At the same time, two other cases of SARS-CoV-2 infection occurred in the same ward. Histopathology and immunohistochemistry of a skin biopsy showed a scarce predominantly perivascular lymphocytic infiltration in the upper dermis, predominantly by CD4+ T cells, a slight epidermotropism, spongiosis and focal parakeratosis, compatible with a viral exanthema or a maculopapular drug eruption. Patch testing with possible culprit drugs were negative. We seek to add value in understanding all the manifestations of SARS-CoV-2 infection and to draw attention to the importance of early identification of skin manifestations in association with COVID-19.

Chronic telogen effluvium can be defined as a hair loss greater than the physiological one (above 150-200 hairs / day) for a period of more than six months, without an evident cause. Although common, it is often underdiagnosed, and raises several questions of a practical nature that the literature still has some difficulties in answering, from its etiopathogenesis to therapy. In this article on Continuing Medical Education, we intend to help answer these questions, reviewing the definition, pathophysiology, clinical / tricoscopic / histological characteristics and the therapy of the chronic telogen effluvium.

Nowadays, with the recent development of biological agents and other new drugs, some of which already approved in pediatric age, it is important to contextualize the role of phototherapy in dermatology. They have an excellent and well-recognized safety profile for decades, in addition to not requiring laboratory monitoring, which is an advantage, especially in the pediatric population. They have been successfully used in this age group in the treatment of several dermatological diseases. In this article, a review is carried out about the main particularities of the use of phototherapy in pediatric age, focusing on adverse effects, the main challenges, their indications and the individualized selection of different modalities, in order to improve the clinical practice of this therapy.

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