Abstract The correct identification of pigmented nodular lesions of the scalp is often challenging. Despite the importance of clinical patterns and dermoscopy, important adjuvant tools that are usually helpful, their interpretation sometimes is not clear-cut. Here, the authors discuss a case of sebaceoma mimicking a malignant pigmented neoplasia, with conclusive histopathology.

Abstract: Background: Dermatological diseases are among the primary causes of the demand for basic health care. Studies on the frequency of dermatoses are important for the proper management of health planning. Objectives: To evaluate the nosological and behavioral profiles of dermatological consultations in Brazil. Methods: The Brazilian Society of Dermatology invited all of its members to complete an online form on patients who sought consultations from March 21-26, 2018. The form contained questions about patient demographics, consultation type according to the patient's funding, the municipality of the consultation, diagnosis, treatments and procedures. Diagnostic and therapeutic decisions were compared between subgroups. Results: Data from 9629 visits were recorded. The most frequent causes for consultation were acne (8.0%), photoaging (7.7%), nonmelanoma skin cancer (5.4%), and actinic keratosis (4.7%). The identified diseases had distinct patterns with regard to gender, skin color, geographic region, type of funding for the consultation, and age group. Concerning the medical conducts, photoprotection was indicated in 44% of consultations, surgical diagnostic procedures were performed in 7.3%, surgical therapeutic procedures were conducted in 19.2%, and cosmetic procedures were performed in 7.1%. Study limitations: Nonrandomized survey, with a sample period of one week. Conclusion: This research allowed us to identify the epidemiological profiles of the demands of outpatients for dermatologists in various contexts. The results also highlight the importance of aesthetic demands in privately funded consultations and the significance of diseases such as acne, nonmelanoma skin cancer, leprosy, and psoriasis to public health.

Abstract: The medical-dermatological demographics favors health planning and guides expansion of the specialty. We conducted an ecological study of dermatologists members of the Brazilian Society of Dermatology (SBD). We evaluated: gender, age, address; which were compared with population and human development index indicators of municipalities. We evaluated 8384 members, distributed in 527 (9.5%) municipalities throughout Brazil. The female sex represented 78.4% of the members and the median age was 43 (36-54) years. The median density of dermatologists was 0.35 (0.21-0.37) per 10,000 inhabitants. The correlation (Spearman's rho) between density of dermatologists and human development index was 0.39 (p <0.01). The Brazilian dermatologist is characterized as: female, age <50 years and presenting an heterogeneous distribution throught the country.

Abstract: Melanomas can arise either de novo (70%) or from pre-existing melanocytic lesions (30%). Of the latter, most cases arise at the dermoepidermal junction from small congenital or acquired non-blue nevi while only a few arise from blue nevi, notably the cellular subtype and less commonly the common (dendritic) type. Melanomas that arise from blue nevi usually occur on the scalp with greater frequency, as in the case described. Although previous studies have discussed melanoma arising from giant congenital blue nevi, few have discussed those arising from intermediate blue nevi. We present a case of a 52-yearold man with melanoma on the scalp evolving from an intermediate congenital common blue nevus.

Aspergillosis is an infection caused by saprophytic fungi of the genus Aspergillus, which typically occurs in immunosuppressed individuals, but has also been reported in immunocompetent patients. The main routes of entry are the respiratory tract, skin, cornea, and ear, and the infection may be localized or disseminated by contiguity or vascular invasion. We report a severe case of rhinosinusitis with cutaneous involvement, caused by invasive aspergillosis, in an immunocompetent user of inhaled cocaine. Invasive aspergillosis related to cocaine abuse has not yet been reported in the literature. After itraconazole treatment and surgical debridement, complete clinical remission was achieved. Nasal reconstruction with a skin graft over a silicone prosthesis resulted in a satisfactory esthetic outcome.

Os autores relatam um caso de esquistossomose cutânea ectópica em uma paciente de 35 anos que apresentou máculas e pápulas eritematosas agrupadas na nádega esquerda. O diagnostico não foi suspeitado durante a avaliação clínica, tendo sido obtido através da visualização dos ovos no exame histopatológico.

The authors report a case of ectopic cutaneous schistosomiasis in a 35 year-old female who presented clustered reddish macules and papules on the left buttock. The diagnosis was not suspected during clinical evaluation and required visualization of Schistosoma mansoni eggs on sections of tissue.

A dermatose bolhosa por IgA linear tem sido crescentemente associada com doenças inflamatórias intestinais, especialmente a retocolite ulcerativa. Relatamos o caso de um adolescente masculino, 13 anos de idade, com retocolite ulcerativa diagnosticada 11 meses antes, que desenvolveu vesículas, pústulas e erosões na pele da face, do tronco e das nádegas e na mucosa oral. A investigação revelou doença bolhosa subepidérmica rica em neutrófilos e deposição linear de IgA ao longo da junção dermoepidérmica, estabelecendo o diagnóstico de dermatose bolhosa por IgA linear. O paciente experimentou controle insatisfatório dos sintomas cutâneos e gastrointestinais apesar do uso de adalimumab, mesalazina, prednisona e dapsona por alguns meses. Após colectomia total, ele apresentou remissão completa das lesões cutâneas, sem necessidade de medicações durante os dois anos de seguimento. Neste artigo, revisamos os casos previamente relatados desta associação e debatemos o papel da retocolite ulcerativa no desencadeamento da dermatose bolhosa por IgA linear.

Linear IgA dermatosis has been increasingly associated with inflammatory bowel diseases, particularly ulcerative colitis. A 13-year-old male patient with an 11-month history of ulcerative colitis developed vesicles, pustules and erosions on the skin of the face, trunk and buttocks and in the oral mucosa. The work-up revealed a neutrophil-rich sub-epidermal bullous disease and linear deposition of IgA along the dermoepidermal junction, establishing the diagnosis of linear IgA dermatosis. The patient experienced unsatisfactory partial control of skin and intestinal symptoms despite the use of adalimumab, mesalazine, prednisone and dapsone for some months. After total colectomy, he presented complete remission of skin lesions, with no need of medications during two years of follow-up. A review of previously reported cases of the association is provided here and the role of ulcerative colitis in triggering linear IgA dermatosis is discussed.

Lesões melanocíticas adquiridas assemelhando-se à melanoma têm sido descritas nos principais grupos da Epidermólise bolhosa, e referidas como "Nevos da Epidermólise bolhosa''. Induzem facilmente ao erro diagnóstico, apesar de nenhuma transformação maligna ter sido descrita. Relatamos o desenvolvimento de um nevo melanocítico adquirido grande no local de bolhas recorrentes em uma criança de 5 anos portadora de Epidermólise bolhosa simples. O padrão dermatoscópico global foi sugestivo de benignidade, e os achados histopatológicos foram compatíveis com um nevo melanocítico composto. Este é o primeiro caso de um Nevo da Epidermólise bolhosa publicado na literatura brasileira

Acquired melanocytic lesions resembling malignant melanoma have been described in all major categories of Epidermolysis bullosa and referred to as "Epidermolysis bullosa nevi''. They easily induce to diagnostic error, although no malignant transformation has been reported. We report the development of a large acquired melanocytic nevus at a site of recurrent blisters in a 5-year-old child with Epidermolysis bullosa simplex. The global dermoscopic pattern was suggestive of benignity, and the histopathological findings were compatible with a compound melanocytic nevus. This is the first published case of Epidermolysis bullosa nevi in Brazilian literature. Despite their benign behavior, we emphasize the importance of regular clinical and dermoscopic monitoring, since a malignant course still cannot be totally excluded

A retículo-histiocitose congênita autolimitada é o espectro benigno das histiocitoses de células de Langerhans, caracterizada pela presença de lesões cutâneas ao nascimento ou no período neonatal, ausência de manifestações sistêmicas e resolução espontânea do quadro clínico. Apesar do curso benigno e frequente autorresolução na maior parte dos pacientes, estudos mostram que, em alguns casos, pode haver disseminação ou recaída da doença, enfatizando que o curso clínico é variável, havendo necessidade de seguimento em longo prazo. O acompanhamento do paciente por longo período é importante para detectar possível envolvimento sistêmico, pois existe relato de recorrência, envolvendo pele, mucosa, ossos e glândula pituitária

Congenital self-healing reticulohistiocytosis is the benign spectrum of Langerhans Cell Histiocytosis, characterized by cutaneous lesions at birth or in the neonatal period, absence of systemic manifestations and spontaneous resolution of clinical status. Despite the benign and often self-resolving course in most patients, studies show that in some cases there may be metastasis or recurrence of the disease, emphasizing that the clinical course is variable, requiring long-term follow-up. The monitoring of the patient for a long period is important to detect possible systemic involvement, as there is a report of recurrence involving the skin, mucosa, bone and pituitary gland

O perineurioma esclerosante é uma neoplasia benigna rara,constituída exclusivamente por células com diferenciação perineural, dispersas em meio a estroma fibroso denso. Acomete preferencialmente a pele dos quirodáctilos e das regiões palmares e se apresenta como pápula ou nódulo firme, normocrômico e assintomático. Apresentamos um caso de perineurioma esclerosante localizado na região palmar esquerda de uma paciente feminina de 16 anos de idade, com detalhada demonstração dos aspectos clínicos, histopatologia e revisão da literatura publicada em língua inglesa.

Sclerosing perineurioma is a rare benign neoplasm composed exclusively of perineural differentiation cells spread in a dense fibrous stroma. It affects primarily the skin of fingers and that of the palm of the hands. It appears as a hard papule or nodule, normochromic and asymptomatic. A case of sclerosing perineurioma in the left palm of a 16-year-old female is described, with detailed demonstration of clinical aspects, histopathology and literature review published in the English language.

Os autores apresentam um caso de alopecia cicatricial associada a lesões papulosas na face e no tronco, com quatro anos de evolução. O diagnóstico de sarcoidose foi confirmado pelo exame histopatológico. Durante o seguimento, a paciente desenvolveu lesões pulmonares. A alopecia cicatricial é complicação rara da sarcoidose e se confunde, clinicamente, com outras dermatoses, entre elas o lúpus eritematoso discóide e o líquen plano pilar.

The authors describe a case of cicatricial alopecia associated with papular lesions on the face and trunk with four years of evolution. The diagnosis of sarcoidosis was confirmed by histopathological examination. During the follow-up the patient developed lung lesions. Cicatricial alopecia is a rare complication of sarcoidosis. It is often confused, in clinical findings, with other dermatoses, among them discoid lupus erythematosus and lichen planopilaris.

FUNDAMENTOS: Os autores apresentam ampla revisão sobre os fundamentos da biópsia da unidade ungueal, fornecendo bases teóricas sobre anatomia, histologia e histopatologia. Abordam, detalhadamente, as indicações e os objetivos da biópsia da unidade ungueal e as várias técnicas disponíveis. OBJETIVOS: Definir os locais adequados da biópsia do aparelho ungueal para as diferentes doenças da unha, comparar duas formas de amaciamento da lâmina ungueal, uma utilizando KOH a 20%, outra, solução aquosa de Tween 40 a 10%, e estabelecer uma rotina para o processamento do material de biópsia. MÉTODOS: O grupo de estudo constou de 11 pacientes com doença ungueal, que procuraram o ambulatório de Dermatologia do HUPE/UERJ para esclarecimento diagnóstico. Foi realizado o total de 12 biópsias. RESULTADOS: Não houve diferença na dificuldade técnica, em incluir ou cortar o material, consoante ao método de amaciamento utilizado, nem prejuízo citológico ou histológico ao exame histopatológico. CONCLUSÕES: Os autores concluíram que biópsia ungueal é procedimento seguro e eficaz para esclarecer o diagnóstico das doenças ungueais quando o exame clínico ou outras técnicas falharam. Também é importante, para quem deseja realizar o procedimento, o conhecimento adequado da anatomia dessa região.

BACKGROUND: In this paper a broad review of nail biopsy is presented, emphasizing its anatomy, embryology, histology and histopathology. The indication and purpose of nail biopsy as well as the techniques available are reviewed in detail. OBJECTIVE: Define the appropriate site for nail biopsy according to nail disorder, compare two different methods of nail specimen softening: soaking in 20% potassium hydroxide and in 10% aqueous solution of Tween 40 and establish a routine for the nail biopsy procedure. METHODS: Our group studied eleven patients with nail disease who presented at the Dermatology Department in Pedro Ernesto University Hospital for a definite diagnosis. Twelve biopsies were performed. RESULTS: There were no differences in the softness achieved with the two methods and none harmed the cytologic and histologic analysis. CONCLUSIONS: The authors concluded that nail biopsy is a safe and useful procedure for nail diseases when clinical and laboratory methods fail to reach a diagnosis. A complete and thorough understanding of the nail unit anatomy is necessary to perform the procedure