ABSTRACT Objective To analyze the pattern of triggering and exacerbation of dermatological diseases between March and July 2020 and to compare this pattern to the corresponding period of 2019. Methods This was a quantitative, descriptive, comparative and documentary study that was carried out through the retrospective analysis of medical records (March to July 2019 and 2020) of individuals assisted at a private dermatology practice service located in the southern area of the city of São Paulo (SP). Results We evaluated 992 medical consultations in 2019 and 1,176 in 2020. In 2020, we observed a significant increase in cases of telogen effluvium (276%), psoriasis (1,400%), atopic dermatitis (178%), seborrheic dermatitis (200%), herpes zoster (1,200%) and vitiligo (433%). All diseases had stress as a possible initial trigger. In addition, fragile nail syndrome and contact dermatitis, pathologies associated with behavioral measures, also had an important increase in the prevalence (6,400% and 5,500%, respectively). However, the number of aesthetic procedures decreased by approximately 54% during the pandemic period. Conclusion During the pandemic period, the pattern of incidence of dermatoses had changed compared with the previous year. An emphasis was observed on diseases triggered by a psychological component, as well as those pathologies that have behavioral measures as the main cause. For this reason, the impacts of COVID-19 is greater than only among those infected.

Abstract Granuloma annulare is a benign cutaneous inflammatory disease, whose lesions have spontaneous improvement in two years in 50% of cases, but there is recurrence in 40% of patients. Treatment may be topical, intralesional or systemic. The use of phototherapy with narrowband UVB is highlighted, whose mechanism of action in this disease is still unclear, probably related to the inhibition of T lymphocytes. Herein, a case of a disseminated granuloma annulare of difficult therapeutic management is described. It was treated with narrowband UVB phototherapy twice a week for six months, with good clinical improvement, being a good low-risk therapeutic option and that, in this case, provided quick and satisfactory response.

Abstract Morbihan syndrome is a rare entity that more commonly affects women in the third or fourth decade of life. It is considered a special form of rosacea and its pathogenesis is not fully known. It is clinically characterized by the slow appearance of erythema and solid edemas on the upper portion of the face, with accentuation in the periorbital region, forehead, glabella, nose, and cheeks. We report the case of a patient presented with edema on the upper eyelid for a year. These findings suggested the diagnosis of Morbihan syndrome. We aim to report a rare, particularly refractory and chronic form of rosacea, which has received little attention in the literature.

Fima é o estágio final da rosácea e ocorre devido ao edema e inflamação crônica. Pode acometer nariz (rinofima), mento (gnatofima), fronte (metofima), orelhas (otofima) e pálpebras (blefarofima). Rinofima é a localização mais encontrada e há raros relatos de gnatofima. Relataremos paciente feminina, 41 anos, que apresentava placa infiltrada, eritêmato-edematosa, em todo o mento e lábio inferior há dois anos. Histopatológico com infiltrado linfocitário perianexial e perivascular, folículos e glândulas sebáceas hipertrofiadas, vasos ectasiados e fibrose perianexial. Foi instituído tratamento com tetraciclina via oral, ivermectina via oral e metronidazol creme com resposta satisfatória. Através da correlação clínica, histopatológica e resposta terapêutica confirmou-se o diagnóstico da variante rara de fima, gnatofima.

Phyma is the last stage of rosacea and is due to chronic inflammation and edema. It can affect nose (rhinophyma), chin (gnatophyma), forehead (metophyma), ears (otophyma) and eyelids (blepharophyma). Rhinophyma is the most frequent location and there are few reports about gnatophyma. We report the case of a female patient, 41 years old, who had an infiltrated, erythematous, edematous plaque around the chin and lower lip for two years. Histopathology showed perivascular lymphocytic infiltrate, hypertrophied follicles and sebaceous glands, dilated vessels and fibrosis. She was treated with oral tetracycline, oral ivermectin and metronidazole cream with a satisfactory response. The clinical, histopathological and therapeutic response correlation confirmed the diagnosis of gnatophyma, a rare variant of phyma.