Resumo Introdução: Dermatofitoses constituem as infecções fúngicas da pele, cabelo e unha mais comuns em seres humanos, acometendo cerca de 20% da população mundial e todas as faixas etárias. Objetivos: Analisar características clínicas, epidemiológicas e terapêuticas de pacientes com dermatofitoses atendidos num serviço de referência em dermatologia geral e tropical na região da Amazônia Brasileira. Métodos: Foram analisados 75 prontuários do período de janeiro de 2016 a janeiro de 2020, cujos dados sobre formas clínicas, tratamento e recorrência foram coletados em protocolo próprio dos pesquisadores. Foi utilizado o teste Qui-quadrado de aderência na análise estatística e para a tomada de decisão adotou-se p < 0,05. Resultados: Houve predomínio do sexo feminino, média de 49 anos de idade, e em 28% dos casos observaram-se mais de 10 lesões no mesmo indivíduo. O principal tipo de dermatofitose foi onicomicose em adultos, seguida por Tinea capitis (24%) na faixa etária pediátrica (média 11,39 anos). De forma geral, idosos (37,33%) e crianças (26,67%) foram os mais atingidos. Optou-se, na maioria dos casos, pelo tratamento com medicações tópicas e sistémicas combinadas, sendo a griseofulvina e a terbinafina as mais prescritas para o tratamento sistêmico e a ciclopirox olamina o principal tópico prescrito (36%). Apesar de 77,3% dos pacientes terem comparecido em consulta subsequente, 25,33% recidivaram em menos de um ano. Conclusão: Os dados analisados ressaltam a importância do diagnóstico e tratamento precoce das dermatofitoses, sobretudo em idades extremas —faixa etária pediátrica e idosos— além de destacar a importância ativa das medidas não farmacológicas na viabilização da redução de recidivas e morbilidade aos pacientes.

Abstract Introduction: Dermatophytosis is the most common fungal infection of the skin, hair, and nails in humans. It affects about 20% of the world's population in all age groups. Objectives: To analyze clinical, epidemiological, and therapeutic characteristics of patients diagnosed with dermatophytosis treated at a general and tropical dermatology reference service in the Brazilian Amazon region. Methods: We analyzed 75 medical records from January 2016 to January 2020, with a researchers' protocol to collect data on clinical forms, treatment, and recurrence. Statistical analysis used the chi-square test of adherence, and p < 0.05 was considered statistically significant. Results: There was a female predominance, mean age of 49 years and 28% of patients had more than 10 lesions. The dominant type of dermatophytosis was onychomycosis in adults, followed by Tinea capitis (24%) in the pediatric group (mean 11.39 years). The elderly (37.33%) and children (26.67%) were the most affected. In most cases, treatment with combined topical and systemic medications was chosen. Griseofulvin and terbinafine were the most prescribed for systemic treatment and ciclopirox olamine was the main prescribed topic (36%). Although 77.3% of the patients attended a follow-up appointment, 25.33% relapsed in less than one year. Conclusion: The analyzed data emphasizes the importance of early diagnosis and treatment of dermatophytosis, especially in the extreme age group —pediatric and elderly age groups— besides the active importance of non-pharmacological measures to reduce recurrences and morbidity for patients.

RESUMO Introdução: A psoríase é uma doença crónica inflamatória multissistêmica com diversas comorbidades, entre elas estão os transtornos de ansiedade e de depressão. Metodologia: Avaliar a prevalência de ansiedade e depressão, respectivamente pelos questionários GAD-7 and PHQ-9 em relação com variáveis socio-demográficas e formas de tratamento. Resultados: Foram avaliados 90 pacientes (56 do género feminino), 41 pacientes (45,56%) utilizavam apenas tratamento tópico, 28 pacientes (31,11%) utilizavam metotrexato via oral e 21 (23,33%) utilizavam imunobiológicos (agentes anti-TNF-alfa). Observou-se que 47 pacientes dos avaliados (52,23%) apresentaram algum grau de depressão (leve, moderado ou severo) e que 53 pacientes (58,89%) apresentaram algum grau de transtorno de ansiedade (leve, moderado ou severo). Não houve relação estatística significante entre o quadro de ansiedade e de depressão e o score PASI, assim como a faixa etária, a empregabilidade ou a escolaridade. Houve associação estatística entre o quadro psiquiátrico e o género feminino (p<0,0001) e menor prevalência de depressão (p=0,0336) com o uso de imunobiológicos. Conclusão: Os achados ratificam os achados encontrados na literatura, nos quais o quadro psiquiátrico possui também uma ampla associação com a fisiopatogenia inflamatória da psoríase, em especial em relação ao TNF-alfa, de modo que terapias anti-TNF possam vir a ser uma alternativa para o tratamento de depressão ou de transtornos de ansiedade associados à psoríase.

ABSTRACT 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.

ABSTRACT A 37-year-old male patient, Fitzpatrick skin phototype IV, a student living in Belem, Amazon region, in 2015 had a confirmed diagnosis of acquired immunodeficiency virus (HIV) infection, but did not initiate antiretroviral treatment at his own option. Three years after the diagnosis, erythematous maculae appeared on the dorsum of the nose with rapid progression to the entire face, with posterior diffuse infiltration and appearance of nodules on the chin and shoulder. In December 2018, the patient presented with exacerbation of the condition with an increase in infiltrated violaceous plaques and disseminated violaceous nodules. A histopathological biopsy of the skin was performed, confirming the diagnosis of angiomatoid proliferation suggestive of Kaposi’s sarcoma (KS), with an important dissemination of this disease to the noble organs. In addition, it is important to note that he only started antiretroviral therapy (ART) after the exacerbation of Kaposi (December 2018). In such cases, chemotherapy associated with ART is crucial for the treatment and follow-up of the patient, since Kaposi’s sarcoma develops relatively low in patients who do not have immunodeficiency.

Abstract: Background: Kaposi’s sarcoma (KS) is a rare neoplasm with indolent progression. Since 1981, the Kaposi’s sarcoma epidemic has increased as co-infection with HIV. Objectives: The study aimed to identify the clinical and demographic characteristics and therapeutic approaches in HIV/AIDS patients in a regional referral hospital. Methods: We analyzed the medical records of 51 patients with histopathological diagnosis of Kaposi’s sarcoma hospitalized at Hospital Universitário João de Barros Barreto (HUJBB) from 2004 to 2015. Results: The study sample consisted of individuals 15 to 44 years of age (80.4%), male (80.4%), single (86.3%), and residing in Greater Metropolitan Belém, Pará State, Brazil. The primary skin lesions identified at diagnosis were violaceous macules (45%) and violaceous papules (25%). Visceral involvement was seen in 62.7%, mainly affecting the stomach (75%). The most frequent treatment regimen was 2 NRTI + NNRTI, and 60.8% were referred to chemotherapy. Study limitations: We assumed that more patients had been admitted to hospital without histopathological confirmation or with pathology reports from other services, so that the current study probably underestimated the number of KS cases. Conclusion: Although the cutaneous manifestations in most of these patients were non-exuberant skin lesions like macules and papules, many already showed visceral involvement. Meticulous screening of these patients is thus mandatory, even if the skin lesions are subtle and localized.

RESUMO Objetivos: Relatar as manifestações oculares observadas em pacientes com psoríase atendidos no Ambulatório de Dermatologia da X e encaminhados ao Y, no período de outubro de 2013 a agosto de 2014. Métodos: A amostra foi constituída por um grupo composto por 43 pacientes com psoríase e um grupo controle com 86 pacientes sem psoríase. Foi realizada uma entrevista clínica com dados epidemiológicos, aspectos clínicos da doença e terapia empregada, sendo todas as informações registradas em protocolo próprio. Posteriormente, realizou-se o exame dermatológico, no qual foi avaliado o índice de gravidade da Psoríase por área (PASI) e índice dermatológico de qualidade de vida (DLQI), e o exame oftalmológico completo, incluindo: Acuidade Visual, Biomicroscopia, Tonometria, Fundoscopia, Teste de Schirmer I, Tempo de Ruptura do Filme Lacrimal (TBUT), rosa bengala, índice de doença da superfície ocular (OSDI) e exames para glaucoma. Resultados: Observou-se que nos pacientes com psoríase houve frequência estatisticamente maior de envolvimento ocular, como olho seco (16,28%), provável olho seco (32,56%) e blefarite (16,28%). Além disso, os valores do rosa bengala e do OSDI apresentaram-se mais alterados nos pacientes com psoríase (p<0,05). Conclusão: Dessa forma, sugere-se que esses pacientes realizem exames oftalmológicos periódicos, já que as manifestações oculares podem progredir sem sintomatologia e ocorrer independentemente de fatores de risco.

ABSTRACT Purpose: We aimed to report the ocular manifestations observed in patients with psoriasis. Methods: Patients were included and referred to our ophthalmology clinic from dermatology clinics of Universidade do Estado do Pará between October 2013 and August 2014. Clinical interviews were conducted to identify relevant epidemiological data, clinical features, and treatment details, and data were recorded using the same protocol. Subsequent dermatological examinations were performed and disease severity was rated using the Psoriasis Area and Severity Index and the Dermatological Life Quality Index. Complete eye examination was conducted, including visual acuity, biomicroscopy, tonometry, fundoscopy, Schirmer I test, tear breakup time, rose bengal staining, ocular surface disease index, and glaucoma tests. Results: In total, we included 43 patients with psoriasis and 86 controls. Patients with psoriasis had statistically higher incidences of dry eye (16.28%), likely dry eye (32.56%), and blepharitis (16.28%). Furthermore, the rose bengal and ocular surface disease tests were more abnormal in patients with psoriasis (p<0.05). Conclusions: Patients with psoriasis should undergo regular eye exams, regardless of risk factors, to monitor for the progression of symptomatic or asymptomatic ocular manifestations.

Abstract: Cutaneous lymphomas are classified according to their cellular origin into T-cell lymphoma and B-cell lymphoma. The annual incidence rate is 0.3 per 100,000 population. We report a case of a 56-year-old male patient who presented with a two-month history of nodules of varying sizes, some ulcerated, on the face, abdomen, and upper limbs. Histopathological examination and immunohistochemical study confirmed the diagnosis of primary cutaneous centrofollicular lymphoma. Studies have shown an increased incidence of non-Hodgkin lymphomas in the last decade. We report an infrequent case that should be kept as a differential diagnosis of patients with nodules and cutaneous papules.

RESUMO Objetivo: Avaliar o impacto da dermatite atópica na qualidade de vida de pacientes pediátricos de 5 a 16 anos e seus responsáveis, atendidos no serviço de dermatologia da Universidade do Estado do Pará (UEPA) em 2015. Métodos: Estudo transversal de 51 pacientes juntamente com seus responsáveis, aos quais foram aplicados dois questionários de qualidade de vida, o Escore da Qualidade de Vida na Dermatologia Infantil (CDLQI) e o Impacto da Dermatite Atópica na Família (DFI). Para avaliar a gravidade da doença, os pesquisadores aplicaram o índice de Severity Scoring of Atopic Dermatitis (SCORAD). A correlação linear de Pearson foi aplicada para averiguar a correspondência entre os instrumentos CDLQI, DFI e SCORAD, e o coeficiente de contingência C para avaliar a associação entre as variáveis qualitativas. Considerou-se significante p<0,05. Resultados: Dos pacientes, 55% pertenciam ao sexo feminino. A idade média foi de 9.5±3.2 anos, e 41% tinha renda familiar de até um salário-mínimo. A média dos escores foi de 5.4±5.1 para o CDLQI, 6.6±4.5 para o DFI e 28.3±19.8 para o SCORAD. Atestou-se correlação altamente significante entre os escores CDLQI, DFI e SCORAD pela correlação linear de Pearson (p<0.001). Conclusões: A dermatite atópica afeta a qualidade de vida tanto das crianças quanto de seus responsáveis, o que indica a importância de inserir o estudo da qualidade de vida de forma complementar à avaliação clínica dos pacientes.

ABSTRACT Objective: To evaluate the impact of atopic dermatitis on the quality of life of pediatric patients in the age group of 5-16 years, and their parents, assisted at the Dermatology Department of Universidade do Estado do Pará in 2015. Methods: A cross-sectional study including 51 patients and their guardians, to whom two questionnaires about the quality of life were applied, the Children’s Dermatology Life Quality Index (CDLQI) and the Dermatitis Family Impact (DFI). To evaluate the severity of the disease, the researchers applied the Severity Scoring of Atopic Dermatitis (SCORAD) index. The Pearson Product-Moment Correlation Coefficient (PPMCC) evaluated the correlation between CDLQI, DFI, SCORAD, and the contingency coefficient C evaluated the association between the qualitative variables, considering p<0.05 significant. Results: Of the patients, 55% were female. The average age was 9.5±3.2 years, and 41% had family income up ≤1 minimum wage. The average score was 5.4±5.1 for CDLQI, 6.6±4.5 for DFI, and 28.3±19.8 for SCORAD. The correlation among the scores CDLQI, DFI, and SCORAD was significant by the PPMCC (p<0,001). Conclusions: Atopic dermatitis affects the quality of life of both children and their guardians, and indicates the importance of including the study of quality of life as a complement to clinical evaluation.

BACKGROUND: Leprosy and HIV are diseases that have a major impact on public health in Brazil. Patients coinfected with both diseases, appear to be at higher risk to develop leprosy reactions. OBJECTIVE: The aim of this study is to describe the histopathological aspects of cutaneous lesions during reactional states in a group of patients with HIV-leprosy coinfection, compared to patients with leprosy, without coinfection. METHODS: Two groups were established: group 1 comprised of 40 patients coinfected with HIV-leprosy; group 2, comprised of 107 patients with leprosy only. Patients presenting reactional states of leprosy had their lesions biopsied and comparatively evaluated. RESULTS: Reversal reaction was the most frequent feature in both groups, with dermis edema as the most common histopathological finding. Giant cells were seen in all group 1 histopathological examinations. Dermis edema was the most common finding in patients with erythema nodosum leprosum. CONCLUSION: Few histopathological differences were found in both groups, with reversal reaction as the most significant one, although this fact should be analyzed considering the predominant BT clinical form in the coinfected group and BB form in the group without HIV. Larger prospective studies in patients with HIV-leprosy coinfection are needed to confirm and broaden these results.

BACKGROUND: Pemphigusis a bullous, rare and chronic autoimmune disease. There are two major forms of pemphigus: vulgaris and foliaceus. Epidemiological data and clinical outcome in patients diagnosed in the Brazilian Amazon states are still rare. OBJECTIVES: To study the occurrence of the disease during the study period and analyze the epidemiological profile of patients, the most common subtype of pemphigus, and the clinical evolution of patients. METHODS: Retrospective analysis of medical records of hospitalized patients with pemphigus foliaceus and pemphigus vulgaris in the period from 2003 to 2010 in Dermatology Service of Hospital Fundação Santa Casa de Misericórdia do Pará, Belém, Northern Brazil. RESULTS: We found a total of 20 cases of pemphigus during the study period, 8 of which were of foliaceus pemphigus and 12 of vulgaris pemphigus. Pemphigus foliaceus had the predominance of male patients (75%), showed satisfactory clinical evolution, and was characterized by absence of pediatric cases. Pemphigus vulgaris affected more women (66.7%), showed mean hospital stay of 1 to 3 months (50%), and there were three cases of death (25%). The prescribed immunosuppressive drugs included prednisone with or without combination of azathioprine and/or dapsone. Sepsis was associated with 100% of the deaths. CONCLUSIONS: The occurrence of the disease is rare, there are no familiar/endemic outbreaks in the sample. Evolution is usually favorable, but secondary infection is associated with worse prognosis. The choice of best drugs to treat pemphigus remains controversial.

PURPOSE:To investigate diclofenac topical gel as an alternative to reduce phlogistic signals and maintain quality of wound repair.METHODS:Fifteen Wistar rats were used in this study; four excisional wounds were performed on the dorsum of each animal. Once in a day, cranial wounds received topical diclofenac gel administration and caudal wounds were washed with isotonic saline. After seven, 14 and 21 postoperative days, five animals were randomly chosen for macroscopic and microscopic wound analysis.RESULTS:On the 7th day: diclofenac wounds showed significant higher scab formation, however showed less phlogistic signal; diclofenac wounds had larger area and had less neutrophil invasion. On the 14th day: No area difference was noted and diclofenac wounds showed less hyperemia and phlogistic signals; diclofenac wounds showed greater keratinocytes invasion. On the 21st day: Almost all wounds were closed and there were no difference regarding the type of scar formation; diclofenac wounds showed greater monocytes invasion and lower angiogenesis level. No difference was noted in any postoperative day regarding fibroblast invasion, collagen deposit quantity and quality.CONCLUSION: Diclofenac topical gel is capable of reducing phlogistic signals and do not cause fibroblast or keratinocyte downregulation thus do not lead to excisional wound healing impairment.

BACKGROUND: The cutaneous mycoses, mainly caused by dermatophyte fungi, are among the most common fungal infections worldwide. It is estimated that 10% to 15% of the population will be infected by a dermatophyte at some point in their lives, thus making this a group of diseases with great public health importance. OBJECTIVE: To analyze the clinical, epidemiological, and therapeutic profile of dermatophytosis in patients enrolled at the Dermatology service of Universidade do Estado do Pará, Brazil, from July 2010 to September 2012. METHOD: A total of 145 medical records of patients diagnosed with dermatophytosis were surveyed. Data were collected and subsequently recorded according to a protocol developed by the researchers. This protocol consisted of information regarding epidemiological and clinical aspects of the disease and the therapy employed. RESULTS: The main clinical form of dermatophyte infection was onychomycosis, followed by tinea corporis, tinea pedis, and tinea capitis. Furthermore, the female population and the age group of 51 to 60 years were the most affected. Regarding therapy, there was a preference for treatments that combine topical and systemic drugs, and the most widely used drugs were fluconazole (systemic) and ciclopirox olamine (topical). CONCLUSION: This study showed the importance of recurrent analysis of the epidemiological profile of dermatophytosis to enable correct therapeutic and preventive management of these conditions, which have significant clinical consequences, with chronic, difficult-totreat lesions that can decrease patient quality of life and cause disfigurement.

Psoriasiform Keratosis is a rare clinic entity. The etiopathogenesis remains unknown and the disease is characterized by a solitary, scaly or keratotic papule, or plaque mainly located on the extremities. Histopathological features closely resemble those of psoriasis. We report the case of a 70-year-old woman presenting a solitary and asymptomatic keratotic plaque, located on the back of the left leg, unresponsive to topical corticosteroids. We performed an excisional biopsy and histopathology was consistent with psoriasiform keratosis.

O Hemangioma em penacho é uma proliferação vascular adquirida de características histológicas peculiares. Sua característica clínica mais comum são máculas eritematosas. Ocorre predominantemente em crianças e adultos jovens, principalmente no tórax e pescoço. Relata-se o caso de paciente do sexo masculino, 12 anos, com aumento do pavilhão auricular direito associado a máculas eritematosas e aumento da temperatura local, encaminhado com diagnóstico de Hanseníase Virchowiana, entretanto, tal diagnóstico foi questionado. Histopatologia compatível com Hemangioma em penacho.

Tufted angioma is an acquired vascular proliferation with specific histological characteristics. The most common clinical features are erythematous macules. It occurs predominantly in children and young adults, especially in the chest and neck. We report the case of a male patient, 12 years old, with an increased right ear auricle associated with erythematous macules and increased local temperature, referred with a diagnosis of lepromatous leprosy; however, this diagnosis was questioned. Histopathology was consistent with tufted angioma.

OBJETIVO: Descrever o perfil dos cuidadores de idoso, bem como sua importância e principais dificuldades no ato de cuidar do idoso. METODOLOGIA: Trata-se de estudo transversal descritivo e exploratório realizado pela equipe PET Saúde, em uma Estratégia de Saúde da Família (ESF), no município de Ananindeua, Pará. A coleta de dados foi feita por meio de um questionário semiestruturado abordando aspectos sociodemográficos e questões referentes a importância e dificuldades encontradas pelos cuidadores de idosos. RESULTADOS: Foram entrevistados 31 cuidadores, predominando sexo feminino, estado civil casado, com ensino médio completo, renda entre dois e três salários mínimos, tempo de exercício da função maior que 12 meses, em sua abrangência cuidadores informais e com vínculo de parentesco com o idoso. Os cuidadores reconheceram que é importante a presença de um cuidador e consideraram o idoso sob seu cuidado como saudável. CONCLUSÃO: A maioria dos cuidadores era do tipo informal, caracterizada por mulheres, com vínculo familiar, que destacaram a paciência e a falta de conhecimento como as principais dificuldades do cuidador. Os dados deste estudo se limitam a uma realidade local, necessitando de mais pesquisas para fomentar as particularidades e dificuldades enfrentadas pelos cuidadores.

OBJECTIVE: To describe the profile of caregivers of elderly, as well as their importance and main difficulties in caring for the elderly. METHODOLOGY: This was a descriptive, exploratory cross-sectional study conducted by the PET Saúde staff in a Family Health Strategy (FHS) in the city of Ananindeua, state of Pará, Brazil. Data was collected through a semistructured questionnaire addressing sociodemographic and issues concerning the importance and difficulties encountered by caregivers of the elderly. RESULTS: We interviewed 31 caregivers, predominantly female, married state, with complete secondary education, income between two and three minimum wages, time of exercise of the function over 12 months, most of them informal caregivers and with family relationship with elderly. Caregivers acknowledged the importance of a caregiver and found the elderly under their care as healthy. CONCLUSIONS: Most caregivers were informal type, characterized by women with family ties, which emphasized patience and lack of knowledge as the main difficulties of the caregiver. Data from this study are limited to a local reality, requiring further research to foster the particularities and difficulties faced by caregivers.