Anais Brasileiros de Dermatologia, Volume: 95, Issue: 2, Published: 2020
  • Use of psychiatric drugs in Dermatology Continuing Medical Education

    Weber, Magda Blessmann; Recuero, Júlia Kanaan; Almeida, Camila Saraiva

    Abstract in English:

    Abstract Patients with psychocutaneous disorders often refuse psychiatric intervention in their first consultations, leaving initial management to the dermatologist. The use of psychotropic agents in dermatological practice, represented by antidepressants, antipsychotics, anxiolytics, and mood stabilizers, should be indicated so that patients receive the most suitable treatment rapidly. It is important for dermatologists to be familiar with the most commonly used drugs for the best management of psychiatric symptoms associated with dermatoses, as well as to manage dermatologic symptoms triggered by psychiatric disorders.
  • Aspects of Langerhans cells and TNF-α in the cutaneous immunity of anogenital warts Investigation

    Veasey, John Verrinder; Campaner, Adriana Bittencourt; Lellis, Rute Facchini

    Abstract in English:

    Abstract Background: Anogenital warts are the leading sexually transmitted infection in patients seeking care at specialized clinics. They may display a vast array of forms, according to the interaction of the virus with the host's immunity. Cellular immunity is the epithelium's main form of defense against the virus, involving an active participation of the Langerhans cells and pro-inflammatory cytokines such as TNF-α. Objective: To assess the epithelial immune response of anogenital warts in males, according to the number of lesions presented. Methods: This is a prospective, cross-sectional study carried out at the dermatology outpatient clinic in a tertiary hospital. We included male patients over 18 years of age without comorbidities who had anogenital condylomata and no previous treatments.In order to evaluate the local epithelial immunity, the lesions were quantified, then removed and employed in CD1a immunohistochemistry assays for assessing the morphometry and morphology of Langerhans cells; TNF-α; reaction was used for determining cytokine positivity in the epithelium. Results: 48 patients were included in the study. There was no statistically significant difference as to the number of Langerhans cells, in their morphology, or the presence of TNF-α. However, patients presenting with more Langerhans cells in the lesions had cells with a star-like and dendritic morphology, whereas in those with a lower cell count had cells with a rounded morphology and no dendrites (p < 0.001). Study limitations: Small number of patients analyzed. Conclusion: There was no difference in epithelial immunity between patients having few or many anogenital condyloma lesions as measured by the morphology and morphometry of Langerhans cells and TNF-α; positivity. Such an assessment employing immunity markers differing from the usual ones is expected to yield useful results.
  • Analysis of cardiovascular risk and carotid intima-media thickness in patients with psoriasis Investigation

    Abrahão-Machado, Elaine Cristina Faria; Mendonça, José Alexandre; Arruda, Ana Carolina Belini Bazán; Nucci, Luciana Bertoldi; Santos, Marcel Alex Soares dos

    Abstract in English:

    Abstract Background: Psoriasis is associated with atherosclerosis and increased cardiovascular risk. Currently, an automated ultrasound, called quantitative intima media thickness, has proven to be a useful method to evaluate subclinical atherosclerosis. Objectives: To compare increased cardiovascular risk in psoriasis patients receiving two types of treatments: Methotrexate and tumor necrosis factor inhibitor and to evaluate the correlation between the Framingham score and quantitative intima media thickness. Methods: Fifty patients with plaque psoriasis were selected from June 2017 to July 2018, divided into two groups, receiving methotrexate and tumor necrosis factor inhibitor. Measurement of abdominal circumference, blood pressure, body mass index and presence of metabolic syndrome were performed. Afterwards, the patients were evaluated for increased cardiovascular risk with the Framingham score and for the quantitative intima media thickness of the carotid arteries. Results: The mean age was 54.8 (±12.5) with a slight male predominance (58%). Overall, 84% of the patients had elevated waist circumference, 82% had a body mass index above ideal, and 50% had a metabolic syndrome. For the correlation between quantitative intima media thickness and Framingham Score, Pearson's linear correlation coefficient was 0.617 (p < 0.001), indicating a moderate to strong positive association. Study limitations: The protective effect of the therapies cited in relation to the increased cardiovascular risk was not evaluated. Conclusions: A moderate to strong positive association was found correlating the Framingham Score values with the quantitative intima media thickness measurement and it is not possible to state which drug has the highest increased cardiovascular risk.
  • Worse survival of invasive melanoma patients in men and "de novo" lesions Investigation

    Giavina-Bianchi, Mara Huffenbaecher; Festa-Neto, Cyro; Sanches, Jose Antonio; Teixeira, Monica La Porte; Waldvogel, Bernadette Cunha

    Abstract in English:

    Abstract Background: The incidence and mortality of melanoma is increasing in many countries, including Brazil. Survival studies are still scarce in our country, but much needed to know and address this problem better. Objective: To analyze the disease-specific survival of patients with invasive melanoma and to correlate it with clinical and histopathological variables. Methods: Retrospective cohort analysis of 565 cases of invasive melanoma in a tertiary hospital with the objective of testing variables that could be associated with a worse prognosis, such as gender, phototype, thickness, histological type and presence of pre-existing clinical lesion at the site of the tumor. Results: The worst survival rates were significantly associated with thicker tumors (p < 0.001), male sex (p = 0.014), high phototype (p = 0.047), nodular melanoma (p = 0.024) and "de novo" lesions (p = 0.005). When all variables were adjusted for melanoma thickness, male patients (p = 0.011) and "de novo" melanomas (p = 0.025) remained associated with worse survival. Study limitations: Retrospective study of a single tertiary hospital. Conclusions: Although the causes are still unknown, melanoma-specific survival was statistically worse for males and for "de novo" melanomas even after adjustment of tumor thickness.
  • Higher incidence of metabolic syndrome components in vitiligo patients: a prospective cross-sectional study Investigation

    Tanacan, Efsun; Atakan, Nilgun

    Abstract in English:

    Abstract Background/Objectives: To investigate the association between vitiligo and metabolic syndrome. Methods: A prospective cross-sectional study was conducted between 2014 and 2016. Study (n = 155) and control groups (n = 155) were evaluated for metabolic syndrome according to National Cholesterol Education Program Adult Treatment Panel III and the International Diabetes Federation criteria. Study group was divided into three groups according to their vitiligo area severity index and vitiligo disease activity score values (Group 1: 6.89 for VASI score, Group A: −1-0, Group B: 1-2 and Group C: 3-4 for vitiligo disease activity score respectively). MetS rates according to both criteria were compared between the vitiligo disease activity score and vitiligo area severity index groups. Results: Metabolic syndrome rates were 37.4% and 40% in the study group and 19.4% and 26.5% in the control group according to National CholesterolEducation Program Adult Treatment Panel III and International Diabetes Federation criteria, respectively (p < 001 and p = 0.011). Metabolic syndrome was more frequent in vitiligo area severity index Groups 2 and 3 compared to vitiligo area severity index Group 1, and in vitiligo disease activity score Group C compared to vitiligo disease activity score Groups A and B. Study limitations: Single center experience, absence of more specific oxidative-stress markers and lack of long-term follow-up of the patients. Conclusions: Frequency of metabolic syndrome was higher in patients with non-segmental vitiligo and the rate was higher in active/severe form of the disease.
  • Analysis of filaggrin 2 gene polymorphisms in patients with atopic dermatitis Investigation

    Hertz, Amanda; Azulay-Abulafia, Luna; Nascimento, Adriana Paulino do; Ohara, Cintya Yumi; Kuschnir, Fabio Chigres; Porto, Luís Cristovão

    Abstract in English:

    Abstract Background: Polymorphisms of the filaggrin 2 gene (rs 12568784 and rs 16899374) are associated with persistent atopic dermatitis in African American patients. Filaggrin 2 is a protein with a function similar to filaggrin and also encoded in the epidermal differentiation complex on chromosome 1q21. Objective: To evaluate the polymorphisms in the filaggrin 2 gene (rs 12568784 and rs 16899374) in children and adults with atopic dermatitis and to verify the association of these with the severity of the clinical picture, presence of other allergic diseases, and socio-demographic factors. Method: The study was carried out with patients and control group. Questionnaires were used to evaluate ethnicity, sex, age, family history, scoring, atopic dermatitis (SCORAD), among other parameters. Genotyping of the filaggrin 2 gene was performed by real-time polymerase chain reaction. Results: Forty-eight patients and 83 controls were evaluated. No correlation was found between the variables studied in patients with atopic dermatitis and polymorphisms, no significant difference between the prevalence of polymorphisms in the patients and in the control group p > 0.05. Study limits: The exclusive use of self-reported ethnicity information and the sample size. Results: The results of this work can be an incentive for the study of the polymorphisms in atopic dermaititis, considering the characteristic of the Brazilian multi ethnic population. Conclusion: This is an unpublished work in Brazil and the first study in the world to have a control group to evaluate alterations in the gene of filaggrin 2.
  • Impairment of myocardial functions and arterial stiffness in patients with lichen planus Investigation

    Baykal Selcuk, Leyla; Sahin, Mursel; Arıca, Deniz Aksu; Orem, Asım; Karaca Ural, Zeynep; Yaylı, Savaş

    Abstract in English:

    Abstract Background: Lichen planus is a chronic inflammatory mucocutaneous disease. Recent studies have suggested that it is associated with an increased risk of cardiovascular comorbidities. Objective: The purpose of this study was to assess and compare arterial stiffness and cardiovascular hemodynamics in patients with lichen planus and a healthy control group. Methods: Fifty-five patients with lichen planus and 42 healthy controls were enrolled. All patients underwent echocardiographic examination, and arterial stiffness was measured using applanation tonometry. Results: No statistically significant difference was determined between the patient and control groups in terms of arterial stiffness, but stiffness was markedly higher in patients with erosive lichen planus compared to the control group and other patients (p = 0.006, and p = 0.023, respectively). Moderate positive correlation was determined between duration of disease and arterial stiffness. Impairment of systolic and diastolic functions was also determined in patients with lichen planus compared to the control group (p < 0.001, and p = 0.005, respectively). Study limitations: Relatively low number of patients. Conclusion: The positive correlation observed between duration of disease and arterial stiffness in patients with lichen planus suggests that these patients should be followed-up in terms of cardiovascular risk in the presence of resistant and long-term disease, particularly in case of erosive lichen planus.
  • Demodex folliculorum infestations in common facial dermatoses: acne vulgaris, rosacea, seborrheic dermatitis Investigation

    Aktaş Karabay, Ezgi; Aksu Çerman, Aslı

    Abstract in English:

    Abstract Background: Demodex mites are found on the skin of many healthy individuals. Demodex mites in high densities are considered to play a pathogenic role. Objective: To investigate the association between Demodex infestation and the three most common facial dermatoses: acne vulgaris, rosacea and seborrheic dermatitis. Methods: This prospective, observational case-control study included 127 patients (43 with acne vulgaris, 43 with rosacea and 41 with seborrheic dermatitis) and 77 healthy controls. The presence of demodicosis was evaluated by standardized skin surface biopsy in both the patient and control groups. Results: In terms of gender and age, no significant difference was found between the patients and controls (p > 0.05). Demodex infestation rates were significantly higher in patients than in controls (p = 0.001). Demodex infestation rates were significantly higher in the rosacea group than acne vulgaris and seborrheic dermatitis groups and controls (p = 0.001; p = 0.024; p = 0.001, respectively). Demodex infestation was found to be significantly higher in the acne vulgaris and seborrheic dermatitis groups than in controls (p = 0.001 and p = 0.001, respectively). No difference was observed between the acne vulgaris and seborrheic dermatitis groups in terms of demodicosis (p = 0.294). Study limitations: Small sample size is a limitation of the study. The lack of an objective scoring system in the diagnosis of Demodex infestation is another limitation. Conclusion: The findings of the present study emphasize that acne vulgaris, rosacea and seborrheic dermatitis are significantly associated with Demodex infestation. Standardized skin surface biopsy is a practical tool in the determination of Demodex infestation.
  • High rate of sensitization to Kathon CG, detected by patch tests in patients with suspected allergic contact dermatitis Investigation

    Silva, Eliane Aparecida; Bosco, Marcia Regina Miras; Lozano, Rejane Rojas; Latini, Ana Carla Pereira; Souza, Vânia Nieto Brito de

    Abstract in English:

    Abstract Background: Kathon CG, a combination of methylchloroisothiazolinone and methylisothiazolinone, is widely used as preservative in cosmetics, as well in household cleaning products, industrial products such as paints and glues. It has emerged as an important sensitizing agent in allergic contact dermatitis. Objectives: This study evaluated the reactivity to this substance in patients subjected to patch tests at the Dermatology Institute in Bauru, São Paulo from 2015 to 2017 and its correlation with other preservatives, the professional activity and location of the lesions. Methods: The patients were submitted to standard series of epicutaneous tests, standardized by the Brazilian Group Studies on Contact Dermatitis. Results: Out the 267 patients tested, 192 presented positivity to at least one substance and 29 of the patients (15.10%) presented reaction to Kathon CG, with predominance of the female gender (n = 27); main professional activity associated with Kathon CG sensibilization was cleaning (17.24%), followed by aesthetic areas (13.79%) and health care (10.34%). The most prevalent sensitizations among the substances tested were nickel sulphate (56.3%), followed by cobalt chloride (23.4%), neomycin (18.2%), potassium dichromate (17.7%), thimerosal (14.5%), formaldehyde (13.2%), paraphenylenediamine (9.3%), and fragrance mix (8.3%). Study limitations: We do not have data from patients that were submitted to patch test a decade ago in order to confront to current data and establish whether or no sensitization to Kathon CG has increased. Conclusion: High positivity to Kathon CG corroborates the recent findings in the literature, suggesting more attention to concentration of this substance, used in cosmetics and products for domestic use.
  • Exuberant case of erythema elevatum diutinum in a patient infected with HIV and hepatitis B virus Case Report

    Hirayama, Sayuri Aparecida; Pinheiro, Cezar Arthur Tavares; Guarenti, Isabelle Maffei; Oliveira, Danise Senna

    Abstract in English:

    Abstract Erythema elevatum diutinum is a small vessel vasculitis which is benign, rare, and chronic. It is clinically characterized by violaceous, brown, or yellowish plaques, nodules, and papules. It has been associated with autoimmune, infectious, and neoplastic processes. The following case describes a patient with hepatitis B virus and human immunodeficiency virus with CD4 count < 200 mm3, HIV-seropositive for 16 years, and diagnosed with hepatitis B virus at the hospital. The patient was treated with oral dapsone 100 mg/day, showing regression after seven months of treatment. The authors found three cases in the literature of association of erythema elevatum diutinum, human immunodeficiency virus, and hepatitis B virus.
  • PsAPASH: a rare and recent autoinflammatory syndrome associated with hidradenitis suppurativa Case Report

    Gadelha, Raissa de Lima; Paiva, Renata da Silveira Rodrigues; Palitot, Esther Bastos; Costa, Joanne Elizabeth Ferraz da

    Abstract in English:

    Abstract Hidradenitis suppurativa is a chronic inflammatory skin disease, which affects 1% of the population, being more common in young, obese and smokers, and mainly affects armpits and groin, with formation of pustules, nodules, abscesses, scars and fistulas. Recently, its association with other autoimmune diseases such as psoriasis, psoriatic arthritis, pyoderma gangrenosum, pyogenic arthritis and ulcerative colitis have been reported. These associated forms are usually resistant to standard treatment, with immunobiologicals as promising therapy. The case of a rare form of association is reported, with only one case previously described in the literature: psoriasis arthritis, pyoderma gangrenosum, acne and hidradenitis suppurativa.
  • Success in the use of oral propranolol in the treatment of infantile hemangioma in nasal tip - Report of two cases Case Report

    Costa, Mariana Carvalho; Andrade, Odil Garrido Campos de; Pereira, Lethícia de Castro; Costa, Izelda Maria Carvalho

    Abstract in English:

    Abstract Infantile hemangioma is the most common pediatric vascular tumor, with the following risk factors: low birth weight, prematurity, white skin, female gender, multiparity and advanced maternal age. The use of oral and topical beta-blockers, although recent, has emerged as the first line of treatment, with superior safety and efficacy to previously used therapies, such as corticosteroids and surgeries. This report describes two cases of nasal tip infantile hemangioma, treated with oral propranolol. Both presented excellent therapeutic responses.
  • Cutaneous protothecosis in kidney transplant recipient Case Report

    Godofredo, Valeria Romero; Enokihara, Milvia Maria Simões e Silva; Tomimori, Jane; Ogawa, Marilia Marufuji

    Abstract in English:

    Abstract Protothecosis is a rare condition caused by the aclorophylated algae of the genus Prototheca. In humans, protothecosis, caused mainly by P. wickerhamii, manifests itself in three forms: cutaneous, articular and systemic. It can occur in both immunocompetent and immunosuppressed individuals, being much more common in the latter. We present a new case of protothecosis in Brazil in a kidney transplant recipient.
  • Papillary intralymphatic angioendothelioma: Dabska tumor Dermatopathology

    Silva, Thadeu Santos; Araujo, Luciana Rebouças de; Paiva, Geise Rezende; Andrade, Rodrigo Guimarães

    Abstract in English:

    Abstract Papillary intralymphatic angioendothelioma (Dabska tumor) is a rarely metastasizing lymphatic vascular neoplasm that usually affects children and young adults. The majority of these cases occur in soft tissues of extremities, and to date less than 40 cases have been described. Despite the generally indolent evolution, can be locally invasive with the potential to metastasize. We describe a case of a young woman presenting with a plantar lesion, for 9 months and histological diagnosis of Dabska tumor. This neoplasm should be considered in the differential diagnosis of vascular dermatoses, allowing early diagnosis and treatment. Long-term follow-up should be performed.
  • Melanonychia associated with subungual follicular inclusions: report of three cases Dermatopathology

    Câmara de Oliveira, Marina; Barcaui, Carlos Baptista; Barcaui, Elisa de Oliveira; Piñeiro-Maceira, Juan

    Abstract in English:

    Abstract Melanonychia is the change in the coloration of the nail plate resulting from the deposition of melanin. Among its causes are melanocytic hyperplasia, melanocytic activation and nail melanoma. Subungual follicular inclusions are histological findings of unknown etiology, possibly related to trauma. We present three cases of melanonychia of different etiologies with subungual follicular inclusions, an association that has not been well described and with an indefinite pathogenesis.
  • Management of dermatologic adverse events from cancer therapies: recommendations of an expert panel Review

    Cury-Martins, Jade; Eris, Adriana Pessoa Mendes; Abdalla, Cristina Martinez Zugaib; Silva, Giselle de Barros; Moura, Veronica Paula Torel de; Sanches, Jose Antonio

    Abstract in English:

    Abstract With the development of new cancer therapies, systemic toxicity profile and effects on survival achieved an important improvement. However, a constellation of toxicities has emerged, even more remarkably, cutaneous adverse events. This report, developed by a board of Brazilian experts in oncodermatology, aims to establish a guideline for the dermatological care of oncologic patients. When possible, evidence-based recommendations were made, but in many cases, when strong evidence was not available, a consensus was reached, based on some data supporting therapies combined with personal experiences.
  • Histopathological changes in epithelium of hair follicles and acrosyringium caused by measles in child Tropical/infectoparasitary Dermatology

    Santana, Monique Freire; Ferreira, Luiz Carlos de Lima; Oliveira, Joao Gabriel Nogueira de; Francesconi, Fábio

    Abstract in English:

    Abstract Some epidermal alterations in measles has been described, such as keratinocytes apoptotic, parakeratosis, giant-cell formation, intranuclear and cytoplasmic inclusions, dyskeratosis, spongiosis, and intracellular edema. The authors report for the first time in human a case of measles with the presence of multinucleated giant cells in the hair follicle and dyskeratosis in acrosyringium.
  • Therapeutic failure with itraconazole in sporotrichosis due to bariatric surgery Tropical/infectoparasitary Dermatology

    Crestani, Larissa; Souza, Bruno de Castro e; Kakizaki, Priscila; Valente, Neusa Yuriko Sakai

    Abstract in English:

    Abstract Sporotrichosis is a deep mycosis of subacute or chronic evolution, caused by the dimorphic fungus of the genus Sporothrix. The treatment is carried out with antifungal orally or intravenously. Therapeutic success can be affected by several factors, such as altered gastrointestinal physiology by surgery. More and more patients are submitted to bariatric surgeries and the literature for the alterations of the absorption of medications in this context is very scarce. We intend to contribute to a better understanding with this case report of cutaneous-lymphatic sporotrichosis in a patient after bariatric surgery without response to itraconazole treatment, even at high doses.
  • Dermoscopic pattern of Kyrle's disease Images In Dermatology

    Ozbagcivan, Ozlem; Lebe, Banu; Fetil, Emel

    Abstract in English:

    Abstract The clinical diagnosis of Kyrle's disease may sometimes be challenging, due to the clinical similarity of lesions to other pruritic dermatosis. Although the dermoscopy is being increasingly used in daily practice, there is insufficient data in literature describing the dermoscopic patterns of Kyrle's disease, since only one report has been published to date. Herein we report our dermoscopic observation with additional diagnostic tips in a case who was diagnosed with Kyrle's disease histopathologically.
  • Pseudoxanthoma elasticum-like papillary dermal elastolysis in non-exposed skin Images In Dermatology

    Setó-Torrent, Nuria; Iglesias-Sancho, Maribel; Arandes-Marcocci, Jorge; Fernández-Figueras, María Teresa

    Abstract in English:

    Abstract Pseudoxanthoma elasticum-like papillary dermal elastolysis is an acquired elastic tissue disorder clinically similar to pseudoxanthoma elasticum in the absence of systemic involvement. Histopathologically, special staining of elastic fibers demonstrates a total or partial band-like loss of elastic fibers in the papillary dermis. Although ultraviolet radiation seems to be one of the main etiological factors in this entity, we report a case of pseudoxanthoma elasticum-like papillary dermal elastolysis on the neck of a woman who wore hijab.
  • Case for diagnosis. Erythematous and pruritic papules on forearms What Is Your Diagnosis?

    Santana, Aline Palitot; Cardoso, Alberto Eduardo Cox; Passos, Rafaela Tenório; Ferreira, Íris Sampaio Costa

    Abstract in English:

    Abstract Gamasoidosis is a poorly known and underdiagnosed mite infestation. It is characterized by the presence of erythematous and flattened papules that are quite pruritic, and can affect any region of the body, with preference for areas of folds. This article reports a case of the disease caused by mites of the species Dermanyssus gallinae. Increasingly, the agents that cause this disease are found in urban environments, increasing the incidence of people affected by the disease. This dermatosis has a self-limiting clinical picture and the treatment is done with the use of topical corticosteroids and oral antihistamines.
  • Analysis of clinical aspects of leprosy patients between 2010-2017 at a reference center in Campinas Research Letter

    Santos, Marcel Alex Soares dos; Aquino, José Luis Braga de; Pegas, Elisangela; Machado, Elaine Cristina Faria Abrahao
  • Bullous congenital diffuse cutaneous mastocytosis Case Letter

    Cardoso, Julia Marcon; Cabral, Camila Angelico S.; Lellis, Rute Facchini; Ravelli, Flavia Naranjo
  • Noncultured epidermal cell suspension for the treatment of recalcitrant segmental vitiligo in a solid-organ transplant recipient Case Letter

    Dellatorre, Gerson; Castro, Caio César Silva de
  • Pityriasis lichenoides et varioliformis acuta following anti-tetanus and diphtheria adult vaccine Case Letter

    Merlotto, Maira Renata; Bicudo, Natália Parente; Marques, Mariangela Esther Alencar; Marques, Silvio Alencar
  • Diffuse normolipemic plane xanthoma and hepatitis C: chance? Case Letter

    Souza, Maria Carolina Casa; Martins, Paulo Henrique Teixeira; Vivian, Analú; Luzzatto, Laura
  • Multilayer elastic compression for the treatment of a 30-year venous ulcer Case Letter

    Velozo, Bruna Cristina; Colenci, Raquel; Abbade, Luciana Patrícia Fernandes
  • Allergic contact dermatitis to slime Case Letter

    Pessotti, Nabila Scabine; Hafner, Mariana de Figueiredo Silva; Possa, Mellanie Starck; Lazzarini, Rosana
  • Onychomadesis secondary to hand-foot-and-mouth disease: report of two cases Case Letter

    Xavier, Juliana Polizel Ocanha; Xavier Junior, José Cândido Caldeira
  • Idiopathic follicular mucinosis in childhood Case Letter

    Bauer, Fernanda José; Almeida, José Roberto Paes de; Sementilli, Angelo; Mattos e Dinato, Sandra Lopes
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