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Anais Brasileiros de Dermatologia, Volume: 95, Issue: 4, Published: 2020
  • Severe bacterial skin infections, Continuing Medical Education

    Marques, Sílvio Alencar; Abbade, Luciana Patrícia Fernandes

    Abstract in English:

    Abstract The severe bacterial diseases discussed herein are those that present dermatological lesions as their initial manifestations, for which the dermatologist is often called upon to give an opinion or is even the first to examine the patient. This review focuses on those that evolve with skin necrosis during their natural history, that is, necrotizing fasciitis, Fournier gangrene, and ecthyma gangrenosum. Notice that the more descriptive terminology was adopted; each disease was individualized, rather than being referred by the generic term “necrotizing soft tissue infections”. Due to their relevance and increasing frequency, infections by methicillin-resistant Staphylococcus aureus (MRSA) were also included, more specifically abscesses, furuncle, and carbuncle, and their potential etiologies by MRSA. This article focuses on the epidemiology, clinical dermatological manifestations, methods of diagnosis, and treatment of each of the diseases mentioned.
  • Healing effects of natural latex serum 1% from Hevea brasiliensis in an experimental skin abrasion wound model, Investigation

    Leite, Marcel Nani; Leite, Saulo Nani; Caetano, Guilherme Ferreira; Andrade, Thiago Antônio Moretti de; Fronza, Márcio; Frade, Marco Andrey Cipriani

    Abstract in English:

    Abstract Background Dermabrasion is related with mechanical and surgical traumas on the skin; usually topical antiseptics and/or saline have been used for healing. Natural products for wound healing can also be used for abrasions, such as latex from Hevea brasiliensis. Objective This study aimed to evaluate the in vitro viability and migratory/proliferative effects of latex serum from H. brasiliensis and to compare with a commercially available standard antiseptic solution and saline in experimental dermabrasion on rats. Methods For in vitro evaluation, MTT and scratch assays were used. In vivo testing was performed in 72 rats submitted to dermabrasion, treated with saline, antiseptic, or latex serum. This study evaluated re-epithelialization, neutrophilic infiltration, and the quantification of crust and epidermis. Results Latex showed viability at 1% and 0.1% concentrations and migratory/proliferative activity at 0.01% concentrations. The re-epithelialization was highest in latex group on 7th day. The latex group displayed lower thickness of crusts and greater extent of epidermal layers. The latex and antiseptic groups showed increases of myeloperoxidase levels on the 2nd day and showed important reductions from the 7th day. Study limitations Acute superficial wound model in rats and non-use of gel-cream (medium) without latex. Conclusion In conclusion, non-toxic latex stimulated migration/proliferation of keratinocytes in vitro and significantly accelerated wound healing in animal excoriation models compared to chlorhexidine or saline.
  • Nosological profile of dermatological diseases in primary health care and dermatology secondary care in Florianópolis (2016-2017), Investigation

    Ferreira, Iago Gonçalves; Godoi, Dannielle Fernandes; Perugini, Elaine Regina

    Abstract in English:

    Abstract Background Dermatology encompasses the management of many disorders of the skin and cutaneous appendages, making the analysis of epidemiological profiles relevant for health planning. Objective The study aims to describe the nosological profile of dermatological diseases in Florianopolis, analyzing the interrelation among the primary health care and dermatology services, from January 2016 to December 2017. Method Descriptive study from records of medical visits from the primary health care and dermatology services, as well as records of reports issued by the teledermatology service. Results In primary health care, from 55,265 medical visits - 28,546 in 2016 and 26,719 in 2017, there was a higher prevalence of “Atopic dermatitis” (6.38%), “other disorders of skin and subcutaneous tissue” (5.10%), and “Scabies” (4.55%). In dermatology secondary care, from 19,964 visits - 10,068 in 2016 and 9626 in 2017, the most prevalent diagnoses were “Other malignant neoplasms of the skin” (14.75%) and “Skin changes due to chronic exposure to nonionizing radiation” (10.20%). Study limitations Some dermatological consultations in primary health care may have been under-registered due to the attribution of non-specific or overly broad diagnoses. Conclusion This study presents different nosological profiles of skin diseases in primary health care and dermatology secondary care, reinforcing the importance of primary health care's role in the management of less complex conditions, referring more complex cases that require more specialized experience to dermatology services..
  • Clinical and epidemiological characteristics and associated factors of hair graying: a population-based, cross-sectional study in Turkey, Investigation

    Acer, Ersoy; Arslantaş, Didem; Emiral, Gülsüm Öztürk; Ünsal, Alaattin; Atalay, Burcu Işıktekin; Göktaş, Saniye

    Abstract in English:

    Abstract Background Hair graying is common in humans; but there is scarce data about its epidemiology. Objective This study aimed to evaluate the clinical and epidemiological characteristics and associated factors of hair graying. Methods A total of 1541 volunteers between 15 and 65 years old were included in this population-based, cross-sectional study. A questionnaire on characteristics and associated factors of hair graying was filled in by face-to-face interview method. Results One thousand sixty three participants (69.0%) had hair graying. The mean onset age of hair graying was 32.9 ± 9.8 years. It was 31.7 ± 9.5 years in females, whereas 33.7 ± 10.0 years in males (p = 0.001). The most common involved area of hair graying at the onset and at the time of the interview was temporal region. When it was evaluated by gender, it was temporal in males whereas parietal in females. Hair graying was more severe in males than in females and in late-onset hair graying than early-onset hair graying (respectively, p = 0.000, p < 0.001). The most common involved area at the onset and at the present was temporal in severe hair graying; whereas parietal in mild hair graying. In logistic regression analysis, age, educational status, presence of hair loss, skin type, family history of early-onset hair graying and anxiety were independently related to hair graying (p < 0.05). Study limitations The study was performed in only Turkish individuals. The recall biases were another limitations. Conclusion Male gender, late-onset and temporal-onset of hair graying may be considered to be poor prognostic factors for hair graying. There is need for further epidemiological studies in people with different ethnic origin to illuminate the clinical and epidemiological characteristics and associated factors of hair graying.
  • Ischemia-modified albumin as a possible marker of oxidative stress in patients with telogen effluvium, Investigation

    Savci, Unsal; Senel, Engin; Oztekin, Aynure; Sungur, Mustafa; Erel, Ozcan; Neselioglu, Salim

    Abstract in English:

    Abstract Background Telogen effluvium is the most common form of non-scarring alopecia characterized by diffuse hair loss. Ischemia-modified albumin is a marker of oxidative stress and inflammation. Objective The aim of this study was to compare the levels of ischemia-modified albumin of telogen effluvium patients with healthy controls. Methods Ninety-one patients diagnosed with telogen effluvium and 35 healthy volunteers were included in the study. Serum ischemia-modified albumin level was determined by a fast-colorimetric method, and albumin cobalt binding test. The results were evaluated statistically. Results There was no statistically significant difference between the serum albumin values of patient and control groups (p = 0.739). Serum ischemia-modified albumin values were significantly higher in the patients with telogen effluvium than healthy controls (p < 0.001). Study limitations Body mass index values of the patient and control groups could not be calculated. Conclusions To the best of the authors’ knowledge, this is the first clinical study to investigate the role of oxidative stress in the pathogenesis of telogen effluvium using ischemia-modified albumin as a biomarker. Based on the results of the present study, it can be considered that oxidative stress plays an important role in the pathogenesis of telogen effluvium. There is a need for further studies to support the results of this study, to demonstrate the possible effects of oxidative stress, and to investigate the other oxidative stress markers in the pathogenesis of telogen effluvium.
  • Dietary patterns of patients with psoriasis at a public healthcare institution in Brazil, Investigation

    Polo, Tatiana Cristina Figueira; Corrente, José Eduardo; Miot, Luciane Donida Bartoli; Papini, Silvia Justina; Miot, Hélio Amante

    Abstract in English:

    Abstract Background Psoriasis is a chronic inflammatory disease with systemic repercussions and an association with comorbidities such as metabolic syndrome, cardiovascular diseases, and obesity. Psoriasis patients have a higher prevalence of obesity compared to the general population. Diet is a relevant environmental factor, since malnutrition, inadequate body weight, and metabolic diseases, in addition to the direct health risk, impair the treatment of psoriasis. Objectives To evaluate food intake patterns, anthropometric, and metabolic syndrome-related aspects in psoriasis patients. Methods Cross-sectional study through anthropometric assessment and food frequency questionnaire. Food frequency questionnaire items were evaluated by exploratory factor analysis and identified dietary patterns were analyzed by multivariate methods. Results This study evaluated 94 patients, 57% female, with a mean age of 54.9 years; the prevalence of obesity was 48% and of metabolic syndrome, 50%. Factor analysis of the food frequency questionnaire identified two dietary patterns: Pattern 1 - predominance of processed foods; Pattern 2 - predominance of fresh foods. Multivariate analysis revealed that Patterns 1 and 2 showed inverse behaviors, and greater adherence to Pattern 2 was associated with females, eutrophic individuals, absence of lipid and blood pressure alterations, and lower waist-to-hip ratio and skin disease activity. Study limitations Monocentric study conducted at a public institution, dependent on dietary memory. Conclusion Two dietary patterns were identified in a Brazilian sample of psoriasis patients. The prevalence of obesity and metabolic syndrome were greater than in the adult Brazilian population. The fresh diet was associated with lower indicators of metabolic syndrome in this sample.
  • Identification of Leishmania species by high-resolution DNA dissociation in cases of American cutaneous leishmaniasis, Investigation

    Veasey, John Verrinder; Zampieri, Ricardo Andrade; Lellis, Rute Facchini; Freitas, Thaís Helena Proença de; Winter, Lucile Maria Floeter

    Abstract in English:

    Abstract Background American cutaneous leishmaniasis is an infectious dermatosis caused by protozoa of the genus Leishmania, which comprises a broad spectrum of clinical manifestations depending on the parasite species involved in the infections and the immunogenetic response of the host. The use of techniques for amplification of the parasites DNA based on polymerase chain reaction polymerase chain reaction and the recent application of combined techniques, such as high-resolution DNA dissociation, have been described as a viable alternative for the detection and identification of Leishmania spp. in biological samples. Objectives To identify the Leishmania species using the polymerase chain reaction high-resolution DNA dissociation technique in skin biopsies of hospital-treated patients, and compare with results obtained by other molecular identification techniques. Methods A retrospective study assessing patients with suspected American cutaneous leishmaniasis seen at a hospital in São Paulo/Brazil was conducted. The paraffin blocks of 22 patients were analyzed by polymerase chain reaction high-resolution DNA dissociation to confirm the diagnosis and identify the species. Results Of the 22 patients with suspected American cutaneous leishmaniasis, the parasite was identified in 14, comprising five cases (35.6%) of infection by L. amazonensis, four (28.5%) by L. braziliensis, two (14.4%) by L. amazonensis + L. infantum chagasi, two (14.4%) by L. guyanensis, and one (7.1%) by Leishmania infantum chagasi. In one of the samples, in which the presence of amastigotes was confirmed on histopathological examination, the polymerase chain reaction high-resolution DNA dissociation technique failed to detect the DNA of the parasite. Study limitations The retrospective nature of the study and small number of patients. Conclusions The method detected and identified Leishmania species in paraffin-embedded skin biopsies with a sensitivity of 96.4% and could be routinely used in the public health system.
  • Successful therapeutic approach in a patient with elephantiasic pretibial myxedema, Case Report

    Ferreira, Marina; Zacaron, Luciana Helena; Valle, Annair Freitas do; Gamonal, Aloisio Carlos Couri

    Abstract in English:

    Abstract Localized pretibial myxedema is a dermopathy whose treatment is a challenge in dermatology, occurring in 0.5-4% of patients with Graves’ disease. This autoimmune thyroid condition stimulates the production of hyaluronic acid and glycosaminoglycans that are deposited particularly in the pretibial region. Clinically, it presents as a localized, circumscribed, and non-depressible infiltrate in plaques. Several treatment modalities have been proposed, and their results vary, with worse response observed in severe cases. This report presents the case of a patient with elephantiasic pretibial myxedema who was subjected to intralesional corticosteroid applications, resulting in an excellent and encouraging therapeutic response that was maintained.
  • Partial repigmentation of vitiligo with tofacitinib, without exposure to ultraviolet radiation, Case Report

    Komnitski, Melpone; Komnitski, Angelo; Komnitski Junior, Amilton; Castro, Caio César Silva de

    Abstract in English:

    Abstract Vitiligo is a disease that causes macules and achromic and/or hypochromic patches, which can affect from small areas to the entire tegument. Treatment options are few and are generally ineffective. Recently, some case reports have appeared which show positive results with the use of Janus kinase inhibitors associated with phototherapy. This report details the case of a patient with rheumatoid arthritis associated with vitiligo in treatment for two years, whose condition partially improved initially after eight months of oral tofacitinib at a dose of 5 mg twice a day, without exposure to ultraviolet radiation and with continuous improvement during these two years of treatment.
  • Atypical lymphangioma and hyperkeratosis in a patient with morbid obesity, Case Report

    Morán-Mariños, Cristian; Nieto-Gutierrez, Wendy; Pacheco-Mendoza, Josmel

    Abstract in English:

    Abstract Lymphangioma is a rare and understudied pathology that is usually detected in the first decade of life, and its appearance in adults is rare. This report details a 51-year-old man with morbid obesity who presented, for the last eight months, multiple asymmetric tumor lesions with extension to the scrotal region. The diagnosis of circumscribed lymphangioma with associated infection was confirmed. This case report demonstrates an unusual presentation of the characteristics of the lymphangioma that are seldom described in the literature.
  • Multinucleate cell angiohistiocytoma: an uncommon cutaneous tumor, Case Report

    Costa, Anderson Alves; Wedy, Glaucia Ferreira; Belda Junior, Walter; Criado, Paulo Ricardo

    Abstract in English:

    Abstract Multinucleate cell angiohistiocytoma is a rare, benign vascular proliferation of unknown etiology. It occurs mainly in middle-aged women and usually affects the acral regions; the lesions appear as discrete, grouped, and asymptomatic violaceous papules. Histopathology shows proliferation and dilated small vessels in the papillary dermis, fibrous stroma with thickened collagen bundles, and multinucleated giant cells. To date, there are approximately 140 cases described in the indexed literature. This report presents the case of a 62-year-old woman with a typical clinical condition, who chose not undergo treatment, considering the benign character of her illness. The clinical and immunohistological aspects of this unusual dermatological entity are emphasized.
  • Annular epidermolytic ichthyosis: a case report and literature review, Case Report

    Mikilita, Emanuella Stella; Hernandez, Irina Paipilla; Boff, Ana Letícia; Kiszewski, Ana Elisa

    Abstract in English:

    Abstract Annular epidermolytic ichthyosis is a rare subtype of epidermolytic ichthyosis that is characterized by erythematous, polycyclic, and migratory scaly plaques accompanied by palmoplantar keratoderma. This report presents the case of an 8-year-old girl who developed migratory, erythematous, scaly plaques associated with palmoplantar keratoderma. The initial hypothesis was erythrokeratodermia variabilis et progressiva; however, the finding of epidermolytic hyperkeratosis in histopathological examination led to the diagnosis of annular epidermolytic ichthyosis.
  • Signet ring cells in carcinomatous lymphangitis due to gastric adenocarcinoma, Dermatopathology

    Souza, Beatriz da Silva; Bonamigo, Renan Rangel; Viapiana, Gabriela Lusa; Cartell, André

    Abstract in English:

    Abstract Cutaneous metastases are rare. They usually present as nodules or tumors. Diagnosis is based on histopathological examination and prognosis is unfavorable. This report describes the case of a female patient, 72 years old, with surgically treated gastric antrum adenocarcinoma. Pathology showed poorly differentiated adenocarcinoma with signet ring cells. It evolved with bone involvement, lymph node enlargement in the inguinal region, and skin infiltration in the lower limbs, abdomen, and root of the upper limbs. Skin biopsy demonstrated signet ring carcinoma embolizing the dermal and hypodermic vessels and invasion of adipose tissue, confirming carcinomatous lymphangitis. Carcinomatous lymphangitis is the cutaneous and subcutaneous lymphatic invasion by tumor cells. Cutaneous metastasis is relatively uncommon and presents mainly as cutaneous or subcutaneous nodules, and more rarely as inflammatory lesions. The present case reports carcinomatous lymphangitis associated with gastric cancer.
  • Update on vasculitis: overview and relevant dermatological aspects for the clinical and histopathological diagnosis - Part II, Review

    Morita, Thâmara Cristiane Alves Batista; Criado, Paulo Ricardo; Criado, Roberta Fachini Jardim; Trés, Gabriela Franco S.; Sotto, Mirian Nacagami

    Abstract in English:

    Abstract Vasculitis is a group of several clinical conditions in which the main histopathological finding is fibrinoid necrosis in the walls of blood vessels. This article assesses the main dermatological aspects relevant to the clinical and laboratory diagnosis of small- and medium-vessel cutaneous and systemic vasculitis syndromes. The most important aspects of treatment are also discussed.
  • Epidemiological monitoring of leprosy indicators in Sergipe (2001-2015): segmented regression analysis, Tropical/infectoparasitary Dermatology

    Souza, Carlos Dornels Freire de; Leal, Thiago Cavalcanti; Paiva, João Paulo Silva de; Santos, Victor Santana

    Abstract in English:

    Abstract This study analyzed the trend of leprosy indicators in Sergipe, between 2001 and 2015. It was a time series study that analyzed the trend for general detection coefficient, children under 15 years of age, and new cases with grade 2 disability. The joinpoint model was used. Two (2.6%) municipalities had an increasing trend in general detection coefficient, five (6.6%) had an increasing trend in detection rate in children under 15, and 19 (25.3%) had an increasing trend in detection coefficient of new leprosy cases with grade 2 disability. The findings suggest maintenance of the chain of transmission.
  • Cutaneous infection by Mycobacterium lentiflavum after subcutaneous injection of lipolytic formula, Tropical/infectoparasitary Dermatology

    Mello, Renan Bernardes de; Moreira, Dalton Nogueira; Pereira, Ana Carolina Gomes; Lustosa, Nicole Ramalho

    Abstract in English:

    Abstract The incidence of nontuberculous mycobacterial infections is increasing worldwide; by 2017, more than 190 species and subspecies have been documented. Although classically associated with immunosuppression, the recognition of these etiological agents in diseases affecting immunocompetent individuals and in healthcare-associated infections, such as after surgical and cosmetic procedures, makes the study of the epidemiology and pathogenesis of these microorganisms relevant in medical practice. Mycobacterium lentiflavum is slow-growing and rarely affects the skin. A case of cutaneous mycobacteriosis caused by M. lentiflavum is reported in an immunocompetent patient after subcutaneous injection of a lipolytic compound, treated with clarithromycin and levofloxacin.
  • Trichoscopic stages of dissecting cellulitis: a potential complementary tool to clinical assessment, Images In Dermatology

    Melo, Daniel Fernandes; Lemes, Luciana Rodino; Pirmez, Rodrigo; Duque-Estrada, Bruna

    Abstract in English:

    Abstract Dissecting cellulitis is a chronic, progressive, and relapsing inflammatory disease that predominantly affects the vertex and occiput of young Afro-descendent men. It starts with papules and pustules that evolve to nodules, abscesses, and cicatricial alopecia. This article illustrates the evolutive trichoscopy of dissecting cellulitis, from its early phase, through the abscess phase, to the fibrotic cicatricial phase. Trichoscopy complements clinical-pathological classification, representing a complementary tool useful in early diagnosis and monitoring of the patient during treatment.
  • Dermatoscopic findings of syphilitic alopecia, Images In Dermatology

    Bomfim, Izabella Cristina Cardozo; Ianhez, Mayra; Miot, Hélio Amante

    Abstract in English:

    Abstract Syphilis is an infectious disease that has afflicted mankind for centuries, but a recent increase in worldwide incidence has been evidenced. The authors describe a patient with typical lesions of secondary syphilis and moth-eaten alopecia, whose dermoscopic examination demonstrated empty hair follicles, vellus hair, follicular hyperkeratosis, peripheral black dots, dilated and tortuous vessels, reddish brown background, and hypopigmentation of the hair shafts. Furthermore, this case presented an erythematous background more evident than previously described cases.
  • Case for diagnosis. Pruritic erythematosquamous lesion in the auricle, What Is Your Diagnosis?

    Melo, Elaine Dias; Morais, Patrícia Motta de; Fernandes, Débora Cristina de Lima; Rebello, Paula Frassinetti Bessa

    Abstract in English:

    Abstract Chromoblastomycosis is a subcutaneous mycosis with chronic evolution that mainly affects the lower limbs and, less frequently, the auricles. Clinically, it presents with papillary verrucous, nodular, and/or tumoral lesions, whether isolated or infiltrated, forming plaques and, sometimes, atrophic in some areas. Histopathologically, it is characterized by a dermal granulomatous inflammatory infiltrate, and the diagnosis can be confirmed by the presence of fumagoid bodies in anatomopathological or direct mycological exams. The treatment to be indicated will depend on the extent and location of the lesions, using systemic antifungals, surgical removal, cryotherapy, thermotherapy, and immunoadjuvants. The present study reports an atypical presentation of chromoblastomycosis on the auricle.
  • Case for diagnosis. Single-digit clubbing, What Is Your Diagnosis?

    Crestani, Larissa; Fasciani, Isaura Azevedo; Kakizaki, Priscila; Valente, Neusa Yuriko Sakai

    Abstract in English:

    Abstract A 58-year-old female patient presented with a single-digit clubbing on the second finger of her right hand two years previously. After investigation with imaging and incisional biopsy, superficial acral fibromyxoma was diagnosed. A brief review on single-digit clubbing and its causes is presented, focusing on superficial acral fibromyxoma.
  • Molecular detection of Merkel cell polyomavirus in basal cell carcinoma and perilesional tissue: a cross-sectional study, Research Letter

    Gonçalves, Marianna Tavares Venceslau; Varella, Rafael Brandão; Almeida, Núbia Karla de Oliveira; Guimarães, Maria Angelica Arpon Marandino; Luz, Flávio Barbosa
  • Daylight photodynamic therapy for Bowen's disease, Research Letter

    Martins, Carla Corrêa; Bakos, Renato Marchiori; Martins Costa, Manuela
  • Melanoma risk factors in a Latin American population, Research Letter

    Nova, John Alexander; Sánchez-Vanegas, Guillermo; Gamboa, Mauricio; Gil-Quiñones, Sebastian Ramiro
  • Cutaneous metastases from primary solid and hematopoietic neoplasms at a referral hospital in Colombia: a cross-sectional study, Research Letter

    Ordóñez-Rubiano, María Fernanda; Dávila-Osorio, Victoria Lucía; Rubiano-Mojica, Paula Celeste; Mariño-Álvarez, Ángela Marcela
  • Sporadic form of epidermolysis bullosa simplex with mottled pigmentation, Case Letter

    Ferreira, Flávia Regina; Pereira, Carolina Fernandes; Moretto, Juliana Carvalho; Naville, Mariana Patriota
  • Rare presentation of Rothmund-Thomson syndrome with novel compound heterozygous mutations of the RECQL4 gene, Case Letter

    Zhang, Xinyue; Geng, Songmei; Zheng, Yi
  • Acute generalized exanthematous pustulosis with features mimicking toxic epidermal necrolysis secondary to amiodarone, Case Letter

    Distel, Cheryl; Bollea Garlatti, María Luz; Torre, Ana Clara; Riganti, Julia
  • ASIA case after injection of liquid silicone, Case Letter

    Libardi, Camila Secco; Diniz, Lucia Martins; Musso, Carlos; Badaró, Bruna Anjos
  • On variations in micrographic surgery and the use of horizontal histological sections in the evaluation of the surgical margin, Correspondence

    Miola, Anna Carolina; Miot, Hélio Amante; Kopke, Luis Fernando Figueiredo
  • On the different methods of micrographic surgery and their differences in the visualization of the tumor and surgical margin, and in the contribution to clinical and oncological aspects, Correspondence

    Simão Filho, Sandro Corrêa
  • Histopathological aspects of the inclusion of surgical material in micrographic surgery using the Munich method and its comparison with horizontal histological sections, Correspondence

    Vilar, Airá Novello; Ferreira, Arthur César Farah
  • On variations in micrographic surgery and the use of horizontal histological sections in the evaluation of the surgical margin - Reply Correspondence

    Paschoal, Francisco Macedo
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