Incidence of radiodermatitis and factors associated with its severity in women with breast cancer: a cohort study

Abstract Background: One of the main adverse reactions of adjuvant radiotherapy for breast cancer is radiodermatitis. Objective: To assess the incidence of radiodermatitis in women with breast cancer, identify factors associated with its severity and determine the time at which this event occurs. Methods: Prospective cohort study in 113 women with breast cancer who were evaluated before radiotherapy and at every fifth session until the end of treatment. Logistic regression and Cox proportional regression model were used for the assessment of risk factors; P values < 0.05 were considered significant. Results: The incidence rate of radiodermatitis was 98.2% and it was demonstrated that for each additional point of the Body Mass Index (BMI), the chance of occurrence of grades II to IV radiodermatitis increases by 14% (OR = 1.14 [95% CI 1.04-1.26]; p = 0.004) and statin use increases the risk of more severe skin lesions by four-fold (OR = 4.27 [95% CI 1.11-16.42]; p = 0.035). The exclusive use of hydrogel for skin hydration was an independent factor in delaying the onset of radiodermatitis (HR = 0.55 [95% CI 0.36-0.82]; p = 0.004). Study limitations: The main limitation of this study was its external validity. The identified factors should be considered for services and populations similar to those in this study. Conclusions: There was a high incidence of radiodermatitis and its severity was related to higher BMI, statin use; there was a protective effect of hydrogel use.

Efficacy of sunscreen with photolyase or regular sunscreen associated with topical antioxidants in treating advanced photodamage and cutaneous field cancerization: a randomized clinical trial

Abstract Background Several treatments are available for skin with advanced photodamage, which is characterized by the presence of actinic keratoses (AK). Objectives Evaluate the efficacy of using sunscreen with photolyase compared to regular sunscreen, as well as to compare the combination of a topical formulation of antioxidants versus placebo in the treatment of advanced photodamage. Methods This was a randomized, double-blind, factorial clinical trial. Participants with AKs on their forearms were randomized to apply regular sunscreen (SC) or sunscreen with photolyase (SC+P) on both forearms during the day. One of the forearms in each group was randomized again to receive topical antioxidants (AOx), and the other forearm received a placebo cream (both for night application). The four groups were SC/AOx, SC/placebo, SC+P/AOx, and SC+P/placebo. The duration of treatment was 8 weeks. Primary outcomes were total AK clearance, decrease in Forearm Photoaging Scale (FPS), and AK severity scores. Secondary outcomes were reduction in AK count, partial clearance rate, and safety. Results Forty participants (80 forearms) were included. All groups showed significant improvement in outcomes at week eight. There were no significant differences between SC and SC+P for either outcome. AOx led to a significant reduction in AK count (22%; p < 0.05). Partial clearance was obtained in 18 (47.4%) forearms treated with AOx and in 9 (23.7%) treated with placebo (p < 0.05). All groups reduced the FPS score, without significant differences among them. Conclusions There is no difference in the treatment of advanced photodamage skin when comparing the use of sunscreen with photolyase and regular sunscreen, and topical antioxidants were more efficient in reducing AK count than placebo. Study limitations Short interval of follow-up and absence of re-evaluation in the absence of treatment were limitations of the present study.

Lesões por pressão relacionadas ao uso de máscaras N95 na pandemia por COVID-19 / Lesiones por presión relacionadas con el uso de mascarillas N95 en la pandemia de COVID-19 / Pressure injury related to the use of N95 mask in COVID-19 pandemic

Objetivo: avaliar o desenvolvimento de lesão por pressão em profissionais de saúde desencadeadas pelas máscaras de proteção individual N95, assim como avaliar o uso de barreiras de proteção usadas como interface para prevenção desse tipo de lesão. Método: Trata-se de um estudo transversal desenvolvido de julho de 2020 a julho de 2021. Para a coleta de dados, foi aplicado questionário para avaliar as particularidades da pele, desenvolvimento de lesão, classificação e os fatores de risco para seu desenvolvimento. Para análise estatística foi considerada a significância de p <0,1 e regressão logística múltipla. Resultados: Foram avaliados 85 profissionais, sendo que 91,8% destes apresentaram algum tipo de lesão. Conclusão: Conclui-se que a lesão por pressão relacionada ao uso de máscaras de proteção individual N95 apresentou alta ocorrência nessa população. E embora importantes, barreiras protetoras foram pouco utilizadas devido a questões financeiras da instituição(AU)

Objective: to evaluate the development of pressure injuries triggered by N95 personal protective masks in health professionals, as well as to evaluate the use of protective barriers used as an interface to prevent this type of injury. Method: This is a cross-sectional study developed from July 2020 to July 2021. For data collection, a questionnaire was applied to assess the particularities of the skin, lesion development, classification and risk factors for its development. For statistical analysis, significance of p <0.1 and multiple logistic regression were considered. Results: Eighty-five professionals were evaluated, and 91.8% of them developed some type of injury. Conclusion: Pressure injuries related to the use of N95 personal protective masks were highly prevalent in this population. And although important, protective barriers were under-used due to financial issues in the institution(AU)

Objetivo: evaluar el desarrollo de lesiones por presión en profesionales de la salud provocadas por máscaras de protección personal N95, así como evaluar el uso de barreras protectoras utilizadas como interfaz para prevenir este tipo de lesión. Método: Se trata de un estudio transversal desarrollado de julio de 2020 a julio de 2021. Para la recolección de datos se aplicó un cuestionario para evaluar las particularidades de la piel, desarrollo de la lesión, clasificación y factores de riesgo para su desarrollo. Para el análisis estadístico se consideró la significación de p < 0,1 y la regresión logística múltiple. Resultados: Se evaluaron 85 profesionales, de los cuales el 91,8% presentaba algún tipo de lesión. Conclusión: Se concluye que las lesiones por presión relacionadas con el uso de máscaras de protección personal N95 fueron altamente prevalentes en esta población. Y aunque importantes, las barreras de protección fueron poco utilizadas por cuestiones financieras de la institución.

Disseminated paracoccidioidomycosis in a liver transplant patient

Abstract Paracoccidioidomycosis is an endemic systemic mycosis caused by Paracoccidioides brasiliensis complex and P. lutzii. It is a rare disease in non-HIV-induced immunosuppressed individuals. In organ transplant recipients, it is more frequently associated with immunosuppression after kidney transplantation. In a liver transplant patient, only one case has been published in the literature to date. The present report comprises the case of a 47-year-old female patient with disseminated skin lesions associated with signs and symptoms of systemic involvement of paracoccidioidomycosis that manifested one year after liver transplantation and under an immunosuppression regimen with tacrolimus and mycophenolate mofetil.

Cultural adaptation of the Glamorgan Scale to Brazilian Portuguese: Pressure Injury in Pediatrics / Adaptação cultural da Glamorgan Scale para o português do Brasil: lesão por pressão em pediatria / Adaptación cultural de la Escala de Glamorgan al portugués de Brasil: úlceras por presión en pediatría

Objective: to describe the methodological process of cultural adaptation of the Glamorgan Scale to Brazilian Portuguese. Method: a methodological study of translation and cultural adaptation of the Glamorgan Scale, following the six stages: initial translation, synthesis of translations, back-translation, committee of experts, pre-test, and submission of the adapted version to the author for approval. The committee of experts was composed of five physicians and, during evaluation, a semantic, idiomatic, cultural and conceptual analysis was carried out. The agreement and representativeness of the items were assessed using the Content Validity Index. A minimum value of 80% agreement was considered. Results: all stages of the translation and cross-cultural adaptation process were satisfactory. In the evaluation made by the committee of experts, all items obtained an agreement greater than 80% in the first evaluation round. The pre-test stage allowed for a critical overview of the instrument, where few modifications were suggested by the participants. Conclusion: the Glamorgan Scale was translated and culturally adapted to Brazilian Portuguese. Future psychometric studies are necessary to validate the scale.

Objetivo: descrever o processo metodológico de adaptação cultural da Glamorgan Scale para o português do Brasil. Método: estudo metodológico de tradução e adaptação cultural da Glamorgan Scale, seguindo as seis etapas: tradução inicial, síntese das traduções, retrotradução, comitê de especialistas, pré-teste e envio da versão adaptada para aprovação ao autor do instrumento original. O comitê de especialistas foi composto por cinco doutores e, durante sua avaliação, foi realizada análise semântica, idiomática, cultural e conceitual. A concordância e a representatividade dos itens foram avaliadas por meio do Índice de Validade de Conteúdo. Considerou-se o valor mínimo de 80% de concordância. Resultados: todas as etapas do processo de tradução e adaptação transcultural foram satisfatórias. Na avaliação realizada pelo comitê de especialistas, todos os itens obtiveram concordância superior a 80% na primeira rodada de avaliação. A etapa do pré-teste permitiu uma visão crítica geral do instrumento, onde foram sugeridas pequenas modificações pelos participantes. Conclusão: a Escala de Glamorgan foi traduzida e adaptada culturalmente para o português do Brasil. Estudos psicométricos futuros são necessários para validação da escala.

Objetivo: describir el proceso metodológico de adaptación cultural de la Escala de Glamorgan al portugués de Brasil. Método: estudio metodológico de traducción y adaptación cultural de la Escala de Glamorgan siguiendo seis etapas: traducción inicial, síntesis de las traducciones, retrotraducción, comité de especialistas, prueba previa y envío de la versión adaptada para aprobación del autor. El comité de especialistas está formado por cinco médicos y, durante su evaluación, se realizó un análisis semántico, idiomático, cultural y conceptual. Se evaluó la concordancia y la representatividad de los ítems a través del Índice de Validez del Contenido. Se consideró un valor mínimo del 80% de concordancia. Resultados: todas las etapas del proceso de traducción y adaptación transcultural fueron satisfactorias. En la evaluación realizada por el comité de especialistas, todos los ítems obtuvieron un nivel de concordancia superior al 80 % en la primera etapa de evaluación. La etapa de la prueba previa permitió una visión crítica general del instrumento, en la cual los participantes sugirieron pocas modificaciones. Conclusión: se tradujo y se adaptó culturalmente la Escala de Glamorgan al portugués de Brasil. Se requieren estudios psicométricos futuros para validar la escala.

Severe bacterial skin infections

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.

Chronic venous ulcers: a review on treatment with fibrin sealant and prognostic advances using proteomic strategies

Venous ulcers are the main causes of chronic lower-limb ulcers. The healing difficulties encourage the research and development of new products in order to achieve better therapeutic results. Fibrin sealant is one of these alternatives. Besides being a validated scaffold and drug delivery system, it possesses excellent healing properties. This review covered the last 25 years of the literature and showed that the fibrin sealant is used in various clinical situations to promote the healing of different types of ulcers, especially chronic ones. These are mostly venous in origin and usually does not respond to conventional treatment. Commercially, only the homologous fibrin sealants obtained from human blood are available, which are highly efficient but very expensive. The heterologous fibrin sealant is a non-commercial experimental low-cost product and easily produced due to the abundance of raw material. The phase I/II clinical trial is already completed and showed that the product is safe and promisingly efficacious for the treatment of chronic venous ulcers. In addition, clinical proteomic strategies to assess disease prognosis have been increasingly used. By analyzing liquid samples from the wounds through proteomic strategies, it is possible to predict before treatment which ulcers will evolve favorably and which ones will be difficult to heal. This prognosis is only possible by evaluating the expression of isolated proteins in exudates and analysis using label-free strategies for shotgun. Multicentric clinical trials will be required to evaluate the efficacy of fibrin sealant to treat chronic ulcers, as well as to validate the proteomic strategies to assess prognosis.(AU)

Team-Based Learning: a randomized clinical trial in undergraduate nursing / Aprendizaje Basado en Equipos: un ensayo clínico randomizado en la graduación en enfermería / Aprendizagem baseada em equipes: um ensaio clínico randomizado na graduação em enfermagem

ABSTRACT Objectives: To compare the knowledge on surgical safety through the team-based learning methodology and lecture classes for undergraduate Nursing students, and evaluate the learning satisfaction with team-based learning. Methods: Randomized, controlled, parallel, two-arm, unblinded clinical trial developed in the Faculty of Medicine of a public university in Botucatu, Brazil. The groups included 14 students for team-based learning and 11 students for lecture classes. Results: Students' apprehension of knowledge in the team-based learning group was significantly higher compared to the control group (p<0.002) by considering the pre-test results. After 30 days, there was no significant difference between groups. The experience with the methodology was considered positive among students. Conclusions: Team-based learning is an important pedagogic tool available and has proven effective in education and learning with students playing the role of protagonists.

RESUMEN Objetivos: Comparar la aprehensión del conocimiento en seguridad quirúrgica por la metodología del aprendizaje basada en equipos y clase expositiva para alumnos de graduación en enfermería y evaluar la satisfacción del aprendizaje en el aprendizaje basado en equipos. Métodos: Ensayo clínico aleatorizado, controlado, paralelo, con dos brazos, no ciego, desarrollado en una universidad pública ubicada en Botucatu, Brasil. Los grupos fueron compuestos por 14 alumnos para el aprendizaje basado en equipos y 11 alumnos para clase expositiva. Resultados: La aprehensión del conocimiento de los alumnos del grupo aprendizaje basado en equipos fue significativamente mayor comparado al grupo control (p <0,002) considerados los resultados del pre-test. Después de los 30 días, no hubo diferencia significativa entre los grupos. La experiencia con la metodología fue considerada positiva entre los alumnos. Conclusiones: El aprendizaje basado en equipos es una importante herramienta pedagógica disponible y se muestra eficaz en el proceso de enseñanza-aprendizaje teniendo al alumno como su protagonista.

RESUMO Objetivos: Comparar a apreensão do conhecimento em segurança cirúrgica pela metodologia da aprendizagem baseada em equipes e aula expositiva dialogada para alunos de graduação em enfermagem e avaliar a satisfação do aprendizado na aprendizagem baseada em equipes. Métodos: Ensaio clínico randomizado, controlado, paralelo, com dois braços, sem cegamento, desenvolvido em uma universidade pública paulista. Os grupos foram compostos por 14 alunos para aprendizagem baseada em equipes e 11 alunos para aula expositiva dialogada. Resultados: A apreensão de conhecimento dos alunos do grupo aprendizagem baseada em equipes foi significativamente maior em comparação com o grupo controle (p<0,002) considerados os resultados do pré-teste. Após os 30 dias, não houve diferença significativa entre os grupos. A experiência com a metodologia foi considerada positiva entre os alunos. Conclusões: A aprendizagem baseada em equipes é uma importante ferramenta pedagógica disponível e mostra-se eficaz no processo de ensino-aprendizagem tendo o aluno como seu protagonista.

Team-Based Learning: a randomized clinical trial in undergraduate nursing / Aprendizaje Basado en Equipos: un ensayo clínico randomizado en la graduación en enfermería / Aprendizagem baseada em equipes: um ensaio clínico randomizado na graduação em enfermagem

ABSTRACT Objectives: To compare the knowledge on surgical safety through the team-based learning methodology and lecture classes for undergraduate Nursing students, and evaluate the learning satisfaction with team-based learning. Methods: Randomized, controlled, parallel, two-arm, unblinded clinical trial developed in the Faculty of Medicine of a public university in Botucatu, Brazil. The groups included 14 students for team-based learning and 11 students for lecture classes. Results: Students' apprehension of knowledge in the team-based learning group was significantly higher compared to the control group (p<0.002) by considering the pre-test results. After 30 days, there was no significant difference between groups. The experience with the methodology was considered positive among students. Conclusions: Team-based learning is an important pedagogic tool available and has proven effective in education and learning with students playing the role of protagonists.

RESUMEN Objetivos: Comparar la aprehensión del conocimiento en seguridad quirúrgica por la metodología del aprendizaje basada en equipos y clase expositiva para alumnos de graduación en enfermería y evaluar la satisfacción del aprendizaje en el aprendizaje basado en equipos. Métodos: Ensayo clínico aleatorizado, controlado, paralelo, con dos brazos, no ciego, desarrollado en una universidad pública ubicada en Botucatu, Brasil. Los grupos fueron compuestos por 14 alumnos para el aprendizaje basado en equipos y 11 alumnos para clase expositiva. Resultados: La aprehensión del conocimiento de los alumnos del grupo aprendizaje basado en equipos fue significativamente mayor comparado al grupo control (p <0,002) considerados los resultados del pre-test. Después de los 30 días, no hubo diferencia significativa entre los grupos. La experiencia con la metodología fue considerada positiva entre los alumnos. Conclusiones: El aprendizaje basado en equipos es una importante herramienta pedagógica disponible y se muestra eficaz en el proceso de enseñanza-aprendizaje teniendo al alumno como su protagonista.

RESUMO Objetivos: Comparar a apreensão do conhecimento em segurança cirúrgica pela metodologia da aprendizagem baseada em equipes e aula expositiva dialogada para alunos de graduação em enfermagem e avaliar a satisfação do aprendizado na aprendizagem baseada em equipes. Métodos: Ensaio clínico randomizado, controlado, paralelo, com dois braços, sem cegamento, desenvolvido em uma universidade pública paulista. Os grupos foram compostos por 14 alunos para aprendizagem baseada em equipes e 11 alunos para aula expositiva dialogada. Resultados: A apreensão de conhecimento dos alunos do grupo aprendizagem baseada em equipes foi significativamente maior em comparação com o grupo controle (p<0,002) considerados os resultados do pré-teste. Após os 30 dias, não houve diferença significativa entre os grupos. A experiência com a metodologia foi considerada positiva entre os alunos. Conclusões: A aprendizagem baseada em equipes é uma importante ferramenta pedagógica disponível e mostra-se eficaz no processo de ensino-aprendizagem tendo o aluno como seu protagonista.

Fundamental aspects of the local approach to cutaneous ulcers

Abstract: Ulcers or wounds can be classified as acute or chronic. Their treatment involves overall assessment of the patient and choice of suitable local therapy, and the appropriate indication and use of products. Technological progress in the field of wound treatment has increased rapidly. Constant updating, with emphasis on available scientific evidence, is necessary to offer the best approaches to patients with acute and chronic wounds. A qualitative analysis of literature was conducted to identify scientific publications that update the concepts involved in local wound treatment, to present some resources that can aid the healing process and describe the different types of dressings available. This review includes wound assessment using the acronym TIME (tissue, infection/inflammation, moisture balance and edge of wound), cleaning and debridement, infection/inflammation control, exudate control, dressing types and main indications.

Pilot study of homologous platelet gel in venous ulcers

Abstract: Background: Venous ulcers represent 70% of the lower limb ulcers. They are difficult to heal, requiring a correct diagnostic and therapeutic approach. Many products have been developed to healing, such as homologous platelet gel obtained from the platelet concentrate exceeding from blood transfusion. Objective: To evaluate the safety and efficacy of homologous platelet gel in venous ulcers compared with hydrocolloid dressing. Method: A pilot randomized clinical trial in patients with venous ulcers. Randomized groups (homologous platelet gel and hydrocolloid groups) were followed for 90 days and were assessed through the evolution of ulcerated area, qualitative analysis of vascularization and adverse events. Both groups used elastic compression. Results: We included 16 participants, with a total of 21 venous ulcers. Both treatments promoted a reduction of the areas of the ulcers in 90 days (mean 69%), there was significant difference between the groups concerning the gradual reduction of the ulcers areas, favorably to the hydrocolloid (70% vs 64%; p <0.01). There were some mild adverse events in both groups. Study limitations: Single-center study with a small number of patients, preventing more accurate assessment of the effects of platelet gel. Conclusion: The homologous platelet gel associated with the elastic compression can be an alternative to the venous ulcer treatment and is safe due to the occurrence of a few mild local adverse events and no serious adverse events. Clinical trials with larger numbers of patients must be performed to maintain the indication of this treatment for venous ulcer.

Fatores que levam à negligência quanto aos cânceres da pele não melanoma / Factors leading to neglect of non-melanoma skin cancers

Contexto: Câncer da pele não melanoma é o mais prevalente no Brasil, sendo o carcinoma basocelular (CBC) e o espinocelular (CEC) os subtipos de maior ocorrência. Apesar das estratégias de conscientização da população sobre os riscos da fotoexposição e da campanha anual da Sociedade Brasileira de Dermatologia para diagnóstico precoce e capacitação dos médicos da atenção primária em saúde para diagnóstico do câncer da pele, ainda são muitos os casos de diagnóstico tardio dos cânceres da pele, dificultando a realização do tratamento adequado e comprometendo, inclusive, o prognóstico do paciente. Descrição dos casos: Caso 1 ­ homem de 86 anos, analfabeto, com úlcera inguinal esquerda há dois anos, de 15 centímetros de diâmetro, friável, bem delimitada. Biópsia incisional revelou: CBC. Realizada exérese com linfadenectomia locorregional. O paciente evoluiu bem, mas perdeu seguimento. Caso 2 ­ mulher de 93 anos, analfabeta, hipertensa e diabética, há três anos com tumoração de oito centímetros, friável, localizada na fronte e glabela. Biópsia incisional revelou: CEC. Tendo em vista a idade avançada e suas comorbidades, optou-se por realização de radioterapia. Entretanto, a paciente perdeu seguimento. Discussão: Negligência quanto aos cânceres da pele não melanoma se relaciona, principalmente, a pobreza e baixo nível educacional do paciente, hábitos inadequados de higiene, desconhecimento sobre tumores de pele, idade avançada, moradia longe dos centros urbanos e ausência de dor. Conclusões: Ocorrência de câncer da pele de grandes dimensões ainda é uma realidade no Brasil. Negligência sobre os cânceres de pele e o atraso no diagnóstico/conduta pode alterar a história natural da doença, aumentando os riscos de recidiva, metástase e óbito.

Heterologous fibrin sealant derived from snake venom: from bench to bedside - an overview

Hemostatic and adhesive agents date back to World War II, when homologous fibrin sealant came onto scene. Considering that infectious diseases can be transmitted via human blood, a new heterologous fibrin sealant was standardized in the 1990s. Its components were a serine protease (a thrombin-like enzyme) extracted from the venom of Crotalus durissus terrificus snakes and a fibrinogen-rich cryoprecipitate extracted from the blood of Bubalus bubalis buffaloes. This new bioproduct has been used as a coagulant, sealant, adhesive and recently as a candidate scaffold for mesenchymal stem cells and bone and cartilage repair. This review discusses the composition of a new heterologous fibrin sealant, and cites published articles related to its preclinical applications aiming at repairing nervous system traumas and regenerating bone marrow. Finally, we present an innovative safety trial I/II that found the product to be a safe and clinically promising candidate for treating chronic venous ulcers. A multicenter clinical trial, phase II/III, with a larger number of participants will be performed to prove the efficacy of an innovative biopharmaceutical product derived from animal venom.(AU)

Heterologous fibrin sealant derived from snake venom: from bench to bedside an overview

Abstract Hemostatic and adhesive agents date back to World War II, when homologous fibrin sealant came onto scene. Considering that infectious diseases can be transmitted via human blood, a new heterologous fibrin sealant was standardized in the 1990s. Its components were a serine protease (a thrombin-like enzyme) extracted from the venom of Crotalus durissus terrificus snakes and a fibrinogen-rich cryoprecipitate extracted from the blood of Bubalus bubalis buffaloes. This new bioproduct has been used as a coagulant, sealant, adhesive and recently as a candidate scaffold for mesenchymal stem cells and bone and cartilage repair. This review discusses the composition of a new heterologous fibrin sealant, and cites published articles related to its preclinical applications aiming at repairing nervous system traumas and regenerating bone marrow. Finally, we present an innovative safety trial I/II that found the product to be a safe and clinically promising candidate for treating chronic venous ulcers. A multicenter clinical trial, phase II/III, with a larger number of participants will be performed to prove the efficacy of an innovative biopharmaceutical product derived from animal venom.

Do you know this syndrome? Type 2 benign symmetric lipomatosis (Launois-Bensaude)

Abstract A 57-year-old female showed bulky, loose tumors, which progressively spread to her arms, anterior chest, and back. She reported dysphagia and dyspnea after mild exertion. She denied alcohol consumption. CT scan of her chest showed no internal lesions. Benign symmetric lipomatosis is a rare syndrome, clinically described as multiple nonencapsulated lipomas of various sizes and symmetrical distribution. This syndrome has three known phenotypes; in type 2 (Launois-Bensaude syndrome), lesions occur primarily on the shoulders, upper arms, and chest, and is unrelated to alcoholism. It causes aesthetic deformities and might block the upper airways. Mediastinal invasion might occur as well.