Avaliação clínica e histológica de pacientes com melasma refratário tratadas com laser de érbio: Yag fracionado / Clinical and histological evaluation of patients with refractory melasma treated with fractional Erbium: YAG laser

Introdução: Melasma é hiperpigmentação adquirida que afeta primariamente a face, e acomete mais comumente mulheres de pele escura. Diversas são as terapias utilizadas para seu tratamento; seu manejo clínico a longo prazo, entretanto, permanece um desafio. Objetivos: Avaliar a eficácia do laser de érbio: YAG fracionado, analisar histologicamente as características usuais do melasma e a quantidade de pigmento na epiderme e derme antes e após o tratamento. Métodos: Dez pacientes foram submetidas a três sessões do laser de érbio: YAG fracionado ablativo com intervalo de um mês de uma para outra. As pacientes foram biopsiadas antes e após o tratamento. Foram realizadas avaliações clínicas subjetivas e objetivas, antes, durante e após o tratamento. Resultados: Não foi observada melhora do escore Masi ao longo do tratamento. Histologicamente foram observadas hiperpigmentação da camada basal e deposição de pigmento em derme superficial. Em sete casos observou-se redução no grau de hiperpigmentação da epiderme, sem significância estatística. Conclusões: O tratamento do melasma com o laser de érbio: YAG fracionado ablativo não se mostrou efetivo, apesar de haver tendência a diminuição dos escore Masi e no grau de hiperpigmentação da epiderme, sugerindo que o laser de érbio: YAG pode ser capaz de melhorar tanto clínica quanto histologicamente o grau de hiperpigmentação da pele.

Introduction: Melasma is an acquired hyperpigmentation that affects primarily the face and occurs more frequently in women with darker skin. There are several therapies for treating melasma, however its longterm management remains a challenge. Objectives: To evaluate fractional Erbium:YAG laser's clinical effectiveness in treating refractory melasma through the histological analysis of usual characteristics and the amount of epidermal and dermal pigment before and after treatment. Methods: Ten patients underwent three fractional Erbium:YAG laser sessions at monthly intervals. Biopsies were obtained before and after treatment. Subjective and objective clinical evaluations were carried out before, during, and after treatment. Results: No statistical improvement in Melasma Area Severity Index score was observed during the treatment. Hyperpigmentation of the basal layer and pigment deposition in the dermis was observed histologically. In seven cases, there was a reduction in the degree of hyperpigmentation in the epidermis, which was not statistically significant. Conclusions: The treatment of melasma with fractional Erbium:YAG laser was ineffective. Nonetheless, a decrease in Melasma Area Severity Index scores and in the degree of hyperpigmentation of the epidermis was detected, suggesting that fractional Erbium:YAG laser can clinically and histologically improve the degree of hyperpigmentation of the skin.

Disseminated cutaneous sporotrichosis in a patient with AIDS: report of a case

We describe a case report of disseminated cutaneous sporotrichosis as the initial presentation of AIDS in a 24-year-old HIV-positive male patient. He presented multiple ulcerated skin lesions distributed over the face, thorax, legs and arms. Biopsy of one of the cutaneous lesions was suggestive of sporotrichosis and culture isolated Sporothrix schenckii. Itraconazole was started and the lesions progressively resolved after 15 days of medication. The patient was discharged with this medication but he did not return for follow-up. He died three months later in another hospital. Therapy of sporotrichosis in HIV-infected patients remains unclear and the response to therapy is variable. Itraconazole is highly concentrated in the skin and is one of the options for treatment of disseminated sporotrichosis