Tratamento de púrpura actínica com hidroxiapatita de cálcio / Treatment of actinic purpura with calcium hydroxyapatite

A púrpura actínica é caracterizada por máculas roxas escurecidas localizadas, principalmente nas áreas fotoexpostas das faces extensoras dos braços e das mãos de indivíduos idosos. Até o momento, não há tratamento satisfatório. Relatamos o caso de um paciente de 80 anos que foi submetido ao tratamento com duas sessões de preenchimento dos antebraços com hidroxiapatita de cálcio, apresentando bom resultado.

Actinic purpura is characterized by dark purple patches, mainly on photoexposed areas of the extensor surfaces of the arms and hands of elderly individuals. Thus far, there is no satisfactory treatment. We report the case of an 80-year-old patient who underwent treatment with two sessions of calcium hydroxyapatite filler application in the forearms, with good results.

Scleroderma en coup de sabre treated with polymethylmethacrylate - Case report

Abstract The scleroderma en coup de sabre is a variant of localized scleroderma that occurs preferentially in children. The disease progresses with a proliferative and inflammatory phase and later atrophy and residual deformity, which are treated with surgical techniques such as injectable fillers, transplanted or autologous fat grafting and resection of the lesion. Among the most widely used fillers is hyaluronic acid. However, there are limitations that motivate the search for alternatives, such as polymethylmethacrylate, a permanent filler that is biocompatible, non-toxic, non-mutagenic and immunologically inert. In order to illustrate its application, a case of scleroderma en coup de sabre in a 17-year-old patient, who was treated with polymethylmethacrylate with excellent aesthetic results, is reported.

Reação reversa atípica em paciente com hanseníase dimorfa co-infectado pelo HIV / Atypical reversal reaction in a borderline leprosy patient co-infected with HIV

A infecção pelo HIV não altera a história natural da hanseníase. Observa-se maior incidência de estados reacionais nos pacientes co-infectados, além de casos mais graves de neurite. Paciente soropositiva com hanseníase dimorfa tuberculóide manifestou reação reversa exuberante. Lesões cutâneas atípicas e raras surgiram após a introdução da terapia anti-retroviral que promoveu o início da recuperação imunológica com aumento de linfócitos T CD4+ e queda da carga viral. A restauração da imunidade celular nos pacientes soropositivos pode precipitar reações reversas, descritas recentemente como uma das manifestações da síndrome inflamatória de reconstituição imunológica associada à hanseníase.

HIV infection does not modify the natural course of leprosy. However, HIV co-infection seems to be associated with an increased rate of reactional states and more severe cases of neuritis. The authors describe a case of borderline tuberculoid leprosy in a HIV-positive patient who developed a marked reversal reaction. Atypical and rare skin manifestations, such as verrucous lesions and ulcers, appeared after highly active antiretroviral therapy, which resulted in increased CD4+ T-lymphocyte count and drop in viral load. The restoration of the cellular immunity in HIV-seropositive patients can trigger reversal reactions that are one of the manifestations of the immune reconstitution inflammatory syndrome. Only recently the syndrome has been associated with leprosy.

Cinco anos de corticoterapia em paciente com pênfigo foliáceo e Aids / Five years of corticotherapy in a patient with pemphigus foliaceus and Aids

Os autores apresentam um caso de pênfigo foliáceo em pacientes com Aids que, a despeito da corticoterapia prolongada empregada, näo apresentou aceleraçäo em sua doença de base. E discutem, principalmente, o uso de corticosteróides sistêmicos em pacientes HIV-positivos