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1.
An. bras. dermatol ; 96(4): 487-489, July-Aug. 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1285103

ABSTRACT

Abstract Neurofibromatosis is a common genodermatosis, whose diagnosis often involves the participation of a dermatologist. A case of a 38-year-old female patient with four café-au-lait macules and eleven neurofibromas on clinical examination is presented. Dermoscopy allowed the identification of Lisch nodules in the iris, bilaterally. The combination of these findings allowed the diagnosis of neurofibromatosis type 1, according to NIH criteria. Lisch nodules are melanocytic hamartomas of the iris, which must be evaluated through a visual augmentation method, usually employed in ophthalmology. Alternatively, dermoscopy can be used and contribute to the early diagnosis of neurofibromatosis type 1.

4.
An. bras. dermatol ; 96(3): 332-345, May-June 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1285074

ABSTRACT

Abstract The study of skin, the science of dermatology, has undergone significant transformations throughout the centuries. From the first descriptions of skin diseases in Egyptian papyri and in Hippocratic writings to the first treatises on dermatology, important individuals and discoveries have marked the specialty. In the 18th and 19th centuries, the specialty consolidated itself as a field of medical study based on the first classifications of dermatoses, diagnostic methods, and drug treatments. In the 20th century, the scientific and technological revolution transformed dermatological practice, incorporating new therapeutic resources, as well as surgical and aesthetic procedures. In the face of such a vigorous process, it is important to provide a historical synthesis for the medical community to recognize and understand the origins that supported one of the most relevant specialties in the current medical scenario.

5.
An. bras. dermatol ; 95(6): 728-730, Nov.-Dec. 2020. graf
Article in English | LILACS-Express | LILACS, ColecionaSUS | ID: biblio-1142126

ABSTRACT

Abstract Dermatofibrosarcoma protuberans is a rare mesenchymal tumor; it is locally aggressive and presents high rates of local recurrence. It may present as a nodular or plaque vegetating lesion. It mainly affects the trunk and proximal limbs, being rare in the distal extremities. Biopsy and immunohistochemistry help confirm the diagnosis. The authors report a case of dermatofibrosarcoma protuberans with plantar region involvement, a rare presentation. To the best of the authors' knowledge, only 11 cases of involvement of the feet were described in the international literature.

7.
An. bras. dermatol ; 95(supl.1): 53-69, Nov.-Dec. 2020. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1152779

ABSTRACT

Abstract Background: Rosacea is a chronic inflammatory disease of the skin, relatively more frequent in women over 30 with a low phototype and proven genetic predisposition. Although its etiology is unknown and possibly multifactorial, the immunological abnormality, associated with neurovascular dysregulation and triggering factors, are important elements in its pathophysiology, which lead to the main changes of inflammation, vasodilation, and angiogenesis that are responsible for the clinical manifestations. Despite the lack of cure, numerous therapeutic options are available for the different clinical presentations of the disease, with satisfactory responses. Objective: To reach a consensus, with recommendations from experts, on the therapeutic management of rosacea suitable to the Brazilian setting. Methods: The study was conducted by five specialized dermatologists from university centers, representatives of the different Brazilian regions, with experience in rosacea, who were appointed by the Brazilian Society of Dermatology. Based on the adapted DELPHI methodology, the experts contributed through an updated bibliographic review of the scientific evidence, combined with personal experiences. Results: The group of experts reached a consensus on the relevant aspects in the therapeutic management of rosacea, providing information on epidemiology, pathophysiology, triggering factors, clinical condition, classification, quality of life, and comorbidities. Consensus was defined as approval by at least 90% of the panel. Conclusion: Despite the impossibility of cure, there are several therapeutic alternatives specific to each patient that provide excellent results, with chances of total improvement and long periods of remission, promoting a positive impact on quality of life. This consensus provides detailed guidance for clinical practice and therapeutic decisions in rosacea.

8.
An. bras. dermatol ; 95(4): 490-492, July-Aug. 2020. graf
Article in English | LILACS-Express | LILACS, ColecionaSUS | ID: biblio-1130927

ABSTRACT

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.

9.
An. bras. dermatol ; 95(1): 75-77, Jan.-Feb. 2020. graf
Article in English | LILACS-Express | LILACS | ID: biblio-1088714

ABSTRACT

Abstract Hailey-Hailey disease, or familial benign pemphigus, is a rare bullous genodermatosis that usually presents with flaccid blisters, erosions, and maceration limited to flexural areas, resulting in increased morbidity and reduced quality of life for affected patients. The authors report an unusual case of generalized Hailey-Hailey disease with erythroderma and fatal outcome.

11.
An. bras. dermatol ; 94(2,supl.1): 56-66, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1011090

ABSTRACT

Abstract: Background: Urticarias are frequent diseases, with 15% to 20% of the population presenting at least one acute episode in their lifetime. Urticaria are classified in acute ( ≤ 6 weeks) or chronic (> 6 weeks). They may be induced or spontaneous. Objectives: To verify the diagnostic and therapeutic recommendations in chronic spontaneous urticaria (CSU), according to the experience of Brazilian experts, regarding the available guidelines (international and US). Methods: A questionnaire was sent to Brazilian experts, with questions concerning diagnostic and therapeutic recommendations for CSU in adults. Results: Sixteen Brazilian experts answered the questionnaire related to diagnosis and therapy of CSU in adults and data were analyzed. Final text was written, considering the available guidelines (International and US), adapted to the medical practices in Brazil. Diagnostic work up in CSU is rarely necessary. Biopsy of skin lesion and histopathology may be indicated to rule out other diseases, such as, urticarial vasculitis. Other laboratory tests, such as complete blood count, CRP, ESR and thyroid screening. Treatment of CSU includes second-generation anti-histamines (sgAH) at licensed doses, sgAH two, three to fourfold doses (non-licensed) and omalizumab. Other drugs, such as, cyclosporine, immunomodulatory drugs and immunosuppressants may be indicated (non-licensed and with limited scientific evidence). Conclusions: Most of the Brazilian experts in this study partially agreed with the diagnostic and therapeutic recommendations of the International and US guidelines. They agreed with the use of sgAH at licensed doses. Increase in the dose to fourfold of sgAH may be suggested with restrictions, due to its non-licensed dose. Sedating anti-histamines, as suggested by the US guideline, are indicated by some of the Brazilian experts, due to its availability. Adaptations are mandatory in the treatment of CSU, due to scarce or lack of other therapeutic resources in the public health system in Brazil, such as omalizumab or cyclosporine.


Subject(s)
Humans , Adult , Urticaria/diagnosis , Urticaria/drug therapy , Consensus , Societies, Medical , Urticaria/prevention & control , Severity of Illness Index , Brazil , Chronic Disease , Anti-Allergic Agents/therapeutic use , Cyclosporins/therapeutic use , Histamine H1 Antagonists, Non-Sedating/therapeutic use , Dermatology , Omalizumab/therapeutic use , Immunosuppressive Agents/therapeutic use
12.
An. bras. dermatol ; 94(1): 47-51, Jan.-Feb. 2019. tab
Article in English | LILACS | ID: biblio-983750

ABSTRACT

Abstract: Background: Sentinel lymph node biopsy in thin invasive primary cutaneous melanoma (up to 1mm thick) is a controversial subject. The presence of tumor-infiltrating lymphocytes could be a factor to be considered in the decision to perform this procedure. Objective: To evaluate the association between the presence of tumor-infiltrating lymphocytes and lymph node metastases caused by thin primary cutaneous melanoma. Methods: Cross-sectional study with 137 records of thin invasive primary cutaneous melanoma submitted to sentinel lymph node biopsy from 2003 to 2015. The clinical variables considered were age, sex and topography of the lesion. The histopathological variables assessed were: tumor-infiltrating lymphocytes, melanoma subtype, Breslow thickness, Clark levels, number of mitoses per mm2, ulceration, regression and satellitosis. Univariate analyzes and logistic regression tests were performed as well the odds ratio and statistical relevance was considered when p <0.05. Results: Among the 137 cases of thin primary cutaneous melanoma submitted to sentinel lymph node biopsy, 10 (7.3%) had metastatic involvement. Ulceration on histopathology was positively associated with the presence of metastatic lymph node, with odds ratio =12.8 (2.77-59.4 95% CI, p=0.001). The presence of moderate/marked tumor-infiltrating lymphocytes was shown to be a protective factor for the presence of metastatic lymph node, with OR=0.20 (0.05-0.72 95% CI, p=0.014). The other variables - clinical and histopathological - were not associated with the outcome. Study limitations: The relatively small number of positive sentinel lymph node biopsy may explain such an expressive association of ulceration with metastatization. Conclusions: In patients with thin invasive primary cutaneous melanoma, few or absent tumor-infiltrating lymphocytes, as well as ulceration, represent independent risk factors for lymph node metastasis.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Skin Neoplasms/pathology , Lymphocytes, Tumor-Infiltrating/pathology , Sentinel Lymph Node/pathology , Lymphatic Metastasis/pathology , Melanoma/pathology , Logistic Models , Cross-Sectional Studies , Multivariate Analysis , Risk Factors , ROC Curve , Sex Distribution , Statistics, Nonparametric , Risk Assessment , Sentinel Lymph Node Biopsy/methods
13.
Rev. iberoam. micol ; 36(2): 55-60, 2019. tab
Article in English | LILACS, ColecionaSUS, CONASS, SES-RS | ID: biblio-1121303

ABSTRACT

Background: The number of fungal infections has increased in recent years in Rio Grande do Sul (RS), Brazil. Epidemiological studies are important for proper control of infections. Aims: To evaluate the etiology of fungal infections in patients in RS, from 2003 to 2015. Methods: This is a retrospective and longitudinal study carried out at Mycology Department of Central Laboratory of RS; 13,707 samples were evaluated. The variables sex, age, site of infection, and etiologic agent were analyzed. Susceptibility of Candida to fluconazole was tested in samples collected in 2015from 51 outpatients. Results: Of the 13,707 samples, 840 cases (6.12%) of fungal infections were found and included in the analyses; female gender accounted for the 55.9% of the cases. The main fungus was Candida albicans (450 cases, 53.38%; p < 0.001). Onychomycosis was the most frequent infection in superficial mycoses. Systemic mycoses accounted for 54.05% of the cases, from which 68.8% occurred in males, mainly HIVpositive (33.11%), and the main etiologic agent in these cases was Cryptococcus neoformans (73.13%). Among 51 samples tested for susceptibility to fluconazole, 78.43% of Candida isolates were susceptible; 5.88% were susceptible in a dose-dependent manner, and 15.69% were resistant. Conclusions: C. albicans is a common cause of fungal infections in RS, accounting for half of the cases;resistance to antifungals was found in non-hospitalized patients. In addition, women seem to be moresusceptible to fungal infections than men, however men show more systemic mycoses than women. Thenails are the most common site of infection. (AU)


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Fungi/classification , Mycoses/epidemiology , Brazil/epidemiology , Fluconazole/pharmacology , Prevalence , Retrospective Studies , Longitudinal Studies , Drug Resistance, Fungal , Fungi/drug effects
14.
An. bras. dermatol ; 93(5): 712-715, Sept.-Oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-949960

ABSTRACT

Abstract: Verrucous hemangioma is a rare vascular skin disorder with an immune profile similar to vascular neoplasms, but with behavior and evolution of vascular malformations. Its main differential diagnosis is angiokeratoma circumscriptum neviforme, with an almost indistinguishable clinical presentation because both diseases appear as erythematous patches that evolve to violaceous plaques, becoming scaly and even verrucous, most commonly affecting the lower limbs. Histopathology is crucial for the correct diagnosis: while in angiokeratoma the vascular alterations are limited to the papillary dermis, verrucous hemangioma extends deep into the dermis, reaching the subcutaneous tissue.


Subject(s)
Humans , Female , Child, Preschool , Skin Neoplasms/pathology , Hemangioma/pathology , Angiokeratoma/pathology , Skin Neoplasms/diagnosis , Diagnosis, Differential , Hemangioma/diagnosis , Angiokeratoma/diagnosis
15.
An. bras. dermatol ; 93(4): 605-607, July-Aug. 2018. graf
Article in English | LILACS | ID: biblio-1038275

ABSTRACT

Abstract: Pyoderma gangrenosum (PG) is an uncommon neutrophilic dermatosis, with variable clinical features, nonspecific histopathology and multifactorial pathogenesis, posing a challenging diagnosis for the dermatologist. Pyoderma gangrenosum is a diagnosis of exclusion and should be included in the differential diagnoses of the verrucous syndrome. We report a granulomatous variant affecting the face.


Subject(s)
Humans , Male , Aged , Warts/pathology , Pyoderma Gangrenosum/pathology , Face/pathology , Facial Dermatoses/pathology , Syndrome , Diagnosis, Differential
16.
An. bras. dermatol ; 93(3): 462-464, May-June 2018. tab
Article in English | LILACS | ID: biblio-1038269

ABSTRACT

Abstract: The number of new cases of emerging fungal infections has increased considerably in recent years, mainly due to the large number of immunocompromised individuals. The objective of this study was to evaluate the susceptibility of emerging fungi to fluconazole, itraconazole and amphotericin B by disk diffusion method. In 2015, 82 emerging fungi were evaluated in IPB-LACEN/RS and 13 (15.8%) were resistant: 10/52 were from superficial mycoses and 3/30 from systemic mycoses. The data from the study point to the need for permanent vigilance regarding the careful evaluation in the prescription and clinical and laboratory follow-up of patients affected by fungal infections.


Subject(s)
Humans , Male , Female , Adult , Aged , Drug Resistance, Fungal , Fungi/drug effects , Antifungal Agents/therapeutic use , Microbial Sensitivity Tests , Fluconazole/therapeutic use , HIV Infections/complications , Amphotericin B/therapeutic use , Itraconazole/therapeutic use , Fungi/isolation & purification , Mycoses/microbiology , Mycoses/drug therapy , Antifungal Agents/pharmacology
17.
Rev. AMRIGS ; 60(4): 370-373, out.-dez. 2016. ilus
Article in Portuguese | LILACS | ID: biblio-847858

ABSTRACT

Pilomatricoma é uma neoplasia folicular benigna relativamente rara. Pode ocorrer em qualquer idade, mas menos de 13% dos casos acontecem em pessoas com mais de 50 anos, sendo mais comum em mulheres (1,5 a 2,5 mulheres:1 homem). A localização mais frequente é a região cervical, seguida das áreas frontais, periorbitárias e pré-auriculares (1). Clinicamente, apresenta-se como um tumor subcutâneo ou intradérmico, endurecido e de crescimento lento. O diagnóstico pré-cirúrgico é quase sempre difícil (3). O tratamento padrão é o cirúrgico, com margens de segurança amplas para minimizar o risco de recorrência nas variantes malignas (2,3). Relatamos um caso atípico e exuberante de múltiplos pilomatricomas em membros superiores em um paciente do sexo masculino de 55 anos (AU)


Pilomatricoma is a relatively rare benign follicular neoplasm. It can occur at any age, but less than 13% of cases occur in people over 50 years old, and it is more common in women (1.5 to 2.5 women: 1 man). The most frequent location is the cervical region, followed by the frontal, periorbital and pre-auricular areas (1). Clinically it presents as a hardened and slowly growing subcutaneous or intradermal tumor. Preoperative diagnosis is almost always difficult (3). The standard treatment is surgical, with wide safety margins to minimize the risk of recurrence in malignant variants (2,3). We report an atypical and exuberant case of multiple pilomatricomas in upper limbs in a 55-year-old male patient (AU)


Subject(s)
Humans , Male , Middle Aged , Pilomatrixoma/diagnosis , Pilomatrixoma/pathology , Diagnosis, Differential , Pilomatrixoma/surgery , Skin Neoplasms/diagnosis , Skin Neoplasms/pathology , Upper Extremity
18.
An. bras. dermatol ; 91(5): 604-610, Sept.-Oct. 2016. tab, graf
Article in English | LILACS | ID: biblio-827754

ABSTRACT

Abstract: Background: Topical antimicrobial drugs are indicated for limited superficial pyodermitis treatment, although they are largely used as self-prescribed medication for a variety of inflammatory dermatoses, including atopic dermatitis. Monitoring bacterial susceptibility to these drugs is difficult, given the paucity of laboratory standardization. Objective: To evaluate the prevalence of Staphylococcus aureus topical antimicrobial drug resistance in atopic dermatitis patients. Methods: We conducted a cross-sectional study of children and adults diagnosed with atopic dermatitis and S. aureus colonization. We used miscellaneous literature reported breakpoints to define S. aureus resistance to mupirocin, fusidic acid, gentamicin, neomycin and bacitracin. Results: A total of 91 patients were included and 100 S. aureus isolates were analyzed. All strains were methicillin-susceptible S. aureus. We found a low prevalence of mupirocin and fusidic acid resistance (1.1% and 5.9%, respectively), but high levels of neomycin and bacitracin resistance (42.6% and 100%, respectively). Fusidic acid resistance was associated with more severe atopic dermatitis, demonstrated by higher EASI scores (median 17.8 vs 5.7, p=.009). Our results also corroborate the literature on the absence of cross-resistance between the aminoglycosides neomycin and gentamicin. Conclusions: Our data, in a southern Brazilian sample of AD patients, revealed a low prevalence of mupirocin and fusidic acid resistance of S. aureus atopic eczema colonizer strains. However, for neomycin and bacitracin, which are commonly used topical antimicrobial drugs in Brazil, high levels of resistance were identified. Further restrictions on the use of these antimicrobials seem necessary to keep resistance as low as possible.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Young Adult , Staphylococcus aureus/drug effects , Drug Resistance, Bacterial , Dermatitis, Atopic/microbiology , Anti-Bacterial Agents/pharmacology , Bacitracin/pharmacology , Gentamicins/pharmacology , Neomycin/pharmacology , Cross-Sectional Studies , Mupirocin/pharmacology , Disk Diffusion Antimicrobial Tests/methods , Fusidic Acid/pharmacology
19.
An. bras. dermatol ; 91(3): 326-330, tab, graf
Article in English | LILACS | ID: lil-787287

ABSTRACT

Abstract: Background: In this paper, the basic elements related to the selection of participants for a health research are discussed. Sample representativeness, sample frame, types of sampling, as well as the impact that non-respondents may have on results of a study are described. The whole discussion is supported by practical examples to facilitate the reader's understanding. Objective: To introduce readers to issues related to sampling.


Subject(s)
Humans , Sampling Studies , Patient Selection , Selection Bias , Data Collection/standards , Sample Size
20.
An. bras. dermatol ; 90(4): 523-528, July-Aug. 2015. tab, ilus
Article in English | LILACS | ID: lil-759204

ABSTRACT

AbstractBACKGROUND:Hypothesis tests are statistical tools widely used for assessing whether or not there is an association between two or more variables. These tests provide a probability of the type 1 error (p-value), which is used to accept or reject the null study hypothesis.OBJECTIVE:To provide a practical guide to help researchers carefully select the most appropriate procedure to answer the research question. We discuss the logic of hypothesis testing and present the prerequisites of each procedure based on practical examples.


Subject(s)
Humans , Data Interpretation, Statistical , Multivariate Analysis , Research Design/standards , Bias , Biomedical Research , Linear Models , Reference Values
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