Hiperqueratose lenticular persistente / Hyperkeratosis lenticularis perstans

Doença de Flegel ou hiperqueratose lenticular persistente é uma doença rara, caracterizada por pequenas pápulas hiperceratóticas, assintomáticas, localizadas preferencialmente nos membros inferiores. Histologicamente, há hiperortoceratose, atrofia epidérmica e infiltrado inflamatório em banda. Os tratamentos, em geral, são ineficazes. Relatamos um caso em que as lesões biopsiadas não recidivaram após dois anos de seguimento.

Flegel's disease, also known as hyperkeratosis lenticularis perstans, is a rare skin disease characterized by small reddish-brown asymptomatic hyperkeratotic papules usually located on the lower extremities. The histopathological features are hyperorthokeratosis, epidermal atrophy and band-like inflammatory infiltrate in the superficial dermis. Treatment is generally ineffective. We report a case of hyperkeratosis lenticularis perstans that improved following excisional biopsy of the lesions.

A Rare Case of a Subcutaneous Phaeomycotic Cyst with a Brief Review of Literature

Phaeohyphomycosis consists of a heterogeneous group of fungal infections caused by more than 80 genera and species. Subcutaneous infection usually follows traumatic implantation of a fungus by a wooden splinter that the fungus inh abits as a saprophyte. The growth of the fungus forms verrucous plaques or a painless subcutaneous abscess. We report a subcutaneous cyst (phaeomycotic cyst) in the leg of a 60-year-old woman that developed after a thorn prick at that site. With the provisional diagnosis of an epidermoid cyst, she was treated with a simple excision of the cyst. However, histopathological examination of the cyst revealed the typical features of fungus, and a definitive diagnosis of a phaeomycotic cyst was made. As the infective aetiology was not considered clinically, the specimen was not sent for microbiological culture, and hence the exact species was not identified. As the lesion was localised, simple excision was sufficient treatment, and no recurrence was observed during 12 months of follow-up.

Úlceras crônicas dos membros inferiores: avaliação pela fotografia digital / Chronic ulcers of the lower limbs: area evaluation by digital photography

OBJETIVO: Avaliar o desempenho da análise de imagem digital na estimativa da área acometida pelas úlceras crônicas dos membros inferiores. MÉTODOS: Estudo prospectivo em que foram mensuradas úlceras empregando o método planimétrico clássico, utilizando desenho dos seus contornos em filme plástico transparente, medida sua área posteriormente por folha milimetrada. Esses valores foram utilizados como padrão para a comparação com a estimativa de área pelas fotografias digitais padronizadas das úlceras e dos desenhos das mesmas em filme plástico. Para criar um referencial de conversão dos pixels em milímetros, foi empregado um adesivo com tamanho conhecido, adjacente à úlcera. RESULTADOS: foram avaliadas 42 lesões em 20 pacientes portadores de úlceras crônicas de membros inferiores. As áreas das úlceras variaram de 0,24 a 101,65cm². Observou-se forte correlação entre as medidas planimétricas e as fotos das úlceras (R²=0,86 p<0,01), porém a correlação das medidas planimétricas com as fotos digitais dos desenhos das úlceras foi ainda maior (R²=0,99 p<0,01). CONCLUSÃO: A fotografia digital padronizada revelou-se método rápido, preciso e não-invasivo capaz de estimar a área afetada por úlceras. A avaliação das medidas fotográficas dos contornos das úlceras deve ser preferida em relação à análise de sua fotografia direta.

OBJECTIVES: To evaluate results of digital imaging analysis in estimating the areas of chronic ulcers in the lower limbs. METHODS: In a prospective study the ulcer areas were estimated by the classic planimetric method, where ulcer perimeters are drawn on a transparent plastic film. Areas were then measured in millimetered paper. These values were considered as gold standards to evaluate standardized digital photographs of ulcers and of drawings for area estimation. A known length of adhesive was placed adjacent to ulcers to estimate the proportion of pixels relative to real millimeters. RESULTS: Forty two lesions from 20 patients with chronic lower limb ulcers were evaluated. Areas ranged from 0.24 to 101.65cm2. Planimetric measures strongly correlated with photos of the ulcers (R²=0.86 p<0.01), however, their correlation with digital photos of the ulcer drawings was even higher (R²=0.99 p<0.01). CONCLUSIONS: Standardized digital photography proved to be a quick, precise and non-invasive method to estimate ulcer areas. The evaluation of measurements from drawings of ulcer perimeters should be preferred to direct photographic analysis of the ulcers.