Prurigo actínico en un centro dermatológico de referencia en Colombia: 108 casos / Actinic prurigo in a dermatological reference center in Colombia: 108 cases

Introducción. El prurigo actínico es una fotodermatosis crónica. Afecta con mayor frecuencia a la población latinoamericana, predomina en mujeres y compromete la piel expuesta al sol, las conjuntivas y los labios. Objetivo. Actualizar la información sobre las características clínico-epidemiológicas y el tratamiento de pacientes con prurigo actínico en Colombia. Materiales y métodos. Se hizo un estudio de corte transversal que incluyó los registros clínicos de pacientes con prurigo actínico atendidos en el Servicio de Fotodermatología del Hospital Universitario Centro Dermatológico Federico Lleras Acosta entre el 2011 y el 2016, y se describieron sus características demográficas, clínicas e histopatológicas, así como su tratamiento. Resultados. Se incluyeron 108 pacientes, el 71,3 % de ellos mujeres y el 28,7% hombres, con predominio de los fototipos III-IV (70 %). La enfermedad se había iniciado durante la primera década de vida en el 66,4% de los casos y el 25 % de los pacientes tenía antecedentes familiares de la enfermedad. Las lesiones predominaban en el rostro (93,5 %), los antebrazos (79,6 %) y el dorso de las manos (70,4 %). También, se documentó compromiso ocular (87,9 %) y de los labios (88,8 %). Se hizo la prueba de fotoprovocación con radiación ultravioleta A en el 25 % de los casos y biopsia cutánea en el 19,4 %. Todos los pacientes se trataron con protección solar química y física. En los casos leves a moderados, se formularon corticoides tópicos (91,7 %) e inhibidores de la calcineurina (65,7 %), y en los graves, talidomida (33,3 %) y pentoxifilina (14,8 %). Conclusión. Las características de los pacientes colombianos con prurigo actínico son similares a las reportadas en otros países latinoamericanos: inicio temprano de la enfermedad, predominio en mujeres, compromiso frecuente de conjuntivas y labios, y adecuada respuesta al tratamiento tópico y sistémico.

Introduction: Actinic prurigo is a chronic photodermatosis. It affects the Latin American population more frequently, predominantly women, and involves the sun-exposed areas of the skin, conjunctiva, and lips. Objective: To update the information on the clinical-epidemiological characteristics and treatment of patients with actinic prurigo in Colombia. Materials and methods: We conducted a cross-sectional study including the medical records of patients with actinic prurigo treated in the Photodermatology Service of Hospital Universitario Centro Dermatológico Federico Lleras Acosta between 2011 and 2016. We described the demographic, clinical, histopathological, and treatment characteristics of the patients. Results: We included 108 patients, 77 (71.3%) were women and 31 (28.7%) men, mainly with phototypes III-IV (70%). The disease had begun during the first decade of life in 66.4% of the cases and 25% of the patients had a family history with the condition. The lesions predominated on the face (93.5%), forearms (79.6%), and back of the hands (70.4%). Ocular (87.9%) and lip (88.8%) involvement was also documented. A photo-provocation test with UVA was performed in 25% of the cases and skin biopsies in 19.4%. Physical and chemical photoprotection was indicated in all patients. Mild to moderate cases were treated with topical corticosteroids (91.7%) and calcineurin inhibitors (65.7%) while severe cases received thalidomide (33.3%) and pentoxifylline (14.8%). Conclusion: The characteristics of actinic prurigo patients in Colombia are similar to those reported in other Latin American countries: early onset of the disease, predominance in women, frequent involvement of conjunctiva and lips, and adequate response to topical and systemic treatment.

Incapacitating solar urticaria: successful treatment with omalizumab

Abstract: Solar urticaria is a rare form of physical urticaria mediated by immunoglobulin E. The lesions appear immediately after the sun exposure, interfering with the patient's normal daily life. Omalizumab, a monoclonal anti-IgE antibody, has been recently approved for the treatment of chronic spontaneous urticaria, and the latest reports support its role also in the treatment of solar urticaria. Hereby, we report a case of solar urticaria refractory to conventional treatment strategies, with an excellent response to treatment with omalizumab and phototesting normalization.

Expression of caspase-14 in skin lesions of patients with chronic actinic dermatitis and effect of ultraviolet B radiation on its mRNA and protein expression in HaCaT cells / 中华皮肤科杂志

Objective To determine the expression of caspase-14 in skin lesions of patients with chronic actinic dermatitis (CAD),and to explore the effect of ultraviolet B (UVB) radiation on its mRNA and protein expression in HaCaT cells.Methods In 2016,skin samples were collected from lesions of 10 patients with CAD (test group),10 patients with eczema (positive control group) and from normal skin of 10 healthy controls after cosmetic surgery (negative control group) in the Department of Dermatology,First Affiliated Hospital of Kunming Medical University.Immunohistochemical staining was performed to determine the expression of caspase-14 in the normal skin,CAD and eczema lesions.Cultured HaCaT cells were divided into several groups:UVB groups irradiated with 0,30,60,90 mJ/cm2 UVB separately,and 5-AzaC groups irradiated with 0,30,60,90 mJ/cm2 UVB separately followed by the treatment with the methylase inhibitor 5-AzaC for 24 hours.Then,the cells were collected,and real-time fluorescence-based quantitative PCR (RT-PCR) and Western blot analysis were conducted to determine the mRNA and protein expression of caspase-14 respectively in HaCaT cells in the UVB groups and 5-AzaC groups.Statistical analysis was carried out with SPSS22.0 software by using chi-square test for the comparison of rates,and t test and two-factor analysis of variance for the comparison of means.Results In the CAD and eczema lesions,caspase-14 was mainly expressed in the spinous and granular layers,but not in the stratum comeum.However,caspase-14 was markedly expressed in the stratum corneum of the normal skin tissues.Of the 10 CAD samples,5 were positive for caspase-14,and 9 of 10 normal skin samples were positive for caspase-14.The positive rate of caspase-14 significantly differed between the two above groups (x2 =7.30,P ＜ 0.05).RT-PCR and Western blot analysis showed significant changes in the mRNA and protein expression of caspase-14 in HaCaT cells after irradiation with different doses of UVB (F =87.54,23.46,both P ＜ 0.05),which showed a decreasing trend along with the increase in the dose of UVB.After exposure to 0,30,60 and 90 mJ/cm2 UVB,the mRNA and protein expression of caspase-14 was significantly higher in the 5-AzaC groups than in the UVB groups (all P ＜ 0.05).Conclusions In CAD lesions,the expression of caspase-14 markedly decreased,and was absent in the stratum corneum.UVB radiation can downregulate the mRNA and protein expression of caspase-14 in HaCaT cells.

Lupus erythematosus tumidus in childhood treated with antimalarials / Lupus eritematoso tumidus en la infancia tratado con antimalárico

Abstract Lupus erythematosus tumidus is a rare dermatosis. It is considered a subtype of chronic cutaneous lupus erythematosus of uncertain pathogenesis, favorable prognosis and rare association with systemic lupus erythematosus. Clinically, it manifests as urticarial-like plaques in photo exposed areas, mainly affecting adults, being extremely rare in pediatric age. Herein, we present two cases of six and nine-year-old male patients with clinical and histological characteristics typical of lupus erythematosus tumidus and poor response to first-line treatment (topical, intralesional steroids and topical calcineurin inhibitors); therefore, it was decided to start systemic therapy with antimalarials, obtaining a very good response.

Resumen El lupus eritematoso tumidus es una dermatosis poco frecuente. Es considerada una variante del lupus eritematoso cutáneo crónico, de patogénesis incierta, pronóstico favorable y rara asociación con lupus eritematoso sistémico. Clínicamente, se manifiesta como placas de aspecto urticarial en zonas fotoexpuestas, que principalmente afectan a los adultos, siendo extremadamente rara en edad pediátrica. A continuación presentamos dos casos de pacientes de sexo masculino de seis y nueve años, con características clínicas e histológicas típicas de lupus eritematoso tumidus y poca respuesta al tratamiento de primera línea (esteroides tópicos, intralesionales e inhibidores de calcineurina tópica), por lo que se decidió iniciar manejo sistémico con antimalárico, obteniendo muy buena respuesta terapéutica.

Risk factors associated with actinic prurigo: a case control study

Abstract: Background: Actinic prurigo (AP) is an idiopathic photodermatosis. Although its initial manifestations can appear in 6 to 8-year-old children, cases are diagnosed later, between the second and fourth decades of life, when the injuries are exacerbated. Objective: To identify risk factors associated with clinical manifestations of AP such as skin and mucosal lesions. Methods: Thirty patients with AP and 60 controls were included in the study, the dependent variable was the presence of skin or labial mucosal lesions, the independent variables were age, sex, solar exposure, living with pets or farm animals, exposure to wood smoke, smoking habit, years smoking, and hours spent per day and per week in contact with people who smoke. Results: Of the 30 diagnosed AP patients, 66.7% were female. Patients age ranged from 7 to 71 years and the mean age was 35.77 ± 14.55 years. We found significant differences with the age and cohabitation with farm animals. Those who lived with farm animals presented 14.31 times higher probability of developing AP (95% CI 3-78.06). Study limitations: This is a case-control study; therefore, a causal relationship cannot be proven, and these results cannot be generalized to every population. Conclusions: The identification of factors related to the development of AP increases our knowledge of its physiopathology. Moreover, identifying antigens that possibly trigger the allergic reaction will have preventive and therapeutic applications in populations at risk of AP.

Queilitis actínica: aspectos histológicos, clínicos y epidemiológicos / Actinic cheilitis: histological, clinical and epidemiological characteristics

Introducción: la destrucción de la capa de ozono ha provocado un aumento en la incidencia de lesiones de la piel, a la que se suma la queilitis actínica. Objetivo: describir los aspectos histológicos, clínicos y epidemiológicos de la queilitis actínica a partir de la literatura reciente. Métodos: se revisaron las bases electrónicas PubMed, SciELO y Google Scholar con los términos claves en inglés y español: queilitis, queratosis, actínica, solar. Se incluyeron artículos originales, de revisión, reportes de casos, tesis y libros de la especialidad publicados preferentemente en el período 2005-2014. Resultados: La queilitis actínica es un trastorno potencialmente maligno inducido por la exposición solar y caracterizado por alteraciones micro y macroestructurales del labio. Factores de riesgo que interaccionan con la exposición solar son el fototipo (piel clara), hábito tabáquico, sexo (hombres), edad y ocupación (aire libre). Entre las alteraciones histológicas se encuentran la displasia epitelial y la elastosis solar; sin embargo, la severidad de estas no correlacionan con la gravedad clínica. Los pacientes con queilitis actínica presentan alteraciones de color, descamación, ulceraciones, difuminación del bermellón, entre otras. En muchas ocasiones la consulta y el diagnóstico son tardíos; se realizan cuando el cuadro ha evolucionado a cáncer. El diagnóstico es principalmente clínico, sumado a la biopsia de las lesiones con presentaciones moderadas y severas. Actualmente la terapia incluye métodos quirúrgicos y farmacológicos, y métodos innovadores como la fototerapia. Sin duda, la estrategia de prevención más importante es aumentar el uso de protectores solares, especialmente en la población de alto riesgo ocupacional. Conclusiones: la queilitis actínica es una patología relevante para los países sudamericanos, debido a que los factores de riesgo están presentes diariamente en las actividades de millones de trabajadores de nuestra región, por eso es necesario potenciar la investigación que permita mejorar la prevención, tratamiento y rehabilitación de esta patología(AU)

Introduction: depletion of the ozone layer has brought about an increase in the incidence of skin lesions, including actinic cheilitis. Objective: describe the histological, clinical and epidemiological characteristics of actinic cheilitis based on a review of recent literature. Methods: a search was conducted in the databases PubMed, SciELO and Google Scholar using the descriptors cheilitis, keratosis, actinic, solar, and their counterparts in Spanish. The search included original papers, review papers, case reports, theses and books about the specialty preferably published from 2005 to 2014. Results: actinic cheilitis is a potentially malignant condition induced by sun exposure and characterized by micro- and macrostructural alterations of the lip. The risk factors interacting with sun exposure are the skin phototype (light skin), smoking, gender (male), age and occupation (outdoor jobs). Histological alterations include epithelial dysplasia and solar elastosis, though their severity does not correlate with the degree of clinical seriousness. Patients with actinic cheilitis present color alterations, desquamation, ulceration and blurring of the vermillion border, among other signs and symptoms. On many occasions patients do not seek care during the early stages of the disease. As a result, diagnosis is made when the condition has already evolved into cancer. The diagnosis is basically clinic, with the support of the biopsy of lesions with moderate to severe characteristics. Current therapy includes surgery and medication, as well as innovative techniques like phototherapy. The most important strategy is no doubt the use of sunscreens, especially by the population at high occupational risk. Conclusions: actinic cheilitis is a condition relevant to South American countries, since its risk factors are present in the daily activities of millions of workers from our region. It is therefore necessary to foster research aimed at improving its prevention, treatment and rehabilitation(AU)

Correlation of serum IgE levels and clinical manifestations in patients with actinic prurigo

Abstract BACKGROUND: Actinic prurigo is an idiopathic photodermatosis, the pathophysiology of which has been hypothesized to involve subtype IV type b (Th2) hypersensitive response, whereby IL4, IL5, and IL13 are secreted and mediate the production of B cells, IgE, and IgG4. OBJECTIVES: To examine the association of serum IgE levels and the clinical severity of injuries. METHODS: This case-control study comprised patients with a clinical and histopathological diagnosis of actinic prurigo, as well as clinically healthy subjects, from whom 3cc of peripheral blood was taken for immunoassay. Cases were classified by lesion severity as mild, moderate, and severe. Descriptive statistics were analyzed, and chi-square test was performed. RESULTS: We included 21 actinic prurigo patients and 21 subjects without disease; 11 patients with actinic prurigo had elevated serum IgE levels, and 10 had low serum levels. Six actinic prurigo (AP) patients with elevated serum levels of IgE had moderate injuries, 4 had severe injuries, and 1 had minor injuries. Eight out of 10 patients with normal IgE levels presented with minor injuries in the clinical evaluation. The 21 controls did not have increased serum IgE levels. CONCLUSIONS: Elevated IgE levels are associated with moderate to severe clinical lesions, suggesting that actinic prurigo entails a type IV subtype b hypersensitivity response in which Th2 cells predominate.

Photobiological responses in patients with chronic actinic dermatitis and their relationship with the melanocortin-1 receptor gene Arg163Gln variant:a preliminary study / 中华皮肤科杂志

Objective To explore differences in phototest and photopatch test results, and in skin color?related parameters between healthy subjects and patients with chronic actinic dermatitis (CAD), and to examine their relationship with the melanocortin?1 receptor gene(MC1R)Arg163Gln variant. Methods Phototests were performed by using a sun simulator SUN1000, and skin color was analyzed by using Hexameter MX18 in 25 patients with CAD and 25 healthy subjects. The MC1R genotype at position?163 was determined by PCR. Photopatch tests were performed on 25 patients with CAD and 5 healthy subjects using a standard series of photoallergens(RuiMin)and an ultraviolet (UV)phototherapy equipment, SS?03A. Results Regarding phototest results, both UVA?minimal persistent pigment darkening dose(MPPD)and UVB?minimal erythema dose(MED)were significantly lower in CAD patients compared with healthy controls (both P 0.05), but that of the CAA genotype differed significantly between the two groups(P<0.01). UVA?MPPD and UVB?MED were both significantly lower in CAD patients with the CAA genotype at position?163 in the MC1R gene than in those without the genotype(P=0.055, 0.325, respectively). Conclusions Skin photobiological testing plays a critical role in the diagnosis of CAD. Further studies are needed to clarify the role of the CAA genotype at position?163 in the MC1R gene in the diagnosis, prevention and treatment of CAD.

Actinic comedonal plaque-variant of Favre-Racouchot syndrome: report of two cases

The actinic comedonal plaque is characterized by papules, cysts and comedones forming a yellowish plaque in areas of chronic sun exposure skin. There are few reports in literature about this entity, considered a rare and ectopic form of Favré-Racouchot Syndrome. We report two cases of lesions located on forearms and thorax. Favré-Racouchot Syndrome is a condition usually restricted to the periorbital area; however, there are reports of similar findings in atypical locations, such as forearms and chest, which are known as actinic comedonal plaque. Ultraviolet radiation exposure is the main factor involved in its pathogenesis. The objective of this study was to provide accurate knowledge of this dermatosis and stimulate dermatologists to provide a correct diagnosis of the condition.

Sporadic Kindler Syndrome with a novel mutation / Sindrome de Kindler esporadica com uma mutacao nao descrita previamente

We report the case of a 28-year-old woman with Kindler syndrome, a rare form of epidermolysis bullosa. Clinically, since childhood, she had widespread pigmentary changes in her skin as well as photosensitivity and fragility of the skin and mucous membranes. The mucosal involvement led to an erosive stomatitis as well as esophageal, anal and vaginal stenoses, requiring surgical intervention. The diagnosis of Kindler syndrome was confirmed by DNA sequencing with compound heterozygosity for a nonsense/frameshift combination of mutations (p.Arg110X; p.Ala289GlyfsX7) in the FERMT1 gene.

Nós relatamos uma paciente feminina de 28 anos com Síndrome de Kindler, uma forma rara de Epidermólise Bolhosa. Clinicamente, ela apresentava alterações cutâneas pigmentares disseminadas, fotossensibilidade e fragilidade da pele e das mucosas desde a infância. O envolvimento mucoso levou à estomatite erosiva e a estenoses esofágica, anal e vaginal, as quais necessitaram de intervenções cirúrgicas. O diagnóstico de Síndrome de Kindler foi confirmado por sequenciamento de DNA, que demonstrou heterozigose composta uma combinação de mutações uma nonsense e outra frameshift (p.Arg110X; p.Ala289GlyfsX7) no gene FERMT1.

Extensive hydroa vacciniforme / Hidroa vaciniforme extensa

Hydroa Vaciniforme is a very rare photodermatosis that is mainly seen in childhood. An 18 year old female student reported that since the age of 5 she has been suffering necrotic lesions and vesicles lesions in exposed areas, leaving asymptomatic varioliform scars, which worsened in summer. Light microscopy showed epidermal necrosis with lymphocytic infiltration . Sunscreens were prescribed with light improvement.

O Hidroa Vaciniforme é uma fotodermatose muito rara vista geralmente na infância. Uma paciente de 18 anos foi examinada, a qual apresenta lesões vesiculosas e necróticas varioliformes nas áreas fotoexpostas, que evoluem para cicatrizes atróficas, piorando no verão. A microscopia óptica mostrou necrose epidérmica com infiltrado linfocítico. Houve pouca melhora com uso de filtros solares.

Effects of sun protection education on the severity and treatment of polymorphous light eruption / 中华皮肤科杂志

Objective To estimate the effect of sun protection education on the severity and treatment of polymorphous light eruption (PLE).Methods Sixty-two patients with PLE were enrolled in this study,and randomly assigned into the control group (n =31) and intervention group (n =31) by using a random number table.Routine therapy was provided to all the subjects at their visits.The intervention group attended two lectures on sun protection at the beginning of spring and summer,and was given an education manual after each lecture.All the subjects completed a face to face interview and a questionnaire on the severity and therapy of PLE at the baseline and 12 months after enrollment.SPSS 11.5 software was used for data processing.Rank sum test,t test and chi-square test were carried out to assess the differences in the severity and treatment of PLE between the control group and intervention group as well as between pre-and post-intervention.Results The patients receiving sun protection education showed a significant decrease in the severity of PLE,including the number of months affected by PLE (t =4.611,P ＜ 0.01),number of PLE episodes (t =3.569,P ＜ 0.01),frequency of facial involvement (Z =2.369,P ＜ 0.05) and the time taken for lesions to appear after sun exposure (Z =2.650,P ＜0.01) in the year after enrollment compared with that before enrollment.Significant differences were also observed between the intervention group and control group in the number of months affected by PLE (t =3.679,P ＜ 0.01),number of PLE episodes (t =2.995,P ＜ 0.05),frequency of facial involvement (Z =2.169,P ＜ 0.05),the time taken for lesions to appear after sun exposure (Z =2.169,P ＜ 0.05) in the year after enrollment.The percentage of patients applying highly potent topical glucocorticosteroids (x2 =10.928,P ＜ 0.01)and administrating antihistamines (x2 =18.723,P ＜ 0.01) as well as the cumulative time of treatment with oral antihistamines (Z =2.656,P ＜ 0.01) were significantly reduced in the intervention group in the year after enrollment than in that before enrollment.Further more,a marked decrease was found in the percentage of patients applying topical highly potent glucocorticosteroids (x2 =4.521,P ＜ 0.05) and administrating antihistamines (x2 =10.949,P ＜0.01) as well as the cumulative time of treatment with oral antihistamines (Z =3.353,P ＜ 0.01).Conclusions Sun protection education through lectures and manuals appears to be an efficient adjuvant for the relief of PLE severity as well as for the reduction in the use of antihistamines and glucocorticosteroids,suggesting that dermatologists should pay more attention to sun protection education in the treatment of photosensitive diseases.

Kindler syndrome: report of two cases / Síndrome de Kindler: relato de dois casos

Kindler syndrome is a rare autosomal recessive genodermatosis characterized by trauma-induced blisters, progressive poikiloderma and varying degrees of photosensitivity. In 2003, loss-of-function mutations were identified in the gene KIND1 mapped to chromosome 20p12.3. In this paper, we report Kindler syndrome in two children born to consanguineous parents presenting acral blistering, photosensitivity, poikiloderma, cutaneous atrophy and periodontitis.

A síndrome de Kindler é uma genodermatose rara, autossômica recessiva, caracterizada pela presença de bolhas induzidas por traumas, fotossensibilidade, atrofia cutânea e poiquilodermia progressiva. A alteração genética da síndrome foi descrita em 2003, com a identificação de mutação no gene KINDIN1, localizado no cromossomo 20p12.3. Nesse trabalho relata-se a presença da síndrome de Kindler em irmãos, filhos de pais consangüíneos, que apresentavam, desde a infância, fotossensibilidade, bolhas após pequenos traumas, poiquilodermia, atrofia cutânea e periodontite.

Queilite actínica: avaliação comparativa estética e funcional entre as vermelhectomias clássica e em W-plastia / Actinic cheilitis: aesthetic and functional comparative evaluation of vermilionectomy using the classic and W-plasty techniques

FUNDAMENTO: A queilite actínica crônica é a ceratose actínica localizada no vermelhão labial. O tratamento é de crucial importância, devido ao potencial de transformação maligna. OBJETIVO: Avaliar os resultados estéticos e funcionais das vermelhectomias clássica e em W-plastia na queilite actínica. Na técnica clássica, a cicatriz é linear; na W-plastia, em linha quebrada. MÉTODOS: Foram tratados 32 pacientes com diagnóstico clínico e histopatológico de queilite actínica. Quinze deles foram submetidos à técnica em W-plastia e 17, à técnica clássica. Avaliaram-se parâmetros como retração cicatricial e alterações funcionais. RESULTADOS: Houve associação estatisticamente significativa entre a técnica utilizada e a presença de retração cicatricial, sendo a associação positiva com a clássica (p=0,01 com correção de Yates). O risco relativo (odds ratio - OR) calculado foi de 11,25, ou seja, houve maior chance de retração nos pacientes submetidos à técnica clássica. Nenhuma das técnicas apresentou alterações funcionais. Avaliaram-se complicações pós-operatórias como presença de crostas, lábios secos, parestesia e deiscência de sutura. Não houve associação estatisticamente significante entre as complicações e a técnica utilizada (p=0,69). CONCLUSÃO: Concluiu-se que a vermelhectomia em W-plastia oferece melhores resultados estéticos e índices de complicações semelhantes.

BACKGROUND: Chronic actinic cheilitis is actinic keratosis located on the vermilion border. Treatment is essential because of the potential for malignant transformation. OBJECTIVE: To evaluate the aesthetic and functional results of vermilionectomy using the classic and Wplasty techniques in actinic cheilitis. In the classic technique, the scar is linear and in the W-plasty one, it is a broken line. METHODS: 32 patients with clinical and histopathological diagnosis of actinic cheilitis were treated. Out of the 32 patients, 15 underwent the W-plasty technique and 17 underwent the classic one. We evaluated parameters such as scar retraction and functional changes. RESULTS: A statistically significant association between the technique used and scar retraction was found, which was positive when using the classic technique (p = 0.01 with Yates' correction). The odds ratio was calculated at 11.25, i.e., there was a greater chance of retraction in patients undergoing the classic technique. Both techniques revealed no functional changes. We evaluated postoperative complications such as the presence of crusts, dry lips, paresthesia, and suture dehiscence. There was no statistically significant association between complications and the technique used (p = 0.69). CONCLUSION: We concluded that vermilionectomy using the W-plasty technique shows better cosmetic results and similar complication rates.

Caso para diagnóstico / Case for diagnosis

Paciente do sexo masculino, negro, 13 anos, apresenta há dois anos lesões pruriginosas, pápulonodulares nos antebraços, associadas a edema do lábio inferior, fotofobia, conjuntivite e pterígio. O exame histopatológico do lábio inferior revelou acantose, espongiose e infiltrado inflamatório perivascular superficial, composto por linfócitos, plasmócitos e eosinófilos, compatível com o diagnóstico de prurigo actínico. As lesões regrediram com o uso de talidomida 100 mg/dia.

A 13-year-old black boy had pruritic papular and nodular lesions on his forearms associated to edema of the lower lip, photophobia, conjunctivitis and pterygium. Skin biopsy of the lower lip revealed acanthosis, spongiosis with dermal perivascular mononuclear cell infiltration composed by lymphocytes, plasma cells and eosinophils consistent with actinic prurigo. Lesions improved considerably with the use of thalidomide 100mg/ day.

Relationship of severity of chronic actinic dermatitis with photosensitivity profile of patients / 中华皮肤科杂志

ED are correlated with the severity of CAD in a degree.

Vermilionectomy: a treatment alternative for actinic cheilitis / Vermelhectomia: uma opção de tratamento para queilite actínica

Purpose: Ultraviolet radiation is the main etiological agent associated with the development of actinic cheilitis, a premalignant irreversible disease that frequently affects the vermilion border of the lower lip. This paper aimed to describe the case of a patient with actinic cheilitis and treated with scalpel vermilionectomy. Case Description: A male, Caucasian, 66 year-old subject sought dental treatment complaining of "wounds on the lip that not heal" for approximately 15 years. The patient reported that he had worked in farms since the age of 5 year-old and was a frequent user of alcohol and tobacco. Atrophic and erosive areas associated with many ulcers covered with eschars were observed throughout the length of the lip. Based on the patient history and clinical exam, scalpel vermilionectomy was proposed. The histopathological analysis revealed a superficially invasive squamous cell carcinoma with free borders. The patient was monitored for two years with no relapse. Conclusion: Scapel vermilionectomy was chose to treat this case due to its low cost, relatively short time for repair, and possibility of histopathological analysis of the removed tissue.

Objetivo: A radiação ultravioleta é o principal agente etiológico associado ao desenvolvimento da queilite actínica, uma lesão pré-maligna que afeta o lábio inferior. Este trabalho descreveu o caso clínico de um paciente que apresentava várias ulcerações recobertas por crosta no lábio inferior e foi tratado pela técnica da vermelhectomia. Descrição do caso: Um sujeito do sexo masculino, Caucasiano, de 66 anos de idade, procurou tratamento odontológico com queixa de "feridas no lábio que não cicatrizavam" por 15 anos. O paciente relatou que tinha trabalhado em fazendas desde os 5 anos de idade e fazia uso frequente de tabaco e álcool. Áreas erosivas e atróficas associadas a múltiplas úlceras cobertas com escaras foram observadas em todo o lábio. Com base na história do paciente e exame clínico, foi proposto tratamento por vermelhectomia. O diagnóstico histopatológico foi de carcinoma espinocelular superficialmente invasivo, com margens livres, e o paciente foi acompanhado por um período de 2 anos sem recidiva. Conclusão: A técnica da vermelhectomia foi a escolha preferencial de tratamento por ser de baixo custo, ter um tempo cicatricial relativamente curto e, especialmente, permitir que o tecido removido possa ser examinado histopatologicamente.

Skin damage induced by ultraviolet radiation in high altitude: a survey in officers and soldiers / 中华皮肤科杂志

Objective To characterize the skin damage induced by ultraviolet radiation in officers was observed in 67.5% of the 1286 officers and soldiers:tanning in 62.05%(798/1286),photoaging in 18.66%(240/1286),polymorphous light eruption in 13.69%(176/1286)and sunbum in 13.30%(171/1286).Two hundred and thirteen subjects each had two kinds of skin amage,and 152 subjects each had three kinds of skin damage.With the time of being in the army and cumulative sun-exposure period,the prevalence of tanning,photoaging and polymorphous light eruption increased,while the prevalence of sunburn decreased.Sunburn mostly occurred in newly assigned soldiers.Conclusions The condition of skin damage nduced by ltraviolet radiation iS severe in officers and soldiers working in high altitude,and effective measures are warranted for the prevention and treatment of the skin damage.

Imbalance of Tc Cells in the Pathogenesis of Chronic Actinic Dermatitis / 中华皮肤科杂志

Objective To investigate the association of imbalance of Tc1 and Tc2 cells with chronic actinic dermatitis (CAD). Methods Immunohistochemistry (S-P method) was used to test the subgroups of infiltrating cells and the expression of receptors of interleukin-4 (IL-4), interleukin-10 (IL-10), interleukin-12 (IL-12) and interferon-? (IFN-?) in these cells of the eruptions from 28 patients with CAD and 7 normal controls. The serum levels of IL-4, IL-10, IL-12 and IFN-? from 33 patients with CAD and 32 normal controls were tested by ELISA. Results The major infiltrating cells in the eruptions of patients with CAD were T cells, which were significantly more than B cells (P