La tricoscopía como herramienta diagnóstica en afecciones del pelo y el cuero cabelludo

RESUMEN La tricoscopía es la técnica que permite visualizar, sin distinción de la región corporal, las fibras capilares, las aberturas foliculares, la epidermis circundante y los vasos sanguíneos, mediante un dermatoscopio o videodermatoscopio. Se realizó una revisión bibliográfica en las bases de datos Medline, PubMed y SciELO, entre enero y abril de 2021, con el objetivo de conocer los aspectos básicos de la técnica y los principales hallazgos tricoscópicos en pacientes sanos y con diagnóstico de enfermedades pilosas. Los términos de búsqueda incluyeron "tricoscopía", "dermatoscopía", "pelo" y "alopecia", en español y en inglés; para su delimitación se usó el tesauro DeCS-Descriptores en Ciencias de la Salud. La búsqueda reveló 70 artículos, de los cuales 39 cumplieron con los criterios de inclusión. El 83 % de los trabajos pertenecían a conocimientos de la técnica y hallazgos tricoscópicos asociados a enfermedades pilosas. El 17 % expresaban conceptos actuales de las entidades que afectan estas áreas. Se describieron los elementos básicos de la tricoscopía y hallazgos tricoscópicos en pacientes sanos y aquellos que padecían alguna afección regional. Al analizar el comportamiento de los artículos y su representatividad en las revistas científicas, se apreció que International Journal of Trichology y Skin Appendage Disorders, fueron las que aportaron más estudios. El papel de la tricoscopía es indiscutible en el diagnóstico de patologías del pelo y el cuero cabelludo. El conocimiento de la técnica y de los patrones tricoscópicos descritos y adaptables para entidades específicas, resultan importantes para realizar un análisis y seguimiento adecuado de los casos.

ABSTRACT Trichoscopy is the technique that allows to visualize perifollicular epidermis and blood vessels, without distinction of the corporal region, hair fibers and follicular openings, by means of a dermatoscope or videodermatoscope. A bibliographic review was carried out in Medline, PubMed and SciELO databases between January and April 2021, with the aim of understanding the main aspects of the technique and the main trichoscopic findings in healthy patients and in those with diagnosis of hair diseases. The search terms included "trichoscopy", "dermatoscopy", "hair" and "alopecia", in Spanish and in English; the DeCS-Descriptors in Health Sciences thesaurus was used for the delimitation. The search revealed 70 articles of which only 39 met the inclusion criteria. 83 % of the papers belonged to technique knowledge and trichoscopic findings associated to hair diseases. 17 % stated current concepts of the entities that affect these areas. There were described basic elements of trichoscopy and trichoscopic findings in healthy patients and in those suffering any regional condition. When analyzing the behavior of the articles and their representativeness in scientific journals, it was found that International Journal of Trichology and Skin Appendage Disorders, were those publications that contributed with more studies. The role of trichoscopy is unquestionable in hair and scalp pathologies. Knowledge of the technique and the trichoscopic patterns described and adaptable to specific entities are important to carry out an adequate analysis and follow-up of cases.

Características clínico dermatoscópica de pacientes pediátricos con nevos melanocíticos congénitos / Dermatoscopic clinical characteristics of pediatric patients with congenital melanocytic nevi

Introducción: El nevo melanocítico congénito es una lesión pigmentada melanocítica, que está generalmente presente en el momento del nacimiento. La dermatoscopia es una técnica útil en el diagnóstico de los nevos. Objetivo: Examinar las características clínicas y dermatoscópicas de pacientes pediátricos con nevos melanocíticos congénitos. Métodos: Investigación de tipo descriptivo transversal. La población incluyó 340 pacientes pediátricos que asistieron a la consulta de dermatoscopia del Hospital Pediátrico Universitario "José Luis Miranda", Santa Clara, entre abril 2016- abril de 2017. La muestra quedó constituida por 128 pacientes con diagnóstico de nevos melanocíticos congénitos. Los datos obtenidos se analizaron a través del paquete estadístico SPSS 21.0. Se emplearon los métodos de la estadística descriptiva. Resultados: El cambio clínico más frecuente fue el crecimiento en 76 (47,8 por ciento) nevos. La localización más comprometida fue en los miembros superiores con 28 (17,6 por ciento) nevos. Existió una relación estadísticamente significativa (p< 0,05) entre el tamaño de los nevos y la localización en zonas fotoexpuestas con la presencia de cambios clínicos. El patrón en empedrado (27,7 por ciento) fue el más frecuente; sin embargo, el patrón globular (24,5 por ciento) se observó en todas las localizaciones. Ninguno de los nevos detectados empeoró hacia el melanoma maligno. Conclusiones: La mayoría de los nevos melanocíticos congénitos en este trabajo aparecieron desde el nacimiento. La presencia de cambios clínicos fue más evidente en las regiones fotoexpuestas. No se observó ningún nevo con estructuras o patrones dermatoscópicos relacionados con malignidad(AU)

Introduction: Congenital melanocytic nevi is a melanocytic pigmented lesion, which is usually present at birth. Dermatoscopy is a useful technique in the diagnosis of nevi. Objective: To examine the clinical and dermatoscopic characteristics of pediatric patients with congenital melanocytic nevi. Methods: Cross-sectional descriptive type research. The data obtained were analyzed through the SPSS 21.0 statistical package. The methods of descriptive statistics were used. Results: The most common clinical change was growth, in 76 (47.8 percent) nevi. The most compromised location was in the upper members with 28 (17.6 percent) nevi. There was a statistically significant relation (p< 0.05) among the size of the nevi and the location in photoexposed areas with the presence of clinical changes. The cobbled pattern (27.7 percent) was the most common; however, the globular pattern (24.5 percent) was observed in all locations. None of the detected nevi worsen towards malignant melanoma. Conclusions: Most congenital melanocytic nevi are shown from birth. The presence of clinical changes was most evident in photoexposed regions. No nevi was observed with dermatoscopic structures or patterns related to malignancy(AU)

Biópsia excisional do carcinoma basocelular primário e bem delimitado diagnosticado pela clínica e dermatoscopia: acurácia diagnóstica e terapêutica / Excisional biopsy of primary and well-defined basal cell carcinoma diagnosed by clinic and- dermoscopy: diagnostic and therapeutic accuracy

Introdução: O carcinoma basocelular (CBC) é a neoplasia maligna mais comum. Corresponde a 70- 80% dos tumores cutâneos. É diagnosticado pela suspeita clínica aliada à dermatoscopia, que permite definir os seus limites. Objetivo: Avaliar se critérios clínicos e dermatoscópicos podem ser suficientes para diagnóstico e tratamento do CBC primário e bem delimitado. Materiais e métodos: Revisão de suspeitas de CBCs primários, bem delimitados, operados por biópsia excisional (margem de 3mm) no serviço de Dermatologia da Universidade de Mogi das Cruzes (2017 a 2019). Aplicado o teste qui-quadrado para avaliar a significância das margens. Resultados: Foram 169 lesões avaliadas. Predominaram: sexo feminino, 8a década de vida. Resultaram no exame histopatológico 141 CBCs. Avaliando-se as margens de segurança para os casos de CBC houve 95% de margens livres (p=0,0004998). Discussão: Existem elementos dermatoscópicos comuns entre o CBC e outras neoplasias e lesões benignas, o que justifica outros diagnósticos encontrados. A margem cirúrgica de 3mm foi apropriada para CBCs primários bem delimitados, agilizando o processo de cura e reduzindo custos. Conclusão: Para suspeitas clínico-dermatoscópicas de CBC bem delimitados, a biópsia excisional mostrou-se eficaz quanto ao diagnóstico e às margens de segurança.

Introduction: Basal cell carcinoma (BCC) is the most common malign neoplasm. It corresponds to 70-80% of skin tumors. The diagnosis is made based on clinical suspicion combined with dermoscopy, which also allows defining its limits. Objective: To assess whether clinical and dermoscopic criteria are sufficient for the diagnosis and treatment of primary and well-defined BCC. Materials and methods: Review of suspected cases of well-defined primary BCC surgically approached by excisional biopsy (3 mm margin) at the Dermatology Service of the University of Mogi das Cruzes (2017 to 2019). The Chi-square test was applied to assess the significance of the margins. Results: 169 injuries were assessed, with a predominance of women in the 8th decade. The histopathological examination concluded on 141 BCCs. When evaluating the excision margins for BCC cases, there was 95% of free margins (p = 0.0004998). Discussion: There are common dermoscopic elements between BCC and other neoplasms and benign lesions, which justifies other diagnoses found. The 3 mm surgical margin was accurate for well-defined primary BCCs, speeding up healing time and reduces costs. Conclusion: For clinical-dermatoscopic suspicions of well-defined BCC, an excisional biopsy was effective in the diagnosis and clinical safety margins

Escleromixedema. Reporte de un caso / Scleromyxedema. Case report

Resumen Se presenta una paciente femenina con erupción papulosa generalizada que compromete cara, tronco y cuatro miembros. En el examen físico se visualizaengrosamientoy oscurecimiento de la piel. Se realiza el estudio integral y el correspondiente diagnóstico diferencial.El estudio histopatológico cutáneo exhibió un incremento excesivo de mucina intersticial, actividad fibroblástica y engrosamiento de los haces de colágeno. Se arriba al diagnóstico de escleromixedema debido a las manifestaciones cutáneas características. Se constata compromiso extracutáneo en ausencia de gammapatía monoclonal. Se indica prednisona, talidomida ehidroxicloroquina con excelente evolución.

Abstract A female patient presents with a generalized papular rash involving face, trunk, and four limbs. The skin is thickened and darkened, forming yellowish erythematous plaques that are linearly arranged papules. It is assumed as a generalized sclerodermiform syndrome and a comprehensive study and corresponding differential diagnosis is performed. The histopathological study of the skin showed an excessive increase of interstitial mucin, fibroblast activity and thickening of collagen bundles. The characteristic clinical expression and the histopathological study added to the extra cutaneous involvement lead to the diagnosis of scleromyxedema. There was no evidence of monoclonal gammopathy. Prednisone, thalidomide and hydroxychloroquine are indicated with excellent evolution.

Sebaceoma: hallazgos dermatoscópicos a propósito de dos casos / Sebaceoma: dermatoscopic findings at purpose of two cases

El sebaceoma es una neoplasia sebácea benigna inusual, que inicialmente se denominaba epitelioma sebáceo, lo que generaba confusión respecto a su biología tumoral, dado que histopatológicamente no presenta diferenciación suficiente como el adenoma sebáceo y tampoco es tan indeferenciado como el carcinoma sebáceo. Su diagnóstico precoz tiene gran relevancia, dado que, junto con el adenoma sebáceo y el carcinoma sebáceo, tienen una asociación directa con el síndrome de Muirr-Torre y, por lo tanto, con el desarrollo de cáncer de colon, endometrio, entre otros. En este punto, el uso de la dermatoscopia es muy importante. Considerando los pocos reportes en la literatura sobre la dermatoscopia en sebaceomas, presentamos dos casos clínicos en adultos, donde se destaca la presencia de estructuras amarillas homogéneas y vasos en corona o arboriformes.

Sebaceoma is an unusual benign sebaceous neoplasm, initially known as sebaceous epithelioma, which generated confusion regarding its tumor biology, given that it is histopathologically less differentiated than sebaceous adenoma, but with a higher differentiation than sebaceous carcinoma. Early diagnosis becomes relevant, given that together with sebaceous adenoma and sebaceous carcinoma, there is a direct association with Muirr-Torre syndrome and therefore the development of colon and endometrial cancer, among others. Because of this, the use of dermatoscopy becomes very important. Given the few reports in the literature on dermatoscopy in sebaceomas, we present two clinical cases, where the presence of homogeneous yellow structures and crown or arboriform vessels stands out.

Dermoscopy - a simple and rapid in vivo diagnostic technique for tinea incognito

Abstract Tinea incognito resulting from corticosteroid abuse is becoming very common in the tropics. Its diagnosis is tricky owing to its confusing morphology, as well as practical and technical issues associated with mycological tests. Dermoscopy has now evolved as a novel diagnostic tool for diagnosing tinea incognito in such challenging situations, since the typical hair changes such as Morse-code hairs, deformable hairs, translucent hairs, comma and cork screw hairs, and perifollicular scaling may be seen despite steroid use, irrespective of mycological results.

Liquen Plano Pigmentado:a propósito de un caso / Flat LichenPigmented:Clinical case

RESUMEN El Liquen Plano Pigmentado es una dermatosis crónica frecuente de etiología aún desconocida, caracterizada clínicamente por la presencia de pápulas purpúreas, poligonales, pruriginosasdistribuidas en forma simétrica. ElLiquen Plano Pigmentado representa una de todas las variantes clínicas, cuya característica histológica distintiva es la incontinencia de pigmento melánico. Su curso es autolimitado pues se resuelve en un período de meses a años, pero puede persistir indefinidamente. Existen múltiples opciones de tratamiento, que incluyen corticoides tópicos, intralesionales y sistémicos, retinoides, fototerapia, inmunomoduladores tópicos y, en casos graves o resistentes al tratamiento, la ciclosporina, metotrexato. La dermatoscopía es una técnica auxiliar de diagnóstico no invasivaque permite incrementar la certeza diagnóstica en diversasenfermedades cutáneas; en el caso del Liquen Plano Pigmentado se observa la lesión clásica que consiste en una pápula poligonal aplanada, de tonalidad eritemato-violácea que suele tener finas escamas adherentes en la superficie,denominadasestrías de Wickham, queconsisten en estructuras polimórficas blanquecinas y que corresponden histológicamente a zonas de ortoqueratosis.Es una herramienta de gran utilidad para el diagnóstico de estas lesiones.

ABSTRACT The Pigmented Flat Lichen is a frequent chronic dermatosis of etiology still unknown, clinically characterized by the presence of purpuric, polygonal, pruritic papules distributed symmetrically. The Pigmented Flat Lichen represents one of all clinical variants, where the distinctive histological feature is melanin pigment incontinence. Its course is self-limited, it resolves over a period of months to years, but it can persist indefinitely. There are multiple treatment options that include topical, intralesional and systemic corticosteroids, retinoids, phototherapy, topical immunomodulators and in severe or resistant cases to treatment, cyclosporine, methotrexate. Dermatoscopy is a non-invasive diagnostic auxiliary technique that allows accelerating diagnostic certainty in various skin diseases; in the case of the Pigmented Flat Lichen, the classic lesion is observed, consisting of a flattened polygonal papule, with an erythematous-violet hue that usually has fine adherent scales on the surface, called Wickham striae, which consists of whitish polymorphic structures and that corresponds histologically to areas of orthokeratosis. It is a very useful tool for the diagnosis of these lesions.

A Study Of Use Of Dermatoscopy In The Classification Of Melasma In Patients Attending A Tertiary Care Centre

Background:Melasma is one of the most common causes of acquired facial melanosis in Indian patients. Dermatoscopy is a non invasive office tool which magnifies the surface and sub-surface structures of skin. It helps in early diagnosis and monitoring the treatment of melasma. The present study was carried out to evaluate melasma both clinically and dermoscopically.Methods:Atotal of 90 patients with clinical diagnosis of melasma were enrolled in the study. Clinical and dermatoscopic evaluation were done and all findings recorded.Results:Out of 90 patients enrolled, 83 were females and 7 were males. Centrofacial type was the most common clinical type of melasma (57.7%). On dermatoscopic examination, 56.2% had epidermal melasma, 36.7% had mixed melasma and 11.1% had dermal melasma. The most common dermatoscopic pattern was sparing of follicles seen in 80% of cases.Conclusion:Melasma has significant psychological impact in the patient. Dermatoscopy Ahelps in diagnosis, prognosis and monitoring of therapeutic efficacy. It also reduces the need of invasive techniques like biopsy on face.

Poroma no pigmentado inusualmente grande: reporte de un caso y revisión de la literatura / Unusually large unpigmented poroma: a case report and literature review

El poroma es un tumor benigno infrecuente derivado de la porción intraepitelial del epitelio ductal de la glándula sudorípara. La presentación clínica más habitual es un pápula o nódulo de color rosado a rojo, de pequeño diámetro, localizado con mayor frecuencia en palmas y plantas, generalmente asintomático. Debido a su variabilidad morfológica, los poromas son usualmente difíciles de reconocer, siendo la dermatoscopía una herramienta útil en su diagnóstico. Presentamos el caso de un paciente masculino con un gran tumor en su pierna derecha de 40 mm de diámetro, con características dermatoscópicas compatibles con poroma no pigmentado. El diagnóstico confirmatorio se realizó con una biopsia incisional seguido de la extirpación quirúrgica completa del tumor

Poroma is a rare benign tumour derived from the intraepithelial portion of the sweat glands' ductal epithelium. The most common clinical presentation is a pink to red papule or nodule, small in diameter, predominantly in the palms and soles and generally asymptomatic. Due to its morphologic variability, poromas are usually difficult to recognize, thus dermatoscopy becomes a useful aid in its diagnosis. We present the case of a male patient with a large tumour on his right leg, 40 mm in diameter, with dermatoscopic features consistent with nonpigmented poroma. Confirmatory diagnosis was made by incisional biopsy followed by the total surgical excision of the tumor.

Tiña negra: reporte de tres casos pediátricos / Tinea nigra: report of three pediatrics cases

Resumen: Introducción: La tiña negra es una micosis superficial causada por Hortaea werneckii. Su caracte rística clínica es la aparición de una mácula café negruzca de rápido crecimiento, producto del pig mento sintetizado por el mismo hongo. Sus características pigmentarias y de rápido crecimiento, de localización preferentemente acral, genera preocupación en los pacientes y en sus médicos tratantes por la sospecha de una lesion névica en evolución. Objetivos: Presentar 3 casos clínicos de pacientes pediátricos con esta patología y dar a conocer las herramientas para su diagnóstico diferencial. Casos clínicos: Tres pacientes, edades 3 y 5 años, con lesión macular pigmentada en palmas o plantas, cuyos padres referían habían crecido en forma rápida en poco tiempo. Dos de los casos tenían antecedentes de viajes previos al Caribe. Ante la sospecha clínica y dermatoscópica de una tiña negra, se realizó exámen micológico que confirmó el diagnóstico. En todos los casos, el tratamiento con antimicóticos tópicos llevó a la resolución completa de las lesiones. Conclusión: Aunque la tiña negra es rara en un clima seco, los viajes cada vez más frecuentes de los pacientes a países tropicales, probablemente aumentarán el número de casos. La dermatoscopía y el examen micológico son las herramientas que permiten realizar un correcto diagnóstico, evitando biopsias y/o cirugías innecesarias.

Abstract: Introduction: Tinea nigra is a superficial mycosis caused by Hortaea werneckii. Its clinical characte ristic is the appearance of a blackish brown macula of rapid growth, caused by the pigment produced by the fungus itself. The presence of a dark, fast growing, acral pigmentary lesion causes concern among patients and their treating physician about the possibility of a malignant pigmentary lesion. Objective: To present a series of three clinical cases in pediatric patients with this pathology and to show the tools that help to make a differential diagnosis. Clinical cases: Three patients between three and five years of age, which present a macular pigmented lesion on palms or soles, whose parents reported a rapid growth over a short period of time. Two of the patients reported previous trips to the Caribbean. Clinical and dermatoscopy suspicion of tinea nigra lead to a direct mycological exa mination, which confirmed the diagnosis. In all three cases, treatment with topical antifungals led to complete healing of the lesions. Conclusions: Although tinea nigra is rare in a dry climate, increasing travel of patients to tropical countries will increase the number of cases. Dermatoscopy and direct mycological examination are the tools that allow performing a correct diagnosis and avoiding unne cessary biopsies and/or surgeries.

Patrón dermatoscópico en arcoiris (irisado) en dermatofibroma hemosiderótico: reporte de un caso / Dermoscopic pattern in rainbow (iridescent) in hemosiderotic dermatofibroma: a case report

El patrón en arcoiris ha sido un tema controvertido, dado que en un principio se planteó como un patrón dermatoscópico específico asociado al diagnóstico de Sarcoma de Kaposi. Sin embargo, esta asociación ha sido cuestionada por diversos reportes que han evidenciado la presencia de este patrón dermatoscópico en otro tipo de lesiones, tales como, otros tumores vaculares, cicatriz hipertrófica, angioqueratoma, dermatitis por estasis, pseudo-Kaposi (acroangiodermatitis), melanoma, liquen plano, dermatofibroma hemosiderótico, entre otros. Se ha propuesto que este efecto se genera por la absorción, difracción y difusión de la luz polarizada y su interferencia con diferentes componentes vasculares y fibrosos de la dermis más que por algún hallazgo histopatológico específico. Presentamos el primer caso con registro fotográfico de dermatofibroma hemosiderótico con presencia de un 'patrón irisado' en la dermatoscopía.

The dermoscopic 'rainbow pattern' has been a controversial issue; it was initially proposed as a specific dermatoscopic pattern associated with Kaposi's Sarcoma. However, this has been questioned by several reports that have shown the presence of this dermoscopic pattern in a wide variety of lesions such as other vascular tumors, hypertrophic scars, angiokeratoma, stasis dermatitis, pseudo-Kaposi acroandgiodermatitis), melanoma, lichen planus, and hemosiderotic dermatofibroma, among others. It has been proposed that this effect is generated by the absorption, diffraction and diffusion of polarized light and its interference with different vascular and fibrous components of the dermis, rather than being caused by a specific histopathologic finding. We present the first photographically recorded case of hemosiderotic dermatofibroma, characterized by the presence of a rainbow pattern in dermoscopy.

Dermatoscopic characteristics of 15 cases of lichen sclerosis / 中华皮肤科杂志

Objective To assess dermatoscopic characteristics of lichen sclerosus(LS). Methods Dermatoscopy was performed to observe 27 genital or extragenital porcelain-white skin lesions in 15 outpatients with confirmed LS. Results As dermatoscopy showed, of the 27 skin lesions, 24 showed white-yellowish structureless areas, 25 linear vessels, 27 white patches, 17 keratotic plugs. Characteristic cloverleaf-like structure was observed in 7 skin lesions in 4 patients, which was consistent with LS. Conclusion Patients with LS show atypical clinical manifestations, but specific dermatoscopic patterns.

A dermatoscopia como aliado no diagnóstico da alopecia areata infantil / The dermatoscopy as an ally in the diagnosis of childhood alopecia areata

OBJETIVO: Dentre as alopecias não cicatriciais, a alopecia areata se caracteriza mais frequentemente pela perda rápida e completa dos pelos em uma ou mais áreas do couro cabeludo, acometendo sobretudo jovens. Quando acomete crianças, o atraso de diagnóstico pode tornar-se um desafio, devido a seu prejuízo estético e pela ansiedade dos pais. A história clínica minuciosa e exame físico bem detalhado são de fundamental importância para nos fornecer pistas diagnósticas, posto que a biópsia é um procedimento muitas vezes inviável em crianças. Apresentamos um caso em que, além de anamnese e exame físico, a dermatoscopia foi de grande relevância na diferenciação da tricotilomania com a alopecia areata, entidades que apresentam características clínicas semelhantes. RELATO DO CASO: Paciente do sexo feminino, 1 ano e 11 meses de idade, foi levada ao consultório de dermatologia pelos pais, que referiam queda de cabelos e diminuição do volume capilar há cerca de 4 meses. Havia feito uso de fenobarbital no período de dois meses, para tratamento de convulsão febril, o que a tornou mais agressiva, fazendo com que puxasse os próprios cabelos em determinadas ocasiões. Ao exame físico apresentava área de rarefação capilar frontoparietal seguindo a linha média, com teste de tração positivo. A dermatoscopia mostrou alterações compatíveis com alopecia areata. CONCLUSÃO: A presença do pelo em exclamação na dermatoscopia do caso contribuiu para o diagnóstico etiológico da alopecia em questão. Ao fazer o diagnóstico é válido examinar sempre o aparelho ungueal das crianças acometidas, posto que as alterações ungueais são mais frequentes nas crianças, em comparação com os adultos, na alopecia areata. Ressaltamos também a importância da pesquisa de doenças autoimunes concomitantes, principalmente da tireoide e estado atópico.Objetivo: Dentre as alopecias não cicatriciais, a alopecia areata se caracteriza mais frequentemente pela perda rápida e completa dos pelos em uma ou mais áreas do couro cabeludo, acometendo sobretudo jovens. Quando acomete crianças, o atraso de diagnóstico pode tornar-se um desafio, devido a seu prejuízo estético e pela ansiedade dos pais. A história clínica minuciosa e exame físico bem detalhado são de fundamental importância para nos fornecer pistas diagnósticas, posto que a biópsia é um procedimento muitas vezes inviável em crianças. Apresentamos um caso em que, além de anamnese e exame físico, a dermatoscopia foi de grande relevância na diferenciação da tricotilomania com a alopecia areata, entidades que apresentam características clínicas semelhantes. Relato do caso: Paciente do sexo feminino, 1 ano e 11 meses de idade, foi levada ao consultório de dermatologia pelos pais, que referiam queda de cabelos e diminuição do volume capilar há cerca de 4 meses. Havia feito uso de fenobarbital no período de dois meses, para tratamento de convulsão febril, o que a tornou mais agressiva, fazendo com que puxasse os próprios cabelos em determinadas ocasiões. Ao exame físico apresentava área de rarefação capilar frontoparietal seguindo a linha média, com teste de tração positivo. A dermatoscopia mostrou alterações compatíveis com alopecia areata. Conclusão: A presença do pelo em exclamação na dermatoscopia do caso contribuiu para o diagnóstico etiológico da alopecia em questão. Ao fazer o diagnóstico é válido examinar sempre o aparelho ungueal das crianças acometidas, posto que as alterações ungueais são mais frequentes nas crianças, em comparação com os adultos, na alopecia areata. Ressaltamos também a importância da pesquisa de doenças autoimunes concomitantes, principalmente da tireoide e estado atópico.

Nevo sebáceo de Jadassonh / Sebaceous nevus of Jadassonh

O nevo sebáceo de Jadassonh é um nevo epidérmico composto por glândulas sebáceas de coloração rosa ou amarelada, que pode apresentar o desenvolvimento de várias neoplasias benignas e malignas. É uma das malformações anexais que ocorre com maior frequência nas crianças1,2. Clinicamente aparece como uma placa bem definida de alopecia no couro cabeludo, face ou colo. Está presente desde o nascimento ou pode surgir alguns anos mais tarde1. Apresentamos o caso de um nevo sebáceo de Jadassohn no couro cabeludo a partir do qual um carcinoma basocelular se desenvolveu e foi diagnosticado com o auxílio da dermatoscopia.

Usefulness of Dermatoscopy for the Preoperative Assessment of the Histopathologic Aggressiveness of Basal Cell Carcinoma

BACKGROUND: Limited information is available regarding dermatoscopic differences between non-aggressive and aggressive types of basal cell carcinoma (BCC). OBJECTIVE: To investigate dermatoscopic differences between non-aggressive and aggressive types. METHODS: We evaluated 145 histopathologically confirmed BCCs from 141 patients. Histopathologic types and aggressiveness from 4 mm punch biopsy and their dermatoscopic findings were evaluated. We assessed the statistical significance of dermatoscopic differences between non-aggressive and aggressive types. To objectively predict aggressiveness, we created a "dermatoscopic index of BCC aggressiveness" in which 1 point was added and subtracted for each dermatoscopic finding significantly higher in aggressive and non-aggressive types, respectively. RESULTS: Large blue-gray ovoid nests were found more frequently in non-aggressive type than aggressive one (85/105 [80.9%] vs. 21/40 [52.5%], p=0.001). Compared to non-aggressive type, aggressive type had more multiple blue-gray globules (29/40 [72.5%] vs. 57/105 [54.3%], p=0.046), arborizing telangiectasia (29/40 [72.5%] vs. 48/105 [45.7%], p=0.004), and concentric structure (11/40 [27.5%] vs. 12/105 [11.4%], p=0.018). Regarding dermatoscopic index, cases of aggressive type with a score of 1 were most common (n=18, 45.0%), followed by a score of 2 (n=14, 35.0%). Limited number of aggressive type of BCCs and the effect of width on the determination of histopathologic aggressiveness. CONCLUSION: Aggressive type BCCs more often exhibited multiple blue-gray globules, arborizing telangiectasia, and concentric structure, while the non-aggressive type exhibited large blue-gray ovoid nests more frequently. Score exceeding 2 on the dermoscopic index can be screening criteria for aggressiveness. These dermatoscopic features and dermoscopic index could be useful for assessing aggressiveness of BCCs before surgery.

Importancia actual del tatuaje: la vacuna BCG / Current importance of BCG-scar tatoo

En Uruguay desde 1940 hasta 1978 para la vacunación BCG se utilizó la técnica de multipunturas. Se administraban gotas de linfa vaccinal sobre la piel del brazo derecho del recién nacido y se realizaba simultáneamente un tatuaje en el dedo gordo del pie izquierdo a los nacidos en el Hospital Pereira Rossell. Teniendo de esa forma una marca indeleble que permitiría en el futuro saber si la persona había sido vacunada. Estos “tatuajes” clínicamente se describen como lesiones redondeadas de escasos milímetros, azules o azulgrisáceas que a la dermatoscopía presentan un patrón homogéneo. El diagnóstico diferencial que se debe tener presente, sobre todo si no se tiene el antecedente del tatuaje, es el de melanoma.

In Uruguay, from 1940 to 1978, BCG vaccination was performed by multi- punctures technique. It consisted in the administration of vaccine lymph drops in the right arm of the newborn, while simultaneously, a tattoo was made in the left big toe. This technique was performed on all the children who were born in Pereira Rossell Hospital, allowing to have an indelible mark that would show in the future that the person had been vaccinated. These “tattoos” clinically represent rounded lesions of a few millimeters, blue or blue-gray in color, and exhibit an homogeneous dermoscopic pattern. The differential diagnosis to keep in mind, especially if you have a history of tattooing, is melanoma.

Tiña negra (tinea nigra): comunicación de un caso alóctono en Chile / Tinea Nigra: a allochthonous case report in Chile

Tinea nigra is a superficial mycosis caused by Hortaea werneckii. It is an infrequent asymptomatic infection that affects mainly human palms and soles, and it is mostly seen in tropical countries. It has not been reported in Chile yet. The clinical presentation is generally a single macule, not symptomatic, of brown color in palms and soles. We report a case of a Chilean woman that developed brown macules on both soles after travel to the United States and Central America. The diagnosis of Tinea nigra was confirmed by direct microscopic examination and mycological culture. She had a good response to treatment with oral itraconazol.

La tiña negra (tinea nigra) es una micosis cutánea causada por Hortaea werneckii. Es poco frecuente, limitada a países tropicales o subtropicales. Hasta la presente publicación, esta micosis no había sido comunicada en Chile. La presentación clínica es generalmente una mácula única, asintomática, color café en palmas y plantas. Se presenta el caso de una mujer chilena, que después de varios viajes a E.U.A y Centroamérica, presentó manchas color café en ambas plantas. Se confirmó el diagnóstico de tiña negra con un examen microscópico directo y cultivo micológico. La paciente presentó una buena respuesta clínica luego del tratamiento con itraconazol por vía oral.

Diffuse alopecia areata is associated with intense inflammatory infiltration and CD8+ T cells in hair loss regions and an increase in serum IgE level.

Background: Mechanism leading to an abrupt hair loss in diffuse alopecia areata (AA) remains unclear. Aims: To explore the characteristics of diffuse AA and possible factors involved in its pathogenesis. Methods: Clinical and laboratory data of 17 diffuse AA patients and 37 patchy AA patients were analyzed retrospectively. Serum IgE level was evaluated in all diffuse and patchy AA patients, as well as 27 healthy subjects without hair loss to serve as normal control. Univariate analysis was performed using Fisher's exact test and Wilcoxon rank-sum test. Associations between inflammatory cell infiltration and laboratory values were analyzed using Spearman rank correlation test. Results: The mean age of patients with diffuse AA was 27 years with a mean disease duration of 1.77 months. All of them presented in spring or summer with an acute onset of diffuse hair loss preceded by higher incidence of scalp pruritus. Although no statistically significant difference on the incidence of atopic disease among three groups has been found, serum IgE level in diffuse AA was higher than that in healthy controls, but was comparable to that in patchy AA group. Histopathology of lesional scalp biopsies showed more intense infiltration comprising of mononuclear cells, eosinophils, CD3 + , and CD8 + T cells around hair bulbs in diffuse AA group than in patchy AA group. Moreover, IgE level in diffuse AA patients positively correlated with intensity of infiltration by mononuclear cells, eosinophils, and CD8 + T cells. Conclusions: Hypersensitivity may be involved in pathogenesis of diffuse AA. The acute onset of diffuse AA may be related to intense local inflammatory infiltration of hair loss region and an increase in serum IgE level.

The role of various immersion liquids at digital dermoscopy in structural analysis.

Background: Dermoscopy is a useful method that allows dermal and epidermal structures to be easily analysed non-invasively. Aim: In this study, immersion oil, which is widely used in dermoscopy, and ultrasound gel, which is less preferred, are evaluated comparatively in terms of displaying structural parameters and number of air bubbles in the image. Methods: A total of 71 nevomelanocytic or non-melanocytic pigmented lesions were taken up for this study. Structural characteristics of the obtained images were assessed by an experienced observer who scored the images in terms of color, pigment network, globule, vascular structure, number of air bubbles and other pigmentation parameters. Results: In the images obtained through immersion oil or ultrasound gel from all of the lesions, no statistical difference was found between the average values of air bubbles and in the evaluation of structural components (t=1.09, P=0.2). In the identification of pigment network in melanocytic lesions, immersion oil was observed to be more appropriate than ultrasound gel (t=0.01, P=0.02). Conclusions: Ultrasound gel may be preferred in the assessment of mucosa and nail bed lesions. Ultrasound gel is a good alternative compared to immersion oil in pigmented skin lesions as it is cheap and easily removable.

Dermatoscopy of non-melanocytic skin tumors.

Dermatoscopy is a cheap and non-invasive diagnostic technique that improves the diagnostic accuracy of non-pigmented benign and malignant skin tumors. Dermatologist should be aware of dermatoscopic features of non-melanocytic skin tumors to reach the correct diagnosis.