A case of a 62-year-old male with Actinomycetoma successfully treated using combined medical and surgical therapy

INTRODUCTION@#Actinomycetoma is a neglected infectious disease that presents with a triad of subcutaneous mass, with sinus formation and seropurulent discharge containing grains. This causes severe functional disability to patients if not treated early and properly.@*CASE REPORT@#We report a case of a 62-year-old adult Filipino farmer diagnosed with actinomycetoma of the left foot. For 8 years, the patient medicated with several antibiotic therapies affording minimal improvement of symptoms. Hence, surgical intervention with combination antimicrobial therapy was done which provided resolution of symptoms, improving the quality of life of the patient.@*CONCLUSION@#Treatment of actinomycetoma must be individualized among patients. Although oral antibiotics became the standard of treatment, combining surgical treatment with oral medications may be considered to ensure effective management of the disease.

Dapsone-induced hemolytic anemia in non-G6PD deficient leprosy patients receiving multidrug therapy in Southern Philippines Medical Center: A retrospective study

Background@#Due to the high prevalence and incidence of leprosy in the Philippines, there is a continuing need to detect and document the occurrence of dapsone-induced hemolytic anemia. @*Objective@#The aim of this study is to determine the incidence of dapsone-induced hemolytic anemia in non-glucose-6-phosphate dehydrogenase deficient leprosy patients receiving multidrug therapy (MDT) in Southern Philippines Medical Center.@*Methodology@#This is a retrospective study through chart review of leprosy patients treated with MDT regimen at Southern Philippines Medical Center from January 2016 to December 2018. The demographic profile, clinical characteristics, hemoglobin and hematocrit concentrations before and after initiation of MDT, the presence of symptoms of anemia, and the occurrence of dapsone-induced hemolytic anemia in leprosy patients were collected. The main outcome measure for this study was the incidence rate of dapsone- induced hemolytic anemia. Statistical-based analysis were used for continuous and categorical data which were summarized using means and standard deviations, and frequencies and percentages, respectively.@*Results@#There was a decrease in the mean hemoglobin and hematocrit levels noted in the majority of patients after initiation of MDT from baseline 143.46 g/dl and 0.44, respectively, to 94 g/dl and 0.28 on the third month of MDT. The incidence rate of dapsone-induced hemolytic anemia during the 3-year period was 20 cases per 100.@*Conclusion@#The relatively high incidence rate of dapsone-induced hemolytic anemia highlights the importance of frequent monitoring of hemoglobin and hematocrit concentrations in leprosy patients being treated with multidrug therapy.

Tratamento da UCE refratária aos anti-histamínicos e na impossibilidade do omalizumabe, nos adultos / Treatment of CSU refractory to antihistamines and in the impossibility of omalizumab therapy in adults

Há o empenho contínuo de especialistas no desenvolvimento de tratamentos resolutivos ou eficazes nos controles das doenças, no entanto, a entidade urticária crônica espontânea (UCE), quando refratária à primeira linha de tratamento, os anti-histamínicos, apresenta um prognóstico desfavorável. Existe um arsenal de medicamentos biológicos disponíveis já consolidados como eficazes e seguros, porém eventualmente nos defrontamos com a inacessibilidade a estes medicamentos, devido aos custos dos mesmos e aos trâmites necessários para dar início ao tratamento. Tais fatos fundamentam a discussão sobre terapias alternativas com outros fármacos, visando manter o manejo adequado da doença e a qualidade de vida dos pacientes.

Specialists have made a continuous effort for the development of effective treatments for disease control; however, chronic spontaneous urticaria (CSU), when refractory to the first line of treatment, ie, antihistamines, has an unfavorable prognosis. There are biological medicines available, which have been consolidated as effective and safe, but we are occasionally faced with a lack of access to these medicines due to their costs and the necessary procedures to start treatment. Such facts support the discussion about alternative therapies with other drugs, aiming at maintaining the adequate management of the disease and the quality of life of patients.

Adverse effects of polychemotherapy for leprosy in 13 years of follow-up at a university hospital

Abstract Leprosy is one of the neglected diseases in the world and Brazil is the second country with more cases. A retrospective study was conducted based on the medical records of 196 leprosy patients diagnosed during the course of 13 years at a university hospital. The aim was to describe the adverse effects of polychemotherapy, as well the most prevalent and most vulnerable populations. In the study, dapsone was the most implicated drug, especially in women, and the risk increased with age. The authors conclude that with this patient profile, greater vigilance should be taken regarding possible adverse effects, especially anemia.

Dermatosis IgA lineal asociada a sífilis secundaria / Linear IgA bullous dermatosis associated secondary syphilis

La dermatosis IgA lineal del adulto es una enfermedad que pertenece al grupo de las dermatosis ampollares adquiridas. De etiología desconocida e infrecuente, se presenta en adultos mayores y se asocia a múltiples fármacos, neoplasias y enfermedades autoinmunes e infecciosas. Se presenta el caso de un paciente con una dermatosis IgA lineal asociada a una sífilis secundaria.

Linear bullous IgA dermatosis of adult is a disease that belongs to the group of acquired bullous dermatoses. It is of unknown aetiology and infrequent in adults and is associated with drugs, neoplasms, autoimmune and infectious diseases. We present a case of a male patient in whom a linear IgA dermatosis and secondary syphilis coexist.

Mycobacterium leprae: aspectos da resistência aos fármacos na poliquimioterapia / Drug resistance in multidrug therapy for Mycobacterium leprae

Introdução: O diagnóstico da hanseníase possui números significativos que causam preocupação à saúde pública. Os casos de resistência medicamentosa nessa doença se iniciaram em meados dos anos 60 e diante do problema, a Organização Mundial da Saúde instituiu em 1981 a poliquimioterapia, associação dos antibióticos rifampicina, dapsona e clofazimina, tratamento atual de escolha. A resistência aos fármacos na hanseníase é reportada pela literatura, desvelando um obstáculo à sua eliminação. Apresentamos nessa revisão os principais aspectos da resistência medicamentosa no tratamento para hanseníase e seus impactos. Metodologia: Revisão sistemática sobre os aspectos da resistência medicamentosa utilizando a pesquisa exploratória como metodologia de abordagem. Foram pesquisados os termos resistência medicamentosa, hanseníase, recidiva, alterações genéticas e os operadores booleanos "and" e "or" na busca. Resultados e discussão: A dificuldade de tomar a medicação corretamente foi um dos principais fatores que acarretaram resistência do bacilo Mycobacterium leprae aos fármacos. Homens de países norte e sul-americanos e asiáticos foram os mais atingidos por episódios de resistência. A resistência medicamentosa é uma das principais causas de recidivas em hanseníase. O principal fármaco causador de resistência medicamentosa descrito nos trabalhos foi a dapsona (46,6%) e a maioria das alterações genéticas encontradas estão no gene rpoB; 23,2% dos registros relatados foram de resistência secundária aos fármacos e, também, sete casos de resistência múltipla a esses medicamentos. Conclusão: Os principais aspectos da resistência medicamentosa na hanseníase são os equívocos ao ingerir os medicamentos e as alterações genéticas na bactéria. Os impactos causados estão na dificuldade de refazer o tratamento, a possibilidade de nova transmissão e o aparecimento de sintomas mais graves.

Introduction: The diagnosis of leprosy has significant numbers causing public health concern. Reports of drug resistance in this disease begun in the mid-1960s and due to this problem, the World Health Organization instituted a multidrug therapy with rifampicin, dapsone, and clofazimine antibiotic association in 1981, which is currently the first-choice treatment for leprosy. Cases of drug resistance have been reported in literature, revealing an obstacle to the eradication of the disease. This paper has the purpose of presenting the key aspects and impacts of drug resistance in the treatment for leprosy. Methods: Systematic review of the drug resistance aspects using exploratory research as an approach methodology. The authors searched the terms drug resistance, leprosy, recurrence, genetic alterations, and the Boolean operators "and" and "or" between them. Results and discussion: The difficulty in taking the medication correctly was one of the key factors that led to drug resistance for Mycobacterium leprae. Men from North and South American, as well as from Asian countries, were the most affected by episodes of resistance. Drug resistance is one of the main causes of leprosy recurrences. Dapsone was the most frequently identified drug resistance in the studies (46.6%), while most of the genetic alterations were found in the rpoB gene; 23.2% of the cases were from secondary resistance episodes, and seven cases of multiple resistance were reported. Conclusion: The misconceptions when taking the treatment and the Mycobacterium leprae genetic alterations have been described as the key aspects of drugs resistance in leprosy and the impacts caused are the difficulty in redoing the treatment, the possibility of new transmission, and the appearance of more severe symptoms.

Lupus miliaris disseminatus faciei: when a rare skin disease involves the eyelid / Lupus miliaris disseminatus faciei: quando uma rara dermatose acomete a pálpebra

ABSTRACT The authors present a case of lupus miliaris disseminatus faciei , a rare skin disease of unknown etiology, which may cause unaesthetic scarring due to its difficult treatment. The histopathological examination of epithelioid granulomas with caseating necrosis, together with the clinical features, are important for diagnosis and early treatment with better results. Despite difficult and unsatisfactory treatment, there are ongoing studies on therapy to improve aesthetic and social impairment. This case report describes an initial misdiagnosis delaying appropriate treatment, and highlights the value of physical examination and clinical judgment for another pathological examination, whenever necessary, aiming at better treatment outcomes in daily practice.

RESUMO Os autores apresentam um caso de lupus miliaris disseminatus faciei , uma dermatose rara, de etiologia desconhecida, que pode deixar cicatrizes não estéticas, pela dificuldade de tratamento. O exame histopatológico de granulomas compostos por células epitelioides, com necrose caseosa, e as características clínicas, são importantes para o diagnóstico e tratamento precoce, com melhores resultados. Apesar do tratamento difícil e insatisfatório, há estudos em andamento sobre terapias para melhorar o comprometimento estético e social. Este relato de caso descreve um diagnóstico inicial errôneo, que atrasou o tratamento adequado, e destaca o valor do exame físico e raciocínio clínico para solicitar outro exame anatomopatológico, quando necessário, de forma a obter melhores desfechos com o tratamento, na prática diária.

Metahemoglobinemia, una entidad de diagnóstico complejo. Reporte de un caso

Methemoglobinemia is a rare condition with serious consequences if not diagnosed. We report the case of a 64-year-old woman with a history of allergy to sulfa drugs and a recent diagnosis of a small vessel vasculitis (ANCA-p) who started induction therapy with corticosteroids and rituximab. Due to the need for infectious prophylaxis, and considering her history, dapsone was administered instead of cotrimoxazole after ruling out glucose-6-phosphate dehydrogenase deficiency. During the admission to the hospital for her second dose of rituximab, and while being asymptomatic, she persistently presented a pulse oximetry ≪ 90% despite the administration of O2. Therefore, the infusion was postponed to study the patient. The arterial gasometric study by direct potentiometry revealed an O2 saturation of 98%, with a saturation gap > 5%. Considering the use of dapsone, a methemoglobinemia was suspected and confirmed by co-oximetry (methemoglobinemia 9%). Dapsone was suspended and one week later, her methemoglobinemia was absent.

Urticária crônica espontânea de difícil tratamento: existiria um lugar para usar dapsona na falta de omalizumabe? / Spontaneous chronic urticaria of difficult treatment: is there a place to use dapsone in the lack of omalizumab?

Muitos estudos sugerem que a urticária crônica espontânea (UCE) seja uma doença autoimune. A primeira linha de tratamento consiste no uso de anti-histamínicos H1 de segunda geração, que podem ser empregados em até quatro vezes a dose recomendada. A Dapsona ­ diaminodifenil sulfona (DDS) ­ é um quimioterápico com propriedades antimicrobianas e anti-inflamatórias. Em dermatologia, a DDS é usada em doenças nas quais predominam neutrófilos. O omalizumabe é um anticorpo monoclonal, que se liga às moléculas de IgE na circulação e impede que estas IgEs se liguem aos seus receptores. Omalizumabe é recomendado como terceira linha de tratamento de pacientes com UCE, refratários a anti-histamínicos em doses quadriplicadas, na dose de 300 mg a cada quatro semanas. Paciente do sexo feminino, com 41 anos, com UCE sem períodos de remissão por mais de um ano, tratada sem sucesso, com diferentes anti-histamínicos. Existia uma extensa investigação laboratorial. Foi-lhe administrada Cetirizina (anti-histamínico H1 de segunda geração), em elevada dose (40 mg/dia) associada a antileucotrieno (10 mg/dia) por um período de duas semanas. No final do período, a UCE manteve-se completamente inalterada. Foi realizada biopsias das urticas com diagnóstico histopatológico "Dermatite neutrofílica com infiltrado intersticial neutrofílico, sem vasculite ativa e sem eosinófilos". Na falta de omalizumabe, a paciente continuou o tratamento com Cetirizina (40 mg/dia), agora associado a 100 mg/dia de DDS. Atualmente, após 16 semanas de observação, seu quadro mantém-se estável, com urticas ausentes, afora alguns surtos leves, intermitentes. Poder-se-ia usar a DDS na UCE refratária a anti-histamínicos? Alguns estudos bem conduzidos oferecem essa oportunidade.

Many studies suggest that chronic spontaneous urticaria (CSU) is an autoimmune disease. The first line of treatment consists of the use of second-generation H1 antihistamines, which can be used at up to four times the recommended dose. dapsone ­ diaminodiphenyl sulfone (DDS) ­ is a chemotherapeutic agent with antimicrobial and anti-inflammatory properties. In dermatology, DDS is used to treat diseases in which neutrophils predominate. Omalizumab is a monoclonal antibody that binds to IgE molecules in the circulation and prevents these IgEs from binding to their receptors. Omalizumab is recommended as a third-line treatment for patients with CSU refractory to antihistamines in quadruplicate doses, at a dose of 300 mg every four weeks. A 41 year-old female patient with CSU without remission periods for more than one year was unsuccessfully treated with different antihistamines. An extensive laboratory investigation was conducted. She was given a high dose (40 mg/day) of cetirizine (second-generation H1 antihistamine) associated with antileukotriene (10 mg/ day) for a period of two weeks. At the end of the period, CSU remained completely unchanged. Wheal biopsies were performed, with histopathological diagnosis: neutrophilic dermatitis with neutrophilic interstitial infiltrate, without active vasculitis and without eosinophils. In the absence of omalizumab, the patient continued treatment with cetirizine (40 mg/day), now associated with 100 mg/day of DDS. Currently, after 16 weeks of observation, her condition remains stable and the wheals disappeared, apart from some mild, intermittent outbreaks. Could DDS be used in the CSU refractory to antihistamines? Some well-conducted studies offer this opportunity.

Consensus on the treatment of autoimmune bullous dermatoses: dermatitis herpetiformis and linear IgA bullous dermatosis - Brazilian Society of Dermatology

Abstract: Dermatitis herpetiformis and linear IgA bullous dermatosis are autoimmune diseases that present with pruritic urticarial papules and plaques, with formation of vesicles and blisters of subepidermal location, mediated by IgA antibodies. Mucosal lesions are present only in linear IgA bullous dermatosis. The elaboration of this consensus consisted of a brief presentation of the different aspects of these dermatoses and, above all, of an updated literature review on the various therapeutic options that were discussed and compared with the authors' experience, aiming at the treatment orientation of these diseases in Brazil. Dermatitis herpetiformis is a cutaneous manifestation of celiac disease, and can be controlled with a gluten-free diet and dapsone. On the other hand, linear IgA bullous dermatosis arises spontaneously or is triggered by drugs, and can be controlled with dapsone, but often requires the association of systemic corticosteroids and eventually immunosuppressants.

Acute renal failure by rapidly progressive glomerulonephritis with IgA deposition in a patient concomitantly diagnosed with multibacillary Hansen's disease: a case report / IRA por glomerulonefrite rapidamente progressiva com depósito de IgA em uma paciente com diagnóstico concomitante de hanseníase multibacilar: relato de caso

ABSTRACT Rapidly progressive glomerulonephritis (RPGN) is a renal disease with an extensive differential diagnosis. This paper reports the case of a 55-year-old female patient diagnosed with Hansen's disease with acute progressive renal impairment after developing lower limb pyoderma. The association between Hansen's and kidney disease has been well documented, with glomerulonephritis (GN) ranked as the most common form of renal involvement. Post-infectious glomerulonephritis (PIGN) in adults has been associated with a number of pathogens occurring in diverse sites. The patient described in this case report had RPGN and biopsy findings suggestive of PIGN with C3 and IgA detected on immunofluorescence and kidney injury secondary to recent infection by Staphylococcus, a well-documented manifestation of renal impairment in patients with Hansen's disease.

RESUMO A Glomerulonefrite Rapidamente Progressiva (GNRP) é um padrão de doença renal com amplo diagnóstico diferencial. O caso reporta uma paciente de 55 anos com deterioração aguda e progressiva da função renal após quadro de piodermite em membro inferior com diagnóstico concomitante de hanseníase. Associação da hanseníase com doença renal é bem descrita, sendo a GN a forma de acometimento renal mais comum. As glomerulonefrites pós-infecciosas (GNPIs) em adultos ocorrem devido a um grande número de patógenos, nos mais diversos sítios. A paciente do caso relatado apresentava quadro de GNRP e achados de biópsia que sugerem GNPI com marcação de C3 e IgA na imunofluorescência, sugestiva de lesão renal secundária a infecção recente por Staphylococcus, uma manifestação bem descrita de doença renal em pacientes com hanseníase.

Mastitis granulomatosa idiopática recurrente tratada con dapsona: reporte de un caso / Recurrent idiopathic granulomatous mastitis treated with dapsone: a case report

La mastitis granulomatosa idiopática (IGM, por sus siglas en inglés) es una afección inflamatoria crónica infrecuente y benigna de los senos. Puede simular tres trastornos mamarios muy frecuentes: carcinoma de mama, mastitis y absceso mamario. La IGM se presenta típicamente como una masa mamaria unilateral y dolorosa. La etiología de la IGM no está bien definida, pero se ha propuesto que podría ser una reacción inmune localizada del tejido mamario.El diagnostico de IGM recurrente es complejo porque los hallazgos clínicos y radiológicos no son específicos, por lo que el estudio histopatológico es crucial. El cáncer de mama, la inflamación gra-nulomatosa infecciosa y no infecciosa deben des-cartarse. El tratamiento de la IGM es controver-tido, e incluye vigilancia estrecha, medicamentos inmunosupresores, antibióticos si hay evidencia de infección y escisión quirúrgica. Presentamos un caso de IGM recurrente tratada con dapsona, con buena respuesta a tratamiento, demostrando que este fármaco podría ser una buena alternativa terapéutica debido a su efecto inmunomodulador, antiinflamatorio y ahorrador de esteroides.

Idiopathic granulomatous mastitis (IGM) is an uncommon, non-malignant, chronic inflamma-tory breast condition. It can mimic three very fre-quent breast disorders: breast carcinoma, mastitis and breast abscess. IGM typically presents as a unilateral and painful breast mass. The etiology of IGM is not well defined, but it has been pro-posed that it could be localized immune reaction to breast tissue. The diagnosis of recurrent IGM is complex be-cause clinical and radiological findings are nons-pecific, therefore histopathologic evaluation is crucial. Breast cancer and infectious and nonin-fectious granulomatous inflammation should be discarded. Treatment of IGM is controversial, including close monitoring, immunosuppressive drugs, antibiotics if there is infection evidence and surgical excision. This is a case report of recurrent IGM treated with Dapsone, with good response to treatment, showing that this drug could be a good therapeutic alternative due to its immunomodulatory and anti-inflammatory and steroid sparing.

A case of Sneddon-Wilkinson disease with hypersensitivity to dapsone successfully managed with colchicine

Introduction@#Sneddon-Wilkinson disease (SWD) is a rare, recurrent neutrophilic dermatosis presenting as sterile pustules, with a predilection for flexural and intertriginous areas.@*Case summary@#A 49-year-old Filipino female presented with a three-year history of recurrent pustules and papules on the flexural areas of trunk and extremities. Skin punch biopsy was done and histopathology was consistent with subcorneal pustular dermatosis/SWD. She was started on Dapsone but after two weeks of intake, the patient developed generalized erythematous desquamating plaques on the trunk and extremities, with palmoplantar involvement. The patient did not have fever, jaundice, lymphadenopathy, and abdominal tenderness. Laboratory investigation such as complete blood count and liver function tests were normal. The final diagnosis was SWD with hypersensitivity to Dapsone. Dapsone was immediately discontinued and she was shifted to oral colchicine. After six weeks of oral colchicine therapy, the lesions have completely resolved. Patient was in remission for six months thereafter.@*Conclusion@#SWD is rare and the drug of choice is dapsone. In instances where dapsone is not suitable, oral colchicine can be an ideal alternative treatment.

Role of ascorbic acid in dapsone induced methemoglobinemia

No abstract available.

Erythema Elevatum Diutinum with Various Clinicohistological Stages / 대한피부과학회지

A 61-year-old man presented with a 3-year history of erythematous firm nodules on the hands and feet. Histopathological findings of the lesional skin revealed perivascular and diffuse neutrophilic infiltrations on the upper and mid-dermis. Increased and dilated blood vessels were observed in the upper dermis. Fibrinoid necrosis of the vessel walls was unremarkable, but endothelial swelling and scant red blood cell (RBC) extravasation were noted. Fibrosis and sclerosis of collagen fibers were noted on the deep dermis. Results of laboratory examinations, including complete blood count (CBC), routine chemistry, c-reactive protein (CRP), syphilis and human immunodeficiency virus (HIV) tests, and serum immunoglobulin electrophoresis, were all negative or within normal limit. A diagnosis of erythema elevatum diutinum was made based on the clinical and histological findings. The patient was treated with prednisolone, dapsone, colchicine, and intralesional injection of triamcinolone and showed slight improvement after treatment for 8 months.

Neutrophilic dermatosis of the dorsal hands: response to dapsone monotherapy

Abstract: Neutrophilic dermatosis of the dorsal hands is considered a rare and localized variant of Sweet's syndrome. Although the etiology is unknown, there are reports of association with infections, neoplasias, autoimmune diseases and medications. Histopathology shows a dense neutrophilic inflammatory infiltrate in the dermis. Treatment is based on the administration of systemic corticosteroids; however, a combination of medications is useful, given the frequency of relapses. The authors report a classic and clinically exuberant case of neutrophilic dermatosis of the dorsal hands, with excellent response to oral dapsone treatment, and offer a brief literature review.

Metahemoglobinemia inducida por dapsona: presentación de un caso pediátrico / Methemoglobinemia due to Dapsone: a pediatric case report

La metahemoglobinemia es una patología caracterizada por la presencia de altas concentraciones de metahemoglobina en sangre. Esta es una forma oxidada de la hemoglobina, muy afín al oxígeno, que es incapaz de cederlo a los tejidos. Es una entidad poco frecuente, con baja sospecha diagnóstica. Aunque puede ser congénita en recién nacidos con cianosis, es más frecuente la adquirida por fármacos y tóxicos. En la Argentina, no se conoce la incidencia real de esta patología. El objetivo es comunicar un caso de metahemoglobinemia en una paciente pediátrica que ingresó al Hospital Magdalena V. de Martínez con cianosis en la cara y las extremidades, en mal estado general, con el antecedente de ingesta de varios comprimidos de dapsona, y se constató concentración sérica de metahemoglobina del 35%. El tratamiento consistió en la administración endovenosa de azul de metileno. Su evolución fue favorable.

Methemoglobinemia is a condition characterized by a high blood concentration of methemoglobin. Methemoglobinemia is a disorder that occurs when hemoglobin in the blood is oxidized to form methemoglobin, rendering it unable to transport oxygen. Although it can be congenital in cyanotic newborn, it is more often an adverse medication effect. The aim is to report a pediatric methemoglobinemia case, assisted in Magdalena V. de Martínez Hospital, with cyanosis in face and limb, in poor condition, that consumed dapsone accidentally. Her methemoglobin concentration was 35%. Intravenous methylene blue was administered with favorable outcome.

Clinical trial for uniform multidrug therapy for leprosy patients in Brazil (U-MDT/CT-BR): adverse effects approach

Abstract: BACKGROUND: The Clinical Trial for Uniform Multidrug Therapy for Leprosy Patients in Brazil (U-MDT/CT-BR), designed to evaluate the effectiveness of a six-months regimen, assessed the adverse effects caused by the drugs. OBJECTIVE: Describe adverse effects due to MDT in U-MDT/CT-BR, comparing the uniform regimen (U-MDT) to the current WHO regimen (R-MDT). Patients and methods: After operational classification, patients were randomly allocated to the study groups. U-MDT PB and U-MDT MB groups, received the U-MDT regimen, six doses of MB-MDT (rifampicin, dapsone and clofazimine). R-MDT PB and R-MDT MB groups, received the WHO regimens: six doses (rifampicin and dapsone) for PB and 12 doses (rifampicin, dapsone and clofazimine) for MB. During treatment, patients returned monthly for clinical and laboratorial evaluation. Patients with single lesion were not included in this trial. RESULTS: Skin pigmentation (21.7%) and xerosis (16.9%) were the most frequent complaints among 753 patients. Laboratory exams showed hemoglobin concentration lower than 10g/dL in 23.3% of the patients, glutamic oxaloacetic transaminase (GOT) above 40U/L in 29.5% and glutamic pyruvic transaminase (GPT) above 40U/L in 28.5%. Twenty-four patients (3.2%) stopped dapsone intake due to adverse effects, of whom 16.6% due to severe anemia. One case of sulfone syndrome was reported. STUDY LIMITATIONS: Loss of some monthly laboratory sample collection. CONCLUSIONS: There was no statistical difference regarding adverse effects in the R-MDT and U-MDT groups but anemia was greater in patients from R-MDT/MB group, therefore adverse effects do not represent a constraint to recommend the six-month uniform regimen of treatment for all leprosy patients.

Subcorneal pustular dermatosis in the pediatric age

Abstract: Subcorneal pustular dermatosis is a rare pustular eruption which occurs mainly in middle-aged women and rarely during childhood. We report a case of a 15-year-old female with a 4-year history of pustular lesions on the proximal region of the upper limbs with subsequent impairment of the trunk. Physical examination revealed small pustules distributed on the trunk and proximal region of the limbs. Histopathology showed a subcorneal pustule and direct immunofluorescence for IgA, IgM, IgG and fibrinogen was negative, confirming the diagnosis of subcorneal pustular dermatosis. The patient was treated with dapsone with good clinical response after one month. Subcorneal pustular dermatosis is a rare condition and there are only isolated cases reported in the literature in pediatric patients. Thus, we discuss the main clinical aspects and treatment response of this condition during childhood.