In vitro sensitivity of Malassezia furfur isolates from HIV-positive and negative patients to antifungal agents / Sensibilidad in vitro a antifúngicos de aislamientos de Malassezia furfur de pacientes positivos y negativos para HIV

Introduction. Malassezia is a lipophilic and lipid-dependent yeast genus belonging to the skin microbiota of humans and other animals. However, due to dysbiosis processes or other factors in the host, this yeast can cause different pathologies, ranging from skin diseases, such as seborrheic dermatitis, to fungemia. Isolation of Malassezia furfur has been reported in HIV-positive patients with or without skin lesions. Due to its opportunistic nature and its variable resistance to antifungal compounds, it is relevant to know the Malassezia sensitivity profiles. Objective. To determine the sensitivity to different antifungal agents, of clinical isolates of M. furfur obtained from HIV-positive or negative patients, with or without seborrheic dermatitis. Materials and methods. Assessment of isolates sensitivity to itraconazole, voriconazole, fluconazole, and amphotericin B was performed by two techniques: (1) Broth microdilution using Clinical and Laboratory Standards Institute (CLSI) protocol M27-A3 with modifications; and (2) agar tests using Etest®. Results. Isolates obtained from HIV patients showed an increase in the minimum inhibitory concentration of fluconazole, voriconazole, and amphotericin B, compared with those of non-HIV patients. Itraconazole was the antifungal with the lowest minimum inhibitory concentration (MIC) in most isolates. Conclusion. We observed differences in the sensitivity profiles of M. furfur isolates according to the context of the patient. High MIC of antifungals like fluconazole, commonly used for treating pathologies caused by Malassezia, were identified.

Introducción. Malassezia es un género de levaduras lipofílicas que dependen de los lípidos y hacen parte de la microbiota de la piel de humanos y otros animales. No obstante, debido a procesos de disbiosis u otros factores en el huésped, esta levadura puede llegar a causar diferentes enfermedades: desde cutáneas (como dermatitis seborreica) hasta fungemias. Se han reportado aislamientos de Malassezia furfur en pacientes positivos para HIV, con lesiones cutáneas o sin ellas. Por su carácter oportunista y sensibilidad variable a los compuestos antifúngicos, es relevante conocer los perfiles de sensibilidad. Objetivo. Determinar la sensibilidad a diferentes antifúngicos de aislamientos clínicos de M. furfur obtenidos de pacientes positivos o negativos para HIV, con dermatitis seborreica o sin ella. Materiales y métodos. La sensibilidad de los aislamientos a itraconazol, voriconazol, fluconazol y anfotericina B, se determinó mediante dos técnicas: microdilución en caldo según el protocolo M27-A3 del Clinical & Laboratory Standards Institute (CLSI), con modificaciones, y pruebas en agar mediante Etest®. Resultados. Los aislamientos obtenidos de pacientes con HIV mostraron aumento de la concentración inhibitoria mínima a fluconazol, voriconazol y anfotericina B, en comparación con los de pacientes sin HIV. Por otro lado, al evaluar la mayoría de los aislamientos, el itraconazol fue el antifúngico con la menor concentración inhibitoria mínima. Conclusión. Se evidencian diferencias en los perfiles de sensibilidad de los aislamientos de M. furfur, según el contexto del paciente, y elevadas concentraciones inhibitorias mínimas de antifúngicos como el fluconazol, usados comúnmente para el tratamiento de las enfermedades causadas por Malassezia spp.

Histiocitosis de células de Langerhans: reporte de caso y revisión de la literatura / Langerhans cell histiocytosis: Case report and literature review

Resumen La histiocitosis de células de Langerhans comprende un grupo heterogéneo de enfermedades inflamatorias cuyos principales componentes celulares son las células dendríticas y los macrófagos. El infiltrado inflamatorio puede afectar la piel y otros órganos, y el resultado clínico varía de leve a letal, dependiendo del subconjunto de células involucradas y el compromiso multisistémico. La demora en el diagnóstico puede ocurrir debido a su presentación inespecífica y a que los médicos tratantes no suelen sospecharla. Se reporta el caso de una lactante mayor a la cual, a pesar de múltiples consultas con síntomas inespecíficos pero característicos de la enfermedad, solamente se le pudo hacer el diagnóstico gracias a los hallazgos histopatológicos.

Abstract Histiocytosis comprises a heterogeneous group of inflammatory diseases whose main cellular components are dendritic cells and macrophages. The inflammatory infiltrate can affect the skin and other organs and the clinical outcome varies from mild to fatal depending on the involved cell subset and multisystemic compromise. Delay in diagnosis may occur due to its non-specific presentation and to a low suspicion on the part of the clinician. We report the case of an infant who despite multiple consultations with nonspecific but characteristic symptoms of the disease was only finally diagnosed thanks to histopathological findings.

Seborrheic dermatitis and its relationship with Malassezia spp / Dermatitis seborreica y su relación con Malassezia spp

Abstract Seborrheic dermatitis (SD) is a chronic inflammatory disease that that is difficult to manage and with a high impact on the individual's quality of life. Besides, it is a multifactorial entity that typically occurs as an inflammatory response to Malassezia species, along with specific triggers that contribute to its pathophysiology. Sin ce the primary underlying pathogenic mechanisms include Malassezia proliferation and skin inflammation, the most common treatment includes topical antifungal keratolytics and anti-inflammatory agents. However, the consequences of eliminating the yeast population from the skin, the resistance profiles of Malassezia spp. and the effectivity among different groups of medications are unknown. Thus, in this review, we summarize the current knowledge on the disease´s pathophysio logy and the role of Malassezia sp. on it, as well as, the different antifungal treatment alternatives, including topical and oral treatment in the management of SD.

Resumen La dermatitis seborreica (DS) es una enfermedad inflamatoria crónica, con un elevado impacto en la calidad de vida del individuo. Además, DS es una entidad multifactorial que ocurre como respuesta inflamatoria a las levaduras del género Malassezia spp., junto con factores desencadenantes que contribuyen a la fisio patología de la enfermedad. Dado que el mecanismo patogénico principal involucra la proliferación e inflamación generada por Malassezia spp., el tratamiento más usado son los agentes tópicos antifúngicos y antiinflamatorios. Sin embargo, se desconocen las consecuencias de eliminar la población de levaduras de la piel, los perfiles de resistencia de Malassezia spp. y la efectividad entre grupos diferentes de medicamentos. Por tanto, en esta revisión de la literatura, resumimos el conocimiento actual sobre la fisiopatología de la enfermedad y el papel de Malassezia sp., así como de las diferentes alternativas de tratamiento antifúngico tanto tópico como oral en el manejo de la DS.

Leishmaniose visceral em um Pastor Belga: relato de caso / Visceral leishmaniasis in a Belgian Pastor: case report

O presente trabalho tem como objetivo relatar um caso de um Pastor Belga, do município de Ponta Porã, Mato Grosso do Sul, positivo para Leishmaniose Visceral, atendido em 2017 em uma clínica veterinária localizada em Pedro Juan Caballero, Paraguai. O diagnóstico foi confirmado através dos sinais clínicos característicos, e dos exames ELISA e PCR positivos. O animal foi submetido ao tratamento clínico para melhora dos sintomas, cujo tratamento antiparasitário inicial foi realizado com a associação de estibogluconato de sódio 75 mg/kg e alopurinol 100 mg seguido de aloputinol 100mg de uso contínuo e uso da coleira antileishmaniose. Tratamento esse considerado eficiente, com melhora clínica do animal. Após 24 meses o animal foi diagnosticado com tumor de mama e lesão da bolsa escrotal, sendo submetido a tratamento clínico e cirúrgico. Com 30 e 36 meses do diagnóstico inicial repetiu-se os exames ELISA (positivo) e PCR (negativo), e então o animal foi considerado curado clinicamente devido à ausência de sinais clínicos. Tendo em vista a complexidade dos fatores no ciclo de transmissão, conclui-se que as medidas em saúde ainda são insuficientes para o controle efetivo da doença. É importante o papel do Médico Veterinário na saúde pública, devido a obrigatoriedade de notificação de casos de Leishmaniose Visceral Canina, sendo necessários esforços nas diferentes áreas da saúde animal, humana e do meio ambiente, visando medidas de vigilância e controle da doença no país.

The present work aims to report a case of a Belgian Shepherd, from the municipality of Ponta Porã, Mato Grosso do Sul, positive for Visceral Leishmaniasis, treated in 2017 in a veterinary clinic located in Pedro Juan Caballero, Paraguay. The diagnosis was confirmed through the characteristic clinical signs, and the positive ELISA and PCR tests. The animal was submitted to clinical treatment for improvement of symptoms, whose initial antiparasitic treatment was performed with the association of sodium stibogluconate 75 mg/kg and allopurinol 100 mg followed by alloputinol 100mg of continuous use and use of the antileishmaniasis collar. This treatment was considered efficient, with clinical improvement of the animal. After 24 months the animal was diagnosed with a breast tumor and scrotum injury, and was submitted to clinical and surgical treatment. At 30 and 36 months from the initial diagnosis, the ELISA tests (positive) and PCR (negative) were repeated, and then the animal was considered clinically cured due to the absence of clinical signs. Considering the complexity of the factors in the transmission cycle, it is concluded that the health measures are still insufficient for the effective control of the disease. The role of the veterinarian in public health is important, due to the obligatory notification of cases of Canine Visceral Leishmaniasis, being necessary efforts in the different areas of animal health, human and environment, aiming at measures of surveillance and control of the disease in the country.

Prevalence of Vitamin D insufficiency and deficiency among seborrheic dermatitis patients: A cross-sectional study at Makati Medical Center

Introduction@#Seborrheic dermatitis is a chronic and recurrent inflammatory dermatosis affecting different age groups with a prevalence rate of 1–5% among Asian adults. Due to its immune-modulatory and anti-inflammatory properties, vitamin D has been correlated with inflammatory dermatoses such as seborrheic dermatitis.@*Objectives@#To determine the prevalence of vitamin D insufficiency, deficiency and severe deficiency among Filipino adult pa- tients with moderate to severe seborrheic dermatitis.@*Methods@#A single-center, analytical, cross-sectional study at Makati Medical Center, which included Filipino patients aged 18– 60 years, diagnosed with moderate-to-severe seborrheic dermatitis based on Investigator's Static Global Assessment (ISGA) with serum vitamin D levels classified as normal, insufficient, deficient and severely deficient.@*Results@#We included 61 patients, 5 patients (8%) of whom presented with normal Vitamin D levels. Twenty-one patients (34%) pre- sented with vitamin D insufficiency, 32 patients (52%) presented with vitamin D deficiency, while 3 patients (5%) presented with se- vere deficiency. Vitamin D insufficiency and deficiency were more prevalent among patients in the younger age group (p = 0.001), with predominant scalp lesions (p = 0.006), and those who are single (p = 0.015). There was no statistically significant difference in the prevalence of vitamin D insufficiency and/or deficiency based on seborrheic dermatitis severity as per ISGA scale (p = 0.126).@*Conclusion@#Seborrheic dermatitis in Filipinos has been associated with vitamin D insufficiency, deficiency and severe defi- ciency. The prevalence of vitamin D deficiency is seen in almost half of patients while vitamin D insufficiency is seen in almost one-third of patients with seborrheic dermatitis. While topical and oral medications have been the treatment of choice for seb- orrheic dermatitis, the role of oral vitamin D supplementation as adjunct treatment may be studied.

Frequência das doenças de pele não tumorais em cães no município de João Pessoa, Paraíba, Brasil (2014-2016) / [Frequency of non tumor skin diseases in dogs in the city of João Pessoa, Paraíba, Brazil (2014-2016)]

Diante da carência de estudos sobre a frequência de dermatopatias que acometem cães por região geográfica no Brasil, o presente estudo objetivou conhecer a frequência das principais doenças cutâneas que afetam cães na região metropolitana de João Pessoa, Paraíba, Brasil. Os dados foram coletados de cães que passaram por atendimento dermatológico no período de setembro de 2014 a dezembro de 2016. Além dos exames clínicos e dermatológicos os cães foram submetidos a exames complementares (citológico, raspado de pele, parasitológico, tricograma, bacteriológico, micológico, histopatológico e molecular). No período do estudo, foram atendidos 1.083 cães, em que 18,65% (202/1.083) apresentavam algum tipo de dermatopatia não tumoral. Dos 202 cães acometidos, 51,49% (104/202) eram machos e 48,51% (98/202), fêmeas. Desses 202 cães, 13 tinham dois diagnósticos, totalizando 215 dermatopatias. Dos cães afetados, 62,87% (127/202) eram de raça definida e 37,13% (75/202), sem raça definida (SRD). As lesões observadas com mais frequência caracterizaram-se por áreas alopécicas, hipotricoicas, maculosas, erosivas e ulcerativas, placoides, eritematosas, assim como comedões, colaretes, seborreia. As dermatopatias parasitárias foram as mais frequentes (35,35%; 76/215), seguidas pelas dermatopatias bacterianas (24,19%; 52/215), dermatopatias alérgicas (20,00%; 43/215), dermatopatias fúngicas (17,21%; 37/215), dermatopatias por outras causas (2,32%; 5/215) e pelas dermatopatias autoimunes (0,93%; 2/215). Os exames físicos e dermatológicos, incluindo anamnese detalhada, histórico clínico apurado, associado a exames complementares, são ferramentas importantes para o diagnóstico das dermatopatias em cães. Presume-se que a frequência de dermatopatias em cães na região de estudo possa ser maior do que a observada.(AU)

Faced with the lack of studies on the frequency of dermatopathies that affect dogs by geographical region in Brazil, the present study aimed to evaluate the frequency of dermatopathies that affect the canine species in the metropolitan region of João Pessoa, Paraíba, Brazil. Data was collected from dogs that underwent dermatological care from September 2014 to December 2016. In addition to the clinical and dermatological examinations, dogs underwent complementary exams, such as cytological, skin scraping, parasitological skin examination, trichogram, bacteriological, mycological, histopathological and/or polymerase chain reaction. During the study period, 1,083 dogs were examined, in which 18.65% (202 /1,083) had some form of non-tumoral dermatopathy. Of the 202 dogs affected, 51.49% (104/202) were males and 48.51% (98/202) females. Of these 202 dogs, thirteen had two diagnoses, totaling 215 dermatopathies. 62.87% (127/202) of the affected dogs were purebred and 37.13% (75/202) were without a defined breed (WDB). The most frequently observed lesions were alopecia, hypotric, macular, erosive and ulcerative, placoid, erythematous areas, as well as comedones, collaretes and seborrhoea. The parasitic dermatopathies were the most frequent (35.35%; 76/215), followed by bacterial dermatopathies (24,19%; 52/215), allergic dermatopathies (20,00%; 43/215), dermatomycosis (17,21%; 37/215), dermatopathies for other causes (2,32%; 5/215) and autoimmune dermatopathies (0.93%; 2/215). Clinical and dermatological examination, including a detailed anamnesis, accurate clinical history and associated complementary exams are important tools for the diagnosis of dermatopathies in dogs. Available literature present some studies with canine dermatopathies frequencies superior to that obtained in the present study; however, the number of animals examined was smaller. In this survey, it was possible to establish the primary and secondary diagnoses in 100.0% of the non-tumoral dermatopathies in dogs, results higher than in previous studies. Probably, the frequency of canine dermatopathies in this region is higher than that observed, thus requiring additional studies with greater sampling.(AU)

Demodex folliculorum infestations in common facial dermatoses: acne vulgaris, rosacea, seborrheic dermatitis

Abstract Background: Demodex mites are found on the skin of many healthy individuals. Demodex mites in high densities are considered to play a pathogenic role. Objective: To investigate the association between Demodex infestation and the three most common facial dermatoses: acne vulgaris, rosacea and seborrheic dermatitis. Methods: This prospective, observational case-control study included 127 patients (43 with acne vulgaris, 43 with rosacea and 41 with seborrheic dermatitis) and 77 healthy controls. The presence of demodicosis was evaluated by standardized skin surface biopsy in both the patient and control groups. Results: In terms of gender and age, no significant difference was found between the patients and controls (p > 0.05). Demodex infestation rates were significantly higher in patients than in controls (p = 0.001). Demodex infestation rates were significantly higher in the rosacea group than acne vulgaris and seborrheic dermatitis groups and controls (p = 0.001; p = 0.024; p = 0.001, respectively). Demodex infestation was found to be significantly higher in the acne vulgaris and seborrheic dermatitis groups than in controls (p = 0.001 and p = 0.001, respectively). No difference was observed between the acne vulgaris and seborrheic dermatitis groups in terms of demodicosis (p = 0.294). Study limitations: Small sample size is a limitation of the study. The lack of an objective scoring system in the diagnosis of Demodex infestation is another limitation. Conclusion: The findings of the present study emphasize that acne vulgaris, rosacea and seborrheic dermatitis are significantly associated with Demodex infestation. Standardized skin surface biopsy is a practical tool in the determination of Demodex infestation.

Clinical study on treatment of facial seborrheic dermatitis with intense pulsed light combined with 30% supramolecular salicylic acid

OBJECTIVES: In this study, we investigated the effects of intense pulsed light (IPL) combined with 30% supramolecular salicylic acid on facial seborrheic dermatitis. METHODS: A total of 45 patients with mild or moderate facial seborrheic dermatitis were selected from our hospital between September 2018 and September 2019. The patients were divided into three groups consisting of 15 patients each. The first group was exposed to a combination of IPL and 30% supramolecular salicylic acid treatment, the second group was exposed to the IPL treatment alone, and the third group was exposed to the 30% supramolecular salicylic acid treatment alone. They were treated once every 4 weeks in three consecutive rounds. RESULTS: Facial lesions and symptoms were observed 4 and 12 weeks after the first treatment, and adverse reactions were recorded. The combination group showed significant improvement in symptoms 4 weeks after the first treatment, while the individual treatment groups showed no significant improvement. After three rounds of treatments, seborrheic dermatitis had significantly decreased in the three groups; the efficacy of the combined treatment group was significantly higher than that of the IPL group and the 30% supramolecular salicylic acid group. CONCLUSION: IPL combined with 30% supramolecular salicylic acid was effective in the treatment of facial seborrheic dermatitis and provided a quicker result with no adverse reactions.

Isolation of Malassezia spp. in HIV-positive patients with and without seborrheic dermatitis

Abstract Background Malassezia, a skin saprophyte, is frequently isolated from patients with seborrheic dermatitis, which is one of the most common dermatoses in HIV-infected patients. Its role in pathophysiology has not been defined. Objective To determine whether patients living with HIV and seborrheic dermatitis have more Malassezia than those without seborrheic dermatitis. Method This is an descriptive, observational, prospective cross-sectional study to which all adult patients living with HIV that attend the infectious disease outpatient clinic at the Dr. Manuel Gea González General Hospital were invited. Patients presenting with scale and erythema were included in Group 1, while patients without erythema were included in Group 2. Samples were taken from all patients for smear and culture. Results Thirty patients were included in each group. All patients with seborrheic dermatitis had a positive smear, with varying amounts of yeasts. In the control group, 36.7% of patients had a negative smear. The results are statistically significant, as well as the number of colonies in the cultures.Study limitations The study used a small sample size and the subspecies were not identified. Conclusions Patients with clinical manifestations of seborrheic dermatitis have larger amounts of Malassezia. Further studies need to be performed to analyze if the greater amount is related to imbalances in the microbiota of the skin.

Second-to-fourth digit ratio and seborrheic dermatitis in males: a cross-sectional study*

Abstract: Background: Seborrheic dermatitis is a common disease characterized by the erythematous plaques with oily-yellow desquamation. Increased sebaceous gland activity by androgenic hormones has played a role in the etiology of the disease. The second-to-fourth digit (2D:4D) ratio is thought to be a marker of prenatal androgen exposure. Objectives: To investigate the association between 2D:4D ratios and seborrheic dermatitis in a male population. Methods: Healthy male controls and patients with seborrheic dermatitis were included in this study. One hundred seborrheic dermatitis patients and 120 healthy controls, aged 17-59, were enrolled. A digital Vernier caliper was used to measure the finger lengths. Seborrheic dermatitis severity was assessed using the Seborrheic Dermatitis Area and Severity Index (SDASI). Results: The 2D:4D ratios of the patients (x = 0.977) were significantly lower than those of the controls (x = 1.050) for right hands (t = 6.948; p = 0.000; > 0.05). No similar relationship was found between the 2D:4D ratio for left hands (t = 0.901; p = 0.368; > 0.05). Seborrheic dermatitis severity was negatively correlated with 2D:4D ratios of right hands (r = -0.391; p = 0.000-0.05). Study limitations: One of the main limitations of this study was the small sample, which got a head of us from acquiring certain findings about the 2D:4D ratio and seborrheic dermatitis. The other limitation is that the patient selection did not reflect the general population, as a single clinic was studied. Conclusion: To the authors' knowledge, this is the first study examining the relationship between 2D:4D ratios and seborrheic dermatitis. The result of this study may indicate a line of investigation and can support the theory of prenatal androgen exposure.

Demodiciose canina por Demodex injai: relato de caso / Canine demodicosis by Demodex injai: case report

A demodiciose é uma doença parasitária comum em cães, sendo, até o momento, reconhecidas três formas de Demodex que parasitam os cães. O D. injai foi descrito como potencial causador da enfermidade canina, porém ainda há poucos casos relatados em literatura. Dessa forma, este trabalho tem como objetivo acrescentar novos aspectos clínicos da enfermidade no cão. Para tanto, descreve-se o caso de canino da raça Chow Chow com 10 anos de idade, fêmea, com demodiciose cutânea e presença de prurido intenso e seborreia. Diversos ácaros com tamanho médio superior a 370 µm, proporção opistossoma e comprimento total médio superior a 60% foram observados e caracterizados como da espécie D. injai. Nesse sentido, a raça Chow Chow passa a ser incluída dentre aquelas passíveis de apresentarem a demodiciose causada por D. injai.

Demodicosis is a common parasitic skin disease in dogs, and to date three forms of Demodex are recognized as parasitizing dogs. D. injai has been described as a potential cause of the canine disease, however there are few cases reported in literature in the specie, so this work aims to add new clinical aspects of the disease in the dog. Therefore, is described a clinical case of a Chow Chow dog, female, 10 years old that presented cutaneous demodicosis, very itchy and with a dorsal oily dyskeratosis. Mites were observed in optical microscopy with middle larger than 370 µm and opistossoma ratio and total middle lenght over 60%, characterized as D. injai mites. Thus, the Chow Chow breed is included among those able to present the demodicosis caused by D. injai.

Skin Disease in Korean Human Immunodeficiency Virus Patient

BACKGROUND: In Korea, new human immunodeficiency virus (HIV) patients continue to be diagnosed. Due to the development of highly active anti-retroviral therapy (HAART) and lengthening of survival period of infected person, the aspect of skin diseases of HIV-infected patients is also changing. OBJECTIVE: To determine skin diseases of HIV-infected patients according to immune status and the relationship between folliculitis and HAART drug. METHODS: Subjects were HIV-infected patients who were treated in the department of dermatology from September 1, 2008 to August 31, 2018. Medical records of 376 subjects were retrospectively analyzed. RESULTS: Of 376 patients were studied, tinea infection, folliculitis, and seborrheic dermatitis were the most common regardless of their CD4 T cell counts or treatment group (initial treatment or retreatment). Seborrheic dermatitis, irritant contact dermatitis, and pruritic papular eruption were significantly more common in patients with CD4+T cells less than 200×106 cells/L while warts were significantly more frequent in patients with CD4+T cells greater than 200×106 cells/L. Most HAART agents were found to be helpful in reducing the incidence of folliculitis. CONCLUSION: There were many skin diseases in HIV patients, different from previous studies. In our study, the top three diagnoses were tinea infection, folliculitis, and seborrheic dermatitis. HAART medication was helpful in reducing folliculitis. These changes will require different treatments for skin diseases in HIV patients.

Tratamiento del acné en la adolescencia / Treatment of acne in adolescents

El acné es la enfermedad dermatológica más común de la adolescencia. Aunque casi todos los casos remiten alrededor de la tercera década de la vida, cuando este problema conlleva una carga emocional para el paciente se requiere indicar tratamiento. En esta actualización, los autores revisan los distintos grados de compromiso de esta patología, el tratami-ento y los niveles de evidencia que tiene cada uno de ellos, con el objetivo de facilitar a los médicos de atención primaria el manejo de los pacientes que presentan esta enfermedad. (AU)

Acne is the most common dermatological condition in adolescents. Even though almost all cases will resolve around the third decade of life, treatment is indicated when this health problem carries an emotional burden for the patient. In this update, the authors review the grades of involvement of the disease and the available treatments according to levels of evidence, with the aim of helping primary care physicians to manage the patients presenting this illness. (AU)

Wound myiasis: the role of entodermoscopy

Abstract: Although wound or traumatic myiasis is common in tropical countries, only recently cases associated with underlying dermatoses, such as seborrheic dermatitis and psoriasis, have been reported. We describe a patient with seborrheic dermatitis and an ulcerated lesion on the scalp, in which the dermatological examination with the aid of dermoscopy allowed the identification of larvae (maggots) compatible with infestation by Cochliomyia hominivorax. Treatment was performed with oral and topical ivermectin, followed by manual extraction of the larvae.

Reconhecimento e diagnóstico dos sintomas cutâneos do hiperandrogenismo em mulheres: proposta do Grupo Appropriate Care for Women with Androgen Excess (AWARE)) / Recognition and diagnosis of hyperandrogenic skin symptoms in women: proposal of the Appropriate Care for Women with Androgen Excess group (AWARE))

O hiperandrogenismo representa um problema de saúde pública complexo. Essa condição pode acome- ter 1/5 das mulheres na idade reprodutiva e apresenta um impacto negativo importante na qualidade de vida. As mulheres com hiperandrogenismo podem apresentar uma combinação de diferentes sintomas e repercussões clínicas. Os sintomas cutüneos incluem a seborreia, acne, hirsutismo e aIopecia. Trata-se de uma condição desafiadora tanto para as mulheres afetadas quanto para os profissionais de saúde. A nomenclatura atribuída ao hiperandrogenismo é confusa e faltam ainda recomendações diagnósticas e terapêuticas padronizadas. O grupo Appropriate Care for Women with Androgen Excede (AWARE) foi criado com proposta de aborda os aspectos confusos e inconclusivos do hiperandrogenismo. Foram elaborados protocolos simplificados referentes ao diagnóstico e tratamento do hiperandrogenismo visando contribuir de forma mais eficaz com os médicos em seus diferentes cenários de atuação. O roteiro para o reconhecimento e abordagem dos sintomas cutâneos do hiperandrogenismo em mulheres compreende perguntas chaves e ações específicas, sinalizando para a indicação de métodos propedêuticos adicionais.(AU)

Hyperandrogenism is a complex public health problem. This condition can affect 1/5 of women in repro- ductive age and has a significant negative impact on quality of life. Women with hyperandrogenism may exhibit a combination of different symptoms and clinical repercussions. Cutaneous symptoms include seborrhea, acne, hirsutism, and alopecia. It is a challenging condition for both affected women and health professionals.The nomenclature attributed to hyperandrogenism is confusing, and standard diagnostic and therapeutic recommendations are lacking. The Appropriate Care for Women with Androgen Excess (AWARE) group was created to address the confusing and inconclusive aspects of hyperandrogenism. Simplified protocols have been developed for the diagnosis and treatment of hyperandrogenism, aiming to contribute more effectively to physicians in their different settings.The roadmap for recognizing and approaching the cutaneous symptoms of hyperandrogenism in women comprises key questions and specific actions, signaling for indication of additional propaedeutic methods.(AU)

Unilateral acne after facial palsy

Abstract: We describe a case of unilateral acne which appeared after an episode of facial nerve palsy. An 18-year-old female patient presented with papules and pustules predominantly located on the side where the facial paralysis occurred. The patient suffered right facial paralysis, which was treated with prednisone and kinesiotherapy with massages, electrostimulation, and infrared light. Two weeks later, acne lesions appeared in the area affected by the paralysis. As suggested in other cases of paralysis, including cases of Parkinson's disease and spinal cord injury, an increased sebum excretion rate and the immobility of the affected area are most likely what caused the unilateral acne lesions.

Histiocitosis de células de Langerhans: el "camaleón" de la dermatopediatría / Langerhans cell histiocytosis

La Histiocitosis de Células de Langerhans (HCL) es una neoplasia mieloide de las células dendríticas Langerhans (CDL), caracterizada por acúmulos de células dendríticas mieloides CD207+. Corresponden a un espectro de enfermedades, desde sólo cutáneas a variantes multiorgánicas. El objetivo de este reporte es describir el caso clínico de un paciente pediátrico, con diagnóstico de Histiocitosis de Células de Langerhans, enfatizando el algoritmo clínico. Paciente masculino de 1 año y 5 meses, con antecedentes de otorrea persistente, refractaria a tratamiento, de un año de evolución. Consulta en policlínico de dermatología por "dermatitis severa" desde hace 1 año. Al examen físico se constatan lesiones tipo dermatitis seborreica generalizadas en tronco y cuero cabelludo, intertrigo fisurado, pápulas eritemato-costrosas plantares con petequias y pus en conducto auditivo externo bilateral. Presenta Hemoglobina 9,5 mg/dl, Hematocrito31,9%, leucocitos 12.400, linfocitos 33,3%, plaquetas 920.000, VHS 27. Subpoblaciones linfocitarias: CD3: 34,7%, C4: 22,7%, CD8: 9,7%, CD19:47,8%. HTLV negativo, VIH negativo. Acaro-test negativo. Dermatopatología: Denso infiltrado de células linfomonocíticas en dermis papilar, con ensanchamiento de estas y gran epidermotropismo, con abundante citoplasma eosinófilo con núcleos arriñonados, CD1a y langerina positivo. Recomendamos elevar la sospecha diagnóstica ante un cuadro de dermatitis seborreica generalizada que esta fuera del rango etario característico y en casos de dermatitis refractarias, donde a pesar de un adecuado tratamiento médico, el paciente persiste comprometido.

Langerhans Cell Histiocytosis (HCL) is a myeloid neoplasm of Langerhans dendritic cells (CDL), characterized by accumulations of myeloid dendritic cells CD207 +. They correspond to a spectrum of diseases, from cutaneous to multi-organ variants. The objective of this report is to describe the clinical case of a pediatric patient with diagnosis of, emphasizing the clinical algorithm. Male patient,1 year and 5 months old, with a history of refractory persistent otorrhea, consulted because of long term severe dermatitis. Physical examination revealed generalized seborrheic dermatitis lesions on the trunk and scalp, cleft intertrigo, plantar erythematous-crusted papules with petechiae, and pus in the external auditory canal. Laboratory findings showed: Hemoglobin 9.5 mg / dl, Hematocrit: 31.9%, leukocytes: 12,400, lymphocytes 33.3%, platelets: 920,000, HSV 27. Lymphocyte subpopulations: CD3: 34.7%, C4: 22.7%, CD8: 9.7%, CD19: 47.8%. HTLV negative, HIV negative. Scabies Negative. Dermatopathology: Dense infiltrate of lymphomonocytic cells in the papillary dermis with widening of the papilla and large epidermotropism, cells show abundant eosinophilic cytoplasm with "kidney nuclei", CD1a and langerin were positive. We recommend elevating the diagnostic suspicion in the face of a generalized seborrheic dermatitis that is outside the characteristic age range and in cases of refractory dermatitis, where the patient persists compromised.