Patología dermatológica facial asociada al uso de la mascarilla durante la pandemia causada por el virus Sars-CoV-2 / Facial dermatological pathology associated with use of the mask during the pandemic caused by the Sars-CoV-2 virus

The use of facemask has become a key element to prevent the infection of Covid-19. Its prolonged use, both, by health personnel and the general population, has caused the appearance of multiple adverse effects at the facial level; highlighting the report of symptoms such as discomfort with the mask, facial itching, redness, erythema, among others. The appearance of dermatological diseases such as acne, allergic and irritative contact dermatitis, and exacerbation of pre-existing pathologies such as acne, rosacea and seborrheic dermatitis are also frequent. Knowledge of these complications is important for their prevention and proper management. (AU)

Análise do perfil clínico e epidemiológico dos pacientes atendidos em um serviço terciário de dermatologia / Analysis of the clinico-epidemiological profile of patients attended in a tertiary dermatology service / Análisis del perfil clínico y epidemiológico de los pacientes atendidos en un servicio terciario de dermatología

OBJETIVO: Este artigo analisou o perfil epidemiológico e clínico dos pacientes atendidos em um serviço terciário de Dermatologia no município de Ponta Grossa-PR no período de 2016 a 2018. MÉTODOS: Trata-se de um estudo descritivo, exploratório, transversal e de abordagem quantitativa com dados coletados do prontuário médico. RESULTADOS: A maioria dos pacientes atendidos (I) era do sexo feminino; (II) com mais de 50 anos; (III) realizaram somente uma consulta, (IV) não foram submetidos a exames adicionais; e (V) apresentavam comorbidades, sobretudo, dermatológicas; o segmento corporal com maior número de lesões dermatológicas foi a cabeça; o grupo diagnóstico mais comum foi a afecção dos anexos cutâneos e o diagnóstico mais frequente foi a ceratose actínica. CONCLUSÃO: O estudo é fundamental para demonstrar quais são os pacientes e as doenças dermatológicas comumente encaminhadas para o serviço especializado, o que pode direcionar ações de prevenção primária, secundária e terciária.

OBJECTIVE: This article analyzed the epidemiological and clinical profile of patients treated at the outpatient Dermatology clinic, during 2016-2018, located in the municipality of Ponta Grossa-PR. METHODS: This is a descriptive exploratory, cross-sectional study with a quantitative approach, with data collected from the medical records. RESULTS: Most of the patients examinated: (I) were female; (II) over 50 years old; (III) attended to a single consultation; (IV) were not submitted to additional exams; and (V) had comorbidities, especially dermatological; the head was the most affected body segment; the most common diagnostic group was cutaneous annexes affections and the most frequent diagnosis was actinic keratosis. CONCLUSION: The study is fundamental to demonstrate who are the patients and which are the dermatological diseases commonly referred to the specialized service, which can guide primary, secondary and tertiary prevention actions.

OBJETIVO: Este artículo analizó el perfil epidemiológico y clínico de los pacientes atendidos en un servicio terciario de Dermatología en el municipio de Ponta Grossa-PR en el período de 2016 a 2018. MÉTODOS: Se trata de un estudio descriptivo, exploratorio y transversal con un enfoque cuantitativo con datos recogidos de las historias clínicas. RESULTADOS: La mayoría de los pacientes atendidos (I) eran mujeres; (II) tenían más de 50 años; (III) tenían una sola consulta, (IV) no se sometieron a exámenes adicionales; y (V) presentaban comorbilidades, principalmente, dermatológicas; el segmento corporal con mayor número de lesiones dermatológicas fue la cabeza; el grupo diagnóstico más común fue la afección de apéndices cutáneos y el diagnóstico más frecuente fue la queratosis actínica. CONCLUSIÓN: El estudio es fundamental para demostrar cuáles son los pacientes y las enfermedades dermatológicas que se derivan habitualmente al servicio especializado, lo que puede dirigir las acciones de prevención primaria, secundaria y terciaria.

Primary skin diseases and cutaneous manifestations of systemic diseases in swine / Doenças primárias da pele e manifestações cutâneas de doenças sistêmicas em suínos

Skin diseases in pigs can negatively impact the production. They cause losses related to the death of the affected pigs, to the cost with the treatment, growth retardation and condemnations in the slaughterhouses. This study was developed to determine the frequency and describe the histopathological findings of skin diseases in pigs in different age groups through a retrospective study from 2006 to 2018. A total of 154 conclusive cases were analyzed, including skin restricted diseases (allergic dermatitis, exudative epidermitis, vesicular dermatitis, pityriasis rosea, swinepox, follicular cyst, papilloma and scrotal hemangioma) or skin lesions secondary to systemic diseases (erysipelas, porcine dermatitis and nephropathy syndrome (PDNS), bacterial septicemia and multiple hemorrhages without definite cause). The skin lesions were classified as bacterial (46.1%), viral (26.6%), allergic (12.3%), neoplastic (1.3%) and others (13.6%). Swine erysipelas was the most frequent diagnosis (47/154), followed by PDNS (23/154), allergic dermatitis (19/154) and exudative epidermitis (15/154). Vesicular dermatitis (9/154), pityriasis rosea (9/154), septicemia with cutaneous manifestations (9/154), swinepox (9/154) and multiple hemorrhages without definite cause (7/154) were also observed. Follicular cyst (3/154), hyperkeratosis without definite cause (2/154), papilloma (1/154), and scrotal hemangioma (1/154) were less frequently described. Of the conclusive diagnosis, age was reported in 138 cases, with the highest frequency of skin lesions observed at the inspection process during slaughter (56/138).(AU)

As doenças de pele em suínos podem impactar negativamente a produção. Estas causam perdas relacionadas à morte dos acometidos, a custo com tratamentos, atraso no crescimento e condenações nos frigoríficos. Este trabalho foi desenvolvido para determinar a frequência e descrever os achados histopatológicos das doenças de pele em suínos nas diferentes faixas etárias, através de um estudo retrospectivo no período de 2006 a 2018. Foram analisados 154 casos conclusivos incluindo as doenças restritas a pele (dermatites alérgicas, epidermite exsudativa, dermatite vesicular, pitiríase rósea, varíola suína, cisto folicular, papiloma e hemangioma escrotal) e as secundárias a doenças sistêmicas (erisipela, síndrome dermatite nefropatia suína (SDNS), septicemia bacteriana e hemorragias múltiplas de causa não determinada). Estas foram classificadas em bacterianas (46,1%), virais (26,6%), alérgicas (12,3%), neoplásicas (1,3%) e outras (13,6%). A erisipela suína foi a enfermidade mais diagnosticada (47/154), seguida por SDNS (23/154), dermatite alérgica (19/154) e epidermite exsudativa (15/154). Observamos ainda dermatite vesicular (9/154), pitiríase rósea (9/154), septicemia bacteriana com manifestações cutâneas (9/154), varíola suína (9/154) e hemorragias múltiplas de causa não determinada (7/154). Em menor número, cisto folicular (3/154), hiperqueratose sem causa definida (2/154), papiloma (1/154) e hemangioma escrotal (1/154). Dos casos conclusivos, a idade foi informada em 138 casos, sendo a maior frequência das lesões de pele observadas na linha de inspeção, durante o abate (56/138).(AU)

Spontaneous and experimental poisoning by Froelichia humboldtiana in cattle / Intoxicação espontânea e experimental por Froelichia humboldtiana em bovinos

The aim of this work was to describe the epidemiological, clinical and pathological aspects of two outbreaks of spontaneous poisoning caused by Froelichia humboldtiana in cattle in Pernambuco, northeastern Brazil and reproduce experimentally this poisoning in cattle. Spontaneous poisonings of primary photosensitization occurred in two farms at the municipalities of Cachoeirinha and São Caetano and affected twenty-two adult bovines and two suckling calves after the rainy season. All bovines have recovered 21 days after they were removed from the pasture. To reproduce experimental poisoning, three cows and a calf were maintained in a pasture with 1ha composed by F. humboldtiana during 14 days. Clinical signs and skin lesions were similar in both spontaneous and experimental poisoning and consisted of cutaneous itching and hyperemia of non-pigmented areas of skin that evolved into edema, exudative dermatitis and extensive areas of skin necrosis. Serum levels of aspartate aminotransferase (AST), gamma glutamyltransferase (GGT), total, direct and indirect bilirubin were normal in all cattle examined. Histologically, lesions consisted of epidermal necrosis, hyperkeratosis with large amounts of degenerate neutrophils and acanthosis. In the dermis, edema and inflammatory infiltrate composed of eosinophils, lymphocytes and plasma cells mainly around the blood vessels were observed. In the experimental group, clinical signs of photosensitization were observed after the third day of F. humboldtiana consumption. The suckling calf displayed mild clinical signs of photodermatitis on the 8th day of the experiment. It was estimated that the average consumption of F. humboldtiana necessary to initiate clinical signs in each adult bovine was 78kg.(AU)

Os objetivos deste trabalho foram descrever os aspectos epidemiológicos, clínicos e patológicos de dois surtos de intoxicação por Froelichia humboldtiana em bovinos em Pernambuco e reproduzir experimentalmente essa intoxicação em bovinos. Intoxicações espontâneas foram observadas após o início do período chuvoso nos municípios de Cachoerinha e São Caetano. Vinte e dois bovinos apresentaram sinais clínicos e lesões cutâneas compatíveis com fotossensibilização primária, dentre os quais, dois bezerros lactentes. Todos os bovinos se recuperaram totalmente cerca de 21 dias após serem retirados da pastagem. Para reproduzir experimentalmente a intoxicação, três vacas, uma delas com bezerro ao pé, foram mantidas em um piquete de 1ha composto por F. humboldtiana por 14 dias consecutivos. O quadro clínico e as lesões tegumentares, tanto nos bovinos intoxicados nos surtos espontâneos, quanto nos bovinos do experimento consistiram em prurido e hiperemia em áreas despigmentadas de pele, que evoluíam para edema, dermatite exsudativa e necrose de áreas extensas de pele. Em todos os bovinos examinados, os níveis séricos de aspartato aminotransferase (AST), gamaglutamiltransferase (GGT), bilirrubina total, direta e indireta estavam normais. Histologicamente, as lesões consistiram em necrose da epiderme, hiperqueratose com grande quantidade de neutrófilos degenerados e acantose. Na derme havia edema e infiltrado inflamatório composto por eosinófilos, linfócitos e plasmócitos principalmente ao redor dos vasos sanguíneos. Nos bovinos do experimento, sinais clínicos de fotossensibilização foram observados após o terceiro dia de consumo de F. humboldtiana. O bezerro lactente apresentou sinais clínicos leves de fotodermatite no 8º dia do experimento. Estimou-se que o consumo médio de matéria seca de F. humboldtiana necessário para iniciar os sinais clínicos em cada bovino adulto foi de 78kg.(AU)

Lupus eritematoso cutáneo y lupus eritematoso sistémico: revisión de una historia sin fin / Cutaneous lupus erythematosus and systemic lupus erythematosus: endless story review

l lupus eritematoso es una afección que se conoce desde antiguo, referida en especial al compromiso cutáneo, pero ha sido mejor definida desde principios del siglo XIX, constituyéndose como una enfermedad sistémica con una base autoinmune. Mecanismos patogénicos inmunogenéticos desempeñan un papel en la susceptibilidad a la enfermedad, sobre la que actuarían variaciones hormonales y factores ambientales. De esta interacción deriva la producción de múltiples anormalidades inmunológicas, cuya acción sobre los tejidos da origen a la expresión clínica de la enfermedad. La relación entre el compromiso cutáneo, en especial crónico discoide, y sistémico, ha sido un factor de polémica, importante de dilucidar por el significado terapéutico y de pronóstico para el enfermo. De esta revisión se puede concluir que las diferentes manifestaciones del lupus constituyen una misma enfermedad, pero probablemente factores etiopatogénicos genéticos, hormonales y ambientales marcan la diferencia.

Lupus erythematosus is a condition that has been known since ancient times, especially referring to skin involvement, but has been better defined since the beginning of the 19th century, constituting itself as a systemic disease with an autoimmune basis. Immunogenetic pathogenic mechanisms play a role in disease susceptibility, on which hormonal variations and environmental factors would act. From this interaction derives the production of multiple immunological abnormalities, whose action on the tissues gives rise to the clinical expression of the disease. The relationship between cutaneous involvement, especially chronic discoid, and systemic, has been a controversial factor, important to elucidate due to its therapeutic and prognostic significance for the patient. From this review it can be concluded that the different manifestations of lupus constitute the same disease, but genetics, hormonal and environmental etiopathogenic factors probably make the difference.

Chagas disease reactivation: cutaneous manifestations in a transplanted patient

Abstract: Chagas disease is an endemic zoonosis caused by a protozoan agent called Trypanosoma cruzi. It is mainly transmitted by a hematophagous vector, and less frequently by blood transfusion, transplacental and solid organ transplant. In most cases, primary infection is not diagnosed and the disease progresses to a chronic phase. Immunosuppressed patients are a vulnerable population that may present an acute, atypical and severe reactivation of the chronic form of this disease. We hereby report a case of a female patient, who received a renal transplant with immunosuppressive treatment, who was diagnosed with a chagasic hypodermitis secondary to an acute reactivation of a chronic phase of this disease. We describe the clinical features, epidemiological and histopathological findings, treatment and course.

Caracterização clínica e histopatológica das dermatites alérgicas em cães / Clinical and histopathological characterization of allergic dermatitis in dogs

Descrevem-se as características clínicas e histopatológicas da dermatite alérgica diagnosticada em cães da região metropolitana de João Pessoa, Paraíba. Durante o período de setembro de 2014 a setembro de 2015, um total de 90 cães com lesões cutâneas. Desses 24 apresentaram alterações compatíveis com dermatite alérgica, sendo 12 machos e 12 fêmeas. A dermatite atópica (DA) foi a mais frequente, afetando 58,33% (14/24) dos cães, seguido por dermatite por hipersensibilidade alimentar (HA) 25% (6/24), dermatite de contato alérgica (DAC) com 8,33% (2/24) dos casos, dermatite alérgica por picada de pulgas (DAPP) com um caso e a hipersensibilidade a medicamento (farmacodermia) também um caso, que representou 4,17% respectivamente. As lesões macroscópicas incluíram hipotricose, hiperpigmentação, comedões, eritema, alopecia, xerose, erosões, úlceras e exsudato, anatomicamente distribuídas na face, cabeça, pescoço, toracolombar, lombossacra, flanco, membros e abdome. As lesões microscópicas mais frequentes foram hiperceratose, acantose, espongiose e exocitose de linfócitos na epiderme. Na derme superficial foi observada perivasculite, perianexite e em alguns casos de incontinência pigmentar, edema, dilatação de vasos sanguíneos, linfáticos e glândulas sudoríparas. O exame histopatológico associado com a história clínica, exame clínico e pele são ferramentas importantes para o diagnóstico de dermatite alérgica em cães, bem como medidas terapêuticas associadas.(AU)

This paper describes the clinical and histopathological features of allergic dermatitis in dogs diagnosed the metropolitan region of João Pessoa, Paraíba. From September 2014 to September 2015 a total of 90 dogs with skin lesions was studied. Twenty-four cases showed changes consistent with allergic dermatitis, in 12 males and 12 females. The age of dogs ranged from 3 months to 15 years. Atopic dermatitis was the most common, affecting 58.33% (14/24) of the dogs, followed by food hypersensitivity dermatitis at 25% (6/24), allergic contact dermatitis at 8.33% (2/24), a case of allergic dermatitis flea and one case of drug hypersensitivity, which represented 4.17% respectively. Gross lesions included hypotrichosis, hyperpigmentation, comedones, erythema, alopecia, xerosis, erosions, ulcers, and exudates. Anatomically distributed was on face, head, neck, thoracolumbar, lumbosacral, flank, limbs and abdomen. The most common microscopic lesions were hyperkeratosis, acanthosis, spongiosis and exocytosis of lymphocytes in the epidermis. In the superficial dermis was observed perivasculitis, perianexite and in some cases pigmentary incontinence, edema, dilated lymphatic vessels and sweat glands. Histopathological examination associated with medical history, clinical examination and skin examen are important tools for the diagnosis of allergic dermatitis in dogs, as well as for associated therapeutic measures.(AU)

Sarcoidal granulomatous reaction due to tattoos: report of two cases

Abstract Numerous infectious, inflammatory and neoplastic complications secondary to tattoo placement have been reported in the literature. Within inflammatory complications sarcoidal granulomatous reactions have been described. We report two cases, a 55-year-old woman with yellowish infiltrated plaques on bilateral ciliary region, 16 years after the placement of a permanent tattoo in the eyebrows, and a 20-year-old tattoo artist who developed orange papules on 3 of his tattoos. Histopathology in both cases confirmed diagnosis of sarcoidal granulomatous reaction due to tattoo pigment.

Interstitial granulomatous dermatitis: rare cutaneous manifestation of rheumatoid arthritis

Abstract Besides being an uncommon clinicopathological entity, interstitial granulomatous dermatitis, also described as interstitial granulomatous dermatitis with arthritis (IGDA), has shown a wide spectrum of clinical manifestations, such as linear and erythematous lesions, papules, plaques and nodules. Histological features include dense dermal histiocytic infiltrate, usually in a palisade configuration, and scattered neutrophils and eosinophils. We describe a middle aged woman with rheumatoid arthritis of difficult management and cutaneous lesions compatible with IGDA.

Bed bug dermatitis, description of two cases in Rio de Janeiro, Brazil

Bed bugs are hematophagous insects which due to their morphological and biological characteristics are able to easily adapt themselves to human households. The authors describe two cases of dermatitis caused by bed bug bites in the city of Rio de Janeiro, Brazil. Patients presented linear lesions in the usual "breakfast, lunch and dinner" arrangement, suggesting this diagnosis. A visit to their dwellings showed infestation of insects identified as Cimex hemipterus. The knowledge of these insects by the dermatological community will contribute to an accurate diagnosis as well as subsidize the dissemination of information aiming for prevention.

Paederus beetles: the agent of human dermatitis

Background Rove beetles of the genus Paederus cause dermatitis when they come in contact with human skin. This condition is prevalent in some tropical and subtropical regions, such as in northern Pakistan, where it was recorded for the first time by US troops. Despite much research from other countries on this subject, few studies, mostly clinical, have been performed in a Pakistani context. A survey was carried out in villages, towns and cities of Punjab province, Pakistan, to explore the rove beetle population dynamics and to develop a model to elucidate the symptoms, preventive measures and treatment strategies for this dermatitis. Methods The prospective observational and patient surveys were performed bimonthly over a period of two years, in different districts of Punjab province. Collection was carried out in fields, gardens and houses during every visit with the aid of a pitfall trap, light trap, flight intercept trap, Berlese funnel trap and sweep netting. These traps were installed for four days during every visit. Interviews of ten individuals of different ages and sexes from each site were recorded during each visit. Results Out of 980 individuals, 26.4% were found to suffer from Paederus dermatitis. Lesions were most commonly found on the neck followed by the face. In July-August during the rainy season, this skin irritation was most prevalent and the population of these beetles peaked (36.2%). During May-June, the beetle population was lowest (7.85%) due to soil dryness. About 70% of such irritation cases were from individuals living in farming villages or in farmhouses. Their houses typically (80%) had broken doors and screen-less windows while 97% of the residents were unaware of how they may have come into contact with these beetles. In most cases (91% from villages/small towns and 24% from cities and adjoining areas) the local residents were unaware of modern treatment strategies. Paederus dermatitis is extremely frequent in villages with poor housing facilities and could be avoided via community awareness.(AU)

Shiitake dermatitis: the first case reported in Brazil / Dermatite flagelada por shiitake, primeiro relato de caso no Brasil

Shiitake Dermatitis is often presented as papules and erythemato-violaceous linear streaks. It can be associated with bleomycin treatment, dermatomyositis and shiitake mushroom (Lentinus edodes). There is not any previous report concerning this rare etiology in our country. Shiitake is the second most consumed mushroom worldwide and it can cause flagellate erythema when ingested raw or half cooked. It has a higher incidence in Oriental countries because of their eating habits, this is the first case reported in Brazil, in a male patient that presented a cutaneous rash after consuming this raw mushroom.

A dermatite flagelada é caracterizada por pápulas eritematosas lineares com aspecto de "chicotada". A etiologia pode ser associada ao uso de bleomicina, dermatomiosite e shiitake (Lentinus edodes). Este é o segundo cogumelo mais consumido no mundo e pode ser causa de dermatite flagelada quando ingerido cru ou mal cozido. Não há relatos nas literaturas de quadro de dermatite flagelada por shiitake em nosso país, reportamos o primeiro caso no Brasil de um paciente masculino que desenvolveu o quadro após a ingesta desse cogumelo cru.

Autoimmune thyroiditis presenting as interstitial granulomatous dermatitis / Dermatite intersticial granulomatosa como apresentação de tireoidite autoimune

A 54-year-old female presented with recurrent, widespread, erythematous, painful plaques, over a 3-month period. Skin biopsy was compatible with interstitial granulomatous dermatitis. Additional investigation revealed hypothyroidism and positive anti-thyroid antibodies. Normalization of thyroid function and high-potency topical corticosteroids provided only transitory improvement of the dermatosis. Interstitial granulomatous dermatitis is a histologic inflammatory reaction, with variable cutaneous expression. It has been reported in association with several drugs, lymphoproliferative diseases and autoimmune disorders, such as rheumatoid arthritis, systemic lupus erythematosus and vasculitis, but association with autoimmune thyroiditis is rare. Optimal therapy for this condition is yet to be established, but topical corticosteroids have been a mainstay of treatment. In most cases, this disease is characterized by flares and remissions.

Uma doente de 54 anos foi avaliada por placas eritematosas, dolorosas, disseminadas, recorrentes, com 3 meses de evolução. A biopsia cutânea foi compatível com dermatite intersticial granulomatosa. Os restantes exames laboratoriais revelaram hipotiroidismo e anticorpos anti-tiroideus positivos. Apesar da normalização da função tiroideia e de tratamento com corticóide tópico de alta potência, a dermatose melhorou apenas parcialmente. Dermatite intersticial inflamatória é um diagnóstico histopatológico, com expressão clínica variável. Tem sido associada a vários fármacos, doenças linfoproliferativas e autoimunes, nomeadamente artrite reumatóide, lupus eritematoso sistémico e vasculites, mas a associação com tireoidite autoimune é rara. Até ao momento, não foi definido nenhum tratamento específico, mas os corticóides tópicos são dos fármacos mais utilizados. A doença caracteriza-se por períodos de agravamento e remissão.

Dermatitis de pabellón auricular por picadura de jerjeles: Una entidad clínica diferente no descrita / Dermatitis of the pinna by puncture of the black fly: A different clinical disease not yet described

Introducción: La picadura de jerjeles o simúlidos de la cara anterior del pabellón auricular presenta características clínicas diferente a las picaduras del mismo insecto en la piel del resto del cuerpo y requiere también un tratamiento diferente. Estos hechos no han sido descritos en la literatura. Objetivos: El objetivo es detallar los síntomas y signos de estas picaduras y las causas de las diferencias clínicas y de su tratamiento. Material y método: Para ello se hace el estudio y análisis de 6 pacientes aquejados por picaduras de jerjeles en la cara anterior de la oreja. Se investiga la biología de estos simúlidos. Finalmente se hace una revisión de la histología de la piel que recubre el cartílago auricular. Resultados: El síntoma principal de todos los pacientes fue un intenso dolor y edema de la oreja que les impedía dormir. La razón principal de estos síntomas es la íntima adhesión del dermis al cartílago auricular y que forma el pericondrio de éste, además de las múltiples toxinas salivales del insecto que tienen propiedades anticoagulantes, vasodilatadoras, e inhibidoras de la inmunidad celular. Conclusiones: Las plagas de jerjeles y sus picaduras serán cada vez más numerosas en Chile debido al calentamiento global, la destrucción de los ecosistemas por el hombre que han ido eliminando sus enemigos naturales y la contaminación de la casi totalidad de ríos y lagos de nuestro país. Para el tratamiento de las picaduras de jerjeles del pabellón auricular es necesario recurrir al uso de corticoesteroides en dosis altas y por períodos breves de menos de una semana.

Introduction: Puncture of the black fly or dipteral simuliidae on the external surface of the ear auricle shows clinical characteristics which differ from the puncture of this same insect on other different parts of the body Thus, it requires a different treatment, as well. These facts have not been clinically described yet, therefore, there is no literature available on this topic. Aim: To describe symptoms and signs of this disease.To outline the causes of the clinical differences and medical treatment. Material and method: Study and analysis of six patients suffering from puncture of black fly on the surface of ear auricle are carried out. The biology of these insects is studied. A revision of the histology of the skin of the ear auricle is made Results: The main symptoms experimented by patients suffering from black fly puncture are: excruciating pain and severe edema on the auricle area. The pain even prevents them from sleeping. The main cause of these symptoms is that the skin on the external surface of the auricle is firmly attaches to the underlying cartilage. Besides, the countless toxins inoculated in the saliva of the fly contain not only anticoagulant agents but also produce vasodilatation of capillaries and inhibit cellular immunity. Conclusions: The black fly plague and its infectious and painful puncture will be on the increase in Chile due to: global warming; elimination of the natural predators of this insect; man induced pollution of the majority of lakes and rivers in the country. The medical treatment for black fly puncture indicates corticosteroids in high dose for a short period of time (under a week).

Flagellate dermatitis caused by shiitake mushrooms / Dermatite flagelada após a ingestão de fungos shiitake

Shiitake (Lentinus edodes) is the second most consumed mushroom in the world. It has long been known in Asian medicine for its anticarcinogenic, antihypertensive and serum cholesterol level reduction properties. Nevertheless, the consumption of raw or not well-cooked mushrooms may cause skin eruptions which usually occur 24 to 48 hours after ingestion and are characterized by linearly arranged pruritic erythematous papules and plaques. We present a 36-year-old patient that developed typical symptoms 24 hours after consumption of shiitake mushrooms and summarize therapeutic options and particularities of this disease.

Shiitake (Lentinus edodes) é o segundo tipo de cogumelo mais consumido no mundo. Suas propriedades terapêuticas antitumorais, anti-hipertensivas e redutoras dos níveis elevados de colesterol são há muito conhecidas pela população asiática. Após ingestão desse cogumelo, cru ou malcozido, podem desenvolver-se lesões eritematosas lineares, pruriginosas, que surgem após 24 ou 48 horas em todo o corpo. Apresentamos um paciente de 36 anos com anamnese e clínica típicos, e comentamos as alternativas terapêuticas e nuances dessa dermatose.

Dermatitis gravitacional / Gravitational dermatitis

La dermatitis gravitacional es una dermatosis inflamatoria crónica de la piel, que ocurre en las piernas de personas de edad avanzada, de etiopatogenia compleja y multifactorial, caracterizada clínicamente por placas de aspecto eczematosas, eritematosas, escamosas, fisuradas e hiperpigmentadas, asociada con frecuencia a insuficiencia venosa crónica. En este artículo se discuten la etiopatogenia, factores de riesgo, las manifestaciones clínicas y la conducta terapéutica en la dermatitis gravitacional.

Gravitational dermatitis is a chronic inflammatory dermatosis that occurs in the legs of elderly of complex and multifactorial pathogenesis that is clinically characterized by eczematous, erythematous, scaly, fissured and noninflammatory plates, often associated with chronic venous insufficiency. This article discusses the etiopathogenesis, risk factors, clinical manifestations and therapeutical behavior.