Calcinosis escrotal: ¿una entidad idiopática? / Scrotal Calcinosis: an Idiopathic Entity?

La calcinosis escrotal es una enfermedad benigna e infrecuente que se presenta en adultos de mediana edad, con múltiples nódulos asintomáticos a nivel de la piel del escroto. Algunos autores vinculan la aparición de estas lesiones a la calcificación secundaria de quistes epidérmicos o ecrinos. Cuando no se encuentra relacionada con dichas entidades ni con alteraciones del metabolismo fosfocálcico, el cuadro se considera idiopático. El tratamiento de elección es quirúrgico, en caso de impacto en la calidad de vida o relevancia estética para el paciente. (AU)

Scrotal calcinosis is a rare, benign disease that presents in middle-aged adults with multiple asymptomatic nodules on the skin of the scrotum. Some authors link the appearance of these lesions to the secondary calcification of epidermal or eccrine cysts. When it is not related to these entities or to alterations in phosphocalcic metabolism, the condition is considered idiopathic. The treatment of choice is surgical, in case of impact on the quality of life or aesthetic relevance for the patient. (AU)

Dermoscopic features and management strategy of a 10-year history acral lentiginous melanoma in a 55-year-old Filipino

Introduction@#Acral lentiginous melanoma (ALM) is the most common type of cutaneous melanoma in Asians that is not associated with ultraviolet radiation (UV) exposure. Dermoscopy enables clinicians to distinguish between benign and malignant acral melanocytic lesions, with some dermoscopic characteristics playing a role in staging and have prognostic implications, which allows for appropriate surgical intervention. The difficulty of making an early diagnosis of ALM is highlighted by this case. ALM’s destructive nature, alongside the patient’s lack of awareness and vigilance, and healthcare access inequality, influences its prognosis. @*Case Report@#This is a case of a long-standing acral lentiginous melanoma with no palpable lymphadenopathies in which it was not immediately detected through biopsy. Upon detection, wide excision with 2 cm margins and disarticulation of the 5th digit of the right foot reconstructed with a fasciocutaneous advancement flap with split thickness skin graft, grafted from the right anterior thigh was done.

Generalized Purpuric Lichen Nitidus in a 32-year-old Filipino male with Acute Myeloid Leukemia: Case report

@#A 32-year-old Filipino male managed as a case of acute myeloid leukemia presented with a 6-month history of generalized, red-brown papules. After chemotherapy, the patient was advised 30-minutes daily sun exposure as a form of natural phototherapy. On follow-up, most lesions flattened. This case demonstrates chemotherapy’s potential role in controlling the patient’s inflammatory state and using ultraviolet light therapy in the form of sunlight to manage generalized purpuric lichen nitidus.

Usefulness of dermoscopy in the evaluation of patch test reactions

Abstract Background: Despite being widely used in different areas of dermatology, there have been few studies evaluating the benefit of dermoscopy in the interpretation of patch tests, especially in weak and doubtful reactions. Objectives: To evaluate the role of dermoscopy in the interpretation of patch tests and describe the main findings of the reactions. Method: Prospective study, carried out in dermatology reference centers in southern Brazil, which evaluated the final results of patch tests analyzed with the aid of dermoscopy. Results: 77 patients and 160 reactions were included. The most prevalent substances were nickel sulphate (23.8%), kathon CG (9.4%), and perfume mix (8.8%). The main dermoscopic findings were reaction area greater than half of the chamber site (90%), homogeneous erythema (86.9%), vesicles (30%), crusts (21.3%), perifollicular erythema (35%), pore reaction (19.4%) and pustules (8.8%). Dermoscopy was found to facilitate the definition of erythema in reactions on black skin and when due to substances with deposition of pigment. Of the 64 weak or doubtful reactions, 36 (56.25%) showed a change in the final result after dermoscopy evaluation; of the 36 doubtful reactions, 33 (91.6%) showed a change in the final result after dermoscopy evaluation (p < 0.001). Study limitations: The probable limitation of the study is its sample size. Though certain significance levels have been reached, other possible relationships may not have been observed. Conclusion: Dermoscopy improves significantly the interpretation of patch tests, especially in weak and doubtful reactions.

Dermoscopy of skin infestations and infections (entomodermoscopy) - Part II: viral, fungal and other infections,

Abstract In addition to the infestations and bacterial infections reported in part I, the study of entomodermoscopy also involves descriptions of dermoscopic findings of a growing number of viral and fungal infections, among others. In this article, the main clinical situations in viral infections where dermoscopy can be useful will be described, that is in the evaluation of viral warts, molluscum contagiosum, and even in recent scenarios such as the COVID-19 pandemic. As for fungal infections, dermoscopy is particularly important, not only in the evaluation of the skin surface, but also of skin annexes, such as hairs and nails. The differential diagnosis with skin tumors, especially melanomas, can be facilitated by dermoscopy, especially in the evaluation of cases of verruca plantaris, onychomycosis and tinea nigra.

Dermoscopy of skin infestations and infections (entomodermoscopy) - Part I: dermatozoonoses and bacterial infections

Abstract Dermoscopy is an essential in vivo diagnostic technique in the clinical evaluation of skin tumors. Currently, the same can also be said about its implications when approaching different clinical situations in Dermatology. A growing number of reports on dermatological scenarios and diseases have been published, in which dermoscopy has been of great diagnostic help. The term ‟entomodermoscopy" was coined to describe dermoscopic findings in skin infestations and also in dermatoses of infectious etiology. In part I of this article, the main dermoscopic descriptions of zoodermatoses and bacterial infections will be addressed. In many of them, such as scabies, pediculosis, myiasis, and tungiasis, it is possible to identify the pathogen and, consequently, attain the diagnosis more quickly and use the technique to follow-up therapeutic effectiveness. In other situations that will be described, dermoscopy can allow the observation of clinical findings with greater detail, rule out differential diagnoses, and increase the level of confidence in a clinical suspicion.

Bowen's disease of the penile shaft presenting as a pigmented macule: dermoscopy, reflectance confocal microscopy and histopathological correlation,

Abstract The penile localization of pigmented Bowen's disease has been rarely reported and has been mostly related to human papillomavirus infection. Early diagnosis and treatment are important to prevent progression to invasive squamous cell carcinoma. However, diagnosis can be challenging because it may be difficult to distinguish from melanoma, even using dermoscopy. Reflectance confocal microscopy may be useful in suggesting the bedside diagnosis before the histopathological confirmation. A case of penile pigmented Bowen's disease is described along with its dermoscopy and reflectance confocal microscopy findings and their correlation with histopathology.

Total body mapping in the follow-up of melanocytic lesions: recommendations of the Brazilian Society of Dermatology

Abstract Total body mapping comprises photographic documentation of the entire body surface followed by digital dermatoscopy of selected melanocytic lesions, aiming to compare their evolution over time and identify new lesions. As this is an exam based on comparative analysis of serial dermoscopic body images, standardization of the technique for performing total body mapping is essential. Prepared by specialists from the Brazilian Society of Dermatology, using the modified Delphi method, this article provides recommendations for carrying out total body mapping in Brazil, regarding its indications, technical aspects, and the issuing of the report.

Dermoscopy of the iris: identification of Lisch nodules and contribution to the diagnosis of neurofibromatosis type 1

Abstract Neurofibromatosis is a common genodermatosis, whose diagnosis often involves the participation of a dermatologist. A case of a 38-year-old female patient with four café-au-lait macules and eleven neurofibromas on clinical examination is presented. Dermoscopy allowed the identification of Lisch nodules in the iris, bilaterally. The combination of these findings allowed the diagnosis of neurofibromatosis type 1, according to NIH criteria. Lisch nodules are melanocytic hamartomas of the iris, which must be evaluated through a visual augmentation method, usually employed in ophthalmology. Alternatively, dermoscopy can be used and contribute to the early diagnosis of neurofibromatosis type 1.

Evaluation of non-endemic pemphigus foliaceus in a large series of patients: a single-center retrospective study from Turkey focuses on the relapses

Abstract Background: Pemphigus foliaceus is exceedingly rare around the world, except within the few regions where it occurs as an endemic variant. Various factors can trigger immune mechanisms that induce pemphigus foliaceus or worsen its course. Objective: To determine the demographic and clinical characteristics of the patients with pemphigus foliaceus in a large series from a non-endemic country, investigate the triggering factors, and seasonal patterns. Methods: The data of the patients diagnosed with pemphigus foliaceus in the study's center between 1989-2018 were retrospectively analyzed. Results: Sixty-eight patients (mean age, 45.7 ± 14.5 years) were included in the study. The number of onsets reached its peak in spring-summer (p = 0.008). A total of 117 relapses occurred in 42 patients and were most common in spring-summer (not significant). Specific trigger factors were detected in 45 relapses. In the other 72 relapses, the peak was observed in spring-summer (p = 0.005). There were no significant differences in the demographic and clinical variables investigated between relapsed and non-relapsed patients. Study limitations: Retrospective design. Conclusions: Triggering factors could not be identified in more than half of the relapses in the study's series. The subgroup of relapses (without identified causes), as well as the onsets of the disease, showed a significant seasonal variation with a peak in spring-summer; however, the seasonal variable did not justify the total group of relapses. Although the seasonal variation may be caused by a combination of factors, UV radiation should be considered a trigger factor for the peaks in spring-summer, particularly in Turkey.

Utilidad del dermatoscopio en la correlación clínica e histológica de nevus pigmentados / Usefulness of Dermatoscopy in the clinical and histological correlation of Pigmented Nevi

Introducción: La precisión diagnóstica de los nevus pigmentados ha sido una constante preocupación por los dermatólogos. Objetivo: Identificar la utilidad del dermatoscopio en la correlación de las características clínicas y los patrones dermatoscópicos de nevus pigmentados y su asociación con el diagnóstico histológico. Métodos: Se realizó una investigación observacional, analítica, de tipo correlacional, con pacientes de la zona sur de Ciego de Ávila que acudieron a la consulta de dermatología del Hospital Provincial General Docente Dr. Antonio Luaces Iraola en el periodo de abril 2017 a diciembre 2019. Resultados: Predominó el sexo femenino, el grupo de edad de 21 a 30 años, el fototipo II de piel y la zona expuesta (cara y V del escote) (18 ;35,3 por ciento) sin relación entre estas variables. El diagnóstico histológico de nevus de la unión se encontró asociado a la simetría (p < 0,004), la pigmentación homogénea (p < 0,000), así como al patrón dermatoscópico reticular (p < 0,000), globular (p < 0,002) y homogéneo (p < 0,008). El nevus intradérmico se observó asociado a la característica clínica de pigmentación homogénea (p < 0,007), y al patrón dermatoscópico reticular (p < 0,000) y homogéneo (p < 0,005). El nevus compuesto no presentó relación con las características clínicas ni dermatoscópicas. El nevus azul solo se correlacionó con el patrón dermatoscópico homogéneo (p < 0,025). Conclusión: Los patrones dermatoscópicos fueron útiles para el diagnóstico clínico e histológico de los nevus pigmentados(AU)

Introduction: The diagnostic precision of pigmented nevi has been a constant concern of dermatologists. Objective: To determine the usefulness of the Dermatoscope in the correlation of the clinical characteristics and the dermoscopic patterns of pigmented nevi and their association with the histological diagnosis. Methods: An analytical observational investigation of a correlational type was carried out in patients from the southern area of Ciego de Ávila who attended the Dermatology consultation at the Antonio Luaces Iraola Provincial Hospital in the period from April 2017 to December 2019. Results: The female sex, the age group of 21 to 30 years, skin phototype II and the exposed area (face and V of the neckline) (18; 35.3 percent) predominated with no relationship between these variables. The histological diagnosis of junctional nevus was found associated with symmetry (p <0.004), homogeneous pigmentation (p <0.000), as well as the reticular dermoscopic pattern (p <0.000), globular (p <0.002) and homogeneous (p <0.008). The intradermal nevus was observed associated with the clinical characteristic of homogeneous pigmentation (p <0.007), and with the reticular (p <0.000) and homogeneous (p <0.005) dermoscopic pattern. The composite nevus was not related to clinical or dermoscopic characteristics. The blue nevus only correlated with the homogeneous dermoscopic pattern (p <0.025). Conclusions: The dermoscopic patterns were useful for the clinical and histological diagnosis of pigmented nevi(AU)

Esporotricosis, una realidad aún presente en Chile: a propósito de un caso / Sporotrichosis, a reality still present in Chile: a case report

OBJETIVO: Reportar un caso de esporotricosis linfocutánea contraída en Chile y realizar una revisión de la literatura con énfasis en los hallazgos dermatoscópicos de las lesiones y en los casos reportados en el país. CASO CLÍNICO: Paciente adulto mayor con lesiones nodulares ulceradas siguiendo trayecto linfático en extremidad superior derecha. RESULTADOS: Estudio micológico confirmó la presencia de Sporothrix schenckii. Se inició tratamiento con antifúngico oral con buena respuesta terapéutica. CONCLUSIONES: Existe un escaso número de reporte de esporotricosis linfocutánea contraída en Chile con confirmación micológica. Este es el único caso chileno con descripción dermatoscópica de las lesiones.

OBJETIVE: To report a case of lymphocutaneous sporotrichosis adquired in Chile and provide a review of the literature with emphasis on dermoscopic findings and previous cases reported in the country. CLINICAL CASE: An elderly patient presented with ulcerated nodular lesions following lymphatic vessels in his right upper limb.RESULTS: Mycological work-up confirmed the presence of Sporothrix schenkii. Oral antifungal treatment was initiated with good therapeutic response. CONCLUSIONS: Few case reports of lymphocutaneous sporotricosis adquired in Chile can be found in literature. Until now this is the only chilean case with dermoscopic description of the lesions.

Dermoscopic evaluation of superficial spreading melanoma

Abstract Background: Dermoscopy increases the sensitivity of the diagnosis of melanoma, leading to its early identification and increasing the chances of cure. Objective: To describe the clinical and dermoscopic characteristics of superficial spreading melanomas, and to detect the differences between in situ and invasive 1-mm thick melanomas. Methods: This was a cross-sectional study in which dermoscopic images of 58 melanomas, grouped according to their thickness, were evaluated. Results: 24 in situ melanomas were evaluated, 28 invasive melanomas with Breslow ≤ 1 mm (0.50 ± 0.22 mm) and six with Breslow > 1 mm (2.35 ± 2.02 mm). In situ melanomas were smaller than invasive melanomas. The most commonly found dermoscopic criteria were asymmetry (84.5%), three or more colors (81.0%), and atypical network (79.3%). A non-specific pattern was more common in in situ melanomas (p = 0.028) and atypical network in invasive melanomas with Breslow 1 mm presented inverted network (p = 0.018). Study limitations: The sample was selected by convenience, since it was necessary to have a preoperative photo of the tumor, which may have led to the loss of clinically less significant lesions, as well as those highly suggestive of melanoma. Conclusions: Melanomas in early stages showed a more frequent nonspecific pattern and atypical network, while invasive melanomas showed a multicomponent pattern, three or more colors, and an inverted network.

Melanomas de diámetro pequeño: papel de la dermatoscopia y seguimiento con dermatoscopia digital / Small-diameter melanomas: role of dermoscopy and digital dermoscopy follow-up

Antecedentes: El reconocimiento de los melanomas de diámetro pequeño (MDP) a menudo plantea un desafío. Objetivos: Analizar el papel de la dermatoscopia y el seguimiento con dermatoscopia digital en el diagnóstico de los MDP. Diseño: Análisis retrospectivo, observacional, descriptivo, de una serie de 50 MDP diagnosticados entre 2015 y 2019. Resultados: De los MDP, 9 fueron motivo de consulta del paciente (MMC), 30 se detectaron durante el control rutinario de nevos (MMCR) y 11 se diagnosticaron por los cambios observados durante el seguimiento con dermatoscopia digital (MMDD). Cerca del 45% de los MMC fueron clasificados correctamente como lesiones malignas según la "regla ABCD de dermatoscopia"; esto se observó solo en el 20% de los MMCR y en ninguno de los MMDD. El algoritmo "caos y pistas" condujo a la extirpación en casi el 90% de los MMC, el 60% de los MMCR y el 50% de los MMDD. Los porcentajes de melanoma in situ fueron: 55% entre los MMC, 73,3% entre los MMCR y 72,9% entre los MMDD. En los melanomas invasores, el grosor de Breslow medio fue de 0,62 mm en el grupo MMC, de 0,5 mm en el MMCR y de 0,4 mm en el MMDD. Conclusiones: El uso rutinario de la dermatoscopia permite la detección de melanomas con bajo índice de sospecha que los pacientes podrían desconocer. Mediante el seguimiento digital es posible la detección de los melanomas incipientes que carecen no solo de criterios clínicos, sino también dermatoscópicos de malignidad.

Background: Recognition of small-diameter melanomas (SDM) is often challenging. Objective: To analyze the role of dermoscopy and follow-up with digital dermoscopy in the diagnosis of SDM. Design: Retrospective, observational, descriptive analysis of a series of 50 SDM diagnosed between 2015 and 2019. Results: Among the SMD, 9 cases were the patients' reason for consultation (MMC), 30 were detected during routine nevi control (MMCR) and 11 were diagnosed due to changes observed during followup with digital dermoscopy (MMDD). Near 45% of the MMC were correctly classified as malignant lesions according to the "ABCD rule of dermoscopy"; this was observed only in 20% of the MMCR and in none of the MMDD. The "chaos and clues" algorithm led to excision in almost 90% of MMC, 60% of MMCR, and 50% of MMDD. The percentages of in situ melanoma were: 55% in the MMC, 73.3% in the MMCR and 72.9% in the MMDD. Among invasive melanomas, mean Breslow thickness was 0.62 mm in the MMC group, 0.5 mm in the MMCR, and 0.4 mm in the MMDD. Conclusions: The routine use of dermoscopy allows for the detection of melanomas with a low index of suspicion that patients may not be aware of. The use of digital follow-up enables the detection of incipient melanomas that lack not only clinical but also dermoscopic criteria of malignancy.

Perfil clínico, histopatológico e tricoscópico da alopecia frontal fibrosante: estudo retrospectivo de casos de um serviço de referência de dermatologia / Clinical, histopathological and trichoscopic of frontal alopecia fibrosing: retrospective study of cases of a service of dermatology reference

Contexto: Alopecia frontal fibrosante (AFF) é uma alopecia cicatricial que acomete a região frontotemporal, e predomina em mulheres pós-menopausadas. Objetivo: Descrever o perfil clínico, histopatológico e tricoscópico de pacientes com diagnóstico de AFF. Desenho e local: Estudo de coorte retrospectivo observacional que foi desenvolvido no ambulatório de tricologia do departamento de dermatologia do Hospital Santa Casa de Misericórdia de Vitória, Vitória (ES), Brasil. Métodos: O estudo foi realizado por meio da análise de prontuários e de revisão histopatológica de pacientes com diagnóstico de AFF atendidos entre 1 de março de 2019 a 29 de fevereiro de 2020. Resultados: No período, 17 pacientes do sexo feminino foram diagnosticadas com AFF, 76,5% delas na pós-menopausa. Todas apresentavam alopecia frontotemporal e madarose. À tricoscopia, ausência de pelos velus, aberturas foliculares reduzidas, hiperceratose folicular e eritema perifolicular foram encontrados na maioria dos casos. Todas as biópsias mostraram aspectos microscópicos compatíveis com AFF. O tratamento mais utilizado foi tacrolimo 0,1%. Discussão: A patogênese da AFF ainda não é compreendida. A associação com doenças autoimunes sugere a influência da imunidade no quadro. A tricoscopia é uma ferramenta de fácil acesso e não invasiva que pode auxiliar no diagnóstico. Histopatologicamente a AFF é indistinguível do líquen plano pilar. O tratamento objetiva reduzir a inflamação e retardar a progressão da doença. Conclusões: Embora apresentações clínicas e tricoscópicas tenham sido descritas ao longo dos anos, a patogênese, a histologia e os tratamentos eficazes para AFF ainda são debatidos. O reconhecimento e o tratamento precoce da doença permitiriam a redução da progressão da doença.

Rosettes in T-cell pseudolymphoma: a new dermoscopic finding

Abstract Rosettes are small white structures visible with polarized light dermoscopy, whose exact morphological correlation is not yet defined. These small shiny structures are found in several conditions such as scarring, dermatofibroma, molluscum contagiosum, squamous cell carcinoma, basal cell carcinoma, melanoma, melanocytic nevus, discoid lupus erythematosus, and papulopustular rosacea. In this novel report, the authors describe the presence of rosettes in a T-cell pseudolymphoma lesion.