Relação entre aspectos psicossomáticos e psoríase / Relationship between psychosomatic aspects and psoriasis / Relación entre aspectos psicosomáticos y psoriasis

Psoríase é uma dermatose de caráter inflamatório ligado a diversas composições do ser, sendo estas a genética, o sistema imune, o ambiente e o estado mental do paciente, apresentando evidências de ser um quadro clínico multifacetado. A composição da medicina psicossomática empenha-se na relação mental e emocional e do corpo, sendo importante mostrar a relação desta com a psoríase. Por isso, busca-se avaliar as evidências disponíveis na literatura sobre a relação entre a psoríase e os aspectos psicossomáticos. Foi realizado uma a revisão de literatura, por meio de seleção de artigos das base de dados Medical Literature Analysis and Retrieval System Online (PubMed/Medline), biblioteca virtual em saúde Scientific Electronic Library Online (SciElo), UpToDate e Google acadêmico. A busca por artigos científicos resultou em 20 artigos selecionados. Foi possível concluir, que há estudos fundamentados correlacionando a medicina psicossomática e a psoríase, além de que diversos fatores que afetam a homeostase corporal, provocam alterações nervosas, e consequentemente afetam as células da pele. Além disso, foi encontrado evidências que a estigmatização que os pacientes sofrem influenciam no aumento da gravidade da doença, sendo necessário a realização de um tratamento psico cognitivo-comportamental juntamente com o tratamento dos sinais e sintomas gerais da doença. Desta forma, o presente trabalho pôde olhar para a patologia com um olhar ampliado relacionado ao aspecto mental e emocional o que promove melhor compreensão e as consequências disto são a maior capacidade de intervenção sobre a psoríase.

Psoriasis is an inflammatory dermatosis linked to several compositions of the being, which are genetics, the immune system, the environment and the patient's mental state, that is, it shows evidence of being a multifaceted clinical picture. Since the composition of psychosomatic medicine is committed to the relationship between the mental, emotional, and body, it is important to show its relationship with psoriasis. Therefore, we sought to evaluate the available evidence in the literature on the relationship between psoriasis and psychosomatic aspects. A literature review was conducted by selecting articles from the Medical Literature Analysis and Retrieval System Online (PubMed/Medline), Scientific Electronic Library Online (SciElo), UpToDate and Google Scholar databases. The search for scientific articles resulted in 20 selected articles. It was possible to conclude that there are well-founded studies correlating psychosomatic medicine and psoriasis, and that several factors that affect the body's homeostasis cause nervous alterations, and consequently affect the skin cells. Moreover, it was found evidence that the stigmatization that patients suffer influences the increase of the severity of the disease, being necessary the realization of a psycho cognitive-behavioral treatment along with the treatment of the general signs and symptoms of the disease. Thus, the present work could look at the pathology with a broader view related to the mental and emotional aspect, which promotes better understanding and the consequences of this are a greater ability to intervene on psoriasis.

La psoriasis es una dermatosis inflamatoria vinculada a varias composiciones del ser, que son la genética, el sistema inmunitario, el medio ambiente y el estado mental del paciente, es decir, muestra evidencias de ser un cuadro clínico multifacético. Dado que la composición de la medicina psicosomática está comprometida con la relación entre lo mental, lo emocional y el cuerpo, es importante mostrar su relación con la psoriasis. Por lo tanto, se buscó evaluar la evidencia disponible en la literatura sobre la relación entre la psoriasis y los aspectos psicosomáticos. Se realizó una revisión bibliográfica seleccionando artículos de las bases de datos Medical Literature Analysis and Retrieval System Online (PubMed/Medline), Scientific Electronic Library Online (SciElo), UpToDate y Google Scholar. La búsqueda de artículos científicos dio como resultado 20 artículos seleccionados. Se pudo concluir que existen estudios bien fundamentados que correlacionan la medicina psicosomática y la psoriasis, y que diversos factores que afectan a la homeostasis del organismo provocan alteraciones nerviosas y, en consecuencia, afectan a las células de la piel. Además, se encontraron evidencias de que la estigmatización que sufren los pacientes influye en el aumento de la gravedad de la enfermedad, siendo necesaria la realización de un tratamiento psico cognitivo- conductual junto con el tratamiento de los signos y síntomas generales de la enfermedad. Así, el presente trabajo pudo contemplar la patología con una visión más amplia relacionada con el aspecto mental y emocional, lo que favorece una mejor comprensión y las consecuencias de ello son una mayor capacidad de intervención sobre la psoriasis.

Clinicopathological features of ectopic meningothelial hamartoma / 中华病理学杂志

Objective: To investigate the clinicopathological features, diagnosis and differential diagnosis of ectopic meningothelial hamartoma (EMH). Methods: Three cases of EMH diagnosed in the First Affiliated Hospital of Nanjing Medical University from January 2014 to December 2020 were enrolled. All cases were evaluated by clinical and imaging features, HE and immunohistochemical staining, and the relevant literature was reviewed. Results: There were one male and two female patients, aged 2, 67 and 19 years, respectively. Clinically, they presented as skin masses in the head and face region (two cases) and sacro-coccygeal region (one case). Grossly, the lesions ranged in size from 1.6 cm to 8.9 cm. Microscopically, the lesions were ill-defined, and located in the dermis and subcutis, and showed pseudovascular channels lined by monolayer of cuboidal to flattened epithelium with mild atypia, with variable cystic cavity formation. There was prominent interstitial fibrosis. Concentric, lamellated, onion skin-like arrangement with short spindle or ovoid cells and psammoma bodies were noted. Immunohistochemically, these cells were strongly positive for SSTR2, EMA, vimentin and progesterone receptor. Ki-67 positive index was low, approximately 1%. Conclusions: EMH is uncommon. Definitive diagnosis relies on histopathologic examination. The importance in recognizing the lesions is to differentiate from other more aggressive tumors.

Patrones clínicos e histopatológicos de dermatosis en pacientes con infección por COVID-19 en la Unidad Médica de Alta Especialidad del Bajío, IMSS-T1, de León, Guanajuato / Clinical and histopathological patterns of dermatosis in COVID-19 positive patients treated in the Unidad Médica de Alta Especialidad del Bajío, IMSS-T1, de León, Guanajuato

INTRODUCCIÓN: La enfermedad COVID-19, además de presentar síntomas respiratorios, puede afectar otros órganos como la piel. Al momento, se han descrito cinco variantes clínicas de manifestaciones cutáneas por COVID-19. Pocos reportes abordan el tema de la gravedad de las dermatosis cutáneas de COVID-19 y el pronóstico. OBJETIVO: Describir patrones clínicos e histológicos de dermatosis en pacientes con COVID-19. Pacientes y MÉTODOS: Es una cohorte para pacientes del IMSS-T1 en León, Guanajuato, México, entre septiembre 2020 y enero 2021. Identificamos pacientes con dermatosis asociada a COVID-19 desde su ingreso hospitalario y aquellos que la desarrollaron durante su estancia. Se les invitó a participar para evaluación clínica y toma de biopsia que fueron descritas por un patólogo experto. RESULTADOS: La frecuencia de las dermatosis por COVID-19 fue de 15,7%. Los que desarrollaron las lesiones durante su estancia hospitalaria presentaron mayor morbi-mortalidad (p = 0,001). Las lesiones vaso-oclusivas fueron las más diagnosticadas y asociadas con mayor mortalidad (p = 0,003). Histológicamente el hallazgo más común fue trombosis superficial y profunda (58%). CONCLUSIONES: Los pacientes que desarrollaron las lesiones durante su hospitalización y aquellos con lesiones vaso-oclusivas tuvieron la mayor morbi-mortalidad. Las lesiones vaso-oclusivas pueden ser un factor de mal pronóstico en pacientes con COVID-19.

BACKGROUND: COVID-19 disease, besides presenting respiratory manifestations, can affect other organs such as kidneys, gastrointestinal system, heart, and skin. So far, five clinical variants of dermatoses have been described. Few reports discuss the severity associated with the cutaneous manifestations of COVID-19 and the prognosis. AIM: To describe the clinical and histopathological patterns of dermatoses in patients with COVID-19 infection. PATIENTS AND METHODS: Prospective cohort study conducted in patients admitted to "IMSS T1" in Leon, Guanajuato, Mexico from September 2020 to January 2021. We identified those with COVID-19 dermatosis from the moment they were admitted; and those who developed them during hospitalization. Patients were invited to participate for a clinical evaluation and biopsy. The biopsies were described by an expert pathologist. RESULTS: The frequency of dermatological lesions was 15.7%. Those who developed dermatosis during their hospital stay presented higher mortality (p = 0.001) and severity of COVID-19 (p = 0.001) Vasoocclusive lesions were the most frequent in the hospital setting, and were associated to higher mortality (p = 0.003). The most frequent histopathological feature was superficial and deep thrombosis (58%). CONCLUSIONS: Patients who developed dermatologic lesions during hospitalization and those with vaso-occlusive dermatoses had higher morbi-mortality. Vaso-occlusive lesions could be considered as a poor prognostic factor.

Pacientes con compromiso orbitario y renal: Diagnósticos diferenciales poco frecuentes / Patients with orbitary and kidney commitment: Rare differential diagnoses

Se comunica una serie de tres casos clínicos que consultaron al servicio de Reumatología por compromiso orbitario y renal. Uno de ellos presentó pseudotumor orbitario con proteinuria en rango nefrótico; se realizó biopsia y se encontró infiltrado linfoplasmocitario denso y fibrosis estoriforme con inmunohistoquímica: 15 células IgG4+ por campo de alto poder y relación IgG/IgG4 ≤40%, concluyendo diagnóstico de enfermedad relacionada por IgG4. El segundo y tercer caso presentaron compromiso ocular con "ojos de mapache" y lesiones amarillentas en párpados, ambos con proteinuria >500 mg/24 h, con biopsia de piel rojo Congo positiva y birrefringencia verde manzana con luz polarizada. Se discuten distintos diagnósticos diferenciales poco frecuentes a tener en cuenta en estos pacientes.

A series of three cases that consulted the rheumatology service due to orbital and renal involvement is reported. One of them presented orbital pseudotumor with proteinuria in the nephrotic range, a biopsy was performed, finding dense lymphoplasmacytic infiltrate and storiform fibrosis with immunohistochemistry: 15 IgG4 positive cells per HPF and IgG/IgG4 ratio ≤40%, concluding diagnosis of IgG4 related disease. The second and third cases presented ocular involvement with raccoon eyes and yellowish lesions on the eyelids, both with proteinuria greater than 500 mg/24 h, with apple-green birefringence of amyloid on congo red staining. Different rare differential diagnoses to take into account in these patients are discussed.

Esteatocistoma solitario de cuero cabelludo / Solitary steatocystoma of the scalp

El esteatocistoma es un hamartoma quístico de la porción media de las unidades folículo sebáceas que afecta principalmente el ducto sebáceo. Comúnmente se encuentra de manera múltiple y se transmite en forma autosómica dominante; en algunos casos se presenta en un contexto no familiar y en otros puede ser solitario. La primera descripción del esteatocistoma múltiple (EM) muy probablemente corresponde a Jamieson en 1873. La forma solitaria de esteatocistoma fue descrito por primera vez en 1982 por Brownstein y existen pocos casos descritos en la literatura Presentamos un caso clínico de paciente varón joven con tumoración solitaria en cuero cabelludo que fue extirpado cuyo resultado histopatológico fue de esteatocistoma solitario.

Steatocystoma is a cystic hamartoma of the middle portion of the sebaceous follicular units that mainly affects the sebaceous duct. It commonly presents in multiple forms and is transmitted in an autosomal dominant manner; in some cases, it occurs in a non-familial context and in others it may be solitary. The first description of steatocystoma multiplex (MS) is most likely by Jamieson in 1873. The solitary form of steatocystoma was first described in 1982 by Brownstein and there are few cases described in the literature. We present a clinical case of a young male patient with a solitary tumor on the scalp that was excised and whose histopathological result was solitary steatocystoma.

Upper eyelid juvenile xanthogranuloma: a case report / Xantogranuloma juvenil em pálpebra superior: relato de caso

ABSTRACT Juvenile xanthogranuloma is a rare benign non-Langerhans cell histiocytosis. Clinical manifestation usually occurs up to the age of 2 years, with yellowish papules and variable clinical progression. Approximately 0.75% of patients had systemic involvement and 0.25%, ocular alterations. The purpose of this report is to describe a case of a preschool 2-year-old female patient, with nodules in the upper right eyelid, 0.5-cm wide, with well-defined edges, an uncertain date of onset, a stable growth for 6 months, with no inflammatory signs, pruritus, pain, bleeding, or other similar lesions in the body. No further changes were observed in the physical examination. Histopathological examination of the specimen showed a skin lesion with histiocytoid, spindle-shaped cells and xanthomized cells, inflammatory infiltrate and numerous Touton giant cells. The result was compatible with diagnosis of juvenile xanthogranuloma. Therefore, the importance of including juvenile xanthogranuloma in the differential diagnosis of eyelid lesions is emphasized, especially in children.

RESUMO O xantogranuloma juvenil é uma patologia histiocítica benigna rara. A manifestação clínica ocorre geralmente até os 2 anos de idade com pápulas amareladas e evolução clínica variável. Cerca de 0,75% dos pacientes apresentaram comprometimento sistêmico e 0,25%, comprometimento ocular. O objetivo deste relato é descrever o caso de uma pré-escolar de 2 anos do sexo feminino, com nodulação em pálpebra superior direita, 0,5cm de base e bordos bem definidos, data de início não estimada, mas crescimento estável há 6 meses, sem sinais flogísticos, prurido, dor, sangramentos ou outras lesões similares no corpo. Sem mais alterações ao exame físico. A análise histopatológica da peça evidenciou lesão cutânea com células histiocitoides, fusiformes e outras xantomizadas; infiltrado inflamatório de permeio e numerosas células gigantes do tipo Touton, resultado compatível com o diagnóstico de xantogranuloma juvenil. Assim, ressalta-se a importância da inclusão do xantogranuloma juvenil no diagnóstico diferencial de lesões palpebrais, especialmente em crianças.

Granuloma anular en niños: serie de casos / Annulare Granuloma in children: case series

Antecedentes: El Granuloma anular es una dermatosis benigna, autolimitada, de etiología desconocida, más frecuente en el género femenino y caracterizada por pápulas que adoptan usualmente una configuración anular. De acuerdo a su presentación ha sido clasificado en: localizado, generalizado, subcutáneo y perforante. El diagnóstico es clínico, pero en casos dudosos se recurre a estudios histopatológicos y dermatoscópicos. Su curso es generalmente autolimitado por lo que una conducta expectante, es lo más apropiado. Descripción de casos clínicos: Se presentan 3 casos pediátricos evaluados en la consulta externa del servicio de dermatología del Hospital Escuela, por lesiones localizadas principalmente en manos y pies. El caso 1 y 2, corresponden típicamente a granuloma anular localizado. El caso 3 presentó lesiones poco usuales, tipo pápulas de 1 a 3 mm de diámetro con umbilicación central, correspondiendo clínicamente a una variante rara, de granuloma anular papular umbilicado. La biopsia confirmó el diagnóstico de granuloma anular en los 3 casos. Conclusiones: El conocimiento de esta patología relativamente frecuente, permitirá al gremio médico en general y pediatras en particular, reconocer que se trata de una enfermedad que tiene un curso benigno y autolimitado, evitando así procedimientos agresivos e innecesarios...(AU)

Acquired reactive perforating collagenosis in association with prostate adenocarcinoma, chronic lymphocytic leukemia, and Graves disease

Abstract Acquired reactive perforating collagenosis is a rare skin disorder characterized by the presence of umbilicated pruritic papules and nodules. Transepidermal elimination of altered and perforating bundles of basophilic collagen from the epidermis is a characteristic histologic feature of acquired reactive perforating collagenosis. Along with its well-known association with systemic diseases such as diabetes mellitus, chronic renal failure, and dermatomyositis, there are reports of acquired reactive perforating collagenosis being associated with malignancies. Herein, we present a case of acquired reactive perforating collagenosis associated with chronic lymphocytic leukemia, prostate adenocarcinoma, and Graves's disease. Clinicians are required to be more vigilant in evaluating patients with acquired reactive perforating collagenosis due to its unique association with malignancies and other systemic diseases.

Cutaneous sarcoidosis: clinico-epidemiological profile of 72 patients at a tertiary hospital in São Paulo, Brazil,

Abstract Background: Sarcoidosis is a multisystem disease of unknown cause that is characterized by the presence of granulomas in various organs. Cutaneous involvement is common and the reported incidence has varied from 9% to 37%. Studies on cutaneous sarcoidosis in Brazil are lacking. Objectives: To describe the clinical and epidemiological aspects of patients with cutaneous sarcoidosis diagnosed at the Department of Dermatology of the University of São Paulo, from May 1994 to March 2018. Methods: Clinical data of patients with confirmed cutaneous sarcoidosis were retrospectively reviewed and classified according to gender, ethnicity, age at diagnosis, cutaneous presentation, systemic involvement and treatment. Results: Cutaneous sarcoidosis was diagnosed in 72 patients with a female predominance (74%). The mean age at diagnosis was 49.6 years and most of the patients were white (61%). Papules and plaques were the most common lesions. Systemic sarcoidosis was detected in 81% of patients, affecting mainly the lungs and thoracic lymph nodes (97%). Typically, cutaneous lesions were the first manifestation (74%). Systemic therapy was necessary for 72% of patients; the dermatologist managed many of these cases. Oral glucocorticoids were the most commonly used systemic medication (92%). The mean number of systemic drugs used was 1.98 per patient. Limitations: Insufficient data in medical records. Conclusions: This series highlights the dermatologist role in recognizing and diagnosing cutaneous sarcoidosis, evaluating patients for systemic disease involvement and treating the skin manifestations. Cutaneous sarcoidosis was once considered exceedingly infrequent in Brazil in comparison to infectious granulomatous diseases; however, the present series seems to suggest that the disease is not so rare in this region.

Small fiber neuropathy and related factors in patients with systemic lupus erythematosus; the results of cutaneous silent period and skin biopsy

Abstract Introduction Evaluating small nerve fibers in patients with systemic lupus erythematosus (SLE) using cutaneous silent period (CSP) and skin biopsy and assesssing the relationship between clinical signs, autoantibodies and neuropathic pain score. Objective - methods Fifty one SLE patients and 46 healthy volunteers were included in this study. Nerve conduction studies and CSP were performed both on upper and lower limbs in subjects. Skin biopsy was performed and the number of epidermal nerve density and IL-6 staining were evaluated. Results In SLE patients, CSP latencies were significantly prolonged both in lower and upper limbs and lower and upper extremity CSP durations were significantly shorter when compared to controls ( p < 0.001). The number of epidermal nerve was significantly lower in SLE patients when compared to healthy controls ( p < 0.001). Conclusion We detected marked small nerve fiber damage in both lower and upper limbs in SLE patients using CSP. Decreased epidermal nerve density also supports this finding.(AU)

Lobular capillary hemangioma in a patient with ankylosing spondylitis using adalimumab: an exuberant presentation

Abstract Lobular capillary hemangioma or pyogenic granuloma is a benign vascular tumor of the skin or mucous membranes. Most patients present a single lesion. It manifests clinically as an erythematous, friable, and fast-growing tumor. This report details a case with exuberant presentation in a patient with ankylosing spondylitis, using adalimumab. Factors triggering pyogenic granuloma are not well known. They may spontaneously regress, but most require treatment.

Granulomatous pigmented purpuric dermatosis: report of a Latin-American case with blaschkoid distribution

Abstract Granulomatous pigmented purpuric dermatosis clinically manifests as hyperpigmented maculae and petechiae, predominantly on the lower extremities. Histopathologically, it is characterized by a lymphocytic infiltrate in the upper dermis, extravasated erythrocytes, and hemosiderin deposits. There is an infrequent variant called granulomatous pigmented purpuric dermatosis, which histologically is characterized by the presence of non-necrotizing granulomas associated with the classic findings of other pigmented purpuric dermatoses. It more frequently affects middle-aged women of Asian origin, and predominantly on the lower extremities. The authors present the case of a female patient with granulomatous pigmented purpuric dermatosis on the lower extremities with blaschkoid distribution.

Dermatoses in the early neonatal period: their association with neonatal, obstetric and demographic variables / Dermatoses no período neonatal precoce: associação com variáveis neonatais, obstétricas e demográficas

ABSTRACT Objective: To evaluate the prevalence of neonatal dermatoses in the early neonatal period and to associate them with neonatal, demographic and obstetric variables. Methods: A cross-sectional study with neonates and their respective mothers, who were hospitalized in a public maternity hospital in Curitiba, PR, Brazil. Data collection was performed using information present in the medical records and a physical examination of the newborn during the period between April 2015 and May 2016. Results: 350 neonates were evaluated. 54.8% were male, and 94.8% (332/350) presented a dermatosis. Among them, 84.6% had, concomitantly, two or more dermatoses. A total of 23 types of dermatoses were diagnosed. The most prevalent were: sebaceous hyperplasia (66%); fluff (42.6%); and salmon patches (41.4%). The mean age of the mothers was 24.9±4.9 years old, and they were predominately white (57.7%). Vernix caseosa was associated with the female gender (p=0.034). Nonwhite mothers were associated with genital hyperpigmentation (p=0.03) and Mongolian spots (p=0.001). Physiological flaking was associated with cesarean deliveries (p=0.03) and a gestational age of over 40 weeks (p=0.054). Salmon patches was associated with primiparity (p=0.0001). Conclusions: There was a high prevalence of neonatal dermatosis in the studied population. Each newborn had, on average, three different dermatoses. Dermatosis in neonates was associated with primiparity, nonwhites, a gestational age of over 40 weeks, and the sex of the newborn.

RESUMO Objetivo: Avaliar a prevalência de dermatoses no período neonatal precoce e associar sua ocorrência a variáveis neonatais, demográficas e obstétricas. Métodos: Estudo transversal com neonatos e respectivas puérperas internados em alojamento conjunto de uma maternidade pública de Curitiba (PR). A coleta de dados foi realizada por meio de informações presentes nos prontuários e no exame físico do recém-nato durante o período de abril de 2015 a maio de 2016. Resultados: Foram avaliados 350 recém-nascidos, 54,8% do sexo masculino, e 332 (94,8%) apresentaram dermatoses. Desses 332, 84,6% tiveram, concomitantemente, duas ou mais dermatoses. Diagnosticou-se o total de 23 tipos de dermatoses, sendo mais prevalentes: hiperplasia sebácea (66,6%); lanugem (42,6%); e mancha salmão (41,4%). A média de idade das puérperas foi de 24,9±4,9 anos, com predomínio de etnia branca (57,7%). Vérnix foi associado a sexo feminino (p=0,034). A etnia materna não branca associou-se à hiperpigmentação genital (p=0,030) e mancha mongólica (p=0,001). A descamação fisiológica associou-se ao parto cesáreo (p=0,030) e à idade gestacional acima de 40 semanas (p=0,054); e mancha salmão, à primiparidade (p=0,0001). Conclusões: Verificou-se alta prevalência de dermatose neonatal na população estudada, sendo cada recém-nascido acometido em média por três tipos. Houve associação da presença de dermatoses com primiparidade, mães não brancas, idade gestacional superior a 40 semanas e sexo do neonato.

Combined high-frequency and Doppler ultrasound in early diagnosis of atrophoderma of Pasini and Pierini

Abstract: Atrophoderma of Pasini and Pierini is a skin disorder affecting dermal collagen and is clinically characterized by well-defined plaques of depressed skin. Histopathological changes are subtle, and in most cases, the diagnosis requires a comparative study with healthy skin from the same anatomical site. High frequency ultrasound is a useful imaging method for diagnosis of atrophic skin changes. A case is presented in which ultrasound can support the clinical and the histopathological diagnosis of atrophoderma of Pasini and Pierini.

Lichen myxedematosus: a rare group of cutaneous mucinosis

Abstract: Cutaneous mucinoses are a heterogeneous group of dermatoses in which excess deposition of mucin in the dermis gives the skin a waxy appearance, with papules and plaques that can vary from self-healing mucinosis to even disrupting the normal shape of a patient's face, conferring a leonine facies, or be part of life threatening diseases like scleromyxedema. This review will describe the most recent classification on lichen myxedematosus in the generalized (scleromyxedema) and the localized forms, as well as the different organ systems involved in scleromyxedema, diagnostic workup, current management, and prognosis.