Treatment of acquired perforant dermatoses with allopurinol / Tratamento de dermatose perfurante adquirida com alopurinol

Perforating dermatoses are papulonodular cutaneous pathologies characterized by transepithelial extrusion of components of the extracellular matrix of the dermis, by inflammation or degeneration. When secondary, the systemic diseases are called Acquired Perforating Diseases. Our letter aims to report a case of acquired perforating dermatoses secondary to chronic renal dialysis. The treatment with Allopurinol proved to be effective in this case. Allopurinol would act as an antioxidant, reducing the inflammatory reaction in tissues and consequent damage to the collagen fibers (AU)

Dermatoses perfurantes são patologias cutâneas papulonodulares que se caracterizam pela extrusão transepitelial de componentes da matriz extracelular da derme, por inflamação ou degeneração. Quando são secundárias as doenças sistêmicas são chamadas Doenças Perfurantes Adquiridas. Nossa carta tem como objetivo relatar caso de dermatose perfurante adquirida secundária a insuficiência renal crônica dialítica. O tratamento com Alopurinol se mostrou eficaz neste caso. O Alopurinol atuaria como antioxidante, reduzindo a reação inflamatória nos tecidos e consequentes danos nas fibras colágenas (AU)

Advances on the research and treatment of autoimmune disease-related chronic wounds / 中华烧伤杂志

Autoimmune disease is a disease caused by the body's immune system being misdirected to attack the host itself. Patients with this type of diseases are in poor general condition, and are affected by vascular and skin tissue lesions, and therapeutic drugs. Once the skin is broken, chronic wounds that do not heal could easily develop. This type of wounds is difficult to treat and requires joint diagnosis and treatment of multidisciplinary physicians. Therefore, this article reviews the advances on research and treatment of autoimmune disease-related chronic wounds in order to provide reference for their clinical treatment.

History of dermatology: the study of skin diseases over the centuries

Abstract The study of skin, the science of dermatology, has undergone significant transformations throughout the centuries. From the first descriptions of skin diseases in Egyptian papyri and in Hippocratic writings to the first treatises on dermatology, important individuals and discoveries have marked the specialty. In the 18th and 19th centuries, the specialty consolidated itself as a field of medical study based on the first classifications of dermatoses, diagnostic methods, and drug treatments. In the 20th century, the scientific and technological revolution transformed dermatological practice, incorporating new therapeutic resources, as well as surgical and aesthetic procedures. In the face of such a vigorous process, it is important to provide a historical synthesis for the medical community to recognize and understand the origins that supported one of the most relevant specialties in the current medical scenario.

Probióticos y prebióticos: beneficios en dermatología / Probiotics and prebiotics: benefits in dermatology

La piel es el órgano más extenso del cuerpo humano, y constituye el límite físico entre el individuo y su entorno; a pesar de tener un sistema inmunológico funcional la piel está colonizada por diversos tipos de microorganismos, en su mayoría benéficos, que en conjunto componen el microbioma cutáneo, el cual juega un papel importante en la homeostasis corporal y su modificación está implicada en diversas patologías, lo que lo ha convertido en una potencial diana terapéutica. Los probióticos y prebióticos se han estudiado en afecciones inflamatorias de la piel como la dermatitis atópica, el acné, la dermatitis seborreica y el cáncer de piel. En esta revisión describimos a la luz de la evidencia actual su eficacia en dermatosis relacionadas con disbiosis cutánea.

The skin is the largest organ in the human body and constitutes the physical boundary between the individual and their environment; despite having a functional immune system, the skin is colonized by various types of microorganisms, mostly beneficial, which together constitute the skin microbiome, which plays an important role in body homeostasis and its modification is involved in various pathologies, which has made it a potential therapeutic target. Probiotics and prebiotics have been studied in inflammatory skin conditions such as atopic dermatitis, acne, seborrheic dermatitis, and skin cancer. In this review we describe its efficacy in dermatoses related to cutaneous dysbiosis in light of current evidence.

Pioderma gangrenoso após mamoplastia redutora: desafios diagnóstico e terapêutico / Pyoderma gangrenosum after reduction mammoplasty: diagnostic and therapeutic challenges

O pioderma gangrenoso (PG) é doença inflamatória da pele, que pode se desenvolver espontaneamente, associado a certas doenças sistêmicas e neoplásicas, ou ao trauma cirúrgico, incluindo os das mamas. Há relatos cada vez mais frequentes, considerando o aumento desse procedimento nos dias atuais. A manifestação clínica das úlceras é característica e deve ser lembrada nas evoluções cicatriciais desfavoráveis com intensa reação inflamatória, perdas teciduais, secreção sanguinolenta e/ ou purulenta, fundo granuloso e bordas elevadas. Relatase o caso de paciente que teve pioderma gangrenoso após mamoplastia redutora. Respondeu ao corticosteroide sistêmico, e vem evoluindo sem recidivas até o momento.

Pyoderma gangrenosum (PG) is an inflammatory disease of the skin that may develop spontaneously. It is associated with certain systemic and neoplastic diseases, including those of the breasts. PG is also associated with surgical trauma. It has been increasingly reported, along with the increase in the incidence of reduction mammoplasty procedures. The clinical manifestation of ulcers is characteristic of PG and it should be considered in cases of poor healing with intense inflammatory reaction, tissue loss, bloody and/ or purulent secretion, granular background, and lesions with high edges. We describe a patient who developed PG after reduction mammoplasty. She has since responded to systemic corticosteroids and has had no relapse to date.

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.

Dermatosis autoinfligida: presentación de un caso y revisión / Self-inflicted dermatosis: presentation of a case and review

Las dermatosis autoinfligidas representan un motivo habitual de consulta, así como un desafío diagnóstico y terapéutico. Se caracterizan por la autoprovocación de lesiones cutáneas de manera consciente o inconsciente en el contexto de trastornos psiquiátricos complejos. Comunicamos el caso de una paciente que consultó al Servicio de Dermatología por úlceras irregulares y sobreinfectadas localizadas en rostro, de 2 meses de evolución. El caso representó una dificultad diagnóstica ya que solo a partir del interrogatorio exhaustivo y los exámenes complementarios, que descartaron otras patologías, se arribó al diagnóstico de úlceras autoprovocadas en contexto de patología psiquiátrica que requirió manejo interdisciplinario. (AU)

Self-inflicted dermatoses are a frequent cause for consultation and represent a diagnostic and therapeutic challenge. They are characterized by the conscious or unconscious self-generation of cutaneous lesions in the context of complex psychiatric disorders. We report the case of a patient who consulted at the dermatology department with two months history of irregular and superinfected ulcers located on the face. This case represented a diagnostic difficulty since only from an exhaustive interrogation and complementary examinations, which ruled out other pathologies, we arrived at the diagnosis of self-inflicted ulcers in the context of psychiatric pathology that required interdisciplinary management. (AU)

Dermatite piogranulomatosa ulcerativa em bovino por Corynebacterium pseudotuberculosis / Ulcerative pyogranulomatous dermatitis in bovine by Corynebacterium pseudotuberculosis

Relata-se um caso de lesão cutânea secundária à infecção por Corynebacterium pseudotuberculosis em bovino. Abscessos e múltiplas lesões cutâneas nodulares, variando de 8x10 para 20x25cm de diâmetro, firmes, sensíveis ao toque e sem mobilidade, algumas com superfície ulcerada, circundada por halo avermelhado e drenando secreção piossanguinolenta, e outras com superfícies alopécicas, foram identificados na região torácica lateral do animal. Exames histopatológicos e o isolamento do agente de fragmentos obtidos após remoção cirúrgica das lesões confirmaram tratar-se da forma cutânea da infecção pelo C. pseudotuberculosis. As lesões microscópicas caracterizaram-se por dermatite nodular piogranulomatosa e ulcerativa. A avaliação da susceptibilidade in vitro do C. pseudotuberculosis a antimicrobianos demonstrou que o agente era resistente à amicacina, kanamicina, neomicina e penicilina G, apresentando sensibilidade à ampicilina adicionada de subactam, amoxicilia com ácido clavulônico, cefalexina, cefalotina, cefotaxima, enrofloxacina, gentamicina e tetraciclina. A retirada cirúrgica das lesões e o tratamento com enrofloxacina resultaram na cura do animal. Lesões de pele observadas em casos de ptiose, carcinoma de células escamosas e na forma atípica da actinobacilose devem ser consideradas no diagnóstico diferencial da forma cutânea da infecção por C. pseudotuberculosis em bovinos. Os dados apresentados demonstram que a infecção pelo C. pseudotuberculosis deve ser considerada no diagnóstico diferencial das lesões de pele em bovinos no Brasil.(AU)

We report a case of secondary skin lesionby infection with Corynebacterium pseudotuberculosis in bovine. Abscesses and multiple nodular lesions, ranging from 8x10 to 20x25 cm in diameter, firm, sensitive to touch, and without mobility, some with ulcerated surface, surrounded by reddish halo and draining piosanguinolenta secretion, and other surfaces with alopecia, were identified in the skin of the animal`s thoracic area. Histopathology and isolation of the agent from fragments obtained after surgical removal of the lesions confirmed the cutaneous infection by C. pseudotuberculosis. Microscopic lesions were characterized by lumpy skin disease and ulcerative pyogranulomatous. Evaluation of in vitro susceptibility to antimicrobial demonstrated that the agent was resistant to amikacin, kanamycin, neomycin and penicillin G, and sensitive to ampicillin + subactam, amoxicilia with clavulonic acid, cephalexin, cephalothin, cefotaxime, enrofloxacin, gentamicin, and tetracycline. The surgical removal of the lesions, and treatment with enrofloxacin resulted in animal cure. Skin lesions observed in case of ptiose, squamous cell carcinoma and atypical form of Actinobacillosis should be considered in the differential diagnosis of cutaneous form of C. pseudotuberculosis infection in cattle. The data presented demonstrate that infection with C. pseudotuberculosis should be considered in the differential diagnosis of skin lesions in cattle in Brazil.(AU)

Sensitive skin: review of an ascending concept

Abstract: Sensitive skin is a condition characterized by stinging, burning and itching sensations. The diagnosis, pathophysiology and treatment of sensitive skin are still under discussion. In the last years, studies on its epidemiology have been performed, showing a high prevalence and impact on quality of life. Brazilian population was also considered in these studies. Cosmetics, climate changes and skin barrier impairment are the main factors that contribute for skin hyperreactivity. New studies are trying to bring new knowledge about the theme. This review will describe data on epidemiology, triggering factors, pathophysiology, diagnosis and treatment.

The need of dermatologists, psychiatrists and psychologists joint care in psychodermatology

Abstract: The mind-skin connection has been studied since the nineteenth century. The last 40 years have set the development of new research areas which allowed the clarifying of how these two dimensions interact. The diseases that involve skin and mind constitute the field of psychodermatology and require that specialists in dermatology, psychiatry and psychology together and integrated take part in it, since skin, nervous system and mind are simultaneously affected. This paper aims to expose how psychodermatoses are currently conceptualized and the need of integration of these three specialties for conveniently treating the patients.

Abordagem cutânea na necrólise epidérmica tóxica / Cutaneous approach in toxic epidermal necrolysis

Introdução: Necrólise epidérmica tóxica é uma erupção mucocutânea aguda grave, geralmente induzida por medicamentos, associada a alta taxa de morbidade e mortalidade. Os cuidados com as lesões mucosas e cutâneas e a abordagem multidisciplinar são muito importantes para o prognóstico e sequelas futuras. Objetivos: Discutir os principais aspectos dessa síndrome por meio da revisão de literatura, ilustrada por um caso clínico. Métodos: Revisão de literatura utilizando bases de dados on-line PubMed e Scielo. Incluímos artigos em língua inglesa, portuguesa, francesa e espanhola, e ilustração com caso clínico pediátrico. Termos procurados foram "toxic epidermal necrolysis", "Stevens-Johnson overlap", ''necrólise epidérmica tóxica'', ''síndrome Stevens-Johnson''. Resultados: Apresentamos dados para guiar o manejo de pacientes com necrólise epidérmica tóxica para cirurgiões plásticos, pediatras, intensivistas, dermatologistas e emergencistas. O caso tratado teve evolução favorável, sem sequelas cutâneas. Conclusão: O alto nível de suspeição é imprescindível para um diagnóstico e estratificação de risco adequados e instituição precoce de medidas de suporte, e o tratamento deve ser realizado por uma equipe multidisciplinar treinada para reduzir sequelas e mortalidade.

Introduction: Toxic epidermal necrolysis is a severe acute mucocutaneous condition usually induced by drugs associated with a high rate of morbidity and mortality. The care of the mucous lesions and skin and a multidisciplinary approach are very important for the prognosis and future sequelae. Objectives: To discuss the main aspects of this syndrome through a literature review illustrated by a clinical case. Methods: Review of the literature using the PubMed and SciELO online databases was performed. Articles in English, Portuguese, French, and Spanish were included and illustrated with a pediatric clinical case. The keywords used were as follows: "toxic epidermal necrolysis," "Stevens-Johnson overlap," "necrólise epidérmica tóxica," and "síndrome Stevens-Johnson." Results: We presented data to guide the management of patients with toxic epidermal necrolysis for plastic surgeons, pediatricians, intensivists, dermatologists, and emergency physicians. The case treated had a favorable disease course without sequelae. Conclusion: A high level of suspicion is necessary for an adequate diagnosis and risk stratification, and early support measures and treatment should be performed by a multidisciplinary team trained to minimize damage and mortality.

Cutaneous graft-versus-host disease after hematopoietic stem cell transplant - a review

Abstract Graft-versus-host disease (GVHD) is a major complication of allogeneic hematopoietic stem cell transplants (allo-HSCT) associated with significant morbidity and mortality. The earliest and most common manifestation is cutaneous graft-versus-host disease. This review focuses on the pathophysiology, clinical features, prevention and treatment of cutaneous graft-versus-host disease. We discuss various insights into the disease's mechanisms and the different treatments for acute and chronic skin graft-versus-host disease.

Perfil de clientes hospitalizados com lesões cutâneas / Perfil de los clientes hospitalizados con lesiones de piel / Profile of clients hospitalized with skin lesions

Introdução: ao se identificar os tipos mais frequentes de lesões que acometem os clientes internados, o enfermeiro deve planejar, organizar, implementar e avaliar as ações de cuidado a portadores de lesões ulcerativas, cirúrgicas e/ou traumáticas procurando minimizar o tempo de internação, diminuir os custos das internações prolongadas em decorrência de complicações e iatrogenias. Objetivo: caracterizar o perfil de clientes hospitalizados com lesões cutâneas. Métodos: estudo quantitativo e exploratório realizado nas enfermarias de clínica médica de um Hospital Universitário no Estado do Rio de Janeiro com 50 clientes que apresentavam alguma lesão cutânea no período de abril a julho de 2014. Foram utilizados dois instrumentos para coleta de dados: análise documental em prontuário e entrevista estruturada. Os dados foram submetidos à análise estatística simples. Resultados: maioria do sexo feminino (58 percento), média de idade de 58,33 ± 16,83 anos. A lesão cutânea mais prevalente foi a úlcera por pressão (20,3 percento) e quanto ao local, as lesões estavam localizadas nos membros inferiores (25,4 percento). Conclusão: o cuidado das lesões torna-se um aspecto importante na sistematização da assistência de enfermagem, pois o enfermeiro não deve contemplar somente a realização dos curativos, mas avaliar os fatores etiológicos e de risco relacionados à lesão cutânea(AU)

Introducción: para identificar los tipos más frecuentes de lesiones que afectan a los pacientes internados, el enfermero debe delinear, organizar, implementar y estimar las acciones de cuidado a los portadores de lesiones ulcerosas, quirúrgicas o traumáticas, procurando minimizar el tiempo de internación, disminuir los costos de las internaciones prolongadas y efectos de complicaciones e iatrogenias. Objetivo: caracterizar el perfil de los pacientes hospitalizados con lesiones de piel. Métodos: estudio exploratorio cuantitativo, llevado a cabo en las salas clínicas de un Hospital Universitario en el estado de Río de Janeiro con 50 pacientes que presentaron alguna lesión cutánea en el período de abril a julio de 2014. Se utilizaron dos instrumentos para recolectar datos: documento de análisis de tabla y entrevista estructurada. Los datos fueron sometidos a análisis estadístico simple. Resultados: predominóel sexo femenino (58 por ciento) y la edad media de 58,33 ± 16,83 años. La lesión cutánea más frecuente fue la úlcera de decúbito (20,3 por ciento) y en cuanto a la ubicación, las lesiones se localizaron en las extremidades inferiores (25,4 por ciento). Conclusión: el cuidado de la lesión se convierte en un aspecto importante en la sistematización de la atención de enfermería, porque la enfermera no debe contemplar sólo la realización de los vendajes, sino evaluar los factores etiológicos y el riesgo relacionados con la lesión cutánea(AU)

Introduction: the nurse must intervene in order to prevent and identify injuries, providing guidance related to the process of hospitalization and high planning this client, seeking to minimize the time and costs of hospitalization. Objective: to characterize the profile of clients hospitalized with skin lesions. Method: quantitative and exploratory study carried out in the clinical wards of a University Hospital in the State of Rio de Janeiro with 50 customers who presented some skin lesion in the period from April to July 2014. Two instruments were used to collect data: document analysis in chart and structured interview. The data were subjected to statistical analysis simple. Results: most female (58 percent), mean age of 58.33 ± 16.83 years. The most prevalent skin lesion was the pressure ulcer (20.3 percent) and as for the location, the lesions were located in the lower limbs (25.4 percent). Conclusion: the care of injury becomes an important aspect in the systematization of nursing care, because the nurse should not contemplate only the realisation of the dressings, but evaluate the etiological factors and risk related to skin lesion(AU)

Dermatology relevance to graduates from the Universidade Estadual de Campinas Medical School

AbstractBACKGROUND:Some research indicates that physicians do not dominate the expected dermatological content for the proper exercise of the profession. This fact compromises their diagnostic and therapeutic performance, generating unnecessary costs.OBJECTIVE:The aim of this study was to evaluate the relevance of Dermatology and the knowledge acquired in the specialty during the undergraduate course in clinical practice of graduates at the State University of Campinas Medical School (FCM/UNICAMP).METHOD:A questionnaire with 22 closed questions and two open ones was electronically sent to physicians who had graduated more than 10 years ago and others for less than 10 years. In the first group, physicians were trained by the same curriculum and in the second group there were subjects trained by the old and the new curriculum.RESULTS:Of the 126 respondents, 83% had completed a specialization course. Among all, 82% did not study dermatology after graduation. The majority considered that Dermatology has high relevance in clinical practice, regardless of the group. There was a statistically significant difference between non-dermatologist doctors graduated for more than 10 years and those graduated for less than 10 years regarding confidence about lesion diagnosis, diagnostic investigation and treatment of skin diseases. Physicians who have graduated for a longer time feel more insecure in relation to patients with dermatoses. Concerning contributions offered by graduation program completion they prioritized outpatient care, ability to diagnose, knowledge of pathology, research and knowledge of lesions.CONCLUSION:This study has shown that Dermatology is relevant in medical practice and more recent graduates from the FCM/UNICAMP feel less insecure when treating a patient with dermatoses.

Terra firma-forme dermatosis

Terra firma-forme dermatosis [TFFD] is a recently described cutaneous pigmentation disorder. It is a bizarre, acquired and idiopathic dermatosis and is characterized by brown, dirt-like discoloration that cannot be removed by bathing with water or rubbed off with routine detergent soap, but can be removed by isopropyl alcohol. A 20-year-old male came for treatment of chickenpox. Incidentally we observed multiple hyperpigmented plaques on the trunk and back, which disappeared on rubbing with isopropyl alcohol. He had normal washing habits and lesions disappeared after scrub bath. We propose scrub bath as one of the treatment modality