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1.
An. bras. dermatol ; 94(6): 744-746, Nov.-Dec. 2019. graf
Article in English | LILACS | ID: biblio-1054899

ABSTRACT

Abstract This report describes a case of unusual deep skin ulcers with tortuous sinus tract formation in an immunocompetent woman. She was initially diagnosed with a Staphylococcus aureus skin infection and histopathologically diagnosed with pyoderma gangrenosum. However, culture from the deep end of ribbon gauze inserted into the subcutaneous sinus tract revealed shiny, light-yellow mucoid colonies, which were identified as Cryptococcus neoformans var. grubii. She was treated with fluconazole for nine months and completely healed. Cryptococcosis is an opportunistic infection caused by variants of C. neoformans species. Cutaneous manifestations of cryptococcosis are quite divergent, rarely occurring as deep skin ulcers with sinus formation.


Subject(s)
Humans , Female , Adult , Skin Ulcer/microbiology , Skin Ulcer/pathology , Cryptococcosis/pathology , Cryptococcus neoformans/isolation & purification , Dermatomycoses/pathology , Immunocompetence , Skin Ulcer/drug therapy , Fluconazole/therapeutic use , Immunocompromised Host , Cryptococcosis/microbiology , Cryptococcosis/drug therapy , Dermatomycoses/microbiology , Dermatomycoses/drug therapy , Antifungal Agents/therapeutic use
2.
An. bras. dermatol ; 94(5): 615-617, Sept.-Oct. 2019. graf
Article in English | LILACS | ID: biblio-1054849

ABSTRACT

Abstract Langerhans cell histiocytosis is a rare clonal proliferative disease, characterized by the infiltration of one or multiple organs by histiocytes. Due to the diversity of signs and symptoms, the diagnosis of this disease is often late. The estimated incidence in adults is one to two cases per million, but the disease is probably underdiagnosed in this population. This report presents a case of disseminated Langerhans cell histiocytosis. The authors highlight the most characteristic aspects of this rare and heterogeneous disease, which usually presents as a challenging clinical diagnosis.


Subject(s)
Humans , Female , Middle Aged , Skin Ulcer/pathology , Histiocytosis, Non-Langerhans-Cell/pathology , Skin Ulcer/diagnosis , Biopsy , Immunohistochemistry , Histiocytosis, Non-Langerhans-Cell/diagnosis
3.
Rev. chil. dermatol ; 35(4): 146-149, 2019. ilus
Article in Spanish | LILACS | ID: biblio-1120285

ABSTRACT

Se presenta caso de paciente masculino de 67 años de edad, fototipo III, con antecedentes patológicos personales de lepra lepromatosa en tratamiento, que acude a consulta especializada de Dermatología en el Hospital Guillermo Fernández Baquero (La Habana, Cuba) por lesiones ulcerosas diseminadas. Se realizan complementarios y se concluye caso como fenómeno de Lucio. Resaltando la infrecuencia de este eritema necrosante y la severidad de los estados reactivos de la lepra pues son procesos distintos pero destructores de los tejidos, supuestamente dirigidos por el sistema inmunológico que aumentan en gran medida la morbimortalidad de esta enfermedad


A case of a 67 year old male patient, phototype III, with a personal pathological history of lepromatous leprosy in treatment is presented at a specialized dermatology clinic at Guillermo Fernández Vaquero hospital for disseminated ulcerative lesions. Complementary are performed and case is concluded as a phenomenon of Lucio. Highlighting the infrequency of this necrotizingerythema and the severity of the reactive states of leprosy are different but destructive processes of the tissues, supposedlydirected by the immune system that greatly increase the morbidity and mortality of this disease.


Subject(s)
Humans , Male , Aged , Skin Ulcer/diagnosis , Skin Ulcer/etiology , Leprosy, Lepromatous/complications , Skin Ulcer/pathology , Erythema , Necrosis
4.
Rev. Hosp. Ital. B. Aires (2004) ; 38(2): 82-84, jun. 2018. ilus.
Article in Spanish | LILACS | ID: biblio-1023177

ABSTRACT

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)


Subject(s)
Humans , Skin Ulcer/psychology , Mental Disorders/complications , Signs and Symptoms , Skin Diseases/diagnosis , Skin Diseases/etiology , Skin Diseases/pathology , Skin Diseases/psychology , Skin Diseases/therapy , Skin Ulcer/pathology , Skin Ulcer/therapy , Facial Injuries/pathology , Facial Injuries/therapy , Degloving Injuries/etiology , Degloving Injuries/therapy
5.
An. bras. dermatol ; 93(1): 19-26, Jan.-Feb. 2018. tab, graf
Article in English | LILACS | ID: biblio-887157

ABSTRACT

Abstract: Background: Melanoma is a malignant neoplasia that shows high mortality when diagnosed in advanced stages. Early identification of high-risk patients for the development of melanoma metastases is the main strategy to reduce mortality. Objective: To assess the influence of eight epidemiological and histopathologic features on the development of metastases in patients diagnosed with primary cutaneous melanoma. Methods: Our historical cohort comprised patients with invasive primary cutaneous melanoma seen between 1995 and 2012 at a public university hospital and a private oncologic surgery institution in Southeastern Brazil. The following variables were analyzed: gender, age, family history of melanoma, site of the primary tumor, clinical and histologic subtype, Breslow thickness, histologic ulceration and the mitotic index. Kaplan-Meier univariate test and multivariate Cox proportional hazard analysis were used to assess factors associated with disease-free survival. Results: Five hundred and fourteen patients were enrolled. The univariate analysis identified the following significant risk factors: gender, age, site of the tumor, clinical and histologic subtype, Breslow thickness, histologic ulceration and mitotic index. Multivariate analysis included 244 patients and detected four significant prognostic factors: male gender, nodular clinical and histologic subtype, Breslow thickness > 4mm, and histologic ulceration. The mitotic index was not included in this analysis. Study limitations: Small number of patients in multivariate analysis. Conclusions: The following prognostic factors to the development of melanoma metastasis were identified in the study: male gender, nodular histologic subtype, Breslow thickness > 4mm and ulceration.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Skin Neoplasms/pathology , Skin Ulcer/diagnosis , Melanoma/secondary , Prognosis , Skin Ulcer/pathology , Proportional Hazards Models , Sex Factors , Risk Factors , Analysis of Variance , Age Factors , Melanoma/pathology , Neoplasm Staging
6.
Arch. argent. pediatr ; 115(6): 436-439, dic. 2017. ilus, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-887409

ABSTRACT

Las úlceras genitales son una patología poco frecuente en las consultas de pediatría, pero que generan gran ansiedad familiar. Las úlceras de Lipschütz son úlceras vulvares agudas, dolorosas y autolimitadas de causa desconocida. Aparecen en mujeres jóvenes que no han tenido relaciones sexuales previas o tras un período de abstinencia. Paciente de 10 años con úlceras vulvares dolorosas que, tres días antes de la aparición de las lesiones, había presentado un cuadro de deposiciones diarreicas y fiebre. Se realizó una anamnesis y exploración física detallada y se llevaron a cabo diferentes pruebas complementarias para descartar enfermedades infecciosas de origen venéreo y no venéreo, todas ellas negativas. Se indicó tratamiento sintomático, y se observó, al mes, una completa resolución del cuadro, por lo que se confirmó el diagnóstico de úlceras de Lipschütz.


Genital ulcers are a rare entity in pediatric consultation, but they generate great family anxiety. Lipschütz ulcers are acute, painful, and self-limiting vulvar ulcers of unknown cause. These ulcers appear in young women who have not had previous sexual intercourse or after a period of sexual abstinence. We present a 10-year-old girl with painful vulvar ulcers with a 3-day history of diarrhea and fever before the onset of the lesions. A complete anamnesis and detailed physical examination were carried out and complementary tests were performed to investigate sexually and non-sexually transmitted disease; the results were negative. Symptomatic treatment was started; at one-month follow-up a complete resolution of ulcers confirmed the diagnosis of ulcer of Lipschütz.


Subject(s)
Humans , Female , Child , Skin Ulcer/pathology , Vulvar Diseases/pathology , Skin Ulcer/diagnosis , Vulvar Diseases/diagnosis , Acute Disease , Diagnosis, Differential
8.
Rev. Assoc. Med. Bras. (1992) ; 63(5): 422-426, May 2017. tab, graf
Article in English | LILACS | ID: biblio-896345

ABSTRACT

Summary Introduction: In systemic sclerosis (SSc), digital ulcers (DU) are debilitating and recurrent. They are markers of prognosis and are associated with disability and mortality. Treatment strategies have been developed to block the proposed mechanisms of this complication. Objective: Clinical description of a population of SSc patients with DU, treatment, complications and outcome. Method: Analysis of 48 SSc patients meeting 2013 ACR-EULAR criteria, followed between 1999-2015; 13 patients had DU. Treatment protocol applied included cycles of 21 days of alprostadil, which can be repeated in the absence of DU healing. After DU healing, bosentan was initiated. Results: DU healing was achieved with intravenous prostanoid in 12 patients; seven patients required repeated treatment for DU healing. Twelve patients were later treated with bosentan; three of them experienced recurrence of DU, while one was anti-B2-GPI positive. Four patients had soft tissue loss and three other suffered digital amputation, these being late diagnosis. Conclusion: Younger patients and early referrals had better outcomes. Endothelin receptor antagonist toxicity should be monitored, particularly in patients previously exposed to hepatotoxic drugs.


Resumo Introdução: As úlceras digitais (UD) são complicações incapacitantes e recorrentes, associadas a menor qualidade de vida e maior mortalidade na esclerose sistêmica (ES). O tratamento baseia-se em antagonizar os mecanismos fisiopatológicos em causa. Objetivo: Descrever uma amostra de doentes com diagnóstico de ES e UD, o tratamento, as complicações e os resultados clínicos. Método: Série de 48 casos diagnosticados com ES, critérios de classificação ACR-EULAR 2013, seguidos entre 1999 e 2015, dos quais 13 apresentavam UD. O protocolo aplicado incluía ciclos de 21 dias de alprostadil podendo ser repetidos no caso de não existir cicatrização. Nos casos em que houve cicatrização foi iniciado bosentano. Resultados: No tratamento das UD, 12 doentes realizaram prostaciclina endovenosa, com necessidade de tratamentos repetidos em sete doentes. Doze doentes foram posteriormente tratados com bosentano, com recorrência de UD em três doentes, um deles com presença de anti-B2-GPI. Quatro doentes ficaram com cicatrizes e em três houve amputação digital, sendo casos de diagnóstico tardio. Conclusão: Os doentes mais jovens tiveram melhores resultados, possivelmente em razão de melhorias globais nos cuidados de saúde prestados e de referenciação precoce. A toxicidade dos antagonistas dos receptores da endotelina deve ser monitorizada, sobretudo em doentes com exposição prévia a drogas hepatotóxicas.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Scleroderma, Systemic/complications , Skin Ulcer/etiology , Skin Ulcer/drug therapy , Sulfonamides/therapeutic use , Vasodilator Agents/therapeutic use , Alprostadil/therapeutic use , Fingers , Endothelin Receptor Antagonists/therapeutic use , Skin Ulcer/pathology , Time Factors , Wound Healing/drug effects , Reproducibility of Results , Treatment Outcome , Dose-Response Relationship, Drug , Bosentan , Hand Dermatoses/etiology , Hand Dermatoses/pathology , Hand Dermatoses/drug therapy , Middle Aged
11.
An. bras. dermatol ; 92(5,supl.1): 148-150, 2017. graf
Article in English | LILACS | ID: biblio-887082

ABSTRACT

Abstract Trigeminal trophic syndrome is an uncommon cause of facial ulcers, that affects the sensitive area of the trigeminal nerve. We present the case of an 84-year-old patient with ulcerated facial trigeminal trophic syndrome, and report the development of a clinico-dermoscopic approach for his clinical examination. The value of this model for the diagnosis of facial ulcers suspected to be a rodent ulcer basal cell carcinoma is suggested.


Subject(s)
Humans , Animals , Male , Aged, 80 and over , Skin Neoplasms/pathology , Skin Ulcer/pathology , Carcinoma, Basal Cell/pathology , Trigeminal Nerve Diseases/pathology , Facial Dermatoses/pathology , Syndrome , Magnetic Resonance Imaging , Dermoscopy , Diagnosis, Differential
12.
An. bras. dermatol ; 91(6): 815-816, Nov.-Dec. 2016. graf
Article in English | LILACS | ID: biblio-837971

ABSTRACT

Abstract Ecthyma gangrenosum is an uncommon dermatological manifestation characterized by round, indurated ulcers with a central necrotic black eschar and surrounding erythema. This report describes the case of a 5-year-old girl, affected by acute lymphocytic leukemia, presenting with a black eschar on her right thigh. Such lesions should always be correctly identified to avoid potentially fatal bacteraemia. Furthermore, because of its similar clinical presentation, cutaneous anthrax must be ruled out.


Subject(s)
Humans , Female , Child, Preschool , Pseudomonas Infections/microbiology , Skin Ulcer/microbiology , Ecthyma/microbiology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Pseudomonas aeruginosa , Pseudomonas Infections/pathology , Skin Ulcer/pathology , Ecthyma/pathology
13.
J. vasc. bras ; 15(4): 287-292, Oct.-Dec. 2016. graf
Article in English | LILACS | ID: biblio-841391

ABSTRACT

Abstract Air plethysmography is a non-invasive test that can quantify venous reflux and obstruction by measuring volume changes in the leg. Its findings correlate with clinical and hemodynamic measures. It can quantitatively assess several components of venous hemodynamics: valvular reflux, calf muscle pump function, and venous obstruction. Although clinical uses of air plethysmography have been validated, it is used almost exclusively for medical research. Air plethysmography can be used to assess chronic venous disease, to evaluate improvement after venous surgery, to diagnose acute and past episodes of deep venous thrombosis, to evaluate compression stocking therapy, to study the physiological implications of high-heeled shoes in healthy women, and even to evaluate the probability of ulcer healing.


Resumo A pletismografia a ar é um método não invasivo que pode quantificar refluxo e obstrução venosa medindo alterações no volume das pernas. Seus achados se correlacionam com parâmetros clínicos e hemodinâmicos. Ela pode fornecer informações quantitativas dos diferentes componentes da hemodinâmica venosa: refluxo valvular, função de bomba muscular da panturrilha e obstrução venosa. Apesar de ter seu uso clínico validado, a pletismografia a ar é usada quase que exclusivamente para pesquisa. Ela pode ser usada para avaliar a doença venosa crônica, mensurar o ganho hemodinâmico após cirurgia venosa, diagnosticar trombose venosa profunda atual ou prévia, avaliar os efeitos da elastocompressão, estudar as implicações fisiológicas do uso de salto alto em mulheres e também avaliar a probabilidade de cura de uma úlcera venosa.


Subject(s)
Humans , Female , Skin Ulcer/pathology , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/pathology , Chronic Disease , Plethysmography/classification
14.
An. bras. dermatol ; 91(5,supl.1): 60-63, Sept.-Oct. 2016. tab, graf
Article in English | LILACS | ID: biblio-837947

ABSTRACT

Abstract Lucio’s phenomenon is an uncommon reaction characterized by severe necrotizing cutaneous lesions that occurs in patients with Lucio’s leprosy and lepromatous leprosy. It is considered by some authors as a variant of type 2 or 3 reaction. Death can occur because of blood dyscrasia or sepsis. Precipitating factors include infections, drugs and pregnancy. We report a 31-year-old female patient exhibiting both clinical and histopathological features of lepromatous leprosy and Lucio’s phenomenon presenting favorable response to treatment. We complement our report with a literature review of the Brazilian cases of Lucio’s phenomenon published in Portuguese and English.


Subject(s)
Humans , Female , Adult , Skin Ulcer/pathology , Leprosy, Lepromatous/pathology , Skin/pathology , Skin Ulcer/drug therapy , Biopsy , Severity of Illness Index , Brazil , Leprosy, Lepromatous/drug therapy , Treatment Outcome , Necrosis
15.
An. bras. dermatol ; 91(5,supl.1): 148-150, Sept.-Oct. 2016. graf
Article in English | LILACS | ID: biblio-837944

ABSTRACT

Abstract Early malignant syphilis is a rare and severe variant of secondary syphilis. It is clinically characterized by lesions, which can suppurate and be accompanied by systemic symptoms such as high fever, asthenia, myalgia, and torpor state. We report a diabetic patient with characteristic features of the disease showing favorable evolution of the lesions after appropriate treatment.


Subject(s)
Humans , Female , Middle Aged , Skin/pathology , Syphilis, Cutaneous/pathology , Syphilis/pathology , Diabetes Mellitus/pathology , Skin Ulcer/pathology , Erythema/pathology , Immunocompetence
16.
An. bras. dermatol ; 91(5,supl.1): 166-168, Sept.-Oct. 2016. graf
Article in English | LILACS | ID: biblio-837959

ABSTRACT

Abstract Verrucous epidermal nevi are hamartomatous lesions of the epidermis that, unlike other epidermal nevi (such as sebaceous nevus or nevus comedonicus), are rarely associated with malignant neoplasms. The majority of squamous cell carcinoma develop in linear or multiple epidermal nevus and rarely in solitary epidermal nevus. In general, the prognosis is favorable. We report a case of well-differentiated invasive squamous cell carcinoma arising from a multiple verrucous epidermal nevus. Although there is no consensus on prophylactic removal of epidermal nevus, its removal and biopsy should be considered if changes occur.


Subject(s)
Humans , Male , Adult , Skin Neoplasms/etiology , Carcinoma, Squamous Cell/etiology , Nevus, Sebaceous of Jadassohn/complications , Skin Neoplasms/pathology , Skin Ulcer/pathology , Biopsy , Carcinoma, Squamous Cell/pathology , Epidermis/pathology , Nevus, Sebaceous of Jadassohn/pathology , Neoplasms, Multiple Primary/complications , Neoplasms, Multiple Primary/pathology
17.
Rev. méd. Chile ; 144(9): 1214-1217, set. 2016. ilus
Article in Spanish | LILACS | ID: biblio-830630

ABSTRACT

Pityriasis lichenoides et varioliformis acuta (PLEVA), pityriasis lichenoides chronica (PLC) and febrile ulceronecrotic Mucha-Habermann disease (FUMHD) are considered different manifestations of the same disease. Febrile ulceronecrotic Mucha-Habermann disease is a rare, and potentially lethal illness which is characterized by fast progression of numerous papules that converge, ulcerate and form a plaque with a necrotic center, together with hemorrhagic vesicles and pustules that are associated with high fever and variable systemic symptoms. We report a 16 years old male presenting with erythematous papules with crusts and fever. The diagnosis of febrile ulceronecrotic Mucha-Habermann disease was confirmed with the pathological study of the lesions. He was successfully treated with minocycline after a failed attempt of treatment with prednisone.


Subject(s)
Humans , Male , Adolescent , Prednisone/therapeutic use , Pityriasis Lichenoides/drug therapy , Herpes Simplex/drug therapy , Anti-Inflammatory Agents/therapeutic use , Minocycline/therapeutic use , Skin Ulcer/pathology , Treatment Outcome , Pityriasis Lichenoides/pathology , Herpes Simplex/pathology
18.
An. bras. dermatol ; 91(3): 381-383, graf
Article in English | LILACS | ID: lil-787301

ABSTRACT

Abstract: We describe the case of a 9-year-old boy with idiopathic bone marrow aplasia and severe neutropenia, who developed skin ulcers under cardiac monitoring electrodes. The diagnosis of primary cutaneous aspergillosis was made after the second biopsy and culture. Imaging investigation did not reveal internal fungal infection. The child was treated, but did not improve and died 3 months after admission. The report highlights and discusses the preventable risk of aspergillus skin infection in immunocompromised patients.


Subject(s)
Humans , Male , Child , Aspergillosis/microbiology , Aspergillus niger/isolation & purification , Skin Ulcer/microbiology , Dermatomycoses/microbiology , Anemia, Aplastic/immunology , Aspergillosis/complications , Aspergillosis/pathology , Skin Ulcer/pathology , Fatal Outcome , Hyphae/isolation & purification , Dermatomycoses/complications , Dermatomycoses/pathology , Electrodes/adverse effects , Anemia, Aplastic/complications , Necrosis , Neutropenia/complications
19.
An. bras. dermatol ; 91(3): 375-377, graf
Article in English | LILACS | ID: lil-787291

ABSTRACT

Abstract: Methotrexate is one of the most used drugs in the treatment of psoriasis with indication of systemic therapy. Cutaneous and mucous side effects are described by pharmacological characteristics of the drug itself or due to overdose. We report the case of a patient with ulcerations in oral mucosa and psoriatic plaques after incorrect use of Methotrexate. Prescribed in a weekly dose, it was used continuously for 10 days and without simultaneous intake of folic acid. It is important to ensure correct comprehension of the prescription.


Subject(s)
Humans , Female , Middle Aged , Skin Ulcer/chemically induced , Methotrexate/adverse effects , Drug Eruptions/etiology , Oral Ulcer/chemically induced , Folic Acid Antagonists/adverse effects , Psoriasis/drug therapy , Skin Ulcer/pathology , Methotrexate/administration & dosage , Administration, Oral , Drug Eruptions/pathology , Oral Ulcer/pathology , Prescription Drug Overuse/adverse effects , Folic Acid Antagonists/administration & dosage , Leukopenia/chemically induced , Medication Errors/adverse effects
20.
An. bras. dermatol ; 91(2): 236-238, Mar.-Apr. 2016. graf
Article in English | LILACS | ID: lil-781363

ABSTRACT

Abstract Waldenstrom’s macroglobulinemia is considered a lymphoma by the World Health Organization. Cutaneous lesions, particularly of a specific type, are rare occurring in 5% of patients. What draws attention in this case is the unusual cutaneous clinical manifestation and its location on the genitals, which has not been described in researched literature, therefore imposing differential diagnosis with other etiologies of genital ulcers.


Subject(s)
Humans , Male , Middle Aged , Penile Neoplasms/pathology , Skin Ulcer/pathology , Waldenstrom Macroglobulinemia , Skin/pathology , Fatal Outcome
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