Granulomatous slack skin: a rare subtype of mycosis fungoides

Abstract: We report a case of granulomatous slack skin, a rare and indolent subtype of mycosis fungoides. It affects mainly men between the third and fourth decades. It is characterized by hardened and erithematous plaques that mainly affect flexural areas and become pedunculated after some years. Histological examination shows a dense infiltrate of small atypical lymphocytes involving the dermis (and sometimes the subcutaneous tissue) associated with histiocytic and multinucleated giant cells containing lymphocytes and elastic fibers (lymphophagocytosis and elastophagocytosis, respectively). Patients affected by this entity can develop secondary lymphomas. There are several but little effective therapeutic modalities described. Despite the indolent behavior of granulomatous slack skin, its early recognition and continuous monitoring by a dermatologist becomes essential for its management and prevention of an unfavorable outcome.

Profile of leprosy in children under 15 years of age monitored in a Brazilian referral center (2004-2012)

Abstract: Leprosy in children under 15 years of age is a serious public health problem. In this retrospective case series conducted in a Brazilian reference center (2004-2012), we found 18 cases with a mean age of 10.0±3.6 years of age and 16.6% between 0-5 years of age. Almost 56% of the cases were female, with a median time between the first symptoms and diagnosis of 11 months (4-24); 77.8% reported household contact with leprosy patients. Upon hospital admission, 66.7% presented mostly skin symptoms, while 27.8% presented a degree 2 disability. Most were classified as multibacillary (66.7%). Half of the sample developed a reaction (predominantly type 1) during the follow-up period, while 22.2% developed a late disability.

Trichotillomania: a case report with clinical and dermatoscopic differential diagnosis with alopecia areata

ABSTRACT Trichotillomania is a psychodermatologic disorder characterized by uncontrollable urge to pull one's own hair. Differential diagnoses include the most common forms of alopecia such as alopecia areata. It is usually associated with depression and obsessive-compulsive disorder. Trichotillomania treatment standardization is a gap in the medical literature. Recent studies demonstrated the efficacy of N-acetylcysteine (a glutamate modulator) for the treatment of the disease. We report the clinical case of a 12-year-old female patient who received the initial diagnosis of alopecia areata, but presented with clinical and dermoscopic features of trichotillomania. She was treated with the combination of psychotropic drugs and N-acetylcysteine with good clinical response. Due to the chronic and recurring nature of trichotillomania, more studies need to be conducted for the establishment of a formal treatment algorithm.

Acrokeratosis verruciformis of Hopf - Case report

Abstract: A 54 year-old woman with a 3-year history of rheumatoid arthritis (RA) consulted us because of weight loss, fever and skin eruption. On physical examination, erythematous plaques with a pseudo-vesicular appearance were seen on the back of both shoulders. Histological examination was consistent with rheumatoid neutrophilic dermatosis (RND). After three days of prednisone treatment, the skin eruption resolved. RND is a rare cutaneous manifestation of seropositive RA, characterized by asymptomatic, symmetrical erythematous plaques with a pseudo-vesicular appearance. Histology characteristically reveals a dense, neutrophilic infiltrate with leucocitoclasis but without other signs of vasculitis. Lesions may resolve spontaneously or with RA treatment. This case illustrates an uncommon skin manifestation of active rheumatoid arthritis.

Perfil clínico e epidemiológico do vitiligo infantil: análise de 113 casos diagnosticados em um centro de referência em dermatologia de 2004 a 2014 / Clinical and epidemiological profile of childhood vitiligo: analysis of 113 cases diagnosed at a dermatology referral center from 2004 to 2014

Introdução: O vitiligo é forma adquirida autoimune de hipopigmentação ou despigmentação, iniciando-se na infância metade de seus casos. Objetivos: Traçar o perfil clínico e epidemiológico do vitiligo infantil em um centro de referência em dermatologia. Métodos: Estudo transversal e descritivo com análise dos prontuários de pacientes com menos de 13 anos diagnosticados como portadores de vitiligo entre 2004 e 2014. Resultados: Dos 113 casos identificados, 54% eram do sexo feminino e 46% do sexo masculino; a idade variou de zero a 12 anos com a maioria dos pacientes (54,8%) no subgrupo de quatro a oito anos. Em 59% dos prontuários não havia registro sobre fatores desencadeantes do vitiligo; 31% dos pacientes associaram o início da doença a estresse emocional, 3% a trauma físico, e 7% não associaram a fator desencadeante. Conclusões: A discreta prevalência no sexo feminino também foi descrita em outros estudos. O comportamento do vitiligo na criança é diferente daquele observado nos adultos. A influência dos fatores psicológicos como desencadeantes e os potenciais efeitos duradouros na autoestima devem ser levados em consideração na abordagem do paciente. Os resultados deste trabalho foram semelhantes aos relatos existentes sobre o vitiligo nessa faixa etária, que são, aliás, poucos na literatura

Introduction: Vitiligo is an acquired autoimmune form of hypopigmentation or depigmentation in which half of the cases begins in childhood. Objectives: To describe the clinical and epidemiological profile of childhood vitiligo in a referral center for dermatology. Methods: A cross-sectional, descriptive study was carried out based on the analysis of medical records of patients younger than 13 years diagnosed with vitiligo from 2004 to 2014. Results: Of the 113 cases identified, 54% were female and 46% male, the age ranged from 0 to 12 years, with most patients in the 4-8 years-old subgroup (54.8%). In 59% of the medical records there was no record of triggering factors of vitiligo; 31% of patients associated the onset of the illness to emotional stress, 3% to physical trauma and 7% did not associate it to any triggering factor. Conclusions: The discreet prevalence in women has also been reported in other studies. Vitiligo behavior in children is different from that observed in adults. The influence of psychological factors as triggers and potential lasting effects on self-esteem should be considered in the approach of the patient. Although studies on vitiligo in this age group are scarce in the literature, the results of the present study were similar to the reports already available in the literature

Estudo clínico, epidemiológico e imunológico para leishmaniose tegumentar americana em centro de referência em dermatologia / Clinical, epidemiological and immunological study to american tegumentary leishmaniasis in a dermatology reference center

Leishmaniose Tegumentar Americana (LTA) é uma doença infecciosa, causada por protozoários do gênero Leishmania. É uma das doenças infectoparasitárias mais incidentes no mundo. No presente trabalho realizou-se um estudo transversal retrospectivo das características clínicas, epidemiológicas e imunológicas de portadores de Leishmaniose Tegumentar Americana.Foram utilizados prontuários de 34 pacientes com diagnóstico de LTA. A análise estatística foi realizada pelo Teste de Spearman. O sexo masculino foi acometido em 68% e o feminino 32%. A idade variou de 1 a 92 anos. A forma cutânea localizada ocorreu em 79,5%,sendo as úlceras a forma clínica mais comum (56%).Principal área acometida foi face (44%). O tempo para o diagnóstico foi menor que 10 meses em 68% dos indivíduos.Intradermorreação de Montenegro (IDRM) foi realizada em 29 pacientes, com positividade em 89,6% e a imunofluorescência indireta (IFI) em apenas 16 pacientes, sendo positiva em 13. A idade e o tempode evolução da doença apresentaram associação significativa com IDRM. Entretanto não foi observada associação da IFI com a idade do paciente e o tempo de doença, pelo teste de Spearman. O tratamento foi realizado na maioria dos casos com glucantime (71%),seguido de pentamidina (17%). Os resultados evidenciam que os exames sorológicos constituem uma ferramenta auxiliar e a correlação com achados clínicos e histopatológicos são imprescindíveis.

Introduction: American cutaneous leishmaniasis (ACL) is an infectious disease caused by protozoa of the genus Leishmania. World  leishmaniasis  is an important endemic disease and public health problem in developing countries. Methods: We conducted a retrospective, descriptive and analytical cross-sectional study of 34 patients diagnosed with ACL. Statistical analysis was performed using the nonparametric Spearman’s test. Results: The gender involved was male (68%) and female(32%); the age range of 1 to 92 years old. The most common clinical manifestations were localized cutaneous form (79.5%) and the ulcers (56%).The face was main affected area (44%) and the minor time from onset of symptoms to consultation was 10 months (68%) of patients. Montenegro skin test (MST) was performed in 29 patients, being positive in (89.6%) and the indirect immunofluorescence (IIF) in only 16 patients, being positive in 13. The age and the duration of the disease were significantly associated with MST. Conclusions: It was not observed the IFI association with the patient’s age and disease duration. The treatment was in most cases, meglumine antimoniate (71%), followed Pentamidine (17%). The results demonstrated thatthe serological tests constitute an auxiliary tool andthe correlations with clinical and histopathological findings are essential.

Hanseníase históide símile: desafio diagnóstico / Histoid like leprosy: diagnostic challenge

Em 1963, Wade descreveu a hanseníase histoide, que acometia pacientes previamente tratados com dapsona.Caracteriza-se por lesão com aspecto queloideano, na histopatologia vemos histiócitos fusiformes e um grande número de bacilos. Relata-se caso de hanseníase dimorfa virchoviana com padrão de lesão históide, um verdadeiro desafio diagnóstico, a fim de atentar para manifestações atípicas dessa doença e reforçar a importância da confirmação histológica de casos suspeitos de hanseníase históide.

In 1963, Wade described Histoid Leprosy, that affected patients previously treated with dapsone. This type of leprosy is characterized by keloid-like lesions, in which spindle histiocytes and a large number of bacilli can be seen in the histopathology. A case of borderline lepromatous leprosy with histoid pattern is described, a true diagnostic challenge, in order to attempt to atypical manifestations of the disease and reinforce the importance of histological confirmation in suspected cases of histoid leprosy.