Actinic keratoses: review of clinical, dermoscopic, and therapeutic aspects

Abstract Actinic keratoses are dysplastic proliferations of keratinocytes with potential for malignant transformation. Clinically, actinic keratoses present as macules, papules, or hyperkeratotic plaques with an erythematous background that occur on photoexposed areas. At initial stages, they may be better identified by palpation rather than by visual inspection. They may also be pigmented and show variable degrees of infiltration; when multiple they then constitute the so-called field cancerization. Their prevalence ranges from 11% to 60% in Caucasian individuals above 40 years. Ultraviolet radiation is the main factor involved in pathogenesis, but individual factors also play a role in the predisposing to lesions appearance. Diagnosis of lesions is based on clinical and dermoscopic examination, but in some situations histopathological analysis may be necessary. The risk of transformation into squamous cell carcinoma is the major concern regarding actinic keratoses. Therapeutic modalities for actinic keratoses include topical medications, and ablative and surgical methods; the best treatment option should always be individualized according to the patient.

Vohwinkel syndrome: ichthyosiform variant in a family

Abstract: Vohwinkel syndrome belongs to the group of hereditary palmoplantar keratoderma, having an autosomal dominant inheritance. In this report, the authors present a case of a four-year-old boy with diffuse scaling over his entire body and transgredient palmoplantar hyperkeratosis with some fissured areas. Family evaluation revealed that his mother and other family members were affected. Based on his clinical findings and on family history, the diagnosis of the ichthyotic Vohwinkel syndrome subtype, characterized by generalized ichthyosis and palmoplantar hyperkeratosis, was established.

Laser versus microagulhamento para tratamento de cicatriz facial - Relato de caso / Laser versus microneedling for the treatment of facial scar ­ Case report

Tanto o microagulhamento quanto o laser fracionado ablativo podem ser utilizados para o tratamento de cicatrizes. Neste artigo relata-se o caso de paciente do sexo feminino foi tratada em metade de cicatriz perioral com laser fracionado ablativo de CO2 e na outra metade da cicatriz com microagulhamento utilizando roller 2mm. Os resultados obtidos foram superiores na metade submetida ao procedimento com laser.

Both microneedling and ablative fractional laser can be used for the treatment of scars. The present article reports the case of a female patient who had the first half of a perioral scar treated with ablative fractional CO2 laser, and the second half treated with microneedling, using a 2mm roller. Outcomes were superior in the half treated with laser.

Secondary syphilis: The great imitator can't be forgotten / Sífilis secundária: a grande imitadora não pode ser esquecida

Summary Syphilis is an infection caused by Treponema pallidum, mainly transmitted by sexual contact. Since 2001, primary and secondary syphilis rates started to rise, with an epidemic resurgence. The authors describe an exuberant case of secondary syphilis, presenting with annular and lichen planus-like lesions, as well as one mucocutaneous lesion. Physicians must be aware of syphilis in daily practice, since the vast spectrum of its cutaneous manifestations is rising worldwide.

Resumo A sífilis é uma infecção causada pela espiroqueta Treponema pallidum, transmitida principalmente por contato sexual. Desde 2001, houve o ressurgimento dessa epidemia, com aumento das taxas de sífilis primária e secundária. Os autores descrevem um caso exuberante de sífilis secundária apresentando lesões cutâneas anulares e lesões que lembram líquen plano, além de uma lesão mucocutânea. Médicos de todas as especialidades devem estar cientes das diversas apresentações de sífilis: o vasto espectro de manifestações cutâneas da sífilis secundária e as crescentes taxas dessa patologia representam um desafio.

Luz intensa pulsada: revisão das indicações clínicas / Intense Pulsed Light: review of clinical indications

A luz intensa pulsada é um dispositivo que emite luz de alta intensidade, policromática, não coerente e não colimada. Sua versatilidade permite combinar parâmetros e tratar vários tipos de lesões cutâneas vasculares e melanocíticas, além da realização da epilação e do fotorrejuvenescimento não ablativo. Embasado na literatura médica, o presente artigo descreve indicações clássicas e inovadoras do uso da luz intensa pulsada.

Intense pulsed light is a device that emits high intensity, polychromatic, non-coherent and not collimated light. IPL versatility allows combining parameters to treat a variety of skin vascular and melanocytic lesions, epilation and non ablative photorejuvenation. This article describes classic and innovative indications for intense pulsed light use based on medical literature.

Microagulhamento: série de casos associados drug delivery / Microneedling: a case series associated with drug delivery

A associação do microagulhamento com o drug delivery tem-se mostrado benéfica pois potencializa os resultados de ambas as técnicas. Seis pacientes foram submetidas a duas sessões dessa associação de técnicas no tratamento da face, mãos e estrias, com intervalo de 20 dias. As avaliações foram realizadas por fotografias comparativas padronizadas. Os resultados revelaram redução da acne e melhora das manchas e textura da pele na face, melhora das manchas e textura da pele das mãos, e redução das dimensões e visibilidade das estrias. O presente estudo apresentou resultados promissores associando microagulhamento e drug delivery para tratamentos dermatológicos em face, mãos e estrias.

Six patients underwent two sessions of microneedling associated to drug delivery on the face, hands or stretch marks, at three-week interval between sessions. Patients were evaluated using clinical analysis and objective measures. Compared to baseline, objective face analysis showed decrease in acne lesions and improvement in the skin texture. The evaluation of stretch marks showed great improvement, and face and hands presented excellent results compared to baseline. The association of microneedling to drug delivery for rejuvenation of the face and hands, and for the treatment of stretch marks presented promising results in our study.

Laser toning e drug delivery: estudo-piloto utilizando laser Q-switched Nd:YAG 1064nm / Laser toning and drug delivery: a pilot study using laser Q-switched laser 1064nm

Introdução: A técnica de laser toning é realizada com a modalidade Q-switched Nd:YAG 1064nm, com o objetivo de estimular a neocolagênese. A técnica também pode ser associada à aplicação de medicamentos apropriados para drug delivery, aumentando seu potencial de permeação cutânea. Objetivo: Avaliar os resultados da técnica de laser toning Q-switched Nd:YAG 1064nm associada ao drug delivery por meio de estudo-piloto. Métodos: Quatro pacientes realizaram quatro sessões do laser com aplicação de uma fórmula para drug delivery ou placebo, em intervalos quinzenais. Resultados: Segundo a avaliação fotográfica, o laser toning promoveu melhora da acne, poros, rugas e sensibilidade. Quando associado ao drug delivery, houve superioridade nos resultados. Na avaliação clínica observaram-se diferenças apenas na análise de poros (+11%). 75% dos pacientes apresentaram erupção acneiforme. Conclusão: Os resultados deste estudo-piloto demonstram que o laser toning pode ser potencializado quando associado ao drug delivery.

Introduction: Laser toning technique is performed with the Q-switched Nd:YAG laser 1064 nm, aiming at stimulating neocollagenesis. The technique can also be associated with the application of suitable medicines for drug delivery, increasing its potential for skin permeation. Objective: To evaluate the results of laser toning Q-switched Nd:YAG laser 1064 nm associated with drug delivery through a pilot study. Methods: Four patients underwent four laser sessions with application of a formula for drug delivery or placebo, fortnightly. Results: According to the photographic assessment, laser toning promoted improvement of acne, pores, wrinkles and sensitivity. When associated with the drug delivery, there was superiority in results. In clinical evaluation differences were observed only in the pores analysis (+11%). 75% of patients had acneiform eruption. Conclusion: Results of this pilot study show that laser toning can be enhanced when combined with drug delivery.

Syndrome In Question

The authors describe a case of Cowden´s syndrome in a female patient with classic cutaneous lesions, plus papillomatous lesions in the gastrointestinal tract and a previous history of thyroid carcinoma. Mucocutaneous lesions occur in 90% of Cowden's syndrome cases and are characterized by facial trichilemmomas, oral mucosal papillomas and benign acral keratoses. Sites of extracutaneous involvement include: the thyroid, gastrointestinal tract, breast and endometrial tissue. There is risk of malignancies in these organs and they need to be monitored with imaging tests. The early diagnosis of the syndrome by a dermatologist through mucocutaneous lesions enables the investigation and diagnosis of extracutaneous involvement. .

Assessment of the quality of life of pediatric patients at a center of excellence in dermatology in southern Brazil / Avaliação da qualidade de vida dos pacientes pediátricos de um centro de referência em dermatologia no sul do Brasil

BACKGROUND: Skin diseases cause negative impact on the emotional state, social relationships and daily activities, due to the stigma caused by the appearance of the lesions. OBJECTIVE: This study aimed to assess the quality of life of pediatric patients with skin diseases attending a dermatology service, compare the scores obtained among the dermatoses found in the sample and associate them to the variables, in addition to observing how the skin disease specifically affects quality of life. METHODS: Cross-sectional study, with patients between 5 and 16 years attending the Dermatology Service of the University of Health Sciences of Porto Alegre, Brazil, between July 2010 and February 2011. The data collection instruments were the Children's Dermatology Life Quality Index questionnaire and the AUEQI questionnaire. RESULTS: A total of 161 patients were interviewed, with mean age of 9,66 years. The main dermatoses were atopic dermatitis (29.8%), warts (13%) and molluscum contagiosum (7.5%). Chronic diseases (73.9%) were the most prevalent. The overall mean Children's Dermatology Life Quality Index score was 5.01 for chronic dermatoses and 2.07 for acute illnesses, indicating a compromised quality of life among chronically ill patients. The comparison between the scores obtained with the AUEQI scale and the Children's Dermatology Life Quality Index scores indicates that the overall quality of life is less affected than the specific quality of life related to the dermatosis. CONCLUSIONS: The data presented reinforce how important it is that the patients, their families and caregivers understand the symptoms, triggers and treatment of the skin disease in question. This information facilitates adherence to the treatment and justifies the conduct adopted by the dermatologist.

FUNDAMENTOS: Doenças dermatológicas, em razão dos estigmas pela aparência das lesões, são fonte de impacto negativo no estado emocional, relações sociais e atividades cotidianas. OBJETIVOS: Este estudo objetiva avaliar a qualidade de vida nos pacientes dermatológicos pediátricos em um centro de referência em dermatologia, comparar os índices de qualidade de vida entre as dermatoses e associá-los às variáveis, além de avaliar de que forma as dermatoses afetam a qualidade de vida especificamente. MÉTODOS: Estudo analítico transversal, pacientes entre 5 e 16 anos, do Serviço de Dermatologia da Universidade Federal de Ciências da Saúde de Porto Alegre, entre julho de 2010 e fevereiro de 2011. Instrumentos utilizados: questionário Índice Pediátrico de Qualidade de Vida em Dermatologia e escala AUQEI. RESULTADOS: Um total de 161 pacientes, média de idade de 9,66 anos. As principais dermatoses foram dermatite atópica (29,8%), verrugas vulgares (13%) e molusco contagioso (7,5%). Doenças crônicas (73,9%) foram mais prevalentes. A média do Índice Pediátrico de Qualidade de Vida em Dermatologia de 5,01 para dermatoses crônicas, e de 2,07 em agudas, indicando maior comprometimento da qualidade de vida entre os pacientes cronicamente enfermos. A comparação entre os escores obtivos com a escala AUEQI e o Índice Pediátrico de Qualidade de Vida em Dermatologia indicam que a qualidade de vida global é afetada com menor intensidade do que a relacionada especificamente à dermatose. CONCLUSÃO: Os dados obtidos reforçam a importância do entendimento dos sintomas, desencadeantes e da terapêutica da dermatose em questão pelos pacientes, por seus familiares e por seus cuidadores. Tais infomações facilitam a aderência ao tratamento e justificam a conduta adotada pelo dermatologista.