Fasciotomia em membro superior após síndrome compartimental por acidente ofídico com posterior enxertia e plástica em Z: relato de caso / Fasciotomy in the upper limb after compartment syndrome due to snakebite with subsequent grafting and z-plasty: case report

Este relato de caso aborda o curso clínico de um envenenamento botrópico ocorrido no município de Jarinu, SP, no ano de 2021. O paciente necessitou de fasciotomia em membro superior após síndrome compartimental aguda com enxertia dermoepidérmica em um segundo momento cirúrgico. No pós-operatório tardio, o paciente evoluiu com retração, necessitando de reabordagem cirúrgica com correção de retração de membro superior esquerdo. Discute-se a gravidade do acidente ofídico, efeitos do veneno nos tecidos, complicações, síndrome compartimental aguda, indicação e técnica da fasciotomia descompressiva com base na literatura.

This case study examines the clinical course of a Bothrops snakebite poisoning that occurred in Jarinu, São Paulo, Brazil, in 2021. The patient required a fasciotomy in the upper limb due to acute compartment syndrome, followed by a second surgical procedure involving dermo-epidermal grafting. In the late postoperative period, the patient experienced retraction, leading to a subsequent surgical intervention to correct the retraction in the left upper limb. The severity of the snakebite accident, the effects of venom on tissues, complications, acute compartment syndrome, as well as the indications and techniques for decompressive fasciotomy, are discussed based on the available literature.

New-onset childhood extensive cutaneous lichen planus following asymptomatic COVID-19 infection: report of a case / Líquen plano cutâneo extenso de início recente na infância após infecção assintomática por COVID-19: relato de caso

ABSTRACT Objective: The objective of this study was to describe a case of cutaneous lichen planus (LP) that appeared following COVID-19 infection. Case description: We report a case of extensive cutaneous classic familial LP in a 4-year-old male child after an asymptomatic serologically confirmed COVID-19 infection. The patient developed intensely itchy, purple, flat-topped papules and plaques, mainly on the dorsal surface of the hands, feet, forearms, and shins. Histopathological examination of the skin biopsy showed vacuolar and apoptotic degeneration of the basal cell layer with a band-like lymphocyte infiltrate at the dermo-epidermal junction and confirmed the diagnosis of LP. Comments: LP could be considered among the differential diagnoses of pediatric post-COVID inflammatory skin lesions, either in the patients recovering from COVID-19 infection or in the suspicious asymptomatic cases in close contact with COVID-19-infected patients.

RESUMO Objetivo: Descrever um caso de líquen plano cutâneo (LP) após infecção por COVID-19. Descrição do caso: Relatamos um caso de LP familiar clássico extenso cutâneo em uma criança de quatro anos de idade após uma infecção por COVID-19 assintomática e sorologicamente confirmada. O paciente desenvolveu pápulas e placas intensamente pruriginosas, roxas e achatadas, principalmente na superfície dorsal das mãos, pés, antebraços e canelas. O exame histopatológico da biópsia de pele mostrou degeneração vacuolar e apoptótica da camada basal com infiltrado de linfócitos em faixa na junção dermoepidérmica e confirmou o diagnóstico de líquen plano. Comentários: O líquen plano pode ser considerado entre os diagnósticos diferenciais de lesões cutâneas inflamatórias pós-COVID pediátricas, tanto em pacientes em recuperação de infecção por COVID-19 quanto em casos assintomáticos suspeitos em contato próximo com pacientes infectados por COVID-19.

Non-invasive imaging of pathological scars using a portable handheld two-photon microscope / 中华医学杂志(英文版)

BACKGROUND@#Pathological scars are a disorder that can lead to various cosmetic, psychological, and functional problems, and no effective assessment methods are currently available. Assessment and treatment of pathological scars are based on cutaneous manifestations. A two-photon microscope (TPM) with the potential for real-time non-invasive assessment may help determine the under-surface pathophysiological conditions in vivo . This study used a portable handheld TPM to image epidermal cells and dermal collagen structures in pathological scars and normal skin in vivo to evaluate the effectiveness of treatment in scar patients.@*METHODS@#Fifteen patients with pathological scars and three healthy controls were recruited. Imaging was performed using a portable handheld TPM. Five indexes were extracted from two dimensional (2D) and three dimensional (3D) perspectives, including collagen depth, dermo-epidermal junction (DEJ) contour ratio, thickness, orientation, and occupation (proportion of collagen fibers in the field of view) of collagen. Two depth-dependent indexes were computed through the 3D second harmonic generation image and three morphology-related indexes from the 2D images. We assessed index differences between scar and normal skin and changes before and after treatment.@*RESULTS@#Pathological scars and normal skin differed markedly regarding the epidermal morphological structure and the spectral characteristics of collagen fibers. Five indexes were employed to distinguish between normal skin and scar tissue. Statistically significant differences were found in average depth ( t = 9.917, P <0.001), thickness ( t = 4.037, P <0.001), occupation ( t = 2.169, P <0.050), orientation of collagen ( t = 3.669, P <0.001), and the DEJ contour ratio ( t = 5.105, P <0.001).@*CONCLUSIONS@#Use of portable handheld TPM can distinguish collagen from skin tissues; thus, it is more suitable for scar imaging than reflectance confocal microscopy. Thus, a TPM may be an auxiliary tool for scar treatment selection and assessing treatment efficacy.

Clinicopathological and prognostic features of subungual melanoma in situ / 中华病理学杂志

Objective: To investigate the clinicopathological characteristics, immunohistochemical profiles, molecular features, and prognosis of subungual melanoma in situ (SMIS). Methods: Thirty cases of SMIS were collected in Fudan University Shanghai Cancer Center, Shanghai, China from 2018 to 2022. The clinicopathological characteristics and follow-up data were retrospectively analyzed. Histopathologic evaluation and immunohistochemical studies were carried out. By using Vysis melanoma fluorescence in situ hybridization (FISH) probe kit, combined with 9p21(CDKN2A) and 8q24(MYC) assays were performed. Results: There were 8 males and 22 females. The patients' ages ranged from 22 to 65 years (median 48 years). All patients presented with longitudinal melanonychia involving a single digit. Thumb was the most commonly affected digit (16/30, 53.3%). 56.7% (17/30) of the cases presented with Hutchinson's sign. Microscopically, melanocytes proliferated along the dermo-epithelial junction. Hyperchromatism and nuclear pleomorphism were two of the most common histological features. The melanocyte count ranged from 30 to 185. Most cases showed small to medium nuclear enlargement (29/30, 96.7%). Pagetoid spread was seen in all cases. Intra-epithelial mitoses were identified in 56.7% (17/30) of the cases. Involvement of nailfold was found in 19 cases, 4 of which were accompanied by cutaneous adnexal extension. The positive rates of SOX10, PNL2, Melan A, HMB45, S-100, and PRAME were 100.0%, 100.0%, 96.0%, 95.0%, 76.9%, and 83.3%, respectively. FISH analysis was positive in 6/9 of the cases. Follow-up data were available in 28 patients, and all of them were alive without disease. Conclusions: SMIS mainly shows small to medium-sized cells. High melanocyte count, hyperchromatism, nuclear pleomorphism, Pagetoid spreading, intra-epithelial mitosis, nailfold involvement, and cutaneous adnexal extension are important diagnostic hallmarks. Immunohistochemistry including SOX10 and PRAME, combined with FISH analysis, is valuable for the diagnosis of SMIS.

Histopathological finding of vesiculobullous lesions of skin in relation to their clinical presentation: Prospective study from a tertiary care center

Background: Vesiculobullous disorders (VBDs) are extant with diverse clinical manifestations. Vesicles and bullae are fluid-filled cavities present within or beneath the epidermis. They are autoimmune blistering disorders in which autoantibodies are directed against target antigens present in the epidermis and dermo-epidermal junction. Objective: Evaluation of the various clinicodemographic profile of patients with a pattern of distribution (subtypes) of VBDs of the skin and assess the association between clinical aspects and histological changes in vesiculobullous lesions of the skin. Materials and Methods: The study material constituted 93 cases of VBDs out of 936 skin biopsies reported over two and a half years (January 2016 to June 2018) from the tertiary care center. A detailed history of the patients was taken, and a complete physical and dermatological examination with findings including clinical diagnosis was recorded. Histopathological examination (incisional/excisional/punch biopsy) was done in each case. The clinico-demographic evaluation was done and the results were correlated with histopathological findings. Results: Vesiculobullous lesions constituted 10.06% of all skin biopsies. The majority of cases were of pemphigus vulgaris (PV) 30 (32.25%) followed by 16 (17.2%) of bullous pemphigoid. In 83 cases (89.24%) histopathology findings were consistent with clinical diagnosis. Out of 34 cases that were diagnosed clinically as PV , the histopathological study proved 30 cases (88.23%) as PV. Conclusion: Vesiculobullous lesions of the skin are a heterogeneous group of disorders. It is essential to differentiate each pattern of subtype based on clinical examination and histopathological findings. Histopathological diagnosis with clinical correlation plays a major role in arriving at the diagnosis.

Dermolipectomía por lipodistrofia abdominal grave en obesidad mórbida / Dermolipectomy for severe abdominal lipodystrophy in morbid obesity

RESUMEN La obesidad y el sobrepeso se definen como una acumulación anormal o excesiva de grasa que puede ser perjudicial para la salud. Es una enfermedad crónica de origen multifactorial, que como consecuencia ocasiona problemas higiénicos, discapacidad funcional y alteración de la calidad de vida. La dermolipectomía abdominal es una técnica quirúrgica que constituye la única opción para el tratamiento de pacientes con panículo adiposo prominente; de esa forma se logra disminuir las complicaciones y se reintegra socialmente al paciente que, a causa del enorme faldón abdominal, estuvo limitado por muchos años. Presentamos el caso de una paciente de 53 años con lipodistrofia abdominal grave, que llegaba a ambos tobillos con afectación cutánea, y discapacidad para realizar actividades diarias, resuelta con dermolipectomía abdominal y resección de 29 kg de tejido dermograso. Se realizará, además, una revisión bibliográfica del tema.

ABSTRACT Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health. It is a chronic disease caused by multiple factors, which results in hygienic issues, functional disability and impaired quality of life. Abdominal dermolipectomy is the only surgical option for the treatment of patients with prominent panniculus morbidus, thus reducing complications and providing social reintegration for the patient who has been limited for many years due to the enormous abdominal panniculus. We report the case of a 53-year-old female patient with severe abdominal lipodystrophy with coverage of both ankles, skin involvement, and disability to perform daily activities, that was managed with abdominal dermolipectomy and resection of 29 kg of dermo-adipose tissue. Bibliographic research is also presented.

Epidermolysis bullosa acquisita

Abstract Epidermolysis bullosa acquisita is a rare autoimmune disease, characterized by the synthesis of anti-collagen VII autoantibodies, the main component of hemidesmosome anchoring fibrils. The antigen-antibody binding elicits a complex inflammatory response, which culminates in the loss of dermo-epidermal adhesion of the skin and/or mucous membranes. Skin fragility with bullae, erosions, and milia in areas of trauma characterizes the mechanobullous form of the disease. In the inflammatory form of epidermolysis bullosa acquisita, urticarial inflammatory plaques with tense bullae, similar to bullous pemphigoid, or mucosal lesions can determine permanent scars and loss of functionality in the ocular, oral, esophageal, and urogenital regions. Due to the similarity of the clinical findings of epidermolysis bullosa acquisita with other diseases of the pemphigoid group and with porphyria cutanea tarda, the diagnosis is currently confirmed mainly based on the clinical correlation with histopathological findings (pauci-inflammatory subepidermal cleavage or with a neutrophilic infiltrate) and the demonstration of the presence of anti-collagen VII IgG in situ by direct immunofluorescence, or circulating anti-collagen VII IgG through indirect immunofluorescence and/or ELISA. There is no specific therapy for epidermolysis bullosa acquisita and the response to treatment is variable, usually with complete remission in children and a worse prognosis in adults with mucosal involvement. Systemic corticosteroids and immunomodulators (colchicine and dapsone) are alternatives for the treatment of mild forms of the disease, while severe forms require the use of corticosteroid therapy associated with immunosuppressants, intravenous immunoglobulin, and rituximab.

Alternativa de manejo miniinvasivo para el tratamiento de pacientes con diástasis abdominal y colgajo dermograso mediante la táctica VER: Vaser® + endoscopia + Renuvion® / Minimally invasive management alternative for the treatment of patients with abdominal diastasis and dermo-fat flap using the VER tactic: Vaser® + endoscopy + Renuvion®

El tratamiento de la diástasis abdominal en pacientes con colgajo dermograso no está estandarizado y puede realizarse mediante diferentes técnicas. Presentamos una alternativa para el manejo miniinvasivo de pacientes con diástasis abdominal asociada a colgajo dermograso mediante la combinación de tres procedimientos que denominamos "táctica VER": Vaser® + endoscopia + Renuvion®. Según nuestra experiencia preliminar, la combinación de los 3 procedimientos es segura y efectiva en los casos seleccionados

The treatment of abdominal diastasis in patients with a dermo-fat flap is not standardized and can be performed using different techniques. We present an alternative for the minimally invasive management of patients with abdominal diastasis associated with dermo-fat flap through the combination of three procedures that we call "VER tactic": Vaser® + Endoscopy + Renuvion®. Based on our preliminary experience, the combination of the 3 procedures is safe and effective in selected cases

Resultados en el corto y mediano plazo del tratamiento endovascular en la enfermedad arterial obstructiva infrapoplítea en pacientes con isquemia crítica de una extremidad / Short to midterm results after endovascular approach in critical limb isquemia in patients with below-the-knee arterial disease

Resumen Objetivo: Mostrar los resultados en el corto y mediano plazo del tratamiento endovascular de angioplastia transluminal percutánea (ATP) con balón en pacientes en estado de isquemia crítica por enfermedad arterial obstructiva infrapoplítea. Materiales y Método: Estudio descriptivo, observacional, retrospectivo. Se incluyeron los pacientes hospitalizados entre 2009 y 2018 por isquemia crítica Fontaine III o IV sometidos a una ATP del territorio infrapoplíteo. Se observó como objetivos primarios la preservación de la extremidad afectada y la mortalidad posoperatoria a un año plazo, y como objetivos secundarios los procedimientos adicionales en pacientes con lesiones o necrosis distales, estadía hospitalaria, complicaciones posoperatorias y necesidad de reintervención. Resultados: Se incluyeron 42 pacientes con un promedio de edad de 66 años (46-82), con importantes comorbilidades. Un 83,3% ingresó en etapa Fontaine IV. En 16 casos se realizó una angioplastia percutánea en más de una arteria. No se colocó stents. Se presentaron complicaciones en 3 pacientes, 2 requirieron una amputación mayor y en otro se debió efectuar un nuevo procedimiento endovascular de rescate. La estadía hospitalaria promedio fue 22 días. No hubo mortalidad precoz posprocedimiento. La mortalidad global a un año fue 9,5%. A todos los pacientes en etapa Fontaine IV se les efectuó algún procedimiento adicional, a 31 una amputación menor, 3 cerraron sus lesiones por segunda intención y en otro se realizó un injerto dermo-epidérmico. De los 35 pacientes con seguimiento, 77% preservó su extremidad a un año. Conclusión: La reparación endovascular mediante una angioplastia percutánea en estos casos es un procedimiento seguro y tiene una alta tasa de preservación de la extremidad inicial a un año de seguimiento.

Aim: Show initial and midterms results of endovascular Percutaneous Transluminal Angioplasty (PTA) in critical limb isquemia (CLI) patients caused by below-the-knee arterial disease. Materials and Method: Observational, descriptive and retrospective study. 42 CLI patients admitted in our hospital from 2009 until 2018 with Fontaine III or IV treated by PTA in infrapopliteal arteries were analyzed, collecting demographic, clinical and surgical characteristics, additional procedures in Fontaine IV, hospital stay, postoperative complications, need of reintervention, limb preservation and mortality with one year follow-up after procedure. Results: 42 patients, average age 66 year-old (46-82), with significant comorbidities. Fontaine IV stage patients were 83.3%. In 16 cases more than one artery was intervened. No stent revascularization was performed. Complications occurred in 3 patients, 2 required major amputation and an urgent endovascular reintervention was required in another. Average hospital stay was 22 days with no post-operative mortality. One-year global mortality was 9.5 One-year follow-up in 35 patients shows that 77% preserved their limb. Conclusión: Percutaneous transluminal angioplasty procedure in this patients has a high rate of limb preservation in a one-year follow-up. There was no post-operative mortality.

Lymphocytic thrombophilic arteritis with lower-limb ulcers

Abstract Lymphocytic thrombophilic arteritis is a recently described entity, histopathologically characterized by lymphocytic vasculitis that affects the arterioles of the dermo-hypodermic junction, associated with deposition of fibrin and a luminal fibrin ring. A 49-year-old female patient presented with achromic maculae and a well-defined ulcer on the medial aspect of the left lower limb. The biopsy showed intense inflammatory infiltrate in the papillary dermis with a predominance of lymphocytes, and medium-caliber vessels surrounded by mononuclear infiltrates in the deep reticular dermis. Masson's trichrome staining showed intense destruction of the muscle layer of the vascular wall and a fibrin ring. Good clinical response was attained with azathioprine. The authors believe that the ulceration might be another clinical presentation or represent an atypical progression of this condition.

Clinical and pathological analysis of 320 cases of Spitzoid tumors / 中华皮肤科杂志

Objective:To analyze clinical and pathological features of 320 cases of Spitzoid tumors.Methods:Clinical and pathological data were collected from 320 patients with Spitzoid tumors in Department of Dermatology, Xijing Hospital from January 2005 to January 2020, and retrospectively analyzed.Results:The 320 patients included 141 males and 179 females, aged 0 - 65 (12.5 ± 11.7) years, and their course of disease ranged from 1 month to 30 years. Among them, there were 307 patients with Spitz nevi, 8 with atypical Spitz tumors and 5 with Spitzoid melanoma. Most skin lesions were solitary, and occurred on the head, face, trunk and limbs, with clear boundaries. Among the 307 patients with Spitz nevi, the skin lesions were mainly black (132 cases, 43.0%) and red (108 cases, 35.1%) in color, most of which were uniformly pigmented (262 cases, 85.3%) with smooth surfaces (272 cases, 88.6%) . There were several special clinical subtypes of Spitz nevi, including Spitz nevus arising in a nevus spilus (11 cases, 3.6%) , agminated Spitz nevus (11 cases, 3.6%) , disseminated Spitz nevus (6 cases, 2.0%) , nodular Spitz nevus (7 cases, 2.3%) and keloid-like Spitz nevus (1 case, 0.3%) . Characteristic histopathological manifestations of Spitz nevi included pagetoid spread of epidermal nevus cells (123 cases, 40.1%) , Kamino bodies at the dermo-epidermal junction (74 cases, 24.1%) , horizontal band-like distribution of nevus cells (177 cases, 57.8) , wedge-shaped distribution of nevus cells (118 cases, 38.4%) , fissures around nevus cell nests (177 cases, 57.8%) , physiological mitotic figures (117 cases, 38.1%) , and fine nuclear chromatin (307 cases, 100%) . According to the special histopathological manifestations, Spitz nevi were divided into pigmented epithelioid Spitz nevus (9 cases, 2.9%) , desmoplastic Spitz nevus (13 cases, 4.2%) , hemangiomatous Spitz nevus (8 cases, 2.6%) , verrucous Spitz nevus (12 cases, 3.9%) , mucoid Spitz nevus (10 cases, 3.3%) , halo-like Spitz nevus (4 cases, 1.3%) , etc. Among the 8 cases of atypical Spitz tumors, 4 skin lesions were black, 7 were uniformly pigmented, and 3 had rough surfaces; the characteristic pathological manifestations included mild to moderate atypia of cells, mitotic figures (2 - 6 cells/mm 2 in 7 cases) , and coarse nuclear chromatin (5 cases) . Among the 5 cases of Spitzoid melanoma, 3 had red skin lesions, 4 were non-uniformly pigmented, and 3 had rough surfaces; the characteristic pathological manifestations included pagetoid spread of melanocytes (3 cases) , non-polar infiltrating growth of immature tumor cells, pathological mitotic figures (3 cases, > 6 cells/mm 2) , coarse nuclear chromatin and obviously stained nuclear membrane. Conclusions:Spitzoid tumors are characterized by unique clinical and histopathological features. There are various clinical and pathological subtypes of Spitz nevi, and atypical Spitz tumors have clinical and pathological characteristics of both Spitz nevi and melanoma.

Tratamientos utilizados en los pacientes hospitalizados por úlceras flebostáticas / Treatments Used in Patients Hospitalized for Phlebostatic Ulcers

Introducción: Las úlceras flebostáticas son de difícil curación, no existe un tratamiento único y efectivo, por lo que hay que combinarlos en un mismo paciente. Objetivo: Identificar los tratamientos utilizados en los pacientes ingresados por úlceras flebostáticas y la relación entre el tiempo de estadía hospitalaria, el tratamiento recibido y el estado de las úlceras al egreso hospitalario. Métodos: Estudio descriptivo ambispectivo en 121 ingresos hospitalario con el diagnóstico de úlceras flebostáticas. Las variables de estudio fueron: tratamientos recibidos, estado de la lesión al egreso y estadía hospitalaria. Se asociaron las variables entre sí utilizando la prueba Ji-cuadrada no paramétrica para variables independientes. Resultados: En los 121 ingresos se realizó tratamiento convencional, el 93,4 por ciento recibió antibióticos; el 60,3 po ciento tratamiento compresivo; y quirúrgico en el 56,2 por ciento, con predominio del injerto libre de piel en 72,1 por ciento de estos tratamientos quirúrgicos. El 42,2 por ciento egresó con la lesión curada (tratamiento quirúrgico). Se encontraron asociaciones directas entre el tratamiento quirúrgico con la estadía hospitalaria (( 2 = 31,22; p= 0,0001), con la cura de la lesión (( 2 = 19,92; p= 0,0100) y con su estado al alta hospitalaria (( 2 = 36,07; p= 0,0001). Conclusiones: El tratamiento más empleado es el quirúrgico y dentro de estos, el autoinjerto dermo-epidérmico es el más utilizado, puesto que presenta los mejores resultados en cuanto a la curación de la lesión pero mayor estadía hospitalaria en los pacientes(AU)

Introduction: Phlebostatic ulcers are difficult to heal; there is no single and effective treatment, so several treatments must be combined in the same patient. Objective: To identify the treatments used in patients admitted for phlebostatic ulcers and the relationship between hospital stay, treatment received, condition of the ulcers at hospital discharge. Methods: Ambispective descriptive study of 121 hospital admissions with the diagnosis of phlebostatic ulcers. The study variables were treatments received, status of the injury at discharge, and hospital stay. The variables were associated with each other, using the non-parametric Chi-square test for independent variables. Results: The 121 admissions received conventional treatment. 93.4 percent received antibiotics; 60.3 percent, compression treatment; and 56.2 percent, surgical treatment, with predominance of free skin grafting in 72.1 percent of these surgical treatments. 42.2 percent was discharged with the lesion healed (by surgical treatment). Direct associations were found between surgical treatment with hospital stay (( 2 = 31.22; p = 0.0001), with the cure of the lesion (( 2 = 19.92; p=0.0100), and with the ulcer state at hospital discharge (( 2 =36.07; p= 0.0001). Conclusions: The most used treatment is the surgical one, specifically the dermo-epidermal autograft, which presented the best outcome regarding the healing of the injury, but a longer hospital stay for the patients(AU)

Eruptive disseminated Spitz nevi - Case report

Abstract Spitz nevus is a benign melanocytic lesion, which presents in several ways: solitary, agminated, or disseminated. The disseminated variant is uncommon; it may have a rapid evolution (the eruptive form) and be difficult to manage. This report presents the case of a 24-year-old patient with multiple papules on his limbs, which had appeared four years previously. On physical examination, 120 pink and skin-colored papules were seen, which under dermoscopy were observed to be homogeneous, pink vascular lesions. Histopathologic study revealed epithelioid cells arranged in groups or singly in the dermis and dermo-epidermal junction. They were HMB-45 positive in the superficial dermis, and Ki-67 < 1%. Given these findings, a diagnosis of eruptive disseminated Spitz nevi was made.

Diagnostic performance of modified Ho-Vert technique in 21 cases of classical lichen planopilaris: a clinicopathological study / 中华皮肤科杂志

Objective@#To compare diagnostic performance of traditional vertical section technique, horizontal section technique and modified Ho-Vert technique for classical lichen planopilaris.@*Methods@#Clinical data were collected from patients with classical lichen planopilaris in Department of Dermatology, The Affiliated Wuxi People′s Hospital of Nanjing Medical University from January 1st 2015 to January 1st 2019. With the help of dermoscopy, 2 scalp specimens were obtained from each patient and sliced horizontally and vertically respectively by using modified Ho-Vert technique. The horizontal and vertical sections were read separately or simultaneously, and histopathological changes were observed.@*Results@#Totally, 21 patients with classical lichen planopilaris were enrolled into this study, including 15 males and 6 females. Their age was 50.0 ± 13.6 years, and the average course of disease was 18 months. The patients mainly presented with multifocal or confluent patchy hair loss, and scalp atrophy, perifollicular hyperkeratosis, loss of follicular ostia, fibrous white dots and orbit sign were observed. On the horizontal sections, lichenoid lymphocytic infiltration around the infundibulum and isthmus of hair follicles and follicular micro-scars could be observed in all patients, and the dermo-epidermal interface could be seen in 7 patients. On the vertical sections, lichenoid lymphocytic infiltration around the infundibulum and isthmus of hair follicles only could be observed in 9 patients, follicular micro-scars could be seen in 4, and the dermo-epidermal interface could be observed in all patients. Moreover, the detection rates of interfollicular interface dermatitis, follicular keratotic plugs, lymphocytic infiltration around sebaceous glands, atrophy or disappearance of sebaceous glands and inflammatory infiltration around hair follicle bulbs were significantly different between the horizontal and vertical sections. In combination with clinical manifestations, 7 patients could be exactly diagnosed with lichen planopilaris according to findings from horizontal sections, and 9 could be diagnosed exactly according to findings from vertical sections, while 21 could be diagnosed exactly according to histopathological findings from both horizontal and vertical sections.@*Conclusion@#With the help of dermoscopy, modified Ho-Vert technique can improve the efficacy of pathological diagnosis of classical lichen planopilaris, by multidimensionally showing histopathological changes.

A Clinical and Histopathological Study of 25 Cases of Vulvar Lichen Sclerosus et Atrophicus / 대한피부과학회지

Background@#Lichen sclerosus et atrophicus is an uncommon, benign, chronic lymphocyte-mediated inflammatory dermatosis that occurs mainly in the genital area. It causes substantial discomfort and morbidity, mostly in adult women. @*Objective@#To investigate the clinicopathological characteristics of patients with vulvar lichen sclerosus et atrophicus. @*Methods@#We retrospectively reviewed the clinical and histopathological features of 25 patients diagnosed with vulvar lichen sclerosus et atrophicus, who visited the dermatologic department between January 2009 and June 2017. @*Results@#The average age was 54.2 years, and the disease duration was mostly less than 1 year. The major clinical features were diffuse patch, followed by diffuse plaque and multiple macules. It often presented with diabetes mellitus, thyroid disease, and hypertension. Itching was the most common symptom, followed by pain and burning sensations. Histopathological findings were hyperkeratosis with follicular plugging; atrophy and loss of rete ridge elongation in the epidermis; liquefaction degeneration and keratinocyte necrosis in the dermo-epidermal junction;collagen fibers hyalinization; and infiltration of inflammatory cells in the dermis. Antihistamines and topical steroids were used in most cases for treatment. @*Conclusion@#Vulvar lichen sclerosus et atrophicus causes discomfort and diminishes the quality of life in older women. Early diagnosis and prompt treatment are vital in preventing disease progression and complications. This study will provide valuable data on vulvar lichen sclerosus et atrophicus to dermatologists.

Clinicopathological analysis of nine cases of hypopigmented mycosis fungoides / 中华皮肤科杂志

Objective:To analyze clinical and pathological characteristics of 9 cases of hypopigmented mycosis fungoides (HMF) .Methods:Nine patients with clinically and histopathologically confirmed HMF were collected at Department of Dermatology, Hangzhou Third People's Hospital from 2014 to 2018, and their clinical and pathological manifestations and follow-up findings were retrospectively analyzed.Results:Among the 9 patients, there were 7 males and 2 females; the age ranged from 6 to 29 years (average, 12.4 years) ; the duration of disease varied from 6 months to 3 years (average, 20.7 months) . All skin lesions manifested as poorly demarcated, irregular, hypopigmented patches, some hypopigmented patches were confluent, and hypopigmented patches were covered with scales in 2 cases. Wood′s lamp examination of hypopigmented patches showed a grayish-white color with weak fluorescence. Dermoscopic images showed white scales on the lesions and blood vessels distributed in spermatozoa-like, punctiform or short linear patterns. Reflectance confocal microscopy showed mild hypopigmentation in the basal layer without obvious depigmentation, and highly-refractive atypical cells at the dermo-epidermal junction. Histopathological examination of the 9 cases showed epidermotropic phenomenon of atypical lymphocytes, and some cells clustered and formed Pautrier′s microabscess, immunohistochemical staining revealed that all the cells expressed T cell phenotypes, and were mainly infiltrating CD8 + T cells. The 9 patients were treated with narrow-band ultraviolet B (NB-UVB) , and all of them achieved clinical complete response. During a follow-up of 23.8 months on average, 2 patients experienced recurrence, and they achieved clinical complete response again after NB-UVB treatment. Conclusions:HMF progresses slowly, and NB-UVB treatment is effective. There is the possibility of recurrence after clinical recovery in patients with HMF, and a long-term follow-up is needed.

Diagnostic performance of modified Ho-Vert technique in 21 cases of classical lichen planopilaris: a clinicopathological study / 中华皮肤科杂志

Objective To compare diagnostic performance of traditional vertical section technique,horizontal section technique and modified Ho-Vert technique for classical lichen planopilaris.Methods Clinical data were collected from patients with classical lichen planopilaris in Department of Dermatology,The Affiliated Wuxi People's Hospital of Nanjing Medical University from January 1st 2015 to January 1st 2019.With the help of dermoscopy,2 scalp specimens were obtained from each patient and sliced horizontally and vertically respectively by using modified Ho-Vert technique.The horizontal and vertical sections were read separately or simultaneously,and histopathological changes were observed.Results Totally,21 patients with classical lichen planopilaris were enrolled into this study,including 15 males and 6 females.Their age was 50.0 ± 13.6 years,and the average course of disease was 18 months.The patients mainly presented with muhifocal or confluent patchy hair loss,and scalp atrophy,perifollicular hyperkeratosis,loss of follicular ostia,fibrous white dots and orbit sign were observed.On the horizontal sections,lichenoid lymphocytic infiltration around the infundibulum and isthmus of hair follicles and follicular micro-scars could be observed in all patients,and the dermo-epidermal interface could be seen in 7 patients.On the vertical sections,lichenoid lymphocytic infiltration around the infundibulum and isthmus of hair follicles only could be observed in 9 patients,follicular micro-scars could be seen in 4,and the dermoepidermal interface could be observed in all patients.Moreover,the detection rates of interfollicular interface dermatitis,follicular keratotic plugs,lymphocytic infiltration around sebaceous glands,atrophy or disappearance of sebaceous glands and inflammatory infiltration around hair follicle bulbs were significantly different between the horizontal and vertical sections.In combination with clinical manifestations,7 patients could be exactly diagnosed with lichen planopilaris according to findings from horizontal sections,and 9 could be diagnosed exactly according to findings from vertical sections,while 21 could be diagnosed exactly according to histopathological findings from both horizontal and vertical sections.Conclusion With the help of dermoscopy,modified Ho-Vert technique can improve the efficacy of pathological diagnosis of classical lichen planopilaris,by multidimensionally showing histopathological changes.

Dermatitis herpetiformis-like Linear IgA bullous disease in a Filipino

@#INTRODUCTION: Linear IgA bullous disease (LABD) is a rare autoimmune blistering disease characterized by subepithelial bullae and linear IgA deposition along the basement membrane zone of the epidermis. Lesions present as pruritic papulovesicles and tense bullae which may coalesce forming annular or polycyclic urticarial plaques with blistering on the edge of the lesions forming the classic “string of pearls” sign. Lesions may affect the face, trunk, and extensor extremities. Incidence rates range from 0.5 to 2.3 cases per million individuals per year. Due to its rare occurrence, there are only a fewdocumented reports on cases of LABD, particularly in the Filipino population. CASE REPORT: A 33 year-old Filipino female consulted because of a 3-week history of severely pruritic vesicles and crusts on the face, trunk, and arms. Patient noted no gastrointestinal symptoms on consultation. Skin punch biopsy revealed subepidermal blisters with collection of neutrophils at the dermal papillae. Direct immunofluorescence showed strong (+2) deposits of linear IgA at the dermo- epidermal junction in perilesional skin thus validating the diagnosis. The patient’s serum was negative for IgA anti-tissue transglutaminase and IgA antiendomysial antibodies. Patient was treated with topical corticosteroids and Dapsone 50 mgs OD with remarkable improvement. CONCLUSION: Linear IgA bullous disease has very few reported cases especially in the Philippine setting. Dapsone is considered the first-line treatment. The disease may persist for a decade or longer, and relapses may occur. Careful history-taking accompanied by the histological, immunofluorescence, and serological findings must be done to ensure proper treatment and good prognosis.

A Clinical and Histopathological Study of 25 Cases of Vulvar Lichen Sclerosus et Atrophicus / 대한피부과학회지

Background@#Lichen sclerosus et atrophicus is an uncommon, benign, chronic lymphocyte-mediated inflammatory dermatosis that occurs mainly in the genital area. It causes substantial discomfort and morbidity, mostly in adult women. @*Objective@#To investigate the clinicopathological characteristics of patients with vulvar lichen sclerosus et atrophicus. @*Methods@#We retrospectively reviewed the clinical and histopathological features of 25 patients diagnosed with vulvar lichen sclerosus et atrophicus, who visited the dermatologic department between January 2009 and June 2017. @*Results@#The average age was 54.2 years, and the disease duration was mostly less than 1 year. The major clinical features were diffuse patch, followed by diffuse plaque and multiple macules. It often presented with diabetes mellitus, thyroid disease, and hypertension. Itching was the most common symptom, followed by pain and burning sensations. Histopathological findings were hyperkeratosis with follicular plugging; atrophy and loss of rete ridge elongation in the epidermis; liquefaction degeneration and keratinocyte necrosis in the dermo-epidermal junction;collagen fibers hyalinization; and infiltration of inflammatory cells in the dermis. Antihistamines and topical steroids were used in most cases for treatment. @*Conclusion@#Vulvar lichen sclerosus et atrophicus causes discomfort and diminishes the quality of life in older women. Early diagnosis and prompt treatment are vital in preventing disease progression and complications. This study will provide valuable data on vulvar lichen sclerosus et atrophicus to dermatologists.

Dermolipectomía abdominal funcional en paciente de alto riesgo quirúrgico / Functional abdominal dermolipectomy in patient with high surgical risk

La obesidad mórbida aparece como estadio final de la obesidad. Es una enfermedad crónica de origen multifactorial caracterizada por acumulación excesiva de grasa o hipertrofia del tejido adiposo, ocasionando problemas higiénicos, discapacidad funcional, afectando la calidad de vida. Se presenta paciente masculino de 66 años de edad, con panículo adiposo colgante severo, llegando a ambas rodillas con afectación cutánea, limitación funcional, movilización dependiente y discapacidad para realizar actividades diarias, siendo un paciente con alto riesgo y lipodistrofia abdominal severa. Se realizó Dermolipectomía Abdominal Funcional con resección de 20 kg de tejido dermograso. No presentó complicaciones y se logró su reincorporación social. La Dermolipectomía Abdominal Funcional constituye la única opción para el tratamiento de pacientes con vientre péndulo. Aplicando cuidados perioperatorios adecuados se logra disminuir el número de complicaciones y se reintegra socialmente a un paciente minusválido que, a causa del enorme faldón abdominal estuvo limitado por muchos años.

Morbid obesity appears as final stage of obesity. It is a chronic disease of multifactorial origin characterized by excessive accumulation of fat or hypertrophy of adipose tissue, causing hygienic problems, functional disability, affecting the quality of life. It is presented a male patient of 66 years oíd, with severe hanging panniculus adipose, reaching both knees with skin involvement, functional limitation, dependent mobilization and disability to perform daily activities, is a patient with high risk and severe abdominal lipodystrophy. Functional Abdominal Dermolipectomy was performed with resection of 20 kg of dermo-fat tissue. There were no complications and his social reincorporation was achieved. Functional Abdominal Dermolipectomy is the only option for treatment of patients with a pendulum belly. By applying adequate perioperative care, the number of complications is reduced and socially reintegrated into a handicapped patient who, due to the enormous abdominal skirt, was limited for many years.