Primary skin diseases and cutaneous manifestations of systemic diseases in swine / Doenças primárias da pele e manifestações cutâneas de doenças sistêmicas em suínos

Skin diseases in pigs can negatively impact the production. They cause losses related to the death of the affected pigs, to the cost with the treatment, growth retardation and condemnations in the slaughterhouses. This study was developed to determine the frequency and describe the histopathological findings of skin diseases in pigs in different age groups through a retrospective study from 2006 to 2018. A total of 154 conclusive cases were analyzed, including skin restricted diseases (allergic dermatitis, exudative epidermitis, vesicular dermatitis, pityriasis rosea, swinepox, follicular cyst, papilloma and scrotal hemangioma) or skin lesions secondary to systemic diseases (erysipelas, porcine dermatitis and nephropathy syndrome (PDNS), bacterial septicemia and multiple hemorrhages without definite cause). The skin lesions were classified as bacterial (46.1%), viral (26.6%), allergic (12.3%), neoplastic (1.3%) and others (13.6%). Swine erysipelas was the most frequent diagnosis (47/154), followed by PDNS (23/154), allergic dermatitis (19/154) and exudative epidermitis (15/154). Vesicular dermatitis (9/154), pityriasis rosea (9/154), septicemia with cutaneous manifestations (9/154), swinepox (9/154) and multiple hemorrhages without definite cause (7/154) were also observed. Follicular cyst (3/154), hyperkeratosis without definite cause (2/154), papilloma (1/154), and scrotal hemangioma (1/154) were less frequently described. Of the conclusive diagnosis, age was reported in 138 cases, with the highest frequency of skin lesions observed at the inspection process during slaughter (56/138).(AU)

As doenças de pele em suínos podem impactar negativamente a produção. Estas causam perdas relacionadas à morte dos acometidos, a custo com tratamentos, atraso no crescimento e condenações nos frigoríficos. Este trabalho foi desenvolvido para determinar a frequência e descrever os achados histopatológicos das doenças de pele em suínos nas diferentes faixas etárias, através de um estudo retrospectivo no período de 2006 a 2018. Foram analisados 154 casos conclusivos incluindo as doenças restritas a pele (dermatites alérgicas, epidermite exsudativa, dermatite vesicular, pitiríase rósea, varíola suína, cisto folicular, papiloma e hemangioma escrotal) e as secundárias a doenças sistêmicas (erisipela, síndrome dermatite nefropatia suína (SDNS), septicemia bacteriana e hemorragias múltiplas de causa não determinada). Estas foram classificadas em bacterianas (46,1%), virais (26,6%), alérgicas (12,3%), neoplásicas (1,3%) e outras (13,6%). A erisipela suína foi a enfermidade mais diagnosticada (47/154), seguida por SDNS (23/154), dermatite alérgica (19/154) e epidermite exsudativa (15/154). Observamos ainda dermatite vesicular (9/154), pitiríase rósea (9/154), septicemia bacteriana com manifestações cutâneas (9/154), varíola suína (9/154) e hemorragias múltiplas de causa não determinada (7/154). Em menor número, cisto folicular (3/154), hiperqueratose sem causa definida (2/154), papiloma (1/154) e hemangioma escrotal (1/154). Dos casos conclusivos, a idade foi informada em 138 casos, sendo a maior frequência das lesões de pele observadas na linha de inspeção, durante o abate (56/138).(AU)

Sífilis secundaria con compromiso pulmonar / Secondary syphilis with pulmonary involvement

La sífilis es una enfermedad de transmisión sexual causada por una espiroqueta, Treponema palidum. Presentamos el caso de una mujer de 62 años de edad, que consultó por fiebre de 38°, dolor torácico en puntada de costado y lesiones pruriginosas en piel. Se realizó examen de laboratorio de sangre periférica, radiografía y tomografía de tórax. Recibió tratamiento antibiótico y fue diagnosticada como neumonía aguda de la comunidad. Debido a la respuesta parcial de los síntomas y persistencia de lesiones pruriginosas se realizó biopsia de piel que informó Treponema palidum, el cual fue confirmado con test serológico VDRL y FtA-abs positivo. La paciente recibió 4 dosis de penicilina G benzatínica con favorable evolución de las lesiones en piel y mejoría de las imágenes radiológicas.

We present the case of a 62-year-old woman who consulted for fever (38°), stabbing thoracic pain (on one side), and pruritic skin lesions. She underwent peripheral blood tests, chest X-rays and CT. Her symptoms were interpreted as severe community-acquired pneumonia. After a treatment with antibiotics, her skin lesions persisted, and other symptoms were only partially relieved. A skin biopsy was performed, which revealed Treponema pallidum. Such finding was confirmed through positive serum VDRL and FTA-ABS tests. The patient received 4 doses of benzathine penicillin G with favorable evolution of skin lesions and improvement of radiological images.

Síndrome de Sweet en una niña preescolar / Sweet syndrome in a 5-year-old girl

El síndrome de Sweet, también conocido como dermatosis neutrofílica febril, es un trastorno dermatológico poco frecuente en pediatría. Clínicamente, se caracteriza por la aparición de lesiones papulares y/o nodulares de una coloración rojiza-violeta con hipersensibilidad local. Se reporta el caso de una paciente femenina de 5 años, quien consultó por un cuadro clínico de 10 días de evolución de aparición de lesión forunculosa en el arco nasal. Se realizó una biopsia de piel, que reportó dermatitis difusa con predominio de polimorfonucleares neutrófilos, necrosis epidérmica y ausencia de vasculitis. No se identificaron microorganismos. Se consideró el cuadro compatible con síndrome de Sweet. Es importante tener en cuenta este diagnóstico en cuadros clínicos similares y se deben descartar otros diagnósticos más frecuentes primero.

Sweet syndrome, also known as acute febrile neutrophilic dermatosis, is an infrequent dermatological disorder in pediatrics. Clinically it is characterized by the development of papular and/or nodular lesions of a reddish-violet coloration with local hypersensitivity. We report the case of a 5-year-old female who consulted 1 month after the appearance of the lesion in the nasal arch. A skin biopsy was performed and it reported diffuse dermatitis with a predominance of neutrophil polymorphonuclear cells, epidermal necrosis and absence of vasculitis. No microorganisms were identified. It was considered compatible with Sweet syndrome. It is important to consider this diagnosis in similar clinical cases and other more frequent diagnoses must be ruled out first.

Lymphocytoma cutis on the inguinal region: report of a rare case of benign lymphoproliferative disorder

Abstract Lymphocytoma cutis, or benign reactive lymphoid hyperplasia, is an inflammatory skin lesion that mimics clinically and histologically malignant lymphoma. Most cases are idiopathic, but they may also be triggered by multiple factors, such as insect bites, tattoos, injections and herpes zoster. Clinically, the lesions are erythematous, soft papules, plaques or nodules, usually located on the upper limbs and face. The diagnosis is mainly based on histopathology and immunohistochemistry. Corticosteroid injections, cryosurgery, PUVA therapy, radiotherapy and surgery can be therapeutic options in cases requiring immediate treatment. To demonstrate an atypical presentation of this tumor, a case lymphocytoma skin on the groin will be reported, describing its diagnosis and treatment.

Sarcoidal granulomatous reaction due to tattoos: report of two cases

Abstract Numerous infectious, inflammatory and neoplastic complications secondary to tattoo placement have been reported in the literature. Within inflammatory complications sarcoidal granulomatous reactions have been described. We report two cases, a 55-year-old woman with yellowish infiltrated plaques on bilateral ciliary region, 16 years after the placement of a permanent tattoo in the eyebrows, and a 20-year-old tattoo artist who developed orange papules on 3 of his tattoos. Histopathology in both cases confirmed diagnosis of sarcoidal granulomatous reaction due to tattoo pigment.

Dermatitis numular: presentación de dos casos pediátricos / Nummular dermatitis: report of two cases in children

La dermatitis o eccema numular es una patología poco frecuente en pediatría. El cuadro se caracteriza por un inicio con diminutas pápulas y vesículas eritematovioláceas que confluyen en placas exudativas de forma circular y evolucionan a placas eccematosas o liquenificadas de forma discoide o anular. Aparecen, predominantemente, en superficies extensoras de las extremidades, aunque pueden encontrarse en el tronco, las manos o los pies. El diagnóstico es clínico; solo en casos con mala evolución pueden ser necesarias pruebas complementarias. La base del tratamiento son los corticoides tópicos y, si se encuentra un desencadenante infeccioso, el tratamiento de la causa. Su evolución suele ser crónica o recidivante. Se presentan dos casos clínicos en población pediátrica con la finalidad de difundir entre los pediatras su conocimiento y manejo.

Nummular eczema or dermatitis is an uncommon paediatric pathology. It is presented as red-purplish small papules and vesicles that join to form exudative circular patches and then to eczematous or lichenified patches with discoid shape. The lesions appear predominantly on the extensor surface of extremities, although they can appear in trunk, hands or feet. This pathology has a clinical diagnosis; only few cases require complementary test. The topical corticosteroids are the mainstay of the treatment, and the causal treatment whether an infectious trigger is found. The patients have chronic or recurrent evolution. We report two cases in children with the aim of spreading knowledge among pediatricians.

Interstitial granulomatous dermatitis: rare cutaneous manifestation of rheumatoid arthritis

Abstract Besides being an uncommon clinicopathological entity, interstitial granulomatous dermatitis, also described as interstitial granulomatous dermatitis with arthritis (IGDA), has shown a wide spectrum of clinical manifestations, such as linear and erythematous lesions, papules, plaques and nodules. Histological features include dense dermal histiocytic infiltrate, usually in a palisade configuration, and scattered neutrophils and eosinophils. We describe a middle aged woman with rheumatoid arthritis of difficult management and cutaneous lesions compatible with IGDA.

A case of generalized ostraceous psoriasis mimicking dermatitis neglecta

Lithium has been implicated in the exacerbation of pre-existing psoriasis, in the induction of psoriasis on previously uninvolved skin of psoriasis patients, and in the triggering of psoriasis for the first time in patients without a personal or family history. Lithium-induced psoriasis (and its resistance to treatment) is one of the major reasons for noncompliance in patients treated with lithium. We describe a male patient who developed generalized ostraceous psoriasis whose clinical appearance mimicked dermatitis neglecta, 10 months after starting therapy with lithium.

HTLV-1-associated infective dermatitis and probable HTLV-1- associated myelopathy in an adolescent female

Human T cell lymphotropic virus type 1 (HTLV-1)-associated infective dermatitis (ID) is a chronic, severe and recurrent eczema occurring during childhood in patients vertically infected with HTLV-1. HTLV-1-associated myelopathy/tropical spastic paraparesia (HAM/ TSP) is slow and progressive. We report the case of an adolescent female from a non-endemic area for HTLV-1 who presents ID and, most likely, associated HAM/TSP.

Bed bug dermatitis, description of two cases in Rio de Janeiro, Brazil

Bed bugs are hematophagous insects which due to their morphological and biological characteristics are able to easily adapt themselves to human households. The authors describe two cases of dermatitis caused by bed bug bites in the city of Rio de Janeiro, Brazil. Patients presented linear lesions in the usual "breakfast, lunch and dinner" arrangement, suggesting this diagnosis. A visit to their dwellings showed infestation of insects identified as Cimex hemipterus. The knowledge of these insects by the dermatological community will contribute to an accurate diagnosis as well as subsidize the dissemination of information aiming for prevention.

Adaptation and Evaluation of the Incontinence Care Protocol

PURPOSE: This study was done to develop an evidence-based incontinence care protocol through an adaptation process and to evaluate the effects of the protocol. METHODS: The protocol was developed according to the guideline of adaptation. A non-randomized controlled trial was used for testing the effects of the new Incontinence Care Protocol. A total of 120 patients having bowel incontinence with Bristol stool type 5, 6, and 7 and admitted to intensive care units were recruited to this study. The newly developed incontinence care protocol was used with patients in the experimental group and conventional skin care was given to patients in the control group. Outcome variables were incontinence-associated dermatitis (IAD) severity, pressure ulcer occurrence and severity. RESULTS: The experimental group had significantly less severe IAD (t=6.69, p<.001), lower occurrence of pressure ulcers (chi2=7.35, p=.007), and less severity of pressure ulcers (Mann-Whitney=86.00, p=.009) than the control group. CONCLUSION: Use of this incontinence care protocol has the effects of preventing pressure ulcers and inhibiting worsening of IAD and pressure ulcers. Therefore, this incontinence care protocol is expected to contribute to managing IAD and pressure ulcers.

Case for diagnosis

Graham-Little-Piccardi-Lassueur Syndrome is a rare form of Lichen Planus, characterized by the presence of the triad: non-scarring hair loss in the inguinal and axillary regions and follicular spinous or disseminated acuminate papules; typical, cutaneous or mucous LP; and scarring alopecia of the scalp with or without atrophy. These features do not have to be present simultaneously.

Biomodulation effects of LED and therapeutic ultrasound combined with semipermeable dressing in the repair process of cutaneous lesions in rats

PURPOSE: To compare the biomodulatory effects of LED and ultrasound combined with semipermeable dressing in the repair of cutaneous lesions. METHODS: Eighty-four Wistar rats were submitted to surgical injury (2.5 cm) and divided into four groups (n=21): Group I (control), Group II (LED therapy, LED), Group III (LED therapy + dressing, LED+D) and Group IV (ultrasound + dressing, US+D). At seven, 14 and 21 days, the animals were euthanized, and the specimens of interest removed for histological analysis. RESULTS: Histological and histomorphometric analysis revealed a greater percent wound regression in animals receiving the dressing (group III: 55.97; group IV: 53.06), as well as a greater reduction in the inflammatory infiltrate (group III: 29.14; group IV: 31.71) since day 7. A later effect, with progression of the tissue repair process only after 14 and 21 days, was observed in the LED group intense fibroblast proliferation and greater collagen fiber production and organization were seen in the LED+D and US+D groups compared to the other groups. CONCLUSION: LED combined with a dressing was more effective at accelerating in the repair of cutaneous lesions. .

Utilização da técnica de imuno-histoquímica para confirmar casos de pitiose cutânea equina diagnosticados por meio de caracterização clínica e avaliação histopatológica / Immunohistochemistry analysis to confirm cases of cutaneous pythiosis in horses diagnosed by means of clinic characterization and histopathologic evaluation

Avaliaram-se 12 feridas granulomatosas em membros torácicos e pélvicos de equinos da raça Pantaneira. Foi realizado diagnóstico sugestivo para pitiose cutânea de acordo com as características clínicas das feridas e avaliação histopatológica, com as colorações de hematoxilina-eosina (HE) e Prata Metenamina de Grocott (GMS). A confirmação do diagnóstico foi realizada por exame imuno-histoquímico, método streptavidina-biotina marcada (LSAB). O diagnóstico histopatológico foi de dermatite piogranulomatosa, focal extensa, acentuada, associada a "pseudo-hifas" características de Pythium insidiosum (pitiose cutânea), nos 12 animais desta pesquisa. O diagnóstico de pitiose foi confirmado em 100% dos casos pela imunomarcação positiva (LSAB) para Pythium insidiosum, caracterizada pela visualização de estruturas ramificadas e septadas, sendo observados 100% de paridade entre as técnicas. É possível concluir que a caracterização clínica das feridas granulomatosas com aspecto de pitiose em equinos associada ao resultado histopatológico sugestivo para pitiose equina constituem métodos de diagnóstico confiáveis, os quais podem ser confirmados pela técnica de imuno-histoquímica.

Twelve granulomatous lesions in the thoracic and pelvic limbs of horses from pantaneira breed were evaluated. It was performed suggestive diagnostic of cutaneous pythiosis according to the clinic characteristics of the lesions and histopathological exams using hematoxylin and eosin (HE) and Grocott's methenamine silver (GMS) stains. The confirmation of the diagnoses was performed by the labelled streptavidin biotin (LSAB) method (immunohistochemistry). Extensive focal pyogranulomatous dermatitis associated with "pseudo hyphae" characteristic of Pythium insidiosum (subcutaneous pythiosis) was the histopathological diagnosis for all 12 horses used in this study. It was confirmed in 100% of the cases by the positive result to Pythium insidiosum in the immunohistochemistry exam, characterized by the visualization of branched and septated structures. It was observed 100% of parity between the techniques. We can conclude that clinical characterization of the granulomatous lesions with pythiosis aspects in horses associated with histopathology suggestive of equine pythiosis constitute a reliable method of diagnostic that can be confirmed by immunohistochemistry technique.

Shiitake dermatitis: the first case reported in Brazil / Dermatite flagelada por shiitake, primeiro relato de caso no Brasil

Shiitake Dermatitis is often presented as papules and erythemato-violaceous linear streaks. It can be associated with bleomycin treatment, dermatomyositis and shiitake mushroom (Lentinus edodes). There is not any previous report concerning this rare etiology in our country. Shiitake is the second most consumed mushroom worldwide and it can cause flagellate erythema when ingested raw or half cooked. It has a higher incidence in Oriental countries because of their eating habits, this is the first case reported in Brazil, in a male patient that presented a cutaneous rash after consuming this raw mushroom.

A dermatite flagelada é caracterizada por pápulas eritematosas lineares com aspecto de "chicotada". A etiologia pode ser associada ao uso de bleomicina, dermatomiosite e shiitake (Lentinus edodes). Este é o segundo cogumelo mais consumido no mundo e pode ser causa de dermatite flagelada quando ingerido cru ou mal cozido. Não há relatos nas literaturas de quadro de dermatite flagelada por shiitake em nosso país, reportamos o primeiro caso no Brasil de um paciente masculino que desenvolveu o quadro após a ingesta desse cogumelo cru.

Gamasoidosis illustrated: from the nest to dermoscopy / Gamasoidose ilustrada: do ninho à dermatoscopia

Gamasoidosis (acariasis, avian-mite dermatitis or bird-mite dermatitis) is a challenging diagnosis that is becoming more common because of the frequent use of window air conditioners in tropical countries. These devices may serve as shelters for nests of urban birds such as pigeons. Dermatologists should become familiar with this infestation to establish the correct diagnosis and treatment.

Gamasoidose (acaríase, infestação por "piolhinho-de-pombo" ou dermatite por ácaros aviários) é um diagnóstico desafiador que está se tornando mais comum devido ao uso frequente de aparelhos de ar-condicionado de janela em países tropicais, que servem de abrigo para ninhos de pássaros urbanos tais como pombos. Dermatologistas devem se familiarizar com esta infestação para fazerem diagnóstico e tratamento adequados.