Manifestação clínica de sarcoidose sistêmica após preenchimento cutâneo / Clinical manifestation of systemic sarcoidosis after cutaneous filling

A sarcoidose é doença granulomatosa não infecciosa de etiologia desconhecida, em que fatores ambientais, infecciosos, imunológicos e genéticos parecem estar relacionados. Manifestações clínicas podem ocorrer em qualquer órgão, mas há predomínio em pulmão e linfonodos intratorácicos. O envolvimento cutâneo da doença ocorre em cerca de 25% dos casos, sendo o procedimento de preenchimento cutâneo um potencial desencadeante. Relata-se caso de uma paciente que apresentou lesões granulomatosas na face após preenchimento cutâneo com ácido hialurônico. Na investigação das lesões cutâneas, a paciente apresentou critérios diagnósticos de sarcoidose com extenso acometimento pulmonar.

Sarcoidosis is a non-infectious granulomatous disease of unknown etiology in which environmental, infectious, immunological, and genetic factors appear to be correlated. Clinical manifestations can occur in any organ, however there is predominance in the lungs and in intrathoracic lymph nodes. The cutaneous involvement of the disease occurs in roughly 25% of cases, with cutaneous filling procedures figuring as a potential trigger. The authors of the present article report a case of a patient who had granulomatous lesions on the face following cutaneous filling with hyaluronic acid. In the investigation of cutaneous lesions, the patient presented diagnostic criteria for sarcoidosis, with extensive pulmonary involvement.

Chromoblastomycosis: tissue modifications during itraconazole treatment

Abstract: Background: Histological and mycological changes during itraconazole use have not been totally established in chromoblastomycosis. Objectives: To evaluate tissue modifications in chromoblastomycosis carriers under itraconazole treatment. Methods: A histological retrospective study of 20 cases of chromoblastomycosis seen at the university hospital at the south of Brazil, during itraconazole 400 mg daily treatment. Patients were classified into two groups: plaque or tumor lesions, and underwent periodic evaluations every four months during three years. Hematoxylin-eosin stain was used to analyze epidermal modifications, inflammatory infiltrate and fibrosis, and Fontana-Masson stain for parasite evaluation. Results: Fontana-Masson stain was superior to hematoxylin-eosin stain in fungal count in the epidermis (mean difference=0.14; p<0.05). The most distinct mycosis tissue responses were registered in the dermis. Epidermal thinning, granulomatous infiltrate decrease or disappearance, fibrosis increase and quantitative/morphological changes occurred during treatment. Study limitations: Patients could not be located to have their current skin condition examined. Conclusion: Parasitic and tissue changes verified in this study can reflect the parasite-host dynamics under itraconazole action.

Frontal fibrosing alopecia and lichen planus pigmentosus: diagnosis and therapeutic challenge

Abstract Frontal fibrosing alopecia is a variant of lichen planopilaris with marginal progressive hair loss on the scalp, eyebrows and axillae. We report a case of frontal fibrosing alopecia and lichen planus pigmentosus in a postmenopausal woman, that started with alopecia on the eyebrows and then on the frontoparietal region, with periocular and cervical hyperpigmentation of difficult management. The condition was controlled with systemic corticosteroid therapy and finasteride. Lichen planus pigmentosus is an uncommon variant of lichen planus frequently associated with frontal fibrosing alopecia in darker phototipes. It should be considered in patients affected by scarring alopecia with a pattern of lichen planopilaris and areas of skin hyperpigmentation revealing perifollicular hyperpigmentation refractory to multiple treatments. This case illustrates diagnostic and therapeutic challenge in face of scarring alopecia and perifollicular hyperpigmentation.

Dapsone in the treatment of pemphigus vulgaris: adverse effects and its importance as a corticosteroid sparing agent

Pemphigus vulgaris is an autoimmune disease characterized by suprabasal blisters with acantholysis, which has a fatal course in a large number of untreated patients. Systemic corticosteroid therapy is considered first-line therapy. Adjuvant treatment with the goal of sparing corticosteroids include, among others, dapsone. This drug is not without side effects and its use requires clinical and laboratory control. We present a patient with PV initially managed with suboptimal dose of prednisone, evolving into drug-induced hepatitis after introduction of dapsone.