Erupção medicamentosa fixa na face associada a dipirona: correlação dos achados clínicos, histopatológicos e dermatoscópicos / Fixed drug eruption on the face associated with dipyrone: correlation of clinical, histopathological and dermatoscopic findings

As reações adversas associadas aos fármacos com manifestações cutâneas não são raras, expressando-se com múltiplos aspectos clínicos, podendo gerar morbidade significativa. A erupção medicamentosa fixa é uma reação adversa comum, com envolvimento cutâneo, associada ao uso de inúmeros medicamentos. A dipirona é fármaco com efeitos analgésicos e antitérmicos amplamente utilizada no Brasil, porém, sabe-se que é uma substância potencialmente desencadeadora de reações adversas, e a erupção medicamentosa fixa entre elas. Relata-se um caso de erupção medicamentosa fixa relacionada ao uso da dipirona, com apresentação clínica singular e correlacionam-se os achados clínicos, histopatológicos e dermatoscópicos encontrados.

Adverse reactions associated with drugs presenting cutaneous manifestations are among the most common, expressing itself with multiple clinical aspects and causing significant morbidity. The fixed drug eruption (FDE) is a common adverse reaction with cutaneous involvement and is associated with the use of numerous drugs. Dipyrone is a drug with analgesic and antipyretic effects prescribed widely used in Brazil, however, it is known for its potential to triggering adverse reactions, including the FDE. This report shows an EMF case related to the use of dipyrone, with unique clinical presentation and correlate the clinical, histopathological and dermatoscopic found.

Amantadine-induced livedo reticularis - Case report

AbstractLivedo reticularis is a spastic-anatomical condition of the small vessels which translates morphologically by a reticular pattern, interspersing cyanosis, pallor and erythema. The same can be congenital or acquired. Among the acquired, we highlight the physiological livedo reticularis and the idiopathic livedo by vasospasm; the latter configures the most common cause. The drug-induced type is less common. The drugs amantadine and norepinephrine are often implicated. Cyanosis is usually reversible if the causative factor is removed, however, with chronicity, the vessels may become permanently dilated and telangiectatic. We report a case of a patient diagnosed with Parkinson's disease with chronic livedo reticularis associated with the use of amantadine and improvement after discontinuation of the drug.

Penfigoide bolhoso induzido por enalapril / Bullous pemphigoid induced by enalapril

O penfigoide bolhoso (PB) é uma dermatose bolhosa autoimune subepidérmica que comumente afeta indivíduos idosos. O desencadeamento da doença por medicamentos é conhecido, entretanto, pouco descrito na literatura, especialmente casos associados ao uso de enalapril. A interrupção do fármaco desencadeante constitui o pilar terapêutico, entretanto medicações podem ser necessárias. Descrevemos um caso de PB em um paciente com 45 anos associado ao uso do enalapril e discutimos sobre a variante de PB induzida por medicamentos.

Dermatoscopic fi ndings as a complementary tool in the differential diagnosis of the etiological agent of tinea capitis

Tinea capitis is a scalp infection caused by fungi. In Brazil, the main causative agents are Microsporum canis and the Trichophyton tonsurans. Etiological diagnosis is based on suggestive clinical findings and confirmation depends on the fungus growth in culture. However, it is not always possible to perform this test due to lack of availability. We reveal the dermoscopic findings that enable distinction between the main causative agents of Tinea capitis, M. canis and T. tonsurans. The association of clinical and dermatoscopic findings in suspected Tinea capitis cases may help with the differential diagnosis of the etiological agent, making feasible the precocious, specific treatment.

Anti-TNF-α and hydralazine drug-induced lupus

Drug-induced lupus is a rare drug reaction featuring the same symptoms as idiopathic lupus erythematosus. Recently, with the introduction of new medicines in clinical practice, an increase in the number of illness-triggering implicated drugs has been reported, with special emphasis on anti-TNF-α drugs. In the up-to-date list, almost one hundred medications have been associated with the occurrence of drug-induced lupus. The authors present two case reports of the illness induced respectively by hydralazine and infliximab, addressing the clinical and laboratorial characteristics, diagnosis, and treatment.

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.

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.

Update on cutaneous tuberculosis

Tuberculosis continues to draw special attention from health care professionals and society in general. Cutaneous tuberculosis is an infection caused by M. tuberculosis complex, M. bovis and bacillus Calmette-Guérin. Depending on individual immunity, environmental factors and the type of inoculum, it may present varied clinical and evolutionary aspects. Patients with HIV and those using immunobiological drugs are more prone to infection, which is a great concern in centers where the disease is considered endemic. This paper aims to review the current situation of cutaneous tuberculosis in light of this new scenario, highlighting the emergence of new and more specific methods of diagnosis, and the molecular and cellular mechanisms that regulate the parasite-host interaction.

Esporotricose cutâneo linfática com transmissão zoonótica / Cutaneous-lymphatic sporotrichosis with zoonotic transmission

Os autores apresentam o caso de uma paciente do sexo feminino, de 43 anos, com esporotricose cutâneo linfática, transmitida por seu gato que apresentava lesão na face. O caso de esporotricose humana foi notificado e o felino encaminhado para avaliação veterinária.

History of leprosy in Rio de Janeiro

The record of the first cases of leprosy in Rio de Janeiro dates from the seventeenth century. The first local host of leprosy patients was created from 1741, and the first colonies hospitals were built in the early twentieth century, in order to avoid contagion of the population. The first structures dedicated to research also date from this time: the Leprosy International Institute, the Leprology Institute, and the Leprosy Laboratory of the Oswaldo Cruz Foundation, where the most prestigious leprologists of Rio de Janeiro worked. Currently, investigations are focused on the Oswaldo Cruz Foundation; additionally, leprosy patients are treated at municipal health centers and state hospitals, and former colony hospitals only accept patients with severe disabilities.

Confluent and reticulate papillomatosis of Gougerot-Carteaud and obesity: dermoscopic findings

Confluent and reticulated papillomatosis of Gougerot and Carteaud is a dermatosis that despite showing characteristic clinical signs is often poorly recognized and diagnosed. The authors present a case with extensive skin involvement, discuss its association with obesity and describe dermoscopic findings making the histopathological correlation.

Dermoscopy applied to pediculosis corporis diagnosis

We report the case of a 47-year-old homeless male with a massive infestation of Pediculus humanus corporis on his entire body. Dermoscopy helped to diagnose pediculosis by showing the involvement of scalp, beard and the genital region in this disease.

Eritromelalgia: apresentação clínica incomum / Erythromelalgia: an unusual clinical presentation

Eritromelalgia é uma doença rara caracterizada pela tríade: eritema, calor e dor em queimação. Pode envolver os pés, as mãos e, menos comumente, o segmento cefálico. Geralmente é bilateral, entretanto, pode manifestar-se de forma unilateral. O resfriamento das áreas afetadas pode resultar em alívio dos sintomas. Relatamos um caso de eritromelalgia no pavilhão auricular direito, uma localização não habitual.

Dermoscopy as an auxiliary method in the diagnosis of social wasp (Hymenoptera, Vespidae) stings

We describe the case of a 32-year-old male patient that sought medical treatment complaining of severe pain in his second and third right-hand fingers. The symptoms had started two hours before. The hypotheses of spider bite, scorpion or insect sting and injury caused by a foreign body were considered in the differential diagnoses. On dermoscopy, two foreign bodies were identified on his skin. After extraction, we concluded that they were wasp stingers.

Acometimento hepático na síndrome sulfona dapsona-induzida durante tratamento de hanseníase / Hepatic involvement in sulfone dapsone-induced syndrome during treatment of leprosy

A hanseníase é uma doença endêmica no Brasil e constitui grave problema de saúde pública. Em números absolutos, o Brasil é o segundo país que mais registra novos casos da doença por ano no mundo. O tratamento da hanseníase compreende: quimioterapia específica, supressão dos surtos reacionais, prevenção de incapacidades físicas, reabilitação física e psicossocial. A síndrome sulfona é uma condição multissistêmica potencialmente grave que pode ocorrer durante o tratamento de algumas dermatoses, entre elas a hanseníase. Relatamos um caso de síndrome de hipersensibilidade à dapsona (SHD) em um paciente masculino, de 32 anos, ocorrida durante o tratamento de hanseníase multibacilar...

Talon noir: auxílio da dermatoscopia no diagnóstico diferencial de lesão pigmentada / Talon noir: dermoscopy assisted differential diagnosis of pigmented lesions

Talon noir foi descrita pela primeira vez em 1961 por Peachey, como erupção petequial traumática característica dos saltos dos jogadores de basquete e originalmente chamada de petéquias do calcâneo. É dermatose relacionada ao trauma, com lesões assintomáticas e marcada pela presença de sangue dentro do estrato córneo. Apresenta manifestações clínicas variadas e sua localização depende do fator provocativo envolvido. Os autores apresentam caso de talon noir em paciente com psoríase vulgar e demonstram a importância da correlação das características clínicas, dermatoscópicas e histopatológicas.

Talon noir was first described in 1961 by Peachey as atraumatic petechial eruption characteristic of basketball players' heels, and were originally called calcaneal petechiae. It is a dermatosis linked to trauma, with asymptomatic lesions, marked by the presence of blood within the stratum corneum. It presents varied clinical manifestations, with the location depending on the involved provocative fac-tor. The present study describes a case of talon noir in a patient with psoriasis vulgaris and demonstrates the importance of the correlation of clinical, dermoscopic, and histopathological characteristics.