Micose fungoide hipocromiante na infância: avaliação de um caso clínico / Hypopigmented mycosis fungoides in childhood: evaluation of a clinical case

Micose fungoide é uma neoplasia dos linfócitos T helper que afeta a pele e geralmente não apresenta manifestações extracutâneas por muitos anos. Já a micose fungoide hipocromiante (MFH) corresponde a um subtipo daquela com melhor prognóstico e que se apresenta com lesões hipocrômicas a acrômicas, com distribuição mais comum em tronco, regiões proximais de extremidades e cintura pélvica. O diagnóstico é firmado pela apresentação clínica aliada à histopatologia, que evidencia epidermotropismo com linfócitos atípicos. A doença geralmente apresenta boa resposta ao tratamento, o qual pode ser realizado com fototerapia com raios ultravioleta A (UVA), ultravioleta B (UVB), mostarda nitrogenada tópica, carmustina tópica e irradiação cutânea com elétrons. Descreve-se o caso de uma criança com máculas hipocrômicas que surgiram inicialmente no abdome, posteriormente se estendendo para raiz de coxas e região inguinal. As lesões apresentavam descamação fina, porém sem eritema ou prurido e ausência de linfonodomegalia palpável. A princípio o caso foi conduzido como eczemátide hipocromiante, mas o paciente apresentou agravamento importante das lesões em poucos meses apesar do tratamento, sendo assim, aventada a hipótese diagnóstica de MFH. Duas biópsias de pele foram realizadas, e os exames anatomopatológico e imunohistoquímica evidenciaram certo epidermotropismo, mas sem atipia de linfócitos. Foi orientado helioterapia domiciliar, com exposição corporal de 10 minutos no período da manhã, além do uso de emolientes e cuidados gerais com a pele, com relativa boa resposta. O acompanhamento é semestral e caso haja modificação do quadro, a biópsia com estudo histopatológico e a imunohistoquímica serão realizados novamente. (AU)

Mycosis fungoides is a type of cancer of the T helper lymphocytes that affects the skin and generally has no extracutaneous manifestations for many years. Otherwise, hypopigmented mycosis fungoides corresponds to a subtype with better prognosis and presents as hypopigmented or achromatic lesions, with more widespread distribution in the trunk, proximal parts of extremities and pelvic girdle. The diagnosis is confirmed by clinical presentation and histopathology, which shows epidermotropism and atypical lymphocytes. The disease usually show good response to treatment, which is performed with phototherapy with ultraviolet A (UVA), ultraviolet B (UVB), topical nitrogen mustard, topical carmustine and cutaneous irradiation with electrons. We describe the case of a child with hypochromic taint that initially appeared in the abdomen, later extending to root thighs and groin. The lesions had fine scaling, absence of erythema or itching, without the presence of palpable lymph node enlargement. At first the case was conducted as pytiriasis alba, but the patient had significant aggravation of injuries in a few months in spite of the treatment, thus mooted diagnosis of hypopigmented mycosis fungoides. Two skin biopsies were performed, and the histological and immunohistochemical tests showed epidermotropism but no atypia of lymphocytes. It was guided home heliotherapy, with body exposure of 10 minutes in the morning, besides the use of emollients and general skin care, with a relatively good response. The follow-up is bi-annually and if there is a modification in the condition, the biopsy with histopathological study and immunohistochemistry will be performed again. (AU)

Colgajo de Limberg: variantes y aplicaciones / Limberg´s fl aps: variants and applications

La piel es asiento frecuente de injurias en especial traumáticas o neoplásicas, surgiendo la necesidad de la reconstrucción de la brecha quirúrgica. Existen múltiples opciones de reconstrucción y su uso dependerá del tamaño del defecto quirúrgico a reparar y de la experiencia y preferencia del cirujano tratante. Presentaremos al colgajo romboidal de Limberg y sus variantes como una técnica reconstructiva de gran utilidad para cubrir defectos cutáneos en cara y otras partes del cuerpo respetando la función y estética de la región.

The skin is a frequent seat of injuries especially traumatic or neoplastic, arising the need for reconstruction of the surgical gap. There are multiple reconstruction options and their use will depend on the size of the surgical defect to be repaired and on the experience and preference of the treating surgeon. We will present the rhombus Limberg fl ap and its variants as a reconstructive technique of great utility to cover skin defects in the face and other parts of the body respecting the function and aesthetics of the region.

Histological study of the effect of bone marrow-derived mesenchymal stem cells on healing of skin defect in adult male albino rats

Despite advances in wound care, skin loss results in significant morbidity and mortality. There is increasing evidence that bone marrow-derived mesenchymal stem cells [BM-MSCs] are useful for tissue regeneration because of their multipotency and easy isolation and culture. The objective of this study was to evaluate the efficacy of local administration of in-vitro-expanded BM-MSCs in the healing of experimentally induced full-thickness excisional wounds in adult male albino rats. Thirty-five adult male albino rats were used. They were divided into three groups. In group I rats, BM was isolated and cultured and skin specimens were obtained as a control. In group II rats, a full-thickness circular skin wound of 5mm in diameter was inflicted on the mid back of each rat and was examined on days 3, 7, and 14. In group III rats, the wound was inflicted as in group II, which was then treated with BM-MSCs and examined as in group II. The wound areas were excised and used for histological and immunohistochemical studies for CD105. Morphometric analysis was performed for assessment of epidermal thickness, area percentage of collagen and elastic fibers, and number of CD105-positive cells. Wounds treated with BM-MSCs [group III] showed evidence of re-epithelialization, increased epidermal thickness, hair follicle formation, collagen, and elastic fibers compared with wounds in group II. Similarly, the number of CD105-positive cells was prominently increased in the skin of the same group. Local administration of in-vitro-expanded BM-MSCs accelerates and promotes healing in full-thickness excisional wounds

Tratamiento de lesiones pigmentarias en pacientes pediátricos con laser Q-switched Nd: YAG / Treatment of pigmented lesions in pediatric patients with laser Q-switched Nd: YAG

Las lesiones pigmentarias en la infancia pueden ser: epidérmicas, como las efélides, las máculas café con leche, los nevos pigmentarios, los lentigos y el nevo Spilus; dermoepidémicas, como el nevo de Becker y la pigmentación postinflamatoria; y de localización dérmica, como el nevo de Ota, la mancha mongólica, el nevo de Ito y el nevo de Hori. El avance en la tecnología láser nos permite tratar muchas de estas lesiones en forma segura y eficaz. Se hace una revisión de la literatura sobre el uso del láser Q-switched neodymium yttrium aluminum garnet (Nd:YAG) para el tratamiento de lesiones pigmentarias.

Pigmented lesions in children can be due to pigment located in the epidermis, such as freckles, café au lait spots, pigmented nevi, lentigo and Spilus nevus; in the dermo-epidermal junction such as Becker´s nevus, post-inflammatory hyperpigmentation and others are due to pigment in the dermis, like nevus of Ota, Mongolian spots, nevus of Ito and Hori´s nevus. Recent advances in laser technology make possible the treatment of many of these lesions possible in a safe and efficacious way. This is a literature review about the applications of Q-switched neodymium yttrium aluminum garnet (Nd:YAG) for the treatment of pigmented lesions in children.

Factores relacionados con la aparición de estrías atróficas en mujeres adolescentes de dos establecimientos educativos privados de la ciudad de Medellín, 1997-1998 / Related factors with atrophic stretch marks in adolescent female students from two private educational establishments from the city of Medellin, 1997-1999

Objetivos: determinar la prevalencia de estrías atróficas e identificar la frecuencia de lo factores de riesgo relacionados con su aparición en mujeres adolescentes. Métodos: se realizó un estudio descriptivo en 210 estudiantes entre 12 y 18 años de dos establecimientos educativos privados de la ciudad de Medellín, Colombia. A cada estudiante se le aplicó una encuesta autodirigida y se le realizó un examen físico para observar la presencia de estrías. Resultados: el 75,2% de las adolescentes presentaron estrías, el 59,5% tenían entre 15 a 18 años. La localización más frecuente fueron los glúteos (78,3%). Se encontró asociación entre las estrías y factores como: obesidad (p=0,011), antecedentes familiares positivos (p=0,006), uso de hormonas no esteroideas (anticonceptivos) (p=0,003), consumo de productos dietéticos (p=0,025) y grasas (p= 0,026). No se encontró correlación con el fototipo, enfermedades, uso de esteroides, hábito de fumar y práctica de ejercicio. Conclusiones: las estrías atróficas son una entidad clínica de alta prevalencia en mujeres jóvenes, afectando múltiples zonas corporales con deterioro de la autoimagen. Ciertas conductas de alimentación y consumo de medicamentos, además de los antecedentes familiares, pueden estar implicados en el aumento de la frecuencia de esta enfermedad.

Objective: This study was designed to determine the prevalence of stretch marks in adolescent young woman and to identify the associated risk factors. Methods: It was performed a descriptive study on 210 students between 12 and 18 years old from two private schools in Medellín, Colombia. Each student answered a questionnaire and was examined. Results: 75.2% of the adolescents had stretch marks and 59.5% of them were between 15 and 18 years old. Most frequent affected body site was the buttock (78.3%). It was found a greater prevalence between the presence of stretch marks and factors like: obesity (p=0.011), family members with stretch marks (p= 0.006), use of nonsteroidal hormones (p=0.003), diet products (p=0.025), and fats (p=0.0265). It was not found association with phototype, diseases, glucocorticoids, smoking or exercise. Conclusions: The stretch marks are very frequent in adolescent female, they are a source of esthetic discomfort and have great psychological impact on those who have them. Eating habits, medications intake, personal and family histories can influence the appearance of stretch marks.

Diferentes espectros en las malformaciones vasculares congénitas / Different spectra in congenital vascular malformations

Las malformaciones vasculares son anomalías de los vasos debidas a una alteración del desarrollo embriológico. A diferencia de los hemangiomas, están siempre presentes en el nacimiento y aumentan de tamaño proporcionalmente al crecimiento del niño. No involucionan y, por lo tanto, siempre van a estar presentes a lo largo de la vida del paciente. Desde la clasificación de la ISSVA (International Society for the Study of Vascular Anomalies), las malformaciones vasculares se dividen en función del vaso afectado en capilares, venosas arteriovenosas, linfáticas y complejas o combinadas. Presentamos tres casos clínicos caracterizados los dos primeros por predominar el componente vascular, venoso y linfático y el tercero de tipo venolinfático y glómico.

Síndrome de ectrodactilia-displasia ectodérmica-labio/paladar hendido / Ectrodactyly ectodermal dysplasia cletfing syndrome

Se presenta el caso de femenina de 26 meses de edad, producto de primer parto, hija de padres sanos no consanguíneos, quien desde el nacimiento presentó displasia ectodérmica; ausencia de varios dedos(ectrodactilia) de forma simétrica en miembros superiores e inferiores; labio y paladar hendido; cabello escaso, fino y ralo; piel seca (xerosis); disminución de la sudoración (hipohidrosis) y erupción retardada de las piezas dentales. No había alteraciones en otros órganos, ni otros familiares afectados. Esta paciente ilustra un caso esporádico del Síndrome de ectrodactilia-displasia ectodérmica- labio/paladar hendido con los signos cardinales característicos del síndrome: 1.Ectrodactilia 2. Displasia ectodérmica y 3. Labio/paladar.

Cutis verticis gyrata primario esencial: comunicación de dos casos / Essential primary cutis verticis gyrata: report of two cases

Se presentan dos pacientes de 21 y 26 años de edad con cutis verticis gyrata. No se encontraron en ellos enfermedades subyacentes y el examen histopatológico no mostró alteraciones relevantes. Por lo tanto los incluimos en el tipo de cutis verticis gyrata primario esencial.

Nevo congênito gigante / Congenital giant nevi

O correto manejo do nevo congênito é de extrema importância clínica devido ao potencial de transformação maligna e à dificuldade terapêutica imposta por estas lesões. Apesar deste tema ser bastante controverso, muitos aspectos conceituais, terapêuticos e prognósticos já estão estabelecidos e possibilitam uma conduta com embasamento clínico-epidemiológico para o nevo congênito gigante. O objetivo deste trabalho é ajudar o médico que se depara com um caso de nevo congênito gigante a estabelecer uma conduta correta e atualizada