Cutaneous manifestations of COVID-19 patients in a Hospital in São Paulo, Brazil, and global literature review

Abstract Background: Since the beginning of the COVID-19 pandemic, a myriad of cutaneous manifestations have been described in association with this viral infection. However, in Latin America, this kind of data is still scarce. Objective: In this sense, the goal of this study was to describe the dermatological findings observed during SARS-CoV-2 infection, in a Brazilian Hospital. Methods: This is a cross-sectional, retrospective and descriptive study of 50 cases of new-onset dermatologic symptoms in patients with COVID-19, treated at Hospital Sírio-Libanês, from February to June 2020. Results: The patients (n = 50) were classified into 6 groups, according to the elementary lesions and the statistical analysis was performed. The most common cutaneous lesions were maculopapular eruptions (44%), necrosis, purpura, and livedo (32%), urticarial lesions (12%), pseudochilblains (4%) and papular-vesicular eruption (4%). In 46% of the patients the cutaneous lesions occurred in association with other symptoms, such as pruritus (38%), pain and burning sensation (8%). Lower limbs were affected in 44% of the cases, followed by the trunk (38%), upper limbs (24%) and face (14%). Cutaneous lesions were mostly found after other COVID-19 systemic symptoms, with a mean period between the viral syndrome and cutaneous signs of 5 days (SD = 6.1 days). Study limitations: It is a small sample, in a single-center study, with patients exclusively from a private Hospitals. Conclusions: Patients in Brazil have the same proportion of lesions as revealed in other studies in Europa. The compiled data is essential for a better understanding of cutaneous manifestations deemed secondary to COVID.

Pseudoxanthoma elasticum: report of two cases

Pseudoxanthoma elasticum is a rare inherited multisystem disorder that is characterized by a pathological mineralization of the elastic connective tissue, which involves predominantly the skin, eyes and cardiovascular system. Its cause lies on mutations in the ABCC6 gene, which lead to reduction or absence of the transmembrane transport ADP dependent protein (MRP6), causing an accumulation of extracellular material and subsequent deposition of calcium and other minerals in the elastic tissue. The authors report two cases of pseudoxanthoma elasticum, emphasizing its major clinical features and the importance of early diagnosis of the disorder, aiming for adequate therapeutic management of associated complications.

Incontinentia pigmenti or Bloch-Sulzberger syndrome: a rare X-linked genodermatosis

Incontinentia pigmenti is a rare X-linked genodermatosis that affects mainly female neonates. The first manifestation occurs in the early neonatal period and progresses through four stages: vesicular, verruciform, hyperpigmented and hypopigmented. Clinical features also manifest themselves through changes in the teeth, eyes, hair, central nervous system, bone structures, skeletal musculature and immune system. The authors report the case of a patient with cutaneous lesions and histological findings that are compatible with the vesicular stage, emphasizing the importance of early diagnosis and appropriate therapeutic management.

Onicomatricoma: tumor raro do aparelho ungueal: relato de três casos / Onychomatricoma: a rare tumor of the nail apparatus: report of three cases

Os onicomatricomas são tumores benignos raros que se originam a partir da matriz ungueal e do estroma subjacente. São geralmente assintomáticos e de crescimento lento. Acometem igualmente homens e mulheres de meia idade, comprometendo com maior frequência os dígitos das mãos. As características clínicas fundamentais para o diagnóstico são: faixa longitudinal amarelada de espessura variável, estilhaços hemorrágicos, estrias longitudinais associadas à hipercurvatura transversal e projeções digitiformes emergentes da matriz ungueal. Os autores relatam três casos desse tumor acometendo pododáctilos, enfatizando seus principais aspectos clínicos, achados dermatoscópicos e tratamento cirúrgico.

Onychomatricomas are rare benign tumors originating from the nail matrix and underlying stroma. They are usually asymptomatic and slow growing, affecting both middle-aged men and women, and more frequently involve the digits of the hands. Key clinical features for diagnosis are: yellowish longitudinal band of variable width, splinter hemorrhages, longitudinal grooves associated with the transverse overcurvature and fingerlike projections emerging from the nail matrix. The authors report three cases of this tumor affecting toes, emphasizing main clinical aspects, dermoscopic findings, and surgical treatment.

Esquema alternativo para tratamento de hanseníase multibacilar em um caso de hepatotoxicidade durante a poliquimioterapia / Alternative treatment of multibacillary leprosy in a case of hepatotoxicity during multidrug therapy

A associação da dapsona, rifampicina e clofazimina tem se mostrado eficaz do tratamento da hanseníase multibacilar,entretanto a dapsona é responsável por inúmeros efeitos colaterais. Relata-se um caso de hepatoxocidade durante a poliquimioterapia, tratado com sucesso com a introdução de esquema alternativo com rifampicina,clofazimina e ofloxacino.

The combination of dapsone, rifampicin and clofazimine has proven quite effective in the treatment of multibacillary leprosy, however dapsone is responsible for numerous side effects. We report a case of hepatoxocidade during multidrug therapy, successfully treated with the introduction of alternative treatment with rifampicin,clofazimine and ofloxacin.

Síndrome da Sulfona: uma grave reação de hipersensibilidade / Sulfone syndrome: a severe hypersensitivity reaction

A dapsona é uma medicação utilizada no tratamento da hanseníase e outras doenças cutâneas. Mesmo em doses habituais pode causar um quadro denominado síndrome da sulfona caracterizado por febre, hepatite,dermatite esfoliativa, linfadenomegalia, anemia hemolítica e atipia linfocitária. Trata-se de uma rara e grave reação de hipersensibilidade à sulfona com curso clínico imprevisível. Os autores relatam um caso de síndrome da sulfona, enfatizando seus principais achados clínicos,laboratoriais e histopatológicos.

Dapsone is a drug used to treat leprosy and other skin diseases. Even in normal doses can cause a condition called sulfona syndrome, characterized by fever, hepatiti sexfoliative dermatitis, generalised lymphadenopathy, hemolytic anemia and atypical lymphocytes in peripheral blood. It’s a rare and severe hypersensitivity reaction to sulfone with an unpredictable clinical course. The authors report a case of sulfone syndrome, emphasizing its main clinical, laboratory and histopathological findings.