Consensus on the treatment of alopecia areata - Brazilian Society of Dermatology

Abstract Background: Alopecia areata is a highly frequent disease with an impact on quality of life and several treatment options with little clinical confirmatory evidence. Objective: To disseminate the recommendations of Brazilian dermatologists with expertise in the treatment of alopecia areata. Methods: Eight specialists with expertise in alopecia areata from different university centers were appointed by the Brazilian Society of Dermatology to reach a consensus on its treatment. Based on the adapted DELPHI methodology, the relevant elements were considered; then, an analysis of recent literature was carried out and the consensus was written down. Consensus on the management of alopecia areata was defined with the approval of at least 70% of the panel. Results/Conclusions: Intralesional injectable corticotherapy was considered the first option for localized disease in adults. In extensive cases with signs of activity, systemic corticosteroid therapy should be considered and can be used together with immunosuppressants (corticosteroid-sparing agents). The use of an immunosensitizer (diphencyprone) is an option for stable long-term cases. Evaluation of side effects is as important as the rate of hair regrowth.

Porokeratosis of Mibelli - literature review and a case report / Poroqueratose de Mibelli - revisao da literatura e relato de um caso

Porokeratosis is a disorder of epidermal keratinization characterized by annular plaques with an atrophic center and hyperkeratotic edges, and includes a heterogeneous group of disorders that are mostly inherited in an autosomal dominant form. This report describes a 5 year-old female patient, with porokeratosis of Mibelli confirmed histopathologically. The rarity of this disorder, its clinical exuberance and the destructive character of the lesions, as well as the facial and mucosal involvements, unusual in this form of porokeratosis, and also its onset in early childhood motivated this report.

A poroqueratose é uma desordem da queratinização epidérmica caracterizada por placas anulares com centro atrófico e bordas hiperqueratóticas, e inclui um grupo heterogêneo de desordens que são na sua maioria herdadas de forma autossômica dominante. O presente caso refere-se a uma paciente feminina de 5 anos de idade, com poroqueratose de Mibelli confirmada histologicamente. A raridade desta desordem, a exuberância clínica e o caráter destrutivo das lesões, o acometimento facial e mucoso pouco usuais nesta forma de poroqueratose e o início na infância precoce motivaram este relato.

Dermoscopy examination of petechial lesions in a patient with Dermatitis Herpetiformis / Exame dermatoscopico de lesoes petequiais num paciente com Dermatite Herpetiforme

An uncommon skin manifestation of Dermatitis Herpetiformis is palmar and plantar purpura. Dermoscopic examination is useful for any skin condition since it allows recognition of structures that are not discernible to the naked eye. A 22 year-old Caucasian man was admitted with excoriated lesions and pruritus. Petechial lesions could be seen on volar aspect of the digits on the hands and feet. Dermoscopy examination revealed erythematous and violaceous dots and erythematous and brown dots.

Púrpura palmar e plantar é uma manifestação cutânea incomum da Dermatite Herpetiforme. A dermatoscopia é útil para o exame dermatológico por permitir o reconhecimento de estruturas que ao olho nu não são perceptíveis. Doente caucasiano masculino de 22 anos que queixava-se de lesões escoriadas e prurido. Observouse na face volar dos dedos dos pés e das mãos lesões petequiais. O exame dermatoscópico revelou pontos eritematosos e violáceos, além de pontos eritematosos e marrons.

Abordagem Cirúrgica da Ginecomastia Verdadeira / Surgical approach to True Gynecomastia

A ginecomastia verdadeira é uma proliferação benigna do tecido glandular da mama masculina. Em geral, o manejo é conservador, porem se houver o desenvolvimento de fibrose após a fase inflamatória, preconiza-se a cirurgia. Relata-se um caso de ginecomastia verdadeira, em homem com aumento simétrico das mamas desde a adolescência. Frente a este diagnóstico foi realizada cirurgia corretiva com anestesia tumescente e exérese em bloco da glândula mamária.

True gynecomastia is a benign proliferation of the glandular tissue of the male breast. In general, management is conservative, however if there is development of fibrosis after the inflammatory phase, surgery is recommended. The present article describes a case of true gynecomastia with symmetrical enlargement of the breasts since adolescence. In light of this diagnosis, corrective surgery was performed with tumescent anesthesia and exeresis in block of the mammary gland.