Excited skin syndrome.

BACKGROUND: Excited skin syndrome (ESS) occurs when, after a battery of patch tests is applied to patients with suspect allergic contact dermatitis, an excessive number of positive patch tests is obtained that are no longer reproduced when the patient is retested. OBJECTIVE: This study was performed to verify the occurrence of ESS when patch tests were applied to a population with a hypothetical diagnosis of allergic contact dermatitis, to determine the rate of positive test result loss among the tested patients who developed ESS, and to try to identify factors that might initiate the ESS. METHODS: From January 1985 to May 1990, patch tests were performed on 1,500 patients referred to the Allergy Sector of the Dermatology Clinic of Santa Casa de São Paulo with a hypothetical diagnosis of contact dermatitis. Thirty-four of the 1,500 patients were considered because they showed three or more positive test results during the first phase of the patch tests. These patients were submitted to the retesting of substances with positive test results in the first phase. RESULTS AND CONCLUSIONS: Analysis of the results allowed us to conclude that the frequency of ESS in the 1,500 patients tested was 2.2% and that the number of lost test results between the first and the second phase was 175, showing a loss rate of positive test results of 63.5%. Regarding the facts that might interfere with the ESS, it was shown that (1) the loss rate of positive test results varied among patients, ie, polysensitized patients showed a lower rate of test result losses than monosensitized or bisensitized patients; (2) the longer the time of evolution of the chronic eczematous dermatitis, the higher the tendency to develop ESS; (3) ESS might be initiated by positive test results of weak, medium, or high intensity; (4) when the patch tests are applied close to one another, the positive test results may induce additional responses in the area; and (5) it was not possible to show statistically that the nature of certain substances interferes with the induction of ESS.

Risk factors for basal cell carcinoma: a case-control study.

A controlled trial was performed with the purpose of investigating which factors could be considered of significant risk for the development of basal cell carcinoma. A total of 259 cases of basal cell carcinoma diagnosed from July 1991 to July 1992 were compared with 518 controls matched for age and sex. All subjects in both groups were white. Protocol data were submitted to statistical analysis by the chi-square test and by multiple conditional logistic regression analysis and the following conclusions were reached: 1) light skin color (types I and II of the Fitzpatrick classification), odds ratio of 2.8; outdoor work under constant sunlight, odds ratio of 5.0; the presence of actinic lesions due to exposure to the sun, odds ratio of 4.9, are risk factors per se. 2) Type III skin in the Fitzpatrick classification only represents a risk factor when the patient reports a history of intense sunburns, but not in the absence of such a history. 3) Sunburns per se do not represent a risk factor althorig the point made in item 2 of these conclusions is valid. 4) Other suspected risk factors whose significance was not confirmed by multiple conditioned logistic regression analysis were: residence in rural areas, light eyes and blond hair color, extent of the awareness of the "sun x skin cancer" relationship, familial occurrence of skin cancer, excessive exposure to the sun, and freckles appearing in childhood.

[Dermatophytosis in childhood: clinical and therapeutic aspects]. / Dermatofitoses na infância: aspectos clínicos e terapêuticos.

Dermatophytoses have peculiar aspects in children, making them different from adult dermatophytoses. The author reviewed 139 of his personal cases to evidence these peculiarities; based on these cases he was able to discuss: a) clinical aspects of dermatophytoses and the frequency of each form in the child; b) analysis of the species of dermatophytes isolated in the 101 patients studied. The author adds a therapeutical orientation for cases of dermatophytosis in children.

[Thalidomide: an eclectic medication in dermatology]. / Talidomida: uma medicação eclética em dermatologia.

The authors review the indications for the use of thalidomide in dermatological conditions. They consider leprotic reaction, prurigo nodularis of Hyde, actinic prurigo, discoid lupus erythematosus, Weber-Christian panniculitis, recurrent mouth aphtosis, Behcet's syndrome, and pyoderma gangrenosum. The dramatic situation created by the use of thalidomide in the sixties not-withstanding, interest in its use is warranted within certain limits due to its wide therapeutic action.

[Interpretation of the Mitsuda and Kveim tests in the differential diagnosis of tuberculoid hanseniasis and cutaneous sarcoidosis]. / Interpretação dos testes de Mitsuda e de Kveim no diagnóstico diferencial entre hanseníase tuberculóide e sarcoidose cutânea.

Patients with sarcoidosis that present only cutaneous lesions are uncommon but have been described. In countries where leprosy occurs as an endemic disease the differential diagnosis between sarcoidosis and tuberculoid leprosy may be difficult to establish. In order to entrance the correct diagnosis this study presents a table in which the results of lepromin and Kveim tests are analyzed are correlated to the other.

[Epidemiological study of tinea pedis in a population studied in Santa Casa de Sao Paulo]. / Estudo epidemiológico da tinha do pé em população estudada na Santa Casa de São Paulo.

The authors make an epidemiologic study of tinea pedis aiming at establishing its minimal frequency in the population studied, as well as recognizing the most frequent fungi and the clinical aspects they determine. We've tried to study the role of the dermatophytes in the normal microbiota of the feet. Finally we analyzed the influence of sex and seasonality factors on the incidence of tinea pedis.

[Ulerythema ophryogenes and folliculitis ulerythematosa reticulata]. / Ulerythema ophryogenes und Folliculitis ulerythematosa reticulata.

Three fundamental alterations characterize keratosis pilaris syndrome: follicular keratosis, vasodilatation and atrophy. Ulerythema ophryogenes and folliculitis ulerythematosa reticulata are types of the syndrome that localize on the eyebrows and cheeks and sometimes affect the ears and scalp. Punctuate atrophy and hair rarefaction may result. The patients frequently exhibit keratosis simplex as well. The clinical picture is considered to be an autosomal dominant genodermatosis and its treatment is ineffective.

[Achromatizing contact dermatitis caused by rubber sandals]. / Dermatite de contato acromiante por sandálias de borracha.

Depigmentation due to contact dermatitis, presents itself in most of the cases as a professional disease, and in only few reports it is shown to be caused by the use of personal items. From June 1982 to March 1983, six patients were observed with a symmetrically distributed contact dermatitis, located on the upper side of the feet, showing the marks of rubber sandal straps, know as "Hawaiian sandals". All patients were exposed to standard patch tests, containing 31 elements among which, there are seven substances that are related to the rubber manufacturing process, such as: potassium dichromate, mercaptobenzothiazole, diphenylguanidine, thiuram-rubber-mixture, colophony, p-phenylenediamine, hydroquinone. The interpretation of the patch tests was done after 48 an 72 hours, following the criteria that were established by the International Contact Dermatitis Research Group (ICORG). Five patients showed sensitiveness to at least, two of the suspected substances. Mercaptobenzothiazole and/or thiuram rubber mixture were the substances most frequently related to these cases of depigmentation. Two patients who had a positive patch test for the thiuram-mix, developed a depigmentation area on the site of the test after two weeks. Depigmentation produced by the thiuram-mix had not been related formerly and though our study it became evident that this substance can lead to it.

[Behavior of the intradermal reaction with lepromin in sarcoidosis patients]. / Comportamento da intradermo-reação con lepromina em doentes de sarcoidose.

The Lepromin (Mitsuda) skin test was performed in 14 patients with sarcoidosis and in 40 controls. In the sarcoidosis patients results were negative in 85.8% and positive in 14.2%. In the control group, on the contrary, results were negative in 15.0% and positive in 85.0%. Thus it became evident that patients with sarcoidosis produce an impaired reaction to the characteristic granuloma formation of the Mitsuda test. This seems to be a paradoxical response, since sarcoidosis is an essentially granulomatous disease.

Dificuldades para diagnostico de sarcoidose exclusivamente cutanea. / Difficulties in the diagnosis of exclu sively cutaneous sarcoidosis

Dez pacientes que receberam o diagnostico de sarcoidose, em sua forma estritamente cutanea, foram acompanhados e/ou revistos em um periodo de dois a cinco anos, apos o diagnostico inicial. Cinco pacientes tiveram seus diagnosticos confirmados e se mantem curados apos tratamento com corticosteroides. Um paciente, apos tres anos, evoluiu para uma forma ganglionar e pulmonar de sarcoidose. Tres pacientes tiveram seus diagnosticos reformulados para hanseniase tuberculoide e foram tratados com sulfona. Um paciente teve seu diagnostico retificado para paracoccidioidomicose,forma cutanea localizada. Os autores discutem o comportamento dos testes tuberculinico, leprominico e de Kveim, no grupo estudado.Concluem reconhecendo a existencia de formas cutaneas estritas de sarcoidose, mas chamam a atencao para a dificuldade do diagnostico diferencial, sobretudo com hanseniase tuberculoide

[Comparative study of the lepromin reaction performed on medical students and on a control group]. / Estudo comparativo da lepromino-reação praticada em estudantes de medicina e em grupo controle.

The lepromin test was studied in 64 medical students and in a control group consisted of 40 patients from the orthopedic clinic. Both groups matched with respect to age and sex, but differed with regard to socio-economical conditions. The Fernandez reaction showed low frequency of positive results in both groups: 10% in the first group and 5,6% in the second one. This difference was not significant. The Mitsuda reaction showed high frequency of positive results: 98,4% in the medical students and 85,0% in the control group. This difference was significant. The authors discuss the factors that might have caused the high positivity of the lepromin test among the medical students.

[Similarities and differences between Brazilian wild fire and pemphigus foliaceus Cazenave]. / Ahnlichkeiten und Unterschiede zwischen brasilianischem "Fogo selvagem" und Pemphigus foliaceus Cazenave.

Pemphigus foliaceus Cazenave and "fogo selvagem" ("wild fire") show not only common aspects but also important differences. Based on their own experience and that of other Brazilian physicians, the authors demonstrate epidemiologic and clinical differences as well as prognostic dissimilarities. They refer to metabolic and endocrine alterations in fogo selvagem patients, not yet observed in pemphigus foliaceus patients. Finally, they point out that no difference was observed up to now as regards immunopathologic and electron-microscopic aspects.

[Kveim test performed with antigen obtained from lymph nodes]. / Reação de Kveim praticada com antígeno obtido de linfonodos.

This is our second paper about the Kveim test performed with G-77 antigen obtained from sarcoid lymph nodes. The antigen was tested in 46 patients with proved or suspected sarcoidosis and in 50 controls. Results were: 1) In 27 patients with active proved sarcoidosis and without treatment the test was positive in 85,1% (23/27 patients); 2) In 2/3 patients with proved sarcoidosis after therapeutic remission for more than two years and without treatment presently, the results were positive in one of them; 4) In 14 patients suspected to have sarcoidosis but showing lesions only on the skin the test was positive in 58,1% (8/14 patients); 5) In 48 controls the test was negative but in 2 it was positive. Our results agree with those of the literature.

Um caso de micetoma nocardiosico.Reavaliacao doze anos apos a cura clinica. / Mycetoma due to Nocardia brasiliensis. Reevaluation twelve years after clinical cure

Os autores reavaliam um caso de micetoma actinomicetico nocardiosico, 12 anos apos a cura clinica. Nao obstante a multiplicidade das lesoes existentes, com acometimento osseo extenso, enfatizam que foi obtida uma resposta rapida com o emprego da associacao corticosteroide-sulfamidico.A cura se mantem decorridos 12 anos.A reavaliacao clinica mostrou apenas lesoes cicatriciais. O estudo radiologico mostrou que no femur as alteracoes se mantinham, e ainda mais, que houve recuperacao completa das alteracoes radiologicas inicialmente observadas em fibula e tibia