An unusually large onychomatricoma.

Onychomatricoma is a rare benign tumour of the nail matrix first described in 1992, and since then, no more than 80 cases have been reported. Despite distinct clinical characteristics, it is frequently misdiagnosed as onychomycosis partly due to remaining an unknown entity. The authors present the case of a patient with a 30-year history of nail abnormalities with more recent growth to alarming dimensions.

Eruptive collagenoma in a child.

Eruptive collagenoma is a rare entity, with unknownetiology, considered to be a type of connective tissuenevus composed of collagen. It is usually reported inyoung adults occurring predominantly on the trunkand extremities. Systemic findings and family historyof a similar condition are not typically associated andthe prognosis is excellent. There are few pediatric casesreported in literature. Herein we report an uncommoncase of eruptive collagenoma in a 12-year-old childand present a brief review of the literature.

Giant subungual glomus tumor: clinical, dermoscopy, imagiologic and surgery details.

Glomus tumor is a rare benign vascular hamartoma derived from the modified smooth muscle cells of the glomus body. Paroxysmal pain is the leading symptom. A 78-year-old woman presented at our clinic with a 50-year history of a slow growing painful purple blue tender nodule under the right fourth finger nail. Dermoscopy and magnetic ressonance confirmed the presence of a large subungual tumor and total surgical excision was performed after partial nail plate avulsion. Histologic examination confirmed a glomus tumor. After 1 year of follow-up, the nail grew with normal shape and neither complications nor recurrence were observed.

Variants of dermatofibroma--a histopathological study.

Several variants of dermatofibroma have been described. They are essentially distinguished by their clinical and histopathological features. To review the mainfeaturesof these variants, a retrospective study of skin biopsies and tissue excisions of dermatofibromasperformed in the dermatology and venereology service at the Hospital Garcia de Orta between May 2007 and April 2012 was carried out. During that period, 192 dermatofibromas were diagnosed in 181 patients, the lesions being more common in women. Median age of the study population was 48 years. The most common lesion site was the limbs (74% of patients). The histopathological types found were common fibrous histiocytoma (80%) and the aneurysmal (5.7%),hemosiderotic (5.7%), epithelioid (2.6%), cellular (2.1%), lipidized (2.1%), atrophic (1.0) and clear cell (0.5%) variants. Based on these findings, this review focuses on the clinical and histological features of the various variants of dermatofibroma in terms of their clinical presentation, distinct histopathological features, differential diagnosis and prognosis.

Variants of dermatofibroma - a histopathological study

Several variants of dermatofibroma have been described. They are essentially distinguished by their clinical and histopathological features. To review the mainfeaturesof these variants, a retrospective study of skin biopsies and tissue excisions of dermatofibromasperformed in the dermatology and venereology service at the Hospital Garcia de Orta between May 2007 and April 2012 was carried out. During that period, 192 dermatofibromas were diagnosed in 181 patients, the lesions being more common in women. Median age of the study population was 48 years. The most common lesion site was the limbs (74% of patients). The histopathological types found were common fibrous histiocytoma (80%) and the aneurysmal (5.7%),hemosiderotic (5.7%), epithelioid (2.6%), cellular (2.1%), lipidized (2.1%), atrophic (1.0) and clear cell (0.5%) variants. Based on these findings, this review focuses on the clinical and histological features of the various variants of dermatofibroma in terms of their clinical presentation, distinct histopathological features, differential diagnosis and prognosis.

Z-Plasty: useful uses in dermatologic surgery.

Z-Plasty is a procedure involving the transposition of two interdigitating triangular flaps. This technique is useful in a number of dermatological procedures. It can be used to correct defects resulting from surgical complications. This paper highlights several examples where Z-Plasty is of benefit in dermatosurgery, including the correction of: ectropion, lip misalignment and bifid earlobe. A valuable technique that every dermatologist should be able to perform.

Perforating Granuloma Annulare - An Unusual Subtype of a Common Disease.

Perforating granuloma annulare (GA) is a rare subset of GA with an unknown etiology and chronic course. Herein, we report the case of 72 year-old women with a 3-month history of a post-traumatic, persistent, erythematous and exudative plaque located on her left leg. Differential diagnosis included mycobacterial infection, subcutaneous mycosis, perforating dermatoses, pyoderma and squamous cell carcinoma. The histopathology was highly suggestive of a perforating GA. The patient was treated with betamethasone dipropionate cream applied once daily and a complete resolution of the lesion was observed in three weeks. Despite being a very rare subtype of a common disease, perforating granuloma annulare has clinical and histopathological characteristic features that facilitate the differential diagnosis, avoiding unnecessary procedures and inadequate and potentially more invasive treatments.

Using 80% trichloroacetic acid in the treatment of ingrown toenails / Acido Tricloroacetico a 80% no tratamento da onicocriptose

BACKGROUND: Ingrown nails are a very common problem. There are different stages of disease and diverse therapeutic options. Phenol and sodium hydroxide are commonly used agents for chemical matricectomy but both frequently entail excessive healing times. OBJECTIVE: This prospective study aimed mainly to evaluate the efficacy of partial nail avulsion and selective chemical cauterization of the matrix using 80% TCA in the treatment of the ingrowing nail. METHODS: One-hundred-and-thirty-three patients with 197 ingrown toenails were included in this study. Preoperatively, we tried to find predisposing factors to the disease. In the postoperative period, patients were evaluated for potential complications at days 3, 30, 180, 270 and 360. Pain was measured before surgery, as well as 24 hours and 72 hours after surgery. RESULTS: There were only 3 cases (out of 197) of ingrown nail recurrence. Preoperatively, we found the presence of drainage in 82% of patients, which, following the first visit after surgery, was reduced to 19%. Persistent granulation tissue was found in 3% of the patients (versus 75% prior to surgery). The most frequent predisposing factors for the ingrown nail were excessive trimming of the lateral nail plate (63%), plantar hyperhidrosis (58%) and heavy nail folds (39%). Pain was substantially reduced after surgery. CONCLUSION: It is assumed that chemical procedures for the ingrown toenail are associated with delayed healing times but our results demonstrated quick recovery. Using 80% TCA for selective matricectomy in the ingrown toenail is an effective, quick and easy method. .

FUNDAMENTO: A unha encravada é uma patologia muito frequente. A doença engloba diferentes estadios existindo diferentes soluções terapêuticas. O fenol e o hidróxido de sódio são largamente utilizados na matricetomia química porém ambos cursam com longos tempos de cura. OBJETIVO: O principal objectivo deste estudo prospectivo foi avaliar a eficácia da mactricectomia com ácido tricloroacético a 80% no tratamento da unha encravada. MÉTODOS: Foram incluídos no estudo 133 doentes com 197 unhas encravadas. Factores predisponentes foram avaliados pré-operatoriamente. No período pós-operatório os doentes foram avaliados para potenciais complicações ao dia 3, 30, 180, 270 e 360. A dor foi avaliada antes da cirurgia, 24 horas e 72 horas depois da cirurgia. RESULTADOS: Ocorreram apenas 3 (em 197) casos de recorrência da unha encravada. Antes da cirurgia registou-se exsudação em 82% dos doentes sendo que na primeira visita após a cirurgia este número foi reduzido para 19%. Observou-se ainda tecido de granulação persistente em 3% dos doentes (versus 75% antes da cirurgia). Os factores predisponentes mais frequentemente encontrados para unha encravada foram o corte excessivo da porção lateral da placa ungueal (63%), hiperhidrose plantar (58%) e pregas ungueais espessadas (39%). A dor teve uma redução dramática após a cirurgia. CONCLUSÃO: É assumido que os procedimentos químicos para a unha encravada estão associados com longos tempos de cura mas os nossos resultados mostraram uma rápida recuperação. No tratamento da unha encravada a matricectomia parcial com ácido tricloroacético a 80% é um método rápido, eficaz e de fácil execução. .

Photoletter to the editor - Calciphylaxis: a diagnostic and therapeutic challenge.

Calciphylaxis is an uncommon necrotizing dermal condition, most often related to end-stage renal disease, associated with secondary hyperparathyroidism. The incidence is 1-4% per year in dialyzed patients. The condition is characterized by microcalcification of small and medium-sized blood vessels, causing cutaneous and soft tissue necrosis. The etiology of calciphylaxis is poorly understood, although many reports highlight the abnormal calcium-phosphate products as an important etiological factor. Calciphylaxis is associated with significant morbidity and mortality with estimated 5-year survival rates of less than 50%. Sepsis is the main cause of death. We report two patients of calciphylaxis treated with surgical debridement and excellent outcome in both cases.

Photoletter to the editor: Atrophic dermatofibrosarcoma protuberans with minimal clinical manifestation.

Dermatofibrosarcoma protuberans is an uncommon soft tissue neoplasm. In the vast majority of cases it presents as a nodule or a firm tumor that can reach massive dimensions producing the protuberant nodules for which it is named. We report a case of a 34-year-old woman presented at our department with an 8-year history of a small and discretely erythematous supraclavicular atrophic plaque. Skin biopsy lead to the diagnosis of dermatofibrosarcoma protuberans and a wide local excision of the tumor was performed in collaboration with the Plastic Surgery department. In this clinical case we describe an uncommon variant of the disease with minimal clinical manifestation that can cause serious diagnostic difficulties. The small and discrete atrophic plaque of our patient could have been easily ignored with serious clinical and prognostic implications for the patient.

Photoletter to the editor: Botryomycosis in an immunocompetent woman.

Botryomycosis is a chronic, granulomatous infection of the skin, soft tissue and viscera. It is uncommon and mainly occurs in immunocompromised patients. Splendore-Hoeppli phenomenon represents an immunological host reaction to antigens of infectious and non-infectious agents. We report a case of a 64-year-old immunocompetent woman presented at our department with a 2-month history of abdominal papules and discharging nodules. She was treated with several antibiotics with no success. Skin biopsy showed granular bodies in the dermis with a Splendore-Hoeppli phenomenon. Microbiologic study isolated a Staphylococcus aureus. Patient was successfully treated 4 weeks with oral clindamycin 300 mg bid. Lack of drug penetration into the "encapsulated-like" microcolonies could explain the therapeutic challenge of this case.

Using 80% trichloroacetic acid in the treatment of ingrown toenails.

BACKGROUND: Ingrown nails are a very common problem. There are different stages of disease and diverse therapeutic options. Phenol and sodium hydroxide are commonly used agents for chemical matricectomy but both frequently entail excessive healing times. OBJECTIVE: This prospective study aimed mainly to evaluate the efficacy of partial nail avulsion and selective chemical cauterization of the matrix using 80% TCA in the treatment of the ingrowing nail. METHODS: One-hundred-and-thirty-three patients with 197 ingrown toenails were included in this study. Preoperatively, we tried to find predisposing factors to the disease. In the postoperative period, patients were evaluated for potential complications at days 3, 30, 180, 270 and 360. Pain was measured before surgery, as well as 24 hours and 72 hours after surgery. RESULTS: There were only 3 cases (out of 197) of ingrown nail recurrence. Preoperatively, we found the presence of drainage in 82% of patients, which, following the first visit after surgery, was reduced to 19%. Persistent granulation tissue was found in 3% of the patients (versus 75% prior to surgery). The most frequent predisposing factors for the ingrown nail were excessive trimming of the lateral nail plate (63%), plantar hyperhidrosis (58%) and heavy nail folds (39%). Pain was substantially reduced after surgery. CONCLUSION: It is assumed that chemical procedures for the ingrown toenail are associated with delayed healing times but our results demonstrated quick recovery. Using 80% TCA for selective matricectomy in the ingrown toenail is an effective, quick and easy method.

Cutaneous thrombosis related to paroxysmal nocturnal hemoglobinuria: clinical report.

Paroxysmal nocturnal hemoglobinuria is a clonal stem cell disorder typically characterized by hemolysis, bone marrow failure, and venous thrombosis. The latter can affect up to 40 percent of patients and is a significant cause of mortality. Despite being recognized as a possible complication, cutaneous thrombosis is quite uncommon and a variety of findings have been reported. Owing to the rarity of this complication and the importance of its correct and timely diagnosis, we report the case of a 64-year-old man with paroxysmal nocturnal hemoglobinuria who presented with isolated and well-demarcated erythematous-violaceous plaques, mainly located on the neck and trunk. Given the history and the histological features, the diagnosis of cutaneous thrombosis related to paroxysmal nocturnal hemoglobinuria was assumed and the patient was successfully treated with therapeutic anticoagulation. The early identification of these patients is essential for necessary surveillance because they could carry a higher probability of recurrence compared with those with no prior complications.