Study of lipid profile in adult women with acne.

OBJECTIVE: The aim of this study was to establish the lipid profile of female patients with acne in the Acne-in-Adult-Women Ambulatory Care Clinic in order to observe the prevalence of dyslipidemia in those patients. METHODS: This is a retrospective transversal study that evaluated the medical records of 416 patients who attended at the Acne-in-Adult-Women Ambulatory Care Clinic, at the Dermatology Department, Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil, in the year 2012. Relevant data included age and clinical classification of acne. The lipid profile was analyzed according to the results of laboratory tests ordered during outpatient visits, which included total and fractionated cholesterol levels and triglycerides. RESULTS: The epidemiological study sample was of 219 patients, with ages ranging from 21 to 61 years (mean of 32.23 years). The predominant clinical grade was papule-pustule acne (grade II) with 156 patients (71%). Regarding the lipid profile of the patients, there was a high increase in total cholesterol levels in 17.35% of the cases. High-density lipoprotein levels were low in 11.42% of the patients, with normal prevalence in 194 subjects. Low-density lipoprotein levels were normal in most patients (60.27%). Very-low-density lipoprotein values were normal in almost all patients (94.06%) and increased in only 13 patients (5.94%). Only 18 patients presented high levels of triglycerides (8.22%). CONCLUSION: The conclusion was that patients with grades II and III acne are more likely to have total cholesterol and low-density lipoprotein altered. A correct and early diagnosis can be an important measure for the prevention of the metabolic syndrome in these patients.

Hanseníase virchowiana difusa e o diagnóstico diferencial com outras doenças sistêmicas / Lepromatous leprosy and the differential diagnosis with other systemic diseases

A Hanseníase é uma doença causada pelo Mycobacterium leprae, com manifestações cutâneas acompanhadas de perda da sensibilidade e envolvimento de sistema nervoso periférico, podendo acometer vísceras e mucosas. O Brasil ocupa o 2° lugar no ranking de prevalência da doença. A classificação própria da hanseníase evidencia sua complexidade clínica e polimorfismo; e possibilita intersecções com patologias como o linfoma não Hodgkin. Este é uma neoplasia maligna de linfonodos, e pode manifestar-se primariamente na pele. Paciente masculino, 51 anos. Procurou o serviço com queixa de “pele rachada”, lesões em boca e língua, e emagrecimento. Ao exame físico, presença de placas em palato, formações esbranquiçadas em dorso de língua e infiltração em lóbulo de orelha. Identificaram-se ainda, alterações sensitivas em extremidades, rash cutâneo eritemato-descamativo generalizado, tumoração em cotovelo, e lesões eritemato-infiltradas com exulcerações em membros inferiores. As hipóteses diagnósticas foram: hanseníase, leishmaniose cutâneo-mucosa, SIDA, Sífilis secundária e linfoma não Hodgkin. Durante a investigação, obtiveram-se resultados negativos para todas as sorologias, exceto a pesquisa de BAAR e biópsia sugerindo Hanseníase Virchowiana. Iniciou-se tratamento poliquimioterápico e houve remissão completa das lesões. Na hanseníase virchowiana, notam-se lesões sólidas papulosas, nodulares, ou em placas com características variáveis. Além disso, é possível encontrar espessamento de pavilhão auricular, madarose e obstrução nasal. Lesões em cavidade oral, também são descritas nestes casos. Os linfomas não Hodgkin de apresentação cutânea primária, podem se assemelhar a formas difusas de Hanseníase virchowiana, pois são neoplasias linforreticulares que se manifestam durante a história natural da doença em tecidos extranodais, dentre eles, a pele.

Leprosy is a disease caused by Mycobacterium leprae, with skin manifestations accompanied by loss of sensation and involvement of the peripheral nervous system that can also affect mucous membranes and viscera. Brazil ranks 2nd in the ranking of disease prevalence. The classification of leprosy itself shows its clinical polymorphism; and allows intersections with diseases such as non-Hodgkin lymphoma. This is a malignant neoplasm of lymph nodes, and may manifest primarily inthe skin. A 51 years-old male patient came to us complaining of “chapped skin”, lesions in the mouth and the tongue and weight loss. On physical examination there was the presence of plaques on the palate, whitish formations on back of tongue and ear lobe infiltration. We identified sensory changes, widespread erythematous rash, a tumor in the elbow, and infiltrated erythematous lesions with exulcerations in lower limbs. The diagnostic hypotheses were: mucocutaneous leishmaniosis, AIDS, secondary syphilis, leprosy and non-Hodgkin lymphoma. During the investigation, all serological test were negative, however, acid fast bacilli staining and biopsy suggested lepromatous leprosy. After multidrugtherapy treatment there was complete resolution of the lesions. In lepromatous leprosy solid nodular, papular lesions or plaques with variable characteristics may be noticed. Additionally, thickening of the pinna, madarosis and nasal obstruction can be found. Lesions in the oral cavity are also described in cases of lepromatous leprosy. Non-Hodgkin lymphomas with primary cutaneous presentation, may resemble indeterminate forms of leprosy, since they are characterized as lymphoreticular neoplasms that arise during the natural history of the disease, in extranodal tissues, including the skin.

The importance of the dermatologist at the hospital.

Skin lesions are often underestimated when patients are hospitalized in clinical or surgical areas. We made weekly visits to Mario Covas State Hospital of Sao Paulo, Brazil, for 35 weeks. Patients answered a questionnaire and underwent skin examination. The skin lesions were photographed. Of the 359 patients evaluated, a total of 1098 dermatological conditions were diagnosed. The most prevalent skin conditions included photodermatosis, neoplasms, vasculopathies and onychopathies. The growing number of dermatological diseases in hospitals justifies the active and constant presence of the dermatologist in a multidisciplinary team, thereby improving prognosis and patients' quality of life.

Spontaneous involution of keratoacanthoma, iconographic documentation and similarity with volcanoes of nature.

Through iconography, we show a case of keratoacanthoma (KA) on the nasal dorsum at two different stages of evolution (maturation and regression) and its similarity with images of the Mount St. Helens volcano and the Orcus Patera crater. Using these illustrations, we highlight why the crateriform aspect of this tumor is included in its classic clinical description. Moreover, we photographically documented the self-involuting tendency of KA, an aspect that is seldom documented in the literature.

Spontaneous involution of keratoacanthoma, iconographic documentation and similarity with volcanoes of nature / Ceratoacantoma de involução espontânea, documentação iconográfica e semelhança com vulcões da natureza

Through iconography, we show a case of keratoacanthoma (KA) on the nasal dorsum at two different stages of evolution (maturation and regression) and its similarity with images of the Mount St. Helens volcano and the Orcus Patera crater. Using these illustrations, we highlight why the crateriform aspect of this tumor is included in its classic clinical description. Moreover, we photographically documented the self-involuting tendency of KA, an aspect that is seldom documented in the literature.

Mediante iconografia, mostramos o caso de um ceratoacantoma (CA) de dorso nasal em duas fases diferentes de evolução (maturação e regressão) e sua semellhança com as imagens do vulcão Monte Santa Helena e da cratera Orcus Patera. Por meio dessas ilustrações, destacamos por que o aspecto crateriforme foi acrescentado à descrição clínica clássica desse tipo de tumor. Além disso, documentamos fotograficamente a tendência autoinvolutiva do CA, o que não se encontra muito documentado na literatura.

[Basic life support and advanced cardiac life support: proposal of a new strategy to approach and prevent clinical events in dermatologic surgery]. / Suporte básico de vida e suporte avançado de vida em cardiologia: proposta de uma nova estratégia para abordagem e prevenção das intercorrências clínicas em cirurgia dermatológica.

Since complexity of surgical procedures has increased, and patients' co-morbidities have become more frequent, the risk of clinical complications in dermatologic surgery has also increased in the past decades. In order to better assess these risks, a flowchart based on a ruling triad consisting of the patient's health status, sedation level, and procedure complexity was developed to establish the type of cardiovascular support adequate to each procedure. Patients undergoing small surgeries with ASA < 2 should be assigned to basic life support; patients undergoing small surgeries with ASA > 2, and those undergoing medium-sized surgeries or deep sedation should be assigned to advanced cardiac life support (ACLS).

Suporte básico de vida e suporte avançado de vida em cardiologia: proposta de uma nova estratégia para abordagem e prevenção das intercorrências clínicas em cirurgia dermatológica / Basic life support and advanced cardiac life support: proposal of a new strategy to approach and prevent clinical events in dermatologic surgery

Com o aumento da complexidade cirúrgica e comorbidades da população, o risco de intercorrências clínicas em cirurgia dermatológica aumentou nas últimas décadas. Para sua abordagem foi criado um fluxograma baseado na tríade decisória formada pelo estado físico do paciente, grau de sedação e porte do procedimento, indicando o tipo de suporte cardiovascular em cada procedimento. Pacientes submetidos a cirurgias de "porte pequeno" e ASA < 2 devem receber suporte básico de vida; os submetidos a cirurgias de "porte pequeno" e ASA > 2, a cirurgias de "porte médio" ou a sedação profunda devem receber suporte avançado de vida em cardiologia.

Since complexity of surgical procedures has increased, and patients' co-morbidities have become more frequent, the risk of clinical complications in dermatologic surgery has also increased in the past decades. In order to better assess these risks, a flowchart based on a ruling triad consisting of the patient's health status, sedation level, and procedure complexity was developed to establish the type of cardiovascular support adequate to each procedure. Patients undergoing small surgeries with ASA < 2 should be assigned to basic life support; patients undergoing small surgeries with ASA > 2, and those undergoing medium-sized surgeries or deep sedation should be assigned to advanced cardiac life support (ACLS).

Mastocytosis.

Mastocytosis is characterized by pathologic accumulation and activation of mast cells in tissues and organs. Although the classification for mastocytosis and diagnostic criteria are well accepted, there remains a need to define standards for the application of diagnostic tests, clinical evaluations, and responses to treatment. The objective of this article was to make an extensive literature review, providing comprehensive knowledge about the etiopathological and pathophysiological mechanisms, with a special emphasis on diagnosis, classification and treatment of mastocytosis, promoting continued medical education.

Mastocitose / Mastocytosis

A mastocitose é caracterizada pelo acúmulo patológico e ativação de mastócitos nos tecidos e órgãos. Embora a classificação da mastocitose e seus critérios diagnósticos sejam bem aceitos, há necessidade de estabelecer parâmetros para aplicação de testes diagnósticos, avaliação clínica e respostas aos tratamentos. O objetivo deste trabalho é fazer uma revisão extensa da literatura, oferecendo conhecimento global sobre os mecanismos etiopatológicos e isiopatológicos, dando especial ênfase à diagnose, classificação e tratamento da mastocitose, promovendo a educação médica continuada.

Mastocytosis is characterized by pathologic accumulation and activation of mast cells in tissues and organs. Although the classification for mastocytosis and diagnostic criteria are well accepted, there remains a need to define standards for the application of diagnostic tests, clinical evaluations, and responses to treatment. The objective of this article was to make an extensive literature review, providing comprehensive knowledge about the etiopathological and pathophysiological mechanisms, with a special emphasis on diagnosis, classification and treatment of mastocytosis, promoting continued medical education.

Avaliação do impacto da blefaroplastia superior na qualidade de vida utilizando questionário padronizado (Qblefaro): estudo piloto / Assessing the impact of upper blepharoplasty on quality of life with a standardized questionnaire (QBleflaro): a pilot study

FUNDAMENTOS: Há escassa literatura sobre a avaliação dos resultados cirúrgicos e do impacto da cirurgia de blefaroplastia superior na qualidade de vida dos pacientes. OBJETIVO: Avaliar o impacto na qualidade de vida dos pacientes submetidos à cirurgia de blefaroplastia superior. MÉTODOS: Estudo prospectivo com questionário padronizado, em mulheres adultas submetidas à blefaroplastia superior e avaliadas após 90 dias para estimativa do impacto cirúrgico na qualidade de vida e de complicações. RESULTADOS: Foram avaliadas 41 mulheres adultas saudáveis (idade mediana 53 anos) no período de junho de 2005 a março de 2006. O questionário apresentou alta consistência interna. O elemento de qualidade de vida de maior impacto na primeira semana foi relacionado à percepção da aparência física, e o de menor impacto foi relacionadoà convivência com as pessoas próximas. A cicatrização hipertrófica foi a principal complicação tardia. O grau de satisfação com a cirurgia relacionou-se significativamente com a ausência de efeitos indesejados (p<0,01). CONCLUSÕES: Os autores sugerem ferramenta consistente para avaliar o impacto dessa intervenção cirúrgica na qualidade de vida dos pacientes. Destacam ainda altos índices de satisfação dos pacientes com a blefaroplastia superior.

BACKGROUND: There is scarce literature on assessing surgical results and the impact of upper blepharoplasty on quality of life of patients. OBJECTIVE: To evaluate the impact on quality of life of patients submitted to upper blepharoplasty. METHODS: A prospective study using a standardized questionnaire applied to adult women submitted to upper blepharoplasty and evaluated 90 days later to estimate the surgical impact on quality of life and complications. RESULTS: Forty-one healthy adult females (median age of 53 years) were evaluated from June 2005 to March 2006. The questionnaire showed high internal consistency. The quality of life element with greater impact on the first postoperative week was related to physical appearance perception and that of lesser impact was associated to relationship with relatives and close friends. Hypertrophic scar was the main late complication. Satisfaction levels with the surgery were significantly related with absence of undesirable effects (p<0.01). CONCLUSIONS: The authors suggest a consistent tool to evaluate the impact of this surgical procedure on quality of life of patients. High satisfaction levels with upper blepharoplasty stood out.

Vitiligo: avaliação histológica e clínica após curetagem seqüencial / Vitiligo: histological and clinical evaluation after sequential curettage

FUNDAMENTOS: Melanócitos amelanóticos inativos estão presentes no folículo piloso, constituindo reserva melanocítica no vitiligo. Procedimentos que provocam abrasão superficial da pele induzem a ativação e a migração de melanócitos do folículo piloso. OBJETIVO: Teve-se por objetivos avaliar: 1) o percentual médio do número de melanócitos em relação aos ceratinócitos na camada basal epidérmica e a presença de melanina à histopatologia; 2) a evolução clínica, após curetagem seqüencial em lesões de vitiligo. MÉTODOS: Foram avaliados 16 pacientes nos quais foi realizada seqüência de três curetagens superficiais a cada 30 dias, com biópsias pré-curetagem (controle) e 30 dias após cada curetagem. Coloração pela hematoxilina-eosina foi utilizada para contagem do percentual de melanócitos em relação aos ceratinócitos da camada basal epidérmica, e de Fontana-Masson para determinar a presença de melanina. A evolução clínica foi avaliada por documentação iconográfica. RESULTADOS: Observaram-se tendência ao aumento do percentual médio de melanócitos (p<0,10) e aumento estatisticamente significante da presença de melanina e de repigmentação cutânea (p<0,05) após a terceira curetagem. CONCLUSÕES: Uma seqüência de curetagens tende a elevar o percentual médio de melanócitos na camada basal epidérmica, induz a formação de grânulos de melanina e o aumento da repigmentação no vitiligo.

BACKGROUND: Inactive amelanotic melanocytes are found in hair follicles as a melanocytic reservoir in vitiligo. Procedures that cause superficial skin abrasion induce the activation and migration of melanocytes from hair follicles. OBJECTIVE: To evaluate 1) the proportion of melanocytes in relation to keratinocytes in the epidermal basal layer, and to the presence of melanin at histopathology and 2) the clinical progression after sequential curettage in vitiligo lesions. METHODS: Sixteen patients were evaluated and submitted to three surface curettages performed every 30 days, precurettage biopsy (control) and biopsies 30 days after each curettage. Hematoxylin-eosin staining was used to analyze the proportion of melanocytes and Fontana-Masson staining to determine melanin presence. Clinical progression was assessed through iconographic documentation. CONCLUSION: A sequence of curettages tends to increase the mean number of melanocytes in the epidermal basal layer, induce the melanin granule formation and enhance vitiligo repigmentation.

Usos dermatológico da fosfatidilcolina / Dermatologic use of phosphatidylcholine

A fosfatidilcolina de soja foi usada por via subcutânea para redução de gordura localizada em clinicas dermatológicas e estéticas nos anos 2000. No final de 2002, a ocorrência de infecções secundárias e paniculites devido a seu uso indiscriminado levou à Agência Nacional de Vigilância Sanitária (ANVISA) a proibir seu uso em território nacional. Esta revisão traz conhecimentos científicos sobre a fosfatidilcolina e seu uso na área da saúde. Em dermatologia seu uso subcutâneo tem sido realizado de forma empírica, não estando claro seu mecanismo de ação, uma vez que a publicação nesta área é restrita. Seus benefícios em medicina interna são bem conhecidos. Tentamos então dar uma visão geral sobre esta substância.

Phosphatidylcholine has been used subcutaneously to reduce local fat in dermatology and aesthetic clinicssince the year 2000. By the end of 2002, the ocurrence of secondary infections due to its indiscriminate useled the authorities to forbid its use in all Brazilian territory. This revision brings scientific knowledge about phosphatidylcholine and its uses in health care. In dermatology, the subcutaneous use has been madeempirically, so its mechanisms of action are not well known. Its benefits in internal medicine are, on the other hand, well known.

Vitiligo: analysis of grafting versus curettage alone, using melanocyte morphology and reverse transcriptase polymerase chain reaction for tyrosinase mRNA.

CONTEXT AND OBJECTIVE: Recent studies have indicated that vitiligo areas contain inactive or dormant melanocytes. Melanin synthesis is related to tyrosinase presence and indicative of active metabolic state. The aim of this study was to compare repigmentation, epidermal melanocyte distribution and tyrosinase mRNA detection through reverse transcriptase polymerase chain reaction, in tissue samples of vitiligo, before and after curettage, with or without subsequent autologous skin graft using a new method. DESIGN AND SETTING: Prospective, in the Department of Dermatology, Faculdade de Medicina do ABC, Santo André. METHODS: Two vitiligo areas were curetted. One subsequently received grafted normal sacral autologous skin, whereas the other had no further treatment. The curetted areas were examined after 30 days, to evaluate the degree of repigmentation. The melanocyte percentages and tyrosinase mRNA presence in normal skin and vitiligo areas, before and after curettage and grafting, were compared. RESULTS: Complete repigmentation was seen in all grafted areas, whereas non-grafted curetted vitiligo presented partial repigmentation. The melanocyte percentage in grafted areas was greater than in non-treated vitiligo skin (p = 0.01) and skin with curettage alone (p = 0.015). Tyrosinase mRNA was negative in 93.75% of non-treated vitiligo areas. After treatment (curettage alone or curettage and grafting), all lesions became positive for tyrosinase mRNA. CONCLUSION: Metabolically inactive or dormant melanocytes are probably present within vitiligo areas, and may be activated by exogenous or endogenous stimuli.

Neoplasias malignas cutânea: estudo epidemiológico / Cutaneous malignant neoplasias: study epidemiologist

Fundamentos: O câncer no mundo, atualmente é o de pele. Sua incidência vem aumentando significativamente, porém o número de casos exatos não é conhecido, especialmente no Brasil. Objetivo: Atualização do levantamento estatístico de câncer de pele feito no Serviço de Dermatologia da Faculdade de Medicina do ABC em 1987. Material e Métodos: Em um levantamento de 50.000 prontuários correspondentes ao período de janeiro de 1987 a Dezembro de 1998,realizou-se um estudo retrospectivo de 1040 pacientes que apresentavam 1194 neoplasias malignas de pele, diagnosticadas por exame anatomopatológico e posteriormente submetidas a tratamento cirúrgico no Serviço de Dermatologia da Faculdade de Medicina do ABC. Resultado: O tumor de pele mais encontrado foi o Carcinoma basocelular (CBC) 73,3%, seguido pelo carcinoma espinocelular (CEC) 18,8%, doença de Bowen 4,86% e melanoma 3,0%. Conclusões: Os resultados encontrados foram compatíveis com os relatados na literatura, exceto pelo predomínio do sexo feminino nos casos de carcinoma basocelular em nosso estudo.