Treatment of keloids and hypertrophic scars. Position statement of the Brazilian expert group GREMCIQ.

Keloids (K) and hypertrophic scars (HS) are abnormal responses to wound healing that occur as the result of dermal inflammation. Despite the advances on their treatment, many patients still suffer from the negative effects of excessive scarring; its approach is impaired by the lack of objective data on different treatments and the large genetic variability among patients and the difficulties in producing multicentre studies. Their incidence among the Brazilian population is high, as the result of an admixture of Amerindians, Europeans and Africans ancestral roots. With the aim of producing multicentre studies on K and HS, a panel of senior Brazilian dermatologists focused on their treatment was invited to contribute with the K and HS Treatment Brazilian Guidelines. In the first part of this study, different treatment modalities for keloids and HS are fully reviewed by the panel. The second part of the study presents a consensus recommendation of treatment for different types of lesions. More than a literature review, this article aims to show the pitfalls and pearls of each therapeutic option, as well as a therapeutic approach by the Panel of Experts on keloids and Scars on a highly mixed population, providing simple guidelines.

A new fibrin sealant from Crotalus durissus terrificus venom: applications in medicine.

Fibrin sealant, a widely available tissue adhesive, has been used since 1940 in a variety of clinical applications. Commercially available fibrin sealant products are synthesized from bovine thrombin and human fibrinogen, which may transmit infectious diseases, and recipients may also develop antibodies against bovine thrombin. Bearing these disadvantages in mind, a new fibrin sealant was developed in 1989 by a group of researchers from the Center for the Study of Venoms and Venomous Animals, in Sao Paulo State, Brazil. The main purpose was to produce an adhesive fibrin without using human blood, to avoid transmitting infectious diseases. The components of this novel sealant were extracted from large animals and a serine proteinase extracted from Crotalus durissus terrificus snake venom. The applicability of this sealant was tested in animals and humans with beneficial results. The new fibrin sealant can be a useful tool clinically due to its flexibility and diversity of applications. This sealant is a biological and biodegradable product that (1) does not produce adverse reactions, (1) contains no human blood, (3) has a good adhesive capacity, (4) gives no transmission of infectious diseases, and (5) may be used as an adjuvant in conventional suture procedures. The effectiveness of this new fibrin sealant is reviewed and its development and employment are described.

[Outbreak of American cutaneous leishmaniasis in Itaporanga, São Paulo (Brazil)]. / Surto de leishmaniose tegumentar americana em Itaporanga, São Paulo (Brasil).

An outbreak of cutaneous leishmaniasis in a small rural settlement, located in the Southern of São Paulo State-Brazil was observed. This region has basic agricultural activities, and has no forests. Two hundred and thirty one persons were evaluated, and the following aspects were observed. 1) 67 individuals (29%) had skin lesions, confirmed by histopathologic study and the Montenegro skin test; 2) of these cases, 40 (59.7%) were males; 3) The youngest patients were 2 years (5 cases), and the oldest, 86 (1 case); 4) the following types of cutaneous lesions, were observed: a) 54 cases (80.6%) had ulcers, 13 (19.4%) had nodules, 4 (5.9%) had verrucose lesions, and 3 (4.4%) had typical scars. In all the cases, the parasite identified was Leishmania (Viannia) braziliensis. The vector captured in the region was Lutzomyia intermedia, a strong anthropophilic sandfly very frequently observed in São Paulo. This study shows that apart from the well-known outbreak observed in the forest environments, leishmaniasis can be transmitted within or around dwellings.

[Accidental cutaneous leishmaniasis]. / Leishmaniose cutânea acidental.

The authors report the 3rd case of cutaneous leishmaniasis due to accidental contamination of a student of biological sciences during laboratory research. The inoculation occurred when amastigotes of Leishmania (Viannia) braziliensis from infected hamsters were injected in healthy animals. At this stage, the student had her glove bitten by a healthy hamster and the infection was probably conveyed by the direct contact of the inoculum with the skin.

Paracoccidioidomycosis: a comparative study of the evolutionary serologic, clinical and radiologic results for patients treated with ketoconazole or amphotericin B plus sulfonamides.

A comparative study of two groups of patients with paracoccidioidomycosis was carried out with the objective of comparing the evolutionary serologic, clinical and radiologic results after 6, 12, 15 and 18 months of treatment with ketoconazole (22 patients) or amphotericin B plus sulfonamides (32 patients). The serologic data analyzed as a whole showed a tendency to sharper drops in antibody titers in the patients treated with ketoconazole. Clinically patients treated with ketoconazole fared better but the differences were not statistically significant. No statistical difference was detected between groups in terms of the results of radiologic evolution.

Microsporum nanum. Relato do segundo caso de infeccao humana no Brasil. / Microsporum nanum. Report of the second case of infection in Brazil

E comunicado o segundo caso de infeccao humana por Microsporum nanum no Brasil. A investigacao epidemiologica visando determinar a fonte de infeccao nao obteve sucesso. O padrao dermatologico das lesoes foi o de Tinea corporis classica