António Massa

Cutaneous manifestations of familial amyloidotic polyneuropathy

Familial amyloidotic polyneuropathy is an autosomal dominant amyloidosis, characterized by the systemic deposition of amyloid with a particular involvement of the peripheral nerves.

Immediate and Delayed Hypersensitivity to Mite Antigens in Atopic Dermatitis

Atopic dermatitis (AD) is a common disorder and appears to be on the increase, especially among children. It was thought at first to be a manifestation of immediate hypersensitivity, but it is now known that delayed hypersensitivity also plays an important role. Sensitivity to mite antigens is found in 20% to 60% of patients when immediate hypersensitivity is evaluated by the detection of specific IgE antibodies and prick tests, and in 30% to 50% of patients when delayed hypersensitivity is studied by patch testing. A prospective randomized study was carried out in the pediatric dermatology clinic on a sample of 51 children under 15 years of age. A prevalence of immediate and delayed hypersensitivity to mites, like that described for other populations, was found. It was further found that there was a positive association, not described in the literature, between the younger age groups and delayed hypersensitivity to mite antigens, while the opposite was true for immediate hypersensitivity. We believe that patch tests with airborne allergens, specifically mites, should be part of the protocol for assessing children with AD, particularly in the younger age groups.

The prevalence of acne among a group of Portuguese medical students

Background  Worldwide, very few studies have been published on the prevalence of acne among university students.

Generalized morphea and lichen sclerosus et atrophicus successfully treated with sulphasalazine.

To the Editor: A 75-year-old white woman was first seen with erythematous, infiltrated plaques with violaceous border initially on the breast (Fig. 1) and lumbar region. Thes’e plaques later became necrotic white and involved most of the tegument, giving the subject the feeling of pulling and hardening of the skin, which made movement difficult. There was no relevant past history with respect to pathology, and no history of previous pharmacological administration. Skin biopsy showed hyperkeratosis, decreased epidermal thickness, and destruction of the normal papillary structure. In the papillary dermis there was a strip of hyalinization, edema, with prominent capillary vessel ectasy, beneath which there was multifocal lymphocyte and histiocyte infiltration. The reticular dermis was markedly thickened, projecting into the connective tissue septa made up mainly of thickened collagen bundles. There was also a moderate infiltration of lymphocytes and histiocytes around the vessel and nerve bundles involving the dermal subcutaneous junction. Direct immunofluorescence was negative. There was no evidence of Raynaud’s phenomenon, dysphagia or dyspnea. Full blood count, ESR, liver and ludney function tests, chest X-ray and ECG were all normal. The rheumatoid factor test was negative, as were those for anti-nuclear antibodies and proteins in the acute phase of inflammation.

Plasma cell cheilitis.

Plasma cell cheilitis is a rare inflammatory disorder of the lip with a characteristic band‐like infiltrate of plasma cells in the upper dermis. Differential diagnosis should consider allergic/irritant contact cheilitis, candidiasis, syphilis, Queyrats erythroplasia, granulomatous cheilitis, plasmoacanthoma, plasmacytoma, squamous cell carcinoma and exfoliative or factitious cheilitis. We observed plasma cell cheilitis in a 60‐year‐old Caucasian female who had a partial response to topical steroids and oral griseofulvin.

Piroxicam-β-cyclodextrin and photosensitivity reactions

Piroxicam is one of the more frequently prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) in Portugal, due to its efficacy and once-daily dosage (1). A new piroxicam formulation has recently been marketed in Portugal: piroxicam-b-cyclodextrine (PBCD; BrexinA), the result of supermolecular encapsulation of piroxicam with the cyclic oligosaccharide b-ciclodextrine, which results in increased bioavailibility (2). Piroxicam photosensitivity reactions are well-known (3). Their proximate cause is a photoproduct, induced by the UVA radiation, which cross-reacts with thimerosal (4, 5). In 1996, thimerosal accounted for 15.4% of patch test reactions in the grouped data of the GPEDC (6).

Unusual cutaneous metastases presenting breast cancer: case report.

To the Editor Cutaneous metastases occur in up to 9% of visceral malignancies, but are rarely the first manifestation. 1,2 Such an event is far more common in men than in women and for cancer of the lung, kidney and ovary. 3,4 In women, breast carcinoma is the most common source of cutaneous metastases, affecting about one-quarter of all subjects (23.9–26.5% 1,4 ); there is also almost always a manifest and advanced malignancy, without a significant change in survival because of the usual and concomitant dissemination to lymph nodes, bones, liver or brain. Only less than 3.5% of primary breast carcinomas are preceded by the diagnosis of cutaneous metastases, 3,4 thus associated with worse prognosis. Several presentations of cutaneous metastatic disease have been described, 5 with nodules as the most frequent and characteristic presentation. 2

Childhood cutaneous mucinosis.

A case of childhood cutaneous mucinosis is described. This is a clinical condition that is rarely seen and has only recently been included in the group of primary mucinosis.

Cutaneous sarcoid-like granulomas with alveolar hemorrhage and c-ANCA PR-3

A 28‐year‐old woman, employed as a leather factory worker, noted asymptomatic, well‐delimited plaques on both knees, 6 years ago. The plaques were violaceous with a smooth surface. One appeared over a post‐traumatic scar from childhood ( Fig. 1 ). Two years later, she began to complain of symptoms suggestive of polyarthritis, first of the small joints of the hands (proximal interphalanges) and then of the larger joints (wrists, elbows, and knees). She was diagnosed with rheumatoid arthritis and began treatment with nonsteroidal anti‐inflammatory drugs for 1 month without any change. Deflazacort, 12 mg/day, and hydroxychloroquine, 400 mg/day, were administered for 3 months, with improvement of her articular complaints, but not her skin lesions.

Portuguese Position Paper on the Use of Biosimilars in Psoriasis.

1. Consulta de Psoríase. Serviço de Dermatologia. Centro Hospitalar do Porto. Porto. Portugal. 2. Instituto de Ciências Biomédicas Abel Salazar. Universidade do Porto. Porto. Portugal. 3. Serviço de Dermatologia. Centro Hospitalar de Lisboa Central. Lisboa. Portugal. 4. Serviço de Dermatologia. Hospital da Luz. Lisboa. Portugal. 5. Unidade de Psoríase. Hospital Cuf – Descobertas. Lisboa. Portugal. 6. Serviço de Dermatologia. Centro Hospitalar de Leiria. Leiria. Portugal. 7. Serviço de Dermatologia. Clinica Laser de Belém. Lisboa. Portugal. 8. Serviço de Dermatologia. Centro Hospitalar de S. João. Porto. Portugal. 9. Departamento de Farmacologia e Terapêutica. Faculdade de Medicina. Universidade do Porto. Porto. Portugal. 10. Consulta de Fototerapia. Serviço de Dermatologia. Hospital de Santo António dos Capuchos. Centro Hospitalar de Lisboa Central. Lisboa. Portugal. 11. Serviço de Dermatologia. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal. 12. Unidade Curricular de Dermatologia. Escola de Ciências da Saúde. Universidade do Minho. Braga. Portugal. 13. Unidade de Dermatologia. Hospital dos Lusíadas. Lisboa. Portugal. 14. Centro de Ambulatório. Centro Hospitalar de Vila Nova de Gaia e Espinho. Vila Nova de Gaia. Portugal. 15. Unidade de Fototerapia. Serviço de Dermatologia. Centro Hospitalar de Vila Nova de Gaia e Espinho. Vila Nova de Gaia. Portugal. 16. Sociedade Portuguesa de Dermatologia e Venereologia. Lisboa. Portugal. 17. Serviço de Dermatologia. Centro Hospitalar do Porto. Porto. Portugal. 18. Colégio de Especialidade de Dermatologia. Lisboa. Portugal. 19. Serviço de Dermatologia. Centro Hospitalar Lisboa Norte. Lisboa. Portugal. 20. Unidade Curricular de Dermatologia. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal. 21. Unidade de Investigação em Dermatologia. Instituto de Medicina Molecular. Universidade de Lisboa. Lisboa. Portugal.  Autor correspondente: Tiago Torres. torres.tiago@outlook.com Recebido: 16 de agosto de 2016 Aceite: 17 de agosto de 2016 | Copyright