Bernardo Gontijo

Leishmaniose tegumentar americana

American cutaneous leishmaniasis is endemic in widespread areas of Latin America. The causative agents include L. (V.) braziliensis, L. (L.) mexicana, L. (V.) panamensis, and related species. The spectrum of disease includes single, localized, cutaneous ulcers, diffuse cutaneous leishmaniasis, and mucosal disease.The main reservoirs for L. (V.) braziliensis and other Leishmania (Vianna) spp. are small forest rodents. The vectors are ground-dwelling or arboreal Lutzomyia sandflies, which are abundant in the forest. Disease is most common in persons working at the edge of the forest and among rural settlers. The incubation period of cutaneous leishmaniasis varies from two weeks to several months. A wide variety of skin manifestations ranging from small, dry, crusted lesions to large, deep, mutilating ulcers may be seen. Ulcerative lesions are usually shallow and circular with well-defined, raised borders and a bed of granulation tissue. In L. (V.) braziliensis infection, regional lymphadenopathy often precedes the development of cutaneous lesions by one to 12 weeks. A definite diagnosis depends on the identification of amastigotes in tissue or promastigotes in culture. Antileishmanial antibodies are present in the serum of some patients with cutaneous leishmaniasis as detected by ELISA, immunofluorescent assays, direct agglutination tests or other assays, but the titers are usually low. The leishmanin skin test result usually becomes positive during the course of the disease. For treatment two pentavalent antimony-containing drugs are used: stibogluconate sodium, and meglumine antimoniate (Glucantime). Amphotericin B deoxycholate is an alternative for persons who fail to respond to pentavalent antimony. Immunoprophylaxis and immunotherapy are promising new approaches to prevention and treatment.

Influence of narrow-band UVB phototherapy on cutaneous microbiota of children with atopic dermatitis.

Objective  In the present work, the effect of narrow‐band ultraviolet B (UVB) phototherapy on a cutaneous microbial population was evaluated in patients with atopic dermatitis (AD) and compared with control patients (vitiligo).

Giant congenital melanocytic nevus

Giant congenital melanocytic nevus is usually defined as a melanocytic lesion present at birth that will reach a diameter ≥ 20 cm in adulthood. Its incidence is estimated in <1:20,000 newborns. Despite its rarity, this lesion is important because it may associate with severe complications such as malignant melanoma, affect the central nervous system (neurocutaneous melanosis), and have major psychosocial impact on the patient and his family due to its unsightly appearance. Giant congenital melanocytic nevus generally presents as a brown lesion, with flat or mammilated surface, well-demarcated borders and hypertrichosis. Congenital melanocytic nevus is primarily a clinical diagnosis. However, congenital nevi are histologically distinguished from acquired nevi mainly by their larger size, the spread of the nevus cells to the deep layers of the skin and by their more varied architecture and morphology. Although giant congenital melanocytic nevus is recognized as a risk factor for the development of melanoma, the precise magnitude of this risk is still controversial. The estimated lifetime risk of developing melanoma varies from 5 to 10%. On account of these uncertainties and the size of the lesions, the management of giant congenital melanocytic nevus needs individualization. Treatment may include surgical and non-surgical procedures, psychological intervention and/or clinical follow-up, with special attention to changes in color, texture or on the surface of the lesion. The only absolute indication for surgery in giant congenital melanocytic nevus is the development of a malignant neoplasm on the lesion.

Hemangioma of infancy

New classifications and availability of modern radiologic diagnostic tools have not only allowed a precise distinction between vascular tumors and vascular malformations but have also significantly modified management and treatment of these vascular anomalies. Hemangioma of infancy, the most common vascular tumor of this age and subject of this review, is approached from its clinical and laboratory features, differential diagnosis and therapeutic options. Although non-intervention remains the treatment of choice for the majority of cases, critical judgement is mandatory to decide whether other therapeutic modalities should be used.

Epidermolysis Bullosa Acquisita in Childhood

Epidermolysis bullosa acquisita (EBA) is a subepidermal autoimmune blistering disease that is rarely reported in childhood. We describe a nine‐month‐old mulatto boy presenting with multiple, annular, widespread, tense blisters and oral lesions. The diagnosis of EBA was confirmed by histopathology, immunofluorescence, and immunoblotting analysis. The patient was successfully treated with systemic steroids (prednisone) and dapsone. After 20 months of initial treatment, clinical remission was observed, and dapsone remains as the current treatment. This case report emphasizes the rarity of EBA in childhood and the difficulties in reaching the final diagnosis.

Contact sensitivity to metals (chromium, cobalt and nickel) in childhood

Metals, especially nickel, are the most common contact allergens in children. Recent data has shown increased incidence of allergy in industrialized countries. Sensitization can occur at any age, even in neonates. Costume jewelry, particularly earrings, is linked to increased sensitization to nickel. Sensitization to cobalt often occurs by the use of costume jewelry. The most common source of sensitization to chromium is leather. Due to the absence of a specific therapy, the main treatment is to identify and avoid the responsible allergens. This article presents an updated view on the epidemiological and clinical aspects of contact allergy to metals, focusing on prevention strategies and risk factors, and warns about possible and new sources of contact.

Perfuração dos lóbulos das orelhas como fator de risco para o desenvolvimento de alergia de contato ao níquel

OBJETIVOS: Determinar a prevalencia da alergia de contato aos metais em criancas que frequentam um centro de saude e caracterizar o subgrupo com alergia em relacao aos fatores de risco. METODOS: Estudo transversal nao controlado, conduzido em um centro de saude de Belo Horizonte (MG). Foram incluidas criancas com idades entre 0 e 12 anos que se apresentaram para consulta pediatrica de rotina, sendo aplicados testes de contato para o cromo, o cobalto e o niquel. As analises estatisticas foram realizadas com base na leitura do teste em 96 horas. Leituras classificadas como fraca (+), forte (++) ou extrema (+++) foram consideradas como reacao, enquanto as classificadas como duvidosa, negativa ou irritativa foram consideradas como nao reacao. RESULTADOS: Completaram o estudo 144 criancas. Destas, 4,9% apresentaram reacao ao cromo, 9,7% ao cobalto e 20,1% ao niquel. Os pacientes com orelha perfurada tiveram mais chance de reacao ao niquel do que aqueles sem essa caracteristica (p = 0,031 e odds ratio = 2,8). CONCLUSOES: Em face da tendencia atual ao aumento da alergia ao niquel, familiares devem ser alertados sobre a sua associacao com a perfuracao das orelhas. Estudos posteriores sao necessarios para avaliar a idade ideal para a perfuracao das orelhas e o material ideal para brincos.

Vitiligo na infância: características clínicas e epidemiológicas

BACKGROUND: vitiligo affects 0.5 to 4% of the world population. Twenty-five per cent of cases have their onset before the age of 10 years. Although the condition is prevalent in childhood, there are few epidemiological reports in children in the Brazilian literature. OBJECTIVE: to evaluate clinical and epidemiologic characteristics of vitiligo in childhood. METHODS: a descriptive study was performed in 73 children with vitiligo seen at the Pediatric Dermatology Outpatient Clinics of the Hospital das Clinicas- Universage Federal de Minas Gerais. The variables sex, age of onset of disease and treatment, affected body surface area, clinical type, site, autoimmune disease association, family history of vitiligo and initial treatment were evaluated. The statistical analysis was performed using simple frequency and means were compared through analysis of variance. RESULTS: Females accounted for 60.3% of the sample. The mean age at onset of disease was 5.7 years and the mean age at onset of treatment was 7 years. The body surface area affected was smaller than 1% in 71.8% and the localized type was detected in 76.7%. The most common site affected was the head. Family history of vitiligo was observed in 30.1% of patients. Hypothyroidism was found in one patient and 11% reported autoimmune diseases in their families. The initial treatment was topical steroids in the majority of patients. CONCLUSIONS: the findings of vitiligo in childhood in this study are basically similar to those reported in other countries.

Efficacy and safety of itraconazole pulse therapy: Brazilian multicentric study on toenail onychomycosis caused by dermatophytes

BACKGROUND Itraconazole is a large spectrum triazole with known efficacy in both continuous and pulse therapy for various mycoses. OBJECTIVES Evaluate the efficacy and tolerability of itraconazole pulse therapy for onychomycosis of the toenails due to dermatophytes, in a prospective, open, non-comparative and multicentric investigation. Patients and methods The trial was completed by 72 patients of an initial total of 89. Treatment consisted of four cycles of itraconazole, 200 mg twice a day, for seven consecutive days each month. Patients were evaluated clinically, mycologically and biochemically before, during and at the end of the investigation, and were divided into two groups according to the measure of normal portion of the most affected nail (target nail), as follows: Group 1: 0-5.9 mm; and Group 2: more than 6 mm. RESULTS Improvement was satisfactory and progressive. Results were statistically significant, when comparing the three moments of the study: pre-treatment, end of therapy (fourth month) and follow-up (ninth month) in both groups. CONCLUSIONS Itraconazole pulse therapy was efficient and safe for the treatment of onychomycosis caused by dermatophytes, although a much higher daily dosage than the known continuous administration was used. Group 1, with nails initially more extensively affected, had a more evident improvement, by the mean variation in millimeters of normal portion of the target nail. This group showed a very satisfactory response, although not reaching total cure, thus demonstrating the great importance of early treatment of this disease. A residual therapeutic effect is maintained even after suspension of the drug. Group 2 obtained better total cure rates, and four pulses were, in general, sufficient, whereas more cycles would have been beneficial for the Group 1 patients with more extensive involvement.

Open clinical study of the efficacy and safety of terbinafine cream 1% in children with tinea corporis and tinea cruris.

BACKGROUND Topical application of antifungal agents is considered the treatment of choice for dermatomycoses. Most of the available drugs are fungistatic, requiring long term treatment to prevent relapses. Terbinafine is a synthetic antifungal agent that, because of its fungicidal action, provides high cure rates and low relapse rates after short periods of treatment. METHODS Ninety-seven children ages 2 to 15 years with a suspected diagnosis of tinea corporis and/or tinea cruris were enrolled in this open trial. After mycologic assessment to confirm diagnosis (culture and direct microscopy) terbinafine 1% cream was applied once daily during 1 week. Clinical and mycologic assessments were made at the baseline visit and on Days 7, 14 and 21. Efficacy assessment was based on 88 children (9 patients excluded by protocol violation). RESULTS Therapy was considered effective in 92.0% (81 of 88) of patients (complete clinical and mycologic cure or mycologic cure with minimum signs and symptoms or clinical improvement, > or = 50%). Tolerability was assessed in 97 patients on an intention-to-treat basis. Adverse reactions were itching 3% (3 of 97), itching associated with erythema exacerbation 1% (1 of 97) and contact dermatitis 1% (1 of 97). CONCLUSION Terbinafine 1% cream appears to be an effective and well-tolerated treatment for tinea corporis and tinea cruris in children.