Catarina Araújo

A proposal for the use of new silver-seaweed-cotton fibers in the treatment of atopic dermatitis

Abstract Background: Atopic dermatitis (AD) is a disease with multifactorial etiology. Staphylococcus aureus is one of the predominant environmental factors acting on the course and intensity of the disease. Objectives: The aims of the study were to evaluate the efficacy and safety of clothing made of cellulose fibers with seaweed enriched with silver ions in the treatment of children with AD. Methods: A prospective, randomized and double-blinded controlled selection was done to recruit 19 children with diagnosis of AD. This sample was divided in two groups with similar demographic and clinical characteristics (the “control” group of seven children who wore placebo clothing and the “trial textile” group of 12 children who wore clothing with the new textile). The severity of AD and clinical response were assessed by the SCORAD index, the intensity of pruritus and the changes in sleep characteristics, at the start of the study and after 7 and 90 d. Results: The SCORAD index improvement in the group with the fiber under study was statistically significant after the first 7 d of treatment (p < 0.001) and was reduced by about 45% after 90 d. There was also a statistically relevant reduction of the intensity of pruritus and an improvement in the sleep quality after the initial 7 d and at day 90. Conclusion: The results showed that the textile clothing with seaweed enriched with silver ions brings a quicker improvement of the patients in the first days in opposition to the use of standard all-cotton clothes. The results also reinforce the importance of non-pharmacological measures, like clothing, in the management of patients with a diagnosis of AD.

Late-onset of eruptive syringomas: a diagnostic challenge

Syringoma is a benign, adnexal tumor of the eccrine sweat gland ducts. Eruptive syringomas are a rare variant, occurring before or during puberty in most cases. A 57-year-old man was observed in our department, with a 10-year history of multiple brownish papules (1-4mm in diameter), localized on the neck, shoulders, trunk and axillae. The clinical diagnosis was cutaneous mastocytosis. Histopathological examination from a papule in the trunk was compatible with the diagnosis of syringoma. The patient was treated with isotretinoin, without any improvement. The clinical diagnosis of eruptive syringoma is diffi cult and histological examination is crucial for its diagnosis. Long-term morbidity is not associated with syringomas; they are treated for cosmetic reasons with unsatisfactory results.

Giant Congenital Melanocytic Nevi and Neurocutaneous Melanosis

Introduction. The major medical concern with giant congenital melanocytic nevi CMN is high risk of developing cutaneous melanoma, leptomeningeal melanoma, and neurocutaneous melanocytosis. Case Report. A 30-year-old woman with a giant congenital melanocytic nevus covering nearly the entire right thoracodorsal region and multiple disseminated melanocytic nevi presented with neurological symptoms. Cerebral magnetic resonance imaging revealed a large expansive lesion in the left frontal region. Postsurgically pathological diagnosis revealed characteristics of melanoma. Immunohistochemical examination showed S100(+), HMB45(+), MelanA(+), and MiTF(+). She received radiotherapy with temozolomide followed by two more chemotherapy cycles with temozolomide. She followed a rapidly progressive course, reflecting widespread leptomeningeal infiltration, and she died of multiorgan failure seven months after diagnosis of cerebral melanoma. Discussion. This patient was diagnosed as having a neurocutaneous melanosis with malignant widespread leptomeningeal infiltration. Diffuse spinal involvement is unusual and is described in only another patient.

A Case of IFAP Syndrome with Severe Atopic Dermatitis

Introduction. The IFAP syndrome is a rare X-linked genetic disorder characterized by the triad of follicular ichthyosis, atrichia, and photophobia. Case Report. A three-month-old Caucasian, male patient was observed with noncicatricial universal alopecia and persistent eczema from birth. He had dystrophic nails, spiky follicular hyperkeratosis, and photophobia which became apparent at the first year of life. Short stature and psychomotor developmental delay were also noticed. Histopathological examination of skin biopsy on left thigh showed epidermis with irregular acanthosis, lamellar orthokeratotic hyperkeratosis, and hair follicles fulfilled by parakeratotic hyperkeratosis. The chromosomal study showed a karyotype 46, XY. Total IgE was 374 IU/mL. One missense mutation c.1360G>C (p.Ala454Pro) in hemizygosity was detected on the MBTPS2 gene thus confirming the diagnosis of IFAP syndrome. Conclusions. We describe a boy with a typical clinical presentation of IFAP syndrome and severe atopic manifestations. A novel missense mutation c.1360G>C (p.Ala454Pro) in MBTPS2 gene was observed. The phenotypic expression of disease is quantitatively related to a reduced function of a key cellular regulatory system affecting cholesterol and endoplasmic reticulum homeostasis. It can cause epithelial disturbance with failure in differentiation of epidermal structures and abnormal skin permeability barrier. However, no correlation phenotype/genotype could be established.

Late onset Ito's nevus

Dermal melanocytoses include a variety of congenital and acquired melanocytic lesions characterised by the presence of multiple spindle-shaped dendritic melanocytes in the dermis. These lesions are commonly found in the skin of Asians, but they can also appear in Caucasians. The Mongolian spot, nevi of Ota and Ito are the most common morphological forms. We report a case of a 24-year-old Caucasian woman presented with a 10-months history of progressive darkening of the right side of her upper back. Cutaneous examination revealed a macular blue-grey hyperpigmentation of the right side of her upper back. Biopsy specimen from the macule showed multiple darkly pigmented, spindle-shaped dendritic melanocytes in the superficial dermis, interstitially arranged between collagen bundles. The diagnosis of nevus of Ito was established. Our patient is maintaining vigilance in dermatology consultation.

Cutis marmorata telangiectatica congenital

Cutis marmorata telangiectatica congenita (CMTC) is a skin vascular malformation of low flow, compromising venous and capillary vessels, of unknown origin, with about 300 cases described in the literature.1 ,2 Clinical manifestations include a purple erythema, which is either generalised or more frequently localised over a limb, with hypotrophy of the affected limb.1 ,3 CMTC can be associated with extracutaneous findings in 20–80%, including ocular and neurological abnormalities.2 ,3 CMTC resembles cutis …

PSORÍASE EM PLACAS EM DOENTE COM SÍNDROME DE DOWN - POTENCIAL PATOFISIOLOGIA COMUM E DIFICULDADE DE TRATAMENTO

Introduction: Psoriasis occurs in up to 8% of patients with Down syndrome and, although poorly characterized, appears to be correlated with immune imbalance in cells Th1 and biochemical changes of cyclic nucleotides. Case report: Female patient, 38 years old, with Down syndrome and psoriasis (initial PASI 30) since 18 years. Initially treated with cyclosporine and methotrexate and subsequently with etanercept, adalimumab and ustecinumab because of progressive loss of response (current PASI 10). Conclusion: We describe this case for the poor response to treatment including various biological agents. Potential poor adherence to therapy and immune dysfunction may limit the therapeutic options.

TERAPÊUTICA FOTODINÂMICA NO TRATAMENTO DO CARCINOMA BASOCELULAR – EXPERIÊNCIA DO HOSPITAL DE BRAGA

Introduction: Photodynamic therapy is noninvasive and is based on the topical application of a photosensitizing agent, which after exposure to light source generates free radicals that selectively injure the pre-neoplastic and neoplastic cells. It is approved for the treatment of actinic keratosis, Bowens disease and basal cell carcinomas.Methods: This retrospective study evaluated the results obtained in the treatment of basal cell carcinoma with photodynamic therapy in the Department of Dermatology, Hospital de Braga, during a 10-year period (2003-2013), in particular cosmetic outcome, patient satisfaction, the relapse and side effects.Results: A total of 161 patients were included. In females, the median age of patients was 69 years and for males the median age was 68 years. Regarding sex, 85 (52.8%) of the patients were female and 76 (47.2%) were male. In females there was a predominance of basal cell carcinomas on the face (n = 97, 50.8%), while in males there was a predominance in the trunk (n = 67, 41.1%), and this difference was statistically significant. The median area of treated basal cell carcinomas was 20 mm2. All patients reported slight pain at the time of irradiation. The recurrence of treated lesions was 0.5%.Discussion: Photodynamic therapy had excellent cosmetic results, low percentage of recurrence, few secondary effects and high patient satisfaction. However, the classical surgery continues to play a key role, particularly in nodular basal cell carcinoma and morpheaform basal cell carcinoma, which are contraindications to performing the photodynamic therapy.

PROVÁVEL RELAÇÃO ENTRE DUAS DOENÇAS AUTO-IMUNES: ESCLEROSE MÚLTIPLA E PENFIGOIDE BOLHOSO

Cristina Resende1, Catarina Araújo1, Ana PaulaVieira2, Celeste Brito3 1Interna do Internato Complementar de Dermatologia e Venereologia/Resident, Dermatology and Venereology. 2Assistente Hospitalar Graduada de Dermatologia e Venereologia/Graduated Consultant Dermatology and Venereology. 3Chefe de Serviço, Diretora do Serviço de Dermatologia e Venereologia/Consultant Chief, Head of Department of Dermatology and Venereology Serviço de Dermatologia e Venereologia, Hospital de Braga, Braga, Portugal

Kikuchi´s disease of the xanthomathous type with cutaneous manifestations

Kikuchis disease is a benign, self-limiting disease, whose pathogenesis remains unknown. Patients most often present with cervical lymphadenopathy, sometimes associated with fever and leukopenia. It has been reported that up to 40% of patients with Kikuchis disease have also cutaneous eruptions, but no specific skin changes have been described. Kikuchis disease can be subclassified into three histologic subtypes: a proliferative type, a necrotizing type and a xantomathous type. Most patients with Kikuchis disease require no specific treatment, because the disease regresses spontaneously, within a few weeks to months. We report a case of a 31-year-old woman with xanthomatous type of Kikuchis disease, whose first manifestation was the onset of erythematous papules with central suppuration on her face and on her left hand.