Celso Tavares Sodré

Padrão dermatoscópico das alopecias cicatriciais causadas por lúpus eritematoso discoide e líquen plano pilar

BACKGROUND Dermoscopy is an important tool for the diagnosis of benign and malignant melanocytic diseases. Recently, this method has also been found to be extremely useful in the diagnosis and follow-up of alopecias. OBJECTIVE The objective of this study was to describe dermoscopic findings in patients with clinical and histopathological characteristics of cicatricial alopecia. METHODS A descriptive cross-sectional study was conducted in which 14 patients with cicatricial alopecia were selected based on clinical and histopathological evaluation of the scalp. The underlying cause was classic lichen planopilaris in four cases, frontal fibrosing alopecia in five and discoid lupus erythematosus in the remaining five. The patients were evaluated using videodermoscopy and conventional dermoscopy (with a handheld dermoscope), performed independently by three different examiners. Magnification ranged from 10x to 70x. RESULTS Principal findings in cases of discoid lupus erythematosus were: white patches, branching capillaries, keratin plugs and areas of reduced follicular ostia; in classic lichen planopilaris: perifollicular scales, white dots and reduced follicular ostia; and in frontal fibrosing alopecia: reduced follicular ostia, perifollicular scales, perifollicular erythema and branching capillaries. The blue-grey dots described in this paper were a novel feature in scalp dermoscopy. CONCLUSIONS The use of dermoscopy for the clinical evaluation of the scalp in cases of cicatricial alopecia improves diagnostic capacity beyond simple clinical inspection and reveals novel features of the disease.

Lyme Disease in Rio de Janeiro, Brazil

Abstract: Five patients living in Rio de Janeiro, Brazil, were found to have Lyme disease. These are among the first known cases in South America.

Dermoscopy findings of alopecia areata in an African-American patient

BACKGROUND Dermoscopy has been established as an indispensable tool in the diagnosis and follow up of hair disorders. In alopecia areata, dermoscopy of active disease shows yellow dots, dystrophic hairs, as well as cadaverized (black dots) and exclamation mark hairs. Alopecia areata has been reported to occur equally among races, however, until date, there are no published data regarding dermoscopic findings in African-American patient. MAIN OBSERVATION We report a case of scalp dermoscopy of alopecia areata in an African-American patient that shows a diffuse honeycomb-like pigmented network, few yellow dots and white dots. CONCLUSION This case shows that skin color may affect dermoscopic findings in alopecia areata. In our African-American patient with alopecia areata dermoscopy showed a diffuse honeycomb-like pigmented network, which was previously considered characteristic for androgenic alopecia and white dots, which were considered characteristic for cicatricial alopecia. Further studies are needed to elucidate the presence of white dots in alopecia areata.

Exclamation marks and other trichoscopic signs of chemotherapy-induced alopecia

Chemotherapy-induced alopecia (CIA) represents one of the major unresolved problems in clinical oncology. It is still considered one of the most traumatic factors in cancer patient care and occurs with an estimated incidence of 65%. It is a medical issue requiring more research for further clarification of its pathogenesis and management. In 1960, by means of a microscopic examination of epilated scalp hairs, Crounse and Van Scott first described the effect of a wide range of cytotoxic drugs on the hair shafts. Trichoscopy is a non-invasive technique that has been recently used to facilitate the diagnosis and management of hair and scalp disorders. To our knowledge, there are still no published data on the trichoscopic findings of CIA. We report here our findings, including those on exclamation mark hairs, considered by many authors to be pathognomonic of alopecia areata (AA).

Coexistence of frontal fibrosing alopecia and discoid lupus erythematosus of the scalp in 7 patients: just a coincidence?

able in all cases (Fig. 2). These sonographic findings support the presence of hyperplasia and/or hypertrophy of the ungual connective tissue and their blood vessels perhaps combined with an inflammatory component. Interestingly, in spite, that the digital arteries were dilated and/or prominent in these cases, the presence of both dilated and numerous arterial vessels was noted mainly within the nail bed tissue and not in the periungual regions or proximal part of the fingers. Thus, we may postulate that perhaps the nail can present a more sensitive response and/or specific receptors to the unbalanced manifestation of the several physicochemical and growth factors involved in the physiopathology of CF which can also be a particular response to the chronic vasodilation of the distal portion of the digital arteries. Additionally, the presence of a prominent ungual hypervascularity may explain the reported presence of splinter haemorrhages in these cases. In conclusion, colour Doppler ultrasound may be a useful imaging technique for understanding the physiopathology of clubbing and exploring ‘in vivo’ the nails in this entity.

Quality of life in alopecia areata: A case-control study

Background: Although alopecia areata (AA) is typically seen by medical staff as a benign, not life-threatening cosmetic disease, some studies have found significant impairment in quality of life (QL) in AA patients. There are no studies that assess QL in Brazilian AA patients. Objectives: To evaluate QL in AA patients, using the 36-item Short-Form Health Survey (SF-36). The most affected SF-36 dimensions were compared to two culturally different AA QL studies. Materials and Methods: We performed a case-control study with 37 AA patients and 49 age- and sex-matched volunteer blood donors. The results of a Turkish and a French study were compared to our results. Results: The dimensions social functioning (P = 0,001), role emotional (P = 0,019), and mental health (P = 0,000) scored statistically lower in the AA group in relation to controls, suggesting a worse QL. Incomparison to the Turkish and French studies, we found: (1) On the dimension role emotional, QL was equally impaired; (2) on the dimension social functioning, it was not different than the Turkish study; (3) social life of French AA patients was more affected; and (4) vitality and mental health dimensions were significantly more affected in French and Turkish patients. Conclusions: Impairment in QL in AA patients affected psychological, emotional, and social aspects of theirlives. Despite the scores of SF-36 dimensions varied significantly among different cultural groups, impairment of QL was found in all three studies; thus, we can suppose that these findings are not linked to a specific culture.

Dermatoscopic fi ndings as a complementary tool in the differential diagnosis of the etiological agent of tinea capitis

Tinea capitis is a scalp infection caused by fungi. In Brazil, the main causative agents are Microsporum canis and the Trichophyton tonsurans. Etiological diagnosis is based on suggestive clinical findings and confirmation depends on the fungus growth in culture. However, it is not always possible to perform this test due to lack of availability. We reveal the dermoscopic findings that enable distinction between the main causative agents of Tinea capitis, M. canis and T. tonsurans. The association of clinical and dermatoscopic findings in suspected Tinea capitis cases may help with the differential diagnosis of the etiological agent, making feasible the precocious, specific treatment.

Chromonychia Secondary to Chemotherapy

Chemotherapy drugs can affect the skin and its appendages. Several clinical presentations can be observed, depending on the affected structure. The most common dermatological side effect is chromonychia. The main causative agents are: (1) cyclophosphamide, which can provoke a diffuse, black pigmentation, longitudinal striae and dark grey pigmentation located proximally on the nails; (2) doxorubicin, which promotes dark brown bands alternating with white striae and dark brown pigmentation in transverse bands, and (3) hydroxyurea, which produces a distal, diffuse, dark brown pigmentation. In the majority of cases, the effects are reversible after the suspension of the causative agent for a few months. We report a patient who developed chromonychia while undergoing treatment with cyclophosphamide, vincristine, doxorubicin, dexamethasone, methotrexate and cytarabine for acute lymphocytic leukemia.

Follicular red dots: a normal trichoscopy feature in patients with pigmentary disorders?

Follicular red dots have been described as a trichoscopic feature of active discoid lupus erythematosus of the scalp and its presence associated with a better prognosis. We report five patients with pigmentary disorders in whom follicular red dots were detected during scalp examination. We suggest that this pattern is probably related to the rich vasculature that naturally envelops the normal hair follicle. The possible implications of such proposition in cases of discoid lupus erythematosus and other scalp disorders are also discussed.

Epidermólise bolhosa albopapulóide (variante de Pasini)

A epidermolise bolhosa albopapuloide e doenca rara, de carater autossomico dominante, tambem conhecida como epidermolise bolhosa distrofica albopapuloide de Pasini. Os autores relatam o caso de uma paciente de 37 anos de idade, com inicio do quadro aos sete anos, com lesoes bolhosas e milia nas areas de traumatismo, alem de maculas hipocromicas e atroficas (lesoes albopapuloides) no corpo. A paciente tambem apresenta pele apergaminhada, xerotica, e distrofia ungueal dos pes. A histopatologia da lesao bolhosa revelou clivagem subepidermica, compativel com o diagnostico clinico.