Clarissa Prieto Herman Reinehr

Assessment of the quality of life of pediatric patients at a center of excellence in dermatology in southern Brazil

BACKGROUND Skin diseases cause negative impact on the emotional state, social relationships and daily activities, due to the stigma caused by the appearance of the lesions. OBJECTIVE This study aimed to assess the quality of life of pediatric patients with skin diseases attending a dermatology service, compare the scores obtained among the dermatoses found in the sample and associate them to the variables, in addition to observing how the skin disease specifically affects quality of life. METHODS Cross-sectional study, with patients between 5 and 16 years attending the Dermatology Service of the University of Health Sciences of Porto Alegre, Brazil, between July 2010 and February 2011. The data collection instruments were the Childrens Dermatology Life Quality Index questionnaire and the AUEQI questionnaire. RESULTS A total of 161 patients were interviewed, with mean age of 9,66 years. The main dermatoses were atopic dermatitis (29.8%), warts (13%) and molluscum contagiosum (7.5%). Chronic diseases (73.9%) were the most prevalent. The overall mean Childrens Dermatology Life Quality Index score was 5.01 for chronic dermatoses and 2.07 for acute illnesses, indicating a compromised quality of life among chronically ill patients. The comparison between the scores obtained with the AUEQI scale and the Childrens Dermatology Life Quality Index scores indicates that the overall quality of life is less affected than the specific quality of life related to the dermatosis. CONCLUSIONS The data presented reinforce how important it is that the patients, their families and caregivers understand the symptoms, triggers and treatment of the skin disease in question. This information facilitates adherence to the treatment and justifies the conduct adopted by the dermatologist.

Evaluation of cutaneous rejuvenation associated with the use of ortho-silicic acid stabilized by hydrolyzed marine collagen

Organic silicon plays an important role in dermal structure by promoting neocollagenesis. Thus, the supplementation of silicon in a highly bioavailable form can be used for skin rejuvenation.

Cutaneous human immunodeficiency virus (HIV)‐associated lymphomatoid granulomatosis: complete regression following antiretroviral therapy

1 Lombeck T, Schnippering HG, Ritzl F, Bremer HJ, et al. Absorption of zinc in Acrodermatitis enteropathica. Lancet 1975; 1: 855. 2 Mortimer PS, Gough P, Newbold PC, et al. Acrodermatitis enteropathica. J R Soc Med 1984; 77: 67–68. 3 Donbolt N. Acrodermatitis enteropathica. Br J Dermatol 1979; 100: 37–40. 4 Wang F, Kim BE, Dufiner-Beattie J, et al. Acrodermatitis enterpathica mutations affect transport activity, localization and zinc-responsive trafficking of the mouse ZIP4 zinc transporter. Hum Mol Genet 2004; 13: 563–571. 5 Geiser J, Venken KJT, De Lisle RC, et al. A mouse model of Acrodermatitis enteropathica: loss of intestine zinc transporter ZIP4 (Slc39a4) disrupts the stem cell niche and intestine integrity. PLoS Genet 2012; 8: e1002766. 6 Schmitt S, K€ ury S, Giraud M, et al. An update on mutations of SLC39A4 gene in acrodermatitis euteropathica. Hum Mutat 2009; 30: 826–933. 7 Rodd F. Kahena, Queen of the Berbers: “A Sketch of the Arab Invasion of North Africa in the First Century of the Hijra. Bull Sch Orient Stud 1925; 3: 731–732.

Laser versus microagulhamento para tratamento de cicatriz facial - Relato de caso

Both microneedling and ablative fractional laser can be used for the treatment of scars. The present article reports the case of a female patient who had the first half of a perioral scar treated with ablative fractional CO2 laser, and the second half treated with microneedling, using a 2mm roller. Outcomes were superior in the half treated with laser.Both microneedling and ablative fractional laser can be used for the treatment of scars. The present article reports the case of a female patient who had the first half of a perioral scar treated with ablative fractional CO2 laser, and the second half treated with microneedling, using a 2mm roller. Outcomes were superior in the half treated with laser

Periumbilical purpura: dermatoscopic findings in disseminated strongyloidiasis

Periumbilical purpura: dermatoscopic findings in disseminated strongyloidiasis A 54-year-old male with autoimmune hemolytic anemia receiving high-dose corticosteroid therapy was hospitalized with diarrhea, vomiting, and lower respiratory tract symptoms. Two days later, he evolved to respiratory insufficiency and developed palpable purpura in the abdomen, more prominent in the periumbilical region (Fig. 1). Dermatoscopy of the lesions showed nonerythematous and nonnecrotizing homogeneous purpuric areas, corresponding to hemorrhagic areas (Fig. 2a). A cutaneous biopsy was performed on a purpuric lesion. Histopathological examination revealed a neutrophilic small vessel vasculitis, an eosinophilic infiltrate, and the presence of Strongyloides stercoralis in dermal lymphatics (Fig. 2b,c). Serum test of HTLV I and II were negative. Stool examinations were positive for Strongyloides stercoralis, and larvae were observed in the bronchoalveolar lavage as well. The patient was treated with ivermectin 6 mg two tablets once daily for 22 days, until absence of larvae in stool tests and complete remission of symptoms. Disseminated strongyloidiasis (DS) is a helminthic infection that occurs most frequently in immunosuppressed patients, with high mortality rates. Although cutaneous manifestations are uncommon, if present, they might be relevant for the suspiciousness of the condition. DS incidence is rising; most cases are associated with the use of systemic corticosteroids or immunosupressant agents. HTLV-infected patients are at higher risk to acquire more severe and difficult to treat strongyloidiasis, because of the immune dysregulation caused by the virus, for this reason HTLV serology should be performed for all patients presenting DS. The most common cutaneous manifestation of Strongyloides stercoralis infection is larva currens: a linear, urticariform, and pruritic lesion from the active penetration of larvae on the skin. Cutaneous manifestations in disseminated strongyloidiasis

Vohwinkel syndrome: ichthyosiform variant in a family

Vohwinkel syndrome belongs to the group of hereditary palmoplantar keratoderma, having an autosomal dominant inheritance. In this report, the authors present a case of a four-year-old boy with diffuse scaling over his entire body and transgredient palmoplantar hyperkeratosis with some fissured areas. Family evaluation revealed that his mother and other family members were affected. Based on his clinical findings and on family history, the diagnosis of the ichthyotic Vohwinkel syndrome subtype, characterized by generalized ichthyosis and palmoplantar hyperkeratosis, was established.Vohwinkel syndrome belongs to the group of hereditary palmoplantar keratoderma, having an autosomal dominant inheritance. In this report, the authors present a case of a four-year-old boy with diffuse scaling over his entire body and transgredient palmoplantar hyperkeratosis with some fissured areas. Family evaluation revealed that his mother and other family members were affected. Based on his clinical findings and on family history, the diagnosis of the ichthyotic Vohwinkel syndrome subtype, characterized by generalized ichthyosis and palmoplantar hyperkeratosis, was established.

Microneedling: a case series associated with drug delivery

Six patients underwent two sessions of microneedling associated to drug delivery on the face, hands or stretch marks, at three-week interval between sessions. Patients were evaluated using clinical analysis and objective measures. Compared to baseline, objective face analysis showed decrease in acne lesions and improvement in the skin texture. The evaluation of stretch marks showed great improvement, and face and hands presented excellent results compared to baseline. The association of microneedling to drug delivery for rejuvenation of the face and hands, and for the treatment of stretch marks presented promising results in our study.

Secondary syphilis: The great imitator can't be forgotten

Syphilis is an infection caused by Treponema pallidum, mainly transmitted by sexual contact. Since 2001, primary and secondary syphilis rates started to rise, with an epidemic resurgence. The authors describe an exuberant case of secondary syphilis, presenting with annular and lichen planus-like lesions, as well as one mucocutaneous lesion. Physicians must be aware of syphilis in daily practice, since the vast spectrum of its cutaneous manifestations is rising worldwide.

Dermatoscopic Patterns of Nonfacial Actinic Keratosis: Characterization of Pigmented and Nonpigmented Lesions

BACKGROUND Actinic keratoses (AKs) are dysplastic proliferations of keratinocytes. Studies evaluating nonfacial dermatoscopic pattern of AKs are scarce. OBJECTIVE This study aimed to evaluate the dermatoscopic patterns of AKs located in nonfacial sites and to compare their patterns with facial lesions. MATERIALS AND METHODS Patients with concomitant facial and nonfacial AKs were recruited to participate and evaluated by clinical and dermatoscopic images of their AKs. RESULTS Sixty-eight patients were included in the study. A total of 258 nonfacial AKs and 68 facial AKs were analyzed. The most frequent nonfacial AK dermatoscopic structures were white opaque scales (97.3%) and erythema (57.4%). When analyzed in combination, white scales plus erythema were found in 55.4% of nonfacial AKs. Pigmented structures were observed in 22.5% nonfacial AKs. Homogeneous brown pigmentation was the most prevalent pigmented structure in nonfacial pigmented AK (pAK) (93.1%). There was a positive association between patients having concomitant pigmented facial and nonfacial AKs (p < .001). CONCLUSION The combinations of erythema and white opaque scales or yellow opaque scales and homogeneous pigmentation are suggestive, respectively of nonpigmented and pigmented nonfacial AKs. Pigmented AKs occur concomitantly in facial and nonfacial areas.

Laser assisted drug delivery: a review

The topical route for the delivery of drugs is essential in dermatology: it optimizes the penetration of medicaments, and when performed with the assistance of lasers, it takes place in a uniform and controlled manner. The degree of evidence of drug delivery is being investigated for many drugs. Moreover, the technique combines outstandingly with lasers for rejuvenation and treatment of skin diseases. It is therefore possible to conclude that the use of lasers for drug delivery is promising. While there are clinical studies on some substances that allow their indication and use, others require further controlled analyses, with longer follow-up periods, aimed at allowing thorough evaluations.