David Pacheco

Autoimmune thyroiditis presenting as interstitial granulomatous dermatitis

A 54-year-old female presented with recurrent, widespread, erythematous, painful plaques, over a 3-month period. Skin biopsy was compatible with interstitial granulomatous dermatitis. Additional investigation revealed hypothyroidism and positive anti-thyroid antibodies. Normalization of thyroid function and high-potency topical corticosteroids provided only transitory improvement of the dermatosis. Interstitial granulomatous dermatitis is a histologic inflammatory reaction, with variable cutaneous expression. It has been reported in association with several drugs, lymphoproliferative diseases and autoimmune disorders, such as rheumatoid arthritis, systemic lupus erythematosus and vasculitis, but association with autoimmune thyroiditis is rare. Optimal therapy for this condition is yet to be established, but topical corticosteroids have been a mainstay of treatment. In most cases, this disease is characterized by flares and remissions.

Occupational airborne contact dermatitis caused by usnic acid in a domestic worker

6. Sands MF, Blume JW, Schwartz SA. Successful treatment of 3 patients with recurrent idiopathic angioedema with omalizumab. J Allergy Clin Immunol. 2007;120:979-81. 7. Metz M, Maurer M. Omalizumab in chronic urticaria. Curr Opin Allergy Clin Immunol. 2012;12:406-11. 8. Rodríguez-Trabado A, Fernández Pereira LM, Romero-Chala S, García-Trujillo JA, Cámara Hijón C. Monitoring omalizumab treatment efficacy in chronic urticaria by the basophil activation test. Allergol Immunopathol (Madr). 2011 [Epub ahead of print]. 9. Lemoli E, Piconi S, Fusi A, Borgonovo L, Borelli M, Trabattoni D. Immunological effects of omalizumab in chronic urticaria: a case report. J Investig Allergol Clin Immunol. 2010;20: 252--4. 10. Sánchez-Machín I, Iglesias-Souto J, Franco A, Barrios Y, González R, Matheu V. T cell activity in successful treatment of chronic urticaria with omalizumab. Clin Mol Allergy. 2011;9:11. M. Rodríguez-Rodríguez ∗, D. Antolin-Amerigo, J. Barbarroja-Escudero, M.J. Sánchez-González, M. Alvarez-Mon

The importance of patch tests in the differential diagnosis of adverse drug reactions

Exudative erythema multiforme is an acute self-limited skin disease often associated with infections (usually viral), and also with systemic diseases and drugs. We report the case of a 39-year-old woman diagnosed with systemic lupus erythematosus, who presented at the emergency clinic with exudative erythema multiforme which started 10 days after taking amoxicillin and clavulanic acid for tonsillitis together (almost simultaneously) with the pneumococcal vaccine. Rowells syndrome was also considered to be a possibility. Skin patch tests were carried with the standard battery of patches (GPEDC) and the active ingredients of the suspected drugs (Chemotechnique ®), with readings at D2 and D3. The tests were positive for amoxicillin 10% pet (++), ampicillin 10% pet (+ +) and penicillin G potassium 10% pet (+). We accepted the diagnosis of erythema multiforme due to amoxicillin, confirmed by patch testing.

Allergic hypersensitivity to Deflazacort

1. Textiles and shoes. In: Fisher’s contact dermatitis. 6th ed. Hamilton, Ontario: Bc Decker Inc.; 2008. p. 339--69. 2. Warshaw EM, Schram SE, Belsito DV, DeLeo VA, Fowler Jr JF, Maibach HI, et al. Shoe allergens: retrospective analysis of cross-sectional data from the North American contact dermatitis group, 2001--2004. Dermatitis. 2007;18:191. 3. Fleming AJ. The provocative test for assaying the dermatitis hazards of dyes and finishes used on nylon. J Invest Dermatol. 1948;10:281--91. 4. Edward Gaul L, Underwood GB. Primary irritants and sensitizers used in fabrication of footwear. Arch Derm Syphilol. 1949;60 Pt I:649--75. 5. Leppard BJ, Parhizgar B. Contact dermatitis to PPD rubber in Maleki shoes. Contact Dermatitis. 1977:91--3. 6. Johansen JD, Frosch PJ, Lepoittevin J-P. Contact dermatitis. 5th ed. Berlin: Springer; 2011. p. 545--76. 7. Lepoittevin JP, Le Coz C. Chimie des colorants vestimentaries. In: Libbey J, editor. Progrès en Dermato-allergologié. GERDA; 1999. p. 133--42. 8. Seidenari S, Mantovani L, Manzini BM, Pignatti M. Crosssensitizations between azo-dyes and para-amino compounds. A study of 236 azo-dye sensitive subjects. Contact Dermatitis. 1997;36:91--6. 9. Dooms-Goossens A. Textile dye dermatitis. Contact Dermatitis. 1992;27:321--3. 10. Goon AT, Gilmour NJ, Basketter DA, White IR, Rycroft RJ, McFadden JP. High frequency of simultaneous sensitivity to Disperse Orange 3 in patients with positive patch tests to para-phenylenediamine. Contact Dermatitis. 2003;48: 248--50.

BASALIOMA PIGMENTADO DA VULVA – RELEVÂNCIA DO DIAGNÓSTICO DIFERENCIAL COM OUTRAS LESÕES PIGMENTADAS VULVARES

Introducao: Os basaliomas sao os tumores malignos mais frequentemente encontrados na raca humana e com uma incidencia cada vez maior nas ultimas decadas. Neste tipo de neoplasias, a vulva e uma localizacao atipica, provavelmente porque os fatores etiologicos sao diferentes dos de outras areas anatomicas. Tem uma clinica monotona e inespecifica. Caso Clinico: Mulher de 69 anos, que surge com uma placa erosionada com cerca de 3cm de eixo maior, fundo duro com pequenas areas pigmentadas na periferia do grande labio direito. A histologia revelou tratar-se de um basalioma pigmentado. Foi submetida a exerese cirurgica alargada da lesao, nao se tendo verificado recidiva apos tres anos de seguimento. Conclusao: Os basaliomas pigmentados da vulva sao muito raros. Salienta-se a importância do diagnostico diferencial com outras lesoes pigmentadas nesta regiao, que podem ser neoplasias de maior gravidade, que requerem outros tratamentos mais invasivos. Como a taxa de recidiva dos basaliomas e elevada o seguimento periodico e obrigatorio. PALAVRAS-CHAVE – Basaliomas; Neoplasias da pele; Neoplasias da vulva.

Solitary T-cell pseudolymphoma of the breast, treated by PUVA.

ejd.2013.2043 Auteur(s) : David Pacheco pachecocas@hotmail.com, Ana Rita Travassos, Luis Soares de Almeida, Raquel Silva, Paulo Filipe Servico de Dermatologia, Hospital de Santa Maria Avenida Prof. Egas Moniz 1649-028 Lisboa, Portugal Cutaneous pseudolymphoma (PL) is considered to be a reactive skin condition with benign proliferations of lymphocytes, which imitates cutaneous T-cell lymphoma. Differential diagnosis includes solitary mycosis fungoides, lichenoid keratosis and even pleomorphic T-cell [...]

INCISÕES DE RELAXAMENTO PARA REPARAÇÃO DE DEFEITOS CIRÚRGICOS DE GRANDES DIMENSÕES NO COURO CABELUDO

91- year-old, Caucasian male patient, with a 35x40mm tumor, located in the right parietal region. Due to de dimension of the defects, primary closure was not able to accomplish, parallel relaxing incisions to the surgical defect was an option for reconstruction. Relaxing incisions to correct large defects of the scalp was proposed as an alternative and effective technique that avoids the execution of complex flaps and skin grafts procedures and has an acceptable cosmetic result. KEYWORDS – Reconstructive surgical procedures; Scalp; Surgical flaps.

Atypical cutaneous mycobacteriosis co-infection with pulmonary tuberculosis in an immunocompetent patient

ejd.2011.1441 Auteur(s) : Joana Antunes joana_antunes@yahoo.com, Paulo Filipe, David Pacheco, Rita Travassos Dermatology Department, Hospital de Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisbon, Portugal Atypical mycobacterial infections are caused by mycobacteria other than Mycobacterium tuberculosis and M. leprae. Almost all atypical mycobacteria have been implicated in skin diseases [1]. M. avium-intracellulare complex (MAI) consists of M. avium, M. intracellulare and other unidentified species, [...]