David Rubem Azulay

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.

Oral candidiasis in patients with psoriasis: correlation of oral examination and cytopathological evaluation with psoriasis disease severity and treatment.

BACKGROUND Infections are known to trigger and exacerbate psoriasis. Although oral candidiasis is often clinically diagnosed, it is not always confirmed by laboratory tests such as oral cytopathology. OBJECTIVES The aims of this study were to determine the prevalence of oral candidiasis in patients with psoriasis through clinical and cytopathological diagnosis and to investigate the association between oral candidiasis and psoriasis with regards to the severity of the clinical presentation and the type of treatment for psoriasis. METHODS A total of 140 patients with psoriasis and 140 healthy control subjects received an oral examination. Scrapings of the tongue were also obtained for a cytopathological examination. RESULTS The oral examination and the results of the cytopathological smear revealed 37 (26%) cases of candidiasis in the patients with psoriasis and no cases of candidiasis in the healthy control subjects. There was no correlation between the type of psoriasis treatment and the presence of oral candidiasis (P = .616). There was a statistically significant association (P = .033) between the clinical severity of psoriasis and the presence of Candida. LIMITATIONS This study was limited by the small number of subjects and the lack of follow-up to determine the development of psoriasis after treatment for oral candidiasis. CONCLUSIONS The presence of oral candidiasis is higher in patients with psoriasis and it is associated with disease severity. This increased presence of oral candidiasis was apparent despite any type of treatment for the psoriasis. Cytopathology to rule out oral candidiasis should be used in the routine medical workup of patients with psoriasis.

Update on therapy for superficial mycoses: review article part I

Superficial fungal infections of the hair, skin and nails are a major cause of morbidity in the world. Choosing the right treatment is not always simple because of the possibility of drug interactions and side effects. The first part of the article discusses the main treatments for superficial mycoses - keratophytoses, dermatophytosis, candidiasis, with a practical approach to the most commonly-used topical and systemic drugs , referring also to their dosage and duration of use. Promising new, antifungal therapeutic alternatives are also highlighted, as well as available options on the Brazilian and world markets.

Pyoderma gangrenosum following isotretinoin therapy for acne nodulocystic

A 19‐year‐old man with nodulocystic acne on baseline was treated with isotretinoin therapy. After 1 month on the medication, he developed pyoderma gangrenosum on his pubis area, arms and legs, and pathergy on a puncture site. Possible underlying diseases were excluded. The patient was started on steroids (prednisone 1 mg/kg/d) and isotretinoin therapy was withdrawn. Later the prednisone was tappered and dapsone 100 mg/daily was initiated. After 10 months of follow‐up all lesions had healed and no underlying diseases developed.

Doenças sexualmente transmissíveis na gestação: uma síntese de particularidades

Sexually transmitted diseases (STDs) have a significant prevalence in both the general population and pregnant women. Accordingly, we consider the physiological changes of the maternal organism that can alter the clinical course of these diseases. In addition, obstetric and neonatal complications may occur, resulting in increased maternal and infant morbidity and mortality. We explore features of the natural course and treatment during pregnancy of the major STDs: soft chancre, donovanosis, gonorrhea, chlamydia, viral hepatitis, genital herpes, human papillomavirus (HPV) infection, lymphogranuloma venereum, syphilis, and vulvovaginitis. We believe that health professionals should pay careful attention to STDs, particularly in relation to early diagnosis and precautions on the use of drugs during pregnancy. Prevention and partner treatment to achieve effective results are also extremely relevant.

Prevalence of plexiform neurofibroma in children and adolescents with type i neurofibromatosis

OBJECTIVE To assess prevalence of plexiform neurofibroma in children and adolescents with type I neurofibromatosis and its malignant potential. METHODS A retrospective study was conducted through analysis of the database at Centro Nacional de Neurofibromatose [Brazilian Neurofibromatosis Center], collected from the following reference services between 1996 and 2004: Instituto de Dermatologia Prof. Rubem David Azulay da Santa Casa de Misericórdia do Rio de Janeiro, Instituto de Pediatria e Puericultura Martagão Gesteira da Universidade Federal do Rio de Janeiro and Department of Immunology and Microbiology at Faculdade de Medicina de Teresópolis. RESULTS Over that period, 104 patients aged between 1-17 years were admitted with clinical diagnosis of type I neurofibromatosis. Of these, 53 were male and 51 were female, and 28 patients (15 male and 13 female) had plexiform neurofibroma (26.9%). Division by age group resulted in 21.42% (six) between 1-5 years; 35.71% (10) between 6-12 years and 42.85% (12) between 13-17 years. Of the 104 patients, two developed a malignant peripheral nerve sheath tumor (1.92%). CONCLUSIONS Plexiform neurofibromas are relatively common manifestations in patients with type I neurofibromatosis and may be a cause of significant increase in morbidity and mortality among patients. In this study, we conclude that frequency of plexiform neurofibroma and its malignant potential in the population studied is in agreement with data from the international literature.

Prevalência de neurofibromas plexiformes em crianças e adolescentes com neurofibromatose tipo 1

OBJECTIVE: To assess prevalence of plexiform neurofibroma in children and adolescents with type I neurofibromatosis and its malignant potential. METHODS: A retrospective study was conducted through analysis of the database at Centro Nacional de Neurofibromatose [Brazilian Neurofibromatosis Center], collected from the following reference services between 1996 and 2004: Instituto de Dermatologia Prof. Rubem David Azulay da Santa Casa de Misericordia do Rio de Janeiro, Instituto de Pediatria e Puericultura Martagao Gesteira da Universidade Federal do Rio de Janeiro and Department of Immunology and Microbiology at Faculdade de Medicina de Teresopolis. RESULTS: Over that period, 104 patients aged between 1-17 years were admitted with clinical diagnosis of type I neurofibromatosis. Of these, 53 were male and 51 were female, and 28 patients (15 male and 13 female) had plexiform neurofibroma (26.9%). Division by age group resulted in 21.42% (six) between 1-5 years; 35.71% (10) between 6-12 years and 42.85% (12) between 13-17 years. Of the 104 patients, two developed a malignant peripheral nerve sheath tumor (1.92%). CONCLUSIONS: Plexiform neurofibromas are relatively common manifestations in patients with type I neurofibromatosis and may be a cause of significant increase in morbidity and mortality among patients. In this study, we conclude that frequency of plexiform neurofibroma and its malignant potential in the population studied is in agreement with data from the international literature.

Treatment of superficial mycoses: review - part II

Superficial fungal infections of the hair, skin and nails are a major cause of morbidity in the world. Choosing the right treatment is not always simple because of the possibility of drug interactions and side effects. The first part of the article discusses the main treatments for superficial mycoses - keratophytoses, dermatophytosis, candidiasis, with a practical approach to the most commonly-used topical and systemic drugs , referring also to their dosage and duration of use. Promising new, antifungal therapeutic alternatives are also highlighted, as well as available options on the Brazilian and world markets.

Geographic Tongue and Fissured Tongue in 348 Patients with Psoriasis: Correlation with Disease Severity

Geographic tongue (GT) and fissured tongue (FT) are the more frequent oral lesions in patients with psoriasis. The aims of this study were to compare the prevalence of GT/FT between psoriasis group (PG) and healthy controls (HC) and investigate the correlation between GT/FT and psoriasis severity using the PASI and age of psoriasis onset. Three hundred and forty-eight PG and 348 HC were selected. According to the age of psoriasis onset, the individuals were classified as having early psoriasis and late psoriasis. The severity of vulgaris psoriasis was determined according to PASI. A follow-up was conducted in patients with psoriasis vulgaris (PV) with GT to evaluate the progression of oral and cutaneous lesions. The FT and GT were more frequent in PG than in HC. The incidence of GT was higher in patients with early psoriasis and that of FT in late-psoriasis. There is association between psoriasis intensity and GT; and a higher monthly decrease of PASI score in patients without GT. The presence of GT and FT is higher in PG than in the HC. GT is associated with disease severity and may be a marker of the psoriasis severity.

Síndrome do nevo de Becker

Becker nevus syndrome is a phenotype characterized by the fundamental presence of Beckers nevus with ipsilateral hypoplasia of the breast or other skin, skeletal and/or muscular disorders. This syndrome generally originates at birth, intensifies significantly in adolescence and is one of the syndromes that constitute epidermal nevus syndrome. To the best of our knowledge, this is the first case published in the Brazilian literature of Becker nevus syndrome associated with Beckers nevus, ipsilateral breast hypoplasia and scoliosis in a 14-year-old girl.