Enoi Aparecida Guedes Vilar

Síndrome de Sweet: estudo de 73 casos, com ênfase nos achados histopatológicos

BACKGROUND Sweets syndrome refers to a set of cutaneous, systemic and histopathological alterations that occur in response to different stimuli, in a similar way to that occurring in erythema nodosum, erythema multiforme and leukocytoclastic vasculitis. The syndrome has been described in association with conditions such as infections, pregnancy, the use of certain medications and malignancy. OBJECTIVES To evaluate the clinical and histopathological alterations occurring in this syndrome and to assess the association between these alterations and other conditions. METHODS A retrospective study of 73 cases was conducted, evaluating data on the microscopic examination of skin lesions, as well as clinical and laboratory data. RESULTS The majority of the patients were female (83.0%), white (49.2%) and between 30 and 60 years of age (73.8%). The principal alterations found were: erythymatous plaques (76.9%), papules (43.0%), pseudo-vesiculation (PV) (38.4%) and target lesions (18.5%). With respect to the associated conditions, upper respiratory tract infections (15.4%) and the use of medication (10.8%) were the most common. Other associations, albeit represented by only one case each, were: Hodgkins lymphoma, pregnancy, ulcerative colitis, polycythemia vera and lupus erythematosus in a patient with acquired immune deficiency syndrome (AIDS). The principal microscopic findings were: neutrophils with leukocytoclasia (98.6%), collagen degeneration (87.7%), edema (74.0%) and PV (38.4%). The presence of eosinophils (41.1%) ranged from rare to abundant and was usually unrelated to the use of medication. Inflammatory infiltrate reached the deep epidermal layer in 47.9% of cases and panniculitis was found in 80.0% of cases in which the hypodermis was affected (10 cases). CONCLUSIONS In general, these findings are in agreement with results published in the literature, emphasizing the frequent finding of eosinophils unrelated to drug use, panniculitis and the rare association with Hodgkins lymphoma. This is the fifth report of an association between Sweets syndrome and Hodgkins disease.

Transepidermal Retinoic Acid Delivery Using Ablative Fractional Radiofrequency Associated With Acoustic Pressure Ultrasound for Stretch Marks Treatment

Striae distensae (SD) treatment still remains a therapeutic challenge to dermatologists. Ablative fractional laser and radiofrequency (RF) enhance skin‐drug permeability for SD treatment.

PARACOCCIDIOIDOMYCOSIS IN A RENAL TRANSPLANT RECIPIENT

Paracoccidioidomycosis (PCM) is the most common endemic mycosis in Latin America. The etiological agents, which comprise two species, Paracoccidioides brasiliensis and P. lutzii, are thermodimorphic fungi that usually affect previously healthy adults. They primarily involve the lungs and then disseminate to other organs. Such mycosis is rare in organ transplant recipients; there have been only three cases reported in literature, until now. We report a case of PCM in a renal transplant recipient with an unusual dermatological presentation.

Fox-Fordyce disease: response to adapalene 0.1%

The Fox-Fordyce disease is a rare inflammatory dermatosis that affects mainly young women and is characterized by multiple follicular papules, skin color or brownish, very itchy, localized in areas rich in apocrine glands. Histopathology shows focal spongiosis of the upper infundibulum with fibrosis and perifollicular lymphohistiocytic infiltrate. The diagnosis is based on clinical and histopathological examination. Many treatment options have been described; however none of them is excellent. We chose the topic adapalene 0.1% and a satisfactory improvement of the signs and symptoms of the disease was observed.

Síndrome de Sweet associada à policitemia vera

Abstract: Sweet’s syndrome may be associated with hematological malignancies, particularly with acutemyelogenous leukemia, but there are few reports of its association with polycythemiavera. We descri-bethe case of a 65-year-old male patient, diagnosed with polycythemiavera, which developedinto para-neoplastic Sweets syndrome.Keywords: Granulocyte-macrophage colony-stimulating factor; Macrophages; Polycythemia vera;Sweet’s syndrome Recebido em 19.05.2008.Aprovado pelo Conselho Consultivo e aceito para publicacao em 31.07.09. * Trabalho realizado no Servico de Dermatologia da Universidade Federal Fluminense (UFF) – Niteroi (RJ), Brasil.Conflito de interesse: Nenhum / Conflict of interest: NoneSuporte financeiro: Nenhum / Financial funding: None 1 Pos-graduanda do Servico de Dermatologia da Universidade Federal Fluminense (UFF) – Niteroi (RJ), Brasil. 2 Pos-graduanda do Servico de Dermatologia da Universidade Federal Fluminense (UFF) – Niteroi (RJ), Brasil. 3 Professora titular e chefe do Servico de Dermatologia da Universidade Federal Fluminense (UFF) – Niteroi (RJ), Brasil.Sweet’s syndrome may be associated with hematological malignancies, particularly with acute myelogenous leukemia, but there are few reports of its association with polycythemiavera. We describethe case of a 65-year-old male patient, diagnosed with polycythemiavera, which developedinto paraneoplastic Sweets syndrome.

Comedo-like openings in melanoma

We describe a case of melanoma with the presence of comedo-like openings at dermoscopy. These structures, typical of seborrheic keratosis, represent an uncommon finding in melanoma. We emphasize the importance of searching for specific dermoscopic criteria for melanocytic lesions during the examination of a pigmented lesion, despite possible observations of characteristic structures of non-melanocytic lesions, in order to increase the accuracy in the diagnosis of melanoma.

Padrão lesional da medula óssea na imunodeficiência adquirida (AIDS)

The bone marrow of 20 autopsy cases of patients with Acquired Immune Deficiency Syndrome was examined. The study suggests that the bone marrow changes are frequent and of diagnostic value to recognize the syndrome. It is assumed that there is a diagnostic lesional pattern in which the following elements are predominant: hypercellularity, absent or reduced granulopoiesis, plasmocytosis, histiocytosis and megakariocytic dysplasia.

Nevus lipomatosus cutaneous superficialis

Nevus lipomatosus cutaneous superficialis is a rare benign hamartomatous skin tumor characterized by dermal deposition of mature adipose tissue. Two clinical forms have been described (classical and solitary types). We describe a case of nevus lipomatosus cutaneous superficialis with a 13-year history of growth in a young woman who had a solitary skin-colored tumoral mass on the right buttock. Histopathological findings were typical and confirmed the diagnosis. In this case, the lesion was a skin-colored isolated mass, as described in the solitary type, but its localization and age of appearance were compatible with the classical type. The combination of simultaneous clinical findings of both types had not been published before.

Scleredema of Buschke associated with difficult-to-control type 2 diabetes mellitus

Scleredema of Buschke (SB) is a rare disorder of connective tissue characterized by diffuse non-pitting induration of the skin, mainly on the cervical, deltoid and dorsal regions. It is a cutaneous mucinosis of unknown etiology and is associated with bacterial or viral infections, hematological disorders and diabetes mellitus. Histopathological examination shows thickened dermis with wide collagen bundles separated by gaps that correspond to mucopolysaccharide deposits, visualized using special staining. Several treatments are reported in the literature without well-established results. We report a case of SB in a patient with type 2 diabetes mellitus.

Cutaneous leukocytoclastic vasculitis in the presence of methimazole therapy

Treatment with antithyroid drugs may be accompanied by side effects. We present a patient diagnosed with Graves Disease who developed extensive vasculitis in the lower limbs during methimazole use. After suspension of the methimazole and the introduction of prednisone in immunesupressor doses the cutaneous lesions started to involute.