Felicidade Santiago

Epicutaneous patch testing in drug hypersensitivity syndrome (DRESS)

Background: In some patterns of cutaneous adverse drug reactions, and depending on the culprit drug, patch testing has been helpful in confirming its cause. Its value in Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) has not been established in a large cohort of patients.

Value of patch tests in clindamycin-related drug eruptions

Background. Patch tests help to confirm the aetiology of the cutaneous adverse drug reactions involving delayed hypersensitivity mechanisms, but the results vary with the pattern of skin reaction and the culprit drug.

Low‐dose UVA1 phototherapy for scleroderma: what benefit can we expect?

Background  The first reports of the application of ultravioletA1 (UVA1) phototherapy for scleroderma go back only to 1995, but since then, several studies have proven its effectiveness in this disease.

Incidence and factors associated with recurrence after incomplete excision of basal cell carcinomas: a study of 90 cases.

Background  Management of incompletely excised basal cell carcinomas (BCC) remains controversial.

Adverse cutaneous reactions to epidermal growth factor receptor inhibitors: a study of 14 patients.

BACKGROUND Cetuximab and erlotinib, epidermal growth factor receptor inhibitors, often cause peculiar adverse cutaneous reactions. OBJECTIVES Our aim was to evaluate adverse cutaneous reactions and their management in patients undergoing treatment with cetuximab and erlotinib. PATIENTS AND METHODS Between March/2005 and September/2009, we observed 14 patients with a mean age of 59.6 years undergoing treatment with cetuximab (7) or erlotinib (7), due to lung(10) or colorectal cancer (4). We evaluated the interval between introduction of the drug and onset of symptoms, treatment response, and the clinical pattern of evolution of the cutaneous reaction retrospectively. RESULTS Twelve patients presented papular-pustular eruption typically affecting the face, chest and back, which appeared in average 13.5 days after starting the drug treatment. The patients underwent oral treatment with minocycline or doxycycline and topical treatment with metronidazole, benzoyl peroxide and/or corticosteroids. All patients showed improvement of the lesions. Five patients presented periungual pyogenic granulomas, which were associated with paronychia in 4 cases, after an average of 8 weeks of treatment. There was improvement of the lesions with topical treatment (antibiotics, corticosteroids and antiseptics). Xerosis was observed in some patients. Other less frequent adverse side effects such as telangiectasia and angiomas, hair and eyelash alterations, and eruptive melanocytic nevi were also described. Treatment with epidermal growth factor receptor inhibitor was maintained in most patients. CONCLUSION The increasing use of these targeted therapies requires knowledge of their adverse cutaneous side effects to ensure timely intervention in order to allow the continuation of the therapy.

Linear psoriasis - a case report.

A 56-year-old woman presented with a 3-month history of erythematous plaques covered by scales and limited to the right side of her body. The plaques were arranged along Blaschko’s lines with a marked mid-line cutoff. The histopathologic analysis of a skin biopsy in conjunction with the anamnesis allowed the diagnosis of linear psoriasis. Our patient showed a good clinical response to antipsoriatic treatment.

Coexistence of reticulate acropigmentation of Kitamura and Dowling-Degos disease.

Reticulate acropigmentation of Kitamura (RAK) and Dowling-Degos Disease (DDD) are rare genodermatosis inherited as an autosomal dominant trait with variable penetrance. They are part of a spectrum of diseases with hyperpigmented macules coalescing in a reticular pattern, facial and palmoplantar pits, breaks in dermatoglyphics, comedo-like lesions and epidermoid cysts, and a unique histological picture of hyperpigmented digitate epidermal downgrowths. The authors describe the case of a 45-year-old female with reticulate acropigmentation of the dorsa of the hands and feet, hyperpigmented macules on the axilla and around the mouth, and palmar pitting. Clinical and histological findings, together with a relevant family history, allowed the authors to consider this case an example of the rare event of an overlap RAK-DDD.

Loose anagen hair syndrome: an unusual cause of alopecia of cosmetic importance only

A 5‐year‐old girl was referred to our clinic because of a 5‐month history of diffuse hair loss. Her hair was light brown and dull with evident patches of alopecia. There were no signs of scalp inflammation or scarring. A hair pull test revealed multiple hairs, easily and painlessly extracted. Light microscopic examination and trichogram were consistent with loose anagen hair syndrome. This is an unusual benign hair disorder of childhood that improves spontaneously with aging.

Late-onset hyperpigmentation: a case with multi-systemic involvement and recombinant X chromosome

photosensitivity. During sun exposure the volunteers examined at the dermatologic centre were informed directly through their mobile phones by SMSs, about the optimal UV dose for their skin, an estimate of the residual exposure time and the protection factor of the sunscreen they needed according to UVI units registered. The information released by mobile phone was based on the correlation of daily UVI registered by the experimental set-up and the individual photosensitivity, thus obtaining an estimate of the maximum exposure time expressed in minutes to prevent sunburn. These values were reached on the basis of the effective erythemal dose (DE) expressed in MED/h using the following algorithm ST 1⁄4 60/DE. Therefore, in a typically sunny August day with a UVI equal to 6 (2.6 MED/h), a phototype I or II at his/her first sun exposure would develop a sunburn after about 20 min, while in a moderately pigmented subject, this would take some hours (Table 1). This campaign aimed to capture the attention of young people by an experimental photodermatology service and to promote preventive care through a system of customized UVI teledosimetry using information technology such as mobile phones, keen to young people. This pilot study could represent an example of cooperation between information technology and clinicians using information technology in the field of photoprotection and can suggest further research development to optimize the sun prevention devices.

Postauricular pull-through transpositional flap: An option for one-stage reconstruction of anterior auricle defects

Abstract The reconstruction of anterior-superior defects of the auricle is usually a challenging task. We describe three patients with non-melanoma skin cancer localized in the upper portion of the antihelix. Tumour sizes ranged from 0.6 cm to 1.3 cm. All patients underwent a postauricular pull-through transpositional flap to repair the primary defect. The donor sites were closed using a T-plasty. The final results were aesthetically good. The main advantages as well as disadvantages of this one-stage reconstruction of anterior auricle defects are discussed.