Fernando Augusto de Almeida

Endemic pemphigus foliaceus (fogo seivagem). I. Clinical features and immunopathology

Endemic pemphigus foliaceus is an autoimmune disease that has remarkable features. Endemic foci are found in characteristic environments within the interior of Brazil. The epidemiologic data strongly suggest that an environmental factor initiates the autoantibody response in the host. As such it is an important disease for in-depth study. A group of interested investigators in both Brazil and the United States has been formed to attempt to do just that. As part of the overall effort, this Cooperative Research Group for the Study of Fogo Selvagem presents a definition of the disease, a proposed clinical classification for various forms of the disease, and an outline of what is currently known of its immunopathologic characteristics.

Dermabrasion for Acne Scars During Treatment with Oral Isotretinoin

BACKGROUND Oral isotretinoin is the criterion standard treatment for severe inflammatory acne associated with scar development. Atypical or exaggerated cicatrization related to oral isotretinoin was reported throughout the 1980s and 1990s. Dermabrasion for atrophic acne scar revision is not recommended 6 to 12 months from the end of oral isotretinoin treatment. OBJECTIVE To evaluate wound healing after localized dermabrasion in patients receiving oral isotretinoin. MATERIALS & METHODS Interventional, prospective study involving seven patients taking oral isotretinoin to treat acne and with atrophic acne scars on the face. Manual dermabrasion was performed on all patients in an area of approximately 1 cm2, and a 6‐month reepithelization follow‐up by clinical evaluation was conducted. RESULTS All patients presented normal cicatrization evolution; hypertrophic scarring or keloid as a result of localized abrasion was not observed, and atrophic acne scar revision result was excellent. CONCLUSION The current recommendation to wait 6 to 12 months after treatment with oral isotretinoin for acne scar revision using dermabrasion should be re‐evaluated. Abrasion of a small test area may be a useful predictor of wound healing, enabling earlier acne scar treatment using this procedure.

Limitations of DNA Sequencing for Diagnosis of a Mixed Infection by Two Fungi, Phaeoacremonium venezuelense and a Plectophomella sp., in a Transplant Recipient

ABSTRACT We describe a rare case of a subcutaneous infection by both Phaeoacremonium venezuelense and Plectophomella sp. in a Brazilian male. Sequencing of a β-tubulin gene fragment allowed us to confirm the identification of the former. However, a similar procedure of sequencing rRNA gene fragments was not useful for the identification of the latter fungus.

Squamous Cell Carcinoma in Chronic Ulcer in Lepromatous Leprosy

Marjolin’s ulcer was first described in 1828 and involves a rare, malignant transformation of chronic scar tissue or ulcers. The delay between the occurrence of the scar and malignant transformation can be as long as 70 years. Although rare, this association between chronic ulcers and squamous cell carcinoma (SCC) is well documented, although the clinical presentation of SCC varies, ranging from innocuous-appearing lesions to overtly exophytic growth.

Catarata subcapsular posterior em pacientes com pênfigo e penfigóide tratados com corticoterapia oral

BACKGROUND: Oral corticosteroid is the treatment most used for patients with chronic bullous dermatosis, often at high dosages and over long periods of time. Arterial hypertension, diabetes, osteoporosis, infections and hydro-electrolytic disturbances frequently occur as side effects of this therapy. Posterior subcapsular cataract is rarely mentioned in the literature as a side effect of corticosteroid in patients with bullous diseases. OBJECTIVES: To evaluate the incidence of posterior subcapsular cataract as a side effect of oral corticosteroid. METHODS: A retrospective study: 49 patients with chronic bullous diseases using a corticosteroid were followed-up from 1987 to 1997 at the Bullous Dermatosis Outpatient Care Unit of the Department of Dermatology, UNIFESP - EPM. The patients were regularly submitted to ophthalmologic evaluation in search for cortisone cataract. This evaluation was carried out at the beginning of the treatment and regularly during the use of the corticosteroid. RESULTS: From 1987 to 1997, the incidence of posterior subcapsular cataract as a side effect of oral corticosteroid was 28.57% in these patients. CONCLUSIONS: 1) among 49 patients, 14 (28.57%) presented with cortisone cataract. 2) the period of time of prednisone use up to the appearance of cataract varied from eight months to nine years and three months (average 45.71 months). 3) the maximum dose of oral corticosteroid required for the management of the clinical picture ranged from 60 to 120 mg daily (average of 78.57 mg daily).