Hebert Roberto Clivati Brandt

Vasculite cutânea de pequenos vasos: etiologia, patogênese, classificação e critérios diagnósticos - Parte I

Vasculitis is an inflammation of vessel walls. It may range in severity from a self-limited disorder in one single organ to a life-threatening disease due to multiple-organ failure. It has many causes, although they result in only a few histological patterns of vascular inflammation. Vessels of any type in any organ can be affected, a fact that results in a broad variety of signs and symptoms. Different vasculitides with indistinguishable clinical presentations have very different prognosis and treatments. This condition presents many challenges to physicians in terms of classification, diagnosis, appropriate laboratory workup, treatment, and the need for careful follow-up. This article reviews the classification, etiology, pathology and diagnostic criteria of cutaneous vasculitis.

Reações tegumentares adversas relacionadas aos agentes antineoplásicos: parte I

The local and systemic treatment of tumors can cause changes in the skin, mucous membranes, hair and nails. Accurate diagnosis and appropriate treatment of side effects require knowledge about the patterns of the most common adverse reactions to drugs the patient may be using. The dermatologist must be familiar with the manifestations of certain soft tissue neoplasms, as well as with the adverse mucocutaneous forms of cancer treatment.

Urticaria and dermographism in patients with adult-onset Still’s disease

Adult-onset Still’s disease (AOSD) patients typically present with arthralgia, fever, lymphadenopathy and a transient salmon maculopapular rash. Only approximately 25 cases of AOSD with urticaria were described in the literature. In this article, the authors report three additional cases of AOSD with urticarial and dermographic lesions who had a good clinical response to glucocorticoid and antihistamines. A review of the literature concerning this issue is also herein written.

Prevalence of thrombophilia associated with leg ulcers

(Schwann cells, endoneurial cells or perineurial cells) rather than dermal fibroblasts are most probably responsible for the intraneural mucin accumulation in our patient. As perineurial and endoneurial cells originate from fibroblasts or myofibroblasts, it is reasonable to suggest that these cells have the ability to produce mucin. In addition, Schwann cells have been shown to produce hyaluronic acid under certain conditions. Nevertheless, the factors which induce these cells to produce mucin are as yet unknown. The excessive mucin deposition inside the cutaneous nerve appeared to interfere with nerve function as the patient experienced paraesthesia and tenderness when pressure was applied over the skin nodule. This is in contrast to cutaneous focal mucinosis which is normally asymptomatic. The sensory neuropathy in our patient may be caused by the mechanical compressive effect of mucin deposition within a tight perineurial sheath, or the mucinous accumulation may interfere with the metabolism and function of axons and Schwann cells. Various tumours derived from perineurial tissue or Schwann cells have been known to produce a mucinous matrix, including schwannomas, neurofibromas, neurothekeomas and perineuriomas. In particular, perineurioma, which is composed almost entirely of perineurial cells, may contain mucinous areas. Therefore an inherent ability of peripheral nerve sheath tissue to produce mucin is not unexpected. Our report demonstrates that peripheral nerve sheath tissue, even in the absence of tumoral transformation, may have the ability to produce excessive amounts of mucin resulting in mucin deposition within cutaneous nerves. The cutaneous mucinoses are named according to the site of mucin deposition: dermal mucinoses, follicular mucinoses or epithelial mucinoses. The accumulation of mucin in cutaneous nerves is not well defined in the scientific literature. We therefore propose the term ‘cutaneous neural mucinosis’ to encompass nontumour-associated conditions of neural and perineurial tissue with excessive mucin deposition. Recent studies have shown that the functional status of dermal nerve fibres may influence skin homeostasis. Further investigations are warranted to elucidate the physiological or pathological significance of this previously unrecognized condition.

Tratamento do papiloma vírus humano na infância com creme de imiquimode a 5

In children, lesions caused by the human papillomavirus (HPV) constitute a significant epidemiological issue and a therapeutic dilemma, particularly in the case of anogenital warts. The treatment of anogenital warts in children is a challenge, since standard treatments are generally painful and require the patient to be anesthetized. Imiquimod, a topical immune response modifier, constitutes an alternative therapeutic agent for the treatment of HPV. The present report describes four cases in which treatment with topically applied imiquimod 5% cream was implemented with successful results.

Nasoseptal perforation secondary to lupus vulgaris

Dear Editor, Nasoseptal perforation is a condition most commonly associated with trauma. Inflammatory causes have included sarcoidosis, lupus erythematosus and Wegener’s granulomatosis. Inhaled irritants can also cause perforation, cocaine being the irritant most often associated with this condition. Specific infections, such as syphilis and leishmaniasis as well as neoplasms, such as lethal midline granuloma and idiopathic destructive disease, have eventually been observed. We report the rare instance of septal perforation associated with cutaneous tuberculosis. A 31-year-old Brazilian woman presented with a 4-year history of an asymptomatic nasal lesion. Examination found a reddish-brown circular plaque with a keratotic surface, 1,5 cm in diameter, localized on the tip of the nose associated, with a 4-mm nasoseptal perforation (Fig. 1a). Diascopy revealed an “applejelly” appearance of the plaque. Empiric treatment for leishmaniasis 2 years ago with glucantime showed no improvement. There was no personal or familial history of tuberculosis. A history of fever, anorexia, weight loss, cough or ganglionar swelling could not be elicited. She had received Bacille Calmette-Guerin (BCG) vaccination in childhood. Skin biopsy of the plaque evidenced a caseating granulomatous reaction with giant cells in the upper dermis. No acid-fast bacilli could be demonstrated. Culture of biopsied tissue was negative. Systemic investigation revealed a normal hemogram, liver and renal function tests. Purified protein derivative (PPD) test showed an intense reaction with 20 mm induration and vesicle formation. Chest roentgenography and chest computed-tomography images demonstrated bilateral parenchymal consolidations. Lung biopsy revealed caseating granulomatous reaction. Polymerase chain reaction (PCR), enzyme-linked immunosorbent assay (ELISA) and indirect immunofluorescence for leishmaniasis were negative. Intradermal Montenegro reaction was negative. ELISA for HIV was negative. Cultures of the tissue homogenate for typical and atypical mycobacteria

Dermatite verrucosa de Pedroso e Gomes (Cromomicose): 90 anos depois, ainda entre nós

In this report, the authors describe the clinical case of a woman seeking care at this dermatology outpatient clinic with a verrucous plaque on her left elbow.

Fusariose em paciente imunocomprometido: sucesso terapêutico com voriconazol

Fusarium infection is known to be potentially severe in immunocompromised patients, especially those with hematologic malignancies. Mortality rates are high and there are few therapeutic options, due to the severe underlying condition of this group of patients and the relative resistance of Fusarium to conventional antifungal therapy. Voriconazole has been shown to be an effective antifungal agent for neutropenic patients with fusariosis that are refractory or unresponsive to amphotericin B. We report the successful treatment of disseminated Fusarium infection in an immunocompromised host.

Adverse mucocutaneous reactions related to chemotherapeutic agents: part II

Events and reactions involving chemotherapy are common in clinical oncology. Chemotherapeutic agents are widely used in therapy. Side effects range from the common to the rare and may be confused with other mucocutaneous manifestations resulting from the oncological treatment. The objective of this paper was to present data on skin reactions to chemotherapy, particularly those cases in which the dermatologist is requested to issue a report and asked to comment on the safety and viability of readministration of a specific drug. The authors describe aspects associated with these events, presenting a detailed analysis of each one of them.

Leg ulcers associated with factor V Leiden and prothrombin G20210A and methyltetrahydrofolate reductase mutations: successful treatment with warfarin.

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