José Eduardo Costa Martins

Dermatophyte agents in the city of São Paulo, from 1992 to 2002

Dermatophytosis are superficial mycoses caused by fungi that can invade stratum corneum and keratinized tissues. In order to study the frequency of dermatophytes species and the clinical manifestations caused by these fungi, in São Paulo, SP, Brazil, the authors analyzed cultures isolated at the Mycology Laboratory from a selected population (15,300 out-patients of the Hospital das Clínicas, Department of Dermatology, Faculty of Medicine of University of São Paulo) from January 1992 to June 2002. The most prevalent dermatophyte was Trichophyton rubrum (48.7%), followed by Microsporum canis (20.9%), Trichophyton tonsurans (13.8%), Trichophyton mentagrophytes (9.7%), Epidermophyton floccosum (4.1%), and Microsporum gypseum (2.5%). These agents determined more than one clinical manifestation, i.e., tinea corporis (31.5%), tinea capitis (27.5%), tinea unguium (14.8%), tinea cruris (13.9%), tinea pedis (9.9%), and tinea manuum (1.9%). Clinical variants of dermatophytosis and their relationship to the etiologic agents were studied and the results were compared to those obtained in previous studies in other regions of Brazil and in other countries.

Cromoblastomicose: relato de 27 casos e revisão da literatura

BACKGROUND: Chromoblastomycosis is a subcutaneous mycosis that occurs mainly in rural workers although is being more commonly found among people working in other sectors. The fungus penetrates the skin after its inoculation and the most frequently isolated agent is the Fonsecaea pedrosoi. OBJECTIVES: This study aims at evaluating patients suffering from chromoblastomycosis admitted into the Department of Dermatology of the University Hospital of the Faculty of Medicine of Sao Paulo State during the ten-year period from 1997 to 2007. METHODS: It is a retrospective study and the medical report cards of 27 Brazilian patients diagnosed as suffering from Chromoblastomycosis from 1997 to 2007 at the Dermatology Department of the Medical School, University of Sao Paulo were reviewed. The following items were analyzed: previous therapeutic approaches; treatment implemented by the group; length of time between the appearing of the lesion and diagnosis; age; gender; profession; origin; site of lesions; isolated agents found in culture and histopathology. RESULTS: Twenty two patients were from the state of Sao Paulo whereas the others came from the states of Bahia and Rondonia. 37% of them were rural workers. Men were more frequently infected (85%). Lesions were more commonly found on the lower limbs (59.2%). In 52% of the cases the isolated agent was the dematiaceous fungus Fonsecaea. pedrosoi. Biopsies showed sclerotic bodies in 92.5% of the cases. CONCLUSION: Data found are in accordance with medical literature on the subject. The disease had been previously studied in our institution in 1983 by Cuce et al. This present study is the second retrospective one about the characteristics of patients suffering from chromoblastmycosis which has been published in indexed medical literature in the state of Sao Paulo.

Urticaria unresponsive to antihistaminic treatment: An open study of therapeutic options based on histopathologic features

Background: The non‐ or low‐sedating H1 receptor antagonists represent the basic therapy for urticaria. Objective: To test an alternative approach to patients unresponsive to conventional treatment. Materials and methods: A total of 22 patients with chronic urticaria unresponsive to conventional antihistamine treatment were enrolled for this study. They had uncontrolled urticaria even using multiple combinations of antihistamines on maximum doses and corticosteroids in short cycles (prednisone 20–40 mg, per os once a day, 3–7 days per month). Cutaneous biopsies of the urticaria lesions were taken. These findings were classified as: (I) a mixture of perivascular dermal inflammatory infiltrate composed of lymphocytes, monocytes and neutrophils and/or eosinophils; (II) inflammatory infiltrate composed chiefly of neutrophils; and (III) inflammatory infiltrate composed mainly of eosinophils. According to histology, the patients were submitted to one of the following therapeutic schemes: class A – antihistamine treatment plus dapsone; class B – colchicine or dapsone; class C – montelukast. Results: Four patients in class A, 08 in class B and seven in class C displayed complete control of urticaria after 12 weeks of treatment; one patient in class B and two in class C did not respond to treatment. Two years after discontinuation, 16 patients are still free of urticaria. Conclusions: This study suggests an alternative approach for treating unresponsive chronic urticaria.

Cutaneous protothecosis: report of a third Brazilian case

The present report describes a case of cutaneous protothecosis caused by Prototheca wickerhamii in a nonimmunocompromised Brazilian female. Dermatological examination revealed a 15‐cm diffusely infiltrated eczema‐like plaque recovered with many pustule‐like lesions on the right forearm. We emphasize the mycological and pathological aspects of this infection that can lead to misdiagnosis. The patient was successfully treated with itraconazole.

Pityrosporum Folliculitis : Renal Transplantation Case Report

Pityrosporum folliculitis is caused by the fungus Pityrosporum ovale. It is characterized by the presence of pruriginous follicular papulae and papulae‐pustules in face, upper part of the trunk, and upper limb root. It is more prevailing in places with hot and humid climates. Its incidence can be associated with either immunosuppressive or chemotherapy states secondary to pathiologies. We report herewith a case of pityrosporum folliculitis in a patient who had previously underwent kidney transplantation and thes result of the itraconazol therapeutics given.

Entomoftoromicose rinofacial por Conidiobolus coronatus: registro de um caso tratado com sucesso pelo fluconazol

A case of rhinofacial entomophthoromycosis caused by Conidiobolus coronatus is reported in a 30 years old male from Sao Paulo, Brazil. The patient was successfully treated with oral fluconazole in a prolonged regimen. The diagnosis was confirmed by histopathological and mycological data.

An unusual association between scalp psoriasis and ophiasic alopecia areata: the Renbök phenomenon

The Renbök phenomenon or inverse Köbner phenomenon was originally described by R. Happle et al. in 1991, referring to normal hair growth in psoriatic plaques observed in patients with both alopecia areata and psoriasis. A 39-year-old white woman, with a 20-year history of ophiasic alopecia areata (AA), presented with a 1-year history of erythematous, scaling lesions on her scalp. The patient had never observed any hair regrowth within the scalp areas affected by the AA. She reported a history of rheumatic fever during early childhood, and hypothyroidism at the age of 25 years. In addition, her father had moderate psoriasis, involving the knees, elbows and scalp. Dermatological examination revealed well-defined areas of nonscarring alopecia with an ophiasic pattern affecting the temporal, parietal and occipital regions of the scalp. Moreover, psoriatic plaques with silvery-white scales and positive Auspitz’s sign were seen on the interparietal and parietal areas. Interestingly, the ophiasic area with psoriasis presented completely normal hair growth, with no signs of rarefaction or morphological alterations. The limit zone between psoriasis and the AA lesions on the scalp showed an interface region where both erythematous, white, scaling plaques and AA were evident (Fig. 1a). A punch biopsy of this interface region revealed a typical psoriasiform pattern associated with a reduced number of follicles, with no scarring (Fig. 1b). Laboratory investigations including fasting blood glucose, levels of antithyroid and antinuclear antibodies, thyroid hormones (T3, T4) and thyroid-stimulating hormone, lipid profile and full blood count showed no abnormalities. The Renbök phenomenon has been reported to occur in patients with psoriasis and AA universalis, as well as in patients with AA sparing areas of naevus flammeus on the parietal scalp and AA sparing a congenital melanocytic naevus of the eyebrow. The Renbök phenomenon occurring in psoriasis, sparing areas of ophiasic AA of the scalp, was reported in a patient with Turner’s syndrome in 2003. The pathophysiological mechanism of such phenomena is still unclear. It has been proposed that genetic mosaicism present in congenital naevi might protect against hair loss in the affected regions, whereas in the neighbouring area of these naevi an autoimmune reaction could possibly be eliciting AA. In our patient, it would seem reasonable to propose that cell systems involved in the pathogenesis of psoriasis, including the predominance of memory CD4+ T cells in the dermal plexus, and alterations in the number and distribution of Langerhans cells and phagocytic macrophages in the psoriatic plaques, could induce a therapeutic effect on AA. A similar mechanism is observed after induced, delayed-hypersensitivity reactions to various sensitizers in the treatment of AA, such as diphencyprone and dinitrochlorobenzene. Ganor in 1977 studied the association between AA and psoriasis. Of 5033 patients observed between 1968 and 1975, 407 were diagnosed as having psoriasis and 23 AA. Five of the 23 patients with AA had also psoriasis. We propose that the microenvironment in psoriasis, rich in tumour necrosis factor-a, is not a favourable environment for the development of inflammation seen in AA, therefore inducing the Renbök phenomenon.

Porfiria cutânea tardia

This is a review article of porphyria cutanea tarda addressing pathophysiology, clinical features, associated conditions, triggering factors, biochemistry, histopathology, electronic microscopy, immunofluorescence microscopy and treatment of the disease.

Urticaria as a Cutaneous Sign of Adult-Onset Still's Disease

Background: The cardinal signs and symptoms of adult-onset Stills disease (AOSD) include periodic fever, arthralgia and arthritis, lymphadenopathy, hepatosplenomegaly, an evanescent rash accompanied by neutrophilic granulocytosis, and a negative rheumatoid factor and antinuclear antibody test. Objective: To alert clinicians and dermatologists to internal diseases such as AOSD when assisting patients with urticarial eruptions and systemic symptoms. Methods: A case report of a 52-year-old white woman who received conventional therapy for urticaria for 3 years, with no improvement. Following this period, a diagnosis of AOSD was performed based on the presence of systemic symptoms. Results: The inflammatory activity markers decreased by the second month of methotrexate therapy; however, the cutaneous lesions failed to disappear. Thalidomide was initiated, and total improvement of the cutaneous lesions was observed after 2 weeks. Conclusion: Urticarial rash is an uncommon presentation of AOSD, and clinicians must be alert to the possibility of a misdiagnosis in these cases.

Evaluation of phenotypic and genotypic alterations induced by long periods of subculturing of Cryptococcus neoformans strains.

Cryptococcus neoformans is an encapsulated fungal organism that can cause disease in apparently immunocompetent, as well as immunocompromised, hosts. Since 1930, successive subculture has been used to preserve C. neoformans isolates in our Fungus Collection. In the 1970s, some of these Fungus Collection samples were selected to be subjected to a different methods of maintenance--that of lyophilized. Our objective was to analyze C. neoformans isolates in order to make a comparative evaluation between these two methods of preservation. The overall aim of this study was to qualify the preservation technique used in our mycology laboratory since the technique used might affect the survival, stability and purity of the primary isolates in culture. The samples were analyzed using classical mycology methods and using the randomly amplified polymorphic DNA technique In the analysis of phenotypes and genotypes, the typical characteristics of C. neoformans were found to differ in relation to the different methods of preservation employed. The aim of this study was to demonstrate the importance of selecting the appropriate method of preservation for fungus collections. This selection can affect the survival and purity of the cultures, and preserve the stability of their physiological, biochemical, and genetic characteristics.