Kerstin Taniguchi Abagge

Palmar Hyperhidrosis: Long-term Follow-up of Nine Children and Adolescents Treated with Botulinum Toxin Type A

Abstract:  Primary palmar hyperhidrosis in children and adolescents may be severe enough to affect school and physical activities, causing emotional problems, stress in the patient’s life, and a compromised quality of life. Nine patients with palmar hyperhidrosis underwent treatment with botulinum A. Before the session, and in the 1‐, 3‐, 6‐, 9‐, and 12‐month post‐session follow‐ups, the patients were administered the Minor test, gravimetry, the Scales of Frequency and Severity, and the Questionnaire of Quality of Life. The mean age was 11 years, with seven girls and two boys. Each patient was administered at least one treatment of botulinum toxin in the palm of the hands (75–150 U for palm), with the mean number of sessions 2.2 (range: 1–4). All sessions in the patients resulted in drying of the hands, with a mean duration of effect of 7 months. Botulinum toxin A controls excessive sweat in the palms of children and adolescents who have primary palmar hyperhidrosis, with an improvement in the quality of life. The therapy is safe and effective in this pediatric group and can be considered before surgical interventions.

An inflammatory reaction surrounding molluscum contagiosum as possible manifestation of immune reconstitution inflammatory syndrome in HIV infection.

Abstract:  Highly active antiretroviral therapy can restore specific immune responses and control of microorganism infections in human immunodeficiency virus‐positive patients. This immune recovery may cause an inflammatory reaction to microbial and autoimmune antigens known as immune reconstitution inflammatory syndrome. We describe a clinical case with an intense inflammatory response surrounding molluscum contagiosum after highly active antiretroviral therapy. The clinical and laboratory findings suggested that the reaction was due to immune reconstitution inflammatory syndrome occurring during a period of immune recovery in a child with acquired immune deficiency syndrome.

The relevance of recognizing clinical and morphologic features of pityriasis lichenoides: clinicopathological study of 29 cases.

Background: Pityriasis lichenoides (PL) is a lymphoproliferative disease of unknown origin; its diagnosis is based on clinical characteristics and confirmed by histology. Objectives: To describe clinical and histological features of PL in 29 pediatric patients. Materials and Methods: Retrospective descriptive study of children (patients less than 15 years old) diagnosed with PL between 1986 and 2010 at a Reference Service in Pediatric Dermatology from South Brazil. Results: Twenty-nine PL cases were found by chart review in 24 years. Mean age of diagnosis was 8 years (22 to 178 months) and a mean time of diagnosis was 13.8 months (1 to 120 months). Twenty cases (69%) were male. Seasonal correlation was found with colder months in 62% of cases (p<0.01). Clinical diagnosis was pityriasis lichenoides chronica (PLC) in 25 cases, and pityriasis lichenoides et varioliformis acuta (PLEVA) in four. Itching was the main reported symptom occurring in 13 (45%). Fourteen cases had been histologically evaluated. In six, microscopic findings were consistent with PLC, in four consistent with PLEVA, and four biopsies exhibited mixed characteristics of both forms. Concordance between clinical and histological diagnosis was seen in most cases. Conclusion: PL occurs in children and young adults, more commonly in males, and during cold months. PLC was the more frequent clinicohistologic form, and necrotic lesions characterized PLEVA. Associating clinical and histological findings is important for differentiating between PLC and PLEVA diagnosis.

Onychomycosis by Fusarium oxysporum probably acquired in utero

Fusarium oxysporum has been described as a pathogen causing onychomycosis, its incidence has been increasing in immunocompetent and disseminated infection can occur in immunosuppressed individuals. We describe the first case of congenital onychomycosis in a child caused by Fusarium oxysporum. The infection being acquired in utero was proven by molecular methods with the identification of the fungus both in the nail and placenta, most probably as an ascending contamination/infection in a HIV-positive, immunosuppressed mother.

Cutaneous manifestations in patients with Wiskott–Aldrich syndrome submitted to haematopoietic stem cell transplantation

Introduction Wiskott–Aldrich syndrome (WAS) is an X-linked primary immunodeficiency caused by a mutation of the WAS protein gene. This protein actively participates in important cellular processes, and its presence is related to diverse clinical manifestations, including cutaneous alterations. The classical triad of WAS consists of recurrent infections, thrombocytopaenia with small platelets and atopic dermatitis (AD)-like lesions. Objective To evaluate the frequencies of cutaneous manifestations in patients with WAS prior to haematopoietic stem cell transplantation (HSCT). Results Twenty-four boys diagnosed with WAS and treated with HSCT between 1992 and 2007 were included. The characteristic triad of WAS occurred in 46% of patients. Before HSCT, the most frequent cutaneous manifestations included eczema similar to AD (71%), followed by petechiae and/or ecchymosis (58%) and cutaneous infections (17%). Conclusions Cutaneous manifestations in patients with WAS are frequent, especially those similar to the eczema found in AD.

Polyomavirus BK: possibly associated skin eruption in a patient with hemorrhagic cystitis.

Abstract:  A 14‐year‐old girl with Fanconi anemia was submitted to allogeneic hematopoietic stem cell transplantation. After 17 days she developed hemorrhagic cystitis due to polyoma BK virus (BKV), confirmed by PCR (polymerase chain reaction). Two weeks after the appearance of the urinary symptoms the patient presented numerous papules and vesicles on both hands and feet. PCR of the skin lesions and plasma was positive for BKV. The relationship of BKV with frequent infections in immunocompromised patients is well established. The positive PCR of vesicular fluid suggests that this was the causative agent of the skin lesion in this case. There are no reports of skin lesions with positive PCR for BKV.

Paraqueratose granular: relato de seis casos em crianças

Granular parakeratosis is an alteration of keratinization that was first described in adults. It is characterized by hiperkeratotic plaques and papules in intertriginous areas. The authors describe six cases of granular parakeratosis in children. One patient had lesions on the buttocks; two children presented papules in both axillae and cervical region (presentations never described before in the literature). The remaining three patients presented with lesions in the inguinal folds. Review of the literature and discussion on the pathogenesis of this rare dermatosis are presented.

Hematohidrosis: insights in the pathophysiology

Hematohidrosis: insights in the pathophysiology The spontaneous discharge of bloody secretion through normal skin is known as hematohidrosis. We present a case of this rare condition and discuss possible mechanisms to explain the clinical manifestations. Written consent by the patient for this submission was obtained. An 18-year-old Caucasian female presented with episodes of spontaneous bleeding of the palms, back of the hands, forehead (Fig. 1), and tear ducts since the age of 12. No skin lesions were present, and they stopped spontaneously after a few minutes. There was no relation with the menstrual cycle, and sometimes extensive bleeding occurred during her sleep. Physical examination, gynecological evaluation, complete blood cell count, metabolic panel, and coagulation tests were normal. On dermatologic evaluation, no skin lesions were found, and a punch biopsy was performed on the back of the left hand, where spontaneous bleeding had just started. Smear preparation of the bloody secretion had peripheral blood characteristics – many erythrocytes, few leukocytes. Skin biopsy – stained with hematoxylin–eosin and Pearl – revealed normal skin, preserved adnexa, and normal blood vessels. Over 120 histological sections were evaluated, and no erythrocytes were found anywhere outside the vessels (Fig. 2). The patient was admitted to the hospital and carefully watched to rule out malingering; in fact, she presented several bleeding episodes under our close visual monitoring. During follow-up, she was diagnosed with conversion, dissociative, and generalized anxiety disorders, which were controlled with clonazepam, sertraline, valproic acid, and risperidone, but this treatment did not interfere with the bleeding. Although there was no psychiatric evaluation of the patient prior to the bleeding episodes, we can only suppose that the impact of the skin condition helped develop or exacerbate the psychiatric diseases. Curiously, it was noticed that the bleeding episodes were coincident with high blood pressure peaks (180 9 90 mmHg), but the 24-hour ambulatory blood pressure monitoring, Holter, and echocardiogram were normal. To control blood pressure levels, she was started on atenolol. During six months, she showed marked improvement with no more bleeding episodes. Owing to irregular intake of the medication, the bleedings restarted sporadically. Hematohidrosis is a rare clinical condition that manifests as self-limiting episodes of spontaneous discharge of bloody secretion through intact skin or sweat gland orifices, with an unknown cause. Some theories have been proposed, including: increased vascular pressure leading to the passage of blood cells through the ducts of the sweat glands; vasculitis of dermal vessels; and exacerbated sympathetic activation leading to periglandular vessel constriction and subsequent expansion, allowing the passage of blood content into the ducts. Only five reported cases in the literature present a histological description of a skin biopsy performed immediately after the bleeding. They show sporadic and inconsistent findings, such as: periglandular congested vessels; red blood cells in the follicular lumen and among the collagen fibers; leakage of blood around dermal capillaries; or even normal skin. In the patient described herein, the skin biopsy was completely normal. This excludes other causes of bleeding and may also indicate that no permanent anatomical changes occur in the pathophysiology of the disease. Differential diagnosis should include chromhidrosis, factitious dermatitis, vicarious menstruation, vasculitis, and platelet and coagulation disorders.

Clinical features and nail clippings in 52 children with psoriasis

Nail clipping, the act of cutting the distal portion of a nail for microscopic analysis, can complement the diagnosis of skin diseases with nail involvement, such as psoriasis. This study aimed to describe histopathologic findings on 81 nails from 52 children and adolescents with skin psoriasis and to determine whether these changes correlated with the severity of skin and nail involvement.

Critical assessment of the pH of children's soap

OBJECTIVE To evaluate the pH value of childrens antibacterial soaps and syndets used in childrens baths and verify whether there is information regarding pH on the product label. METHODS Quantitative, cross-sectional, analytical observational study that included ninety soap samples, both in bar and liquid presentations, as follows: 67 childrens soap (group 1), 17 antibacterial soaps (group 2), and 6 syndets (group 3). Each sample had its pH measured after 1% dilution. In addition to descriptive statistics, the Pearson-Yates chi-squared test and Students t-tests were applied, considering the minimal significance level of 5%. The Wilcoxon-Mann-Whitney test, Fishers exact test, and the Kruskal-Wallis test were used for inferential statistics. RESULTS The pH levels varied considerably between liquid and bar presentations, with lower levels (4.4-7.9) found for the liquids (p<0.05). Syndets showed pH levels close to the ideal (slightly acid) and the antibacterial soaps showed the highest pH levels (up to 11.34) (p<0.05). Only two of the soaps included in the study had information about their pH levels on the product packaging. CONCLUSIONS Knowledge of the pH of childrens soap by doctors and users is important, considering the great pH variability found in this study. Moreover, liquid soaps, and especially syndets, are the most recommended for the sensitive skin of neonates and infants, in order to guarantee skin barrier efficacy.