Leonor Ramos

Allergic contact dermatitis caused by acrylates and methacrylates – a 7-year study

Allergic contact dermatitis (ACD) caused by (meth)acrylates is traditionally an occupational disease among dentists, printers, and fibreglass workers. With the use of artificial nails, cases have been reported both in nail technicians and in users.

Methylisothiazolinone: second ‘epidemic’ of isothiazolinone sensitization

Isothiazolinones are used as biocides in a wide variety of products, such as cosmetics, detergents, and industrial products. In the 1980s, a formulation with methylchloroisothiazolinone (MCI) and methylisothiazolinone (MI) was responsible for an allergic contact dermatitis ‘epidemic’. To control this phenomenon, a maximum allowed dose was set. However in 2005, MI alone was introduced in cosmetics, and this was followed by a new ‘epidemic’ of sensitization to MI and MCI/MI (1). We performed a retrospective study, consulting the medical files of patch tested patients reactive to ISs, from 2005 to 2013. MCI/MI was tested at 100 ppm in water (TROLAB® patch test allergens, Almirall Hermal

Benign follicular tumors

Benign follicular tumors comprise a large and heterogeneous group of neoplasms that share a common histogenesis and display morphological features resembling one or several portions of the normal hair follicle, or recapitulate part of its embryological development. Most cases present it as clinically nondescript single lesions and essentially of dermatological relevance. Occasionally, however, these lesions be multiple and represent a cutaneous marker of complex syndromes associated with an increased risk of visceral neoplasms. In this article, the authors present the microscopic structure of the normal hair follicle as a basis to understand the type and level of differentiation of the various follicular tumors. The main clinicopathological features and differential diagnosis of benign follicular tumors are then discussed, including dilated pore of Winer, pilar sheath acanthoma, trichoadenoma, trichilemmoma, infundibuloma, proliferating trichilemmal cyst/tumor, trichoblastoma and its variants, pilomatricoma, trichodiscoma/fibrofolliculoma, neurofollicular hamartoma and trichofolliculoma. In addition, the main syndromes presenting with multiple follicular tumors are also discussed, namely Cowden, Birt-Hogg-Dubé, Rombo and Bazex-Dupré-Christol syndromes, as well as multiple tumors of follicular infundibulum (infundibulomatosis) and multiple trichoepitheliomas. Although the diagnosis of follicular tumors relies on histological examination, we highlight the importance of their knowledge for the clinician, especially when in presence of patients with multiple lesions that may be the cutaneous marker of a cancer-prone syndrome. The dermatologist is therefore in a privileged position to recognize these lesions, which is extremely important to provide further propedeutic, appropriate referral and genetic counseling for these patients.

Mycobacterium chelonae Is an Ubiquitous Atypical Mycobacterium.

The type of cutaneous infection varies mainly according to the patients immune status, and the disseminated form is mostly found in the context of immunosuppression. We report the case of a 62-year-old male who was under long-term systemic corticosteroid therapy and presented with a 7-month history of multiple painless cutaneous lesions at various stages of development: papules, nodules, pustules and hemorrhagic crusts, as well as small erosions and ulcers distributed over the limbs and scalp. Cutaneous biopsy showed a suppurative granulomatous infiltrate with abscess formation. Fite stain revealed numerous extracellular bacilli, suggesting mycobacterial infection, particularly by atypical mycobacteria. Culture of a skin sample revealed Mycobacterium chelonae. The patient started multidrug therapy and showed clinical improvement despite of resistance to one of the antibiotics. This striking presentation underlines the role of immunosuppression with corticotherapy as a major risk factor for these infections. Multidrug therapy is advised and antibiogram is essential in directing treatment.

Plaque‐like papular xanthoma: a new variant of non‐Langerhans cell disease

The histological examination showed a blister in elimination and dermal eosinophil infiltration (Fig. 2d). DIF revealed linear reactivity for IgG (Fig. 2e), IgM and C3 along the DEJ. High levels of IgG anti-BP180 (312 U/mL) were detected in IIF (ELISA). They were both treated with oral prednisolone (1.5 mg/kg/ day) and methylprednisolone aceponate 0.1% cream id. In case 1, there was complete remission within 2 months of the treatment. In case 2, there were relapses during the attempts to reduce the oral prednisolone, which was continued for 2.5 months. There was a complete remission within 3 months of treatment. They are both free of lesions after 18 months of follow-up. Childhood BP is a sub-epidermal blistering disease with eosinophil infiltration. There are 2 peaks of incidence: the first year of life (with facial lesions and acral distribution with palmo-plantar involvement) and around the age of 8. In our case, an intra-epidermal vesicle was observed but, as biopsies were performed in lesions that were present for more than 1 week, we can suspect that the process of re-epithelialization might have been responsible for this histological finding. Vaccination has been reported as preceding the onset of childhood BP, raising the possibility of association between vaccination and childhood BP. Because the number of vaccines in the first year of life is quite high, it is sometimes difficult to establish a causal relation. Childhood BP is generally self-limited, with a good and rapid response to topical or systemic corticotherapy, being remission usually achieved within a few months. In case of resistance, other drugs can be used, such as dapsone, azathioprine, cyclosporine, intravenous immunoglobulins and mycophenolate mofetil. L. Ramos, O. Tellechea, A. Moreno, L. Martins, N. Neves, G. Janu ario, C. Rodrigues Servic o de Dermatologia e Venereologia, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universit ario de Coimbra, Servic o de Pediatria, Hospital Pedi atrico, Centro Hospitalar e Universit ario de Coimbra, Servic o de Pediatria, Centro Hospitalar da Cova da Beira *Correspondence: L. Ramos. E-mail: leonoricr@gmail.com

O'Brien Actinic Granuloma: A Case Report and Brief Review of Literature.

O’Brien first described the actinic granuloma in 1975, as an infrequent granulomatous disorder occurring in sun-exposed skin, with a slow but often self-limited course. Ever since its initial description, the actinic physiopathogenic hypothesis has been debated by many authors. We report a 60-year-old female rural worker that presented with a 14 × 7 cm annular lesion with erythematous elevated borders and an atrophic center on the right calf. The lesion was evolving for 2 years, and histopathology confirmed actinic granuloma. She started acitretin with halting of disease progression after 6 months of therapy. Our case can also be associated to actinic damage, despite its unusual location, therefore highlighting the role of solar elastosis in the development of O’Brien actinic granuloma.

IgE levels are negatively correlated with clinical response to ciclosporin in chronic spontaneous urticaria

First and second line therapy of chronic spontaneous urticaria (CSU) include second-generation H1-antihistamines, but more than 50% of CSU shows little benefit1,2 . Omalizumab and ciclosporin are recommended as 3rd and 4th line treatments1 , respectively. Despite its inferior safety profile compared to omalizumab1,2 , efficacy of ciclosporin has been shown in controlled trials and case series, with approximately 60% of patients with severe CSU having a good response3 . This article is protected by copyright. All rights reserved.

Psoríase, Psicofármacos e Comorbilidades Psiquiátricas: Um Estudo de Caso-Controlo numa População de Doentes Hospitalizados

Introduction: Psoriasis is a chronic inflammatory dermatosis with significant impact on quality of life and multiple comorbidities, with recognition especially given to cardiovascular risk factors. Recently it has been highlighted the high prevalence of psychiatric comorbidities.Methods: The primary outcome was to assess the prevalence of psychotropic drugs in the chronic medication of patients with diagnosis of psoriasis. We performed a case-control study at the Department of Dermatology of Coimbra Hospital and University Centre, between 2010 and 2015. The results were compared with age- and gender-matched controls. The medication was grouped according to the INFARMED. The secondary outcome was to compare the prevalence of treatments for cardiovascular risk factors in both groups and to compile the information on psychiatric comorbidities available in the medical records of the psoriasis patients included in this study. The data were processed by STATA 14 and statistical significance was considered when p<0.05. Results: The sample consisted of 79 patients, 67% male and 33% female, mean age of 59.30±17.17 years. There was association (p<0.01) between psoriasis and psychotropic drugs, especially anxiolytics and antipsychotics, with 63% of patients with at least one psychotropic drug. It was found an association between psoriasis and antihypertensive drugs (p<0.05). Frequently, psychiatric diagnoses were not mentioned or were inaccurately described in the medical records.Conclusion: The results highlight the high prevalence of psychotropic drugs and reinforce previous studies about the lack of assessment of psychopathology in dermatology, a topic of high relevance in patients with psychodermatologic diseases, such as psoriasis.

Dermatite de Contacto Alérgica em Idade Pediátrica: Estudo Retrospectivo

Introduction : Allergic contact dermatitis in children, although usually considered infrequent, has been the object of numerous recent publications and an apparent increase in prevalence. This may be due to early exposure and sensitization to contact allergens, increasing the likelihood of skin reactions in a new exposure, or the more widespread use of patch tests, which are crucial to the diagnosis of this pathology. Methods : In order to know the characteristics and causes of allergic contact dermatitis in the pediatric age, we evaluated the medical records of patients with < 18 years who were patch tested between January 2005 and December 2014 at the Contact Allergology Unit of the Department of Dermatology University Hospital of Coimbra. The following parameters were analyzed: sex, age, personal and familiar history of atopy, main location of the dermatitis, reactive allergens within the baseline or complementary test series, suspected and final diagnosis. Results : A total of 106 pediatric patients were tested (3.6% of all patients), 68 females (64.2%) and 38 males (35.8%), four aged between 3-5 years (3.8%), 28 between 6-11 years (26.4%) and 74 between 12-17 years (69.8%), 52,8% with a personal history of atopy, 36.8% with facial and/or neck lesions. At least one positive test was observed in 51 patients (48.1%), mostly in girls especially because of nickel (18.9%). Nevertheless there were no positive tests to nickel in the last two years of the study. After nickel, cobalt, p-phenylenediamine, caine mix and palladium were reactive in five patients. Twelve patients reacted to allergens that are not included in the baseline series, mostly to drugs. Discussion : Contact allergy and allergic contact dermatitis were a relatively common diagnosis before the age of 18. An early etiologic diagnosis is important to prevent chronicity of lesions and a possible future negative personal and professional impact. Knowing the main allergens in this age group is important to establish avoidance measures and prevent further sensitization.

NEVO AZUL EM PLACA – UMA VARIANTE SINGULAR DE NEVO AZUL

Introduction: Plaque-type blue nevus is a rare variant of blue nevus, presenting usually as blue-gray plaque with superimposed nodules, beginning at birth or in early childhood and becoming stable during puberty. Its clinical, dermoscopic and even histopathological features may be worrisome and distinction from malignant blue nevus can be difficult, although its prognosis is generally favourable. Case Report: We present a 48 year-old male who had a blue-gray plaque with multinodularity arising in the left scapular region. The lesion had been present since birth, becoming stable during adolescence. Dermoscopy revealed a central structureless polychromatic plaque (blue, gray, black and brown areas) and extensive areas of blue-whitish veil. Adjacent to the central lesion, small blue satellite globules could be seen. Incisional biopsy showed a common blue nevus, and complete excision of the lesion confirmed the presence of a blue nevus predominantly of the common type, and focal cellular areas in its deeper portion. The patient is so far free of recurrence. Conclusion: There are many variants of blue nevus, and plaque-type blue nevus is one of the rarest. Classically regarded as having good prognosis, recent case-reports have shown a tendency towards local and lymph-node recurrence, the reason why recognition of this entity and appropriate follow-up are important.