Lívia Arroyo Trídico

Neurofibromatosis: chronological history and current issues

Neurofibromatosis, which was first described in 1882 by Von Recklinghausen, is a genetic disease characterized by a neuroectodermal abnormality and by clinical manifestations of systemic and progressive involvement which mainly affect the skin, nervous system, bones, eyes and possibly other organs. The disease may manifest in several ways and it can vary from individual to individual. Given the wealth of information about neurofibromatosis, we attempted to present this information in different ways. In the first part of this work, we present a chronological history, which describes the evolution of the disease since the early publications about the disorder until the conclusion of this work, focusing on relevant aspects which can be used by those wishing to investigate this disease. In the second part, we present an update on the various aspects that constitute this disease.

Correlation between dermoscopic and histopathological diagnoses of atypical nevi in a dermatology outpatient clinic of the Medical School of São José do Rio Preto, SP, Brazil

BACKGROUND The incidence of cutaneous melanoma is increasing worldwide. Since it is an aggressive neoplasm, it is difficult to treat in advanced stages; early diagnosis is important to heal the patient. Melanocytic nevi are benign pigmented skin lesions while atypical nevi are associated with the risk of developing melanoma because they have a different histological pattern than common nevi. Thus, the clinical diagnosis of pigmented lesions is of great importance to differentiate benign, atypical and malignant lesions. Dermoscopy appeared as an auxiliary test in vivo, playing an important role in the diagnosis of pigmented lesions, because it allows the visualization of structures located below the stratum corneum. It shows a new morphological dimension of these lesions to the dermatologist and allows greater diagnostic accuracy. However, histopathology is considered the gold standard for the diagnosis. OBJECTIVES To establish the sensitivity and specificity of dermoscopy in the diagnosis of pigmented lesions suspected of malignancy (atypical nevi), comparing both the dermatoscopic with the histopathological diagnosis, at the Dermatology Service of the outpatient clinic of Hospital de Base, São José do Rio Preto, SP. METHODS Analysis of melanocytic nevi by dermoscopy and subsequent biopsy on suspicion of atypia or if the patient so desires, for subsequent histopathological diagnosis. RESULTS Sensitivity: 93%. Specificity: 42%. CONCLUSIONS Dermoscopy is a highly sensitive method for the diagnosis of atypical melanocytic nevi. Despite the low specificity with many false positive diagnoses, the method is effective for scanning lesions with suspected features of malignancy.

Erythroplasia of Queyrat treated with topical 5-fluorouracil

We report a 33-year-old male patient diagnosed with erythroplasia of Queyrat. The patient had an erythematous and eroded lesion affecting more than 50% of the glans associated with bleeding and local pain. Despite previous indication of penectomy, he was successfully treated with topical 5-fluorouracil.

Androgenetic alopecia treatment: associating 1550nm erbium-glass laser with drug injections of active principles

Introduction: Introduction: Androgenetic alopecia is the most common type of hair loss in men and women. Nowadays, medication based treatments are the most frequently used nevertheless they yield poor results. More recently, the use of lasers has been proposed to treat this condition. At the same time, the infiltration of medications in the scalp has also been growing as a therapeutic option, although there are few scientific studies on this treatment modality. Objective: To evaluate the results of using 1,550nm Erbium-Glass laser associated with the injection of active principles (minoxidil, finasteride, growth factors and a vitamin complex) for the treatment of male and female androgenetic alopecia. Methods: A retrospective study was carried out with patients with androgenetic alopecia diagnosis, who underwent monthly sessions of the proposed combination therapy. The results were evaluated by means of comparative photographs taken before and after the treatment period and the assessment of the patients’ opinion. Results: Sixty-two patients were treated with 3 to 14 sessions; 48.39% of patients had mild improvement, and 46.77% had significant improvement. The vast majority (96.77%) was satisfied with the treatment. The patients who were very satisfied with the outcomes underwent a greater number of sessions (more than six, on average). Conclusions: The association of 1,550nm Erbium-Glass laser therapy with the injection of active principles in the scalp is an effective and safe option for the treatment of androgenetic alopecia.

Effectiveness and safety of infliximab for 11 years in a patient with erythrodermic psoriasis and psoriatic arthritis

An Bras Dermatol. 2017;92(5):740-50. in size from 2 to 10cm, most often found on the upper trunk, cervical area, and proximal aspect of the limbs, besides other locations such as face and oral mucosa.1 Lesions are usually asymptomatic, but can be very painful and present with hypertrichosis and hyperhidrosis.2 It must be differentiated from other conditions, such as congenital hemangioma, infantile hemangioma, vascular malformations, pyogenic granuloma and, in adults, kaposiform hemangioendothelioma and Kaposi sarcoma. To differentiate between other tumors or to assess the area involved, imaging as ultrasound or magnetic resonance can be used..3 Histopathology of TA shows many lobules of tufts spread across the dermis with a “cannonball” appearance, crescent-shaped spaces around the vascular tufts and similar spaces in the tumor stroma.2,4,5 Immunohistochemistry can be strongly positive for Ulex uropaeus I lectin and EN4, besides CD31 and CD34, and rarely positive for smooth muscle actin and negative staining for GLUT1.3, 4 The main treatment option for tufted angioma is surgical excision. Other therapeutic modalities have been reported, such as cryotherapy, laser, topical or systemic corticosteroids and chemotherapy. Some authors believe the lesion should only be monitored due to the possibility of spontaneous regression of these cases.3, 5 q

Clouston Syndrome: 25-year follow-up of a patient

Clouston syndrome is a rare genodermatosis that affects skin and annexes. It is a form of ectodermal dysplasia characterized by generalized hypotrichosis, palmoplantar hyperkeratosis and nail dystrophy. This paper reports a 25-year follow-up of a patient with Clouston syndrome, from childhood to adulthood, monitoring diagnosis and clinical course of the disease.