Luciana Pantaleão

Síndrome de Sweet: estudo de 73 casos, com ênfase nos achados histopatológicos

BACKGROUND Sweets syndrome refers to a set of cutaneous, systemic and histopathological alterations that occur in response to different stimuli, in a similar way to that occurring in erythema nodosum, erythema multiforme and leukocytoclastic vasculitis. The syndrome has been described in association with conditions such as infections, pregnancy, the use of certain medications and malignancy. OBJECTIVES To evaluate the clinical and histopathological alterations occurring in this syndrome and to assess the association between these alterations and other conditions. METHODS A retrospective study of 73 cases was conducted, evaluating data on the microscopic examination of skin lesions, as well as clinical and laboratory data. RESULTS The majority of the patients were female (83.0%), white (49.2%) and between 30 and 60 years of age (73.8%). The principal alterations found were: erythymatous plaques (76.9%), papules (43.0%), pseudo-vesiculation (PV) (38.4%) and target lesions (18.5%). With respect to the associated conditions, upper respiratory tract infections (15.4%) and the use of medication (10.8%) were the most common. Other associations, albeit represented by only one case each, were: Hodgkins lymphoma, pregnancy, ulcerative colitis, polycythemia vera and lupus erythematosus in a patient with acquired immune deficiency syndrome (AIDS). The principal microscopic findings were: neutrophils with leukocytoclasia (98.6%), collagen degeneration (87.7%), edema (74.0%) and PV (38.4%). The presence of eosinophils (41.1%) ranged from rare to abundant and was usually unrelated to the use of medication. Inflammatory infiltrate reached the deep epidermal layer in 47.9% of cases and panniculitis was found in 80.0% of cases in which the hypodermis was affected (10 cases). CONCLUSIONS In general, these findings are in agreement with results published in the literature, emphasizing the frequent finding of eosinophils unrelated to drug use, panniculitis and the rare association with Hodgkins lymphoma. This is the fifth report of an association between Sweets syndrome and Hodgkins disease.

Transepidermal Retinoic Acid Delivery Using Ablative Fractional Radiofrequency Associated With Acoustic Pressure Ultrasound for Stretch Marks Treatment

Striae distensae (SD) treatment still remains a therapeutic challenge to dermatologists. Ablative fractional laser and radiofrequency (RF) enhance skin‐drug permeability for SD treatment.

Estudo da espessura da regressão como fator prognóstico nos melanomas cutâneos finos

BACKGROUND: The diagnosis of thin cutaneous malignant melanomas has been increasingly more frequent. These lesions, initially associated with excellent prognosis, have presented recurrence or metastases and sometimes have been fatal. Many variables have been studied and, although none of them has explained this behaviour, regression and its possible negative impact have been focused on recently. According to some authors, late regression bears major relevance in the prognosis. OBJECTIVE: To correlate the maximum regression thickness of thin cutaneous malignant melanomas with disease-free survival time. MATERIALS AND METHOD: Retrospective study of 84 cases of thin cutaneous malignant melanomas. The criteria of Kang et al. (1993) for identification and evolutionary classification (early, intermediate and late) of the regression were applied. RESULTS: Regression (in any phase) was observed in 70 out of 84 thin cutaneous malignant melanomas (83.3%), and 30 cases (35.7%) showed late regression. The maximum regression thickness measurement ranged from 0.16 to 1.53 mm. Disease-free survival time ranged from 17 days to 108 months. Five cases (5.9%) had an unfavorable outcome, from which three were in situ melanomas. There was no correlation between the studied variables (p > 0.05). DISCUSSION: The meaning of regression in thin cutaneous malignant melanomas is controversial, probably due to the different methods applied in the few studies carried out about the subject and the wide variety of size and composition of the samples. There is no medical consensus as to a standardized regression measurement system, which partially explains the controversial results obtained to date. CONCLUSIONS: There was no statistical correlation between regression thickness in thick cutaneous melanomas and disease-free survival time (p > 0.05). Future studies with wider samples may contribute to a better understanding of this phenomenon.

Merkel cell carcinoma in an immunosuppressed patient

Merkel cell carcinoma is an uncommon neuroendocrine carcinoma with a rising incidence and an aggressive behavior. It predominantly occurs in older patients, with onset occurring at a mean age of 75-80 years. Recognized risk factors are ultraviolet sunlight exposure, immunosuppression, and, more recently, Merkel cell polyomavirus. We report a case of Merkel cell carcinoma in a young HIV positive patient with Merkel Cell polyomavirus detected in the tumor.

Folliculitis Decalvans Mimicking Frontal Fibrosing Alopecia

Folliculitis decalvans (FD) is a neutrophilic scarring alopecia with peripheral spreading alopecic patches with pustules, crusting and tufted hair. Frontal fibrosing alopecia (FFA) is a lymphocyte-mediated primary cicatricial alopecia that affects frontal hairline and eyebrows. We report a 27-year-old black male presenting scarring alopecia with symmetrical retreat of the frontal and temporal borders of the hair implantation and eyebrow thinning. Skin biopsy revealed compact orthokeratosis, corneal plugs, regular acanthosis, superficial and deep perivascular and periadnexal inflammatory infiltrate, that was compatible with FD. We present a case of FD with retreat of hair line implantation and thinning of the eyebrows, as it is seen in FFA.

Study of 448 cases of melanoma in situ in two hospitals in Rio de Janeiro

The diagnosis of cutaneous melanoma in situ, considered to have excellent prognosis, has been increasingly frequent, with rare isolated reports of cutaneous melanoma in situ presenting recurrence, metastasis, and death. No specific study is found in the literature about these lesions of unexpected behavior. We describe the demographic and histopathological findings of 448 cases of cutaneous melanoma in situ in 369 patients, emphasizing the prognostic criteria of those with unfavorable outcomes, corresponding to 9 cases in which regression had no significant role. Adnexotropism was found in 44.5% of cases. The study of early lesions would allow clinicians to have a better understanding of the evolutionary processes of the disease.

Lichen planopilaris developed during childhood

Lichen planopilaris is a disease that appears with lymphocytic cicatricial alopecia. It is considered a follicular variant of lichen planus. The examination of affected areas shows alopecia with perifollicular erythema and scaling, revealing a predilection for hair follicles. The involvement of children is uncommon, with few reports in this population in the literature. This study presents a clinical case of a male patient of 15 years of age with characteristic lesions of lichen planopilaris.

Coexistence of nail lichen planus and lichen planus pigmentosus

We describe a fifty-six-year old, Afro-descendent female patient showing dystrophy of her twenty nails and hyperchromic, asymptomatic macule on her face. Histopathological examination of the macule showed vacuolization of the basal layer, melanophages in the superficial dermis and lymphoplasmocytic inflammatory infiltrate. Nail biopsy revealed orthokeratotic hyperkeratosis and lichenoid inflammatory infiltrate. Lichen planus pigmentosus is an uncommon variety of lichen planus. It is characterized by typical hyperpigmented macules on the face and neck. Nail changes might be present in 10% of lichen planus cases, but no associations with lichen planus pigmentosus have been described. We report a case of lichen planus in twenty nails associated with lichen planus pigmentosus on the patients face.