Luna Azulay-Abulafia

Hydroquinone-induced exogenous ochronosis: a report of four cases and usefulness of dermoscopy

Hydroquinone is the first choice of topical bleaching agents used in treatment of melasma. In Brazil, hydroquinone is widely prescribed by physicians and often used by patients without a prescription. The principal adverse effects of its chronic use are confetti‐like depigmentation and exogenous ochronosis. The latter manifests clinically with gray‐brown or blue‐black hyperpigmentation, as well as pinpoint hyperchromic papules that look like caviar, and therefore called caviar‐like. On histopathology, curved ochre‐colored structures, ‘banana‐shaped’ fibers, appear in the papillary dermis. No description of dermoscopy in ochronosis is found in the literature. We report four cases of hydroquinone‐induced exogenous ochronosis. Dermoscopy was performed in two patients on the areas with ochronosis, and in addition to the melasma findings, amorphous densely pigmented structures obliterating some follicular openings were observed. Exogenous ochronosis is an avoidable dermatosis that is difficult to treat. Dermatologists should be able to differentiate it from melasma and immediately discontinue hydroquinone. Dermoscopy might become a valuable resource in approaching exogenous ochronosis.

Pistas dermatoscópicas para diferenciar a tricotilomania da alopecia areata em placa

BACKGROUND Trichotillomania and patchy alopecia areata have similar clinical and dermoscopic features. OBSERVATIONS In trichotillomania, dermoscopy shows decreased hair density, short vellus hair, broken hairs with different shaft lengths, coiled hairs, short vellus hair, trichoptilosis, sparse yellow dots, which may or may not contain black dots and no exclamation mark hairs. CONCLUSIONS In the case of patchy alopecia and broken hairs, the absence of exclamation mark hairs suggests a diagnosis of trichotillomania. On the other hand, the finding of yellow dots without black dots does not exclude it.

Lyme Disease in Rio de Janeiro, Brazil

Abstract: Five patients living in Rio de Janeiro, Brazil, were found to have Lyme disease. These are among the first known cases in South America.

Epidemiology of melasma in Brazilian patients: a multicenter study

Melasma is an acquired, irregularly patterned, light to dark‐brown hypermelanosis, with symmetric distribution mostly over the face. The aim of this study was to evaluate clinical characteristics and factors related to melasma in Brazilian patients.

Dermoscopy features for the diagnosis of furuncular myiasis

We describe a 56-year-old Brazilian woman presenting three nodular lesions on the scalp. Dermoscopy of all lesions showed a creamy-white body with central birds feet-like structures surrounded by a thorn crown, corresponding to the posterior segment of the Dermatobia hominis larvae. These novel dermoscopic features allowed us to easily diagnose furuncular myiasis.

Sporotrichosis in pregnancy: case reports of 5 patients in a zoonotic epidemic in Rio de Janeiro, Brazil

Five cases of sporotrichosis occurring in pregnant women in a zoonotic epidemic in Rio de Janeiro, Brazil, are described. The main clinical features, as well as the challenging therapeutic choices for this specific group of patients, are discussed.

In vivo reflectance confocal microscopy in a typical case of melasma

Melasma is a common disorder of hypermelanosis that affects mainly young and middle-aged women of Fitzpatricks phototypes III-V. The disease significantly impacts their lives. In vivo reflectance confocal microscopy, a spreading technology for the noninvasive evaluation of the skin up to the papillary dermis, provides real-time en face images with cellular resolution. We present a case of melasma with in vivo reflectance confocal microscopy findings closely correlated to the histopathological features described in the literature.

Multiple lesions by vampire bat bites in a patient in Niterói, Brazil - Case report

Over the last few centuries, the expansion of urbanization brought bats closer to urbanized areas, increasing the risk of accidents by bat bites. The morphology of bat bites can be varied, usually having an elliptical shape, about 0.5 cm along its greatest length, and the characteristic corkscrew bite pattern. The authors present the case of a patient who was repeatedly bitten by vampire bats for two months. A polymerase chain reaction was performed in the cutaneous nerves at the base of the hair follicles which showed negativity towards the rabies virus. The authors highlight the public health importance of this case, and discuss the morphological characteristics of these hematophagous bat bites.

Pele na gestação

As manifestacoes cutâneas durante a gravidez correspondem a alteracoes fisiologicas, dermatoses proprias do periodo gestacional ou doencas pre-existentes. O penfigoide gestacional, a erupcao polimorfa da gravidez, a foliculite pruriginosa, o prurigo da gravidez e o prurido gravidico sao considerados dermatoses proprias da gestacao. Uma forma de psoriase pustulosa grave, o impetigo herpetiforme, esta descrito na gestacao. As lesoes cutâneas da artrite psoriasica, do lupus eritematoso, da dermatopolimiosite e os penfigos podem piorar na gravidez. O eritema nodoso e o eritema nodoso hanseniano podem ser desencadeados pela gravidez. O tratamento deve considerar os riscos e beneficios para a mae e o concepto.

Lesões molusco-símiles em paciente com esporotricose

Sporotrichosis is a subcutaneous fungal infection caused by Sporothrix schenckii and acquired by direct inoculation. Although the majority of cases consist of the classic lymphocutaneous presentation, the frequency of atypical and severe clinical forms of the disease has increased progressively. Systemic and disseminated cutaneous sporotrichosis constitute rare variants and such cases are generally associated with cellular immunodeficiency or debilitated states. The present paper describes the first published case of molluscum-like lesions in disseminated mucocutaneous sporotrichosis. Direct mycological examination and histopathology revealed numerous yeast cells.