Maira Mitsue Mukai

Porocarcinoma écrino: relato de quatro casos e revisão da literatura

Eccrine porocarcinoma is an extremely rare skin tumor derived from the acrosyringium. Four cases of eccrine porocarcinoma are described, two males and two females, aged from 49 to 64 years. Tumors grew in an interval of one to 20 years. Lesions ranged from 1.2 x 2 cm to 4 x 5 cm and were on limbs or face. Two patients had basal cell carcinoma in a site different from the eccrine porocarcinoma. Two biopsies were described as eccrine poroma. Malignancy was observed in all cases after wide excision. Therefore, eccrine porocarcinoma should always be considered after a biopsy compatible with eccrine poroma.

NAPSI utilization as an evaluation method of nail psoriasis in patients using acitretin.

BACKGROUND assessment instruments of nail psoriasis have been published in literature as means to standardize the previous subjective assessments of authors. OBJECTIVES Using Nail Psoriasis Severity Index for evaluation in patients with plaque psoriasis during treatment with acitretin. METHODS Thirty volunteers with plaque psoriasis were selected for the study. Twenty patients (8 women and 12 men) completed the study. The initial dose of acitretin was 0.3 mg/kg/day for 30 days and was later raised to 0.5 mg/kg/day. Nail Psoriasis Severity Index was collected in the first evaluation, after 2 and 4 months. Nails of both hands were evaluated. RESULTS nail lesions were present in all patients at first evaluation. The initial Nail Psoriasis Severity Index median was 20 and the final score 20.5 (2.5% of worsening at the end of the study). No statistically significant difference between the three evaluations was found (X2 = 0.8084, GL = 2, p = 0.6657). Seven patients worsened in the final score. Three patients improved 50% of the initial Nail Psoriasis Severity Index and only one had an improvement of 75%. Linear correlation showed a weak association between the improvement percentage in PASI and Nail Psoriasis Severity Index (r = 0.105, F = 2.12, p = 0.162). CONCLUSION The method was easy and of rapid execution while potentially bringing information about changes in nail plate and matrix during treatment. The Nail Psoriasis Severity Index does not quantify the existing lesions and might not have the sensitivity to detect small changes.

Mucormycosis and chromoblastomycosis occurring in a patient with leprosy type 2 reaction under prolonged corticosteroid and thalidomide therapy

Mucormycosis is an uncommon fungal infection caused by Mucorales. It frequently occurs in patients with neutropenia, diabetes, malignancy and on corticoid therapy. However, it is rare in patients with AIDS. Clinical disease can be manifested in several forms. The case reported illustrates the rare occurrence of chromoblastomycosis and mucormycosis in an immunosuppressed patient with multibacillary leprosy, under prolonged corticosteroid and thalidomide therapy to control leprosy type 2 reaction. Neutrophil dysfunction, thalidomide therapy and work activities are some of the risk factors in this case. Chromoblastomycosis was treated by surgical excision and mucormycosis with amphotericin B. Although the prognosis of mucormycosis is generally poor, in the reported case the patient recovered successfully. This case should alert dermatologists to possible opportunistic infections in immunosuppressed patients.

Sarcoma de Kaposi primário do pênis

Kaposis sarcoma is a vascular tumor involving the wall of lymphatic vessels. There are four types: classic, endemic, iatrogenic and HIV-associated. It is a systemic, malignant and multifactorial disease and has a variable course. The primary presentation on the penis is uncommon and is mainly observed in HIV-positive patients. In HIV-negative individuals, asymptomatic papules, nodules, plaques and verrucous lesions are found. The treatment for the classic form involves surgery, cryotherapy, electrosurgery, laser and radiation therapy. The authors present a rare case of a patient with the classic form on the penis, who was successfully treated by radiation therapy.

Apresentação atípica de infecção por herpes simples em um paciente imunossuprimido

The herpes simplex infection can produce peculiar clinical features easily recognized by the physician. However, in immunocompromised people, the clinical presentation can be atypical, difficulting the diagnosis and treatment. Therefore, a case of herpes simplex occurring in a pacient taking chemotherapy is presented.

Connective Tissue Diseases

Connective tissue diseases share certain common traits such as skin inflammation, and joint and other structures rich in connective tissue, along with immune defects. They represent a heterogeneous group of diseases characterized by a wide variety of signs and symptoms. The autoimmune connective tissue diseases include lupus erythematous, dermatomyositis, and morphea, and are considered classic connective tissue diseases. In this chapter The Epidemiology, etiopathogenesis, clinical presentation, differential diagnosis, complementary examinations, and therapeutic approaches for connective tissue diseases are discussed.

Metastatic cutaneous Crohn’s disease as an important differential diagnosis of granulomatous skin disease

Patients with Crohns disease may show extraintestinal manifestations, including cutaneous, whose frequency ranges from 2% to 34%. Metastatic cutaneous Crohns disease is considered a specific and rare manifestation, since the histopathology reveals granulomatous pattern with the same characteristics of the underlying bowel condition. The objective of this study is to report two cases of metastatic cutaneous Crohns disease confirmed by histopathologic analysis, after excluding other granulomatous skin diseases. Case 1: Adult woman with pruritic erythematous scaly plaques disseminated on the upper limbs. Case 2: Adult man with grayish hyperchromic plaque infiltrated on the left buttock.