Marjorie Uber

Serum Vitamin D Levels Not Associated with Atopic Dermatitis Severity

The objective of the current study was to determine the relationship between serum vitamin D levels and the severity of atopic dermatitis (AD) in a Brazilian population.

Hematohidrosis: insights in the pathophysiology

Hematohidrosis: insights in the pathophysiology The spontaneous discharge of bloody secretion through normal skin is known as hematohidrosis. We present a case of this rare condition and discuss possible mechanisms to explain the clinical manifestations. Written consent by the patient for this submission was obtained. An 18-year-old Caucasian female presented with episodes of spontaneous bleeding of the palms, back of the hands, forehead (Fig. 1), and tear ducts since the age of 12. No skin lesions were present, and they stopped spontaneously after a few minutes. There was no relation with the menstrual cycle, and sometimes extensive bleeding occurred during her sleep. Physical examination, gynecological evaluation, complete blood cell count, metabolic panel, and coagulation tests were normal. On dermatologic evaluation, no skin lesions were found, and a punch biopsy was performed on the back of the left hand, where spontaneous bleeding had just started. Smear preparation of the bloody secretion had peripheral blood characteristics – many erythrocytes, few leukocytes. Skin biopsy – stained with hematoxylin–eosin and Pearl – revealed normal skin, preserved adnexa, and normal blood vessels. Over 120 histological sections were evaluated, and no erythrocytes were found anywhere outside the vessels (Fig. 2). The patient was admitted to the hospital and carefully watched to rule out malingering; in fact, she presented several bleeding episodes under our close visual monitoring. During follow-up, she was diagnosed with conversion, dissociative, and generalized anxiety disorders, which were controlled with clonazepam, sertraline, valproic acid, and risperidone, but this treatment did not interfere with the bleeding. Although there was no psychiatric evaluation of the patient prior to the bleeding episodes, we can only suppose that the impact of the skin condition helped develop or exacerbate the psychiatric diseases. Curiously, it was noticed that the bleeding episodes were coincident with high blood pressure peaks (180 9 90 mmHg), but the 24-hour ambulatory blood pressure monitoring, Holter, and echocardiogram were normal. To control blood pressure levels, she was started on atenolol. During six months, she showed marked improvement with no more bleeding episodes. Owing to irregular intake of the medication, the bleedings restarted sporadically. Hematohidrosis is a rare clinical condition that manifests as self-limiting episodes of spontaneous discharge of bloody secretion through intact skin or sweat gland orifices, with an unknown cause. Some theories have been proposed, including: increased vascular pressure leading to the passage of blood cells through the ducts of the sweat glands; vasculitis of dermal vessels; and exacerbated sympathetic activation leading to periglandular vessel constriction and subsequent expansion, allowing the passage of blood content into the ducts. Only five reported cases in the literature present a histological description of a skin biopsy performed immediately after the bleeding. They show sporadic and inconsistent findings, such as: periglandular congested vessels; red blood cells in the follicular lumen and among the collagen fibers; leakage of blood around dermal capillaries; or even normal skin. In the patient described herein, the skin biopsy was completely normal. This excludes other causes of bleeding and may also indicate that no permanent anatomical changes occur in the pathophysiology of the disease. Differential diagnosis should include chromhidrosis, factitious dermatitis, vicarious menstruation, vasculitis, and platelet and coagulation disorders.

Clinical features and nail clippings in 52 children with psoriasis

Nail clipping, the act of cutting the distal portion of a nail for microscopic analysis, can complement the diagnosis of skin diseases with nail involvement, such as psoriasis. This study aimed to describe histopathologic findings on 81 nails from 52 children and adolescents with skin psoriasis and to determine whether these changes correlated with the severity of skin and nail involvement.

Critical assessment of the pH of children's soap

OBJECTIVE To evaluate the pH value of childrens antibacterial soaps and syndets used in childrens baths and verify whether there is information regarding pH on the product label. METHODS Quantitative, cross-sectional, analytical observational study that included ninety soap samples, both in bar and liquid presentations, as follows: 67 childrens soap (group 1), 17 antibacterial soaps (group 2), and 6 syndets (group 3). Each sample had its pH measured after 1% dilution. In addition to descriptive statistics, the Pearson-Yates chi-squared test and Students t-tests were applied, considering the minimal significance level of 5%. The Wilcoxon-Mann-Whitney test, Fishers exact test, and the Kruskal-Wallis test were used for inferential statistics. RESULTS The pH levels varied considerably between liquid and bar presentations, with lower levels (4.4-7.9) found for the liquids (p<0.05). Syndets showed pH levels close to the ideal (slightly acid) and the antibacterial soaps showed the highest pH levels (up to 11.34) (p<0.05). Only two of the soaps included in the study had information about their pH levels on the product packaging. CONCLUSIONS Knowledge of the pH of childrens soap by doctors and users is important, considering the great pH variability found in this study. Moreover, liquid soaps, and especially syndets, are the most recommended for the sensitive skin of neonates and infants, in order to guarantee skin barrier efficacy.

Nail changes in psoriatic children

Indian Journal of Dermatology, Venereology, and Leprology | May-June 2016 | Vol 82 | Issue 3 314 and mean facial sebum excretion have been detected.[5] Therefore, sleep may affect sebum levels via its interactions with these hormones. We propose that our findings regarding the positive relationship between good sleep quality and higher sebum levels may be related to these physiologic characteristics of sleep and sebum.

Papular crusted rash in a child after immunisation

A 2-year-old boy was referred to our hospital with a 4-week widespread itchy skin eruption that had started 6 days after receiving measles–mumps–rubella vaccine. The rash first appeared on his face, and then spread to the arms, hands and feet. Skin examination revealed monomorphic erythematous 3–5 mm papules, some covered with crusts, in a symmetrical acral distribution over the face, hands, buttocks, feet, upper and lower limbs …

Multifocal Congenital Hemangiopericytoma

Congenital hemangiopericytoma (HPC) is a rare mesenchymal tumor with less aggressive behavior and a more favorable prognosis than similar tumors in adults. Multifocal presentation is even less common than isolated HPC and hence its clinical and histologic recognition may be challenging. A newborn infant with multifocal congenital HPC causing severe deformity but with a favorable outcome after chemotherapy and surgical removal is reported.

Answers to Dermatophile

The answer is (F)—Erythema infectiosum (EI): EI is a rash caused by parvovirus B19, also known as The Fifth Disease.1 ,2 It is common in school-aged children, especially during winter and spring. The pathogenesis is still not fully understood.2 Infection is transmitted through the respiratory tract and symptoms such as headache, fever and myalgia end after 5 to 7 days with the production of anti-B19 immunoglobulin M (IgM) antibodies.1 ,2 The anti-B19 IgG appears during the third week of illness and coincides with the appearance of the rash and arthralgia.1 It presents as an asymptomatic infection in approximately 50% of cases.2 The most characteristic sign is known as ‘slapped cheek’, due to the fiery-red facial erythema occurring within 3 days of the onset of prodromal symptoms. Exposure to sunlight or heat worsens the rash. In the evolution of the condition, the patient develops an itchy and evanescent reticulate rash on the extremities and trunk. In some cases there are transient joint symptoms, mainly involving …

Nappy (diaper) rash: what else besides irritant contact dermatitis?

Nappy (diaper) rash is a common cutaneous disorder of infancy, and diverse dermatoses may affect this region. To perform a differential diagnosis can be challenging. We present four cases to emphasise the importance of clinical diagnosis.

Not only athlete’s foot survives in feet

From the questions on page 75 . The answer is F, Tinea pedis. Tinea pedis is the most prevalent dermatophyte infection encountered in practice,1–3 which is mostly caused by Trichophyton rubrum and Trichophyton mentagrophytes .1 It has three common presentations.2 The interdigital form of tinea pedis is the most common and, just like the case above, it is characterised by fissuring, maceration and desquamation in the interdigital spaces of the toes.2 Clinically, the moccasin-like form presents with hyperkeratosis and erythema of the soles and sides of the feet.2 The vesiculobullous form of tinea pedis is characterised by the development of vesicles, pustules and bullae, usually on the …