Nurimar Conceição Fernandes

Dermatophytoses in children: study of 137 cases

Dermatophytoses are common fungal infections caused by dermatophytes but there are few data about this condition in the childhood. 137 children below the age of 12 and clinically diagnosed as tineas were investigated prospectively at Instituto de Puericultura e Pediatria, Rio de Janeiro, from 1994 to 1999. Hair, skin/nails scraping and pus swabs were collected from lesions and processed for fungus. Male children from 2 to 12 years were mostly affected; tinea capitis (78 cases) mainly caused by Microsporum canis (46 cases) was the most common clinical form. Tinea corporis (43 cases) mainly caused by Trichophyton rubrum (17 cases) accounted for the second most frequent clinical form. Tinea cruris (10 cases) with Trichophyton rubrum (5 cases) as the most common etiologic agent accounted for the third most frequent clinical form. Tinea pedis and tinea unguium were much less frequent (3 cases each). Trichophyton rubrum was the most common etiologic agent isolated in these cases (3 cases).

Tinea capitis: study of asymptomatic carriers and sick adolescents, adults and elderly who live with children with the disease

Tinea capitis is a dermatophyte infection that occurs mainly in childhood; there are few reports, in Brazil, in adolescents and adults. The detection of asymptomatic carriers is of great importance in the disease control. From February 1998 to February 1999, a study was performed at the outpatient Dermatologic Unit of Instituto de Puericultura e Pediatria Martagão Gesteira (Universidade Federal do Rio de Janeiro, Brasil) to verify the frequency of asymptomatic carriers and tinea capitis between 79 adolescents, adults and elderly who lived in the same household of 56 children (0-12 years) with tinea capitis. Of these, one female and one male adults (2.5%) were asymptomatic carriers and the cultures revealed Trichophyton tonsurans and Microsporum canis respectively. One female adolescent and two female adults (3.8%) had tinea capitis and all cultures revealed Trichophyton tonsurans. The study has shown that adolescents and adults who live in the same household of children with tinea capitis may be sick or asymptomatic carriers.

Treatment of pemphigus vulgaris and pemphigus foliaceus: experience with 71 patients over a 20 year period

Forty one cases of pemphigus vulgaris and thirty cases of pemphigus foliaceus were investigated at Hospital Universitário Clementino Fraga Filho from 1978 to 1999. They were divided into two treatment groups: one group received up to 100 mg of oral prednisone daily and the other group received >120 mg daily. The dose up to 100 mg provided good initial control of pemphigus vulgaris and pemphigus foliaceus and did not increase the mortality rate associated to disease. The dose >120 mg induced higher morbidity. These data allowed us to establish a regimen of oral prednisone (1-2 mg/kg/daily) with maximum of 120 mg daily in the treatment of pemphigus vulgaris and pemphigus foliaceus.

Úlcera de Marjolin: relato de 12 casos

The authors report twelve cases of Marjolins ulcer that have been diagnosed between 1990 and 2003 at HUCFF-UFRJ. Five females and seven males, aged 38 to 86 years old, formed the group. Evolution time from scar to squamous cell carcinoma onset ranged from 10 to 50 years. Amputation was performed in eight cases and in one of them radiation therapy was associated. Two patients underwent local excision. One patient who already had spinal metastasis was submitted to palliative local excision. Finally, one case had no therapeutic possibilities. Early biopsy was concluded to be essential in chronic ulcers, to establish the difference between squamous cell carcinoma and pseudoepitheliomatous hyperplasia

Refractory pemphigus vulgaris associated with herpes infection: case report and review

BACKGROUND Pemphigus vulgaris (PV) is an autoimmune disease characterized by blistering of the skin and mucosa, which develops due to the interaction between predisposing genetic and environmental factors. Infections caused by members of the Herpesviridae family have been suggested as a possible triggering factor for PV. OBJECTIVE AND METHODS In this report, we investigate the presence of herpesviruses in refractory lesions on the right upper eyelid. The lesion has persisted despite the treatment with corticosteroids. Polymerase chain reaction (PCR) and DNA sequence analysis have been used to detect the DNA of HSV 1/2, VZV, EBV, CMV, HHV-6, HHV-7, and HHV-8. RESULTS The sample collected from the right upper eyelid has tested positive for HSV 1/2. Sequence analysis has confirmed the PCR results and allowed the identification of the HSV strain as belonging to type 1. After treatment with acyclovir, the lesion of the right upper eyelid has cleared and not relapsed. CONCLUSION When patients present PV lesions which are refractory to corticosteroid therapy, herpetic infection should be considered.

Melanoma cutâneo: estudo prospectivo de 65 casos

BACKGROUND: Incidence and mortality of cutaneous melanoma are increasing all over the world. The data base for the Brazilian population is still inadequate. OBJECTIVES: Prospective study of 65 cases seen at University Hospital Clementino Fraga Filho, from 1993 to 2003. METHODS: Patients age, sex, ethnic group, anatomic site, clinical histological presentation and staging were analyzed. RESULTS: The case distribution was 64.7% aged 40 to 69 years, males (49.2%) and females (50.8%), majority white (83.1%), most lesions in the trunk (35.3%), more frequently of the clinical histological superficial spreading type (63%/30.7%) and significant relationship between foot acral type in non-whites. According to American Joint Committee on Cancer 2002 system, 22 cases (33.8%) in stage IA, 14 (21.5%) melanomas in situ, and one indeterminate case. CONCLUSIONS: Primary cutaneous melanoma in the present study has a similar pattern to other published series and higher frequency of stage IA and in situ melanomas.

Childhood vitiligo and thyroid disease

The association of vitiligo / thyroid disease in childhood is debatable; 50 children with vitiligo and 40 without it were submitted to serum dosage of antithyroid antibodies and thyrostimulating hormone. One case (test group) and one control showed a serum titer of TSH above the normal limit; vitiligo did not represent a greater risk for thyroid disease.

Erythema nodosum: prospective study of 32 cases

The results of 32 cases studied lead us to the conclusion that erythema nodosums investigation routine is very important, once in our retrospective study, the percentage of cases of unknown etiology was 69.4%, and in this prospective study it is 21.8%. In 10 cases (31.2%), more than one causing agent was suspected. Infections (bacterial, helminthic, fungal, by protozoa) were diagnosed in 26 cases, streptococcal infection having predominated (12 cases). Drugs-dipirone, aspirin, anovulatory--were suspected as causing agents in 13 cases. The association of erythema nodosum and histoplasmosis capsulata is described for the first time in Brazil. We consider erythema nodosum to be a complex syndrome which should be regarded as a manifestation of underlying diseases. The fact that all 32 subjects were women, 26 of them during menacme, suggests that particular hormonal media may favor the action of various processes (infections and drugs), precipitating erythema nodosums clinical picture.

Clinical epidemiological profile of vitiligo in children and adolescents

94 children and 25 adolescents, 42% male and 58% female, aged predominantly between six and ten years old (40%) were studied at the Martagão Gesteira Childcare and Pediatrics Institute (Rio de Janeiro Federal University) between 2005 and 2011. The prevalent clinical form of vitiligo was the generalized type (34%). Although the clinical response was similar between the treatment modalities, we decided for low and high power topical steroids in our routine. Halo nevi were found in seven (5.9%) cases. Thirty (25%) patients underwent specialized evaluation and 18 (60%) reported some relevant psychological situation.

Tratamento da alopecia areata com corticóide tópico: estudo prospectivo randomizado duplo cego em crianças

BACKGROUND: In alopecia areata, there is a sudden and asymptomatic hair loss in any hairy area of the body. The etiology is unknown and the treatments do not usually alter its natural and unpredictable course. It also occurs in children, who are less responsive to treatment and more susceptible to extensive forms of the disease. Atopy is considered a worsening factor in the prognosis; the relationship between both diseases is probably immunologic, but the point of connection is unknown. OBJECTIVE: Evaluation of the efficacy of 0.05% betamethasone dipropionate (cream), and the influence of atopy in the therapeutic response. METHODS: Prospective double-blind controlled assay in 35 children, aged up to 12 years with alopecia areata, attended at Instituto de Puericultura e Pediatria Martagao Gesteira - UFRJ and Hospital Municipal Jesus - RJ in the period 1996 -1998. RESULTS: Thirty (85.7%) out of the 35 children studied achieved positive response after six months follow-up. The response was similar in both therapies - betamethasone dipropionate and placebo (p = 0.47). Twenty-six (89.6%) out of the 29 atopic children had a positive response. No significant correlation has been established between therapeutic response and atopy (p = 0.19). CONCLUSION: There was no statistically significant difference between therapeutic responses; atopy did ot influence the therapeutic response.