Paulo Varela

Immediate and Delayed Hypersensitivity to Mite Antigens in Atopic Dermatitis

Atopic dermatitis (AD) is a common disorder and appears to be on the increase, especially among children. It was thought at first to be a manifestation of immediate hypersensitivity, but it is now known that delayed hypersensitivity also plays an important role. Sensitivity to mite antigens is found in 20% to 60% of patients when immediate hypersensitivity is evaluated by the detection of specific IgE antibodies and prick tests, and in 30% to 50% of patients when delayed hypersensitivity is studied by patch testing. A prospective randomized study was carried out in the pediatric dermatology clinic on a sample of 51 children under 15 years of age. A prevalence of immediate and delayed hypersensitivity to mites, like that described for other populations, was found. It was further found that there was a positive association, not described in the literature, between the younger age groups and delayed hypersensitivity to mite antigens, while the opposite was true for immediate hypersensitivity. We believe that patch tests with airborne allergens, specifically mites, should be part of the protocol for assessing children with AD, particularly in the younger age groups.

Description and management of cutaneous side effects during erlotinib and cetuximab treatment in lung and colorectal cancer patients: A prospective and descriptive study of 19 patients

Erlotinib and cetuximab are human epidermal growth factor receptor inhibitors (EGFRI) that are approved in monotherapy for the treatment of patients with locally advanced or metastatic non-small cell lung cancer after failure of at least one prior chemotherapy regimen. Papulopustular eruptions are the most frequent adverse effect, their occurrence being associated with increased survival in some studies. We describe 19 patients who presented with a rash located mainly to the face and trunk, without presence of comedones, shortly after initiation of EGFRI therapy. We present our algorithm to manage these patients and their respective responses. We also report other therapeutic options and cutaneous alterations that may be seen.

Piroxicam-β-cyclodextrin and photosensitivity reactions

Piroxicam is one of the more frequently prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) in Portugal, due to its efficacy and once-daily dosage (1). A new piroxicam formulation has recently been marketed in Portugal: piroxicam-b-cyclodextrine (PBCD; BrexinA), the result of supermolecular encapsulation of piroxicam with the cyclic oligosaccharide b-ciclodextrine, which results in increased bioavailibility (2). Piroxicam photosensitivity reactions are well-known (3). Their proximate cause is a photoproduct, induced by the UVA radiation, which cross-reacts with thimerosal (4, 5). In 1996, thimerosal accounted for 15.4% of patch test reactions in the grouped data of the GPEDC (6).

Pemphigus vulgaris--still a difficult disease to treat.

the parotid gland has been reported. As PLCNA is considered to be a type of isolated plasmacytoma, such association seems to be relevant. We hypothesize that growth factors and cytokines involved in CREST and other autoimmune diseases may interfere with extramedullary plasma cell proliferation, i.e. in cutaneous amyloidosis. Appropriate reassurance should be given to patients, as the progression rate from PLCNA to systemic amyloidosis, once believed to be 50%, is now believed to be closer to 7%. Despite this, follow-up for the development of systemic symptoms of an associated disorder or a plasma cell dyscrasia is recommended.

Inverse psoriasis treated with ustekinumab

Inverse psoriasis is characterised by the involvement of flexural skin folds. This form of psoriasis has distinct clinical and therapeutic features. This report refers to the case of a 48-year-old Caucasian man who was observed in our department, with a clinically and biopsy proven diagnosis of inverse psoriasis. For 2 years, the patient was treated with different combinations of corticosteroids, vitamin D analogues and methotrexate, with no satisfactory response. Given the lack of a clinical response and comorbidities, latent tuberculosis was excluded, and we started treatment with ustekinumab. We chose this biological agent because the patient was a long-distance truck driver and refused the possibility of autoinjections. The patient underwent three ustekinumab injections, which resulted in significant improvement of pruritus, erythaematous lesions and quality of life.

Unilateral nevoid acanthosis nigricans treated with CO2 laser

Acanthosis nigricans (AN) can be classified into eight variants, including the benign, obesity associated, syndromic, malignant, acral, unilateral, medication induced and mixed type.1 Unilateral nevoid AN (UNAN) is an extremely rare form of AN and may be localised as a solitary lesion or along the Blaschkos lines.2 It is not associated with syndromes, endocrinopathies, drugs or malignancies. Various treatments have been described, including retinoids, calcipotriol, fish oil, ammonium lactate cream, cryotherapy, dermabrasion, excision (if small lesion) and long-pulse alexandrite …

Portuguese Position Paper on the Use of Biosimilars in Psoriasis.

1. Consulta de Psoríase. Serviço de Dermatologia. Centro Hospitalar do Porto. Porto. Portugal. 2. Instituto de Ciências Biomédicas Abel Salazar. Universidade do Porto. Porto. Portugal. 3. Serviço de Dermatologia. Centro Hospitalar de Lisboa Central. Lisboa. Portugal. 4. Serviço de Dermatologia. Hospital da Luz. Lisboa. Portugal. 5. Unidade de Psoríase. Hospital Cuf – Descobertas. Lisboa. Portugal. 6. Serviço de Dermatologia. Centro Hospitalar de Leiria. Leiria. Portugal. 7. Serviço de Dermatologia. Clinica Laser de Belém. Lisboa. Portugal. 8. Serviço de Dermatologia. Centro Hospitalar de S. João. Porto. Portugal. 9. Departamento de Farmacologia e Terapêutica. Faculdade de Medicina. Universidade do Porto. Porto. Portugal. 10. Consulta de Fototerapia. Serviço de Dermatologia. Hospital de Santo António dos Capuchos. Centro Hospitalar de Lisboa Central. Lisboa. Portugal. 11. Serviço de Dermatologia. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal. 12. Unidade Curricular de Dermatologia. Escola de Ciências da Saúde. Universidade do Minho. Braga. Portugal. 13. Unidade de Dermatologia. Hospital dos Lusíadas. Lisboa. Portugal. 14. Centro de Ambulatório. Centro Hospitalar de Vila Nova de Gaia e Espinho. Vila Nova de Gaia. Portugal. 15. Unidade de Fototerapia. Serviço de Dermatologia. Centro Hospitalar de Vila Nova de Gaia e Espinho. Vila Nova de Gaia. Portugal. 16. Sociedade Portuguesa de Dermatologia e Venereologia. Lisboa. Portugal. 17. Serviço de Dermatologia. Centro Hospitalar do Porto. Porto. Portugal. 18. Colégio de Especialidade de Dermatologia. Lisboa. Portugal. 19. Serviço de Dermatologia. Centro Hospitalar Lisboa Norte. Lisboa. Portugal. 20. Unidade Curricular de Dermatologia. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal. 21. Unidade de Investigação em Dermatologia. Instituto de Medicina Molecular. Universidade de Lisboa. Lisboa. Portugal.  Autor correspondente: Tiago Torres. torres.tiago@outlook.com Recebido: 16 de agosto de 2016 Aceite: 17 de agosto de 2016 | Copyright

Blue-gray plaque of the penis

CLINICAL PRESENTATION We report the case of a 66-year-old white man with a 6-month history of a blue-gray plaque of the glans. The patient was heterosexual, with 2 sexual partners in the last 6 months, and denied condom use. There was no personal or family history of melanoma. Physical examination of the uncircumcised penis found a round, well-demarcated, smooth, blue-gray plaque measuring 83 10 mm, arising within an erythematous background plaque of the glans (Fig 1). The remaining physical examination was unremarkable, including the oral cavity.

Bullous pemphigoid in a patient with multiple sclerosis being treated with human immunoglobulin

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Cutaneous B cell lymphoma in a patient with leprosy

Authors report the case of a male patient treated in the Dermatology Department for cutaneous leprosy, and then sent to the Plastic Surgery Department for excisional biopsy of a giant shoulder nodule unresponsive to antibacilar chemotherapy and interpreted as a leprosy reaction. The extemporary histological result was of a cutaneous lymphoma and the defect was reconstructed with two random regional fasciocutaneous flaps, a rotation scapular flap and a transposition anterior brachial flap. The rarity of this association, not previously reported in the literature, and the success of the chosen surgical treatment motivated us to publish the case. We present the clinical evolution of the lesion, the surgical reconstructive option and the final result which we consider excellent from clinical, aesthetic and functional points of view.