Rita Cabral

Allergic contact dermatitis caused by acrylates and methacrylates – a 7-year study

Allergic contact dermatitis (ACD) caused by (meth)acrylates is traditionally an occupational disease among dentists, printers, and fibreglass workers. With the use of artificial nails, cases have been reported both in nail technicians and in users.

Bullous pemphigoid and comorbidities: a case-control study in Portuguese patients

BACKGROUND aAlthough rare, bullous pemphigoid (BP) is the most common autoimmune blistering disease. Recent studies have shown that patients with bullous pemphigoid are more likely to have neurological and psychiatric diseases, particularly prior to the diagnosis of bullous pemphigoid. OBJECTIVE The aims were: (i) to evaluate the demographic and clinical features of bullous pemphigoid from a database of patients at a Portuguese university hospital and (ii) to compare the prevalence of comorbid conditions before the diagnosis of bullous pemphigoid with a control group. METHODS Seventy-seven patients with bullous pemphigoid were enrolled in the study. They were compared with 176 age- and gender-matched controls, which also had the same inpatient to outpatient ratio, but no history of bullous or cutaneous malignant disease. Univariate and multivariate analyses were used to calculate odds ratios for specific comorbid diseases. RESULTS At least one neurologic diagnosis was present in 55.8% of BP patients compared with 20.5% controls (p<0.001). Comparing cases to controls, stroke was seen in 35.1 vs. 6.8%, OR 8.10 (3.80-17.25); dementia in 37.7 vs. 11.9%, OR 5.25 (2.71-10.16); and Parkinsons disease in 5.2 vs. 1.1%, OR 4.91 (0.88-27.44). Using multivariate analysis, all diseases except Parkinsons retained their association with BP. Patients under systemic treatment were eight times more likely to have complications than those treated with topical steroids (p< 0.017). CONCLUSIONS The results of this study substantiate the association between BP and neurological diseases. In addition, they highlight the potential complications associated with the treatment of BP.

Contact allergy to local anaesthetics–value of patch testing with a caine mix in the baseline series

Background Contact allergy to local anaesthetics is relatively common. Patch testing with benzocaine in the European baseline series is recommended for diagnosis, even though a caine mix has been previously suggested to be superior.

Prediction of Sentinel Node Status and Clinical Outcome in a Melanoma Centre

Background. Sentinel lymph node biopsy (SLNB) is a standard procedure for patients with localized cutaneous melanoma. The National Comprehensive Cancer Network (NCCN) Melanoma Panel has reinforced the status of the sentinel lymph node (SLN) as an important prognostic factor for melanoma survival. We sought to identify predictive factors associated with a positive SLNB and overall survival in our population. Methods. We performed a retrospective chart review of 221 patients who have done a successful SLNB for melanoma between 2004 and 2010 at our department. Univariate and multivariate analyses were done. Results. The SLNB was positive in 48 patients (21.7%). Univariate analysis showed that male gender, increasing Breslow thickness, tumor type, and absence of tumor-infiltrating lymphocytes were significantly associated with a positive SLNB. Multivariate analysis confirmed that Breslow thickness and the absence of tumor-infiltrating lymphocytes are independently predictive of SLN metastasis. The 5-year survival rates were 53.1% for SLN positive patients and 88.2% for SLN negative patients. Breslow thickness and the SLN status independently predict overall survival. Conclusions. The risk factors for a positive SLNB are consistent with those found in the previous literature. In addition, the SLN status is a major determinant of survival, which highlights its importance in melanoma management.

Exuberant connubial allergic contact dermatitis from diphenhydramine

Abstract Connubial or consort allergic contact dermatitis occurs when the agent causing the dermatitis has not been used by the patient but by his partner or other cohabitants or proxy. Most cases are due to fragrances, cosmetics or topical nonsteroidal anti-inflammatory agents. We report a case of a connubial dermatitis caused by topical diphenhydramine in a woman who applied the cream on her husband’s back.

Nodular malignant melanoma. Or maybe not

On histopathological examination, there was a wellcircumscribed epithelial proliferation of monomorphic cuboidal cells, with focal evidence of ductal differentiation (Fig. 2). In the lateral intraepidermal component, the proliferation was composed of similar cells with heavily pigmented cytoplasm, forming nests that were fairly well-demarcated from the adjacent keratinocytes (Fig. 3). Rare mitoses were seen, but there were no atypical mitotic figures or cytological atypia.

Case for diagnosis. Pemphigoid gestationis.

Pemphigoid gestationis is a rare, autoimmune blistering dermatosis of pregnancy. No increase in fetal or maternal mortality has been demonstrated, but a greater prevalence of premature and small-for-gestationalage babies has been reported. Topical and systemic corticosteroids and antihistamines are the manstay of treatment. The authors report a case of a 27-year-old woman at 28-weeks gestation with sudden onset of pruriginous vesicles and blisters in the abdomen and limbs. Systemic corticosteroids were introduced and maintained throughout gestation to prevent flares and tapered after the birth of a healthy child.

Histopathology of the exanthema in DRESS in correlation with markers of severe systemic involvement

Methods Skin biopsies performed in in-patients with a diagnosis of DRESS according to REGISCAR criteria, were independently evaluated by two Dermatopathologists. Epidermal and dermal parameters were scored (lymphocyte, eosinophil and neutrophil infiltrate, lymphocyte exocytosis, spongiosis and necrotic/vacuolated keratinocytes) and correlated with the severity of systemic symptoms (eosinophilia, liver cytolysis and cholestasis, evaluated respectively by serum ALT and GGT values) and the presence of circulating HHV-6 DNA.

Asymptomatic papules and plaques in the scalp

A 78-year-old man presented with a 2-month-historyof several skin-coloured asymptomatic papules thathad been enlarging progressively. The lesions werelocated on the right frontoparietal region of the scalp,and measured 5–10 mm in diameter, with one groupforming a 20-mm plaque. There were no systemicsymptoms or palpable lymphadenopathy. Computedtomography (CT) scan of the head, thorax and abdo-men and ultrasonography of the cervical region wereunremarkable.

BIOPSIA DE GÂNGLIO SENTINELA EM PORTUGAL – EXPERIÊNCIA DE UM CENTRO DE REFERÊNCIA

Background: Sentinel lymph node biopsy is undertaken as a standard procedure for patients with localized cutaneous melanoma. The National Comprehensive Cancer Network (NCCN) melanoma panel has reinforced the status of Sentinel lymph node biopsy as the most important prognostic factor for disease survival.Objectives: We sought to identify predictive factors associated with positive SLN biopsy and correlation with overall survival in our population.Methods: A retrospective chart review of 221 patients who had undergone successful Sentinel lymph node biopsy for melanoma between 2004 and 2010 at our department was done. Univariate and multivariate analyzes were performed.Results: Sixty-one point five percent of patients were women and the mean age was 59.3 years. Most of the primary lesions were located on the lower limbs (43%), mainly on the feet (21.3%). The Sentinel lymph node biopsy was positive in 48 patients (21.7%). Univariate analysis showed that male gender, increasing Breslow thickness, tumor type, and presence of tumor-infiltrating lymphocytes were significantly associated with a positive Sentinel lymph node biopsy. Multivariate analysis confirmed that Breslow thickness and the presence of tumor-infiltrating lymphocytes are independently predictive of Sentinel lymph node metastasis. The 5-year survival rates were 53.1% for Sentinel lymph node positive patients and 88.2% for SLN negative patients. Breslow thickness and the Sentinel lymph node status independently predict overall survival.Conclusions: The risk factors for positive Sentinel lymph node biopsy in our study were consistent with those previous found in the literature. In addition, Sentinel lymph node status is a major determinant for survival, which highlights its importance in melanoma management.