Rubem David Azulay

Lyme Disease in Rio de Janeiro, Brazil

Abstract: Five patients living in Rio de Janeiro, Brazil, were found to have Lyme disease. These are among the first known cases in South America.

Epidermólise bolhosa albopapulóide (variante de Pasini)

A epidermolise bolhosa albopapuloide e doenca rara, de carater autossomico dominante, tambem conhecida como epidermolise bolhosa distrofica albopapuloide de Pasini. Os autores relatam o caso de uma paciente de 37 anos de idade, com inicio do quadro aos sete anos, com lesoes bolhosas e milia nas areas de traumatismo, alem de maculas hipocromicas e atroficas (lesoes albopapuloides) no corpo. A paciente tambem apresenta pele apergaminhada, xerotica, e distrofia ungueal dos pes. A histopatologia da lesao bolhosa revelou clivagem subepidermica, compativel com o diagnostico clinico.

Acroangiodermatite (pseudo-sarcoma de Kaposi)

Acroangiodermatitis is a very rare disease. It is characterized by erythematous violaceous cutaneous lesions, localized mainly in the legs and feet, resembling Kaposis Sarcoma. A case is presented of a female, 57 years old presenting erythematous-violaceous lesions in both legs. She also presented varices, reticularis livedo and venous stasis. The clinical and histopathological lesions resembled Kaposis Sarcoma. The immunohistochemistry (CD-34) confirmed the diagnosis. This is the first case observed in Brazil.

Acute Disseminated Paracoccidioidomycosis Septic Shock

A l 5 year-old single girl, a student, mestizo, and Brazilian, came from the State of Maranhao to our hospital due to generalized skin lesions, pains all over the body, and fever since August 1984. The physical examination showed discrete enlargement of the lymph nodes located symmetrically in the cervical, submandibular, axillary, paravertebral, and inquinal regions and hepatomegaly. The skin lesions were vegetating, yaws-like lesions, some ulcerated and others covered by crusts 0.5-2.0 cm in diameter, localized in the face, trunk, and extremities; subcutaneous nodules 0.5-2.0 cm in diameter all over the body; pustules in the face, trunk, and extremities; and ulcerations in the palate, jugal mucosa, and oropharynx. The articulations were voluminous and painful. The patient could hardly move in the bed. The x-rays of the bones showed osteolytic lesions in both clavicles, humerus, radius, ulna, femur, tibia, and fibula. Pathologic fractures in both distal extremities of radius and ulna were observed. The x-rays of the lungs showed an image of residual fibrosis in the superior third of the right lung.

Contribution of Brazilian dermatologists to the development of dermatology

The first recognized publications in dermatology are from the 18th century in France, England, Austria, and Germany. In 1912, Brazilian dermatology was created as a specialty. Since then, 18 new dermatoses or new clinical forms of recognized dermatologic diseases have been described. • Keratomycose nigricans palmar (tinea nigra). In 1891, Alexandre Cerqueira described a new disease characterized by black lesions, localized on the palm of the hand, produced by a fungus. This disease was inoculated in a male volunteer. This discovery was written by his son, Cerqueira-Pinto 1 (Fig. 1). • Fogo selvagem (Brazilian pemphigus foliaceus). In 1903, Paes Lemos 2 described an endemic dermatosis in Brazil known by the name of “fogo selvagem.” It is actually pemphigus foliaceus, which acquires a different form in the endemic variety that occurs in the interior areas of Brazil and South America. According to Flaviano Silva, 3 the first clinical diagnosis of Brazilian pemphigus was made before 1900 by Professor Alexandre Cerqueira. Unfortunately, it was not published. • Lutz mycosis (paracoccidioidomycosis). This was described by Adolpho Lutz in 1908. 4 He demonstrated that paracoccidioidomycosis, a novel systemic mycosis, was caused by a different organism from that producing coccidioidomycosis. • Piedra nigra. This is a variant of a known disease (piedra) which presents with white nodules in the hair. Parreiras Horta 5 described another form of hair infection with black nodules, called piedra nigra. • Blastomicose nigra (chromoblastomycosis). In 1911, Alexandrino Pedroso and J. M. Gomes discovered a new disease characterized by verrucous lesions, showing black round parasites inside the histopathologic lesions. They called it black blastomycosis. This finding was referenced by Fonseca and Area Leão. 6

Talidomida: indicações em Dermatologia

Thalidomide was discovered in East Germany in 1954. It presented with several therapeutic effects: antiemetic, sedative and hypnotic. From 1959 to 1961, roughly 12,000 children born with teratogenic defects were described. Its use was consequently halted. Sheskin started using the drug again and observed its beneficial effect on erythema nodosa leprosum. Thalidomide is derived from glutamic acid. Its urinary elimination is minimal (1%). It has the following actions: anti-inflammatory, immunomodulary and antiangiogenic. It has been used with a successful therapeutic outcome on some entities, which have been studied further. The main side effect is teratogenic: limb alterations, ears, eyes and internal organs. The teratogenic effects are assumed to result from antiangiogenic action. Other side effects are cephalea, dry skin and mouth mucous, pruritus, cutaneous eruption, weight gain, hypothyroidism, neutropenia, bradycardia or tachycardia, and hypotension. It interacts with other medicine: barbiturates, chlorpromazine, reserpine, alcohol, acetaminophen, histamine, serotonin and prostaglandin.

Hiperceratose epidermolítica em mosaico

Epidermolytic Hyperkeratosis is a genetic disorder of keratinization, initially described as bullous ichthyotic erythroderma. It is transmitted as an autosomal dominant trait, although 50% of cases may occur as spontaneous mutations. This disease frequently presents with blistering, redness and peeling at birth. With time it may develop into generalized hyperkeratosis with or without erythroderma. It has a distinctive histopathologic feature of vacuolar degeneration of the upper epidermis and associated thick stratum corneum. Sporadic epidermolytic hyperkeratosis due to postzygotic, spontaneous mutation during embryogenesis may appear in a mosaic pattern of skin involvement showing areas of hyperkeratosis distributed in streaks along Blaschkos lines, and alternating with normal skin. Mutations occur in either keratin 1 and 10. The authors present the case of a 15 year-old adolescent, who since the age of ten has presented vesico-bullous lesions that gradually became hyperkeratotic. They affected the limbs, the body and the cervical region following Blaschkos lines, and alternating with normal skin. The histopathologic study was compatible with epidermolytic hyperkeratosis. He was treated with acitretin, which obtained a good response.

Joseph Plenck (1735-1807): autor do primeiro livro de Dermatologia

1 Professor Emérito da UFRJ e da UFF. Professor Titular da Fundação Técnico Educacional Souza Marques e da Universidade Gama Filho. Chefe do Instituto de Dermatologia do Hospital da Santa Casa da Misericórdia do Rio de Janeiro. / Emeritus Professor at the UFRJ and UFF. Titular Professor at the “Fundação Técnico Educacional Souza Marques” and Gama Filho University. Head of the Institute of Dermatology at the Santa Casa Charitable Hospital of Rio de Janeiro.

Professor Luiz Marino Bechelli

Editorial de homenagem ao Prof. Luiz Marino Bechelli, que completou 90 anos em 2002 e continua trabalhando apesar de aposentado desde 1982. Sua maior contribuicao cientifica e profissional fez-se no campo da Hansenologia, seus trabalhos e intensa atividade profissional levaram-no a exercer praticamente todos os postos oficiais desta especialidade. Foi um dos principais autores do Tratado Brasileiro de Leprologia

Comentários sobre o XX Congresso Internacional de Dermatologia

Breve analise do XX Congresso Internacional de Dermatologia, que se realiza de 5 em 5 anos, sendo este realizado em Paris, no Palacio dos Congressos, sob a Presidencia do Prof. Jean Revus(Franca, sendo a Delegacao brasileira a terceira maior em numero de participantes sendo que, 108 dermatologos apresentaram posteres, dos quais 11 do Instituto de Dermatologia da Santa Casa de Misericordia do Rio de Janeiro, estando o proximo Congresso marcado para 2007, na Argentina