Samuel Henrique Mandelbaum

Cicatrização: conceitos atuais e recursos auxiliares - Parte I

In Part I of this article, published in the previous edition of the Brazilian Annals of Dermatology, the cicatrization concepts were revised and the importance of the multidisciplinary approach was emphasized in the management of wounds as well as considering the global aspects of the patient. In Part II, we present the resources that can aid the cicatrization process, as well as the various types of curatives available and their respective indication.

Cicatrization: current concepts and auxiliary resources - Part II

The study of cicatrization of the skin involves an enormous gamut of events and special situations. It requires a basic knowledge of anatomy, histology, biochemistry, immunology, pharmacology and many other sciences. This article offers a revision of the concepts of cicatrization, in its diverse aspects, and underscores the importance of a team with practitioners from various fields for the wound management as well as a global perception of the patient. The economic aspects of acute and chronic wounds are considered. Furthermore, the resources which can be used to aid the healing process and the various types of curatives available are also presented.

Drug-induced lupus with leukocytoclastic vasculitis: a rare expression associated with adalimumab.

TNF alpha antagonist-induced lupus-like syndrome is a rare condition which predominantly affects women (4:1). The average age of onset is 46-51 years. It occurs after exposure to TNF alpha antagonist and disappears after discontinuation of such agents. The pathogenic mechanism for development of the TNF alpha antagonist-induced lupus-like syndrome is not fully defined. It is believed that the medication induces apoptosis, leading to an accumulation of nucleosomal antigens of apoptotic cells. This would cause autoantibodies to be produced by susceptible individuals. The most common cutaneous manifestations include maculopapular exanthem, malar rash, alopecia, photosensitivity and, more rarely, vasculitis. Extracutaneous manifestations include: fever, weight loss, arthritis or arthralgia, myositis and hematological abnormalities. Antinuclear antibody may be positive in 80% of cases and anti-histone antibody is considered a disease marker for TNF alpha antagonist-induced lupus-like syndrome. Treatment corresponds to drug discontinuation. We report a rare case of sub-acute cutaneous lupus erythematosus with leukocytoclastic vasculitis induced by adalimumab in a 42-year-old patient.

Association of giant congenital melanocytic nevus, halo nevus and vitiligo in a 75-year-old patient

A giant congenital melanocytic nevus represents a rare condition. The halo phenomenon may be seen in congenital or acquired melanocytic nevi. In the literature, association of halo nevus and giant congenital melanocytic nevus is rare and the association of both with vitiligo even more rare. A 75-yearold woman at first consultation complained of a hyperchromic bluish-brown hairy macula on the lower back, buttocks and thighs present since birth and an achromic halo of onset three years ago. The histological features were consistent with congenital melanocytic nevus and halo nevus, respectively. After two years the patient developed achromic areas in normal skin, histologically consistent with vitiligo. The authors emphasize the rarity of this triple combination, the patients age and the absence of malignant degeneration to date.

Involucrin in the differential diagnosis between linear psoriasis and inflammatory linear verrucous epidermal nevus: a report of one case

Inflammatory linear verrucous epidermal nevus is a variant of verrucous epidermal nevus, characterized by recurrent inflammatory phenomena. Despite well-established clinical manifestations, the differential diagnosis between inflammatory linear verrucous epidermal nevus and linear psoriasis remains difficult. Clinical history, physical examination and histopathology analysis may not be sufficient to confirm the diagnosis. We report the case of a 4-year-old girl in which the involucrin immunostaining was helpful in the diagnosis of inflammatory linear verrucous epidermal nevus. Our findings confirm that involucrin immunohistochemistry is a useful tool in such cases.

Acral pseudolymphomatous angiokeratoma: case report and literature review

The authors describe a case of a female patient with Acral Pseudolymphomatous Angiokeratoma of Children, known as APACHE. It is a rare benign cutaneous disease, of unknown etiology, characterized by multiple, asymptomatic erythematous-violaceous papules and nodules, usually located unilaterally with acral distribution. Today, this denomination is questionable, since there are published reports of this disease in adults and in different locations. Clinically, it is similar to an angiokeratoma, whereas hystologically, it corresponds to a distinct type of pseudolymphoma. The immunohistochemical study is required to distinguish APACHE from cutaneous lymphoma.

Skin cancer prevention campaign in childhood: survey based on 3676 children in Brazil

Primary skin cancer prevention campaigns are essential and more effective among children, not only because of the importance of sun exposure effects during this period, but also because this age is when individuals are developing behaviours. The Brazilian Society of Dermatology – Regional State of Sao Paulo developed and conducted the programme named ‘The Sun, Friend of Childhood’, a school health education and disease prevention project for children and parents. Our objective was to evaluate the cognitive and behavioural effects of the children and parents before and after an education model‐based intervention of sun protection.

Phototherapy: experience from a reference service

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Melanoma Desmoplásico - um desafio diagnóstico

Desmoplastic melanoma is a rare variant of melanoma characterized by an invasive lesion of spindle cells and varying degrees of desmoplasia. It is more frequent in men of an advanced age having a history of chronic exposure to sunlight. The extremely variable and nonspecific clinical appearance makes it a challenging diagnosis. The authors present an exuberant case of desmoplastic melanoma in an unusual location, with an initial diagnosis of dermatofibrosarcomaDesmoplastic melanoma is a rare variant of melanoma characterized by an invasive lesion of spindle cells and varying degrees of desmoplasia. It is more frequent in men of an advanced age having a history of chronic exposure to sunlight. The extremely variable and nonspecific clinical appearance makes it a challenging diagnosis. The authors present an exuberant case of desmoplastic melanoma in an unusual location, with an initial diagnosis of dermatofibrosarcoma.

Erythema elevatum diutinum and hypothyroidism: coincidence or causal relationship?

Erythema elevatum diutinum is a rare chronic leukocytoclastic vasculitis of unknown etiology. It is believed to be due to deposition of immune complexes in the vessels. Clinically it is manifested as erythematous violaceous papules and nodules, isolated or confluent with hardened consistency, symmetrical, usually located on the extensor surface of the extremities, particularly over the joints. Diagnosis is based on clinical and histological findings. We report the case of a woman, 71 years old, with erythematous violaceous nodules on the hands, elbows, back and legs, beginning two years ago, with pain and itching. Histopathological analysis revealed leukocytoclastic vasculitis, confirming the clinical suspicion. Laboratory tests revealed hypothyroidism. We report the case because of its rarity, with subsequent review of the literature.