Silmara da Costa Pereira Cestari

Padrões dermatoscópicos do molusco contagioso: estudo de 211 lesões confirmadas por exame histopatológico

BACKGROUNDS Although easily diagnosed, molluscum contagiosum may present as a single lesion or as several small, inflamed lesions of difficult diagnosis. OBJECTIVE To describe the dermoscopic characteristics of molluscum contagiosum and to compare the findings from clinical examination and dermoscopy. METHODS Histopathologically confirmed lesions were evaluated clinically and dermoscopically in 57 patients. RESULTS At clinical examination and dermoscopy of 211 lesions, orifices were visualized in 50.24% and 96.68% of the lesions, and vessels in 6.16% and 89.10%, respectively. The vascular patterns found in the 188 lesions in which vessels were found at dermoscopy were the crown (72.34%), radial (54.25%) and punctiform patterns (20.21%). Half of the 188 lesions had a combination of vascular patterns, with the flower pattern (a new vascular pattern) being found in 19.68% of cases. More orifices and vessels were identified at dermoscopy than at clinical examination, including cases with inflammation or perilesional eczema and small lesions. Punctiform vessels were associated with inflammation, excoriation and perilesional eczema. CONCLUSIONS Dermoscopy performed on molluscum contagiosum lesions proved superior to dermatological examination even in cases in which clinical diagnosis was difficult. The presence of orifices, vessels and specific vascular patterns aids diagnosis, including differential diagnosis with other types of skin lesion.BACKGROUNDS: Although easily diagnosed, molluscum contagiosum may present as a single lesion or as several small, inflamed lesions of difficult diagnosis. OBJECTIVE: To describe the dermoscopic characteristics of molluscum contagiosum and to compare the findings from clinical examination and dermoscopy. METHODS: Histopathologically confirmed lesions were evaluated clinically and dermoscopically in 57 patients. RESULTS: At clinical examination and dermoscopy of 211 lesions, orifices were visualized in 50.24% and 96.68% of the lesions, and vessels in 6.16% and 89.10%, respectively. The vascular patterns found in the 188 lesions in which vessels were found at dermoscopy were the crown (72.34%), radial (54.25%) and punctiform patterns (20.21%). Half of the 188 lesions had a combination of vascular patterns, with the flower pattern (a new vascular pattern) being found in 19.68% of cases. More orifices and vessels were identified at dermoscopy than at clinical examination, including cases with inflammation or perilesional eczema and small lesions. Punctiform vessels were associated with inflammation, excoriation and perilesional eczema. CONCLUSIONS: Dermoscopy performed on molluscum contagiosum lesions proved superior to dermatological examination even in cases in which clinical diagnosis was difficult. The presence of orifices, vessels and specific vascular patterns aids diagnosis, including differential diagnosis with other types of skin lesion.

Estudo da correlação entre molusco contagioso e dermatite atópica em crianças

BACKGROUND: Although no scientific evidence has yet been published, it is widely understood that molluscum contagiosum tends to be more common and more intense in patients with atopic dermatitis. This lack of evidence led to the development of the present study. OBJECTIVES: To evaluate the prevalence of the association between atopic dermatitis and molluscum contagiosum; to evaluate whether molluscum contagiosum is more likely to be recurrent and/or disseminated in patients with atopic dermatitis and whether the occurrence of eczema surrounding the molluscum contagiosum lesions, pruritus and/or infection is more prevalent in these patients compared to patients without atopic dermatitis. METHODS: A total of 284 children of both sexes with a diagnosis of molluscum contagiosum and/or atopic dermatitis were evaluated. RESULTS: Only 13.4% of the patients had both conditions. The number of anatomical areas affected by molluscum contagiosum and the occurrence of surrounding eczema and pruritus was greater in the patients who also had atopic dermatitis. There was no statistically significant difference in the frequency of secondary infection associated with the molluscum contagiosum lesions between the patients who had atopic dermatitis and those who did not. CONCLUSION: The prevalence of atopic dermatitis associated with molluscum contagiosum was low. There was no statistically significant difference in the recurrence rates associated with molluscum contagiosum or in the number of lesions between the patients who had atopic dermatitis and those who did not. The number of anatomical areas affected by the molluscum contagiosum lesions and the presence of surrounding eczema and pruritus were higher in the patients with atopic dermatitis. There was no statistically significant difference in the occurrence of secondary bacterial infection between the groups with and without atopic dermatitisBACKGROUND Although no scientific evidence has yet been published, it is widely understood that molluscum contagiosum tends to be more common and more intense in patients with atopic dermatitis. This lack of evidence led to the development of the present study. OBJECTIVES To evaluate the prevalence of the association between atopic dermatitis and molluscum contagiosum; to evaluate whether molluscum contagiosum is more likely to be recurrent and/or disseminated in patients with atopic dermatitis and whether the occurrence of eczema surrounding the molluscum contagiosum lesions, pruritus and/or infection is more prevalent in these patients compared to patients without atopic dermatitis. METHODS A total of 284 children of both sexes with a diagnosis of molluscum contagiosum and/or atopic dermatitis were evaluated. RESULTS Only 13.4% of the patients had both conditions. The number of anatomical areas affected by molluscum contagiosum and the occurrence of surrounding eczema and pruritus was greater in the patients who also had atopic dermatitis. There was no statistically significant difference in the frequency of secondary infection associated with the molluscum contagiosum lesions between the patients who had atopic dermatitis and those who did not. CONCLUSION The prevalence of atopic dermatitis associated with molluscum contagiosum was low. There was no statistically significant difference in the recurrence rates associated with molluscum contagiosum or in the number of lesions between the patients who had atopic dermatitis and those who did not. The number of anatomical areas affected by the molluscum contagiosum lesions and the presence of surrounding eczema and pruritus were higher in the patients with atopic dermatitis. There was no statistically significant difference in the occurrence of secondary bacterial infection between the groups with and without atopic dermatitis.

Urticária aquagênica familiar: relato de dois casos e revisão da literatura

Aquagenic urticaria is a rare form of physical urticaria, characterized by pruritic wheals that appear following contact with water, independently of its temperature. There are few reports of cases of aquagenic urticaria, and only five include the familial form. We present the first case of familial aquagenic urticaria in Brazil (mother and daughter). Both patients presented wheals following contact with water, especially when showering, regardless of its temperature. The mother reported onset of urticaria four years before and the daughter presented wheals since birth. For diagnostic purposes, they were submitted to a challenge test with water, and both subjects presented wheals, as well as to tests using ice cubes in plastic bag with dermographometer and challenge tests for cholinergic urticaria, with no appearance of lesions, excluding other forms of physical urticaria.

Generalized Lichen nitidus associated with Down's syndrome: case report

Lichen nitidus is a disease of unknown etiology, characterized by flesh-colored, shiny papules of 1-2 mm and generally asymptomatic or with mild pruritus. The most common sites of occurrence are genitalia, upper limbs, trunk and abdomen. The generalized form is rare. This is the fourth reported case of lichen nitidus associated with Down Syndrome.

Prevalência de dermatoses em escolares na região do ABC paulista

BACKGROUND: Literature shows that prevalence of skin diseases in children and adolescents aged 7-14 years is very significant, as well as lack of treatment worsening the situation. OBJECTIVES: An investigative analysis was conducted to determine the prevalence of skin diseases in individuals 714 years and focus on whether or not they are related directly to their respective socio-economic status. METHODS: 200 children and adolescents were examined aged 7-14 years,between August and November 2006,100 children in two public schools located in the periphery and 100 in two private schools located in upper middleclass neighborhood in Santo Andre,located in Sao Paulo.Investigative method used was the clinical examination of the whole skin, mucous areas and palpable ganglia,and the population sample analyzed according to the chi-square. RESULTS: 87.5% of children had some skin disease.46 dermatoses were found,the most important:a)melanocytic nevi (p <0.001);b)acne grade II (p = 0.004);c)pityriasis alba (p <0.001);d)livedo reticularis (p = 0.025); e)pediculosis (p <0.001);f)asteatosis (p <0.001);g) frictional dermatitis (p = 0.007).Small prevalence of skin diseases was observed in children in public schools (53.14%). CONCLUSIONS: This population sample indicated that 87.5% of children had skin diseases,which prevalence was much higher than those found in the literature(30-50%),showing a lightly enhanced prevalence in public schools.The study showed the neglect of parents and caregivers,indicating the need for interference from public policy,which lack certainly is responsible for high rate and can increase it

Avaliação da eficácia e segurança do tacrolimo pomada 0,03% no tratamento da dermatite atópica em pacientes pediátricos

BACKGROUND: Tacrolimus ointment has been shown to be effective in treatment of atopic dermatitis. OBJECTIVES: To evaluate the efficacy and safety of 0.03% tacrolimus ointment (Protopic®) in pediatric patients with mild, moderate and severe atopic dermatitis. METHODS: Open, non-comparative, multicentric study carried out in Brazil. 174 patients (ages from two to 10) with mild to severe atopic dermatitis were included. Patients were instructed to apply Protopic® twice a day for six weeks. Primary efficacy criterion was clinical improvement > 90% assessed by the physician (Clinical Response Global Evaluation Scale). Other efficacy criteria included reduction of the Eczema Area Severity Index (EASI), decrease of the affected body surface area (%BSA) and evaluation of the itching by the patients or their guardians (visual analogical scale). Safety was evaluated by adverse events reported by patients and/or guardians or by investigators. RESULTS: Thirty-three percent of patients showed clinical improvement > 90%. 45.5% of patients (1st week) decreased EASI and 61.8% (6th week) (p<0,001). %BSA decreased 30.4% and 55.5% in the first and sixth week. Improvement was also significant when measured by itching (p<0,001). Most frequentadverse effects were: burning and itching. CONCLUSION: 0.03% tacrolimus ointment is a safe and effective therapy for mild to severe atopic dermatitis in pediatric patients.

Atypical Gianotti-Crosti syndrome

We report the case of a male 22-month-old child, with atypical presentation of Gianotti-Crosti syndrome after infection with Epstein-Barr virus.We report the case of a male 22-month-old child, with atypical presentation of Gianotti-Crosti syndrome after infection with Epstein-Barr virus.

Pyoderma gangrenosum associated with left iliac vein compression syndrome: presentation of difficult diagnosis

Pyoderma gangrenosum is a rare neutrophilic dermatosis of unknown etiology, of which the most frequent clinical manifestations are ulcers. The diagnosis difficulty is, among other things, to rule out other causes of ulcers, since it is considered a diagnosis of exclusion. Skin ulcerations may also occur in the iliac vein compression syndrome, which, like pyoderma gangrenosum, mainly affects young women. Because they have such similar characteristics, the presence of vascular disease may hinder the diagnosis of concurrent pyoderma gangrenosum. Because of the clinical relevance of ulcerated lesions and scars, the early diagnosis and treatment of this condition is considered extremely important. We report a case in which the two diseases were associated, hampering the diagnosis of pyoderma gangrenosum.

Acne arising on a facial Becker nevus following the lines of Blaschko

Dear Editor, Becker nevus (BN) is characterized by a unilateral lesion consisting of hypermelanosis and hypertrichosis. It develops on the upper torso, shoulders, or arms, especially of male adolescents. Most cases are acquired, and the time of onset varies from infancy to adulthood. Although the etiology of this nevus is not yet known, an association with the expression of androgen receptors is proposed.1 Due to an unusual presentation, we report the case of a young adult patient with acne arising on a facial BN following the lines of Blaschko. A 28-year-old male patient complained of a linear, hyperpigmented lesion on the forehead and nose since the age of 15 years. Three years after the onset, the patient repeatedly presented with pustules and nodules only on the right side of the nose, which led to the development of a scar area on the site. Physical examination revealed a linear, hyperpigmented, and brownish macula on the forehead and right side of the nose, with dark terminal hairs. We also observed a scarring area on the same side of the nose, completely sparing the left side and the right nasal wing (Figure 1). Interestingly, the macula closely followed one of the lines of Blaschko on the face (Figure 2). A histopathological study revealed acanthosis and hyperpigmentation of the basal layer in the epidermis (Figure 3). In some areas, the dermis showed smooth muscle hyperplasia, confirming the diagnosis of BN (Figure 3). BN is a cutaneous hamartoma characterized by a generally large hyperpigmented and unilateral area, with irregular borders and dark terminal hairs in about 50% of cases. Although the sites of predilection are shoulders, anterior aspect of the thorax, and scapular region, any other area of the body can be affected. Anatomopathological examinations of BN reveal alterations of the epidermis characterized by acanthosis with regular lengthening of interpapillary ridges. In some cases, papillomatosis is also found. Hyperpigmentation of basal layer cells are observed, and melanophages can be found in the papillary dermis. The number and size of piloerector muscles are increased, often resulting in an indistinguishable aspect from smooth muscle hamartoma (SMH). Acne rarely appears in a segmental manner, usually occurring in cases of mosaicism such as nevus comedonicus, Happle-Tinschert syndrome, and Alpert syndrome. It is also usually associated with epidermal nevi, such as BN. A review of 375 cases demonstrated that most patients (n = 349) were affected by nevus comedonicus, all following the lines of Blaschko.2 In relation to the association with BN, only 10 cases were described, all in the thoracic region with a block-like configuration, none of them following the lines of Blaschko.2 The first description of acne in a BN patient was reported in 740

Dermoscopic patterns of melanocytic nevi in children and adolescents: a cross-sectional study

Background Childhood is a dynamic period regarding nevogenesis. Dermoscopy is a noninvasive technique, recommended for the evaluation of pigmented cutaneous lesions. Objectives The purpose of this study was to describe the structures and dermoscopic patterns of melanocytic nevi observed in children and adolescents. Methods Dermoscopy with photographic documentation was used for nevi located on the face, trunk, and extremities of 38 patients aged from one to 16 years examined at the Pediatric Dermatology Outpatient Clinic of the Federal University of São Paulo. Results The study included 201 skin lesions that were diagnosed as nevi during clinic examination. Upon evaluation of the global dermoscopic pattern of the lesions, the most frequently observed nevi were reticular (39.0%), followed by homogeneous (23.9%) and globular nevi (16.4%). During evaluation of the dermoscopic structures, according to the body site, the pigment network was the most observed in the extremities. Study limitations A limitation to be considered is that the inclusion of small or new lesions may hinder the differentiation between dots and globules. Conclusions In our study, the most observed pattern was reticular. There was a difference in the predominance of structures dependent on the anatomical location.