Sofia Lopes

Lesão Nodular e Ulcerada na Planta Direita de um Doente Imunodeprimido

A 56-year-old man, phototype VI, from Cape Verde, resident in Portugal for 30 years, with a kidney transplant for 2 years on therapy with tacrolimus, mycophenolate mofetil and prednisolone since then, was referred to dermatology consultation due to the appearance of a hyperpigmented patch on his right sole for about 6 months, without history of trauma. The lesion grew progressively, become nodular, ulcerated and painful, with 23 x 28 mm at the time of observation (Fig. 1). On dermoscopy, hyperpigmentation covering papillary ridges and ulceration were observed, without any other characteristic elements (Fig. 2). Histopathology from a skin biopsy was non-specific, revealing epidermal acanthosis and capillary proliferation in the dermis, with swollen endothelium, cellular debris and fusiform cells. There was no immunoreactivity for HHV-8. Complete excision, histological examination (Fig. 3) and microbiological tests of the skin sample were performed. Ziehl-Neelsen was negative. Research for DNA by polymerase chain reaction of Mycobacterium tuberculosis, Mycobacterium marinum, Mycobacterium ulcerans, Mycobacterium avium complex and Sporothrix schenkii was negative. Cultures for bacteria, mycobacteria, parasites and fungi were carried out.

Cutaneous Morbidity Among Inflammatory Bowel Disease Patients: A Cohort Study

Background and AimsnPatients with inflammatory bowel diseases are prone to cutaneous manifestations. The aim of this study was to investigate their prevalence, type and association to demographic and clinical factors.nnnMethodsnThis was a cross-sectional study. Information relative to patients of a central Portuguese hospital with a definitive diagnosis of an inflammatory bowel disease, who were prospectively recruited, was collected.nnnResultsnThe final cohort included 342 patients, 62% of whom had Crohns disease and 38% had ulcerative colitis. Cutaneous extraintestinal manifestations were present in 44.4% of all patients; this prevalence was lower [14.9%] when excluding cutaneous manifestations secondary to nutrition deficiency or drugs. These skin lesions were classified as granulomatous [0.3%], reactive [4.4%], immunologically associated [10.5%] and secondary to nutritional deficiencies [6.4%] or to bowel-related therapy [29.5%]. Excluding those secondary to nutrition or drugs, cutaneous manifestations were significantly associated with females (odds ratio [OR] 3.210 [1.625-6.340], p = 0.001) and younger patients (OR 0.954 [0.924-0.985], p = 0.004). Additionally, their occurrence was related to patients up to 16 years (OR 13.875 [1.332-144.484], p = 0.028) among the Crohns disease sub-cohort, whereas in the ulcerative colitis sub-cohort they were more likely to occur in patients with extensive colitis (OR 5.317 [1.552-18.214], p = 0.008).nnnConclusionsnNearly half of the patients analysed had at least one cutaneous extraintestinal manifestation. The fact that certain lesions tend to be more common among patients with defined characteristics should alert the physicians and allow an early diagnosis and, when pertinent, a reference to dermatology.

Flat-topped papules arising in a young woman's tattoo

A 21-year-old female presented with asymptomatic verrucous lesions evolving during the last 4 years in an infraumbilical tattoo made 6 years ago. She had no relevant medical history. Clinical examination revealed multiple discrete flat-topped skin-colored papules (Fig. 1). They were smooth and had a uniform dimension around 2 mm of diameter, diffusely distributed in the most pigmented areas of the abdominal tattoo (Fig. 2). She had two more tattoos in different regions of the body, made in different times, without associated lesions.

Dermatoscopy of flat pigmented facial lesions—the evolution of lentigo maligna

Recognition of facial lentigo maligna (LM) is often difficult, particularly at early stages. Algorithms and multivariate diagnostic models have recently been elaborated on the attempt to improve the diagnostic accuracy. We conducted a cross-sectional and retrospective study to evaluate dermatoscopic criteria aiding in diagnosis of flat pigmented facial lesions (FPFL). We examined 46 FPFL in 42 Caucasian patients and found that 4 of 20 dermatoscopic criteria reached the significance level required for features indicating malignancy namely, hyperpigmented follicular openings, obliterated follicular opening, annular-granular structures, and pigment rhomboids. Concomitant presence of at least 2 or 3 of the 4 mentioned criteria was significantly more frequent in LM than in pigmented actinic keratosis (PAK). However, despite more frequently seen in LM, these features were also displayed in some of the PAK and other FPFL, so we found them not specific for LM. Although dermatoscopy enhances the diagnostic accuracy in evaluating FPFL, histopathology remains the gold standard for correct diagnosis, making evident the need for improvements in early noninvasive diagnosis of LM.

Topical timolol for the treatment of pyoderma gangrenosum

Treatment of pyoderma gangrenosum (PG) remains a challenge, and there are currently no specific or uniformly effective therapies. Although widespread or rapidly progressive disease often requires systemic treatment, localised and mild lesions may be effectively controlled with topical agents. The most frequently applied topical drugs are corticosteroids and calcineurin inhibitors. Recently, a patient with idiopathic PG of the lower limb was successfully treated with topical timolol and collagenase. Here, we report a case of a patient with collagenous colitis, ankylosing spondylitis and periumbilical PG. Persistent ulcerated skin lesions were successfully treated with topical timolol, although a flare of the underlying bowel disease temporarily interrupted the improvement. The case presented enhances the previously reported therapeutic potential of topical timolol in the treatment of PG. Control of chronic underlying disorders is critical to prevent rebound flares and maintain the benefit.

Bluish nodules of the breast in an adolescent girl

A 15-year-old girl was referred due to skin lesions of the right breast, which had first been noticed shortly after birth and had enlarged slowly with the patients growth but more rapidly in the past few years. Family history disclosed that the patients father had similar lesions on the left shoulder. Physical examination revealed multiple bluish coalescent soft nodules on the right breast, which were slightly tender to palpation (figure 1). Histological examination demonstrated dilated irregular vascular channels surrounded by endothelial cells and one to several layers of uniform cuboidal cells with a pale or faintly eosinophilic cytoplasm (figure 2). These features were consistent with the diagnosis of glomuvenous malformation (GVM).nnnnFigurexa01 nClinical presentation. Multiple well-defined bluish to purple coalescent soft and slightly tender nodules on the right breast.nnnnnnFigurexa02 nHistopathological findings. Dilated capillaries containing erythrocytes. Layers of glomus cells surrounding capillaries (H&E, original magnification ×100).nnnnGVM, …

P347 Severe scalp and skin involvement in Crohn's disease patients under treatment with anti-tumor necrosis factor alpha

P346 Short term dose tailoring of anti TNF-a therapy delivers useful clinical efficacy in Crohn’s disease patients with secondary loss of response S. Ghaly1 *, S. Costello2, L. Beswick3, A. Pudipeddi4, A. Agarwal2, A. Sechi5, B. Headon3, R. Prosser6, S. Connor5, I.C. Lawrance7, M. Sparrow3, P. Bampton6, A. Walsh4, J. Andrews2. 1St. Vincent’s Hospital, University of New South Wales, Department of Gastroenterology, Sydney, Australia, 2Royal Adelaide Hospital, Department of Gastroenterology, Adelaide, Australia, 3The Alfred Hospital, Department of Gastroenterology, Melbourne, Australia, 4St. Vincent’s Hospital, Department of Gastroenterology, Sydney, Australia, 5Liverpool Hospital, Department of Gastroenterology, Sydney, Australia, 6Flinders Medical Centre, Department of Gastroenterology, Adelaide, Australia, 7Fremantle Hospital, Centre for Inflammatory Bowel Disease, Fremantle, Australia