Teresa Pereira

Indeterminate cell histiocytosis in association with acute myeloid leukemia.

Indeterminate cell histiocytosis (ICH) is a rare proliferative disorder, in which the predominant cells share morphologic and immunophenotypic features from both Langerhans and non-Langerhans cell histiocytosis. We describe a 62-year-old man presenting a 2-month history of firm nodular lesions on the upper lip. Histopathology, immunohistochemical, and ultrastructural analysis showed typical findings of ICH. The patient was treated with thalidomide and almost complete regression of the lesions was reached within 7 months. Nevertheless, one month after remission, he developed an acute myeloid leukemia of the subtype monocytic leukemia (M5). The patients condition rapidly worsened and he died due to a respiratory failure four weeks later. We present this case because apart of being rare it joins the effectiveness of thalidomide and the association with an acute monocytic leukemia. A review of the literature is made.

Rosacea with extensive extrafacial lesions

Rosacea is a very common skin disorder in the clinical practice that primarily affects the convex areas of the face. Extrafacial rosacea lesions have occasionally been described, but extensive involvement is exceptional. In the absence of its typical clinical or histological features, the diagnosis of extrafacial rosacea may be problematic. We describe an unusual case of rosacea with very exuberant extrafacial lesions, when compared with the limited involvement of the face.

Contact dermatitis due to Centella asiatica

Fig. 1. Positive reaction to Centella asiatica extract (1% and 5% pet.). phlebitis, cellulitis, and striae distensae (1). It is claimed to have actions on various phases of wound repair, stimulating extracellular matrix accumulation and collagen synthesis. Centella contains several active constituents, of which the most important are the triterpenoid saponins–asiaticoside, madecassoside, and asiatic acid (1).

Allergic contact dermatitis caused by (meth)acrylates in nail cosmetic products in users and nail technicians – a 5-year study

The increasing use of long‐lasting nail aesthetic products has led to a growing number of cases of allergic contact dermatitis (ACD) caused by (meth)acrylates in recent years.

Late-onset of eruptive syringomas: a diagnostic challenge

Syringoma is a benign, adnexal tumor of the eccrine sweat gland ducts. Eruptive syringomas are a rare variant, occurring before or during puberty in most cases. A 57-year-old man was observed in our department, with a 10-year history of multiple brownish papules (1-4mm in diameter), localized on the neck, shoulders, trunk and axillae. The clinical diagnosis was cutaneous mastocytosis. Histopathological examination from a papule in the trunk was compatible with the diagnosis of syringoma. The patient was treated with isotretinoin, without any improvement. The clinical diagnosis of eruptive syringoma is diffi cult and histological examination is crucial for its diagnosis. Long-term morbidity is not associated with syringomas; they are treated for cosmetic reasons with unsatisfactory results.

Occupational Protein Contact Dermatitis: Two Case Reports

Protein contact dermatitis (PCD) is a contact dermatitis caused by high-molecular-weight proteins. This entity has been reported with increasing frequency, most commonly as occupational hand dermatitis in food handlers. Clinically, it is characterized by a chronic and recurrent dermatitis with erythema, scaling, and fissures with acute exacerbations occurring a few minutes after contact with offending allergen. We report two cases in confectioners who presented with chronic hand dermatitis.

Eczema das Mãos: Qualidade de Vida e Gravidade da Doença numa População Portuguesa

Introduction: Hand eczema is a very common disease with a significant social and occupational impact. Objectives: To characterize a Portuguese outpatient population with hand eczema; to evaluate the impairment of the disease in quality of life (QoL); to relate the disease severity with QoL. Methods: The authors designed a prospective study. Information about atopy, psoriasis, occupational exposure and duration of disease, was recorded. The QoL was assessed by the DLQI questionnaire (Dermatology Life Quality Index) and the severity was assessed using the hand eczema severity index (HECSI). All participants were patch tested. Results: Eighty-five patients were included with a female predominance (78.8%). The median DLQI was 9.0. We found statistically significant differences in the variable HECSI between genders with greater impact in males. A significant positive correlation was found between HECSI and DLQI. DLQI and HECSI were independent of atopy, psoriasis or etiology. Increasing age significantly affects DLQI but not HECSI. Conclusions: Hand eczema has a significant impact in QoL. Although the disease is more prevalent among women it was found to be of greater severity among men. The QoL seems to be influenced by disease severity and increasing age but it was independent of the other studied variables.

Erythema multiforme major induced by exotic wood

A 51-year-old male construction worker with type 2 diabetes mellitus, hypertension, and dyslipidaemia, treated for several years with metformin, olmesartan/amlodipine, and atorvastatin, was admitted to the department of dermatology because of the sudden appearance of facial oedema accompanied by erythema and tense bullae with onset in the head, neck, and upper limbs, evolving during 3 days. Later, the intense pruritic dermatosis progressed to the trunk and, to a lesser extent, the lower limbs. Dermatological examination showed target lesions, some with tense bullae arranged on the margins, on the upper limbs, trunk, and lower limbs (Figures 1–3). Cutaneous detachment and erosions were present on <20% of the body surface area, particularly on the back, and the Nikolsky sign was positive. There were also erosions of the oral mucosa and oedema of the glans penis. This clinical picture suggested a case of erythema multiforme major. Laboratory examinations, namely infectious serological investigations for herpes simplex virus, Epstein-Barr virus, cytomegalovirus, and Mycoplasma pneumoniae, gave unremarkable findings. A skin biopsy taken from a target lesion of the left arm showed the formation of subepidermal blisters containing lymphocytes mixed with eosinophils and necrotic keratinocytes, which are aspects compatible with the clinical diagnosis of bullous erythema multiforme. The patient was treated with prednisolone and intravenous immunoglobulins, with progressive clinical improvement. Skin and mucosal lesions completely resolved within 2 weeks. The patient denied previous viral infection, particularly with herpes virus, or the introduction of new drugs. However, after detailed questioning, he revealed that, in the week previous to the onset of the dermatosis, he had handled a different exotic wood (pao santo/ ferro; M. scleroxylon Tul.) at his workplace. One month after the dermatitis had healed, patch tests with the Portuguese Contact Dermatitis Group baseline series and sawdust of

Herpes simplex virus type 1: an atypical presentation of primary infection

A 3-year-old female child with personal history of atopic dermatitis presented with confluent vesicular and shallow ulcers pruritic rash surrounded by an erythematous base located to both hands and wrists, with 1-week evolution. She had no fever or other symptoms. There was no personal or family history of herpetic infections. Topical antibiotic, topical corticosteroid and oral antihistaminic were tried with no improvement. Physical examination was unremarkable except for generalised dry skin and lesions in figure 1. On suspicion of superinfected viral rash or bullous impetigo she was treated with oral …

Sweet's syndrome associated with cellulitis - a challenging diagnosis

Sweets syndrome is a neutrophilic dermatosis with worldwide distribution that has been associated with inflammatory autoimmune diseases, infections, malignancies, drugs, and pregnancy. The disease is idiopathic in up to 50% of patients. A 64-year-old woman, diagnosed with right limb cellulitis (4 days of evolution), was seen at our department, due to persistent cellulitis and progressive appearance of painful nodules and plaques in both shins and the right forearm (2 days of evolution). Taken together, clinical, laboratory and pathological data suggested the diagnosis of Sweets syndrome, probably secondary to cellulitis of the right inferior limb. We suggest that cellulitis may be associated with Sweets syndrome, a rare association in the literature.