Thais Helena Proença de Freitas

Associação entre líquen plano e infecção pelo vírus da hepatite C: um estudo prospectivo envolvendo 66 pacientes da clínica de dermatologia da Santa Casa de Misericórdia de São Paulo

BACKGROUND: Lichen planus is a chronic inflammatory dermatosis of unknown etiology. Its association with liver diseases, particularly hepatitis C, has been widely approached since 1990, when serology for the detection of hepatitis C virus became available. OBJECTIVES: The objective of this study was to evaluate a possible causal relation between virus C infection and lichen planus. METHODS: Sixty-six patients with lichen planus seen at the Dermatology Department of Santa Casa de Misericorida de Sao Paulo from 2000 to 2003 were included in the study group. The control group comprised volunteer blood donors of the Blood Bank of Santa Casa de Misericorida de Sao Paulo, from October 2001 to October 2002. RESULTS: Five out of the 66 patients with lichen planus had a positive serology for HCV, representing 7.5% in comparison with 0.69% of the blood donors. CONCLUSIONS: Our findings are consistent with those reported in the medical literature. However, further studies are necessary to improve our knowledge on such a controversial relation.

Sulfasalazine-induced DRESS syndrome (Drug Rash with Eosinophilia and Systemic Symptoms)

CONTEXT DRESS syndrome (Drug Rash with Eosinophilia and Systemic Symptoms) is a type of drug reaction commonly mistaken for a viral infection. It must be recognized promptly due to its high morbidity and 10% mortality rate. Few cases of DRESS syndrome induced by sulfasalazine have been reported in the literature. CASE REPORT The case of a 47-year-old white Brazilian woman who developed DRESS syndrome eight weeks after starting a course of sulfasalazine for treatment of seronegative arthritis is reported. She presented a skin rash, fever, hepatitis, lymphadenopathy, eosinophilia and atypical lymphocytes. The causative drug was discontinued immediately, but she only improved after treatment with prednisone.

Lupus eritematoso cutâneo crônico: estudo de 290 pacientes

BACKGROUND: Chronic cutaneous lupus erythematosus is a chronic inflammatory disease, which albeit relatively frequent, has been the object of few studies. OBJECTIVE: To characterize the epidemiological and clinical aspects of patients with chronic cutaneous lupus erythematosus, with a view to comparing the data obtained with the world literature. PATIENTS AND METHODS: A retrospective study was done on 290 patients with chronic cutaneous lupus erythematosus from 1982 to 1996, attended at the Dermatology Clinic of Hospital Santa Casa de Sao Paulo. RESULTS: The mean age at onset of the disease was 32.3 years, there was a female prevalence in relation to males (3.4:1), most of the patients had lesions located in the cephalic segment (58.3%). Regarding the clinical types, there was a prevalence of the typical discoid plaque in 90.4% of cases, followed by the verrucous or hypertrophic forms (7.9%), erythematous lupus pernio (1.4%) and tumid (0.3%). Lesions in the mucous membranes or transition epithelia occurred in 27.2% of the patients. CONCLUSIONS: Chronic cutaneous lupus erythematosus is a disease more frequent in adult women and the most common lesion is the typical discoid plaque. Mucous lesions occurred in approximately one fourth of the cases.

Severe Multi-Resistant Pemphigus vulgaris: prolonged remission with a single cycle of Rituximab

Pemphigus vulgaris is an autoimmune bullous disease whose therapy is based on systemic corticosteroids, with or without immunosuppressants. Rituximab is a chimeric monoclonal antibody of the IgG class, directed at a specific CD20 B cell surface antigen, used in pemphigus vulgaris empirically since 2002, with success in 90% of the cases and long periods of remission. Male patient, 33 years old, diagnosed with pemphigus vulgaris, confirmed by histopathology and direct immunofluorescence. He was treated for seven months with numerous treatments, including immunosuppressive drugs, with an unsatisfactory response, until he had complete remission with the use of rituximab. During a 34-month follow-up period, the patient presented a slight clinical relapse, which was successfully controlled with prednisone in a daily dose of 120mg, soon reduced to 20mg.

Mieloma múltiplo com plasmocitomas cutâneos

Multiple myeloma is a malignant proliferation of plasma cells which infiltrate bone marrow; cutaneous involvement with plasma cell neoplasms is uncommon, and may be nonspecific or specific. The specific dermatologic lesions arise either as a direct extension from the underlying bone lesions or by metastatic accumulation in the form of nodules and plaques. The authors report the case of a 59-year-old male patient with multiple myeloma, who developed cutaneous plasmacytomas (violaceous nodules on the limbs) seven months after the disease diagnosis.

Estudo clínico de 35 pacientes com diagnóstico de erisipela internados no Hospital Central da Irmandade da Santa Casa de Misericórdia de São Paulo

FUNDAMENTOS: Erisipela e celulite sao infeccoes cutâneas frequentes. OBJETIVOS: Com o objetivo de avaliar incidencia, fatores de risco, principais complicacoes, esquemas terapeuticos utilizados e evolucao. METODOS: Foram estudados 35 pacientes com diagnostico de erisipela internados nas enfermarias do Hospital Central da Irmandade da Santa Casa de Misericordia de Sao Paulo no periodo de abril a agosto de 2002. RESULTADOS: A incidencia de pacientes com diagnostico de erisipela no periodo estudado foi de 0,87%. O fator de risco local mais encontrado foi o linfedema, seguido por episodios previos de erisipela. Dos fatores de risco gerais, aqueles que comprometem a imunidade, como diabetes mellitus, etilismo e neoplasias, foram os mais observados em associacao ao quadro de infeccao dermatologica. Sinais inflamatorios locais foram encontrados em 97,8% dos casos. Verificaram-se quatro casos com complicacoes: necrose, abscesso, trombose venosa profunda e septicemia. A evolucao dos pacientes foi satisfatoria em mais de 97% dos casos. CONCLUSOES: O tratamento com penicilina cristalina foi associado ao menor numero de complicacoes (p<0,05) e ao menor custo (p<0,05), e a associacao de anticoagulantes a terapia evidenciou menor incidencia de complicacoes (p<0,05).

Corticosteróides sistêmicos na prática dermatológica. Parte I: Principais efeitos adversos

Systemic corticosteroids have been used in dermatological practice for approximately 60 years due to their anti-inflammatory and immunosuppressive effects. The challenge of corticosteroid therapy is to counterbalance the desirable actions and undesirable pharmacological effects. Unfortunately, advanced understanding of the mechanisms of action of corticosteroids has not resulted in the development of minimal toxicity regimens. In this article, we report the main pharmacological properties of systemic corticosteroids, their major indications in clinical practice and the adverse effects of high doses and/or prolonged administration.

Skin gangrene as an extraintestinal manifestation of inflammatory bowel disease.

Inflammatory bowel diseases can commonly present many cutaneous lesions which can contribute to the diagnosis of the disease or its activity. The most frequent cutaneous or mucocutaneous manifestations suggesting ulcerative rectocolitis activity are erythema nodosum (3-10%), pyoderma gangrenosum (5-12%) and aphthous stomatitis (4%). Other reactive skin manifestations related to immunological mechanisms associated with the inflammatory bowel disease are: Sweets syndrome, arthritis-dermatitis syndrome associated with inflammatory bowel disease and leukocytoclastic vasculitis. We describe the case of a young man with diagnosis of ulcerative rectocolitis, which presented an extensive cutaneous gangrene secondary to microvascular thrombosis. The case represents a dermatologic rarity and should be recognized as a cutaneous manifestation related to the hypercoagulability state observed in the diseases activity.

Corticosteróides sistêmicos na prática dermatológica. Parte II: estratégias para minimizar os efeitos adversos

The beneficial effects of systemic corticosteroids in treatment and/or control of several skin diseases are unquestionable. Nevertheless, dermatologists should be aware of the main adverse effects of these drugs and do what is necessary to avoid any harm to patients. The authors report the measures physicians should take before and during glucocorticoid therapy, so that any complications be immediately diagnosed and treated.