Oral lichen planus in a young patient: a case report with nine-year follow-up / Líquen plano oral em paciente jovem: um relato de caso com acompanhamento de nove anos

INTRODUCTION: Oral lichen planus is an inflammatory condition that affects the stratified squamous epithelium of the oral mucosa. It occurs more frequently in female patients and it is rarely observed in children, adolescents, or young adults. This study aims to report a case of oral lichen planus in a young patient with a nine-year followup. CASE REPORT: A 19-year-old man reported to the Dentistry Department with a complaint of an asymptomatic white lesion on the dorsum and left lateral border of his tongue, which had appeared a few weeks before. Two weeks later, a second lesion, very similar to the previous one, appeared on the central region of his tongue. An incisional biopsy was performed. The histological slides were stained with hematoxylin-eosin and the expression of interleukin-1beta (IL-1ß) and tumor necrosis factor-alpha (TNF-α) was assessed by immunohistochemistry. No pharmacological treatment was prescribed. The clinical and histopathological findings were suggestive of oral lichen planus. The IL-1ß/TNF-α expression was low. There was a spontaneous regression of the lesions after approximately one year. The nine-year follow-up showed no signs of recurrence. CONCLUSION: This case presents atypical features such as the age of the patient and the spontaneous remission of the lesions.

INTRODUÇÃO: O líquen plano oral é uma condição inflamatória que acomete o epitélio escamoso estratificado da mucosa oral. Ocorre mais frequentemente em pacientes do gênero feminino e é raramente encontrado em pacientes pediátricos ou juvenis. O objetivo do presente estudo é relatar um caso de líquen plano oral em um paciente jovem com acompanhamento de nove anos. RELATO DE CASO: Um rapaz de 19 anos procurou atendimento no Departamento de Odontologia com a queixa de uma lesão branca assintomática em região de dorso e borda lateral esquerda de sua língua, com tempo de evolução de algumas semanas. Duas semanas depois, uma segunda lesão, muito similar à primeira, apareceu na região central de sua língua. Uma biópsia incisional foi realizada. As lâminas histológicas foram coradas com hematoxilina-eosina e a expressão de interleucina-1beta (IL-1ß) e de fator de necrose tumoral alfa (TNF-α) foram avaliadas por imunohistoquímica. Nenhum tratamento farmacológico foi prescrito. Os achados clínicos e histopatológicos foram sugestivos de líquen plano oral. A expressão de IL-1ß/TNF-α foi baixa. Houve uma regressão espontânea das lesões após aproximadamente um ano. O acompanhamento de nove anos não detectou sinais de recorrência. CONCLUSÃO: Esse caso apresenta características atípicas, como a idade do paciente e a remissão espontânea das lesões.

Histopathological changes in epithelium of hair follicles and acrosyringium caused by measles in child

Abstract Some epidermal alterations in measles has been described, such as keratinocytes apoptotic, parakeratosis, giant-cell formation, intranuclear and cytoplasmic inclusions, dyskeratosis, spongiosis, and intracellular edema. The authors report for the first time in human a case of measles with the presence of multinucleated giant cells in the hair follicle and dyskeratosis in acrosyringium.

Caso de paraqueratosis pustulosa: entidad poco frecuente y síntoma de enfermedad inflamatoria del aparato ungueal en pacientes pediátricos / Case of pustular parakeratosis: a rare entity common and symptom of inflammatory disease of the nail apparatus in pediatric patients

La paraqueratosis pustulosa es una entidad poco descrita en la literatura y se define como un proceso inflamatorio cutáneo, ungueal y periungueal en el área distal de un dedo habitualmente pulgar o índice, frecuentemente en la infancia. Su evolución suele ser benigna y la respuesta a emolientes tópicos es favorable. A continuación, se presenta un caso de esta enfermedad con el objetivo de resaltar su consideración en patologías ungueales pediátricas.

Pustular parakeratosis is an entity scantly described in literature. It has been described as a skin, nail, and periungual inflammatory process in the distal area of a finger, usually the thumb or index finger, frequently in childhood. Its evolution is usually benign and management is favorable with topical emollients. A clinical case is presented, to raise awareness of this entity in pediatric nail pathologies.

Nail clipping in onychomycosis and comparison with normal nails and ungual psoriasis

Abstract: Background: Of all nail disorders seen in dermatology offices, half of them are due to onychomycosis. The main differential diagnosis is nail psoriasis. The objective of this study was to compare the microscopic findings, other than the presence of fungi, in the clipping of onychomycosis versus normal nails and nail psoriasis. Methods: Cross-sectional study of onychomycosis cases, analyzed by clipping and compared with data on normal nails and those with nail psoriasis. Results: Sixty-two onychomycosis samples were compared with 30 normal nails and 50 nails with psoriasis. In onychomycosis, measurement of subungual region, serous lakes, neutrophils and number of layers of parakeratosis are more intense than in psoriasis. Onychocariosis is less common in psoriasis, while bacteria are more frequent. The nail transition zone is more commonly blurred and irregular in onychomycosis. Conclusion: Clipping helps in the differential diagnosis of onychomycosis and nail psoriasis and may be useful even when fungi are not found.

Porokeratotic eccrine and hair follicle nevus: a report of two cases and review of the literature

Abstract: Porokeratotic eccrine and hair follicle nevus is a very rare non-hereditary disorder of keratinization with eccrine and hair follicle involvement with only 9 cases described in the literature. In 2009 the term porokeratotic anexial ostial nevus was proposed to comprehend porokeratotic eccrine and hair follicle nevus and a related and more common process without follicular involvement: porokeratotic eccrine ostial and dermal duct nevus Recent findings suggest that both entities may be produced by a mutation in GJB2 gene, which is associated to KID syndrome. Herein we report 2 cases of porokeratotic eccrine and hair follicle nevus and review the existing cases in the Spanish and English literature.

Incidence, clinical manifestations and clipping of nail psoriasis in the dermatology center of the Hospital Universitário Evangélico de Curitiba

Abstract: Background: Psoriasis is a chronic inflammatory skin disease that often progresses with nail alterations. It is suspected that there is a correlation between nail psoriasis and enthesitis of the distal interphalangeal joint, seeming to serve as a predictor. Objectives: To analyze the profile of patients with nail psoriasis and correlate the presence of nail alterations with psoriatic arthritis, quality of life, extent of psoriasis and the histopathology of the nail. Methods: An observational cross-sectional study with 40 patients with a diagnosis of psoriasis and without systemic treatment. The patient profile was researched, including quality of life and evaluated for the presence of psoriatic arthritis. The severity of the skin psoriasis and the presence of nail lesions were evaluated. Nail fragments were collected and analyzed through clipping. It obtained 100% of positivity for psoriasis in the histopathology exam of the nail plate. Results: Of the 40 patients, 65% were diagnosed with nail psoriasis. Suggestive findings of psoriatic arthritis in hands were present in 33%, being more frequent in those with nail alteration (p = 0.01). In 92.3% of patients diagnosed with psoriatic arthritis in the hands there was some nail injury. The most frequent injuries were pitting and onycholysis. Conclusions: Patients with nail psoriasis are usually men, with worse quality of life and higher chance of psoriatic arthritis. The correlation between the nail involvement of psoriasis and psoriatic arthritis in hands confirms the association between these two forms. The clinical diagnosis of nail psoriasis did not correlate with the histological diagnosis.

Paraqueratosis granular: revisión de la literatura a propósito de un caso / Granular parakeratosis: review of the literature apropos of a case

La paraqueratosis granular es un desorden de la queratinización adquirido, secundario a un error en la diferenciación epidérmica. Se presenta en forma de pápulas y placas pruriginosas, eritematosas o de color marrón oscuro, que afectan áreas intertriginosas. Su patogénesis es desconocida, pero algunos casos han sido relacionados con ciertos factores, tales como irritantes físicos o agentes químicos. Entre los hallazgos histopatológicos se incluyen un estrato córneo engrosado, paraqueratosis compacta con retención de gránulos de queratohialina, mientras que el estrato granuloso está preservado. Presentamos un caso de paraqueratosis granular axilar en una mujer y se revisan las principales características clínicas, histológicas y terapéuticas de esta inusual entidad.

Granular parakeratosis is a rare acquired keratinization disorder suspected as a consequence of an error in epidermal differentiation. Clinically it appears as dark or erythematous pruritic papules and plaques, that usually involve intertriginous areas. The pathogenesis of this entity is unknown, but some cases have been related to different factors, such as physical irritation or chemical agents. Histopathologic features include a thickened stratum corneum, compact parakeratosis with retention of keratohyalin granules whereas the stratum granulosum is preserved. We report a case of axillary granular parakeratosis in an adult female and a revision of the clinical, therapeutic and histological features of this unusual entity

Paraqueratosis granulosa en niños / Granular parakeratosis in children

La paraqueratosis granulosa es una enfermedad cutánea benigna, de etiología poco clara. Se considera una alteración adquirida de la queratinización en la que persisten los gránulos de profilagrina en la capa córnea. Clínicamente se manifiesta con pápulas eritematosas o café parduscas con hiperqueratosis, las cuales pueden ser coalescentes,y formar placas con hiperpigmentación variable, ser de presentación unilateral o bilateral, localizadas en áreas intertriginosas con irritación crónica (región axilar, inframamaria, inguinal), en el área abdominal y lumbosacra, principalmente en los pliegues o zonas con oclusión. El prurito se encuentra asociado en forma variable. En el estudio histopatológico se ha demostrado papilomatosis y acantosis, con un estrato córneo paraqueratósico engrosado y numerosos gránulos basófilos en los corneocitos. La mayoría de reportes a nivel mundial han sido de casos en adultos y pocos reportes en niños, por lo que se presenta un caso de paraqueratosis granulosa en un niño colombiano y se hace una revisión del tema.

Características histopatológicas de la leucoplasia bucal homogénea / Histological and pathological characteristics of the homogeneous oral leucoplakia

Se efectuó un estudio descriptivo, transversal, retrospectivo y analítico de 35 pacientes con leucoplasia bucal homogénea asociada al hábito de fumar, atendidos en la consulta de Cirugía Maxilofacial del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba desde enero de 2007 hasta igual mes de 2009, con vistas a determinar la presencia de alteraciones de la queratinización como paraqueratosis, ortoqueratosis y disqueratosis, pero también de displasia epitelial. La información primaria se obtuvo a través del estudio histopatológico de las biopsias realizadas y procesadas en el Departamento de Anatomía Patológica de la mencionada institución. La característica microscópica distintiva fue la hiperparaqueratosis, existiese desarrollo anormal de tejido o no.

A descriptive, retrospective, cross-sectional, and analytical study of 35 patients with homogeneous oral leucoplakia associated to the smoking habit, assisted at the Outpatient Department of Maxillofacial Surgery from Dr Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba was carried out from January, 2007 to the same month of 2009, aimed at determining the presence not only of changes of keratinisation as parakeratosis, orthokeratosis, and dyskeratosis, but also of epithelial dysplasia. The primary information was obtained through the histological-pathological study of the biopsies processed in the Pathology Department of the aforementioned institution. The distinctive microscopic characteristic was the hyperparakeratosis, with the presence of the abnormal development of the tissue or without it.

Paraqueratosis granular: descripción de un caso y revisión de la literatura / Granular parakeratosis, report of a case and review of the literatura

La paraqueratosis granular es una dermatosis de probable etiología reaccional descripta en la última década. Se presenta como pápulas hiperqueratósicas y eritematosas que confluyen formando placas de aspecto reticulado. Predomina en mujeres de entre 50 y 60 años, en zona de pliegues, particularmente axilares. Comunicamos un caso de paraqueratosis granular axilar, el primero dentro de la literatura médica argentina, y revisamos la bibliografía sobre el tema.

Granular parakeratosis is a cutaneous eruption probably due to a re-active mechanism described during the past decade. It has hyper-keratotic erythematous papules that coalesce into reticular plaques.Women are mostly affected, in their 5th to 6th decade, with a prefer-ence for axillary folds. This is the first report of a patient a with axillarygranular parakeratosis in Argentina, and review the medical literature on this condition.

Acrodermatitis enteropática / Acrodermatitis enteropathica

La acrodermatitis enteropática es una rara patología de herenciaautosómica recesiva ocasionada por una deficiente absorcióndel zinc de la dieta. Se caracteriza por la tríada de alopecía,diarrea y dermatitis acral y periorificial. Se presenta una paciente de 11 meses de edad con síntomas característicos cuyo diagnóstico fue confirmado por bajos niveles plasmáticos de zinc (37,7 µg%). Se realizó tratamiento consulfato de zinc a dosis de 5 mg/kg/día con evolución claramente favorable.

Acrodermatitis enteropathica is a rare autosomal recesive disorder, caused by impaired absorption of zinc dietary intake. It is characterized by a triad of alopecia, diarrhea and acral and periorificial dermatitis. We report an 11 month-old girl with tipical symptoms in whom the diagnosis was confirmed by decreased plasma zinc level (37,7 µg%). The patient was given zinc sulfate 5 mg/kg/day and showed marked improvement.

Paraqueratosis granular / Granular parakeratosis

La paraqueratosis granular es un fenómeno histológico con características clínicas variables en áreas intertriginosas; su presentación en el pliegue axilar puede ser unilateral o bilateral y suele acompañarse de prurito y placas hiperqueratósicas. Se presenta el caso de un paciente varón de 80 años de edad, quien refiere un cuadro de seis meses de evolución caracterizado por ardor y prurito en ambas axilas y sensación de cuerpo extraño. Se encontró placas hiperqueratósicas, hiperpigmentadas localizadas en axilas, de forma bilateral, con un predominio en el lado izquierdo. La histología demostró paraqueratosis con un mantenimiento del estrato granuloso y retención de gránulos de queratohialina a lo largo del estrato córneo.

Cambios histopatológicos de la mucosa gingival en masticadores de hoja de coca varones del distrito de Laraos, Provincia de Yauyos / Hystopathological changes of the gingival mucosa in the coca leaves chewer's males of district of Laraos, Province of Yauyos

El presente estudio tuvo como objetivo describir los cambios histopatológicos de la mucosa gingival. El estudio se realizó en el Puesto de Salud del Distrito de Laraos, provincia de Yauyos, en donde el hábito de la masticación de hojas de coca sigue vigente. El grupo de estudio estuvo conformado por 30 masticadores de hoja de coca, varones de 40 a 61 años de edad y el grupo control por 30 no masticadores de hoja de coca, cuyas edades y características fueron similares al grupo de estudio. Para la selección de la muestra se utilizó una ficha de selección de acuerdo a los criterios establecidos. Los datos encontrados se registraron en una ficha de Registro Histológico. La prueba Chi cuadrada para variables cualitativas con un nivel de significancia de 95 por ciento nos indican una asociación altamente significativa entre acantosis e hiperparaqueratosis (p = 0,010, p = 0,020 respectivamente) y el hábito de la masticación de hojas de coca. Es decir, el epitelio del masticador de hoja de coca pasa de un epitelio paraqueratinizado o queratinizado a un epitelio hiperparaqueratósico sin mostrar cambios malignos. No se encontró diferencia significativa (p mayor que 0,05) entre los cambios histopatológicos a nivel del tejido conectivo con el hábito de la masticación de hojas de coca.

The present study had the objective to describe the hystopathological changes of the gingival mucosa. The study was made at the “Puesto de Salud Laraos”, province of Yauyos, in where the habit of the coca leaves chewing follows effective. The study group was conformed by 30 men coca leaves chewers of 40 to 61 years old and the control group by 30 men non coca leaves chewers, whose ages and characteristics were similar to the study group. For the selection of the sample, a card of selection according to the established criteria was used. The found data were registered in an Histological Data card. The Chi Square test for qualitative variables with a level a significance of 95% indicates a high significant association between acanthosis and hyperparakeratosis (p=0,010, p=0,020 respectively) and the habit of the coca leaves chewing. Consequently, the coca leaves chewers’ epithelia go from a parakeratinized or queratinized epithelia to a hiperparakeratosic epithelia without showing malignant changes. There was no significant difference (p > 0,05) between the histopathological changes in the connective tissue with the habit of coca leaves chewing.

Granular parakeratosis

This is a report of a 60 year-old black female patient presenting with pruritic brownish crusted plaques on both axillae of one month evolution. Histopathology revealed findings characteristic of axillary granular parakeratosis. This entity was first described by Northcutt et al in 1991. Since then, involvement of other intertriginous areas have also been reported. A review of the literature was performed and the term granular parakeratosis is suggested to emphasize its pathognomonic histopathologic features

Paraqueratosis granulosa de la axila / Axillary granular parakeratosis

La paraqueratosis granulosa de la axila es un transtorno adquirido de la cornificación, en el cual la capa córnea es muy gruesa y conserva los gránulos de profilagrina (queratohialina). Se han publicado 32 casos desde su descripción en 1991, de Estados Unidos, Europa y Australia. No conocemos informes de la entidad en Latinoamérica. Estudiamos tres mujeres obesas que presentaron pápulas y placas axilares, costrosas, hiperqueratósicas e hiperpigmentadas, que se diagnosticaron clínicamente como pénfigo familiar benigno o tinea nigra. Las biopsias mostraron enorme capa córnea paraqueratósica con aspecto basófilo dado por la presencia de gránulos de queratohialina, identificados con la hematoxilina-eosina y con microscopía electrónica del tejido obtenido del bloque de parafina. La inmunohistoquímica para S-100 no demostró células de Langerhans en las lesiones. La coloración de PAS no demostró hongos. Los infundíbulos presentaron voluminosos tapones córneos con el mismo cambio. No se vio mayor inflamación dérmica. Estos hallazgos sugieren que la entidad es una dermatitis de contacto irritativo. Las historias clínicas y la revisión de la literatura indican que el uso de desodorantes, la obesidad y la humedad son los factores desencadenantes. El diagnóstico debe ser realizado sin dificultad por el patólogo o el dermatopatólogo, ya que por ser una entidad relativamente nueva no es fácil reconocerla clínicamente.

Distrofia ungueal en el liquen estriado / Ungual dystrophia in the striatus lichen

Presentamos una niña de 7 años de edad, con un liquen estriado en el miembro superior derecho acompañado de onicodistrofia del pulgar. La alteración ungueal, previa al rash cutáneo, mejoró espontáneamente en el curso de tres años

Células de "Paraqueratosis Atípica" en la citología del cáncer de cervix / \"Atypical Parakeratosis\" cells in the cervix cancer cytology

Estudiamos retrospectivamente 18 citologías (con confirmación histológica) de carcinoma de cérvix duranete 1992 a 1995 en la clínica "Francisco Pizarro" (IPSS)-Lima-PERU. Reportamos unas células que en nuestra experiencia en citología cérvico-vaginal lo hemos encontrado solo en el cáncer de cérvix las que exfoliarían de zonas donde las células neoplásicas presentan el fenómeno de diferenciación celular (en la superficie y en las perlas córneas) y por su parecido histológico con la paraqueratosis de la patología dermatológica sugerimos el término de "paraqueratosis atípica" a las celulas que reportamos cuya morfología se caracteriza por ser fusiforme, naranjófila y con un núcleo fusiforme, hipercromático y homogéneo. El tamaño de las células de "Paraqueratosis atípica" varía de 105 x 9 micras (con un núcleo de 21 x 5 micras) a 39 x 4 micras (con un núcleo de 7 x 3 micras). Resalatamos la importancia del hallazgo de las células de "Paaraqueratosis atípica" para detectar citologías que pueden ser diagnosticadas como negativa a células neoplasicas y que en nuestra casuística fueron la base para la detección de 4 carcinomas infiltrantes de cérvix.