Problema de pele em paciente estomizada: relato de caso / Skin problems in a stomized patient: a case report

Objetivo: Relatar o caso vivenciado na prática de enfermagem, no manejo de complicações de pele periestoma,e avaliar as mudanças clínicas obtidas após a utilização de protetores cutâneos. Relato de caso: O estudo foi desenvolvido em uma paciente estomizada de 57 anos, cuja pele periestoma apresentava extensa dermatite periestomal com aspecto brilhante, altamente exsudativa, irritativa e dolorosa, em que o dispositivo para estomia mantinha-se adaptado por menos de 24 horas. Conclusão: Após o manejo dos protetores cutâneos, houve evolução satisfatória em relação à lesão periestomal e no emocional, o que resultou no fechamento da ileostomia.

Objective: To report a case experienced in nursing practice regarding the management of peristomal skin complications, as well as to evaluate the clinical changes obtained after the use of skin protectors. Case report: this study was developed in a patient with stoma 57, whose skin had extensive peristomal dermatitis, glossy, highly exudative, irritating and painful, who had a device installed for ostomy adapted forless than 24 hours. Conclusion: After the management of skin protectors, there was satisfactory progress in relation to peristomal and emotional injury, which resulted in the closure of the ileostomy.

[Disseminated perinaevic Meyerson phenomenon revealing melanoma]. / Phénomène de Meyerson périnævique disséminé révélateur d'un mélanome.

BACKGROUND: Meyerson phenomenon (MP) consists of an eczematous reaction occurring around a pre-existing dermatologic lesion that is usually melanocytic and generally benign, and which is known as a Meyerson naevus. We report a case of multiple Meyerson naevi revealing melanoma, which itself was surrounded by a halo of eczema. PATIENTS AND METHODS: A 55-year-old man of phototype III with atopic eczema presented for pruritic eczema present for a fortnight, found solely on and around the naevi on his trunk and at roots of his limbs. One of the melanocytic lesions affected by these Meyerson phenomena was clinically atypical and had been active for several years. Excision confirmed the diagnosis of level II extensive superficial melanoma measuring 0.75 mm in thickness and associated with lesional and perilesional eczematous remodelling. After surgery involving a 1-cm excision margin and local corticosteroid therapy of the eczema, the Meyerson phenomenon subsided with complete remission of the melanoma at 1 year. DISCUSSION: Meyerson phenomenon can affect one or more naevi at the same time; it is generally transient, may recur on occasion, and has a favourable outcome either spontaneously or with corticosteroid treatment. When not removed for histological verification, the melanocytic lesion regains its initial appearance following resolution of the phenomenon. MP differs from Sutton phenomenon (SP), which is a perinaevic vitiligo reaction leading to complete or partial regression of the melanocytic lesion, which may be either benign or malignant. CONCLUSION: This case of Meyerson phenomenon revealing melanoma shows that the melanocytic lesions targeted by MP are not necessarily benign.

[Eosinophilic dermatosis associated with hematological disorders: A clinical, histopathological and immunohistochemical study of six observations]. / Dermatose éosinophilique associée aux hémopathies : étude clinique, histopathologique et immunohistochimique de six cas.

BACKGROUND: Eosinophilic dermatosis of hematologic disease (EDH) or insect bite-like reaction is a pruritic dermatitis described mostly in patients with chronic lymphocytic leukaemia (CLL). We describe six patients with the disorder in association with CLL and other blood dyscrasias. PATIENTS AND METHODS: We reviewed the medical records of patients with EDH seen between 2004 and 2009 in our department and re-examined histological slides. RESULTS: Mean age at dermatosis onset was 75.6 years and the sex ratio was 1. There were three CLL, two mantle-cell lymphomas and one MALT-type lymphoma. The dermatitis was quite polymorphic, with erythematous papules, wheals and plaques. The initial skin lesions appeared at the same time as or after the diagnosis of haematological neoplasm. Their reappearance heralded relapse of the blood disease in three cases. Histologically, all lesions had a dense dermal infiltrate of small, mostly CD4+ T-cells, with numerous eosinophils. In three patients, there was marked folliculotropism, resembling folliculotropic T-cell lymphoma. In most cases, EDH disappeared after appropriate chemotherapy for the blood disorder. DISCUSSION: Our cases show that the clinical expression of EDH is quite polymorphic. Its appearance may precede relapse of or may indicate prompt search screening for blood dyscrasia. The most efficient treatment of this dermatosis appears to be specific chemotherapy for the blood dyscrasia. There is reason to believe that a population of T-helper 2 (Th2) lymphocytes, reactive to malignant B-cells, induces tissue eosinophilia, mainly through production of interleukin (IL)-5, among other cytokines. Eosinophils appear to be the main effector cells.

Meyerson phenomenon within a nevus flammeus. The different eczematous reactions within port-wine stains.

Only few reports about eczematous reactions overlying nevi flammei exist. All of them were observed in children. The description of an eczematous reaction within a congenital nevus flammeus on the left lower leg of a male adult gives reason to discuss this rare phenomenon. Eczema or inflammatory changes within a port-wine stain may mostly be a collision dermatosis with an atopic dermatitis, especially when they arise in children and are localized to the neck and face. When they are observed within a grossly visible vascular malformation, as for example in the Klippel-Trenaunay syndrome, they may have a pathogenesis similar to stasis dermatitis. In rare cases, an eczematous reaction within a nevus flammeus may be the result of genetic mosaicism and is interpreted as a variant of the so-called Meyerson phenomenon.

Demodecidosis: ¿comensalismo o parasitismo? / Demodecidosis: commensalism o parasitism?

Con el objeto de evaluar la importancia que tiene el hallazgo de Demodex sp. en dermatología humana, se realizó el presente estudio de casos y controles, completando con análisis químico del parásito. Los casos presentaban rosácea o eccematide seborreica, mientras que los controles, piel normal. Las muestras fueron extraídas del rostro mediante aplicación de cintas adhesivas transparentes sobre la piel, las que luego se adhirieron a portaobjetos para buscar el artrópodo por microscopía. El hallazgo de un solo parásito fue suficiente como criterio de positividad. Además se realizó análisis espectrofotométrico de los parásitos, por fluorescencia de rayos X. El 36,6 por ciento de los casos presentó Demodex sp. asociado con dermatitis perioral, rosácea, eccematide seborreica y en conducto nasal asociado a Staphylococcus aureus. Solamente en el 3,3 por ciento de los controles se demostró la presencia del parásito. Odds Ratio: 16,79; X²:8,44; p: 0,0036, límite de confianza 95 por ciento. El análisis espectrométrico por fluorescencia de rayos X, demostró presencia de: calcio, titanio, hierro, azufre, fósforo, cobre, níquel, zinc, potasio, cloro, magnesio, aluminio y silicio en los artrópodos, correspondiendo al cobre y al hierro los picos de mayor intensidad. Luego del tratamiento para Demodex sp. se produjo remisión de los cuadros. Se concluye que existe asociación estadísticamente significativa entre las dermatopatías mencionadas y Demodex sp. El cobre y el hierro de los parásitos podrían, eventualmente, contribuir a agravar los cuadros por reacciones alérgicas

Late onset systemic lupus erythematosus diagnosed in an elderly man with unusual skin eruptions and sudden death.

A rare case of late onset SLE in an elderly man presented with generalized toxicoderma-like eruptions. The rash first appeared at age 64 years and was characterized by dark or purplish erythematous eruptions disseminated over the body surface. Histological examination revealed marked liquefaction degeneration and leukocytoclastic vasculitis. Direct immunofluorescence study and serological examination results were suggestive of SLE; however, the patient had no episodes of photosensitivity, malar erythema, or arthralgia. He was diagnosed as having SLE 11 months after his first visit and died suddenly 16 months after onset. Elderly men with SLE can present with unusual clinical manifestations; careful examination of these patients is required to reach a correct diagnosis.

[Generalized granuloma annulare]. / Granulome annulaire généralisé.

The generalized or atypical granuloma annulare represents 8.5-15 p. 100 of all cases of granuloma annulare (GA). It differs from the localized GA variant by its morphology, its localization, a later age of onset, its protracted course, a poor response to therapy and its facultative association to diabetes mellitus. We present a typical case of generalized GA associated with eczematous dermatitis.

Prolonged infection of the floor of the mouth in hyperimmunoglobulinemia E (Buckley's syndrome). Report of a case.

A case of prolonged infection of the floor of the mouth with a generalized eczematous dermatitis in a 13-year-old boy is described. Immunologic examination revealed markedly elevated serum concentration of immunoglobulin E (IgE) and impaired neutrophil chemotaxis. The disorder was diagnosed as the hyperimmunoglobulinemia E (Buckley's syndrome) and was successfully treated with high doses of antibiotics and human immunoglobulin.

HIV transmission by needle stick and eczematous lesion--three cases from Germany.

Two cases of documented HIV-1 transmission by needle stick and one case of probable transmission by eczematous lesion in three nurses in Germany are reported in the period 1988 to 1991. In two of the cases the nurse knew of the AIDS status of the index patient. A review of the three cases reiterates the importance of repeated training on the prevention of accident and on measures to be taken after an accident, as well as the need to keep the workplace free of additional burden when AIDS or HIV-infected patients are treated.