RESUMO
Kaposi's sarcoma (KS) is an angioproliferative disorder caused by human herpesvirus 8 (HHV-8). Current research efforts have focused on the study of the relative role of KSHV-encoded genes in Kaposi's sarcomagenesis in order to identify novel mechanism-based therapies for patients suffering from this tumor. Although several viral genes have potential for KS pathogenesis, compelling data point to the KSHV-encoded G protein-coupled receptor (vGPCR) as a leading candidate viral gene for the initiation of KS. Interestingly, the oncogenic potential of vGPCR seems to correlate with its capacity to activate the mammalian target of rapamycin (mTOR) signaling pathway. Rapamycin, the prototypical inhibitor of the mTOR signaling pathway, has recently emerged as an effective treatment for KS when administered orally. In this case report, we present an immunocompetent patient with KS lesions treated with topical rapamycin achieving clinical and histologic healing after 16 weeks of treatment. The topical application of rapamycin could be a novel therapeutic option for the treatment of KS.
Assuntos
Antibióticos Antineoplásicos/uso terapêutico , Sarcoma de Kaposi/tratamento farmacológico , Sirolimo/uso terapêutico , Neoplasias Cutâneas/tratamento farmacológico , Administração Cutânea , Idoso , Antibióticos Antineoplásicos/administração & dosagem , Antibióticos Antineoplásicos/farmacologia , Humanos , Masculino , Sarcoma de Kaposi/patologia , Sirolimo/administração & dosagem , Sirolimo/farmacologia , Neoplasias Cutâneas/patologia , Resultado do TratamentoAssuntos
Vesícula/virologia , Dermatoses da Mão/virologia , Herpes Simples/diagnóstico , Herpes Simples/tratamento farmacológico , Aciclovir/análogos & derivados , Aciclovir/uso terapêutico , Adulto , Antivirais/uso terapêutico , Vesícula/diagnóstico , Vesícula/tratamento farmacológico , Diagnóstico Diferencial , Feminino , Dermatoses da Mão/diagnóstico , Dermatoses da Mão/tratamento farmacológico , Humanos , Pró-Fármacos/uso terapêutico , Reação em Cadeia da Polimerase em Tempo Real , Recidiva , Valaciclovir , Valina/análogos & derivados , Valina/uso terapêuticoRESUMO
BACKGROUND: Necrobiosis lipoidica presents with a distinctive appearance making it an important clinical diagnosis. OBJECTIVE: To describe a case of necrobiosis lipoidica in a patient with type 1 diabetes mellitus, and to discuss differential diagnoses and management. DISCUSSION: Necrobiosis lipoidica is most commonly found on the shins, presenting as a well-defined plaque. Management is challenging and options are discussed. Avoiding ulceration is a key concern.
Assuntos
Diabetes Mellitus Tipo 1/complicações , Imunossupressores/uso terapêutico , Necrobiose Lipoídica/diagnóstico , Necrobiose Lipoídica/tratamento farmacológico , Tacrolimo/uso terapêutico , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Úlcera da Perna/etiologia , Úlcera da Perna/prevenção & controle , Necrobiose Lipoídica/complicações , Fatores de RiscoRESUMO
BACKGROUND: To our knowledge, there are no large multicenter studies concerning frontal fibrosing alopecia (FFA) that could give clues about its pathogenesis and best treatment. OBJECTIVE: We sought to describe the epidemiology, comorbidities, clinical presentation, diagnostic findings, and therapeutic choices in a large series of patients with FFA. METHODS: This retrospective multicenter study included patients given the diagnosis of FFA. Clinical severity was classified based on the recession of the frontotemporal hairline. RESULTS: In all, 355 patients (343 women [49 premenopausal] and 12 men) with a mean age of 61 years (range 23-86) were included. Early menopause was detected in 49 patients (14%), whereas 46 (13%) had undergone hysterectomy. Severe FFA was observed in 131 patients (37%). Independent factors associated with severe FFA after multivariate analysis were: eyelash loss, facial papules, and body hair involvement. Eyebrow loss as the initial clinical presentation was associated with mild forms. Antiandrogens such as finasteride and dutasteride were used in 111 patients (31%), with improvement in 52 (47%) and stabilization in 59 (53%). LIMITATIONS: The retrospective design is a limitation. CONCLUSIONS: Eyelash loss, facial papules, and body hair involvement were associated with severe FFA. Antiandrogens were the most useful treatment.
Assuntos
Alopecia/tratamento farmacológico , Alopecia/patologia , Azasteroides/uso terapêutico , Finasterida/uso terapêutico , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Alopecia/epidemiologia , Biópsia por Agulha , Estudos de Coortes , Dutasterida , Feminino , Fibrose/epidemiologia , Fibrose/patologia , Testa , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pós-Menopausa/fisiologia , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Distribuição por Sexo , Espanha/epidemiologia , Resultado do Tratamento , Adulto JovemRESUMO
A female, aged 17 years and with a history of anorexia nervosa, presented with a 3 month history of a large, irregular area of hair loss over the pubis. Physical examination revealed scattered short hairs of varying length, follicular hyperkeratosis and hyperpigmentation throughout the area of alopecia (Figure 1a). A magnified view revealed decreased hair density, broken hairs with different shaft lengths, short vellous hairs and signs of recent haemorrhage (Figure 1b). The remainder of the hairs appeared normal, and her nails did not show any pathological changes. The hair-pull test was negative. Potassium hydroxide (KOH) examination and fungal culture were negative. Biochemical studies, abdominal X-ray and ultrasonography were normal.
Assuntos
Alopecia/diagnóstico , Sínfise Pubiana , Tricotilomania/diagnóstico , Adolescente , Terapia Cognitivo-Comportamental , Diagnóstico Diferencial , Feminino , Humanos , Tricotilomania/terapiaRESUMO
Glomovenous malformations are disseminated variants of cutaneous glomus tumors. These malformations are subdivided into regional or localized, disseminated, and congenital plaque-like forms. The congenital plaque-like form is the rarest variant. Most treatment modalities have been disappointing in the treatment of large glomangiomas, leading to high recurrence rates. We report a case of a 34-year-old man with a congenital plaque-like glomangioma on his left arm and forearm treated successfully with sequential pulsed-dye neodymium yttrium aluminum garnet laser.
Assuntos
Tumor Glômico , Terapia a Laser/métodos , Neoplasias Cutâneas , Adulto , Tumor Glômico/congênito , Tumor Glômico/patologia , Tumor Glômico/cirurgia , Humanos , Masculino , Neoplasias Cutâneas/congênito , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgiaRESUMO
The management of venous malformation (VM) located on genitalia is complex and challenging. Surgical excision and sclerotherapy are the first-lines therapeutic options, but in certain areas such as the genitalia can be too aggressive. We present a case of VM on the glans penis treated successfully with dual wavelength 595 and 1064 nm laser system.
Assuntos
Lasers de Corante/uso terapêutico , Lasers de Estado Sólido/uso terapêutico , Doenças do Pênis/terapia , Pênis/irrigação sanguínea , Dermatopatias Vasculares/terapia , Malformações Vasculares/terapia , Adolescente , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Ácido Fusídico/uso terapêutico , Humanos , Masculino , Prednisolona/uso terapêuticoAssuntos
Ciclosporina/efeitos adversos , Dermatoses Faciais/induzido quimicamente , Transplante de Coração , Imunossupressores/efeitos adversos , Complicações Pós-Operatórias/induzido quimicamente , Glândulas Sebáceas/patologia , Ciclosporina/administração & dosagem , Ciclosporina/uso terapêutico , Humanos , Hiperplasia , Imunossupressores/administração & dosagem , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-IdadeRESUMO
Azathioprine (AZA) is an imidazole derivative of mercaptopurine. It antagonizes purine metabolism, and it may inhibit synthesis of DNA, RNA, and proteins. The 6-thioguanine nucleotides appear to mediate the majority of AZAs immunosuppressive and toxic effects. While cutaneous adverse side-effects are not uncommon, perforating dermatosis has not been reported in association to AZA. We speculate that immunological disorders induced by AZA in susceptible individuals could be related to perforating dermatosis.
Assuntos
Degeneração do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/diagnóstico , Parestesia/diagnóstico , Prurido/etiologia , Vértebras Torácicas/patologia , Idoso , Doença Crônica , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Parestesia/complicações , Parestesia/terapiaAssuntos
Anticorpos Monoclonais/efeitos adversos , Pestanas/efeitos dos fármacos , Doenças do Cabelo/induzido quimicamente , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/secundário , Adenocarcinoma/cirurgia , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/farmacologia , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Camptotecina/administração & dosagem , Camptotecina/análogos & derivados , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/cirurgia , Receptores ErbB/antagonistas & inibidores , Receptores ErbB/fisiologia , Pestanas/crescimento & desenvolvimento , Feminino , Fluoruracila/administração & dosagem , Humanos , Leucovorina/administração & dosagem , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Pessoa de Meia-Idade , Terapia Neoadjuvante , Proteínas de Neoplasias/antagonistas & inibidores , PanitumumabeRESUMO
A congenital smooth muscle hamartoma is a rare, benign proliferation of smooth muscle bundles in the dermis that is usually diagnosed in the neonatal period or infancy. Surgical excision is the first-line therapeutic option, but in certain areas such as the face, surgery may be too aggressive, and different treatments should be considered. We present the case of a congenital smooth muscle hamartoma on the face treated using pulsed dye laser with good response.
Assuntos
Hamartoma/patologia , Hamartoma/terapia , Terapia a Laser/métodos , Músculo Liso/patologia , Dermatopatias/patologia , Dermatopatias/terapia , Adolescente , Feminino , Hamartoma/congênito , Humanos , Hipertricose/congênito , Hipertricose/patologia , Hipertricose/terapia , Lasers de Corante , Dermatopatias/congênito , Resultado do TratamentoAssuntos
Erros de Diagnóstico , Infiltração de Neutrófilos , Pioderma Gangrenoso/diagnóstico , Infecção da Ferida Cirúrgica/diagnóstico , Antibacterianos/uso terapêutico , Fraturas Ósseas/cirurgia , Virilha/patologia , Virilha/cirurgia , Humanos , Leucocitose/etiologia , Masculino , Pessoa de Meia-Idade , Prednisona/uso terapêutico , Pioderma Gangrenoso/tratamento farmacológico , Pioderma Gangrenoso/patologia , Deiscência da Ferida Operatória , Tórax/patologia , Lesões no CotoveloRESUMO
Case study A man, 77 years of age, presented with haematemesis, abdominal pain and increasing limb weakness. He also had a skin rash on his chest and face.