A pediatric case of disseminated American cutaneous leishmaniasis in Rio de Janeiro, Brazil.

American cutaneous leishmaniasis is an infectious disease caused by the protozoa of the genus Leishmania. Clinical manifestations vary according to the virulence of the parasite speciesand the host's immune response. We report a case of a 2-year-old girl vertically exposed to HIV who presented painful and itchy papules throughout her lower limbs with further dissemination of vegetative ulcers all over the body and scalp. The histopathological examination evidenced the amastigote form of Leishmania and the polymerase chain reaction was positive for Leishmania sp. in the tissue sample. The patient was treated with amphotericin B and demonstrated improvement of lesions. Despite successful treatment for American cutaneous leishmaniasis, she developed osteomyelitis related to a bacterial secondary infection over the site of a previous ulcer on the left ankle and required a 6-week course of intravenous antimicrobial treatment. Children with vertical exposure to HIV, even without seroconversion, are at greater risk of infections if compared to non-exposed children. This is perhaps the reason for such an exuberant and rare case of complicated eishmaniasis.

Pruritic folliculitis of pregnancy

Abstract Pruritic folliculitis of pregnancy is a rare disease of unknown etiology. It occcurs primarily during pregnancy, usually with spontaneous resolution postpartum. It is characterized by a benign dermatosis, with papular and pustular follicular lesions that first appear on the torso and occasionally spread throughout the body. We report the case of a patient in the 27th week of pregnancy, with a two-month evolution of pruritic and papular erythematous lesions on her lower back. Differential diagnosis includes other pregnancy-specific dermatoses: gestational pemphigoid, pruritic urticarial papules and plaques of pregnancy (PUPPP), prurigo of pregnancy, and (PUPPP) and prurigo of pregancy. Histopathological tests showed changes consistent with pruritic folliculitis of pregnancy. This case is relevant due to its rare nature and its clinical and histopathological characteristics.

Pruritic folliculitis of pregnancy.

Pruritic folliculitis of pregnancy is a rare disease of unknown etiology. It occcurs primarily during pregnancy, usually with spontaneous resolution postpartum. It is characterized by a benign dermatosis, with papular and pustular follicular lesions that first appear on the torso and occasionally spread throughout the body. We report the case of a patient in the 27th week of pregnancy, with a two-month evolution of pruritic and papular erythematous lesions on her lower back. Differential diagnosis includes other pregnancy-specific dermatoses: gestational pemphigoid, pruritic urticarial papules and plaques of pregnancy (PUPPP), prurigo of pregnancy, and (PUPPP) and prurigo of pregancy. Histopathological tests showed changes consistent with pruritic folliculitis of pregnancy. This case is relevant due to its rare nature and its clinical and histopathological characteristics.

Transepidermal retinoic acid delivery using ablative fractional radiofrequency associated with acoustic pressure ultrasound for stretch marks treatment.

BACKGROUND: Striae distensae (SD) treatment still remains a therapeutic challenge to dermatologists. Ablative fractional laser and radiofrequency (RF) enhance skin-drug permeability for SD treatment. OBJECTIVE: To clinically evaluate the efficacy and safety as well as patient's satisfaction in relation to a method using ablative fractional RF associated with retinoic acid 0.05% cream and an acoustic pressure wave ultrasound (US) in patients with alba-type SD on the breast. METHODS AND MATERIALS: Eight patients with alba-type SD on the breast were treated with three step procedure: (1) fractional ablative RF for skin perforation; (2) topical application of retinoic acid 0.05% on the perforated skin; and (3) US was applied to enhance the retinoic acid penetration into the skin. Other eight patients with alba-type SD on the abdominal area were submitted to RF treatment isolated without retinoic acid or US. Three of them were submitted to skin biopsies. RESULTS: Three patients with SD on the breast area improved from "severe" to "moderate;" two patients improved from "severe" to "mild;" two patients from "moderate" to "mild;" one patient from "marked" to "mild." Clinical assessment demonstrated significant improvement in the appearance of SD in all patients treated with RF associated with retinoic acid 0.05% cream and US (P = 0.008), with low incidence of side effects and high level of patient's satisfaction. Among the patients treated only with RF, two patients improved from "severe" to "marked;" one patient from "marked" to "moderate;" and one patient improved from "marked" to "mild." Four patients did not show any sort of improvement. Clinical assessment demonstrated no significant improvement in the appearance of SD treated with RF isolated with low incidence of side effects, but low-level of patient's satisfaction. CONCLUSION: Ablative fractional RF and acoustic pressure US associated with retinoic acid 0.05% cream is safe and effective for alba-type SD treatment.

Fox-Fordyce disease: response to adapalene 0.1%.

The Fox-Fordyce disease is a rare inflammatory dermatosis that affects mainly young women and is characterized by multiple follicular papules, skin color or brownish, very itchy, localized in areas rich in apocrine glands. Histopathology shows focal spongiosis of the upper infundibulum with fibrosis and perifollicular lymphohistiocytic infiltrate. The diagnosis is based on clinical and histopathological examination. Many treatment options have been described; however none of them is excellent. We chose the topic adapalene 0.1% and a satisfactory improvement of the signs and symptoms of the disease was observed.

[Mycosis fungoides in children and adolescents: a report of six cases with predominantly hypopigmentation, along with a literature review]. / Micose fungóide em crianças e adolescentes: Relato de seis casos com predomínio da forma hipocromiante e revisão da literatura.

UNLABELLED: Mycosis fungoides (MF), the most common form of cutaneous T cell lymphoma (CTCL), is mainly manifested in the elderly. However, it has been described in children and teenagers. OBJECTIVES: To report six patients with mycosis fungoides diagnosed in patients under 20 years of age. Our focus is on epidemiologic data, clinical features, histopathological aspects, and immunophenotypical findings. METHODS: The files of all patients diagnosed with CTCL at Hospital Universitário Antônio Pedro (HUAP) / Universidade Federal Fluminense (UFF), Niterói, Brazil, from 2007 to 2010 were searched to identify patients under 20 years of age. Slides were reviewed with routine methods (H&E) and immunohistochemical stains by two dermatopathologists and one surgical pathologist. RESULTS: Among a total of 66 patients with MF, six were children and adolescents between five and nineteen years of age. Most of them had dark skin and presented with the hypopigmented variant of MF; some expressed the T cell CD8+ phenotype, although the prognosis remains the same as for classical CTCL. The main histopathological findings were basilar lymphocytes, Pautrier microabscesses, eccrine infiltration, and dermal fibrosis. One patient had shown pityriasis lichenoides chronica for 10 years before the diagnosis of MF. CONCLUSIONS: The incidence of juvenile mycosis fungoides has increased, corresponding to 9.1 percent of patients diagnosed with MF in our institution in four years. In this sample, 83.3 percent of the patients had the hypopigmented variant and 50 percent of them showed the CD3+/CD8+ T cells phenotype. We emphasize the occurrence of pityriasis lichenoides chronica before the onset of MF in one of our cases. This association, although rare, must be considered in cases of atypical evolution of PLC. The diagnosis of hypopigmented MF should also be considered in patients when hypochromic patches are persistent. We would like to highlight the importance of Pautrier microabscesses, basilar distribution, and eccrine involvement by neoplastic lymphocytes as histopathological diagnostic criteria for this variant of MF.

Cutaneous metastasis of gastric adenocarcinoma: an exuberant and unusual clinical presentation.

There are different types of skin changes associated with internal malignancy. One type is the skin involvement as a result of cutaneous metastasis from an internal tumor. The skin is an uncommon site for distant metastasis; when it is present the most common sources are breast, lung, and colon. Metastasis generally occurs after an internal malignancy had been discovered and signifies disseminated disease with a poor prognosis. We report an exuberant and rare case of cutaneous metastasis from gastric adenocarcinoma as the first sign of this serious visceral cancer.

Cat-transmitted cutaneous lymphatic sporothricosis.

Sporotrichosis is the most common of the deep mycoses. In most cases the transmission occurs secondary to recent penetrating trauma with plant thorns, wood splinters or contaminated organic material. We report a case of a 68-year-old Brazilian female with a small ulcer on her right forefinger and palpable erythematous nodules on her right forearm. These occurred after the bite of a domestic cat that had a lesion on its hind-foot. Since the 1980s, the role of felines in the transmission of this mycosis to humans has gained attention among animal owners, veterinarians, and caretakers. Humans can be contaminated by a cat scratch or bite and even by contact with contaminated solutions.

Eletrorretinografia experimental em coelho / experimental electro-retinography in rabbits

Os autores salientam que a eletrorretinografia, por ser um exame objetivo, constitui-se num excelente meio para avaliar os efeitos de certas substâncias sobre a retina de animais de experimentaçäo. Utilizaram-se seis coelhos pigmentados, adultos, com o objetivo de padronizar as condiçöes de exame do eletrorretinograma (ERG) e estimar os valores da amplitude e tempo de latência das ondas a e b e o tempo de culminaçäo da onda b. Os valores obtidos foram 87 uV e 206 uV, respectivamente, para as amplitudes de onda a e b. Os tempos de latência das ondas a e b foram 4,8 e 15 mseg. O tempo de culminaçäo da onda foi 54 mseg. Os autores acreditam que os dados eletrorretinográficos alcançados possam auxiliar aos que se proponham a pesquisar experimentalmente os efeitos de diferentes substâncias sobre a retina de coelho.

Estudo experimental do efeito do SF6 sobre a retina por meio da microscopia óptica e eletrônica / Experimental study on the SF6 effect on the retina by means of ligt and electroin microscopy

Os autores enfatizam que os gases, especialmente o hexafluoreto de enxofre (SF6) têm sido empregados com frequência aumentada na retinopexia pneumática, nos casos de roturas gigantes, buraco macular e descolamento de retina complicados; procuram estudar pela microscopia óptica e eletrônica e efeito do SF6 sobre a retina de coelhos em olhos vitrectomizados. Foram utilizados 7 coelhos. Um deles teve seus olhos considerados como controle, näo operados. Os outros 6 foram operados (os seus olhos direitos foram apenas vitrectomizados e considerados como controles pós-operatórios e os esquerdos, vitrectomizados com injeçäo de SF6 intravítrea e considerados como experimetais). As microscopias óptica e eletrônica revelaram lesöes dispostas aleatoriamente nas hemi-retinas superiores e inferiores dos olhos controle näo operados, dos controle operados e dos experimentais, fazendo supor que estas lesöes sejam artefatos gerados durante os procedimentos histológicos. Os autores concluem que, o SF6 intravítreo, provavelmente, näo representa fator de lesäo retiniana

Estudo experimental do efeito do SF6 sobre a retina de coelho por meio da eletrorretinografia / Experimental study on the effect of SF6 on the rabbit's retina by means of electroretinography

Os autores enfatizam que a retinopexia pneumática consiste de injeçöes repetidas de gases (entre as quais o hexafluoreto de enxôfre - SF6), que se expandem rapidamente dentro do vítreo e ajudam a reaplicar de imediato a retina; procuram, ainda, avaliar o efeito do SF6 sobre a retina de coelhos por meio da eletrorretinografia. Depois de vitrectomizados, os olhos direitos foram considerados como controles pós-operatórios e os esquerdos como experimentais após administraçäo de SF6 na cavidade vítrea no final do tempo operatório. O estudo estatístico dos valores obtidos pela eletrorretinografia näo demonstrou nenhuma diferença significante (p<0,05) entre o olho controle e o experimental, tanto quanto as amplitudes, quanto aos tempos de latência e de culminaçäo das ondas "a" e "b" (a, b, 1a e 1b e c), demonstrando que o SF6 provavelmente näo seja tóxico para a retina