Geographic tongue severity index: A new and clinical scoring system.

OBJECTIVE: This study was designed to develop a severity index for geographic tongue (GT) based on the Psoriasis Area and Severity Index. STUDY DESIGN: This cross-sectional observational study, with a retrospective sample of 100 participants, included 5 photographs of each case (dorsum, right border, left border, apex, and lingual belly), totaling 500 images of GT, which were evaluated by 3 experienced researchers in the area of GT and psoriasis. At the end of the analysis, GT was classified as mild, moderate, or severe. RESULTS: Of the 100 patients, white women were most prevalent, accounting for 53% of cases. Of these participants, 34% had psoriasis and 24% reported a burning sensation. The values of the proposed new index obtained at time 1 (0.855) and time 2 (0.819) presented low variability, and intra- and interrater correlations produced satisfactory values ranging from 0.950 to 0.898 and 0.898 to 0.850, respectively. CONCLUSION: The new index, Geographic Tongue Area and Severity Index, provides a better characterization of GT by assessing the severity of lesions in an easy and reliable manner, and it is indicated as a first step for interpreting the condition in clinical routines and clinical trials.

Angiolymphoid hyperplasia with eosinophilia versus Kimura's disease: a case report and a clinical and histopathological comparison.

Angiolymphoid hyperplasia with eosinophilia is a rare and benign vascular tumor whose etiology remains uncertain. It clinically presents itself by angiomatous papules or nodules located on the head and neck. Many controversies in the literature are found in relation to angiolymphoid hyperplasia with eosinophilia and Kimura's disease - its main differential diagnosis - due to their clinical and histopathological similarities. However, currently, most studies agree that they are distinct diseases. The present case illustrates a characteristic description of angiolymphoid hyperplasia with eosinophilia and also highlights the main differences with Kimura's disease.

Etanercept in erythema nodosum leprosum

Abstract: One of the biggest challenges in treating leprosy is the control of reaction events. Patients with lepromatous leprosy may present reaction type II, or erythema nodosum leprosum, during treatment, and this reaction can remain in a recurrent form after being released from the hospital, requiring the use of thalidomide and/or prednisone for long periods of time, in turn increasing the risk of side effects. Two reports of the use of antiTNF to treat erythema nodosum leprosum were found in the literature. A good response was found after an assay with infliximab and etanercept. This study reports on a patient with lepromatous leprosy and recurrent reaction, controlled by using etanercept and a 10-month follow-up, with the interruption of thalidomide and the maintenance of prednisone at 10 mg/day.

Angiolymphoid hyperplasia with eosinophilia versus Kimura's disease: a case report and a clinical and histopathological comparison

Abstract Angiolymphoid hyperplasia with eosinophilia is a rare and benign vascular tumor whose etiology remains uncertain. It clinically presents itself by angiomatous papules or nodules located on the head and neck. Many controversies in the literature are found in relation to angiolymphoid hyperplasia with eosinophilia and Kimura's disease - its main differential diagnosis - due to their clinical and histopathological similarities. However, currently, most studies agree that they are distinct diseases. The present case illustrates a characteristic description of angiolymphoid hyperplasia with eosinophilia and also highlights the main differences with Kimura's disease.

Ulcerations due to methotrexate toxicity in a psoriasis patient

Abstract: Methotrexate is one of the most used drugs in the treatment of psoriasis with indication of systemic therapy. Cutaneous and mucous side effects are described by pharmacological characteristics of the drug itself or due to overdose. We report the case of a patient with ulcerations in oral mucosa and psoriatic plaques after incorrect use of Methotrexate. Prescribed in a weekly dose, it was used continuously for 10 days and without simultaneous intake of folic acid. It is important to ensure correct comprehension of the prescription.

Bed bug dermatitis, description of two cases in Rio de Janeiro, Brazil

Bed bugs are hematophagous insects which due to their morphological and biological characteristics are able to easily adapt themselves to human households. The authors describe two cases of dermatitis caused by bed bug bites in the city of Rio de Janeiro, Brazil. Patients presented linear lesions in the usual "breakfast, lunch and dinner" arrangement, suggesting this diagnosis. A visit to their dwellings showed infestation of insects identified as Cimex hemipterus. The knowledge of these insects by the dermatological community will contribute to an accurate diagnosis as well as subsidize the dissemination of information aiming for prevention.

Two cases of renal cell cancer during immunobiologic therapy for psoriasis

Immunobiologic therapy is indicated for severe forms of psoriasis, resistant to conventional therapy. There is growing concern about their safety profile and possible association with cancer development. This article documents two cases of renal cell cancer during treatment with biologic therapy, reviewing what is described in the literature . The risk of solid tumors as a complication of using TNF-alpha inhibitors is controversial. No conclusion can be drawn from the data in the literature, however, we believe that special attention should be given to those with known risk factors for a specific neoplasm.

Two cases of renal cell cancer during immunobiologic therapy for psoriasis.

Immunobiologic therapy is indicated for severe forms of psoriasis, resistant to conventional therapy. There is growing concern about their safety profile and possible association with cancer development. This article documents two cases of renal cell cancer during treatment with biologic therapy, reviewing what is described in the literature . The risk of solid tumors as a complication of using TNF-alpha inhibitors is controversial. No conclusion can be drawn from the data in the literature, however, we believe that special attention should be given to those with known risk factors for a specific neoplasm.

History of leprosy in Rio de Janeiro

The record of the first cases of leprosy in Rio de Janeiro dates from the seventeenth century. The first local host of leprosy patients was created from 1741, and the first colonies hospitals were built in the early twentieth century, in order to avoid contagion of the population. The first structures dedicated to research also date from this time: the Leprosy International Institute, the Leprology Institute, and the Leprosy Laboratory of the Oswaldo Cruz Foundation, where the most prestigious leprologists of Rio de Janeiro worked. Currently, investigations are focused on the Oswaldo Cruz Foundation; additionally, leprosy patients are treated at municipal health centers and state hospitals, and former colony hospitals only accept patients with severe disabilities.

Importância da variação do PASI realizado por diversos observadores / Inter-rater concordance study of the PASI (Psoriasis Area and Severity Index)

FUNDAMENTO: O índice da área e gravidade da psoríase foi método desenvolvido em 1978, para quantificar a gravidade da psoríase. Desde então, têm recebido algumas críticas, por ser longo, complexo e apresentar divergências na sua interpretação. OBJETIVO: Demonstrar o grau de concordância do índice da área e gravidade da psoríase aplicado em pacientes de psoríase por três avaliadores isoladamente. MATERIAL E MÉTODO: Estudo observacional, transversal, realizado no ambulatório de psoríase, no ano de 2007, onde foram selecionados 20 pacientes. Os pacientes foram avaliados por três pós-graduandos de dermatologia, que determinaram o índice da área e gravidade da psoríase, isoladamente. A fidedignidade interobservador foi avaliada pelo coeficiente de correlação intraclasses (ICC) e os gráficos de Bland & Altman. RESULTADOS: O ICC de 0,729 (IC 95 por cento: 0,440 - 0,882) demonstrou que existe boa concordância entre os observadores. Pela análise dos gráficos de Bland e Altman, no máximo, duas diferenças estão fora dos limites de concordância, expressando boa concordância. Observou-se também que existe comportamento sistemático nas diferenças do índice da área e gravidade da psoríase em relação a sua média, segundo o qual mostrou para valores altos do índice da área e gravidade da psoríase, ou seja, um predomínio de diferenças maiores. CONCLUSÃO: Notamos, através deste estudo, que o índice da área e gravidade da psoríase apresenta bons critérios de confiabilidade quando houve a avaliação da gravidade da psoríase, mesmo que realizado por diferentes avaliadores.

BACKGROUND: Developed in 1978, the PASI (Psoriasis Area and Severity Index) is a method to rate psoriasis severity. Since then, it has been criticized for being extremely long, complex and for yielding significantly divergent interpretations. OBJECTIVE: To determine the PASI inter-rater reliability among three independent evaluators examining the same patients. METHODS:Cross-sectional study conducted in 2007 at a psoriasis treatment center, where 20 patients were selected. The patients were evaluated by three postgraduate students of Dermatology who independently determined the PASI of each patient. The inter-rater reliability coefficient was determined by employing intraclass correlation coefficients (ICC) and Bland & Altman plots. RESULTS: An ICC of 0.729 (IC 95 percent: 0.440 - 0.882) showed a significant degree of concordance among evaluators. By graphic means, the Bland & Altman plot method presents concordance gap ranges. As shown in this study, narrow gap ranges indicate a good concordance degree. It was also observed that for high PASI values, wider concordance gap ranges predominate. CONCLUSION: Based on this analysis, we may conclude that the PASI is a reliable indicator of psoriasis severity because it shows significant concordance when independent evaluations are performed.

Granulomatous reactivation during the course of a leprosy infection: reaction or relapse.

BACKGROUND: Leprosy is a chronic granulomatous infectious disease and is still endemic in many parts of the world. It causes disabilities which are the consequence of nerve damage. This damage is in most cases the result of immunological reactions. OBJECTIVES: To investigate the differences between a type 1 leprosy (reversal) reaction and relapse on using histopathology. METHODS: The histopathological changes in 167 biopsies from 66 leprosy patients were studied. The patients were selected when their sequential biopsies demonstrated either different patterns or maintained the same pattern of granulomatous reaction over more than two years during or after the treatment of leprosy. RESULTS: In 57 of the patients studied, a reactivation was seen which coincided with a decrease in the bacteriological index (BI), suggesting that this reactivation (reversal reaction or type 1 leprosy reaction) coincides with an effective capacity for bacteriological clearance. In nine patients, an increase of the bacteriologic index (IB) or persistence of solid bacilli occurred during the reactivation, indicating proliferative activity, suggestive of a relapse. The histopathological aspects of the granulomas were similar in both groups. CONCLUSION: Bacterioscopy provided the only means to differentiate a reversal reaction from a relapse in patients with granulomatous reactivation. The type 1 leprosy reaction may be considered as a part effective immune reconstitution (reversal, upgrading reaction) or as a mere hypersensitivity reaction (downgrading reaction) in a relapse.

Seroprevalence of HHV-8 infection in the pediatric population of two university hospitals in Rio de Janeiro, Brazil.

BACKGROUND: The authors present a serologic survey of the prevalence of herpesvirus-8 (HHV-8) among 171 children from 0 to 12 years old in Rio de Janeiro, Brazil. MATERIALS AND METHODS: Sera were tested for latent nuclear and lytic antigens using indirect immunofluorescence and Western blotting. RESULTS: Serology for HHV-8 was positive in 16 of 171 patients (9.35%). Among 13 HIV-positive patients, four (31%) were also positive for HHV-8. The seropositivity among healthy children was 7.6%, and females were significantly (P<0.002) more associated with HHV-8 seropositivity (16%) than males (1.1%). CONCLUSIONS: We detected a higher HHV-8 seroprevalence among the pediatric population in Rio de Janeiro, Brazil, when compared with similar studies performed in other countries. Nonsexual routes of transmission are a possible explanation for this pattern. The unusual finding of a higher seroprevalence among female children could be explained by a specific route of exposition or even an epidemiological bias.

Sífilis: diagnóstico, tratamento e controle / Syphilis: diagnosis, treatment and control

A sífilis é doença infecto-contagiosa, transmitida pela via sexual e verticalmente durante a gestação. Caracteriza-se por períodos de atividade e latência; pelo acometimento sistêmico disseminado e pela evolução para complicações graves em parte dos pacientes que não trataram ou que foram tratados inadequadamente. É conhecida desde o século XV, e seu estudo ocupou todas as especialidades médicas e, de modo especial, a dermatologia. Seu agente etiológico, o Treponema pallidum, nunca foi cultivado e, apesar de descrito há mais de 100 anos e sendo tratado desde 1943 pela penicilina, sua droga mais eficaz, continua como um problema de saúde importante em países desenvolvidos ou subdesenvolvidos. Dadas as características da forma de transmissão, a doença acompanhou as mudanças comportamentais da sociedade e nos últimos anos tornou-se mais importante ainda devido à possibilidade de aumentar o risco de transmissão da síndrome de imunodeficiência adquirida. Novos testes laboratoriais e medidas de controle principalmente voltadas para o tratamento adequado do paciente e parceiro, uso de preservativo, informação à população fazem parte das medidas adotadas para controle da sífilis pelos responsáveis por programas de saúde.

Persistence of viable bacilli in highly bacilliferous multibacillary leprosy patients after the twelve doses of multidrug therapy WHO/MDT

The present study evaluate efficacy of twelve doses of multidrug therapy, as suggested by World Health Organization, in ten lepromatous leprosy patients with bacilloscopic index equal or higher than 4. The patients have taken the doses in twelve month-doses regularly. At the end od treatment a specimen was collected by punch biopsy and inoculated into mouse hind footpad acoording to Shepard's technique. Persistence of viable bacilli was demonstrated in three patients. In spite of the small number of patients, same results have been found by other authors, showing that in highly bacilliferous leprosy patients, at the beginning of treatment more doses may be required to prevent relapses.

Persistencia de bacilos viaveis em pacientes de hanseniase multibacilar altamente baciliferos apos doze doses do esquema poliquimioterapico (PQT/OMS) / Persistence of viable bacilli in highly bacilliferous multibacillary leprosy patients after the twelve doses of multidrug therapy WHO/MDT

Trabalho de investigacao, com o obejtivo de avaliar a eficacia do tratamento de doze doses com o esquema poliquimioterapico proposto pela Organizacao Mundial da Saude em 10 pacientes de hanseniase virchoviana em indice baciloscopico igual ou maior que 4. Os pacientes foram submetidos ao tratamento por 12 meses, regularmente. Apos o final do tratamento, foi feita retirada de material e inoculacao em coxim plantar de camundongos, conforme a tecnica de Shepard. Os resultados mostraram persistencia de bacilos viaveis em tres pacientes. Os autores, apesar da amostra pequena, observam que os mesmos resultados tem sido encontrados por outros autores surgerindo que talves seja necessario tratar os pacientes com altos indices baciloscopico no inicio do tratamento, por mais tempo, na tentativa de evitar possiveis recidivas.

Neuropatia por sulfona e talidomida / ?

A sulfona e a talidomida sao duas drogas usadas no tratamento da hanseniase que podem apresentar como efeito adverso uma neuropatia periferica. O diagnostico deste efeito colateral pode encontrar dificuldade pelo acometimento do sistema nervoso periferico pelo M. leprae. Na neuropatia periferica induzida pela sulfona o acometimento motor e mais frequente e grave que o sensitivo, e o sintoma mais comum e a fraqueza muscular em membros superiores e inferiores. A regressao total e parcial pode ser obtida com a suspensao ou diminuicao da sulfona. A neuropatia por talidomida e essencialmente sensitiva, com sintomas parestesicos predominantes em membros inferiores (alfinetadas, dormencia, caibras, fraqueza muscular). Ao contrario da neuropatia por sulfona, a degeneracao e progressiva com irreversibilidade do quadro na maioria dos pacientes.

Tratamento da hanseniase / ?

O controle da hanseniase e considerado uma das prioridades da OMS, por ser uma endemia com potencial incapacitante importante. Os autores fazem uma revisao do tratamento da hanseniase desde a utilizacao do oleo de chaulmugra em 1854, passando pela introducao da sulfona em 1941, ao aparecimento da resistencia secundaria e primaria a sulfona, razao da associacao de outras drogas no tratamento da doenca. O esquema dividia os pacientes em multibacilares e paucibacilares, usando regimes com tres drogas (Rifampicina, Clofazimina e Dapsona) para as formas multibacilares e duas drogas (Rifampicina e Sulfona) para os paucibacilares. Foram realizadas mudancas na duracao do tratamento, e novas drogas como as quinolonas, claritromicina e minociclina mostraram eficacia contra o M. leprae possam ser utilizadas em esquemas alternativos.