Caudal regression in fetus with de novo SMARCA2 pathogenic variant.

Nicolaides-Baraitser syndrome (NCBRS) is a rare autosomal dominant genetic condition that is characterized by severe intellectual disability, dysmorphic facial features, short stature, sparse hair, and early onset seizures. This diagnosis is established by suggestive clinical findings and the identification of a heterozygous SMARCA2 pathogenic variant by molecular genetic testing. There are not, however, consensus clinical diagnostic criteria for this condition as there are so few documented cases. Here, we present a case of prenatally diagnosed caudal regression with sacral agenesis and congenital vertical talus (rocker bottom feet) that was ultimately found to have a de novo SMARCA2 pathogenic variant. The patient had an amniocentesis with normal karyotype and microarray followed by failed direct rapid whole exome sequencing (WES) due to maternal cell contamination. She elected for termination of the pregnancy based on the clinical prognosis of the ultrasound findings; WES revealed a pathogenic variant after her termination. We believe this is the first case of these findings associated with NCBRS. If any future cases of either finding are found in association with a SMARCA2 genetic variant, caudal regression and rocker bottom feet should be included in the spectrum of physical traits associated with this pathogenic variant.

Extensive and deep granulomatous ulcers as an atypical manifestation of cartilage-hair hypoplasia syndrome: A diagnostic and therapeutic challenge.

Cartilage hypoplasia syndrome is a primary immunodeficiency disease characterized by short stature, hypoplastic hair and a variable degree of immunodeficiency. Noninfectious cutaneous granulomas represent an uncommon yet well-recognized manifestation within the spectrum of primary immunodeficiency diseases. However, cutaneous granulomas as a manifestation of cartilage-hair hypoplasia syndrome, are extremely rare. We present a case of a middle-aged man with cartilage hypoplasia syndrome featuring cutaneous granulomas, manifesting as chronic, extensive and deep cutaneous ulcers. The patient was treated with anti-TNF-alpha adalimumab with partial improvement. Our case underscores the broad spectrum of clinical manifestations associated with cartilage hypoplasia syndrome and adds new evidence to the potential therapeutic efficacy of anti-TNF-alpha drugs in its treatment.

[Genetic analysis of a child with Hypotrichosis simplex].

OBJECTIVE: To explore the clinical phenotype and genetic characteristics of a child with Hypotrichosis 14. METHODS: A child who had presented at the Henan Provincial People's Hospital on May 4, 2020 due to hair thinning was selected as the study subject. Clinical data of the child was collected. Peripheral venous blood samples were collected from the child and her parents. Genomic DNA was extracted and subjected to whole exome sequencing. Candidate variants were validated by Sanger sequencing and bioinformatic analysis. RESULTS: The child, a 5-year-old female, had presented with thin, soft lanugo-like hair which was easy to fall off. The child was found to harbor compound heterozygous missense variants of the LSS gene, namely c.1609G>A (p.V537M) in exon 17 and c.802T>G (p.F268V) in exon 8, which were respectively inherited from her father and mother. Both variant sites were highly conserved, though based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), both variants were rated as variants of unknown significance (PM2_Supporting+PP3+PP4). CONCLUSION: The c.1609G>A (p.V537M) and c.802T>G (p.F268V) compound heterozygous variants of the LSS gene probably underlay the clinical phenotype in this patient.

Acrokeratosis paraneoplastica (Basex syndrome) with trachyonychia preceding the diagnosis of squamous cell carcinoma of the lung.

Acrokeratosis paraneoplastica (Basex syndrome) is a rare paraneoplastic condition hallmarked by psoriasiform lesion development on acral surfaces, most often related to an underlying squamous cell carcinoma. Patients may also present with nail plate changes. Successful management of this condition can be accomplished by treating the underlying malignancy.

Cartilage-hair hypoplasia-anauxetic dysplasia spectrum disorders harboring RMRP mutations in two Korean children: A case report.

RATIONALE: Cartilage-hair hypoplasia (CHH, OMIM # 250250) is a rare autosomal recessive disorder, which includes cartilage-hair hypoplasia-anauxetic dysplasia (CHH-AD) spectrum disorders. CHH-AD is caused by homozygous or compound heterozygous mutations in the RNA component of the mitochondrial RNA-processing Endoribonuclease (RMRP) gene. PATIENT CONCERNS: Here, we report 2 cases of Korean children with CHH-AD. DIAGNOSES: In the first case, the patient had metaphyseal dysplasia without hypotrichosis, diagnosed by whole exome sequencing (WES), and exhibited only skeletal dysplasia and lacked extraskeletal manifestations, such as hair hypoplasia and immunodeficiency. In the second case, the patient had skeletal dysplasia, hair hypoplasia, and immunodeficiency, which were identified by WES. INTERVENTIONS: The second case is the first CHH reported in Korea. The patients in both cases received regular immune and lung function checkups. OUTCOMES: Our cases suggest that children with extremely short stature from birth, with or without extraskeletal manifestations, should include CHH-AD as a differential diagnosis. LESSONS SUBSECTIONS: Clinical suspicion is the most important and RMRP sequencing should be considered for the diagnosis of CHH-AD.

[Bazex syndrome: a rare paraneoplastic disease]. / Síndrome de Bazex: una enfermedad paraneoplásica infrecuente.

Bazex syndrome is a paraneoplastic disorder most commonly linked to squamous cell carcinomas of the upper aerodigestive tract, followed by lung cancer and other malignancies. It manifests through three stages of skin involvement that mirror the tumor's progression. Remarkably, skin lesions precede tumor symptoms or diagnosis in two-thirds of cases, underscoring the crucial role of suspecting this condition as it can promptly reveal an underlying neoplasm. Treatment primarily focuses on addressing the root neoplasm, with recurrent skin lesions potentially indicating tumor relapse. In this context, we present a clinical case involving a male patient whose manifestation of this syndrome facilitated the timely diagnosis of lung adenocarcinoma. This case underscores the significance of understanding this uncommon syndrome and its link to cancer, enabling early and accurate oncological diagnosis.

El síndrome de Bazex es una enfermedad paraneoplásica que se asocia con mayor frecuencia a carcinomas de células escamosas del tracto aerodigestivo superior, seguido en frecuencia por el cáncer de pulmón y otras neoplasias. Afecta a la piel en tres etapas que tienen un comportamiento paralelo al crecimiento del tumor. En dos tercios de los casos, las lesiones cutáneas preceden a los síntomas o al diagnóstico del tumor. De ahí la importancia de la sospecha de esta entidad, que puede desenmascarar a la neoplasia asociada en una etapa temprana. Su tratamiento consiste en tratar la neoplasia subyacente. La recurrencia de las lesiones cutáneas puede revelar la recaída del tumor. Comunicamos el caso clínico de un paciente de sexo masculino en el cual el hallazgo de este síndrome permitió realizar el diagnóstico de un adenocarcinoma de pulmón, lo cual destaca la importancia de conocer a esta rara enfermedad y su asociación con cáncer, para poder realizar el diagnóstico oncológico de forma temprana y oportuna.

Identification of a founder effect involving n.197C>T variant in RMRP gene associated to cartilage-hair hypoplasia syndrome in Brazilian patients.

Cartilage-hair hypoplasia syndrome (CHH) is an autosomal recessive disorder frequently linked to n.72A>G (previously known as n.70A>G and n.71A>G), the most common RMRP variant worldwide. More than 130 pathogenic variants in this gene have already been described associated with CHH, and founder alterations were reported in the Finnish and Japanese populations. Our previous study in Brazilian CHH patients showed a high prevalence of n.197C>T variant (former n.195C>T and n.196C>T) when compared to other populations. The aim of this study was to investigate a possible founder effect of the n.197C>T variant in the RMRP gene in a series of CHH Brazilian patients. We have selected four TAG SNPs within chromosome 9 and genotyped the probands and their parents (23 patients previously described and nine novel). A common haplotype to the n.197C>T variant carriers was identified. Patients were also characterized for 46 autosomal Ancestry Informative Markers (AIMs). European ancestry was the most prevalent (58%), followed by African (24%) and Native American (18%). Our results strengthen the hypothesis of a founder effect for the n.197C>T variant in Brazil and indicate that this variant in the RMRP gene originated from a single event on chromosome 9 with a possible European origin.

A Missense Mutation in the Collagen Triple Helix of EDA Is Associated with X-Linked Recessive Hypohidrotic Ectodermal Dysplasia in Fleckvieh Cattle.

Mutations within the ectodysplasin A (EDA) gene have been associated with congenital hypotrichosis and anodontia (HAD/XHED) in humans, mice, dogs and cattle. We identified a three-generation family of Fleckvieh cattle with male calves exhibiting clinical and histopathological signs consistent with an X-linked recessive HAD (XHED). Whole genome and Sanger sequencing of cDNA showed a perfect association of the missense mutation g.85716041G>A (ss2019497443, rs1114816375) within the EDA gene with all three cases following an X-linked recessive inheritance, but normal EDAR and EDARADD. This mutation causes an exchange of glycine (G) with arginine (R) at amino acid position 227 (p.227G>R) in the second collagen triple helix repeat domain of EDA. The EDA variant was associated with a significant reduction and underdevelopment of hair follicles along with a reduced outgrowth of hairs, a complete loss of seromucous nasolabial and mucous tracheal and bronchial glands and a malformation of and reduction in number of teeth. Thermostability of EDA G227R was reduced, consistent with a relatively mild hair and tooth phenotype. However, incisors and canines were more severely affected in one of the calves, which correlated with the presence of a homozygous missense mutation of RNF111 (g.51306765T>G), a putative candidate gene possibly associated with tooth number in EDA-deficient Fleckvieh calves.

Estudo exploratório da Síndrome Hipoplasia Cartilagem-Cabelo no Brasil: uma abordagem genômica, proteômica e de análise estrutural de RNA / Exploratory study of Hypoplastic Cartilage-Hair Syndrome in Brazil: a genomic, proteomic and RNA structural analysis approach

A Hipoplasia Cartilagem-Cabelo (do inglês, Cartilage Hair Hypoplasia; CHH) é uma doença autossômica recessiva descrita por McKusick et al., em 1964 em crianças da comunidade Amish. Clinicamente, os pacientes apresentam displasia óssea metafisária em diferentes graus de gravidade. Além disso, também pode ser observado hipotricose e imunodeficiência. Já no âmbito molecular, a condição se caracteriza por variantes patogênicas do gene RMRP. Apesar de ter sido delineada há quase 60 anos, ainda não existe uma correlação genótipo-fenótipo bem compreendida. Este trabalho é uma continuação do trabalho de mestrado realizado no IFF/Fiocruz, durante 2017 e 2018, no qual foi descrita uma coorte de 23 pacientes brasileiros com CHH em que foram encontradas diversas variantes patogênicas. Dentre estas, a variante g.196C>T destacou-se por sua elevada frequência no grupo estudado, diferentemente do observado em pacientes de outras nacionalidades, sugerindo um possível efeito fundador (EF) para a população brasileira. Esse trabalho teve por objetivo realizar diferentes ensaios moleculares para auxiliar na compreensão da CHH, além de investigar a hipótese de uma origem ancestral comum da variante g.196C>T. O estudo foi dividido em 4 eixos, sendo três relacionados às pesquisas de caráter exploratório dos mecanismos da doença e um dedicado à análise do EF. Dentro deste último, utilizando um painel de marcadores do tipo TAG SNPs cuidadosamente selecionados, foi observado que cromossomos de diferentes regiões brasileiras carregando o nucleotídeo T na posição196 do gene RMRP compartilharam o haplótipo T/C/G/A (16/17 haplótipos), apontando para uma origem comum desta substituição de base no gene RMRP. Adicionalmente, foram realizadas análises de proteômica comparativa, evidenciando que o perfil proteômico dos leucócitos de pacientes e controles expressam proteínas que traduzem vias moleculares distintas, além de apresentar diferenças de expressão de proteínas importantes relacionadas aos fenótipos clínicos da doença. Também foram realizados ensaios de RT-qPCR que mostraram que tanto os níveis do RNA RMRP, quanto dos dois pequenos RNAs derivados de RMRP, estavam significativamente reduzidos nos pacientes em relação ao grupo controle. Por fim, com o intuito de tentar prever o impacto das variantes na estrutura tridimensional do RNA, foi realizada uma análise in silico que mostrou que as alterações patogênicas identificadas nos pacientes ocorreram tanto em regiões conservadas entre espécies de mamíferos quanto em domínios essenciais para o complexo ribonucleoproteico. Duas alterações estão localizadas em regiões associadas à biogênese dos pequenos RNAs derivados de RMRP. Além disso, foi possível observar que certas variantes podem alterar o pareamento de bases e a topologia da estrutura das alças da molécula, o que poderia influenciar na montagem do complexo RNAse MRP. Em conjunto, os dados desta tese lançam luz sobre diversos pontos ainda não explorados para CHH, além de dar suporte para novos estudos que tenham por objetivo viabilizar uma medicina de precisão, contribuindo para minimizar os impactos da doença e para a promoção da qualidade de vida dos pacientes.

Cartilage Hair Hypoplasia (CHH) is an autosomal recessive disease described by McKusick et al. in 1964 in the Amish community. Clinically, patients present metaphyseal bone dysplasia in different degrees of severity. In addition, hypotrichosis and immunodeficiency may also be present. At the molecular level, the condition is characterized by pathogenic variants of the RMRP gene. Although CHH has been described more than 60 years ago, the genotype-phenotype correlation is still not well-understood. This work is a continuation of the dissertation carried out at IFF/Fiocruz, during 2017 and 2018, in which a cohort of 23 Brazilian patients with CHH was described and several pathogenic variants were found. Among these, the high frequency of g.196C>T variant in the studied group called our attention, unlike that observed in patients of other nationalities, suggesting a possible founder effect (EF) in the Brazilian population. This work aimed to perform different molecular assays to aid in the understanding of CHH, in addition to investigating the hypothesis of a common ancestral origin of the g.196C>T variant. The study was divided into 4 axes, three related to exploratory research on disease mechanisms and one dedicated to the analysis of EF. Within the latter, using a carefully selected panel of TAG SNPs markers, it was observed that chromosomes from different Brazilian regions carrying T at nucleotide 196 of the RMRP gene shared the T/C/G/A haplotype (16/17 haplotypes), indicating a common origin of this base substitution at position 196 of the RMRP gene. Additionally, comparative proteomics analysis was performed, showing that the proteomic profile of leukocytes from patients and controls express proteins that translate distinct molecular pathways, in addition to presenting differences in the expression of proteins related to important clinical phenotypes of the disease. RT-qPCR assays were also performed, which showed that both RMRP RNA levels and the two RMRP-derived small RNAs were significantly reduced in patients compared to the control group. Finally, in order to try to predict the impact of the variants on the three-dimensional structure of the RNA, an in silico analysis was performed which showed that the pathogenic alterations identified in the patients occurred both in regions conserved between mammalian species and in domains essential for the ribonucleoprotein complex. Two alterations are located in regions associated with the biogenesis of RMRP-derived small RNAs. In addition, it was possible to observe that certain variants can change the base pairing and the topology of the structure of the molecule's loops, which could influence the assembly of the RNAse MRP complex. Together, the data from this thesis shed light on several points not yet explored for CHH, in addition to providing support for new studies that aim to enable a precision medicine toward CHH patients, helping to minimize the impacts of the disease and to promote quality of life of patients.

Displasia ectodérmica: diagnóstico neonatal / Ectodermal dysplasia: neonatal diagnosis

Presentamos el caso de un neonato sin antecedentes familiares ni prenatales de importancia, con peso bajo para la edad, fascies envejecida, puente nasal ancho, hipotricosis, piel descamativa, apergaminada, seca y hepatomegalia, aparente hipohidrosis con episodios de hipertermia, fenotipo compatible con displasia ectodérmica hipohidrótica, por alteraciones en la diferenciación y desarrollo de estructuras ectodérmicas: piel, pelo, dientes y glándulas sudoríparas, alteración en las señales entre ectodermo y mesénquima, además de mayor riesgo de desarrollar alteraciones inmunológicas y en la supresión de tumores. Este paciente requiere cuidados dérmicos y evitar la hipertemia que puede ocasionar un daño cerebral fatal, tratamiento dental precoz para restaurar la función, monitoreo permanente de función auditiva y oftálmica, consejo genético a la familia; y al asociarse con inmunodeficiencia puede requerir terapias de restitución inmune, tratamientos agresivos de las infecciones asociadas y/o un trasplante de células madre hematopoyéticas, según la evolución clínica.

This is the case of a newborn without family history of important diseases, with low weight for age, aged fascies, broad nasal bridge, hypotrichosis, desquamative skin, parchment, dry and hepatomegaly, apparent hypohidrosis with episodes of hyperthermia, phenotype compatible with dysplasia ectodermic hypohydrotic, by alterations in the differentiation and development of ectodermal structures: skin, hair, teeth and sweat glands, alteration in the signals between ectoderm and mesenchyme, as well as a greater risk of developing immunological alterations and tumor suppression. This patient requires dermal care and avoids the hyperthermia that can cause fatal brain damage, early dental treatment to restore function, permanent monitoring of auditory and ophthalmic function, genetic counseling to the family, and to associate with immunodeficiency, probably, requires therapies of immune restitution, aggressive treatments of associated infections and / or a transplant of hematopoietic stem cells, according to the clinical evolution.

Hypotrichosis with juvenile macular dystrophy: a case report with molecular study / Hipotricose com distrofia macular juvenil: relato de caso com estudo molecular

ABSTRACT Hypotrichosis with juvenile macular dystrophy is a rare autosomal recessive disorder characterized by sparse scalp hair caused by hair follicle abnormalities as well as progressive retinal degeneration leading to blindness in the second or third decade of life. It is associated with mutations of the cadherin 3 (CDH3) gene, which result in abnormal expression of P-cadherin. Mutations in CDH3 are related to ectodermal dysplasia, ectrodactyly, and macular dystrophy. In this report, we describe an 11-year-old Iranian boy born with a missing left index fingernail and sparse scalp hair who later displayed macular pigmentary changes. Genetic testing of the CDH3 gene revealed a homozygous gene variant at exon 6 (640A>T). This novel in-frame mutation converts a lysine to a premature stop codon, altering synthesis of P-cadherin on chromosome 16q22.

RESUMO Hipotricose com distrofia macular juvenil (HDMJ) é uma doença autossômica recessiva rara caracterizada por rarefação capilar por alteração nos folículos pilosos e degeneracão progressiva da retina levando a cegueira na segunda e terceira década de vida. Associada a mutações no gene CDH3, resultando em expressão anormal de P-caderina. Mutações no gene CDH3 estão relacionados à displasia ectodérmica, ectrodactilia e distrofia macular. Neste relato descrevemos um menino Iraniano de 11 anos de idade, com ausência da unha na mão esquerda e rarefação capilar desde o nascimento, e que posteriormente apresentou alterações pigmentares maculares. Teste genético do gene CDH3 revelou uma variação homozigótica no exon 6 (640A>T). Essa mutação in-frame troca uma lisina por um codon de parada prematura, alterando a síntese da proteína P-caderina no cromossomo 16q22.

Monilethrix: a typical case report with microscopic and dermatoscopic findings

Monilethrix is a rare hereditary condition generally considered to be an autosomal dominant disorder with variable penetrance. A case of a 6-year-old girl without a familial background for this disease is reported. The diagnosis was made by optic microscopy and dermoscopy. A therapeutic trial with topical minoxidil was conducted.

Efeitos da ingestão de cafeína durante a gestação e a lactação sobre a pele de ratas e de filhotes e sua relação com as concentrações séricas do cortisol materno / Effects of caffeine intake during pregnancy and lactation on the skin of rats and offspring and their relationship to maternal serum concentrations of cortisol

O objetivo deste trabalho foi verificar os efeitos da ingestão materna de diferentes doses de cafeína durante a gestação e a lactação, na pele de ratas-mães e filhotes, bem como sua relação com as concentrações séricas do cortisol materno. Vinte e quatro ratas Wistar adultas foram distribuídas em quatro grupos, representados pelo controle e tratados, com cafeína nas doses de 25, 50 e 100mg/kg. Os grupos tratados receberam cafeína por sonda orogástrica durante toda a gestação e a lactação. O controle recebeu água destilada como placebo. Foram avaliados e quantificados os diferentes tipos de folículos pilosos e a espessura da epiderme. A técnica de imuno-histoquímica, com o uso do anticorpo anti-CDC47, foi utilizada para avaliar a proliferação celular da epiderme e dos folículos pilosos das mães. Na mãe, também foram mensurados os níveis séricos de cortisol pela técnica da quimioluminescência. Os dados foram submetidos à análise de variância com comparação das médias pelos testes Kruskal-Wallis e SNK. Nos grupos tratados com cafeína nas doses de 25 e 50mg/kg, tanto as mães quanto seus filhotes apresentaram hipotricose e/ou alopecia focal. Apesar de a frequência de alterações macroscópicas das mães ter sido superior a dos filhotes, nestes as lesões, quando presentes, foram difusas. A análise histológica demonstrou calcinose de folículos pilosos nas mães e nos filhotes. Mas a morfometria somente revelou diferença significativa no número de folículos pilosos das mães, bem como redução significativa da proliferação celular dos folículos pilosos do grupo tratado com 50mg/kg de cafeína. Os níveis de cortisol materno somente foram significativamente elevados no grupo tratado com 100mg/kg de cafeína. Conclui-se que a cafeína ingerida pelas ratas gestantes e lactantes pode causar lesões cutâneas tanto nas mães quanto nos filhotes, caracterizadas por hipotricose e/ou alopecia, independentemente dos níveis séricos do cortisol materno.

The aim of this study was to investigate the effects of maternal caffeine intake during pregnancy and lactation on the skin of rats and their offspring, as well as their relationship to maternal serum levels of cortisol. 24 adult Wistar rats were equally divided into four groups represented by the control and treated with caffeine at doses of 25, 50 and 100mg/kg. The groups received caffeine by orogastric tube during the entire pregnancy and lactation. The control received distilled water as placebo. Different types of hair follicles and the thickness of the epidermis were assessed and quantified. Immunohystochemistry technique using antibody anti-CDC47 was used to evaluate cellular proliferation of the epidermis and hair follicles of the mothers. Also in the mothers, serum levels of cortisol were measured by the chemiluminescence technique. Data were submitted to analysis of variance comparing mediums by Kruskall Wallis Test and SNK. In groups treated with caffeine 25 and 50mg/kg, both mothers and their puppies had focal alopecia and/or hypotrichosis. Despite the higher frequency of macroscopic changes on the mothers, these lesions were diffuse when present on the puppies. Histological analysis showed calcinosis of hair follicles in the mothers and their puppies. But morphometry revealed significant difference in the number of hair follicles from mothers, as well as a significant reduction of cell proliferation of hair follicles in the group treated with 50mg/kg of caffeine. Maternal cortisol levels were significantly elevated in the group treated with 100mg/kg of caffeine. It is concluded that caffeine intake by pregnant and lactating rats can cause skin lesions in both the mothers and their offspring, characterized by alopecia and/or hypotrichosis, regardless of serum levels of maternal cortisol.

Displasia ectodérmica hipohidróticaa en dos hermanas / Hypohidrotic ectodermal dysplasia in two sisters

La displasia ectodérmica hipohidrótica es un síndrome congénito, caracterizado por la tríada hipohidrosis, hipotricosis e hipodoncia no progresivas. La forma más común es lade herencia recesiva ligada al cromosoma X, aunque también existe una autosómica recesiva y otra dominante. Su tratamiento incluye un manejo interdisciplinario, con medidas de soporte para las manifestaciones clínicas del trastorno y el asesoramiento genético familiar.

Hypohidrotic ectodermal dysplasia is a congenital syndrome characterized by the triad of hypohidrosis, hypotrichosis and non-progressivehypodontia. The most common form is the one inherited in a recessive X-linked way, although there is also an autosomal recessive and a dominant ones. Treatment includes the interdisciplinary management, supportive for the clinical manifestations of the disorder and family genetic counseling.

Do you know this syndrome? / Voce conhece esta sindrome?

POEMS syndrome is a unique clinical entity, the diagnosis of which is made when polyneuropathy and monoclonal gammopathy occur together, associated with other changes such as organomegaly, endocrinopathy, skin changes and papilledema. Cutaneous manifestations are heterogeneous, with diffuse cutaneous hyperpigmentation, hemangiomas and hypertrichosis occurring more frequently. We report the case of a 65- year-old female patient with this syndrome, diagnosed after 15 years of disabling peripheral neuropathy.

A síndrome de POEMS é uma entidade clínica única cujo diagnóstico é colocado quando existe polineuropatia e gamapatia monoclonal associada a outras alterações tais como organomegalia, endocrinopatia, alterações cutâneas e papiledema. As manifestações cutâneas são heterogéneas, sendo as mais frequentes a hiperpigmentação cutânea difusa, os hemangiomas e a hipertricose. Relata-se o caso de uma doente de 65 anos com essa síndrome diagnosticada após 15 anos de neuropatia periférica.

Bazex Syndrome / Sindrome de Bazex

Acrokeratosis Paraneoplastica or Bazex syndrome is a dermatologic manifestation usually associated with the diagnosis of squamous cell carcinoma of the upper aerodigestive tract. We report a case with exuberant clinical manifestations, exemplifying the typical cutaneous lesions in this rare syndrome, in a patient with squamous cell carcinoma of the esophagus.

Acroceratose paraneoplásica ou síndrome de Bazex é uma manifestação cutânea paraneoplásica rara, geralmente associada a carcinoma de células escamosas do trato aerodigestivo superior. Relata-se um caso com manifestações clínicas exuberantes, ilustrativo quanto às lesões cutâneas típicas da síndrome, em paciente portadora de carcinoma de células escamosas do esôfago.

Graham-Little Piccardi Lassueur Syndrome: case report / Síndrome de Graham-Little Piccardi Lassueur: relato de caso

A 33-year-old woman presented with a 3-year history of progressive alopecia of the scalp. Past treatment with hydroxicloroquine did not show improvement. Physical examination revealed multiple areas of alopecia with atrophic aspect of the scalp, and axillary and pubic hypotrichosis. Dermoscopy showed hyperkeratosis and accentuation of follicular ostia. Anatomopathological examination revealed decrease in the number of hair follicles, upper perifollicular infiltrate and areas with fibrosis. The Piccardi-Lassueur-Graham-Little syndrome is a rare disorder, characterized by the triad of multifocal scarring alopecia of the scalp, keratotic follicular eruption and hypotrichosis of axillary and pubic regions. Management is a challenge and many medications tried have controversial results. We report a case of this rare syndrome which improved with corticoids.

Mulher, 33 anos, apresenta quadro de alopecia progressiva do couro cabeludo há 3 anos. Tratamento com hidroxicloroquina há 12 meses, sem apresentar melhora. Ao exame físico exibe múltiplas áreas de alopecia cicatricial no couro cabeludo, além de hipotricose axilar e pubiana. A dermatoscopia evidencia hipercetose folicular e acentuação dos óstios foliculares. O exame anatomopatológico revela diminuição do número de folículos pilosos, infiltrado perifolicular e fibrose. A síndrome de Graham-Little Piccardi Lassueur é uma dermatose rara, caracterizada pela tríade de alopecia cicatricial multifocal do couro cabeludo, ceratose folicular disseminada e hipotricose das regiões axilares e pubianas. A terapêutica desta dermatose é um desafio, muitas medicações relatadas tem resultados controversos. Relatamos o caso desta síndrome rara que apresentou melhora com corticoterapia.

Algoritmo para as alopécias cicatriciais e suas opções de tratamento / Algorithm for approaching scar alopecia and treatment options

A cirurgia plástica dispõe de um variado arsenal de técnicas para o tratamento das alopéciascicatriciais. A correção cirúrgica dos defeitos do couro cabeludo deve começar por uma sistematizaçãoda classificação das lesões. A proposta de um algoritmo tem por objetivo organizarde maneira racional as opções para cada caso, sem, no entanto, substituir o julgamento e acriatividade do cirurgião. Este trabalho apresenta um raciocínio clínico que poderá facilitara escolha da melhor opção cirúrgica para corrigir cicatrizes do couro cabeludo.

Plastic surgery has a varied arsenal of techniques for the treatment of scar alopecia. Thesurgical correction of scalp defects should begin with a systematic classification of thetype of injury. An algorithm has been developed that rationalizes and organizes the surgicaloptions in each case, without attempting to replace the surgeon’s judgment and creativity.This paper presents a clinical analysis that could assist the selection of the best surgicalalternative for different cases of scar alopecia.