Oral isotretinoin in photoaging: clinical and histopathological evidence of efficacy of an off-label indication.

BACKGROUND: Despite evidences of the beneficial clinical effects of oral isotretinoin in the treatment of cutaneous photoaging, scientific evidences are still scarce, mainly supported by histopathological and morphometric studies. OBJECTIVES: To analyse possible clinical and morphological changes resulting from the treatment of photoaging with oral isotretinoin. METHODS: Thirty female patients, aged 40 to 55 years, phototypes II to IV, with moderate to severe photoaging were randomly assigned to two groups of 15 each. Group I (G I) patients were treated with 10 mg of isotretinoin and group II (G II) with 20 mg of oral isotretinoin thrice a week for 3 months. Skin biopsies were performed before and after the end of therapy, and the various sections were submitted to specific staining for collagen and elastic fibres. To analyse the changes, morphometric studies were performed, and the results obtained were analysed by Student's t-test (paired and non-paired). Clinical results of therapy regarding texture, colouring and aspect of the wrinkles were assessed by both physician and patient. RESULTS: The increase in the amount of collagen fibres was statistically significant with both dosage regimens (mean, 37.8%, increasing to 44.4%; P = 0.029 with the 10-mg dosage; and mean, 36.6%, increasing to 41.9%; P = 0.01 with the 20-mg dosage). A pattern pointing toward a decrease in the number of elastic fibres was found (mean, 15.3-12%; P = 0.014 with the 10-mg dosage; mean, 15.5-14%; P = 0.125 with the 20-mg dosage). Additionally, there was improvement in the general aspect of the skin, regarding texture, wrinkles depth and skin coloration. LIMITATIONS: Despite ethical considerations, a lack of a control group using placebo may render the results less accurate. CONCLUSION: Low dosages of oral isotretinoin seem to be an effective therapeutic option for cutaneous photoaging.

[Calcinosis of the scrotum]. / Calcinose da bolsa escrotal.

A critical review of the present classification of the calcinosis cutis is done and the difficulties to make it more precise are pointed out: it is hard to put together diseases totally different that have in common only calcium deposits in the skin; there is a lot of confusion in the current terminology; some authors don't recognize certain entities and; in a few times their own definitions are not respected. A cause of scrotal calcinosis (SC) secondary to epidermoid cysts calcification is presented. The authors believe that many cases classified as idiopathic calcinosis of the scrotum can be in reality late stages of a dystrophic calcification. They suggest that serial cuts in the histopathology examination of every lesion of SC should be performed in order to establish the existence or not of any epithelial remnant. Considering the fact that the treatment is surgical and mostly due to esthetic reasons, they also suggest to follow, if possible, a significant number of patients from an early to a late stage of the disease; only in this way it will be possible to know about the natural history of the scrotal calcinosis.

[Transient acantholytic dermatosis. Presentation of a case]. / Dermatose acantolítica transitória. Apresentação de um caso.

A case of DAT is presented and the literature is reviewed. The authors verify the limitation of the present therapeutics and they discuss the possible pathogenic mechanism. They also say that "unspecific" lesions resistant to conventional therapy, and mostly localized in the trunk of middle-aged patients may suggest the diagnosis of DAT if biopsy is performed in these cases there probably will be a higher incidence of the disease. As far as we know this is the first brazilian case of DAT reported.

[A new classification of photodermatoses]. / Uma nova classificação das fotodermatoses.

The authors present a new classification for photodermatosis in five groups: 1. Primary toxic photodermatosis that means lesions produced in all human beings by non-ionized radiation. 2. Photodermatosis induced by drugs, with two subgroups--phototoxic and photoalergic--according to the mechanism of action of the drug. 3. Idiopathic photodermatosis in which the photonic effects are known but the chromophores are unknown; four conditions are included here polymorphous actinic eruption, solar urticaria, actinic reticuloid and hidroa vacciniforme. 4. Miscelanea group which includes several conditions of unknown mechanism which are not included in the other groups, such as: actinic cheilitis, actinic poikiloderma, actinic ceratoses, epitheliomas, melanomas and others. 5. Conditions precipitated or aggravated by solar radiation with two sub-groups: hereditary (xeroderma pigmentosum, Hartnup's syndrome and other) and acquired (lupus erythematosus, pellagra and other). In group 1, the authors propose the designation of actinic elastotic dermatosis to unify different conditions described by several authors such as: diffuse elastosis, citrein skin, cutis rhomboidalis, and others.

[Hypersensitivity syndrome caused by phenytoins and phenobarbital]. / Síndrome de hipersensibilidade às fenitoinas e ao fenobarbital.

Recently we have seen three patients with a clinically characteristic hypersensitivity reaction to phenytoin two to four weeks after they started these therapy. The picture simulated a severe infectious exanthem; it was characterized by a generalized erythematous macular eruption, massive edema of the face, fever, generalized lymphadenopathy and hepatic involvement. The laboratory findings revealed leukocytosis with atypical lymphocytes, eosinophilia and altered liver function. Involution of the eruption was characterized by exfoliation similar to that observed in scarlet fever. There was prompt and good response to treatment with systemic steroids.

Lyme disease in Rio de Janeiro, Brazil.

Five patients living in Rio de Janeiro, Brazil, were found to have Lyme disease. These are among the first known cases in South America.

Foto-onicolise por doxiciclina. / Photo-onycholysis due to doxicycline

Os autores um caso de fotossensibilidade cutanea, discromia ungueal e onicolise por doxiciclina. Chamam atencao para a onicodinia severa que precedeu o descolamento das unhas das maos e discutem o quadro clinico e a tiopatogenia do processo. Este parece ser o primeiro relato de foto-onicolise por derivados de tetraciclina descrito no Brasil

Tumor de células gigantes da Bainha do Tendäo / Giant cell tumor of the Tendon Sheath

O tumor de células gigantes da bainha do tendäo é um tumor de tecidos moles relativamente comum, porém raro na literatura dermatológica. Deve-se a uma proliferaçäo benigna de histócitos na articulaçäo e tecido sinovial peritendinoso que se desenvolve ao redor da bainha do tendäo, ligamento articular e sinovia articular. Apresentamos um caso de localizaçäo em 2§ pododáctilo direito que serve para chamar a atençäo a esse diagnóstico e ao seu diagnóstico diferencial. Foi feita uma revisäo da literatura