ABSTRACT
Mília são cistos de queratina de 1-3mm de diâmetro, que ocorrem devido à obstrução de glândulas sudoríparas écrinas ou de folículos pilosos. Descrevemos um caso em paciente feminina, com múltiplas pápulas branco-amareladas, distribuídas sobre uma tatuagem realizada seis meses antes da consulta médica. O tratamento conservador é uma opção, uma vez que há a possibilidade de que a lesão seja transitória e desapareça espontaneamente. Optamos por tratamento conservador com ótimo resultado estético final.
Milia are keratin cysts of 1-3mm in diameter that occur due to the obstruction of eccrine sweat glands or hair follicles. We describe the case of a female patient with multiple white-yellow papules over a tattoo made six months prior to the consultation. Conservative treatment is an option, since there is the possibility of the lesion being transient and that it will spontaneously resolve. We opted for a conservative treatment with excellent final cosmetic outcome.
Subject(s)
Conservative TreatmentABSTRACT
Paracoccidioidomycosis (PCM), which is caused by the dimorphic fungus Paracoccidioides spp, is the most prevalent systemic mycosis in immunocompetent individuals in Brazil. The fungus lives in the soil and usually infects the patient through inhalation of airborne propagules, the lungs being the portal of entry. In areas of larger endemicity, such as Brazil, the annual incidence reaches 3 cases per 100,000 inhabitants. Cutaneous lesions in PCM are frequent and ulcer or ulcerous-vegetative lesions are the commonest morphological type, followed by the infiltrative pattern. The histology shows a dermal granulomatous inflammation. Infiltrative PCM can be easily misdiagnosed, once clinical and histological similarities may occur specially with cutaneous sarcoidosis. We describe a case of cutaneous paracoccidioidomycosis misdiagnosed as sarcoidosis both in clinical examination and in the histopathological analysis. Further exams confirmed Paracoccidioides sp. as the causative agent through mycological cultures and Grocott's stain. We believe this case may help physicians around the world to suspect and consider PCM as a differential diagnosis, especially if the patient has traveled to endemic area or the current therapy for sarcoidosis lacks clinical improvement. (AU)
Importância do problema: Paracoccidioidomicose (PCM) é a micose sistêmica mais prevalente em indivíduos imunocompetentes no Brasil, sendo causado pelo fungo dimórfico Paracoccidioides spp. O fungo vive no solo e geralmente sua porta de entrada no paciente ocorre pelos pulmões por inalação de propágulos presentes no ar. Em áreas de maior endemicidade, como no Brasil, a incidência chega a três casos por 100 mil habitantes. As lesões cutâneas na PCM são frequentes. Lesões ulceradas ou ulcerovegetantes são os tipos morfológicos mais comuns, sendo o padrão infiltrativo o segundo mais descrito. A histologia demonstra inflamação granulomatosa na derme. A PCM infiltrativa pode ser facilmente confundida com sarcoidose, visto que ambas possuem similaridades clínicas e histopatológicas. Comentários: Nós descrevemos um caso de PCM cutânea com diagnóstico inicial incorreto de sarcoidose, tanto pelo quadro morfológico, como pelo exame histopatológico semelhante. Exames posteriores revelaram a presença de Paracoccidioides sp na coloração pelo Grocott e na cultura do material para fungos. Os autores acreditam que esse caso possa ajudar médicos a suspeitarem e considerarem PCM no diagnóstico diferencial de lesões cutâneas infiltrativas, especialmente se houver história epidemiológica de viagem a área endêmica ou resposta insatisfatória ao tratamento para sarcoidose. (AU)
Subject(s)
Humans , Male , Adult , Diagnosis, Differential , Mycoses , Paracoccidioidomycosis , SarcoidosisABSTRACT
Abstract Perforating dermatoses are a group of skin diseases characterized by transepidermal elimination of dermal material. The disease is divided into two groups: the primary group and the secondary group. The classical or primary perforating dermatoses are subdivided into four types according to the eliminated dermal materials: Kyrle disease, perforating reactive collagenosis, elastosis perforans serpiginosa, and perforating folliculitis. The secondary form is known as acquired perforating dermatosis. The term was proposed in 1989 by Rapini to designate the perforating dermatoses affecting adult patients with systemic disease, regardless of the dermal materials eliminated. This report describes a case of the disease with elimination of collagen and elastic fibers in a patient with chronic renal failure.
Subject(s)
Humans , Male , Middle Aged , Skin Diseases/etiology , Skin Diseases/pathology , Collagen Diseases/pathology , Epidermis/pathology , Kidney Failure, Chronic/complications , Collagen , Elastic Tissue/pathologyABSTRACT
Abstract: Gastric syphilis is an uncommon extracutaneous manifestation of syphilis, occurring in less than 1% of patients, presenting nonspecific clinical manifestations. In general, it occurs on secondary stage. The critical point is the recognition of the syphilitic gastric involvement, without which there may be incorrect diagnosis of malignancy of the digestive tract. In this report, a case of secondary syphilis with gastric involvement that had complete remission with benzathine penicillin will be described.
Subject(s)
Humans , Male , Middle Aged , Stomach Diseases/diagnosis , Syphilis/diagnosis , Penicillin G Benzathine/therapeutic use , Biopsy , Endoscopy, Gastrointestinal , Anti-Bacterial Agents/therapeutic useABSTRACT
Sporotrichosis is the most common subcutaneous mycosis. It is caused by the dimorphic fungus Sporothrix schenckii, and the infection is usually acquired by traumatic inoculation. We describe a case of sporotrichosis in an uncommon location with an unusual mode of transmission. A 49-year-old female patient who lived in an urban area of Rio de Janeiro presented with involvement of the left ear. No history of contact with soil, plants or animals was elicited. The suspected source of infection was a pair of handmade wooden earrings. The delay in the diagnosis and treatment resulted in higher morbidity, unsightly scarring and loss of ear lobe.
.Subject(s)
Female , Humans , Middle Aged , Ear Auricle/pathology , Sporotrichosis/pathology , Delayed Diagnosis , Ear Auricle/microbiology , Itraconazole/therapeutic use , Jewelry/microbiology , Sporotrichosis/transmission , Wood/microbiologyABSTRACT
Eccrine syringofibroadenoma is a rare benign adnexal neoplasm derived from cells of the acrosyringium of eccrine sweat glands. ESFA usually manifests as a solitary nodule on the extremities of elderly patients, but it may also present as papules, nodules or plaques. Its clinical appearance is nonspecific and malignant neoplasms should beconsidered in the differential diagnosis. However, histopathological findings are typical. The main treatment is surgical excision. In order to illustrate a typical presentation of the tumor, we report a case of solitary eccrine syringofibroadenoma, including the surgical treatment used and its result.
.Subject(s)
Aged, 80 and over , Female , Humans , Eccrine Glands/pathology , Fibroadenoma/pathology , Sweat Gland Neoplasms/pathology , Syringoma/pathology , Ankle , Biopsy , Eccrine Glands/surgery , Fibroadenoma/surgery , Sweat Gland Neoplasms/surgery , Syringoma/surgery , Treatment OutcomeABSTRACT
Degos disease, also known as malignant atrophic papulosis, is a rare occlusive vasculopathy of unknown etiology characterized by infarcts in the dermis, gastrointestinal tract, central nervous system, and other organs. It is characterized by papules, which become umbilicated and evolve with a depressed porcelain-white central area, with an erythematous halo with telangiectasias. Histological findings include wedge-shaped dermoepidermal necrosis and blood vessel thrombosis. Approximately 50-60% of patients with systemic symptoms die within 2-3 years, most due to gastrointestinal perforation. We report a typical case, with lethal outcome, in a 45-year-old woman.
Subject(s)
Humans , Female , Middle Aged , Skin/pathology , Malignant Atrophic Papulosis/pathology , Biopsy , Fatal Outcome , Venous Thrombosis/pathology , Malignant Atrophic Papulosis/complications , Intestinal Perforation/complicationsABSTRACT
Dermatofibrosarcoma protuberans is a fibrohistiocytic tumor of intermediate malignancy with aggressive localized growth, high recurrence rate, but low metastatic potential. It appears as a hardened plaque, with slow growth, upon which the development of nodules occurs. It predominates in the trunk and is unusual in acral locations. Histopathology reveals spindle cells with storiform pattern and cartwheel-like or whirlwind-like aspect. Immunohistochemistry shows positivity for CD34. The treatment is surgical. We report a case of long evolution, with an unusual location, that relapsed after surgery, to emphasize the importance of early diagnosis and proper treatment, avoiding aggressive resections with increased morbidity.
Subject(s)
Humans , Female , Middle Aged , Skin Neoplasms/pathology , Dermatofibrosarcoma/pathology , Skin Neoplasms/surgery , Biopsy , Immunohistochemistry , Treatment Outcome , Dermatofibrosarcoma/surgery , Fingers/pathologyABSTRACT
Os autores relatam o caso de um paciente HIV-positivo, portador de molusco contagioso disseminado, tratado com aplicação tópica de ácido tricloroacético, com bom resultado. Discutem-se aspectos epidemiológicos, clínicos e terapêuticos da infecção do molusco contagioso nos imunocompetentes e imunodeprimidos.
ABSTRACT
Erythema elevatum diutinum is a rare chronic cutaneous vasculitis which usually affects adults. It is characterized by symmetrical and persistent papules, plaques, and nodules. These lesions are usually located on the extensor surfaces of the extremities. We report a case of erythema elevatum diutinum in which the association of dapsone and surgical excision promoted complete remission of skin lesions, providing a new approach to the treatments described in the literature.
O eritema elevatum diutinum é uma vasculite cutânea rara, crônica, que costuma afetar adultos, manifestando-se com pápulas, placas e nódulos, simétricos e persistentes, nas regiões extensoras das extremidades. Relata-se um caso de eritema elevatum diutinum, onde a associação terapêutica da dapsona e excisão cirúrgica promoveu a remissão completa das lesões cutâneas, oferecendo uma nova abordagem aos tratamentos descritos na literatura.
Subject(s)
Humans , Male , Middle Aged , Anti-Infective Agents/therapeutic use , Dapsone/therapeutic use , Vasculitis, Leukocytoclastic, Cutaneous/therapy , Biopsy , Combined Modality Therapy/methods , Skin Diseases/pathology , Skin Diseases/therapy , Treatment Outcome , Vasculitis, Leukocytoclastic, Cutaneous/pathologyABSTRACT
Cutaneous protothecosis is a rare infection caused by achlorophyllic algae of the genus Prototheca. The lesions usually occur on exposed areas, related with trauma, in immunocompromised patients. The most common clinical presentation is a vesicobullous and ulcerative lesion with pustules and scabs, simulating bacterial, fungal or herpetic infections or eczema. The diagnosis is determined by agent identification through histopathology, culture and the carbohydrates assimilation test. The finding of morula-like spherules is characteristic of Prototheca sp. Its rarity and non-specific clinical aspect may difficult the disease diagnosis. We report a case of a diabetic patient, in chronic use of systemic corticosteroids, that developed a skin lesion after trauma to the right leg.
A prototecose cutânea é uma infecção rara causada por algas aclorofílicas do gênero Prototheca. Geralmente as lesões ocorrem em áreas expostas, relacionadas à trauma, em indivíduos imunocomprometidos. A apresentação clínica mais comum é uma lesão vesico-bolhosa e ulcerativa com pústulas e crostas, simulando piodermites, infecções fúngicas, infecções herpéticas ou eczemas. O diagnóstico é realizado pela identificação do agente através do exame histopatológico, da cultura e do teste de assimilação dos carboidratos. O achado de esférulas com aspecto de mórula são características da Prototheca sp. A raridade da doença e o aspecto clínico inespecífico dificultam o diagnóstico da doença. Relatamos um caso em paciente diabética, em uso crônico de corticoide sistêmico, que desenvolveu lesão cutânea após trauma na perna direita.
Subject(s)
Female , Humans , Middle Aged , Prototheca , Skin Diseases, Infectious/pathology , Antifungal Agents/therapeutic use , Biopsy , /immunology , Itraconazole/therapeutic use , Skin Diseases, Infectious/drug therapy , Skin Diseases, Infectious/immunology , Treatment OutcomeABSTRACT
The chondroid syringoma is a rare benign tumor, also called mixed cutaneous tumor by the presence of epithelial and mesenchymal components, consisting of sweat elements in cartilaginous, collagenous, myxoid or osseous stroma, among others. It mainly affects middle-aged men and is characterized by asymptomatic and slowgrowing, dermal or subcutaneous nodules. The most common locations are the head and neck. It is rare on the extremities. There are reports of malignant variants predominantly in women, located on the extremities. We report a case of a female patient with a lesion on the toe, with excellent outcome after surgical treatment.
O siringoma condroide é um tumor benigno, raro, também chamado de tumor misto cutâneo pela presença de componentes epiteliais e mesenquimais, que consistem em elementos sudoríparos em estroma cartilaginoso, colagênico, mixoide ou ósseo, entre outros. Acomete, principalmente, homens de meia-idade e caracteriza-se por nódulos subcutâneos ou dérmicos, assintomáticos e com crescimento lento. As localizações preferenciais são a cabeça e o pescoço, sendo raro nas extremidades. Existem relatos de variantes malignas, com predomínio em mulheres, localizadas nas extremidades. Relatamos um caso em paciente do sexo feminino, com lesão em extremidade e excelente resultado após o tratamento cirúrgico.
Subject(s)
Aged , Humans , Male , Dendritic Cells/pathology , Skin Neoplasms/pathology , Antigens, CD/analysis , Fatal OutcomeABSTRACT
FUNDAMENTO - O tumor glômico apresenta-se como lesäo de relativa raridade e de escassa informaçäo nacional. OBJETIVO - Caracterizar seu comportamento epidemiológico, clínico e histopatológico no Brasil. MÉTODO - Foram analisados 44 pacientes, tratados entre 1973 e 1995 no Rio de Janeiro e Niterói, mediante estudo retrospectivo multicêntrico. RESULTADOS - Em pacientes do sexo feminino, os tumores preferiram os quirodáctilos em 70,9 porcento e, nos do sexo masculino, em 38,4 porcento. A tríade "dor paroxística, sensibilidade local e hipersensibilidade à alteraçäo de temperatura"näo foi relatada. Recidivas ocorreram em 12 porcento dos casos, 83,3 porcento deles seis meses depois da cirurgia. A cápsula tumoral esteve presente em um terço das preparaçöes. Tumores múltiplos näo foram observados. CONCLUSÖES - A sintomatologia dolorosa pode ser discreta ou mesmo näo estar presente. A distribuiçäo topográfica do tumor foi diferente entre os sexos. O curto acompanhamento e as recidivas tardias sugerem a necessidade de seguimento pós-operatório mais longo
Subject(s)
Humans , Male , Female , Adolescent , Adult , Glomus Tumor , Multicenter Studies as Topic , Retrospective Studies , Vascular Neoplasms , Pain/etiology , Postoperative Care , Recurrence , Glomus Tumor/surgery , Glomus Tumor/diagnosis , Glomus Tumor/epidemiology , Glomus Tumor/physiopathologyABSTRACT
Os autores relatam um caso clínico de lúpus eritematoso neonatal (LEN) numa criança de três meses que apresentava lesöes cutâneas desde os 18 dias de vida. Além disso säo feitas consideraçöes quanto a etiopatogenia, aspectos clínicos, tratamento e prognóstico da síndrome
Subject(s)
Humans , Female , Infant, Newborn , Infant, Newborn , Lupus Erythematosus, Cutaneous/therapy , Lupus Erythematosus, Cutaneous/diagnosis , Signs and SymptomsABSTRACT
As unhas podem ser acometidas em algumas doenças sistêmicas. Os autores examinaram 50 pacientes portadores de insuficiência renal crônica e constataram que unha "meio a meio" foi a mais freqüente alteraçäo e ocorrem em 32 por cento dos casos.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Renal Insufficiency, Chronic/physiopathology , Nails/physiopathology , Aged, 80 and overABSTRACT
O autor discorre sobre esta rara alteraçäo dermatológica, comentando as síndromes correlatas e o diagnóstico diferencial a partir do relato de um caso
Subject(s)
Adult , Humans , Male , Foot Dermatoses/diagnosis , Toe JointABSTRACT
Os autores fazem uma breve revisäo sobre úlcera de estresse, relacionando os mecanismos bioquímicos envolvidos com a fisiopatologia e a incidência da doença. Discutem-se, ainda, perspectivas atuais do tratamento e complicaçöes encontradas