Merkel cell polyomavirus and its etiological relationship with skin tumors

Abstract Viruses have been frequently identified in several human neoplasms, but the etiological role of these viruses in some tumors is still a matter of controversy. Polyomaviruses stand out among the main viruses with oncogenic capacity, specifically the Merkel cell polyomavirus (MCPyV). Recent revisions in the taxonomy of polyomaviruses have divided the Polyomaviridae family into six genera, including 117 species, with a total of 14 currently known human-infecting species. Although the oncogenicity of polyomaviruses has been widely reported in the literature since 1950, the first description of a polyomavirus as an etiological agent of a neoplasm in humans was made only in 2008 with the description of MCPyV, present in approximately 80% of cases of Merkel cell carcinoma (MCC), with the integration of its genome to that of the tumor cells and tumor-specific mutations, and it is considered the etiological agent of this neoplasm since then. MCPyV has also been detected in keratinocyte carcinomas, such as basal cell carcinoma and squamous cell carcinoma of the skin in individuals with and without immunosuppression. Data on the occurrence of oncogenic viruses potentially involved in oncogenesis, which cause persistence and tissue injury, related to the Merkel cell polyomavirus are still scarce, and the hypothesis that the Merkel cell polyomavirus may play a relevant role in the genesis of other cutaneous carcinomas in addition to MCC remains debatable. Therefore, the present study proposes to explore the current knowledge about the presence of MCPyV in keratinocyte carcinomas.

Cicatrização de feridas diabéticas com fator de crescimento epidérmico: revisão integrativa / Healing of diabetic wounds with epidemic growth factor: integrative review / Curación de heridas diabéticas con factor de crecimiento epidérmico: revisión integrativa

Objetivo: Analisar as produções científicas sobre a efetividade do Fator de crescimento epitelial recombinante humano na cicatrização de feridas diabéticas. Métodos: Trata-se de uma revisão sistemática da literatura, a busca foi realizada nas bases de dados: Pubmed; Scopus e Lilacs. Resultados: Foram selecionados 21 artigos, sendo a maioria estudos experimentais (48%). A cicatrização completa de lesões tratadas com Fator de crescimento epitelial recombinante humano foi relatada por 17 artigos (81%). O aumento do tecido de granulação foi relatado em nove publicações (43%). Da mesma maneira, a diminuição da área da lesão foi descrita em dois artigos incluídos (10%). Duas publicações descrevem a diminuição do número de amputações e do estresse oxidativo e 62% dos artigos abordaram eventos adversos associados ao uso do produto (13/21), dos quais foram prioritários a ocorrência de tremores, dor local, calafrios, náuseas, infecção superficial, sensação de queimação e hematomas, considerados eventos adversos leves. Apenas um estudo apresentou a ocorrência de dor no peito como evento adverso grave. Conclusão: O fator de crescimento epitelial recombinante humano é indicado para uso tópico no tratamento de feridas diabéticas, evidenciando boa eficácia, porém mais estudos clínicos devem ser desenvolvidos. (AU)

Objective: To analyse the scientific studies of Human recombinant epithelial growth factor for the healing of diabetic wounds. Methods: A thorough review of the literature was performed in the following databases: PubMed, Scopus and LILACS. Results: 21 articles were selected, most studies were experimental (48%). Complete healing of Human recombinant epithelial growth factor-treated lesions has been reported by 17 articles (81%). Increased granulation tissue has been reported in nine publications (43%). Similarly, the reduction of the lesion area was described in two included articles (10%). Two publication describes the decrease in the number of amputations and oxidative stress and 62% of the articles addressed adverse events associated with the use of the product (13/21), of which the occurrence of tremors, local pain, chills, nausea, superficial infection, burning sensation and bruising were considered priority, considered adverse events light. Only one study showed chest pain as a serious adverse event. Conclusion: Although Human recombinant epithelial growth factor is indicated for topical use in the treatment of diabetic wounds and demonstrates good efficacy, more clinical studies should be developed. (AU)

Objetivo: Analizar la producción científica sobre la efectividad de Factor de crecimiento epitelial humano recombinante en la curación de heridas diabéticas. Métodos: Esta es una revisión sistemática de la literatura, la búsqueda se realizó en las bases de datos: Pubmed; Scopus y lilas. Resultados: Se seleccionaron 21 artículos. La mayoría de los estudios fueron experimentales (48%). 17 artículos informaron sobre la curación completa de lesiones tratadas con factor de crecimiento epitelial humano recombinante (81%). El aumento en el tejido de granulación se informó en nueve publicaciones (43%). Asimismo, se utilizó una reducción en el área de la lesión en dos artículos incluidos (10%). Dos publicaciones describen una disminución en el número de amputaciones y estrés oxidativo y el 62% de los artículos abordaron eventos adversos asociados con el uso del producto (13/21), que son las prioridades prioritarias en la aparición de temblores, dolor local, escalofríos, náuseas, infección superficial, sensación de ardor y hematomas, reflejos de eventos adversos leves. Solo un estudio muestra la aparición de dolor torácico como un evento adverso grave. Conclusión: Factor de crecimiento epitelial humano recombinante está indicado para uso tópico en el tratamiento de heridas diabéticas, mostrando buena eficacia, pero se deben desarrollar más estudios clínicos. (AU)

Evaluation of vitamin D plasma levels after mild exposure to the sun with photoprotection

Abstract: Background: Most of the organism's vitamin D (VD) is obtained through the cutaneous synthesis after exposure to the sun's UVB radiation. Sunscreens are indicated for the prevention of actinic damage to the skin, however, there are few clinical trials assessing the synthesis of cutaneous VD in real-life situations of sun exposure with ordinary clothing and usual photoprotection. Objectives: To evaluate the synthesis of VD with suberythemal sun exposure in healthy adults using topical photoprotection (SPF 30). Methods: Quasi-experimental study, conducted at Rio de Janeiro (Brazil), during winter, with 95 healthy adults who had 25-OH-VD checked twice, 24 hours apart, and were exposed to the sun (UVB=20 mJ/cm2), according to a randomized grouping: SC - use of SPF 30 on the face, neck and chest (n=64), NO - no sunscreens (n=10), CO - confined from sun exposure for 24h (n=21). The groups were matched according to the propensity score related to gender, age, phototype, body mass index, glycosylated hemoglobin and baseline levels of VD. The outcome evaluated was the variation (ΔVD) in serum level of 25-OH-VD (ng/ml) between the groups. Results: A statistically significant difference was identified between CO and SC groups [median (p25-p75)]: ΔVD =1.4 (-0.3-3.6) vs. 5.5 (4.8-6.6); p<0.01. There was no difference between SC and NO groups: 5.4 (3.1-6.1) vs. 4.1 (2.5-6.0); p=0.17. Study limitations: Laboratory analysis technique (chemiluminescence) with great variability, loss of food intake standardatization, unbalanced groups. Conclusions: Suberythemal sun exposure with sunscreen (SPF 30) provides similar vitamin D serum variation than without photoprotection in healthy adults.

Profile of dermatological consultations in Brazil (2018)

Abstract: Background: Dermatological diseases are among the primary causes of the demand for basic health care. Studies on the frequency of dermatoses are important for the proper management of health planning. Objectives: To evaluate the nosological and behavioral profiles of dermatological consultations in Brazil. Methods: The Brazilian Society of Dermatology invited all of its members to complete an online form on patients who sought consultations from March 21-26, 2018. The form contained questions about patient demographics, consultation type according to the patient's funding, the municipality of the consultation, diagnosis, treatments and procedures. Diagnostic and therapeutic decisions were compared between subgroups. Results: Data from 9629 visits were recorded. The most frequent causes for consultation were acne (8.0%), photoaging (7.7%), nonmelanoma skin cancer (5.4%), and actinic keratosis (4.7%). The identified diseases had distinct patterns with regard to gender, skin color, geographic region, type of funding for the consultation, and age group. Concerning the medical conducts, photoprotection was indicated in 44% of consultations, surgical diagnostic procedures were performed in 7.3%, surgical therapeutic procedures were conducted in 19.2%, and cosmetic procedures were performed in 7.1%. Study limitations: Nonrandomized survey, with a sample period of one week. Conclusion: This research allowed us to identify the epidemiological profiles of the demands of outpatients for dermatologists in various contexts. The results also highlight the importance of aesthetic demands in privately funded consultations and the significance of diseases such as acne, nonmelanoma skin cancer, leprosy, and psoriasis to public health.

Demographics and spatial distribution of the Brazilian dermatologists

Abstract: The medical-dermatological demographics favors health planning and guides expansion of the specialty. We conducted an ecological study of dermatologists members of the Brazilian Society of Dermatology (SBD). We evaluated: gender, age, address; which were compared with population and human development index indicators of municipalities. We evaluated 8384 members, distributed in 527 (9.5%) municipalities throughout Brazil. The female sex represented 78.4% of the members and the median age was 43 (36-54) years. The median density of dermatologists was 0.35 (0.21-0.37) per 10,000 inhabitants. The correlation (Spearman's rho) between density of dermatologists and human development index was 0.39 (p <0.01). The Brazilian dermatologist is characterized as: female, age <50 years and presenting an heterogeneous distribution throught the country.

Drug delivery de anestésicos tópicos é uma técnica eficaz para diminuição da dor no microagulhamento: um estudo-piloto / Drug delivery of topical anesthetics as an effective technique for reducing pain in microneedling: a pilot study

Introdução: O microagulhamento, também conhecido como terapia percutânea de indução de colágeno, é procedimento seguro e eficaz, usado para rejuvenescimento, melhora de cicatrizes, melasma, alopecias e outras indicações clínicas, bem como drug delivery em geral. Apesar dos benefícios e da segurança da técnica, o controle da dor ainda é seu maior fator limitante. Objetivo: Avaliar se a realização de drug delivery de anestésicos tópicos imediatamente antes do microagulhamento pode diminuir a sensação de dor. Métodos: Estudo-piloto de casos, split face com nove pacientes consecutivos, buscando tratamento para cicatrizes de acne, rejuvenescimento e melhora da firmeza da pele. Após limpeza da pele, foi aplicado creme anestésico tópico em toda a face, seguido de drug delivery deste com roller de 0,5mm somente no lado esquerdo. Imediatamente após, o anestésico foi removido de toda a face e realizado o microagulhamento nos dois lados com roller de 1mm. Resultados: O lado esquerdo da face, onde foi realizado drug delivery do anestésico tópico antes do microagulhamento, apresentou significativa diminuição da dor (p < 0,01) com média de 3,33 (± 1,49) quando comparado com o lado direito da face [média de 5,22 (± 1,74)], no qual foi aplicado o mesmo anestésico e pelo mesmo tempo. Conclusão: Neste ensaio, a técnica de drug delivery do anestésico tópico foi eficaz e segura para diminuir a sensação de dor durante o microagulhamento.

Introduction: Microneedling, also known as percutaneous collagen induction therapy, is a safe and effective procedure, mostly used for rejuvenation, treatment of scars, melasma, alopecia, and other conditions, as well as for drug delivery. Despite the safety and benefits of this technique, the control of pain during the procedure is its major limiting factor. Objectives: To assess whether the drug delivery system for topical anesthesia immediately before a microneedling session is capable of reducing the pain. Methods: A split-face pilot study was carried out with nine consecutive cases of microneedling that had been indicated for the treatment of acne scars, rejuvenation and collagen induction. All patients underwent cleansing of the skin followed by the application of topical anesthetics on the entire face, and drug delivery with a 0.5mm roller only on the left hand side of the face. Next, all anesthetics were removed and microneedling with a 1.0mm roller was performed on both sides of the face Results: There was a significant reduction of the pain on the left hand side of the face, where the drug delivery was carried out (p <0.01), with a mean value of 3.33 (± 1.49) on the Visual Analogue Scale as compared to the right hand side, which yielded a mean value of 5.22 (± 1.74). Conclusion: The topical anesthetic drug delivery technique was effective and successful in reducing the pain during microneedling procedures carried out in the study's patients group.

Merkel cell carcinoma in an immunosuppressed patient

Abstract Merkel cell carcinoma is an uncommon neuroendocrine carcinoma with a rising incidence and an aggressive behavior. It predominantly occurs in older patients, with onset occurring at a mean age of 75-80 years. Recognized risk factors are ultraviolet sunlight exposure, immunosuppression, and, more recently, Merkel cell polyomavirus. We report a case of Merkel cell carcinoma in a young HIV positive patient with Merkel Cell polyomavirus detected in the tumor.

Analysis of effectiveness of a surgical treatment algorithm for basal cell carcinoma

Abstract BACKGROUND: Surgical excision is the treatment of choice for basal cell carcinoma and micrographic surgery considered the gold standard, however not yet used routinely worldwide available, as in Brazil. Considering this, a previously developed treatment guideline, which the majority of tumors were treated by conventional technique (not micrographic) was tested. OBJECTIVE: To establish the recurrence rate of basal cell carcinomas treated according to this guideline. METHOD: Between May 2001 and July 2012, 919 basal cell carcinoma lesions in 410 patients were treated according to the proposed guideline. Patients were followed-up and reviewed between September 2013 and February 2014 for clinical, dermatoscopic and histopathologic detection of possible recurrences. RESULTS: After application of exclusion criteria, 520 lesions were studied, with 88.3% primary and 11.7% recurrent tumors. Histological pattern was indolent in 85.5%, 48.6% were located in high risk areas and 70% small tumors. Only 7.3% were treated by Mohs micrographic surgery. The recurrence rate, in an average follow-up period of 4.37 years, was 1.3% for primary and 1.63% for recurrent tumors. Study limitations: unicenter study, with all patients operated on by the same surgeon. CONCLUSION: The treatment guideline utilized seems a helpful guide for surgical treatment of basal cell carcinoma, especially if micrographic surgery is not available.

Curetagem aspirativa para o tratamento da hiperidrose axilar ­ passo a passo da técnica / Aspiration curettage for the treatment of axillary hyperhidrosis ­ the technique step-by-step

A curetagem aspirativa das glândulas sudoríparas é uma técnica cirúrgica minimamente invasiva utilizada para o tratamento da hiperidrose axilar. É facilmente executada e segura, possui alta taxa de sucesso e relativamente poucos efeitos colaterais. Em geral é bem tolerada pelos pacientes e requer reduzido tempo de recuperação quando comparada a outras modalidades cirúrgicas.

Aspiration curettage of sweat glands is a minimally invasive surgical technique for the treatment of axillary hyperhidrosis. It is safe and easy to perform, offers a high success rate and comparatively few side effects. It is generally well tolerated by patients and requires a reduced recovery time when compared to other surgical modalities.

Surgical treatment of basal cell carcinoma: an algorithm based on the literature

Abstract Although basal cell carcinoma can be effectively managed through surgical excision, the most suitable surgical margins have not yet been fully determined. Furthermore, micrographic surgery is not readily available in many places around the world. A review of the literature regarding the surgical treatment of basal cell carcinoma was conducted in order to develop an algorithm for the surgical treatment of basal cell carcinoma that could help the choice of surgical technique and safety margins, considering the major factors that affect cure rates. Through this review, it was found that surgical margins of 4mm seem to be suitable for small, primary, well-defined basal cell carcinomas, although some good results can be achieved with smaller margins and the use of margin control surgical techniques. For treatment of high-risk and recurrent tumors, margins of 5-6 mm or margin control of the surgical excision is required. Previous treatment, histological subtype, site and size of the lesion should be considered in surgical planning because these factors have been proven to affect cure rates. Thus, considering these factors, the algorithm can be a useful tool, especially for places where micrographic surgery is not widely available.

Surgical treatment of axillary hyperhidrosis by suction-curettage of sweat glands

Suction curettage is a dermatologic surgery technique for the treatment of axillary hyperhidrosis, which is becoming more popular. Objective: The purpose of this study is to describe the current technique of removal of axillary sweat glands, and evaluate its efficacy and safety. Conclusion: Suction-curettage of sweat glands is a minimally invasive surgical technique that is easy to perform, safe, has high rates of success and relatively few side-effects. It is generally well tolerated by patients and requires shorter time away from daily activities, when compared with other surgical modalities.

M-plastia pós-ajustada / Post-adjusted M-plasty

M-plastia pós-ajustada pode ser usada em qualquer defeito cirúrgico passível de fechamento por aproximação direta das bordas, evitando formação de protrusões apicais. É realizada sem planejamento prévio, sendo retirado tecido somente quando houver protrusão percebida pelo cirurgião no ato cirúrgico. Possui as vantagens de poupar tecido sadio, adaptar as incisões às linhas de força, rugas e unidades de junção cosmética de cada paciente, além da possível utilização do pedículo do M como pequeno retalho de avanço. Neste trabalho, é relatado o passo a passo desse procedimento cirúrgico, evidenciando suas diferenças e vantagens quando comparado à M-plastia tradicional.

Post-adjusted M-plasty can be used in any surgical defect that can be closed by direct approximation of the borders to avoid the formation of apical protrusions. It is performedwithout prior planning; the tissue is removed only if the surgeon detects a protrusion during surgery. This method offers the advantage of sparing healthy tissue by adjusting the incisions to each patient?s skin?s tension lines, wrinkles and junctions of cosmetic units, in addition to the possible use of the ?M?s pedicle as a small advancement flap. This study describes the procedure step by step, highlighting the differences and advantages compared to traditional M-plasty.

Tratamento de queloides por criocirurgia intralesional: proposição de acessório de baixo custo / Keloid treatment with intralesional cryosurgery: proposal of a low cost device

A criocirurgia é técnica consagrada no tratamento de queloides. Importante avanço nessa técnica foi o desenvolvimento da criocirurgia intralesional que oferece melhores resultados em queloides grandes e refratários, bem como menor incidência de complicações. Os autores apresentam novo acessório para criocirurgia intralesional de baixo custo e fácil manuseio em praticamente qualquer área do corpo.

Cryosurgery is an established technique for treating keloids. The development of intralesional cryosurgery has been an important advance in that technique. In addition to producing better results in large and refractory keloids, intralesional cryosurgery presents a lower rate of complications. The authors present a new low-cost device for use in intralesional cryosurgery that allows easy handling in practically all body areas.

Halo nevo spilus / Halo nevus spilus

Os autores descrevem o caso de paciente de 15 anos que apresenta um componente juncional de seu nevo spilus envolto por halo acrômico na coxa direita. O mecanismo imunológico constante no fenômeno halo e a resposta imune ao melanoma estão intimamente relacionados. Aparentemente, o fenômeno halo representa uma reação imunológica mediada por células contra um antígeno desconhecido presente nas lesões melanocíticas. Há também presença de anticorpos nessa reação.

Os histiócitos e as histiocitoses não Langerhans em Dermatologia / Histiocytes and non-Langerhans cell histiocytoses in dermatology

Atualmente, os histiócitos não são mais compreendidos como células únicas, mas como um grupo heterogêneo de células com o mesmo aspecto histológico, mas com características e funções distintas entre si. Várias doenças proliferativas de histiócitos, conhecidas como histiocitoses, são descritas. Tais doenças são raras, e seu estudo costuma ser difícil. Este artigo objetiva simplificar o entendimento desse grupo de doenças, adequando-o a esse novo paradigma da heterogeneidade dos histiócitos

Reticulohistiocitose multicêntrica / Multicentric reticulohistiocytosis

A reticulohistiocitose multicêntrica (RM) é doença sistêmica proliferativa de histiócitos, de causa desconhecida, caracterizada clinicamente por nódulos cutâneo-mucosos que se distribuem craniocaudalmente de forma decrescente e por lesöes osteoarticulares distintivas. Evolui por surtos que progridem em gravidade por período de seis a oito anos, regredindo espontaneamente mas deixando, em geral, artrite incapacitante e lesöes faciais desfigurantes. Acomete preferencialmente pessoa em torno dos 45 anos de idade, mormente, mulheres caucasianas. Há significativa associaçäo com câncer interno (de 15 a 31 porcento, dependendo da série), sem apresentar com ele paralelismo evolutivo. Os aspectos histopatológicos säo característicos, com denso infiltrado mononuclear contendo as típicas células multinucleadas que apresentam, em seu interior, material PAS-positivo e diastase-resistente, que confere aspecto de vidro moído na coloraçäo pela hematoxilina-eosina. Embora se considere que näo exista tratamento capaz de influir em sua história natural, esquemas recentes com imunomoduladores têm obtido resultados animadores.

HPV em carcinoma verrucoso sobre líquen escleroso do pênis / HPV in verrucous carcinoma over a penile lichen sclerous lichen

Os autores reportam um caso de carcinoma verrucoso(CV) que surgiu sobre uma lesäo de líquem escleroso(LE) do pênis. Por meio da técnica de imuno-histoquímica foi evidenciada a presença do vírus do papiloma humano(HPV) na lesäo tumoral, estando ele ausente na área de LE. Sugerem que a induçäo do CV tenha sido decorrente da açäo do HPV, tendo como provável agente facilitador da expressäo de sua oncogenicidade o LE.

Tratamento da sarna crostosa com ivermectina / Crusted scabies treatment with ivermectin

O tratamento da sarna crostosa (SC) usualmente representa um desafio. Uma paciente portadora de SC foi tratada com sucesso com duas doses de ivermectina por via oral. Entretanto, houve recidiva do quadro um mês após, evidenciando tanto a importância do tratamento dos contactantes quanto o fato de a ivermectina näo possuir efeito residual após um mês. A ivermectina é droga promissora no tratamento da escabiose, principalmente de sua variante crostosa

Cinco anos de corticoterapia em paciente com pênfigo foliáceo e Aids / Five years of corticotherapy in a patient with pemphigus foliaceus and Aids

Os autores apresentam um caso de pênfigo foliáceo em pacientes com Aids que, a despeito da corticoterapia prolongada empregada, näo apresentou aceleraçäo em sua doença de base. E discutem, principalmente, o uso de corticosteróides sistêmicos em pacientes HIV-positivos