Diabetes mellitus and the skin

Abstract: Several dermatoses are routinely associated with diabetes mellitus, especially in patients with chronic disease. This relationship can be easily proven in some skin disorders, but it is not so clear in others. Dermatoses such necrobiosis lipoidica, granuloma annulare, acanthosis nigricans and others are discussed in this text, with an emphasis on proven link with the diabetes or not, disease identification and treatment strategy used to control those dermatoses and diabetes.

Urticaria papular y sus agentes causales en Colombia / Papular urticaria: A review of causal agents in Colombia

Resumen La urticaria papular es una enfermedad alérgica causada por la picadura de insectos, la cual predomina en el trópico. El objetivo de esta revisión fue profundizar en sus aspectos epidemiológicos e inmunológicos, particularmente con base en datos publicados en Latinoamérica. Se hizo una revisión no sistemática mediante la búsqueda electrónica de artículos sobre la epidemiología de la urticaria papular, las características entomológicas de los agentes causales y los mecanismos inmunológicos asociados. Según los diversos reportes de centros médicos de Latinoamérica la urticaria papular es frecuente; el único estudio de prevalencia publicado indica que afecta a una cuarta parte de los niños escolares de Bogotá. Hay información sobre la relación causal entre la exposición domiciliaria a la pulga, la pobreza y la urticaria papular en Bogotá, una ciudad representativa de las altitudes andinas. No hay estudios que indaguen directamente sobre los insectos causales en zonas cálidas, aunque se sospecha clínicamente de los mosquitos Aedes aegypti y Culex quinquefasciatus. En cuanto a su patogenia, se destaca la participación de mecanismos celulares que involucran las células colaboradoras Th2, lo cual explica que sea una condición de hipersensibilidad retardada. El papel de la inmunoglobulina E (IgE) en la urticaria papular no está tan claro. Se desconocen los antígenos derivados de los insectos que causan la enfermedad, aunque se plantea que existen moléculas comunes de reacción cruzada entre los insectos, tales como el alérgeno Cte f 2 en la pulga, y sus homólogos en los mosquitos. La urticaria papular es una condición frecuente en Latinoamérica que debe investigarse en profundidad. La caracterización inmunológica de los componentes moleculares que causan esta condición puede resolver interrogantes sobre su etiología y su patogenia.

Abstract Papular urticaria is a chronic allergic reaction induced by insect bites, which is common in the tropics. The objective of this review was to deepen on epidemiological and immunological aspects of this disease, focused on data published in Latin American countries. We conducted a non-systematic review of the literature through electronic search on the epidemiology of papular urticaria, the entomological characteristics of the causative agents and associated immunological mechanisms. Several reports from medical centers suggest that papular urticaria is common in Latin America. Only one epidemiological survey designed to estimate prevalence of papular urticaria has been published, reporting that about a quarter of children under six years of age is affected by this condition in Bogotá. There is evidence on the causal relationship among exposure to indoor fleas, poverty and papular urticaria in Bogotá, a representative city of the Andean altitudes. Information about causal insects in tropical warmer areas is scarce, although from clinical reports Aedes aegypti and Culex quienquefasciatus appear to be the most common. Th2 cellular-mediated mechanisms are involved in its pathogenesis, which explains its delayed hypersensitivity. The role of immunoglobulin E is not clear in this disease. Insect-derived antigens directly involved in papular urticaria etiology are unknown. However, it is possible that common molecules among causal insects mediate cross-reactive reactions, such as Cte f 2 allergen, found in cat fleas, and its counterparts in mosquitoes. Papular urticaria is a frequent disease in Latin America that should be further investigated. Immunological characterization of the molecular components that cause this condition may solve questions about its pathogenesis.

Lúpus eritematoso sistêmico bolhoso em gestante: relato de caso / Bullous systemic lupus erythematosus in a pregnant woman: a case report

O lúpus eritematoso sistêmico pode apresentar inúmeras lesões cutâneas. As lesões bolhosas específicas do lúpus, apesar de raras, apresentam características clínicas e imunopatológicas próprias e implicam em diagnóstico diferencial entre inúmeras patologias bolhosas que podem sobrepor-se ao lúpus eritematoso sistêmico. Apresenta-se um caso de lúpus eritematoso sistêmico bolhoso em gestante.

Systemic lupus erythematosus (SLE) can cause numerous skin lesions. Despite being rare, lupus-specific bullous lesions demonstrate characteristic clinical and immunopathological features and require differential diagnosis among numerous bullous conditions that may overlap with SLE. The present study presents a case of bullous systemic lupus erythematosus (BSLE) in a pregnant woman.

An outbreak of Portuguese man-of-war (Physalia physalis - Linnaeus, 1758) envenoming in Southeastern Brazil

Introduction Portuguese man-of-war, Physalia physalis (Linnaeus, 1758), are cnidarians capable of discharging intracellular organelles filled with venom, resulting in severe envenomation in humans. Methods We report the clinical and therapeutic aspects of 331 accidents involving Portuguese man-of-war in an outbreak on the coast of the State of São Paulo, Brazil. Results The clinical manifestations of envenomation were rare and mild and mostly local, systemic reactions; there was a low rate of late complications. Conclusions The consequences of envenomation were of moderate severity, and first aid measures were effective in controlling the pain. Outbreaks of accidents involving Portuguese man-of-war occur periodically in the area without a clear explanation. .

Dermatomiosite vesiculobolhosa como manifestação paraneoplásica de tumores sincrônicos de próstata e língua: relato de caso / Paraneoplastic vesiculobullous dermatomyositis with synchronic prostate and tongue tumors: case report

A dermatomiosite é uma miopatia inflamatória que cursa com manifestações cutâneas. No adulto acima de 50 anos, pode estar associada a neoplasias malignas, comportando-se como um grande sinalizador de malignidade. OBJETIVO: Demonstrar essa associação com aspectos peculiares: dermatomiosite de apresentação atípica paralela a dois tumores sincrônicos, em geral, não relacionados àquela. RELATO DO CASO: Descrevemos o caso de um paciente do gênero masculino de 72 anos, que desenvolveu dermatomiosite, inicialmente apenas com quadro cutâneo clássico, evoluindo com lesões vesiculobolhosas, e, meses após, com miopatia. Após extensa investigação, foi localizado um adenocarcinoma de próstata. Houve remissão da doença após tratamento do câncer e administração de glicocorticoide. Durante a retirada gradual do glicocorticoide, ocorreu reativação da dermatomiosite, sendo reiniciadas investigações, que revelaram a presença de carcinoma escamoso de língua. Tratada esta neoplasia, houve remissão completa, mesmo após a retirada total do corticoide. CONCLUSÃO: Trata-se de um caso raro por envolver as formas menos usuais de apresentação da dermatomiosite, tanto com relação ao quadro cutaneomuscular, quanto à sua associação a tumores de próstata e língua (tumores nunca antes relatados juntos). Este caso demonstra a importância da investigação minuciosa em busca de neoplasias na abordagem desses pacientes.

Dermatomyositis is an inflammatory myopathy with skin manifestations. In the adult over the age of 50 years, it can be associated with malignant neoplasias, being, thus, a signal of malignancy. OBJECTIVE: To show the association of dermatomyositis of atypical presentation with two synchronous tumors, usually not related to that. CASE REPORT: We report the case of a 72-year-old male, who developed dermatomyositis, initially with only classic skin findings, which progressed to vesiculobullous lesions, and, months later, to myopathy. After extensive investigation, prostate adenocarcinoma was diagnosed. After treatment of the cancer and administration of glucocorticoid, the disease went into remission. During gradual glucocorticoid withdrawal, dermatomyositis recurred, and the new investigation revealed the presence of squamous cell carcinoma of the tongue. After treating this neoplasia, complete remission occurred, even after total corticoid withdrawal. CONCLUSION: This is a rare case involving less usual dermatomyositis presentation forms, relating to the cutaneous-muscle findings and the association with prostate and tongue tumors (tumors never reported together). This case demonstrates the importance of a careful investigation, searching for neoplasias, when approaching such patients.

Intertriginous bullous morphea: A clue for the pathogenesis?

Bullae occurring in lesions of morphea are uncommon. The cause of bullae formation in morphea is multifactorial, although lymphatic obstruction from the sclerodermatous process is considered the likeliest cause. Bullous morphea may be confused clinically with lichen sclerosus et atrophicus since both diseases may cause bullae in sclerodermatous plaques. A 69-year-old woman presented with a history of generalized morphea diagnosed 9 years earlier; and a 1-month history of pruritic bullae on her inframammary folds, axillary regions, lower abdomen, upper extremities and inguinal folds. Physical examination revealed multiple erythematous erosions, hemorrhagic vesicles and eroded bullae with slight scale or crusts overlying hypopigmented, indurated, shiny plaques. Skin biopsy revealed prominent edema in the papillary dermis, resulting in bulla formation and thickening of collagen fibers within the dermis. Direct immunofluorescence was negative. According to histologic and clinical features, the diagnosis of bullous morphea was established.

Dermatosis ampollar por IgA lineal de la infancia: reporte de un caso y revisión de la literatura / Ampuller dermatose by IgA lineal of the cildhood: report of a case and literature review

La dermatosis ampollar por IgA lineal es una enfermedad vesiculoampollar subepidérmica de etiología autoinmune que puede ser idiopática o también inducida por drogas. Clínicamente suele ser muy heterogénea pudiendo presentar características fenotípicas de epidermólisis ampollar adquirida, dermatitis herpetiforme, penfigoide ampollar y cicatricial. Se discute el caso de un preescolar de 6 años de edad en el cual se establece diagnóstico de dermatosis ampollar por IgA lineal por clínica, histopatológia e inmunofluorescencia, evolucionando satisfactoriamente con la administración combinada de metilprednisolona y dapsona

Manifestaciones cutáneas en pacientes con diabetes mellitus / Cutaneous manifestations in patients with mellitus diabetes

La Diabetes Mellitus es una patología frecuente en la población, caracterizada por el aumento del nivel plasmático de la glucosa y por disturbios en el metabolismo de carbohidratos y lípidos. según diversos estudios, entre un 30 por ciento y un 100 por ciento de los pacientes diabéticos presentan alteraciones en la piel, las cuales pueden clasificarse en 4 grandes grupos: manifestaciones cutáneas relacionadas con descompensación metabólica, tales como infecciones de diversos tipos, aquellas relacionadas con complicaciones degenerativas crónicas como el pié diabético, desórdenes cutáneos que son más comunes en Diabetes Mellitus y que no se correlacionan con descompensación metabólica ni con cambios degenerativos como la acantosis nigricans y, por último, reacciones como consecuencia del tratamiento de la Diabetes Mellitus, entre las cuales se mencionan las erupciones morbiliformes

Lesiones vesiculosas y ulcerosas bucofaríngeas / Vesiculate and ulcerative oropharyngeal injuries

Se revisan brevemente los principales tipos de lesiones vesiculosas y ulcerosas de la cavidad orofaríngea. Según su etiopatogenia se distinguen lesiones virales, bacterianas, micóticas, inmunológicas y hematológicas. En general forman parte de un cortejo sintomático que incluye manifestaciones cutáneas (síndromes mucocutáneos), articulaciones y/o viscerales, así como fiebre y compromiso del estado general. Las lesiones más frecuentes son las virales y las de naturaleza inmunológica

Pustulose exantemática aguda generalizada / Generalized acute exanthematic pustulose

Relato de caso de pustulose exantemática aguda generalizada devida a ampicilina, parecendo tratar-se do primeiro relato na literatura brasileira. É feita breve revisäo bibliográfica, enfatizando-se os critérios definidos para o diagnóstico.

Dermatose alérgica bolhosa após picada de mosquito / Skin disease bullous after insect sting

As reaçöes cutâneas mais freqüentemente observadas após picada de mosquito incluem pápulas e nódulos eritematopruriginosos, estrófulo, urticária e angioedema. Raramente surgem sintomas constitucionais e anafilaxia. O autor descreve uma dermatose alérgica bolhosa atípica associada à picada de mosquito. Documentou-se IgE antimosquito através de teste alérgico intradérmico positivo. Säo discutidas as condutas profilática e terapêutica.

Skin involvement in leukemia.

Skin infiltration in leukaemia occurs rarely. We describe here four such cases of acute leukaemia. In two, the skin infiltration was evident at presentation; in the other two, it developed while on treatment. The lesions varied from maculopapular to tumorous stage. Complete remission could be achieved with chemotherapy, however, the long term prognosis was poor.

Enfermedades vesiculo-ampollares / Vesicle-ampullar diseases

Fueron integradas bajo esta denominación un grupo de noxas que tienen en común la aparición de lesiones vesiculares y ampollares en forma crónica y recidivante. Hace una clasificacción de las enfermedades ampollares y refiere los aspectos etiológicos y terapéuticos de la dermatitis bullosas y el penfigo