RESUMO
Neonatal jaundice is a frequent condition in newborns and is commonly treated with phototherapy. We describe the case of a neonate with hemolytic disease of the newborn who developed a rarely described purpuric eruption. Laboratory testing revealed elevated porphyrins.
Assuntos
Icterícia Neonatal , Fototerapia , Púrpura , Humanos , Recém-Nascido , Fototerapia/efeitos adversos , Púrpura/etiologia , Púrpura/diagnóstico , Icterícia Neonatal/terapia , Icterícia Neonatal/etiologia , Icterícia Neonatal/diagnóstico , Masculino , Feminino , PorfirinasRESUMO
Purpose: Onychopapilloma is a rare benign nail tumor affecting the distal matrix and the nail bed. Currently, the only available treatment is surgical resection, which has a recurrence rate of 20% and may lead to various complications. Here we report a new method to treat onychopapilloma with pulsed dye laser (PDL).Materials and methods: We retrospectively analyzed 13 cases and evaluated disease classification, dermoscopic examination, laser treatment parameters, photographs before and after treatment, and treatment outcome.Results: The site distribution of onychopapilloma was consistent with previous reports. PDL treatment was performed with 595 nm laser, with 1.5 ms pulse duration, spot diameter 3-5 mm, and 11.5-13.5 J/cm2 fluence. Irradiation covered the telangiectatic area up to the edge of the nail folds, with the terminal response of purpura occurrence. The overall effective rate was 77%; the effective rates for erythronychia, leukonychia, and melanonychia were 88%, 67%, and 50%, respectively.Conclusions: PDL treatment for onychopapilloma provides an alternative to traditional surgery with comparable effectiveness but much less risk for complications.
Assuntos
Lasers de Corante , Terapia com Luz de Baixa Intensidade , Doenças da Unha , Púrpura , Humanos , Lasers de Corante/uso terapêutico , Estudos Retrospectivos , Resultado do Tratamento , Terapia com Luz de Baixa Intensidade/efeitos adversos , Doenças da Unha/radioterapia , Doenças da Unha/cirurgiaRESUMO
A dermatoporose é a síndrome de fragilidade cutânea. Acomete principalmente indivíduos acima de 60 anos, com maior prevalência no sexo feminino. Os principais fatores de risco são: envelhecimento, exposição solar intensa e uso de corticoterapia tópica e sistêmica. Se manifesta clinicamente por atrofia cutânea, púrpuras senis, pseudo cicatrizes estrelares e lacerações, podendo evoluir com hematomas dissecantes e infecções graves. Trata-se de uma doença com grande impacto na qualidade de vida dos pacientes e, até o presente momento, não há terapias com resultados satisfatórios. Hidratação, vitamina C tópica e oral, luz intensa pulsada foram algumas das terapêuticas estudadas. A hidroxiapatita de cálcio é um bioestimulador de colágeno composto por microesferas em um veículo de carboximetilcelulose (Radiesse®). Tem sido usada para estimular a produção endógena de colágeno e consequentemente melhorar a qualidade e espessura da pele. Este efeito do produto poderia melhorar o quadro clínico da dermatoporose. O estudo teve como objetivo avaliar a melhora das lesões purpúricas e da atrofia da pele após aplicação de Radiesse® no antebraço de 5 pacientes portadores de dermatoporose no setor de Dermatologia do Hospital do Servidor Público Municipal de São Paulo. Os 5 pacientes foram submetidos a aplicação de Radiesse® nos antebraços e foram avaliadas 45 e 90 dias após o procedimento, o número de lesões purpúricas, grau de atrofia da pele através do teste de pinçamento e realizado comparação fotográfica. Após o tratamento, observou-se melhora do número das lesões purpúricas, melhora da atrofia da pele e melhora da qualidade de pele quando comparada fotograficamente. Dessa forma, o tratamento com Radiesse® mostrou-se promissor, com resultados satisfatórios e com um bom perfil de segurança. Palavras-chave: Dermatoporose. Púrpura senil. Radiesse. Bioestimulador. Tratamento.
Assuntos
Púrpura/tratamento farmacológico , Atrofia/diagnóstico , Pele/efeitos dos fármacos , Dermatopatias/diagnóstico , Envelhecimento/efeitos dos fármacos , Carboximetilcelulose Sódica/administração & dosagem , Envelhecimento da Pele/efeitos dos fármacos , Corticosteroides/efeitos adversos , Desidroepiandrosterona/fisiologia , Durapatita/administração & dosagem , Durapatita/uso terapêutico , Terapia com Luz de Baixa IntensidadeRESUMO
Prolonged vitamin C deficiency can result in numerous metabolic abnormalities like impaired tissue repair and defective collagen synthesis. This case report describes a middle-age Japanese man presenting painful purpura on his lower limbs, severe anemia, and altered consciousness. The patient had been eating a selective diet lacking in vegetables and fruits since childhood. A serum analysis demonstrated a low level of vitamin C. The patient was treated with vitamin supplementation and psychological intervention. Scurvy is an under-considered illness with a favorable prognosis if diagnosed early while it is still sporadically encountered in some patients with malabsorption or malnutrition even in modern times.
Assuntos
Púrpura , Escorbuto , Ácido Ascórbico/uso terapêutico , Criança , Humanos , Perna (Membro) , Masculino , Pessoa de Meia-Idade , Dor/complicações , Púrpura/etiologia , Escorbuto/complicações , Escorbuto/diagnóstico , Vitaminas/uso terapêuticoRESUMO
ABSTRACT CONTEXT: Various skin manifestations have been reported in coronavirus disease. It may be difficult to determine the etiology of these lesions in view of the increased frequency of handwashing during the pandemic, along with occurrences of irritant contact dermatitis and allergic contact dermatitis due to disinfectant use; usage of herbal medicine and supplements to strengthen the immune system; and urticarial or maculopapular drug eruptions due to COVID-19 treatment. The variety of associated skin manifestations seen with COVID-19 makes it challenging to identify virus-specific skin manifestations. Petechiae, purpura, acrocyanosis and necrotic and non-necrotic purpura, which can be considered as manifestations of vascular involvement on the skin, have been reported. CASE REPORT: Here, we report a case of eruptive cherry angiomas, which was thought to have developed due to COVID-19, with a papulovesicular rash on distal extremities that progressed over time to reticular purpura. CONCLUSION: The case presented had a papulovesicular rash at the onset, which evolved to retiform purpura, and eruptive cherry angiomas were observed. It should be kept in mind that dermatological signs may vary in patients with COVID-19.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Púrpura/virologia , Pele/virologia , Dermatopatias Virais/virologia , Exantema/virologia , COVID-19/complicações , COVID-19/virologia , Hemangioma/virologia , Pele/efeitos dos fármacos , Pele/patologia , Resultado do Tratamento , Dermatopatias Virais/diagnóstico , Dermatopatias Virais/terapia , Teste para COVID-19 , SARS-CoV-2 , COVID-19/tratamento farmacológico , COVID-19/terapiaRESUMO
CONTEXT: Various skin manifestations have been reported in coronavirus disease. It may be difficult to determine the etiology of these lesions in view of the increased frequency of handwashing during the pandemic, along with occurrences of irritant contact dermatitis and allergic contact dermatitis due to disinfectant use; usage of herbal medicine and supplements to strengthen the immune system; and urticarial or maculopapular drug eruptions due to COVID-19 treatment. The variety of associated skin manifestations seen with COVID-19 makes it challenging to identify virus-specific skin manifestations. Petechiae, purpura, acrocyanosis and necrotic and non-necrotic purpura, which can be considered as manifestations of vascular involvement on the skin, have been reported. CASE REPORT: Here, we report a case of eruptive cherry angiomas, which was thought to have developed due to COVID-19, with a papulovesicular rash on distal extremities that progressed over time to reticular purpura. CONCLUSION: The case presented had a papulovesicular rash at the onset, which evolved to retiform purpura, and eruptive cherry angiomas were observed. It should be kept in mind that dermatological signs may vary in patients with COVID-19.
Assuntos
COVID-19/complicações , COVID-19/virologia , Exantema/virologia , Hemangioma/virologia , Púrpura/virologia , Dermatopatias Virais/virologia , Pele/virologia , COVID-19/terapia , Teste para COVID-19 , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2 , Pele/efeitos dos fármacos , Pele/patologia , Dermatopatias Virais/diagnóstico , Dermatopatias Virais/terapia , Resultado do Tratamento , Tratamento Farmacológico da COVID-19RESUMO
BACKGROUND: Scurvy is a clinical syndrome resulting from ascorbic acid deficiency. Although presently rare in the developed world, it continues to occur within certain susceptible populations, particularly the elderly and those with dietary habits with low vitamin C intake. CASES: Two men aged 87 and 69 were referred with multifactorial, progressive ulceration of the lower limbs, without scarring, in a context of arterial disease and other associated comorbidities. In both cases, the level of vitamin C was undetectable. An improvement in the necrotic component and in the purpura was promptly observed after vitamin C supplementation. CONCLUSIONS: Diagnosis of scurvy can be challenging. This report highlights the importance of maintaining a high index of suspicion for scurvy in atypical necrotic ulcerations of lower extremities with poor response to standard therapy especially in populations at high risk of vitamin C deficiency. Early diagnosis can improve patient prognosis.
Assuntos
Púrpura , Escorbuto , Idoso , Diagnóstico Diferencial , Humanos , Extremidade Inferior , Masculino , Púrpura/diagnóstico , Púrpura/etiologia , Escorbuto/complicações , Escorbuto/diagnóstico , ÚlceraRESUMO
El escorbuto es una enfermedad ocasionada por el déficit de vitamina C. La vitamina C, también llamada ácido ascórbico, actúa como cofactor de la propil-lisil hidroxilasa, enzima que interviene en la biosíntesis de colágeno; por ello es de vital importancia en la integridad estructural de piel, mucosas, anexos, vasos sanguíneos, huesos y dientes. Las manifestaciones clínicas incluyen síntomas constitucionales severos como debilidad y fatiga. Los hallazgos cutáneos iniciales son pápulas hiperqueratósicas foliculares y púrpura palpable perifolicular. Con el tiempo aparecen áreas extensas de equimosis, edema en miembros inferiores, hemorragias en astillas en uñas y alopecia difusa. Por lo general se describe esta enfermedad como asociada a tiempos pasados y extremadamente infrecuente en países desarrollados. Sin embargo, actualmente se ha detectado un aumento en el número de casos, asociados con malnutrición severa. Desórdenes psiquiátricos como la anorexia nerviosa, alcoholismo y deficiencias nutricionales por dietas excesivas y mal balanceadas o escasez de recursos económicos constituyen los principales factores de riesgo hoy en día. El tratamiento consiste en la corrección del déficit mediante la mediante suplementación con vitamina C vía oral. Presentamos una mujer de 24 años con escorbuto asociado a anorexia nerviosa y a dieta pobre en vegetales y fruta.
Scurvy is a disease caused by a deficit of vitamin C. Vitamin C, also called ascorbic acid, acts as a cofactor for propyl-lysyl hydroxylase, an enzyme that is involved in collagen biosynthesis, vitally important in the structural integrity of skin, mucous membranes, annexes, blood vessels, bones and teeth. Clinical manifestations include severe constitutional symptoms such as weakness and fatigue. The initial cutaneous findings are follicular hyperkeratotic papules and perifollicular palpable purpura. Over time, large areas of ecchymosis, edema of the lower limbs, splinter hemorrhages in nails and diffuse alopecia appear. Usually this disease is described as associated with past times and extremely uncommon in developed countries. However, the number of cases have been increasing, especially those associated with severe malnutrition. Psychiatric disorders such as anorexia nervosa, alcoholism and nutritional deficiencies due to excessive and poorly balanced diets or shortage of economic resources are the main risk factors nowadays. Correcting the deficit with oral vitamin C supplementation is the treatment of the disease. We present a 24-year-old woman with scurvy associated with anorexia nervosa and a diet low in vegetables and fruit.
Assuntos
Humanos , Feminino , Adulto , Púrpura , Ácido Ascórbico/uso terapêutico , Deficiência de Ácido Ascórbico/terapia , Escorbuto/diagnóstico , Deficiências Nutricionais/terapia , Desnutrição/complicações , Diagnóstico PrecoceRESUMO
BACKGROUND: Lichen aureus (LA) is a variant of pigmented purpuric dermatosis (PPDs) that typically presents with the acute onset of a solitary, unilateral, purple to rust-yellow colored lichenoid patch or plaque on lower extremities. Treatment remains challenging and is based on anecdotal case reports often with poor results. AIMS: Describe a case of LA successfully treated with 595 nm wavelength pulsed-dye laser (PDL). PATIENT/METHOD: A 46-year-old woman with segmental LA was treated using a 595 nm PDL at a uniform spot size of 10 mm, with pulse durations of 10 milliseconds and fluence of 6 J/cm2. The patient had received previous treatments with no improvement. RESULTS: Clearance was archived after three sessions with PDL. Sessions were performed at intervals of 4 weeks, with no serious adverse events nor recurrence. CONCLUSION: We hypothesize the favorable clinical outcome with PDL is due to the affinity of the wavelength for oxyhemoglobin (allowing uniform vessel penetration and energy delivery to fragile capillaries and intraluminal blood) and to its anti-inflammatory profile. PDL seems to be an alternative for patients with progressive LA that have failed other therapies.
Assuntos
Lasers de Corante/uso terapêutico , Erupções Liquenoides/terapia , Terapia com Luz de Baixa Intensidade/instrumentação , Púrpura/terapia , Biópsia , Feminino , Humanos , Erupções Liquenoides/diagnóstico , Erupções Liquenoides/patologia , Pessoa de Meia-Idade , Púrpura/diagnóstico , Púrpura/patologia , Pele/patologia , Pele/efeitos da radiação , Resultado do TratamentoAssuntos
Transtornos Autoinduzidos/diagnóstico , Púrpura/diagnóstico , Braço , Criança , Maus-Tratos Infantis/diagnóstico , Transtornos da Nutrição Infantil/diagnóstico , Ventosaterapia/efeitos adversos , Diagnóstico Diferencial , Síndrome de Ehlers-Danlos/diagnóstico , Humanos , Vasculite por IgA/diagnóstico , Masculino , Infecções Meningocócicas/diagnóstico , Púrpura Trombocitopênica Idiopática/diagnóstico , Febre Maculosa das Montanhas Rochosas/diagnóstico , TóraxAssuntos
Lasers de Estado Sólido/uso terapêutico , Terapia com Luz de Baixa Intensidade/métodos , Púrpura/radioterapia , Envelhecimento da Pele/efeitos da radiação , Humanos , Terapia com Luz de Baixa Intensidade/instrumentação , Púrpura/diagnóstico , Púrpura/etiologia , Índice de Gravidade de Doença , Luz Solar/efeitos adversos , Resultado do TratamentoRESUMO
Yellow phosphorous (YP) is the toxic form of elemental phosphorous and the chief constituent of firecrackers and rodenticides. In India, the rodenticide paste is frequently used for the suicidal purpose. This study is an autopsy-based observational study which describes the histopathological features of heart, lungs, liver, and kidney of fatal cases of YP poisoning. The most common autopsy features in the viscera were congestion and petechial hemorrhage. The liver histopathology findings were microvesicular steatosis (68%), hepatic necrosis (62%), macrovesicular steatosis (50%), inflammatory cells (46%), sinusoidal congestion (40%), cholestasis (32%), and toxic hepatitis (18%). Hepatic necrosis ranged from being focal to centrizonal in distribution. Congestion was the most common feature observed in the lungs and the kidney. This is the largest autopsy-based study on YP poisoning till date. The histopathological features of liver were consistent with YP poisoning whereas the findings of heart, lungs, and kidney were nonspecific in nature.
Assuntos
Fósforo/intoxicação , Rodenticidas/intoxicação , Adulto , Doença Hepática Induzida por Substâncias e Drogas/patologia , Edema/patologia , Fígado Gorduroso/patologia , Feminino , Patologia Legal , Hemorragia/patologia , Humanos , Índia , Rim/patologia , Fígado/patologia , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Miocárdio/patologia , Necrose , Estudos Prospectivos , Púrpura/patologia , Vacúolos/patologia , Adulto JovemAssuntos
Glicosídeos/uso terapêutico , Erupções Liquenoides/tratamento farmacológico , Extratos Vegetais/uso terapêutico , Púrpura/tratamento farmacológico , Tripterygium , Adulto , Dermatoses do Pé/tratamento farmacológico , Dermatoses da Mão/tratamento farmacológico , Humanos , Masculino , Fitoterapia , Púrpura/patologiaRESUMO
BACKGROUND: The purpose of this report is to demonstrate the clinical effect of Korean medicine treatment for pigmented purpuric dermatosis (PPD). METHODS: Five cases of PPD with skin purpura and blood heat due to blood deficiency were evaluated. All patients had been in a chronic disease state for at least 1 year. The treatment consisted only of the Korean herbal medicine Gami-Samultang (GS). The degree of symptoms that the patients experienced when they first visited our clinic was set at a visual analog scale (VAS) score of 10. RESULTS: After treatment, body purpura disappeared in all cases. In contrast, the patients' symptoms had not resolved following previous steroid treatment. All patients were satisfied with the treatment results and showed a VAS score of 0 for purpura. CONCLUSION: This report suggests that GS can be used to effectively treat PPD. Additional clinical studies on PPD are needed to develop more comprehensive treatment guidelines.
Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Púrpura/tratamento farmacológico , Adolescente , Adulto , Feminino , Humanos , MasculinoRESUMO
BACKGROUND AND OBJECTIVES: This study was performed to better understand the cutaneous effects of using a fractional picosecond laser at 755 nm with a diffractive lens array and a picosecond Nd:YAG laser at 532 mn and 1064 nm with a holographic optic. We characterized the injuries created by these devices on skin clinically and histologically over 24 hours. With this information we modeled the effects of these devices on a cutaneous target. METHODS: Eight patients, representing Fitzpatrick skin types I-VI, were treated on their backs with a picosecond Alexandrite laser with a diffractive lens array, as well as a picosecond Nd:YAG laser at 532 nm and 1064 nm with a holographic optic. Photographs were taken 15 minutes and 24 hours after treatments. Punch biopsies were obtained at 24 hours and examined histologically. RESULTS: Treatment with the picosecond Nd:YAG laser at both 532 nm and 1064 nm with the holographic optic revealed erythema and small scatted areas of petechial hemorrhage areas immediately and in many cases at 24 hours after treatment. The 755 nm picosecond Alexandrite laser with diffractive lens array produced erythema immediately after treatment, which largely dissipated 24 hours later. Histologies revealed intra-epidermal vacuoles with all three wavelengths. Fractional picosecond Nd:YAG laser at 532 nm and 1064 nm with the holographic optic showed focal areas of dermal and intra-epidermal hemorrhage with areas of vascular damage in some patients. CONCLUSIONS: This study demonstrates that both fractional picosecond devices produce vacuoles in the skin, which are most likely due to areas of laser induced optical breakdown (LIOB). In the patients (skin type II-IV) we observed scatter areas of hemorrhage in the skin, due to vascular damage with the 532 nm and 1064 nm, but not with 755 nm wavelengths. Lasers Surg. Med. 50:37-44, 2018. © 2017 Wiley Periodicals, Inc.
Assuntos
Eritema/etiologia , Lasers de Estado Sólido/uso terapêutico , Terapia com Luz de Baixa Intensidade/instrumentação , Púrpura/etiologia , Pele/efeitos da radiação , Adolescente , Adulto , Eritema/patologia , Feminino , Humanos , Púrpura/patologia , Pele/patologia , Adulto JovemRESUMO
Hydrogen sulfide (sulfide) accumulates at high levels in brain of patients with ethylmalonic encephalopathy (EE). In the present study, we evaluated whether sulfide could disturb energy and redox homeostasis, and induce mitochondrial permeability transition (mPT) pore opening in rat brain aiming to better clarify the neuropathophysiology of EE. Sulfide decreased the activities of citrate synthase and aconitase in rat cerebral cortex mitochondria, and of creatine kinase (CK) in rat cerebral cortex, striatum and hippocampus supernatants. Glutathione prevented sulfide-induced CK activity decrease in the cerebral cortex. Sulfide also diminished mitochondrial respiration in cerebral cortex homogenates, and dissipated mitochondrial membrane potential (ΔΨm) and induced swelling in the presence of calcium in brain mitochondria. Alterations in ΔΨm and swelling caused by sulfide were prevented by the combination of ADP and cyclosporine A, and by ruthenium red, indicating the involvement of mPT in these effects. Furthermore, sulfide increased the levels of malondialdehyde in cerebral cortex supernatants, which was prevented by resveratrol and attenuated by glutathione, and of thiol groups in a medium devoid of brain samples. Finally, we verified that sulfide did not alter cell viability and DCFH oxidation in cerebral cortex slices, primary cortical astrocyte cultures and SH-SY5Y cells. Our data provide evidence that bioenergetics disturbance and lipid peroxidation along with mPT pore opening are involved in the pathophysiology of brain damage observed in EE.
Assuntos
Encefalopatias Metabólicas Congênitas/metabolismo , Córtex Cerebral/metabolismo , Metabolismo Energético/efeitos dos fármacos , Sulfeto de Hidrogênio/efeitos adversos , Peroxidação de Lipídeos/efeitos dos fármacos , Proteínas de Transporte da Membrana Mitocondrial/metabolismo , Púrpura/metabolismo , Animais , Encefalopatias Metabólicas Congênitas/induzido quimicamente , Encefalopatias Metabólicas Congênitas/patologia , Linhagem Celular Tumoral , Córtex Cerebral/patologia , Sulfeto de Hidrogênio/farmacologia , Masculino , Potencial da Membrana Mitocondrial/efeitos dos fármacos , Poro de Transição de Permeabilidade Mitocondrial , Púrpura/induzido quimicamente , Púrpura/patologia , Ratos , Ratos WistarRESUMO
Presentamos el caso de un varón institucionalizado de 57 años, afectado por síndrome de Down, que presentó lesiones purpúricas en manos y extremidades inferiores tras administración de una dosis de amoxicilina-ácido clavulánico. Se sospechó una reacción de hipersensibilidad por fármacos, pero la reacción cutánea persistió tras la suspensión del antibiótico. Tras descartar otras etiologías, fue diagnosticado de escorbuto. El paciente fue tratado con suplementos de vitamina C, mostrando clara mejoría de las lesiones. El escorbuto no es un diagnóstico frecuente en la actualidad, sin embargo esta patología de otras épocas no ha desaparecido del todo. Se trata de una enfermedad que resulta fácil olvidar al plantearnos un diagnóstico diferencial y cuyo tratamiento con la suplementación vitamínica es simple y efectivo (AU)
We report the case of an institutionalized 57-year-old man affected by Down syndrome, with purpura in hands and lower extremities after the administration of a dose of amoxicillin-clavulanic acid. We suspected a drug hypersensitivity reaction but the skin reaction persisted after discontinuation of the antibiotic. After ruling out any other etiology, scurvy was diagnosed. The patient was treated with vitamin C supplements, showing a clear improvement. Scurvy is not a common diagnosis at the present time, but this disease from the past has not disappeared entirely. It can be easily overlooked in differential diagnosis, but vitamin supplementation is a simple and effective treatment (AU)