Reading of the Mitsuda test: comparison between diameter and total area by means of a computerized method.

The Mitsuda test is a skin test based on the individual's immune response through late and highly specific hypersensitivity reaction to the Mycobacterium leprae bacillus. A negative reaction identifies individuals who present a higher risk of becoming ill if exposed to M. leprae and, if they become ill, to develop the virchowian form of disease. The Mitsuda test reading is performed by means of a millimeter ruler. The dermatoscopy is a method that has not been used in the evaluation of cutaneous tests, although its use has increased in several areas. The study aimed to compare the results between the standardized reading and the total area of the Mitsuda test obtained by a computerized method which was structured by the association of digital dermatoscopy, the Dermatology Web system and the Image Tool 3.0 software. Data collection was performed at the Dermatology Outpatient Clinic of the Eduardo de Menezes Hospital, in Belo Horizonte, from November 2015 to August 2016. The sample consisted of 100 leprosy domiciliary contacts. There was an excellent agreement between the Mitsuda test (diameter and area), with a coefficient greater than 80%, and an excellent correlation with the Spearman's correlation coefficient (0.936). The intraclass correlation coefficient indicated a low (0.219) but significant agreement between the two measurements. In conclusion, there is a significant correlation between the standardized reading and the total area of the Mitsuda test. Digital dermoscopy can be an alternative instrument of evaluation, allowing the computerization and recording of the Mitsuda test.

Tratamento de pênfigo vulgar com imunoglobulina humana como adjuvante ao corticoide oral: um relato de caso / Pemphigus vulgaris treatment with human immunoglobulin as adjuvant to oral corticoid: a case report

Introdução: o pênfigo vulgar é uma doença de caráter autoimune, que leva à formação de bolhas locais ou generalizadas causadas pelo ataque de autoanticorpos às estruturas da epiderme. A terapêutica Recebido em: 25/09/2018 com imunoglobulina humana como adjuvante é uma excelente opção para os casos em que há resistência ao tratamento habitual, além de poder diminuir o tempo de tratamento com imunossupressores. Objetivo: descrever um relato de caso sobre um paciente portador de pênfigo vulgar submetido ao tratamento com imunoglobulina humana como adjuvante ao corticoide oral. Relato do caso: paciente 49 anos, foi internado apresentando lesões erosivas em mucosa oral e conjuntival, com piora sistêmica após início de tratamento com antibióticos e anti-inflamatório. Inicialmente realizou-se o tratamento convencional com corticoterapia, porém sem resultados satisfatórios. Devido ao agravamento da clínica, e ao estabelecimento do diagnóstico de pênfigo vulgar, foi incluída no tratamento a imunoglobulina humana como adjuvante, o que culminou em uma melhora progressiva do paciente. Conclusão: apesar de o tratamento do pênfigo vulgar ter os corticoides como primeira opção, é importante conhecer tratamentos adjuvantes e/ou alternativos, como as imunoglobulinas humanas, para auxiliar no tratamento dos pacientes que não respondem ao corticoide.

Introduction: Pemphigus Vulgaris is an autoimmune disease that leads to the formation of local or generalized blisters as a result of autoantibodies against epidermal structures. Therapy with human immunoglobulin as an adjuvant is an excellent option for cases where there is resistance to usual treatment, in addition to being able to reduce the time of treatment with immunosuppressant. Thus, it is an alternative treatment for patients with severe infections or immunological deficiencies. Aim: to describe a case report about a carrier patient of pemphigus vulgaris treated with human immunoglobulin as adjuvant to oral corticosteroids. Case report: patient with 49 years old, was hospitalized in the city of Belo Horizonte (MG) presenting erosive lesions in the oral and conjunctival mucosa, with systemic worsening after starting treatment with antibiotics and anti-inflammatory. Initially, conventional steroid therapy was performed, but with no satisfactory results. Due to worsening symptoms and the diagnosis of Pemphigus Vulgaris, human immunoglobulin was included in the treatment as an adjuvant, which resulted in a progressive improvement of the patient. Conclusion: although treatment of Pemphigus Vulgaris has steroids as the first option, it is vital that the physician knows adjuvant and/or alternative therapies, such as human immunoglobulins, to assist in the treatment of patients who do not respond to steroids.