RESUMO
Granuloma annulare is a benign and self-limited cutaneous disease. Subcutaneous granuloma annulare is an uncommon variant seen almost exclusively in young children, characterized by firm nodules appearing more frequently in lower extremities, buttocks, hands and scalp. OBJECTIVE: To report a case of subcutaneous granuloma annulare and review its differential diagnoses and treatments. CLINICAL CASE: A 4 year-old male patient. Since 2 and a half years of age he presented asymptomatic firm subcutaneous nodules on the back of the left middle finger and later on the back of the left hand, right big toe, left frontal area and scalp. Excisional biopsy of some lesions from the scalp was consistent with subcutaneous granuloma annulare. Clobetasol 0,05% cream twice a day for 1 month was prescribed without response. CONCLUSIONS: Subcutaneous granuloma annulare must be considered within the differential diagnosis of subcutaneous nodules in children. In most of the cases a biopsy and histopathology of the lesions will be required to confirm the diagnosis. Due to its tendency to spontaneous resolution, treatment often is not necessary and periodic evaluation is recommended.
Assuntos
Granuloma Anular/diagnóstico , Pré-Escolar , Diagnóstico Diferencial , Mãos , Humanos , Masculino , Couro Cabeludo , Dedos do PéRESUMO
INTRODUCTION: Pityriasis lichenoides is a benign inflammatory disease of unknown etiology. There are two types of this condition: an acute form (PLEVA = pityriasis lichenoides et varioliformis acuta) and a chronic one (PLC = pityriasis lichenoid chronica). Both are more common in children and young adults. OBJECTIVE: To describe a case of PLC, discuss its clinical presentation, diagnosis, treatment and present a review of the literature. CASE REPORT: A seven-year-old child who presented with recurrent oligosymptomatic episodes of bright erythematous papular lesions in centripetal distribution, which subsided and left behind hypopigmented macules. The biopsy of the lesions confirmed chronic pityriasis lichenoid. During the 3 years of follow-up, multiple treatment regimens were used to reduce exacerbations, resulting in a partial response. CONCLUSION: PLC is a rare disease that represents a diagnostic and therapeutic challenge to the physician. The diagnosis of this condition is suspected clinically and confirmed by histology. It does not have specific treatment, but it responds well to corticosteroids, antibiotics, immunosuppressants and phototherapy with UVB narrowband (UVBnb). The latter has given the best results. It is important to monitor patients for risk of developing lymphoproliferative disorders.
Assuntos
Pitiríase Liquenoide/diagnóstico , Terapia Ultravioleta/métodos , Corticosteroides/uso terapêutico , Assistência ao Convalescente , Antibacterianos/uso terapêutico , Biópsia , Criança , Doença Crônica , Humanos , Masculino , Pitiríase Liquenoide/patologia , Pitiríase Liquenoide/terapia , Resultado do TratamentoRESUMO
INTRODUCTION: Bloody nipple discharge is an infrequent symptom during childhood. The most common cause in this population is mammary duct ectasia (MDE), which is a benign and self-limiting condition, that is characterized by dilatation of the mammary ducts, fibrosis and periductal inflammation. OBJECTIVE: Report of a case of MDE in order to improve physicians' diagnosis accuracy and avoid aggressive studies and treatments. CASE REPORT: Six-months old male healthy infant, exclusively breastfeeded, that visited our clinic with a lump beneath his right nipple and bloody discharge from the same nipple. An ultrasound was performed which showed a multicystic lesion suggestive of MDE. Watchful waiting was decided as treatment, with good evolution after six months of follow up. CONCLUSIONS: The MDE is the leading cause of bloody discharge in pediatric population, being a benign condition that resolves spontaneously before nine months. The knowledge of this condition is essential so as to accurately diagnose and treat it.
Assuntos
Doenças Mamárias/diagnóstico , Exsudatos e Transudatos/metabolismo , Glândulas Mamárias Humanas/patologia , Mamilos/metabolismo , Doenças Mamárias/patologia , Seguimentos , Humanos , Lactente , MasculinoRESUMO
Introducción: Los niños con cáncer pueden presentar múltiples dermatosis derivadas del cáncer mismo o secundarias a su terapéutica. El objetivo es conocer las manifestaciones cutáneas e niños con cáncer en quimioterapia, y compararlas con niños controles sanos. Este es el primer estudio chileno que las describe. Pacientes y método: Se realizó un estudio analítico descriptivo transversal, mediante examen físico y registro en ficha. Se estudiaron 82 niños. Los casos fueron 41 niños con cáncer en quimioterapia del Servicio de Oncología Infantil del Hospital Sótero del Río. Los controles, 41 pacientes sanos hospitalizados por patología quirúrgica en el mismo hospital. Ambos grupos fueron pareados por sexo, edad, estado nutricional, fenotipo y tipo de exposición solar en relación 1:1. Los datos se analizaron con software SPSS. Resultados: La xerosis fue la manifestación cutánea más frecuente en ambos grupos 73,2% (n=60). En niños con cáncer se observó en el 82,4% (34) y en niños sanos 63,4% (26). Ambos grupos, tuvieron igual frecuencia de enfermedades infecciosas 14,6% e inflamatorias 19,5%. En los niños oncológicos predominaron las infecciones virales; dermatitis de contacto; y efectos asociados a la quimioterapia, como la hiperpigmentación cutánea y efluvio anágeno. En los niños controles, se encontraron más frecuentemente las tiñas y prurigo. No se reportaron efectos adversos a medicamentos. En ambos grupos, no hubo diferencia en cuanto al número total de nevi. Conclusión: La manifestación cutánea más frecuente fue la xerosis en ambos grupos y los niños con cáncer no presentaron más dermatosis que los controles sanos, salvo las asociadas a su tratamiento.
Introduction: Children with cancer can present multiple dermatoses derived from the cancer itself or secondary to its therapy. The objective is to know the skin manifestations of children with cancer in chemotherapy, and compare them with healthy controls. This is the first Chilean study that describes them. Patients and method: A transversal descriptive analytical study was carried out. By means of a physical examination and review the medical record, 82 children were studied. The cases were 41 children with cancer in chemotherapy from the Children's Oncology Service of Sótero del Río Hospital. The controls, 41 healthy patients hospitalized for surgical pathology in the same hospital. Both groups were matched by sex, age, nutritional status, phenotype and type of sun exposure in a 1: 1 ratio. The data was analyzed with SPSS software. Results: Xerosis was the most common cutaneous manifestation found in both groups 73.2% (n = 60). In children with cancer was found 82,4% (34) and in cases 63,4% (n = 26). Both groups had the same frequency of inflammatory 14,6%, or infectious dermatosis 19,5%. In oncologyc patients, predominated viral infections; contact dermatitis; and adverse drugs reactions associated with chemotherapy, such as skin hyperpigmentation and anagen effluvium. In the controls, were more found superficial fungal infections, and prurigo. No adverse drugs reactions were observed in this group. In both groups, there was no difference in the total number of nevi. Conclusion: The most frequent cutaneous manifestation was xerosis in both groups and children with cancer did not present more dermatosis than healthy controls, except those associated with their treatment.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Dermatopatias/induzido quimicamente , Neoplasias/tratamento farmacológico , Antineoplásicos/efeitos adversos , Dermatopatias/etiologia , Manifestações Cutâneas , Epidemiologia Descritiva , Estudos Transversais , Neoplasias/complicaçõesRESUMO
El granuloma anular es una dermatosis inflamatoria granulomatosa de carácter benigno y autolimitado. El granuloma anular subcutáneo es una variante poco común, que se presenta casi exclusivamente en niños menores y se caracteriza por la aparición de nódulos de consistencia firme de predominio en extremidades inferiores, glúteos, manos y cuero cabelludo. OBJETIVO: Reportar un caso de granuloma anular subcutáneo, revisar su diagnóstico diferencial y las opciones terapéuticas actuales. CASO CLÍNICO: Paciente de sexo masculino de 4 años. Desde los 2 años y medio con nódulos subcutáneos indurados asintomáticos, inicialmente en dorso de dedo medio mano izquierda, luego en dorso de mano izquierda, primer ortejo derecho, zona frontal izquierda y cuero cabelludo. La biopsia excisional de algunas lesiones de cuero cabelludo fue compatible con granuloma anular subcutáneo. Como tratamiento se indicó clobetasol 0,05% crema 2 veces al día en lesiones por 1 mes, sin cambio en las lesiones. CONCLUSIONES: El granuloma anular subcutáneo debe considerarse dentro del diagnóstico diferencial de nódulos subcutáneos en niños. En la mayoría de los casos se requerirá biopsia y estudio histopatológico de las lesiones para su confirmación diagnóstica. Debido a su tendencia a la resolución espontánea, generalmente se sugiere no tratar y controlar periódicamente.
Granuloma annulare is a benign and self-limited cutaneous disease. Subcutaneous granuloma annulare is an uncommon variant seen almost exclusively in young children, characterized by firm nodules appearing more frequently in lower extremities, buttocks, hands and scalp. OBJECTIVE: To report a case of subcutaneous granuloma annulare and review its differential diagnoses and treatments. CLINICAL CASE: A 4 year-old male patient. Since 2 and a half years of age he presented asymptomatic firm subcutaneous nodules on the back of the left middle finger and later on the back of the left hand, right big toe, left frontal area and scalp. Excisional biopsy of some lesions from the scalp was consistent with subcutaneous granuloma annulare. Clobetasol 0,05% cream twice a day for 1 month was prescribed without response. CONCLUSIONS: Subcutaneous granuloma annulare must be considered within the differential diagnosis of subcutaneous nodules in children. In most of the cases a biopsy and histopathology of the lesions will be required to confirm the diagnosis. Due to its tendency to spontaneous resolution, treatment often is not necessary and periodic evaluation is recommended.
Assuntos
Humanos , Masculino , Pré-Escolar , Granuloma Anular/diagnóstico , Couro Cabeludo , Dedos do Pé , Diagnóstico Diferencial , MãosRESUMO
Introducción: La telorragia es un síntoma poco frecuente en pacientes pediátricos, la causa más frecuente en esta población es la ectasia ductal mamaria (EDM), que es una afección benigna y autolimitada, caracterizada por la dilatación del conducto mamario, fibrosis e inflamación periductal. Objetivo: Presentar un caso de EDM, para facilitar el rápido reconocimiento por parte de los médicos, y evitar estudios y tratamientos agresivos. Caso clínico: Lactante de sexo masculino de 6 meses de edad, sano, alimentado por lactancia materna exclusiva; consultó por un nódulo retroareolar derecho y telorragia unilateral. Se realizó una ecografía Doppler que mostró una lesión multiquística, sugerente de una EDM. Se planteó tratamiento expectante y acudió a control a los 6 meses con excelente evolución. Conclusiones: La EDM es la principal causa de telorragia en niños, corresponde a una afección benigna, y la resolución generalmente es espontánea, antes de los 9 meses. Por lo que su conocimiento es de gran relevancia para el adecuado diagnóstico y manejo de estos pacientes.
Introduction: Bloody nipple discharge is an infrequent symptom during childhood. The most common cause in this population is mammary duct ectasia (MDE), which is a benign and self-limiting condition, that is characterized by dilatation of the mammary ducts, fibrosis and periductal inflammation. Objective: Report of a case of MDE in order to improve physicians’ diagnosis accuracy and avoid aggressive studies and treatments. Case report: Six-months old male healthy infant, exclusively breastfeeded, that visited our clinic with a lump beneath his right nipple and bloody discharge from the same nipple. An ultrasound was performed which showed a multicystic lesion suggestive of MDE. Watchful waiting was decided as treatment, with good evolution after six months of follow up. Conclusions: The MDE is the leading cause of bloody discharge in pediatric population, being a benign condition that resolves spontaneously before nine months. The knowledge of this condition is essential so as to accurately diagnose and treat it.
Assuntos
Humanos , Cátions/química , Indicadores e Reagentes/química , Lipídeos/química , Polienos/química , RNA Interferente Pequeno/química , Linhagem Celular Tumoral , Química Farmacêutica/métodos , Técnicas de Transferência de Genes , Vetores Genéticos/genética , Células HeLa , Lipossomos/química , Luciferases/química , Fosfolipídeos/química , RNA Interferente Pequeno/genética , Transfecção/métodosRESUMO
El síndrome de Gianotti-Crosti, también llamado acrodermatitis papular de la infancia, es un exantema infrecuente de la infancia, que se presenta generalmente en niños entre 1 y 6 años de edad. Dado que estos pacientes generalmente son llevados a su pediatra, es fundamental el conocimiento de las características de este síndrome. El cuadro clínico se caracteriza por una reacción pápulo-vesicular asintomática y autolimitada de distribución simétrica en cara, nalgas y superficies extensoras de las extremidades, formando placas o permaneciendo aisladas. El tronco generalmente se encuentra respetado y las lesiones usualmente no son pruriginosas. Se reportan los casos de dos pacientes que consultaron en el Servicio de Dermatología de la Pontificia Universidad Católica de Chile, por un cuadro compatible con síndrome de Gianotti-Crosti. A propósito de los casos, se presentan los aspectos más relevantes sobre esta patología.
The Gianotti-Crosti syndrome, also known as papular acrodermatitis of childhood, is an uncommon rash that usually occurs in children between 1 and 6 years old. Given that these patients are usually brought to their pediatrician, it is essential to know the characteristics of this syndrome. The clinical picture is characterized by a self-limited and asymptomatic papulo-vesicular reaction, symmetrically distributed on the face, buttocks and extensor surfaces of the extremities. The trunk is generally respected and the lesions are usually not itchy. We report the cases of two patients treated at the Dermatology Department at the Pontificia Universidad Católica de Chile, with symptoms consistent with Gianotti-Crosti syndrome. We also present the most relevant aspects of this disease.
Assuntos
Humanos , Feminino , Lactente , Criança , Acrodermatite/diagnóstico , Acrodermatite/etiologia , Exantema , Remissão EspontâneaRESUMO
Las disrafias espinales ocultas son patologías caracterizadas por la fusión incompleta del tubo neural, en las que la lesión se encuentra cubierta por piel y no hay exposición del tejido nervioso. El diagnóstico precoz es de gran importancia, ya que la corrección quirúrgica oportuna puede prevenir daño neurológico irreversible. Existen alteraciones cutáneas que se asocian a la presencia de disrafias espinales ocultas. Debido a que en muchos casos estos marcadores cutáneos son la única manifestación inicial de estas alteraciones, es fundamental que el pediatra esté familiarizado con ellos, para poder realizar un estudio diagnóstico y terapéutico adecuado. Dentro de los marcadores cutáneos descritos en la literatura, una combinación de dos o más alteraciones cutáneas congénitas de la línea media constituye probablemente el predictor más importante de disrafia espinal oculta. Lesiones como el lipoma de la línea media y la cola de fauno son los marcadores aislados de mayor riesgo. Actualmente las disrafias espinales ocultas cuentan con cobertura GES, por lo que todo paciente en el que se sospeche el diagnóstico, debe ser derivado a neurocirujano, quien deberá evaluarlo en un plazo máximo de tres meses.
Occult spinal dysraphism are diseases characterized by the incomplete fusion of the neural tube, where the lesion is covered by skin and there is no exposure of nerve tissue. Early diagnosis is very important, because prompt surgical correction can prevent irreversible neurological damage. There are usually skin changes associated with the presence of occult spinal dysraphism. Because in many cases these skin lesions are the only initial manifestation of the disease, its essential for the pediatrician to know them well, for achieving a timely and appropriate diagnosis. Among the skin markers described in the literature, a combination of two or more skin lesions of the midline is probably the best predictor of occult spinal dysraphism. Lesions such as lipoma of the midline and faun tail have the highest risk for these disorders. Occult spinal dysraphism have GES financing, so every patient in whom the diagnosis is suspected should be referred to a neurosurgeon, who will perform an evaluation within three months.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Criança , Dermatopatias/diagnóstico , Dermatopatias/etiologia , Espinha Bífida Oculta/complicações , Espinha Bífida Oculta/diagnóstico , Hipertricose , Lipoma , Defeitos do Tubo Neural , Diagnóstico Diferencial , Disrafismo Espinal/complicações , Disrafismo Espinal/diagnóstico , Estudos Retrospectivos , Hemangioma , Neoplasias Cutâneas , Nevo Pigmentado , PapilomaRESUMO
Jellyfish are aquatic organisms, whose number increases under certain conditions of water temperature. They can sting humans, which can be fatal. The liberation of structures known as nematocysts induces the extrusion of the poison, to attack their victims. The poison produces characteristic local and systemic reactions. Since an increased number of these organisms has been detected in our coastline, we review the epidemiology, symptoms and diagnosis of the syndrome produced by the bite, to improve its management.
Assuntos
Mordeduras e Picadas , Venenos de Cnidários/intoxicação , Cifozoários , Animais , Mordeduras e Picadas/diagnóstico , Mordeduras e Picadas/epidemiologia , Mordeduras e Picadas/etiologia , Humanos , Masculino , Cifozoários/classificação , SíndromeRESUMO
Paciente de tres años de edad que nació con una malformación vascular capilar (MVC) extensa, del tipo mancha en vino de Oporto o nevus flammeus, en hemitórax y brazo derecho asociada a agenesia distal de dicha extremidad. El niño fue un recién nacido de 39 semanas, sin patologías del embarazo, complicaciones perinatales ni consumo materno de drogas o fármacos. Al nacer se estudió la alteración musculoesquelética con radiografía que mostró hipoplasia radiocubital y agenesia de los huesos del carpo así como de los restantes huesos de la mano. Se realizó búsqueda de otras malformaciones la que fue negativa. Evaluado por genetista, se descartó genopatía. El diagnóstico definitivo fue de defecto terminal transverso asociado a MVC gigante. El paciente presentó crecimiento pondoestatural adecuado y desarrollo psicomotor normal. Las malformaciones vasculares pueden asociarse a diversas malformaciones musculoesqueléticas. En términos generales, las malformaciones venosas pueden asociarse a alteraciones del crecimiento de la extremidad y las malformaciones capilares a hipertrofia. Sin embargo, no existen descripciones de casos de malformaciones vasculares coexistentes con agenesia de la extremidad, por lo que creemos que ésta es una nueva asociación que requiere mayor estudio
We report a case of a three years old boy that was born with an extended capillary malformation (CM), of the port-wine stain or nevus flammeus type, that covered his right arm, shoulder and hemithorax associated with distal agenesis of the same extremity. Patient was a 39-weeks new born without any diseases during pregnancy, use of maternal drugs nor perinatal complications. A radiography of the arm showed radius and ulna hypoplasia and complete agenesis of carpal and other bones of the hand. Different exams were made to exclude other malformations, with no pathological findings. A Geneticist ruled out any genopathy. Final diagnosis was terminal transverse defect of the right arm associated with a CM of the extremity. Vascular malformations may be associated with musculoskeletal malformations. Generally, venous malformations may have bone growth alterations of extremities and CM may be associated with hypertrophy. However, there are no reported cases of a vascular malformations associated with agenesis of the extremity. Therefore, we think this is a new association that needs to be studied
Assuntos
Humanos , Masculino , Pré-Escolar , Mancha Vinho do Porto , Malformações Vasculares , Braço/anormalidades , Anormalidades Musculoesqueléticas , Extremidade SuperiorRESUMO
Las enfermedades del tejido conectivo presentan baja frecuencia en la población pediátrica, pero, debido a las secuelas, la interferencia con el proceso normal del desarrollo y al hecho de que pueden representar una amenaza en la vida de nuestros pacientes, el diagnóstico adecuado y oportuno es de gran importancia. Es habitual que el dermatólogo se encuentre ante un paciente cuyas lesiones le recuerden a patologías del espectro autoinmune. Por ello, es necesario actualizar nuestros conocimientos en esta área. En esta revisión sintetizamos la información disponible hasta la actualidad sobre la historia natural de las enfermedades autoinmunes juveniles como el lupus eritematoso, la esclerodermia y la dermatomiositis.
Juvenile connective tissue diseases present low frequency in the pediatric population, but because of the sequelae, the interference with the normal growth of the child and because they can threaten the life of the patients, making the correct diagnosis is of utter importance. It is common for the dermatologist to run into a patient whose cutaneous symptoms remind him of diseases from the autoimmune spectrum. Because of that, it is important to update our knowledge on this area. In this review we resume the current information available about the natural history of autoimmune diseases like juvenile lupus erythematosus, scleroderma and dermatomyositis.
Assuntos
Criança , Dermatomiosite , Lúpus Eritematoso Cutâneo , Lúpus Eritematoso Discoide , Lúpus Eritematoso Sistêmico , Esclerodermia Difusa , Esclerodermia Localizada , Escleroderma Sistêmico , Doenças do ColágenoRESUMO
Estudio retrospectivo de pacientes atendidos con diagnóstico de Alopecia Areata en el Servicio de Dermatología del Centro de Diagnóstico de la Pontificia Universidad Católica de Chile. Se revisaron las fichas de 77 pacientes con diagnóstico de Alopecia Areata, 38 por ciento hombres, 62 por ciento mujeres, con un promedio de edad de 26.7 (DSI 15.7; rango 2-65): 15 por ciento presentaron depresión, 11 por ciento rinitis alérgica, 6,5 por ciento presentaron ansiedad, 3,9 por ciento hipotiroidismo y 2,6 por ciento, vitíligo. La Alopecia Areata se asocia a un evento estresante en 27 por ciento de los pacientes. Dentro de los exámenes solicitados, un 2/26 tuvieron anticuerpos antitiroídeos positivos y 2/27, TSH alterada. Se discuten las diversas modalidades terapéuticas para tratar la Alopecia Areata.