Lepromatous leprosy simulating rheumatoid arthritis - Report of a neglected disease.

Brazil has the second largest number of leprosy cases in the world; nevertheless, late diagnosis is common. We report the case of a male patient with pain and numbness in both hands and feet for six years with positive rheumatoid factor and anticardiolipin under rheumatoid arthritis treatment for five years. Examination revealed diffuse cutaneous infiltration and leonine facies, characteristic features of lepromatous leprosy. Autoantibodies such as rheumatoid factor and anticardiolipin are markers of rheumatic autoimmune diseases, but their presence is also described in leprosy. We report the present case in order to alert health professionals to remember leprosy, even in areas where the disease is considered eliminated as a public health problem, avoiding misinterpretations of serologic findings and misdiagnosis.

Amiodarone and itraconazole improve the activity of pentavalent antimonial in the treatment of experimental cutaneous leishmaniasis.

Leishmaniasis affect millions of people, causing morbidity and mortality, especially in developing tropical and subtropical countries. Unfortunately, the possibilities of treatment for these infections are still quite limited and most of the available drugs present serious side effects. The objective of this paper was to evaluate the therapeutic role of amiodarone and itraconazole in the treatment of cutaneous leishmaniasis caused by Leishmania (Leishmania) amazonensis. In order to perform this evaluation, hamsters were infected with 1 × 106 metaciclic promastigotes of the parasite in the hind footpad and, after the onset of the lesions, were treated with glucantime, amiodarone, itraconazole, glucantime and amiodarone, glucantime and itraconazole or amiodarone and itraconazole. The treatments' efficacy was evaluated per analysis of the size of the cutaneous lesions and by parasitic investigation of the infected foot (by histopathological examination and PCR) and possible side effects were analyzed taking into account the weight of the animals and some biochemical and metabolic parameters (glucose, urea, creatinine, AST, ALT and ALP). The results have shown that, in hamsters, amiodarone and itraconazole, either used isolated or in combination, are unable to stop the development of cutaneous lesions caused by L. (L.) amazonensis, but improve the activity of glucantime in the treatment of these lesions and seem to present no evident side effects. More studies are necessary in order to investigate the clinical potential of these combinations, so there can be the possibility of broadening the therapeutic options available, especially in resistant cases.

Lepromatous leprosy simulating rheumatoid arthritis - Report of a neglected disease

Abstract Brazil has the second largest number of leprosy cases in the world; nevertheless, late diagnosis is common. We report the case of a male patient with pain and numbness in both hands and feet for six years with positive rheumatoid factor and anticardiolipin under rheumatoid arthritis treatment for five years. Examination revealed diffuse cutaneous infiltration and leonine facies, characteristic features of lepromatous leprosy. Autoantibodies such as rheumatoid factor and anticardiolipin are markers of rheumatic autoimmune diseases, but their presence is also described in leprosy. We report the present case in order to alert health professionals to remember leprosy, even in areas where the disease is considered eliminated as a public health problem, avoiding misinterpretations of serologic findings and misdiagnosis.

Hidradenitis suppurativa: epidemiological study of cases diagnosed at a dermatological reference center in the city of Bauru, in the Brazilian southeast State of São Paulo, between 2005 and 2015.

BACKGROUND:: Hidradenitis is a chronic inflammatory disease of the hair follicles. A treatment is necessary due to chronicity and psychological changes that patient present. OBJECTIVE:: To investigate epidemiological aspects and elaborate a risk group profile, promote early diagnosis and contribute to the knowledge about the disease. METHODS:: This cross-sectional descriptive study with retrospective analysis of medical records of 194 patients diagnosed with hidrosadenitis in a dermatological reference center in the city of Bauru (SP) between 2005 and 2015. RESULTS:: Females accounted for 74% of cases. The age at diagnosis ranged from 10 to 67 years and the majority was within the 3rd and 4th decade of life. It occurred Association with diabetes mellitus in 33%, obesity in 55% and smoking in 61% was observed. Mean time between the onset of the disease and diagnosis was nine years. Hurley stage II was the most common at diagnosis. The therapeutic option mostly used in Hurley I and II was systemic antibiotics and in Hurley III was surgery. STUDY LIMITATIONS:: the main limitation of this study is its retrospective design, which does not allow the true clinical confirmation of the disease by investigators. CONCLUSION:: we outlined the following profile: women, caucasian, between 3rd and 4th decade of life, associated with obesity, smoking, late diagnosis and multiple potential therapeutic modalities. We highlight the importance of studies like this in order to identify risk groups and encourage early diagnosis.

Hidradenitis suppurativa: epidemiological study of cases diagnosed at a dermatological reference center in the city of Bauru, in the Brazilian southeast State of São Paulo, between 2005 and 2015

Abstract: Background: Hidradenitis is a chronic inflammatory disease of the hair follicles. A treatment is necessary due to chronicity and psychological changes that patient present. Objective: To investigate epidemiological aspects and elaborate a risk group profile, promote early diagnosis and contribute to the knowledge about the disease. Methods: This cross-sectional descriptive study with retrospective analysis of medical records of 194 patients diagnosed with hidrosadenitis in a dermatological reference center in the city of Bauru (SP) between 2005 and 2015. Results: Females accounted for 74% of cases. The age at diagnosis ranged from 10 to 67 years and the majority was within the 3rd and 4th decade of life. It occurred Association with diabetes mellitus in 33%, obesity in 55% and smoking in 61% was observed. Mean time between the onset of the disease and diagnosis was nine years. Hurley stage II was the most common at diagnosis. The therapeutic option mostly used in Hurley I and II was systemic antibiotics and in Hurley III was surgery. Study limitations: the main limitation of this study is its retrospective design, which does not allow the true clinical confirmation of the disease by investigators. Conclusion: we outlined the following profile: women, caucasian, between 3rd and 4th decade of life, associated with obesity, smoking, late diagnosis and multiple potential therapeutic modalities. We highlight the importance of studies like this in order to identify risk groups and encourage early diagnosis.

Líquen plano pilar: a importância do diagnóstico precoce / Lichen planopilaris: the importance of early diagnosis

O líquen plano pilar é desordem rara da ordem das alopecias cicatriciais primárias. Descreve- se um caso de paciente do sexo feminino, portadora de placas eritêmato-descamativas e plugues foliculares em região frontoparietal bilateralmente, associados a teste de tração positivo. Após biópsia compatível com líquen plano pilar, a paciente foi tratada com prednisona associada a clobetasol, apresentando repilação da área acometida. O tratamento dessa patologia é um desafio devido à escassez de dados sobre eficácia das terapêuticas e constante recidiva. Trata-se de quadro irreversível se não for tratado precocemente. É descrito um caso clássico de líquen plano pilar com boa resposta terapêutica, destacando- -se a importância do diagnóstico precoce, já que em fase inicial a maioria das alopecias cicatriciais é não cicatricial, devendo, por esse motivo, ser manejada como emergência em tricologia.

Lichen planopilaris is a rare disorder that belongs to the primary scarring alopecia type. The present study describes the case of a female patient bearing desquamative erythematous plaques and follicular plugs bilaterally in the frontoparietal region, associated with positive pull test. The biopsy's result was consistent with lichen planopilaris and the patient was treated with prednisone associated with clobetasol, with regrowth of the hair in the affected area. The treatment of this pathology is a challenge due to the lack of data on efficacy of therapies and constant recurrence. The picture is irreversible if not treated early. This paper describes a classic case of a case of lichen planopilaris with good therapeutic response, highlighting the importance of early diagnosis, due to the fact that most cicatricial alopecias do not produce scarring in their initial stage and should for this reason be managed as an emergency in trichology.