EFFICACY OF METHOTREXATE MICROINFUSION IN SCALP LESIONS OF PATIENTS WITH FIBROSING FRONTAL ALOPECIA: A PROSPECTIVE CONTROLLED TRIAL / EFICÁCIA DA MICROINFUSÃO DE METOTREXATO EM LESÕES DO COURO DE PACIENTES COM ALOPECIA FIBROSANTE: ENSAIO CLÍNICO PROSPECTIVO CONTROLADO

Introdução: A alopecia frontal fibrosante (AFF) é uma cicatriz linfocítica, com queda de cabelo pela linha de implantação frontal do couro cabeludo e outras áreas do corpo. Drogas tópicas e sistêmicas, como casos o MTX, não controlam a atividade da doença na maioria dos casos, a necessidade de novas terapias. Objetivo: Avaliar a diligência da microinfusão de metotrexato em AFF. Métodos: Ensaio clínico prospectivo, controlador, realizado com 17 voluntários com 1 diagnóstico clínico e histológico de AFF. As aplicações de MTX por MMP® (método de microinfusão de pele) foram feitas a cada 30 dias, num total de 3 aplicações, na direita da área de alopecia; a outra metade serviu como controle.medidas frontais glalares e parciais, dermatoscópicas, índice de avaliação externa dos olhos, a percepção do plano dos sinais do paciente (LPPAI). Hemograma total e testes de função hepática também foram médios. Resultados: Houve uma redução significativa nas medidas fronto-glabela e frontal temporo-parietal no local tratado, enquanto no local nãou a AAF aumentou. A paciente refere melhora do prurido e descamação, mas não da queda de cabelo e eritema local. A das fotos dermatoscópicas e a análise do LPPAI não são relevantes. Cerca de 9 participantes e todos nós não resultaram em 5% dos resultados com nenhum resultado de nenhum dos exames.Conclusão: A aplicação de MTX por MMP® melhorou os sintomas associados à AFF e as medidas fronto-glabela e fronto-parietal.

Introdução: A alopecia frontal fibrosante (AFF) é cicatricial linfocítica, com queda de cabelo pela linha de implantação frontal do couro cabeludo e outras áreas do corpo. Drogas tópicas e sistêmicas, como o metotrexato (MTX), não controlam a atividade da doença na maioria dos casos, mostrando a necessidade de novas terapias. Objetivo: Avaliar a eficácia da microinfusão de metotrexato em AFF. Métodos: Ensaio clínico prospectivo, controlado, realizado com 17 voluntários com diagnóstico clínico e histológico de AFF. As aplicações de MTX por MMP® (método de microinfusão de drogas na pele) foram feitas a cada 30 dias, totalizando 3 aplicações, na metade direita da área da alopecia; a outra metade serviu como controle. Foram avaliadas as medidas frontoglabela e frontal temporoparietal. Fotos de dermatoscopia foram analisadas por avaliadores cegos e externos com percepção de sinais e sintomas do paciente e o Índice de Atividade do Líquen Planopilar (LPPAI). Hemograma total e testes de função hepática também foram medidos. Resultados: Houve redução significativa nas medidas frontoglabela e frontal temporoparietal no local tratado, enquanto no não tratado a AAF aumentou. Houve melhora do prurido e descamação, mas não da queda de cabelo e eritema local. A análise das fotos dermatoscópicas e o cálculo do LPPAI não mostraram alterações relevantes. Cerca de 95% dos participantes ficaram satisfeitos ou muito satisfeitos com os resultados e nenhum deles teve alteração nos resultados dos exames laboratoriais. Conclusão: A aplicação de MTX por MMP® melhorou os sintomas associados à AFF e as medidas frontoglabela e frontoparietal. Esta técnica mostrou-se segura e bem tolerada.

Do you know this syndrome? Clouston syndrome.

Ectodermal dysplasias are conditions that present primary defects in two or more tissues of ectodermal origin and can be classified as hypohidrotic and hidrotic. Hidrotic ectodermal dysplasia or Clouston syndrome is an autosomal dominant genodermatosis and appears as a triad of clinical findings: palmoplantar keratoderma, nail dystrophy, and hypotrichosis. The hair is sparse and brittle. The nails become thickened and dystrophic, which is an essential characteristic of the syndrome. The diagnosis is made based on clinical findings. This study reports a case of a patient who began with changes in hair, nails and palmoplantar keratoderma in early childhood.

Do you know this syndrome? Clouston syndrome

Abstract Ectodermal dysplasias are conditions that present primary defects in two or more tissues of ectodermal origin and can be classified as hypohidrotic and hidrotic. Hidrotic ectodermal dysplasia or Clouston syndrome is an autosomal dominant genodermatosis and appears as a triad of clinical findings: palmoplantar keratoderma, nail dystrophy, and hypotrichosis. The hair is sparse and brittle. The nails become thickened and dystrophic, which is an essential characteristic of the syndrome. The diagnosis is made based on clinical findings. This study reports a case of a patient who began with changes in hair, nails and palmoplantar keratoderma in early childhood.

Case for diagnosis.

Intravascular papillary endothelial hyperplasia is a benign vascular lesion caused by proliferation of endothelium. It is reactive to thrombotic or inflammatory stimuli in the vessel wall.We report the case of a 14-yearold male patient with a violet-colored erythematous tumoral lesion of progressive growth in the occipital region. The diagnosis of intravascular papillary endothelial hyperplasia (IPEH) was confirmed by clinical and histopathological findings. Total lesion exeresis was performed with no recurrence up to date. IPEH presents clinical importance due to its clinical and histological resemblance to angiosarcoma. In order to differentiate it from angiosarcoma, distinguishing features of the benign disease should be considered, such as lack of cellular atypia and rare mitotic activity.Prognosis is good.

Case for diagnosis

Intravascular papillary endothelial hyperplasia is a benign vascular lesion caused by proliferation of endothelium. It is reactive to thrombotic or inflammatory stimuli in the vessel wall.We report the case of a 14-yearold male patient with a violet-colored erythematous tumoral lesion of progressive growth in the occipital region. The diagnosis of intravascular papillary endothelial hyperplasia (IPEH) was confirmed by clinical and histopathological findings. Total lesion exeresis was performed with no recurrence up to date. IPEH presents clinical importance due to its clinical and histological resemblance to angiosarcoma. In order to differentiate it from angiosarcoma, distinguishing features of the benign disease should be considered, such as lack of cellular atypia and rare mitotic activity.Prognosis is good.

Follicular mucinosis - case report.

Follicular mucinosis, also known as alopecia mucinosa, is a cutaneous mucinosis histologically characterized by accumulation of dermal type mucin in the pilosebaceous follicle and sebaceous glands. It presents in two forms, a primary or idiopathic form and a secondary form associated with various benign or malignant processes. Among the malignant processes, the main association is with mycosis fungoides. The frequent overlap of clinical, histopathological, immunohistochemical and molecular biology characteristics makes the correct classification of these conditions difficult, therefore a long follow-up of all cases is recommended. We report the case of an adolescent with disseminated lesions and discuss the difficulty of early identification of secondary follicular mucinosis associated with cutaneous lymphoma.

Follicular mucinosis - Case report

Follicular mucinosis, also known as alopecia mucinosa, is a cutaneous mucinosis histologically characterized by accumulation of dermal type mucin in the pilosebaceous follicle and sebaceous glands. It presents in two forms, a primary or idiopathic form and a secondary form associated with various benign or malignant processes. Among the malignant processes, the main association is with mycosis fungoides. The frequent overlap of clinical, histopathological, immunohistochemical and molecular biology characteristics makes the correct classification of these conditions difficult, therefore a long follow-up of all cases is recommended. We report the case of an adolescent with disseminated lesions and discuss the difficulty of early identification of secondary follicular mucinosis associated with cutaneous lymphoma.