Tratamento bem-sucedido da cromoblastomicose pela associação entre criocirurgia e itraconazol em dose baixa / Successful treatment of chromoblastomycosis by the combination of cryosurgery with low-dose itraconazole

Cromoblastomicose é uma infecção granulomatosa crônica causada por fungos dematiáceos, com apresentações clínicas variadas, que podem representar um desafio terapêutico. Neste relato, apresentamos um caso de cromoblastomicose em forma localizada, de longa evolução, em paciente idoso, resistente a terapêuticas medicamentosas prévias, tratado com sucesso pela associação entre um método físico e tratamento farmacológico sistêmico, o que permitiu o uso de dose reduzida do medicamento.

Chromoblastomycosis is a chronic granulomatous infection caused by dematiaceous fungi with varied clinical presentations, which may represent a therapeutic challenge. In this report, we present a case of chromoblastomycosis in a localized form, with a long evolution, in an elderly patient, resistant to previous drug therapies, successfully treated by the association of a physical method with systemic pharmacological treatment, which allowed the use of a reduced dose of the drug

Evaluation of ocular involvement in patients with Hansen's disease.

Hansen's disease (HD) belongs to the group of neglected diseases and can cause physical deformities and disabilities, in addition to leading to social discrimination. Ocular involvement in HD is estimated at 70-75% worldwide. About 10-50% suffer from severe ocular symptoms and loss of vision occurs in approximately 5% of cases. Ocular changes may persist or worsen even after patients are considered cured and it is necessary to better understand these conditions in order to determine the need for additional public policies. The objective of this study was to identify the prevalence of ocular involvement in patients with HD at two specialist referral centers for treatment of the disease. A cross-sectional study was conducted with ophthalmological evaluations of patients with HD from June 2017 to June 2018. Diagnostic ocular findings, corrected visual acuity, and refractive error were described. Findings were correlated with patients' clinical and epidemiological variables. A total of 86 patients were evaluated, with a mean age of 50.1 years, predominantly males (59.3%), and with multibacillary HD (92%). The prevalence of ophthalmologic changes was 100% and the most common were dysfunction of the Meibomian glands (89.5%) and dry eye syndrome (81.4%). Cataracts were observed in 22 patients (25.6%), but best corrected visual acuity was normal or near normal in 84 patients (97.7%) and there were no cases of bilateral blindness. Patients with some degree of physical disability had more ophthalmological alterations, involving both the ocular adnexa (p = 0.03) and the ocular globe (p = 0.04). Ocular involvement is common in patients with Hansen's disease, reinforcing the importance of ophthalmologic examination in the evaluation and follow-up of these patients.

Development and validation of an instrument to assess the knowledge of general practitioners and pediatricians about photoprotection and solar radiation.

BACKGROUND: The knowledge of general practitioners about photoprotection is unknown. OBJECTIVES: To develop and validate an instrument to evaluate the knowledge of general practitioners and pediatricians about photoprotection, gauging the knowledge of these professionals. METHODS: The study followed the steps: (1) Literature identification and item elaboration related to the theme; (2) Content validation; (3) Apparent validation; (4) Construct validation: internal consistency analysis and discriminatory analysis; (5) Reliability analysis. In Step 4, the instrument was applied to 217 general practitioners and pediatricians who worked in the host city of the study; the scores were compared with dermatologists scores. RESULTS: The final instrument had 41 items and showed satisfactory internal consistency (Cronbach's alpha=0.780), satisfactory reproducibility and good test-retest reliability (good-to-excellent kappa statistic in more than 60% of items). The discriminatory analysis registered a mean score of 54.1 points for dermatologists and 31.1 points for generalists and pediatricians, from a total of 82 possible points, representing a statistically significant difference (p<0.001). Generalists and pediatricians demonstrated an understanding of the relationship between excessive sun exposure and skin cancer, but they revealed lack of technical information necessary for their professional practice. STUDY LIMITATIONS: The instrument evaluates only knowledge, without evaluating the conduct of the participants. CONCLUSION: The results show that the instrument has good internal consistency and good reproducibility. It could be useful in the identification of general practitioners and pediatricians knowledge gaps on the subject, for the subsequent development of training and educational strategies.

Recurrence rate of basal cell carcinoma in patients submitted to skin flaps or grafts.

BACKGROUND: Basal cell carcinoma is the most common type of skin cancer. Although the literature provides a great deal of information on the recurrences of basal cell carcinoma, studies about these indices addressing only the cases in which flaps and/or grafts have been performed for surgical reconstruction of the excision of this tumor are still lacking. OBJECTIVES: To evaluate rates of recurrence of basal cell carcinoma submitted to conventional surgery with pre-established margins and reconstruction by flaps or grafts. METHODS: A retrospective and observational study was performed through the analysis of 109 patients, who met inclusion criteria with 116 basal cell carcinomas submitted to conventional surgery and pre-established safety margins, requiring reconstruction through a graft or cutaneous flap. This work was performed the small surgeries sector of Dermatology of the Specialty Outpatient Clinic of the University Hospital of the State University of Londrina, between January 1, 2011 and December 31, 2015. The following data were collected and inserted in an Excel worksheet: name, registration number of the hospital patient, sex, age, tumor location, histopathological type of BCC, procedure performed (type of flap and/or graft), follow-up time, recurrence. RESULTS: Of the 116 procedures, there were recurrences in 3 cases (2.6%) that were located in the nasal region and related to sclerodermiform or micronodular histological types. STUDY LIMITATIONS: Retrospective nature of the study. CONCLUSION: The present study of the dermatology department of this university hospital showed a low rate of recurrence of basal cell carcinoma in cases where flaps and/or grafts were used in the surgical reconstruction.

Development and validation of an instrument to assess the knowledge of general practitioners and pediatricians about photoprotection and solar radiation

Abstract Background The knowledge of general practitioners about photoprotection is unknown. Objectives To develop and validate an instrument to evaluate the knowledge of general practitioners and pediatricians about photoprotection, gauging the knowledge of these professionals. Methods The study followed the steps: (1) Literature identification and item elaboration related to the theme; (2) Content validation; (3) Apparent validation; (4) Construct validation: internal consistency analysis and discriminatory analysis; (5) Reliability analysis. In Step 4, the instrument was applied to 217 general practitioners and pediatricians who worked in the host city of the study; the scores were compared with dermatologists scores. Results The final instrument had 41 items and showed satisfactory internal consistency (Cronbach's alpha = 0.780), satisfactory reproducibility and good test-retest reliability (good-to-excellent kappa statistic in more than 60% of items). The discriminatory analysis registered a mean score of 54.1 points for dermatologists and 31.1 points for generalists and pediatricians, from a total of 82 possible points, representing a statistically significant difference (p < 0.001). Generalists and pediatricians demonstrated an understanding of the relationship between excessive sun exposure and skin cancer, but they revealed lack of technical information necessary for their professional practice. Study limitations The instrument evaluates only knowledge, without evaluating the conduct of the participants. Conclusion The results show that the instrument has good internal consistency and good reproducibility. It could be useful in the identification of general practitioners and pediatricians knowledge gaps on the subject, for the subsequent development of training and educational strategies.

Recurrence rate of basal cell carcinoma in patients submitted to skin flaps or grafts

Abstract: Background: Basal cell carcinoma is the most common type of skin cancer. Although the literature provides a great deal of information on the recurrences of basal cell carcinoma, studies about these indices addressing only the cases in which flaps and/or grafts have been performed for surgical reconstruction of the excision of this tumor are still lacking. Objectives: To evaluate rates of recurrence of basal cell carcinoma submitted to conventional surgery with pre-established margins and reconstruction by flaps or grafts. Methods: A retrospective and observational study was performed through the analysis of 109 patients, who met inclusion criteria with 116 basal cell carcinomas submitted to conventional surgery and pre-established safety margins, requiring reconstruction through a graft or cutaneous flap. This work was performed the small surgeries sector of Dermatology of the Specialty Outpatient Clinic of the University Hospital of the State University of Londrina, between January 1, 2011 and December 31, 2015. The following data were collected and inserted in an Excel worksheet: name, registration number of the hospital patient, sex, age, tumor location, histopathological type of BCC, procedure performed (type of flap and/or graft), follow-up time, recurrence. Results: Of the 116 procedures, there were recurrences in 3 cases (2.6%) that were located in the nasal region and related to sclerodermiform or micronodular histological types. Study limitations: Retrospective nature of the study. Conclusion: The present study of the dermatology department of this university hospital showed a low rate of recurrence of basal cell carcinoma in cases where flaps and/or grafts were used in the surgical reconstruction.

Herpes simplex virus: isolation, cytopathological characterization and antiviral sensitivity.

BACKGROUND: Herpes simplex virus (HSV) infection is an endemic disease and it is estimated that 6095% of the adult population are infected with symptoms that are usually self-limiting, though they can be serious, extensive and prolonged in immunocompromised individuals, highlighted by the emergence of drug-resistant strains. The study of the wild-type HSV strains based on the cytopathogenic features and its antiviral sensitivity are important in the establishment of an antivirogram for controlling the infection. OBJECTIVE: This study sought to isolate and examine the cytopathological characteristics of circulating strains of the Herpes simplex virus, from clinical specimens and their sensitivity to commercially available antiherpesvirus drugs, acyclovir, phosphonophormic acid and trifluridine. METHODS: Herpes simplex virus isolation, cytopathological features and antiviral sensitivity assays were performed in cell culture by tissue culture infectious dose or plaque forming unit assay. RESULTS: From twenty-two clinical specimens, we isolated and adapted nine strains. Overall, the cytopathic effect was detected 24 h post-infection (p.i.) and the presence of syncytia was remarkable 48 h p.i., observed after cell staining. Out of eight isolates, four developed plaques of varying sizes. All the isolates were sensitive to acyclovir, phosphonophormic and trifluridine, with the percentage of virus inhibition (%VI) ranging from 49.7-100%. CONCLUSIONS: The methodology for HSV isolation and characterization is a straightforward approach, but the drug sensitivity test, regarded as being of great practical importance, needs to be better understood.

Herpes simplex virus: isolation, cytopathological characterization and antiviral sensitivity

BACKGROUND: Herpes simplex virus (HSV) infection is an endemic disease and it is estimated that 6095% of the adult population are infected with symptoms that are usually self-limiting, though they can be serious, extensive and prolonged in immunocompromised individuals, highlighted by the emergence of drug-resistant strains. The study of the wild-type HSV strains based on the cytopathogenic features and its antiviral sensitivity are important in the establishment of an antivirogram for controlling the infection. OBJECTIVE: This study sought to isolate and examine the cytopathological characteristics of circulating strains of the Herpes simplex virus, from clinical specimens and their sensitivity to commercially available antiherpesvirus drugs, acyclovir, phosphonophormic acid and trifluridine. METHODS: Herpes simplex virus isolation, cytopathological features and antiviral sensitivity assays were performed in cell culture by tissue culture infectious dose or plaque forming unit assay. RESULTS: From twenty-two clinical specimens, we isolated and adapted nine strains. Overall, the cytopathic effect was detected 24 h post-infection (p.i.) and the presence of syncytia was remarkable 48 h p.i., observed after cell staining. Out of eight isolates, four developed plaques of varying sizes. All the isolates were sensitive to acyclovir, phosphonophormic and trifluridine, with the percentage of virus inhibition (%VI) ranging from 49.7-100%. CONCLUSIONS: The methodology for HSV isolation and characterization is a straightforward approach, but the drug sensitivity test, regarded as being of great practical importance, needs to be better understood. .

American cutaneous leishmaniasis: epidemiological profile of patients treated in Londrina from 1998 to 2009.

BACKGROUND: American cutaneous leishmaniasis is a dermatozoonosis of compulsory notification with relevant morbidity. The disease is considered endemic in northern Paraná. OBJECTIVES: To evaluate the clinical, laboratory and epidemiological aspects of patients with American cutaneous leishmaniasis treated at Clinics Hospital, State University of Londrina, Brazil (Paraná). METHODS: This was an observational, cross-sectional, retrospective and descriptive study. The medical records of patients with American cutaneous leishmaniasis treated at the University Hospital of Londrina - Paraná, from 1998 to 2009 were evaluated. RESULTS: A total of 470 patients, with prevalence of 8.72 cases / 100,000 inhabitants, participated in the study. Most patients were male, aged 21-40 years, with a single ulcerated lesion as the most common clinical presentation, located mainly in an exposed area of the body. With regard to immunological tests, the Montenegro intradermal reaction was positive in 84.4% of cases. Treatment with pentavalent antimony was well tolerated, and patient follow-up for a year occurred in 59% of cases. CONCLUSION: American cutaneous leishmaniasis is still an endemic disease in the region, with a high potential for morbidity, but with a cure rate of around 95% after treatment. The use of immunological techniques facilitates the diagnosis of clinically suspicious cases.

American cutaneous leishmaniasis: epidemiological profile of patients treated in Londrina from 1998 to 2009 / Leishmaniose tegumentar americana: perfil epidemiologico dos pacientes atendidos no municipio de Londrina entre 1998 e 2009

BACKGROUND: American cutaneous leishmaniasis is a dermatozoonosis of compulsory notification with relevant morbidity. The disease is considered endemic in northern Paraná. OBJECTIVES: To evaluate the clinical, laboratory and epidemiological aspects of patients with American cutaneous leishmaniasis treated at Clinics Hospital, State University of Londrina, Brazil (Paraná). METHODS: This was an observational, cross-sectional, retrospective and descriptive study. The medical records of patients with American cutaneous leishmaniasis treated at the University Hospital of Londrina - Paraná, from 1998 to 2009 were evaluated. RESULTS: A total of 470 patients, with prevalence of 8.72 cases / 100,000 inhabitants, participated in the study. Most patients were male, aged 21-40 years, with a single ulcerated lesion as the most common clinical presentation, located mainly in an exposed area of the body. With regard to immunological tests, the Montenegro intradermal reaction was positive in 84.4% of cases. Treatment with pentavalent antimony was well tolerated, and patient follow-up for a year occurred in 59% of cases. CONCLUSION: American cutaneous leishmaniasis is still an endemic disease in the region, with a high potential for morbidity, but with a cure rate of around 95% after treatment. The use of immunological techniques facilitates the diagnosis of clinically suspicious cases. .

FUNDAMENTOS: Leishmaniose tegumentar americana é uma dermatozoonose de notificação compulsória com morbidade relevante, considerada endêmica no norte do Paraná. OBJETIVOS: Avaliar os aspectos clinicos, laboratoriais e epidemiológicos de pacientes com leishmaniose tegumentar americana atendidos no Hospital das Clinicas da Universidade Estadual de Londrina, Brasil (Paraná). MÉTODOS: Estudo observacional, transversal, retrospectivo com caráter descritivo. Realizada a avaliação dos prontuários médicos dos pacientes com leishmaniose tegumentar americana atendidos no Hospital Universitário de Londrina - Paraná, no período compreendido entre 1998 e 2009. RESULTADOS: Incluídos no estudo um total de 470 pacientes com uma prevalência de 8,72 casos/ 100.000 habitantes. A maior parte dos pacientes eram do sexo masculino, na faixa etária de 21 a 40 anos, com lesão única ulcerada como apresentação clínica mais comum, com localização principal em área descoberta. Dentre os testes imunológicos, a intradermoreação de Montenegro apresentou positividade em 84,4% dos casos. O tratamento com antimonial pentavalente foi bem tolerado, e o seguimento dos pacientes por um ano ocorreu em 59% dos casos. CONCLUSÃO: Leishmaniose tegumentar americana ainda é uma doença com caráter endêmico na região, com potencial mórbido elevado, porém com percentual de cura com o tratamento usual em torno de 95%. O uso de técnicas imunológicas facilita o diagnóstico de casos clinicamente duvidosos. .

Micoses superficiais na mulher / Superficial mycosis on woman

Micoses superficiais são as infecções cutâneas causadas por fungos que se limitam aos tecidos superficiais queratinizados e semiqueratinizados de pele, unhas e pelos. Englobam as ceratofitoses, dermatofitoses e candidíases. Diagnóstico e tratamento das micoses superficiais são revisados neste trabalho, com ênfase na mulher.

Lúpus eritematoso crônico: uma abordagem clínica, epidemiológica, laboratorial e terapêutica / Chronic lupus erythematosus: a clinical approach, epidemiological, laboratory and therapeutic

O lúpus eritematoso cutâneo crônico, caracterizado, sobretudo, pelo lúpus discoide, é uma entidade clínica incomum, porém de elevada prevalência em mulheres em idade fértil. A sua etiologia é desconhecida, mas fatores genéticos, autoimunes, hormonais e ambientais compõem o processo fisiopatológico da doença. Os meios diagnósticos utilizados para que se possa iniciar o tratamento específico, composto de protetores solares, corticosteroides tópicos e, se preciso, medicações sistêmicas, principalmente os antimaláricos, são o exame clínico, a imunofluorescência direta e o estudo histopatológico. Este artigo descreve de maneira sucinta os principais aspectos epidemiológicos, clínicos, diagnósticos e terapêuticos do lúpus eritematoso cutâneo crônico, conforme revisão de literatura.

Dermatite de contato por tatuagens temporárias de henna / Contact dermatitis after temporary henna tattoos

A henna é um corante natural, bastante utilizado em tatuagens temporárias, que raramente causa reações alérgicas. Porém, a adição de compostos químicos, como a parafenilenodiamina, pode desencadear reações adversas locais, como dermatite alérgica de contato, hipopigmentação ou hiperpigmentação. A população deve ser orientada quanto aos riscos a curto e a longo prazo desta prática.

Doença de Behçet e tromboembolismo múltiplo / Behçet?s disease and multiple thromboembolism

A doença de Behçet (DB) é uma vasculite sistêmica, recorrente e crônica com manifestações que incluem úlceras orogenitais, uveíte, sinovite, tromboflebite e sintomas envolvendo o sistema nervoso central, trato gastrointestinal e pulmão. Apresenta etiologia desconhecida e diagnóstico baseado em critérios clínicos. A maioria dos casos apresenta manifestações benignas, no entanto, ocasionalmente cursa com trombose de grandes vasos que podem levar ao óbito. Os autores descrevem um caso peculiar, tanto pela dificuldade diagnóstica quanto pela gravidade das manifestações vasculares, e desfecho letal.

Case for diagnosis. Inflammatory linear verrucous epidermal nevus.

Inflammatory linear verrucous epidermal nevus (Ilven) is a rare variant of epidermal verrucous nevus that commonly affects females. Clinically is characterized by the appearance, since birth, of recurrent inflammatory phenomena with chronic eczematous or psoriasiform aspects, usually unilateral, with severe pruritus, and refractory to therapy.

Caso para diagnóstico / Case for diagnosis

Nevo epidérmico verrucoso inflamatório linear (Nevil) é uma variante do nevo epidérmico verrucoso que acomete mais comumente o sexo feminino. Clinicamente, é caracterizado por fenômenos inflamatórios recorrentes, conferindo aspecto de dermatite eczematosa crônica ou psoriasiforme, frequentemente unilateral, com prurido intenso, de aparecimento desde o nascimento e de difícil tratamento.

Inflammatory linear verrucous epidermal nevus (Ilven) is a rare variant of epidermal verrucous nevus that commonly affects females. Clinically is characterized by the appearance, since birth, of recurrent inflammatory phenomena with chronic eczematous or psoriasiform aspects, usually unilateral, with severe pruritus, and refractory to therapy.

Keratoacanthoma in a tattoo.

Several malignant lesions have been reported in association with tattoos, including basal cell carcinomas, squamous cell carcinomas and melanoma. We report a keratoacanthoma arising in a recent tattoo. A 60-year-old woman presented with a tumor on her right leg, over an area of red pigment in a professional tattoo. Histological analysis confirmed the clinical diagnosis of keratoacanthoma. Although the association between malignancy and tattoos is very uncommon dermatologists and dermatologic surgeons should be attentive to this possibility.

Análise comportamental de problemas de interação social de indivíduos com psoríase / Behavioral analysis of social interaction problemas of individuals with psoriasis

Psoríase é uma doença crônica que acomete a pele de indivíduos de ambos os sexos a partir da segunda década de vida. Além do desconforto físico decorrente de sintomas como descamação e prurido, queixas referentes a dificuldades interpessoais são relatadas com frequência por pacientes que buscam atendimento médico. O indivíduo com psoríase pode apresentar dificuldades de interação social em diversos contextos pela reação negativa dos outros à aparência inestética das lesões. Por esta razão, este indivíduo tenta fugir ou esquivar-se de situações em que exista a possibilidade de exposição física, com o intuito de escapar aos olhares constantes e comentários das outras pessoas em relação à sua aparência. Quando isso não é possível, procura ocultar as lesões por meio de cosméticos (camuflagem) ou de roupas mais fechadas, mesmo em dias de clima quente. Neste artigo, os autores avaliam esse enfoque psicológico, como possíveis variáveis ambientais podem controlá-lo, alterando a probabilidade de sua ocorrência em diferentes contextos sociais (AU)

Análise comportamental de problemas de interação social de indivíduos com psoríase / Behavioral analysis of social interaction problemas of individuals with psoriasis

Psoríase é uma doença crônica que acomete a pele de indivíduos de ambos os sexos a partir da segunda década de vida. Além do desconforto físico decorrente de sintomas como descamação e prurido, queixas referentes a dificuldades interpessoais são relatadas com frequência por pacientes que buscam atendimento médico. O indivíduo com psoríase pode apresentar dificuldades de interação social em diversos contextos pela reação negativa dos outros à aparência inestética das lesões. Por esta razão, este indivíduo tenta fugir ou esquivar-se de situações em que exista a possibilidade de exposição física, com o intuito de escapar aos olhares constantes e comentários das outras pessoas em relação à sua aparência. Quando isso não é possível, procura ocultar as lesões por meio de cosméticos (camuflagem) ou de roupas mais fechadas, mesmo em dias de clima quente. Neste artigo, os autores avaliam esse enfoque psicológico, como possíveis variáveis ambientais podem controlá-lo, alterando a probabilidade de sua ocorrência em diferentes contextos sociais.