Subungual Basal Cell Carcinoma: A Rare Nail Tumor with a Challenging Diagnosis.

Subungual basal cell carcinoma (BCC) is a rare disorder associated with many factors, including contact with some topical and oral substances. A differential diagnosis and an early approach are important to minimize the functional damage of the limbs affected by this type of tumor. We report a case of subungual BCC in a 70-year-old woman that was managed by surgical excision. The patient's medical history included the previous use of arsenic. We emphasize the contribution of an early diagnosis to achieve better treatment results in this instance.

Melanoma spitzoide simulando lesão vascular - Relato de caso / Spitzoid melanoma simulating vascular lesion - Case report

O melanoma maligno é um tumor de melanócitos responsável por mais de 75% dos óbitos por câncer de pele. As variantes raras desta patologia são responsáveis por 5% dos casos e podem mimetizar outras patologias. Relatamos caso de paciente com melanoma spitzoide e discutimos os achados dermatoscópicos, histopatológicos e estudo imuno-histoquímico, assim como o seguimento desta rara variante de melanoma.

Malignant melanoma is a melanocyte tumor responsible for more than 75% of skin cancer deaths. The rare variants of this pathology are responsible for 5% of the cases and may mimic other pathologies. We report the case of a patient with spitzoid melanoma and we discuss the dermoscopic, histopathological, and immunohistochemical findings, as well as the follow-up of this rare variant of melanoma.

Fatores de crescimento e cicatrização: experiência em um serviço de Dermatologia / Growth factors and healing: experience in a Dermatology service

Introdução: A cicatrização é um fenômeno que ocorre após lesão tecidual e envolve mecanismos celulares e moleculares complexos. Os fatores de crescimento parecem ser um complemento eficaz e seguro no tratamento das feridas. Objetivo: Avaliar a cicatrização de feridas após eletrocoagulação, comparando-se o veículo isolado à sua associação com o fator de crescimento epidérmico. Métodos: Ensaio clínico duplo-cego em Serviço de Dermatologia entre 2016 e 2018. Incluídos pacientes de ambos os sexos, acima de 18 anos, submetidos à eletrocoagulação de duas lesões e posterior aplicação de veículo (cold cream) em uma e fator de crescimento epidermico em cold cream na outra. Avaliações com sete, 14 e 28 dias, analisaram: eritema, edema, crosta, secreção e cicatrização. Utilizou-se o teste binomial para duas proporções e o teste exato de Fisher para dados dicotômicos. Resultados: Em relação a eritema, edema, crosta e secreção foram encontrados resultados variáveis, ora favorecendo o veículo, ora o fator de crescimento, porém sem significância estatística. Quanto à cicatrização, a epitelização mostrou-se mais rápida com fator de crescimento epidermico (p<0,05). Conclusões: Os resultados deste estudo, que avaliou o impacto do fator de crescimento epidérmico no processo de cicatrização, corroboram os dados da escassa literatura atual e servem de base para estudos futuros.

Introduction: Healing is a phenomenon that occurs after tissue injury and involves complex cellular and molecular mechanisms. Growth factors seem to be an effective and safe complement for the treatment of wounds. Objective: To evaluate wound healing after electrocoagulation, comparing the vehicle in isolation and its association with epidermal growth factor. Methods: Double-blind clinical trial in a Dermatology service between 2016 and 2018. Patients of both genders, older than 18 years of age, submitted to electrocoagulation of two lesions and subsequent application of the vehicle (cold cream) on one and epidermal growth factor in cold cream on the other were included. Evaluations after 7, 14 and 28 days, analysed erythema, edema, crusting, discharge and healing. Analyzed: edema, edema, crusting, discharge and healing. The binomial test was used for two ratios and Fisher's exact test was used for dichotomic data. Results: Variable results were found regarding erythema, edema, crusting and discharge, sometimes favoring the vehicle, sometimes the growth factor, however with no statistical significance. Regarding healing, epithelialization was quicker with epidermal growth factor (p<0.05). Conclusions: This study evaluated the impact of epidermal growth factor in the healing process, and its results reinforce scarce data of the current literature and are a foundation for future studies.

Carcinoma basocelular, siringocistoadenoma papilífero, adenoma apócrino e triquilemoma sobre nevo sebáceo de Jadassohn / Basal cell carcinoma, papillary syringocystadenoma, apocrine adenoma and trichilemmoma on nevus sebaceous of Jadassohn

Descrito por Jadassohn e também conhecido como nevo organoide, o nevo sebáceo é considerado hamartoma que exibe má-formação folicular, sebácea, écrina e apócrina de graus variados. Durante a idade adulta, de dez a 30% dos pacientes com nevo sebáceo de Jadassohn têm risco de desenvolver neoplasia cutânea ou anexial. Relatamos caso de paciente com nevo sebáceo de Jadassohn associado a múltiplas neoplasias (benignas e malignas) de diferentes linhagens e ressaltamos a importância do conhecimento dessa entidade e do exame do couro cabeludo por parte do dermatologista.

Described by Jadassohn and also known as organoid nevus, nevus sebaceous is considered a hamartoma that exhibits follicular, sebaceous, eccrine and apocrine malformations of varying degrees. Between 10% and 30% of patients with sebaceous nevi of Jadassohn are at risk of developing cutaneous or adnexal neoplasia during adulthood. The authors describe the case of a patient with nevus sebaceous of Jadassohn associated with multiple tumors (benign and malignant) of different strains, highlighting the importance of the dermatologist physician's knowing this entity and how to perform an examination of the scalp.

Coexistência de psoríase e comorbidades relacionadas à síndrome metabólica / Coexistence of psoriasis with metabolic syndrome-related comorbidities

OBJETIVOS: Avaliar a coexistência da psoríase e comorbidades relacionadas à síndrome metabólica, e identificar a associação de características dessa dermatose (gravidade, forma clínica e tipo de tratamento) com essas comorbidades. MÉTODOS: Trata-se de um estudo transversal e descritivo de base hospitalar, envolvendo indivíduos com psoríase em acompanhamento em um ambulatório de referência, de 2014 a 2015, sem restrições para seleção dos mesmos. A análise dos dados, obtidos por meio de questionário, avaliação clínica e exames complementares, foi inicialmente descritiva e, posteriormente, por regressão logística univariada. RESULTADOS: Foram incluídos 59 indivíduos. Destes, 55,9% apresentaram obesidade abdominal, 72,9% hipertensão arterial e 62,7% redução da HDL-c. A presença de psoríase de maior gravidade (Índice de Gravidade da Psoríase por Área − PASI>10) indicou maior chance para a ocorrência de hipertensão arterial, elevação da glicemia e de triglicerídeos; pacientes com forma clínica não vulgar apresentaram maior chance para todas as comorbidades, exceto para elevação de triglicerídeos, e pacientes em uso de medicação sistêmica apresentaram maior chance para ocorrência de obesidade abdominal, elevação da glicemia e de triglicerídeos. CONCLUSÕES: Psoríase e comorbidades relacionadas à síndrome metabólica coexistiram. Possivelmente, as formas clínicas não vulgar, a psoríase grave e o tratamento sistêmico com essas comorbidades estão associadas

OBJECTIVE: To evaluate the coexistence of psoriasis with metabolic syndrome-related comorbidities, and to identify the association of this dermatosis features (severity, clinical presentation and type of treatment) with these comorbidities. METHODS: This is a hospital based, cross-sectional and descriptive study involving individuals with psoriasis attended in a reference outpatient clinic, from 2014 to 2015, with no selection restrictions. Data were obtained through a questionnaire, clinical evaluation and laboratory tests; data analysis was first descriptive and, subsequently, by univariate logistic regression. RESULTS: Fifty-nine subjects were included. Among these, 55.9% had abdominal obesity, 72.9% had arterial hypertension, and 62.7% had decrease in HDL cholesterol. The presence of more severe psoriasis (Psoriasis Area Severity Index - PASI>10) indicated increased odds for the occurrence of arterial hypertension, high blood glucose and triglycerides levels; patients with clinical presentations other than psoriasis vulgaris had increased odds to all comorbidities, except for high triglycerides levels, and patients using systemic medications had increased odds to abdominal obesity, high blood glucose and triglycerides levels. CONCLUSIONS: There was coexistence of psoriasis with metabolic syndrome-related comorbidities. There is possible association of clinical presentations other than psoriasis vulgaris, severe psoriasis and systemic treatment with these comorbidities.

Enxerto por raspagem epidérmica no vitiligo estável: uma opção terapêutica / Grafting by epidermal scraping in stable vitiligo: a therapeutic option

O vitiligo é despigmentação adquirida caracterizada pela perda parcial ou total dos melanócitos da epiderme. Inúmeras modalidades terapêuticas foram propostas para seu tratamento. Nos casos de vitiligo estável os tratamentos cirúrgicos são a preferência. O enxerto por raspagem epidérmica é uma variante da técnica de microenxertos por punch. Constitui técnica nova, simples e de baixo custo, com altas taxas de repigmentação. O objetivo deste relato é demonstrar a experiência dos autores com essa técnica e discutir os resultados obtidos numa série inicial de dois casos (três lesões).

Vitiligo is an acquired depigmentation characterized by partial or total loss of epidermal melanocytes. Many therapeutic modalities have been proposed for its treatment. In cases of stable vitiligo surgical treatments are preferred. Grafting by epidermal scraping is a variant of micrografts by punch technique. It is a new, simple and low cost technique, with high rates of repigmentation. The objective of this report is to demonstrate the authors' experience with this technique and discuss the results in an initial series of two cases (three lesions).

Erythema elevatum diutinum and hypothyroidism: coincidence or causal relationship?

Erythema elevatum diutinum is a rare chronic leukocytoclastic vasculitis of unknown etiology. It is believed to be due to deposition of immune complexes in the vessels. Clinically it is manifested as erythematous violaceous papules and nodules, isolated or confluent with hardened consistency, symmetrical, usually located on the extensor surface of the extremities, particularly over the joints. Diagnosis is based on clinical and histological findings. We report the case of a woman, 71 years old, with erythematous violaceous nodules on the hands, elbows, back and legs, beginning two years ago, with pain and itching. Histopathological analysis revealed leukocytoclastic vasculitis, confirming the clinical suspicion. Laboratory tests revealed hypothyroidism. We report the case because of its rarity, with subsequent review of the literature.

Drug-induced lupus with leukocytoclastic vasculitis: a rare expression associated with adalimumab.

TNF alpha antagonist-induced lupus-like syndrome is a rare condition which predominantly affects women (4:1). The average age of onset is 46-51 years. It occurs after exposure to TNF alpha antagonist and disappears after discontinuation of such agents. The pathogenic mechanism for development of the TNF alpha antagonist-induced lupus-like syndrome is not fully defined. It is believed that the medication induces apoptosis, leading to an accumulation of nucleosomal antigens of apoptotic cells. This would cause autoantibodies to be produced by susceptible individuals. The most common cutaneous manifestations include maculopapular exanthem, malar rash, alopecia, photosensitivity and, more rarely, vasculitis. Extracutaneous manifestations include: fever, weight loss, arthritis or arthralgia, myositis and hematological abnormalities. Antinuclear antibody may be positive in 80% of cases and anti-histone antibody is considered a disease marker for TNF alpha antagonist-induced lupus-like syndrome. Treatment corresponds to drug discontinuation. We report a rare case of sub-acute cutaneous lupus erythematosus with leukocytoclastic vasculitis induced by adalimumab in a 42-year-old patient.

Erythema elevatum diutinum and hypothyroidism: coincidence or causal relationship?

AbstractErythema elevatum diutinum is a rare chronic leukocytoclastic vasculitis of unknown etiology. It is believed to be due to deposition of immune complexes in the vessels. Clinically it is manifested as erythematous violaceous papules and nodules, isolated or confluent with hardened consistency, symmetrical, usually located on the extensor surface of the extremities, particularly over the joints. Diagnosis is based on clinical and histological findings. We report the case of a woman, 71 years old, with erythematous violaceous nodules on the hands, elbows, back and legs, beginning two years ago, with pain and itching. Histopathological analysis revealed leukocytoclastic vasculitis, confirming the clinical suspicion. Laboratory tests revealed hypothyroidism. We report the case because of its rarity, with subsequent review of the literature.

Drug-induced lupus with leukocytoclastic vasculitis: a rare expression associated with adalimumab

TNF alpha antagonist-induced lupus-like syndrome is a rare condition which predominantly affects women (4:1). The average age of onset is 46-51 years. It occurs after exposure to TNF alpha antagonist and disappears after discontinuation of such agents. The pathogenic mechanism for development of the TNF alpha antagonist-induced lupus-like syndrome is not fully defined. It is believed that the medication induces apoptosis, leading to an accumulation of nucleosomal antigens of apoptotic cells. This would cause autoantibodies to be produced by susceptible individuals. The most common cutaneous manifestations include maculopapular exanthem, malar rash, alopecia, photosensitivity and, more rarely, vasculitis. Extracutaneous manifestations include: fever, weight loss, arthritis or arthralgia, myositis and hematological abnormalities. Antinuclear antibody may be positive in 80% of cases and anti-histone antibody is considered a disease marker for TNF alpha antagonist-induced lupus-like syndrome. Treatment corresponds to drug discontinuation. We report a rare case of sub-acute cutaneous lupus erythematosus with leukocytoclastic vasculitis induced by adalimumab in a 42-year-old patient.

Acral pseudolymphomatous angiokeratoma: case report and literature review.

The authors describe a case of a female patient with Acral Pseudolymphomatous Angiokeratoma of Children, known as APACHE. It is a rare benign cutaneous disease, of unknown etiology, characterized by multiple, asymptomatic erythematous-violaceous papules and nodules, usually located unilaterally with acral distribution. Today, this denomination is questionable, since there are published reports of this disease in adults and in different locations. Clinically, it is similar to an angiokeratoma, whereas hystologically, it corresponds to a distinct type of pseudolymphoma. The immunohistochemical study is required to distinguish APACHE from cutaneous lymphoma.

Acral pseudolymphomatous angiokeratoma: case report and literature review / Angioqueratoma pseudolinfomatoso acral: relato de caso e revisao da literatura

The authors describe a case of a female patient with Acral Pseudolymphomatous Angiokeratoma of Children, known as APACHE. It is a rare benign cutaneous disease, of unknown etiology, characterized by multiple, asymptomatic erythematous-violaceous papules and nodules, usually located unilaterally with acral distribution. Today, this denomination is questionable, since there are published reports of this disease in adults and in different locations. Clinically, it is similar to an angiokeratoma, whereas hystologically, it corresponds to a distinct type of pseudolymphoma. The immunohistochemical study is required to distinguish APACHE from cutaneous lymphoma.

Relata-se o caso de uma paciente com diagnóstico de angioqueratoma pseudolinfomatoso acral, conhecido por sua sigla em inglês APACHE - Acral Pseudolymphomatous Angiokeratoma of Children. É uma doença cutânea benigna, rara, de etiologia desconhecida, caracterizada por múltiplas pápulas e nódulos eritêmato-violáceos assintomáticos, de localização geralmente unilateral e acral. Atualmente, questiona-se esta denominação, já que há relatos na literatura do quadro em adultos e em outras localizações. Clinicamente, é similar a um angioqueratoma, porém, histologicamente, corresponde a um tipo distinto de pseudolinfoma. O estudo imuno-histoquímico é necessário para diferenciação dos linfomas cutâneos.

Involucrin in the differential diagnosis between linear psoriasis and inflammatory linear verrucous epidermal nevus: a report of one case.

Inflammatory linear verrucous epidermal nevus is a variant of verrucous epidermal nevus, characterized by recurrent inflammatory phenomena. Despite well-established clinical manifestations, the differential diagnosis between inflammatory linear verrucous epidermal nevus and linear psoriasis remains difficult. Clinical history, physical examination and histopathology analysis may not be sufficient to confirm the diagnosis. We report the case of a 4-year-old girl in which the involucrin immunostaining was helpful in the diagnosis of inflammatory linear verrucous epidermal nevus. Our findings confirm that involucrin immunohistochemistry is a useful tool in such cases.

Involucrin in the differential diagnosis between linear psoriasis and inflammatory linear verrucous epidermal nevus: a report of one case / Involucrina na diagnose diferencial entre a psoriase linear e o nevo epidermico verrucoso inflamatorio linear: relato de um caso

Inflammatory linear verrucous epidermal nevus is a variant of verrucous epidermal nevus, characterized by recurrent inflammatory phenomena. Despite well-established clinical manifestations, the differential diagnosis between inflammatory linear verrucous epidermal nevus and linear psoriasis remains difficult. Clinical history, physical examination and histopathology analysis may not be sufficient to confirm the diagnosis. We report the case of a 4-year-old girl in which the involucrin immunostaining was helpful in the diagnosis of inflammatory linear verrucous epidermal nevus. Our findings confirm that involucrin immunohistochemistry is a useful tool in such cases.

O nevo epidérmico verrucoso inflamatório linear é uma variante do nevo epidérmico verrucoso caracterizada por fenômenos inflamatórios recorrentes. A despeito das manifestações clínicas bem estabelecidas o diagnóstico diferencial entre nevo epidérmico verrucoso inflamatório linear e psoríase linear permanece difícil. A história clínica, o exame físico e análise histopatológica podem não ser suficientes para a confirmação diagnóstica. Nós relatamos o caso de uma menina de 4 anos de idade no qual o uso da involucrina foi útil para o diagnóstico do nevo epidérmico verrucoso inflamatório linear . Nossos achados corroboram a imunohistoquímica com a involucrina como uma ferramenta importante nestes casos.