Flushing episodes in the context of frontal fibrosing alopecia with facial papules.

Frontal fibrosing alopecia (FFA) is a progressive frontotemporal hairline recession with eyebrow loss. Facial papules are present in up to 14% of FFA cases and can start with facial flushes. Nevertheless, these flushes are commonly associated with rosacea, a much more prevalent disease. In this case, a woman with FFA had, at first, clinical and histopathological findings of rosacea and was treated with ivermectin 1% cream with no improvement. She returned reporting new papules in the frontal region, reaching the frontotemporal hairline. Trichoscopy of the scalp showed mild perifollicular erythema and follicular scale. The new skin biopsy was compatible with FFA, and oral finasteride (5 mg/day) and hydroxychloroquine were introduced to stabilise the disease.

Sebaceoma on the scalp simulating a malignant pigmented neoplasia.

The correct identification of pigmented nodular lesions of the scalp is often challenging. Despite the importance of clinical patterns and dermoscopy, important adjuvant tools that are usually helpful, their interpretation sometimes is not clear-cut. Here, the authors discuss a case of sebaceoma mimicking a malignant pigmented neoplasia, with conclusive histopathology.

Sebaceoma on the scalp simulating a malignant pigmented neoplasia

Abstract The correct identification of pigmented nodular lesions of the scalp is often challenging. Despite the importance of clinical patterns and dermoscopy, important adjuvant tools that are usually helpful, their interpretation sometimes is not clear-cut. Here, the authors discuss a case of sebaceoma mimicking a malignant pigmented neoplasia, with conclusive histopathology.

Profile of dermatological consultations in Brazil (2018)

Abstract: Background: Dermatological diseases are among the primary causes of the demand for basic health care. Studies on the frequency of dermatoses are important for the proper management of health planning. Objectives: To evaluate the nosological and behavioral profiles of dermatological consultations in Brazil. Methods: The Brazilian Society of Dermatology invited all of its members to complete an online form on patients who sought consultations from March 21-26, 2018. The form contained questions about patient demographics, consultation type according to the patient's funding, the municipality of the consultation, diagnosis, treatments and procedures. Diagnostic and therapeutic decisions were compared between subgroups. Results: Data from 9629 visits were recorded. The most frequent causes for consultation were acne (8.0%), photoaging (7.7%), nonmelanoma skin cancer (5.4%), and actinic keratosis (4.7%). The identified diseases had distinct patterns with regard to gender, skin color, geographic region, type of funding for the consultation, and age group. Concerning the medical conducts, photoprotection was indicated in 44% of consultations, surgical diagnostic procedures were performed in 7.3%, surgical therapeutic procedures were conducted in 19.2%, and cosmetic procedures were performed in 7.1%. Study limitations: Nonrandomized survey, with a sample period of one week. Conclusion: This research allowed us to identify the epidemiological profiles of the demands of outpatients for dermatologists in various contexts. The results also highlight the importance of aesthetic demands in privately funded consultations and the significance of diseases such as acne, nonmelanoma skin cancer, leprosy, and psoriasis to public health.

Profile of dermatological consultations in Brazil (2018).

BACKGROUND: Dermatological diseases are among the primary causes of the demand for basic health care. Studies on the frequency of dermatoses are important for the proper management of health planning. OBJECTIVES: To evaluate the nosological and behavioral profiles of dermatological consultations in Brazil. METHODS: The Brazilian Society of Dermatology invited all of its members to complete an online form on patients who sought consultations from March 21-26, 2018. The form contained questions about patient demographics, consultation type according to the patient's funding, the municipality of the consultation, diagnosis, treatments and procedures. Diagnostic and therapeutic decisions were compared between subgroups. RESULTS: Data from 9629 visits were recorded. The most frequent causes for consultation were acne (8.0%), photoaging (7.7%), nonmelanoma skin cancer (5.4%), and actinic keratosis (4.7%). The identified diseases had distinct patterns with regard to gender, skin color, geographic region, type of funding for the consultation, and age group. Concerning the medical conducts, photoprotection was indicated in 44% of consultations, surgical diagnostic procedures were performed in 7.3%, surgical therapeutic procedures were conducted in 19.2%, and cosmetic procedures were performed in 7.1%. STUDY LIMITATIONS: Nonrandomized survey, with a sample period of one week. CONCLUSION: This research allowed us to identify the epidemiological profiles of the demands of outpatients for dermatologists in various contexts. The results also highlight the importance of aesthetic demands in privately funded consultations and the significance of diseases such as acne, nonmelanoma skin cancer, leprosy, and psoriasis to public health.

Demographics and spatial distribution of the Brazilian dermatologists.

The medical-dermatological demographics favors health planning and guides expansion of the specialty. We conducted an ecological study of dermatologists members of the Brazilian Society of Dermatology (SBD). We evaluated: gender, age, address; which were compared with population and human development index indicators of municipalities. We evaluated 8384 members, distributed in 527 (9.5%) municipalities throughout Brazil. The female sex represented 78.4% of the members and the median age was 43 (36-54) years. The median density of dermatologists was 0.35 (0.21-0.37) per 10,000 inhabitants. The correlation (Spearman's rho) between density of dermatologists and human development index was 0.39 (p <0.01). The Brazilian dermatologist is characterized as: female, age <50 years and presenting an heterogeneous distribution throught the country.

Demographics and spatial distribution of the Brazilian dermatologists

Abstract: The medical-dermatological demographics favors health planning and guides expansion of the specialty. We conducted an ecological study of dermatologists members of the Brazilian Society of Dermatology (SBD). We evaluated: gender, age, address; which were compared with population and human development index indicators of municipalities. We evaluated 8384 members, distributed in 527 (9.5%) municipalities throughout Brazil. The female sex represented 78.4% of the members and the median age was 43 (36-54) years. The median density of dermatologists was 0.35 (0.21-0.37) per 10,000 inhabitants. The correlation (Spearman's rho) between density of dermatologists and human development index was 0.39 (p <0.01). The Brazilian dermatologist is characterized as: female, age <50 years and presenting an heterogeneous distribution throught the country.

Melanoma associated with congenital intermediate common blue nevus of the scalp - Case report.

Melanomas can arise either de novo (70%) or from pre-existing melanocytic lesions (30%). Of the latter, most cases arise at the dermoepidermal junction from small congenital or acquired non-blue nevi while only a few arise from blue nevi, notably the cellular subtype and less commonly the common (dendritic) type. Melanomas that arise from blue nevi usually occur on the scalp with greater frequency, as in the case described. Although previous studies have discussed melanoma arising from giant congenital blue nevi, few have discussed those arising from intermediate blue nevi. We present a case of a 52-yearold man with melanoma on the scalp evolving from an intermediate congenital common blue nevus.

Melanoma associated with congenital intermediate common blue nevus of the scalp - Case report

Abstract: Melanomas can arise either de novo (70%) or from pre-existing melanocytic lesions (30%). Of the latter, most cases arise at the dermoepidermal junction from small congenital or acquired non-blue nevi while only a few arise from blue nevi, notably the cellular subtype and less commonly the common (dendritic) type. Melanomas that arise from blue nevi usually occur on the scalp with greater frequency, as in the case described. Although previous studies have discussed melanoma arising from giant congenital blue nevi, few have discussed those arising from intermediate blue nevi. We present a case of a 52-yearold man with melanoma on the scalp evolving from an intermediate congenital common blue nevus.

Invasive aspergillosis in a user of inhaled cocaine: rhinosinusitis with bone and cartilage destruction.

Aspergillosis is an infection caused by saprophytic fungi of the genus Aspergillus, which typically occurs in immunosuppressed individuals, but has also been reported in immunocompetent patients. The main routes of entry are the respiratory tract, skin, cornea, and ear, and the infection may be localized or disseminated by contiguity or vascular invasion. We report a severe case of rhinosinusitis with cutaneous involvement, caused by invasive aspergillosis, in an immunocompetent user of inhaled cocaine. Invasive aspergillosis related to cocaine abuse has not yet been reported in the literature. After itraconazole treatment and surgical debridement, complete clinical remission was achieved. Nasal reconstruction with a skin graft over a silicone prosthesis resulted in a satisfactory esthetic outcome.

Invasive aspergillosis in a user of inhaled cocaine: rhinosinusitis with bone and cartilage destruction

Aspergillosis is an infection caused by saprophytic fungi of the genus Aspergillus, which typically occurs in immunosuppressed individuals, but has also been reported in immunocompetent patients. The main routes of entry are the respiratory tract, skin, cornea, and ear, and the infection may be localized or disseminated by contiguity or vascular invasion. We report a severe case of rhinosinusitis with cutaneous involvement, caused by invasive aspergillosis, in an immunocompetent user of inhaled cocaine. Invasive aspergillosis related to cocaine abuse has not yet been reported in the literature. After itraconazole treatment and surgical debridement, complete clinical remission was achieved. Nasal reconstruction with a skin graft over a silicone prosthesis resulted in a satisfactory esthetic outcome.

Ectopic cutaneous Schistosomiasis.

The authors report a case of ectopic cutaneous schistosomiasis in a 35 year-old female who presented clustered reddish macules and papules on the left buttock. The diagnosis was not suspected during clinical evaluation and required visualization of Schistosoma mansoni eggs on sections of tissue.

Ectopic cutaneous Schistosomiasis / Esquistossomose cutanea ectopica

The authors report a case of ectopic cutaneous schistosomiasis in a 35 year-old female who presented clustered reddish macules and papules on the left buttock. The diagnosis was not suspected during clinical evaluation and required visualization of Schistosoma mansoni eggs on sections of tissue.

Os autores relatam um caso de esquistossomose cutânea ectópica em uma paciente de 35 anos que apresentou máculas e pápulas eritematosas agrupadas na nádega esquerda. O diagnostico não foi suspeitado durante a avaliação clínica, tendo sido obtido através da visualização dos ovos no exame histopatológico.

Linear IgA dermatosis associated with ulcerative colitis: complete and sustained remission after total colectomy.

Linear IgA dermatosis has been increasingly associated with inflammatory bowel diseases, particularly ulcerative colitis. A 13-year-old male patient with an 11-month history of ulcerative colitis developed vesicles, pustules and erosions on the skin of the face, trunk and buttocks and in the oral mucosa. The work-up revealed a neutrophil-rich sub-epidermal bullous disease and linear deposition of IgA along the dermoepidermal junction, establishing the diagnosis of linear IgA dermatosis. The patient experienced unsatisfactory partial control of skin and intestinal symptoms despite the use of adalimumab, mesalazine, prednisone and dapsone for some months. After total colectomy, he presented complete remission of skin lesions, with no need of medications during two years of follow-up. A review of previously reported cases of the association is provided here and the role of ulcerative colitis in triggering linear IgA dermatosis is discussed.

Linear IgA dermatosis associated with ulcerative colitis: complete and sustained remission after total colectomy / Dermatose bolhosa por IgA linear associada a retocolite ulcerativa: remissao completa e sustentada apos colectomia total

Linear IgA dermatosis has been increasingly associated with inflammatory bowel diseases, particularly ulcerative colitis. A 13-year-old male patient with an 11-month history of ulcerative colitis developed vesicles, pustules and erosions on the skin of the face, trunk and buttocks and in the oral mucosa. The work-up revealed a neutrophil-rich sub-epidermal bullous disease and linear deposition of IgA along the dermoepidermal junction, establishing the diagnosis of linear IgA dermatosis. The patient experienced unsatisfactory partial control of skin and intestinal symptoms despite the use of adalimumab, mesalazine, prednisone and dapsone for some months. After total colectomy, he presented complete remission of skin lesions, with no need of medications during two years of follow-up. A review of previously reported cases of the association is provided here and the role of ulcerative colitis in triggering linear IgA dermatosis is discussed.

A dermatose bolhosa por IgA linear tem sido crescentemente associada com doenças inflamatórias intestinais, especialmente a retocolite ulcerativa. Relatamos o caso de um adolescente masculino, 13 anos de idade, com retocolite ulcerativa diagnosticada 11 meses antes, que desenvolveu vesículas, pústulas e erosões na pele da face, do tronco e das nádegas e na mucosa oral. A investigação revelou doença bolhosa subepidérmica rica em neutrófilos e deposição linear de IgA ao longo da junção dermoepidérmica, estabelecendo o diagnóstico de dermatose bolhosa por IgA linear. O paciente experimentou controle insatisfatório dos sintomas cutâneos e gastrointestinais apesar do uso de adalimumab, mesalazina, prednisona e dapsona por alguns meses. Após colectomia total, ele apresentou remissão completa das lesões cutâneas, sem necessidade de medicações durante os dois anos de seguimento. Neste artigo, revisamos os casos previamente relatados desta associação e debatemos o papel da retocolite ulcerativa no desencadeamento da dermatose bolhosa por IgA linear.

Pigmented poroma with unusual location and dermatoscopic features.

Poroma is a benign adnexal neoplasm with atn "poroid"/ductal differentiation that mimics benign and malignant skin tumors. Histopathology shows circumscribed proliferation of poroid cells intermingled with a variable number of cuticular cells. We report a case of pigmented poroma located on the face that simulated clinically and dermatoscopically a pigmented basal cell carcinoma. The features of pigmented and non-pigmented poromas were revisited in order to assist in the diagnosis.

Langerhans cell histiocytosis - a case report.

A 17-year-old male presented for dermatologic consultation with slightly elevated reddish papules covered by yellowish scales in the scalp for the last two years and reddish and indurated ulcers in the perineum lasting six months. Additional complaints included polyuria, polydipsia, delay in the development of secondary sexual characteristics and hearing loss of the right ear secondary to a medium otitis. Lesions from scalp and perineum were sampled for histopathologic examination and revealed a dense cellular infiltrate made up of mononuclear cells with conspicuous eosinophilic cytoplasm and large cleaved vesicular nucleus, some of them with shapes resembling the format of a kidney and others reminiscent of coffee beans. Numerous intermingling eosinophils were present. The diagnosis of Langerhans cell histiocytosis was then rendered and confirmed by positive immunostaining of neo-plastic cells for anti-CD1a and anti-S100 protein antibodies. The work-up revealed diabetes insipidus, hypogonadotropic hypogonadism, hiperprolactenemia, growing-hormone deficiency and thickness of the pituitary stalk. The patient was treated with prednisone and vinblastin based chemotherapy regimen for six months with complete remission, but presented recurrence of some lesions in the scalp, which were handled with topical mustard and corticosteroids. After chemotherapy, the endocrinologic disturbances were corrected with hormonal replacement therapy. The patient is currently in good health with a follow-up of five years.

Epidermolysis bullosa nevus: case report and literature review.

Acquired melanocytic lesions resembling malignant melanoma have been described in all major categories of Epidermolysis bullosa and referred to as "Epidermolysis bullosa nevi''. They easily induce to diagnostic error, although no malignant transformation has been reported. We report the development of a large acquired melanocytic nevus at a site of recurrent blisters in a 5-year-old child with Epidermolysis bullosa simplex. The global dermoscopic pattern was suggestive of benignity, and the histopathological findings were compatible with a compound melanocytic nevus. This is the first published case of Epidermolysis bullosa nevi in Brazilian literature. Despite their benign behavior, we emphasize the importance of regular clinical and dermoscopic monitoring, since a malignant course still cannot be totally excluded.

Congenital self healing reticulohistiocytosis in a newborn (Hashimoto Pritzker).

Congenital self-healing reticulohistiocytosis is the benign spectrum of Langerhans Cell Histiocytosis, characterized by cutaneous lesions at birth or in the neonatal period, absence of systemic manifestations and spontaneous resolution of clinical status. Despite the benign and often self-resolving course in most patients, studies show that in some cases there may be metastasis or recurrence of the disease, emphasizing that the clinical course is variable, requiring long-term follow-up. The monitoring of the patient for a long period is important to detect possible systemic involvement, as there is a report of recurrence involving the skin, mucosa, bone and pituitary gland.

Nevo da epidermólise bolhosa: caso clínico e revisão da literatura / Epidermolysis bullosa nevus: case report and literature review

Lesões melanocíticas adquiridas assemelhando-se à melanoma têm sido descritas nos principais grupos da Epidermólise bolhosa, e referidas como "Nevos da Epidermólise bolhosa''. Induzem facilmente ao erro diagnóstico, apesar de nenhuma transformação maligna ter sido descrita. Relatamos o desenvolvimento de um nevo melanocítico adquirido grande no local de bolhas recorrentes em uma criança de 5 anos portadora de Epidermólise bolhosa simples. O padrão dermatoscópico global foi sugestivo de benignidade, e os achados histopatológicos foram compatíveis com um nevo melanocítico composto. Este é o primeiro caso de um Nevo da Epidermólise bolhosa publicado na literatura brasileira.

Acquired melanocytic lesions resembling malignant melanoma have been described in all major categories of Epidermolysis bullosa and referred to as "Epidermolysis bullosa nevi''. They easily induce to diagnostic error, although no malignant transformation has been reported. We report the development of a large acquired melanocytic nevus at a site of recurrent blisters in a 5-year-old child with Epidermolysis bullosa simplex. The global dermoscopic pattern was suggestive of benignity, and the histopathological findings were compatible with a compound melanocytic nevus. This is the first published case of Epidermolysis bullosa nevi in Brazilian literature. Despite their benign behavior, we emphasize the importance of regular clinical and dermoscopic monitoring, since a malignant course still cannot be totally excluded.