Importancia de la apropiada selección de aditamentos protésicos sobre implantes para conservar el estado de salud gingival: reporte de caso / Importance of the appropriate selection of prosthetic attachments on implants to preserve the state of gingival health: case report

Introducción: La rehabilitación oral en pacientes edéntulos parciales que requieren implantes dentales ha incrementado su demanda en los últimos años, convirtiéndose en un tratamiento de rutina, donde procedimientos quirúrgicos y protésicos tienen un éxito considerable. En algunos casos estas complicaciones se resuelven de forma simple, en otros, se necesita de una mejor planificación. Objetivo: Modificar y complementar el plan de tratamiento del paciente como solución definitiva al posicionamiento equivocado de los implantes dentales oseo integrados. Presentación del Caso: Paciente de 64 años, hombre, asistió a Centro de Atención Odontológica de la Universidad de Las Américas (CAO/UDLA), para terminar tratamiento odontológico de especialidad, rehabilitación de cuatro implantes colocados en zona 1.6 (Mis: C1 4.20 x 13mm); 1.4 (Mis: C1 3.75x11.50 mm); 1.2 (Mis: C1 3.75 x 11.50 mm); 2.1 (Mis: C1 4.20 x 11.50 mm), a examen clínico se pudo observar prótesis acrílica transicional inmediata desadaptada e inestable oclusalmente como resultado de proceso de cicatrización de tejidos, pérdida de piezas dentales postero-inferiores (3.6; 3.7; 4.6 y 4.7).La angulación equivocada de los implantes anteriores obligó la necesidad de corregirla mediante el uso de aditamentos rotacionales Multi-unit rectos de 2 mm altura en implantes 1.6; 1.4, aditamentos anti rotacionales tipo Multi-unit angulados de 1 mm de altura a 30º para los implantes 1.2 y 2.1 con healingcaps para proteger el aditamento de la acumulación de placa bacteriana y facilitar la higienización e inserción de la prótesis múltiple. Conclusiones: Los aditamentos colocados modificaron y complementaron la rehabilitación de los implantes incluso en la zona anterior donde se encontró tejido mucoso insuficiente que cubra de forma completa el aditamento elegido. (AU)

Introduction: Oral rehabilitation in partial edentulous patients who require dental implants has increased its demand in recent years, becoming a routine treatment, where surgical and prosthetic procedures have considerable success In some cases these complications are resolved simply, in others. Aims: Better planning is needed modify and complement the patient’s treatment plan as a definitive solution to the wrong positioning of osseointegrated dental implants. Presentation of the Case: Patient of 64 years, man, attended the Dental Care Center of the University of the Americas (CAO / UDLA), to finish specialty dental treatment, rehabilitation of four implants placed in zone 1.6 (Mis: C1 4.20 x 13mm); 1.4 (Mis: C1 3.75x11.50 mm); 1.2 (Mis: C1 3.75 x 11.50 mm); 2.1 (Mis: C1 4.20 x 11.50 mm), On clinical examination, immediate transitional acrylic prosthesis could be observed maladapted and occlusally unstable as a result of tissue healing process, loss of postero-inferior teeth (3.6; 3.7; 4.6 and 4.7). The wrong angulation of the previous implants forced the need to correct it through the use of 2 mm high straight Multi-unit rotational attachments in implants 1.6; 1.4, angled Multi-unit anti-rotational attachments from 1 mm high to 30 mm for implants 1.2 and 2.1 with healing caps to protect the attachment from the accumulation of bacterial plaque and facilitate the sanitization and insertion of the multiple prosthesis. Conclusions: The attachments placed modified and complemented the rehabilitation of the implants even in the anterior area where insufficient mucous tissue was found to completely cover the chosen attachment. (AU)

Oral lesions after infection by SARS CoV 2: two case reports / Lesiones bucales posteriores a infección por SARS CoV 2 presentación de dos casos

Introduction: The SARS CoV 2 infection has resulted in several health, economic, and social crises in all areas. The disease shows a substantial biological diversity in humans causing a series of sequels in the trans- or post-infection period in the entire organism. Case Report: The manifestations that occur in the oral cavity and pharynx have not been evaluated. In this study, two clinical cases are reported. The first patient, a 67-year-old male, presents erosive lesions on the dorsal surface of his tongue after SARS CoV 2 infection. Results: Therapy consisting of reinforcing oral cleaning, use of antifungal solutions, mouthwashes containing superoxidation solution and B complex was given to the patient. The reported lesions improved satisfactorily. The second case, a 47-year-old male patient, presented vesiculobullous lesions on the lingual and labial mucosa accompanied by severe painful symptoms after SARS CoV 2 infection. An incisional biopsy was performed. The histopathological result was compatible with pemphigus vulgaris, and the treatment protocol was started with 0.1% topical mometasone and 2g miconazole gel, observing adequate involution of the lesions after 20 days. Conclusions: The aim of this study is to report on the lesions affecting the oral cavity and pharynx in post-COVID patients with the aim of carrying out a thorough intraoral examination, establishing a clinical or histopathological diagnosis to implement a specific treatment plan in each case to improve the health and quality of life of the patients. Keywords: SARS-CoV-2; Oral manifestations; Oral ulcer; Pemphigus; Mouth; Mucous membrane.

Introducción: La infección por virus de SARS CoV 2 ha dejado a su paso una estela de crisis en materia de salud, económica, social y en todos los ámbitos a la fecha seguimos realizando la observación del comportamiento de la enfermedad en los seres humanos con una diversidad biológica importante y que ha traído como consecuencia una serie de secuelas que se presentan en el periodo trans o posterior a la infección en toda la economía corporal. Reporte de Caso: Se ha evaluado poco las manifestaciones que se presentan en la cavidad bucal y faringe; se presentan dos casos clínicos el primero paciente masculino de 67 años de edad posterior a la infección por SARS CoV 2 presenta diluciones de continuidad en bordes laterales de la lengua se indica terapia y refuerza limpieza bucal, antimicótico, colutorios con solución de superoxidación y complejo B, las úlceras involucionan de manera satisfactoria. Resultados: El segundo caso masculino de 47 años posterior a la infección por SARS CoV 2 debuta con lesiones vesículo-ampollosas en mucosa lingual, labial con sintomatología dolorosa severa, se realiza biopsia incisional donde el resultado histopatológico es compatible con pénfigo vulgar, se inicia protocolo de tratamiento con mometasona tópica al 0.1% y miconazol gel 2g observándose una adecuada involución de las lesiones a los 20 días. Conclusiones: El objetivo de este trabajo es poner en contexto de la comunidad médica y científica las lesiones concernientes a la cavidad bucal y faringe que están presentando los pacientes postcovid con el objetivo de realizar una exhaustiva exploración intraoral, establecer un diagnóstico clínico o histopatológico y con base en esto instaurar un plan de tratamiento específico en cada caso en particular con el fin fundamental de mejorar la salud y calidad de vida del paciente.

Ocular cicatricial pemphigoid. From a rheumatology and ophthalmology point of view / Penfigoide ocular cicatrizal, enfoque diagnóstico y terapéutico integral entre el oftalmólogo y el reumatólogo

ABSTRACT Ocular cicatricial pemphigoid (OCP) is a chronic, immune-mediated, bullous, cicatricial disease within the spectrum of mucocutaneous membranous pemphigoids (MMP). Although the diagnosis is often ophthalmological, due to the autoimmune nature of the pathology, it requires a joint approach with rheumatologists and immunologists. The objective of this narrative review was to explore the evidence available in the literature from 2000 to 2020 with respect to clinical manifestations, diagnosis, and treatment. The clinical presentation varies widely, from mild cases with slow progression of years of progression, to severe cases with a torpid and rapidly progressive evolution to fibrosis, refractory to multiple treatments. A com plete evaluation of the patient will help guide the diagnosis. The gold standard for diagnosis is conjunctival biopsy with direct immunofluorescence, although on occasions it can be reached if the symptoms are characteristic. Treatment is local and systemic according to its severity and evolution. The evidence on topical and systemic therapeutics is obtained mainly from uncontrolled observational and experimental studies. Immunomodulatory therapy has made it possible to preserve vision and, in many cases, prevent sequelae. The evolu tion is linked to the early diagnosis and immunosuppressive treatment, so it is essential to be aware of this disease, the diagnostic methods, as well as the immunomodulating and immunosuppressive therapies available.

RESUMEN El penfigoide ocular cicatrizal (POC) es una enfermedad crónica, inmunomediada ampollar, mucosinequiante, comprendida dentro del espectro de penfigoides membranosos mucocutáneos (PMM). El diagnóstico es, con frecuencia, oftalmológico, pero debido al carácter autoinmune de la patología, requiere el abordaje en conjunto con reumatólogos e inmunólogos. El objetivo de esta revisión narrativa fue explorar la evidencia disponible en la literatura, desde el año 2000 hasta el 2020, en lo que respecta a sus manifestaciones clínicas, diagnóstico y tratamiento. La presentación clínica varía ampliamente, desde casos leves con progresión lenta de años de evolución hasta casos severos con evolución tórpida y rápidamente progresiva a la fibrosis, refractarios a múltiples tratamientos. Una evaluación completa del paciente ayudará a guiar el diagnóstico. El estándar de oro diagnóstico es la biopsia conjuntival con inmunofluorescencia directa, si bien en ocasiones puede diagnosticarse por la clínica característica. El tratamiento es local y sistêmico de acuerdo con su severidad y evolución. En los últimos 20 anos, la evidencia sobre los tratamientos tópicos y sistêmicos corresponde en su mayoría a estudios observacionales y experimentales no controlados. Los métodos de tratamiento inmunomoduladores han permitido preservar la visión y, en muchos casos, prevenir secuelas. La evolución está ligada al diagnóstico temprano y a los tratamientos disponibles, por lo que es fundamental el conocimiento de esta patología, los métodos diagnósticos y los tratamientos inmunomoduladores e inmunosupresores.

Alternative Oral Mucous Membrane Pemphigoid Therapy Using Tacrolimus: A Case Report

ABSTRACT: Mucous membrane pemphigoid (MMP) is a blistering disease that predominantly involves the mucous membranes and that can lead to major negative impacts on patient quality of life. The first-line MMP treatment is based on the use of topical and systemic corticosteroids. In this report, we presented a 45-year-old female patient presented blisters in the inferior gingiva for over 8-months. The patient reported being allergic to corticosteroids. Under the clinical hypothesi s of oral lichen planus and MMP, an incisional biopsy was performed, and the histopathological diagnosis of MMP was established. Thus, it was instituted an alternative therapy with tacrolimus 0.03 %. The patient showed an excellent clinical outcome with no recurrence five months after the end of therapy. Tacrolimus 0.03 % may represent an effective therapeutic alternative in MMP treatment and may be used in cases of hypersensitivity to standard therapy.

RESUMEN: El penfigoide de la membrana mucosa (PMM) es una enfermedad ampollosa que afecta predominantemente a las membranas mucosas y que puede provocar importantes impactos negativos en la calidad de vida del paciente. El tratamiento de primera línea de PMM se basa en el uso de corticosteroides tópicos y sistémicos. En este informe, presentamos un caso de una paciente femenina de 45 años que presentó ampollas en la encía inferior durante más de 8 meses. La paciente informó ser alérgica a los corticosteroides. Bajo la hipótesis clínica de liquen plano oral y PMM, se realizó una biopsia incisional y se estableció el diagnóstico histopatológico de PMM. Por lo tanto, se instituyó una terapia alternativa con tacrolimus tópico al 0,03 %. La paciente mostró un excelente resultado clínico sin recurrencia después de 5 meses de la terapia final. Tacrolimus 0,03 % puede representar una alternativa terapéutica efectiva en el tratamiento de PMM y se puede usar en casos de hipersensibilidad a la terapia estándar.

Pénfigo vulgar mucoso: a propósito de un caso. Revisión de la literatura / Mucous pemphigus vulgaris: a case report

Introducción: El Pénfigo Vulgar (PV) es una enfermedad de origen autoinmune caracterizada por causar ampollas intraepidérmicas en piel y mucosas, como consecuencia de la agresión de autoanticuerpos hacia varios tipos de proteínas desmosómicas. El elemento eruptivo primordial es la ampolla, que puede presentarse de manera individual o en coalescencia con la consecuente formación de placas erosivo-costrosas. En el 90% de los casos las lesiones afectan a la mucosa oral, mientras que en el 50-70% de los mismos constituyen la primera manifestación de la enfermedad. Objetivo: Se presenta un caso clínico de PV y una revisión bibliográfica actualizada, con el objetivo de analizar sus factores etiológicos y sus opciones terapéuticas. Caso clínico: Se presenta el caso de un paciente varón, de 71 años, fumador, con condición prediabética y síndrome de Guillain Barré remitido al Servicio de Cirugía Bucal e Implantología del Hospital Virgen de la Paloma de Madrid con un cuadro clínico caracterizado por infección oral y pérdida de peso. Una vez confirmado el diagnóstico de PV mucoso mediante examen histopatológico, se estableció una terapia con corticoides sistémicos obteniendo una remisión casi completa de las lesiones. Tras varias semanas de tratamiento su dermatólogo decidió suspender los corticoides para llevar a cabo, sin éxito, una terapia sustitutiva con inmunosupresores. La recidiva de las lesiones, unida a los efectos adversos causados por la nueva terapia, obligó a reconsiderar la suministración de corticoides con una resolución positiva de la enfermedad. (AU)

Introduction: Pemphigus Vulgaris is an autoimmune disease characterized by causing intraepidermal blisters on the skin and mucosa, as a consequence of the aggression of autoantibodies towards various types of desmosomal proteins. The primary eruptive element is the blister, which can appear in coalescence with the consequent formation of erosive-crusted plaques. In 90% of cases lesions affect the oral mucosa, while in 50-70% they are the first manifestation of the disease. Objective: We aim to report a case of Pemphigus Vulgaris and an updated literature review to analyse its etiological factors and treatment options. Clinical case: We present the case of a 71-year-old male patient, smoker, with prediabetic condition and sindrome Guillain Barré referred to the Oral Surgery and Implantology Service of the Virgen de la Paloma Hospital in Madrid with a clinical picture characterized by oral infection. Once the diagnosis of mucosal PV was confirmed, a systemic corticosteroid therapy was established, obtaining almost complete remission of the lesions. After several weeks of treatment, his dermatologist decided to suspend the corticosteroids to carry out unsuccessful immunosuppressant replacement therapy. The recurrence of the lesions, together with the adverse effects caused by the new therapy, forced the reconsideration of the supply of corticosteroids with a positive resolution of the disease. (AU)

Penfigoide de membrana mucosa asociado a carcinoma pulmonar ¿penfigoide paraneoplásico? / Mucous membrane penfigoid associated with pulmonary carcinoma ¿paraneoplastic penfigoid?

El penfigoide de la membrana mucosa es una enfermedad autoinmune, que afecta a los diferentes estratos de la mucosa y la piel, y se caracteriza por lesiones vesiculo-ampollosas polimórficas. Presentando combinaciones variables de lesiones orales, oculares, cutáneas, genitales, nasofaríngeas, esofágicas y laríngeas. Su relación con las neoplasias malignas es poco conocida y sigue siendo controvertida. El presente artículo describe el manejo multidisciplinario de una paciente de 46 años de edad que desarrolló un penfigoide de membrana mucosa a nivel de la cavidad oral. Esta patología estuvo asociada a un carcinoma de pulmón, y posteriormente presentó alteraciones multiorgánicas. El tratamiento fue realizado por las especialidades de dermatología, medicina interna, cirugía general, oftalmología, estomatología, cirugía oral y maxilofacial, dicho tratamiento se llevó a cabo por etapas y tuvo una duración de 2 meses aproximadamente, logrando la resolución de las lesiones que presentaba la paciente. Consideramos que se abre una puerta para futuras investigaciones que confirman la relación entre el penfigoide de la membrana mucosa y el carcinoma de pulmón.

Mucous membrane pemphigoid is an autoimmune disease that affects different layers from mucosa and skin, characterized by polymorphic vesicular-bullous lesions, presenting variable combinations of oral, ocular, skin, genital, nasopharyngeal, esophageal, and laryngeal lesions. Its relationship to malignant neoplasms is poorly understood and remains controversial. This article describes the multidisciplinary management of a 46-year-old patient who developed mucous membrane pemphigoid at the oral cavity level. This pathology was associated with lung carcinoma, and later presented multiorgan alterations, for which a treatment was carried out with the specialties of dermatology, internal medicine, general surgery, ophthalmology, stomatology, oral and maxillofacial surgery, said treatment was carried out in stages and lasted for approximately 2 months, achieving the resolution about lesions that patient presented. We believe that a door opens for future research confirming the relationship between mucous membrane pemphigoid and lung carcinoma.

Complete enucleation surgical treatment and histological analysis of a mucocele in lower lip in a child: case report / Tratamiento quirúrgico de enucleación completa y análisis histológico de un mucocele en el labio inferior en un niño: reporte de caso

Objective: The aim of this case report is to describe the surgical removal of a mucocele and its histological analysis, in a child. Case Report: An 11-year-old female patient attended the Pediatric Dentistry clinic complaining of a lower lip lesion. During the anamnesis, the mother reported that the child had a habit of biting and sucking the spot frequently. Clinical examination showed the lesion was compatible with a mucocele. The proposed treatment was a complete enucleation of the lesion under local anesthesia. The incision and tissue divulsion were performed for maximum preservation of the mucosa, avoiding a possible recurrence. Total adjacent glands removal was also performed. The lesion was placed in 10% formaldehyde for histopathological analysis (H&E Staining), which showed dense connective tissue presenting chronic inflammatory infiltrate and extravasated mucin, presence of granulation tissue delimiting the area of extravasated mucin and presence of minor salivary glands. The patient was advised to quit the habit, and after seven days the sutures were removed. At the one-year follow-up there was no recurrence of the lesion. Conclusion: The proposed treatment proved to be effective without recurrence of the lesion.

Objetivo: El objetivo de este reporte de caso es describir la extirpación quirúrgica de un mucocele y su análisis histológico en un niño. Informe del caso: una paciente de 11 años de edad asistió a la clínica de Odontopediatria quejándose de una lesión en el labio inferior. Durante la anamnesis, la madre informó que el niño tenía la costumbre de morder y chupar el lugar con frecuencia. En el examen clínico, la lesión fue compatible con un mucocele. El tratamiento propuesto fue una enucleación completa de la lesión bajo anestesia local. La incisión y la divulgación del tejido se realizaron para la máxima preservación de la mucosa, evitando una posible recurrencia. También se realizó la extracción total de las glándulas adyacentes. La lesión se colocó en formaldehído al 10% para el análisis histopatológico (tinción H&E), que mostró tejido conectivo denso que presenta infiltrado inflamatorio crónico y mucina extravasada, presencia de tejido de granulación que delimita el área de mucina extravasada y presencia de glándulas salivales menores. Se aconsejó al paciente que abandonara el hábito, y después de siete días se retiraron las suturas. En el seguimiento de un año no hubo recurrencia de la lesión. Conclusión: El tratamiento propuesto demostró ser efectivo sin recurrencia de la lesión.

Intraoral acanthosis nigricans and its clinical relevance as a manifestation of a paraneoplastic syndrome: a case report / Acantosis nigricans intraoral y su relevancia clínica como manifestación de un síndrome paraneoplásico: reporte de un caso

Malignant-or-paraneoplastic acanthosis nigricans is a verrucous and hyperpigmented tumor affecting the mucosa and skin. In most cases malignant acanthosis nigricans is a distant manifestation of an intra-abdominal primary cancer. While the diagnosis of malignant acanthosis nigricans is challenging, some specific clinical and histopathological findings could lead to an accurate diagnosis. A rare clinical case of a 59-year-old female, who was referred to the maxillofacial surgery service due to a painful oral lesion in the palatine region, is presented. Upon examination, papillomatous lesions were observed on the hard palate, that were later diagnosed as intraoral malignant acanthosis nigricans secondary to gastric cancer. Both local and systemic evaluations are discussed, highlighting the relevance of a multidisciplinary approach consistent with the fact that these manifestations, although infrequent, should generate suspicion among clinicians and therefore motivation to perform a diligent and complete study since it can reveal the presence of a malignant pathology.

La acantosis nigricans maligna o paraneoplásica es un tumor verrugoso e hiperpigmentado que afecta la mucosa y la piel. En la mayoría de los casos, la acantosis nigricans maligna es una manifestación distante de un cáncer primario intraabdominal. Si bien el diagnóstico de acantosis nigricans maligna es desafiante, algunos hallazgos clínicos e histopatológicos específicos podrían conducir a un diagnóstico preciso. Se presenta un caso clínico raro de una mujer de 59 años, que fue derivada al servicio de cirugía maxilofacial debido a una lesión oral dolorosa en la región palatina. En el examen, se observaron lesiones papilomatosas en el paladar duro, que posteriormente se diagnosticaron como acantosis nigricans maligna intraoral secundaria a cáncer gástrico. Se discuten tanto las evaluaciones locales como las sistémicas, destacando la relevancia de un enfoque multidisciplinario consistente con el hecho de que estas manifestaciones, aunque poco frecuentes, deberían generar sospecha entre los clínicos y, por lo tanto, motivación para un estudio diligente y completo, ya que puede revelar la presencia de una patología maligna.

Desenlaces en pacientes operados con queratoprótesis boston tipo 1 en un centro oftalmológico especializado en la ciudad de Medellín / Outcomes in patients with boston type 1 keratoprosthesis in a specialized center in Medellín

Objetivo: reportar las características y descenlaces de pacientes con queratoprótesis Boston tipo 1. Diseño: estudio observacional descriptivo de corte transversal. Método: se incluyeron los pacientes operados con queratoprótesis Boston tipo 1 residentes en Colombia, mayores de 17 años, sin queratoprótesis previas y que tuviera más de 6 meses de seguimiento, para un total de 39 ojos de 39 pacientes. La cirugía se indicó en los casos con o sin queratoplastia previa que tuvieran agudeza visual (AV) igual o inferior a cuenta dedos y déficit de limbo bilateral o vascularización corneal profunda en más de 3 cuadrantes. Se recolectó y analizó la información de la historia clínica en forma retrospectiva y prospectiva. Las variables principales fueron: agudeza visual, retención del dispositivo y complicaciones. Se realizó un análisis univariado presentando los resultados en frecuencias absolutas y porcentajes para las variables categóricas y para las variables cuantitativas como promedio y desviación estándar (DE) si tienen distribución normal o como mediana y rango intercuartil si no tienen distribución normal. Resultados: La mediana de seguimiento fue de 53.5 meses (rango 6 meses a 10 años). La mayoría de pacientes (66.7%) habían tenido previamente queratoplastia penetrante. El diagnóstico de base fue en 53.8% condiciones no inflamatorias yen 46.2% condiciones inflamatorias. La AV preoperatoria en todos los ojos estaba entre percepción de luz y cuenta dedos; posterior a la cirugía el 97.4% tuvieron mejoría de la AV. Para el fi nal del seguimiento la AV permaneció mejor que la preoperatoria en 53.8%, fue igual a esta en 17.94% y peor que esta en 28.2%. Hubo necrosis periprostética en 28.2%, y 38.5% tuvieron recambio del dispositivo. Al final del seguimiento 89.7% de los pacientes tenían una queratoprótesis in-situ. Conclusión: la queratoprótesis Boston tipo 1 es una opción viable para mejorar la AV en pacientes con trasplantes de córnea fallidos o en quienes se prevé alta tasa de fallo o rechazo de este. En la gran mayoría de los pacientes se logra mejoría inicial significativa de la AV, la cual se mantiene al final del seguimiento en más de la mitad de ellos. Refinamientos progresivos en la técnica quirúrgica y el manejo postoperatorio disminuirán las complicaciones que llevan a la perdida visual progresiva

Purpose: to report characteristics and outcomes in patients with Boston type 1 keratoprosthesis. Design: observational descriptive cross-sectional study. Method: Patients with Boston type 1 queratoprosthesis who were living in Colombia, 17 years or older, without previous keratoprosthesis and with more than 6 months follow up were included, for a fi nal of 39 eyes from 39 patients. Surgery was indicated for those with or without previous keratoplasty who had visual acuity (VA) of counting fi ngers or worse and bilateral limbal stem cell deficiency or deep corneal vascularization in more than 3 quadrants. Information was collected retrospectively and prospectively from medical registries and was analyzed. Main variables were: visual acuity, device retention and complications. An univariate analysis was conducted and results are presented in absolute frequencies and percentages for categoric variables and for quantitative variables in average and standard deviation (SD) if they have normal distribution and in median and interquartile range if they do not have normal distribution. Results: Median follow up was 53.5 months (range 6 months to 10 years). Most patients (66.7%) had previous penetrating keratoplasty. Baseline diagnoses were in 53.8% non-infl ammatory conditions and in 46.2% inflammatory conditions. Preoperative VA ranged between light perception and counting fingers in all eyes; aft er surgery 97.4% had improvement in VA. By the end of follow up VA remained better than preoperative in 53.8%, was the same as preoperative in 17.94% and worse than preoperative in 28.2%. There was periprosthetic necrosis in 28.2%, and 38.5% had keratoprothesis exchange. At the end of follow up 89.7% of patients had a keratoprosthesis in-situ. Conclusion: Boston type 1 keratoprosthesis is a viable option to improve VA in patients with previously failed corneal transplants or in cases that anticipate bad prognosis for keratoplasty. In most patients there was a signifi cant initial improvement in vision, and more than half of them retained better than initial VA on their last follow up. Further refinements in surgical technique and postoperative care would decrease complications that lead to progressive visual loss.

Melanoma anal, importancia del diagnóstico diferencial con la enfermedad anal benigna / Anal melanoma, the importance of differential diagnosis with benign anal pathology

El melanoma anorrectal, descrito inicialmente por Moore en 1857, es un tumor infrecuente y agresivo, cuyo pronóstico suele ser infausto, con una supervivencia a los cinco años menor de 20 %. La principal importancia de este tumor radica en que suele presentarse como una tumoración anorrectal o producir sangrado, o rectorragia, por lo que el diagnóstico diferencial con la enfermedad anal benigna resulta crucial, pues el pronóstico estará condicionado por el estadio en el momento del diagnóstico. Se presenta el caso de una mujer de 70 años que consultó por sangrado rectal y cuyo diagnóstico inicial fue de trombosis hemorroidal. Tras el diagnóstico de melanoma anorrectal y el estudio de extensión negativo para metástasis, se practicó una amputación abdóminoperineal según la técnica de Miles. Tras nueve años de seguimiento, la paciente se encuentra libre de enfermedad

Anorectal melanoma was first described by Moore in 1857. Is an uncommon and aggresive tumor, with inauspicious prognosis. Five-year survival rates are less than 20%. The main important feature of this tumor is that it usually manifests as a rectal tumor or rectal bleeding; therefore, a diferential diagnosis with benign anal conditions is of utmost importance. Prognosis is conditioned by tumor stage at diagnosis. We present a 70-year-old woman with rectal bleeding with an initial diagnosis of hemorrhoidal trombosis. With the diagnosis of rectal melanoma without distant metastasis, an abdominoperineal resection (Miles operation) was performed. After 9-years follow-up, she is disease free

Comparative analysis of endoscopic and histopathological features of superficial elevated lesions resected by endoscopic mucosal resection in the distal and proximal colon / Análise comparativa dos aspectos endoscópicos e histopatológicos das lesões superficialmente elevadas ressecadas por mucosectomias no cólon distal e proximal

ABSTRACT Objective: to compare endoscopic and histopathologic features of superficial, elevated lesions with one or more centimeters in diameter, diagnosed by videocolonoscopy on the distal and proximal colon, and subjected to mucosal resection. Methods: we conducted a retrospective, cross-sectional, observational study involving 8,075 videocolonoscopies. From this total, we evaluated 166 mucosectomies in 145 patients with superficial, elevated lesions with a diameter equal to or greater than 1cm. Results: the lesion prevalence was lower in G1 than in G2 (34.9% vs. 65%). The mean age, gender distribution and size (1.9cm in G1 versus 2.0cm in G2, p=0.921) were similar. There was no difference of mucosal surfaces in relation to the location (p=0.575). Considering Intraepithelial neoplasias, both the low grade, high grade (including carcinomas) and hyperplasic ones showedd no difference (p=0.527), nor did the neoplastic lesions when divided into serrated and non-serrated (p=0.124). Excluding 13 hyperplastic lesions and two carcinomas, 124 (82.1%) were non-serrated and 27 (17.9%), serrated. Conclusion: were found no significant differences between endoscopic and histopathological aspects of superficial, elevated lesions of 1cm or more in diameter in distal colon compared with the proximal, when resected by mucosectomy. Although not significant, there was a tendency of association between the location of the lesion and the presence of serrated features.

RESUMO Objetivo: comparar aspectos endoscópicos e histopatológicos de lesões superficialmente elevadas, com um ou mais centímetros de diâmetro, diagnosticadas por videocolonoscopias e ressecadas por mucosectomias do cólon distal com as do cólon proximal. Métodos: estudo foi retrospectivo, transversal, observacional, envolvendo 8075 videocolonoscopias. Avaliou-se 166 mucosectomias em 145 pacientes com lesões superficialmente elevadas com diâmetro igual ou maior do que 1cm. Resultados: a prevalência de lesões foi menor no G1 do que no G2 (34,9% x 65%). A média de idade, a distribuição por sexo e o tamanho (1,9cm no G1 e 2cm no G2, p=0,921) foram semelhantes. Não houve diferenças das superfícies em relação à localização (p=0,575). Considerando neoplasia intraepitelial de baixo grau, neoplasia intraepitelial de alto grau (incluindo carcinomas) e hiperplásicas, não houve diferença (p=0,527), assim como quando foram divididas as lesões neoplásicas em serrilhadas e não serrilhadas (p=0,124). Excluindo-se 13 lesões hiperplásicas e duas com carcinomas, 124 (82,1%) foram não serrilhadas e 27 (17,9%) serrilhadas. Conclusão: não foram observadas diferenças significativas entre os aspectos endoscópicos e os histopatológicos das lesões superficialmente elevadas, com 1cm ou mais de diâmetro, ressecadas por mucosectomia do cólon distal em relação ao proximal. Embora não significante, há tendência à associação entre a localização da lesão e a presença de características serrilhadas.

Manifestações periodontais associadas às doenças auto-imunes: uma revisão de literatura / Periodontal manifestations associated with autoimmune diseases: a literature review

As doenças auto-imunes envolvem a formação de auto-anticorpos direcionados contra alguns elementos teciduais, particularmente os da pele ou superfícies das mucosas, como forma sistêmica. Dentre estas doenças podemos destacar o pênfigo vulgar, o lúpus eritematoso sistêmico e o penfigóide das membranas mucosas. Estas estão, muitas vezes, associadas com sintomas bucais, podendo apresentar em diversos sítios orais a presença de lesões vesículo-bolhosas e gengivite descamativa. Baseado nisto, este artigo realizou uma revisão de literatura que teve como objetivo associar as manifestações periodontais ao pênfigo vulgar, lúpus eritematoso sistêmico e penfigóide das membranas mucosas com o intuito fornecer aos profissionais um melhor entendimento sobre essas doenças, de modo que eles sejam capazes de oferecer um atendimento clínico mais adequado para estes pacientes. Os resultados puderam mostrar que há uma associação dessas doenças auto-imunes a manifestações periodontais, especialmente a gengivite descamativa. Além disso, a literatura as associa à perda óssea alveolar, ao aumento do sangramento gengival, a perda de inserção e a outras desordens periodontais.

Paracoccidioidomycosis of external genitalia: report of six new cases and review of the literature / Paracoccidioidomicose de localização genital externa: relato de seis novos casos e revisão da literatura

BACKGROUND: Paracoccidioidomycosis is a systemic mycosis of dermatological interest due to the frequency of cutaneous and mucosal lesions. The involvement of the external genitalia is extremely rare and few cases have been reported. OBJECTIVE: To study the prevalence of external genitalia lesions in paracoccidioidomycosis patients, identify clinical characteristics and compare with what is observed in the specific literature. METHODS: This is a cross-sectional, descriptive study, with focus on paracoccidioiodomycosis patients with external genitalia lesions. The demographic and clinical aspects of cases were compared with what has been reported so far on LILACS, SciELO e MEDLINE data bases. RESULTS: Data of 483 cases of paracoccidioidomycosis were studied in a 42-year period. Six (1.2%) patients showed specific lesions on external genitalia. Five patients were male with mean age of 47.2 years and all of them presented with the chronic multifocal clinical form. Only one, a 15-year-old female patient was observed who showed a subacute clinical form, juvenile type. CONCLUSION: Compromise of the genitourinary tract among paracoccidioidomycosis patients is rare and even rarer when only the external genitalia are considered. As observed in the classical picture of paracoccidioidomycosis patients, the male gender and the chronic multifocal clinical form prevailed in the present study.

FUNDAMENTOS: Paracoccidioidomicose é micose sistêmica de interesse dermatológico pela freqüência de lesões tegumentares. Sua localização em genitália externa é extremamente rara e pouco descrita. OBJETIVOS: estudar a prevalência de lesões de paracoccidioidomicose de localização genital, identificar suas características clínicas e compará-las com a literatura específica. MÉTODOS: estudo descritivo, transversal, de série de casos, com inclusão de casos com lesões específicas de paracoccidioidomicose de localização genital externa, estudo das características demográficas e clínicas dos casos, confrontados com dados de revisão da literatura nas bases LILACS, SciELO e MEDLINE. RESULTADOS: foram revisados de 483 pacientes de paracoccidioidomicose diagnosticados no período de 42 anos. Seis (1,2%) pacientes apresentavam lesão específica de genitália externa. Cinco eram do sexo masculino com idade média de 47,2 anos e todos com a forma crônica multifocal da doença, O único caso do sexo feminino, de 15 anos de idade, apresentava a forma subaguda, tipo juvenil. CONCLUSÕES: o comprometimento do trato geniturinário na paracoccidioidomicose é raro e mais ainda quando se considera apenas as localizações de genitália externa. Como na paracoccidioidomicose clássica, o sexo masculino e a forma crônica da doença predominaram na amostragem estudada.

Leishmaniose mucosa: considerações epidemiológicas e de tratamento / Mucosal leishmaniasis: epidemiological and treatment considerations / Leishmaniasis mucosa: consideraciones epidemiológicas y de tratamiento

Na região Sul do Brasil, a leishmaniose tegumentar americana predomina no Estado do Paraná, especialmente ao Norte e Oeste, onde um dos circuitos de produção da doença é localizado. Estima-se que 3 a 5% dos casos de leishmaniose cutânea desenvolvam lesão mucosa, e que cerca de 1% destas podem evoluir para óbito. De longa data, as drogas de escolha para tratamento da doença são os compostos antimoniais sob a forma de sais pentavalentes. O objetivo deste estudo foi descrever características epidemiológicas e de tratamento dos pacientes com leishmaniose mucosa, diagnosticados no período de 2001 a 2007, em municípios localizados na área de abrangência da 13ª Regional de Saúde, com sede no município de Cianorte, no Paraná. As informações foram coletadas do prontuário ambulatorial e das fichas de investigação epidemiológicas do Sistema de Notificação e Informação de Agravos. No período estudado, foram notificados 505 casos de leishmaniose tegumentar americana, 30 deles (6%) na forma mucosa. Foram incluídos no estudo pacientes com diagnóstico de leishmaniose mucosa, que apresentavam exames complementares realizados antes e durante o tratamento. Os resultados evidenciaram a necessidade de acompanhamento cuidadoso dos doentes nas equipes de saúde, dado a possível evolução e presença de efeitos medicamentosos indesejáveis nos pacientes afetados pela condição.

In South Brazil, American tegumentary leishmaniasis is predominant at Paraná, specially on the North and West areas, where it is localized one of the disease's production circuits. It is believed that 3 to 5% of the cases evolve to the mucosal form, and that 1% of these can evolve to death. There is a long time that first choice drugs to treat this disease are the antimony compounds as pentavalent salts. The purpose of this study was to describe epidemiological and treatment characteristics of patients with mucosal leishmaniasis, who were diagnosed during the period from 2001 to 2007 in cities located on the coverage area of the 13 Heath Regional, which is situated in Cianorte, Paraná. The data were collected at the outpatient medical records and the System of Notifications and Information of Diseases epidemiological investigation records. During the mentioned period, 505 cases of American tegumentary leishmaniasis were notified, 30 of them (6%) as the mucosal form. In this study, the patients included were those with diagnosis of mucosal leishmaniasis that had complementary exams performed before and during the treatment. The results showed the need of patients' careful monitoring by health teams, due to the possible evolution of the disease and the presence of unwanted drug effects.

En la región Sur de Brasil, la leishmaniasis tegumentaria americana predomina en el estado de Paraná, principalmente al Norte y Oeste del país, donde está localizado uno de los circuitos de producción de la enfermedad. Se estima que de 3 a 5% de los casos de leishmaniasis cutánea desenvuelvan lesión mucosa, y que cerca de 1% de ellas puedan acabar en muerte. Por mucho tiempo, las drogas escogidas para tratar la enfermedad son los compuestos antimoniales bajo la forma de sales pentavalentes. El objetivo de este estudio fue describir características epidemiológicas y de tratamiento de los pacientes con leishmaniasis mucosa, diagnosticados en el periodo de 2001 a 2007, en municipios localizados en el área de estudio de la 13ª Regional de la Salud, localizada en el municipio de Cianorte, Paraná. Las informaciones fueron colectadas del registro médico y de los papeles de investigación epidemiológicos del SINAN (Sistema de Notificación e Información de Agravios). En el periodo estudiado, fueron notificados 505 casos de leishmaniasis tegumentaria americana, 30 de los cuales (6%) en forma mucosa. Fueron incluidos en el estudio pacientes diagnosticados con leishmaniasis mucosa, que poseían exámenes complementares realizados antes y durante el tratamiento. Los resultados evidenciaron la necesidad de cuidadosamente acompañar los enfermos en los equipos de salud, dada la posible evolución y la presencia de efectos medicamentosos indeseables en los pacientes afectados por la condición.

Melanoma primário de mucosa do trato nasossinusal: relato de 18 pacientes e análise de 1077 pacientes na literatura / Primary mucosal melanoma of the sinonasal tract: report of 18 patients and analysis of 1077 patients in the literature

O presente estudo tem por objetivo relatar as características, fatores prognósticos e desfecho de tratamento de 18 casos de melanoma da mucosa nasossinusal e conduzir uma revisão da literatura. MÉTODO: Entre 1995 e 2005, 18 pacientes consecutivos diagnosticados com melanoma da mucosa do trato nasossinusal e tratados em nossa instituição. Para encontrar as principais casuísticas de estudos relacionados, conduzimos uma revisão da literatura em PubMed e Scopus. No total, encontramos 35 casuísticas, incluindo 1.077 pacientes com melanoma da mucosa nasossinusal. RESULTADOS: Encontramos 16 homens e 2 mulheres. A idade de apresentação foi 51-80 anos (mediana de 58 anos). Todos os pacientes sofreram excisão cirúrgica seguida de radioterapia com ou sem quimioterapia. A mediana de sobrevida foi de 15 meses e a sobrevida geral de 5 anos foi de 23 por cento. Sob análise univariada, estadiamento e remissão completa após tratamento inicial foram importantes fatores prognósticos. Entretanto, sob análise multivariada, somente estágio da doença teve significância estatística. CONCLUSÃO: Melanoma nasossinusal é um tumor raro e agressivo com alto fracasso locorregional e distante e pobre desfecho de tratamento. Entretanto, em uma revisão da literatura, encontramos significativa melhora em termos de sobrevida de 5 anos para casuísticas recentes comparadas com casuísticas previamente relatadas.

The present study aimed at reporting on the characteristics, prognostic factors and treatment outcomes of 18 cases of nasosinusal mucosa melanoma, and do a literature review on the subject. METHODS: between 1995 and 2005, 18 patients consecutively diagnosed with nasosinusal mucosa melanoma were managed in our institution. We reviewed the literature in PubMed and Scopus in order to find the main series from studies associated with this topic. We found a total of 35 series, involving 1,077 patients with nasosinusal mucosa melanoma. RESULTS: we found 16 men and 2 women, with age at presentation between 51 and 80 years (median of 58 years). All these patients were submitted to surgical excision followed by radiotherapy with or without chemotherapy. The survival median was 15 months, and the 5-year general survival had a percentage value of 23 percent. Considering our univariate analysis: tumor staging and complete remission after initial treatment were deemed relevant prognostic factors. Nonetheless, considering the multivariate analysis, only disease stage was statistically significant. CONCLUSION: nasosinusal melanoma is a rare and aggressive tumor, with high loco-regional and distant failure rates, and poor treatment outcomes. Notwithstanding, in a literature review we found significant improvements considering the 5-year survival for recent series when compared to previously reported ones.

Epidermolisis bulosa: presentación de un caso / Epidermolysis bullosa: case Presentation

La Epidermolisis Bullosa es un grupo de desórdenes genéticos ampollares, caracterizados por fragilidad de la piel y membranas mucosas. Se realizó la presentación de un caso de una lactante de dos meses de edad, con lesiones ampollares y erosivas diseminadas en el cuerpo, a la cual se le realizó un diagnóstico genético-clínico-patológico de Epidermolisis Bulosa Juntural, llamando la atención por ser esta una enfermedad de baja incidencia, así como por lo difícil de su clasificación diagnóstica y porque una de las indicaciones médicas utilizadas fue el vegetal brócoli, debido a su poder cicatrizante(AU)

Epidermolysis bullosa is a group of congenital blisterous diseases characterized by frailty skin and mucous membranes. This case presents a two-month old infant with blisterous and erosive lesions disseminated all over the body. A genetic-clinical-pathological study of juntural epidermolysis bullosa was carried out, being remarkable the low incidence of this condition as well as its difficult diagnostic classification. One of the indications prescribed was the consumption of broccoli for its healing power (AU)

Reações tegumentares adversas relacionadas aos agentes antineoplásicos: parte I / Adverse mucocutaneous reactions to chemotherapeutic agents: part I

O tratamento local e sistêmico das neoplasias pode causar alterações na pele, membranas mucosas, cabelos e unhas. O diagnóstico preciso e o tratamento adequado destes efeitos colaterais requerem conhecimento dos padrões das reações adversas mais comuns para as medicações que o paciente está utilizando. O dermatologista deve estar familiarizado com as manifestações tegumentares das neoplasias, bem como com os efeitos adversos mucocutâneos dos tratamentos antineoplásicos.

The local and systemic treatment of tumors can cause changes in the skin, mucous membranes, hair and nails. Accurate diagnosis and appropriate treatment of side effects require knowledge about the patterns of the most common adverse reactions to drugs the patient may be using. The dermatologist must be familiar with the manifestations of certain soft tissue neoplasms, as well as with the adverse mucocutaneous forms of cancer treatment.

Eritema multiforme menor desencadeado por sulfametoxazol-trimetoprima / Erythema multiforme minor caused by sulfamethoxazole-trimethoprim

Eritema multiforme (EM) e outras desordens relacionadas compreendem um grupo de doenças mediadas imunologicamente, desencadeadas, principalmente, por infecções ou drogas, normalmente apresentadas como bolhas e ulcerações em pele e mucosas, que ocasionalmente podem levar a alterações sistêmicas e comprometer a vida. O eritema multiforme menor (EMm) é uma doença principalmente cutânea com lesões em alvo típicas ou atípicas, com menos de 10% da superfície corporal afetada, podendo, em alguns casos, afetar somente a mucosa oral. Este artigo tem por objetivo relatar um caso de EMm desencadeado por sulfametoxazol-trimetoprima com manifestação exclusivamente oral, além de abordar a etiopatogenia e o tratamento dessa patologia.

Erythema multiforme (EM) and other related disorders comprise a group of immunologically mediated diseases, precipitated mainly by infections or drug therapies and are characterized by cutaneous and mucous blisters and ulcers that can occasionally lead to systemic disorders and compromise life. Erythema multiforme minor (EMm) is mainly a cutaneous disease with typical or atypical target lesions, affecting less than 10% of the body surface and, occasionally, only the oral mucosa. The aim of this article is to report a case of oral manifestations of EMm caused by sulfamethoxazole-trimethoprin, in addition to addressing the pathogenesis and treatment of this pathology.

Envolvimento mucocutâneo no lúpus eritematoso sistêmico e sua associação com auto-anticorpos / Mucocutaneous involvement in systemic lupus erythematosus and its association with autoantibodies

FUNDAMENTOS: As manifestações mucocutâneas são comuns em pacientes com lúpus eritematoso sistêmico,podendo assumir espectro bastante variado. OBJETIVOS: Estudar a prevalência de lesões mucocutâneas no lúpus eritematoso sistêmico e verificar suas possíveis associações com auto-anticorpos. MÉTODOS: Submeteram-se 113 pacientes com lúpus eritematoso sistêmico a anamnese dirigida para envolvimento mucocutâneo e exame ectoscópico. Seus prontuários foram examinados para dados demográficos e perfil de auto-anticorpos como anti-Ro/SS-A, antiLa/SS-B, antiDNA e anti-Sm. RESULTADOS: Os achados mais prevalentes foram os de fotossensibilidade (83,1 por cento), alopecia (65,4 por cento), eritema em vespertílio(54,3 por cento) e fenômeno de Raynaud (53,9 por cento). Em 46,9 por cento existia algum tipo de queixa mucocutânea no momento do diagnóstico da doença. Encontrou-se associação entre a ocorrência de lúpus cutâneo subagudo e presença do anti-Ro/SSA (p = 0,03), do fenômeno de Raynaud e o anticorpo anti-Sm (p = 0,05) e do eritema em vespertílio e o anticorpo antiDNA (p = 0,03). CONCLUSÃO: Os achados mucocutâneos estão presentes na maioria dos pacientes com lúpus sistêmico, existindo em aproximadamente metade deles no momento do diagnóstico. As lesões mais comuns foram fotossensibilidade, alopecia, eritema em vespertílio e fenômeno de Raynaud.

BACKGROUND: Mucocutaneous manifestations are very common in systemic lupus erythematosus and vary widely. OBJECTIVES: To study the prevalence of mucocutaneous lesions in systemic lupus erythematosus and to verify their possible association with autoantibodies. METHODS: One hundred and thirteen patients with systemic lupus erythematosus underwent clinical history directed to skin disorders and ectoscopic examination. Their charts were reviewed for demographic data and autoantibody profile (anti-Ro/SS-A, anti-La/SS-B, anti-DNA and anti-Sm). RESULTS: The most prevalent findings were photosensitivity (83.1 percent), alopecia (65.4 percent), butterfly rash (54.3 percent) and Raynaud’s phenomenon (53.9 percent). In 46.9 percent of patients there was mucocutaneous complaint upon diagnosis. We found an association between subacute cutaneous lupus and anti-Ro/SS-A (p=0.03), Raynaud’s phenomenon and anti-Sm(p=0.05), butterfly rash and anti-DNA (p=0.03). CONCLUSION: Mucocutaneous lesions are present in most systemic lupus patients and in almost half of them they are present at diagnosis. The most common findings were photosensitivity, alopecia, butterfly rash and Raynaud’s phenomenon.

Paracoccidioidomicose: freqüência, morfologia e patogênese de lesões tegumentares / Paracoccidioidomycosis: frequency, morphology, and pathogenesis of tegumentary lesions

FUNDAMENTOS: Paracoccidioidomicose é micose sistêmica de alta prevalência no Brasil. As lesões orocutâneas são de importância para o diagnóstico e acompanhamento clínico. OBJETIVO: Quantificar e qualificar a presença de lesões cutâneas em pacientes com paracoccidioidomicose e correlacionar com forma clínica e gravidade dos casos. MÉTODOS: Realizou-se estudo clínico observacional de série de casos, classificados segundo a forma clínica, localização topográfica e morfologia da lesão quando presente. RESULTADOS: Foram estudados 152 pacientes classificados como forma crônica do adulto (87,5 por cento) ou como forma aguda-subaguda, tipo juvenil (12,5 por cento). Lesão cutânea foi identificada em 61,2 por cento dos pacientes. Não houve correlação estatística entre presença de lesão e forma clínica (p=1,000) ou entre presença de lesão e gravidade clínica (p= 0,5607). Houve correlação entre presença de lesão mucosa e a forma clínica crônica do adulto (p<0,001). As lesões localizaram-se no segmento cefálico (47,6 por cento), tronco (14,9 por cento), membro superior (14,9 por cento), membro inferior (21,7 por cento) e região genital (0,7 por cento). As lesões ulceradas (42,8 por cento) e as de padrão infiltrativo (26,6 por cento dos casos), foram predominantes. CONCLUS ÃO: A freqüência de lesões cutâneas e padrão morfológico são úteis ao diagnóstico da paracoccidioidomicose. É incomum a presença de lesão da mucosa oral na forma aguda-subaguda, tipo juvenil.

BACKGROUND: Paracoccidioidomycosis is a highly prevalent systemic mycosis in Brazil. The oral and cutaneous lesions are useful for diagnostic proposals and clinical follow-up. OBJECTIVE: To quantify and qualify skin lesions associated to active paracoccidioidomycosis and to correlate them with the clinical form and severity of cases. METHODS: An observational clinical study of cases was performed. Patients were classified according to the clinical form, topographic distribution and morphology of skin lesions. RESULTS: A total of 152 patients classified as chronic form (adult type) (87.5 percent) or acute-subacute form (juvenile type) (12.5 percent) were studied. Skin lesion was diagnosed in 61.2 percent of patients. There was no statistical correlation between presence of skin lesion and clinical form (p=1.000), nor between skin lesion and severity of disease (p=0.5607). There was statistical correlation between mucosal lesion and adult patients (p <0.001). The lesions were on the cephalic segment (47.6 percent), trunk (14.9 percent), upper limbs (14.9 percent), lower limbs (21.7 percent) and genital region (0.7 percent). The ulcerated lesions (42.8 percent) and infiltrative (26.6 percent) lesions prevailed. CONCLUSION: The frequency of skin lesions and their morphology are useful for diagnosis of paracoccidioidomycosis. Oral lesions in the acute-subacute form (juvenile type) are not common.