Dermoscopic Nevus Patterns Associated with Melanoma Patients.

BACKGROUND: The quantitative and qualitative presence of melanocytic nevi is considered a significant risk factor for melanoma. Little is known whether patients showing any of the recognized global dermoscopic nevus patterns might also be considered at increased risk for the disease. OBJECTIVES: We aimed to investigate the frequency of global dermoscopic patterns of common nevi among melanoma patients and compare them to controls, as well as the dermoscopic patterns of atypical nevi between the groups. METHODS: We included consecutive melanoma patients and age- and sex-matched controls who presented to our Department with at least 10 melanocytic nevi. Total body examination was performed, and all nevi had their dermoscopic pattern described. Global dermoscopic patterns of nevi were compared between groups, as well as atypical nevus patterns. Finally, nevus patterns were stratified by their location and also compared between groups. RESULTS: We included 120 melanoma patients and 120 controls. Melanoma patients presented a larger number of common (p = 0.002) and atypical melanocytic nevi (p < 0.001) and more variability of dermoscopic nevus patterns (p < 0.001). No difference in the global dermatoscopic pattern of common nevi was observed between groups. The complex pattern of atypical nevi was associated with melanoma (OR = 2.87). Melanoma patients also showed more common nevi with a reticular pattern on the back (p = 0.014) and lower limbs (p = 0.041) as well as atypical nevi on the back with reticular pattern (p = 0.01), with reticular-homogeneous pattern (p = 0.001), and with reticular-globular pattern (p = 0.048) than controls. Nevi with multifocal pigmentation were also more frequent among melanoma patients (OR = 2.61). CONCLUSION: Melanoma patients tend to present a higher number of common reticular nevi on the back and lower limbs, as well as atypical nevi with a complex pattern, especially reticular, reticular-homogeneous, and reticular-globular on the back.

Short-Term Follow-Up of a Randomized Controlled Trial of 0.5% and 5% 5-Fluorouracil After Microneedling for Treatment of Facial Actinic Keratoses.

INTRODUCTION: Topical 5-fluorouracil (5-FU) is used to treat actinic keratosis, although side effects limit treatment. Microneedling might be a tool for reducing treatment duration. OBJECTIVE: To evaluate microneedling to promote 5-FU delivery at different concentrations (0.5% and 5%) for actinic keratoses (AKs) treatment. METHODS: Forty-four patients with facial AKs subjected to 1.0 mm microneedling on 1 side of the face were randomized into 5% 5-FU or 0.5% 5-FU groups. Evaluations of efficacy and safety were conducted on days 21 and 111. RESULTS: Forty-four patients aged 47 to 85 years were enrolled. Complete clearance of AKs was similar within groups for the side of the face treated with microneedling and 5-FU and the side treated with 5-FU alone in both the 5% and 0.5% 5-FU groups. Microneedling and 5% 5-FU was superior to microneedling and 0.5% 5-FU to reduce AKs (p = .025). Microneedling and 5% 5-FU resulted in fewer adverse effects than 5% 5-FU alone (p = .011). CONCLUSION: Topical 5% and 0.5% 5-FU delivery for 3 days after microneedling was effective for treating facial AKs and equivalent to 5% and 0.5% 5-FU alone for 15 days after 3 months of follow-up. Microneedling may potentiate 5-FU treatment, reducing treatment time without losing efficacy.

Dermatoscopic Patterns of Nonfacial Actinic Keratosis: Characterization of Pigmented and Nonpigmented Lesions.

BACKGROUND: Actinic keratoses (AKs) are dysplastic proliferations of keratinocytes. Studies evaluating nonfacial dermatoscopic pattern of AKs are scarce. OBJECTIVE: This study aimed to evaluate the dermatoscopic patterns of AKs located in nonfacial sites and to compare their patterns with facial lesions. MATERIALS AND METHODS: Patients with concomitant facial and nonfacial AKs were recruited to participate and evaluated by clinical and dermatoscopic images of their AKs. RESULTS: Sixty-eight patients were included in the study. A total of 258 nonfacial AKs and 68 facial AKs were analyzed. The most frequent nonfacial AK dermatoscopic structures were white opaque scales (97.3%) and erythema (57.4%). When analyzed in combination, white scales plus erythema were found in 55.4% of nonfacial AKs. Pigmented structures were observed in 22.5% nonfacial AKs. Homogeneous brown pigmentation was the most prevalent pigmented structure in nonfacial pigmented AK (pAK) (93.1%). There was a positive association between patients having concomitant pigmented facial and nonfacial AKs (p < .001). CONCLUSION: The combinations of erythema and white opaque scales or yellow opaque scales and homogeneous pigmentation are suggestive, respectively of nonpigmented and pigmented nonfacial AKs. Pigmented AKs occur concomitantly in facial and nonfacial areas.

Dermoscopy of skin infestations and infections (entomodermoscopy) - Part I: dermatozoonoses and bacterial infections.

Dermoscopy is an essential in vivo diagnostic technique in the clinical evaluation of skin tumors. Currently, the same can also be said about its implications when approaching different clinical situations in Dermatology. A growing number of reports on dermatological scenarios and diseases have been published, in which dermoscopy has been of great diagnostic help. The term "entomodermoscopy" was coined to describe dermoscopic findings in skin infestations and also in dermatoses of infectious etiology. In part I of this article, the main dermoscopic descriptions of zoodermatoses and bacterial infections will be addressed. In many of them, such as scabies, pediculosis, myiasis, and tungiasis, it is possible to identify the pathogen and, consequently, attain the diagnosis more quickly and use the technique to follow-up therapeutic effectiveness. In other situations that will be described, dermoscopy can allow the observation of clinical findings with greater detail, rule out differential diagnoses, and increase the level of confidence in a clinical suspicion.

Dermoscopy of skin infestations and infections (entomodermoscopy) - Part II: viral, fungal and other infections.

In addition to the infestations and bacterial infections reported in part I, the study of entomodermoscopy also involves descriptions of dermoscopic findings of a growing number of viral and fungal infections, among others. In this article, the main clinical situations in viral infections where dermoscopy can be useful will be described, that is in the evaluation of viral warts, molluscum contagiosum, and even in recent scenarios such as the COVID-19 pandemic. As for fungal infections, dermoscopy is particularly important, not only in the evaluation of the skin surface, but also of skin annexes, such as hairs and nails. The differential diagnosis with skin tumors, especially melanomas, can be facilitated by dermoscopy, especially in the evaluation of cases of verruca plantaris, onychomycosis and tinea nigra.

Actinic keratoses: review of clinical, dermoscopic, and therapeutic aspects.

Actinic keratoses are dysplastic proliferations of keratinocytes with potential for malignant transformation. Clinically, actinic keratoses present as macules, papules, or hyperkeratotic plaques with an erythematous background that occur on photoexposed areas. At initial stages, they may be better identified by palpation rather than by visual inspection. They may also be pigmented and show variable degrees of infiltration; when multiple they then constitute the so-called field cancerization. Their prevalence ranges from 11% to 60% in Caucasian individuals above 40 years. Ultraviolet radiation is the main factor involved in pathogenesis, but individual factors also play a role in the predisposing to lesions appearance. Diagnosis of lesions is based on clinical and dermoscopic examination, but in some situations histopathological analysis may be necessary. The risk of transformation into squamous cell carcinoma is the major concern regarding actinic keratoses. Therapeutic modalities for actinic keratoses include topical medications, and ablative and surgical methods; the best treatment option should always be individualized according to the patient.

Vohwinkel syndrome: ichthyosiform variant in a family.

Vohwinkel syndrome belongs to the group of hereditary palmoplantar keratoderma, having an autosomal dominant inheritance. In this report, the authors present a case of a four-year-old boy with diffuse scaling over his entire body and transgredient palmoplantar hyperkeratosis with some fissured areas. Family evaluation revealed that his mother and other family members were affected. Based on his clinical findings and on family history, the diagnosis of the ichthyotic Vohwinkel syndrome subtype, characterized by generalized ichthyosis and palmoplantar hyperkeratosis, was established.

Evaluation of cutaneous rejuvenation associated with the use of ortho-silicic acid stabilized by hydrolyzed marine collagen.

BACKGROUND: Organic silicon plays an important role in dermal structure by promoting neocollagenesis. Thus, the supplementation of silicon in a highly bioavailable form can be used for skin rejuvenation. AIMS: This study aimed to evaluate skin changes associated with the use of ortho-silicic acid stabilized by hydrolyzed collagen. PATIENTS/METHODS: Patients were randomized to receive 600 mg of ortho-silicic acid stabilized by hydrolyzed collagen (group 1, n = 11) or placebo (group 2, n = 11) to be taken 15 minutes before breakfast for 90 days. Clinical, photographical, and patients' subjective evaluations were conducted. RESULTS: A total of 22 patients were included. Clinical evaluations demonstrated changes in skin texture, firmness, and hydration statistically superior in group 1. Brightness, firmness, and overall appearance showed trends for a difference favoring group 1 according to patients' subjective evaluations. Objective images showed no statistical differences. No side effects, hypersensitivity, or systemic symptoms were observed in group 1. Treatment satisfaction in group 1 reached 80%. CONCLUSIONS: Ortho-silicic acid stabilized by hydrolyzed collagen in a daily dose of 600 mg showed positive results in skin rejuvenation according to clinical evaluation in firmness, hydration, and skin texture. Further studies with larger and representative samples should be conducted to confirm our results.

Secondary syphilis: The great imitator can't be forgotten.

Syphilis is an infection caused by Treponema pallidum, mainly transmitted by sexual contact. Since 2001, primary and secondary syphilis rates started to rise, with an epidemic resurgence. The authors describe an exuberant case of secondary syphilis, presenting with annular and lichen planus-like lesions, as well as one mucocutaneous lesion. Physicians must be aware of syphilis in daily practice, since the vast spectrum of its cutaneous manifestations is rising worldwide.

Dermoscopy of skin infestations and infections (entomodermoscopy) - Part II: viral, fungal and other infections,

Abstract In addition to the infestations and bacterial infections reported in part I, the study of entomodermoscopy also involves descriptions of dermoscopic findings of a growing number of viral and fungal infections, among others. In this article, the main clinical situations in viral infections where dermoscopy can be useful will be described, that is in the evaluation of viral warts, molluscum contagiosum, and even in recent scenarios such as the COVID-19 pandemic. As for fungal infections, dermoscopy is particularly important, not only in the evaluation of the skin surface, but also of skin annexes, such as hairs and nails. The differential diagnosis with skin tumors, especially melanomas, can be facilitated by dermoscopy, especially in the evaluation of cases of verruca plantaris, onychomycosis and tinea nigra.

Dermoscopy of skin infestations and infections (entomodermoscopy) - Part I: dermatozoonoses and bacterial infections

Abstract Dermoscopy is an essential in vivo diagnostic technique in the clinical evaluation of skin tumors. Currently, the same can also be said about its implications when approaching different clinical situations in Dermatology. A growing number of reports on dermatological scenarios and diseases have been published, in which dermoscopy has been of great diagnostic help. The term ‟entomodermoscopy" was coined to describe dermoscopic findings in skin infestations and also in dermatoses of infectious etiology. In part I of this article, the main dermoscopic descriptions of zoodermatoses and bacterial infections will be addressed. In many of them, such as scabies, pediculosis, myiasis, and tungiasis, it is possible to identify the pathogen and, consequently, attain the diagnosis more quickly and use the technique to follow-up therapeutic effectiveness. In other situations that will be described, dermoscopy can allow the observation of clinical findings with greater detail, rule out differential diagnoses, and increase the level of confidence in a clinical suspicion.

Associação entre o uso de laser de CO2 fracionado ablativo e laser Q-switched Nd: YAG 1064nm para remoção de tatuagem / Association of fractional CO2 laser and Q-switched Nd: YAG 1064 nm laser for tattoo removal

Lasers Q-switched são os mais utilizados para remoção de tatuagens. Paciente feminina, de 48 anos, passou por consulta para remoção de tatuagem preta na coxa esquerda. Foram realizadas dez sessões de laser Q-switched Nd:YAG 1064nm associado ao laser de CO2 fracionado com intervalos de 60 dias entre elas. Seis meses após a última sessão, houve remoção praticamente completa do pigmento, além de melhora da textura da pele. Lasers Q-switched removem tatuagens por meio do fenômeno fotoacústico. A associação com lasers fracionados ablativos é opção para tratamento de tatuagens com grande quantidade de pigmento ou em tatuagens com muitas cores, de difícil remoção.

Q-switched lasers are widely used for tattoo removal. A 48-year-old-woman with a black tattoo on the left thigh was submitted to ten sessions of Q-switched Nd:YAG 1064nm laser associated with fractional CO2 laser, performed every two months. Six months after treatment end, we observed almost complete tattoo removal, besides improvement in skin texture. Q-switched lasers promote tattoo removal by a photoacoustic phenomenon. The association with fractional ablative lasers is an option for intensely pigmented tattoos or for tattoos with several colors, which are hard to remove.

Angioqueratoma de Fordyce tratado com laser Nd: YAG 1064nm pulso longo / Angiokeratoma of Fordyce treated with long pulsed Nd: YAG 1064 nm laser

Introdução: angioqueratomas de Fordyce são pequenas pápulas violáceas, assintomáticas, localizadas no escroto, corpo do pênis ou nos grandes lábios. Vários métodos estão entre as opções terapêuticas, incluindo lasers. Relato do caso: homem, com múltiplas pápulas violáceas na bolsa escrotal, compatíveis com angioqueratomas de Fordyce. Foi realizado tratamento com uma única sessão de laser Nd:YAG de pulso longo. Discussão: o benefício do tratamento de angioqueratomas com lasers é permitir a coagulação dos vasos sem sangramento. Conclusão: embora sejam lesões vasculares benignas, angioqueratomas podem gerar preocupação estética. Dermatologistas devem estar cientes das opções de tratamento disponíveis

Introduction: Angiokeratoma of Fordyce are benign vascular lesions that present as small, asymptomatic, purple papule on the scrotum, shaft of the penis, or labia majora. Therapeutic options comprise several methods, including lasers. Case report: Men presented with multiple violaceous papules on the scrotum, compatible with angiokeratoma of Fordyce. The patient was treated with a single session of long pulsed Nd:YAG 1064 nm laser. Discussion: Treating angiokeratomas with lasers has the benefit of allowing vessel coagulation without bleeding. Conclusion: Even though these are benign lesions, patients seek treatment because of cosmetic concerns. Dermatologists should be aware of treatment options available.

Syndrome in question. A case of Cowden´s syndrome.

The authors describe a case of Cowden's syndrome in a female patient with classic cutaneous lesions, plus papillomatous lesions in the gastrointestinal tract and a previous history of thyroid carcinoma. Mucocutaneous lesions occur in 90% of Cowden's syndrome cases and are characterized by facial trichilemmomas, oral mucosal papillomas and benign acral keratoses. Sites of extracutaneous involvement include: the thyroid, gastrointestinal tract, breast and endometrial tissue. There is risk of malignancies in these organs and they need to be monitored with imaging tests. The early diagnosis of the syndrome by a dermatologist through mucocutaneous lesions enables the investigation and diagnosis of extracutaneous involvement.

Actinic keratoses: review of clinical, dermoscopic, and therapeutic aspects

Abstract Actinic keratoses are dysplastic proliferations of keratinocytes with potential for malignant transformation. Clinically, actinic keratoses present as macules, papules, or hyperkeratotic plaques with an erythematous background that occur on photoexposed areas. At initial stages, they may be better identified by palpation rather than by visual inspection. They may also be pigmented and show variable degrees of infiltration; when multiple they then constitute the so-called field cancerization. Their prevalence ranges from 11% to 60% in Caucasian individuals above 40 years. Ultraviolet radiation is the main factor involved in pathogenesis, but individual factors also play a role in the predisposing to lesions appearance. Diagnosis of lesions is based on clinical and dermoscopic examination, but in some situations histopathological analysis may be necessary. The risk of transformation into squamous cell carcinoma is the major concern regarding actinic keratoses. Therapeutic modalities for actinic keratoses include topical medications, and ablative and surgical methods; the best treatment option should always be individualized according to the patient.