RESUMO
INTRODUCTION: Idiopathic Palmoplantar Eccrine Hidradenitis (IPPH) is a rare neutrophilic derma tosis, with painful erythematous nodules of sudden onset in the plantar or palmoplantar region, in children without other underlying diseases. OBJECTIVE: To present a case that shows the main clinical and histological characteristics of this entity. CLINICAL CASE: 11-year-old girl with a 48-hours history of painful erythematous-violaceous nodules on the right foot plant associated with fever of up to 38.2 °C, with no history of interest except hyperhidrosis and intense exercising on previous days. Given the clinical suspicion of IPPH, a skin biopsy was performed, which showed inflammatory neutrophil infiltration around eccrine sweat glands and neutrophilic abscesses, confirming the diagnosis. Oral NSAIDs and rest were prescribed, with resolution of the lesions in 7 days. CONCLUSIONS: This case demonstrates the most important aspects of this entity, in many cases underdiagnosed, since it can be confused with other pathologies that occur with painful acral nodules, but have different pathogenic and therapeutic implications. To properly identify the IPPH allows preventing an unnecessary alarm, both patients and their parents, as in dermatologists and pediatricians themselves.
Assuntos
Dermatoses do Pé/diagnóstico , Hidradenite/diagnóstico , Dor Aguda/etiologia , Criança , Feminino , Dermatoses do Pé/complicações , Dermatoses do Pé/patologia , Hidradenite/complicações , Hidradenite/patologia , HumanosRESUMO
Genital ulcers are a rare entity in pediatric consultation, but they generate great family anxiety. Lipschütz ulcers are acute, painful, and self-limiting vulvar ulcers of unknown cause. These ulcers appear in young women who have not had previous sexual intercourse or after a period of sexual abstinence. We present a 10-year-old girl with painful vulvar ulcers with a 3-day history of diarrhea and fever before the onset of the lesions. A complete anamnesis and detailed physical examination were carried out and complementary tests were performed to investigate sexually and non-sexually transmitted disease; the results were negative. Symptomatic treatment was started; at one-month follow-up a complete resolution of ulcers confirmed the diagnosis of ulcer of Lipschütz.
Las úlceras genitales son una patología poco frecuente en las consultas de pediatría, pero que generan gran ansiedad familiar. Las úlceras de Lipschütz son úlceras vulvares agudas, dolorosas y autolimitadas de causa desconocida. Aparecen en mujeres jóvenes que no han tenido relaciones sexuales previas o tras un período de abstinencia. Paciente de 10 años con úlceras vulvares dolorosas que, tres días antes de la aparición de las lesiones, había presentado un cuadro de deposiciones diarreicas y fiebre. Se realizó una anamnesis y exploración física detallada y se llevaron a cabo diferentes pruebas complementarias para descartar enfermedades infecciosas de origen venéreo y no venéreo, todas ellas negativas. Se indicó tratamiento sintomático, y se observó, al mes, una completa resolución del cuadro, por lo que se confirmó el diagnóstico de úlceras de Lipschütz.
Assuntos
Úlcera Cutânea/patologia , Doenças da Vulva/patologia , Doença Aguda , Criança , Diagnóstico Diferencial , Feminino , Humanos , Úlcera Cutânea/diagnóstico , Doenças da Vulva/diagnósticoRESUMO
Resumen: Introducción: La Hidradenitis palmoplantar ecrina idiopática (HPPI) es una dermatosis neutrofílica infrecuente, que cursa con nódulos eritematosos dolorosos de comienzo brusco en regiones plantares o palmoplantares, en niños que no tienen otra enfermedad subyacente. Objetivo: Presentar un caso que ilustra las principales características clínicas e histológicas de la HPPI. Caso Clínico: Niña de 11 años evaluada por nódulos eritematovioláceos dolorosos en planta de pie derecho de 48 horas de evo lución y fiebre de hasta 38,2 °C, sin antecedentes de interés salvo hiperhidrosis y práctica intensa de ejercicio en los días previos. Ante la sospecha clínica de HPPI se realizó biopsia cutánea, que mostró infiltrado inflamatorio neutrofílico alrededor de glándulas sudoríparas ecrinas y abscesos de neutrófilos, confirmando el diagnóstico. Se indicaron antiinflamatorios no esteroidales orales y reposo, con resolución de las lesiones en 7 días. Conclusiones: Este caso demuestra los aspectos más importantes de la HPPI. Esta entidad en muchos casos es infradiagnosticada, dado que puede confundirse con otras patologías que también cursan con nódulos acrales dolorosos, pero tienen distintas implicacio nes patogénicas y terapéuticas. Identificar apropiadamente la HPPI permite evitar la alarma innece saria, tanto en pacientes y sus padres, como en los propios dermatólogos y pediatras.
Abstract: Introduction: Idiopathic Palmoplantar Eccrine Hidradenitis (IPPH) is a rare neutrophilic derma tosis, with painful erythematous nodules of sudden onset in the plantar or palmoplantar region, in children without other underlying diseases. Objective: To present a case that shows the main clinical and histological characteristics of this entity. Clinical Case: 11-year-old girl with a 48-hours history of painful erythematous-violaceous nodules on the right foot plant associated with fever of up to 38.2 °C, with no history of interest except hyperhidrosis and intense exercising on previous days. Given the clinical suspicion of IPPH, a skin biopsy was performed, which showed inflammatory neutrophil infiltration around eccrine sweat glands and neutrophilic abscesses, confirming the diagnosis. Oral NSAIDs and rest were prescribed, with resolution of the lesions in 7 days. Conclusions: This case demonstrates the most important aspects of this entity, in many cases underdiagnosed, since it can be confused with other pathologies that occur with painful acral nodules, but have different pathogenic and therapeutic implications. To properly identify the IPPH allows preventing an unnecessary alarm, both patients and their parents, as in dermatologists and pediatricians themselves.
Assuntos
Humanos , Feminino , Criança , Hidradenite/diagnóstico , Dermatoses do Pé/diagnóstico , Hidradenite/complicações , Hidradenite/patologia , Dor Aguda/etiologia , Dermatoses do Pé/complicações , Dermatoses do Pé/patologiaRESUMO
Las úlceras genitales son una patología poco frecuente en las consultas de pediatría, pero que generan gran ansiedad familiar. Las úlceras de Lipschütz son úlceras vulvares agudas, dolorosas y autolimitadas de causa desconocida. Aparecen en mujeres jóvenes que no han tenido relaciones sexuales previas o tras un período de abstinencia. Paciente de 10 años con úlceras vulvares dolorosas que, tres días antes de la aparición de las lesiones, había presentado un cuadro de deposiciones diarreicas y fiebre. Se realizó una anamnesis y exploración física detallada y se llevaron a cabo diferentes pruebas complementarias para descartar enfermedades infecciosas de origen venéreo y no venéreo, todas ellas negativas. Se indicó tratamiento sintomático, y se observó, al mes, una completa resolución del cuadro, por lo que se confirmó el diagnóstico de úlceras de Lipschütz.
Genital ulcers are a rare entity in pediatric consultation, but they generate great family anxiety. Lipschütz ulcers are acute, painful, and self-limiting vulvar ulcers of unknown cause. These ulcers appear in young women who have not had previous sexual intercourse or after a period of sexual abstinence. We present a 10-year-old girl with painful vulvar ulcers with a 3-day history of diarrhea and fever before the onset of the lesions. A complete anamnesis and detailed physical examination were carried out and complementary tests were performed to investigate sexually and non-sexually transmitted disease; the results were negative. Symptomatic treatment was started; at one-month follow-up a complete resolution of ulcers confirmed the diagnosis of ulcer of Lipschütz.
Assuntos
Humanos , Feminino , Criança , Úlcera Cutânea/patologia , Doenças da Vulva/patologia , Úlcera Cutânea/diagnóstico , Doenças da Vulva/diagnóstico , Doença Aguda , Diagnóstico DiferencialRESUMO
La escabiosis o sarna es la infestación cutánea por el ácaro Sarcoptes scabiei var. hominis, cuyo diagnóstico generalmente es clínico, pudiendo confirmarse mediante el test de Müller o, de forma sencilla y fiable, mediante estudio dermatoscópico. Se presenta un caso representativo de escabiosis en lactante y los hallazgos dermatoscópicos patognomónicos en un lactante de 6 meses de edad. Con la sospecha de escabiosis se realizó estudio con dermatoscopia de luz polarizada, confirmando el diagnóstico al visualizar surcos acarinos y lesiones en ala delta. Además, se realizó el test de Müller, observando el ácaro en el examen directo al microscopio óptico tras raspado de piel lesionada. Con este caso se pretende recordar la clínica típica con las características distintivas de la escabiosis en lactantes, y los principales métodos que permiten confirmar el diagnóstico, con especial relevancia de la dermatoscópica como técnica sencilla e inocua
Scabies, a skin infestation caused by Sarcoptes scabiei var. hominis, is generally easy to diagnose because of its characteristic clinical features. The diagnosis can be confirmed by the Müller test or by dermoscopy, a non-invasive, painless, and highly accurate technique. We present a representative case of infantile scabies with pathognomonic dermoscopic findings, in a 6-month-old girl referred for evaluation of a 2-week dermatitis. Under suspicion of scabies, a dermoscopy examination was performed, confirming the diagnosis by showing a distinctive dermoscopic feature composed of a S-shaped furrow with a triangle on one of its endings, known as delta wing jet sign. In addition, Müller test was performed, observing the mite on direct microscope examination after scraping one of the skin injuries. This case is a reminder of the typical clinical presentation of scabies in infants and the main methods that allow us to confirm the diagnosis. We want to highlight the usefulness of dermoscopy, as it is a simple and innocuous technique