Adult tinea capitis and tinea barbae in a tertiary Portuguese hospital: A 11-year audit.

Adult tinea capitis and tinea barbae are nowadays considered uncommon in developed countries. Despite their potential for morbidity and healthcare costs, few series have attempted to characterise these infectious disorders. We conducted a cross-sectional study to analyse the epidemiological, clinical and mycological characteristics of adult tinea capitis and tinea barbae of a large tertiary centre in Southern Europe. All adult patients with a mycological-confirmed tinea capitis or barbae over a 11-year period (January 2008 to December 2018) were considered for the analysis. Concerning tinea capitis, 860 culture-confirmed diagnoses were made during this 11-year period, of which only 15 (1.5%) occurred in adults (15 patients). A disproportionately high number of patients were female and immunocompromised. Microsporum audouinii (20%) and Trichophyton rubrum (20%) were the most common isolates. Half of the cases were initially misdiagnosed. Regarding tinea barbae, 7 cases were diagnosed over this time period. Overuse of topical steroids was widespread in this population. Trichophyton rubrum was the infectious agent in all cases. Initial misdiagnosis was very common (43%). Adult tinea capitis and tinea barbae can still be observed in contemporary practice and remain a public health concern, with the immunosuppressed patient being particularly affected. Initial misdiagnosis is a common occurrence. Anthropophilic fungi are now the most common aetiologic agents of these infections, and they will probably continue to do so as the large urban centres expand peripherally. Awareness for this diagnosis is necessary to prevent unwarranted morbidity and costs.

Trichloroacetic acid (80%) as a chemical debridement method for chronic venous leg ulcers-A pilot study.

Debridement is essential for the optimal care of venous leg ulcers. Several debridement methods with different limitations may be deployed. Trichloroacetic acid (TCA) is used for several dermatological purposes. Its application as a chemical debridement method for leg ulcers has never been explored. We designed a prospective study to determine the role of 80% TCA solution as a chemical debridement method for leg ulcers, regarding efficacy and procedure-associated pain. Chronic venous leg ulcers were treated with 3 cycles of 80% TCA solution or curettage over 1 week. Pain and the mean percentage of fibrin and devitalized tissue covering wound bed were evaluated. At the end of the study, a trend towards larger fibrin mean reduction among the TCA treated ulcers was observed, although this difference was not statistically significant (P = .35). The mean pain score after TCA application was significantly reduced compared to pain after curettage alone (P < 0.001). TCA presented several advantages over mechanical debridement: it is a more selective debridement method, has haemostatic properties, and a simpler and faster application. The 80% TCA solution may be a cheap, simple, and considerably less-painful chemical debridement method for venous leg ulcers compared to classical mechanical debridement.

Subacute radiation dermatitis following an interventional cardiology procedure.

Although radiation dermatitis is a widely known complication of radiotherapy, its association with fluoroscopy-guided interventional procedures is yet under recognized. We present a case of a 66-year-old man with a left scapular cutaneous lesion, initially diagnosed as a fixed drug eruption. The subsequent knowledge of a previous percutaneous aortic paravalvular leak closure procedure allowed a correct clinicopathological correlation and the final diagnosis of subacute radiodermatitis associated with fluoroscopy. Many of the patients with skin injury associated with fluoroscopic procedures do not associate both and seek physicians other than the one who performed the procedure. Besides interventional physicians, dermatologists and other physicians should be aware of this form of radiation injury and its manifestations. Suspicion and active search for a history of previous fluoroscopic procedures in patients with figurate cutaneous lesions in allusive locations may allow the diagnosis of this potentially serious complication that should have long follow-up due to the possibility of long-term side effects.

Dakin's solution: is there a place for it in the 21st century?

Dakin's solution (DS) is a time-honoured antiseptic that still remains part of the wound care armamentarium. In spite of its cytotoxicity, some question its use in the current era. We report the case of a 52-year-old diabetic woman who was admitted for sepsis because of a severely infected diabetic foot. Urgent surgical drainage and debridement left a 9 × 9-cm deep, complex, infected wound with both bone and tendon involvement. Treatment with local negative pressure was unsuccessful. DS was regularly instilled through a tube left in the wound dressing. A marked improvement was observed with this strategy as the wound bed was much cleaner and fully granulated after 6 weeks. No adverse effects were noted. This case debunks the myth that topical antiseptics necessarily impair wound healing. DS can still be considered an option for difficult-to-treat, complex and heavily infected wounds.

Chronic leg ulcers disrupt patients' lives: A study of leg ulcer-related life changes and quality of life.

Chronic leg ulcers have a profound impact on patients' physical, functional, and psychological status, which may result in several life changes and a significant decline in quality of life (QoL). We aimed to study what changed in patients' lives after developing a chronic leg ulcer, including QoL, patients' comprehension of the disease and related feelings. A cross-sectional study, using an anonymous questionnaire and the Dermatology Life Quality Index (DLQI) was performed. Chronic leg ulcers were life changing events, causing abandonment of work in almost 80% of the patients and important limitations in daily activities and autonomy. Familial relationships changed in more than half of the patients. Almost 15% hid or would like to hide their disease from others, especially patients with a shorter duration of disease. QoL was very or extremely affected in 18.2% of the participants completing the DLQI.

Combined Use of Ex Vivo Dermoscopy and Histopathology for the Diagnosis of Melanocytic Tumors.

Dermoscopy can be applied to fixed tissues, and dermoscopic patterns correlate with microscopic findings. Data on the influence of ex vivo dermoscopy on pathologic diagnosis of melanocytic lesions are limited. Therefore, we aimed to determine whether this technique could aid on the histopathological evaluation of melanocytic neoplasms. Sequential cutaneous excisional biopsies of melanocytic lesions and their corresponding ex vivo dermoscopic images were prospectively analyzed. Additional sectioning was executed in areas of dermoscopic concern, having, by reference, a dermoscopic mapping of the sectioned specimens. Diagnostic differences before and after analyzing the new dermoscopy-guided sections were registered. A total of 564 melanocytic lesions were examined, and additional cuts were considered necessary in 84 (14.9%) cases. Of these, 11 lesions (13.1%) had a different final diagnosis after dermoscopy-guided specimen sectioning, including 3 lesions that were reclassified as melanomas and 2 melanomas that were restaged. We found that the combined use of ex vivo dermoscopy and histopathology improves clinical-pathological correlation and allows selection of representative areas for sectioning. Altogether, this technique may improve diagnostic confidence and accuracy in the histopathological evaluation of melanocytic lesions.

Diagnostic Delay in Hidradenitis Suppurativa: Still an Unsolved Problem.

Introduction: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with a diagnostic delay of 7-10 years. A later diagnosis is associated with development of local sequelae and systemic comorbidities, as well as a reduced response to medical treatment. The aim of this study was to analyze the time required for HS diagnosis and investigate factors associated with diagnostic delay. Method: A retrospective observational study was conducted based on clinical records from HS patients followed at a tertiary hospital, with diagnosis between January 2006 and December 2022. Results: A total of 285 patients were included. The mean diagnostic delay was 10.1 years, and there was no difference in time to diagnosis during the considered period. A diagnostic delay of more than 5 years was significantly associated with an earlier onset of symptoms, location on breasts and thighs, follicular phenotype, and with cardiovascular and psychiatric comorbidities. Smoking and body mass index ≥25 kg/m2 were also associated with a longer diagnostic delay. A personal history of acne and a greater disease severity were associated with an earlier diagnosis. Conclusions: This study reveals the lack of improvement in the diagnostic delay in HS and highlights its association with atypical clinical manifestations and systemic comorbidities, scarcely reported in literature.

[Guidelines for the Management of Patients with Hidradenitis Suppurativa]. / Recomendações na Abordagem do Doente com Hidradenite Supurativa.

Hidradenitis suppurativa is a chronic and recurrent inflammatory dermatosis characterized by the presence of inflammatory nodules and abscesses in the apocrine gland-rich areas that may progress to suppurative fistulas and scars. Despite being considered one of the dermatological conditions with the greatest impact on patient quality of life, it is often underdiagnosed. Hidradenitis suppurativa, especially in its severe forms, is associated with numerous comorbidities, so a holistic and multidisciplinary perspective is crucial for the management of these patients. The therapeutic approach is complex and challenging. The medical treatment options are diverse and must be adapted to clinical presentation and disease severity. Surgical therapy should be considered as an adjuvant to medical treatment, particularly in refractory cases and in the presence of scars or anatomical and/or functional mutilation. These recommendations reflect the main aspects of the management of the patient with hidradenitis suppurativa and are addressed to all healthcare professionals who take part in their follow-up.

A hidradenite supurativa é uma dermatose inflamatória crónica e recorrente que se caracteriza pela presença de nódulos inflamatórios e abcessos nas áreas ricas em glândulas apócrinas, que podem evoluir para fístulas supurativas e cicatrizes. Apesar de ser considerada uma das patologias dermatológicas com maior impacto na qualidade de vida dos doentes, é frequentemente subdiagnosticada. A hidradenite supurativa, sobretudo nas suas formas mais graves, associa-se a diversas comorbilidades, pelo que é fundamental adotar uma perspetiva holística e multidisciplinar na gestão destes doentes. A abordagem terapêutica é complexa e desafiante. A terapêutica médica é multifacetada e deve ser adaptada à apresentação clínica e gravidade da doença. A terapêutica cirúrgica deverá ser equacionada como adjuvante à terapêutica médica, em particular nos casos refratários e perante cicatrizes ou mutilação anatómica e/ou funcional. As presentes recomendações pretendem reunir os principais aspetos da abordagem ao doente com hidradenite supurativa e destinam-se a todos os profissionais de saúde envolvidos no seu acompanhamento.

[Microbiological profile and antibiotic susceptibility patterns of organisms isolated from diabetic foot ulcers in a Portuguese hospital]. / Caracterização do perfil microbiológico e de sensibilidade antimicrobiana dos microorganismos isolados em úlceras diabéticas de doentes de um hospital Português.

OBJECTIVES: To determine the microbiological profile and antibiotic susceptibility patterns of organisms isolated from diabetic foot ulcers in a Portuguese hospital. METHODS: Microbiological data from ambulatory and hospitalized patients with diabetic foot infection during the year 2010 were retrospectively analysed. The profile of the isolated organisms was identified, regarding their prevalence both in the outpatient and inpatient settings. Multidrug-resistant organisms ( MDRO ) under surveillance program at the hospital and their antibiotic susceptibility tests were analysed. RESULTS: Gram-positive aerobes were most frequently isolated ( 59.6 % ) from outpatient diabetic foot ulcers. Staphylococcus was the main genus identified ( 49.8 % ), of which 70.0 % were methicillin-sensitive Staphylococcus aureus. Considering samples obtained from hospitalized patients, Gram-negative aerobes were dominant ( 63.3 % ), mainly Pseudomonas aeruginosa ( 35.5 % ). Staphylococcus aureus represented 22.2 % of all isolates, with 60.0 % methicillin-resistance. Extended spectrum ß-lactamase production and methicillin resistance was noted in 35.0 % and 38.0 % of all bacterial isolates, respectively. High levels of resistance were also documented for Pseudomonas aeruginosa and Acinetobacter baumannii complex. CONCLUSIONS: Epidemiological differences seem to exist between the outpatient and inpatient settings concerning the microbiological profile of clinically infected diabetic foot ulcers. MDRO are prevalent in this study. Other studies are needed in order to adapt empirical therapy to the portuguese reality.

Intermammary Hidradenitis Suppurativa: Considerations on a Unique Presentation.

INTRODUCTION: Hidradenitis suppurativa (HS) is a potentially disabling chronic inflammatory disease. The intermammary location, not clearly specified in the usual phenotypic classifications, entails significant functional and cosmetic compromise. CASE PRESENTATION: Eleven cases of predominantly intermammary disease with multiple fistulization and disfiguring scarring were observed at our Department between January 2016 and March 2020. They were young (mean age = 22 years) obese or overweight women, in which the medical-surgical approach has led to variable results. DISCUSSION/CONCLUSION: Intermammary HS possibly represents a unique phenotypic presentation, likely to be fistulizing and severe. We believe that anatomo-functional considerations, which can be paralleled to pilonidal sinus disease, contribute to its pathophysiology and striking appearance, and further emphasize the importance of multidisciplinary endeavor to reduce the morbidity associated with this seemingly overlooked location.

Multiple miliary osteoma cutis: a comprehensive review and update of the literature.

Multiple miliary osteoma cutis consists of heterotopic foci of bone tissue in the dermis and subcutaneous tissue. Patients usually present with multiple, asymptomatic facial papules of several millimetres in diameter which cause distress regarding their cosmetic appearance. The condition is described as rare, as only a few cases have been reported since its first description in 1864 by Virchow. We therefore carried out a comprehensive literature search and review, in which 102 published cases were retrieved and analysed. The demographic and clinical aspects, as well as current therapy solutions, of this probably overlooked condition are discussed.

Conscious sedation with inhaled 50% nitrous oxide/oxygen premix in photodynamic therapy sessions for vulvar lichen sclerosus treatment.

Photodynamic therapy has been described as an effective therapeutic option in selected cases of anogenital lichen sclerosus that are refractory to first-line treatments. However, procedure-related pain is a limiting factor in patient adherence to treatment. The authors report the case of a 75-year-old woman with highly symptomatic vulvar lichen sclerosus, successfully treated with photodynamic therapy. An inhaled 50% nitrous oxide/oxygen premix was administered during sessions, producing a pain-relieving, anxiolytic, and sedative effect without loss of consciousness. This ready-to-use gas mixture may be a well-tolerated and accepted alternative to classical anesthetics in Photodynamic therapy, facilitating patients' adherence to illumination of pain-prone areas.

Onychomycosis in patients with chronic leg ulcer and toenail abnormalities.

Nails have a limited number of reactive patterns to disease. Accordingly, toenail changes of different etiologies may mimic onychomycosis. OBJECTIVE To determine the prevalence of toenail onychomycosis among patients with leg ulcer and toenail abnormalities attending a dermatology clinic. METHODS A cross-sectional study was conducted through the analysis of clinical records and results of mycological examination. RESULTS A total of 81 patients were included, with a median age of 76.0 years. Most ulcers were of venous etiology, followed by those of mixed and arterial pathogenesis. The mycological evaluation confirmed the diagnosis of onychomycosis in 27.2% of the patients. The etiologic agent was a dermatophyte in 59.1% of isolates in nail samples, while Trichophyton interdigitale was the most frequent fungal species (40.9%). CONCLUSIONS Most toenail abnormalities in patients with chronic leg ulcer were not onychomycosis. This study highlights the importance of systematic mycological examination in these patients, in order to avoid overtreatment with systemic antifungals, unnecessary costs and side effects.

Porokeratosis ptychotropica of the scrotum: dermoscopic evaluation of an atypical presentation.

Porokeratosis ptychotropica is a rare variant of porokeratosis that is classically located on the gluteal and perianal regions, seldom extending to the genitalia. The authors report an atypical presentation of porokeratosis ptychotropica and discuss the use of dermoscopy in evaluating this dermatosis. Dermoscopic findings, although not specific to this variant of porokeratosis, are helpful in the differential diagnosis of other genital disorders. Histopathology, through the visualization of multiple cornoid lamellae, prevails as the gold standard for the definite diagnosis of porokeratosis ptychotropica.