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Introduction: Discoid lupus erythematosus can affect periungual tissues leading to onychodystrophy. Squamous cell carcinoma can occur in persistent scars of discoid lupus; this rare occurrence has not yet been reported on the nail unit. Case presentation: we report a case of squamous cell carcinoma occurring on the distal phalanx of the thumb in a patient with longstanding periungual discoid lupus on several fingernails. Discussion: Periungual discoid lupus erythematosus is rare. The scars caused by this disease can very rarely develop into squamous cell carcinoma. This is the first report of this occurrence at the periungual tissues.

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Contexto: A pandemia da doença do coronavírus (COVID-19) revelou uma miríade de manifestações sistêmicas e cutâneas possivelmente relacionadas à infecção por síndrome respiratória aguda grave ocasionada pelo coronavírus (SARS-CoV-2). O comprometimento pulmonar é a causa mais frequente de hospitalização e a progressão para síndrome respiratória aguda grave geralmente requer tratamento com ventilação mecânica na posição pronada. Períodos prolongados e repetidos de pronação aumentam o risco de complicações, incluindo úlcera de pressão, cegueira e neuropatia periférica. Descrição do caso: Relatamos três casos de complicações cutâneas relacionadas à ventilação em pronação avaliadas durante interconsultas no maior hospital terciário universitário da América Latina, e salientamos potenciais causas e medidas de prevenção. Discussão: Complicações da ventilação em pronação para tratamento da COVID-19 são provavelmente resultantes da interação entre múltiplos fatores, dentre os quais as condições clínicas do paciente, períodos prolongados na posição pronada e limitações para mudanças de decúbito. Conclusões: Medidas de prevenção para complicações da pronação e diagnóstico precoce são fundamentais para evitar aumento da morbidade e sequelas graves e irreversíveis associadas à COVID-19.

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INTRODUCTION: The use of thermography in the medical field has been experiencing a renaissance due to advances in the infrared thermographic imaging technology, which improves thermographic equipment and promises cost saving and increased safety. Dermatology is one of the most promising fields of application among the medical areas with potential for the use of thermography. OBJECTIVE: To review the findings on this subject and to describe the use of such technique for dermatology and aesthetic applications. METHODS: A bibliographic survey was carried out, selecting relevant publications and guidelines, focused on monitoring medical diagnostic applications and benefits of thermography for dermatology, inflammatory skin diseases, and aesthetic applications. RESULTS: Inflammatory skin diseases lead to changes of the IRT image. A quantification of treatment effects and monitoring changes on skin can be possible by repeated measurements over time. CONCLUSION: Infrared imaging is a noninvasive, powerful tool in the diagnosis and clinical management of skin conditions and monitoring of aesthetic procedures.

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BACKGROUND: The lesions of porokeratosis (PK) lead to skin atrophy and scarring as long as they spread centrifugally. PK affecting the nail unit is seldom described. OBJECTIVE: The aim was to revise the previously reported cases of ungual PK and to present 3 new cases. METHODS: A PubMed search was performed with the keywords "nail" and "porokeratosis." Previously reported cases as well as 3 new cases are depicted in tables. RESULTS: Only 11 cases of ungual PK were found; 3 new cases have been added. All patients presented with typical lesions of PK (Mibelli, isolated, segmental, or ostial eccrine types) that happened to affect nails due to nail matrix or nail bed compromise, resulting in mild to severe nail scarring, including irreversible anonychia. The present 3 case series contrast with the previous single case reports. CONCLUSIONS: PK affecting the nails is exceedingly rare. Changes in nails affected by PK are irreversible, since, as on the skin, this is a chronic scarring process.

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BACKGROUND: Lichen planus (LP) can lead to severe scarring of the nail unit leading to anonychia. There are very few reports of squamous cell carcinoma (SCC) occurring in the lesions of ungual LP. OBJECTIVE: The aim of this study was to revise the previously reported cases of SCC appearing in ungual LP and to present a new case. METHODS: A PubMed search was performed with the terms "nail lichen planus" and "squamous cell carcinoma." Reported cases as well as a new case were depicted in a table. RESULTS: Only 2 indexed articles reporting 3 cases were found. All patients suffered of long-lasting scarring ungual LP. CONCLUSIONS: The occurrence of SCC in nail LP is rare. LP is not "premalignant" per se, but SCC might rarely arise in LP scars.

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A onicocriptose é afecção bastante comum em adolescentes e adultos jovens. Muitos tratamentos já foram descritos, conservadores e clínicos. Descrevemos a padronização da técnica de cirurgia de onicocriptose com fenol 88% realizada desde 2009 no ambulatório de dermatologia ligado a um serviço universitário.

Onychocryptosis is a common condition in adolescents and young adults. Many conservative and clinical treatments have already been described. The authors of the present paper describe the standardization of the onychocryptosis surgical technique using 88% phenol, which is performed at a university hospital's dermatology outpatient clinic since 2009.

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BACKGROUND: Nail apparatus melanoma (NAM) is rare. The higher mortality reported in the literature is most likely due to advanced disease associated with delayed diagnosis and treatment. OBJECTIVE: All patients diagnosed with NAM were followed at a single reference center during a period of 10 years, with emphasis on dermatological and histological findings. Clinical outcomes were included. METHODS: A retrospective review of medical records, photographs, and histopathological examination. RESULTS: 73.7% of the patients were female and their mean age was 47 years. Caucasian and African-American patients had a similar incidence (47.4%). There was only 1 Asian patient in this study (5.3%). All patients presented with nail plate pigmentation. The mean prediagnosis duration was 33 months. A total of 63.2% patients had in situ melanoma and an average Breslow index of 2.18 mm in invasive cases. Fifteen patients underwent conservative surgery and 3 underwent phalanx amputation. All patients survived, and 4 have had more than a 5-year follow-up. CONCLUSION: In situ lesions showed longitudinal bands or total melanonychia with no nail dystrophy. Invasive cases presented with dystrophic lesions (longitudinal splitting of the nail). Conservative surgery provides a good option without worsening the prognosis. All dermatologists should be aware of early signs of NAM, since prognosis depends on early treatment.

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BACKGROUND: It is estimated that there are around 7 billion mobile phone subscriptions worldwide. Considering the availability and convenience, it appears to be a suitable device for store-and-forward (SF) consultations. INTRODUCTION: Although teledermatology has been suggested as an effective way of reducing costs and providing otherwise inaccessible expert evaluation, most studies have relied on high cost and high technological means. MATERIALS AND METHODS: We conducted a study with inpatients that required dermatological evaluation in a high-complexity university hospital, accessing the correlation between traditional face-to-face evaluation and SF teledermatology, with data and pictures collected by medical students using smartphone cameras and then sent to consultants by e-mail. RESULTS: For 2 months, we evaluated 100 patients and, as a result, the total agreement between both consultation modalities was 54%, the partial agreement was 27%, and the disagreement was 19%. DISCUSSION: This study points out that SF teledermatology with the use of mobile phone is comparable to traditional face-to-face evaluation. Furthermore, most of the disagreements were probably related to the inexperience of the medical residents. CONCLUSION: Our study suggests that a smartphone-based teledermatology inpatient consultation model could be a reasonable option for hospitals lacking dermatological services. Also, it may be as or more effective than face-to-face consultations, if performed by a more experienced dermatologist. When feasible, photographing training should be performed.

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Meyerson nevi occur whenever a rare focal and transitory eczematous eruption arises around melanocytic lesions. The same phenomenon has also been observed in non-melanocytic lesions as well. Herein we report the case of a 25 year old, male patient, who had noticed, two months before, the arising of a pruriginous and erithematous halo around two nevi localized on his abdomen. The lesions were found to be atypical on dermoscopic examination and he was submitted to surgical excision of both nevi. Histopathological examination revealed displastic compound melanocytic nevi, surrounded by intraepidermical vesicles and spongiosis. Present report suggests that Meyerson phenomenon does not seem to alter dermoscopic features of nevi.

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O nevo de Meyerson ocorre quando uma rara erupção eczematosa focal e transitória surge ao redor de lesões melanocíticas. O mesmo fenômeno também foi observado em lesões não melanocíticas. O caso relatado é o de um doente masculino, 25 anos, que há dois meses notara surgimento de eritema e prurido, circundando dois nevos, localizados no abdome. As lesões eram atípicas à dermatoscopia e procedeu-se à excisão cirúrgica dos dois nevos. O exame histopatológico revelou nevos melanocíticos compostos displásicos, envolvidos por espongiose e vesículas intraepidérmicas. O presente relato sugere que o fenômeno de Meyerson não modifica as características dermatoscópicas dos nevos.

Meyerson nevi occur whenever a rare focal and transitory eczematous eruption arises around melanocytic lesions. The same phenomenon has also been observed in non-melanocytic lesions as well. Herein we report the case of a 25 year old, male patient, who had noticed, two months before, the arising of a pruriginous and erithematous halo around two nevi localized on his abdomen. The lesions were found to be atypical on dermoscopic examination and he was submitted to surgical excision of both nevi. Histopathological examination revealed displastic compound melanocytic nevi, surrounded by intraepidermical vesicles and spongiosis. Present report suggests that Meyerson phenomenon does not seem to alter dermoscopic features of nevi.

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In this report, we describe a case of disseminated sporotrichosis that was diagnosed by fine-needle aspiration biopsy (FNAB). The cytologic smears exhibited a large number of macrophages, few polymorphonuclear neutrophils and numerous round or oval, sometimes elongated, isolated and scattered yeast-like structures localized extracellularly or inside macrophages. These structures were clearly visualized by Giemsa and Papanicolaou methods. Cultures from skin biopsy material revealed fungal colonies which were subsequently identified as Sporothrix schenckii. The cytologic aspects, the correlation with histologic findings and the differential cytologic diagnosis were reviewed.

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A variante pigmentada da doença de Paget mamária é rara, com cerca de 12 casos relatados, e pode mimetizar clínica e histologicamente o melanoma. Como na forma clássica, em geral associa-se à neoplasia da mama acometida, com origem principalmente no carcinoma intraductal que se estende à epiderme através de ducto lactóforo. A fisiopatologia da hiperpigmentação permanece desconhecida. Relata-se o caso de paciente de 49 anos que apresentou lesão pigmentada do mamilo, suspeita de melanoma. O exame histológico não foi suficiente para confirmar o diagnóstico, sendo necessária realização de perfil imuno-histoquímico. Apesar de incomum, o diagnóstico de doença de Paget deve ser lembrado como diferencial de melanoma em lesões pigmentadas dessa região, em ambos os sexos.

Pigmented mammary Paget's disease is a rare dermatosis, with approximately 12 reported cases in the literature, which can mimic cutaneous melanoma both clinically and histologically. As for classical mammary Paget's disease, the pigmented variant is associated with neoplasia of the breast, originating mainly from intraductal mammary carcinoma that extends to the epidermis of the nipple and areola through a lactiferous duct. Physiopathology of hyperpigmentation remains unknown. We present a 49-year-old female patient who presented with a pigmented lesion of the nipple suspected of melanoma. Histological examination was not sufficient to confirm diagnosis. Immunohistochemical examination confirmed the diagnosis of Paget's disease. Although uncommon, pigmented Paget's disease must be reminded as a differential diagnosis of melanoma in pigmented lesions of the nipple, in both genders.

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A 46-year-old Brazilian man, with initial pustular lesions, neutrophilic spongiosis and subcorneal cleavage evolved to an atypical pemphigus phenotype, with suprabasal acantholysis. Interestingly, his autoantibody profile, tested by immunofluorescence, immunoblotting, enzyme-linked immunosorbent assay, and immunoprecipitation revealed exclusive IgG anti-desmoglein 1 antibodies in all phases of the disease.

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IgA pemphigus is a rare, neutrophilic, acantholytic skin disorder with approximately 70 cases described in the literature. We report two patients with the subcorneal pustular dermatosis (SPD) type of IgA pemphigus. Initially, both patients were misdiagnosed as subcorneal pustular dermatosis of Sneddon and Wilkinson. The correct diagnosis was only made after detecting intercellular IgA depositions in the epidermis by direct immunofluorescence. Immunoblotting (IB) of normal human epidermal extracts, performed on both sera, was negative for Dsg 1, Dsg 3, BP 230, BP 180, 210 kDa envoplakin, and 190 kDa periplakin. ELISA for desmogleins (Dsg 1 and Dsg 3) showed that neither of the cases had IgA antibodies to Dsg. The c-DNA transfection test for desmocollins (Dsc) revealed that the IgA antibodies of both patients reacted with desmocollin 1. This result supports the hypothesis that the autoantigen in SPD type IgA pemphigus is desmocollin 1.

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