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1.
An Bras Dermatol ; 90(1): 120-2, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25672311

RESUMEN

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.


Asunto(s)
Anestésicos por Inhalación/administración & dosificación , Sedación Consciente , Óxido Nitroso/administración & dosificación , Oxígeno/administración & dosificación , Fotoquimioterapia/métodos , Liquen Escleroso Vulvar/tratamiento farmacológico , Anciano , Femenino , Humanos , Reproducibilidad de los Resultados , Factores de Tiempo , Resultado del Tratamiento
2.
An Bras Dermatol ; 90(1): 136-9, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25672317

RESUMEN

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.


Asunto(s)
Úlcera de la Pierna/epidemiología , Uñas Malformadas/epidemiología , Onicomicosis/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Arthrodermataceae/aislamiento & purificación , Enfermedad Crónica , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Onicomicosis/etiología , Portugal/epidemiología , Prevalencia , Estadísticas no Paramétricas
3.
An. bras. dermatol ; 90(1): 120-122, Jan-Feb/2015. graf
Artículo en Inglés | LILACS | ID: lil-735734

RESUMEN

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.


Asunto(s)
Anciano , Femenino , Humanos , Anestésicos por Inhalación/administración & dosificación , Sedación Consciente , Óxido Nitroso/administración & dosificación , Oxígeno/administración & dosificación , Fotoquimioterapia/métodos , Liquen Escleroso Vulvar/tratamiento farmacológico , Reproducibilidad de los Resultados , Factores de Tiempo , Resultado del Tratamiento
4.
An Bras Dermatol ; 88(6 Suppl 1): 158-61, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-24346907

RESUMEN

Blastic plasmacytoid dendritic cell neoplasm is a rare and aggressive hematodermic neoplasia with frequent cutaneous involvement and leukemic dissemination. We report the case of a 76-year-old man with a 2 month history of violaceous nodules and a tumor with stony consistency, located on the head, and mandibular, cervical and supraclavicular lymphadenopathies. Multiple thoracic and abdominal adenopathies were identified on computerized tomography. Flow cytometry analysis of the skin, lymph node and bone marrow biopsies demonstrated the presence of plasmocytoid dendritic cell neoplastic precursor cells (CD4+, CD45+, CD56+ and CD123+ phenotype). After initial clinical and laboratorial complete remission with chemotherapy, the patient died due to relapse of the disease associated with the appearance of a cervical mass with medullary compromise.


Asunto(s)
Células Dendríticas/patología , Leucemia/patología , Neoplasias Cutáneas/patología , Anciano , Biopsia , Médula Ósea/patología , Resultado Fatal , Citometría de Flujo , Humanos , Masculino , Invasividad Neoplásica , Piel/patología
5.
An Bras Dermatol ; 88(6 Suppl 1): 203-5, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-24346920

RESUMEN

A 45-year-old woman with a history of renal carcinoma was observed for facial, cervical and truncal flesh-colored papules. Relatives had similar skin findings and a brother had repeated episodes of pneumothorax. The computerized tomography scan revealed multiple cysts on both lungs. A skin biopsy revealed a perifollicular fibroma. The clinical diagnosis of Birt-Hogg-Dubé syndrome (BHDS) was corroborated by identification of a novel frameshift c.573delGAinsT (p.G191fsX31) mutation in heterozygosity on exon 6 of the folliculin gene. The presence of multiple and typical benign hair follicle tumors highlights the role of the dermatologist in the diagnosis of this rare genodermatosis that is associated with an increased risk of renal cell cancer and pulmonary cysts, warranting personal and familial follow-up and counseling.


Asunto(s)
Síndrome de Birt-Hogg-Dubé/patología , Piel/patología , Biopsia , Síndrome de Birt-Hogg-Dubé/genética , Femenino , Humanos , Persona de Mediana Edad , Mutación , Proteínas Proto-Oncogénicas/genética , Proteínas Supresoras de Tumor/genética
6.
An. bras. dermatol ; 88(6): 1009-1010, Nov-Dec/2013. graf
Artículo en Inglés | LILACS | ID: lil-699012

RESUMEN

POEMS syndrome is a unique clinical entity, the diagnosis of which is made when polyneuropathy and monoclonal gammopathy occur together, associated with other changes such as organomegaly, endocrinopathy, skin changes and papilledema. Cutaneous manifestations are heterogeneous, with diffuse cutaneous hyperpigmentation, hemangiomas and hypertrichosis occurring more frequently. We report the case of a 65- year-old female patient with this syndrome, diagnosed after 15 years of disabling peripheral neuropathy.


A síndrome de POEMS é uma entidade clínica única cujo diagnóstico é colocado quando existe polineuropatia e gamapatia monoclonal associada a outras alterações tais como organomegalia, endocrinopatia, alterações cutâneas e papiledema. As manifestações cutâneas são heterogéneas, sendo as mais frequentes a hiperpigmentação cutânea difusa, os hemangiomas e a hipertricose. Relata-se o caso de uma doente de 65 anos com essa síndrome diagnosticada após 15 anos de neuropatia periférica.


Asunto(s)
Adolescente , Femenino , Humanos , Hipotricosis/congénito , Degeneración Macular/congénito , Hipotricosis/diagnóstico , Degeneración Macular/diagnóstico , Síndrome
7.
An. bras. dermatol ; 88(6,supl.1): 203-205, Nov-Dec/2013. graf
Artículo en Inglés | LILACS | ID: lil-696791

RESUMEN

A 45-year-old woman with a history of renal carcinoma was observed for facial, cervical and truncal flesh-colored papules. Relatives had similar skin findings and a brother had repeated episodes of pneumothorax. The computerized tomography scan revealed multiple cysts on both lungs. A skin biopsy revealed a perifollicular fibroma. The clinical diagnosis of Birt-Hogg-Dubé syndrome (BHDS) was corroborated by identification of a novel frameshift c.573delGAinsT (p.G191fsX31) mutation in heterozygosity on exon 6 of the folliculin gene. The presence of multiple and typical benign hair follicle tumors highlights the role of the dermatologist in the diagnosis of this rare genodermatosis that is associated with an increased risk of renal cell cancer and pulmonary cysts, warranting personal and familial follow-up and counseling.


Uma mulher de 45 anos com história de carcinoma renal foi observada por pápulas cor da pele, faciais, cervicais e tronculares. Referia história familiar de achados cutâneos semelhantes e irmão com episódios repetidos de pneumotórax. Identificaram-se múltiplos quistos pulmonares por tomografia computorizada. Uma biópsia cutânea revelou fibroma perifolicular. O diagnóstico clínico de síndrome de Birt-Hogg-Dubé (BHDS) foi contudo corroborado pela identificação de uma nova mutação frameshift c.573delGAinsT (p.G191fsX31) em heterozigotia no exão 6 do gene da foliculina. A presença de múltiplos e típicos tumores benignos do folículo piloso, realça o papel do dermatologista no diagnóstico desta rara genodermatose, que está associada a um risco aumentado de tumores de células renais e cistos pulmonares, exigindo seguimento e aconselhamento pessoal e familiar.


Asunto(s)
Femenino , Humanos , Persona de Mediana Edad , Síndrome de Birt-Hogg-Dubé/patología , Piel/patología , Biopsia , Síndrome de Birt-Hogg-Dubé/genética , Mutación , Proteínas Proto-Oncogénicas/genética , Proteínas Supresoras de Tumor/genética
8.
An. bras. dermatol ; 88(6,supl.1): 158-161, Nov-Dec/2013. graf
Artículo en Inglés | LILACS | ID: lil-696794

RESUMEN

Blastic plasmacytoid dendritic cell neoplasm is a rare and aggressive hematodermic neoplasia with frequent cutaneous involvement and leukemic dissemination. We report the case of a 76-year-old man with a 2 month history of violaceous nodules and a tumor with stony consistency, located on the head, and mandibular, cervical and supraclavicular lymphadenopathies. Multiple thoracic and abdominal adenopathies were identified on computerized tomography. Flow cytometry analysis of the skin, lymph node and bone marrow biopsies demonstrated the presence of plasmocytoid dendritic cell neoplastic precursor cells (CD4+, CD45+, CD56+ and CD123+ phenotype). After initial clinical and laboratorial complete remission with chemotherapy, the patient died due to relapse of the disease associated with the appearance of a cervical mass with medullary compromise.


A neoplasia blástica de células dendríticas plasmocitóides é uma neoplasia hematodérmica rara, agressiva, com frequente envolvimento cutâneo e disseminação leucêmica. Relatamos o caso de um homem de 76 anos com quadro clínico com 2 meses de evolução caracterizado por nódulos e tumor de tonalidade violácea, de consistência pétrea, localizados na cabeça, e linfadenopatias mandibular, cervicais e supraclaviculares. Identificaram-se múltiplas adenopatias torácicas e abdominais em tomografia computorizada. A análise por citometria de fluxo de biópsias cutânea, ganglionar e óssea demonstrou a presença de precursores neoplásicos das células dendríticas plasmocitóides (fenótipo CD4+, CD45+, CD56+ e CD123+). Após remissão clínica e laboratorial completa inicial com quimioterapia, veio a falecer por recaída da doença associada ao aparecimento de massa cervical com compromisso medular.


Asunto(s)
Anciano , Humanos , Masculino , Células Dendríticas/patología , Leucemia/patología , Neoplasias Cutáneas/patología , Biopsia , Médula Ósea/patología , Resultado Fatal , Citometría de Flujo , Invasividad Neoplásica , Piel/patología
10.
An Bras Dermatol ; 88(6): 1009-10, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-24474120

RESUMEN

POEMS syndrome is a unique clinical entity, the diagnosis of which is made when polyneuropathy and monoclonal gammopathy occur together, associated with other changes such as organomegaly, endocrinopathy, skin changes and papilledema. Cutaneous manifestations are heterogeneous, with diffuse cutaneous hyperpigmentation, hemangiomas and hypertrichosis occurring more frequently. We report the case of a 65- year-old female patient with this syndrome, diagnosed after 15 years of disabling peripheral neuropathy.


Asunto(s)
Síndrome POEMS/patología , Enfermedades de la Piel/patología , Anciano , Biopsia , Femenino , Hemangioma/patología , Humanos
11.
An. bras. dermatol ; 86(6): 1185-1188, nov.-dez. 2011. ilus
Artículo en Portugués | LILACS | ID: lil-610426

RESUMEN

A infecção pelo vírus herpes simples tipo 2 (HSV-2) é frequente em pacientes infetados pelo vírus de imunodeficiência adquirida (VIH). Nestes casos, o herpes genital pode ter uma apresentação clínica atípica. As variantes hipertróficas e vegetantes são pouco habituais. Os autores relatam um caso de herpes hipertrófico perianal em paciente infetada pelo VIH, com resposta insatisfatória ao aciclovir e valaciclovir, tratado eficazmente com imiquimod tópico. O herpes genital hipertrófico é, frequentemente, refratário aos tratamentos antivirais. Na nossa experiência, o imiquimod é um tratamento eficaz, seguro e bem tolerado que deverá ser considerado na abordagem terapêutica destes pacientes.


Herpes simplex virus type 2 (HSV-2) infections are frequent in HIV (human immunodeficiency virus) infected patients. In those cases, genital herpes may have an atypical clinical presentation. Hypertrophic and vegetating variants are unusual. The authors describe a case of hypertrophic perianal herpes in an HIV patient with unsatisfactory response to acyclovir and valacyclovir, successfully treated with imiquimod. Hypertrophic genital herpes cases are frequently refractory to antiviral treatments. In our experience, imiquimod is an efficient, safe and well tolerated treatment that should be considered in therapeutic approach of these patients.


Asunto(s)
Femenino , Humanos , Persona de Mediana Edad , Aminoquinolinas/uso terapéutico , Antivirales/uso terapéutico , Infecciones por VIH , VIH-1 , Herpes Genital/tratamiento farmacológico , /aislamiento & purificación , Aciclovir/uso terapéutico , Canal Anal/virología , Infecciones por VIH/complicaciones , Herpes Genital/etiología , Herpes Genital/patología
12.
Eur J Dermatol ; 21(6): 916-20, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21983007

RESUMEN

Treatment with tumor necrosis factor alpha (TNF-α) inhibitors may have favourable effects on the lipid profile. This is the first study to assess the impact of etanercept on the lipid profile in patients with moderate-to-severe plaque psoriasis. To investigate the effect of etanercept on the lipid profile after 24 weeks of treatment in patients with moderate-to-severe plaque psoriasis. We conducted a retrospective cohort study reviewing the medical records of 45 consecutive patients who were treated for psoriasis with etanercept between June 2006 and September 2009. Demographic and clinical data were collected. Levels of total cholesterol, LDL-C, HDL-C, triglycerides, fasting glucose and C-reactive protein were recorded at the start of etanercept and at week 24. Levels of total cholesterol, LDL-C and triglycerides increased after 24 weeks of treatment with etanercept, with mean differences of 7.1 mg/dL (p=0.505), 2.0 mg/dL (p=0.718) and 2.8 mg/dL (p=0.180), respectively. HDL-C decreased, with a mean difference of -1.4 mg/dL (p=0.995). None of these changes were statistically significant. We found no favourable changes on the lipid profile after 24 weeks of treatment with etanercept in responding patients with chronic plaque psoriasis.


Asunto(s)
Antiinflamatorios no Esteroideos/uso terapéutico , Inmunoglobulina G/uso terapéutico , Lípidos/sangre , Psoriasis/sangre , Receptores del Factor de Necrosis Tumoral/uso terapéutico , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Adulto , Proteína C-Reactiva/análisis , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Enfermedad Crónica , Comorbilidad , Dislipidemias/epidemiología , Etanercept , Femenino , Humanos , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Sobrepeso/epidemiología , Psoriasis/epidemiología , Estudios Retrospectivos , Triglicéridos/sangre
13.
An Bras Dermatol ; 86(4): 759-62, 2011.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-21987145

RESUMEN

Immunotherapy with Bacillus Calmette-Guérin is widely used for treatment and prophylaxis of superficial urothelial cancer. Complications associated with Bacillus Calmette-Guérin treatment are common. The authors describe a case of granulomatous inflammation of the penis associated with intravesical Bacillus Calmette-Guérin therapy, presenting with multiple erythematous and painless nodules located on the glans. A review of the literature is also performed. Granulomatous balanoposthitis is a rare complication of Bacillus Calmette-Guérin immunotherapy, with heterogeneous clinical presentation, which can make the diagnosis difficult. Its clinical recognition is essential for early start of therapy with antitubercular agents and interruption of Bacillus Calmette-Guérin.


Asunto(s)
Adyuvantes Inmunológicos/efectos adversos , Vacuna BCG/efectos adversos , Balanitis/inducido químicamente , Granuloma/inducido químicamente , Adyuvantes Inmunológicos/administración & dosificación , Administración Intravesical , Anciano , Antituberculosos/uso terapéutico , Vacuna BCG/administración & dosificación , Balanitis/tratamiento farmacológico , Balanitis/patología , Granuloma/tratamiento farmacológico , Granuloma/patología , Humanos , Masculino , Neoplasias de la Vejiga Urinaria/tratamiento farmacológico
14.
An. bras. dermatol ; 86(4): 759-762, jul.-ago. 2011. ilus, tab
Artículo en Portugués | LILACS | ID: lil-600621

RESUMEN

A imunoterapia com o Bacilo Calmette-Guérin é amplamente usada no tratamento e profilaxia da neoplasia urotelial superficial. As complicações associadas ao tratamento são comuns. Os autores relatam um caso de inflamação granulomatosa do pênis, associada à terapia intravesical com Bacilo Calmette-Guérin, com múltiplos nódulos eritematosos indolores localizados na glande. É também efetuada uma revisão da literatura. A balanopostite granulomatosa é uma complicação rara associada à imunoterapia com Bacilo Calmette-Guérin, com uma apresentação clinicamente heterogênea que pode dificultar o diagnóstico. O seu reconhecimento clínico é essencial para o início precoce de tuberculostáticos e interrupção de Bacilo Calmette-Guérin.


Immunotherapy with Bacillus Calmette-Guérin is widely used for treatment and prophylaxis of superficial urothelial cancer. Complications associated with Bacillus Calmette-Guérin treatment are common. The authors describe a case of granulomatous inflammation of the penis associated with intravesical Bacillus Calmette-Guérin therapy, presenting with multiple erythematous and painless nodules located on the glans. A review of the literature is also performed. Granulomatous balanoposthitis is a rare complication of Bacillus Calmette-Guérin immunotherapy, with heterogeneous clinical presentation, which can make the diagnosis difficult. Its clinical recognition is essential for early start of therapy with antitubercular agents and interruption of Bacillus Calmette-Guérin.


Asunto(s)
Anciano , Humanos , Masculino , Adyuvantes Inmunológicos/efectos adversos , Vacuna BCG/efectos adversos , Balanitis/inducido químicamente , Granuloma/inducido químicamente , Administración Intravesical , Adyuvantes Inmunológicos/administración & dosificación , Antituberculosos/uso terapéutico , Vacuna BCG/administración & dosificación , Balanitis/tratamiento farmacológico , Balanitis/patología , Granuloma/tratamiento farmacológico , Granuloma/patología , Neoplasias de la Vejiga Urinaria/tratamiento farmacológico
15.
Pediatr Dermatol ; 28(4): 464-6, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21736606

RESUMEN

Dyskeratosis congenital is reported in two siblings. They presented with the classic triad of mucocutaneous features: leukoplakia of the tongue, dystrophic nails, and a widespread reticulate pigmentation on the neck and upper chest. A genetic analysis was performed and a new missense mutation S356P, hemizygous, was identified in the DKC1 gene in both patients. Acitretin was started at a low-dose in both patients, resulting in clinical improvement and important, positive psychosocial effects.


Asunto(s)
Proteínas de Ciclo Celular/genética , Disqueratosis Congénita/genética , Mutación Missense , Proteínas Nucleares/genética , Acitretina/uso terapéutico , Adolescente , Niño , Disqueratosis Congénita/tratamiento farmacológico , Femenino , Humanos , Queratolíticos/uso terapéutico , Masculino , Hermanos
16.
J Cutan Pathol ; 38(6): 514-20, 2011 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-21352266

RESUMEN

The distinction between primary melanoma and melanoma metastatic to the skin has major prognostic implications. We report a case of a 67-year-old male with a diagnosis of a superficial spreading melanoma (stage IB) rendered 6 years earlier who presented clinically with an atypical nevus on his left thigh. Histopathological examination showed an intraepidermal melanocytic proliferation that was interpreted as melanoma in situ. Subsequently, 45 additional pigmented macules appeared in crops over a 9-month period. Clinically and dermoscopically, these lesions were extremely polymorphic. Histopathological findings were compatible with melanoma in situ, as each lesion consisted of a wholly intraepidermal proliferation of markedly atypical melanocytes arranged singly and in nests. A complete gastrointestinal study showed multiple pigmented metastatic lesions throughout the stomach and small bowel, which supported a diagnosis of metastatic melanoma with gastrointestinal and epidermotropic skin involvement. Monosomy of chromosome 9 and a BRAF V600E mutation were detected in the primary tumor sample and in macro-dissected secondary lesions. No CDKN2A or CDK4 germline mutations were found. Intraepidermal epidermotropic metastases of melanoma have been rarely described in literature. In this case, histopathology alone was insufficient to distinguish metastatic melanoma from multiple in situ melanomas. The recognition of epidermotropic metastases should be based on the correlation between clinical, dermoscopic, histopathological and molecular findings.


Asunto(s)
Carcinoma in Situ/patología , Melanoma/patología , Recurrencia Local de Neoplasia/patología , Neoplasias Cutáneas/patología , Anciano , Diagnóstico Diferencial , Humanos , Masculino
18.
An Bras Dermatol ; 86(6): 1185-8, 2011.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-22281910

RESUMEN

Herpes simplex virus type 2 (HSV-2) infections are frequent in HIV (human immunodeficiency virus) infected patients. In those cases, genital herpes may have an atypical clinical presentation. Hypertrophic and vegetating variants are unusual. The authors describe a case of hypertrophic perianal herpes in an HIV patient with unsatisfactory response to acyclovir and valacyclovir, successfully treated with imiquimod. Hypertrophic genital herpes cases are frequently refractory to antiviral treatments. In our experience, imiquimod is an efficient, safe and well tolerated treatment that should be considered in therapeutic approach of these patients.


Asunto(s)
Aminoquinolinas/uso terapéutico , Antivirales/uso terapéutico , Infecciones por VIH , VIH-1 , Herpes Genital/tratamiento farmacológico , Herpesvirus Humano 2/aislamiento & purificación , Aciclovir/uso terapéutico , Canal Anal/virología , Femenino , Infecciones por VIH/complicaciones , Herpes Genital/etiología , Herpes Genital/patología , Humanos , Imiquimod , Persona de Mediana Edad
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