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Actinomadura madurae mycetoma was diagnosed in two patients by the dermatologic outpatient clinic of the Clementino Fraga Filho University Hospital (UFRJ) and the Antonio Pedro University Hospital (UFF). The first case was a 27-year-old Negro male from the outskirts of Rio de Janeiro, who was injured prior to the onset of the disease in 1988. The affected left foot showed swelling, nodules, sinus tracts, purulent discharge containing grains, and serious bone involvement with lytic lesions. Histological examination showed deeply basophilic stained grains with typical wide-fringed borders. The mycological examination revealed an actinomycete identified as A. madurae by culture. Oral tetracycline for six months did not improve the clinical-radiological picture and the patient was submitted to amputation. The second case was a 70-year-old white male, with previous injury in 1974, which occurred in Pernambuco State. Enlargement of the right foot draining sinuses formation with discharge of pus and grains. In tissue sections the grains were large and surrounded by amorphous eosinophilic clubs radially oriented. There was discrete improvement by tetracycline and sulfonamide. No follow-up.

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A child with systemic lupus erythematosus who has been treated with prednisone for three years, developed crusted scabies. Scrapings from lesions revealed Sarcoptes scabiei adult mites mad eggs. The patient died with septicemia and renal failure soon after starting topical 20% sulfur. A marked improvement was observed in the cutaneous lesions.

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The association of dermatophytosis and atopy on patients from the University Hospital, Federal University of Rio de Janeiro, was carried out during 1984-1985 as follows: a) 141 cases exhibiting lesions on feet, glabrous skin, groins, nails and scalp. The dermatophytes were demonstrated in the material from skin and nail scrapings and depilated hairs by direct microscopic examination and culture; b) 131 cases of several skin diseases other than dermatophytosis (control group). Both were inquired about personal history of atopic dermatitis, asthma and rhinitis. In the first group 14 (9.9%) patients gave a positive personal history of atopy while in the control group only one (0.7%) did it. The comparison between the studied groups was made be means of the chi-square test and a statistically significant difference was established (p less than 0.001) giving a greater risk for getting dermatophytosis to those suffering from atopic disease.

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The authors report 13 cases of tinea manuum and emphasize that this condition is not commonly described in the Brazilian medical literature. Eight males and five females, aged 18 to 72 years, presented an infection ranging from 1 month to 20 years. The main clinical picture was of desquamating type on the palms without fingernails lesions. All patients had associated dermatophytosis of the feet. Trichophyton mentagrophytes, T. rubrum and Epidermophyton floccosum were the species isolated from the hands. The trichophytin test was positive in all cases and treatment with oral griseofulvin and topical clotrimazole and miconazole was rather effective. Clinical evaluation at the end of the treatment and afterwards did not show relapses.

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With the main purpose to recognize the pathogenic fungi which can be isolated from skin diseases and simultaneously from normal and abnormal toe spaces, the authors studied 102 patients with several dermatoses and a control group with 21 cases of dermatophytosis which were diagnosed by direct examination and culture of infected skin and nails, and by clinical features. All patients were submitted to mycological examination of the skin lesions and interdigital spaces. No pathogenic fungi were isolated from dermatoses but species of candida could be found from skin lesions and nails in the control group and from normal and abnormal toe webs in the dermatoses group. The authors conclude that in these previous skin lesions there was no local predisposition to fungus infection and they seem to be less important than heat, moisture, friction, immunosuppression, lymphoma, a variety of endocrine abnormalities and cachetic states.

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A 39 years old black woman with systemic lupus erythematosus developed tense bullae on erythematous bases on the flexor surfaces of the forearms and oral cavity. Some blisters healed with atrophy and pruritus was a striking feature. The diagnosis of systemic lupus erythematosus was based upon the following criteria: the typical blush in the butterfly area, alopecia, a painful macular papular eruption on the palms and fingers, fever, arthralgia, anemia, leukopenia, elevation of erythrocyte sedimentation rate and positive ANA. Histologic examination showed a subepidermal bulla formation and perivascular inflammatory infiltrate containing lymphocytes and eosinophils. By indirect immunofluorescence no autoantibodies were detected. Direct immunofluorescence showed deposition of linear IgG. High doses of prednisone brought about clinical remission but there was no response to sulfone. The patient is on maintenance dose. The authors discuss the differences between the three diseases and conclude that the bullous eruption cannot be classified.

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O autor relata nove casos de eritema nodoso e discute a etiologia obscura em quatro casos da doenca

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Para determinar a casuistica de "ides" em pacientes, apresentando simultaneamente lesoes sugestivas de "ides" em maos e dermatofitose em pes, realizamos investigacao durante treze meses consecutivos na Clinica Dermatologica da Policinica Geral do Rio de Janeiro. Em 100 pacientes completamos o estudo seguindo o esquema: a) exame micologico das lesoes das maos e pes. b) teste de tricofitina. c) terapeutica com griseofulvida oral, alem de clotrimazole e miconazole topicos e cuidados profilaticos durante quarenta e cinco dias. d) avaliacao no final do tratamento e posteriormente durante cento e oitenta dias.21% dos casos eram verdadeiros "ides", predominantes no sexo masculino, nao relacionadas com a atividade profissional e estacoes do ano. A dermatofitose era inflamatoria e o teste da tricofitina mostrou positividade com papula de cinco a dez milimetros. O Trychophyton mentagrophytes foi o dermatofito mais encontrado nos pes, sendo tambem isolado o Tricchophyton rubrum. Quanto aos demais casos, em 13% foi comprovada dermatofitose em maos; em 32% foi observada regressao dos quadros dos pes e maos; embora nao se tratassem de ides e, em 34% nao houve resposta terapeutica. O estudo realizado enfatiza a necessidade de se apurar o diagnostico correto atraves de exames dermatologico e laboratorial criteriosos

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Os autores fizeram um levantamento de todos os pacientes internados nas enfermarias de Dermatologia do Hospital Universitario da Universidade Federal do Rio de Janeiro em 3 anos. Encontraram como primeira causa de internacao o eczema de contato e, com grande destaque, a hanseniase. Assinalam tambem a associacao de enfermidades e tecem comentarios sobre os achados.

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Os autores apresentam um caso de associacao entre psoriase e esclerodermia sistemica progressiva e discutem a sua raridade e evolucao

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Os autores relatam dois casos de associacao de lupus eritematoso sistemico e dermatite herpetiforme de Duhring Brocq enfatizando as dificuldades de diagnostico.Foi confirmada atraves de exames laboratoriais, histopatologia e imunofluorescenci

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