RESUMEN
OBJECTIVES: This study aimed to assess the prevalence of oral lesions in patients living with HIV infection and their association with CD4 count, viral load, and antiretroviral therapy in patients with HIV. METHODS: A cross-sectional study was conducted on a sample of 161 patients attending the All the patients were examined for their oral lesions, current CD4 counts, type, and duration of the therapy. Data analyses were carried out using Chi-Square, Student T/Mann-Whitney, and logistic regression tests. RESULTS: Oral lesions were observed in 58.39% of patients with HIV. Periodontal disease with 78 (48.45%) or without mobility 79 (49.07%) was observed more frequently, followed by hyperpigmentation of oral mucosa 23 (14.29%), Linear Gingival Erythema (LGE) 15 (9.32%), candidiasis pseudomembranous 14 (8.70%). Oral Hairy Leukoplakia (OHL) was observed only in 3 (1.86%). A relationship between periodontal disease with dental mobility and smoking was found (p=0.04), as well duration of treatment (p=1.53e-3) and age (p=0.02). Hyperpigmentation was related to race (p=0.01) and smoking (p=1.30e-6). CD4 count, CD4:CD8 ratio, viral load, or type of treatment were not associated with oral lesions. Logistic regression showed that the duration of treatment has a protective effect on the periodontal disease with dental mobility (OR = 0.28 [-2.27 to -0.25]; p-value=0.03), independent of age or smoking. To hyperpigmentation, the best model included smoking (OR=8.47 [1.18-3.10], p= 1.31e-5), without race or type and duration of treatment. CONCLUSION: Among HIV patients undergoing antiretroviral treatment, oral lesions can be observed, predominantly periodontal disease. Pseudomembranous candidiasis and oral hairy leukoplakia were also observed. No relationship was found between associated oral manifestations in HIV patients and the start of the treatment, TCD4+ and TCD8+ cell count, TCD4:TCD8 ratio, or viral load. The data indicate that there is a protective effect of duration of treatment with relation to periodontal disease with mobility and that hyperpigmentation seems to be more related to smoking than type and duration of treatment. LEVEL OF EVIDENCE: Level 3 (OCEBM Levels of Evidence Working Group*. "The Oxford 2011 Levels of Evidence").
Asunto(s)
Candidiasis Bucal , Infecciones por VIH , Hiperpigmentación , Enfermedades de la Boca , Enfermedades Periodontales , Humanos , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Leucoplasia Vellosa/epidemiología , Leucoplasia Vellosa/complicaciones , Enfermedades de la Boca/etiología , Estudios Transversales , Brasil/epidemiología , Candidiasis Bucal/epidemiología , Candidiasis Bucal/complicaciones , Enfermedades Periodontales/complicaciones , Hiperpigmentación/complicacionesRESUMEN
Hand-foot syndrome (HFS) is a common adverse effect of anticancer therapy. It is known to cause dermatological symptoms including acral erythema and dysesthesia of the palms and soles of the feet, swelling, pain, itching, and scaling. Some drugs, like capecitabine, are known to trigger this condition. However, pigmentation of the oral mucosa is a rare adverse effect. This study aims to report a case of oral mucosa hyperpigmentation caused by capecitabine therapy before the clinical diagnosis of HFS. A 58-year-old female, diagnosed with invasive breast duct carcinoma, had the central nervous system, liver, skin, and lung metastasis, using capecitabine every day for 14 cycles. Oral examination revealed multifocal black macules on the hard palate, bilateral buccal mucosa, gingival mucosa, and dorsum of the tongue. The clinical hypothesis was oral mucosa hyperpigmentation by capecitabine use and only periodic follow-up was necessary. Hyperpigmentation of oral mucosa by capecitabine is a rare consequence of neoplastic therapy and your association with HFS is unclear, and poorly reported. The report of these events is important to alert oncology health teams about the individual tolerance to capecitabine therapy.
Asunto(s)
Síndrome Mano-Pie , Hiperpigmentación , Antimetabolitos Antineoplásicos/efectos adversos , Capecitabina/efectos adversos , Desoxicitidina/efectos adversos , Femenino , Fluorouracilo/efectos adversos , Síndrome Mano-Pie/etiología , Humanos , Hiperpigmentación/inducido químicamente , Hiperpigmentación/complicaciones , Persona de Mediana EdadRESUMEN
INTRODUCTION/OBJECTIVES: Acne is present in about 90% of teenagers and 12% to 14% of adults. Face and trunk are the most affected areas. Lesions can result in postinflammatory hyperpigmentation and scarring, leading to reduced quality of life. Asynchronous teledermatology has been increasingly used around the world, facilitating patient access to dermatologists. Our objectives were to assess: (1) clinical features of acne patients according to gender, age, severity, site of lesions, excoriation, postinflammatory hyperpigmentation (PIH), and atrophic scar (AS) and (2) how many referrals to in-person consultations with dermatologists could be avoided using asynchronous teledermatology in primary care attention? METHODS: We analyzed images, demographic and clinical data of 2459 acne patients assisted by teledermatology, with the aim to confirm the diagnoses, to classify acne severity according to grades I to IV, and to search for the presence of postinflammatory hyperpigmentation, atrophic scars, and/or excoriated acne (EA). We compared the clinical and biological data, looking for associations among them. RESULTS: Acne severity and age were associated with the most common sequels: postinflammatory hyperpigmentation (mainly on the trunk and in females, P < .0001) and atrophic scars (mainly on the face and in males, P < .0001). We also observed different frequencies according to age and sex: 13 to 24 years in males (P = .0023); and <12 (P = .0023) and 25 to 64 years old (P <.0001) for females; 68% of the patients had no need for in-person dermatologists' referral, being kept at primary care attention with proper diagnosis and treatment. CONCLUSION: Clinical features of acne and its sequels differ according to gender, age, site, and severity. The new findings of PIH associated with women and AS, with men, may help offer a more personalized management to patients. Teledermatology was suitable for the majority of the acne cases in primary care.
Asunto(s)
Acné Vulgar , Hiperpigmentación , Acné Vulgar/complicaciones , Acné Vulgar/diagnóstico , Adolescente , Adulto , Cicatriz/complicaciones , Cicatriz/etiología , Femenino , Humanos , Hiperpigmentación/complicaciones , Hiperpigmentación/diagnóstico , Masculino , Atención Primaria de Salud , Calidad de Vida , Resultado del TratamientoRESUMEN
Dowling-Degos disease (DDD) is a rare autosomal-dominant genodermatosis and it has been associated with hidradenitis suppurativa (HS). Deregulation of NOTCH pathway has been linked to the development of HS in DDD context (DDD-HS). However, molecular alterations in DDD-HS, including altered gene expression of NOTCH and downstream effectors that are involved in the follicular differentiation and inflammatory response, are poorly defined. We report two cases of patients diagnosed with DDD-HS, one of those, under Adalimumab treatment. Our results have shown downregulation of NOTCH1/NCSTN pathway, distinct molecular profiles of inflammatory cytokines (IL23A and TNF), and a novel aberrant upregulation of genes involved in the cornified envelope (CE) formation (SPRR1B, SPRR2D, SPRR3, and IVL) in paired HS lesions of two DDD patients.
Asunto(s)
Citocinas/metabolismo , Regulación de la Expresión Génica , Hidradenitis Supurativa/patología , Hiperpigmentación/patología , Mediadores de Inflamación/metabolismo , Receptor Notch1/metabolismo , Enfermedades Cutáneas Genéticas/patología , Enfermedades Cutáneas Papuloescamosas/patología , Adulto , Secretasas de la Proteína Precursora del Amiloide/genética , Secretasas de la Proteína Precursora del Amiloide/metabolismo , Proteínas Ricas en Prolina del Estrato Córneo/genética , Proteínas Ricas en Prolina del Estrato Córneo/metabolismo , Femenino , Hidradenitis Supurativa/complicaciones , Hidradenitis Supurativa/genética , Hidradenitis Supurativa/metabolismo , Humanos , Hiperpigmentación/complicaciones , Hiperpigmentación/genética , Hiperpigmentación/metabolismo , Glicoproteínas de Membrana/genética , Glicoproteínas de Membrana/metabolismo , Persona de Mediana Edad , Pronóstico , Receptor Notch1/genética , Enfermedades Cutáneas Genéticas/complicaciones , Enfermedades Cutáneas Genéticas/genética , Enfermedades Cutáneas Genéticas/metabolismo , Enfermedades Cutáneas Papuloescamosas/complicaciones , Enfermedades Cutáneas Papuloescamosas/genética , Enfermedades Cutáneas Papuloescamosas/metabolismoRESUMEN
Perinevic dermatosis neglecta is an underestimated skin condition usually affecting children and adolescents, characterized by the appearance of dirt-like brownish pigmentation around a preexisting nevus and often a matter of concern for parents. We describe the clinical and dermoscopic findings in a case of perinaevic dermatosis neglecta and discuss the possible etiology of this phenomenon.
Asunto(s)
Melanoma/diagnóstico , Enfermedades de la Piel/diagnóstico , Antiinfecciosos Locales/uso terapéutico , Niño , Dermoscopía , Diagnóstico Diferencial , Etanol/uso terapéutico , Humanos , Hiperpigmentación/complicaciones , Masculino , Nevo Pigmentado/complicaciones , Enfermedades de la Piel/tratamiento farmacológico , Enfermedades de la Piel/etiologíaRESUMEN
Abstract: Perinevic dermatosis neglecta is an underestimated skin condition usually affecting children and adolescents, characterized by the appearance of dirt-like brownish pigmentation around a preexisting nevus and often a matter of concern for parents. We describe the clinical and dermoscopic findings in a case of perinaevic dermatosis neglecta and discuss the possible etiology of this phenomenon.
Asunto(s)
Humanos , Masculino , Niño , Melanoma/diagnóstico , Enfermedades de la Piel/diagnóstico , Enfermedades de la Piel/etiología , Enfermedades de la Piel/tratamiento farmacológico , Hiperpigmentación/complicaciones , Dermoscopía , Diagnóstico Diferencial , Etanol/uso terapéutico , Antiinfecciosos Locales/uso terapéutico , Nevo Pigmentado/complicacionesRESUMEN
We present the case of a 72-year-old Caucasian woman with frontal fibrosing alopecia of one year's duration. Eighteen months later, she presented with sudden hyperpigmentation on the submental area, neck and upper chest. Histopathological examination was consistent with lichen planus pigmentosus. This is the report of a unique case of a FFA and extrafacial lichen planus pigmentosus.
Asunto(s)
Alopecia/patología , Hiperpigmentación/patología , Liquen Plano/patología , Anciano , Alopecia/complicaciones , Dermoscopía , Femenino , Frente/patología , Humanos , Hiperpigmentación/complicaciones , Liquen Plano/complicaciones , Piel/patologíaRESUMEN
Abstract We present the case of a 72-year-old Caucasian woman with frontal fibrosing alopecia of one year's duration. Eighteen months later, she presented with sudden hyperpigmentation on the submental area, neck and upper chest. Histopathological examination was consistent with lichen planus pigmentosus. This is the report of a unique case of a FFA and extrafacial lichen planus pigmentosus.
Asunto(s)
Humanos , Femenino , Anciano , Hiperpigmentación/patología , Alopecia/patología , Liquen Plano/patología , Piel/patología , Hiperpigmentación/complicaciones , Dermoscopía , Alopecia/complicaciones , Frente/patología , Liquen Plano/complicacionesRESUMEN
Abstract We describe a fifty-six-year old, Afro-descendent female patient showing dystrophy of her twenty nails and hyperchromic, asymptomatic macule on her face. Histopathological examination of the macule showed vacuolization of the basal layer, melanophages in the superficial dermis and lymphoplasmocytic inflammatory infiltrate. Nail biopsy revealed orthokeratotic hyperkeratosis and lichenoid inflammatory infiltrate. Lichen planus pigmentosus is an uncommon variety of lichen planus. It is characterized by typical hyperpigmented macules on the face and neck. Nail changes might be present in 10% of lichen planus cases, but no associations with lichen planus pigmentosus have been described. We report a case of lichen planus in twenty nails associated with lichen planus pigmentosus on the patient's face.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Hiperpigmentación/complicaciones , Hiperpigmentación/patología , Liquen Plano/complicaciones , Liquen Plano/patología , Enfermedades de la Uña , Biopsia , Epidermis/patología , Dermatosis Facial/patología , Queratosis/patología , Uñas/patologíaRESUMEN
Laugier-Hunziker syndrome is a rare benign idiopathic condition characterized by acquired macular pigmentation of lips and buccal mucosa, often accompanied with melanonychia. The main concern with this condition is to rule out other differential diagnosis with systemic repercussions and similar hyperpigmentation patterns, such as Peutz-Jeghers syndrome, adrenal insufficiency and melanoma. We report a 58-year-old female with a 20-year history of Sjögrens syndrome, presenting with melanonychia and hyperpigmentation in the buccal mucosa. She had no relevant medication history and is a non-smoker. The patient denied any other symptoms. The histopathology confirmed the diagnosis of Laugier-Hunziker syndrome.
Asunto(s)
Hiperpigmentación/diagnóstico , Enfermedades de la Boca/diagnóstico , Enfermedades de la Uña/diagnóstico , Síndrome de Sjögren/complicaciones , Femenino , Humanos , Hiperpigmentación/complicaciones , Persona de Mediana Edad , Enfermedades de la Boca/complicaciones , Enfermedades de la Uña/complicaciones , SíndromeAsunto(s)
Alopecia/diagnóstico , Hiperpigmentación/diagnóstico , Liquen Plano/diagnóstico , Anciano , Alopecia/complicaciones , Alopecia/tratamiento farmacológico , Cloroquina/administración & dosificación , Cloroquina/uso terapéutico , Diagnóstico Diferencial , Femenino , Humanos , Hiperpigmentación/complicaciones , Hiperpigmentación/tratamiento farmacológico , Liquen Plano/complicaciones , Liquen Plano/tratamiento farmacológico , Tacrolimus/administración & dosificación , Tacrolimus/uso terapéutico , Resultado del TratamientoRESUMEN
Laugier-Hunziker syndrome is a rare benign idiopathic condition characterized by acquired macular pigmentation of lips and buccal mucosa, often accompanied with melanonychia. The main concern with this condition is to rule out other differential diagnosis with systemic repercussions and similar hyperpigmentation patterns, such as Peutz-Jeghers syndrome, adrenal insufficiency and melanoma. We report a 58-year-old female with a 20-year history of Sjögrens syndrome, presenting with melanonychia and hyperpigmentation in the buccal mucosa. She had no relevant medication history and is a non-smoker. The patient denied any other symptoms. The histopathology confirmed the diagnosis of Laugier-Hunziker syndrome.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Síndrome de Sjögren/complicaciones , Hiperpigmentación/diagnóstico , Enfermedades de la Boca/diagnóstico , Enfermedades de la Uña/diagnóstico , Síndrome , Hiperpigmentación/complicaciones , Enfermedades de la Boca/complicaciones , Enfermedades de la Uña/complicacionesRESUMEN
We describe a fifty-six-year old, Afro-descendent female patient showing dystrophy of her twenty nails and hyperchromic, asymptomatic macule on her face. Histopathological examination of the macule showed vacuolization of the basal layer, melanophages in the superficial dermis and lymphoplasmocytic inflammatory infiltrate. Nail biopsy revealed orthokeratotic hyperkeratosis and lichenoid inflammatory infiltrate. Lichen planus pigmentosus is an uncommon variety of lichen planus. It is characterized by typical hyperpigmented macules on the face and neck. Nail changes might be present in 10% of lichen planus cases, but no associations with lichen planus pigmentosus have been described. We report a case of lichen planus in twenty nails associated with lichen planus pigmentosus on the patient's face.
Asunto(s)
Hiperpigmentación/complicaciones , Hiperpigmentación/patología , Liquen Plano/complicaciones , Liquen Plano/patología , Enfermedades de la Uña/complicaciones , Enfermedades de la Uña/patología , Biopsia , Epidermis/patología , Dermatosis Facial/patología , Femenino , Humanos , Queratosis/patología , Persona de Mediana Edad , Uñas/patologíaRESUMEN
La enfermedad de Dowling-Degos es un raro trastorno de la pigmentación, con comportamiento benigno y patrón autosómico dominante. Se comunica el caso de un adolescente sin antecedentes personales de importancia que acude al servicio de Dermatología por máculas hipo e hiperpigmentadas que se distribuían en grandes pliegues y en zonas de presión, de 2 años de evolución. Por los datos clínicos y los estudios complementarios se determinó el diagnóstico de enfermedad de Dowling-Degos.
The Dowling-Degos disease is a rare disorder of pigmentation with benign behavior and autosomal dominant pattern. This paper reports the case of a teenager with no personal history of importance that was referred to the Dermatology Department for presenting hypo and hyperpigmented spots distributed in the large folds and pressure zones, of 2 years of evolution. Considering clinical data and additional studies the diagnosis of Dowling-Degos disease was done.
Asunto(s)
Humanos , Masculino , Adolescente , Hiperpigmentación/complicaciones , Queratoacantoma , Trastornos de la PigmentaciónRESUMEN
La Hiperplasia Suprarrenal Congénita (HSC) es una enfermedad endocrina genética. En el 90% de los casos es causada por mutaciones en el gen CYP21A2, que codifica la enzima esteroide adrenal 21-hidroxilasa (21-OH) implicada en la esteroidogénesis. Esto provoca hipersecreción de la hormona adrenocorticotropa (ACTH), llevando a la producción anormal- mente elevada de andrógenos suprarrenales. Se trata de un recién nacido con genitales ambiguos caracterizados por hipertrofia de clítoris, con la piel hiperpigmentada en el área genital, fusión labio escrotal en línea media y seno urogenital abajo del falo o clítoris de aproximadamente 1 mm de diámetro. No se palparon gónadas. El estudio sonográfico reportó glándulas suprarrenales dentro de los límites normales, con útero de forma y tamaño normal. No se observó presencia de testículos. El diagnóstico oportuno permitió la instauración del tratamiento en los primeros días de vida con la prevención subsecuente de complicaciones...(AU)
Asunto(s)
Humanos , Masculino , Recién Nacido , Hiperplasia Suprarrenal Congénita/genética , Anomalías Congénitas/genética , Familia 21 del Citocromo P450 , Hiperpigmentación/complicacionesRESUMEN
Marshall-Smith Syndrome (OMIM 602535) was described initially by Marshall in two infants with a syndrome characterized by accelerated skeletal maturation, failure to thrive, and dysmorphic facial features. We report a new patient with clinical features of Marshall-Smith syndrome with additional findings such as hyperpigmented lines on trunk and the four extremities. © 2011 Wiley-Liss, Inc.
Asunto(s)
Enfermedades del Desarrollo Óseo/complicaciones , Anomalías Craneofaciales/complicaciones , Hiperpigmentación/complicaciones , Displasia Septo-Óptica/complicaciones , Abdomen/patología , Anomalías Múltiples/diagnóstico , Anomalías Múltiples/patología , Dorso/patología , Enfermedades del Desarrollo Óseo/diagnóstico , Enfermedades del Desarrollo Óseo/patología , Anomalías Craneofaciales/diagnóstico , Anomalías Craneofaciales/patología , Discapacidades del Desarrollo/diagnóstico , Extremidades/patología , Femenino , Humanos , Hiperpigmentación/diagnóstico , Hiperpigmentación/patología , Lactante , Displasia Septo-Óptica/diagnóstico , Displasia Septo-Óptica/patología , Piel/patología , Tórax/patologíaRESUMEN
Dowling-Degos disease is a rare genodermatosis characterized principally by progressive reticulate hyperpigmentation of the flexures. Although the condition is benign, it may be associated with skin malignancies. Furthermore, the characteristic skin changes may be psychologically and socially detrimental to the patient as a result of the unsightliness of the condition. The present report describes a case in which this disease was associated with a keratoacanthoma, and summarizes current concepts on this skin disorder.
Asunto(s)
Hiperpigmentación/patología , Queratoacantoma/patología , Humanos , Hiperpigmentación/complicaciones , Queratoacantoma/complicaciones , Masculino , Persona de Mediana Edad , Enfermedades de la Piel/complicaciones , Enfermedades de la Piel/patologíaRESUMEN
A doença de Dowling-Degos é uma genodermatose rara, caracterizada principalmente por hiperpigmentação reticular progressiva de áreas flexurais. Apesar de apresentar evolução benigna, pode estar associada a neoplasias da pele. Além disso, as alterações cutâneas características potencialmente ocasionam prejuízo psicossocial, devido aos danos estéticos significativos. Os autores descrevem um caso dessa doença associado a ceratoacantoma e sintetizam os conceitos atuais sobre ela.
Dowling-Degos disease is a rare genodermatosis characterized principally by progressive reticulate hyperpigmentation of the flexures. Although the condition is benign, it may be associated with skin malignancies. Furthermore, the characteristic skin changes may be psychologically and socially detrimental to the patient as a result of the unsightliness of the condition. The present report describes a case in which this disease was associated with a keratoacanthoma, and summarizes current concepts on this skin disorder.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Hiperpigmentación/patología , Queratoacantoma/patología , Hiperpigmentación/complicaciones , Queratoacantoma/complicaciones , Enfermedades de la Piel/complicaciones , Enfermedades de la Piel/patologíaRESUMEN
Diffuse iris melanoma is rare, although is the most common primary intraocular neoplasm in cats, and is an unusual variant of anterior uveal melanoma. This neoplasm is malignant with high potential methastazed. Affects olders cats without breed or sex predisposition. The diagnosis can be made with fine needle aspiration cytology of anterior segment. The treatment is variable and depends of clinical signs evolution. The enucleation is commonly indicated when ocurred iridal pigment changes demonstrated as progressively increasing in size or number, or intractables uveitis or glaucoma. This work has for objectives to report a case of diffuse iris melanoma in a cat. Based on information available in the literature, this is the first case of diffuse iris melanoma in a cat documented in Brazil.(AU)