Background: The zika virus belongs to the family flaviviridae, and is transmitted by the arthropod Aedes aegypt. Its major importance is related to the several debilitating neurological manifestations associated with it, such as transverse myelitis. Case:The authors report a case of transverse myelitis in a patient with a previous diagnosis of Zika virus infection. After the image exams and serology, the diagnosis was confirmed and treatment with prednisone was performed with an unsatisfactory clinical outcome. Conclusion:Brazil is the country of greatest concern worldwide due to the thousands of Zika cases with associated neurological complications, causing sequels and physical disabilities. However, cases worldwide have increased substantially.
Introduction: Moderate and severe forms of psoriasis require phototherapy and/or systemic medications. The UVB band, with wavelength between 311 and 312nm, is called narrowband UVB (NB-UVB) and it has proven to be more beneficial for the psoriasis treatment. Goals: to characterize the group of patients with psoriasis treated with NB-UVB phototherapy, according to the clinical form, sex, phototype, and clinical evolution. Methods: All patients with psoriasis who underwent NB-UVB phototherapy between August 2016 and April 2017 were included in this study. Data on the patients were collected retrospectively. Results: During the study, 19 patients were treated with NB-UVB phototherapy, being 09 women (47%) and 10 men (53%), ages ranging from 22 to 81years. The most prevalent phototypes were III (42%) and IV (37%). Only 04 patients (21%) had guttate psoriasis and 15 (79%) had psoriasis vulgaris with variable severity. The total number of phototherapy sections, during the period evaluated, varied from 7 to 51, with an average of 25 sessions. It was observed that, 09 patients (47%) had a response beginning with up to two months of treatment. The minimum number of sections to start improvement varied from 8 to 28, with an average of 16 sessions. Conclusions: The use of NB-UVB phototherapy proved to be a safe and effective treatment, and should be considered a good therapeutic option for psoriasis.
Background: Caring for leprosy patients requires neurological assessment for prevention of potential physical disabilities. This study focused on the neurological impairment and degree of physical incapacity (DI) at the time of the diagnosis and at discharge of leprosy patients from Dermatology Department of the University of the State of Pará. Methods and findings: It was a cross-sectional, observational study based on the medical records, neurological assessment and DI of 14 patients assisted at a referral service between 2012 and 2016, applying descriptive statistical analysis. At diagnosis were observed patients with decreased abduction forces of the 5th finger (14.28%), extension of hallux and foot dorsiflexion (10.72%); loss of protective sensitivity in the ulnar nerve area (3.57%) and tibial nerve area (25%); 7.15% of thickened ulnar nerve; DI 0 (64.28%) and DI 1 (35.72%). At discharge, 10.72% of the patients showed decreased abduction of the 5th finger, extension of hallux and foot dorsiflexion (14.28%); loss of protective sensitivity just in the tibial nerve area (17.87%); 4.28% of thickened ulnar nerve; DI 0 (78.57%) and DI 1 (21.43%). Conclusions: Therefore, most of the patients had normal neurological assessment and DI 0 at both moments, with reduction of alterations in discharge, except for the fibular nerve. Thus, it is highlighted the primary role of the health team, which constitutes one of the main agents promoters of health education, especially when it comes to preventing disabilities in leprosy.
Chromomycosis, or chromomycosis, is a chronic, progressive cutaneous and subcutaneous mycosis caused by several species of pheoid or dermaticeous (darkly pigmented) fungi. It mainly affects male patients, in the age group between 30 and 60 years and is more common on rural areas, being associated to traumatic events, which may explain the high frequency of involvement of the lower limbs and exposed areas. Its lesion starts as a small, nonpruriginous, erythematous papule or macula and slowly spreads to the surrounding skin. Commonly, takes 5 to 15 years or more from the onset to diagnosis the disease. The disease progress and evolve to variable morphology types, chronic lesions and complications usually lead to definitive disability, especially due to treatment limitations. We present three cases of exuberant and disfiguring chromomycosis, including a case were the lesions suffered carcinomatous degeneration. All patients complained about the drug price and one of them abandoned the treatment and medical follow up. All patients were from rural area, one of them complained about the absence of medication and reported financial difficulties for transportation. In conclusion, physicians must be aware of chromomycosis as a possible diagnosis when considering a chronic skin condition. Although not common, prevention strategies and alternative therapies should be investigated to improve chromomycosis management, especially in undeveloped regions. The distance and difficulties to accesses health services may delay the diagnosis and prejudice the treatment, given that small and initial lesions have better prognosis, impairing the improvement in patients' quality of live and the prevention of severe complications and morbidities.
An atopic breast eczema is usually bilateral, with intense pruritus and good response to corticosteroids. The differential diagnosis with mammary Paget's disease is fundamental, mainly in unilateral clinical manifestations, since it is frequently associated to adjacent breast tumors. The aim of the present report was to present a clinical condition of an atopic breast eczema through an exuberant and unilateral clinical presentation, emphasizing the need of the differential diagnosis for malignant diseases at this location.
Background: Dohi's Reticulated Acropigmentation is a rare autosomal dominant genodermatosis with high penetrance, characterized by small, irregular, hypo and hyperpigmented macules on the dorsal surface of the distal extremities. Case:The authors report a case of Dohi's Reticulated Acropigmentation in a 61 years old female patient. The patient complained of spots on hands, feet and posteriorly face involvement since she was 7 years old.
O xantogranuloma juvenil (XGJ) é uma histiocitose de caráter benigno e autolimitado atualmente classificada como desordem de comportamento biológico variável derivada dos dendrócitos e anteriormente classificada como histiocitose de células não Langerhans. Em geral manifesta-se como uma lesão solitária e assintomática que ocorre na maioria das vezes em pacientes menores de um ano de idade com resolução em três a seis anos, mas o envolvimento sistêmico pode ocorrer. Os autores relatam um caso com apresentação clínica incomum com lesões disseminadas por todo o tegumento compatíveis com xantogranuloma juvenil confirmadas por meio dos padrões dermatoscópico, histopatológico e imunohistoquímico, que permitiram a exclusão de possíveis diagnósticos diferenciais.
Introduction: Psoriasis is a chronic inflammatory multisystemic disease with several comorbidities, namely anxiety and depression disorders. Methods: In this study, the prevalence of these psychiatric entities was investigated by the PHQ-9 and GAD-7 questionnaries and related to the socio-demographic variables and to the forms of clinical treatment. Results: A total of 90 patients (56 females) were analyzed. Of these, 41 patients (45.56%) used topical treatment only, 28 patients (31.11%) used oral methotrexate and 21 patients (23.33%) used immunobiological agents (anti-TNF-alfa agents). It was observed that 47 patients (52.23%) presented some degree of depression (mild, moderate or severe) and 53 patients (58.89%) presented some degree of anxiety disorder (mild, moderate or severe). There was no statistical relationship between the anxiety and depression scores and the PASI score, as well as age, employability or schooling. There was a statistical association between psychiatric comorbidities and the female gender (p <0.0001). It was also observed a lower prevalence of depression (p = 0.0336) on patients using immunobiological treatments. Conclusion: The findings confirm published data, showing association of psychiatric conditions with psoriasis, especially in relation to TNF-alpha, so that anti-TNF therapies may become an alternative for the treatment of depression or anxiety disorders associated with psoriasis.
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