Trichotillomania is a psychodermatologic disorder characterized by uncontrollable
urge to pull one's own hair. Differential diagnoses include the most common
forms of alopecia such as alopecia areata. It is usually associated with
depression and obsessive-compulsive disorder. Trichotillomania treatment
standardization is a gap in the medical literature. Recent studies demonstrated
the efficacy of N-acetylcysteine (a glutamate modulator) for the treatment of
the disease. We report the clinical case of a 12-year-old female patient who
received the initial diagnosis of alopecia areata, but presented with clinical
and dermoscopic features of trichotillomania. She was treated with the
combination of psychotropic drugs and N-acetylcysteine with good clinical
response. Due to the chronic and recurring nature of trichotillomania, more
studies need to be conducted for the establishment of a formal treatment
algorithm.
This is a cross-sectional study, conducted from May to November/2014, in a
dermatology reference unit, through review of medical records and interviews. In
a sample of 49 patients with brachioradial pruritus, we observed higher
prevalence of Caucasian (81.6%) and women (73.5 %), with a mean age of 56.1
years. Pruritus occurred in the topography of brachioradialis muscle in 87.8% of
cases; 59.2% of the sample reported worsening of pruritus with sun exposure; the
mean intensity of this symptom before treatment was 8.63. Therapy effectiveness
was described as "very good/good" in 79.2% of cases, and for 55.3% relapses were
categorized as "uncommon".
A 54 year-old woman with a 3-year history of rheumatoid arthritis (RA) consulted
us because of weight loss, fever and skin eruption. On physical examination,
erythematous plaques with a pseudo-vesicular appearance were seen on the back of
both shoulders. Histological examination was consistent with rheumatoid
neutrophilic dermatosis (RND). After three days of prednisone treatment, the
skin eruption resolved. RND is a rare cutaneous manifestation of seropositive
RA, characterized by asymptomatic, symmetrical erythematous plaques with a
pseudo-vesicular appearance. Histology characteristically reveals a dense,
neutrophilic infiltrate with leucocitoclasis but without other signs of
vasculitis. Lesions may resolve spontaneously or with RA treatment. This case
illustrates an uncommon skin manifestation of active rheumatoid arthritis.
Few studies have described therapeutic options in brachioradial pruritus. We
describe a cross-sectional study of brachioradial pruritus patients treated in
an outpatient unit. We reviewed medical records and interviewed brachioradial
pruritus patients without indication for decompressive surgery, in order to
access the perceptions of intensity of pruritus prior to treatment and response
to therapy. We found that antidepressants and anticonvulsants were the most
frequently prescribed drugs. Best reductions in pruritus were associated with
its highest intensities prior to treatment, and with longer periods of
therapy.
Pigmented purpuric dermatoses (PPD) include a spectrum of diseases with different
clinical aspects, but with similar histopathological features. Specific clinical
findings allow the division of PPD in variants. Schamberg's disease is the most
common. Treatment is sometimes ineffective and recurrences are common. There are
reports of patients who responded well to the use of colchicine. We report the
case of a 32-year-old woman, previously healthy, with a history of onset of
asymptomatic lesions in legs. She presented purpuric skin eruptions and brownish
stains diffusely distributed in the lower limbs. Biopsy was compatible with PPD.
We decided for the introduction of colchicine, with good clinical response. The
patient has been followed on outpatient basis for ten months without
recurrence.
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