Pyoderma gangrenosum (PG) is a rare painful ulcerative neutrophilic inflammatory skin disease, necessitating a high level of diagnostic suspicion associated with appropriate treatment to avoid progression. Negative pressure wound therapy (NPWT) has been efficiently used in the treatment of different types of wounds. However, the role of NPWT in the management of PG is still controversial, due to the risk of the pathergy phenomenon. In this article, we conducted a systematic review (according
The bacilloscopy of the slit-skin smear (SSS) is the exclusive laboratory test associated with dermato-neurological evaluation for Hansen’s disease (HD) diagnosis; however, it is negative in the majority of PB or primary neural forms. Thus, a PCR technique involving different sequences and target genes has been performed with an aim to increase the sensitivity and specificity of M. leprae identification, especially in patients with low bacillary loads. Additionally, serological assays based on antibody response reflect infection levels and indicate that this could be a simpler, less invasive technique for estimating M. leprae exposure. Serological tests and PCR have been shown to be more sensitive and accurate than the SSS. Our study aimed to measure accuracy and performance among the SSS and PCR of dermal scrapings stored on filter paper and APGL-I serology for diagnosis in HD. A cross-sectional study analyzing the medical records (n = 345) of an HD outpatient-dermatology clinic from 2014 to 2021 was conducted. Accuracy performance parameters, correlation, and concordance were used to assess the value among the SSS, PCR, and APGL-I exams in HD. The SSS presented 24.5% sensitivity, 100% specificity, 37.4% accuracy, and the lowest negative predictive value (21.5%). The PCR assay had 41, 100, and 51% sensitivity, specificity, and accuracy, respectively. PCR and APGL-I serology increased the detection of HD cases by 16 and 20.6%, respectively. PCR was positive in 51.3% of patients when the SSS was negative. The SSS obtained moderate concordance with PCR [k-value: 0.43 (CI: 0.33–0.55)] and APGL-I [k-value: 0.41 (CI: 0.31–0.53)]. A moderate positive correlation was found between the APGL-I index and the bacillary index (r = 0.53; P < 0.0001). Thus, the use of the SSS is a low sensitivity and accuracy method due to its low performance in HD detection. The use of PCR and serological tests allows for a more sensitive and accurate diagnosis of patients.
Leprosy is a chronic disease with clinical presentations according to the immunologic spectrum. Lepromatous form is the most advanced, with the highest transmissibility and risk of causing disabilities. Lucio’s phenomenon is a rare manifestation among lepromatous patients with a rapid and severe evolution and high mortality. It is difficult to differentiate from ulcerative/necrotic erythema nodosum leprosum and has no consensus on how it should be treated. This article is a qualitative review of the literature after the introduction of multidrug therapy, aiming to bring consensus related to the clinical, laboratory and histopathological diagnostic criteria of the disease and its management.
BackgroundActinic keratoses are benign intraepithelial skin neoplasms that develop in
photoexposed areas and can progress to invasive carcinoma. They are seen
frequently in dermatological practice, occurring in 5.1% of consultations.
Ingenol mebutate (IM) was recently approved in Brazil as a topical therapy
for field cancerization in actinic keratosis.ObjectiveTo evaluate the clearance rate and adverse events in the treatment of actinic
keratoses with ingenol mebutate.MethodsA longitudinal, prospective, non-randomized, interventional, open,
single-center study was conducted. Patients with actinic keratoses applied
ingenol mebutate on a 25cm2 area of the face and/or scalp for
three consecutive days (0.015%) or on the forearm for two days (0.05%).Results27 patients completed the protocol, of whom 13 on the face and/or scalp and
14 on the forearm. Complete clearance occurred in 53.8% in the first group
and 42.8% in the second. Partial response was observed in 15.4% and 35.7%,
respectively. The most common side effects were erythema, edema,
desquamation, pruritus, and local erosion.Study limitationsThe study had a small sample and was not randomized, double-blind,
placebo-controlled, or vehicle-controlled.ConclusionIngenol mebutate is well-tolerated for the treatment of actinic keratosis,
with good patient adherence thanks to the short treatment period.
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