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Dear Editor:Seabather's eruption (SBE) is an acute dermatitis characterized by itchy and erythematous papules that appear during or after bathing in the sea. It is caused by contact with the larvae and adult of the jellyfish (Linuche unguiculata and L. aquila, recently found in the Philippines) and larvae of the sea anemone Edwardsiella lineata 1-3 . Limited information is available on this type of dermatitis. However, it is considered a public health concern in Brazilian coastal areas 2-7 . Here, we report two typical cases of SBE characterized by exuberant and eczematous lesions, aggravated by diagnostic confusion with dermatophytosis and parasitic infestations such as cutaneous larva migrans and scabies.Envenomations occurred in a female and male children aged 2 and 11 years, respectively, who frequently went to the coastal beaches in the state of Santa Catarina, Brazil. The children experienced a pricking sensation in the pubic, genital, and gluteal regions during sea bathing, which progressed to pruritus and intensified at night.The parents of the one child consulted a pharmacist, who diagnosed the condition as ringworm and recommended the use of topical ketoconazole. After 1 week of treatment, the manifestations had worsened. Thus, the parents sought consultation from a dermatologist. The other child was taken by his mother to a pediatric emergency department. The condition was diagnosed as cutaneous larva migrans, and topical thiabendazole was prescribed and used for 2 weeks. However, due to the aggravation of pruritus and lesions, the child returned to the hospital for consultation from the same pediatrician who changed the diagnosis to scabies. Topical permethrin was prescribed, but the mother subsequently decided to consult a dermatologist.Both dermatological examinations revealed intense pruritic and eczematous, erythematous papules located mainly in the gluteal regions (Figures 1A, B, E, and F). Dermoscopic examinations did not reveal the structures of L. unguiculata or cnidocytes, and examination of areas with exulcerated and meliceric crusting revealed nonspecific findings (Figures 1C, D, G, and H).The patients were treated with systemic antihistamines and corticosteroid creams. The condition of both the patients improved, with complete regression of the lesions and pruritus after 15 and 21 days of treatment, respectively.The occurrence of SBE among individuals living on the Brazilian coast is caused by the planulae and the scyphomedusa L. unguiculata, which is found on the Santa Catarina coast 2-8 . Limited information is available of this type of dermatitis, and its occurrence is mainly observed in individuals living on the coastlines of São Paulo and Santa Catarina 3-7 . In this study, the initial clinical manifestations, which include erythematous, itchy papules that appeared during exposure to seawater, particularly in areas covered by bathing suits, with a gradual increase in itching, were typical of SBE in children 1-7 .Clinical and epidemiological diagnoses can be made. However, the absence ...

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A teleconsultoria como ferramenta de qualificação da atenção primária à saúde: Um relato de experiência do núcleo de telessaúde de Santa Catarina The teleconsulting as a tool of qualification of primary health care: An experience relate of telehealth center of Santa Catarina

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BACKGROUNDPsoriatic arthritis (PsA) is an immune-mediated inflammatory disease affecting joints and entheses, with a numerous articular and extra-articular involvement. There are five clinical subtypes described: oligoarticular, polyarticular, distal, axial (that involves the spine and sacroiliac joints) and mutilans. Peripheral joints radiographs often reveal bone loss with eccentric erosions, jointspace narrowing, ankylosis and enthesophytes, while magnetic resonance imaging (MRI) demonstrate focal erosion, synovitis and bone edema. Its treatment ranges from nonbiologic disease-modifying antirheumatic drugs (DMARDs) to biologic DMARDs. Spondyloarthropathies can be accompanied by cardiovascular lesions; however, only few cases of PsA associated with Takayasu's arteritis (TA) have been published. TA is an idiopathic granulomatous large-vessel vasculitis that predominantly affects young females and involves the aorta, its proximal brunches and pulmonary arteries. The inflammation can result in stenosis, dilation, or aneurysm formation. Nonspecific symptoms include fever, night sweats, weight loss, arthralgia, myalgia, and anemia. As the inflammation progresses, it becomes more apparent, with diminished or absent pulses, vascular bruits, hypertension, retinopathy, aortic regurgitation, congestive cardiac failure, seizures, amaurosis, erythema nodosum. Due to the absence of biomarkers and difficulty in accessing tissues for pathological examinations, it is necessary to trust imaging being angiography the gold standard. Since it is an invasive method, some alternatives are computerized tomography angiography and magnetic resonance angiography (MRA). Initial treatment involves immunosuppression with systemic glucocorticoids and nonbiologic DMARDs, in some cases the use of biologic DMARDs or surgical intervention may be necessary.