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.
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.
Leprosy in children under 15 years of age is a serious public health problem. In
this retrospective case series conducted in a Brazilian reference center
(2004-2012), we found 18 cases with a mean age of 10.0±3.6 years of age
and 16.6% between 0-5 years of age. Almost 56% of the cases were female, with a
median time between the first symptoms and diagnosis of 11 months (4-24); 77.8%
reported household contact with leprosy patients. Upon hospital admission, 66.7%
presented mostly skin symptoms, while 27.8% presented a degree 2 disability.
Most were classified as multibacillary (66.7%). Half of the sample developed a
reaction (predominantly type 1) during the follow-up period, while 22.2%
developed a late disability.
We report a case of granulomatous slack skin, a rare and indolent subtype of
mycosis fungoides. It affects mainly men between the third and fourth decades.
It is characterized by hardened and erithematous plaques that mainly affect
flexural areas and become pedunculated after some years. Histological
examination shows a dense infiltrate of small atypical lymphocytes involving the
dermis (and sometimes the subcutaneous tissue) associated with histiocytic and
multinucleated giant cells containing lymphocytes and elastic fibers
(lymphophagocytosis and elastophagocytosis, respectively). Patients affected by
this entity can develop secondary lymphomas. There are several but little
effective therapeutic modalities described. Despite the indolent behavior of
granulomatous slack skin, its early recognition and continuous monitoring by a
dermatologist becomes essential for its management and prevention of an
unfavorable outcome.
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