Cutaneous tuberculosis (CTB) is the result of a chronic infection by Mycobacterium tuberculosis, M. ovis and occasionally by the Calmette-Guerin bacillus. The clinical manifestations are variable and depend on the interaction of several factors including the site of infection and the host's immunity. This article revises the current knowledge about this disease's physiopathology and immunology as well as detailing the possible clinical presentations.

The evolution in the knowledge of tuberculosis' physiopathology allowed not only a better understanding of the immunological factors involved in the disease process, but also the development of new laboratory tests, as well as the establishment of a histological classification that reflects the host's ability to contain the infectious agent. At the same time, the increasing bacilli resistance led to alterations in the basic tuberculosis treatment scheme in 2009. This article critically examines laboratory and histological investigations, treatment regimens for tuberculosis and possible adverse reactions to the most frequently used drugs.

Resumo: A acne é uma condição clínica caracterizada como uma inflamação crônica na pele, mais precisamente na unidade polissebácea. O seu tratamento normalmente é realizado com o uso de antimicrobianos, retinóides e agentes abrasivos. A isotretinoína, embora seja um fármaco de eficácia no tratamento da acne, o mesmo pode desenvolver uma série de efeitos adversos principalmente relacionados a alterações bioquímicas, à pele e membranas mucosas. Objetivo: Identificar através de minuciosa pesquisa bibliográfica os potenciais efeitos adversos do tratamento de acne vulgar com a isotretinoína. Metodologia: Este estudo consiste em uma revisão bibliográfica, que permite analisar a literatura, observando e discutindo sobre métodos, resultados e conclusões gerais sobre o tema escolhido, bem como embasar e possibilitar fomento científico para futuras pesquisas relacionadas ao assunto em questão. Resultados e Discussão: Ao final do estudo verificou-se que os indivíduos que faziam o uso da isotretinoína oral como uma terapêutica contra a acne, apresentou as principais reações adversas, queilite, xerodermia, ressecamento das mucosas, fluxo salivar diminuído e que após o término do tratamento essas alterações desvaneciam. Considerações finais: Ainda que a isotretinoína apresente uma série de reações adversas, a mesma possui uma terapia efetiva no tratamento da acne, solucionando mais de 80 % dos casos, desta forma o farmacêutico deve frisar os riscos teratogênicos, posologia, possíveis reações e interações medicamentosas para uma farmacoterapia bem sucedida. Palavras-chave: Acne vulgar, isotretinoína, reação adversa. Abstract: Acne is a clinical condition characterized as a chronic inflammation in the skin, more precisely in the polysbaceous unit. Its treatment is usually carried out with the use of antimicrobials, retinoids and abrasive agents. Although isotretinoin is an effective drug in the treatment of acne, it can develop a number of adverse effects mainly related to biochemical changes to the skin and mucous membranes. Objective: To identify, through potential bibliographic research, the potential adverse effects of acne vulgaris treatment with isotretinoin. Methodology: This study consists of a bibliographical review, which allows analyzing the literature, observing and discussing general methods, results and conclusions on the chosen topic, as well as to base and enable scientific support for future research related to the subject in question. Results and discussion: At the end of the study, it was verified that the individuals who used oral isotretinoin as a therapy against acne, had the main adverse reactions: cheilitis, xeroderma, mucosal dryness, decreased salivary flow and that, after the end of the treatment, these changes faded. Final considerations: Although isotretinoin has a number of adverse reactions, it has an effective therapy in the treatment of acne, solving more than 80% of cases. So, the pharmacist should emphasize the teratogenic risks, posology, possible reactions and drug interactions for successfu...

Cutaneous schistosomiasis is a rare clinical manifestation of schistosomiasis, an infectious and parasitic disease, caused in Brazil by the trematode Schistosoma mansoni. The lesions are due to the deposition of eggs or, rarely, adult worms, usually involving the genital and groin areas. Extra-genital lesions occur mainly on the torso as papules of zosteriform appearance. The case of a patient with ectopic cutaneous schistosomiasis is reported in this article, due to the rarity of its occurrence and its difficult clinical diagnosis.

BACKGROUNDStaphylococcus aureus has a notable ability to acquire resistance to antibiotics, and methicillin resistance represents a growing public health problem. Methicillin-resistant S. aureus (MRSA) has also become important outside the hospital environment, particularly in the United States. In Brazil, since 2005, cases of community skin infections caused by MRSA have been reported, but resistance studies involving outpatients are scarce.OBJECTIVETo know the resistance profile of S. aureus involved in skin and soft tissue infections of patients seen at the Dermatology outpatient clinic of a university hospital in Recife, Pernambuco State, northeastern Brazil. METHODSProspective study involving 30 patients with skin and soft tissue infections, seen at the Dermatology outpatient clinic from May until November 2011. To evaluate the susceptibility of S. aureus to antibiotics, the disk diffusion method and oxacillin screening agar were used. RESULTSFrom a total of 30 samples of skin lesions, 19 (63%) had positive culture for S. aureus. The following resistance patterns of S. aureus were observed: penicillin, 95%; tetracycline, 32%; erythromycin, 21%; gentamicin, 16%; cefoxitin, 11%; oxacillin, 11%; trimethoprim-sulfamethoxazole, 11%; chloramphenicol, 11%; clindamycin, 5% ; and ciprofloxacin, 0%. One of the identified MRSA was obtained from a patient without risk factors for its acquisition, and was resistant, beyond to the beta-lactams, only to tetracycline. CONCLUSIONSWith regard to the resistance patterns of S. aureus, resistances to tetracycline, erythromycin and gentamicin were the highest. It was documented, for the first time in Pernambuco, a case of skin infection caused by community-associated MRSA.

A síndrome de Cowden (SC) ou síndrome de múltiplos hamartomas (SMH) é genodermatose rara de herança autossômica dominante e expressividade variável. É caracterizada por múltiplas lesões hamartomatosas de origem ectodérmica , mesodérmica e endodérmica. O órgão mais acometido é a pele, e as lesões mucocutâneas estão presentes em proporção que varia de 99 a 100% dos casos. Esses sinais precedem o desenvolvimento do câncer em vários anos, servindo como importantes marcadores clínicos na identificação de pacientes com alto rico para desenvolver câncer da mama e tireóide. Devido a associações com malignidades internas o diagnóstico precoce é essencial. O locus gênico para SC foi identificado no cromossomo 10q22-23. As mutações no gene supressor tumoral, PTEN/MMAC1, localizado no cromossomo 10q23, têm sido implicadas no desenvolvimento do câncer mamário. Os autores relatam um caso dessa rara entidade. Trata-se de paciente do sexo masculino com quadro clínico característico dessa síndrome.

BackgroundKaposi's sarcoma continues to be the most common human immunodeficiency virus - associated neoplasm with considerable morbidity and mortality.ObjectiveTo describe the clinical and laboratory characteristics, initial staging, and outcomes of aids patients with Kaposi's sarcoma at an university hospital of Recife, Pernambuco.MethodsThis is a descriptive study with analytic character, retrospective, of a case series between 2004 and 2014.ResultsOf the 22 patients included in the study, 20 were aged <40 years (72.7%). The majority had CD4+ T lymphocyte counts of <200 cells/mm3 (77.3%) and human immunodeficiency virus loads of <100,000 copies/mL (78.9%). Lesions were most commonly observed on the skin (90%), and internal organs were affected in 11 of the 22 patients. Only 7 (31.8%) of the 22 patients were undergoing antiretroviral therapy (ART) at the time of Kaposis sarcoma diagnosis, and the initial disease staging classification was high risk (Aids Clinical Trials Group Oncology Committee) in 19 of the 22 patients (86.4%). Regarding Kaposi's sarcoma treatment, 17 of 22 patients (77.3%) underwent systemic chemotherapy + ART and 5 were treated exclusively with ART. Eight of the 22 patients died (36.5%); of these, 87.5% had died within one year of Kaposi's sarcoma diagnosis.Limitation of the studyWithout a control group, this study cannot be used to generate hypotheses.ConclusionsDespite the association between aids and late Kaposi's sarcoma diagnosis in the study population, including an unfavorable risk at the time of staging, a lower mortality rate was observed relative to other studies; this might be related to access to a specialized health service.

Background Urticarias are frequent diseases, with 15% to 20% of the population presenting at least one acute episode in their lifetime. Urticaria are classified in acute ( ≤ 6 weeks) or chronic (> 6 weeks). They may be induced or spontaneous. Objectives To verify the diagnostic and therapeutic recommendations in chronic spontaneous urticaria (CSU), according to the experience of Brazilian experts, regarding the available guidelines (international and US). Methods A questionnaire was sent to Brazilian experts, with questions concerning diagnostic and therapeutic recommendations for CSU in adults. Results Sixteen Brazilian experts answered the questionnaire related to diagnosis and therapy of CSU in adults and data were analyzed. Final text was written, considering the available guidelines (International and US), adapted to the medical practices in Brazil. Diagnostic work up in CSU is rarely necessary. Biopsy of skin lesion and histopathology may be indicated to rule out other diseases, such as, urticarial vasculitis. Other laboratory tests, such as complete blood count, CRP, ESR and thyroid screening. Treatment of CSU includes second-generation anti-histamines (sgAH) at licensed doses, sgAH two, three to fourfold doses (non-licensed) and omalizumab. Other drugs, such as, cyclosporine, immunomodulatory drugs and immunosuppressants may be indicated (non-licensed and with limited scientific evidence). Conclusions Most of the Brazilian experts in this study partially agreed with the diagnostic and therapeutic recommendations of the International and US guidelines. They agreed with the use of sgAH at licensed doses. Increase in the dose to fourfold of sgAH may be suggested with restrictions, due to its non-licensed dose. Sedating anti-histamines, as suggested by the US guideline, are indicated by some of the Brazilian experts, due to its availability. Adaptations are mandatory in the treatment of CSU, due to scarce or lack of other therapeutic resources in the public health system in Brazil, such as omalizumab or cyclosporine.