Phaeohyphomycosis caused by Veronaea bothryosa is very rare. We report two cases. To our knowledge, these are the first and second cases to be reported on the American continent, and fourth and fifth cases in the world literature. We report one case in a kidney transplant recipient, and another case in an immunosuppressed non-transplant patient. Both patients presented with a lesion on the dorsal aspect of the foot, following trauma. One patient responded moderately well to treatment with itraconazole.

Angioedema may be caused by nonsteroidal antiinflammatory drugs, angiotensin-converting enzyme inhibitors, radiocontrast media, antibiotics, sea food etc. It can involve an allergic (IgE-mediated) or non-allergic hypersensitivity reaction, both with a similar clinical presentation. While angioedema due to isotretionin has been described previously, this is the first description of angiodema due to acitretin. We report two uncommon cases of palpebral and labial angiodema due to retinoids, by acitretin and oral isotretinoin respectively: a 48-year-old man with psoriasis and a 24-year-old woman with severe acne resistant to antibiotics and topical drugs. In both cases the reaction persisted throughout treatment with these drugs, but resolved quickly after discontinuation. Reintroduction of the drugs brought on angioedema again. Keywords: Acitretin; Angioedema; Edema; Isotretinoin Resumo: Angioedema pode ser causado por diversos fármacos como : antiinflamatórios não-esteroidais, inibidores da ECA, contrastes, antibióticos e frutos do mar, entre outras causas. Pode ser uma reação alérgica, mediada por IgE, ou não-alérgica, com apresentações clínicas semelhantes. Angioedema por isotretinoína já foi relatado, mas não por acitretina. Relatamos dois casos, uma com angioedema palpebral e um labial, por acitretina e isotretinoína, respectivamente: um paciente de 48 anos com psoríase e uma paciente de 24 anos com acne resistente à terapia convencional. Em ambos casos a afecção persistiu durante o tratamento, resolveu com a interrupção e recidivou com reexposição.

Flegel's disea se, also known as hyper ke ra to sis len ti cu la ris pers tans, is a rare skin disea se cha racte ri zed by small red dish-brown asympto ma tic hyper ke ra to tic papu les usually loca ted on the lower extremi ties. The his to pa tho lo gi cal fea tu res are hype ror tho ke ra to sis, epi der mal atrophy and band-like inflam matory infil tra te in the super fi cial der mis. Treatment is gene rally inef fec ti ve. We report a case of hyper ke ra tosis len ti cu la ris pers tans that impro ved fol lo wing exci sio nal biopsy of the lesions. Keywords: Biopsy; Keratinocytes; Keratosis; Leg der ma to ses; Skin disea ses, papu los qua mous; Treatment out come Resumo: Doença de Flegel ou hiper que ra to se len ti cu lar per sis ten te é uma doen ça rara, carac te ri za da por peque nas pápu las hiper ce ra tó ti cas, assin to má ti cas, loca li za das pre fe ren cial men te nos mem bros infe rio res. Histologicamente, há hipe ror to ce ra to se, atro fia epi dér mi ca e infil tra do infla ma tó rio em banda. Os tra tamen tos, em geral, são ine fi ca zes. Relatamos um caso em que as lesões biop sia das não reci di va ram após dois anos de segui men to. Palavras-chave: Biópsia; Ceratose; Dermatopatias papu loes ca mo sas; Dermatoses da perna; Queratinócitos; Resultado de Tratamento Holder of a master's degree in health and behavior -Dermatologist at the Bela Pele private clinic and professor of clinical surgery and ambulatory training at

A case is described of lichen aureus in a 23 year old female with a 2-year history of painful, purpuric, rust-coloured to tan, lichenous lesion on forearm. A biopsy specimen demonstrated a dense lymphohistiocytic infiltrate in the upper dermis, with extravasation of red cells. The "algesiogenic" lichen aureus is a very rare dermatosis. Keywords: Lichenoid eruptions; Pain; Purpura

Editor Macular Amyloidosis (MA) is characterized by the deposition of an amorphous hyaline protein, restricted to the papillary dermis, normally without extracutaneous manifestations. Clinically, MA presents as hyperpigmented macular lesions on the back, involving the interscapular area and legs. Light microscopy using special stainings confirms the diagnosis. Transmission electron microscopy (TEM) is another technique that allows the visualization of long non-branching fibrils in the papillary dermis, that are isolated or in bundles. 1,4 We report a case of extensive MA with an innovative approach using scanning electron microscopy (SEM).A 35-year-old female patient, skin phototype IV, presented extensive areas of hyperpigmented macules, with rippled pattern, slightly pruritic, which began approximately 8 years ago, involving the legs and dorsal region (Fig. 1a,b). The following tests were performed and the results were normal: CBC, liver and kidney function, protein electrophoresis and immunoelectrophoresis. Bence-Jones protein in urine was absent. The tests for HbsAg, VDRL HCV, HIV I and II were negative.Light microscopy showed amyloid deposits, with rippled pattern, in the papillary dermis and in some areas in direct contact with basal cells, either by haematoxylin-eosin and more easily viewed by crystal violet staining (Fig. 1c,d).Using SEM to examine the lateral surface of the punch biopsy, it was possible to observe in the papillary dermis, with low magnification (91800), irregularly arranged collagen fibrils, intermingled with deposits (Fig. 2a).Higher magnification showed that these deposits had variable morphology, predominantly globular, sometimes flattened, stone or gravel-like, among other forms. Very high magnifications (96000-8000) allowed a better view of the irregular, stony or gravel-like deposits, which measured from 2 to 5 microns (Fig. 2c,d). In normal skin, the collagen fibers are well arranged and without deposits (92400) (Fig. 2b).This case is a primary extensive macular amyloidosis, as there was no evidence of systemic involvement or association with other diseases, papules, nodules, purpuric or infiltrative lesions or macroglossia were not found. MA is commonly diagnosed by the presence of eosinophilic, hyaline, homogeneous and fissured deposits in the upper dermis. Sparse perivascular lymphohistiocytic infiltrate and incontinentia pigmenti may also be present. Other criteria include the identification of amyloid deposit using Congo red staining with birefringence seen through a polarized light and bright aspect with ultraviolet fluorescent microscopy.Crystal Violet, which was used in this case report, also allows the visualization of amyloid accumulation. Two other clinical forms of primary skin amyloidosis are also recognized: Lichen Amyloidosis (LA) and Nodular Amyloidosis (NA), which are characterized by papules and nodules respectively. Histologically, the deposits extend beyond the papillary dermis towards the depth. 2,3The exact cause of macular amyloidosis is still unknown, but t...

Editor Acrokeratoelastoidosis (AKE) is a genodermatosis characterized by small, firm papules or plaques on the sides of the hands and feet, 1 and it was first described in 1953 by Costa, in a Brazilian patient. It is a rare disease, and both autosomal dominant and sporadic forms have been observed. 2 It is characterized by multiple hyperkeratotic papules on the palms, soles and dorsum of the hands and feet. Typical histopathological findings in AKE include hyperkeratosis, acanthosis with fragmented and decreased elastic fibres in reticular dermis (elastorrhexis). 3 Electron microscopy (EM) findings in AKE are limited. A 45-year-old white woman presented with small asymptomatic palmar papules that emerged at the beginning of adolescence. These papules were waxy and in great number along the borders of the hands, but were also present in the flexures of the fingers (Fig. 1a). In detail, the dermatoglyphics were not affected (Fig. 1b), suggesting a dermal involvement. The patient had a bureaucratic job and her activities and hobbies did not require constant use of hands. The feet were not affected. She denied a positive family history. Light microscopy with HE staining showed unspecific findings with compact hyperkeratosis and marked acanthosis.

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