We describe a 7-year-old boy with dermatitis herpetiformis (DH) diagnosed on clinical and histologic evidence, negative direct immunofluorescence (DIF) findings for junctional IgA deposits in uninvolved skin, positive IgA endomysial and gliadin antibodies, and jejunal biopsy revealing a gluten-sensitive enteropathy. Treatment with dapsone led to the disappearance of cutaneous lesions and pruritus within 48 hours. Demonstration of IgA immune deposits in the dermal papillae has been the only acceptable criterion for the diagnosis of dermatitis herpetiformis. However, considering several reports in the literature of DH with a negative DIF and our own case, we believe that in the absence of the characteristic DIF pattern, one needs the combination of clinical, histologic, and immunologic data to support the diagnosis of DH. We also discuss recent developments in the diagnosis of DH.
We report a 4-year-old Caucasian girl with congenital skin lesions consisting of hyperpigmented macules that were bilateral and roughly symmetrical, covered with terminal hair and located on the scapular regions, shoulders, and arms. A cutaneous biopsy specimen showed the histologic pattern of Becker nevus. We discuss the classification of this case in the context of the published literature. CASE REPORTA 4-year-old Caucasian girl was born after a normal pregnancy and delivery under medical surveillance without complications. Her parents were in the third decade of life, nonconsanguineous, and had no significant health problems. During pregnancy the mother took no drugs except for supplements of iron and folic acid prescribed by her doctor. There were no relevant familial cases of cutaneous abnormalities.This child was observed in our dermatology department for the first time at the age of 4 years for congenital skin lesions on the scapular regions, shoulders, and arms consisting of bilateral and roughly symmetrical hyperpigmented macules with well-delimited, regular borders, covered with terminal hair (Figs. 1 and 2). There was also a small satellite lesion on the left mammary region. These skin lesions had always been asymptomatic and without evolution since her birth. Mechanical stimulation of these areas did not induce piloerection or any modification on inspection or palpation, observed under tangential lighting. Cutaneous biopsy specimen findings (Fig. 3) were suggestive of Becker nevus and the Masson-Fontana stain confirmed increased pigmentation of the basal layer.The child was otherwise normal, with weight and height in the 50th percentile. No chest or limb asymmetries or any other musculoskeletal defects were found, and her lumbosacral spine films were normal.
Introdução: As infeções fúngicas superficiais são as dermatoses infeciosas mais frequentes e a sua incidência continua a aumentar. Os dermatófitos são os principais agentes causais apresentando, contudo, uma distribuição geográfica variável.Material e Métodos: O presente estudo teve como objetivo a caracterização epidemiológica das infeções fúngicas superficiais diagnosticadas nos Serviços/Unidades de Dermatologia pertencentes ao Serviço Nacional de Saúde Português entre janeiro de 2014 e dezembro 2016 através da análise retrospetiva dos resultados das culturas realizadas durante esse período.Resultados: Foram estudados 2375 isolamentos, pertencentes a 2319 doentes. O dermatófito mais frequentemente isolado foi o Trichophyton rubrum (53,6%), tendo sido o principal agente causal da tinha da pele glabra (52,4%) e das onicomicoses (51,1%). Relativamente às tinhas do couro cabeludo, globalmente o Microsporum audouinii foi o agente mais prevalente (42,6%), seguido do Trichophyton soudanense (22,1%). Enquanto na área metropolitana de Lisboa estes dermatófitos foram os principais agentes de tinha do couro cabeludo, nas regiões Norte e Centro o agente mais frequente foi o Microsporum canis (58,5%). Os fungos leveduriformes foram os principais responsáveis pelas onicomicoses das mãos (76,7%).Conclusão: Os resultados deste estudo estão globalmente concordantes com a literatura científica. O Trichophyton rubrum apresenta-se como o dermatófito mais frequentemente isolado em cultura. Na tinha do couro cabeludo, na área metropolitana de Lisboa, as espécies antropofílicas de importação assumem particular destaque.
879Mean serum baseline TSH levels of the patients with BD and controls were found to be 1.28 ± 0.68 µg/mL and 1.83 ± 1.06 µg/mL, respectively (Table 1). Statistically, mean serum baseline TSH levels of the patients with BD were lower than those of the controls (P < 0.02). TRHstimulated mean TSH levels determined at the 20th and 60th minutes in patients with BD and controls were 9.63 ± 5.3 and 8.4 ± 4.89 µIU/mL, and 15.29 ± 8.33 and 11.07 ± 5.23 µIU/mL, respectively (Table 1). Statistically, mean TRH-stimulated TSH levels of the patients with BD were significantly lower than those of the controls at the 20th and 60th minutes (P < 0.003, P < 0.05).BD was first described as a disease having three symptoms in 1937. 5 Then, it was found that BD is a more complicated entity, as a chronic multisystem disorder with vasculitis. It has multiple systemic associations, including involvement of the gastrointestinal, cardiovascular, pulmonary, skeletal and central nervous systems. 6 Aksu et al. reported that the levels of thyroid hormones were within normal limits; however, TRH-stimulated TSH releasing was not studied. 7 In our study, mean thyroid hormone levels (T 3 , T 4 , fT 3 , fT 4 ) of patients with BD were not statistically different from those of the control group patients at baseline. Hovewer, mean serum baseline TSH levels of the patients with BD were lower than those of the controls statistically (P < 0.02).Mean serum TSH levels after TRH stimulating test were lower in patients with BD (baseline: 1.28 ± 0.83; 20th minute: 9.63 ± 5.3; and 60th minute: 8.4 ± 4.89 µIU/mL) than those of the control group (baseline: 1.83 ± 1.06; 20th minute: 15.29 ± 8.33; and 60th minute: 11.07 ± 5.23 µIU/mL) (P < 0.02, P < 0.003, P < 0.05, respectively).Several diseases such as depression and schizophrenia are known to influence thyroid values. 8 Also, certain drugs 9 (corticosteroids, propranolol) can alter thyroid parameters. None of our patients were in this group of diseases.In conclusions, thyroid functions were normal in patients with BD. However, pituitary gland response to TRH stimulation was found to have decreased in patients with BD.
We report a 4-year-old Caucasian girl with congenital skin lesions consisting of hyperpigmented macules that were bilateral and roughly symmetrical, covered with terminal hair and located on the scapular regions, shoulders, and arms. A cutaneous biopsy specimen showed the histologic pattern of Becker nevus. We discuss the classification of this case in the context of the published literature.
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