Cutaneous endometriosis is a rare manifestation of endometriosis, representing 0.5% to 1% of all endometriosis cases. It can be divided into primary and secondary, when appearing spontaneously or after a surgical procedure, when it is mostly found on surgical scar tissue. Some etiologies were proposed, but none of them could entirely explain the appearance of the tumor. Differential diagnosis includes melanoma, metastatic nodule, keloid and pyogenic granuloma. Dermoscopic features are not yet well established, but there are some characteristics that suggest the diagnosis. Treatment is surgical in larger sized lesions. Malignization can occur. The screening for endometriosis is mandatory by means of gynecologic, imaging and marked-tumor evaluation. We report a case of primary umbilical endometriosis and discuss its dermoscopic aspects.

Psoriasis is a chronic inflammatory disease that affects 1.3% of the Brazilian population. The most common clinical manifestations are erythematous, scaling lesions that affect both genders and can occur on any anatomical site, preferentially involving the knees, elbows, scalp and genitals. Besides the impact on the quality of life, the systemic nature of the disease makes psoriasis an independent risk factor for cardiovascular disease, especially in young patients with severe disease. By an initiative of the Brazilian Society of Dermatology, dermatologists with renowned clinical experience in the management of psoriasis were invited to form a work group that, in a partnership with the Brazilian Medical Association, dedicated themselves to create the Plaque Psoriasis Diagnostic and Treatment Guidelines. The relevant issues for the diagnosis (evaluation of severity and comorbidities) and treatment of plaque psoriasis were defined. The issues generated a search strategy in the Medline-PubMed database up to July 2018. Subsequently, the answers to the questions of the recommendations were devised, and each reference selected presented the respective level of recommendation and strength of scientific evidence. The final recommendations for making up the final text were worded by the coordinators.

Resumo: A mucinose papulosa ou líquen mixedematoso é doença idiopática, manifestada por pápulas, nódulos ou placas por depósito de mucina na derme, na ausência de doença tireoidiana. Apresentamos um caso atípico, com lesões exuberantes em placas, associado ao hipotireoidismo subclínico. Nas mucinoses cutâneas há quantidade anormal de mucina na pele. Tradicionalmente as classificações consideram critério diagnóstico para mucinose papulosa a ausência de doença tireoidiana. Poucos casos associados ao hipotireoidismo são descritos e, assim como o nosso, constituem líquen mixedematoso atípico, sugerindo que a presença de doença tireoidiana não deva ser critério de exclusão para essa doença. Palavras-chave: Escleromixedema; Hipotireoidismo; Mucinas Abstract: Papular mucinosis or lichen myxedematosus is an idiopathic disorder characterized by papules, nodules or plaques caused by mucin deposition in the dermis, in the absence of thyroid disease. The present report describes an atypical case with exuberant lesions in the form of plaques, associated with subclinical hypothyroidism. In cutaneous mucinosis, there is an abnormal quantity of mucin in the dermis. In traditional classifications of papular mucinosis, an absence of thyroid disease constitutes a diagnostic criterion. A few cases of the disease have been reported in association with hypothyroidism constituting, as in the present case, atypical lichen myxedematosus. It is therefore suggested that the presence of thyroid disease should not be considered an exclusion criterion for the diagnosis of this condition. Professor assistente do serviço de dermatologia da Universidade do Estado do Rio de Janeiro (Uerj), mestre em dermatologia pela Universidade Federal Fluminense (UFF) -Rio de Janeiro (RJ), Brasil. 5Professora adjunta do serviço de dermatologia da Universidade do Estado do Rio de Janeiro (Uerj), doutora em dermatologia pela Universidade Federal do Rio de Janeiro (UFRJ) -Rio de Janeiro (RJ), Brasil. ©2010 by Anais Brasileiros de Dermatologia INTRODUÇÃOA mucinose papulosa ou líquen mixedematoso é doença crônica idiopática, caracterizada por pápulas, nódulos ou placas liquenoides causadas por depósi-to de mucina na derme e grau variável de fibrose, na ausência de doença tireoidiana.1,2 Inclui dois subtipos clinicopatológicos. O chamado escleromixedema é forma generalizada e esclerodermoide, acompanhada de gamopatia monoclonal e manifestações sistêmi-cas, que pode ter êxito letal. Por outro lado, a forma papular localizada, que abrange uma série de quadros mais limitados, costuma apresentar curso benigno e crônico.3 Ocasionalmente pode ocorrer sobreposição entre diferentes formas da doença ou ainda casos com características únicas e distintas das descritas para todos os subtipos. Estes são os denominados casos atípicos.

A disorder of unknown origin, psoriasis is characterized by erythemato-squamous eruption. Amongst its clinical and morphologic presentations there is acute generalized pustular psoriasis, termed the von Zumbusch variant, accompanied by generalized toxicity. It is often triggered when stopping steroids, in unstable psoriasis patients. Case report of atypical development that began during prednisone use; complete clearing of lesions and symptoms was achieved with 35 days of acitretin.

Hyperthrofic lichen planus is considered a variant of lichen planus with marked epidermal hyperplasia in response to persistent itch. It is clinically, characterized by symmetric hyperkeratotic plaques, of purplish-grey color, often located in the pretibial region. Intense pruritus, refractoriness to conventional treatments and the possibility of association of the long-term injuries with squamous cell carcinoma requires an effective treatment. The first-line treatment is corticosteroids which can be applied either topically or systemically. Other therapeutic modalities proposed are: NB-UVB phototherapy or PUVA, immunosuppressive drugs and systemic retinoids, notably acitretin. We report a case with exuberant clinical presentation of hyperthrofic lichen planus with excellent response to acitretin after nine months of treatment. Keywords: Acitretin; Immunosuppressive drugs; Lichen planus; Prednisone Resumo: O líquen plano hipertrófico é uma variante do líquen plano, com pronunciada hiperplasia epidér-mica em resposta à coçadura persistente. Clinicamente, caracterizam-se por placas hiperceratósicas, simétri-cas, de coloração cinza-violácea, com predileção pela região pré-tibial. O prurido intenso, a refratariedade aos tratamentos convencionais e a possibilidade de associação de um carcinoma epidermoide às lesões de longa duração impõem um tratamento eficaz. Os corticoides são considerados o tratamento de primeira linha e podem ser aplicados topicamente ou empregados de forma sistêmica. Outras modalidades terapêu-ticas propostas são a fototerapia com UVB-NB ou PUVA, imunossupressores e retinoides sistêmicos, com destaque para a acitretina. Relatamos um caso com apresentação clínica exuberante e excelente resposta à acitretin, totalizando um seguimento de nove meses.