Alternaria species belong to a group of opportunistic fungi that causes skin infection mainly in immunosuppressed patients. The authors describe two clinically distinct cases of cutaneous alternariosis caused by Alternaria infectoria in patients under prolonged corticosteroid treatment. Additionally, a brief review of published cases in portuguese patients is conducted.
Summary
Pediatric androgenetic alopecia is an underrecognized disorder. A clinical evaluation with trichoscopy should be made in children and adolescents with hair loss and/or reduced hair density. Diagnosis is usually clinical, by observation of the hair loss pattern and performance of trichoscopy. In some cases, hyperandrogenism should be excluded. Although there is no approved therapy for androgenetic alopecia in pediatric age, topical minoxidil, oral minoxidil and topical finasteride may be very useful. Hair transplant may be an option for girls in selected cases. This article is a review of the current state of evidence concerning pediatric androgenetic alopecia.
A 20-month-old child presented with annular erythematous plaques.The lesions started at 6 months of age, first in the malar region ( Figure 1) and then on the lower limbs (Figures 2 and 3). Physical examination revealed annular and polycyclic erythematous plaques with raised borders and clear center, with no trailing scale or vesicles. The lesions expanded centrifugally. According to her parents, the lesions disappeared spontaneously every 4 to 6 weeks, with no residual hyperpigmentation or atrophy. Afterward, the child remained lesion-free for a period of 4 to 6 weeks, when the lesions would relapse again in the same areas.She had received no previous medication and had no history of infection or insect bite. The child did not have any constitutional symptoms.Her growth rate was normal and past medical history unremarkable.Her twin brother was healthy and had no similar lesions.Her complete blood count was normal. Immunoglobulin levels were within the normal range, and anti-nuclear antibodies were negative. A punch biopsy was performed on the margin of one lesion (Figure 4).
Ulcerating and mutilating variant of carpal tunnel syndrome occurs in longstanding cases of untreated disease. Pa- tients present with painless ulcers of the second and third fingers, accompanied with other cutaneous and sensory changes. These patients are often misdiagnosed as having a Raynaud disease or systemic sclerosis. Clinical assessment is the gold standard for the diagnosis of carpal tunnel syndrome, but hand radiography and electromyography help supporting the diagnosis. The authors present two cases of this ulcerating variant of carpal tunnel syndrome.
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