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We report the case of a 42-year-old woman with rheumatoid arthritis undergoing treatment with subcutaneous tocilizumab for the past 6 months. Three days after the administration, an asymptomatic inflammatory annular plaque of 4 cm with discrete whitish scales at the inner border margin developed at the injection site in the left iliac fossa. A smaller plaque in the left groin appeared soon after. The mycological exam was negative. Histology showed a lymphoplasmacytic superficial and deep perivascular, and periadnexal, dermal infiltrate, without epidermal changes. Lesions spontaneously regressed in 4 months. The diagnosis was clinically and histologically consistent with erythema annulare centrifugum, following the exclusion of other differential diagnoses. Erythema annulare centrifugum represents a delayed-type hypersensitivity reaction generally considered idiopathic or otherwise related to numerous triggers, including drugs such as biologics. We describe the first reported case of tocilizumab-induced erythema annulare centrifugum. This case should alert dermatologists to this relatively rare and complex entity and should raise awareness to cutaneous biologic drug reactions.

Introduction: Dupilumab is a fully human monoclonal antibody that blocks interleukin-4 and interleukin-13, key drivers of type 2 helper T-cell (Th2)-mediated inflammatory response. It was the first biologic treatment approved for adult patients with inadequately-controlled moderate-to-severe atopic dermatitis (AD). Continuous collection of daily data practice is important in order to evaluate the real effectiveness and safety of dupilumab treatment. Methods: In this observational cohort study, we prospectively included all adult patients with moderate to severe AD treated with dupilumab in our portuguese dermatology center from July 2019 to April 2020. Baseline clinical data was initially collected and treatment effectiveness and safety were assessed after 16 weeks. Results: Twenty-five patients were included. All patients had been previously treated with systemic immunosuppressants. The estimated mean Eczema Area and Severity Index Score (EASI) decreased from 27.8 at baseline to 8.8 at week 16 (+/- 4 weeks). A ΔEASI 75 response was achieved by 58.3% of patients (ΔEASI 90 - 29.1%). Conjunctivitis was the main reported side-effect, affecting 20.8% of patients. Discussion: Our study showed a significant EASI reduction during the first 16-weeks of dupilumab treatment in adult patients with AD. Despite its overall safety, daily-practice data tend to report a higher risk of conjunctivitis than previously expected and we hence recommend that patients should be specifically informed about this possible side-effect.

In recent years, the emergence of antibiotic resistant pathogens made increasingly difficult to establish appropriate empiric antimicrobial therapy protocols for acute diabetic foot infection (DFI) treatment. Early recognition of the population at-risk for multidrug-resistant (MDR) bacterial infection is of paramount importance in order to decrease large-spectrum antibiotic overuse. This study used retrospective cohort study in a multidisciplinary tertiary diabetic foot unit. Patients with severe DFI were included and divided according to their infection resistance profile (susceptible vs MDR bacteria). Data regarding their comorbidities and length of hospital stay were collected. The primary endpoint was to determine the risk factors for MDR infections and to evaluate if these were associated with an increased length of stay (LOS). A total of 112 microbial isolates were included. Predominance of Gram-positive bacteria was observed and 22.3% of isolated bacteria were MDR. Previous hospitalisation was associated with a higher likelihood of MDR infection. MDR bacterial infection was also associated with an increased LOS (P = .0296). Our study showed a high incidence of MDR bacteria in patients with a DFI, especially in those who had a recent hospitalisation. MDR infections were associated with a prolonged LOS and represent a global public health issue for which emergent measures are needed. info:eu-repo/semantics/publishedVersion

Introduction: Basal cell carcinomas are mostly treated surgically, mostly by surgery with postoperative histopathologic margin evaluation (“conventional surgery”), but large long-term data regarding recurrence by completeness of excisions is limited. Methods: Retrospective cohort study of basal cell carcinomas treated by conventional surgery at different medical specialties in a large tertiary centre, between 2008 and 2014. Survival analysis with a Cox proportional-hazards was performed, stratified by completeness of excision (complete excision/incomplete excision) and adjusted to several potentially confounding covariates. Results: A total of 2876 basal cell carcinomas were identified, of which 2306 (2100 primary, 206 recurrent) were considered eligible for analysis. During the 5-years of follow-up, there were 80 (4%) recurrences among 1980 complete excisions (16/1000 cases-year) and 83 (23.9%) recurrences among 348 incomplete excisions (100/1000 cases-year). Survival analysis was performed with multivariable adjustment. In the final adjusted model, we identified an association between relapse and re-intervention on recurrent tumors [adjusted Hazard Ratio (HR) 2.20 (95% Confidence interval (IC), 1.26-3.84), p=0.006], a wrong preoperative clinical diagnosis/surgery devoid of preoperative biopsy [adjusted HR 2.75 (95% CI, 1.68-4.5), p

The genus Fusarium is ubiquitous in the environment and has been emerging as an opportunistic human pathogen. We report the case of a 65-year-old man with a history of neuroischemic, otherwise unamenable to revascularization, diabetic foot, who was admitted due to an infected deep foot ulcer. Despite conventional antibiotic and wound care treatment, no improvement was initially observed. A reappraisal of the diagnosis, with microbiological and histological analyses, documented infection of the foot ulcer with Fusarium oxysporum. Clinical improvement was noted under prolonged oral voriconazole therapy. The present case broadens the differential diagnosis of diabetic foot infection. Subcutaneous fusariosis should be considered in recalcitrant infected diabetic ulcers, as early diagnosis and management may help prevent amputation and life-threatening disease.

Introducao: As doencas da pele sao comuns nos doentes internados nas enfermarias de Medicina Interna e requerem frequentemente a observacao por um dermatologista. Este estudo pretende caracterizar o padrao de patologia cutânea destes doentes, avaliando o impacto da Dermatologia na sua abordagem. Metodos: Foi realizado um estudo retrospectivo dos pedidos de observacao por Dermatologia nos doentes internados nos Servicos de Medicina Interna do Hospital Santo Antonio dos Capuchos, ao longo de 46 meses. Os diagnosticos associados a esses pedidos foram classificados de acordo com a 10a revisao da Classificacao Estatistica Internacional de Doencas e Problemas Relacionados a Saude. Resultados: Foram observados 231 homens e 217 mulheres, com uma idade media de 72,6 anos. As dermites de estase e as ulceras de perna venosa foram o diagnostico mais comum. Discussao e Conclusao: A equipa de Dermatovenereologia diminuiu significativamente o numero de doentes sem diagnostico. O nosso estudo parece reforcar a importância dos dermatologistas em contexto hospitalar.

Retronychia is an increasingly known cause of paronychia. It was classically regarded as an indication for total nail plate avulsion, but recent case series have questioned the real need for this approach. In order to establish a proper recommendation for patients presenting with retronychia, we retrospectively reviewed all articles with retronychia case reports. Total nail plate avulsion is still the most efficient treatment option. Topical steroids and other noninvasive approaches can be useful in some early, mild cases, but further prospective studies are needed in order to access their efficacy.

Trichoteiromania is a self-inflicted traumatic hair injury, with breaking of the hair shafts resulting from repetitive rubbing of the scalp. We describe a patient with trichoteiromania presenting with one lichenified pruriginous plaque on the scalp, associated with fracture and loss of hair shafts giving the conspicuous appearance of monotonous clusters of broom hairs under trichoscopy, which pointed to the diagnosis. As trichoteiromania can be considered a psychodermatological condition, patient education and a behavioral approach are of paramount importance in the management and prognosis of this disorder.