Search

Cutaneous horn is a protuberance constituted by compact keratinous material, with a hard consistence similar to a horn, which occurs more frequently in photoexposed areas. The authors describe a case of cutaneous horn on the glans considered a rare location. Verrucous carcinoma was the histopathological diagnosis of the base of the horn and lichen sclerosis, the precursor lesion., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2021 by S. Karger AG, Basel.)

We report a woman with two giant Basal cell carcinomas (BCCs) on the back, the largest with 12 cm in diameter, inside a vitiligo plaque. They were metatypical subtype BCC associated with a nodular subtype area. Thinking of BCC in vitiligo lesion is extremely important. Giant BCC and vitiligo are rare association., Competing Interests: None declared.

The authors present a case of flagellate dermatitis in a previously healthy young male, triggered by the consumption of shiitake mushrooms. Complete remission without complications was obtained within 7 days, simply by the application of dexamethasone cream 0.1%. Considering the growing use of this originally Asian fungus in cookery worldwide, it is likely that we will see increased occurrence of this benign and self-limited condition also in the Western world., Competing Interests: The authors have no conflicts of interest to declare. There were no financial interests (stocks, patents, employment, honoraria, or royalties) or nonfinancial relationships (political, personal, or professional) that may be interpreted as having influenced the writing of this paper.

The nevus sebaceous of Jadassohn, usually present at birth, is a hamartoma composed predominantly of sebaceous glands, which can progress to benign and malignant tumors. Malignant neoplasms on the nevus sebaceous occur in about 2.5 percent of cases, with basal cell carcinoma accounting for 1.1 percent. Suspected cases of transformation should be clinically monitored and excised. We report the case of a 38-year-old man with a yellowish plaque located in the left parietal region, present from birth, on which a brownish papular lesion developed. The histopathological examination showed that it was a basal cell carcinoma. In presenting this case of basal cell carcinoma on a nevus sebaceous, we emphasize the evolutionary possibilities in order to improve prompt diagnosis and correct treatment., Competing Interests: FUNDING:No funding was received for this study. DISCLOSURES:The authors have no conflicts of interest relevant to the content of this article.

Sporotrichosis is an infection caused by fungi of the Sporothrix complex. The clinical lymphocutaneous presentation corresponds to the great majority of cases. With the increased incidence of sporotrichosis in the State of Rio de Janeiro, Brazil, atypical clinical forms have been reported with increasing frequency, usually associated with immunosuppression. We report the case of a 47-year-old female, with HIV and disseminated sporotrichosis, presenting molluscum-like skin lesions, as well as lung, nasal, and oral mucosa involvement. We also report the first demonstration of culture of Sporothrix in scales of the skin lesion, a fact not identified in the consulted literature.

The authors present a classic case of Churg-Strauss syndrome with an exuberant clinical picture in a 34-year-old woman. She showed the following diagnostic criteria: asthma, polyneuropathy, rhinopathy, marked eosinophilia, positive p-ANCA with a perinuclear pattern, and skin histopathology results suggestive of vasculitis with eosinophils. There was a good response to prednisone, dexamethasone pulse therapy, and cyclophosphamide.

Nevus comedonicus is a rare cutaneous anomaly, characterized by the clustering of papules with firm, blackened horny buffers. It in general has a zosteriform pattern and affects both genders equally. In some patients, there is formation of cysts, abscesses, and fistulas, aggravating its psychosocial impact. The association with extracutaneous lesions characterizes the nevus comedonicus syndrome. Despite several therapeutic options, the result is unsatisfactory in most cases. We report the case of a man with an exuberant congenital lesion, affecting the left suprascapular region, arm, and forearm.

Sporotrichosis is the subcutaneous mycosis caused by several species of the Sporothrix genus. With worldwide occurrence, the State of Rio de Janeiro is presently undergoing a zoonotic sporotrichosis epidemic. The form of lymphocutaneous nocardiosis is rare, being caused especially by Nocardia brasiliensis. It appears as a nodular or ulcerated lesion, with multiple painful erythematous nodules or satellite pustules distributed along the lymphatic tract, similar to the lymphocutaneous variant of sporotrichosis. We present a 61-year-old man who, after an insect bite in the left leg, developed an ulcerated lesion associated with ascending lymphangitis, nonresponsive to previous antibiotic therapies. The patient was admitted for investigation, based on the main diagnostic hypothesis of lymphatic cutaneous sporotrichosis entailed by the highly suggestive morphology, associated with the epidemiologic information that he is a resident of the city of Rio de Janeiro. While culture results were being awaited, the patient was medicated with sulfamethoxazole-trimethoprim to cover CA-MRSA and evolved with total healing of the lesions. After hospital discharge, using an ulcer fragment, an Actinomyces sp. was cultivated and N. brasiliensis was identified by molecular biology. The objective of this report is to demonstrate a case of lymphocutaneous nocardiosis caused by N. brasiliensis after a probable insect bite. Despite the patient being a resident of the State of Rio de Janeiro (endemic region for sporotrichosis), it is highlighted that it is necessary to be aware of the differential diagnoses of an ulcerated lesion with lymphangitis, favoring an early diagnosis and appropriate treatment of the illness.

The authors present a case of onychomatricoma, a rare benign tumour of the nail matrix, first described by Baran and Kint in 1992. The lesion appeared on the proximal nail fold, covering half the nail of the second left finger. The nail was thickened and yellowish with longitudinal melanonychia. It was surgically removed with very satisfactory aesthetic results even after 5 years. A review on the subject is also presented., Competing Interests: There are no conflicts of interest.

Tinea nigra is a superficial fungal infection caused by Hortaea werneckii. It typically affects young individuals as an asymptomatic unilateral macule, from light brown to black on the palms and soles, mainly in tropical and subtropical regions. In 1997, Gupta et al. [Br J Dermatol 1997;137:483-484] described the dermoscopic characteristics of tinea nigra. Topical antifungals with or without keratolytic agents can be used for the treatment. The authors report a case of a 47-year-old man with asymptomatic light brown macules bilaterally on the plantar regions. Dermoscopic examination revealed brownish spicules consistent with the pattern described in the literature. Treatment with isoconazole cream was effective with complete resolution.

We report a new case of neuroendocrine carcinoma for which it was not possible to find the primary site until now. The recent medical literature about skin metastasis of neuroendocrine carcinoma (neuroendocrine tumor) is discussed.

Hepatitis C virus (HCV) chronically infects 0.5-3% of the world population. A large group of patients develop cirrhosis and its complications. Since 2011, telaprevir and boceprevir are used, improving the disease evolution. One of the main side effects of these drugs is skin eruption. We report a 53-year-old patient with cirrhosis due to HCV who started the classic treatment associated with telaprevir. In the ninth week, he presented a severe rash that required the interruption of this drug. We emphasize the importance of early recognition and appropriate management of adverse skin reaction.

Martorell's ulcer is an uncommon ischemic and extremely painful lesion located in the distal portion of the lower limb, resulting from severe systemic and poorly controlled hypertension. It is common in women between 50 and 70 years of age. The diagnosis is clinical and mostly belated, following exclusion of other causes. The response to treatment takes time and is unsatisfactory. A combination of several drugs associated with surgery may be required for wound healing. The authors present a case of Martorell's hypertensive ulcer, with emphasis on the diagnostic and therapeutic difficulties.

Angiolymphoid hyperplasia with eosinophilia is a rare disease considered as being a vascular malformation resulting from a subjacent arteriovenous shunt. It affects mostly the head of women between 20 and 40 years old and may present spontaneous involution.

The authors report a case of sensorimotor polyneuropathy, diffuse cutaneous hyperpigmentation, skin sclerodermiform thickening and papular lesions in the infraclavicular and abdominal region. Besides weight loss, there were diabetes mellitus and hypothyroidism. The alterations were consistent with POEMS (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy and Skin changes) syndrome, which is a rare systemic disease with monoclonal proliferation of plasmacytes and slow progression. Cutaneous alterations are present in 68% of patients with diffuse cutaneous hyperpigmentation, plethora and acrocyanosis. Leukonychia, necrotizing vasculitis, hypertrichosis and cutaneous thickening of sclerodermiform type are also cited. The onset of multiple cutaneous angiomas in this syndrome has been observed in 24-44% of patients.

We report a case of basal cell carcinoma that appeared from an epidermal verrucous nevus in a 61-year-old patient. The onset of basal cell carcinoma in sebaceous nevi, basal cell nevi and dysplastic nevi is relatively common, but it is rarely associated with epidermal verrucous nevi. There is no consensus on whether the two lesions have a common cellular origin or whether they merely represent a collision of two distinct tumors. Since this association - as with other malignant tumors - is rare, there is no need for prophylactic removal of epidermal verrucous nevi.

Oleoma is a non-allergic, foreign body type granulomatous reaction. It appears as response to oily exogenous substances injected to the dermis or subcutis for aesthetical purposes. Treatment for localized lesions is surgical. When they are multiple, steroids may show some result. Newer therapeutic possibilities are being introduced and colchicine constitutes an alternative that is financially accessible and safe in moderate doses for certain dermatological illnesses. We present two women with oleoma on the legs treated with oral colchicine. This option was due to the extension of the clinical picture, which would not have a good surgical outcome. There was significant improvement in one patient, while we had to interrupt the medication in the other because of side effects.

Background: Malignancies secondary to radiation, such as radiation-induced skin cancer, are possible consequences of radiation therapy. The most frequent post-radiation skin neoplasm is basal cell carcinoma., Main Observation: We report a case of a 49-year-old woman who underwent multiple radiotherapy sessions for pinealoma and developed post-radiation alopecia. After 26 years the patient noticed the emergence of eighteen superficial scalp lesions in the previously irradiated areas. Dermoscopy showed predominance of ovoid nests and presence of arborizing vessels on pink background, consistent with basal cells carcinoma. The diagnosis was confirmed by histopathology., Conclusions: There is an absolute need to guide patients through the possible late adverse events of radiotherapy. Regular dermoscopy examinations should be performed, especially in areas previously exposed to radiation.

Background: Paracoccidioidomycosis is an important medical and social problem mainly in rural areas of Brazil, because of the high incidence of the diseases, its long clinical evolution, frequent recurrences and sequels leading to anatomical and functional incapacities., Main Observation: We present a 73-year-old patient with paracoccidioidomycosis showing significant lymph node manifestations, which are only common in children and teenagers., Conclusions: Paracoccidioidomycosis may have a long incubation period, and it can be diagnosed outside of the endemic regions, where it was acquired. Thus, all dermatologists should maintain a high index of suspicion, especially in unusual cases of extensive lymph node enlargement in the elderly patients.

We present a typical case of dermatofibrosarcoma protuberans with local recurrence 2 months after surgery and, motivated by this patient, make a review of the most important aspects. This is a rare tumor and we call special attention to the fact that its recurrence is extremely frequent, so there is absolute need to observe these patients periodically after surgery.

Sporotrichosis is a subacute or chronic mycosis caused by a fungus of the genus Sporothrix, which is found in soil. It can be acquired by trauma to the skin. Bone and joint lesions are very rare. The city of Rio de Janeiro is undergoing an epidemic transmitted by cats, and this should be an alert for the risk to professionals in contact with these animals. The patient was a veterinarian who developed occupational sporotrichosis with osteoarticular involvement transmitted by a cat during a consultation.

Importance: Golimumab is a human monoclonal antibody, used for rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. Adverse reactions are increasing with this class of medication (tumor necrosis factor α inhibitors)., Observations: The authors present a case of a female patient who presented with psoriasis pustulosa after the use of golimumab for rheumatoid arthritis., Conclusions and Relevance: Paradoxically, in this case, golimumab, which is used for psoriasis, induced the pustular form of this disease. We are observing an increasing number of patients who develop collateral effects with tumor necrosis factor α inhibitors, and the understanding of the mechanism of action and how these adverse reactions occur may contribute to avoid these sometimes severe situations.

Background: The incidence of cutaneous melanoma is increasing worldwide and early diagnosis is essential since the prognosis is poor in advanced stages of disease. Dermoscopy emerged as an additional and important diagnostic procedure for the early diagnosis of cutaneous melanoma., Main Observation: We report a case of a 52-year-old man, who developed a pigmented lesion in the right pretibial region. Dermoscopy highly suggestive of melanoma. The initial histopathological evaluation suggested a benign lesion. Since dermoscopy was very suspicious, a more extensive histopathological study of the excised skin fragment was performed. This led to a change of diagnosis to a melanoma with partial regression., Conclusions: The present case shows that occasionally dermoscopy may be more informative for diagnosis of melanoma than an initial histopathology result.

The authors report a case of proliferating trichilemmal tumor on the tip of the nose of a man. This tumor is usually seen in women and on the scalp, and it shows trichilemmal keratinization on histopathology.

Chemotherapy drugs can affect the skin and its appendages. Several clinical presentations can be observed, depending on the affected structure. The most common dermatological side effect is chromonychia. The main causative agents are: (1) cyclophosphamide, which can provoke a diffuse, black pigmentation, longitudinal striae and dark grey pigmentation located proximally on the nails; (2) doxorubicin, which promotes dark brown bands alternating with white striae and dark brown pigmentation in transverse bands, and (3) hydroxyurea, which produces a distal, diffuse, dark brown pigmentation. In the majority of cases, the effects are reversible after the suspension of the causative agent for a few months. We report a patient who developed chromonychia while undergoing treatment with cyclophosphamide, vincristine, doxorubicin, dexamethasone, methotrexate and cytarabine for acute lymphocytic leukemia.

Introduction: Osteonecrosis of the palate is a rare condition which is even rarer when occurring on a torus palatinus and associated with bisphosphonate (BP)., Case Presentation: We report an uncommon case of osteonecrosis of a torus palatinus. Our patient was a 67-year-old white female who presented with a painful intraoral ulcer associated with necrotic bone tissue of her torus palatinus, due to the chronic use of alendronate., Conclusion: We point out the possible causative relationship of BPs and osteonecrosis on torus growth. It is very important to know that torus palatinus and the use of BPs are risk factors for osteonecrosis of the maxilla.

THE AUTHORS PRESENT TWO CASES OF SYPHILIS: one mimicking reactive arthritis and the other Mucha-Habermann disease. Both reports illustrate syphilis as 'the great imitator', a description given by Sir William Osler, and call attention to the strong need for awareness among physicians of all specialties, especially the younger ones, who are not used to seeing this increasingly prevalent disease, as it once was in the past.

Background: Granulomatous slack skin is a very rare subtype of T-cell cutaneous lymphoma, characterized by the slow development of cutaneous sagging, especially on flexural areas. Its behavior is indolent and the treatment, in the majority of cases, disappointing., Main Observation: We report a 54-year-old black patient with granulomatous slack skin, who at the beginning of the investigation showed intense xeroderma and generalized lymph node enlargement. The diagnosis was established based on histopathologic findings long before the disease's characteristic clinical presentation appeared., Conclusions: During the twelve years of follow-up, the clinical manifestation evolved to marked skin looseness, most predominant in flexural regions, illustrating the clinical hallmark of granulomatous slack skin, long after first histological abnormalities were observed.

The authors present a case of telangiectasia macularis eruptiva perstans, an uncommon form of cutaneous mastocytosis, in a 53-year-old man and discuss its clinics, pathophysiology, laboratory results, and treatment. Cutaneous mastocytosis is a proliferation of masts cells on the skin without involvement of other organs. Typically the lesions of telangiectasia macularis eruptiva perstans are telangiectatic macules with color ranging from light to dark brown. It is more frequent in adults, with some reports in children. It is usually insidious, without symptoms at the beginning and, although a manifestation of cutaneous mastocytosis, telangiectasia macularis eruptiva perstans may present systemic involvement. It is very important for dermatologists to know this form of cutaneous mastocytosis and to make an early diagnosis, so they may treat the disorder and improve their patients' quality of life.

Plantar fibromatosis, or Ledderhose disease, is a rare hyperproliferative disorder of the plantar aponeurosis. It may occur at any age with the greatest prevalence at middle age and beyond. This disorder is more common in men than woman and it is sometimes associated with other forms of fibromatosis. A 28-year-old Brazilian woman with a six-year history of painless bilateral plantar nodules is described in this article.

Acrokeratoelastoidosis of Oswaldo Costa, or inverse papular acrokeratosis, is a rare genodermatosis first described in 1952 by Oswaldo Costa, a Brazilian dermatologist. It is characterized by flesh-colored papules on the lateral aspects of the palms and soles and dorsum of hands. The histological features are hyperkeratosis, hyalinized and homogenous collagen, and a decrease in and fragmentation of the elastic fibers (elastorrhexis). In the absence of elastic fiber fragmentation, a similar clinical presentation is diagnosed as focal acral hyperkeratosis. Many cases of inverse papular acrokeratosis of Oswaldo Costa may have been considered focal acral hyperkeratosis since it can be difficult to find the elastorrhexis. The authors report a case of a 51-year-old woman with inverse papular acrokeratosis of Oswaldo Costa with poor response to topical treatments.