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Modelo do Estudo: Relato de caso Importância do problema: No mundo, mais de três milhões de pessoas estão vivendo com deficiência física devido à hanseníase. O Brasil é o segundo país com o maior número de casos novos registrados. A magnitude e o alto risco de incapacidade mantêm a doença como problema de saúde pública. O diagnóstico de hanseníase em geral é simples. Porém, quadros com ausência de lesões cutâneas características, somente com alterações neurais, representam um desafio para o diagnóstico diferencial com outras doenças neurológicas. Comentários: Relatamos o caso de um paciente encaminhado ao serviço de neurologia com história clínica e eletroneuromiografia compatíveis com polineuropatia desmielinizante, sem qualquer lesão cutânea ao exame de admissão. O raciocínio clínico inicial foi direcionado para o diagnóstico das polineuropatias desmielinizantes inflamatórias adquiridas como Polineuropatia Desmielinizante Inflamatória Crônica (CIDP) e suas variantes. No entanto, após anamnese e exame físico detalhados, chamou a atenção a ausência do componente atáxico e a presença predominante de alterações sensitivas de fibra fina, espessamento de nervo e importante fator epidemiológico para hanseníase, motivando a suspeita e a investigação desta enfermidade por meio da biópsia de nervo que foi sugestiva de hanseníase. Após três meses, em novo exame do paciente para biopsiar áreas de anestesia para reforçar o diagnóstico, observou-se o surgimento de extensas lesões levemente hipocrômicas no tronco e membros inferiores, cuja biópsia definiu o diagnóstico de hanseníase.

It is essential for health care providers to be familiared with the full spectrum of clinical presentations of syphilis. We present herein a case of syphilide psoriasiforme, an uncommon but well recognized clinical presentation of secondary syphilis. A 46-year-old HIV-infected female patient was referred to our attention with a presumptive diagnosis of palmoplantar psoriasis. On examination, there were exuberant pinkish-red papules and plaques covered with a thick silvery scale in the palms, flexor surfaces of the wrists, and the medial longitudinal arches of the feet. Serological and histopathological analyses uncovered the diagnosis of syphilis. Clinical remission was obtained after treatment. A detailed review of the literature on syphilide psoriasiforme, including descriptions from older syphilology textsis provided. The present case report emphasizes the need for clinicians to have a heightened awareness of the varied and unusual clinical phenotypes of syphilis.

Objetivo: Descrever o perfil de discentes e docentes de cursos de graduação em ciências da saúde em uma instituição no Nordeste brasileiro. Métodos: Consiste em um estudo transversal, descritivo e quantitativo que utilizou um questionário disponibilizado de forma online, elaborado pelos pesquisadores e validado pelo método Face Validity. O questionário foi aplicado entre março e junho de 2020. Resultados: 123 discentes e 36 docentes participaram da pesquisa. Considerando os discentes, 81,3% eram do sexo feminino, 62,6% se autodeclararam pardos, 79,6% tinham idade entre 18 e 22 anos. Além disso, 95,9% apresentavam experiência pedagógica anterior com ensino tradicional. Considerando os docentes, 69,4% eram do sexo feminino, 50% se autodeclararam brancos e 27,8% tinham idade entre 30 e 34 anos. Além disso, 61,1% estudaram em instituições particulares de ensino, 66,7% eram doutores e 75% apresentavam experiência pedagógica anterior com o ensino tradicional. Conclusão: É possível observar que o perfil de discentes e docentes descrito é heterogêneo e pode retratar o contexto educacional e socioeconômico no qual os indivíduos desta instituição de ensino superior estão envolvidos.

Considering the increased utilization of anti-TNF medications in the treatment of inflammatory and autoimmune diseases, dermatologists should be aware of the possible adverse skin reactions. We describe a case of inverted psoriasis due to the use of infliximab used in the treatment of inflammatory bowel disease.

Objective: To evaluate the occurrence of hematological and functional toxicities during chemotherapy with doxorubicin and cyclophosphamide in women with breast invasive ductal carcinoma. Methods: This was a descriptive, cross-sectional and quantitative study, involving the data collection in clinical records of 119 women undergoing chemotherapy for breast invasive ductal carcinoma in an oncology outpatient clinic, carried out between February 2014 and February 2015. Results: The investigated toxicities and their respectively occurrences in patients exposed to doxorubicin and cyclophosphamide were hemoglobinemia (26,5%), leukopenia (21,6%), neutropenia (10,8%), thrombocytopenia (none) and reduced hematocrit (28,4%), in addition to fatigue (93,1%), fever (20,6%), gain (35,3%) and weight loss (22,5%). In these variables, there were no significant differences between the exposed and not exposed patients. The association with taxanes showed a significant reduction in hematocrit values (p=0.019) and the toxicities distributed by age group were not significant within the exposed group. Conclusions: Exposure to doxorubicin and cyclophosphamide was not associated with an increase in the occurrence of hematotoxicities and functional impacts in women with breast ductal invasive carcinoma, except when associated with taxane agents.

Importância do problema: Paracoccidioidomicose (PCM) e a micose sistemica mais prevalente em individuos imunocompetentes no Brasil, sendo causado pelo fungo dimorfico Paracoccidioides spp. O fungo vive no solo e geralmente sua porta de entrada no paciente ocorre pelos pulmoes por inalacao de propagulos presentes no ar. Em areas de maior endemicidade, como no Brasil, a incidencia chega a tres casos por 100 mil habitantes. As lesoes cutâneas na PCM sao frequentes. Lesoes ulceradas ou ulcerovegetantes sao os tipos morfologicos mais comuns, sendo o padrao infiltrativo o segundo mais descrito. A histologia demonstra inflamacao granulomatosa na derme. A PCM infiltrativa pode ser facilmente confundida com sarcoidose, visto que ambas possuem similaridades clinicas e histopatologicas. Comentarios: Nos descrevemos um caso de PCM cutânea com diagnostico inicial incorreto de sarcoidose, tanto pelo quadro morfologico, como pelo exame histopatologico semelhante. Exames posteriores revelaram a presenca de Paracoccidioides sp na coloracao pelo Grocott e na cultura do material para fungos. Os autores acreditam que esse caso possa ajudar medicos a suspeitarem e considerarem PCM no diagnostico diferencial de lesoes cutâneas infiltrativas, especialmente se houver historia epidemiolo- gica de viagem a area endemica ou resposta insatisfatoria ao tratamento para sarcoidose.

Angiosarcoma of the head and neck is a rare vascular sarcoma associated with high rates of local recurrence and distant metastasis and a poor prognosis. The diagnosis of cutaneous angiosarcoma can be challenging because it often presents insidiously as a bruiselike lesion or a purplish papule thatmay be mistaken for a benign lesion such as hemangioma. The tumor size is a important prognostic factor and a multimodality treatment approach is imperative for successful outcomes. This study reports the case of 58-years-man with angiosarcoma of the scalp aggressive and a poor prognosis

To get to know the quality of life of LGBT students at the Federal University of Sergipe. An analytical, comparative, exploratory, cross - sectional, quantitative, non - probabilistic study with a population composed of undergraduate students from a Health Sciences Campus of the Federal University of Sergipe. Students in the nursing; pharmacy; physiotherapy; speech; language and hearing sciences; medicine; nutrition; dentistry and occupational therapy courses were part of the research. Among the inclusion criteria are: LGBT people, over 18 years of age, students with regular enrollment and who accepted to participate in the study by signing the Free and Informed Consent Term. Participants provided sociodemographic and quality of life information through the WHOQOL-BREF instrument. The WHOQOL-BREF examines four domains related to quality of life (physical, psychological, personal relationships and the environment. The responses followed the Likert scale (from 1 to 5, and the higher the score, the better the quality of life). 65 students with a mean age of 21.7 years old (± 3.4) participated in the study, of which, 22 (33.8%) were female and 43 (66.2%) were male. The means of responses and standard deviation in the physical, psychological, social and environmental domains were, respectively, 2.6 ± 0.6; 2.8 ± 0.7; 2.7 ± 0.7; 2.8 ± 0.6. This study aims to provide support for public policies aimed at the LGBT population, reaching the various spheres of our society, ensuring not only access, but also the permanence of this population group in different spaces, especially in the University, in a dignified, safe and healthy way.

O câncer de mama pode impactar diversas esferas de saúde dos pacientes, uma vez que a vivência frente ao tratamento é frequentemente cercada de medos e anseios. É possível observar que reações adversas da quimioterapia são comuns e mulheres com câncer de mama podem apresentar alta incidência de mucosite oral (MO). Sendo assim, o objetivo desta revisão foi discutir a relação entre o tratamento quimioterápico do câncer de mama e a ocorrência da mucosite oral. A MO é caracterizada pelo surgimento de eritemas ou úlceras na cavidade oral, sendo que a sua classificação varia conforme a escala utilizada. A fisiopatologia está associada aos fatores de risco, visto que o tratamento administrado e o estilo de vida do paciente podem impactar diretamente na ocorrência e progressão da MO. Embora a maioria dos casos apresenta-se como leve ou moderada, o impacto da MO não pode ser subestimado, mesmo em casos de baixa sintomatologia ou impacto funcional, considerando a dor oral e a dificuldade na ingestão de alimentos. Assim, é importante que os profissionais estejam atentos à classificação, fatores de risco e possíveis impactos na saúde, incluindo o planejamento das intervenções preventivas e curativas no manejo desta reação adversa da quimioterapia. Profissionais de saúde, incluindo dentistas, enfermeiros e médicos devem estar preparados para lidar com casos de MO, promovendo ações integradas para reduzir o impacto dessa condição na saúde de mulheres com câncer de mama.

Perforating dermatoses are a group of skin diseases characterized by transepidermal elimination of dermal material. The disease is divided into two groups: the primary group and the secondary group. The classical or primary perforating dermatoses are subdivided into four types according to the eliminated dermal materials: Kyrle disease, perforating reactive collagenosis, elastosis perforans serpiginosa, and perforating folliculitis. The secondary form is known as acquired perforating dermatosis. The term was proposed in 1989 by Rapini to designate the perforating dermatoses affecting adult patients with systemic disease, regardless of the dermal materials eliminated. This report describes a case of the disease with elimination of collagen and elastic fibers in a patient with chronic renal failure.

O objetivo do estudo foi descrever o perfil clínico-epidemiológico de mulheres em tratamento oncológico para carcinoma ductal invasivo da mama. Trata-se de um estudo transversal, descritivo e quantitativo por meio da coleta de dados em prontuários clínicos de mulheres em tratamento oncológico do câncer de mama em um serviço privado de oncologia, considerando variáveis sociodemográficas e clínicas. Foram identificadas 125 mulheres que se adequaram aos critérios de inclusão propostos. A maioria das pacientes incluídas eram sergipanas (71,2%), pardas ou negras (65,6%), com companheiro (56%) e com média de idade de 53,5±11,4 anos. Destas, 80,8% não possuíam ensino superior e 77,6% possuíam renda familiar entre um e três salários mínimos. Todas se submeteram à quimioterapia, 64,8% à mastectomia total e 36% à radioterapia. Além disso, 32,8% apresentaram mudanças na autoimagem, 24,8% na autoestima, 64,8% sinais de ansiedade e 49,6% sintomas depressivos. Além disso, 40% eram portadoras de hipertensão arterial sistêmica. O perfil clínico-epidemiológico das mulheres com carcinoma ductal invasivo da mama descrito é amplo e possui componentes sociodemográficos importantes. O tratamento oncológico pode desencadear alterações clínicas relevantes para a saúde, bem-estar e qualidade de vida destas pacientes.

Sporotrichosis is a subcutaneous mycosis with a worldwide distribution caused by species of the Sporothrix schenkii complex. Since 1998, it has reached epidemic proportions in the city of Rio de Janeiro, Brazil, via transmission from infected cats to humans. The species identified as the primary cause was Sporothrix brasiliensis. This article is protected by copyright. All rights reserved.

Modelo do estudo: relato de caso Importância do problema: A tuberculose é um grave problema de saúde no nosso país, no entanto poucos profissionais sabem identificar as formas extrapulmonares da doença, que são responsáveis por 23,3% dos óbitos por tuberculose no Brasil. Das formas extra-pulmonares, apenas 1-2% representam formas cutâneas. É importante que o médico generalista conheça as formas cutâneas de tuberculose, uma vez que pode ser a única manifestação da doença. O seu diagnóstico é um desafio, pois os exames tradicionais têm menor sensibilidade e especificidade para a apresentação cutânea em relação à forma pulmonar. No entanto, novos exames vêm sendo implantados como o GeneXpert. Comentários: Relatamos um caso raro de tuberculose cutânea em paciente imunocompetente, com a manifestação de três formas clínicas simultaneamente – escrofuloderma, tubercúlide papulonecrótica e eritema indurado de Bazin. A ocorrência de duas formas simultâneas é descrita na literatura mas a ocorrência de três formas simultâneas é inédita. Essa manifestação atípica foi de difícil diagnóstico clínico por simular outras doenças e os exames tradicionais como o RX de tórax, baciloscopia e cultura não evidenciaram o diagnóstico. A identificação do Mycobacterium tuberculosis só foi possível por meio da pesquisa de PCR com o GeneXpert, que mostrou positividade no escarro pulmonar e no exsudato do escrofuloderma, possibilitando iniciar o tratamento precocemente. Este novo exame de alta sensibilidade e especificidade no diagnóstico da tuberculose pulmonar mostrou-se de grande utilidade no diagnóstico deste caso atípico de tuberculose cutânea onde os exames tradicionais não definiram o diagnóstico.

Modelo do estudo: Cohort. Objetivos: Relatar a experiência do setor de Pequenos Procedimentos em Dermatologia do Hospital Universitário Gaffrée e Guinle, determinando os diagnósticos, tipos de tratamentos e resolutividade. Metodologia: Trata-se de estudo prospectivo, observacional, por meio da coleta de dados dos pacientes do Programa de Saúde da Família da Secretaria Municipal de Saúde do Rio de Janeiro encaminhados para a realização de pequenos procedimentos em dermatologia, durante um período de 31 semanas. Resultados: Foram atendidos 884 pacientes. As lesões benignas representaram 77,5% dos diagnósticos clínicos e as malignas 22,5%. Os diagnósticos mais frequentes foram de cisto (133) e carcinoma basocelular (128). Os procedimentos mais realizados foram a excisão e sutura simples (337) e a retirada de lesão por shaving mais eletrocoagulação (161). No total, 98,3% dos procedimentos foram de cirurgia dermatológica básica e 1,7% dos casos necessitaram de procedimentos avançados. Além disso, 90,8% dos pacientes foram operados no dia do primeiro atendimento e 3,7% precisaram ser encaminhados para outras especialidades cirúrgicas. Conclusão: Um serviço de cirurgia dermatológica estruturado para a realização de pequenos procedimentos, em caráter ambulatorial, permite prover atendimento resolutivo à grande maioria dos pacientes com essa necessidade.

Sporotrichosis is the most common subcutaneous mycosis. It is caused by the dimorphic fungus Sporothrix schenckii, and the infection is usually acquired by traumatic inoculation. We describe a case of sporotrichosis in an uncommon location with an unusual mode of transmission. A 49-year-old female patient who lived in an urban area of Rio de Janeiro presented with involvement of the left ear. No history of contact with soil, plants or animals was elicited. The suspected source of infection was a pair of handmade wooden earrings. The delay in the diagnosis and treatment resulted in higher morbidity, unsightly scarring and loss of ear lobe.

Gastric syphilis is an uncommon extracutaneous manifestation of syphilis, occurring in less than 1% of patients, presenting nonspecific clinical manifestations. In general, it occurs on secondary stage. The critical point is the recognition of the syphilitic gastric involvement, without which there may be incorrect diagnosis of malignancy of the digestive tract. In this report, a case of secondary syphilis with gastric involvement that had complete remission with benzathine penicillin will be described.

The scleroderma en coup de sabre is a variant of localized scleroderma that occurs preferentially in children. The disease progresses with a proliferative and inflammatory phase and later atrophy and residual deformity, which are treated with surgical techniques such as injectable fillers, transplanted or autologous fat grafting and resection of the lesion. Among the most widely used fillers is hyaluronic acid. However, there are limitations that motivate the search for alternatives, such as polymethylmethacrylate, a permanent filler that is biocompatible, non-toxic, non-mutagenic and immunologically inert. In order to illustrate its application, a case of scleroderma en coup de sabre in a 17-year-old patient, who was treated with polymethylmethacrylate with excellent aesthetic results, is reported.

Lymphomatoid papulosis (LyP) is defined as a chronic, recurrent, self-healing papulonecrotic or papulonodular skin disease with histologic features suggestive of a (CD30-positive) malignant lymphoma. In up to 20% of patients, LyP are preceded by, associated with, or followed by another type of cutaneous or systemic lymphoma, generally mycosis fungoides (MF), primary cutaneous anaplastic large cell lymphoma (C-ALCL). In this case, we describe a case of MF that preceded and continued to coexist with LyP type C.

The main treatment for pemphigus vulgaris are systemic corticosteroids and immunosuppressive agents, but due to adverse reactions and therapeutic failure, new drugs such as rituximab and mycophenolate mofetil have been used. In this case report are described two cases of severe pemphigus vulgaris refractory to various treatments, with resolution after use of rituximab and mycophenolate mofetil, associated with corticosteroids. A higher-than-usual dose of rituximab was employed, without the occurrence of serious adverse reactions. Mycophenolate mofetil was added as adjunctive therapy due to lack of response to azathioprine.

Erythema elevatum diutinum is a rare chronic cutaneous vasculitis which usually affects adults. It is characterized by symmetrical and persistent papules, plaques, and nodules. These lesions are usually located on the extensor surfaces of the extremities. We report a case of erythema elevatum diutinum in which the association of dapsone and surgical excision promoted complete remission of skin lesions, providing a new approach to the treatments described in the literature.

O presente estudo busca avaliar o comportamento da taxa de câmbio R$/US$ utilizando-se de modelos teóricos que procuram captar os fundamentos da taxa de câmbio e investigar sobre um possível efeito bolha no mercado cambial nacional. Os modelos teóricos utilizados para descrever os fundamentos macroeconômicos que captam os movimentos da taxa de câmbio foram o modelo Monetário e o da Regra de Taylor. Para evidenciar existência de bolha, utilzou-se do teste econométrico de Phillips, Wu e Yu (2011). Os resultados obtidos na análise empírica mostraram que o modelo Monetário não consegue aproximar as flutuações observadas na taxa de câmbio. Diferentemente, os modelos da Regra de Taylor apresentam uma boa descrição do movimento desta variável. Por sua vez os resultados do método aplicado e do teste específico para o efeito bolha conduziram a conclusão de não existência de bolha na taxa de câmbio trimestral brasileira. The present study seeks to evaluate the behavior of the exchange rate R$/US$ using theoretical models that seek to capture the fundamentals of the exchange rate and investigate a possible bubble effect in the national exchange market. The theoretical models used to describe the macroeconomic fundamentals that capture the movements of the exchange rate were the Monetary Model and the Taylor Rule. To prove the existence of a bubble, the econometric test of Phillips e Yu (2011) was used. The results obtained on the empirical analysis showed that the Monetary model could not approximate the observed fluctuations in the exchange rate, while Taylor rule models captured a good description of the movement of this variable. In turn, the results of the applied method and the specific test for the bubble effect led to the conclusion that there is no bubble in the Brazilian quarterly exchange rate.

Lesões melanocíticas adquiridas assemelhando-se à melanoma têm sido descritas nos principais grupos da Epidermólise bolhosa, e referidas como "Nevos da Epidermólise bolhosa''. Induzem facilmente ao erro diagnóstico, apesar de nenhuma transformação maligna ter sido descrita. Relatamos o desenvolvimento de um nevo melanocítico adquirido grande no local de bolhas recorrentes em uma criança de 5 anos portadora de Epidermólise bolhosa simples. O padrão dermatoscópico global foi sugestivo de benignidade, e os achados histopatológicos foram compatíveis com um nevo melanocítico composto. Este é o primeiro caso de um Nevo da Epidermólise bolhosa publicado na literatura brasileiraAcquired melanocytic lesions resembling malignant melanoma have been described in all major categories of Epidermolysis bullosa and referred to as "Epidermolysis bullosa nevi''. They easily induce to diagnostic error, although no malignant transformation has been reported. We report the development of a large acquired melanocytic nevus at a site of recurrent blisters in a 5-year-old child with Epidermolysis bullosa simplex. The global dermoscopic pattern was suggestive of benignity, and the histopathological findings were compatible with a compound melanocytic nevus. This is the first published case of Epidermolysis bullosa nevi in Brazilian literature. Despite their benign behavior, we emphasize the importance of regular clinical and dermoscopic monitoring, since a malignant course still cannot be totally excluded

Acquired melanocytic lesions resembling malignant melanoma have been described in all major categories of Epidermolysis bullosa and referred to as "Epidermolysis bullosa nevi''. They easily induce to diagnostic error, although no malignant transformation has been reported. We report the development of a large acquired melanocytic nevus at a site of recurrent blisters in a 5-year-old child with Epidermolysis bullosa simplex. The global dermoscopic pattern was suggestive of benignity, and the histopathological findings were compatible with a compound melanocytic nevus. This is the first published case of Epidermolysis bullosa nevi in Brazilian literature. Despite their benign behavior, we emphasize the importance of regular clinical and dermoscopic monitoring, since a malignant course still cannot be totally excluded.

Colagenomas são hamartomas do tecido conjuntivo gerados por aumento anormal do colágeno dérmico. O colagenoma eruptivo caracteriza-se por pequenos nódulos duros, assintomáticos, sem relato de trauma ou processo inflamatório prévios. Descreve-se caso de paciente do sexo masculino, de 28 anos, que há 10 anos notou surgimento espontâneo de lesões papulosas no tronco, nos membros superiores e abdômen, e há três anos descobriu ser soropositivo para HIV. O diagnóstico diferencial, a classificação da doença como entidade própria e a associação casual com o HIV são discutidos, bem como a necessidade da realização da coloração vermelho Picrosirius/luz polarizada para confirmação diagnóstica dos colagenomas.Collagenomas are connective tissue nevi predominantly composed of excessive dense and coarse collagen in the dermis. Eruptive collagenoma is a rare disorder occurring in young adults as asymptomatic dermal nodules, with no previous history of injury or inflammation and usually localized on the back. We describe the case of a 28-year-old male patient who was examined for numerous asymptomatic little nodules on the trunk and upper arms, which appeared ten years ago with no previous inflammation or injury. Three years ago the patient was diagnosed HIV-positive. Differential diagnoses, classification of the disease as an autonomous entity, its casual association with HIV, as well as the real need for picrosirius red staining to confirm diagnosis of collagenoma are discussed.

A infecção pelo HIV não altera a história natural da hanseníase. Observa-se maior incidência de estados reacionais nos pacientes co-infectados, além de casos mais graves de neurite. Paciente soropositiva com hanseníase dimorfa tuberculóide manifestou reação reversa exuberante. Lesões cutâneas atípicas e raras surgiram após a introdução da terapia anti-retroviral que promoveu o início da recuperação imunológica com aumento de linfócitos T CD4+ e queda da carga viral. A restauração da imunidade celular nos pacientes soropositivos pode precipitar reações reversas, descritas recentemente como uma das manifestações da síndrome inflamatória de reconstituição imunológica associada à hanseníase.HIV infection does not modify the natural course of leprosy. However, HIV co-infection seems to be associated with an increased rate of reactional states and more severe cases of neuritis. The authors describe a case of borderline tuberculoid leprosy in a HIV-positive patient who developed a marked reversal reaction. Atypical and rare skin manifestations, such as verrucous lesions and ulcers, appeared after highly active antiretroviral therapy, which resulted in increased CD4+ T-lymphocyte count and drop in viral load. The restoration of the cellular immunity in HIV-seropositive patients can trigger reversal reactions that are one of the manifestations of the immune reconstitution inflammatory syndrome. Only recently the syndrome has been associated with leprosy.

A infecção pelo HIV não altera a história natural da hanseníase. Observa-se maior incidência de estados reacionais nos pacientes co-infectados, além de casos mais graves de neurite. Paciente soropositiva com hanseníase dimorfa tuberculóide manifestou reação reversa exuberante. Lesões cutâneas atípicas e raras surgiram após a introdução da terapia anti-retroviral que promoveu o início da recuperação imunológica com aumento de linfócitos T CD4+ e queda da carga viral. A restauração da imunidade celular nos pacientes soropositivos pode precipitar reações reversas, descritas recentemente como uma das manifestações da síndrome inflamatória de reconstituição imunológica associada à hanseníase. HIV infection does not modify the natural course of leprosy. However, HIV co-infection seems to be associated with an increased rate of reactional states and more severe cases of neuritis. The authors describe a case of borderline tuberculoid leprosy in a HIV-positive patient who developed a marked reversal reaction. Atypical and rare skin manifestations, such as verrucous lesions and ulcers, appeared after highly active antiretroviral therapy, which resulted in increased CD4+ T-lymphocyte count and drop in viral load. The restoration of the cellular immunity in HIV-seropositive patients can trigger reversal reactions that are one of the manifestations of the immune reconstitution inflammatory syndrome. Only recently the syndrome has been associated with leprosy.

The chondroid syringoma is a rare benign tumor, also called mixed cutaneous tumor by the presence of epithelial and mesenchymal components, consisting of sweat elements in cartilaginous, collagenous, myxoid or osseous stroma, among others. It mainly affects middle-aged men and is characterized by asymptomatic and slowgrowing, dermal or subcutaneous nodules. The most common locations are the head and neck. It is rare on the extremities. There are reports of malignant variants predominantly in women, located on the extremities. We report a case of a female patient with a lesion on the toe, with excellent outcome after surgical treatment.

Cutaneous protothecosis is a rare infection caused by achlorophyllic algae of the genus Prototheca. The lesions usually occur on exposed areas, related with trauma, in immunocompromised patients. The most common clinical presentation is a vesicobullous and ulcerative lesion with pustules and scabs, simulating bacterial, fungal or herpetic infections or eczema. The diagnosis is determined by agent identification through histopathology, culture and the carbohydrates assimilation test. The finding of morula-like spherules is characteristic of Prototheca sp. Its rarity and non-specific clinical aspect may difficult the disease diagnosis. We report a case of a diabetic patient, in chronic use of systemic corticosteroids, that developed a skin lesion after trauma to the right leg.

Sarcoidosis is a disease which still has uncertain etiology. Possible environmental causes are cited in the literature, like organic and inorganic particles and infectious agents. Recent studies have demonstrated the occurrence of sarcoidosis in patients with chronic C hepatitis; however, this association remains without statistical or causal evidence. In this report a case of sarcoidosis associated with chronic hepatitis C will be described, with subcutaneous lesions, considered rare, and good response to treatment with colchicine and prednisone. The hepatitis C virus was isolated in sarcoid tissue and the association between the two diseases will be discussed.

1 This report describes the case of a female child with an exuberant clinical pre- sentation of LS with genital and disseminated extra- genital lesions.

The chondroid syringoma is a rare benign tumor, also called mixed cutaneous tumor by the presence of epithelial and mesenchymal components, consisting of sweat elements in cartilaginous, collagenous, myxoid or osseous stroma, among others. It mainly affects middle-aged men and is characterized by asymptomatic and slow growing, dermal or subcutaneous nodules. The most common locations are the head and neck. It is rare on the extremities. There are reports of malignant variants predominantly in women, located on the extremities. We report a case of a female patient with a lesion on the toe, with excellent outcome after surgical treatment.

Cutaneous metastases of visceral cancers are relatively rare, with an incidence of 0.7 to 10%. The most frequent primary sites are breast, lung and colon tumors. They generally occur after the primary cancer is diagnosed and signify a poor prognosis. They may occur as the first manifestation in 20% of cancers in general. The most common manifestations are single or multiple asymptomatic nodules, most often located on the chest, abdomen, head and neck, sometimes with unusual clinical features which present a challenge to clinical diagnosis.

Degos disease, also known as malignant atrophic papulosis, is a rare occlusive vasculopathy of unknown etiology characterized by infarcts in the dermis, gastrointestinal tract, central nervous system, and other organs. It is characterized by papules, which become umbilicated and evolve with a depressed porcelain-white central area, with an erythematous halo with telangiectasias. Histological findings include wedge-shaped dermoepidermal necrosis and blood vessel thrombosis. Approximately 50-60% of patients with systemic symptoms die within 2-3 years, most due to gastrointestinal perforation. We report a typical case, with lethal outcome, in a 45-year-old woman.

Acquired melanocytic lesions resembling malignant melanoma have been described in all major categories of Epidermolysis bullosa and referred to as "Epidermolysis bullosa nevi''. They easily induce to diagnostic error, although no malignant transformation has been reported. We report the development of a large acquired melanocytic nevus at a site of recurrent blisters in a 5-year-old child with Epidermolysis bullosa simplex. The global dermoscopic pattern was suggestive of benignity, and the histopathological findings were compatible with a compound melanocytic nevus. This is the first published case of Epidermolysis bullosa nevi in Brazilian literature. Despite their benign behavior, we emphasize the importance of regular clinical and dermoscopic monitoring, since a malignant course still cannot be totally excluded.

Colagenomas são hamartomas do tecido conjuntivo gerados por aumento anormal do colágeno dérmico. O colagenoma eruptivo caracteriza-se por pequenos nódulos duros, assintomáticos, sem relato de trauma ou processo inflamatório prévios. Descreve-se caso de paciente do sexo masculino, de 28 anos, que há 10 anos notou surgimento espontâneo de lesões papulosas no tronco, nos membros superiores e abdômen, e há três anos descobriu ser soropositivo para HIV. O diagnóstico diferencial, a classificação da doença como entidade própria e a associação casual com o HIV são discutidos, bem como a necessidade da realização da coloração vermelho Picrosirius/luz polarizada para confirmação diagnóstica dos colagenomas. Collagenomas are connective tissue nevi predominantly composed of excessive dense and coarse collagen in the dermis. Eruptive collagenoma is a rare disorder occurring in young adults as asymptomatic dermal nodules, with no previous history of injury or inflammation and usually localized on the back. We describe the case of a 28-year-old male patient who was examined for numerous asymptomatic little nodules on the trunk and upper arms, which appeared ten years ago with no previous inflammation or injury. Three years ago the patient was diagnosed HIV-positive. Differential diagnoses, classification of the disease as an autonomous entity, its casual association with HIV, as well as the real need for picrosirius red staining to confirm diagnosis of collagenoma are discussed.

Dermatofibrosarcoma protuberans is a fibrohistiocytic tumor of intermediate malignancy with aggressive localized growth, high recurrence rate, but low metastatic potential. It appears as a hardened plaque, with slow growth, upon which the development of nodules occurs. It predominates in the trunk and is unusual in acral locations. Histopathology reveals spindle cells with storiform pattern and cartwheel-like or whirlwind-like aspect. Immunohistochemistry shows positivity for CD34. The treatment is surgical. We report a case of long evolution, with an unusual location, that relapsed after surgery, to emphasize the importance of early diagnosis and proper treatment, avoiding aggressive resections with increased morbidity.

Cutaneous metastases of visceral cancers are relatively rare, with an incidence of 0.7 to 10%. The most frequent primary sites are breast, lung and colon tumors. They generally occur after the primary cancer is diagnosed and signify a poor prognosis. They may occur as the first manifestation in 20% of cancers in general. The most common manifestations are single or multiple asymptomatic nodules, most often located on the chest, abdomen, head and neck, sometimes with unusual clinical features which present a challenge to clinical diagnosis.