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Scalp seborrheic dermatitis (SSD) is a prevalent chronic, relapsing inflammatory skin disease. The etiology is related to sebum production, bacterial proliferation – Staphylococcus sp., Streptococcus, and M. restricta – and host immunity factors – NK1+, CD16+ cells, IL-1, and IL-8. Trichoscopy features include mostly arborizing vessels and yellowish scales. New trichoscopic findings were described to guide the diagnosis as dandelion vascular conglomerate, “cherry blossom” vascular pattern, and intrafollicular oily material. Antifungals and corticosteroids constitute the essential therapy, but new treatments have been described. This article aims to review and discuss the etiology, pathophysiology, trichoscopy, histopathologic findings, main differential diagnoses, and therapeutic options of SSD.

Objetivo: Relatar o caso clínico de uma paciente com apresentação clínica típica e com diagnóstico histopatológico de dermatomiofibroma, sendo uma rara neoplasia mesenquimal benigna. Detalhamento de Caso: Paciente do sexo feminino, 25 anos, compareceu ao ambulatório de Dermatologia queixando-se de uma placa eritematoacastanhada, assintomática, de surgimento há 6 meses, localizada na região anterior do ombro direito. Realizada uma biópsia incisional da lesão por punch, e o exame histopatológico evidenciou uma ausência de alterações na epiderme, proliferação de fibroblastos e espessamento do colágeno, complementado pela imuno-histoquímica que se fez positiva para Beta Catenina citoplasmática e fator XIIIa, e negativa para S100 e actina de músculo liso, resultados compatíveis de dermatomiofibroma. Considerações finais: Dermatomiofibroma é uma neoplasia mesenquimal benigna cutânea rara de linhagem miofibroblástica com poucos casos relatados até o momento na literatura. Sua forma clínica, geralmente, se apresenta como placa ou nódulo único, assintomático, fibroelástico, pouco definido, de cor eritematoacastanhada. A imuno-histoquímica auxilia no diagnóstico quando o exame histológico não define a doença, possibilitando a exclusão de possíveis neoplasias malignas de apresentações clínicas semelhantes.

Dissecting cellulitis (DC) is a chronic inflammatory primary neutrophilic scarring alopecia. It predominantly affects the vertex and occipital regions of Afro-descendent men. Female DC is uncommon, and little is known about this condition in childhood. This paper reports a pediatric female case of DC with an excellent therapeutic response to low-dose oral isotretinoin.

Morbihan disease is a rare condition characterized by chronic and persistent erythematous solid edema localized on the face. It is believed to be a complication of rosacea and may occur at any stage of the disease. Features of this condition include variable therapeutic response and great refractoriness. We report a case of a 61-year-old man with rosacea history diagnosed with Morbihan disease, who showed excellent therapeutic response with the combination of deflazacort and oral isotretinoin but developed recurrence after corticosteroid discontinuation. We believe that in severe cases of lymphedema of the face this combination is effective and corticosteroid suspension should be done slowly and gradually.

Peeling skin syndrome (PSS) é uma genodermatose rara, de herança autossômica recessiva causada por mutações nos genes CDSN, TGM5 ou CHTS8 dependendo do tipo da doença. É caracterizada por descamação superficial da pele, localizada (acral) ou generalizada, com ou sem eritema e prurido. Relativamente à forma generalizada, Heiko Traupe propôs distinção entre o tipo A, não inflamatório, e o tipo B, associado à eritrodermia congênita (inflamatória). Mevorah descreveu o tipo C que possui características mais próximas ao B. O tipo generalizado não inflamatório é caracterizado por áreas de eliminação espontânea e contínua do estrato córneo, com início no nascimento ou durante a infância. Descrevemos o caso de um paciente masculino de 19 anos, com descamação no pescoço, tronco e membros superiores desde a infância e história de patologia semelhante na família.

Steatocystoma multiplex is a rare genetic disorder characterized by the presence of hamartomatous malformations at the junction of the pilosebaceous duct. It consists of encapsulated cystic lesions in the dermis, with adjacent sebaceous gland. When associated with inflammation, resembling hidradenitis, it is called steatocystoma multiplex suppurativa, a condition rarely reported. This is the first case of steatocystoma multiplex suppurativa reported in the Brazilian literature. Female patient, 23 years old, with papular and nodular cystic lesions that started in the armpits and groin, later spreading to the trunk, lower limbs, anticubital fossa, face and scalp. The presence of papular-nodular lesions associated with disseminated hidradenitis-like lesions in flexural areas and the histopathological diagnosis of steatocystoma defined the diagnosis of steatocystoma multiplex suppurativa.

Blue nevi are benign melanocytic lesions located in the deeper reticular dermis, consequence of failure of melanocytic migration into the dermal-epidermal junction from the neural crest. Lesions are usually asymptomatic and solitary, but may present in a multiple or agminated (grouped) pattern. The agminated subtype is formed when bluish-pigmented lesions cluster together in a well-defined area. Lesions can be flat or raised. We report the case of a patient who presented multiple bluish macules (1-3 mm in diameter) grouped on the left upper back. Dermoscopy and anatomic pathological examination were consistent with blue nevus.

Peeling Skin Syndrome (PSS) é uma genodermatose rara, de provável herança autossômica recessiva, caracterizada por peeling superficial da pele durante a vida, localizada ou generalizada, com ou sem eritema e prurido. A etiologia ainda não foi completamente elucidada. Traupe propôs distinção entre tipo A, não inflamatória, e tipo B, associada à eritrodermia congênita (inflamatória). O tipo generalizado não inflamatório é caracterizado por áreas de eliminação espontânea contínua do estrato córneo, com início no nascimento ou durante a infância.Demonstramos o caso de um paciente masculino, 19 anos, com surgimento das lesões na infância e história familiar positiva.

ResumoA dermatite infecciosa (DI) é uma dermatite grave, crônica e recidivante, descrita como entidade distinta por Sweet em 1966, e associada a infecção pelo HTLV-1 em 1990 por La Grenade e cols. Embora a maioria dos casos descritos tenha início na infância, casos de dermatite infecciosa em adultos tem sido relatados. O quadro dermatológico mimetiza condições comuns como dermatite seborreica, dermatite atópica, dermatite de contato, impetigo e micose fungoide. Em países endêmicos para a infecção por HTLV-1, como o Brasil, é imprescindível que a dermatite infecciosa seja lembrada como diagnóstico diferencial, nestes casos. A identificação precoce é importante a fim de evitar adisseminação e proporcionar acompanhamento e tratamento adequados de possíveis complicações associadas ao vírus, como a mielopatia associada ao HTLV ou paraparesia espástica tropical (HAM/TSP), e a leucemia/linfoma de células T do adulto (ATLL).Relatamos o caso de 2 pacientes do sexo feminino com dermatite infecciosa de início na idade adulta. Para enriquecimento do caso, também apresentamos as fotos da filha de uma das pacientes, com mesmo diagnóstico. Abstract:Infectious dermatitis (ID) is a severe, chronic and relapsing dermatitis, described as a distinct entity by Sweet in 1966 and associated with HTLV-1 in 1990 by La Grenade et al. Although most reported cases have onset in childhood, cases of infectious dermatitis in adults have been reported. The dermatological framework mimics common conditions such as seborrheic dermatitis, atopic dermatitis, contact dermatitis, impetigo and mycosis fungoides. In endemic countries for HTLV-1, like Brazil, it is essential that the infectious dermatitis is remembered as a differential diagnosis in these cases. Early diagnosis is important to prevent the dissemination and provide appropriate monitoring and treatment of possible complications associated with the virus, such as HTLV-1 associated myelopathy or tropical spastic paraparesis (HAM / TSP), and Adult T-cell leukemia / lymphoma (ATLL). We report two female patients with adult-onset ID. In order to enrich the report, we also presented the daughter's photos from one of the patients, with the same diagnosis.

Resumo O lentigo maligno e um melanoma in situ, de crescimento radial e lento, que acomete areas fotoexpostas principalmente em idosos. Quando acomete a palpebra, devido a proximidade a um orgao nobre, a conduta e controversa, porem a cirurgia e o metodo mais usado, com margens que variam de acordo com a referencia utilizada. Terapias conservadoras sao descritas, como o imiquimode 5% e a radioterapia. O presente relato tem como objetivo demonstrar a escassez de estudos sobre a margem cirurgica e citar opcoes de tratamentos nao cirurgicos para o lentigo maligno da face.

Granulomatous mycosis fungoides is a rare subtype of T-cell cutaneous lymphoma. Due to its clinical heterogenicity the diagnosis is delayed and based on histopathological and immuno-histochemical findings, sometimes requiring gene rearrangement studies for confirmation. We report the case of a patient who was submitted to several biopsies before diagnostic conclusion.

Berardinelli-Seip syndrome is a rare autosomal recessive disease characterized by inadequate metabolism and inefficient storing of lipids in fat cells, generating accumulation of fat in organs such as the liver, spleen, pancreas, heart, arterial endothelium and skin. Classically, patients manifest generalized lipoatrophy at birth or until 2 years of age, and in adolescence usually develop marked insulin resistance with rapid progression to diabetes and dyslipidemia. We report the case of a 17-year-old Berardinelli-Seip syndrome patient with eruptive xanthoma associated with severe hypertriglyceridemia. It is worth noting Eruptive xanthoma as a dermatological manifestation that is not generally highlighted in the reports of cases of this genetic metabolic disorder.

A síndrome de Sweet é enfermidade cutânea rara e de etiologia pouco esclarecida. Cerca de 20% dos casos são associados a neoplasias hematológicas, sendo raros os casos relacionados à doença de Hodgkin. Relata-se caso de paciente masculino de 57 anos que desenvolveu a síndrome concomitantemente à neoplasia. As doenças foram controladas com o tratamento específico.

Eritromelanose folicular faciei et colli é uma doença rara, de origem desconhecida, caracterizada por hiperpigmentação eritêmato-acastanhada e simétrica nas regiões frontal, temporal e malar, associada com envolvimento do folículo piloso. É comum apresentar ceratose pilar no pescoço e nos ombros. Sua característica clínica primária é composta pela tríade: eritema (com ou sem telangiectasias), pápulas foliculares discretas e hiperpigmentação acastanhada.

Hidradenitis suppurativa is an inflammatory disease with difficult treatment. Currently, the anti-TNF alfa therapy, with monoclonal antibodies ('biological therapy'), has been shown as a new alternative. However, clinical trials assessing the efficacy of these drugs to treat hidradenitis suppurativa have not yet been published. A case in which the use of infliximab did not result in significant clinical improvement is described.

Berardinelli-Seip syndrome is a rare autosomal recessive disease characterized by inadequate metabolism and inefficient storing of lipids in fat cells, generating accumulation of fat in organs such as the liver, spleen, pancreas, heart, arterial endothelium and skin. Classically, patients manifest generalized lipoatrophy at birth or until 2 years of age, and in adolescence usually develop marked insulin resistance with rapid progression to diabetes and dyslipidemia. We report the case of a 17-year-old Berardinelli-Seip syndrome patient with eruptive xanthoma associated with severe hypertriglyceridemia. It is worth noting Eruptive xanthoma as a dermatological manifestation that is not generally highlighted in the reports of cases of this genetic metabolic disorder.

Male patient, 28 years old, presented with an asymptomatic yellowish erythematous papule on his right thigh. Excisional biopsy was performed for histopathological examination of the lesion. Multinucleated cells (Touton giant cells) were observed. S100 immunohistochemistry was negative for CD1a and positive for CD4 and CD68. Based on clinical and histopathological findings associated with immunohistochemistry, we concluded that it was a case of adult-type xanthogranuloma. Because it was a solitary lesion without other clinical signs and symptoms, the medical conduct adopted was patient orientation.

Leprosy is an infectious disease with an average incubation period of two to five years. It is caused by Mycobacterium leprae, mainly affecting skin, mucous membranes and peripheral nerves. When it occurs in children under fifteen, it reflects an intense and long contact period, with a high bacillary load. Therefore, it is considered an important alert sign that points to the challenge of controlling the disease. The authors report three cases of leprosy in children under fifteen that occurred in the Itaguaí district, Rio de Janeiro. The epidemiologic implications of new cases detected at this age and the fundamental role of examining the patients' close contacts and the possible identification of source cases as an effort for leprosy control are discussed.

Hidradenitis suppurativa is a chronic inflammation of the apocrine glands. It usually starts at or soon after puberty, and women are more often affected than men. The most affected sites are the axillae; however, other regions rich in apocrine glands may also be affected. Involvement restricted to the inframammary fold alone is rare and to the best of our knowledge there have been no reports of any similar cases. The etiology of this condition has yet to be fully clarified.

Acrometastasis is a rare occurrence, especially when affecting the hands. It represents around 0.007-0.2% of all metastatic lesions. The most common site of origin is the lung, accounting for 40-50% of all cases reported in the literature. Kidneys and breasts are other sites also associated with neoplastic lesions that disseminate to the hands. More rarely, the site of origin may be the gastrointestinal tract or other systemic tumors or sarcomas. Early diagnosis is difficult, since the condition may be asymptomatic or may mimic tenosynovitis, arthritis, paronychia, pyogenic granuloma or a local infection. In the present paper, the authors report on a patient with the diagnosis of acrometastasis on both hands originating from a basaloid carcinoma of the anal canal. Response to radiotherapy was poor.

Sweet's syndrome is a rare cutaneous disease of unknown etiology. About 20% of the cases are associated with hematological neoplasms, and cases related with Hodgkin's disease are rare. We present the case of a 57-year old male patient who developed the syndrome concomitantly with the neoplasm. The diseases were controlled with specific treatment.

Hidradenitis suppurativa is an inflammatory disease with difficult treatment. Currently, the anti-TNF alfa therapy, with monoclonal antibodies ('biological therapy'), has been shown as a new alternative. However, clinical trials assessing the efficacy of these drugs to treat hidradenitis suppurativa have not yet been published. A case in which the use of infliximab did not result in significant clinical improvement is described.

Male patient, 28 years old, presented with an asymptomatic yellowish erythematous papule on his right thigh. Excisional biopsy was performed for histopathological examination of the lesion. Multinucleated cells (Touton giant cells) were observed. S100 immunohistochemistry was negative for CD1a and positive for CD4 and CD68. Based on clinical and histopathological findings associated with immunohistochemistry, we concluded that it was a case of adult-type xanthogranuloma. Because it was a solitary lesion without other clinical signs and symptoms, the medical conduct adopted was patient orientation.

A hidradenite é uma inflamação crônica e supurativa das glândulas apócrinas. Ocorre mais frequentemente, nas mulheres, iniciando durante ou após a puberdade. Os locais mais acometidos são as axilas, porém, outras regiões ricas em glândulas apócrinas, podem ser comprometidas. A localização intermamária, de forma exclusiva, é rara e não encontramos relatos de outros casos semelhantes. Sua etiologia ainda não foi completamente elucidada

Resumo O lentigo maligno é um melanoma in situ, de crescimento radial e lento, que acomete áreas fotoexpostas principalmente em idosos. Quando acomete a pálpebra, devido à proximidade a um órgão nobre, a conduta é controversa, porém a cirurgia é o método mais usado, com margens que variam de acordo com a referência utilizada. Terapias conservadoras são descritas, como o imiquimode 5% e a radioterapia. O presente relato tem como objetivo demonstrar a escassez de estudos sobre a margem cirúrgica e citar opções de tratamentos não cirúrgicos para o lentigo maligno da face.