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© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd., Mucormycosis is an uncommon, life-threatening infection caused by opportunistic fungi included in the Mucorales order, which mostly affects immunosuppressed patients. Mucormycosis can exhibit different clinical presentations depending on the involved organ, including pulmonary, gastrointestinal, rhinocerebral, cutaneous, and disseminated infections.

© 2019 The International Society of Dermatology, Background: Acquired perforating dermatosis (APD) comprises an uncommon group of skin disorders that develop in adulthood in association with systemic diseases. The aim of this study was to characterize clinicopathologic features and treatment outcomes in a series of patients diagnosed with APD. Methods: Retrospective study of all patients diagnosed with an APD over a 10-year period (2009-2018) at a tertiary teaching hospital in Lisbon, Portugal. Results: Fifty-seven patients with APD were identified. Thirty-five patients presented lesions in multiple anatomic areas (61.4%), and the lower limbs were the most common location. Forty-six patients reported pruritus (80.7%), which was classified as severe in 21 of them (36.8%). An underlying systemic disease was identified in 53 patients (93.0%). Diabetes mellitus (DM) and chronic kidney disease (CKD) were the most common associated systemic diseases, but psychiatric disorders, malignancies, and chronic infections were present in a significant number of patients. The combination of topical steroids with antihistamines was the most prescribed initial treatment, but only 37.8% of the patients had a complete response. Acitretin, systemic steroids, and phototherapy were the treatments associated with the best outcome. Conclusion: Acquired perforating dermatosis can be associated with many systemic disorders that have pruritus as a common factor. Chronic viral infections and an occult malignancy should be sought, particularly in the absence of DM and CKD. The management of APD is challenging and is best achieved with the control of the underlying systemic diseases.

Introduction: Patients with previous non-melanoma skin cancer have an increased risk of developing another skin cancer and some studies suggest that the histological type of the incident tumour can predict the one of the subsequently diagnosed. The aim of this study was to assess a correlation between the histological type of the first and the subsequent non-melanoma skin cancer diagnosed in immunocompetent patients and in different settings of immunosuppression. Methods: A retrospective study was conducted on all patients without previous skin cancer, with the diagnosis of two or more non-melanoma skin cancer between January 1st, 2008 and December 31th, 2017. Results: A total of 413 patients were included. Fifty-one individuals (12.4%) were immunosuppressed. There was a significative association between the histological type of the first and the subsequent non-melanoma skin cancer diagnosed both in immunocompetent and in immunosuppressed patients, with a higher probability of developing a tumour of the same histological type (p

© 2020 Associação Nacional de Medicina do Trabalho. This is an open access article distributed under the terms of the Creative Commons license., Occupational activities are well-known triggers for the onset or aggravation of several dermatoses. The Koebner phenomenon is characterized by the appearance of cutaneous lesions typical of a given inflammatory dermatosis in an area where the skin was injured by mechanical, chemical, or biological agents. Although it is usually easily identified when associated to significant trauma, the Koebner phenomenon may go unnoticed when a small-scale injury underlies its pathogenesis. Herein, we report a case of Koebner phenomenon induced by the repetitive use of a computer mouse in an occupational setting, leading to recalcitrant psoriatic lesions on the palm of the right hand. When atypical features or unexpected poor responses to treatment are observed in skin conditions, a complete social and occupational anamnesis is paramount to identify aggravating factors and allow successful patient management., Sabe-se que atividades ocupacionais são capazes de desencadear o surgimento ou agravamento de diversas dermatoses. O fenômeno de Koebner é caracterizado pelo aparecimento de lesões cutâneas típicas de uma dada dermatose inflamatória numa área onde a pele foi ferida por agentes mecânicos, químicos ou biológicos. Este fenômeno normalmente é facilmente identificado quando há um trauma significativo, mas pode passar despercebido quando uma lesão de pequena extensão está por trás de sua patogênese. Este relato apresenta um caso de fenômeno de Koebner induzido pelo uso repetitivo de mouse de computador num ambiente ocupacional, levando a lesões psoriásicas na palma da mão direita. No caso de apresentações atípicas de doenças de pele ou respostas insatisfatórias ao tratamento, uma anamnese médica e ocupacional é de extrema relevância para um manejo bem-sucedido do paciente.

Cutaneous clear cell tumors are a heterogeneous group of cutaneous neoplasms, which may show a wide range of histogenesis. We report the clinicopathological features of an agminated clear cell tumor, arising in a 67-year-old man, otherwise asymptomatic, with distinct histopathological and immunohistochemical features, which did not fit into any existing diagnostic categories. The patient presented with several skin-colored papules at the lateral and posterior aspects of the neck, which on histopathological examination showed circumscribed lobular aggregates of clear cells within the dermis. The immunohistochemical marker panel performed showed diffuse expression of vimentin, NKI-C3, and CD64 while revealing marked negativity for factor XIIIa, CD10, CD13, CD14, CD34, CD68, CD163, lysozyme, HMB45, Renal Cell Carcinoma antigen, calponin, h-caldesmon, Anti-alpha smooth muscle actin antibody [1 A4], S100, and pancytokeratin, leading the authors to postulate a monocytic origin.

Nasal type extranodal NK/T-cell lymphoma is a distinct entity according to the World Health Organization classification. Although 60% to 90% of patients with this disease present with a destructive mass in the midline facial tissues, it may also primarily or secondarily involve extranasal sites, like the skin. We report the case of a 77-year-old patient that came to our department with erythematous plaques of the right leg and eczematous lesions of the trunk. These lesions were biopsied and the patient was diagnosed with extranodal NK/T-cell lymphoma, nasal type. He was treated with multi-agent systemic chemotherapy but died 5 months after diagnosis. This case highlights the rarity and variability of cutaneous features of this disease and its aggressive course and poor prognosis.

Viral infections in renal transplant patients are an important cause of morbidity and mortality. In most cases, the clinical presentation of herpes zoster allows the diagnosis to be made only by history and physical examination. However, patients who are immunosuppressed may have uncommon presentations, and require a high index of suspicion and additional diagnostic testing for proper management. We report a rare presentation of herpes zoster duplex bilateralis involving symmetrical dermatomes over the lower limbs occurring in a woman with a recent history of renal transplantation. The skin lesions were also atypical representing a diagnostic challenge. This infection should be part of differential diagnosis of cutaneous manifestations in organ transplant recipients.

The genus Alternaria has more than 80 species. Alternaria alternata and Alternaria infectoria are the most frequent species associated with infections in humans. Their clinical importance lies in the growing number of cases reported in immunocompromised patients. Herein, we report three cases of kidney-transplanted patients with different clinical presentations of cutaneous alternariosis and we discuss the treatment options.

A 54-year-old female presented with recurrent, widespread, erythematous, painful plaques, over a 3-month period. Skin biopsy was compatible with interstitial granulomatous dermatitis. Additional investigation revealed hypothyroidism and positive anti-thyroid antibodies. Normalization of thyroid function and high-potency topical corticosteroids provided only transitory improvement of the dermatosis. Interstitial granulomatous dermatitis is a histologic inflammatory reaction, with variable cutaneous expression. It has been reported in association with several drugs, lymphoproliferative diseases and autoimmune disorders, such as rheumatoid arthritis, systemic lupus erythematosus and vasculitis, but association with autoimmune thyroiditis is rare. Optimal therapy for this condition is yet to be established, but topical corticosteroids have been a mainstay of treatment. In most cases, this disease is characterized by flares and remissions.

In patients infected with human immunodeficiency virus (HIV), genital herpes can result in severe and atypical clinical presentations, and can become resistant to aciclovir treatment. Rarely, these manifestations may represent concurrent herpes simplex virus (HSV) with other agents. We report a 41-year-old black woman with HIV who presented with extensive and painful ulceration of the genitalia. Histological examination of a biopsy sample was suggestive of herpetic infection, and intravenous aciclovir was started, but produced only partial improvement. PCR was performed on the biopsy sample, and both HSV and cytomegalovirus (CMV) DNA was detected. Oral valganciclovir was started with therapeutic success. CMV infection is common in patients infected with HIV, but its presence in mucocutaneous lesions is rarely reported. This case exemplifies the difficulties of diagnosis of genital ulcers in patients infected with HIV. The presence of exuberant and persistent HSV genital ulcers in patients with HIV should also raise suspicions of the presence of co-infection with other organisms such as CMV.

Organ transplant recipients have a high incidence of cancer associated with persistent viral infections, such as human herpes virus 8. This virus is associated with Kaposi9s sarcoma, and a change in the dose or type of immunosuppression regimen should be the first step in its treatment. A multidisciplinary approach with nephrologists, dermatologists and oncologists is necessary for the management of this disease. We report a clinical case with atypical presentation and discuss the treatment options.

© 2015 Informa Healthcare USA, Inc., The bullous hemorrhagic dermatosis induced by enoxaparin is a rare adverse reaction, which may be under-reported given its favorable evolution. We report a 71-year-old man who developed hemorrhagic bullae at sites distant from subcutaneous enoxaparin injections. It is important that clinicians be aware of the different adverse reactions of these widely used drugs.

Pachydermodactyly is a superficial benign fibromatosis of unknown etiology; it is rare, more frequent in adolescent males, and characterized by painless swelling of the proximal interphalangeal joints(PIP) of the hands. Histologic examination of the skin shows epidermal hyperplasia and increased number of dermal fibroblasts and collagen fibers.We report the case of a 16-year-old adolescent boy who presented swelling of the lateral and dorsal regions of all the metacarpophalangeal and PIP joints of the left hand and PIP and metacarpophalangeal joints of the second and fifth fingers of the right hand, with 3 years of evolution and no arthritis or functional impairment. Results of complementary diagnostic examinations were normal, with the exception of hand ultra sound that showed skin thickening, without synovial proliferation or joint effusion. Skin biopsy confirmed pachydermodactyly. The patient under went aesthetic surgery with good outcome, without recurrence.This rare condition should be distinguished from idiopathic juvenile arthritis and other entities such as knuckle pads syndrome.

Pachydermodactyly is a superficial benign fibromatosis of unknown etiology; it is rare, more frequent in adolescent males, and characterized by painless swelling of the proximal interphalangeal joints(PIP) of the hands. Histologic examination of the skin shows epidermal hyperplasia and increased number of dermal fibroblasts and collagen fibers.We report the case of a 16-year-old adolescent boy who presented swelling of the lateral and dorsal regions of all the metacarpophalangeal and PIP joints of the left hand and PIP and metacarpophalangeal joints of the second and fifth fingers of the right hand, with 3 years of evolution and no arthritis or functional impairment. Results of complementary diagnostic examinations were normal, with the exception of hand ultra sound that showed skin thickening, without synovial proliferation or joint effusion. Skin biopsy confirmed pachydermodactyly. The patient under went aesthetic surgery with good outcome, without recurrence.This rare condition should be distinguished from idiopathic juvenile arthritis and other entities such as knuckle pads syndrome.

Introdução: Os basaliomas são os tumores malignos mais frequentemente encontrados na raça humana e com uma incidência cada vez maior nas últimas décadas. Neste tipo de neoplasias, a vulva é uma localização atípica, provavelmente porque os fatores etiológicos são diferentes dos de outras áreas anatómicas. Têm uma clínica monótona e inespecífica. Caso Clínico: Mulher de 69 anos, que surge com uma placa erosionada com cerca de 3cm de eixo maior, fundo duro com pequenas áreas pigmentadas na periferia do grande lábio direito. A histologia revelou tratar-se de um basalioma pigmentado. Foi submetida a exérese cirúrgica alargada da lesão, não se tendo verificado recidiva após três anos de seguimento. Conclusão: Os basaliomas pigmentados da vulva são muito raros. Salienta-se a importância do diagnóstico diferencial com outras lesões pigmentadas nesta região, que podem ser neoplasias de maior gravidade, que requerem outros tratamentos mais invasivos. Como a taxa de recidiva dos basaliomas é elevada o seguimento periódico é obrigatório. PALAVRAS-CHAVE – Basaliomas; Neoplasias da pele; Neoplasias da vulva.

Molluscum contagiosum (MC) lesions on the face are mainly observed in HIV patients and are related to low CD4 cells counts. We report a 41-year-old female patient infected with human immunodeficiency virus who had a CD4 count of 22 cells/mm³. She developed molluscum contagiosum lesions at the right upper eyelid. Skin biopsy was performed to exclude other serious conditions, such as dimorphic fungal infections. A good response was observed with three sessions of curettage and topical application of 70 percent trichloroacetic acid. Facial molluscum contagiosum lesions can be a cutaneous marker of severe immunosuppression in HIV patients and skin biopsy is important in ruling out the diagnosis of dimorphic fungal infections.

Erythema nodosum leprosum is defined by the appearance of tender skin nodules, which can be accompanied by fever, joint pain, neuritis, edema, malaise and/or lymphadenopathy. The authors describe the case of a 19-year-old Angolan black woman, resident in Portugal for the last 10 years, diagnosed with Hansen's disease at the age of 12, irregular with follow-up and non-compliant with treatment. She was referred to our clinic with painful nodules and pustules on the upper limbs, diffuse facial infiltration with pustules and fever, after initiating minocycline with the intention of treating acne. Diagnosis of erythema nodosum leprosum was confirmed by the presence of acid-fast bacilli in the skin smear and also in skin biopsy. Minocycline was suspended and the patient was treated with systemic steroids, with prompt clinical improvement. Our case is reported to alert clinicians to this unusual presentation of erythema nodosum leprosum in a patient treated with highly bactericidal drugs that were not intended to treat Hansen's disease.

Progressive disseminated histoplasmosis is frequently fatal in HIV patients, and the standard diagnostic techniques can cause treatment delay. Skin biopsy can help in the differential diagnosis, allowing also an earlier treatment initiation.

Exudative erythema multiforme is an acute self-limited skin disease often associated with infections (usually viral), and also with systemic diseases and drugs. We report the case of a 39-year-old woman diagnosed with systemic lupus erythematosus, who presented at the emergency clinic with exudative erythema multiforme which started 10 days after taking amoxicillin and clavulanic acid for tonsillitis together (almost simultaneously) with the pneumococcal vaccine. Rowell's syndrome was also considered to be a possibility. Skin patch tests were carried with the standard battery of patches (GPEDC) and the active ingredients of the suspected drugs (Chemotechnique ®), with readings at D2 and D3. The tests were positive for amoxicillin 10% pet (++), ampicillin 10% pet (+ +) and penicillin G potassium 10% pet (+). We accepted the diagnosis of erythema multiforme due to amoxicillin, confirmed by patch testing.

Leishmaniasis is a parasitic disease caused by an intracellular protozoan that belongs to the genus Leishmania and is transmitted by a phlebotomine sandfly. In Southwest Europe, including Portugal, cutaneous leishmaniasis is considered a rare disease of unknown or underestimated prevalence. Leishmania infantum is the only species identified as responsible for the autochthonous cases.We report the case of a 66-year-old man with an erythematous, painless plaque on the mid face region, accompanied by nasal obstruction with 9 months of evolution. The initial diagnoses were: lymphoma, subcutaneous mycosis, Wegener's granulomatosis, and lupus vulgaris. The diagnosis of leishmaniasis was based on histopathology findings and identification of L. infantum by DNA based methods. Blood cultures, abdominal ultrasound and myelogram ruled out systemic involvement. The patient was treated with intravenous meglumine antimoniate (20 mg per kg/day) for four weeks, without major side effects.We emphasize the importance of this case because human cutaneous leishmaniasis has rarely been diagnosed in Portugal and some cases are atypical, such as the situation herein described.

Anti-tumor necrosis factor (anti-TNF) agents have been successfully used to treat both chronic idiopathic inflammatory bowel disease and other immune-mediated chronic diseases, but they can also induce a wide array of cutaneous reactions, including new-onset psoriasis and alopecia. We report a case of alopecia associated with psoriasiform skin lesions in a patient on adalimumab treatment for Crohn's disease.