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Objective: Genital herpes (GH) is one of the most common sexual transmitted infections. Herpes simplex virus type 1 (HSV-1) genital infections have been increasing, with a shift toward its predominance in many developed countries. The aim of this study was to characterize the population with GH diagnosed in Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal. Methods: A retrospective analysis of all laboratory-confirmed diagnosis of GH between 2017 and 2021 was conducted. The diagnosis was established by real-time polymerase chain reaction, in samples collected by swabbing suspicious mucocutaneous lesions. Medical records of included patients were reviewed and data of interest analyzed. Results: During the studied period, a total of 239 patients were diagnosed with GH, from which 76.6% (n = 183) were caused by HSV type 2 (HSV-2). Most patients were men (68%; n = 163), with a mean age of 35.7 years. Compared to the group diagnosed with HSV-2, the mean age was significantly lower in the HSV-1 group (28.6 years vs. 37.9; p < 0.001) and the proportion of patients with first clinical manifestations of GH was significantly higher in the latest (67.8% vs. 30%; p

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

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

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

Background: Skin diseases are common in Internal Medicine wards and often require observation by a dermatologist. This study intends to characterize the pattern of skin pathology in these patients and to evaluate the impact of dermatologists in their approach. Methods: A retrospective study was conducted. Dermatology observations over 46 months in Internal Medicine wards of Hospital Santo António dos Capuchos were analyzed. Patients’ conditions were classified according to the 10th revision of the International Statistical Classification of Diseases and Related Health Problems. Results: 231 men and 217 women were observed, with an average age of 72.6 years. Stasis dermatitis and venous leg ulcers were the most common diagnosis. Discussion and Conclusion: The Dermatology team significantly reduced the number of undiagnosed patients. Our study reinforces the importance of dermatologists in the evaluation of inpatients with skin diseases.