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- Acquired Cold Urticaria: Clinical Features, Particular Phenotypes, and Disease Course in a Tertiary Care Center CohortPublication . Deza, G; Brasileiro, A; Bertolín-Colilla, M; Curto-Barredo, L; Pujol, R; Giménez-Arnau, ABACKGROUND: Data about special phenotypes, natural course, and prognostic variables of patients with acquired cold urticaria (ACU) are scarce. OBJECTIVES: We sought to describe the clinical features and disease course of patients with ACU, with special attention paid to particular phenotypes, and to examine possible parameters that could predict the evolution of the disease. METHODS: This study was a retrospective chart review of 74 patients with ACU who visited a tertiary referral center of urticaria between 2005 and 2015. RESULTS: Fourteen patients (18.9%) presented with life-threatening reactions after cold exposure, and 21 (28.4%) showed negative results after cold stimulation tests (classified as atypical ACU). Nineteen patients (25.7%) achieved complete symptoms resolution at the end of the surveillance period and had no subsequent recurrences. Higher rates of atypical ACU along with a lower likelihood of achieving complete symptom resolution was observed in patients who had an onset of symptoms during childhood (P < .05). In patients with atypical ACU, shorter disease duration and lower doses of antihistamines required for achieving disease control were detected (P < .05). Age at disease onset, symptom severity, and cold urticaria threshold values were found to be related to disease evolution (P < .05). LIMITATIONS: This study was limited by its retrospective nature. CONCLUSIONS: The knowledge of the clinical predictors of the disease evolution along with the clinical features of ACU phenotypes would allow for the establishment of an early and proper therapeutic strategy.
- Adult Tinea Capitis and Tinea Barbae in a Tertiary Portuguese Hospital: a 11-Year AuditPublication . Duarte, B; Galhardas, C; Cabete, JAdult tinea capitis and tinea barbae are nowadays considered uncommon in developed countries. Despite their potential for morbidity and healthcare costs, few series have attempted to characterise these infectious disorders. We conducted a cross-sectional study to analyse the epidemiological, clinical and mycological characteristics of adult tinea capitis and tinea barbae of a large tertiary centre in Southern Europe. All adult patients with a mycological-confirmed tinea capitis or barbae over a 11-year period (January 2008 to December 2018) were considered for the analysis. Concerning tinea capitis, 860 culture-confirmed diagnoses were made during this 11-year period, of which only 15 (1.5%) occurred in adults (15 patients). A disproportionately high number of patients were female and immunocompromised. Microsporum audouinii (20%) and Trichophyton rubrum (20%) were the most common isolates. Half of the cases were initially misdiagnosed. Regarding tinea barbae, 7 cases were diagnosed over this time period. Overuse of topical steroids was widespread in this population. Trichophyton rubrum was the infectious agent in all cases. Initial misdiagnosis was very common (43%). Adult tinea capitis and tinea barbae can still be observed in contemporary practice and remain a public health concern, with the immunosuppressed patient being particularly affected. Initial misdiagnosis is a common occurrence. Anthropophilic fungi are now the most common aetiologic agents of these infections, and they will probably continue to do so as the large urban centres expand peripherally. Awareness for this diagnosis is necessary to prevent unwarranted morbidity and costs.
- Alergia a Fármacos com Manifestações Cutâneas. Abordagem DiagnósticaPublication . Antunes, J; Brás, S; Prates, S; Amaro, C; Leiria-Pinto, PAs reacções adversas a fármacos (RAF) representam um problema frequente na prática clínica. A alergia a fármacos resulta de mecanismos de hipersensibilidade imunológica e representa 6-10% do total de RAF. Clinicamente, as reacções alérgicas a fármacos podem ser classificadas como imediatas (tipo I) ou não-imediatas (com manifestações clínicas diversas e associadas sobretudo a reacções de tipo IV). Neste artigo são abordados aspectos gerais, nomeadamente os mecanismos imunopatogénicos implicados na alergia a fármacos e reactividade cruzada mas também as manifestações cutâneas mais relevantes, nomeadamente exantemas máculo-papulares, eritema fixo a fármacos (EFF), pustulose exantemática aguda generalizada (PEAG), síndrome de hipersensibilidade a fármacos (DRESS – drug rash with eosinophilia and systemic symptoms), síndrome de Stevens-Johnson/necrólise epidérmica tóxica (SSJ/NET). O papel dos testes cutâneos (epicutâneos ou intradérmicos de leitura tardia) na abordagem de reacções não-imediatas é também revisto. Os beta-lactâmicos (BL) são o grupo farmacológico mais frequentemente envolvido em reacções de hipersensibilidade imunológica e que mais dificuldades coloca na prática clínica diária, nomeadamente devido aos riscos de reactividade cruzada, pelo que é analisado em maior detalhe ao longo da revisão. A indução de tolerância a fármacos poderá ser considerada em casos selecionados, sobretudo quando na ausência de alternativas terapêuticas igualmente eficazes ou seguras.
- Allergic Contact Dermatitis Caused by Laurel Leaf OilPublication . Brás, S; Mendes-Bastos, P; Amaro, C; Cardoso, J
- An Unusual Case of Extragenital Primary SyphilisPublication . Santos-Coelho, M; Alves Barbosa, J; Valejo Coelho, MM; João, A
- An Update on Airborne Contact Dermatitis: 2001-2006Publication . Santos, R; Goossens, AReports on airborne dermatoses are mainly published in the context of occupational settings. Hence, in recent years, dermatologists and also occupational physicians have become increasingly aware of the airborne source of contact dermatitis, resulting mainly from exposure to irritants or allergens. However, their occurrence is still underestimated, because reports often omit the term 'airborne' in relation to dust or volatile allergens. For the present update, we screened the journals 'Contact Dermatitis' (July 2000 to December 2006); 'Dermatitis', formerly named 'American Journal of Contact Dermatitis'; 'La Lettre du Gerda' (January 2000 to December 2006); and also included relevant articles from other journals published during the same period. This resulted in an updated list of airborne dermatitis causes.
- Análise Retrospectiva do Protocolo de Tratamento Utilizado na Consulta Multidisciplinar de Úlcera de Perna do Hospital dos Capuchos no Período entre 2002 e 1º Semestre 2006Publication . Dias Coelho, J; Clerigué, A; Neves, J; Pereira Alves, CAs úlceras de perna constituem uma importante patologia causando uma diminuição da qualidade de vida, hospitalizações frequentes e aumento da mortalidade e morbilidade. Têm uma incidência de 1% na população adulta, sendo que esta incidência atinge níveis de 10% nos escalões etários superiores a 70 anos. Cerca de 95% das úlceras são venosas, arteriais, mistas ou diabéticas, sendo as mais frequentes as úlceras venosas (70 a 80%). Com o objectivo de optimizar o tratamento e acompanhamento dos doentes com esta patologia, foi criada em 2002 uma Consulta de Referência Multidisciplinar de Úlcera de Perna, no Hospital dos Capuchos. Simultaneamente foi estabelecido um protocolo de referenciação/ tratamento com os Centros de Saúde da Unidade B da Sub-região de Saúde de Lisboa. Neste protocolo o doente é observado no contexto de uma equipa multidisciplinar. Os autores fizeram um estudo retrospectivo dos doentes observados nesta consulta no período entre 2002 e 1º semestre de 2006. Foram observados e acompanhados 294 novos doentes, tendo 80% idade superior a 60 anos. Em relação à etiologia das úlceras, 51,3% (n=151) eram venosas, 35,4% (n=104) eram diabéticas e 6,8% (n=20) eram arteriais. A área média das úlceras foi 23,9cm2 e o número médio de úlceras foi 1,6. A duração das úlceras tinha em 42,3% dos casos um período superior a 6 meses. Das 199 culturas positivas, 40,2% apresentavam Staphylococcus aureus, sendo 21,2% destes MRSA. Com o protocolo instituído, foi obtida uma taxa de cicatrização de 72,2%. 45,9% dos doentes tiveram uma cicatrização total da úlcera em menos de 2 meses, resultados estes que são muito positivos face às taxas de cicatrização de 6 meses referidas na literatura.
- Aneurismas Venosos Superficiais. Casuística, Casos Clínicos e Revisão da LiteraturaPublication . Neves, J; Sousa, V; Cavadas, D; Cabete, J; Formiga, AOs aneurismas venosos são uma entidade patológica pouco frequente, embora a sua deteção possa vir a aumentar como consequência da crescente utilização do ecodoppler como meio complementar de diagnóstico. Podem apresentar-se, clinicamente, como massas dos tecidos moles, ocasionalmente simulando hérnia ou adenopatia da região inguinal, particularmente os que surgem no sistema venoso superficial dos membros inferiores. Estão descritos na literatura casos de aneurismas venosos superficiais associados a tromboembolismo pulmonar. Considerando a potencial morbimortalidade, a abordagem terapêutica é cirúrgica na maioria dos casos. Os autores apresentam a sua casuística de aneurismas venosos superficiais num período de 20 anos, três casos clínicos mais exemplificativos e fazem uma revisão da literatura.
- Annular Lichen Planus in Association with Crohn DiseasePublication . Serrão, V; Organ, V; Pereira, L; Vale, E; Correia, SBACKGROUND: Lichen planus is an idiopathic inflammatory disease of the skin and mucous membranes. Although the etiology is not established, it has been associated with autoimmune diseases, viral infections, drugs and dental restoration materials. However, the association with inflammatory bowel disease has been very rarely reported in the literature. CASE REPORT: A 19-year-old female patient presented with annular lesions on her upper body and limbs, with a sharply defined border and non-atrophic skin in the center. The lesions were hyperpigmented and had been stable for over one year. The histopathology confirmed the diagnosis of annular lichen planus. She had weight loss, occasional diarrhea, and a severe anemia. The investigation of these symptoms led to the diagnosis of Crohn disease and a sickle cell trait. Therapy with systemic corticosteroids and mesalazine controlled the intestinal disease, with concomitant improvement of the skin lesions. CONCLUSIONS: As lichen planus can be associated with other immunological disorders, the association with inflammatory bowel disease should be considered in the evaluation of the patient.
- Antibodies Towards High-Density Lipoprotein Components in Patients with PsoriasisPublication . Paiva-Lopes, MJ; Batuca, J; Gouveia, S; Alves, M; Papoila, AL; Delgado Alves, JPsoriasis is a chronic inflammatory immune disorder associated with an increased risk of atherosclerosis. This increased risk is not fully understood. High-density lipoproteins (HDL) play an important role in the prevention of atherosclerosis and any factors that may hamper HDL function such as anti-HDL antibodies (aHDL) might be associated with an increased cardiovascular risk. We aimed to determine whether anti-HDL antibodies (aHDL) are present in patients with psoriasis. Sixty-seven patients with psoriasis were compared with a healthy control group. Epidemiologic and clinical data were recorded. IgG and IgM aHDL, IgG anti-apolipoprotein A-I (aApoA-I), anti-apolipoprotein E (aApoE), and anti-paraoxonase 1 (aPON1) antibodies, as well as VCAM-1, IL-6, and TNF-α were assessed by ELISA. Apolipoprotein A-I (ApoA-I) and Apolipoprotein E (ApoE) were measured by immunoturbidimetric immunoassay. Patients with psoriasis had higher titers of IgG aHDL (p < 0.001), IgG aApoA-I (p = 0.001) and aApoE antibodies (p < 0.001). IgG aHDL and aApoE titers were higher in patients with severe psoriasis (p = 0.010 and p = 0.018, respectively). Multiple regression analysis, considering all clinical and biological variables, showed that aApoE, IL-6, and aPON1 are the biological variables that best explain aHDL variability. This is the first report showing the presence of aHDL, aApoA-I, and aApoE antibodies in patients with psoriasis. These antibodies were associated with increased disease severity and may contribute to the pathogenesis of atherosclerosis in psoriasis. They may fulfill the clinical need for biomarkers of cardiovascular risk associated with psoriasis that would help to stratify patients for prevention and therapeutic approaches.