Histoid leprosy : a rare clinical presentation

Histoid leprosy is considered a rare form of lepromatous leprosy. Its peculiar clinicalpicture makes its diagnosis a challenging one, which can delay starting treatment and perpet-uate the disease as endemic. In addition to representing a reservoir of bacilli, and being animportant means of contamination, these patients have greater resistance to standard treat-ment. This is a report of a typical case of this rare presentation, aiming to share the knowledgeand favor earlier diagnosis of the disease

Epidemiological characteristics and trends of leprosy in children and adolescents under 15 years old in a low-endemic State in Southern Brazil

Leprosy is an infectious and contagious disease affecting skin and nerves. The number of cases in individuals under 15 years old is one of the parameters used in Brazil as an indicator of endemic permanence of the disease and its continuous transmission. Rio Grande do Sul State, in Southern Brazil, is low-endemic to leprosy. However, the disease remains a public health problem. This is a retrospective, observational and analytical study of a historical series of new cases of leprosy in children under 15 years old diagnosed in the period from 2000 to 2019, in all health units in Rio Grande do Sul State. Seventy-seven new cases were notified. The male gender was predominant in 53.2% of the cases (n=41). The average age was 10.4 years (standard deviation of 2.9), with predominance of the age group between 10 and 15 incomplete years old. The most frequent operational classification was multibacillary, in 62.3% of cases (n=48), and the most common clinical form was borderline, in 38.9% of cases (n=28). The predominant disability degree in the sample was grade zero, in 80.0% of the cases (n=60), but in 4.0% (n=3) the grade assessed was 2. In 54.0% of cases (n=27), bacilloscopy was performed, with positive results in 36.0% (n=9) of the exams. Multibacillary cases, with physical disability and/or positive bacilloscopy, draws attention that that the diagnosis is frequently not made in early stages

Onychomycosis caused by Arthrinium arundinis in leprosy patient : case report

We report a case of a 56-year-old Brazilian woman, with relapsing lepromatous leprosy, and onychomycosis caused by a non-dermatophyte filamentous fungi. The pathogenic fungi was identified as Arthrinium arundinis and treated with chemical abrasion of the nail with 40% urea and application of terbinafine cream. Onychomycosis caused by Arthrinium species is rare, and this is the second reported case

Evaluation of polymorphisms in toll-like receptor genes as biomarkers of the response to treatment of Erythema nodosum leprosum

Erythema nodosum leprosum (ENL) is an inflammatory complication caused by a dysregulated immune response to Mycobacterium leprae. Some Toll-like receptors (TLRs) have been identified as capable of recognizing antigens from M. leprae, triggering a wide antimicrobial and inflammatory response. Genetic polymorphisms in these receptors could influence in the appearance of ENL as well as in its treatment. Thus, the objective of this work was to evaluate the association of genetic variants of TLRs genes with the response to treatment of ENL with thalidomide and prednisone. A total of 162 ENL patients were recruited from different regions of Brazil and clinical information was collected from their medical records. Genomic DNA was isolated from blood and saliva samples and genetic variants in TLR1 (rs4833095), TLR2 (rs3804099), TLR4 (rs1927914), and TLR6 (rs5743810) genes were genotyped by TaqMan real-time PCR system. In order to evaluate the variants’ association with the dose of the medications used during the treatment, we applied the Generalized Estimating Equations (GEE) analysis. In the present sample, 123 (75.9%) patients were men and 86 (53.1%) were in treatment for leprosy during the ENL episode. We found an association between polymorphisms in TLR1/rs4833095, TLR2/rs3804099, TLR4/rs1927914, and TLR6/rs5783810 with the dose variation of thalidomide in a time-dependent manner, i.e.,the association with the genetic variant and the dose of the drug was different depending on the moment of the treatment evaluated. In addition, we identified that the association of polymorphisms in TLR1/rs4833095, TLR2/rs3804099, and TLR6/rs5783810 with the dose variation of prednisone also were time-dependent. Despite these associations, in all the interactions found, the influence of genetic variants on dose variation was not clinically relevant for therapeutic changes. The results obtained in this study show that TLRs polymorphism might play a role in the response to ENL treatment, however, in this context, they could not be considered as useful biomarkers in the clinical setting due small differences in medication doses. A larger sample size with patients with a more genetic profile is fundamental in order to estimate the association of genetic variants with the treatment of ENL and their clinical significance

Estudo de prevalência das dermatoses encaminhadas ao setor de fototerapia do ambulatório de dermatologia do Hospital de Clínicas de Porto Alegre, RS, Brasil

BACKGROUND: Phototherapy consists of exposure to ultraviolet radiation for therapeutic reasons. Radiation is already used in dermatological practice, and many studies have already proved the beneficial effect of UV light treatment for chronic inflammatory or lymphoproliferative skin diseases. The Dermatology Service of the Clinics Hospital of Porto Alegre (Hospital de Clínicas de Porto Alegre) has been using phototherapy for a long time, and no official data have been described so far. OBJECTIVES: To study the prevalence of dermatoses referred to the phototherapy unit at the Clinics Hospital of Porto Alegre and describe the total number of patients who have already been referred to this sector and their phototype. METHODS: This is a descriptive cross-sectional study. Data were collected through a review of the phototherapy patients’ records (secondary data), which are available on a database of the Dermatology Service of the Clinics Hospital of Porto Alegre, from August 1997 to July 2011. RESULTS: A total of 653 records were analyzed. Phototype 3 was the most prevalent (n=313). Distribution of the prevalence of dermatoses referred to the phototherapy unit was as follows: vitiligo (279), psoriasis (255), cutaneous T-cell lymphoma/mycosis fungoides (29), graftversus- host disease (15), scleroderma (11), atopic dermatitis (10), alopecia areata (6), parapsoriasis (5), eczema (4), granuloma annulare (4), and others (35). As vitiligo and psoriasis were the two most prevalent dermatoses, they were analyzed separately, with no statistical difference in prevalence between them (P=0,177). CONCLUSIONS: Our findings are in accordance with the literature, showing that although phototherapy is still mostly indicated to treat psoriasis, it has been used to treat other dermatoses, since the results are promising.FUNDAMENTOS: Fototerapia é exposição à radiação ultravioleta para uso terapêutico. O uso dessas radiações já é utilizado na prática dermatológica, e estudos já provaram o efeito benéfico do tratamento UV em doenças inflamatórias crônicas ou linfoproliferativas. O Serviço de Dermatologia do Hospital de Clínicas de Porto Alegre tem disponibilizado a fototerapia para seus pacientes há um longo tempo, sem dados oficiais descritos até então. OBJETIVO: Estudar a prevalência das dermatoses encaminhadas à fototerapia do Hospital de Clínicas de Porto Alegre e descrever o número total de pacientes já encaminhados a esse setor e seu fototipo. MÉTODOS: Estudo transversal descritivo. A coleta de dados foi feita por revisão da totalidade das fichas de cadastro dos pacientes de fototerapia (dados secundários), as quais se encontram em um banco de dados no Serviço de Dermatologia do Hospital de Clínicas de Porto Alegre, de agosto de 1997 a julho de 2011. RESULTADOS: Ao todo 653 pacientes foram analisados. O fototipo 3 foi o mais prevalente (n=313). A distribuição da prevalência das dermatoses foi: vitiligo (279), psoríase (255), linfoma cutâneo de células T/ micose fungóide (29), doença do enxerto versus hospedeiro (15), esclerodermia (11), dermatite atópica (10), alopécia areata (6), parapsoríase (5), eczema (4), granuloma anular (4) e outros (35). Visto que vitiligo e psoríase foram as dermatoses mais prevalentes, eles foram analisados separadamente. Não houve diferença estatística entre as prevalências (P = 0, 177). CONCLUSÕES: Nossos resultados estão em conformidade com a literatura, e mostram que, apesar da psoríase ainda ser a principal indicação para a fototerapia, outras dermatoses estão sendo tratadas com ela, uma vez que seus resultados tem sido promissores

Estudo de prevalência das dermatoses encaminhadas ao setor de fototerapia do ambulatório de dermatologia do Hospital de Clínicas de Porto Alegre, RS, Brasil

BACKGROUND: Phototherapy consists of exposure to ultraviolet radiation for therapeutic reasons. Radiation is already used in dermatological practice, and many studies have already proved the beneficial effect of UV light treatment for chronic inflammatory or lymphoproliferative skin diseases. The Dermatology Service of the Clinics Hospital of Porto Alegre (Hospital de Clínicas de Porto Alegre) has been using phototherapy for a long time, and no official data have been described so far. OBJECTIVES: To study the prevalence of dermatoses referred to the phototherapy unit at the Clinics Hospital of Porto Alegre and describe the total number of patients who have already been referred to this sector and their phototype. METHODS: This is a descriptive cross-sectional study. Data were collected through a review of the phototherapy patients’ records (secondary data), which are available on a database of the Dermatology Service of the Clinics Hospital of Porto Alegre, from August 1997 to July 2011. RESULTS: A total of 653 records were analyzed. Phototype 3 was the most prevalent (n=313). Distribution of the prevalence of dermatoses referred to the phototherapy unit was as follows: vitiligo (279), psoriasis (255), cutaneous T-cell lymphoma/mycosis fungoides (29), graftversus- host disease (15), scleroderma (11), atopic dermatitis (10), alopecia areata (6), parapsoriasis (5), eczema (4), granuloma annulare (4), and others (35). As vitiligo and psoriasis were the two most prevalent dermatoses, they were analyzed separately, with no statistical difference in prevalence between them (P=0,177). CONCLUSIONS: Our findings are in accordance with the literature, showing that although phototherapy is still mostly indicated to treat psoriasis, it has been used to treat other dermatoses, since the results are promising.FUNDAMENTOS: Fototerapia é exposição à radiação ultravioleta para uso terapêutico. O uso dessas radiações já é utilizado na prática dermatológica, e estudos já provaram o efeito benéfico do tratamento UV em doenças inflamatórias crônicas ou linfoproliferativas. O Serviço de Dermatologia do Hospital de Clínicas de Porto Alegre tem disponibilizado a fototerapia para seus pacientes há um longo tempo, sem dados oficiais descritos até então. OBJETIVO: Estudar a prevalência das dermatoses encaminhadas à fototerapia do Hospital de Clínicas de Porto Alegre e descrever o número total de pacientes já encaminhados a esse setor e seu fototipo. MÉTODOS: Estudo transversal descritivo. A coleta de dados foi feita por revisão da totalidade das fichas de cadastro dos pacientes de fototerapia (dados secundários), as quais se encontram em um banco de dados no Serviço de Dermatologia do Hospital de Clínicas de Porto Alegre, de agosto de 1997 a julho de 2011. RESULTADOS: Ao todo 653 pacientes foram analisados. O fototipo 3 foi o mais prevalente (n=313). A distribuição da prevalência das dermatoses foi: vitiligo (279), psoríase (255), linfoma cutâneo de células T/ micose fungóide (29), doença do enxerto versus hospedeiro (15), esclerodermia (11), dermatite atópica (10), alopécia areata (6), parapsoríase (5), eczema (4), granuloma anular (4) e outros (35). Visto que vitiligo e psoríase foram as dermatoses mais prevalentes, eles foram analisados separadamente. Não houve diferença estatística entre as prevalências (P = 0, 177). CONCLUSÕES: Nossos resultados estão em conformidade com a literatura, e mostram que, apesar da psoríase ainda ser a principal indicação para a fototerapia, outras dermatoses estão sendo tratadas com ela, uma vez que seus resultados tem sido promissores