Case for diagnosis

O termo úlcera de Marjolin é usado para designar a transformação maligna que se origina na pele cronicamente lesada. Trata-se de neoplasia mais agressiva do que aquelas não relacionadas com cicatriz e, frequentemente, é subdiagnosticada ou tratada de forma inadequada. Relatamos a ocorrência de carcinoma, do tipo espinocelular sobre cicatriz de queimadura, salientando a necessidade do diagnóstico e intervenção precoces visando um melhor prognósticoMarjolin's ulcer is a term used to describe a malignant transformation that originates in chronic skin lesions. These neoplasms may be more aggressive than those unassociated with healing processes and are frequently overlooked or inadequately treated. This case report describes the occurrence of a squamous cell carcinoma occurring at the site of a burn scar and emphasizes the need for early diagnosis and treatment in order to assure better prognosi

Criptococose cutânea disseminada em paciente com SIDA. Relato de caso

The authors study a patient carrying Aids, with exuberant dermatological manifestations of cryptococcosis. They stress the therapeutic effectiveness of short-term amphotericin B. The authors reviewed cases of cutaneous infection with Cryptococcus reported in the national and international literature, verifying that the frequency has increased with the AIDS epidemic. Also, they discuss about the differential diagnosis with some cases of dermatosis, particularly with the disseminated giant molluscum contagiosum. In relation to the therapy, they affirm that the choice of drug depends on the organ involved, as well as the immune state of the patient.Os autores estudam um paciente portador de SIDA, com manifestações dermatológicas exuberantes de criptococose. Destacam a eficácia terapêutica da anfotericina B, a curto prazo. Revisam os casos de criptococose cutânea relatados na literatura nacional e internacional, ressaltando o aumento de sua freqüência com a epidemia da SIDA. Também discutem o diagnóstico diferencial com várias dermatoses, particularmente com o molusco contagioso gigante disseminado. Em relação à terapêutica, afirmam que a escolha da droga depende do órgão comprometido, assim como do estado imunológico do paciente

Ulcerações Labiais Associadas a Comportamento Obsessivo-Compulsivo: Relato de Caso.

Self-inflicted lesions include skin alterations caused by an abnormal behavior. They demand interdisciplinary involvement of health professionals. They are most common among middle-aged women. We report the case of a 42-year-old man with a diagnosis of an ulcerated lesion on the upper and lower lips, secondary to obsessive-compulsive behavior. Histopathological findings were non-specific and the results of laboratory tests performed showed no alterations. Joint evaluation by Psychiatry and Dermatology was initiated, with follow-up sessions of psychotherapy. Patient chose to abandon treatment. The importance of recognizing psychodermatoses for the dermatologist is emphasized, aiming at the early diagnosis and therapeutics, which will allow the prevention of destructive and mutilating lesions.As lesões auto-infligidas compreendem modificações cutâneas induzidas por um desvio do comportamento e demandam o envolvimento de diferentes profissionais da saúde. São mais comuns entre as mulheres de meia idade. Relata-se o caso clínico de um homem de 42 anos com diagnóstico de lesão ulcerada nos lábios superior e inferior, secundária a comportamento obsessivo-compulsivo. Os achados histopatológicos foram inespecíficos e os resultados de exames laboratoriais realizados não apresentaram alterações. Optou-se pelo acompanhamento conjunto entre a Psiquiatria e a Dermatologia, com seguimento de sessões de psicoterapia, mas o paciente acabou por abandonar o tratamento. Ressalta-se a importância do conhecimento das psicodermatoses pelo dermatologista, visando o diagnóstico e a terapêutica precoces, o que permitirá a prevenção de lesões destrutivas e mutiladoras

Prevalência de dermatoses em idosos residentes em instituição de longa permanência Prevalence of dermatoses in residents of institutions for the elderly

OBJETIVOS: Determinar a prevalência das afecções dermatológicas em 75 idosos residentes em instituição de longa permanência na cidade de Santos-SP, e confrontar os achados com revisão da literatura. MÉTODOS: Setenta e cinco idosos foram submetidos a exame dermatológico. Com os dados obtidos calculou-se a prevalência, o número médio por paciente e a freqüência de dermatoses. Foi ainda analisado a distribuição nos subgrupos sexo, raça, faixa etária e nos subgrupos principais de dermatoses. RESULTADOS: O número total de dermatoses diagnosticadas foi 280, o número médio por paciente foi 3,73 e o número total de tipos de dermatoses foi 32. A prevalência das principais dermatoses encontradas foi: melanose solar (53,3%), queratose seborréica (46,6%), onicomicose (37,3%), nevo rubi (33,3%), púrpura senil (29,3%), xerose (14,6%), escabiose (12,0%) e neoplasia maligna (1,3%). A distribuição das dermatoses foi 70% (IC95%: 59% a 81%) maior no sexo feminino do que no masculino. CONCLUSÃO: Apesar da pequena casuística, os dados obtidos são compatíveis com os poucos relatos disponíveis na literatura. Este estudo de prevalência definiu a distribuição de dermatoses em uma fração da população de idosos. Entretanto, os dados agregados de casuísticas subseqüentes podem permitir tornar os dados mais precisos, cuja relevância é indiscutível na orientação de medidas de saúde individual e coletiva.<br>OBJECTIVE: To determine the prevalence of dermatoses in 75 elderly residents in an institution of long permanence in the city of Santos, and to compare findings with those in literature. METHODS: Seventy five healthy elderly persons were submitted to a dermatological exam. The prevalence, the average number per elderly person and the frequency of dermatoses were calculated from the data collected. An analysis was then made of the distribution in the subgroups of, gender, race, age bracket as well as of dermatosis in the main sub-groups. RESULTS: The total number of diagnoses of dermatosis was 280 with an average number of 3. 73/ per elderly person and 32 different types of dermatosis: were found. The prevalence of the dermatosis most often found was respectively: melanosis (53.3%), seborrheic keratosis (46.6%), onychomycosis (37.3%), nevus (33.3%), senile purpura (29.3%), xerosis (14.6%), scabies (12.0%) and malignant neoplasm (1.3%). The distribution of dermatosis was 70% (CI95%: 59% to 81%) higher in the female population than in the male. CONCLUSION: Notwithstanding the small number of cases, these data are compatible with the few reports available in literature. This study of prevalence defined the distribution of dermatosis in a fraction of the elderly population. However the aggregate data of subsequent casuistries may provide the more precise information whose relevance is undeniable in the orientation of individual and collective future health measures

Prevalence of depressive and anxiety symptoms in medical students in the city of Santos

ABSTRACT Objective Ascertain the prevalence of depressive and anxiety symptoms in medical students, considering data in the literature that indicate higher vulnerability to emotional disorders in this population. Methods A descriptive cross-sectional study with a sample of 657 (98%) students. The instruments used were: questionnaire of socioeconomic-demographic characteristics, Beck Depression Inventory and Beck Anxiety Inventory. Results Predominance of the female gender (61%), aged between 17 and 30 years (98%), Catholic religion (64.2%) from the city of São Paulo (40.7%) and other cities in the state (35.7%); 30% presented depressive symptoms and 21% anxiety symptoms. Female students had higher scores both for depression (34.8%) and for anxiety (26.8%). As regards the course year, the highest rates were found in the 5th year (40.7%) for depression and in the 2nd year for anxiety (28.8%). Conclusion The data obtained in this study (30%) agreed with the literature regarding the prevalence of depressive symptoms in medical students, but this index was higher compared to the population in general (15.1% to 16.8%), and related to people in São Paulo city (18.5%). Concerning anxiety the rates found were slightly lower than those in specific literature but higher than those in literature for the population in general (8% to 18%) and in city São Paulo (16.8%). These indices indicate that the school of medicine may play a role as a predisposing and/or triggering factor in some students. The results suggest that more attention should be directed to 5th year students, who are beginning the internship period