Resumo A microbiota intestinal tem importância na saúde e na patogénese de algumas doenças, pois além da digestão, interfere no sistema imunológico e até mesmo na saúde da pele. Evidências mostram que alterações intestinais podem gerar manifestações dermatológicas, como rosácea, acne e dermatite atópica. O uso de probióticos vem sendo estudado pois é possível criar estratégias para modular o sistema imunológico, os quais diminuem a manifestação dessas doenças. Nesse estudo, foi realizado uma revisão bibliográfica das evidências clínicas sobre o uso dos probióticos orais no tratamento da rosácea, acne e dermatite atópica através de uma pesquisa nos bancos de dados eletrônicos, como PubMed, Scientific Electronic Library Online (SCIELO), Literatura Latino-Americana em Ciências da Saúde (LILACS) e Google Scholar, nos últimos 5 anos. Foram encontrados um número limitado de estudos, mas todos evidenciaram o benefício e melhora das lesões da rosácea, acne e dermatite atópica, assim como a diminuição de citocinas pró-inflamatorias. Os resultados encontrados sugerem que o uso de Lactobacillus acidophilus, Bifidobacterium lactis e Bifidobacterium bifidum são promissores nas três patologias. Concomitante, os estudos mostraram que os probióticos usados em conjunto aos antibióticos orais obtiveram melhores respostas do que usados isoladamente. Apesar da resposta positiva, são imprescindíveis mais esforços para a compreensão total dos mecanismos exatos e efeitos terapêuticos dos probióticos orais no manejo de doenças dermatológicas inflamatórias.

Abstract The gut microbiome is an important in the health and pathogenesis of some diseases. Beyond digestion, it interferes with the immune system and even with the skin health. Evidence shows that intestinal changes can be involved in dermatological manifestations, such as rosacea, acne, and atopic dermatitis. The use of probiotics has been studied, because it is possible to create a strategy to modulate the immune system and reduce the manifestations of these diseases. In this study, we performed a bibliographic review of the clinical evidence on the use of oral probiotics in the treatment of rosacea, acne, and atopic dermatitis. The search was made in electronic databases, such as PubMed, Scientific Electronic Library Online (SCIELO), Latin American Literature in Health Sciences (LILACS), and Google Scholar, in the past 5 years. A limited number of studies have been found, but all have shown the benefit and improvement of lesions in patients, as well as the reduction of pro-inflammatory cytokines by the mechanism of immunomodulation. Search results found out that the use of Lactobacillus acidophilus, Bifidobacterium lactis, and Bifidobacterium bifidum are promising in the three pathologies. Moreover, probiotics used in association with oral antibiotics obtained better responses than when used alone. Despite the positive response, more efforts are required to fully understand the exact mechanisms and therapeutic effects of probiotics in the management of inflammatory dermatological diseases.

Abstract Paget's disease is a rare disorder of the nipple and/or the areola that is characterized by an erythematosquamous lesion and is often associated with in situ or invasive breast carcinoma. The authors present an atypical, exuberant case that had evolved over eight years, emphasizing the importance of early diagnosis.

Abstract: Background: Leprosy is a chronic, infectious disease that affects the skin and the peripheral nervous system and can lead to permanent disability and/or deformity. Objectives: To identify the distribution and to quantify the spatial dependence of the detection rates of new cases of Hansen’s disease in the State of São Paulo, correlating with socioeconomic variables. Methods: Ecological and exploratory study with data on the detection rates of new cases of Hansen’s disease among residents of São Paulo State municipalities between 2009-2012. The average rate per 10,0000 inhabitants was estimated. Information on the proportion of the population with low-income and the values of the Gini index were obtained. Thematic maps were constructed with the average rates and with those obtained by the Bayesian estimator; Moran and Kernel maps were also constructed. Spatial analysis by TerraView program. An alpha of 5% was adopted. Results: In total, 7163 new cases of Hansen’s disease were recorded throughout the state. The average rate per 10,000 inhabitants, was 0.71 (SD = 1.06), ranging from zero to 12.87, with higher rates in the west of the State, in the metropolitan area of the capital and the Paraiba Valley. Municipalities with high priority for intervention were located in the west and northwest of the State. There was no correlation between rates with Gini index and low income. Study limitations: Possible inconsistency of Hansen’s disease notification database regarding information quantity, quality and processing. Conclusions: This study identified the distribution and quantified the spatial dependence of the detection rates of new cases of Hansen’s disease in the State of São Paulo, corroborating previous studies and serving as a subsidy to health managers.

Abstract: Neutrophilic dermatosis of the dorsal hands is considered a rare and localized variant of Sweet's syndrome. Although the etiology is unknown, there are reports of association with infections, neoplasias, autoimmune diseases and medications. Histopathology shows a dense neutrophilic inflammatory infiltrate in the dermis. Treatment is based on the administration of systemic corticosteroids; however, a combination of medications is useful, given the frequency of relapses. The authors report a classic and clinically exuberant case of neutrophilic dermatosis of the dorsal hands, with excellent response to oral dapsone treatment, and offer a brief literature review.

Abstract: The vulva corresponds to the external female genitalia. Special features of this region favor a wide range of diseases, whose knowledge allows for better clinical management, impacting on the quality of life. This is a cross-sectional and descriptive study carried out at a vulvar pathology outpatient clinic, between May and December/ 2015. Data obtained from a standard form included demographic parameters, habits, and vulvar dermatosis and allowed to identify the epidemiological profile of patients with vulvar dermatosis treated in this outpatient clinic and to determine the most prevalent dermatoses. Our results, partially concordant with the literature, provide original data that should stimulate further studies

RESUMO JUSTIFICATIVA E OBJETIVOS: O agulhamento seco é uma técnica intervencionista, minimamente invasiva, utilizada no tratamento da dor miofascial. O objetivo deste estudo foi descrever o emprego do agulhamento seco e realizar a análise crítica da literatura sobre os aspectos técnicos de sua utilização por profissionais capacitados da área da saúde. CONTEÚDO: Foi realizada uma busca na literatura por livros em inglês, artigos de revisão, estudos clínicos controlados randomizados ou quase-randomizados, encobertos, ou duplamente encobertos e estudos de séries de casos publicados em português ou inglês. Foram utilizadas as seguintes bases de dados: Cochrane, LILACS e Pubmed. Foram selecionados artigos publicados no período de setembro de 1996 a janeiro de 2017, recrutados após a utilização dos seguintes descritores: agulhamento seco versus síndromes da dor miofascial versus síndrome da disfunção da articulação temporomandibular versus pontos-gatilho versus manipulações musculoesqueléticas versus músculo trapézio (superficial back muscles) versus músculo masseter versus músculo temporal versus músculo pterigoideo versus músculo digástrico. Foram excluídos relatos de casos clínicos, estudos abertos “open-label”, estudos em modelos animais e artigos não relacionados ao agulhamento seco. Após o cruzamento dos descritores e aplicação dos critérios de inclusão e exclusão, foram selecionados seis artigos. CONCLUSÃO: O diagnóstico da dor miofascial pode se apresentar como uma tarefa difícil, uma vez que ela pode simular diferentes algias do sistema mastigatório, desde uma odontalgia até uma dor neuropática trigeminal. Isso pode ser minimizado com uma adequada anamnese, exame clínico envolvendo palpação muscular, além da própria experiência e treinamento profissional. A desativação dos pontos-gatilho miofasciais deve ser prioridade na abordagem terapêutica da dor miofascial já que é observada melhora significativa da dor local e referida, quando essa é realizada. Apesar de resultados favoráveis em estudos sobre o agulhamento seco no tratamento da dor miofascial, relacionada à disfunção temporomandibular e a região cervical, ainda faltam na literatura pesquisas com elevado nível de evidência que comprovem a eficácia e a eficiência dessa técnica. Essa é uma terapia minimamente invasiva, de baixo custo, segura e apresenta efeitos locais, segmentares, extrassegmentares e placebo. Diante do exposto, pode-se recomendar seu emprego por diferentes profissionais da área da saúde nos casos da dor miofascial.

ABSTRACT BACKGROUND AND OBJECTIVES: Dry needling is an interventionist, minimally invasive technique, used in the treatment of myofascial pain. The objective of this study was to describe the use of dry needling and to perform a critical literature analysis about the technical aspects of its use by qualified health care professionals. CONTENTS: A search in the literature was carried out for books in English, review articles, randomized controlled or quasi-randomized clinical trials, blind or double-blind and published case studies series in Portuguese or in English. The following databases were used: Cochrane, LILACS, and Pubmed. Articles published from September 1996 to January 2017 were selected according to the following keywords: dry needling versus myofascial pain syndrome versus temporomandibular joint dysfunction syndrome) versus trigger points versus musculoskeletal manipulations versus trapezius muscle, superficial back muscles versus masseter muscle versus secular muscle versus pterygoid muscles versus digastric muscle, neck muscles. Reports of clinical cases, “open-label” studies, studies with animal models and articles not related to DN were excluded. After the matching descriptors and the implementation of inclusion and exclusion criteria, we selected six articles. CONCLUSION: The diagnosis of myofascial pain can be a difficult task since it can simulate different masticatory system pain, from a toothache to a trigeminal neuropathic pain. This can be minimized with proper history taking, clinical examination involving muscle palpation, as well as the own experience and professional training. The deactivation of myofascial trigger points should be a priority in myofascial pain therapy since there is a significant improvement of local and referred pain when we use this approach. Despite the favorable results of studies about the use of dry needling in myofascial pain treatment related to temporomandibular joint dysfunction and the cervical region, the literature still lacks studies with a high level of evidence proving the effectiveness and efficacy of this technique. This is a minimally invasive, low cost, and safe therapy that provides local, segmental, extra segmental and placebo effects. Therefore, its use should be recommended by different health professionals in cases of myofascial pain.

Abstract: Background: Cutaneous melanoma is a skin cancer with low incidence but high mortality rates. The South region of Brazil has the highest death rates by melanoma per 100,000 inhabitants of the country. Little is known about the spatial distribution of this malignancy in southern Brazil. Objectives: Identify the spatial patterns of deaths from cutaneous melanoma in South region of Brazil, using geoprocessing tools. Methods: This is an ecological and exploratory study of death information by cutaneous melanoma obtained from portal Datasus, for Brazil's southern region, from January 2008 to December 2012. Deaths were separated by gender and rates per 100,000 inhabitants were calculated and used to compile thematic maps, Moran maps and Kernel maps, using TerraView software. It was adopted an alpha = 5%. Results: There were data on 2378 deaths from cutaneous melanoma in the study period. High rates were identified in the northern and littoral regions of Rio Grande do Sul; the northeast of Santa Catarina; and west of Paraná - for the total population, with minor differences detected and indicated regarding gender. The global Moran index presented p-values of 0.03, 0.04 and 0.03, respectively, for male, female and overall deaths. All the micro-regions that showed high priority for intervention were detected in the Rio Grande do Sul. Conclusion: Spatial clusters of micro-regions with high death rates from cutaneous melanoma in South region of Brazil were identified, serving as an important tool for health managers.

BACKGROUND: Nonmelanoma skin cancer is the most common form of cancer in humans and also the malignant disease that is increasingly common among kidney transplant recipients. OBJECTIVE: To determine the epidemiological characteristics of renal transplant recipients with nonmelanoma skin cancer seen at a referral transplantation center. METHODS: Cross-sectional descriptive study with renal transplant recipients presenting nonmelanoma skin cancer, treated at a transplantation referral center between 08/01/2004 and 08/31/2009. Analyzed variables were: gender, age, skin phototype, occupational and recreational sun exposure, use of photoprotection, personal and family history of non-melanoma skin cancer, clinical type and location, time between transplantation and the appearance of the first nonmelanoma skin cancer, occurrence of viral warts, timing of transplantation, type of donor, cause of kidney failure, previous transplants, comorbidities, pre-transplant dialysis, type and duration of dialysis. RESULTS: 64 subjects were included. Males - 71.9%; low skin phototypes (up to Fitzpatrick III) - 89%; mean age - 57.0 years - and mean age at transplant - 47.3 years; sun exposure - 67.2% occupational - and 64.1% recreational; photoprotection - 78.2% (although only 34.4% in a regular manner); squamous cell carcinoma - 67.2%; squamous cell carcinoma/basal cell carcinoma ratio - 2:1; personal history of nonmelanoma skin cancer - 25% - and family history - 10.9%; location at photoexposed area - 98.4%; average latency time between transplantation and first nonmelanoma skin cancer appearance - 78.3 months; viral warts (HPV) after transplant - 53.1%; average timing of transplantation - 115.5 months; living donor - 64.1%; triple regimen (antirejection) - 73.2%; comorbidities - 92.2%; pre-transplant dialysis - 98.4%; hemodialysis - 71.7%; average duration of dialysis - 39.1 months; previous transplants - 3.1%; hypertension as cause of renal failure - 46.9%. CONCLUSION: This study allowed the epidemiological characterization of a population of kidney transplant recipients with nonmelanoma skin cancer.

A poroqueratose é uma desordem da queratinização epidérmica caracterizada por placas anulares com centro atrófico e bordas hiperqueratóticas, e inclui um grupo heterogêneo de desordens que são na sua maioria herdadas de forma autossômica dominante. O presente caso refere-se a uma paciente feminina de 5 anos de idade, com poroqueratose de Mibelli confirmada histologicamente. A raridade desta desordem, a exuberância clínica e o caráter destrutivo das lesões, o acometimento facial e mucoso pouco usuais nesta forma de poroqueratose e o início na infância precoce motivaram este relato.

Porokeratosis is a disorder of epidermal keratinization characterized by annular plaques with an atrophic center and hyperkeratotic edges, and includes a heterogeneous group of disorders that are mostly inherited in an autosomal dominant form. This report describes a 5 year-old female patient, with porokeratosis of Mibelli confirmed histopathologically. The rarity of this disorder, its clinical exuberance and the destructive character of the lesions, as well as the facial and mucosal involvements, unusual in this form of porokeratosis, and also its onset in early childhood motivated this report.

Relata-se o caso de uma paciente com diagnóstico de angioqueratoma pseudolinfomatoso acral, conhecido por sua sigla em inglês APACHE - Acral Pseudolymphomatous Angiokeratoma of Children. É uma doença cutânea benigna, rara, de etiologia desconhecida, caracterizada por múltiplas pápulas e nódulos eritêmato-violáceos assintomáticos, de localização geralmente unilateral e acral. Atualmente, questiona-se esta denominação, já que há relatos na literatura do quadro em adultos e em outras localizações. Clinicamente, é similar a um angioqueratoma, porém, histologicamente, corresponde a um tipo distinto de pseudolinfoma. O estudo imuno-histoquímico é necessário para diferenciação dos linfomas cutâneos.

The authors describe a case of a female patient with Acral Pseudolymphomatous Angiokeratoma of Children, known as APACHE. It is a rare benign cutaneous disease, of unknown etiology, characterized by multiple, asymptomatic erythematous-violaceous papules and nodules, usually located unilaterally with acral distribution. Today, this denomination is questionable, since there are published reports of this disease in adults and in different locations. Clinically, it is similar to an angiokeratoma, whereas hystologically, it corresponds to a distinct type of pseudolymphoma. The immunohistochemical study is required to distinguish APACHE from cutaneous lymphoma.

O nevo epidérmico verrucoso inflamatório linear é uma variante do nevo epidérmico verrucoso caracterizada por fenômenos inflamatórios recorrentes. A despeito das manifestações clínicas bem estabelecidas o diagnóstico diferencial entre nevo epidérmico verrucoso inflamatório linear e psoríase linear permanece difícil. A história clínica, o exame físico e análise histopatológica podem não ser suficientes para a confirmação diagnóstica. Nós relatamos o caso de uma menina de 4 anos de idade no qual o uso da involucrina foi útil para o diagnóstico do nevo epidérmico verrucoso inflamatório linear . Nossos achados corroboram a imunohistoquímica com a involucrina como uma ferramenta importante nestes casos.

Inflammatory linear verrucous epidermal nevus is a variant of verrucous epidermal nevus, characterized by recurrent inflammatory phenomena. Despite well-established clinical manifestations, the differential diagnosis between inflammatory linear verrucous epidermal nevus and linear psoriasis remains difficult. Clinical history, physical examination and histopathology analysis may not be sufficient to confirm the diagnosis. We report the case of a 4-year-old girl in which the involucrin immunostaining was helpful in the diagnosis of inflammatory linear verrucous epidermal nevus. Our findings confirm that involucrin immunohistochemistry is a useful tool in such cases.