Abstract Background Mohs micrographic surgery is an established technique in the treatment of cutaneous neoplasms. It offers higher cure rates and the main indications are non-melanoma malignant skin tumors. Few studies have been performed on the treatment of rare tumors through this technique. Objective To study rare skin tumors and rare variants of basal cell carcinoma and squamous cell carcinoma submitted to Mohs micrographic surgery in a tertiary service in relation to frequency, disease-free evolution, and applicability of this surgical procedure for this group of tumors. Methods This was a retrospective observational study including rare skin tumors and less common variants of basal cell carcinoma and squamous cell carcinoma treated using Mohs micrographic surgery, between October 2008 and April 2021. Results During the study period, 437 tumors were treated using Mohs micrographic surgery, and 22 (5%) rare skin tumors were selected. The tumors comprised three dermatofibrosarcomas protuberans, two atypical fibroxanthomas, two spiradenomas, two hypercellular fibrohistiocytomas, one primary cutaneous adenocarcinoma, one trichoblastoma, one porocarcinoma, one chondroid syringoma, one cutaneous angiosarcoma, one Merkel cell carcinoma, and one sebaceous carcinoma. Six other cases of rare basal cell carcinoma variants with trichoepitheliomatous differentiation, metatypical basal cell carcinoma, and clear cell squamous cell carcinoma were included. There were no cases of recurrence after an average of six years of follow-up. Study limitations This is a retrospective study on rare neoplasms carried out in a single referral center, and this surgical technique isn’t widely available in the public service. Conclusion This retrospective case series showed that Mohs micrographic surgery is an appropriate treatment for rare skin tumors. They corresponded to 5% of the tumors treated by the technique during a 12-year-period, with no recurrences identified.

Abstract Generalized pustular psoriasis (von Zumbusch) is a rare and acute eruption characterized by multiple sterile pustules over an erythematous and edematous background, eventually associated with psoriasis vulgaris. Classically, it manifests as a potentially severe systemic picture and demands prompt diagnosis and intervention. The duration of each flare-up and intervals between the pustular episodes is extremely variable. Recently, genetic abnormalities have been identified mainly in the familial and early variants of this disease. The therapeutic arsenal is limited; however, new drugs being evaluated aim to control both pustular flare-ups and disease recurrences.

Abstract Background: Non-melanoma skin cancer is the most common type of malignancy in the Western world, and surgical excision is the preferred approach. The approach adopted in the face of incomplete excisions of basal cell carcinoma is still controversial. Objectives: To compare the number of tumor recurrences after treatment for incompletely excised basal cell carcinoma. Methods: Selection and statistical analysis of medical records of patients who had compromised margins after excision of basal cell carcinoma in a tertiary hospital from 2008 to 2013. Results: A total of 120 medical records were analyzed; the mean age was 69.6 years, and 50% of the patients were female. The most prevalent histological type was nodular; the mean size was 1.1 cm, and the tumor location with the highest incidence was the nose. The lateral margin was the most frequently positive. Clinical follow-up was more widely adopted; only 40 patients underwent a second surgery. The total number of patients who had tumor recurrence was 34 (28.3%). Only the malar location significantly influenced the incidence of recurrence (p = 0.02). The mean follow-up time was 29.54 months, with no significant difference between the follow-ups, although 32.9% of the patients followed-up clinically showed recurrence, against only 20% of those who underwent a second surgery. Study limitations: Mean follow-up time of less than five years and sample size. Conclusions: The presence of compromised margins does not necessarily imply recurrence. Location, tumor size, histological subtype, previous epithelial tumors, and clinical conditions of the patient must be considered when choosing the best treatment option.

Abstract: Hidradenitis suppurativa is a chronic immune mediated disease of universal distribution that causes great damage to the quality of life of the affected individual, whose prevalence is estimated at 0.41% in the Brazilian population. The objective of this work was update on physiopathogenesis, diagnosis and classification of hidradenitis suppurativa and to establish therapeutic recommendations in the Brazilian reality. It was organized as a work group composed of eight dermatologists from several institutions of the country with experience in the treatment of hidradenitis suppurativa and carried out review on the topic. Recommendations were elaborated and voted by modified Delphi system and statistical analysis of the results was performed. The Brazilian consensus on the clinical approach of hidradenitis suppurativa had the support of the Brazilian Society of Dermatology.

Abstract Clobetasol benefits to control psoriasis lesions are well defined, but there were not studies about its action when used in lacquer vehicle to control skin lesions. A double-blind study was conducted with 40 patients that utilized clobetasol 0.05% in one hemibody and just the vehicle in the other hemibody. Twenty of them used petrolatum as vehicle and the others used lacquer. An assessment was conducted using the clinical index PASI and a quality of life questionnaire (Dermatological Life Quality Index). There was no statistical difference between groups. There was a trend of favorable response particularly in the hemibody treated with clobetasol.

SUMMARY Severe anemia and cholestatic hepatitis are associated with bartonella infections. A putative vertical Bartonella henselae infection was defined on the basis of ultrastructural and molecular analyses in a three-year-old child with anemia, jaundice and hepatosplenomegaly since birth. Physicians should consider bartonellosis in patients with anemia and hepatitis of unknown origin.

OBJECTIVE: Mohs micrographic surgery is a specialized surgical procedure used to treat skin cancer. The purpose of this study was to better understand the profile of the patients who underwent the procedure and to determine how histology might be related to complications and the number of stages required for complete removal. METHODS: The records of patients who underwent Mohs micrographic surgery from October 2008 to November 2013 at the Dermatology Division of the Hospital of the Campinas University were assessed. The variables included were gender, age, anatomical location, histology, number of stages required and complications. RESULTS: Contingency tables were used to compare the number of stages with the histological diagnosis. The analysis showed that patients with superficial basal cell carcinoma were 9.03 times more likely to require more than one stage. A comparison between complications and histological diagnosis showed that patients with superficial basal cell carcinoma were 6.5 times more likely to experience complications. CONCLUSION: Although superficial basal cell carcinoma is typically thought to represent a less-aggressive variant of these tumors, its propensity for demonstrating “skip areas” and clinically indistinct borders make it a challenge to treat. Its particular nature may result in the higher number of surgery stages required, which may, as a consequence, result in more complications, including recurrence. Recurrence likely occurs due to the inadequate excision of the tumors despite their clear margins. Further research on this subtype of basal cell carcinoma is needed to optimize treatments and decrease morbidity.

A frequência de dermatoses é alta, apresentando grande impacto na qualidade de vida dos pacientes. Contudo, há poucas políticas públicas nesta área de saúde, e o tempo destinado ao ensino dermatológico na graduação médica é restrito. Objetivos Definir as hipóteses diagnósticas e as condutas mais frequentes adotadas nas consultas realizadas em uma Unidade Básica de Saúde (UBS). Métodos Foram utilizados cadernos de registro de atendimento da UBS para análise de variantes como idade, sexo, diagnóstico, conduta e encaminhamento dos pacientes. Os dados foram analisados estatisticamente pelo programa SPSS 15.0. Resultados As hipóteses diagnósticas mais frequentes foram: eczemas, tumores benignos, transtornos pigmentares, onicopatias, infecções fúngicas, bacterianas e virais, lesões acneiformes foliculares e eritematodescamativas. Conclusão As hipóteses diagnósticas mais frequentes nas consultas de um médico generalista diferem daquelas feitas pelo especialista. Os resultados deste estudo deverão promover uma discussão sobre o ensino da Dermatologia nos cursos de Medicina.

The frequency of skin disorders is high and they have a considerable impact on patients’ quality of life. However, there are very few public policies for this area of public health and the time devoted to studying Dermatology at medical school is limited. Objectives to define the most common diagnostic hypotheses and procedures in consultations performed at a primary health care unit. Methods medical notebooks entries were used in order to analyze variables such as age, gender, diagnosis, patient conduct and referral. Statistical analysis was performed using the program SPSS 15.0. Results the most frequent diagnostic hypotheses were: eczema, benign tumors, pigment disorders, onychopathy, fungal infections, bacterial infections, viral infections, acneiform and erythemato-squamous conditions. Conclusion the most frequent hypotheses diagnosed by a general practitioner differ greatly from those diagnosed by specialists. The results of this study should promote further discussions on dermatology teaching in Medical courses.

Os distúrbios atróficos da pele abrangem inúmeras doenças, algumas idiopáticas e outras, inflamatórias, em que há perda do volume de segmentos do corpo. A esclerodermia localizada é uma dermatose inflamatória, rara, que pode manifestar-se com alterações atróficas da pele e tecido subcutâneo. A lipoatrofia pode ser herdada geneticamente ou adquirida relacionada a paniculites, infeccção pelo HIV, ou envelhecimento. Muitos tratamentos são propostos. Os resultados são variáveis na fase inflamatória aguda e apresentam pouca resposta quando a esclerose e atrofia já estão instaladas. Descreve-se o tratamento de quatro casos de esclerodermia localizada e um de lipoatrofia idiopática, na face, tratados com enxerto de fragmentos de lóbulos de gordura autóloga extraídos sem a utilização da cânula aspirativa, com resultados duradouros.

A large number of diseases may cause Atrophic skin disorders are caused by a large number of diseases, some of them idiopathic and others inflammatory, in which there is loss of volume of body segments. Localized scleroderma is a rare inflammatory dermatosis, manifested by atrophic skin and subcutaneous tissue alterations. Lipoatrophy may be genetically inherited or acquired as a result of panniculitis, HIV infections or aging. Many treatments have been proposed. Results vary in the acute inflammatory phase and are scarce when sclerosis and atrophy have already been established. This article describes four cases of localized facial scleroderma and one of facial idiopathic lipoatrophy treated with implantation of autologous fat globules extracted from the infragluteal groove, without utilization of cannula aspiration, with lasting results.

FUNDAMENTO: A psoríase é uma dermatose inflamatória crônica caracterizada por lesões eritemato-descamativas que atingem extensas áreas da pele, comprometendo a qualidade de vida dos pacientes por interferir na sua vida pessoal, no relacionamento social e nas atividades diárias. O tratamento permite um bom controle, mas a impressão do paciente, quase sempre, é pouco valorizada. OBJETIVOS: Avaliar a qualidade de vida de pacientes psoriáticos, verificar se há correlação desta com melhoras clínicas e se há equivalência entre dois questionários de qualidade de vida. MÉTODOS: Foram incluídos no estudo pacientes maiores de 18 anos que estavam no início ou troca de tratamento no ambulatório de psoríase do Hospital de Clínicas da Unicamp. Eles responderam dois questionários de qualidade de vida (Psoriasis Disability Index e Dermatological Life Quality Index), até completar 180 atendimentos, para avaliar se haveria correlação entre os questionários. Receberam também um índice clínico (Índice de Área e de Severidade da Psoríase) no tempo inicial da pesquisa e nos retornos subsequentes. RESULTADOS: A pesquisa foi realizada com 138 pacientes (76 homens, idade média de 50 anos). Observou-se correlação entre os questionários aplicados e o índice clínico, mostrando que alterações clínicas se refletem na qualidade de vida, e que há equivalência entre os questionários. CONCLUSÃO: Constatou-se que a maioria dos pacientes atendidos no ambulatório tem apresentado melhora clínica e da qualidade de vida e que há equivalência entre os questionários de qualidade de vida.

BACKGROUND: Psoriasis is a chronic inflammatory dermatosis characterized by erythematous, scaly lesions covering extensive areas of the skin and negatively affecting patients' quality of life by interfering in their personal life, social relationships and routine activities. Treatment offers reasonable control of the condition; however, little importance is generally given to the patient's impression. OBJECTIVES: To evaluate the quality of life of patients with psoriasis, to verify whether there is a correlation between quality of life and clinical improvement and to compare two quality of life questionnaires and evaluate their equivalence. METHODS: Patients over 18 years of age attending the psoriasis outpatient clinic at the Teaching Hospital of the University of Campinas (UNICAMP), who were either initiating treatment or changing to a new form of treatment, were included in the study. Patients answered two quality of life questionnaires (the Psoriasis Disability Index and the Dermatological Life Quality Index) up to a total of 180 consultations to evaluate whether there is a correlation between the questionnaires. Patients were also rated using a clinical index (Psoriasis Area and Severity Index) at baseline and at follow-up visits. RESULTS: The study involved 138 patients (76 men; mean age 50 years). A correlation was found between the questionnaires and the clinical index, showing that clinical changes are reflected in quality of life. The two questionnaires were found to be equivalent. CONCLUSION: It was found that both clinical condition and quality of life improved in the majority of patients receiving care at this outpatient clinic and that the quality of life questionnaires are equivalent.

A criocirurgia com nitrogênio líquido é recurso cirúrgico utilizado para o tratamento de várias lesões cutâneas, benignas, pré-malignas e malignas. Promove destruição dos tecidos acometidos por congelamento e alterações da resposta imunológica. Os autores enfocam a utilização da criocirurgia no tratamento das dermatoses infecciosas, principalmente as verrugas virais, leishmaniose e ccromoblastomicose. Discutem os resultados como tratamento primário ou coadjuvante. O artigo também apresenta os cuidados com os instrumentos no tratamento das doenças infecciosas.

Cryosurgery using liquid nitrogen is a surgical resource to treat several types of benign, pre-malignant and malignant skin lesions. It promotes the destruction of tissues and changes the immune response. The authors identify several uses of cryosurgery in treating skin disorders, particularly viral warts, chromoblastomycosis and leishmaniasis. The results of primary and adjuvant treatments are also discussed. The article focuses on precautions when using surgical instruments during treatment of infectious diseases.

O ensino da dermatologia é pouco valorizado no currículo médico, e as doenças sexualmente transmissíveis, em geral, são apresentadas de forma não sistematizada. Em estudo sobre o ensino da dermatologia, de 83 médicos que participaram do projeto apenas 10 acertaram uma questão sobre sorologia de lues. Mais pesquisas sobre o ensino das doenças sexualmente transmissíveis são necessárias no Brasil, e os dermatologistas devem aproveitar a oportunidade, trazida pelas reformas curriculares, para reassumir a responsabilidade do ensino dessas doenças.

Teaching of Dermatology is little valorized in medical courses, and sexually transmitted diseases are generally presented to the students in a non-systematized way. In a study about the teaching of Dermatology, only ten out of 83 medical doctors taking part in the project correctly answered a question about syphilis serology. More research regarding the teaching of the sexually transmitted diseases is needed in our country. Moreover, dermatologists should take the opportunity brought about by the current discussion on the re-elaboration of medical course curricula to retake the responsibility on teaching about these diseases.