Abstract Background: The pathophysiology of urticaria is still poorly understood. Recent studies demonstrate that the activation of coagulation is correlated with the clinical activity of Chronic Spontaneous Urticaria. Coagulation and inflammation are strongly linked. Objectives: To correlate the severity and activity of Chronic Spontaneous Urticaria with the levels of D-dimer, C-reactive protein, and autologous serum test in patients with Chronic Spontaneous Urticaria. Methods: The study included 55 patients diagnosed with chronic spontaneous urticaria. D-dimer levels were measured using enzyme-linked fluorescent assay and C-reactive protein levels were measured using the nephelometric method; autologous serum testing was performed on patients who discontinued antihistamine therapy. The severity of the disease was assessed using the urticaria activity score. Results: patients with severe, spontaneous, and difficult-to-control chronic urticaria had elevated serum levels of D-dimer, as well as a positive autologous serum test. Little correlation was demonstrated between the severity of chronic spontaneous urticaria and the levels of C-reactive protein. Conclusion: The authors concluded that patients with severe Chronic Spontaneous Urticaria showed signs of activated fibrinolysis. Most patients with high clinical scores had high D-dimer values. Patients with positive results for the autologous serum test also had more severe Chronic Spontaneous Urticaria and needed more drugs to control the disease. Finally, little correlation was found between C-reactive protein levels and disease severity. Study limitations: The main limitation was the small sample of patients. In the present patients, it was demonstrated that serum D-dimer levels and the autologous serum test can act as predictive markers of severity and activity of Chronic Spontaneous Urticaria.

Abstract Background: Mohs micrographic surgery is worldwide used for treating skin cancers. After obtaining tumor-free margins, choosing the most appropriate type of closure can be challenging. Objectives: Our aim was to associate type of surgical reconstructions after Mohs micrographic surgery with the characteristics of the tumors as histological subtype, anatomical localization and especially number of surgical stages to achieve complete excision of the tumour. Methods: Transversal, retrospective analyses of medical records. Compilation of data such as gender, age, tumor location, histological subtype, number of stages to achieve clear margins and type of repair used. Results: A total of 975 of facial and extra-facial cases were analyzed. Linear closure was the most common repair by far (39%) and was associated with the smallest number of Mohs micrographic surgery stages. This type of closure was also more common in most histological subtypes and anatomical locations studied. Using Poisson regression model, nose defects presented 39% higher frequency of other closure types than the frequency of primary repairs, when compared to defects in other anatomic sites (p< 0.05). Tumors with two or more stages had a 28.6% higher frequency of other closure types than those operated in a single stage (p< 0.05). Study limitations: Retrospective study with limitations in obtaining information from medical records. The choice of closure type can be a personal choice. Conclusions: Primary closure should not be forgotten especially in surgical defects with fewer stages and in non-aggressive histological subtypes in main anatomic sites where Mohs micrographic surgery is performed.

Abstract BACKGROUND: Chronic urticaria is characterized by transient, pruritic lesions of varying sizes, with central pallor and well-defined edges, with disease duration longer than six weeks. Its cellular infiltrate consists of neutrophils, lymphocytes and eosinophils. There is a subgroup of patients with eosinophilic or neutrophilic urticaria, resistant to the treatment with antihistamines, but that respond to a combination of antihistamine with other drugs. OBJECTIVE: To evaluate the present infiltration in chronic urticaria biopsies and correlate it with the clinical disease activity and response to treatment. METHODS: Forty-one patients with chronic urticaria were classified according to the score of severity of the disease, response to treatment and type of perivascular infiltrate. Inflammatory infiltrates were divided in eosinophilic (46.30%), neutrophilic and mixed. RESULTS: An association was found between the eosinophilic infiltrate and clinical scores of greater severity (p = 0.002). CONCLUSION: This association shows that the eosinophilic inflammatory infiltrates denote high clinical activity, which means more severe and exuberant clinical pictures of the disease.

Abstract: Background: Heparanase is an enzyme that cleaves heparan sulfate chains. Oligosaccharides generated by heparanase induce tumor progression. Basal cell carcinoma and squamous cell carcinoma comprise types of nonmelanoma skin cancer. Objectives: Evaluate the glycosaminoglycans profile and expression of heparanase in two human cell lines established in culture, immortalized skin keratinocyte (HaCaT) and squamous cell carcinoma (A431) and also investigate the expression of heparanase in basal cell carcinoma, squamous cell carcinoma and eyelid skin of individuals not affected by the disease (control). Methods: Glycosaminoglycans were quantified by electrophoresis and indirect ELISA method. The heparanase expression was analyzed by quantitative RT-PCR (qRTPCR). Results: The A431 strain showed significant increase in the sulfated glycosaminoglycans, increased heparanase expression and decreased hyaluronic acid, comparing to the HaCaT lineage. The mRNA expression of heparanase was significantly higher in Basal cell carcinoma and squamous cell carcinoma compared with control skin samples. It was also observed increased heparanase expression in squamous cell carcinoma compared to the Basal cell carcinoma. Conclusion: The glycosaminoglycans profile, as well as heparanase expression are different between HaCaT and A431 cell lines. The increased expression of heparanase in Basal cell carcinoma and squamous cell carcinoma suggests that this enzyme could be a marker for the diagnosis of such types of non-melanoma cancers, and may be useful as a target molecule for future alternative treatment.

FUNDAMENTOS: Vitiligo é um transtorno de pigmentação freqüente na população mundial. Seu tratamento ainda oferece resultados limitados em alguns pacientes. Nos casos de vitiligo estável clinicamente, o transplante de melanócitos tornase uma opção terapêutica, sendo a técnica de enxertos autólogos por punch empregada com boa resposta na repigmentação. OBJETIVOS: Estudar a ação do corticoesteróide tópico mometasona sobre halos de repigmentação após enxertos autólogos por punch em pacientes com vitiligo estável clinicamente. MÉTODOS: Entre 2009 e 2010, 11 pacientes com vitiligo estável (7 do tipo generalizado, 2 focal e 2 segmentar) foram submetidos a enxertos autólogos por punch nas máculas acrômicas. Conforme o tipo clínico do vitiligo, os pacientes eram orientados a aplicar pomada de mometasona por 6 meses em lesões enxertadas selecionadas individualmente. No primeiro mês, a aplicação era 2 vezes ao dia e nos demais, apenas uma vez ao dia. Eram reavaliados nos meses 1, 3 e 6 após enxertos cujos halos eram fotografados e registrados pelo software fotofinder. No fim do 6̊mês, todas as áreas dos halos de repigmentação com e sem mometasona foram mensuradas e analisadas comparativamente. RESULTADOS: A mediana da área dos halos de repigmentação após os 6 meses com mometasona foi superior (25,96 mm² ) comparada àquela sem mometasona (13,86 mm² ), com diferença estatisticamente significante (p=0,026). CONCLUSÃO: Em nossa casuística, o uso da mometasona tópica determinou incremento dos halos de repigmentação após enxertia. A amplificação da amostra se faz necessária em estudos posteriores a fim de ratificar esta ação positiva da mometasona no tratamento do vitiligo estável.

BACKGROUND: Vitiligo is a prevalent skin pigmentation disorder worldwide. The treatments available still offer limited results to some patients. For patients with clinically stable vitiligo, melanocyte transplantation is an appropriate treatment option, and the technique of autologous punch grafting shows good repigmentation. OBJECTIVE: To evaluate the effect of topical mometasone on the halos of repigmentation after autologous punch grafting in patients with clinically stable vitiligo. METHODS: Between 2009 and 2010, 11 patients with clinically stable vitiligo (7 generalized, 2 focal and 2 segmental) underwent autologous punch grafting in the achromic patches. According to the clinical type of vitiligo, patients were instructed to use the corticosteroid ointment during 6 months, only on a few grafted lesions. In the first month, the mometasone ointment was used twice a day and after that just once. They were reassessed 1, 3 and 6 months after the procedure. Grafted halos were photographed and recorded using the software fotofinder. After 6 months, all the treated and untreated areas of the repigmentation halos were measured and analyzed comparatively. RESULTS: The median area of the repigmentation halos after 6 months of treatment with mometasone was larger (25,96 mm² ) than the one of the untreated halos (13,86 mm² ), showing a statistically significant difference (p = 0,026). CONCLUSION: In this study, the use of mometasone ointment increased the area of the repigmentation halos after punch grafting. However, this should be further investigated in larger samples in order to validate this positive action in the treatment of stable vitiligo.

A natureza pode oferecer elementos passíveis de comparação com algumas lesões dermatológicas, como a semelhança entre a pérola negra e o nevo azul celular observado na região glútea de paciente do sexo masculino, 31 anos.

There are elements in nature that may be compared to some dermatological lesions, such as the black pearl, which is very similar to a cellular blue nevus observed in the gluteus region of a 31-year-old male patient.

Nesse estudo analisou-se a qualidade de vida de indivíduos com hanseníase, além da comparação de índices de qualidade de vida entre duas realidades sócio-econômicas distintas.O trabalho foi realizado no ambulatório de hanseníase da Faculdade de Medicina do ABC-SP e através de visitas à população ribeirinha do Rio Purus , Estado do Amazonas, utilizando-se o Índice de Qualidade de Vida Dermatológico (IQVD).Observou-se que 76,9% dos pacientes avaliados na Amazônia tinham qualidade de vida comprometida, enquanto 19% em Santo André apresentavam esses resultados.No grupo do Amazonas, quem possuía sequela apresentava qualidade de vida comprometida.

This study analyzed the quality of life of individuals with leprosy and compared quality of life indexes of patients in two different socioeconomic scenarios. The study was conducted at the leprosy clinic of the ABC School of Medicine, São Paulo, Brazil and during visits to the populations living along the Purus River in the Brazilian state of Amazonas. The Dermatology Life Quality Index (DLQI) was used to evaluate the patients. Quality of life was found to be impaired in 76.9% of the patients evaluated in the Amazon compared to 19% of the patients in Santo André. In the group of patients in the Amazon who had sequelae of the disease, quality of life was impaired.

FUNDAMENTOS: A insuficiência renal crônica atinge quase todos os sistemas do organismo, inclusive pele e anexos. As alterações ungueais mais observadas nos pacientes com insuficiência renal crônica são: unhas meio a meio, ausência de lúnula e hemorragia em estilhas. OBJETIVOS: Avaliar o espectro e a frequência de alterações ungueais nos pacientes com IRC, submetidos à hemodiálise (HD), e compará-los com uma amostra pareada da população geral. MÉTODOS: Realizado um estudo caso- controle, pareado por gênero e idade, onde 2 grupos foram estudados com relação às alterações ungueais presentes. RESULTADOS: 86% dos pacientes em HD e 75% do grupo controle tiveram, pelo menos, uma alteração ungueal.Ausência de lúnula (62,9%) e unha meio a meio (14,4%) as alterações foram estatisticamente relevantes no grupo HD, em relação ao grupo controle (p < 0,05%). Estrias longitudinais foram mais comuns nos controles em relação ao grupo HD (24,1%). CONCLUSÕES: Ausência de lúnula e unha meio a meio as alterações ungueais foram mais encontradas nos pacientes em HD, corroborando com achados relatados, em estudos anteriores. Estrias longitudinais foram mais observadas no grupo controle e estudos posteriores poderão elucidar se alterações estruturais, tal qual a ausência de lúnula, poderiam relacionar-se a este achado.

BACKGROUND: Chronic renal failure affects almost all the systems of the body, including the skin and appendages. The nail disorders most commonly found in patients with chronic renal failure are half and half nails, absent lunula and splinter hemorrhages. OBJECTIVES: To evaluate the spectrum and the frequency of nail disorders in patients with chronic renal failure submitted to hemodialysis and compare them with a paired sample from the general population. METHODS: A case-controlled study paired for gender and age was conducted in which nail disorders were investigated in the two groups. RESULTS: At least one nail disorder was found in 86% of the hemodialysis patients and in 75% of subjects in the control group. Absent lunula (62.9%) and half and half nails (14.4%) were more common in the hemodialysis group compared to the control group and this difference was statistically significant (p < 0.05). Longitudinal striae were more common in the control group compared to the hemodialysis group (24.1%). CONCLUSIONS: Absent lunula and half and half nails were the most common nail disorders found in patients on hemodialysis, corroborating the findings of previous studies. Longitudinal striae were more common in the control group and future studies may clarify whether structural abnormalities such as absent lunula may be related to this finding.

As drogas com ação anti-histamínica estão entre as medicações mais comumente prescritas na prática dermatológica diária, tanto em adultos como em crianças. Este artigo aborda os novos conceitos da função dos receptores de histamina (receptores H1) e discute os efeitos anti-inflamatórios dessas drogas. A segunda geração de anti-histamínicos difere da primeira geração devido a sua elevada especificidade e afinidade pelos receptores H1 periféricos e devido a seu menor efeito no sistema nervoso central, tendo como resultado menores efeitos sedativos. Embora a eficácia dos diferentes anti-histamínicos H1 (anti-H1) no tratamento de doentes alérgicos seja similar, mesmo quando se comparam anti-H1 de primeira e de segunda geração, eles são muito diferentes em termos de estrutura química, farmacologia e propriedades tóxicas. Consequentemente o conhecimento de suas características farmacocinéticas e farmacodinâmicas é importante para a melhor prática médica, especialmente em gestantes, crianças, idosos e doentes com comorbidades.

Drugs with antihistamine action are the most commonly prescribed medication in daily dermatologic practice, both to adults and children. This article addresses new concepts of the role of histamine receptors (H1 receptors) and discusses the anti-inflammatory effects of these drugs. Second generation antihistamines differs from first generation because of their high specificity and affinity for peripheral H1-receptors. Second generation antihistamines are also less likely to produce sedation because they have less effect on the central nervous system. Although the efficacy of the various H1-antihistamines in the treatment of allergic patients is similar, even when comparing first- and second-generation drugs, these drugs are still very different in terms of their chemical structure, pharmacology and toxic properties. Consequently, knowledge of their pharmacokinetic and pharmacodynamic characteristics is essential for a better medical care, especially that offered to pregnant women, children, the elderly, and patients with comorbidities.

Os autores relatam um caso de nevo halo de Sutton simulando clinicamente o nevo em cocar. Nevo em cocar é uma rara variante do nevo nevomelanocítico adquirido que apresenta característico aspecto de lesão em alvo. Pode determinar dificuldade diagnóstica com nevo nevomelanocítico displásico, melanoma e nevo halo de Sutton.

Authors relate a case of Sutton's nevus clinically simulating the cockade nevus. Cockade nevus is a rare form of acquired nevomelanocytic nevus that presents characteristic aspect of target-like lesion. It may determine difficulty diagnostic with melanoma, dysplastic and Sutton's nevus.