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O diabetes mellitus é doença metabólica que predispõe a diversas afecções, notadamente às doenças cutâneas. São de natureza variada, porém de etiologia infecciosa em sua maioria. Uma revisão detalhada sobre tais doenças, evidenciando suas características clínicas bem como uma adequada abordagem terapêutica é o tema do presente artigo. Diabetes Mellitus is a metabolic disease that predisposes patients to several other diseases, notably cutaneous ones. The latter have different sources, although infections are the commonest. This article consists of a detailed revision of these disorders, evidencing their clinical aspects as well an adequate therapeutic approach.

FUNDAMENTOS: Não há registro de dermatoses em infectados pelo vírus HIV no Rio Grande do Norte, embora haja 899 casos acumulados de AIDS em adultos entre janeiro de 1983 e agosto de 2000 e coeficientes de mortalidade por cem mil habitantes de 3,80 e 2,47, nos anos de 1995 e 1997, respectivamente, coincidindo essa diferença de valores, com o uso de antiretrovirais. OBJETIVOS: Descrever as características epidemiológicas de infectados, a freqüência de dermatoses e suas gravidades em usuários e não usuários de antiretrovirais. MÉTODOS: Foram incluídos 172 pacientes conforme a classificação do CDC/1992; descrevendo-se o uso de antiretrovirais e dermatoses neles presentes. RESULTADOS: A amostra teve 83,72% de homens, com média de idade de 37,17 anos, contaminados por via sexual (96,5%), heterossexuais predominantes (54,7%). As doenças cutâneas mais freqüentes foram as virais, fúngicas e miscelânia. O percentual médio da pele atingida pelas dermatoses foi 12,5%. A média da carga viral foi 109.114,05 cps/ml, e a de linfócitos T CD4+ foi 383,15 céls/mm³, estando 81,4% destes, em uso de antiretrovirais. CONCLUSÕES: O perfil epidemiológico dos infectados pelo vírus HIV no RN não difere das outras regiões brasileiras. Estudos analíticos que minimizem bias de confusão são necessários para aferir o grau de interferência do uso de antiretrovirais nesses indivíduos. BACKGROUND: There is no description of dermatoses among HIV infected individuals in Rio Grande do Norte(RN) / Brazil, althoug this state had an accumulated total of 899 adult Aids cases registered from january 1983 to august 2000 and mortality coefficients per 100,000 residents of 3.80 and 2.47, in the years 1995 and 1997, respectively, such that this difference in values coincided with the introduction of antiretroviral (ARV) usage in this state. OBJECTIVE: To describe epidemiologic caracteristics of retrovirus infected subjects with dermatoses, including frequency of dermatoses and to establish relationships between the caracteristics of users and nonusers of ARV drugs. METHODS: Were included 172 patients, according to HIV infection classification of CDC/1992. The use of ARV drugs was determined and the dermatoses were submited to analysis. RESULTS: The sample comprises 83.72% of men, with mean age of 37.17 years, with sexual way of retrovirus contamination (96.5%), predominant heterossexual behaviour (54.7%). The most frequent form skin diseases were classified into viral, fungic and miscellaneous. The mean percentage of diseased skin area was 12.5%. Mean viral load was 109,114.05 cps/ml, and mean CD4+ T lymphocytes was 383.15 cells/mm³. Overal 81.4% of patients were using ARV drugs. CONCLUSIONS: The epidemiologic profile of HIV infected patients residents in state of RN did not differ from that of others brazilian regions. Analytic studies, minimizing confounding bias, are necessary to discribe the real frequency of HAART (High Active Antiretroviral Therapy) in seropositive HIV subjects.

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.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. 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.

FUNDAMENTOS: A contagem sangüínea de linfócitos T Helper CD4+ e o número de cópias de RNA viral são marcadores laboratoriais da progressão de imunodeficiência induzida pelo vírus HIV. OBJETIVOS: Relacionar os marcadores do grau de imunidade em infectados pelo HIV aos aspectos clínicos das dermatoses neles presentes. MÉTODOS: A amostra compreendeu 172 pacientes, submetidos a quantificações de linfócitos T CD4+ e CD8+, pela técnica de citometria de fluxo; quantificações de RNA viral pela técnica de amplificação de ácidos nucléicos (Nuclisens). Foram classificados em pacientes com e sem imunossupressão acentuada, a partir da classificação clínico-laboratorial da infecção pelo HIV do CDC/1992. RESULTADOS: O percentual médio da pele atingida pelas dermatoses foi 12,5% e a média do número de dermatoses por doente foi 2,08. As dermatoses neoplásicas e do grupo miscelânia predominaram nos indivíduos com valores de linfócitos T CD4+•200 células/mm³, enquanto valores de linfócitos T CD4+>200 células/mm³ em pacientes com infestações por artrópodes. CONCLUSÃO: O número de dermatoses por doente mostrou ser marcador da evolução de imunossupressão (p=0,003). A extensão percentual da pele atingida por dermatoses não se prestou a medir gravidade das dermatoses em infectados pelo HIV (p=0,6058). As contagens de linfócitos T CD4+ e CD8+ e da carga viral foram eficientes medidores do grau de imunossupressão dos infectados com dermatoses (p=0,003). BACKGROUND: The T-helper CD4+ lymphocyte blood count and number of viral RNA copies are laboratory markers tracing the progression of HIV-induced immunodeficiency. OBJECTIVES: Relate the markers indicating the varying degree of imunity in HIV-infected patients to the clinical aspects of the dermatoses present. METHODS: The sample consists of 172 patients, who were submitted to quantifications of T CD4+ and CD8 lymphocytes by the cytometric flow technique as well as quantifications of viral RNA by the nucleic acid amplification technique (NucliSens). They were classified in patients with or without accentuated immunosuppression, based on the CDC-1992 clinic and laboratory classification of HIV infection. RESULTS: The average percentage of skin afflicted by dermatoses was 12.5% and the average number of dermatoses per patient was 2.08. Neoplasic dermatoses and dermatoses of the miscellaneous group predominated in individuals with CD4+ T •200 cells/mm³ lymphocyte values, whereas CD4+ T >200 cells/mm³ lymphocyte values predominated in patients infected by arthropods. CONCLUSION: The number of dermatoses per patient proved to be a marker for the course of immunosuppression (p=0,003). The percentage of skin extension affected by dermatoses did not lend itself to measuring the severity of dermatoses in HIV-infected patients (p=0,6058). The CD4+ T and CD8+ T and viral load lymphocyte count were efficient measurers of the degree of immunosuppression in dermatosis-infected patients (p=0.003).

Se reporta 16 casos de pénfigo foliáceo endémico (PFE) ocurridos en el Departamento de Ucayali, la mayoría procedente de la provincia de Coronel Portillo (94%) y la mitad del Distrito de Campo Verde. El 80% de los pacientes pertenecía a un área rural, 56% del sexo femenino y afectó a la población pediátrica en 43% (7 casos). El compromiso de las lesiones cutáneas fue generalizado en todos los casos, sin compromiso de mucosas. El signo de Nikolsky estuvo presente en 50%. En todos los casos se encontró acantólisis subcorneal por estudios anatomo-patológicos y sólo 40% tuvo inmunofluorescencia positiva para pénfigo., We report 16 cases of Pemphigus foliaceus occurred at Ucayali, department of Peru. Most of them came from Coronel Portillo, Ucayali’s province (94%), and half of them from Campo Verde district. Eighty per cent belonged to rural areas, 56% were females and 7 children were affected (43%). All patients had generalized skin involvement without mucous membranes compromise. Nikolsky sign was present in 50%. In all cases skin biopsy showed subcorneal acantholysis and only 40% presented pemphigus positive immunofluorescence.

We report 16 cases of Pemphigus foliaceus occurred at Ucayali, department of Peru. Most of them came from Coronel Portillo, Ucayali’s province (94%), and half of them from Campo Verde district. Eighty per cent belonged to rural areas, 56% were females and 7 children were affected (43%). All patients had generalized skin involvement without mucous membranes compromise. Nikolsky sign was present in 50%. In all cases skin biopsy showed subcorneal acantholysis and only 40% presented pemphigus positive immunofluorescence. Se reporta 16 casos de pénfigo foliáceo endémico (PFE) ocurridos en el Departamento de Ucayali, la mayoría procedente de la provincia de Coronel Portillo (94%) y la mitad del Distrito de Campo Verde. El 80% de los pacientes pertenecía a un área rural, 56% del sexo femenino y afectó a la población pediátrica en 43% (7 casos). El compromiso de las lesiones cutáneas fue generalizado en todos los casos, sin compromiso de mucosas. El signo de Nikolsky estuvo presente en 50%. En todos los casos se encontró acantólisis subcorneal por estudios anatomo-patológicos y sólo 40% tuvo inmunofluorescencia positiva para pénfigo.

OBJECTIVE: To show the clinicopathological features of non-neoplastic cutaneous lesions in women with HIV/AIDS. DESIGN: Descriptive retrospective study. MATERIAL AND METHODS: Biopsies of skin have been taken from 18 women with non–neoplastic cutaneous lesions, and submitted to histopathological and immuno–histochemical studies. RESULTS: Most women were in the age of 20-to-29 years (55,6%), or 30-to-39 years (22,2%), and catalogued as clinical stage B3 (33,3%), or C3 (27,8%). Dermatitis with fibrosis (50%), and granulomatous dermatitis (38,8%) were the commonest cutaneous lesions. We found Candida (44,4%), and Epstein Barr virus (22,2%) as well. CONCLUSIONS: Young women looking for medical care with AIDS indicators, and pruriginous cutaneous lesions, was the predominant picture. Dermatitis with fibrosis and evidence of Candida in cutaneous lesions has been the most frequent diagnosis., OBJETIVO: Presentar las características clinicopatológicas de lesiones no neoplásicas de piel en mujeres con VIH/SIDA. DISEÑO: Estudio retrospectivo descriptivo. MATERIALES Y MÉTODOS: En 18 casos de mujeres con lesiones no neoplásicas de piel y VIH/SIDA se tomó biopsias de piel para estudio histopatológico e inmunohistoquímico, en búsqueda de otros agentes etiológicos patógenos. RESULTADOS: La mayoría de mujeres estaban en el grupo etáreo de 10 a 29 años (55,6%), y de 30 a 39 años (22,2%); y con estadio clínico B3 (33,3%) o C3 (27,8%). Las lesiones dermatológicas halladas más frecuentemente fueron dermatitis fibrosante (50%) y dermatitis granulomatosa (38,9%); otros agentes patógenos en la piel fueron Cándida (44,4%) y virus Epstein Barr (22,2%). CONCLUSIONES: Se debe alertar a las pacientes con infección por VIH para acudir a consulta médica cuando aparecen lesiones en su piel, con el fin de prevenir la superinfección de ellas por otros microorganismos patógenos, según su estado de inmunodeficiencia.

Os autores relatam o caso clínico de uma doente que procurou atendimento dermatológico em decorrência da presença de lesão em placa papulosa de superfície verrucosa no cotovelo esquerdo.In this report, the authors describe the clinical case of a woman seeking care at this dermatology outpatient clinic with a verrucous plaque on her left elbow.

Dermatose perfurante adquirida é uma condição rara, em geral associada a algumas doenças sistêmicas, ocorrendo especialmente em pacientes diabéticos com insuficiência renal crônica submetidos a diálise. O sintoma principal é o prurido e a apresentação clínica característica é a presença de lesões papulares marrom-avermelhadas no tronco, cabeça e pescoço. Biópsia da lesão revela invaginação epidérmica com preenchimento por plug ceratótico. A etiologia é pouco compreendida e várias tentativas terapêuticas têm sido desapontadoras.Acquired perforating dermatosis is a rare condition often associated with some systemic diseases, especially diabetic patients with chronic renal failure undergoing dialysis. The main symptom is pruritus and it is clinically characterized by the presence of redish-brown papular lesions in the trunk, head and neck. Biopsy of the lesion reveals epidermal invagination with keratotic plug. The etiology is poorly understood and several therapeutic measures have been disappointing.

ResumenEl liquen plano es una erupción papuloescamosa relativamente frecuente en adultos de mediana edad y caracterizada por pequeñas pápulas violáceas, poligonales, de superficie plana muy pruriginosas. La etiología del liquen plano es desconocida de ahí el interés en describir las características clínicas, histopatológicas, de laboratorio y los resultados. Presentamos un caso clínico poco frecuente, de un hombre caucásico con liquen plano generalizado de larga evolución cuyo diagnóstico era compatible con la reacción adversa medicamentosa liquenoide. La afectación en manos y pies es otro signo poco habitual que puede generar confusión con la presencia de la sífilis secundaria. La presentación clínica atípica lenta pero inexorablemente amplia de aspecto similar a otras entidades clínicas, hizo necesario un examen físico y complementario exhaustivo. La biopsia quirúrgica y la confirmación histológica que destacaba en la dermis papilar un infiltrado inflamatorio linfocitario en banda que contactaba con la capa basal de la epidermis que presentaba queratinocitos apoptóticos determinó el diagnóstico. El liquen plano puede presentar dificultad diagnóstica, la biopsia de una de las lesiones en presentaciones atípicas permite el diagnóstico, presentando un buen pronóstico y curación.AbstractLichen planus is a relatively common papulosquamous eruption in middle age and characterized by small, purple, polygonal, pruritic papules very flat surface. The etiology of lichen planus is unknown hence the interest in describing the clinical, histopathological, and laboratory results. We present a rare case of a caucasian man with generalized lichen longstanding plane whose diagnosis was consistent with lichenoid adverse drug reaction. Involvement in hands and feet is another unusual sign that can lead to confusion with the presence of secondary syphilis. The slow but inexorably atypical clinical presentation similar to other large clinical entities aspect necessitated a thorough physical examination and complementary. Surgical biopsy and histologic confirmation that stood in the papillary dermis lymphocytic inflammatory infiltrate in band contacted the basal layer of the epidermis that had determined the diagnosis apoptotic keratinocytes. Lichen planus may present diagnostic difficulty, biopsy of the lesion in atypical presentations allows diagnosis, has a favorable prognosis, and healing.

This study aimed to establish the incidence of skin tumors (cutaneous proliferative lesions of neoplastic or non-neoplastic nature) in dogs diagnosed by histopathological evaluation at the Veterinary Pathology Laboratory (LPV) of the Federal University of Bahia (UFBA) in a 10-year (2007-2016) historical series. Of the 1945 histopathological diagnoses made in this period, 503 were skin biopsies, and 617 dermatological problems (87 dogs, 17.3%, presented more than one positive diagnosis) were found. Of the 617 diagnoses of dermatopathy, 546 (88.49%) were tumors and 71 (11.51%) were non-tumorous alterations. The 546 conditions more profoundly studied were from 453 dogs, 468 (85.7%) neoplastic and 78 (14.3%) non-neoplastic tumors. The 468 neoplasms were classified as follows: 230 benign (49.14%), 215 malignant (45.94%), 23 borderline (epitheliomas) (4.91%), 51.92% (243/468) mesenchymal, 42.74% (200/468) epithelial, 4.91% (23/468) melanocytic, and 0.43% (2/468) metastatic (mammary gland). The most commonly diagnosed neoplastic dermatopathies were mastocytoma (14.7%) and lipoma (7.48%). Among the 78 non-neoplastic conditions (14.3%), epidermal inclusion cyst (39.74%) and trichogranuloma (15.38%) were the most frequent. Canine dermatopathies accounted for 26% of the biopsy files of the LPV-UFBA. Distinct simultaneous dermatological problems were frequently found in the dogs assessed (one in six). Considering that these conditions can present with different cellular origin and biological behavior, it is crucial that histopathological evaluation be performed in fragments from the different cutaneous lesions.

CONTEXT: Erythema elevatum diutinum is a chronic and rare dermatosis that is considered to be a variant of leukocytoclastic vasculitis. It is probably mediated by immune complexes. It is generally associated with autoimmune, neoplastic and infectious processes. Recently, it has been added to the group of specific dermatoses that are associated with HIV. CASE REPORT: We report on the case of a patient who had erythema elevatum diutinum as the first clinical evidence for diagnosing HIV infection. Dapsone was used in the treatment of this patient, and partial regression of the lesions was achieved within 15 days, even before antiretroviral therapy was prescribed. CONCLUSION: When there is a diagnosis of erythema elevatum diutinum, HIV infection should be investigated, especially in atypical and exacerbated clinical manifestations. CONTEXTO: O eritema elevatum diutinum é uma dermatose crônica, rara, variante clínica da vasculite leucocitoclástica, provavelmente mediada por imunocomplexos. Está sendo incluído no grupo das dermatoses específicas associadas à infecção pelo HIV. Em geral, associa-se a outros processos infecciosos, auto-imunes e neoplásicos. RELATO DE CASO: Relatamos o caso de um paciente em que a manifestação cutânea de eritema elevatum diutinum foi a primeira evidência clínica para diagnóstico da infecção pelo HIV. O tratamento foi feito com dapsona e se obteve regressão parcial das lesões após 15 dias, mesmo antes de o esquema anti-retroviral ser prescrito. CONCLUSÃO: Frente ao diagnóstico de eritema elevatum diutinum, deve-se investigar a infecção pelo HIV, principalmente nas apresentações clínicas atípicas e exacerbadas.

Minist?rio da Sa?de. Funda??o Oswaldo Cruz. Instituto Evandro Chagas. Bel?m, PA, Brasil.

Minist?rio da Sa?de. Funda??o Instituto Oswaldo Cruz. Instituto Evandro Chagas. Bel?m, PA, Brasil. Minist?rio da Sa?de. Funda??o Instituto Oswaldo Cruz. Instituto Evandro Chagas. Bel?m, PA, Brasil. Pararama ? uma condi??o ocupacional dos seringueiros do Brasil, causada, aparentemente, pelo contacto com lagartas do lepid?ptero Premolis semirufa. A forma cr?nica da doen?a acarreta imobilidade total ou parcial dos dedos do acidentado. At? agora, por?m, pouco era o que realmente se sabia a respeito do processo patol?gico em si. As pesquisas experimentais com camundongos, aqui relatadas, trazem novos esclarecimentos sobre a mat?ria. Ao penetrarem na pele de camundongos de laborat?rio, as pequenas cerdas dorsais da larva causam inflama??o aguda edematosa quase imediata, seguida de infiltra??o leucocit?ria neutrof?lica. Esse est?gio, por sua vez, d? lugar ? fibrose o ? forma??o de granulomas de corpo estranho. As les?es causadas pelas cerdas foram encontradas no derma, no c?rio das mucosas, nas bainhas tendinosas, no peri?stio e no peric?ndrio, al?m de outras localiza??es A presen?a de les?es nos tecidos conectivos perif?ricos das articula??es corresponde ao quadro cl?nico e radiol?gico associado aos casos de pararama que afetam os dedos dos seringueiros que extraem l?tex da seringueira (Hevea brasiliensis)