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A plethora of prolonged COVID-19 symptoms, or late manifestations has been reported after acute disease and labeled “post-COVID”. The aim of this study was to identify the prevalence of and risk factors for post-COVID up to 12 weeks after the onset of acute COVID-19. An electronic survey was conducted to evaluate post-COVID-19 symptoms, disease severity, demographics, and pre-existing diseases. The participants were recruited through 88,648 SMS messages, and post on social media. The associations between variables were explored through multivariate models. From 6,958 respondents with confirmed COVID-19, 753 (10.8%) required hospitalization, and 5,791 (83.2%) exhibited at least one post-COVID manifestation. Hair loss (49.4%), memory loss (40.7%), low attention (37.0%), fatigue (34.2%), anxiety (31.2%), and headache (29.6%) were the most reported post-COVID manifestations. Female sex, myalgia, anosmia, and severe disease were associated with most post-COVID manifestations. Pre-existing depression was associated with the development of neuropsychiatric manifestations. Post-COVID manifestations were identified in most patients following COVID-19 infection, placing a supplementary burden on the healthcare system. Hair loss, fatigue, and neuropsychiatric symptoms were the most prevalent post-COVID manifestations. Female sex, myalgia, anosmia, and more severe disease are risk factors for multiple post-COVID manifestations.

Syphilis is an infectious disease that has afflicted mankind for centuries, but a recent increase in worldwide incidence has been evidenced. The authors describe a patient with typical lesions of secondary syphilis and moth-eaten alopecia, whose dermoscopic examination demonstrated empty hair follicles, vellus hair, follicular hyperkeratosis, peripheral black dots, dilated and tortuous vessels, reddish brown background, and hypopigmentation of the hair shafts. Furthermore, this case presented an erythematous background more evident than previously described cases.

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Introdução: A fotoexposição crônica pode gerar queratoses actínicas e danos na pele normal adjacente (campo de cancerização), que podem evoluir para câncer de pele. Atualmente, o tratamento das queratoses actínicas visa não apenas destruir lesões individuais (por meio de métodos como crioterapia com nitrogênio líquido, eletrocoagulação, ácido tricloroacético e shaving), mas também tratar o campo de cancerização (com o uso de drogas como 5- fluorouracil, imiquimode, mebutato de ingenol, retinoides orais e tópicos, peelings químicos e terapia fotodinâmica). A maioria dos estudos sobre retinoides tem como objetivo e desfecho primário a prevenção do câncer de pele não melanoma, existindo poucos dados sobre seu uso para tratamento de queratoses actínicas. Retinoides orais e tópicos podem ser usados para a prevenção e o tratamento de queratoses actínicas múltiplas e do campo de cancerização, especialmente em associação com o uso de filtro solar e crioterapia com nitrogênio líquido. Objetivos: O objetivo primário desta pesquisa foi avaliar os efeitos clínicos, histopatológicos e imunohistoquímicos das drogas estudadas para o tratamento de queratoses actínicas múltiplas na epiderme e derme de face e antebraços em pacientes imunocompetentes. Os objetivos secundários foram: 1) avaliar a tolerabilidade e a segurança das medicações usadas; 2) demonstrar o impacto dos tratamentos na qualidade de vida; 3) investigar a reprodutibilidade da contagem de lesões como parâmetro de eficácia; 4) verificar o papel da crioterapia associada ao uso diário de filtro solar no controle das queratoses actínicas. Métodos: Este é um ensaio clínico aberto, randomizado, prospectivo e comparativo, incluindo 61 participantes, de 50 a 75 anos, de ambos os gêneros, com 5 a 60 queratoses actínicas visíveis e/ou palpáveis na face e antebraços. No início (T0) e após 120 dias (T120), todos os participantes foram submetidos à crioterapia com nitrogênio líquido para tratar as queratoses actínicas. Posteriormente, foram randomizados em dois grupos de tratamento: 30 receberam isotretinoína oral, na dose de 10 mg/dia (grupo ISO) e 31 usaram tretinoína tópica vii a 0,05% em creme em noites alternadas (grupo TRE), por seis meses (T300). Todos utilizaram filtro solar com fator de proteção solar (FPS) 60 durante todo o período do estudo. Foram realizadas duas biópsias no antebraço esquerdo no início da randomização (T120) e ao final do estudo (T300). A eficácia foi avaliada por intermédio de parâmetros clínicos (contagem do número de queratoses actínicas) e histopatológicos (pelas colorações hematoxilina-eosina e Weigert-Van Gieson para fibras elásticas), bem como marcadores imunohistoquímicos ligados à apoptose (proteínas p53, Bcl2 e Bax) antes e depois dos tratamentos. A avaliação de segurança incluiu o relato e a observação de eventos adversos e exames laboratoriais bioquímicos para os participantes do grupo ISO. Resultados: Foi identificada diminuição da contagem total de queratoses actínicas relacionada à crioterapia com nitrogênio líquido e uso de filtro solar FPS 60 entre T0 e T120 (-39%) e aos tratamentos do campo de cancerização com isotretinoína oral (-33%) ou tretinoína tópica (-23%), crioterapia e filtro solar FPS 60 entre T120 e T300. Os achados histopatológicos e imunohistoquímicos demonstraram: diminuição da espessura do estrato córneo e da expressão das proteínas p53 e Bax entre T120 e T300. Foram observados aumentos da espessura da camada basal até a camada granulosa e da expressão da proteína Bcl-2 em ambos os grupos. Nenhuma modificação foi encontrada no tecido elástico. De forma geral, os grupos de tratamento não diferiram entre si (p > 0,1). Foram observados apenas efeitos colaterais leves em ambos os grupos, exceto xeroftalmia intensa em um paciente do grupo ISO. Entre T120 e T180, os níveis de colesterol total aumentaram em 76% dos pacientes e os de triglicérides em 61%, sendo este aumento ao redor de 30% do inicial, normalizando-se em T300 sem necessidade de alteração ou suspensão do tratamento. Conclusão: Tanto a isotretinoína oral em dose baixa quanto a tretinoína tópica a 0,05% em creme melhoraram os parâmetros clínicos, histopatológicos e imunohistoquímicos dos pacientes com queratoses actínicas múltiplas e no campo de cancerização, sem diferenças entre si. A escolha do retinoide para o tratamento do campo de cancerização deve ser feita levando-se em conta o perfil do paciente, particularmente em relação aos riscos de eventos adversos. Introduction: Chronic photoexposure can generate actinic keratosis and damage to the surrounding normal skin (field cancerization), which can evolve to skin cancer. Currently, the treatment of actinic keratosis addresses not only the destruction of individual lesions (using methods such as liquid nitrogen cryosurgery, electrocoagulation, trichloroacetic acid, and shaving), but also the treatment of field cancerization (using drugs such as 5-fluorouracil, imiquimod, ingenol mebutate, oral and topical retinoids, chemical peelings, and photodynamic therapy). Most studies involving retinoids have as purpose and primary outcome the prevention of nonmelanoma skin cancer. Therefore, few data are available about their use for the treatment of actinic keratosis. Oral and topical retinoids can be used for prevention and treatment of multiple actinic keratoses and field cancerization, especially in association with sunscreen and liquid nitrogen cryosurgery. Objectives: The primary objective of this research was to evaluate the clinical, histopathological, and immunohistochemical effects on the epidermis and dermis of the studied drugs for the treatment of multiple actinic keratoses of the face and forearms in immunocompetent patients. The secondary objectives were: 1) to evaluate the tolerability and safety of the medications; 2) to demonstrate the impact of the treatments on quality of life; 3) to investigate the reproducibility of lesion count as a parameter of efficacy; 4) to verify the role of cryosurgey associated to daily use of sunscreen in the control of actinic keratosis. Methods: This is an open, randomized, propective, and comparative clinical trial, including 61 participants, from 50 to 75 years of age, from both genders, with 5 to 60 visible and/or palpable actinic keratoses on the face and forearms. At the beginning (T0) and after 120 days (T120), all participants underwent liquid nitrogen cryosurgery to treat their actinic keratoses. Posteriorly, they were randomized in two treatment groups: 30 took oral isotretinoin, at the dose of 10 mg/day (ISO group), and 31 used 0.05% topical tretinoin cream every other night (TRE group), for 6 months (T300). All the subjects used SPF 60 sunscreen during the whole study period. At the beginning of the randomization (T120) and at the end of the study (T300), two biopsies were performed in the left forearm. The efficacy was evaluated using clinical (number of actinic keratoses) and histopathological parameters (hematoxilin-eosin and Weigert-Van Gieson staining, the latter for elastic fibers), as well as immunohistochemical markers of carcinogenesis (proteins p53, Bcl-2, and Bax) before and after the treatments. The safety evaluation included the report and observation of side effects and biochemical laboratory tests for the participants of the ISO group. Results: A decrease in the number of actinic keratoses related to liquid nitrogen cryosurgery and the use of SPF 60 sunscreen was observed between T0 and T120 (-39%) and to the treatments for field cancerization with oral isotretinoin (-33%) and topical tretinoin (-23%), cryosurgery and SPF 60 sunscreen between T120 and T300. The histopathological and immunohistochemical findings demonstrated: thinning of the stratum corneum and reduction of p53 and Bax expression between T120 and T300. Thickening of the basal to the granular layer and increased expression of Bcl-2 protein were observed in both groups. No modifications were found in the elastic tissue. In general, the treatment groups did not differ (p > 0.1). Only slight side effects were observed in both groups, except severe xerophthalmia in one patient of the ISO group. Between T120 and T180, the levels of total cholesterol and triglycerides increased in 76% and 61% of the participants, respectively, and this increase was around 30% of the initial value, returning to normal in T300 without the need to change or interrupt the treatment. Conclusion: Both low-dose oral isotretinoin and 0.05% topical tretinoin cream improved clinical, histopathological, and immunohistochemical parameters in patients with multiple actinic keratoses and field cancerization, without differences between them. The therapeutic choice of retinoids for field cancerization should take into consideration the patient?s profile, particularly in relation to the risk of side effects. CNPq: 476243.2011/4 Dados abertos - Sucupira - Teses e dissertações (2013 a 2016)

A 6 year-old patient began to experience localized hairloss in the right temporal region three years ago. During the first appointment, diagnoses of alopecia areata and congenital triangular alopecia were made. After one year, there was no change. Upon dermatological examination, non-scarring alopecia was noted in the right temporal region, revealing extremely fine and fair hair follicles. A dermoscopy revealed only thin vellus-type hairs. Congenital triangular alopecia is a condition commonly confused with alopecia areata and is thus underdiagnosed. However, well-established clinical parameters and dermoscopic criteria can be used to distinguish skin diseases that affect hair and define the diagnosis.

A 6 year-old patient began to experience localized hairloss in the right temporal region three years ago. During the first appointment, diagnoses of alopecia areata and congenital triangular alopecia were made. After one year, there was no change. Upon dermatological examination, non-scarring alopecia was noted in the right temporal region, revealing extremely fine and fair hair follicles. A dermoscopy revealed only thin vellus-type hairs. Congenital triangular alopecia is a condition commonly confused with alopecia areata and is thus underdiagnosed. However, well-established clinical parameters and dermoscopic criteria can be used to distinguish skin diseases that affect hair and define the diagnosis.