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Background: Hand eczema (HE) is a highly prevalent, recurrent, and multifactorial disease. It encompasses a group of eczematous diseases that affect the hands, etiologically classified into irritant contact dermatitis (ICD), allergic contact dermatitis (ACD) and atopic dermatitis (AD). Few epidemiological studies in Latin America have investigated the characteristics of patients with this condition and the origin of the disease., Objectives: To analyze the profile of patients diagnosed with HE submitted to patch tests aiming to determine its etiology., Methods: A retrospective descriptive study was carried out on epidemiological data and patch tests of patients with HE treated at a tertiary hospital in the city of São Paulo from January 2013 to December 2020., Results: A total of 173 patients were studied, whose final diagnosis was 61.8% of ICD, 23.1% of ACD and 5.2% of AD, with diagnostic overlap in 42.8% of the cases. The main positive and relevant patch tests were: Kathon CG (42%), nickel sulfate (33%), and thiuram mix (18%)., Study Limitations: The number of treated cases and socioeconomic profile was limited to a vulnerable population group., Conclusion: HE is a diagnosis in which overlapping etiologies are frequent, with the main sensitizers identified in ACD being Kathon CG, nickel sulfate and thiuram mix., (Copyright © 2023. Published by Elsevier España, S.L.U.)

Background: The increase in the zoonotic epidemic of sporotrichosis caused by Sporothrix brasiliensis, which started in the late 1990s in Rio de Janeiro and is now found in almost all Brazilian states, has been equally advancing in neighboring countries of Brazil. Changes in the clinical-epidemiological profile, advances in the laboratory diagnosis of the disease, and therapeutic difficulties have been observed throughout these almost 25 years of the epidemic, although there is no national consensus. The last international guideline dates from 2007., Objectives: Update the clinical classification, diagnostic methods and recommendations on the therapeutic management of patients with sporotrichosis., Methods: Twelve experts in human sporotrichosis were selected from different Brazilian regions, and divided into three work groups: clinical, diagnosis and treatment. The bibliographic research was carried out on the EBSCOHost platform. Meetings took place via electronic mail and remote/face-to-face and hybrid settings, resulting in a questionnaire which pointed out 13 divergences, resolved based on the opinion of the majority of the participants., Results: The clinical classification and laboratory diagnosis were updated. Therapeutic recommendations were made for the different clinical forms., Conclusion: Publication of the first national recommendation, carried out by the Brazilian Society of Dermatology, aimed at the Brazilian scientific community, especially dermatologists, infectologists, pediatricians, family medicine personnel, and laboratory professionals who work in the management of human sporotrichosis., (Copyright © 2022 Sociedade Brasileira de Dermatologia. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: The etiological agents of onychomycosis are dermatophyte fungi, nondermatophyte filamentous fungi (NDFF), and yeasts. Nail clippings are an accurate tool for diagnosing onychomycosis. The objective of this study was to correlate the characteristics of fungi observed in nail clipping examinations with the results for agents isolated in culture, indicating whether the fungus found on microscopy is a dermatophyte, NDFF, or yeast., Methods: An observational descriptive study of onychomycosis nail clippings stained with PAS comparing culture results with microscopic criteria of fungi morphology, arrangement/orientation, and location of organisms in the nail and presence of neutrophils, serous lakes, and bacterial colonies was conducted., Results: Thirty-three nail clippings from 29 participants were analyzed. A statistically significant correlation ( p < 0.05) was found between smooth/thin/long hyphae with a "combed" pattern and dermatophyte agents (sensitivity 89.4%, specificity 91.5%), and between irregular/thick/short anarchic distributed hyphae and nondermatophytes (sensitivity 61.5%, specificity 89.4%). No statistical association with region where fungi were in the nail or with the presence of neutrophils, serous lakes or bacteria was found. Small, rounded, yeast-like organisms correlated with Candida infection., Conclusions: Although not a substitute for culture, microscopic analysis of fungal structures offers good accuracy for differentiating agents of onychomycosis., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2022 by S. Karger AG, Basel.)

Introduction: Onychomycosis is a frequent complaint in dermatological practice and corresponds to the most common nail disease. The treatment of onychomycosis remains a challenge, as several factors end up compromising and making treatment difficult. Nail abrasion is considered a useful method in many cases. However, there is controversy about this approach, as there is an aerosol formation that could contaminate the environment and cause fungal changes or hypersensitivity reactions by the disseminated dust. We conducted a pilot study to investigate the fungal viability of nail particles from nails with onychomycosis after abrasion procedure., Methods: In this study, nail dust from the gloves and mask, used in the procedure, was collected from 9 patients with clinical and dermoscopic diagnoses of onychomycosis., Results: Hyaline septate hyphae were found in 12 materials (gloves and/or masks) from 7 patients. However, these hyphae were morphologically deformed or mutilated in all exams. In Mycosel® agar, there was no growth of any fungus., Discussion/conclusion: The absence of dermatophyte isolation in all fungal cultures may demonstrate that the deformed fungal structures shown are not viable and would not present risks of contamination after nail abrasion., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 by S. Karger AG, Basel.)

Background: American cutaneous leishmaniasis is an infectious dermatosis caused by protozoa of the genus Leishmania, which comprises a broad spectrum of clinical manifestations depending on the parasite species involved in the infections and the immunogenetic response of the host. The use of techniques for amplification of the parasites DNA based on polymerase chain reaction polymerase chain reaction and the recent application of combined techniques, such as high-resolution DNA dissociation, have been described as a viable alternative for the detection and identification of Leishmania spp. in biological samples., Objectives: To identify the Leishmania species using the polymerase chain reaction high-resolution DNA dissociation technique in skin biopsies of hospital-treated patients, and compare with results obtained by other molecular identification techniques., Methods: A retrospective study assessing patients with suspected American cutaneous leishmaniasis seen at a hospital in São Paulo/Brazil was conducted. The paraffin blocks of 22 patients were analyzed by polymerase chain reaction high-resolution DNA dissociation to confirm the diagnosis and identify the species., Results: Of the 22 patients with suspected American cutaneous leishmaniasis, the parasite was identified in 14, comprising five cases (35.6%) of infection by L. amazonensis, four (28.5%) by L. braziliensis, two (14.4%) by L. amazonensis+L. infantum chagasi, two (14.4%) by L. guyanensis, and one (7.1%) by Leishmania infantum chagasi. In one of the samples, in which the presence of amastigotes was confirmed on histopathological examination, the polymerase chain reaction high-resolution DNA dissociation technique failed to detect the DNA of the parasite., Study Limitations: The retrospective nature of the study and small number of patients., Conclusions: The method detected and identified Leishmania species in paraffin-embedded skin biopsies with a sensitivity of 96.4% and could be routinely used in the public health system., (Copyright © 2020 Sociedade Brasileira de Dermatologia. Published by Elsevier España, S.L.U. All rights reserved.)

Background: Anogenital warts are the leading sexually transmitted infection in patients seeking care at specialized clinics. They may display a vast array of forms, according to the interaction of the virus with the host's immunity. Cellular immunity is the epithelium's main form of defense against the virus, involving an active participation of the Langerhans cells and pro-inflammatory cytokines such as TNF-α., Objective: To assess the epithelial immune response of anogenital warts in males, according to the number of lesions presented., Methods: This is a prospective, cross-sectional study carried out at the dermatology outpatient clinic in a tertiary hospital. We included male patients over 18 years of age without comorbidities who had anogenital condylomata and no previous treatments.In order to evaluate the local epithelial immunity, the lesions were quantified, then removed and employed in CD1a immunohistochemistry assays for assessing the morphometry and morphology of Langerhans cells; TNF-α; reaction was used for determining cytokine positivity in the epithelium., Results: 48 patients were included in the study. There was no statistically significant difference as to the number of Langerhans cells, in their morphology, or the presence of TNF-α. However, patients presenting with more Langerhans cells in the lesions had cells with a star-like and dendritic morphology, whereas in those with a lower cell count had cells with a rounded morphology and no dendrites (p<0.001)., Study Limitations: Small number of patients analyzed., Conclusion: There was no difference in epithelial immunity between patients having few or many anogenital condyloma lesions as measured by the morphology and morphometry of Langerhans cells and TNF-α; positivity. Such an assessment employing immunity markers differing from the usual ones is expected to yield useful results., (Copyright © 2020 Sociedade Brasileira de Dermatologia. Published by Elsevier España, S.L.U. All rights reserved.)

Background: Tinea capitis (TC) is a dermatophytosis of the scalp caused by the Trichophyton and Microsporum genera. The condition can be classified according to clinical symptoms or based on mycological presentations observed on direct examination. Treatment is best determined after isolation of the causative agent, with griseofulvin indicated for Microsporum and terbinafine for Trichophyton ., Materials and Methods: This was a prospective study correlating clinical and mycological classifications with agents isolated from culture of patients seen at a tertiary hospital in São Paulo (Brazil) between May 15, 2017, and January 11, 2019., Results: A total of 23 patients were treated, comprising 19 (83%) with alopecic clinical aspect (14 [60%] trichophytic and five [23%] microsporic) and 4 (17%) with kerion celsi presentation. According to the parasite invasion at the hair shaft, 9 (40%) were endothrix and 14 (60%) were ectothrix cases. Trichophyton tonsurans was isolated from culture in 14 (60%) patients and Microsporum canis in 5 (40%) patients. A statistically significant association was found for mycological classification and agent isolated from culture ( P = 0.003) with associations of the endothrix form with T. tonsurans and of ectothrix with M. canis ., Conclusions: The mycological classification appears to be a valid method for suggesting the etiological agent of TC., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 International Journal of Trichology.)

Paracoccidioidomycosis is a fungal infection that occurs in immunocompetent patients and are classified into two forms: the acute-subacute form, predominantly in young patients, and the chronic adult form that may present classic ulcerated lesions to rare sarcoid ones. We present the case of a boy whose infection began with sarcoid lesions but, after being mistakenly diagnosed with cutaneous sarcoidosis and treated (for three years) with prednisone, developed painful ulcerations throughout the body. After the correct diagnosis, with evidence of the fungus in histopathological and mycological examinations, the patient was properly treated with itraconazole for eight months and evolved with total remission of the disease.

Atypical mycobacterial infections are caused by mycobacteria other than those from the M. tuberculosis complex and M. leprae. Its incidence has increased progressively, with considerable increase of scientific publications on the subject. Only 10% of the cases present with cutaneous infections, most of them related to surgical interventions and aesthetic procedures. We present a case of mycobacteriosis due to automotive accident that presented a diagnostic challenge due to its clinical presentation with lesions of sporotrichoid progression in the lymphatic system.

Anetoderma is a rare benign condition of diverse etiology whose characteristic is the diminution or absence of the dermal elastic fibers. Classified as primary and secondary, the latter associated with tumors, inflammatory, and infectious diseases. Although the etiology of the lesions is well described in literature, the pathogenesis is still poorly determined. Anetoderma in syphilis is rare, and occurs even in the most uncommon cutaneous manifestations of the disease, such as the nodular form. In order to better understand the changes that lead to elastolysis, we propose a better correlation with the histopathological findings of the lesions that precede it. We present two cases of anetoderma secondary to syphilis, whose clinical aspects resembled the pattern of their initial secondary syphilis rash.

Bowen's disease is an in situ squamous cell carcinoma of the skin with only 2% of pigmented cases reported. It is clinically characterized by papules and plaques of blackened surface that may be caused either by sun damage - usually in photoexposed areas in elderly individuals - or by human papillomavirus infection - usually in the anogenital region of young adults. Dermoscopic aspects of Bowen's disease are discussed for over a decade, but with no definitive criteria that would lead to a definitive diagnosis. We present a case of Bowen's disease affecting the finger of a 57-year-old Asian patient. The lesion clinically and dermoscopically simulated a melanoma. Histopathological findings suggested the diagnosis of pigmented Bowen's disease. Pigmented Bowen's disease should be considered a differential diagnosis of melanoma, since its clinical and dermoscopic criteria are unspecific. Histopathological examination remains the gold standard for the diagnosis of the disease.

Superficial mycoses are fungal infections restricted to the stratum corneum and to the hair shafts, with no penetration in the epidermis; they are: white piedra, black piedra, tinea versicolor, and tinea nigra. This study presents images of mycological tests performed in the laboratory, as well as exams performed at the authors office, in order to improve the dermatologist's knowledge about the diagnosis of these dermatoses, which are common in many countries.

Tinea capitis is the most common fungal infection in children. The identification of the etiologic agent helps clinicians make their therapeutic choice. Studies conducted in different countries show a changing pattern of the main etiological agents according to their regions. We performed a retrospective study in the tertiary public service in São Paulo, analyzing the isolated etiological agents in patients with tinea capitis from March 2013 to May 2015. Microsporum canis was the main agent (56.6%), followed by Trichophyton tonsurans (36.6%). Despite recent migratory movements in the city, we observed no change in the causative agent of tinea capitis.

This is a retrospective study of 160 patients treated in private practice in São Paulo from March 2003 to March 2015. We analyzed 171 results of direct mycological examinations and fungal cultures from nail scrapings. The agreement between direct mycological examination results and fungal culture was satisfactory, consistent with the literature (kappa 0.603). The main agent identified was Trichophyton rubrum (51%). We observed an isolation rate of non-dermatophyte filamentous fungi superior to the literature (34%). Determining the agent is key to defining the appropriate onychomycosis treatment, and knowing the epidemiology of patients treated in private practice helps the dermatologist who works in this context.

Syphilis is a sexually transmitted disease caused by Treponema pallidum and divided into three stages according to the duration of the disease: primary, secondary and tertiary. Secondary syphilis has diverse clinical presentations, such as papular-nodular lesions. This presentation is rare, with 15 cases reported in the literature over the past 20 years. We report a case of secondary syphilis with papular-nodular lesions in a healthy 63-year-old patient, who has presented treponema in immunohistochemical examination of the skin lesions.

Ross syndrome is a rare disease characterized by peripheral nervous system dysautonomia with selective degeneration of cholinergic fibers. It is composed by the triad of unilateral or bilateral segmental anhidrosis, deep hyporeflexia and Holmes-Adie's tonic pupil. The presence of compensatory sweating is frequent, usually the symptom that most afflicts patients. The aspects of the syndrome are put to discussion due to the case of a male patient, caucasian, 47 years old, with clinical onset of 25 years.

Epidermal melasma is a common hyperpigmentation disorder that can be challenging to treat. Although current treatment options for melasma are limited, topical skin-lightening preparations have widely been used as alternatives to hydroquinone. In this prospective, single-arm, open-label study, treatment of epidermal melasma with a novel cream formulation containing nicotinamide 4%, arbutin 3%, bisabolol 1%, and retinaldehyde 0.05% was associated with reductions in Melasma Area and Severity Index (MASI) scores as well as total melasma surface area as measured by medical imaging software. Treatment outcomes including tolerance and safety profiles as well as patient satisfaction and product appreciation showed this novel cosmetic compound may be valuable in the treatment of epidermal melasma.

Chromoblastomycosis is a chronic subcutaneous fungal infection caused by traumatic implantation of dematiaceous fungi in the skin. The clinical presentation is usually a verrucous plaque lesion and the diagnosis is confirmed by the visualization of muriform bodies at direct examination or at the histologic study. This report describes a rare case of tumoral chromoblastomycosis confirmed by histologic study and whose agent was identified by culture and micromorphology.

Genital warts can be diagnosed through physical examination and confirmed by histopathology. Noninvasive methods are useful for ruling out other diagnoses with no harm to the patient. In this study the clinical findings were compared to dermoscopy, reflectance confocal microscopy (RCM), and to histopathology findings, in order to determine possible patterns that can aid diagnosis of the lesion. It was possible to identify structural changes on reflectance confocal microscopy that are already known by dermoscopy, in addition to cellular changes previously seen only by histopathological examination. This study shows the use of reflectance confocal microscopy in cases of genital warts, providing important information that can be used in further studies.