Tropical dermatology: Venomous arthropods and human skin Part I. Insecta

Although many tropical insects carry infectious diseases, cutaneous injury can occur by other mechanisms, for example erucism (envenomation by caterpillars) or lepidopterism (dermatitis from moths). Pararama is a unique form of erucism seen in workers in contact with rubber trees in the Amazon, and it is caused by Premolis larvae, resulting in progressive periarticular fibrosis, ankylosis, and the loss of articulation. Ants and aquatic insects of the Belostomatidae family can cause painful bites and stings. Anaphylactic shock and death can result from the venom of bees and wasps. Beetles can cause vesicular dermatitis via cantharidin or paederin. Myiasis results from fly larvae (maggots) feeding on live or necrotic tissue of humans or other hosts, while New World screwworm fly larvae feed only on living tissue and burrow (ie, screw) more deeply when attempts are made to remove them. Tungiasis is characterized by very pruritic and painful papules and ulcers resulting from a Tunga flea penetrating the host's skin. Dermatologists should be able to diagnose and treat the cutaneous manifestations of these tropical insects and educate their patients on prevention. (J Am Acad Dermatol 2012; 67:339.e1-14.)

Venous ulcer: clinical characteristics and risk factors

BackgroundLower limb venous ulceration ranks among the 10 most common medical problems in Western countries and has significant socioeconomic impact. The aim of this study was to identify the risk factors for unhealed, recurrent, and large ulcers and to characterize patients with active or recently healed venous ulcers.MethodsWe identified 97 patients and assessed 103 ulcerated limbs in 90 patients. All patients underwent clinical examination, arterial and venous system evaluation, ankle-brachial index determination, and ultrasound of the affected limb. Clinical characteristics included age, gender, race, ulcer duration, time since first episode, history of recurrence, localization of ulcer, ulcer area, eczema, ochre dermatitis, lipodermatosclerosis, pain, body mass index, and medical history data. Risk factors were identified by univariate analysis and estimated odds ratios.ResultsWe assessed 90 patients (103 limbs) with active or healed venous leg ulcers, of whom 84.4% were Caucasian and 68.9% were female. Mean age was 56.0 +/- 13.3 years. Ulcers had remained unhealed for < 1 year in 40.7%. Lipodermatosclerosis, lower limb hyperpigmentation, edema, and eczema were seen in 96.7%, 95.6%, 94.4%, and 51.1% of patients, respectively. Pain was a frequent symptom in 74.4%. Body mass index was assessed in 85 patients: 30.6% were slightly, 36.5% moderately, and 7% severely obese. Patient age > 60 years (odds ratio [OR] 4.0), extensive lipodermatosclerosis (OR 8.7), and previous history of ulceration (OR 19.9) were risk factors for unhealed ulcers. Time since first ulcer episode >= 2 years (OR 29.2) and incompetence of venous systems (OR 1.6) were risk factors for recurrence.ConclusionsLongstanding and large ulcers and recurrences are the main problems encountered by venous ulcer patients. Severe lipodermatosclerosis, previous ulcer history, and time since first ulcer episode >= 2 years are significant risk factors.

Tropical dermatology: Marine and aquatic dermatology

Dermatoses caused by marine organisms are frequently seen in dermatology clinics worldwide. Cutaneous injuries after exposure to marine environments include bacterial and fungal infections and lesions caused by aquatic plants and protists. Some of these diseases are well known by dermatologists, such as Vibrio vulnificus septicemia and erysipeloid, but others are uncommon, such as envenomation caused by ingestion or contact with certain dinoflagellates or cyanobacteria, which are associated with rashes that can begin Within minutes after exposure. Many marine/aquatic invertebrates, such as sponges, cnidarians, echinoderms, crustaceans, and mollusks, are associated with different kinds of dermatologic lesions that call vary from irritant or allergic contact dermatitis to physical trauma and envenomations. These cutaneous lesions May result in mild local reactions or can be associated with severe systemic reactions. Invertebrate animals, such as cnidarians, sea urchins, and worms, and aquatic vertebrates, such as venomous fishes and stingrays, are commonly associated with skin lesions in many countries, where they call constitute occupational dermatoses among fishermen and scuba divers, but they can also be observed among persons who contact these animals in kitchens or beaches. The presence of unusual lesions, a recent travel history, and/or a report of contact with an aquatic environment (including ownership of a marine or freshwater aquarium) should alert the dermatologist to the etiology of the cutaneous problems. (J Am Acad Dermatol 2009;61:733-50.)

SEABATHER'S ERUPTION: A CLINICAL and EPIDEMIOLOGICAL STUDY of 38 CASES IN SANTA CATARINA STATE, BRAZIL

Seabather's eruption (SBE) is an intensely itchy, papule-erythematous dermatitis that occurs predominantly in regions of the body covered by bathing costumes, after exposure to marine water. The planulae larvae of Linuche unguiculata scyphomedusae (thimble jellyfish) are the etiologic agent of the dermatitis, which is frequent in waters of Caribbean, Gulf of Mexico and Florida. The authors report 38 cases of SBE in the State of Santa Catarina (Southern region of Brazil), with emphasis on their clinical and epidemiological aspects, such as profile of victim, topography of the papules and conditions predisposing to the accident.

Imuno-histoquímica para o diagnóstico precoce de vitiligo

O vitiligo é uma doença de pele freqüente que acomete 1% da população e é caracterizada por máculas despigmentadas conseqüentes à perda progressiva e localizada dos melanócitos da epiderme. Na maioria dos pacientes, o diagnóstico é feito por exame clínico. A biópsia da pele é realizada quando há necessidade de diagnóstico diferencial com doenças hipocromiantes. O diagnóstico histopatológico de vitiligo é difícil nos preparados corados por hematoxilina e eosina (HE). Há poucos estudos sobre a melhoria da qualidade diagnóstica no vitiligo. OBJETIVO: Avaliar a utilidade dos marcadores imuno-histoquímicos proteína S-100, human melanoma black-45 (HMB-45) e Melan-A para o diagnóstico precoce em casos clinicamente suspeitos ou duvidosos de vitiligo. Material e métodos: Lâminas histológicas de biópsias de pele sã e lesada de 10 pacientes com suspeita clínica de vitiligo coradas pelos métodos de HE, proteína S-100, HMB-45 e Melan-A. Utilizou-se contracoloração com Giemsa como modificação técnica para diferenciar a melanina da imunomarcação. RESULTADOS: Seis casos, com manifestação clínica recente, apresentaram infiltrado linfocitário, do tipo dermatite de interface, na pele lesada na HE. As colorações por S-100, HMB-45 e Melan-A marcaram os melanócitos da camada basal da pele sã, e a proteína S-100 evidenciou as células de Langerhans. Na pele lesada, os melanócitos estavam ausentes ou diminuídos quando comparados com a pele normal. A proteína S-100 demonstrou maior número de células de Langerhans, o que é característico das lesões de vitiligo. CONCLUSÃO: A imuno-histoquímica pode ser utilizada como método auxiliar no diagnóstico dos casos duvidosos de vitiligo.

Qualidade de vida em urticária crônica: inquérito em ambulatório público universitário, Botucatu (Brasil)

OBJETIVO: Avaliar o impacto da urticária crônica na qualidade de vida dos pacientes de ambulatório universitário a partir do questionário DLQI (Dermatology Life Quality Index). MÉTODOS: Inquérito sobre o impacto na qualidade de vida infligido pela urticária crônica a partir do questionário DLQI validado para a língua portuguesa. Pacientes foram entrevistados durante suas consultas em ambulatório especializado, entre maio de 2009 e maio de 2010, em serviço público brasileiro (Botucatu-SP). Os escores do DLQI foram analisados segundo subgrupos: idade, gênero, escolaridade, tempo de doença e presença de angioedema. RESULTADOS: Foram entrevistados 100 pacientes com urticária crônica. Predominou o gênero feminino (86%), a idade média foi de 41,8 anos, duração média da doença foi de seis anos e angioedema ocorreu em 82% dos pacientes. O escore médio do DLQI foi de 13,5, caracterizando grave impacto à qualidade de vida, superior a hanseníase, psoríase, eczema atópico e carcinoma basocelular. Presença de angioedema se associou a maiores escores: 14,5 x 9,9 (p < 0,01). Pacientes do gênero feminino referiram maior impacto quanto ao vestuário, já o gênero masculino referiu quanto ao tratamento, trabalho e estudo (p < 0,05). CONCLUSÃO: Urticária crônica inflige grave comprometimento da qualidade de vida nos pacientes avaliados em serviço universitário brasileiro, especialmente nos portadores de angioedema.

Seabather's eruption: report of five cases in southeast region of Brazil

Os autores relatam cinco acidentes de seabather's eruption ou prurido do traje de banho, uma erupção típica associada na maioria das vezes à água-viva Linuche unguiculata (Cnidaria), que causa um rash pápulo-eritematoso extremamente pruriginoso em áreas cobertas por trajes de banho. O quadro cutâneo é característico e a erupção é comum no Caribe, Flórida, México e estados americanos do Golfo. Os casos são os primeiros relatados no Brasil e larvas de Linuche unguiculata estão presentes nas águas onde ocorreram os acidentes.

Clinical and histopathological aspects of the insect bite hypersensitivity in horses

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Comparação entre as administrações tópica e sistêmica de oxitetraciclina no tratamento de vacas com dermatite digital papilomatosa

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Pênfigo foliáceo em eqüino: relato de caso

Diagnosticou-se pênfigo foliáceo em um eqüino macho, castrado, quatro anos de idade da raça Árabe apresentando dermatite generalizada caracterizada por placas escamo-crostosas e presença de dermatite pustular acantolítica subcorneal.

Mycobacterium DNA detection in liver and skin of a horse with generalized sarcoidosis

Sarcoidosis is a rare equine skin disease characterized primarily by an exfoliative and granulomatous dermatitis but also presenting granulomatous inflammation of multiple systems. The current report presents the clinical and histopathological findings of sarcoidosis in a 16-year-old American Quarter Horse gelding with nested polymerase chain reaction Mycobacterium spp. DNA detection within hepatic and skin samples. Mycobacterium spp. may play a role in the pathogenesis of equine sarcoidosis as has been proposed for human sarcoidosis.

Imunomarcação de células CD3+ e CD79a+ nas lesões descamativas e ulcerativas de cães com leishmaniose

Canine visceral leishmaniasis is an endemic infectious disease in some regions from São Paulo state and even though it is a systemic disease, in the dog, the main clinical sign is dermatological. Thirty dogs with positive results in serology (IFI) and parasitological exams (fine needle aspiration) for leishmaniasis from Aracatuba city were evaluated. They only showed dermatological signs and were divided in two groups, one with exfoliative (n=15) and other with ulcerative (n=15) lesions. There was significant statistical difference between CD3 and CD79a population in the same dermatological pattern, and with CD79a population between exfoliative and ulcerative patterns (p<0,05).

Selecting appropriate bedding to reduce locomotion problems in broilers

Two experiments were carried out at the Poultry Sector of the School of Agrarian Sciences of the Federal University of Grande Dourados to evaluate the incidence of leg problems in broilers reared on two distinct types of bedding material: rice husks or wood shavings, both new and reused. In both trials, a randomized experimental design was applied in factorial arrangement (2 x 2 x 2) using two genetic strains (Cobb® or Ross®); two sexes (male or female), and two litter materials (rice husks or wood shavings). In each trial 1080 one day pullets were reared equally divided in the treatments. The birds were placed in 4.5 m² boxes at a density of 10 birds m-2. All birds were fed diets with equal nutritional density, and water was offered ad libitum. Feeds were divided in three phases: starter diet (1 - 21 days), grower diet (22 - 35 days), and finisher diet (36 - 45 days). on day 45, fifty birds were randomly selected in each experiment to evaluate flock leg problems. The following parameters were analyzed: gait score, incidence of valgus and varus disorder, footpad dermatitis, femoral degeneration, tibial dyschondroplasia, and spondylolisthesis. Ambient temperature during rearing and litter caking and moisture content were recorded in four boxes per treatment. The analytical hierarchy process was used to organize the data into specific criteria. Several criteria, related to the attributes that were determinant according to the statistical analysis, were chosen in order to provide the best input to the process. Results indicated that new wood-shavings bedding was the most appropriate bedding to prevent locomotion problems, followed by new rice husks, reused wood shavings, and reused rice husks. However, when leg problems were associated to sex and genetic strain, male Ross birds strain presented less problems when reared on new rice husks, followed by new wood shavings

Litter materials and the incidence of carcass lesions in broilers chickens

The aim of this study was to evaluate the effects of different litter materials on litter compaction, broiler feathering and the incidence of carcass lesions. In the experiment, 3240 one-day-old Ross® chicks were selected by sex and distributed according to a completely randomized experimental design in a 2 x 6 factorial arrangement (two sex and six litter materials). The following litter materials were used: wood shavings, rice husks, chopped Napier grass, 50% sugar cane bagasse plus 50% wood shavings, 50% sugar cane bagasse plus 50% rice husks, and pure sugar cane bagasse. Litter compaction was weekly assessed using a penetrometer. on days 21, 35 and 42 of the experimental period, feathering on the back and legs was scored according to a 0 - 10 scale. on day 42, birds were slaughtered and the presence of bruises, scratches and footpad lesions was recorded. Litter material had no effect on bird feathering. Carcass lesions (scratches, bruises and footpad lesions) were influenced by the litter material evaluated. Birds reared on sugarcane bagasse and chopped Napier grass presented more scratches, bruises and footpad lesions than the others. Dermatitis was more evident in birds reared on sugarcane bagasse, chopped Napier grass and the combination of litter materials. It was found that males presented higher incidence of dermatitis and footpad lesions than females. Each litter material presented different compaction degrees, which increased along the experimental period. Sugarcane bagasse, chopped Napier grass and the combination of bedding materials presented the highest degree of compaction, compared with wood shavings and rice husks.

Efeito da Densidade de Criação e do Sexo Sobre o Empenamento, Incidência de Lesões na Carcaça e Qualidade da Carne de Peito de Frangos de Corte

O experimento foi conduzido nas instalações experimentais da Faculdade de Medicina Veterinária e Zootecnia - UNESP, Campus de Botucatu, SP, Brasil, com o objetivo de avaliar o efeito da densidade de criação e do sexo sobre o empenamento, incidência de lesões na carcaça e a qualidade de carne de peito de frangos de corte. Foram utilizados 1950 pintos de corte sexados, da linhagem Ross, distribuídos em um delineamento inteiramente casualizado, com esquema fatorial com 3 densidades (10, 13 e 16 aves/m²) e dois sexos com 5 repetições, sendo que uma foi destinada exclusivamente para reserva, criados até os 42 dias de idade. Aos 28, 35 e 42 dias foram amostradas 3 aves por repetição para a determinação do empenamento através da porcentagem de penas e 10 aves para a determinação do escore de empenamento. Também aos 42 dias de idade todas as aves foram identificadas na pata com anilhas numeradas e submetidas à avaliação da incidência de lesões na pele. Foram escolhidas ao acaso 5 aves por repetição para a determinação da qualidade da carne de peito. Pode-se concluir que o aumento na densidade de criação promoveu uma diminuição na velocidade de empenamento e, conseqüentemente, uma maior incidência de lesões na carcaça. O comprimento, a largura e a espessura do peito foram menores para as aves criadas na maior densidade, e a perda de peso por cozimento foi maior para as aves criadas na maior densidade.