Aesthetic Breast Augmentation Mastopexy Followed by Post-surgical Pyoderma Gangrenosum (PSPG): Clinic, Treatment, and Review of the Literature.

INTRODUCTION: Pyoderma gangrenosum (PG) is a rare autoinflammatory neutrophilic ulcerative skin disease, often developing after a trauma or surgical wounds. In the literature there are several reports of post-surgical PG (PSPG) of the breast. The authors of this article experienced an impressive case of PSPG after an aesthetic breast augmentation mastopexy. PSPG is a rare but severe complication in this elective aesthetic surgical procedure. METHOD: A systematic review of the literature was performed, focusing on PSPG after aesthetic breast surgery (augmentation mammoplasty/mastopexy). The online databases Pubmed, Medline, and Cochrane were used and additionally a Google© search was conducted. We compared the data obtained from a systematic literature review to an index case of PSPG after esthetic augmentation mammoplasty. RESULTS: The literature search identified seven articles describing eight cases of PSPG after aesthetic breast surgery. In four of these cases augmentation mammoplasty had been carried out, in two cases mastopexy and in two cases augmentation mammoplasty and mastopexy (augmentation mastopexy). The patient we treated and describe in this paper underwent an augmentation mastopexy outside our clinic. Eight patients suffered from local disease, at the site of surgical wounds, one patient had disseminated disease. Leukocytosis was present in five cases (out of nine). Eight patients had received corticosteroid treatment, one patient refused such treatment. The duration of corticosteroid treatment was on average for 41 days (range 21-60 days). In all cases, the areola had been spared. Complete healing of PSPG was observed on average after 5 months (range 1.5 months-1 year). DISCUSSION: PSPG of the breast after aesthetic breast surgery is rare, but every plastic surgeon should consider this possibility, especially if skin disease develops post-surgery, mimicking wound infection that does not respond to broad-spectrum antibiotic treatment. CONCLUSION: Although the literature does not recommend this step, implant removal is recommended by the authors because bacterial wound infection normally cannot be ruled out definitely in the early stages of disease. Additional surgical intervention should be limited to the absolute necessary and performed only under adequate systemic immunosuppressive therapy. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Canine papillomatosis: a retrospective study of 24 cases (2001-2011) and immunohistochemical characterization

A retrospective study of 24 cases of papillomas in dogs was performed from January 2001 to March 2011. Additionally, immunohistochemistry (IHC) was used to characterize and evaluate the samples. We found that disease was observed more in mixed breed dogs, ages ranging from 6 months to 10 years (mean 3.1 years), and there was no gender predilection. The main lesion sites were the skin (75%), lips (16.7%), and eyelids (8.3%). Upon histological evaluation, we observed papillary exophytic proliferation of squamous epithelium and papillary endophytic proliferation (inverted) in 87.5% and 12.5% of cases, respectively. The tumors were characterized by spinous layer hyperplasia (87.5%) with koilocytes (70.8%) and intranuclear pale basophilic inclusions bodies (8.3%), prominent granular layer with large amounts of keratohyalin granules (95.8%), and hyperkeratosis in the stratum corneum (100%). Positive immunostaining for Papillomavirus was found in 83.3% of cases, which were distributed between the granular layer and the stratum corneum. These findings indicate the following: that papillomas in dogs are caused by Papillomavirus, the viral cytopathic effect induces epithelial lesions, viral particles are found inside the cell nuclei, and inclusions bodies are rare.

Histophilus somni-induced thrombotic meningoencephalitis in cattle from northern Paraná, Brazil

Thrombotic meningoencephalitis (TME) is a fatal neurological disease of cattle, predominantly from North America, that is caused by Histophilus somniwith sporadic descriptions from other countries. This manuscript describes the occurrence of spontaneous TME in cattle from northern Paraná, Brazil. Most cattle had acute neurological manifestations characteristic of brain dysfunction. Hematological and cerebrospinal fluid analyses were not suggestive of bacterial infections of the brain. Histopathology revealed meningoencephalitis with vasculitis and thrombosis of small vessels that contained discrete neutrophilic and/or lymphocytic infiltrates admixed with fibrin at the brainstem, cerebral cortex, and trigeminal nerve ganglion of all animals. All tissues from the central nervous system used during this study were previously characterized as negative for rabies virus by the direct immunofluorescence assay. PCR and RT-PCR assays investigated the participation of infectious agents associated with bovine neurological disease by targeting specific genes of H. somni, Listeria monocytogenes, bovine herpesvirus -1 and -5, bovine viral diarrhea virus, and ovine herpesvirus-2. PCR and subsequent sequencing resulted in partial fragments of the 16S rRNA gene of H. somni from brain sections of all animals with histopathological diagnosis of TME; all other PCR/RT-PCR assays were negative. These findings confirmed the participation of H. somni in the neuropathological disease observed in these animals, extend the geographical distribution of this disease, and support previous findings of H. somni from Brazil.

Polymorphism of the promoter region and exon 1 of the CTLA4 gene in endemic pemphigus foliaceus (fogo selvagem)

Endemic pemphigus foliaceus (EPF) is an autoimmune bullous skin disease characterized by acantholysis and antibodies against a desmosomal protein, desmoglein 1. Genetic and environmental factors contribute to development of this multifactorial disease. HLA class II and some cytokine gene polymorphisms are the only genetic markers thus far known to be associated with susceptibility to or protection from EPF. The cytotoxic T-lymphocyte antigen-4 gene (CTLA4) encodes a key immunoreceptor molecule that regulates and inhibits T-cell proliferation. It participates in the regulatory process controlling autoreactivity and therefore has been considered a strong candidate gene in autoimmune diseases. In the search for genes that might influence EPF pathogenesis, we analyzed variants of the CTLA4 gene in a sample of 118 patients and 291 controls from a Brazilian population. This is the first study investigating the possible role of polymorphisms of the 2q33 chromosomal region in differential susceptibility to pemphigus foliaceus. Promoter region and exon 1 single nucleotide polymorphisms -318 (C,T) and 49 (A,G) were genotyped using sequence-specific oligonucleotide probes after amplification by the polymerase chain reaction. The allelic and genotypic frequencies did not differ significantly between the patient and the control groups (-318T: 9.8 and 10.9%, 49G: 33.0 and 35.2% were the allelic frequencies in patients and controls, respectively). In addition, no significant difference was found when the patient and control population samples were stratified by the presence of HLA-DRB1 alleles. We conclude that the CTLA4 -318 (C,T) and 49 (A,G) polymorphisms do not play a major role in EPF development.

High HTLV-1 proviral load, a marker for HTLV-1 associated myelopathy/tropical spastic paraparesis, is also detected in patients with infective dermatitis associated with HTLV-1

Salvador (BA, Brazil) is an endemic area for human T-cell lymphotrophic virus type 1 (HTLV-1). The overall prevalence of HTLV-1 infection in the general population has been estimated to be 1.76%. HTLV-1 carriers may develop a variety of diseases such as adult T-cell leukemia/lymphoma, HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and infective dermatitis associated with HTLV-1 (IDH). IDH is a chronic and severe form of childhood exudative and infective dermatitis involving mainly the scalp, neck and ears. It has recently been observed that 30% of patients with IDH develop juvenile HAM/TSP. The replication of HTLV-1 has been reported to be greater in adult HAM/TSP patients than in asymptomatic HTLV-1 carriers. In the current study, the proviral load of 28 children and adolescents with IDH not associated with HAM/TSP was determined and the results were compared to those obtained in 28 HTLV-1 adult carriers and 28 adult patients with HAM/TSP. The proviral load in IDH patients was similar to that of patients with HAM/TSP and much higher than that found in HTLV-1 carriers. The high levels of proviral load in IDH patients were not associated with age, duration of illness, duration of breast-feeding, or activity status of the skin disease. Since proviral load is associated with neurological disability, these data support the view that IDH patients are at high risk of developing HAM/TSP.

Exposición laboral de agentes químicos carcinógenos presentes en las empresas afiliadas a una ARL en Colombia 2011-2014

Objetivo: Caracterizar los sectores económicos con mayor susceptibilidad de exposición a agentes químicos carcinógenos, categorizados en el grupo 1 por la Agencia Internacional para la Investigación del Cáncer IARC (formaldehído, polvo de madera, benceno y sílice cristalina) afiliadas a una Administradora de riesgos Laborales (ARL) en Colombia entre el periodo 2011 a 2014. Método: Estudio de tipo descriptivo retrospectivo con datos históricos obtenidos desde 2011 hasta 2014. De acuerdo con el número de mediciones que se realizó en cada área y cargo de las empresas objeto de estudio, se utilizó la medición basal para determinar el estado inicial y evaluar de manera concurrente la exposición de estos cuatro agentes químicos. Resultados: En total se obtuvieron 201 mediciones de higiene industrial para cuatro agentes químicos carcinógenos. Los resultados mostraron que índice de riesgo de la exposición a agentes químicos carcinógenos en diferentes empresas, se encuentra en algunos casos en niveles altos o críticos dado que superar los valores máximos permisibles definidos por la Conferencia Americana de Higienistas Industriales de Gobierno (ACGIH). Conclusión: Los trabajadores de diferentes empresas en Colombia están expuestas a diferentes tipos de concentraciones por agentes químicos cancerígenos. Las concentraciones ambientales obtenidas en el ambiente laboral en algunos casos excedieron las concentraciones máximas permitidas, por lo que se recomienda que las empresas e instituciones del país fortalezcan las medidas de prevención, vigilancia y control para minimizar los riegos a que pueden estar expuestos sus trabajadores.

Modelo tipo de dermatite atópica em rato

A dermatite atópica (DA) é um tema importante na dermatologia clínica. Na verdade, a patogénese dessa doença inflamatória crónica da pele, caracterizada principalmente por pele seca e prurido, ainda está longe de ser totalmente compreendida. A fim de saber mais acerca desta complexa doença, ratos Wistar machos e adultos (n = 10) foram utilizados como modelo animal, nos quais o tratamento com acetona (AA) foi comparado com o tratamento com água por 3 dias (AW). No dia 3, uma hora após o último tratamento, a AA mostrou maior perda transepidérmica de água (TEWL), fluxo sanguíneo capilar e reduzida hidratação quando comparada com AW. A análise comportamental mostrou que a acção de coçar foi marcadamente mais frequente no grupo AA (n = 5) quando comparado ao grupo AW (n = 5). Estes resultados justificam a implementação deste modelo animal como uma ferramenta experimental para investigação da AD.

Design, synthesis and in vitro degradation of a novel co-drug for the treatment of psoriasis

Psoriasis is a common, chronic and relapsing inflammatory skin disease. It affects approximately 2% of the western population and has no cure. Combination therapy for psoriasis often proves more efficacious and better tolerated than monotherapy with a single drug. Combination therapy could be administered in the form of a co-drug, where two or more therapeutic compounds active against the same condition are linked by a cleavable covalent bond. Similar to the pro-drug approach, the liberation of parent moieties post-administration, by enzymatic and/or chemical mechanisms, is a pre-requisite for effective treatment. In this study, a series of co-drugs incorporating dithranol in combination with one of several non-steroidal anti-inflammatory drugs, both useful for the treatment of psoriasis, were designed, synthesized and evaluated. An ester co-drug comprising dithranol and naproxen in a 1:1 stoichiometric ratio was determined to possess the optimal physicochemical properties for topical delivery. The co-drug was fully hydrolyzed in vitro by porcine liver esterase within four hours. When incubated with homogenized porcine skin, 9.5% of the parent compounds were liberated after 24 h, suggesting in situ esterase-mediated cleavage of the co-drug would occur within the skin. The kinetics of the reaction revealed first order kinetics, Vmax = 10.3 μM/min and Km = 65.1 μM. The co-drug contains a modified dithranol chromophore that was just 37% of the absorbance of dithranol at 375 nm and suggests reduced skin/clothes staining. Overall, these findings suggest that the dithranol-naproxen co-drug offers an attractive, novel approach for the treatment of psoriasis.

The Autoimmune Regulator (AIRE), Which Is Defective in Autoimmune Polyendocrinopathy-Candidiasis-Ectodermal Dystrophy Patients, Is Expressed in Human Epidermal and Follicular Keratinocytes and Associates With the Intermediate Filament Protein Cytokeratin 17

Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) syndrome, which is caused by mutation of the autoimmune regulator (AIRE) gene, is a highly variable disease characterized by multiple endocrine failure, chronic mucocutaneous candidiasis, and various ectodermal defects. AIRE is a transcriptional regulator classically expressed in medullary thymic epithelial cells, monocytes, macrophages, and dendritic cells. Previous studies have suggested that AIRE can shuttle between the nucleus and cytoplasm of cells, although its cytoplasmic functions are poorly characterized. Through mass spectrometry analysis of proteins co-immunoprecipitating with cytoplasmic AIRE, we identified a novel association of AIRE with the intermediate filament protein cytokeratin 17 (K17) in the THP-1 monocyte cell line. We confirmed AIRE expression in HaCaT epidermal keratinocytes, as well as its interaction with K17. Confocal microscopy of human fetal and adult scalp hair follicles demonstrated a cytoplasmic pattern of AIRE staining that moderately colocalized with K17. The cytoplasmic association of AIRE with the intermediate filament network in human epidermal and follicular keratinocytes may provide a new path to understanding the ectodermal abnormalities associated with the APECED syndrome. (Am J Pathol 2011, 178:983-988; DOI: 10.1016/j.ajpath.2010.12.007)

Avaliação sócio-comportamental de crianças portadoras de dermatite atópica

Introdução: A dermatite atópica (DA) é uma doença inflamatória crônica da pele que apresenta um impacto significativo na qualidade de vida dos pacientes, em conseqüência de episódios recorrentes durante a vida. Considerando estudos recentes que descrevem a associação entre aspectos psicológicos e a dermatite atópica, acredita-se que a investigação da existência de um possível perfil comportamental destas crianças possa auxiliar o desenvolvimento de intervenções psicoterápicas específicas, assim como aumentar o conhecimento sobre a doença. Método: Este trabalho tem como objetivo realizar uma avaliação do perfil sóciocomportamental de crianças portadoras de DA e comparando-as com crianças sem a doença. Neste estudo, do tipo caso-controle, foram incluídos dois grupos com idades entre 4 e 18 anos: o grupo estudo, com pacientes portadores de dermatite atópica que consultam no ambulatório do Hospital de Clínicas de Porto Alegre (HCPA) e o grupo controle, composto por crianças e adolescentes sem doença dermatológica, matriculados em escola da rede pública de Porto Alegre. O tamanho estimado da amostra foi de 25 indivíduos em cada grupo. A coleta dos dados realizou-se através do CBCL (Child Behavior Checklist), validado no Brasil com o nome de Inventário de Comportamento da Infância e Adolescência. Resultados: Foram encontradas diferenças estatisticamente significativas nas duas dimensões globais (internalização e externalização), sendo que as crianças portadoras de dermatite atópica mostraram mais sintomas relacionados com ansiedade, depressão, alterações de pensamento e comportamento agressivo quando comparadas com crianças sem a doença. Conclusão: Os resultados indicam a necessidade de abordagens interdisciplinares no tratamento da criança com DA, valorizando não só as lesões dermatológicas, como também os aspectos emocionais dos indivíduos.

Desenvolvimento de compósito de pu de mamona com carga de resíduo de couro para isolação térmica

The standardization of the bovine skin thickness in the leather industry generates a residue known as wet-blue . At the end of twentieth century, the brazilian industry discarded about 131 thousand tons of this residue in nature, provoking a great environmental liability. In this paper is presented the analyses of the termophysical properties, thermal and volumetric expansion performance of a composite of vegetable resin of castor oil plant (Ricinus communis) with load of industrial residue of leather "wet-blue", for application as thermal isolation material of warm surfaces. There were considered four percentile levels of residue load in the proportions in mass of 0%, 5%, 10% and 15%, added to the expansible resin of castor oil plant in two configurations: sawed leather and crushed leather in a smaller particle (powder) by grinding in a mill of balls. Twenty-one proof bodies were produced for termophysical properties analysis (three for each configuration) and four proof bodies for rehearsals of thermal acting. Analyses of thermal acting were done in test cameras. The results of the rehearsals were compared to those obtained considering the castor oil plant foam without residue addition. A small reduction of the thermal conductivity of the composite was observed in the proportion of 10% of leather residue in both configurations. Regarding thermal conductivity, calorific capacity and diffusivity, it was verified that the proposed composite showed very close values to the commercial insulating materials (glass wool, rock wool, EPS). It was still demonstrated the technical viability of the use of composite as insulating thermal for systems of low potency. The composite presented larger volumetric expansion with 15% of sawed residue of leather.

Padrões clínicos de acne em mulheres de diferentes faixas etárias

FUNDAMENTOS: Acne é dermatose comum que acomete ambos os gêneros e todas as faixas etárias. Mulheres apresentam diferentes padrões clínicos da doença, além de frequente persistência da acne após a adolescência. OBJETIVO: Analisar características clínicas e epidemiológicas associadas às diferentes faixas etárias acometidas por acne feminina. MÉTODOS: Estudo transversal envolvendo mulheres com diagnóstico de acne, atendidas em ambulatório de dermatologia geral. Variáveis relacionadas à doença e às pacientes foram avaliadas com o emprego de questionário padronizado. RESULTADOS: Avaliaram-se 103 pacientes, cuja idade média na época da consulta foi 21,7 ± 7,3 anos. Definiram-se dois subgrupos com idade de corte de 21 anos e idades médias de 15,8 ± 2,3 e 28,0 ± 5,1 anos. Houve correlação entre a duração do quadro e a idade das pacientes na consulta (R = 0,7). Observaram-se diferenças entre os grupos nas frequências de uso de contraceptivo oral combinado (OR = 48,1), lesões no colo (OR = 11,6), lesões no dorso (OR = 0,2), predominância na topografia superior da face (OR = 0,1) e idade de início das lesões (OR = 1,8). No grupo de mulheres adultas, 80% relataram início do quadro antes dos 20 anos. CONCLUSÕES: Identificaram-se padrões clínicos cronológicos e topográficos que caracterizaram a acne feminina em diferentes faixas etárias, alertando para a importância da abordagem diagnóstica e terapêutica individualizada.

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.

Displasia folicular em cão

A displasia folicular canina é uma dermatopatia incomum caracterizada clinicamente por alopecia e alterações na qualidade da pelagem. Relata-se o caso de um cão, sem raça definida, 7 meses de idade, macho, levado à consulta por apresentar alopecia progressiva disseminada. O diagnóstico anátomo-clínico da displasia folicular canina do caso ora descrito foi estabelecido pelos dados colhidos na resenha e anamnese, achados do exame dermatológico e osteomuscular e confirmado pelas alterações histológicas dos fragmentos de pele biopsiados. Este artigo visa relatar um caso de displasia folicular canina e comparar com outros casos descritos na literatura, pois são esparsos as descrições na literatura brasileira.

Emerging infectious diseases in cetaceans worldwide and the possible role of environmental stressors

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