BACKGROUND notalgia paresthetica is a subdiagnosed sensory neuropathy presenting as a
condition of intense itching and hyperchromic macule on the back that
interferes with daily habits. OBJECTIVES To determine the efficacy of treatment of notalgia paresthetica using oral
gabapentin, assessing the degree of improvement in itching and influence on
quality of life. Moreover, to evaluate the signs and symptoms associated
with notalgia paresthetica. METHODS We conducted an experimental, non-randomized, parallel, non-blinded study
including 20 patients with clinical and histopathological diagnosis of
notalgia paresthetica. After application of the visual analogue scale of
pain adapted for pruritus and of the questionnaire of dermatology life
quality index (DLQI), ten patients with visual analogue scale > 5 were
given treatment with gabapentin at the dose of 300 mg/day for four weeks.
The other ten were treated with topical capsaicin 0.025% daily for four
weeks. After the treatment period, patients answered again the scale of
itching. RESULTS The use of gabapentin was responsible for a significant improvement in
pruritus (p=0.0020). Besides itching and hyperchromic stain on the back,
patients reported paresthesia and back pain. It was observed that the main
factor in the worsening of the rash is heat. CONCLUSION Gabapentin is a good option for the treatment of severe itching caused by
nostalgia paresthetica.
Dermatosis neglecta is the name of a skin condition characterized by papules and
polygonal plaques, which are sometimes warty, brownish and hyperpigmented, adherent
and symmetric, though removable with ethyl or isopropyl alcohol. It occurs due to
inadequate skin cleansing causing accumulation of sebum, sweat, keratin and
impurities. Its occurrence, though little reported, is frequent. The main
differential diagnosis is the Terra fi rma-forme dermatosis. The treatment is simple,
with exfoliation, moisturizing and even rubbing of alcohol. Causes of negligence on
the patient’s side, which can range from hygiene carelessness to psychiatric
disorders, local hypersensitivity, limbs negligence or motor paralysis, should be
investigated. We illustrate the case of dermatosis neglecta in a 45-years old patient
admitted with pulmonary sepsis.
Actinic keratoses are premalignant lesions of the skin caused by excessive sun
exposure. Lesions may become mainly squamous cell carcinoma. Cryotherapy with liquid
nitrogen is one of the main treatments. In order to evaluate the response of actinic
keratosis to cryotherapy by histopathology, two lesions were selected in each of 14
patients with multiple actinic keratoses. In one lesion a biopsy was performed and in
the other lesion a biopsy was performed after cryotherapy. Subsequently, both
biopsies were compared histologically. Of the thirteen patients who completed the
study, the best results were obtained in lesions undergoing cryotherapy concerning
the atypia of keratinocytes, epithelial thickness and corneal layer and lymphocytic
infiltrate. Despite the small number of patients, it was concluded that, if performed
correctly, cryotherapy has high efficacy in the treatment of actinic keratoses.
Histiocytic sarcoma is a rare hematologic malignant neoplasia originating from
histiocytic or dendritic cell clones. The lesions may be in nodal or extranodal
sites, most commonly in the gastrointestinal tract. A small number of cases presents
as unique cutaneous lesions. The definitive diagnosis is made by positivity for the
immunohistochemical markers CD163, CD68, CD4 and lysozyme. The treatment is
controversial, often with combined systemic chemotherapy. This is a case of cutaneous
histiocytic sarcoma in an 82-year-old patient presenting two nodular lesions in the
breast and right arm which were treated with simple excision and multidisciplinary
follow-up, avoiding aggressive management and exhaustive investigations. Although
most studies report aggressive evolution, the patient had good and stable clinical
status during the twelve-month follow-up period.
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