Verrucous hemangioma is a rare vascular skin disorder with an immune profile
similar to vascular neoplasms, but with behavior and evolution of vascular
malformations. Its main differential diagnosis is angiokeratoma circumscriptum
neviforme, with an almost indistinguishable clinical presentation because both
diseases appear as erythematous patches that evolve to violaceous plaques,
becoming scaly and even verrucous, most commonly affecting the lower limbs.
Histopathology is crucial for the correct diagnosis: while in angiokeratoma the
vascular alterations are limited to the papillary dermis, verrucous hemangioma
extends deep into the dermis, reaching the subcutaneous tissue.
Background
Despite being widely used in different areas of dermatology, there have been few studies evaluating the benefit of dermoscopy in the interpretation of patch tests, especially in weak and doubtful reactions.
Objectives
To evaluate the role of dermoscopy in the interpretation of patch tests and describe the main findings of the reactions.
Method
Prospective study, carried out in dermatology reference centers in southern Brazil, which evaluated the final results of patch tests analyzed with the aid of dermoscopy.
Results
77 patients and 160 reactions were included. The most prevalent substances were nickel sulphate (23.8%), kathon CG (9.4%), and perfume mix (8.8%). The main dermoscopic findings were reaction area greater than half of the chamber site (90%), homogeneous erythema (86.9%), vesicles (30%), crusts (21.3%), perifollicular erythema (35%), pore reaction (19.4%) and pustules (8.8%). Dermoscopy was found to facilitate the definition of erythema in reactions on black skin and when due to substances with deposition of pigment. Of the 64 weak or doubtful reactions, 36 (56.25%) showed a change in the final result after dermoscopy evaluation; of the 36 doubtful reactions, 33 (91.6%) showed a change in the final result after dermoscopy evaluation (p < 0.001).
Study limitations
The probable limitation of the study is its sample size. Though certain significance levels have been reached, other possible relationships may not have been observed.
Conclusion
Dermoscopy improves significantly the interpretation of patch tests, especially in weak and doubtful reactions.
Introdução: A Hanseníase (Doença de Hansen) é uma doença infectocontagiosa, que apresenta tropismo pela pele e nervos periféricos, cujo diagnóstico tardio pode causar sequelas físicas e emocionais. A Hanseníase em crianças é considerada um dos principais indicadores da tendência da doença e sugere intensa circulação do Mycobacterium leprae. Métodos: Um estudo retrospectivo, observacional e analítico foi conduzido com dezoito crianças diagnosticadas e tratadas no Ambulatório de Dermatologia Sanitária de Porto Alegre, Brasil. As informações clínicas e sociodemográficas foram obtidas através do Sistema de Informação de Agravos de Notificação (SINAN). Resultados: Durante o período de 2007-2017, 478 indivíduos foram diagnosticados como novos casos de Hanseníase em nosso Serviço; dentre esses, 18 (3,76%) eram crianças menores de 15 anos de idade, e sete foram diagnosticadas somente no ano de 2017. Dentre as 18 crianças, 15 (83,3%) eram multibacilares, e somente uma apresentou grau 2 de incapacidade. Aproximadamente 11% da amostra desenvolveram reações hansênicas durante o período de acompanhamento; 61,1% tinham entre 10 e 14 anos de idade. Contatos domiciliares foram identificados em 77,8% dos pacientes. Conclusão: Este estudo mostra que, apesar da situação endêmica ser menos preocupante no Sul do Brasil em relação às demais regiões brasileiras, o aumento da incidência de casos de Hanseníase em 2017 em indivíduos menores de 15 anos pode indicar uma mudança na tendência da doença e do indicador de detecção de casos novos da Hanseníase no Rio Grande do Sul, Brasil.
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