Publications by authors named "Walter Belda Junior"

23 Publications

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First report of cutaneous mycetoma by Paecilomyces variotii and the successful treatment with combined itraconazole and terbinafine along with resection surgeries.

Australas J Dermatol 2021 Mar 24. Epub 2021 Mar 24.

Laboratory of Pathology of Infectious Diseases (LIM-50), Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil.

Mycetoma is a progressively mutilating infectious disease of the subcutaneous tissue that affects the skin and deep structures, which is poorly responsive to chemotherapy. Here, we report a skin mycetoma caused by Paecilomyces variotii, an uncommon fungus of human infections, and the therapeutic approach that resulted in a complete cure of the patient.
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http://dx.doi.org/10.1111/ajd.13592DOI Listing
March 2021

Donovanosis.

An Bras Dermatol 2020 Nov - Dec;95(6):675-683. Epub 2020 Sep 17.

Department of Dermatology, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil. Electronic address:

Donovanosis is a chronic, progressive, and indolent bacterial disease that affects the skin and mucous membranes of the genital and perigenital regions, often associated with sexual transmission, and with low infectivity. The malignant transformation of donovanosis lesions occurs exceptionally, as is usually seen in long-term ulcerations.
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http://dx.doi.org/10.1016/j.abd.2020.07.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7672488PMC
November 2020

Potential interactions of SARS-CoV-2 with human cell receptors in the skin: Understanding the enigma for a lower frequency of skin lesions compared to other tissues.

Exp Dermatol 2020 10;29(10):936-944

LIM-50, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) represents a new public health problem, with a total of 10.577.263 documented COVID-19 cases worldwide and 513.441 deaths up to the present date. Few cases of disease-related cutaneous manifestations have been reported in the literature, and such manifestations are scarce. Integumentary manifestations from COVID-19 include exanthemas and papular dermatoses, urticarial eruptions, atopic dermatitis, vesiculobullous lesions and skin signs of hypercoagulable states, such as acral ischaemia, livedo and retiform purpura. Most common extracutaneous manifestations from the disease include headache, cough, anosmia, ageusia, fever, dyspnoea, nausea, diarrhoea and cardiovascular events. The objectives of this review were to discuss the role of human cell receptors described as interaction targets of SARS-CoV-2, as well to understand the current state of knowledge on skin expression of these receptors, in order to substantiate future research. The authors present a thorough literature review on SARS-CoV-2 and its possible interaction with cell receptors and human tissues including the skin. They discuss a molecular hypothesis to explain the lower prevalence of dermatological manifestations from direct SARS-CoV-2 infection. Distinct human cell receptors binding the virus appear to be less expressed in the skin compared to other organs. Additionally, the presence of resolvins and the disintegrin metalloprotease ADAM17 provide a putative protection to the skin, explaining the majority of COVID-19 manifestations to be extracutaneous. This review represents an excellent opportunity for future studies using skin biopsies from COVID-19 patients to investigate molecular expression in the pathophysiology of cutaneous manifestations of the disease.
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http://dx.doi.org/10.1111/exd.14186DOI Listing
October 2020

Atypical clinical presentation of an Arthroderma gypseum infection in a renal transplant recipient.

Rev Inst Med Trop Sao Paulo 2020 22;62:e42. Epub 2020 Jun 22.

Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório de Investigação Médica (LIM-50), São Paulo, São Paulo, Brazil.

Dermatophytes are known as a common cause of superficial mycosis, but atypical presentations in immunosuppressed patients make the diagnosis more challenging. Here, we report a case of a 39-year-old patient, a renal transplant recipient from a living donor, who presented with atypical cutaneous lesions of lower extremities caused by Arthroderma gypseum (Nannizzia gypsea), four months after receiving a renal transplant. It is important to highlight the importance of the early detection of fungal infections in immunosuppressed patients. Clinicians should have a high degree of suspicion for the early detection and treatment of the cases.
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http://dx.doi.org/10.1590/S1678-9946202062042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7310607PMC
June 2020

Multinucleate cell angiohistiocytoma: an uncommon cutaneous tumor.

An Bras Dermatol 2020 Jul - Aug;95(4):480-483. Epub 2020 May 11.

Department of Dermatology, Faculdade de Medicina do ABC, Santo André, SP, Brazil.

Multinucleate cell angiohistiocytoma is a rare, benign vascular proliferation of unknown etiology. It occurs mainly in middle-aged women and usually affects the acral regions; the lesions appear as discrete, grouped, and asymptomatic violaceous papules. Histopathology shows proliferation and dilated small vessels in the papillary dermis, fibrous stroma with thickened collagen bundles, and multinucleated giant cells. To date, there are approximately 140 cases described in the indexed literature. This report presents the case of a 62-year-old woman with a typical clinical condition, who chose not undergo treatment, considering the benign character of her illness. The clinical and immunohistological aspects of this unusual dermatological entity are emphasized.
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http://dx.doi.org/10.1016/j.abd.2019.10.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7335878PMC
August 2020

In situ immune response in human dermatophytosis: possible role of Langerhans cells (CD1a+) as a risk factor for dermatophyte infection.

Rev Inst Med Trop Sao Paulo 2019 10;61:e56. Epub 2019 Oct 10.

Universidade de São Paulo, Instituto de Medicina Tropical, Laboratório de Micologia Médica, São Paulo, São Paulo, Brazil.

Dermatophytosis is a cutaneous mycosis caused by a plethora of keratinophilic fungi, but Trichophyton rubrum is the most common etiological agent. Despite its high prevalence worldwide, little is known about the host defense mechanisms in this infection, particularly the in situ immune response. Using an immunohistochemistry approach, we investigated the density of CD1a+, factor XIIIa+ and CD68+ cells in the skin of dermatophytosis patients. Langerhans cells (CD1a+ cells) were significantly decreased in the epidermis of patients, both in affected and unaffected areas. In the dermis, however, no differences in the density of macrophages (CD68+ cells) and dermal dendrocytes (factor XIIIa+ cells) were observed. These results suggest that the decreased number of Langerhans cells may be a risk factor for development of dermatophytosis.
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http://dx.doi.org/10.1590/S1678-9946201961056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6792354PMC
October 2019

Descriptive survival study of nail melanoma patients treated with functional surgery versus distal amputation.

J Am Acad Dermatol 2018 Jul 19;79(1):147-149. Epub 2017 Dec 19.

Hospital do Servidor Público Municipal São Paulo, São Paulo, Brazil.

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http://dx.doi.org/10.1016/j.jaad.2017.12.030DOI Listing
July 2018

Dermoscopy and Onychomycosis: guided nail abrasion for mycological samples.

An Bras Dermatol 2015 Nov-Dec;90(6):904-6

Universidade de São Paulo, São Paulo, SP, Brazil.

Mycological examination is still the cornerstone for the diagnosis of onychomycosis for many dermatologists, but sampling technique interferes on its sensitivity and specificity. Nail abrasion may be used to reach the most proximal part of the lesion and can be easily accomplished with an electric abrasor. We suggest nail plate dermoscopy to identify the best location for localized abrasion to obtain adequate samples for mycological examination.
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http://dx.doi.org/10.1590/abd1806-4841.20154615DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4689084PMC
June 2016

Primary cutaneous histoplasmosis developed in the penis of an immunocompetent patient.

An Bras Dermatol 2015 Mar-Apr;90(2):255-7

Universidade de São Paulo, São Paulo, SP, Brazil.

A 70-year-old male presenting a 3-month history of genital painless erythematous nodules in the balanopreputial sulcus was referred to our service. Histopathological exam presented a chronic dermatitis with epithelioid granulomas and Grocott staining revealed numerous fungal structures with a suggestive morphology of Histoplasma sp. Cultures evidenced Histoplasma capsulatum var. capsulatum. Treatment with oral itraconazole led to complete remission of lesions.
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http://dx.doi.org/10.1590/abd1806-4841.20153224DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4371679PMC
July 2015

Toll-like receptors (TLR) 2 and 4 expression of keratinocytes from patients with localized and disseminated dermatophytosis.

Rev Inst Med Trop Sao Paulo 2015 Jan-Feb;57(1):57-61

Department of Dermatology, Medical School, University of Sao Paulo, São Paulo, SP, Brazil.

There are few studies on the role of innate immune response in dermatophytosis. An investigation was conducted to define the involvement of Toll-Like Receptors (TLRs) 2 and 4 in localized (LD) and disseminated (DD) dermatophytosis due to T. rubrum. Fifteen newly diagnosed patients, eight patients with LD and seven with DD, defined by involvement of at least three body segments were used in this study. Controls comprised twenty skin samples from healthy individuals undergoing plastic surgery. TLR2 and TLR4 were quantified in skin lesions by immunohistochemistry. A reduced expression of TLR4 in the lower and upper epidermis of both LD and DD patients was found compared to controls; TLR2 expression was preserved in the upper and lower epidermis of all three groups. As TLR4 signaling induces the production of inflammatory cytokines and neutrophils recruitment, its reduced expression likely contributed to the lack of resolution of the infection and the consequent chronic nature of the dermatophytosis. As TLR2 expression acts to limit the inflammatory process and preserves the epidermal structure, its preserved expression may also contribute to the persistent infection and limited inflammation that are characteristic of dermatophytic infections.
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http://dx.doi.org/10.1590/S0036-46652015000100008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4325524PMC
July 2015

Cutaneous New World Leishmaniasis on a Port-wine stain birthmark.

An Bras Dermatol 2014 Jul-Aug;89(4):669-70

Universidade de São Paulo, São Paulo, SP, Brazil.

We present an interesting case report of two sarcoid-like lesions on a port-wine stain (PWS) birthmark in a Brazilian patient which on investigation proved to be cutaneous leishmaniasis.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4148289PMC
http://dx.doi.org/10.1590/abd1806-4841.20142532DOI Listing
December 2014

A prospective, open, comparative study of 5% potassium hydroxide solution versus cryotherapy in the treatment of genital warts in men.

An Bras Dermatol 2014 Mar-Apr;89(2):236-40

São Paulo University, São Paulo, SP, Brazil.

Background: Genital warts are caused by human papillomavirus infection and represent one of the most common sexually transmitted diseases. Many infections are transient but the virus may recur, persist, or become latent. To date, there is no effective antiviral treatment to eliminate HPV infection and most therapies are aimed at the destruction of visible lesions. Potassium hydroxide is a strong alkali that has been shown to be safe and effective for the treatment of genital warts and molluscum contagiosum. Cryotherapy is considered one of the most established treatments for genital warts. No comparative trials have been reported to date on the use of potassium hydroxide for genital warts.

Objective: A prospective, open-label, randomized clinical trial was conducted to compare topical potassium hydroxide versus cryotherapy in the treatment of genital warts affecting immunocompetent, sexually active men.

Methods: Over a period of 10 months, 48 patients were enrolled. They were randomly divided into two groups and selected on an alternative basis for either potassium hydroxide therapy or cryotherapy. While response to therapy did not differ substantially between both treatment modalities, side effects such as local pain and post-treatment hypopigmentation were considerably more prevalent in the groups treated using cryotherapy.

Result: In our study, potassium hydroxide therapy proved to be at least as effective as cryotherapy and offered the benefit of a better safety profile.

Conclusion: Topical 5% potassium hydroxide presents an effective, safe, and low-cost treatment modality for genital warts in men and should be included in the spectrum of therapies for genital warts.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008052PMC
http://dx.doi.org/10.1590/abd1806-4841.20141702DOI Listing
September 2014

Zoon's plasma cell balanitis: a report of two cases treated with pimecrolimus.

An Bras Dermatol 2011 Jul-Aug;86(4 Suppl 1):S35-8

Departamento de Dermatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil.

Unlabelled: Initially called (in French) "Balanoposthite chronique circonscrite benigne a plasmocytes", Zoon's plasma cell balanitis is a chronic inflammatory dermatosis affecting the glans and foreskin of uncircumcised men. The different treatment options for this condition often present partial results. Reports have shown therapeutic success using topical tacrolimus. We report the use of pimecrolimus, a homologue of tacrolimus, with good response. Two male patients diagnosed with Zoon's plasma cell balanitis, confirmed by biopsy, were subjected to daily treatment with topical pimecrolimus1%. Significant improvement was noted in patient 1 after 6 weeks and after 8 weeks in patient 2.

Conclusion: Pimecrolimus cream may be an option for the treatment of this disease.
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http://dx.doi.org/10.1590/s0365-05962011000700008DOI Listing
March 2012

Bedbugs (Cimicidae infestation): the worldwide renaissance of an old partner of human kind.

Braz J Infect Dis 2011 Jan-Feb;15(1):74-80

School of Medicine, Hospital das Clínicas, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, Sao Paulo, Brazil.

Bedbugs have been known as a human parasite for thousands of years, but scientific studies about this insect are recent and limited. Cimex lectularius, the common bedbug, was a well-known parasite in human dwellings until the end of the Second World War. Nowadays, bedbugs are considered uncommon in the industrialized world. Anecdotal reports suggest that bedbugs are getting more common in the United States, Canada, and United Kingdom. In Brazil, there are few reports about bedbug infestations in the literature. The aim of this article was to alert physicians, especially in Brazil, about this ectoparasitosis, including aspects of the bedbug biology, their parasitism in human host, treatment and prophylaxis.
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http://dx.doi.org/10.1016/s1413-8670(11)70144-1DOI Listing
September 2011

Treatment of human papillomavirus in childhood with imiquimod 5% cream.

An Bras Dermatol 2010 Jul-Aug;85(4):549-53

Departamento de Dermatologia, Universidade de São Paulo, São Paulo, SP, Brasil.

In children, lesions caused by the human papillomavirus (HPV) constitute a significant epidemiological issue and a therapeutic dilemma, particularly in the case of anogenital warts. The treatment of anogenital warts in children is a challenge, since standard treatments are generally painful and require the patient to be anesthetized. Imiquimod, a topical immune response modifier, constitutes an alternative therapeutic agent for the treatment of HPV. The present report describes four cases in which treatment with topically applied imiquimod 5% cream was implemented with successful results.
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http://dx.doi.org/10.1590/s0365-05962010000400020DOI Listing
April 2011

[Pedroso and Gomes' verrucous Dermatitis (Chromoblastomycosis): 90 years on and still among us].

An Bras Dermatol 2010 Jan-Feb;85(1):104-5

Hospital das Clínicas, Universidade de São Paulo, SP, Brasil.

In this report, the authors describe the clinical case of a woman seeking care at this dermatology outpatient clinic with a verrucous plaque on her left elbow.
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http://dx.doi.org/10.1590/s0365-05962010000100018DOI Listing
September 2010

Approach in sexually transmitted diseases.

An Bras Dermatol 2009 Mar-Apr;84(2):151-9

Department of Sexually Transmitted Diseases /AIDS, Brazilian Society of Dermatology, Brazil.

Nowadays, sexually transmitted diseases are one of the most common public health issues. Among its consequences are the possibility of transmission from mother to baby - which may cause miscarriages and congenital disease, male and female infertility, and the increase of HIV infection risk. Therefore, the main goal of these guidelines is to contribute to the improvement of the treatment for sexually transmitted diseases patients by presenting to the medical community how today's science stands on the matter and also what the recommendation for diagnosing and treating a patient are.
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http://dx.doi.org/10.1590/s0365-05962009000200008DOI Listing
August 2009

Donovanosis.

Braz J Infect Dis 2008 Dec;12(6):521-5

Division of Dermatology, Campinas University, Campinas, SP, Brazil.

Donovanosis is a chronic bacterial illness frequently associated with sexually transmitted infections (STI) and is under diagnosed both in endemic areas as well as in countries in which doctors have little experience with tropical diseases. The utilization of syndromic diagnosis and treatment of STIs in various parts of the world and the previous use of antibiotics make it difficult to find Donovan bodies in the cytodiagnostic and hystopathological exams, requiring the utilization of technology that is neither routine nor often accessible to confirm the hypothesized diagnosis. Therefore, it is necessary to bring medical professionals up to date about this infectious disease.
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http://dx.doi.org/10.1590/s1413-86702008000600015DOI Listing
December 2008

Nonablative 1,064-nm Nd:YAG laser for treating atrophic facial acne scars: histologic and clinical analysis.

Dermatol Surg 2007 Dec;33(12):1470-6

Department of Dermatology, University of São Paulo, São Paulo, Brazil.

Background: Non-ablative methods have been attempted in treating atrophic facial scars, but the histologic findings do not always coincide with the clinical results and patient satisfaction.

Objective: To study the effects and safety of the Nd:YAG laser for treating atrophic facial scars.

Material And Methods: Twelve subjects (skin phototypes II-V) with mild to moderate atrophic facial acne scars received five monthly treatments with 1,064 nm Nd:YAG laser and were photographed before, in the middle of, and 6 months after the last treatment. Histologic evaluations were performed on skin biopsies obtained before treatment and 1 month after the last session. Collagen quantification per area, before and after the treatment, was performed by morphometry, with computerized image analysis. Patient satisfaction and clinical condition were assessed using standard grading scales.

Results: Mild to moderate clinical improvement was observed in most patients. Photographic assessment of scars found visible cosmetic improvement in eleven patients. All patients were satisfied. There were statistically significant collagen increases in the dermis following the treatment. Side effects were limited to mild transient erythema and increased skin sensitivity after the procedure.

Conclusions: The 1,064 nm Nd:YAG laser is a safe and effective nonablative method for improving atrophic scars, even in darker skin.
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http://dx.doi.org/10.1111/j.1524-4725.2007.33318.xDOI Listing
December 2007

Evaluation of the in vitro activity of six antimicrobial agents against Neisseria gonorrhoeae.

Rev Inst Med Trop Sao Paulo 2007 Jan-Feb;49(1):55-8

Department of Dermatology, São Paulo University, São Paulo, SP, Brazil.

Use of antimicrobials for the treatment of gonorrhea started in 1930 with the utilization of sulfonamides. With the years other drugs were used for its treatment such as penicillin, tetracycline, spectinomycin, and others. Although highly specific in the beginning, these drugs, with time did not show anymore the expected therapeutic results because of aspects of chromosomal and plasmid-mediated resistance. The purpose of this study was to evaluate the susceptibility of Neisseria gonorrhoeae strains to six drugs used for its treatment (penicillin, tetracycline, cefoxitin, thiamphenicol, spectinomycin and ofloxacin) by the determination of minimal inhibitory concentrations of these drugs. We concluded that drugs, such as cefoxitin, thiamphenicol and spectinomycin still are excellent pharmacological agents for the treatment of gonorrhea. Penicillin, although still efficient, needs more attention regarding its use, as well as ofloxacin, because of the emergence of resistant strains. Tetracycline and its derivatives should be strongly contraindicated for the treatment of gonorrhea.
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http://dx.doi.org/10.1590/s0036-46652007000100010DOI Listing
July 2007

Acute generalized exanthematous pustulosis (AGEP). Case report.

Rev Inst Med Trop Sao Paulo 2005 May-Jun;47(3):171-6. Epub 2005 Jul 12.

Department of Dermatology, São Paulo University, São Paulo, SP, Brazil.

Acute Generalized Exanthematous Pustulosis (AGEP) is a drug-induced dermatosis characterized by an acute episode of sterile pustules over erythematous-edematous skin. It is accompanied by an episode of fever, which regresses a few days after discontinuation of the drug that caused the condition or as a result of corticosteroid treatment. The main triggering drugs are antibiotics, mainly beta-lactam ones. Other medications, such as antifungal agents, non steroid anti-inflammatory drugs, analgesics, antiarrhythmic, anticonvulsant and antidepressant drugs, may also be responsible. Histologically, it is characterized by the existence of vasculitis, associated with non-follicular subcorneal pustules. A case of a Caucasian female outpatient unit of Dermatology with AGEP, who presented with generalized pustulosis lesions after the use of cephalosporin for urinary infection is related. The diagnosis was confirmed by the clinical and pathological correlations, the resolution of the dermatosis after discontinuation of the drug and use of systemic corticosteroid treatment, and the recurrence of the disorder after the introduction of a similar drug. The importance of the recognition of this drug-induced dermatosis is given by its main differential clinical and histological diagnoses: generalized pustular psoriasis and subcorneal pustulosis.
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http://dx.doi.org/10.1590/s0036-46652005000300011DOI Listing
November 2005
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