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Dermatoscopia práctica
Pápulas acrales múltiples
Multiple Acral Papules
X. Calderón-Castrata,
Corresponding author
xcalderoncastrat@gmail.com

Autor para correspondencia.
, I. Kikushimab, R. Ballonab
a Servicio de Dermatología Pediátrica, Instituto Nacional de Salud del Niño San Borja, Lima, Perú
b Servicio de Dermatología Pediátrica, Instituto Nacional de Salud del Niño Breña, Lima, Perú
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semejante a verrugas v&#237;ricas comunes&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Comentario</span><p id="par0015" class="elsevierStylePara elsevierViewall">La impresi&#243;n cl&#237;nica inicial fue de verrugas comunes&#46; Sin embargo&#44; la evaluaci&#243;n dermatosc&#243;pica revel&#243; un patr&#243;n amarillo sin estructura con un borde hiperquerat&#243;sico perif&#233;rico &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>a&#41;&#44; mostrando alguno de ellos nubes de dep&#243;sitos amarillos m&#225;s claros y vasos lineales &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>b&#41;&#46; Tras una biopsia que revel&#243; infiltraci&#243;n histiocitaria intrad&#233;rmica&#44; integrada por c&#233;lulas xantomatosas y c&#233;lulas gigantes de tipo Touton&#44; y con los hallazgos cl&#237;nicos&#44; dermatosc&#243;picos e histopatol&#243;gicos&#44; se estableci&#243; el diagn&#243;stico de XGJ&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">El XGJ es una histiocitosis de c&#233;lulas no Langerhans&#44; de curso benigno y autolimitado&#44; que afecta principalmente a ni&#241;os<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a>&#46; Se caracteriza cl&#237;nicamente por la presencia de p&#225;pulas y n&#243;dulos amarillentos&#44; solitarios o m&#250;ltiples<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; Se localiza preferentemente en cabeza y tronco&#59; sin embargo&#44; el XGJ puede desarrollarse en cualquier parte del cuerpo&#44; incluidas mucosas y genitales<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a>&#46; El diagn&#243;stico se basa en la mayor&#237;a de los casos en la observaci&#243;n cl&#237;nica&#44; pero puede plantear dificultades en presentaciones o ubicaciones at&#237;picas<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; Se han descrito varias caracter&#237;sticas dermatosc&#243;picas seg&#250;n el estado evolutivo del XGJ como son&#58; el patr&#243;n sin estructura amarillo-naranja con borde eritematoso &#40;signo de &#171;sol poniente&#187;&#41;&#44; gl&#243;bulos en forma de nubes de color amarillo&#44; vasos lineales o ramificados en su superficie y estr&#237;as blanquecinas<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">El diagn&#243;stico diferencial del XGJ acral&#44; en concreto para las lesiones solitarias&#44; incluye&#44; entre otras&#58; el nevo de Spitz&#44; el poroma ecrino<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3&#44;4</span></a>&#44; el granuloma pi&#243;geno<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> y el fibroqueratoma digital<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4&#44;5</span></a>&#46; Adem&#225;s&#44; el XGJ acral m&#250;ltiple puede confundirse f&#225;cilmente con las verrugas v&#237;ricas comunes&#46; Sin embargo&#44; el an&#225;lisis dermatosc&#243;pico revela la ausencia de hemorragias puntiformes y de superficie papilomatosa&#44; caracter&#237;sticas t&#237;picas de la infecci&#243;n v&#237;rica<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a>&#46; En casos at&#237;picos&#44; es necesario realizar un estudio histopatol&#243;gico que muestre la acumulaci&#243;n de c&#233;lulas no Langerhans denominadas c&#233;lulas gigantes de Touton&#44; positivas para el CD68 y negativas para S100 y CD1a&#44; propias de la histiocitosis cl&#225;sica<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El presente caso destaca por la gran variabilidad cl&#237;nica del XGJ y el papel fundamental que juega la dermatoscopia&#44; incluso para aquellas dermatosis de apariencia cl&#237;nicamente benigna como son las verrugas v&#237;ricas&#46; 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Article information
ISSN: 00017310
Original language: Spanish
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2021 January 84 16 100
2020 December 58 19 77
2020 November 55 14 69
2020 October 59 20 79
2020 September 45 12 57
2020 August 79 18 97
2020 July 64 14 78
2020 June 81 33 114
2020 May 121 24 145
2020 April 80 17 97
2020 March 85 22 107
2020 February 77 23 100
2020 January 187 19 206
2019 December 127 33 160
2019 November 6 1 7
2019 September 5 2 7
2019 July 2 0 2
2019 June 4 2 6
2019 May 1 2 3
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Idiomas
Actas Dermo-Sifiliográficas
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¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?