Case and Research Letter
Auricular Pseudocysts After Prolonged Protective Mask Wearing for SARS-CoV2
Pseudoquistes auriculares tras el uso prolongado de mascarillas como protección para el SARS-CoV2
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B)<span class="elsevierStyleHsp" style=""></span>Examen ecográfico: lesiones quísticas hipoecoicas con contenido anecoico y refuerzo posterior con incremento del espesor cartilaginoso en la ecografía. C)<span class="elsevierStyleHsp" style=""></span>Hematoxilina-eosina 10×: espacio intracartilaginoso carente de revestimiento epitelial, con adelgazamiento del cartílago y degeneración hialinizante a lo largo del borde interno del espacio quístico.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Lobato-Berezo, M.T. Fernández Figueras, R.M. Pujol" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Lobato-Berezo" ] 1 => array:2 [ "nombre" => "M.T." "apellidos" => "Fernández Figueras" ] 2 => array:2 [ "nombre" => "R.M." "apellidos" => "Pujol" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731023005173?idApp=UINPBA000044" "url" => "/00017310/0000011400000008/v2_202310161122/S0001731023005173/v2_202310161122/es/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0001731023005367" "issn" => "00017310" "doi" => "10.1016/j.ad.2023.07.004" "estado" => "S300" "fechaPublicacion" => "2023-09-01" "aid" => "3581" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2023;114:T735-T737" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => " Ichthyosiform Sarcoidosis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "T735" "paginaFinal" => "T737" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sarcoidosis ictiosiforme" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 679 "Ancho" => 2007 "Tamanyo" => 586418 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histopathology of lesions on the right knee at low magnification with the presence of a lymphohistiocytic inflammatory infiltrate and poorly formed granulomatous structures (hematoxylin–eosin, ×20). A, Increased magnification better reveals the granulomatous infiltration of the eccrine glands (hematoxylin–eosin, ×100). B, Histopathology of the lesions on the thigh, with infiltration of the eccrine glands by sarcoid granulomas (hematoxylin–eosin, ×100). C, Histopathology of pretibial ichthyosiform lesions showing orthokeratotic hyperkeratosis and sarcoid granulomas in the dermis (hematoxylin–eosin, ×100) (D). E, Immunohistochemistry for CD163 showing a high density of CD163-positive cells in the interstitial area surrounding the epithelioid granulomas (CD163, ×100).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Marcoval, C. Moreno-Vílchez, J. Molinero Caturla, R.M. Penín" "autores" => array:4 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Marcoval" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Moreno-Vílchez" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Molinero Caturla" ] 3 => array:2 [ "nombre" => "R.M." "apellidos" => "Penín" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731023005367?idApp=UINPBA000044" "url" => "/00017310/0000011400000008/v2_202310161122/S0001731023005367/v2_202310161122/en/main.assets" ] "asociados" => array:1 [ 0 => array:18 [ "pii" => "S0001731023005173" "issn" => "00017310" "doi" => "10.1016/j.ad.2022.01.060" "estado" => "S300" "fechaPublicacion" => "2023-09-01" "aid" => "3563" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2023;114:T738-T739" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científico-clínica</span>" "titulo" => " Pseudoquistes auriculares tras el uso prolongado de mascarillas como protección para el SARS-CoV-2" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "T738" "paginaFinal" => "T739" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Auricular Pseudocysts After Prolonged Protective Mask Wearing for SARS-CoV-2" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1770 "Ancho" => 2008 "Tamanyo" => 541617 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A)<span class="elsevierStyleHsp" style=""></span> Nódulos no inflamatorios bien definidos localizados en el hélix superior (lesión más pequeña) y fosa escafoidea (de donde se realizó la biopsia). B)<span class="elsevierStyleHsp" style=""></span>Examen ecográfico: lesiones quísticas hipoecoicas con contenido anecoico y refuerzo posterior con incremento del espesor cartilaginoso en la ecografía. C)<span class="elsevierStyleHsp" style=""></span>Hematoxilina-eosina 10×: espacio intracartilaginoso carente de revestimiento epitelial, con adelgazamiento del cartílago y degeneración hialinizante a lo largo del borde interno del espacio quístico.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Lobato-Berezo, M.T. Fernández Figueras, R.M. Pujol" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Lobato-Berezo" ] 1 => array:2 [ "nombre" => "M.T." "apellidos" => "Fernández Figueras" ] 2 => array:2 [ "nombre" => "R.M." "apellidos" => "Pujol" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731023005173?idApp=UINPBA000044" "url" => "/00017310/0000011400000008/v2_202310161122/S0001731023005173/v2_202310161122/es/main.assets" ] ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Auricular Pseudocysts After Prolonged Protective Mask Wearing for SARS-CoV2" "tieneTextoCompleto" => true "saludo" => "To the Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "738" "paginaFinal" => "739" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Lobato-Berezo, M.T.F. Figueras, R.M. Pujol" "autores" => array:3 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Lobato-Berezo" "email" => array:1 [ 0 => "allobe@hotmail.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M.T.F." "apellidos" => "Figueras" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "R.M." "apellidos" => "Pujol" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Dermatology, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Pathology, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pseudoquistes auriculares tras el uso prolongado de mascarillas como protección para el SARS-CoV2" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1322 "Ancho" => 1500 "Tamanyo" => 383814 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Well-defined non-inflammatory nodules located in the upper helix (small) and scaphoid fossa (biopsy). (B) Ultrasound examination: hypoechoic cystic lesions with anechoic content and posterior reinforcement with increased cartilage thickness in the ultrasounds. (C) Hematoxilin–eosin 10×: intracartilaginous space lacking an epithelial lining with thinning cartilage and hyalinising degeneration along the internal border of the cystic space.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Auricular pseudocyst is a rare benign condition clinically manifested as a painless, fluctuant cystic nodule secondary to intracartilagenous fluid accumulation on the lateral or anterior surface of the ear, usually in the scaphoid or triangularis fossa. The etiology is unknown, although chronic low-grade trauma and congenital embryonic dysplasia of the auricular cartilage have been postulated as predisposing factors. We report the case of a patient with bilateral and synchronous auricular pseudocysts that appeared after prolonged wearing of protective masks during the COVID-19 pandemic.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 35-year-old man presented with slightly tender lesions in both ears that had appeared two months after prolonged wearing (more than 8<span class="elsevierStyleHsp" style=""></span>h per day) non-approved protective masks against SARS-CoV2. The patient denied any local major trauma. Physical examination revealed 5–10<span class="elsevierStyleHsp" style=""></span>mm, elastic, erythematous nodules, located in both left and right upper helix, antihelix and scaphoid fossas of both ears (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Ultrasounds revealed a hypoechoic cystic lesion with anechoic content and posterior reinforcement with increased cartilage thickness (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). No increased intralesional or perilesional blood flow in the Doppler images were noted. Fine needle aspiration showed a viscous straw-yellow fluid that was sterile after culture. A 3<span class="elsevierStyleHsp" style=""></span>mm punch showed an intracartilaginous cleft devoid of epithelial lining and focal eosinophilic hyaline degeneration of the cartilage along the internal border of the cystic space. The overlying dermis showed a perivascular lymphocytic infiltrate (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). Considering the diagnosis of bilateral auricular pseudocysts, the patient was recommended to wear approved protective masks with a non-tight device in order to avoid local pressure from the ears to the occipital area. Two months later, the lesions had resolved and no relapses were noted after six months of follow-up.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Auricular pseudocyst, also known as benign idiopathic cystic chondromalacia, is a rare and probably underreported condition. Clinically is manifested as a localized oval-shaped swelling arising on the lateral surface of pinna. It usually affects an auricle, but rare cases of bilateral involvement have also been reported.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Development of auricular pseudocysts has occasionally been related to chronic, repeated and often mild traumatic events (rubbing, ear pulling, sleeping on hard pillows, wearing helmets, earphones or headphones). In our patient, the lesions were bilateral and resolved two months after releasing both ears of the pressure that was being applied by the protective mask. No recurrences were observed during the follow-up. A potential role of mask-induced pressure microtraumatisms could be postulated as a predisposing factor for the bilateral and symmetrical development of these lesions.</p><p id="par0020" class="elsevierStylePara elsevierViewall">During the pandemic, personal protective equipments have been responsible for some skin-related adverse events, specially if prolonged worn.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Mask usage may have increased the probability of acne flare-ups, commonly called “maskne”, pruritus, worsening of pre-existing dermatoses, irritant contact dermatitis or abrasions.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Bilateral auricular pseudocysts could probably be added to the list of potential mask-induced skin related side effects.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Pseudocysts of the auricle are usually diagnosed by anamnesis (non-acute painless swelling, usually present metachronously, but can also occur synchronously) and examination (absence of inflammatory signs), although a punch biopsy may help to confirm diagnosis. Ultrasounds is also a technique that may aid in the differential diagnoses that include subperichondrial hematoma caused by accumulation of blood secondary to trauma, relapsing polychondritis, chondrodermatitis nodularis helicis, cellulitis and otoseroma.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion, we describe auricular pseudocysts as a new complication caused by long time wearing protective masks that should be taken into account due to a worldwide widespread wearing of these as part of personal protective equipment against SARS-CoV2.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interests" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1322 "Ancho" => 1500 "Tamanyo" => 383814 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Well-defined non-inflammatory nodules located in the upper helix (small) and scaphoid fossa (biopsy). (B) Ultrasound examination: hypoechoic cystic lesions with anechoic content and posterior reinforcement with increased cartilage thickness in the ultrasounds. (C) Hematoxilin–eosin 10×: intracartilaginous space lacking an epithelial lining with thinning cartilage and hyalinising degeneration along the internal border of the cystic space.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Auricular pseudocysts: a systematic review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Ballan" 1 => "S. Zogheib" 2 => "C. Hanna" 3 => "B. Daou" 4 => "M. Nasr" 5 => "S. Jabbour" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Int J Dermatol" "fecha" => "2021" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Skin adverse events related to personal protective equipment: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T. Montero-Vilchez" 1 => "C. Cuenca-Barrales" 2 => "A. Martinez-Lopez" 3 => "A. Molina-Leyva" 4 => "S. Arias-Santiago" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2021" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adverse skin reactions following different types of mask usage during the COVID-19 pandemic" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. Chaiyabutr" 1 => "T. Sukakul" 2 => "C. Pruksaeakanan" 3 => "J. Thumrongtharadol" 4 => "W. Boonchai" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2021" "volumen" => "35" "paginaInicial" => "e176" "paginaFinal" => "e178" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Auricular pseudocyst: sonographic appearance in 17 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Whittle" 1 => "A. Castro" 2 => "M.J. Pereira" 3 => "R. Cabrera" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Ultrasound Q" "fecha" => "2020" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bilateral auricular pseudocyst: recognizing and treating" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Laschen" 1 => "F.R. Datema" 2 => "V.C. Koot" 3 => "P.J. Lohuis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-0034-1396528" "Revista" => array:6 [ "tituloSerie" => "Facial Plast Surg" "fecha" => "2014" "volumen" => "30" "paginaInicial" => "690" "paginaFinal" => "693" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25536139" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00017310/0000011400000008/v2_202310161122/S0001731022001545/v2_202310161122/en/main.assets" "Apartado" => array:4 [ "identificador" => "6160" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Cartas científico-clínicas" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/00017310/0000011400000008/v2_202310161122/S0001731022001545/v2_202310161122/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731022001545?idApp=UINPBA000044" ]
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