Case and Research Letter
Ultrasound Image of a Stair-Like Border in Circumscribed Palmar Hypokeratosis
Hipoqueratosis palmar circunscrita: signo de la escalera ecográfico
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Placa circular eritemato-rosada levemente deprimida, de contorno neto, de 14<span class="elsevierStyleHsp" style=""></span>mm de diámetro localizada en la eminencia hipotenar izquierda.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. Luna-Bastante, M. Sigüenza, L. Nájero, F. Alfageme" "autores" => array:4 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Luna-Bastante" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Sigüenza" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Nájero" ] 3 => array:2 [ "nombre" => "F." 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"apellidos" => "Luna-Bastante" "email" => array:1 [ 0 => "loretoluna.abm@hotmail.com" ] "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." "apellidos" => "Sigüenza" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "L." "apellidos" => "Nájero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "F." "apellidos" => "Alfageme" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Complejo Hospitalario de Toledo, Hospital Virgen del Valle, Toledo, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Universidad Autónoma de Madrid, Ciudad Universitaria de Cantoblanco, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hipoqueratosis palmar circunscrita: signo de la escalera ecográfico" ] ] "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" => 1333 "Ancho" => 750 "Tamanyo" => 88651 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Photograph of the patient's left palm, showing an erythematous, pinkish, slightly depressed plaque on the hypothenar eminence. The lesion has well-circumscribed borders and measures 14<span class="elsevierStyleHsp" style=""></span>mm along the longest axis.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Circumscribed palmar hypokeratosis (CPH), described for the first time in 2002 by Pérez et al.,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> is characterized by a solitary reddish scaly lesion with well-defined borders. Otherwise asymptomatic, CPH lesions are typically located on the thenar or hypothenar eminences of the hand or in the midplantar region of the foot and progress for years before a physician is consulted.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1–5</span></a> CPH resembles Bowen disease and actinic porokeratosis, conditions that must be ruled out. Histologic features are a steep stair-like depression in the epidermis, with thinning of the stratum corneum and a granular appearance that contrasts with adjacent skin.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2,4</span></a> In CPH no cornoid lamella can be observed in serial sections of biopsied tissue, differentiating this diagnosis from actinic porokeratosis.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A 65-year-old woman with no prior medical history of interest consulted us for an asymptomatic lesion on the hypothenar eminence of her left hand. She reported that it was unrelated to friction or injury. Physical examination revealed a solitary pinkish plaque 14<span class="elsevierStyleHsp" style=""></span>mm along the longest axis. The plaque had clearly defined borders, was slightly depressed, not infiltrated, and not scaling (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">High-frequency ultrasound imaging was performed in B and Doppler color modes with a 10-22<span class="elsevierStyleHsp" style=""></span>MHz linear probe (Esaote MyLab Class C, Genoa, Italy). The B-mode image revealed abrupt epidermal thinning, with structural loss in a double hyperechogenic layer that sloped to form a single hyperechogenic layer under which a subepidermal low-echogenic band (SLEB) could be seen. The Doppler color image ruled out abnormal vascularization.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The case is noteworthy for good correlation between the ultrasound images and histologic features in biopsied tissue (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">CPH is a benign condition, but it should be conclusively diagnosed to rule out Bowen disease.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Approximately 50 to 70 case reports of CPH have been published to date and all describe histologic findings consistent with a depression corresponding to stair-like epidermal thinning.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a> Few diagnostic images can be found in the literature, however.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Images recently obtained by optimal coherence tomography in 4 patients with CPH<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> showed a nearly abolished stratum corneum, although the lucidum and granulosum strata were preserved. In 1 patient in that series, high-frequency ultrasound showed the stair-like sign with good histologic correlation.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Characteristic CPH findings were also described by a group using the DermaScan high-frequency ultrasound device.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Loss of structure could be seen in acral skin, where there was thinning of the double echogenic layer, which abruptly dropped to form a single echogenic layer with the decreasing echogenicity of SLEB, findings that correspond to the stair-like sign. The images obtained with the DermaScan device were difficult to interpret, however, and this device is little used in our practice setting.</p><p id="par0045" class="elsevierStylePara elsevierViewall">This report of a case of CPH with histopathologic confirmation also describes high-frequency B-mode ultrasound findings, a diagnostic technique available to dermatologists in our current practice settings in Spain. With this use of ultrasound imaging, a confirmed diagnosis can be reached without resorting to invasive techniques.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0050" class="elsevierStylePara elsevierViewall">The present study received no specific funding from agencies in the public, private, or nonprofit sectors.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of Interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of Interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1333 "Ancho" => 750 "Tamanyo" => 88651 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Photograph of the patient's left palm, showing an erythematous, pinkish, slightly depressed plaque on the hypothenar eminence. The lesion has well-circumscribed borders and measures 14<span class="elsevierStyleHsp" style=""></span>mm along the longest axis.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 703 "Ancho" => 1510 "Tamanyo" => 187819 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Correlation between ultrasound and histologic findings. A, B-mode ultrasound image, 22<span class="elsevierStyleHsp" style=""></span>mHz. Area of abrupt epidermal thinning, sloping downward, with structural loss in a double hyperechogenic layer of acral skin. The image is similar to the stair-like sign. SLEB (a subepidermal low-echogenic band) can be observed under the affected epidermis. B, Histopathology shows an abrupt depression in the epidermis due to corneal layer thinning and shedding. The high correlation between ultrasonography and histology is evident.</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" => "Circumscribed palmar or plantar hypokeratosis: a distinctive epidermal malformation of the palms or soles" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Pérez" 1 => "A. Rütten" 2 => "R. Gold" 3 => "F. Urbina" 4 => "C. Misad" 5 => "M.J. 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Dańczak-Pazdrowska" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5114/aoms.2016.62920" "Revista" => array:6 [ "tituloSerie" => "Arch Med Sci" "fecha" => "2016" "volumen" => "12" "paginaInicial" => "1389" "paginaFinal" => "1391" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27904535" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Examination of circumscribed palmar hypokeratosis with line-field confocal optical coherence tomography: dermoscopic, ultrasonographic and histopathologic correlates" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Tognetti" 1 => "D. Fiorani" 2 => "M. Suppa" 3 => "E. Cinotti" 4 => "M. Fontaine" 5 => "V. Marmol" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/ijdvl.IJDVL_546_19" "Revista" => array:6 [ "tituloSerie" => "Indian J Dermatol Venereol Leprol" "fecha" => "2020" "volumen" => "86" "paginaInicial" => "206" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32031108" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1542356513018375" "estado" => "S300" "issn" => "15423565" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00017310/0000011300000007/v1_202207140532/S0001731022004616/v1_202207140532/en/main.assets" "Apartado" => array:4 [ "identificador" => "6143" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Cartas científico-clínicas" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/00017310/0000011300000007/v1_202207140532/S0001731022004616/v1_202207140532/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731022004616?idApp=UINPBA000044" ]
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| 2024 May | 75 | 37 | 112 |
| 2024 April | 64 | 43 | 107 |
| 2024 March | 64 | 35 | 99 |
| 2024 February | 40 | 22 | 62 |
| 2024 January | 45 | 45 | 90 |
| 2023 December | 42 | 41 | 83 |
| 2023 November | 60 | 34 | 94 |
| 2023 October | 51 | 51 | 102 |
| 2023 September | 49 | 33 | 82 |
| 2023 August | 43 | 18 | 61 |
| 2023 July | 78 | 40 | 118 |
| 2023 June | 44 | 24 | 68 |
| 2023 May | 55 | 25 | 80 |
| 2023 April | 33 | 24 | 57 |
| 2023 March | 59 | 36 | 95 |
| 2023 February | 71 | 32 | 103 |
| 2023 January | 56 | 64 | 120 |
| 2022 December | 70 | 55 | 125 |
| 2022 November | 51 | 43 | 94 |
| 2022 October | 62 | 39 | 101 |
| 2022 September | 53 | 53 | 106 |
| 2022 August | 105 | 99 | 204 |
| 2022 July | 112 | 61 | 173 |
| 2022 June | 92 | 83 | 175 |
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