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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Facial discoid dermatosis &#40;FDD&#41; is a recently described condition<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> that differs from other facial dermatoses in its clinical appearance and histopathologic findings&#8212;which mimic those of pityriasis rubra pilaris &#40;PRP&#41;&#8212;as well as in its failure to respond to treatment&#46; We describe a characteristic case of FDD&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 61-year-old man with no remarkable past medical history presented with 3 intensely pruriginous lesions that had appeared 2 months before&#46; He had tried antihistamines&#44; corticosteroids&#44; antibiotics&#44; and topical antifungal creams without seeing improvement&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Physical examination showed a salmon-colored erythematous plaque with thick yellowish&#44; adherent scaling&#46; The plaque in the left malar region measured approximately 3<span class="elsevierStyleHsp" style=""></span>cm in diameter and affected the lower eyelid&#46; Two other similar but smaller plaques were observed&#46; They were circular and on the right side of the nose&#46; Involvement of the eyelid progressed and eventually caused marked ectropion &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Two biopsies were performed for histopathology &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>a and b&#41;&#46; The results of laboratory analyses &#40;a full blood work-up including biochemistry&#44; immunoglobulins&#44; and antibodies&#41; were normal or negative&#44; as were patch tests&#46; Successive treatments with clobetasol&#44; prednisone&#44; hydroxychloroquine&#44; and methotrexate were ineffective&#46; Despite poor control of the skin disease&#44; the consulting ophthalmologists scheduled surgical ectropion repair&#46; However&#44; the procedure was not performed because 2 months after the last treatment prescribed &#8212; an ointment containing calcipotriol plus betamethasone to be applied at night &#8212; all symptoms resolved &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; At the time of writing a year later&#44; the patient was applying a 0&#46;1&#37; tacrolimus cream twice a week because repeated attempts to stop treatment altogether were followed by relapses&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">FDD is characterized by macules&#44; papules&#44; or well-defined plaques on the face&#46; The lesions are circular&#44; pink-orange in color&#44; and develop adherent scales&#46; The clinical course is chronic and refractory to treatment&#46; The number and size of lesions vary&#44; and cases have been described over a wide range of ages from infancy to the sixth decade of life&#44; usually in females&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#8211;4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The initial description of FDD listed features that were nonspecific but suggestive of PRP&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> Histopathologic features included psoriasiform acanthosis&#44; hyperkeratosis with parakeratosis&#44; and follicular plugs&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> Later additions to the description included spongiosis&#44;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2&#44;4</span></a> a perivascular lymphocytic infiltrate that spared skin adnexa&#44;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3&#44;4</span></a> alternating orthohyperkeratosis and parakeratosis forming a checkerboard pattern with a conserved or prominent granular layer&#44; subcorneal acantholysis&#44; and vacuoled keratinocytes&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">One of the defining characteristics of FDD is its chronic course and resistance to numerous treatments&#44; such as corticosteroids &#40;topical&#44; intralesional&#44; and systemic&#41;&#44; calcitriol&#44; tacrolimus&#44; pimecrolimus&#44; tazarotene&#44; imiquimod&#44; tretinoin&#44; topical and oral antifungal medications&#44; hydroxychloroquine&#44; doxycycline&#44; methotrexate&#44; phototherapy&#44; and pulsed light therapy&#46; The combination of betamethasone dipropionate with oral acitretin was reported to lead to the greatest improvement&#44; but it still failed to achieve complete clearance&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> We report remarkably good results achieved in our patient with the combination of betamethasone and calcipotriol without acitretin&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The differential diagnosis includes other facial skin diseases such as psoriasis&#44; lupus&#44; seborrheic dermatitis contact dermatitis&#44; rosacea&#44; Demodex mite infestation&#44; mycosis fungoides&#44; and seborrheic pemphigus&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#44;4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Since the first description of this condition by Ko et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> the possibility that FDD is related to PRP has been hypothesized&#46; Clinical manifestations &#40;salmon-colored plaques with adherent scaling&#41;&#44; a prolonged course of disease that is resistant to treatment&#44; and compatible histopathologic findings were the arguments put forward by these authors&#44; who wondered whether FDD was an independent entity or a new localized form of PRP&#44; possibly a seventh phenotype&#46; Additional traits noted since then suggest that FDD and PRP are indeed closely related&#46; The presence of alternating orthohyperkeratosis and parakeratosis&#44; for example&#44; as well as subcorneal acantholysis&#44; and vacuoled keratinocytes are histopathologic findings that are characteristic of both processes&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">4&#44;5</span></a> Gan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> therefore also suggested that FDD could be an incomplete form of PRP&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">PRP is one of the few skin diseases that can lead to ectropion&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">6&#44;7</span></a> Classical adult onset PRP&#44; the most severe form&#44; might put patients at greatest risk of this complication&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> Our patient&#39;s unilateral ectropion&#44; which was closely associated with the type and timing of the skin lesions&#44; 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and tends to have a prolonged chronic course&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Case and Research Letter
Facial Discoid Dermatosis: A New Variant of Pityriasis Rubra Pilaris?
Dermatosis discoide facial: ¿una nueva forma de pitiriasis rubra pilaris?
F. Alleguea,
Corresponding author
fallegue@mundo-r.com

Corresponding author.
, C. Fachalb, B. Iglesiasb, A. Zulaicaa
a Servicio de Dermatología, Hospital do Meixoeiro, EOXI, Vigo, Pontevedra, Spain
b Servicio de Anatomía Patológica, Hospital Álvaro Cunqueiro, EOXI, Vigo, Pontevedra, Spain
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Three salmon-colored&#44; discoid facial lesions with thick scaling&#46; The largest one involved the lower eyelid and progressed to cause ectropion&#46; A and B&#44; Presentation at the first clinical visit&#46; C&#44; Presentation 2 months later&#46; D&#8211;F&#44; Presentation 7 months later&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Facial discoid dermatosis &#40;FDD&#41; is a recently described condition<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> that differs from other facial dermatoses in its clinical appearance and histopathologic findings&#8212;which mimic those of pityriasis rubra pilaris &#40;PRP&#41;&#8212;as well as in its failure to respond to treatment&#46; We describe a characteristic case of FDD&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 61-year-old man with no remarkable past medical history presented with 3 intensely pruriginous lesions that had appeared 2 months before&#46; He had tried antihistamines&#44; corticosteroids&#44; antibiotics&#44; and topical antifungal creams without seeing improvement&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Physical examination showed a salmon-colored erythematous plaque with thick yellowish&#44; adherent scaling&#46; The plaque in the left malar region measured approximately 3<span class="elsevierStyleHsp" style=""></span>cm in diameter and affected the lower eyelid&#46; Two other similar but smaller plaques were observed&#46; They were circular and on the right side of the nose&#46; Involvement of the eyelid progressed and eventually caused marked ectropion &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Two biopsies were performed for histopathology &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>a and b&#41;&#46; The results of laboratory analyses &#40;a full blood work-up including biochemistry&#44; immunoglobulins&#44; and antibodies&#41; were normal or negative&#44; as were patch tests&#46; Successive treatments with clobetasol&#44; prednisone&#44; hydroxychloroquine&#44; and methotrexate were ineffective&#46; Despite poor control of the skin disease&#44; the consulting ophthalmologists scheduled surgical ectropion repair&#46; However&#44; the procedure was not performed because 2 months after the last treatment prescribed &#8212; an ointment containing calcipotriol plus betamethasone to be applied at night &#8212; all symptoms resolved &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; At the time of writing a year later&#44; the patient was applying a 0&#46;1&#37; tacrolimus cream twice a week because repeated attempts to stop treatment altogether were followed by relapses&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">FDD is characterized by macules&#44; papules&#44; or well-defined plaques on the face&#46; The lesions are circular&#44; pink-orange in color&#44; and develop adherent scales&#46; The clinical course is chronic and refractory to treatment&#46; The number and size of lesions vary&#44; and cases have been described over a wide range of ages from infancy to the sixth decade of life&#44; usually in females&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#8211;4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The initial description of FDD listed features that were nonspecific but suggestive of PRP&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> Histopathologic features included psoriasiform acanthosis&#44; hyperkeratosis with parakeratosis&#44; and follicular plugs&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> Later additions to the description included spongiosis&#44;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2&#44;4</span></a> a perivascular lymphocytic infiltrate that spared skin adnexa&#44;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3&#44;4</span></a> alternating orthohyperkeratosis and parakeratosis forming a checkerboard pattern with a conserved or prominent granular layer&#44; subcorneal acantholysis&#44; and vacuoled keratinocytes&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">One of the defining characteristics of FDD is its chronic course and resistance to numerous treatments&#44; such as corticosteroids &#40;topical&#44; intralesional&#44; and systemic&#41;&#44; calcitriol&#44; tacrolimus&#44; pimecrolimus&#44; tazarotene&#44; imiquimod&#44; tretinoin&#44; topical and oral antifungal medications&#44; hydroxychloroquine&#44; doxycycline&#44; methotrexate&#44; phototherapy&#44; and pulsed light therapy&#46; The combination of betamethasone dipropionate with oral acitretin was reported to lead to the greatest improvement&#44; but it still failed to achieve complete clearance&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> We report remarkably good results achieved in our patient with the combination of betamethasone and calcipotriol without acitretin&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The differential diagnosis includes other facial skin diseases such as psoriasis&#44; lupus&#44; seborrheic dermatitis contact dermatitis&#44; rosacea&#44; Demodex mite infestation&#44; mycosis fungoides&#44; and seborrheic pemphigus&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#44;4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Since the first description of this condition by Ko et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> the possibility that FDD is related to PRP has been hypothesized&#46; Clinical manifestations &#40;salmon-colored plaques with adherent scaling&#41;&#44; a prolonged course of disease that is resistant to treatment&#44; and compatible histopathologic findings were the arguments put forward by these authors&#44; who wondered whether FDD was an independent entity or a new localized form of PRP&#44; possibly a seventh phenotype&#46; Additional traits noted since then suggest that FDD and PRP are indeed closely related&#46; The presence of alternating orthohyperkeratosis and parakeratosis&#44; for example&#44; as well as subcorneal acantholysis&#44; and vacuoled keratinocytes are histopathologic findings that are characteristic of both processes&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">4&#44;5</span></a> Gan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> therefore also suggested that FDD could be an incomplete form of PRP&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">PRP is one of the few skin diseases that can lead to ectropion&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">6&#44;7</span></a> Classical adult onset PRP&#44; the most severe form&#44; might put patients at greatest risk of this complication&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> Our patient&#39;s unilateral ectropion&#44; which was closely associated with the type and timing of the skin lesions&#44; plus its complete resolution when the FDD was brought under control&#44; would support a relationship between the 2 entities&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">We believe that FDD could be classified as a seventh form of PRP&#44; as originally suggested&#44; and that this addition to the Griffiths classification system<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> could well be added&#44; just as the sixth type was added by the Spanish group of Miralles et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> The term FDD&#44; therefore&#44; would be substituted by the term &#8220;type 7 PRP&#8221; or &#8220;circumscribed facial PRP&#8221; analogous to the description of the fourth PRP type &#40;circumscribed juvenile onset&#41;&#46; These terms would refer to a PRP form that preferentially affects the face&#44; is most often found in women&#44; responds poorly to treatment in general&#44; and tends to have a prolonged chronic course&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A&#41; Epidermal hyperplasia with marked keratotic spikes in the follicular ostium and parakeratosis that is accentuated in the region surrounding the follicular infundibulum&#46; The lymphocytic infiltrate is perivascular in the dermis&#46; Hematoxylin&#8211;eosin &#40;H&#38;E&#41; staining&#44; magnification &#215;40&#46; B&#41; Evident epidermal acanthosis with hyperkeratosis&#44; corneal plugs&#44; and parakeratosis often located around follicles&#46; Munro abscesses were not observed&#46; Thickening of the granular layer and mild spongiosis with lymphocytic exocytosis&#46; Perivascular lymphocytic infiltrate in the dermis&#46; There is basophilic degeneration of collagen&#44; without increased mucin deposition&#46; H&#38;E staining&#44; magnification &#215;100&#46;</p>"
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ISSN: 00017310
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