Case for Diagnosis
Telangiectatic Macules in a 90-Year-Old Woman
Lesiones maculares telangiectásicas en mujer de 90 años
A. Martín-Fuentes
, M.A. Pastor-Nieto, E. De Eusebio-Murillo
Corresponding author
Departamento de Dermatología, Hospital Universitario de Guadalajara, Guadalajara, Spain
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Martín-Fuentes, M.A. Pastor-Nieto, E. De Eusebio-Murillo" "autores" => array:3 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Martín-Fuentes" "email" => array:1 [ 0 => "adriana.mar.fuen@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M.A." "apellidos" => "Pastor-Nieto" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "De Eusebio-Murillo" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Departamento de Dermatología, Hospital Universitario de Guadalajara, Guadalajara, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lesiones maculares telangiectásicas en mujer de 90 años" ] ] "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" => 660 "Ancho" => 899 "Tamanyo" => 266973 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin–eosin, original magnification 10× and 50×.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">The patient was a 90-year-old woman who had a personal history of severe hypoacusis and osteoporosis and was not receiving chronic treatment. She consulted for several asymptomatic lesions on her chest, shoulders, and upper back. The lesions had appeared suddenly 5 years earlier, had never been treated, and had been stable since first onset.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed multiple well-defined erythematous-violaceous telangiectatic macules ranging in diameter from 5<span class="elsevierStyleHsp" style=""></span>mm to 4<span class="elsevierStyleHsp" style=""></span>cm (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The lesions did not blanch with pressure and were negative for the Darier sign.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Histologic examination revealed dilated vascular structures in the superficial capillary plexus with peripheral inflammatory infiltrate characterized by a predominance of mast cells (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Staining showed the mast cells to be tryptase-positive (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">What Is Your Diagnosis?</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagnosis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Telangiectasia macularis eruptiva perstans (TMEP)</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical Course and Treatment</span><p id="par0030" class="elsevierStylePara elsevierViewall">The laboratory workup included a complete blood cell count, biochemistry, liver and kidney function tests, and a serum tryptase test. Serum tryptase was slightly elevated at 16.3<span class="elsevierStyleHsp" style=""></span>μg/L (13.5<span class="elsevierStyleHsp" style=""></span>μg/L being the upper limit of normal). Despite this finding, the patient and her family declined to continue with the exploration due to the patient's advanced age.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Comment</span><p id="par0035" class="elsevierStylePara elsevierViewall">Mastocytosis comprises a group of diseases characterized by an excessive accumulation of mast cells in the skin, and occasionally in the tissue of other organs.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Three clinical variants of mastocytosis with cutaneous involvement have been described: urticaria pigmentosa (either its typical clinical manifestation of plaques and nodules or TMEP), diffuse cutaneous mastocytosis, and mastocytoma.</p><p id="par0045" class="elsevierStylePara elsevierViewall">TMEP was first described by Weber in 1930.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Thought to be a rare subtype of urticaria pigmentosa, it occurs in less than 1% of mastocytosis patients. TMEP occurs mainly in young and middle-aged adults, although cases of pediatric onset have been reported. A familial form of TMEP was described in 4 pediatric patients in 3 generations of a single family.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">It manifests clinically as erythematous macules comprising purplish or brownish asymptomatic telangiectasias that are negative for the Darier sign and located primarily on the trunk and upper limbs. Unilateral segmental manifestations of TMEP that may lead to a differential diagnosis with unilateral nevoid telangiectasia have also been reported.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Histologically, TMEP is characterized by an increase in the relative number of mast cells distributed around dilated capillaries and venules in the superficial capillary plexus. In most cases of TMEP, the number of mast cells does not increase very much in absolute terms, making it difficult to diagnose the disease by means of hematoxylin–eosin staining. Therefore, immunohistochemical staining for tryptase and/or c-kit (CD 117) is recommended.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Although TMEP has been considered to be a form of mastocytosis that only affects the skin, it can cause systemic symptoms, such as hypotension, flushing, pruritus, abdominal pain, and anaphylaxis due to the release of mediators by mast cells. In other cases, it can lead to symptoms caused by the infiltration of other organs, such as splenomegaly, adenopathy, hepatomegaly, and anemia. Finally, in isolated cases, this variant of mastocytosis has been associated with myeloproliferative, lymphoproliferative, and myelodysplastic syndromes.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The choice of treatment depends on whether systemic or exclusively cutaneous involvement is detected. Cases involving only the skin have been treated satisfactorily with topical and intralesional corticosteroids, topical calcineurin inhibitors, 585<span class="elsevierStyleHsp" style=""></span>nm vascular laser treatment, and psoralen-UV-A (PUVA) therapy.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of Interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Histopathology" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Diagnosis" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Clinical Course and Treatment" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Comment" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of Interest" ] 7 => array:2 [ "identificador" => "xack35207" "titulo" => "Acknowledgments" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Martín-Fuentes A, et al. Lesiones maculares telangiectásicas en una mujer de 90 años. Actas Dermosifiliogr. 2012;103:65–6.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 820 "Ancho" => 897 "Tamanyo" => 132600 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Telangiectatic macules with well-defined borders.</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" => 660 "Ancho" => 899 "Tamanyo" => 266973 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin–eosin, original magnification 10× and 50×.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 678 "Ancho" => 897 "Tamanyo" => 189448 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Immunohistochemistry: tryptase, original magnification 40×.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Telangiectasia Macularis Eruptiva Perstans—probably a telangiectatic variety of urticaria pigmentosa in an adult" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F.P. 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García Muñoz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2001" "volumen" => "92" "paginaInicial" => "358" "paginaFinal" => "361" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Two cases of telangiectasia macularis eruptiva perstans demonstrated by immunohistochemistry for c-kit (CD 117)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H.W. Lee" 1 => "Y.I. Jeong" 2 => "J.C. Choi" 3 => "M.W. Lee" 4 => "J.H. Choi" 5 => "K.C. Moon" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Dermatol" "fecha" => "2005" "volumen" => "32" "paginaInicial" => "817" "paginaFinal" => "820" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16361734" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Unusual cutaneous findings of urticaria pigmentosa and telangiectasia macularis eruptiva perstans associated with marked myelofibrosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "I. Turchin" 1 => "B. Barankin" 2 => "E. Schloss" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-4632.2006.02648.x" "Revista" => array:6 [ "tituloSerie" => "Int J Dermatol" "fecha" => "2006" "volumen" => "45" "paginaInicial" => "1215" "paginaFinal" => "1217" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17040445" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Telangiectasia macularis eruptive perstans successfully treated with PUVA therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Sotiriou" 1 => "Z. Apalla" 2 => "D. Ioannides" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1600-0781.2009.00480.x" "Revista" => array:6 [ "tituloSerie" => "Photodermatol Photoimmunol Photomed" "fecha" => "2010" "volumen" => "26" "paginaInicial" => "46" "paginaFinal" => "47" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20070840" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:3 [ "identificador" => "xack35207" "titulo" => "Acknowledgments" "texto" => "<p id="par0075" class="elsevierStylePara elsevierViewall">The authors would like to thank Jesús Cuevas Santos and Luis Cristian Perna Monroy for providing the histopathological images.</p>" ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010300000001/v1_201304241248/S1578219012000546/v1_201304241248/en/main.assets" "Apartado" => array:4 [ "identificador" => "6154" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case for Diagnosis" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010300000001/v1_201304241248/S1578219012000546/v1_201304241248/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012000546?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 9 | 13 | 22 |
| 2024 October | 70 | 58 | 128 |
| 2024 September | 96 | 54 | 150 |
| 2024 August | 118 | 95 | 213 |
| 2024 July | 124 | 57 | 181 |
| 2024 June | 110 | 56 | 166 |
| 2024 May | 92 | 59 | 151 |
| 2024 April | 147 | 53 | 200 |
| 2024 March | 88 | 38 | 126 |
| 2024 February | 102 | 46 | 148 |
| 2024 January | 58 | 37 | 95 |
| 2023 December | 58 | 28 | 86 |
| 2023 November | 79 | 39 | 118 |
| 2023 October | 66 | 22 | 88 |
| 2023 September | 74 | 44 | 118 |
| 2023 August | 66 | 31 | 97 |
| 2023 July | 83 | 57 | 140 |
| 2023 June | 57 | 41 | 98 |
| 2023 May | 90 | 43 | 133 |
| 2023 April | 63 | 33 | 96 |
| 2023 March | 48 | 31 | 79 |
| 2023 February | 68 | 30 | 98 |
| 2023 January | 51 | 39 | 90 |
| 2022 December | 63 | 60 | 123 |
| 2022 November | 37 | 39 | 76 |
| 2022 October | 33 | 36 | 69 |
| 2022 September | 49 | 54 | 103 |
| 2022 August | 28 | 39 | 67 |
| 2022 July | 24 | 45 | 69 |
| 2022 June | 36 | 50 | 86 |
| 2022 May | 43 | 63 | 106 |
| 2022 April | 66 | 41 | 107 |
| 2022 March | 67 | 65 | 132 |
| 2022 February | 42 | 44 | 86 |
| 2022 January | 61 | 38 | 99 |
| 2021 December | 37 | 39 | 76 |
| 2021 November | 45 | 39 | 84 |
| 2021 October | 66 | 51 | 117 |
| 2021 September | 50 | 45 | 95 |
| 2021 August | 64 | 27 | 91 |
| 2021 July | 26 | 16 | 42 |
| 2021 June | 35 | 51 | 86 |
| 2021 May | 57 | 48 | 105 |
| 2021 April | 149 | 51 | 200 |
| 2021 March | 100 | 33 | 133 |
| 2021 February | 69 | 27 | 96 |
| 2021 January | 34 | 19 | 53 |
| 2020 December | 46 | 23 | 69 |
| 2020 November | 39 | 26 | 65 |
| 2020 October | 20 | 21 | 41 |
| 2020 September | 51 | 15 | 66 |
| 2020 August | 23 | 21 | 44 |
| 2020 July | 32 | 20 | 52 |
| 2020 June | 31 | 26 | 57 |
| 2020 May | 29 | 24 | 53 |
| 2020 April | 42 | 27 | 69 |
| 2020 March | 43 | 23 | 66 |
| 2020 February | 6 | 7 | 13 |
| 2020 January | 4 | 5 | 9 |
| 2019 December | 8 | 9 | 17 |
| 2019 November | 4 | 2 | 6 |
| 2019 October | 0 | 5 | 5 |
| 2019 September | 4 | 10 | 14 |
| 2019 August | 4 | 13 | 17 |
| 2019 July | 7 | 11 | 18 |
| 2019 June | 4 | 7 | 11 |
| 2019 May | 7 | 25 | 32 |
| 2019 April | 4 | 22 | 26 |
| 2019 March | 0 | 11 | 11 |
| 2019 February | 4 | 0 | 4 |
| 2019 January | 1 | 4 | 5 |
| 2018 December | 2 | 0 | 2 |
| 2018 November | 2 | 0 | 2 |
| 2018 October | 3 | 0 | 3 |
| 2018 September | 2 | 0 | 2 |
| 2018 July | 0 | 2 | 2 |
| 2018 April | 0 | 13 | 13 |
| 2018 February | 52 | 10 | 62 |
| 2018 January | 89 | 10 | 99 |
| 2017 December | 87 | 9 | 96 |
| 2017 November | 61 | 10 | 71 |
| 2017 October | 56 | 4 | 60 |
| 2017 September | 52 | 1 | 53 |
| 2017 August | 103 | 11 | 114 |
| 2017 July | 62 | 11 | 73 |
| 2017 June | 82 | 44 | 126 |
| 2017 May | 68 | 20 | 88 |
| 2017 April | 70 | 10 | 80 |
| 2017 March | 73 | 31 | 104 |
| 2017 February | 67 | 11 | 78 |
| 2017 January | 54 | 22 | 76 |
| 2016 December | 75 | 18 | 93 |
| 2016 November | 101 | 23 | 124 |
| 2016 October | 151 | 12 | 163 |
| 2016 September | 210 | 14 | 224 |
| 2016 August | 97 | 11 | 108 |
| 2016 July | 75 | 12 | 87 |
| 2016 June | 13 | 15 | 28 |
| 2016 May | 8 | 15 | 23 |
| 2016 April | 2 | 1 | 3 |
| 2016 March | 11 | 23 | 34 |
| 2016 February | 2 | 19 | 21 |
| 2016 January | 12 | 19 | 31 |
| 2015 December | 7 | 10 | 17 |
| 2015 November | 35 | 23 | 58 |
| 2015 October | 32 | 17 | 49 |
| 2015 September | 8 | 9 | 17 |
| 2015 August | 8 | 5 | 13 |
| 2015 July | 120 | 10 | 130 |
| 2015 June | 70 | 9 | 79 |
| 2015 May | 115 | 17 | 132 |
| 2015 April | 75 | 10 | 85 |
| 2015 March | 57 | 11 | 68 |
| 2015 February | 43 | 11 | 54 |
| 2015 January | 45 | 12 | 57 |
| 2014 December | 46 | 9 | 55 |
| 2014 November | 47 | 7 | 54 |
| 2014 October | 64 | 17 | 81 |
| 2014 September | 57 | 9 | 66 |
| 2014 August | 55 | 14 | 69 |
| 2014 July | 101 | 15 | 116 |
| 2014 June | 70 | 12 | 82 |
| 2014 May | 92 | 14 | 106 |
| 2014 April | 76 | 9 | 85 |
| 2014 March | 71 | 16 | 87 |
| 2014 February | 70 | 13 | 83 |
| 2014 January | 61 | 15 | 76 |
| 2013 December | 27 | 4 | 31 |
| 2013 November | 37 | 8 | 45 |
| 2013 October | 17 | 3 | 20 |
| 2013 September | 12 | 5 | 17 |
| 2013 August | 9 | 8 | 17 |
| 2013 July | 11 | 10 | 21 |
| 2013 June | 10 | 13 | 23 |
| 2013 May | 17 | 11 | 28 |
| 2013 April | 7 | 8 | 15 |
| 2013 March | 18 | 4 | 22 |
| 2013 February | 23 | 2 | 25 |
| 2013 January | 27 | 7 | 34 |
| 2012 December | 11 | 3 | 14 |
| 2012 November | 2 | 3 | 5 |
| 2012 October | 1 | 1 | 2 |
| 2012 August | 1 | 0 | 1 |
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