Cases for Diagnosis
Multiple Asymptomatic Congenital Plaques on the Back
Múltiples placas asintomáticas congénitas en la espalda
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Rodríguez-Vázquez, M.L. Martínez-Martínez, G. Fernández-Aragón, M. García-Arpa" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Rodríguez-Vázquez" "email" => array:1 [ 0 => "mrodvaz@yahoo.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.L." "apellidos" => "Martínez-Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "G." "apellidos" => "Fernández-Aragón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "M." "apellidos" => "García-Arpa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital General Universitario de Albacete, Albacete, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital General de Ciudad Real, Ciudad Real, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Múltiples placas asintomáticas congénitas en la espalda" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 317 "Ancho" => 476 "Tamanyo" => 36138 ] ] ] ] "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 24-year-old woman with no relevant medical history. She presented with a raised lesion on her back that caused discomfort when it came into contact with her clothing. This lesion had appeared on 1 of several asymptomatic plaques that had been present on her back since birth and had grown along with the patient.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">The patient's presenting complaint was a brown verrucous lesion clinically suggestive of intradermal melanocytic nevus without atypia. Of greater interest, however, was the presence of multiple well-defined, slightly raised, smooth brown plaques of different sizes that showed no scaling. The plaques were located close together, but without coalescing, on the lower back region and on the right side of the back, stretching as far as the ipsilateral shoulder (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). The patient had no hypopigmented, periungual, or facial skin lesions.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Biopsy of the congenital lesions showed thickened dermal collagen bundles and no epidermal abnormalities. Verhoeff-van Gieson staining revealed elastic fibers that were thinner than those found in normal skin (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The sebaceous glands exhibited no changes.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">What Is Your Diagnosis?</span></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagnosis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Multiple grouped congenital collagenomas on the back.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical Course and Treatment</span><p id="par0030" class="elsevierStylePara elsevierViewall">The patient had no hereditary diseases, no family history of similar lesions, no history of neurocutaneous syndromes, and no skin lesions characteristic of tuberous sclerosis. Because the lesions were asymptomatic, benign, and extensive, no treatment was given.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Comment</span><p id="par0035" class="elsevierStylePara elsevierViewall">Reticular connective tissue nevi are classified according to the component present in unusually large amounts; they are known as collagenomas when there are elevated levels of collagen fiber and as elastomas when there are elevated levels of stromal proteoglycans.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Collagenomas, or collagenous connective tissue nevi, are hamartomatous lesions of the dermis with increased collagen levels. They can be either hereditary or sporadic, and are usually present at birth or appear in early childhood, although acquired forms also exist. They present as firm skin-colored or lightly pigmented papules, nodules, or plaques, and can be solitary, multiple, or even segmental; they can occur on any part of the body.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Several types of collagenoma have been described, including familial cutaneous collagenoma, which follows an autosomal dominant pattern of inheritance, presents as multiple lesions, usually on the trunk during adolescence, and is associated with cardiovascular and systemic disorders.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Eruptive collagenomas are clinically indistinguishable from familial cutaneous collagenomas, except for the fact that family history is negative and onset is abrupt. Plantar cerebriform collagenoma can occur in isolation but is usually associated with Proteus syndrome.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The shagreen patch is a form of collagenoma that usually occurs on the lower back of patients with tuberous sclerosis. Other types of connective tissue nevi include knuckle pads, collagenomas associated with Down syndrome, ichthyosis, multiple fibrofolliculomas, cardiomyopathy, and hypogonadism; there have also been reports of collagenomas in Cowden syndrome<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> (storiform collagenomas), multiple endocrine neoplasia type 1, and Ehlers-Danlos syndrome.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Collagenomas are histologically characterized by the proliferation of connective tissue due to an increase in collagen fibers—especially type I collagen, the most abundant form of collagen in the dermis—and a resulting proportional decrease in elastic fibers.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Although the etiology and pathogenesis of connective tissue nevi are unknown, sporadic collagenomas may be related to trauma, since they appear most frequently in areas subject to friction.</p><p id="par0060" class="elsevierStylePara elsevierViewall">We found no signs or symptoms of neurocutaneous disease in our patient and were thus able to rule out the presence of shagreen patches, which are a manifestation of tuberous sclerosis and a key consideration in the differential diagnosis.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Collagenomas can be treated, purely for cosmetic reasons, with surgery, although some cases have been treated successfully with intralesional corticosteroids.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The literature contains few cases of congenital giant or multiple grouped collagenomas occurring in isolation, rather than in association with another disease.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The clinical cases that have been reported describe a large plaque formed by the coalescence of multiple lesions. Our case is the first reported instance of multiple independent, yet closely grouped, collagenomas covering such a large area of the body.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of Interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 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:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Rodríguez-Vázquez M, et al. Múltiples placas asintomáticas congénitas en la espalda. Actas Dermosifiliogr. 2012;103:241–242.</p>" ] ] "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 713 "Ancho" => 475 "Tamanyo" => 45060 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 317 "Ancho" => 476 "Tamanyo" => 36138 ] ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 819 "Ancho" => 700 "Tamanyo" => 151271 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Hematoxylin–eosin, original magnification ×100. B, Verhoeff-van Gieson, original magnification ×100. C, Verhoeff-van Gieson, original magnification ×400.</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" => "Connective tissue nevi of the skin. Clinical, genetic and histopathologic classification of hamartomas of the collagen, elastin and proteoglycan type" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Uitto" 1 => "D.J. Santa-Cruz" 2 => "A.Z. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 12 | 10 | 22 |
| 2024 October | 70 | 40 | 110 |
| 2024 September | 96 | 35 | 131 |
| 2024 August | 125 | 52 | 177 |
| 2024 July | 84 | 26 | 110 |
| 2024 June | 106 | 37 | 143 |
| 2024 May | 68 | 34 | 102 |
| 2024 April | 82 | 33 | 115 |
| 2024 March | 77 | 29 | 106 |
| 2024 February | 78 | 34 | 112 |
| 2024 January | 79 | 27 | 106 |
| 2023 December | 87 | 18 | 105 |
| 2023 November | 112 | 26 | 138 |
| 2023 October | 82 | 24 | 106 |
| 2023 September | 88 | 36 | 124 |
| 2023 August | 76 | 16 | 92 |
| 2023 July | 91 | 30 | 121 |
| 2023 June | 92 | 26 | 118 |
| 2023 May | 71 | 29 | 100 |
| 2023 April | 67 | 16 | 83 |
| 2023 March | 81 | 24 | 105 |
| 2023 February | 52 | 26 | 78 |
| 2023 January | 39 | 26 | 65 |
| 2022 December | 55 | 34 | 89 |
| 2022 November | 32 | 28 | 60 |
| 2022 October | 29 | 26 | 55 |
| 2022 September | 42 | 31 | 73 |
| 2022 August | 63 | 30 | 93 |
| 2022 July | 24 | 48 | 72 |
| 2022 June | 26 | 21 | 47 |
| 2022 May | 56 | 36 | 92 |
| 2022 April | 79 | 39 | 118 |
| 2022 March | 47 | 39 | 86 |
| 2022 February | 36 | 27 | 63 |
| 2022 January | 60 | 41 | 101 |
| 2021 December | 30 | 36 | 66 |
| 2021 November | 53 | 43 | 96 |
| 2021 October | 125 | 48 | 173 |
| 2021 September | 57 | 35 | 92 |
| 2021 August | 52 | 34 | 86 |
| 2021 July | 41 | 33 | 74 |
| 2021 June | 22 | 25 | 47 |
| 2021 May | 31 | 45 | 76 |
| 2021 April | 61 | 40 | 101 |
| 2021 March | 54 | 32 | 86 |
| 2021 February | 49 | 45 | 94 |
| 2021 January | 23 | 20 | 43 |
| 2020 December | 17 | 19 | 36 |
| 2020 November | 33 | 19 | 52 |
| 2020 October | 22 | 10 | 32 |
| 2020 September | 37 | 18 | 55 |
| 2020 August | 27 | 17 | 44 |
| 2020 July | 25 | 18 | 43 |
| 2020 June | 25 | 26 | 51 |
| 2020 May | 21 | 13 | 34 |
| 2020 April | 30 | 21 | 51 |
| 2020 March | 27 | 12 | 39 |
| 2020 February | 3 | 1 | 4 |
| 2020 January | 4 | 1 | 5 |
| 2019 December | 4 | 4 | 8 |
| 2019 November | 4 | 5 | 9 |
| 2019 October | 0 | 8 | 8 |
| 2019 September | 0 | 6 | 6 |
| 2019 August | 4 | 7 | 11 |
| 2019 July | 4 | 18 | 22 |
| 2019 June | 4 | 10 | 14 |
| 2019 May | 5 | 15 | 20 |
| 2019 April | 2 | 25 | 27 |
| 2019 March | 2 | 7 | 9 |
| 2019 February | 0 | 10 | 10 |
| 2019 January | 2 | 0 | 2 |
| 2018 December | 2 | 5 | 7 |
| 2018 October | 3 | 0 | 3 |
| 2018 September | 2 | 0 | 2 |
| 2018 March | 2 | 0 | 2 |
| 2018 February | 35 | 1 | 36 |
| 2018 January | 55 | 7 | 62 |
| 2017 December | 58 | 7 | 65 |
| 2017 November | 44 | 6 | 50 |
| 2017 October | 35 | 12 | 47 |
| 2017 September | 38 | 7 | 45 |
| 2017 August | 48 | 15 | 63 |
| 2017 July | 23 | 5 | 28 |
| 2017 June | 51 | 28 | 79 |
| 2017 May | 49 | 11 | 60 |
| 2017 April | 53 | 11 | 64 |
| 2017 March | 45 | 43 | 88 |
| 2017 February | 125 | 4 | 129 |
| 2017 January | 46 | 13 | 59 |
| 2016 December | 53 | 9 | 62 |
| 2016 November | 92 | 8 | 100 |
| 2016 October | 107 | 18 | 125 |
| 2016 September | 199 | 12 | 211 |
| 2016 August | 170 | 7 | 177 |
| 2016 July | 48 | 12 | 60 |
| 2016 June | 12 | 7 | 19 |
| 2016 May | 7 | 20 | 27 |
| 2016 April | 6 | 6 | 12 |
| 2016 March | 5 | 4 | 9 |
| 2016 February | 9 | 3 | 12 |
| 2016 January | 10 | 1 | 11 |
| 2015 December | 15 | 0 | 15 |
| 2015 November | 35 | 3 | 38 |
| 2015 October | 29 | 0 | 29 |
| 2015 September | 10 | 2 | 12 |
| 2015 August | 10 | 1 | 11 |
| 2015 July | 145 | 6 | 151 |
| 2015 June | 72 | 4 | 76 |
| 2015 May | 89 | 12 | 101 |
| 2015 April | 68 | 3 | 71 |
| 2015 March | 98 | 9 | 107 |
| 2015 February | 94 | 9 | 103 |
| 2015 January | 66 | 8 | 74 |
| 2014 December | 80 | 9 | 89 |
| 2014 November | 48 | 7 | 55 |
| 2014 October | 76 | 12 | 88 |
| 2014 September | 66 | 12 | 78 |
| 2014 August | 99 | 12 | 111 |
| 2014 July | 104 | 24 | 128 |
| 2014 June | 111 | 12 | 123 |
| 2014 May | 103 | 12 | 115 |
| 2014 April | 81 | 15 | 96 |
| 2014 March | 49 | 6 | 55 |
| 2014 February | 43 | 6 | 49 |
| 2014 January | 31 | 8 | 39 |
| 2013 December | 31 | 8 | 39 |
| 2013 November | 38 | 10 | 48 |
| 2013 October | 29 | 4 | 33 |
| 2013 September | 33 | 3 | 36 |
| 2013 August | 33 | 10 | 43 |
| 2013 July | 33 | 22 | 55 |
| 2013 June | 24 | 13 | 37 |
| 2013 May | 15 | 8 | 23 |
| 2013 April | 10 | 6 | 16 |
| 2013 March | 21 | 7 | 28 |
| 2013 February | 44 | 5 | 49 |
| 2013 January | 41 | 4 | 45 |
| 2012 December | 25 | 3 | 28 |
| 2012 August | 2 | 0 | 2 |
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