Case for Diagnosis
Umbilicated Papules on the Dorsum of Hands
Pápulas umbilicadas en dorso de manos
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Sánchez-Moya, R. Juarez-Tosina, D. García Almagro" "autores" => array:3 [ 0 => array:4 [ "nombre" => "A.I." "apellidos" => "Sánchez-Moya" "email" => array:1 [ 0 => "anai.sanchezmoya@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" => "R." "apellidos" => "Juarez-Tosina" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "D." "apellidos" => "García Almagro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Complejo Hospitalario, Toledo, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Complejo Hospitalario, Toledo, 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" => "Pápulas umbilicadas en dorso de manos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 528 "Ancho" => 666 "Tamanyo" => 75376 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of a 35-year-old woman who presented with pruritic lesions on the dorsum of the hands that had appeared 6 months earlier. After she started working as a baker and received small burns, the patient experienced more intense symptoms and the lesions worsened. She reported a lifelong history of anomalous scarring from minor injuries, taking the form of papular and erosive lesions that regressed after 6 weeks. The patient has 2 brothers who have similar symptoms.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Lesions at various stages of development were observed on the dorsum of the hands and the arms (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). These round, skin-colored, and in some cases umbilicated papules measured from 2 to 5 <span class="elsevierStyleHsp" style=""></span>mm in diameter and contained a small central keratotic plug (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The older lesions were macular, light brown, and infiltrated.</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">Thickened collagen bundles were observed in the superficial dermis. These bundles were surrounded by areas of epidermal proliferation where transepidermal elimination of collagen took place through a small central crater containing keratotic material, mixed inflammatory infiltrate, and cellular detritus (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Additional Tests</span><p id="par0020" class="elsevierStylePara elsevierViewall">The results of a complete blood biochemistry ruled out abnormalities in glucose metabolism and renal insufficiency.</p><p id="par0025" class="elsevierStylePara elsevierViewall">What Is Your Diagnosis?</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagnosis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Familial reactive perforating collagenosis.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical Course and Treatment</span><p id="par0035" class="elsevierStylePara elsevierViewall">Topical treatment was started with tretinoin 0.1%, in combination with emollients, on the more recent lesions. The patient was strongly advised to avoid injury and scratching. Improvement was seen in 4 weeks, with a reduction in the number of lesions and symptom intensity.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Comment</span><p id="par0040" class="elsevierStylePara elsevierViewall">Familial reactive perforating collagenosis is one of the primary perforating diseases, a group of disorders characterized by keratotic plugs through which dermal connective tissue is eliminated through the epidermis.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">These diseases fall into 3 main categories: elastosis perforans serpiginosa involving the elimination of elastic fibers, acquired perforating dermatosis with adult onset often related to diabetes, renal insufficiency, or toxicoderma,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and, least frequently, familial reactive perforating collagenosis.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Mehregan, Schwartz, and Livingood first described this hereditary disorder in 1967; the etiology is still poorly understood and the pattern of transmission varies.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The condition is rare and only 50 cases have been described.</p><p id="par0055" class="elsevierStylePara elsevierViewall">From infancy, these patients develop skin-colored papules measuring less than 10<span class="elsevierStyleHsp" style=""></span>mm in diameter in response to superficial trauma. These lesions become umbilicated and eventually form a crater with a small central keratotic plug. They are typically found on the extensor aspects of the arms, the dorsum of the hands, and, less frequently, the elbows, knees, and feet. The palms of the hands and the soles of the feet are not affected. The lesions disappear within 2 months, leaving atrophy and hypopigmentation. The isomorphic response is more typical in this disease than in other perforating disorders.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The basic defect is thought to be due to a genetic abnormality that affects the collagen, leading to greater lability after injury. The same abnormality is also associated with an increase in serum and tissue concentrations of fibronectin and favors epithelial migration and proliferation, resulting in the transepidermal elimination of damaged collagen.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Histologic examination reveals deposits of basophilic dermal collagen surrounded by inflammatory cells and areas of epidermal proliferation that eventually give rise to transepidermal elimination through a small central crater containing keratotic material and inflammatory cells. Elastic fibres are not affected.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The differential diagnosis must include inflammatory pathologies (folliculitis, prurigo nodularis, arthropod bites), mucoid material deposits (acral persistent papular mucinosis), and tumors (multiple keratoacanthomas, syringomas, and benign fibrous histiocytomas), in addition to all other perforating diseases.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Several treatments have been described, including emollients, topical corticosteroids, topical retinoic acid, oral isotretinoin, and vitamin A supplements, but the results are varied.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The hereditary forms of reactive perforating collagenosis are usually mild and localized, with no alarming symptoms except in rare circumstances.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of Interest</span><p id="par0080" 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" => "Additional Tests" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Diagnosis" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Clinical Course and Treatment" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Comment" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflict of Interest" ] 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: Sánchez-Moya AI, et al. Pápulas umbilicadas en dorso de manos. Actas Dermosifiliogr.2012;103:435-6.</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" => 528 "Ancho" => 666 "Tamanyo" => 75376 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 563 "Ancho" => 750 "Tamanyo" => 118727 ] ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 470 "Ancho" => 630 "Tamanyo" => 124338 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, 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" => "The perforating disoders" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.W. 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Pitha" 5 => "M.A. Everett" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am Jm Dermatopathol" "fecha" => "1998" "volumen" => "20" "paginaInicial" => "147" "paginaFinal" => "154" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Familial reactive perforating collagenosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Y.J. Bhat" 1 => "S. Manzoor" 2 => "S. Qayoom" 3 => "R. Wani" 4 => "A.N. Baba" 5 => "A.H. Bhat" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/0019-5154.57608" "Revista" => array:6 [ "tituloSerie" => "Indian J Dermatol" "fecha" => "2009" "volumen" => "54" "paginaInicial" => "334" "paginaFinal" => "337" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20101333" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010300000005/v1_201304241308/S1578219012001758/v1_201304241308/en/main.assets" "Apartado" => array:4 [ "identificador" => "6171" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Cases for Diagnosis" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010300000005/v1_201304241308/S1578219012001758/v1_201304241308/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012001758?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 28 | 16 | 44 |
| 2024 October | 204 | 50 | 254 |
| 2024 September | 244 | 29 | 273 |
| 2024 August | 319 | 74 | 393 |
| 2024 July | 335 | 43 | 378 |
| 2024 June | 293 | 46 | 339 |
| 2024 May | 233 | 58 | 291 |
| 2024 April | 173 | 36 | 209 |
| 2024 March | 190 | 31 | 221 |
| 2024 February | 240 | 27 | 267 |
| 2024 January | 253 | 33 | 286 |
| 2023 December | 283 | 32 | 315 |
| 2023 November | 284 | 32 | 316 |
| 2023 October | 230 | 19 | 249 |
| 2023 September | 234 | 35 | 269 |
| 2023 August | 182 | 22 | 204 |
| 2023 July | 167 | 50 | 217 |
| 2023 June | 139 | 27 | 166 |
| 2023 May | 259 | 27 | 286 |
| 2023 April | 212 | 21 | 233 |
| 2023 March | 199 | 21 | 220 |
| 2023 February | 173 | 24 | 197 |
| 2023 January | 129 | 38 | 167 |
| 2022 December | 107 | 47 | 154 |
| 2022 November | 67 | 33 | 100 |
| 2022 October | 87 | 23 | 110 |
| 2022 September | 83 | 31 | 114 |
| 2022 August | 73 | 40 | 113 |
| 2022 July | 82 | 42 | 124 |
| 2022 June | 42 | 37 | 79 |
| 2022 May | 142 | 39 | 181 |
| 2022 April | 195 | 53 | 248 |
| 2022 March | 188 | 60 | 248 |
| 2022 February | 153 | 40 | 193 |
| 2022 January | 260 | 42 | 302 |
| 2021 December | 161 | 29 | 190 |
| 2021 November | 147 | 49 | 196 |
| 2021 October | 179 | 54 | 233 |
| 2021 September | 129 | 54 | 183 |
| 2021 August | 158 | 73 | 231 |
| 2021 July | 112 | 49 | 161 |
| 2021 June | 93 | 51 | 144 |
| 2021 May | 68 | 41 | 109 |
| 2021 April | 255 | 63 | 318 |
| 2021 March | 128 | 36 | 164 |
| 2021 February | 98 | 46 | 144 |
| 2021 January | 79 | 40 | 119 |
| 2020 December | 61 | 23 | 84 |
| 2020 November | 41 | 28 | 69 |
| 2020 October | 55 | 29 | 84 |
| 2020 September | 33 | 23 | 56 |
| 2020 August | 37 | 33 | 70 |
| 2020 July | 42 | 21 | 63 |
| 2020 June | 69 | 34 | 103 |
| 2020 May | 36 | 34 | 70 |
| 2020 April | 30 | 35 | 65 |
| 2020 March | 40 | 30 | 70 |
| 2020 February | 3 | 8 | 11 |
| 2020 January | 4 | 14 | 18 |
| 2019 December | 8 | 12 | 20 |
| 2019 November | 4 | 5 | 9 |
| 2019 October | 0 | 5 | 5 |
| 2019 September | 10 | 10 | 20 |
| 2019 August | 4 | 13 | 17 |
| 2019 July | 4 | 14 | 18 |
| 2019 June | 5 | 42 | 47 |
| 2019 May | 4 | 98 | 102 |
| 2019 April | 2 | 64 | 66 |
| 2019 March | 2 | 16 | 18 |
| 2019 February | 2 | 17 | 19 |
| 2019 January | 2 | 9 | 11 |
| 2018 December | 2 | 0 | 2 |
| 2018 November | 3 | 0 | 3 |
| 2018 October | 6 | 0 | 6 |
| 2018 September | 4 | 12 | 16 |
| 2018 August | 0 | 41 | 41 |
| 2018 July | 0 | 22 | 22 |
| 2018 June | 0 | 18 | 18 |
| 2018 May | 0 | 29 | 29 |
| 2018 April | 0 | 15 | 15 |
| 2018 March | 14 | 30 | 44 |
| 2018 February | 100 | 29 | 129 |
| 2018 January | 194 | 29 | 223 |
| 2017 December | 179 | 31 | 210 |
| 2017 November | 108 | 28 | 136 |
| 2017 October | 111 | 25 | 136 |
| 2017 September | 90 | 47 | 137 |
| 2017 August | 126 | 57 | 183 |
| 2017 July | 96 | 46 | 142 |
| 2017 June | 115 | 51 | 166 |
| 2017 May | 107 | 26 | 133 |
| 2017 April | 94 | 51 | 145 |
| 2017 March | 104 | 52 | 156 |
| 2017 February | 79 | 43 | 122 |
| 2017 January | 64 | 21 | 85 |
| 2016 December | 104 | 31 | 135 |
| 2016 November | 144 | 57 | 201 |
| 2016 October | 150 | 40 | 190 |
| 2016 September | 216 | 48 | 264 |
| 2016 August | 135 | 30 | 165 |
| 2016 July | 101 | 26 | 127 |
| 2016 June | 17 | 15 | 32 |
| 2016 May | 9 | 12 | 21 |
| 2016 April | 4 | 1 | 5 |
| 2016 March | 7 | 28 | 35 |
| 2016 February | 10 | 31 | 41 |
| 2016 January | 6 | 42 | 48 |
| 2015 December | 10 | 24 | 34 |
| 2015 November | 35 | 25 | 60 |
| 2015 October | 26 | 28 | 54 |
| 2015 September | 18 | 10 | 28 |
| 2015 August | 11 | 10 | 21 |
| 2015 July | 142 | 16 | 158 |
| 2015 June | 102 | 9 | 111 |
| 2015 May | 125 | 17 | 142 |
| 2015 April | 117 | 21 | 138 |
| 2015 March | 89 | 15 | 104 |
| 2015 February | 88 | 17 | 105 |
| 2015 January | 104 | 18 | 122 |
| 2014 December | 85 | 10 | 95 |
| 2014 November | 94 | 11 | 105 |
| 2014 October | 145 | 24 | 169 |
| 2014 September | 103 | 15 | 118 |
| 2014 August | 133 | 18 | 151 |
| 2014 July | 130 | 19 | 149 |
| 2014 June | 138 | 20 | 158 |
| 2014 May | 81 | 9 | 90 |
| 2014 April | 48 | 4 | 52 |
| 2014 March | 47 | 9 | 56 |
| 2014 February | 60 | 3 | 63 |
| 2014 January | 47 | 7 | 54 |
| 2013 December | 46 | 8 | 54 |
| 2013 November | 39 | 7 | 46 |
| 2013 October | 39 | 8 | 47 |
| 2013 September | 33 | 7 | 40 |
| 2013 August | 31 | 14 | 45 |
| 2013 July | 27 | 15 | 42 |
| 2013 June | 10 | 8 | 18 |
| 2013 May | 14 | 13 | 27 |
| 2013 April | 17 | 10 | 27 |
| 2013 March | 17 | 5 | 22 |
| 2013 February | 36 | 9 | 45 |
| 2013 January | 61 | 4 | 65 |
| 2012 December | 16 | 4 | 20 |
| 2012 November | 1 | 1 | 2 |
| 2012 October | 0 | 1 | 1 |
| 2012 August | 3 | 2 | 5 |
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