Case for Diagnosis
Atrophic Plaque of 8 Years’ Duration on the Scalp
Placa atrófica en cuero cabelludo de 8 años de evolución
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Signs of thrombosis and recanalization can be seen. Acanthosis and hyperkeratosis are present in the epidermis. Some vessels appear to be included within the epidermis. Hematoxylin-eosin, original magnification ×40.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E. Piqué-Duran, J.A. Pérez-Cejudo, D. Cameselle-Martínez, O. García-Vázquez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "Piqué-Duran" ] 1 => array:2 [ "nombre" => "J.A." "apellidos" => "Pérez-Cejudo" ] 2 => array:2 [ "nombre" => "D." "apellidos" => "Cameselle-Martínez" ] 3 => array:2 [ "nombre" => "O." 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Galán-Gutiérrez, R. Ruiz-Villaverde, A. Sanz-Trelles" "autores" => array:3 [ 0 => array:3 [ "nombre" => "M." "apellidos" => "Galán-Gutiérrez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "R." "apellidos" => "Ruiz-Villaverde" "email" => array:1 [ 0 => "ismenios@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" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Sanz-Trelles" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Unidad de gestión clínica de cirugía mayor ambulatoria, Complejo Hospitalario de Jaen, Jaen, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Carlos Haya, Málaga, 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" => "Placa atrófica en cuero cabelludo de 8 años de evolución" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 917 "Ancho" => 1215 "Tamanyo" => 261624 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×40.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 51-year-old man with no relevant personal or family history presented to our dermatology department with a lesion on the scalp that had appeared 8 years earlier and had been biopsied at another center 4 years previously. The histologic diagnosis was compatible with granulomatous dermatitis with eosinophilia, resulting from arthropod bites. However, at the original consultation and again when he consulted our department, the patient denied any prior history of trauma or insect bite. In recent months the lesion had increased in size and occasionally gave rise to itching, despite no change in the original morphologic features. There were no associated systemic symptoms.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">The patient presented a well-defined, slightly raised annular lesion, measuring 3<span class="elsevierStyleHsp" style=""></span>x<span class="elsevierStyleHsp" style=""></span>3.5<span class="elsevierStyleHsp" style=""></span>cm, with an atrophic appearance and superficial telangiectases (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). There were no palpable locoregional lymph nodes.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Histology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Histopathology showed a moderately atrophic epidermis, with an abundant inflammatory infiltrate characterized by polymorphism in the mid to deep dermis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). It contained neutrophils, eosinophils, and lymphocytes and was particularly intense in periadnexal regions (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><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 additional tests (complete blood count, routine biochemistry, thyroid function tests, autoimmune studies, serology for syphilis, chest x-ray, Mantoux test) were within the normal range.</p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">What Is Your Diagnosis?</span></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagnosis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Extrafacial granuloma faciale.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical Course and Treatment</span><p id="par0035" class="elsevierStylePara elsevierViewall">Treatment with twice daily applications of tacrolimus ointment 0.1% achieved a moderate response at 3 months after diagnosis.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Comment</span><p id="par0040" class="elsevierStylePara elsevierViewall">Extrafacial granuloma faciale is a dermatosis of unknown origin that can present as a single or multiple lesion; the clinical course is slow and progressive. An extrafacial site is extremely rare and fewer than 30 cases have been reported in the literature.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">When the lesion is extrafacial, the most common sites are the trunk, upper and lower limbs, and the scalp. In fact, it is not uncommon for facial lesions to precede the development of others at extrafacial sites. Clinically, lesions are usually well-demarcated papules, plaques, or nodules.</p><p id="par0050" class="elsevierStylePara elsevierViewall">There is no generally accepted pathophysiological hypothesis. However, UV radiation appears to be involved, as most cases are found in the facial region in middle-aged to elderly patients with high cumulative sun exposure or even chronic sun-induced damage. Other authors propose an immunologic etiology for this disorder, postulating a delayed hypersensitivity reaction or vasculitis mediated by immune complexes.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The histopathologic characteristics of extrafacial granuloma faciale have been widely described and include a normal or moderately atrophied epidermis. Almost all cases are characterized by a well-demarcated Grenz zone and a polymorphous inflammatory infiltrate rich in eosinophils and arranged in a distinctive periadnexal and vascular pattern. Extrafacial granuloma faciale shares common features with erythema elevatum diutinum. Both conditions involve what Carlson and LeBoit called chronic fibrosing vasculitis, although the presence of this histologic feature will depend on the stage of evolution of the lesion because the initial stages point to classic leukocytoclastic vasculitis.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Caldarola et al<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> have recently contributed to furthering our knowledge of extrafacial granuloma faciale by defining its dermoscopic pattern. A uniform grayish-white background with whitish streaks reveals elongated vascular loops, whose morphology varies significantly after treatment with tacrolimus. The pattern is not specific to this condition and is found in others such as sarcoidosis and lupus.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Treatment of extrafacial granuloma faciale is complicated and often ineffective and there is no first-line therapy or well-defined therapeutic pathways. Some authors have reported a good response to topical tacrolimus,<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> which is emerging as the treatment of choice because of its good risk-benefit profile. Other interesting options include intralesional corticosteroids, dapsone, cryosurgery, and pulsed dye laser, although recurrence is common after discontinuation of treatment.</p></span><span id="sec0040" 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" => "Histology" ] 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" => "Conflicts 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: Galán-Gutiérrez M, et al. Placa atrófica en cuero cabelludo de 8 años de evolución. Actas Dermosifiliogr. 2013;104:161–2.</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" => 917 "Ancho" => 1220 "Tamanyo" => 138473 ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 917 "Ancho" => 1220 "Tamanyo" => 344941 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×10.</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" => 917 "Ancho" => 1215 "Tamanyo" => 261624 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" 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" => "Granuloma faciale: treatment with topical tacrolimus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Marcoval" 1 => "A. Moreno" 2 => "X. Bordas" 3 => "J. Peyrí" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2005.12.019" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2006" "volumen" => "55" "paginaInicial" => "S110" "paginaFinal" => "S111" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17052523" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extrafacial granuloma faciale: report of a case" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D. De" 1 => "A.J. Kanwar" 2 => "B.D. Radotra" 3 => "S. 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Pellicano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1529-8019.2012.01475.x" "Revista" => array:6 [ "tituloSerie" => "Dermatol Ther" "fecha" => "2011" "volumen" => "24" "paginaInicial" => "508" "paginaFinal" => "511" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22353159" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Granuloma faciale of the scalp" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "I. Leite" 1 => "A. Moreira" 2 => "R. Guedes" 3 => "A. Furtado" 4 => "E.O. Ferreira" 5 => "A. Baptista" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Dermatol Online J" "fecha" => "2011" "volumen" => "17" "paginaInicial" => "6" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22233742" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010400000002/v1_201304241618/S1578219013000097/v1_201304241618/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/15782190/0000010400000002/v1_201304241618/S1578219013000097/v1_201304241618/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013000097?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 12 | 8 | 20 |
| 2024 October | 68 | 40 | 108 |
| 2024 September | 73 | 21 | 94 |
| 2024 August | 126 | 60 | 186 |
| 2024 July | 102 | 24 | 126 |
| 2024 June | 88 | 38 | 126 |
| 2024 May | 61 | 26 | 87 |
| 2024 April | 72 | 19 | 91 |
| 2024 March | 57 | 18 | 75 |
| 2024 February | 60 | 34 | 94 |
| 2024 January | 55 | 33 | 88 |
| 2023 December | 62 | 11 | 73 |
| 2023 November | 61 | 26 | 87 |
| 2023 October | 64 | 29 | 93 |
| 2023 September | 63 | 31 | 94 |
| 2023 August | 51 | 17 | 68 |
| 2023 July | 52 | 27 | 79 |
| 2023 June | 54 | 19 | 73 |
| 2023 May | 63 | 21 | 84 |
| 2023 April | 64 | 27 | 91 |
| 2023 March | 88 | 21 | 109 |
| 2023 February | 52 | 16 | 68 |
| 2023 January | 52 | 25 | 77 |
| 2022 December | 60 | 48 | 108 |
| 2022 November | 30 | 28 | 58 |
| 2022 October | 36 | 18 | 54 |
| 2022 September | 28 | 37 | 65 |
| 2022 August | 24 | 30 | 54 |
| 2022 July | 24 | 31 | 55 |
| 2022 June | 34 | 25 | 59 |
| 2022 May | 56 | 26 | 82 |
| 2022 April | 44 | 36 | 80 |
| 2022 March | 69 | 43 | 112 |
| 2022 February | 46 | 34 | 80 |
| 2022 January | 49 | 35 | 84 |
| 2021 December | 43 | 41 | 84 |
| 2021 November | 45 | 46 | 91 |
| 2021 October | 53 | 43 | 96 |
| 2021 September | 54 | 38 | 92 |
| 2021 August | 33 | 31 | 64 |
| 2021 July | 47 | 38 | 85 |
| 2021 June | 34 | 28 | 62 |
| 2021 May | 51 | 46 | 97 |
| 2021 April | 71 | 84 | 155 |
| 2021 March | 115 | 17 | 132 |
| 2021 February | 84 | 27 | 111 |
| 2021 January | 56 | 21 | 77 |
| 2020 December | 38 | 8 | 46 |
| 2020 November | 26 | 17 | 43 |
| 2020 October | 25 | 14 | 39 |
| 2020 September | 31 | 10 | 41 |
| 2020 August | 39 | 23 | 62 |
| 2020 July | 23 | 5 | 28 |
| 2020 June | 38 | 21 | 59 |
| 2020 May | 27 | 16 | 43 |
| 2020 April | 30 | 16 | 46 |
| 2020 March | 27 | 19 | 46 |
| 2020 February | 4 | 1 | 5 |
| 2020 January | 4 | 1 | 5 |
| 2019 December | 8 | 1 | 9 |
| 2019 November | 3 | 0 | 3 |
| 2019 October | 0 | 1 | 1 |
| 2019 September | 9 | 1 | 10 |
| 2019 August | 4 | 0 | 4 |
| 2019 July | 4 | 1 | 5 |
| 2019 June | 4 | 13 | 17 |
| 2019 May | 7 | 30 | 37 |
| 2019 April | 2 | 7 | 9 |
| 2019 March | 0 | 11 | 11 |
| 2019 February | 4 | 2 | 6 |
| 2018 December | 3 | 1 | 4 |
| 2018 November | 2 | 0 | 2 |
| 2018 October | 1 | 4 | 5 |
| 2018 September | 3 | 0 | 3 |
| 2018 June | 0 | 4 | 4 |
| 2018 May | 0 | 12 | 12 |
| 2018 April | 0 | 2 | 2 |
| 2018 March | 2 | 4 | 6 |
| 2018 February | 25 | 7 | 32 |
| 2018 January | 37 | 12 | 49 |
| 2017 December | 33 | 5 | 38 |
| 2017 November | 39 | 9 | 48 |
| 2017 October | 42 | 8 | 50 |
| 2017 September | 47 | 9 | 56 |
| 2017 August | 58 | 10 | 68 |
| 2017 July | 65 | 22 | 87 |
| 2017 June | 52 | 12 | 64 |
| 2017 May | 34 | 20 | 54 |
| 2017 April | 38 | 7 | 45 |
| 2017 March | 39 | 44 | 83 |
| 2017 February | 35 | 9 | 44 |
| 2017 January | 24 | 9 | 33 |
| 2016 December | 35 | 12 | 47 |
| 2016 November | 47 | 7 | 54 |
| 2016 October | 43 | 15 | 58 |
| 2016 September | 46 | 16 | 62 |
| 2016 August | 49 | 11 | 60 |
| 2016 July | 37 | 8 | 45 |
| 2016 June | 8 | 12 | 20 |
| 2016 May | 14 | 8 | 22 |
| 2016 April | 3 | 1 | 4 |
| 2016 March | 11 | 2 | 13 |
| 2016 February | 8 | 3 | 11 |
| 2016 January | 12 | 2 | 14 |
| 2015 December | 10 | 1 | 11 |
| 2015 November | 9 | 2 | 11 |
| 2015 October | 5 | 1 | 6 |
| 2015 September | 6 | 0 | 6 |
| 2015 August | 17 | 4 | 21 |
| 2015 July | 41 | 8 | 49 |
| 2015 June | 51 | 4 | 55 |
| 2015 May | 59 | 17 | 76 |
| 2015 April | 55 | 7 | 62 |
| 2015 March | 32 | 8 | 40 |
| 2015 February | 17 | 4 | 21 |
| 2015 January | 13 | 2 | 15 |
| 2014 December | 25 | 4 | 29 |
| 2014 November | 13 | 2 | 15 |
| 2014 October | 16 | 3 | 19 |
| 2014 September | 17 | 2 | 19 |
| 2014 August | 19 | 3 | 22 |
| 2014 July | 14 | 6 | 20 |
| 2014 June | 25 | 4 | 29 |
| 2014 May | 33 | 6 | 39 |
| 2014 April | 26 | 6 | 32 |
| 2014 March | 45 | 3 | 48 |
| 2014 February | 27 | 4 | 31 |
| 2014 January | 33 | 7 | 40 |
| 2013 December | 33 | 12 | 45 |
| 2013 November | 18 | 2 | 20 |
| 2013 October | 17 | 4 | 21 |
| 2013 September | 8 | 1 | 9 |
| 2013 August | 6 | 4 | 10 |
| 2013 July | 5 | 8 | 13 |
| 2013 June | 5 | 6 | 11 |
| 2013 May | 4 | 2 | 6 |
| 2013 April | 7 | 13 | 20 |
| 2013 March | 7 | 5 | 12 |
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