Case for Diagnosis
Cobblestone Papules on the Neck
Pápulas en empedrado en el cuello
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"apellidos" => "Suárez-Fernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital General Universitario Gregorio Marañón, Madrid, 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 en empedrado en el cuello" ] ] "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" => 595 "Ancho" => 900 "Tamanyo" => 87545 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 65-year-old woman with a 13-year-history of primary biliary cirrhosis, systemic hypertension, dyslipidemia, and osteoporosis came to our clinic for evaluation of lesions that had developed 2 years earlier. The lesions had gradually appeared on the back of the neck and were asymptomatic.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed multiple whitish papules measuring 3 mm in diameter and with a rubbery consistency; the follicular openings were spared and showed no mucinous material when pressed. The papules appeared in clusters on the back of the neck (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), with occasional papules in the right axilla.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">No other areas of the body were affected.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Additional Tests</span><p id="par0020" class="elsevierStylePara elsevierViewall">Dermoscopy revealed well-delimited, homogenous, whitish papules with some dotted vessels at the periphery.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A 4-mm punch biopsy taken from a lesion on the neck showed slightly thickened collagen fibers in the mid dermis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). No calcium deposits were observed and staining of the elastic fibers revealed no abnormality.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">What Is Your Diagnosis?</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagnosis</span><p id="par0035" class="elsevierStylePara elsevierViewall">Fibroelastolytic papulosis of the neck.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Treatment</span><p id="par0040" class="elsevierStylePara elsevierViewall">Given the benign nature of the lesions and the fact that they were asymptomatic, it was decided to adopt a conservative approach and no treatment was given.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Comment</span><p id="par0045" class="elsevierStylePara elsevierViewall">In 1989 Shimizu et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> described white fibrous papulosis of the neck. Clinically this entity was characterized by isolated, asymptomatic whitish papules, mainly located on the back and side of the neck, although they were occasionally found on the shoulders and axillae. Histologically, white fibrous papulosis was classified under collagen disorders, given that the lesions were composed of circumscribed collagen bundles in the papillary and upper reticular dermis.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Rongioletti and Rebora<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> later reported another very similar entity, which they named pseudoxanthoma elasticum-like papillary dermal elastolysis, in which they observed yellowish papules resembling those of white fibrous papulosis. In this case, however, the papules showed a tendency to coalesce, giving rise to cobblestone-like plaques suggestive of pseudoxanthoma elasticum (PXE). Histologically the lesions were mainly characterized by elastolysis, with no calcium deposits or fibrosis, and were categorized as elastic fiber abnormalities.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Balus et al.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> subsequently discovered common clinical and histologic findings when reviewing cases reported for both entities alongside 20 of their own. They concluded that there were 2 variants of a single condition that they named fibroelastolytic papulosis of the neck.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The exact cause of fibroelastolytic papulosis of the neck is unknown, although most authors have related it to the skin aging process. Recently cases have also been reported in younger patients with a history of inflammatory diseases in the same area. This suggests that factors other than aging, such as the inflammation of skin adnexa,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> can exert an influence on the subsequent appearance of fibrosis and elastolysis.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Diagnosis is based on clinical presentation, histologic findings, and, more recently, dermoscopy, which shows well-delimited, whitish papules with some dotted vessels at the periphery, as well as pigment that fails to form a true reticulated area.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The case reported here is more compatible with what was originally known as white fibrous papulosis of the neck. This definitive diagnosis was established from the clinical presentation and dermoscopy, but particularly after the exclusion of other entities, such as PXE, on pathology study of the biopsy.</p><p id="par0075" class="elsevierStylePara elsevierViewall">In conclusion, knowledge of fibroelastolytic papulosis of the neck is important as it bears a strong clinical resemblance to PXE. Unlike PXE, however, prognosis is good and not associated with heart or ophthalmological disease.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:3 [ "identificador" => "sec0015" "titulo" => "Additional Tests" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Diagnosis" ] ] ] 3 => array:2 [ "identificador" => "sec0025" "titulo" => "Treatment" ] 4 => array:2 [ "identificador" => "sec0030" "titulo" => "Comment" ] 5 => 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: Echeverría-García B, et al. Pápulas en empedrado en el cuello. Actas Dermosifiliogr. 2013;104:247–8.</p>" ] ] "multimedia" => array:2 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 595 "Ancho" => 900 "Tamanyo" => 87545 ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1198 "Ancho" => 900 "Tamanyo" => 264899 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×10.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "White fibrous papulosis of the neck: a new clinicopathologic entity?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H. Shimizu" 1 => "S. Kimura" 2 => "T. Harada" 3 => "T. Nishikawa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1989" "volumen" => "20" "paginaInicial" => "1073" "paginaFinal" => "1077" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2666457" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pseudoxanthoma elasticum-like papillary dermal elastolysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F. Rongioletti" 1 => "A. 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Bellocci" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Br J Dermatol" "fecha" => "1997" "volumen" => "137" "paginaInicial" => "461" "paginaFinal" => "466" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9349351" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0002939410009487" "estado" => "S300" "issn" => "00029394" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of fibroelastolytic papulosis on the neck of a young man" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y.C. Song" 1 => "B.H. Oh" 2 => "J.H. Ko" 3 => "J.Y. Kim" 4 => "Y.J. Hwang" 5 => "Y.W. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5021/ad.2011.23.2.193" "Revista" => array:6 [ "tituloSerie" => "Ann Dermatol" "fecha" => "2011" "volumen" => "23" "paginaInicial" => "193" "paginaFinal" => "197" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21747618" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermoscopy of white fibrous papulosis of the neck" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Minagawa" 1 => "H. Koga" 2 => "T. Saida" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archdermatol.2009.368" "Revista" => array:5 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2010" "volumen" => "146" "paginaInicial" => "220" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20157048" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010400000003/v1_201304241622/S1578219013000401/v1_201304241622/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/15782190/0000010400000003/v1_201304241622/S1578219013000401/v1_201304241622/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013000401?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 15 | 14 | 29 |
| 2024 October | 93 | 42 | 135 |
| 2024 September | 94 | 32 | 126 |
| 2024 August | 131 | 57 | 188 |
| 2024 July | 118 | 39 | 157 |
| 2024 June | 104 | 36 | 140 |
| 2024 May | 84 | 29 | 113 |
| 2024 April | 80 | 25 | 105 |
| 2024 March | 99 | 38 | 137 |
| 2024 February | 80 | 29 | 109 |
| 2024 January | 78 | 37 | 115 |
| 2023 December | 73 | 25 | 98 |
| 2023 November | 71 | 24 | 95 |
| 2023 October | 79 | 35 | 114 |
| 2023 September | 98 | 37 | 135 |
| 2023 August | 65 | 13 | 78 |
| 2023 July | 89 | 35 | 124 |
| 2023 June | 102 | 30 | 132 |
| 2023 May | 136 | 28 | 164 |
| 2023 April | 95 | 26 | 121 |
| 2023 March | 69 | 27 | 96 |
| 2023 February | 63 | 31 | 94 |
| 2023 January | 50 | 41 | 91 |
| 2022 December | 55 | 52 | 107 |
| 2022 November | 24 | 35 | 59 |
| 2022 October | 41 | 29 | 70 |
| 2022 September | 34 | 41 | 75 |
| 2022 August | 29 | 32 | 61 |
| 2022 July | 28 | 31 | 59 |
| 2022 June | 30 | 25 | 55 |
| 2022 May | 46 | 45 | 91 |
| 2022 April | 63 | 40 | 103 |
| 2022 March | 65 | 58 | 123 |
| 2022 February | 48 | 28 | 76 |
| 2022 January | 62 | 42 | 104 |
| 2021 December | 38 | 42 | 80 |
| 2021 November | 53 | 34 | 87 |
| 2021 October | 60 | 55 | 115 |
| 2021 September | 47 | 50 | 97 |
| 2021 August | 46 | 30 | 76 |
| 2021 July | 60 | 37 | 97 |
| 2021 June | 77 | 33 | 110 |
| 2021 May | 64 | 43 | 107 |
| 2021 April | 98 | 77 | 175 |
| 2021 March | 73 | 44 | 117 |
| 2021 February | 76 | 32 | 108 |
| 2021 January | 58 | 31 | 89 |
| 2020 December | 54 | 14 | 68 |
| 2020 November | 32 | 16 | 48 |
| 2020 October | 33 | 9 | 42 |
| 2020 September | 38 | 16 | 54 |
| 2020 August | 33 | 17 | 50 |
| 2020 July | 33 | 11 | 44 |
| 2020 June | 38 | 17 | 55 |
| 2020 May | 28 | 17 | 45 |
| 2020 April | 31 | 13 | 44 |
| 2020 March | 48 | 20 | 68 |
| 2020 February | 2 | 0 | 2 |
| 2020 January | 6 | 1 | 7 |
| 2019 December | 8 | 5 | 13 |
| 2019 November | 8 | 0 | 8 |
| 2019 September | 6 | 2 | 8 |
| 2019 August | 8 | 0 | 8 |
| 2019 July | 8 | 2 | 10 |
| 2019 June | 8 | 5 | 13 |
| 2019 May | 10 | 21 | 31 |
| 2019 April | 5 | 4 | 9 |
| 2019 March | 5 | 6 | 11 |
| 2019 February | 0 | 1 | 1 |
| 2019 January | 3 | 0 | 3 |
| 2018 December | 4 | 0 | 4 |
| 2018 November | 3 | 0 | 3 |
| 2018 October | 4 | 0 | 4 |
| 2018 September | 6 | 1 | 7 |
| 2018 July | 0 | 9 | 9 |
| 2018 June | 0 | 4 | 4 |
| 2018 May | 0 | 9 | 9 |
| 2018 April | 0 | 3 | 3 |
| 2018 March | 4 | 4 | 8 |
| 2018 February | 79 | 6 | 85 |
| 2018 January | 85 | 6 | 91 |
| 2017 December | 63 | 8 | 71 |
| 2017 November | 73 | 9 | 82 |
| 2017 October | 95 | 2 | 97 |
| 2017 September | 65 | 22 | 87 |
| 2017 August | 84 | 16 | 100 |
| 2017 July | 70 | 16 | 86 |
| 2017 June | 98 | 18 | 116 |
| 2017 May | 92 | 14 | 106 |
| 2017 April | 71 | 8 | 79 |
| 2017 March | 61 | 40 | 101 |
| 2017 February | 127 | 8 | 135 |
| 2017 January | 68 | 5 | 73 |
| 2016 December | 103 | 6 | 109 |
| 2016 November | 94 | 17 | 111 |
| 2016 October | 148 | 28 | 176 |
| 2016 September | 194 | 7 | 201 |
| 2016 August | 154 | 7 | 161 |
| 2016 July | 67 | 10 | 77 |
| 2016 June | 11 | 10 | 21 |
| 2016 May | 5 | 10 | 15 |
| 2016 April | 4 | 7 | 11 |
| 2016 March | 2 | 2 | 4 |
| 2016 February | 3 | 2 | 5 |
| 2016 January | 10 | 2 | 12 |
| 2015 December | 11 | 0 | 11 |
| 2015 November | 13 | 4 | 17 |
| 2015 October | 9 | 3 | 12 |
| 2015 September | 6 | 1 | 7 |
| 2015 August | 12 | 4 | 16 |
| 2015 July | 161 | 114 | 275 |
| 2015 June | 99 | 13 | 112 |
| 2015 May | 103 | 11 | 114 |
| 2015 April | 101 | 6 | 107 |
| 2015 March | 44 | 2 | 46 |
| 2015 February | 37 | 3 | 40 |
| 2015 January | 41 | 3 | 44 |
| 2014 December | 44 | 4 | 48 |
| 2014 November | 38 | 4 | 42 |
| 2014 October | 34 | 3 | 37 |
| 2014 September | 31 | 0 | 31 |
| 2014 August | 32 | 6 | 38 |
| 2014 July | 31 | 3 | 34 |
| 2014 June | 62 | 11 | 73 |
| 2014 May | 51 | 7 | 58 |
| 2014 April | 43 | 2 | 45 |
| 2014 March | 51 | 6 | 57 |
| 2014 February | 33 | 8 | 41 |
| 2014 January | 24 | 6 | 30 |
| 2013 December | 29 | 8 | 37 |
| 2013 November | 34 | 2 | 36 |
| 2013 October | 34 | 5 | 39 |
| 2013 September | 16 | 1 | 17 |
| 2013 August | 11 | 8 | 19 |
| 2013 July | 3 | 2 | 5 |
| 2013 June | 3 | 5 | 8 |
| 2013 May | 1 | 1 | 2 |
| 2013 April | 3 | 1 | 4 |
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