Case and Research Letters
Radiodermatitis with Signs of Eccrine Squamous Syringometaplasia Following a Diagnostic Procedure
Radiodermitis secundaria a procedimiento diagnóstico con signos de siringometaplasia escamosa ecrina
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Signos de dismaduración epidérmica: células disqueratósicas, con alteración del tamaño y la polaridad de los queratinocitos, algunos de ellos binucleados (HE<span class="elsevierStyleHsp" style=""></span>×10). B) Conductos ecrinos en los que se observan zonas de metaplasia escamosa junto con infiltrado neutrofílico en el interior de los ovillos, así como un moderado infiltrado inflamatorio periecrino (HE<span class="elsevierStyleHsp" style=""></span>×40).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.J. Concha Garzón, M. Llamas-Velasco, J. Sánchez-Pérez, J. Fraga" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M.J." "apellidos" => "Concha Garzón" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Llamas-Velasco" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Sánchez-Pérez" ] 3 => array:2 [ "nombre" => "J." 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Concha Garzón, M. Llamas-Velasco, J. Sánchez-Pérez, J. Fraga" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M.J." "apellidos" => "Concha Garzón" "email" => array:1 [ 0 => "mjconchg@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Llamas-Velasco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "Sánchez-Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Fraga" "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 Universitario La Princesa, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario La Princesa, 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" => "Radiodermitis secundaria a procedimiento diagnóstico con signos de siringometaplasia escamosa ecrina" ] ] "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" => 2812 "Ancho" => 1667 "Tamanyo" => 543800 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Hyperkeratosis and irregular acanthosis. Signs of epidermal dysmaturation: dyskeratotic cells, with keratinocytes of altered size and polarity, some of which are binucleated (hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10). B, Eccrine duct in which areas of squamous metaplasia and a neutrophilic infiltrate can be observed inside the coil, as well as a moderate perieccrine inflammatory infiltrate (hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>40).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Eccrine squamous syringometaplasia (ESS) is a squamous metaplasia of the cuboidal cells of the of the eccrine sweat ducts. ESS is considered a nonspecific reactive response to exposure to toxic agents and drugs but has also been described following cutaneous processes, such as tumors, infections and inflammatory conditions, such as pyoderma gangrenosum, phytophotodermatitis, and chronic ulcers.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report a peculiar case of radiodermatitis with the unusual histopathologic finding of ESS.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The patient was a 62-year-old man who reported the appearance of an itchy erythematous plaque on the right side of his back. The plaque had developed 15 days earlier. His medical history included metabolic syndrome, hyperuricemia, and chronic ischemic heart disease. The patient was receiving regular treatment with atorvastatin, allopurinol, enalapril, isosorbide, carvedilol, ticlopidine, sitagliptin, and metformin. In the previous 2 months, he had undergone a diagnostic coronary angiography and 2 angioplasties.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Physical examination revealed a square-shaped erythematous plaque (9<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>12<span class="elsevierStyleHsp" style=""></span>cm) with well-defined borders and an eroded center (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The location coincided with one of the sites irradiated when the patient received a total dose of 7.8<span class="elsevierStyleHsp" style=""></span>Gy in 3 separate procedures. Histopathology demonstrated hyperkeratosis, irregular acanthosis and dysmaturation of the epidermis, a moderate predominantly neutrophilic perieccrine inflammatory infiltrate in the dermis, and squamous metaplasia of both eccrine coil and duct (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). These findings were compatible with ESS.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The radiodermatitis plaque responded favorably to local treatments and topical corticosteroids. At the time of writing, only slight residual hyperpigmentation persisted.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The frequency of radiodermatitis caused by coronary procedures is not known but is thought to be increasing due to the growing use and complexity of these interventions. The most commonly affected locations are the right axillary region, the middle third of the back, the right anterolateral region of the chest, and the scapular area, as in the present case.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Depending on the time of onset of skin lesions after exposure, radiodermatitis is classically described as either acute or chronic. In recent years, a subacute category has also been added; this form usually occurs weeks to months after the initial exposure.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The radiation dose required to cause erythema is estimated at 3<span class="elsevierStyleHsp" style=""></span>Gy, and doses of over 12<span class="elsevierStyleHsp" style=""></span>Gy can cause peeling as well as secondary necrosis and ulceration. However, the dose threshold varies widely depending on the area exposed and an individual's susceptibility.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> Thus, the radiation dose of more than 7.8<span class="elsevierStyleHsp" style=""></span>Gy received by our patient in the lesion area was sufficient to initiate a cutaneous inflammatory response which may have induced both the radiodermatitis and the ESS.</p><p id="par0045" class="elsevierStylePara elsevierViewall">We have found no similar cases in the literature describing an association between these two conditions.</p><p id="par0050" class="elsevierStylePara elsevierViewall">This patient had not been exposed to any new substances, except for Visipaque (iodixanol), an iodinated contrast agent used during fluoroscopic procedures. However, no association between this substance and ESS has been described.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The differential diagnosis should include dermatitis due to radiation recall, which can present with ESS.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> However, radiation recall dermatitis most commonly affects areas of radiotherapy-exposed skin that are subsequently reactivated by a second substance, often a chemotherapeutic agent. In our case, given the short clinical course of the condition and the lack of exposure to precipitating agents, we can reasonably rule out this diagnosis.</p><p id="par0060" class="elsevierStylePara elsevierViewall">In summary, we have presented an unusual case of ESS in a patient with radiodermatitis, which we believe should be added to the list of dermatological conditions in which signs of ESS may be observed.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Concha Garzón MJ, et al. Radiodermitis secundaria a procedimiento diagnóstico con signos de siringometaplasia escamosa ecrina. Actas Dermosifiliogr. 2013;104:255–7.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 953 "Ancho" => 1332 "Tamanyo" => 106182 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous plaque with an ulcerated center on the right side of the back.</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" => 2812 "Ancho" => 1667 "Tamanyo" => 543800 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Hyperkeratosis and irregular acanthosis. Signs of epidermal dysmaturation: dyskeratotic cells, with keratinocytes of altered size and polarity, some of which are binucleated (hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10). B, Eccrine duct in which areas of squamous metaplasia and a neutrophilic infiltrate can be observed inside the coil, as well as a moderate perieccrine inflammatory infiltrate (hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>40).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chemotherapy-related bilateral dermatitis associated with eccrine squamous syringometaplasia: reappraisal of epidemiological, clinical, and pathological features" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Martorell-Calatayud" 1 => "O. Sanmartín" 2 => "R. Botella-Estrada" 3 => "N.N. Balmer" 4 => "C. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 9 | 12 | 21 |
| 2024 October | 70 | 50 | 120 |
| 2024 September | 67 | 37 | 104 |
| 2024 August | 109 | 71 | 180 |
| 2024 July | 78 | 55 | 133 |
| 2024 June | 92 | 49 | 141 |
| 2024 May | 82 | 50 | 132 |
| 2024 April | 83 | 33 | 116 |
| 2024 March | 79 | 27 | 106 |
| 2024 February | 67 | 36 | 103 |
| 2024 January | 68 | 31 | 99 |
| 2023 December | 57 | 18 | 75 |
| 2023 November | 77 | 31 | 108 |
| 2023 October | 64 | 20 | 84 |
| 2023 September | 64 | 28 | 92 |
| 2023 August | 53 | 15 | 68 |
| 2023 July | 66 | 31 | 97 |
| 2023 June | 71 | 24 | 95 |
| 2023 May | 51 | 27 | 78 |
| 2023 April | 72 | 22 | 94 |
| 2023 March | 46 | 25 | 71 |
| 2023 February | 48 | 26 | 74 |
| 2023 January | 30 | 25 | 55 |
| 2022 December | 47 | 31 | 78 |
| 2022 November | 25 | 18 | 43 |
| 2022 October | 24 | 22 | 46 |
| 2022 September | 26 | 29 | 55 |
| 2022 August | 23 | 35 | 58 |
| 2022 July | 27 | 33 | 60 |
| 2022 June | 25 | 28 | 53 |
| 2022 May | 26 | 32 | 58 |
| 2022 April | 44 | 46 | 90 |
| 2022 March | 38 | 47 | 85 |
| 2022 February | 38 | 26 | 64 |
| 2022 January | 33 | 36 | 69 |
| 2021 December | 40 | 39 | 79 |
| 2021 November | 44 | 36 | 80 |
| 2021 October | 45 | 55 | 100 |
| 2021 September | 47 | 38 | 85 |
| 2021 August | 55 | 26 | 81 |
| 2021 July | 38 | 35 | 73 |
| 2021 June | 39 | 32 | 71 |
| 2021 May | 31 | 31 | 62 |
| 2021 April | 80 | 65 | 145 |
| 2021 March | 65 | 26 | 91 |
| 2021 February | 63 | 25 | 88 |
| 2021 January | 37 | 20 | 57 |
| 2020 December | 30 | 14 | 44 |
| 2020 November | 19 | 11 | 30 |
| 2020 October | 25 | 11 | 36 |
| 2020 September | 31 | 11 | 42 |
| 2020 August | 25 | 17 | 42 |
| 2020 July | 30 | 23 | 53 |
| 2020 June | 35 | 24 | 59 |
| 2020 May | 19 | 11 | 30 |
| 2020 April | 17 | 18 | 35 |
| 2020 March | 29 | 16 | 45 |
| 2020 February | 4 | 1 | 5 |
| 2020 January | 0 | 2 | 2 |
| 2019 December | 2 | 3 | 5 |
| 2019 November | 0 | 1 | 1 |
| 2019 October | 0 | 3 | 3 |
| 2019 September | 4 | 1 | 5 |
| 2019 June | 2 | 21 | 23 |
| 2019 May | 1 | 28 | 29 |
| 2019 April | 0 | 18 | 18 |
| 2019 March | 2 | 10 | 12 |
| 2019 January | 2 | 0 | 2 |
| 2018 November | 0 | 1 | 1 |
| 2018 October | 3 | 0 | 3 |
| 2018 September | 2 | 0 | 2 |
| 2018 May | 0 | 1 | 1 |
| 2018 April | 0 | 1 | 1 |
| 2018 March | 0 | 1 | 1 |
| 2018 February | 38 | 7 | 45 |
| 2018 January | 112 | 6 | 118 |
| 2017 December | 125 | 8 | 133 |
| 2017 November | 34 | 4 | 38 |
| 2017 October | 42 | 8 | 50 |
| 2017 September | 28 | 9 | 37 |
| 2017 August | 29 | 10 | 39 |
| 2017 July | 34 | 5 | 39 |
| 2017 June | 36 | 6 | 42 |
| 2017 May | 34 | 6 | 40 |
| 2017 April | 34 | 9 | 43 |
| 2017 March | 17 | 14 | 31 |
| 2017 February | 24 | 10 | 34 |
| 2017 January | 30 | 10 | 40 |
| 2016 December | 47 | 6 | 53 |
| 2016 November | 67 | 10 | 77 |
| 2016 October | 93 | 10 | 103 |
| 2016 September | 76 | 12 | 88 |
| 2016 August | 51 | 5 | 56 |
| 2016 July | 42 | 5 | 47 |
| 2016 June | 10 | 11 | 21 |
| 2016 May | 8 | 6 | 14 |
| 2016 April | 3 | 14 | 17 |
| 2016 March | 5 | 1 | 6 |
| 2016 February | 5 | 2 | 7 |
| 2016 January | 6 | 2 | 8 |
| 2015 December | 6 | 5 | 11 |
| 2015 November | 14 | 4 | 18 |
| 2015 October | 17 | 3 | 20 |
| 2015 September | 10 | 2 | 12 |
| 2015 August | 6 | 3 | 9 |
| 2015 July | 85 | 115 | 200 |
| 2015 June | 70 | 7 | 77 |
| 2015 May | 94 | 20 | 114 |
| 2015 April | 68 | 7 | 75 |
| 2015 March | 47 | 2 | 49 |
| 2015 February | 55 | 6 | 61 |
| 2015 January | 23 | 2 | 25 |
| 2014 December | 41 | 4 | 45 |
| 2014 November | 24 | 4 | 28 |
| 2014 October | 46 | 14 | 60 |
| 2014 September | 23 | 5 | 28 |
| 2014 August | 27 | 5 | 32 |
| 2014 July | 21 | 7 | 28 |
| 2014 June | 43 | 11 | 54 |
| 2014 May | 45 | 7 | 52 |
| 2014 April | 37 | 2 | 39 |
| 2014 March | 37 | 8 | 45 |
| 2014 February | 37 | 7 | 44 |
| 2014 January | 26 | 6 | 32 |
| 2013 December | 34 | 9 | 43 |
| 2013 November | 34 | 8 | 42 |
| 2013 October | 24 | 3 | 27 |
| 2013 September | 20 | 4 | 24 |
| 2013 August | 14 | 3 | 17 |
| 2013 July | 8 | 5 | 13 |
| 2013 June | 2 | 1 | 3 |
| 2013 May | 1 | 2 | 3 |
| 2013 April | 1 | 0 | 1 |
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