Case for Diagnosis
Nodular Plaque in the Nasolabial Fold
Placa abollonada en surco nasogeniano
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He also had a history of actinic cheilitis and Bowen disease on the right forearm.</p><p id="par0015" class="elsevierStylePara elsevierViewall">On this occasion he was seen in outpatients for a pruritic plaque that had arisen in right nasolabial fold 4 months earlier and showed rapid growth.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0020" class="elsevierStylePara elsevierViewall">On examination there was a well-defined erythematous plaque measuring 2.9<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>1.5<span class="elsevierStyleHsp" style=""></span>cm. The plaque was formed of confluent yellowish papules and nodules that gave it a lumpy appearance. The border of the plaque was in contact with the scar of a previous operation (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathology</span><p id="par0025" class="elsevierStylePara elsevierViewall">On histopathology, the epidermis showed mild acanthosis with orthokeratotic hyperkeratosis and marked solar elastosis. Large, fine-walled cystic structures that contained multilayered basophilic keratin were observed in the papillary and superficial reticular dermis. The few sebaceous glands remaining were hypoplastic. The scar of the previous operation was visible beneath the cysts. Some areas of irregular epithelial cords were present between the cyst and the scar, but there was no atypia and the cords were considered to be reactive (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">What is Your Diagnosis?</span></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Diagnosis</span><p id="par0035" class="elsevierStylePara elsevierViewall">Actinic comedonal plaque.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Clinical Course</span><p id="par0040" class="elsevierStylePara elsevierViewall">The patient died of unrelated causes soon after consultation.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Comment</span><p id="par0045" class="elsevierStylePara elsevierViewall">In 1980, Eastern and Martin<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> described 5 patients under the heading <span class="elsevierStyleItalic">actinic comedonal plaques</span>. A further 3 isolated cases have been reported since that time.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a> In 2003, Morgan et al.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>used the term <span class="elsevierStyleItalic">multiple follicular cysts, infundibular type with vellus hair and solar elastosis of the ears</span> to describe 3 cases of unilateral plaques on the auricle of the ear that, in our opinion, satisfied the criteria for actinic comedonal plaques.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The majority of cases occur in men of advanced age, with marked solar damage and a history of nonmelanoma skin cancer or actinic keratosis. All cases presented single plaques with nodules or cysts and dilated follicular orifices, with a bluish, yellowish, or erythematous color, probably depending on the predominant type of lesion. The upper limbs are the most common site, though lesions have also been reported on the face and on the ear. Histopathology shows marked solar elastosis, with a thin or acanthotic epidermis, and occasionally there is moderate dyskeratosis. Comedones and follicular dilatation are observed in all cases, with a reduced number of sebaceous glands, while the eccrine glands are unaffected. In 1 case, the lesions appeared to be epithelial invaginations, as also observed in our case.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The actinic comedonal plaque is considered to be a localized variant of Favre-Racouchot syndrome because of its clinical and histopathological similarity. However, the lesions in Favre-Racouchot syndrome are bilateral and localized in the periorbital areas and the temples.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The lesion must be distinguished clinically and histopathologically from comedonal nevus. However, comedonal nevus is usually present at birth or appears during childhood, and often presents a linear distribution. From a histopathological point of view, the lesions must also be differentiated from the residual phase of coral reef granuloma and from chronic <span class="elsevierStyleItalic">Staphylococcus aureus</span> infection,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> though there is typically a history of infection in the area. Although dyskeratosis is occasionally observed in actinic comedonal plaque, differentiation from actinic keratosis is rarely a problem. An important factor in our case was the clinical similarity of the lesion with basal cell carcinoma, which was the provisional clinical diagnosis.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Treatment by surgery or with topical corticosteroids<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> or vitamin A derivatives<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> has been unsuccessful. Tetracyclines only improved the inflammatory appearance of the lesions.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Resolution has been reported in some cases after cryotherapy.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 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" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Comment" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Piqué-Duran E, García-Vázquez O, Tang K. Placa abollonada en surco nasogeniano. Actas Dermosifiliogr. 2015;106:63–64.</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" => 599 "Ancho" => 900 "Tamanyo" => 143276 ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 675 "Ancho" => 900 "Tamanyo" => 283847 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×<span class="elsevierStyleHsp" style=""></span>100.</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" => "Actinic comedonal plaque" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.S. Eastern" 1 => "S. Martin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1980" "volumen" => "3" "paginaInicial" => "633" "paginaFinal" => "636" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7204681" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Actinic comedonal plaque of the eyelid" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T. Wojno" 1 => "R.R. 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Rivlin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Cutis" "fecha" => "1997" "volumen" => "60" "paginaInicial" => "145" "paginaFinal" => "146" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9314619" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multiple follicular cysts, infundibular type with vellus hairs and solar elastosis of the ears: A new dermatoheliosis?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.B. Morgan" 1 => "G.L. Stevens" 2 => "S. Somach" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Cutan Pathol" "fecha" => "2003" "volumen" => "30" "paginaInicial" => "29" "paginaFinal" => "31" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12534801" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Actinic comedonal plaque" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 10 | 6 | 16 |
| 2024 October | 77 | 44 | 121 |
| 2024 September | 97 | 40 | 137 |
| 2024 August | 136 | 63 | 199 |
| 2024 July | 108 | 39 | 147 |
| 2024 June | 106 | 35 | 141 |
| 2024 May | 70 | 42 | 112 |
| 2024 April | 78 | 29 | 107 |
| 2024 March | 74 | 43 | 117 |
| 2024 February | 71 | 39 | 110 |
| 2024 January | 76 | 45 | 121 |
| 2023 December | 83 | 33 | 116 |
| 2023 November | 64 | 30 | 94 |
| 2023 October | 73 | 44 | 117 |
| 2023 September | 73 | 37 | 110 |
| 2023 August | 58 | 29 | 87 |
| 2023 July | 63 | 53 | 116 |
| 2023 June | 58 | 38 | 96 |
| 2023 May | 52 | 47 | 99 |
| 2023 April | 72 | 39 | 111 |
| 2023 March | 47 | 42 | 89 |
| 2023 February | 48 | 27 | 75 |
| 2023 January | 58 | 40 | 98 |
| 2022 December | 53 | 50 | 103 |
| 2022 November | 25 | 22 | 47 |
| 2022 October | 32 | 23 | 55 |
| 2022 September | 53 | 45 | 98 |
| 2022 August | 38 | 39 | 77 |
| 2022 July | 39 | 37 | 76 |
| 2022 June | 49 | 29 | 78 |
| 2022 May | 75 | 39 | 114 |
| 2022 April | 65 | 51 | 116 |
| 2022 March | 69 | 58 | 127 |
| 2022 February | 60 | 22 | 82 |
| 2022 January | 70 | 46 | 116 |
| 2021 December | 53 | 41 | 94 |
| 2021 November | 48 | 44 | 92 |
| 2021 October | 102 | 48 | 150 |
| 2021 September | 64 | 38 | 102 |
| 2021 August | 68 | 27 | 95 |
| 2021 July | 53 | 31 | 84 |
| 2021 June | 39 | 29 | 68 |
| 2021 May | 48 | 23 | 71 |
| 2021 April | 85 | 57 | 142 |
| 2021 March | 52 | 38 | 90 |
| 2021 February | 46 | 26 | 72 |
| 2021 January | 43 | 24 | 67 |
| 2020 December | 52 | 15 | 67 |
| 2020 November | 32 | 18 | 50 |
| 2020 October | 46 | 27 | 73 |
| 2020 September | 36 | 8 | 44 |
| 2020 August | 25 | 27 | 52 |
| 2020 July | 28 | 9 | 37 |
| 2020 June | 33 | 25 | 58 |
| 2020 May | 40 | 36 | 76 |
| 2020 April | 37 | 28 | 65 |
| 2020 March | 33 | 16 | 49 |
| 2020 February | 4 | 8 | 12 |
| 2020 January | 4 | 3 | 7 |
| 2019 December | 4 | 7 | 11 |
| 2019 November | 4 | 5 | 9 |
| 2019 October | 0 | 6 | 6 |
| 2019 September | 4 | 8 | 12 |
| 2019 August | 4 | 5 | 9 |
| 2019 July | 4 | 12 | 16 |
| 2019 June | 4 | 27 | 31 |
| 2019 May | 3 | 54 | 57 |
| 2019 April | 4 | 44 | 48 |
| 2019 March | 0 | 10 | 10 |
| 2019 February | 2 | 4 | 6 |
| 2019 January | 0 | 7 | 7 |
| 2018 December | 1 | 11 | 12 |
| 2018 November | 4 | 6 | 10 |
| 2018 October | 1 | 0 | 1 |
| 2018 September | 4 | 8 | 12 |
| 2018 August | 0 | 1 | 1 |
| 2018 July | 0 | 5 | 5 |
| 2018 June | 0 | 1 | 1 |
| 2018 May | 0 | 2 | 2 |
| 2018 April | 0 | 5 | 5 |
| 2018 March | 1 | 0 | 1 |
| 2018 February | 21 | 9 | 30 |
| 2018 January | 35 | 6 | 41 |
| 2017 December | 36 | 7 | 43 |
| 2017 November | 34 | 8 | 42 |
| 2017 October | 23 | 8 | 31 |
| 2017 September | 35 | 4 | 39 |
| 2017 August | 66 | 15 | 81 |
| 2017 July | 30 | 8 | 38 |
| 2017 June | 47 | 34 | 81 |
| 2017 May | 38 | 13 | 51 |
| 2017 April | 24 | 9 | 33 |
| 2017 March | 20 | 17 | 37 |
| 2017 February | 19 | 11 | 30 |
| 2017 January | 17 | 6 | 23 |
| 2016 December | 25 | 16 | 41 |
| 2016 November | 40 | 12 | 52 |
| 2016 October | 26 | 12 | 38 |
| 2016 September | 0 | 12 | 12 |
| 2016 August | 0 | 2 | 2 |
| 2016 July | 10 | 1 | 11 |
| 2016 June | 22 | 1 | 23 |
| 2016 May | 17 | 26 | 43 |
| 2016 April | 22 | 17 | 39 |
| 2016 March | 12 | 11 | 23 |
| 2016 February | 14 | 13 | 27 |
| 2016 January | 9 | 9 | 18 |
| 2015 December | 11 | 6 | 17 |
| 2015 November | 15 | 2 | 17 |
| 2015 October | 9 | 0 | 9 |
| 2015 September | 12 | 1 | 13 |
| 2015 August | 3 | 3 | 6 |
| 2015 July | 22 | 4 | 26 |
| 2015 June | 25 | 4 | 29 |
| 2015 May | 30 | 6 | 36 |
| 2015 April | 31 | 4 | 35 |
| 2015 March | 36 | 11 | 47 |
| 2015 February | 5 | 1 | 6 |
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