Case for Diagnosis
Lesions in the Axilla After Hair Removal Using Intense Pulsed Light
Lesiones axilares después de tratamiento de depilación con luz pulsada intensa
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Alés-Fernández, L. Ortega-Martínez de Victoria, M.J. García-Fernández de Villalta" "autores" => array:3 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Alés-Fernández" "email" => array:1 [ 0 => "malesfer@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" ] ] ] 1 => array:3 [ "nombre" => "L." "apellidos" => "Ortega-Martínez de Victoria" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "M.J." "apellidos" => "García-Fernández de Villalta" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología Médico-Quirúrgica, Hospital Universitario Quirón Madrid, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario Quirón Madrid, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lesiones axilares después de tratamiento de depilación con luz pulsada intensa" ] ] "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" => 1000 "Ancho" => 1337 "Tamanyo" => 609962 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×<span class="elsevierStyleHsp" style=""></span>20.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 24-year-old woman with no medical history of interest presented with a 4-month history of asymptomatic lesions in the axillas. She first noticed the lesions after 3 sessions of hair removal using intense pulsed light.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0050" class="elsevierStylePara elsevierViewall">Physical examination revealed abundant tiny follicular flesh-colored to yellowish papules clustered symmetrically in both axillas (<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="par0015" class="elsevierStylePara elsevierViewall">Skin biopsy revealed apocrine glands with dilated ducts surrounded by an inflammatory infiltrate similar to that located around the follicular infundibulum (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The inflammatory infiltrate was composed mainly of cells with abundant, clear cytoplasm and microscopic lipid granules corresponding to xanthomatous histiocytes and is known as perifollicular xanthomatosis (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Spongiosis was observed in the excretory duct of the apocrine gland, and a keratotic plug was observed in the follicular infundibulum.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" 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="par0060" class="elsevierStylePara elsevierViewall">Fox-Fordyce disease after hair removal using intense pulsed light.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Clinical Course and Treatment</span><p id="par0065" class="elsevierStylePara elsevierViewall">The patient received tretinoin 0.05% cream, which was applied before bedtime. Her condition improved but did not resolve completely.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">Fox-Fordyce disease, or apocrine miliaria, is a rare condition that was described by Fox and Fordyce in 1902. It is characterized by chronic abnormality of the apocrine sweat glands. Clinically, it manifests as symmetrical tiny flesh-colored or yellowish papules at the sites of the apocrine glands, such as the axillas, the mammary areolas, the anogenital area, and the umbilical area.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It mainly affects postpubertal women, and the symptoms tend to resolve with the menopause, oral contraceptives, and pregnancy. It is caused by abnormal keratinization in the infundibulum, which is followed by obstruction of the apocrine duct and dilation of the apocrine gland. The disease is thought to be associated with hormonal and mechanical factors.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Three cases of axillary Fox-Fordyce disease caused by laser hair removal have been reported in recent years.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a> Hair removal systems—both laser and intense pulsed light—are based on the phenomenon of selective photothermolysis, in which the melanin in the hair follicle absorbs the light emitted and converts it to heat, with the consequent damage to the tissue of the follicle and hair loss. The narrow temporal association between these hair removal mechanisms and onset of Fox-Fordyce disease indicates that the procedure can damage the follicular infundibulum, thus affecting maturation of infundibular keratinocytes and triggering pathogenesis.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The histopathologic characteristics of Fox-Fordyce disease are very varied and include traditional findings such as dilation and hyperkeratosis of the follicular infundibulum, spongiosis of the infundibular epithelium, and periadnexal histiocytic and lymphocytic infiltrate. More recently described findings include perifollicular xanthomatosis, which is defined as a clearly consistent and specific marker of Fox-Fordyce disease,<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> especially in the axillas. Perifollicular xanthomatosis is caused by follicular obstruction leading to retention and subsequent extravasation of lipid-rich apocrine material, which is then phagocytosed by macrophages; hence the resultant xanthomatous appearance. The presence of perifollicular foamy macrophages contributes to the elevation of the lesions and gives them their characteristic yellowish coloring.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Treatment of Fox-Fordyce disease is generally unsatisfactory. The treatments proposed include topical and intralesional corticosteroids, topical and systemic retinoids, topical antibiotics (eg, clindamycin), oral contraceptives, topical pimecrolimus, and a modified liposuction technique in the most refractory cases.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of Interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 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 and Treatment" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of Interest" ] 7 => 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: Alés-Fernández M, Ortega-Martínez de Victoria L, García-Fernández de Villalta MJ. Lesiones axilares después de tratamiento de depilación con luz pulsada intensa. Actas Dermosifiliogr. 2015;106:61–62.</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" => 1064 "Ancho" => 1501 "Tamanyo" => 225735 ] ] ] 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" => 1302 "Tamanyo" => 541482 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×<span class="elsevierStyleHsp" style=""></span>20.</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" => 1000 "Ancho" => 1337 "Tamanyo" => 609962 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×<span class="elsevierStyleHsp" style=""></span>20.</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" => "Enfermedad de Fox-Fordyce" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 11 | 15 |
| 2024 October | 64 | 47 | 111 |
| 2024 September | 62 | 45 | 107 |
| 2024 August | 95 | 46 | 141 |
| 2024 July | 70 | 35 | 105 |
| 2024 June | 96 | 44 | 140 |
| 2024 May | 72 | 43 | 115 |
| 2024 April | 55 | 23 | 78 |
| 2024 March | 51 | 41 | 92 |
| 2024 February | 55 | 33 | 88 |
| 2024 January | 47 | 30 | 77 |
| 2023 December | 55 | 16 | 71 |
| 2023 November | 56 | 29 | 85 |
| 2023 October | 48 | 26 | 74 |
| 2023 September | 47 | 30 | 77 |
| 2023 August | 34 | 13 | 47 |
| 2023 July | 39 | 34 | 73 |
| 2023 June | 55 | 22 | 77 |
| 2023 May | 39 | 35 | 74 |
| 2023 April | 53 | 39 | 92 |
| 2023 March | 39 | 37 | 76 |
| 2023 February | 29 | 26 | 55 |
| 2023 January | 54 | 28 | 82 |
| 2022 December | 48 | 48 | 96 |
| 2022 November | 20 | 25 | 45 |
| 2022 October | 25 | 18 | 43 |
| 2022 September | 26 | 40 | 66 |
| 2022 August | 30 | 39 | 69 |
| 2022 July | 25 | 54 | 79 |
| 2022 June | 31 | 28 | 59 |
| 2022 May | 39 | 35 | 74 |
| 2022 April | 50 | 32 | 82 |
| 2022 March | 49 | 52 | 101 |
| 2022 February | 31 | 31 | 62 |
| 2022 January | 41 | 50 | 91 |
| 2021 December | 32 | 36 | 68 |
| 2021 November | 43 | 37 | 80 |
| 2021 October | 84 | 59 | 143 |
| 2021 September | 42 | 31 | 73 |
| 2021 August | 35 | 27 | 62 |
| 2021 July | 74 | 32 | 106 |
| 2021 June | 50 | 33 | 83 |
| 2021 May | 31 | 37 | 68 |
| 2021 April | 101 | 68 | 169 |
| 2021 March | 83 | 21 | 104 |
| 2021 February | 72 | 39 | 111 |
| 2021 January | 23 | 22 | 45 |
| 2020 December | 18 | 20 | 38 |
| 2020 November | 21 | 17 | 38 |
| 2020 October | 14 | 12 | 26 |
| 2020 September | 27 | 5 | 32 |
| 2020 August | 24 | 34 | 58 |
| 2020 July | 24 | 12 | 36 |
| 2020 June | 34 | 16 | 50 |
| 2020 May | 22 | 20 | 42 |
| 2020 April | 25 | 23 | 48 |
| 2020 March | 27 | 21 | 48 |
| 2020 February | 2 | 10 | 12 |
| 2020 January | 0 | 14 | 14 |
| 2019 December | 4 | 0 | 4 |
| 2019 November | 0 | 2 | 2 |
| 2019 October | 0 | 1 | 1 |
| 2019 September | 6 | 1 | 7 |
| 2019 August | 0 | 2 | 2 |
| 2019 July | 0 | 9 | 9 |
| 2019 June | 0 | 16 | 16 |
| 2019 May | 2 | 4 | 6 |
| 2019 April | 0 | 9 | 9 |
| 2019 March | 0 | 4 | 4 |
| 2019 February | 4 | 3 | 7 |
| 2019 January | 0 | 1 | 1 |
| 2018 December | 4 | 5 | 9 |
| 2018 November | 1 | 0 | 1 |
| 2018 October | 1 | 0 | 1 |
| 2018 September | 3 | 0 | 3 |
| 2018 February | 34 | 2 | 36 |
| 2018 January | 63 | 3 | 66 |
| 2017 December | 35 | 6 | 41 |
| 2017 November | 29 | 4 | 33 |
| 2017 October | 31 | 6 | 37 |
| 2017 September | 34 | 3 | 37 |
| 2017 August | 57 | 6 | 63 |
| 2017 July | 54 | 7 | 61 |
| 2017 June | 50 | 1 | 51 |
| 2017 May | 39 | 5 | 44 |
| 2017 April | 26 | 3 | 29 |
| 2017 March | 13 | 16 | 29 |
| 2017 February | 18 | 5 | 23 |
| 2017 January | 25 | 5 | 30 |
| 2016 December | 34 | 11 | 45 |
| 2016 November | 28 | 12 | 40 |
| 2016 October | 22 | 9 | 31 |
| 2016 September | 0 | 7 | 7 |
| 2016 August | 0 | 4 | 4 |
| 2016 July | 10 | 0 | 10 |
| 2016 June | 18 | 2 | 20 |
| 2016 May | 12 | 3 | 15 |
| 2016 April | 9 | 5 | 14 |
| 2016 March | 13 | 2 | 15 |
| 2016 February | 8 | 8 | 16 |
| 2016 January | 11 | 4 | 15 |
| 2015 December | 8 | 2 | 10 |
| 2015 November | 15 | 1 | 16 |
| 2015 October | 7 | 4 | 11 |
| 2015 September | 7 | 3 | 10 |
| 2015 August | 6 | 1 | 7 |
| 2015 July | 36 | 2 | 38 |
| 2015 June | 24 | 7 | 31 |
| 2015 May | 27 | 12 | 39 |
| 2015 April | 24 | 3 | 27 |
| 2015 March | 34 | 13 | 47 |
| 2015 February | 4 | 1 | 5 |
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