Case for Diagnosis
Acquired Linear Lesion in the Presternal Region
Lesión adquirida de distribución lineal en región preesternal
A. Sánchez-Orta
, F. Albízuri-Prado, E. Sendagorta Cudós
Corresponding author
Servicio de Dermatología, Hospital Universitario La Paz, Madrid, España
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Sánchez-Orta, F. Albízuri-Prado, E. Sendagorta Cudós" "autores" => array:3 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Sánchez-Orta" "email" => array:1 [ 0 => "albita.tt@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Albízuri-Prado" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Sendagorta Cudós" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Universitario La Paz, Madrid, España" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lesión adquirida de distribución lineal en región preesternal" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 650 "Ancho" => 445 "Tamanyo" => 56005 ] ] ] ] "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 32-year-old woman consulted for an asymptomatic lesion that had been present on the mid sternum for 12 years, unchanged in size or shape. She was concerned about the cosmetic effect of the lesion, as it looked like a surgical sternotomy scar. The only relevant background was a scoliosis that had required treatment using a corset during childhood.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">A linear midline lesion of approximately 5<span class="elsevierStyleHsp" style=""></span>cm in length was observed. It was formed of papular lesions with central follicular openings that simulated open comedos arranged in line, one after the other (<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">Additional Tests</span><p id="par0015" class="elsevierStylePara elsevierViewall">Epiluminiscence examination made the follicular openings clearly visible; they were found to be full of a homogeneous brownish material (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Histology revealed infundibular dilatations, with no hairs, in the form of contiguous epidermal invaginations into the dermis, filled by laminar keratin (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Chest x-ray revealed a moderate dorsolumbar scoliosis that had been partially corrected years earlier.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Ophthalmologic examination of the right eye revealed an asymptomatic subcapsular cataract, which could have been of recent onset.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Neurologic examination was rigorously normal.</p><p id="par0040" class="elsevierStylePara elsevierViewall">What Is Your Diagnosis?</p><p id="par0045" class="elsevierStylePara elsevierViewall">Nevus comedonicus.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Clinical Course and Treatment</span><p id="par0050" class="elsevierStylePara elsevierViewall">Treatment was started with 0.1% retinoic acid, leading to a notable improvement within a few days, leaving a barely perceptible residual lesion.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Comment</span><p id="par0055" class="elsevierStylePara elsevierViewall">Nevus comedonicus is considered to be a variant of epidermal nevus. It is formed of infundibular dilatations filled by keratin, similar to typical comedos, and it usually arises on the face and neck. The prevalence of this condition is estimated at between 1 in 45 000 and 1 in 100 000 patients, with no gender or racial differences.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> Most commonly it is present at birth or appears during infancy. The typical presentation of these dilated follicles is grouped in a plaque or honeycomb distribution, although we may observe other patterns: unilateral or bilateral, linear, segmental, or Blaschkoid.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> The clinical appearance is usually sufficient to make the diagnosis, although epiluminescence can be useful, as it can make follicles visible as papules with openings filled by brown-colored plugs; the dermoscopic image of acne vulgaris would show numerous superficial comedos of light or dark brown or black color, depending on the type of acne (open or closed comedos).<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> In case of doubt, histology will confirm the diagnosis.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Nevus comedonicus can occur as an isolated finding<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> or, more rarely, be associated with ocular, skeletal, or central nervous system changes, forming part of a neurocutaneous syndrome called nevus comedonicus syndrome. The most common changes described in this syndrome are cataracts (typically ipsilateral), scoliosis, vertebral fusions, spina bifida, and mental retardation, although many and varied alterations have been reported in the literature.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">1,3,4</span></a> The appearance of epithelial tumors within the lesion have also been reported, in particular trichoepitheliomas, syringocystadenoma papilliferum, keratoacanthoma, and, more rarely, basal cell and squamous cell carcinomas.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">In the absence of complications or marked cosmetic alterations, management is conservative. First-line treatment is with keratolytics and topical retinoids. Laser therapy or surgical excision can be considered in some cases.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> The possible associated diseases must be taken into account, and periodic follow-up of the lesion should be performed to detect skin tumors.</p><p id="par0070" class="elsevierStylePara elsevierViewall">In conclusion, we have described the clinical and dermoscopic characteristics of a new case of linear nevus comedonicus of uncertain time since onset, associated with moderate scoliosis and a mild subcapsular cataract. Treatment with topical retinoids was effective. The prevalence of moderate scoliosis and subcapsular cataract is high in the general population, and this association may therefore be mere coincidence, in which case this would not be nevus comedonicus syndrome.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">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" => "Additional Tests" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Clinical Course and Treatment" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Comment" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of Interest" ] 6 => array:2 [ "identificador" => "xack277900" "titulo" => "Acknowledgments" ] 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: Sánchez-Orta A. Lesión adquirida de distribución lineal en región preesternal. Actas Dermosifiliogr. 2016;107:597–598.</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" => 651 "Ancho" => 492 "Tamanyo" => 109083 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 650 "Ancho" => 445 "Tamanyo" => 56005 ] ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 425 "Ancho" => 564 "Tamanyo" => 102525 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification x4.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nevus comedonicus: An updated review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. Tchernev" 1 => "J. Ananiev" 2 => "K. Semkova" 3 => "L.A. Dourmishev" 4 => "J. Schönlebe" 5 => "U. Wollina" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Dermatol Ther" "fecha" => "2013" "volumen" => "3" "paginaInicial" => "33" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermoscopy on nevus comedonicus: A case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G. Kamiñska-Winciorek" 1 => "R. Œpiewak" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Postep Derm Alergol" "fecha" => "2013" "volumen" => "30" "paginaInicial" => "252" "paginaFinal" => "254" "itemHostRev" => array:3 [ "pii" => "S0091674912003478" "estado" => "S300" "issn" => "00916749" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nevus comedonicus syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Pavithra" 1 => "H. Pai" 2 => "H. Mallya" 3 => "G.S. Pai" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/0019-5154.91853" "Revista" => array:6 [ "tituloSerie" => "Indian J Dermatol" "fecha" => "2011" "volumen" => "56" "paginaInicial" => "771" "paginaFinal" => "772" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22345795" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The group of epidermal nevus syndromes. Part I. Well defined phenotypes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R. Happle" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2010.01.017" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2010" "volumen" => "63" "paginaInicial" => "1" "paginaFinal" => "22" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20542174" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack277900" "titulo" => "Acknowledgments" "texto" => "<p id="par0080" class="elsevierStylePara elsevierViewall">We would like to thank Dr. María J. Beato Merino of the Pathology Department of Hospital Universitario La Paz</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010700000007/v2_201704140340/S157821901630138X/v2_201704140340/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/15782190/0000010700000007/v2_201704140340/S157821901630138X/v2_201704140340/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901630138X?idApp=UINPBA000044" ]
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|---|---|---|---|
| 2024 November | 5 | 7 | 12 |
| 2024 October | 74 | 49 | 123 |
| 2024 September | 74 | 34 | 108 |
| 2024 August | 105 | 58 | 163 |
| 2024 July | 83 | 36 | 119 |
| 2024 June | 99 | 30 | 129 |
| 2024 May | 78 | 45 | 123 |
| 2024 April | 72 | 28 | 100 |
| 2024 March | 66 | 41 | 107 |
| 2024 February | 69 | 40 | 109 |
| 2024 January | 47 | 38 | 85 |
| 2023 December | 62 | 19 | 81 |
| 2023 November | 51 | 27 | 78 |
| 2023 October | 59 | 17 | 76 |
| 2023 September | 55 | 32 | 87 |
| 2023 August | 33 | 17 | 50 |
| 2023 July | 43 | 33 | 76 |
| 2023 June | 46 | 22 | 68 |
| 2023 May | 49 | 22 | 71 |
| 2023 April | 41 | 19 | 60 |
| 2023 March | 37 | 27 | 64 |
| 2023 February | 44 | 28 | 72 |
| 2023 January | 34 | 41 | 75 |
| 2022 December | 48 | 38 | 86 |
| 2022 November | 23 | 23 | 46 |
| 2022 October | 27 | 22 | 49 |
| 2022 September | 35 | 48 | 83 |
| 2022 August | 29 | 30 | 59 |
| 2022 July | 28 | 31 | 59 |
| 2022 June | 40 | 28 | 68 |
| 2022 May | 36 | 32 | 68 |
| 2022 April | 40 | 38 | 78 |
| 2022 March | 36 | 57 | 93 |
| 2022 February | 32 | 24 | 56 |
| 2022 January | 31 | 39 | 70 |
| 2021 December | 33 | 34 | 67 |
| 2021 November | 40 | 33 | 73 |
| 2021 October | 41 | 42 | 83 |
| 2021 September | 39 | 37 | 76 |
| 2021 August | 35 | 36 | 71 |
| 2021 July | 31 | 24 | 55 |
| 2021 June | 30 | 19 | 49 |
| 2021 May | 32 | 31 | 63 |
| 2021 April | 32 | 41 | 73 |
| 2021 March | 77 | 17 | 94 |
| 2021 February | 37 | 23 | 60 |
| 2021 January | 27 | 14 | 41 |
| 2020 December | 31 | 16 | 47 |
| 2020 November | 20 | 13 | 33 |
| 2020 October | 26 | 7 | 33 |
| 2020 September | 40 | 12 | 52 |
| 2020 August | 30 | 15 | 45 |
| 2020 July | 15 | 14 | 29 |
| 2020 June | 29 | 32 | 61 |
| 2020 May | 24 | 18 | 42 |
| 2020 April | 31 | 18 | 49 |
| 2020 March | 27 | 13 | 40 |
| 2020 February | 5 | 0 | 5 |
| 2020 January | 4 | 0 | 4 |
| 2019 December | 8 | 0 | 8 |
| 2019 November | 4 | 0 | 4 |
| 2019 September | 4 | 0 | 4 |
| 2019 August | 4 | 0 | 4 |
| 2019 July | 8 | 0 | 8 |
| 2019 June | 4 | 0 | 4 |
| 2019 May | 10 | 0 | 10 |
| 2019 April | 2 | 4 | 6 |
| 2019 February | 4 | 0 | 4 |
| 2018 December | 2 | 0 | 2 |
| 2018 November | 12 | 0 | 12 |
| 2018 October | 18 | 0 | 18 |
| 2018 September | 26 | 0 | 26 |
| 2018 February | 18 | 1 | 19 |
| 2018 January | 27 | 8 | 35 |
| 2017 December | 38 | 10 | 48 |
| 2017 November | 21 | 5 | 26 |
| 2017 October | 28 | 5 | 33 |
| 2017 September | 25 | 3 | 28 |
| 2017 August | 26 | 7 | 33 |
| 2017 July | 28 | 9 | 37 |
| 2017 June | 34 | 4 | 38 |
| 2017 May | 30 | 6 | 36 |
| 2017 April | 25 | 9 | 34 |
| 2017 March | 21 | 5 | 26 |
| 2017 February | 16 | 12 | 28 |
| 2017 January | 18 | 10 | 28 |
| 2016 December | 31 | 18 | 49 |
| 2016 November | 20 | 16 | 36 |
| 2016 October | 32 | 19 | 51 |
| 2016 September | 1 | 0 | 1 |
| 2016 August | 2 | 0 | 2 |
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