Case for Diagnosis
Hyperpigmented Macules on a Young Man's Arms
Máculas hiperpigmentadas bilaterales en brazos de un varón joven
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Martí-Ibor, A. Mateu-Puchades" "autores" => array:3 [ 0 => array:4 [ "nombre" => "S." "apellidos" => "de Asís-Cuestas" "email" => array:1 [ 0 => "aifosofia00@gmail.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" => "E." "apellidos" => "Martí-Ibor" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Mateu-Puchades" "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 Universitario Doctor Peset, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario Doctor Peset, Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Máculas hiperpigmentadas bilaterales en brazos de un varón joven" ] ] "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" => 374 "Ancho" => 500 "Tamanyo" => 43650 ] ] ] ] "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 40-year-old man was referred by the oncology department for assessment of pigmented lesions on the upper limbs that had appeared progressively over the previous 5 years. The patient's medical history included a cholangiocarcinoma diagnosed 2 years earlier, which was treated with surgery, radiation therapy, chemotherapy, and oral capecitabine. The patient was disease-free at the time of the visit.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient reported that the lesions had been stable and asymptomatic since they appeared, that they did not change in appearance when exposed to high temperatures or physical exercise, and that they did not change after treatment with topical antifungal agents prescribed by a primary care physician.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0015" class="elsevierStylePara elsevierViewall">Physical examination revealed multiple well-defined brownish macules with fine superficial telangiectasias, distributed in a bilateral symmetric pattern on the external aspect of both arms (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). The lesions were negative for the Darier sign. No similar lesions were observed elsewhere on the body.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Additional Tests</span><p id="par0020" class="elsevierStylePara elsevierViewall">Biopsy of a lesion revealed basal layer hyperpigmentation and no other findings of interest (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). No increase in the number of mast cells or melanocytes was observed with hematoxylin-eosin staining or with immunostaining for c-kit.</p><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="par0030" class="elsevierStylePara elsevierViewall">Acquired bilateral telangiectatic macules.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Clinical Course</span><p id="par0035" class="elsevierStylePara elsevierViewall">The lesions have remained stable after 1 year of follow-up.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Comment</span><p id="par0040" class="elsevierStylePara elsevierViewall">Acquired bilateral telangiectatic macules are a recently described entity.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> The lesions have certain constant clinical and pathological characteristics that allow them to be differentiated from similar entities.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The lesions typically occur in middle-aged men with skin phototype <span class="elsevierStyleSmallCaps">III-IV</span><a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> and follow an insidious clinical course. Patients present with symmetrically distributed brownish erythematous macules with fine superficial telangiectasias on the extensor surface of the arms. The lesions are asymptomatic and negative for the Darier sign.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Histologic examination of the lesions reveals basal layer hyperpigmentation and capillary proliferation in the dermis, sometimes accompanied by a subtle perivascular inflammatory infiltrate.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> No epidermal alterations are present and the number of mast cells and melanocytes is normal (as can be confirmed by immunohistochemistry for c-kit and Fontana-Masson staining, respectively).</p><p id="par0055" class="elsevierStylePara elsevierViewall">In the case series described by Park et al., the lesions did not improve spontaneously in any of the patients after a mean follow-up period of 4 years. In the case of our patient, we did not prescribe treatment because the lesions were asymptomatic and stable. No significant changes were observed during 14 months of follow-up.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The differential diagnosis includes the following:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">−</span><p id="par0065" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Telangiectasia macularis eruptiva perstans</span><a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,3</span></a><span class="elsevierStyleItalic">:</span> Indolent cutaneous mastocytosis characterized by brownish erythematous macules that are generally asymptomatic. The lesions tend to be negative for the Darier sign. Unlike acquired bilateral telangiectatic macules, this entity also tends to affect the trunk. Histologically, it is characterized by an increase in the number of mast cells.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">−</span><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Acquired brachial cutaneous dyschromatosis</span><a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleItalic">:</span> This recently described entity affects postmenopausal women and is characterized by greyish-brown asymptomatic macules on the extensor surface of the arms. Histologically, it is characterized by epidermal atrophy, basal layer hyperpigmentation, and solar elastosis. Its appearance has been associated with UV radiation and the ingestion of angiotensin-converting enzyme inhibitors.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">−</span><p id="par0075" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Generalized essential telangiectasia</span><a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleItalic">:</span> This entity typically occurs in women 40 to 50 years of age. It manifests as asymptomatic telangiectasias on the lower limbs that subsequently become generalized and is not associated with systemic diseases.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">−</span><p id="par0080" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Hereditary benign telangiectasia</span><a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleItalic">:</span> This rare entity is more frequent in women and children and is characterized by punctate telangiectasias surrounded by a pale halo on the upper third of the trunk, the arms, and the head. The lesions are asymptomatic and are not associated with systemic disease.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">−</span><p id="par0085" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Drug-induced hyperpigmentation:</span> Various drugs—including antimalarial agents, chemotherapeutic agents, antibiotics, amiodarone, phenytoin, and heavy metals—have been associated with pigmentary alterations. In order to diagnose this entity, a good medical history must be taken and a temporal relationship must be established between the administration of the drug and the appearance of the lesions.</p></li></ul></p><p id="par0090" class="elsevierStylePara elsevierViewall">Therefore, differences in sex and age at onset, the absence of systemic symptoms, the site of the lesions, and histologic findings allow us to rule out other diseases and confirm the diagnosis of acquired bilateral telangiectatic macules.</p><p id="par0095" class="elsevierStylePara elsevierViewall">In conclusion, we have presented a new case of acquired bilateral telangiectatic macules, a recently described entity characterized by asymptomatic pigmented lesions on the arms that occurs in grown men and follows a chronic indolent clinical course.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of Interest</span><p id="par0100" 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" => "Diagnosis" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Clinical Course" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Comment" ] 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: de Asís-Cuestas S. Máculas hiperpigmentadas bilaterales en brazos de un varón joven. Actas Dermosifiliogr. 2016;107:683–684.</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" => 375 "Ancho" => 500 "Tamanyo" => 32535 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 374 "Ancho" => 500 "Tamanyo" => 43650 ] ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 375 "Ancho" => 500 "Tamanyo" => 110827 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×10. Inset at lower right, hematoxylin-eosin, original magnification ×20.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acquired bilateral telangiectatic macules: A distinct clinical entity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.H. Park" 1 => "D.J. Lee" 2 => "Y.J. Lee" 3 => "Y.H. Jang" 4 => "H.Y. Kang" 5 => "Y.C. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamadermatol.2013.10238" "Revista" => array:7 [ "tituloSerie" => "JAMA Dermatol" "fecha" => "2014" "volumen" => "150" "paginaInicial" => "974" "paginaFinal" => "977" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24806791" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0302283812002400" "estado" => "S300" "issn" => "03022838" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Telangiectasia macularis eruptiva perstans: More than skin deep" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.E. Watkins" 1 => "W.B. Bokor" 2 => "S. Leicht" 3 => "G. Youngberg" 4 => "G. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 24 | 10 | 34 |
| 2024 October | 165 | 56 | 221 |
| 2024 September | 181 | 33 | 214 |
| 2024 August | 218 | 70 | 288 |
| 2024 July | 141 | 59 | 200 |
| 2024 June | 142 | 66 | 208 |
| 2024 May | 123 | 52 | 175 |
| 2024 April | 111 | 30 | 141 |
| 2024 March | 97 | 37 | 134 |
| 2024 February | 91 | 37 | 128 |
| 2024 January | 78 | 47 | 125 |
| 2023 December | 99 | 47 | 146 |
| 2023 November | 97 | 47 | 144 |
| 2023 October | 114 | 45 | 159 |
| 2023 September | 99 | 81 | 180 |
| 2023 August | 70 | 90 | 160 |
| 2023 July | 114 | 116 | 230 |
| 2023 June | 97 | 59 | 156 |
| 2023 May | 96 | 51 | 147 |
| 2023 April | 82 | 64 | 146 |
| 2023 March | 123 | 39 | 162 |
| 2023 February | 88 | 51 | 139 |
| 2023 January | 105 | 85 | 190 |
| 2022 December | 99 | 76 | 175 |
| 2022 November | 57 | 80 | 137 |
| 2022 October | 39 | 62 | 101 |
| 2022 September | 53 | 64 | 117 |
| 2022 August | 26 | 63 | 89 |
| 2022 July | 35 | 43 | 78 |
| 2022 June | 49 | 39 | 88 |
| 2022 May | 114 | 85 | 199 |
| 2022 April | 99 | 61 | 160 |
| 2022 March | 71 | 67 | 138 |
| 2022 February | 67 | 27 | 94 |
| 2022 January | 91 | 46 | 137 |
| 2021 December | 58 | 61 | 119 |
| 2021 November | 72 | 62 | 134 |
| 2021 October | 95 | 52 | 147 |
| 2021 September | 76 | 53 | 129 |
| 2021 August | 67 | 55 | 122 |
| 2021 July | 59 | 29 | 88 |
| 2021 June | 82 | 37 | 119 |
| 2021 May | 67 | 47 | 114 |
| 2021 April | 168 | 64 | 232 |
| 2021 March | 101 | 33 | 134 |
| 2021 February | 88 | 31 | 119 |
| 2021 January | 39 | 19 | 58 |
| 2020 December | 53 | 17 | 70 |
| 2020 November | 47 | 19 | 66 |
| 2020 October | 44 | 12 | 56 |
| 2020 September | 43 | 15 | 58 |
| 2020 August | 30 | 12 | 42 |
| 2020 July | 30 | 15 | 45 |
| 2020 June | 56 | 27 | 83 |
| 2020 May | 28 | 18 | 46 |
| 2020 April | 31 | 19 | 50 |
| 2020 March | 31 | 18 | 49 |
| 2020 February | 3 | 0 | 3 |
| 2020 January | 4 | 0 | 4 |
| 2019 December | 4 | 0 | 4 |
| 2019 November | 4 | 0 | 4 |
| 2019 August | 4 | 0 | 4 |
| 2019 July | 4 | 0 | 4 |
| 2019 June | 4 | 0 | 4 |
| 2019 May | 6 | 1 | 7 |
| 2019 April | 5 | 3 | 8 |
| 2019 March | 2 | 0 | 2 |
| 2019 February | 2 | 0 | 2 |
| 2019 January | 4 | 0 | 4 |
| 2018 December | 1 | 0 | 1 |
| 2018 November | 2 | 0 | 2 |
| 2018 October | 13 | 0 | 13 |
| 2018 September | 1 | 0 | 1 |
| 2018 February | 17 | 4 | 21 |
| 2018 January | 37 | 9 | 46 |
| 2017 December | 50 | 9 | 59 |
| 2017 November | 44 | 8 | 52 |
| 2017 October | 42 | 7 | 49 |
| 2017 September | 25 | 9 | 34 |
| 2017 August | 29 | 7 | 36 |
| 2017 July | 28 | 8 | 36 |
| 2017 June | 45 | 13 | 58 |
| 2017 May | 53 | 10 | 63 |
| 2017 April | 39 | 14 | 53 |
| 2017 March | 25 | 8 | 33 |
| 2017 February | 21 | 11 | 32 |
| 2017 January | 22 | 9 | 31 |
| 2016 December | 31 | 18 | 49 |
| 2016 November | 34 | 22 | 56 |
| 2016 October | 59 | 34 | 93 |
| 2016 September | 2 | 0 | 2 |
Show all
