Case for Diagnosis
Multiple Papules on Both Hands
Múltiples pápulas en ambas manos
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Panés-Rodríguez, A. Jaka-Moreno, I. Arias-Camisón Montero, A. Tuneu-Valls" "autores" => array:4 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Panés-Rodríguez" "email" => array:1 [ 0 => "adriapanes@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" => "A." "apellidos" => "Jaka-Moreno" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "I." "apellidos" => "Arias-Camisón Montero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "A." "apellidos" => "Tuneu-Valls" "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 Donostia, Donostia-San Sebastián, Guipúzcoa, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Clínica de la Asunción, Tolosa, Guipúzcoa, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Múltiples pápulas en ambas manos" ] ] "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" => 1043 "Ancho" => 1392 "Tamanyo" => 292880 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Verhoeff, original magnification ×100.</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 39-year-old Bolivian woman with no relevant past medical history presented with multiple asymptomatic lesions on both hands that had first appeared 5 years earlier. No treatment had been applied. The patient reported that a maternal aunt had similar lesions at the same site.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed numerous yellowish papules from 2 to 4<span class="elsevierStyleHsp" style=""></span>mm in diameter on the palms of both hands (<a class="elsevierStyleCrossRef" href="#fig0005">Figs. 1</a>A and 1B), occasionally grouped together forming plaques, as well as isolated lesions on the lateral and dorsal aspects of the fingers.</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">A biopsy specimen was taken from one of the lesions and histologic examination revealed orthokeratotic hyperkeratosis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), with a minimal superficial lymphocytic component in the dermis. The Verhoeff histochemical technique revealed reduction and fragmentation of the reticular fibers (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" 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="par0025" class="elsevierStylePara elsevierViewall">Acrokeratoelastoidosis.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Clinical Course and Treatment</span><p id="par0030" class="elsevierStylePara elsevierViewall">No treatment was prescribed because the lesions were asymptomatic and the patient was not concerned.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">Acrokeratoelastoidosis is an idiopathic genodermatosis, first described by Costa<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> in 1953, that affects the palms and soles. It is included in the group of marginal acrokeratodermas, which are characterized by papules and plaques in the lateral margins of the hands and feet; acrokeratoelastoidosis is a hereditary subtype of this group of dermatoses.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Both dominant and recessive patterns of autosomal inheritance have been described.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,3</span></a> Acrokeratoelastoidosis is characterized by well-defined skin-colored or yellowish polygonal papules, some umbilicated, from 2 to 5<span class="elsevierStyleHsp" style=""></span>mm in diameter.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> The lesions are located on the transitional margin between the dorsal and palmar skin of the hands or between the dorsal and plantar skin of the feet and are usually asymptomatic, although they can be pruritic or be associated with hyperhidrosis.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> The distribution is variable and the lesions can be found either in isolation or grouped together forming plaques. Onset frequently occurs in young adulthood.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The etiology and pathogenesis of acrokeratoelastoidosis are unknown. The causal mechanism is suspected to be the anomalous production of bundles of elastic fibers by the fibroblasts, leading to the fragmentation and reduction in quantity of these fibers in the reticular dermis (elastorrhexis).<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> Microscopy reveals a decrease in the number of fibroblasts, which contain dense cytoplasmic granules that could be precursors of reticulin.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> In patients affected by this dermatosis, elastorrhexis without epidermal skin changes at sites not clinically affected has also been reported.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The differential diagnosis should include other marginal acrokeratodermas, especially focal acral hyperkeratosis, degenerative collagenous plaques of the hands, and keratoelastoidosis marginalis.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2,5</span></a> Acrokeratoelastoidosis and focal acral hyperkeratosis both belong to the subgroup of hereditary acrokeratodermas and can be differentiated by their histologic features: acrokeratoelastoidosis is characterized by elastorrhexis, whereas in focal acral hyperkeratosis the elastic fibers are present in normal amounts and with a normal distribution.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> Acquired forms of degenerative collagenous plaques of the hands and keratoelastoidosis marginalis appear in manual laborers with intense actinic damage, a history of chronic sun exposure, and repeated trauma injuries of the hands<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,5</span></a>; these conditions usually affect the medial aspect of the thumb and the lateral aspect of the index finger.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The various treatments used to date—such as cryotherapy, salicylic acid, methotrexate, dapsone, and oral corticosteroids—have been unsatisfactory.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,5</span></a> Only acitretin at a dose of 0.5<span class="elsevierStyleHsp" style=""></span>mg/kg/d has shown some usefulness.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of Interest</span><p id="par0055" 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: Panés-Rodríguez A, Jaka-Moreno A, Montero IA-C, Tuneu-Valls A. Múltiples pápulas en ambas manos. Actas Dermosifiliogr. 2017;108:579–580.</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" => 1417 "Ancho" => 1115 "Tamanyo" => 162634 ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1053 "Ancho" => 1403 "Tamanyo" => 249577 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×5.</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" => 1043 "Ancho" => 1392 "Tamanyo" => 292880 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Verhoeff, original magnification ×100.</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" => "Acroqueratoelastoidosis: presentación de dos nuevos casos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 15 | 10 | 25 |
| 2024 October | 116 | 33 | 149 |
| 2024 September | 134 | 33 | 167 |
| 2024 August | 148 | 64 | 212 |
| 2024 July | 115 | 42 | 157 |
| 2024 June | 118 | 31 | 149 |
| 2024 May | 106 | 30 | 136 |
| 2024 April | 112 | 26 | 138 |
| 2024 March | 94 | 26 | 120 |
| 2024 February | 106 | 35 | 141 |
| 2024 January | 109 | 32 | 141 |
| 2023 December | 69 | 11 | 80 |
| 2023 November | 107 | 18 | 125 |
| 2023 October | 91 | 21 | 112 |
| 2023 September | 88 | 32 | 120 |
| 2023 August | 72 | 17 | 89 |
| 2023 July | 92 | 29 | 121 |
| 2023 June | 74 | 23 | 97 |
| 2023 May | 82 | 23 | 105 |
| 2023 April | 115 | 24 | 139 |
| 2023 March | 105 | 28 | 133 |
| 2023 February | 81 | 27 | 108 |
| 2023 January | 97 | 35 | 132 |
| 2022 December | 82 | 43 | 125 |
| 2022 November | 42 | 31 | 73 |
| 2022 October | 44 | 24 | 68 |
| 2022 September | 45 | 35 | 80 |
| 2022 August | 39 | 36 | 75 |
| 2022 July | 32 | 32 | 64 |
| 2022 June | 43 | 28 | 71 |
| 2022 May | 127 | 40 | 167 |
| 2022 April | 155 | 43 | 198 |
| 2022 March | 123 | 58 | 181 |
| 2022 February | 118 | 39 | 157 |
| 2022 January | 144 | 54 | 198 |
| 2021 December | 82 | 42 | 124 |
| 2021 November | 104 | 46 | 150 |
| 2021 October | 103 | 62 | 165 |
| 2021 September | 74 | 37 | 111 |
| 2021 August | 80 | 43 | 123 |
| 2021 July | 95 | 37 | 132 |
| 2021 June | 106 | 37 | 143 |
| 2021 May | 84 | 45 | 129 |
| 2021 April | 214 | 104 | 318 |
| 2021 March | 109 | 32 | 141 |
| 2021 February | 83 | 40 | 123 |
| 2021 January | 79 | 43 | 122 |
| 2020 December | 71 | 37 | 108 |
| 2020 November | 49 | 42 | 91 |
| 2020 October | 41 | 18 | 59 |
| 2020 September | 35 | 19 | 54 |
| 2020 August | 42 | 27 | 69 |
| 2020 July | 49 | 30 | 79 |
| 2020 June | 38 | 25 | 63 |
| 2020 May | 25 | 10 | 35 |
| 2020 April | 32 | 16 | 48 |
| 2020 March | 18 | 7 | 25 |
| 2020 February | 4 | 0 | 4 |
| 2020 January | 4 | 0 | 4 |
| 2019 December | 4 | 0 | 4 |
| 2019 November | 4 | 0 | 4 |
| 2019 September | 4 | 0 | 4 |
| 2019 August | 1 | 0 | 1 |
| 2019 July | 6 | 0 | 6 |
| 2019 June | 5 | 0 | 5 |
| 2019 May | 4 | 0 | 4 |
| 2019 April | 2 | 0 | 2 |
| 2019 February | 2 | 0 | 2 |
| 2019 January | 1 | 0 | 1 |
| 2018 December | 3 | 0 | 3 |
| 2018 November | 3 | 0 | 3 |
| 2018 October | 4 | 0 | 4 |
| 2018 September | 3 | 0 | 3 |
| 2018 May | 1 | 0 | 1 |
| 2018 February | 55 | 2 | 57 |
| 2018 January | 38 | 5 | 43 |
| 2017 December | 77 | 6 | 83 |
| 2017 November | 36 | 8 | 44 |
| 2017 October | 34 | 11 | 45 |
| 2017 September | 32 | 10 | 42 |
| 2017 August | 49 | 18 | 67 |
| 2017 July | 54 | 24 | 78 |
| 2017 June | 16 | 14 | 30 |
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