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1</a>B&#41;&#46; Some residual hyperpigmented macules were visible in these areas&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathology</span><p id="par0020" class="elsevierStylePara elsevierViewall">Biopsies were taken of a crusted papular lesion and an erythematous plaque on the temple&#44; which the patient had stated were similar to those diagnosed as cutaneous lymphoma&#47;lymphoid hyperplasia&#59; both lesions were histologically similar &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41;&#58; superficial perivascular dermal infiltrate &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41; and deep T lymphocyte infiltrate with abundant eosinophils &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>C&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Other Tests</span><p id="par0025" class="elsevierStylePara elsevierViewall">HLA determination revealed the HLA-DR4 variant &#40;DRB1&#42;04&#58;08&#41;&#46; The autoimmune study was negative and IgE was normal&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">What is your Diagnosis&#63;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Diagnosis</span><p id="par0035" class="elsevierStylePara elsevierViewall">Actinic prurigo &#40;AP&#41;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Treatment and Course</span><p id="par0040" class="elsevierStylePara elsevierViewall">Narrow-band UVB phototherapy was instated to stimulate habituation&#44; with irregular compliance by the patient&#44; who finally abandoned this treatment despite some improvement of the condition&#46; Thalidomide does not currently appear to be an option because the patient suffers from bilateral carpal tunnel syndrome&#44; which makes monitoring potential neuropathy difficult&#46; The patient is currently undergoing treatment with topical corticosteroids&#44; 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predominantly in the areas exposed to sunlight&#44; although they may also appear in unexposed areas&#46; Associated clinical findings such as cheilitis &#40;46&#37; of cases&#41;&#44; conjunctivitis &#40;21&#37; of cases&#41;&#44; eczematous lesions&#44; and lichenification have been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Histology may reveal nonspecific findings that are occasionally similar to the histology of polymorphic light eruptions&#58; a superficial and deep perivascular T lymphocyte infiltrate with presence of eosinophils under a dermis with few abnormalities&#46; Chronic lesions may reveal acanthosis and excoriation in the epidermis&#44; fibrosis&#44; and a larger infiltrate in the dermis&#46; Labial lesions may present infiltrates with follicular hyperplasia as a reactive phenomenon&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> Association with B cell lymphoma occurred in only 2 patients&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> In our patient&#44; doubt remained regarding whether the nodular lesions corresponded to lymphoma or to florid follicular lymphoid hyperplasia&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The differential diagnosis of PA includes bites and stings&#44; scabies&#44; porphyria&#44; adult atopic dermatitis&#44; and other photodermatoses&#44; which have different courses and histology and should be ruled out to reach diagnosis of this entity&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Different therapeutic approaches to AP have been reported&#44; including topical treatments &#40;photoprotection&#44; corticosteroids&#44; calcinuria inhibitors&#41; and phototherapy &#40;PUVA or narrowband UV-B&#41;&#46; Thalidomide&#44; cyclosporin&#44; azathioprine and pentoxifylline have been used in severe cases&#44; with varying results&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">In conclusion&#44; AP is a rare entity in our setting but it cannot be ruled out&#46; Lymphoid hyperplasia may develop during the course of the disease and this should be remembered in order to avoid an erroneous diagnosis that may condition future treatment&#46; Diagnosis of this entity is based on clinical presentation and patient history&#44; and the presence of HLA-DR4 is a finding that supports the suspected diagnosis&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of Interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Case for Diagnosis
Papular Eruption on Sun-Exposed Skin
Erupción papulosa fotodistribuida
L. Schneller-Pavelescu
Corresponding author
lucapavelescu@gmail.com

Corresponding author.
, E. Vergara-de Caso, M.M. Blanes
Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, Spain
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    "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 52-year-old woman presented with pruritic dermatitis that had been treated in different hospitals for more than 40 years&#46; Atopic dermatitis was suspected during childhood and the patient was treated with cyclosporin A with some improvement&#46; In 2002&#44; she presented with facial nodules that were histologically compatible with B-cell lymphoma &#40;CD20<span class="elsevierStyleSup">&#43;</span>&#44; BCL2<span class="elsevierStyleSup">&#43;</span>&#44; IgH rearrangement&#41; and treatment with cyclosporin was suspended&#46; After ruling out extracutaneous involvement&#44; she was given intravenous rituximab at a dosage of 375<span class="elsevierStyleHsp" style=""></span>mg&#47;m<span class="elsevierStyleSup">2</span> in 4 weekly cycles&#46; Symptoms improved but reappeared when treatment was suspended&#46; In 2013&#44; the patient presented again with facial nodules that were histologically compatible with B-cell lymphoid hyperplasia&#46; the patient was treated with rituximab and showed an identical response&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Due to a change of address&#44; she was sent to our department in 2016 with no definitive diagnosis&#46; On questioning&#44; she confirmed the recurrence of the lesions after long periods of exposure to sunlight&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0015" class="elsevierStylePara elsevierViewall">The patient presented erythematous papules&#44; many of which showed central excoriation&#44; that were confluent in some locations &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#44; predominantly in the areas exposed to sunlight &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; Some residual hyperpigmented macules were visible in these areas&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathology</span><p id="par0020" class="elsevierStylePara elsevierViewall">Biopsies were taken of a crusted papular lesion and an erythematous plaque on the temple&#44; which the patient had stated were similar to those diagnosed as cutaneous lymphoma&#47;lymphoid hyperplasia&#59; both lesions were histologically similar &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41;&#58; superficial perivascular dermal infiltrate &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41; and deep T lymphocyte infiltrate with abundant eosinophils &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>C&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Other Tests</span><p id="par0025" class="elsevierStylePara elsevierViewall">HLA determination revealed the HLA-DR4 variant &#40;DRB1&#42;04&#58;08&#41;&#46; The autoimmune study was negative and IgE was normal&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">What is your Diagnosis&#63;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Diagnosis</span><p id="par0035" class="elsevierStylePara elsevierViewall">Actinic prurigo &#40;AP&#41;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Treatment and Course</span><p id="par0040" class="elsevierStylePara elsevierViewall">Narrow-band UVB phototherapy was instated to stimulate habituation&#44; with irregular compliance by the patient&#44; who finally abandoned this treatment despite some improvement of the condition&#46; Thalidomide does not currently appear to be an option because the patient suffers from bilateral carpal tunnel syndrome&#44; which makes monitoring potential neuropathy difficult&#46; The patient is currently undergoing treatment with topical corticosteroids&#44; oral antihistamines&#44; and photoprotection&#44; and maintains mild symptoms&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Comment</span><p id="par0045" class="elsevierStylePara elsevierViewall">AP is a frequent photodermatosis in Native Americans and few cases have been reported in the European population&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> The forms that present in childhood&#44; generally before the age of 10 years&#44; may improve during adolescence&#46; Later onset&#44; though less frequent&#44; tends to be associated with persistence into adulthood&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#8211;3</span></a> Half of patients present a family history of the disease and nearly 90&#37; have HLA-DR4&#44; and HLA-DRB1&#42;04&#58;07 is present in between 60&#37; and 70&#37; of patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3&#44;4</span></a> Our patient reported that her father had presented a similar dermatosis&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Clinical presentation consists of erythematous pruritic papulonodular lesions with excoriation due to scratching&#44; predominantly in the areas exposed to sunlight&#44; although they may also appear in unexposed areas&#46; Associated clinical findings such as cheilitis &#40;46&#37; of cases&#41;&#44; conjunctivitis &#40;21&#37; of cases&#41;&#44; eczematous lesions&#44; and lichenification have been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Histology may reveal nonspecific findings that are occasionally similar to the histology of polymorphic light eruptions&#58; a superficial and deep perivascular T lymphocyte infiltrate with presence of eosinophils under a dermis with few abnormalities&#46; Chronic lesions may reveal acanthosis and excoriation in the epidermis&#44; fibrosis&#44; and a larger infiltrate in the dermis&#46; Labial lesions may present infiltrates with follicular hyperplasia as a reactive phenomenon&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> Association with B cell lymphoma occurred in only 2 patients&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> In our patient&#44; doubt remained regarding whether the nodular lesions corresponded to lymphoma or to florid follicular lymphoid hyperplasia&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The differential diagnosis of PA includes bites and stings&#44; scabies&#44; porphyria&#44; adult atopic dermatitis&#44; and other photodermatoses&#44; which have different courses and histology and should be ruled out to reach diagnosis of this entity&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Different therapeutic approaches to AP have been reported&#44; including topical treatments &#40;photoprotection&#44; corticosteroids&#44; calcinuria inhibitors&#41; and phototherapy &#40;PUVA or narrowband UV-B&#41;&#46; Thalidomide&#44; cyclosporin&#44; azathioprine and pentoxifylline have been used in severe cases&#44; with varying results&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">In conclusion&#44; AP is a rare entity in our setting but it cannot be ruled out&#46; Lymphoid hyperplasia may develop during the course of the disease and this should be remembered in order to avoid an erroneous diagnosis that may condition future treatment&#46; Diagnosis of this entity is based on clinical presentation and patient history&#44; and the presence of HLA-DR4 is a finding that supports the suspected diagnosis&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of Interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Article information
ISSN: 15782190
Original language: English
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2024 January 86 37 123
2023 December 93 18 111
2023 November 128 40 168
2023 October 105 19 124
2023 September 110 35 145
2023 August 105 17 122
2023 July 114 30 144
2023 June 97 23 120
2023 May 159 23 182
2023 April 136 19 155
2023 March 118 30 148
2023 February 133 26 159
2023 January 116 30 146
2022 December 82 34 116
2022 November 29 24 53
2022 October 33 23 56
2022 September 44 38 82
2022 August 59 42 101
2022 July 59 33 92
2022 June 41 33 74
2022 May 95 42 137
2022 April 101 32 133
2022 March 71 42 113
2022 February 63 23 86
2022 January 60 36 96
2021 December 63 31 94
2021 November 71 45 116
2021 October 130 60 190
2021 September 55 32 87
2021 August 41 29 70
2021 July 34 25 59
2021 June 40 21 61
2021 May 31 42 73
2021 April 74 47 121
2021 March 55 17 72
2021 February 31 19 50
2021 January 21 11 32
2020 December 23 12 35
2020 November 28 24 52
2020 October 21 18 39
2020 September 30 9 39
2020 August 22 13 35
2020 July 21 15 36
2020 June 25 24 49
2020 May 18 15 33
2020 April 10 14 24
2020 March 13 7 20
2020 February 2 0 2
2020 January 1 0 1
2019 May 7 0 7
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¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?