Case for Diagnosis
Annular Plaques on the Trunk of a Teenage Boy
Placas anulares en el tronco de un adolescente
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Mir-Bonafé, A. Claret-de Castro, E. Rozas-Muñoz" "autores" => array:3 [ 0 => array:4 [ "nombre" => "J.F." "apellidos" => "Mir-Bonafé" "email" => array:1 [ 0 => "joanmirbonafe@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Claret-de Castro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "E." 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Examination of the patient's torso revealed several asymptomatic brownish erythematous circular plaques. The patient was unsure of when they first appeared. He denied having taken drugs, recent travel, contact with animals, and flea bites.</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 a nonscaling brownish erythematous annular plaque on the skin of the upper abdomen with central hypopigmentation and various isolated smaller circular macules on the abdomen, proximal part of the arms (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), and back. The face, palms, and soles were spared, as were the mucous membranes. The affected skin was neither atrophied nor indurated, and sensitivity was unaltered.</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 class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> showed a dense lichenoid infiltrate on the tips of the papillae and numerous necrotic keratinocytes. Also visible was a chronic perivascular infiltrate in the superficial dermis. No granulomas, atypical lymphocytes, dermal fibrosis, or vasculitis were observed. Periodic acid–Schiff staining was negative.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Additional Tests</span><p id="par0020" class="elsevierStylePara elsevierViewall">The results of the complete blood count and biochemical tests were normal, and serology for <span class="elsevierStyleItalic">Borrelia</span> species was negative.</p><p id="par0025" class="elsevierStylePara elsevierViewall">What is your diagnosis?</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Diagnosis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Annular lichenoid dermatitis of youth (ALDY).</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Treatment and Clinical Course</span><p id="par0035" class="elsevierStylePara elsevierViewall">Given the diagnosis of ALDY, we prescribed clobetasol propionate 0.1% cream for 4 weeks. This led to complete resolution of the lesions. The patient remained free of lesions until the last check-up, which was 6 months after the lesions had resolved.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">ALDY is an uncommon condition whose etiology and pathogenesis are unknown. It forms part of the broad group known as lichenoid dermatitis, and diagnosis is necessarily based on the correlation between clinical and histopathologic findings. The condition is probably underdiagnosed, with only 46 cases reported in the literature since it was first described in 2003. ALDY generally affects children and adolescents—it is rare in adults—most frequently from the Mediterranean area, with a slight predominance in males.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> Clinically, it presents as annular erythematous plaques or macules with a whitish center mainly affecting the trunk. It is usually asymptomatic. The clinical differential diagnosis is broad and is mainly with morphea, deep erythema annulare centrifugum, mycosis fungoides, tinea corporis, chronic migratory erythema, scleroatrophic lichen, granuloma annulare, and even sarcoidosis.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The correlation between clinical and histopathological data is essential. Histologically, ALDY presents as lichenoid dermatitis affecting mainly the dermal papillae and associated with a mild chronic perivascular inflammatory infiltrate in the superficial dermis. The infiltrate is predominantly CD3<span class="elsevierStyleSup">+</span> and CD4<span class="elsevierStyleSup">+</span>, and in some cases, exocytosis of lymphocytes may be observed. When the condition could be confused with mycosis fungoides, it is necessary to perform a clonal rearrangement study, which should yield a negative result.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> Also useful is the frequent finding of CD20 positivity in the ALDY infiltrate; this is usually negative in mycosis fungoides.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">While benign and usually self-limiting, it can be treated successfully with both topical and oral corticosteroids.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> Phototherapy, topical calcineurin inhibitors, and oral antibiotics can be used in the most refractory cases.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">A recent study of 14 patients in western Austria pointed to a possible association between ALDY and <span class="elsevierStyleItalic">Borrelia burgdorferi</span>.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> The authors detected spirochetes in 11 of the 14 samples and a positive result in 9 of the 12 serology tests performed. In fact, 1 patient diagnosed with ALDY eventually had plaque morphea. Therefore, the authors suggested that <span class="elsevierStyleItalic">B burgdorferi</span> could play a role in the etiology or even that ALDY could be an incipient phase of morphea. In the case we present, the association with <span class="elsevierStyleItalic">B burgdorferi</span> was ruled out by serology testing.</p><p id="par0060" class="elsevierStylePara elsevierViewall">We report a typical case of ALDY, with classic clinical and histopathological characteristics that enable us to present an uncommon condition about which we still have much to learn.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of Interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case Description" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Histopathology" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Additional Tests" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Diagnosis" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Treatment and Clinical Course" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of Interest" ] 8 => 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: Mir-Bonafé JF, Claret-de Castro A, Rozas-Muñoz E. Placas anulares en el tronco de un adolescente. Actas Dermosifiliogr. 2020;111:319–320.</p>" ] ] "multimedia" => array:2 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 513 "Ancho" => 951 "Tamanyo" => 66130 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 714 "Ancho" => 951 "Tamanyo" => 242404 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Annular lichenoid dermatitis of youth: a report of 2 cases and a review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "I. 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Girolomoni" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000381705" "Revista" => array:6 [ "tituloSerie" => "Dermatology" "fecha" => "2015" "volumen" => "231" "paginaInicial" => "195" "paginaFinal" => "200" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26160268" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Annular lichenoid dermatitis (of youth) immunohistochemical and serological evidence for another clinical presentation of borrelia infection in patients of western Austria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Wilk" 1 => "B.G. Zelger" 2 => "M. Emberger" 3 => "B. Zelger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/DAD.0000000000000621" "Revista" => array:7 [ "tituloSerie" => "Am J Dermatopathol" "fecha" => "2017" "volumen" => "39" "paginaInicial" => "177" "paginaFinal" => "180" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27391456" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1098301513000223" "estado" => "S300" "issn" => "10983015" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "[Annular lichenoid dermatitis of youth: a case report and literature review]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D. Debois" 1 => "J.L. Dargent" 2 => "P. Ngendahayo" 3 => "P.P. Roquet-Gravy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.annder.2018.02.009" "Revista" => array:7 [ "tituloSerie" => "Ann Dermatol Venereol" "fecha" => "2018" "volumen" => "145" "paginaInicial" => "365" "paginaFinal" => "375" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29673747" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0264410X14007555" "estado" => "S300" "issn" => "0264410X" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000011100000004/v1_202006060751/S1578219020300809/v1_202006060751/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/15782190/0000011100000004/v1_202006060751/S1578219020300809/v1_202006060751/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219020300809?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 12 | 11 | 23 |
| 2024 October | 75 | 67 | 142 |
| 2024 September | 82 | 35 | 117 |
| 2024 August | 102 | 72 | 174 |
| 2024 July | 91 | 41 | 132 |
| 2024 June | 69 | 49 | 118 |
| 2024 May | 75 | 55 | 130 |
| 2024 April | 84 | 32 | 116 |
| 2024 March | 85 | 41 | 126 |
| 2024 February | 70 | 48 | 118 |
| 2024 January | 73 | 41 | 114 |
| 2023 December | 51 | 22 | 73 |
| 2023 November | 97 | 49 | 146 |
| 2023 October | 84 | 35 | 119 |
| 2023 September | 63 | 46 | 109 |
| 2023 August | 52 | 24 | 76 |
| 2023 July | 75 | 50 | 125 |
| 2023 June | 80 | 41 | 121 |
| 2023 May | 101 | 57 | 158 |
| 2023 April | 73 | 46 | 119 |
| 2023 March | 92 | 46 | 138 |
| 2023 February | 103 | 42 | 145 |
| 2023 January | 80 | 35 | 115 |
| 2022 December | 94 | 45 | 139 |
| 2022 November | 79 | 44 | 123 |
| 2022 October | 56 | 27 | 83 |
| 2022 September | 52 | 40 | 92 |
| 2022 August | 32 | 48 | 80 |
| 2022 July | 42 | 38 | 80 |
| 2022 June | 35 | 44 | 79 |
| 2022 May | 113 | 53 | 166 |
| 2022 April | 69 | 41 | 110 |
| 2022 March | 83 | 59 | 142 |
| 2022 February | 74 | 36 | 110 |
| 2022 January | 75 | 47 | 122 |
| 2021 December | 69 | 51 | 120 |
| 2021 November | 74 | 50 | 124 |
| 2021 October | 75 | 61 | 136 |
| 2021 September | 57 | 53 | 110 |
| 2021 August | 42 | 70 | 112 |
| 2021 July | 40 | 37 | 77 |
| 2021 June | 41 | 39 | 80 |
| 2021 May | 40 | 48 | 88 |
| 2021 April | 78 | 73 | 151 |
| 2021 March | 57 | 45 | 102 |
| 2021 February | 57 | 41 | 98 |
| 2021 January | 40 | 26 | 66 |
| 2020 December | 35 | 28 | 63 |
| 2020 November | 25 | 18 | 43 |
| 2020 October | 31 | 33 | 64 |
| 2020 September | 38 | 24 | 62 |
| 2020 August | 42 | 19 | 61 |
| 2020 July | 56 | 27 | 83 |
| 2020 June | 73 | 40 | 113 |
| 2020 May | 54 | 27 | 81 |
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