Case for Diagnosis
Chronic Generalized Excoriation
Excoriaciones diseminadas de larga evolución
J. Company-Quiroga
, S. Córdoba, J. Borbujo
Corresponding author
Servicio de Dermatología del Hospital Universitario de Fuenlabrada, Madrid, Spain
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Company-Quiroga, S. Córdoba, J. Borbujo" "autores" => array:3 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Company-Quiroga" "email" => array:1 [ 0 => "j.companyquiroga@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Córdoba" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Borbujo" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología del Hospital Universitario de Fuenlabrada, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Excoriaciones diseminadas de larga evolución" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 725 "Ancho" => 905 "Tamanyo" => 201727 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin (A, ×10; B and <span class="elsevierStyleSmallCaps">C,</span> ×20; D, ×40).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Clinical Characteristics</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 52-year-old man with hypertension managed by dietary intervention, reported having itchy papular and vesicular lesions for 3 years. The intensity of these lesions varied but they had always been present on the forearms, and to a lesser extent on the cervicofacial region, abdomen, and legs. He received antihistamine treatment and prednisone (15 mg/d) without any improvement. He did not have any personal or family history of atopy. He worked in a factory handling car chassis parts with no clear improvement during vacations.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Skin examination showed the presence of extensive excoriation on an erythematous base. The lesions formed extensive chaffed plaques of eczematous appearance on the forearms, cervicofacial region, abdomen, and legs (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Skin biopsy samples from the lesions were taken. Adhesive tape stripping was performed, and the sample subsequently placed on a microscope slide for viewing under an optical microscope.</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">The blood tests, which included IgE, did not show any significant abnormalities. Skin patch tests were performed with the standard battery of the Spanish Contact Dermatitis and Skin Allergy Research Group, with negative results. Biopsy showed the presence of a subepidermal hemorrhagic blister and hyperkeratosis with acanthosis, consistent with a lesion caused by scratching (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). In the sample obtained by adhesive tape stripping, several linear fragments could be seen with a variable diameter under the microscope with polarized light, consistent with glass fibers (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).<span class="elsevierStyleDisplayedQuote" id="dsq0005"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">[[?]]What was the diagnosis?</p></span></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Diagnosis</span><p id="par0020" class="elsevierStylePara elsevierViewall">Fiberglass dermatitis (FGD)</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Course and Treatment</span><p id="par0025" class="elsevierStylePara elsevierViewall">The patient confirmed close contact with fiberglass materials when handling chassis parts. He was recommended to use protective clothing when at work and was prescribed topical treatment with betamethasone and gentamycin, along with oral antihistamine agents. Given a suboptimal control of the clinical symptoms, the patient took several months sick leave, with substantial and sustained improvement in his condition. He finally obtained occupational disability, and remained completely asymptomatic.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Comment</span><p id="par0030" class="elsevierStylePara elsevierViewall">Fiberglass is a widely used material in construction, although given its thermal, acoustic, and electrical insultation properties, it is also used outside that sector. Fiberglass is a clinically inert material that in itself does not lead to sensitization but this may sometimes occur because of resins and other additives used in the final fiberglass product, giving rise to cases of contact allergic eczema.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Nevertheless, fiberglass dermatitis, first described in 1942 by Sulzberger and Baer,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> is an irritative contact dermatitis considered a frequent cause of occupational dermatitis. The pathogenic mechanism consists of penetration of glass fragments into the stratum corneum, leading to mechanical irritation.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Although less frequently described, an airborne transportation mechanism is also possible.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> From the clinical point of view, presentation is in the form of chaffing caused by uncontrolled itching, which may ultimately resemble prurigo, within a broad spectrum of eczematous lesions. Of note is that the intensity of irritation is proportional to the diameter of the fragments, and inversely proportional to their length. Medical history is essential to identify exposure to glass fiber, and so it is important that dermatologists are aware of the existence of this disease. A further barrier to recognition of the condition is that prolonged exposure generates tolerance to the fiber, whereas patients with shorter durations of exposure are those who develop lesions.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Contact tests are not useful for diagnosis, for the reasons highlighted above, although they may be of relevance for identifying concomitant sensitization to additives. Although histopathological study is of little use, as illustrated by our case, it could eventually identify birefringent fiberglass fragments embedded in the stratum corneum.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> A simple and noninvasive test is to obtain a skin sample from the area of the lesion using an adhesive strip. Fiberglass fragments can be observed among corneal remnants under an electron microscope,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> thus providing a definitive diagnosis.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Clinical Characteristics" ] 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" => "Course and Treatment" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Comment" ] 6 => 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: Company-Quiroga J, Córdoba A, Borbujo J. Excoriaciones diseminadas de larga evolución. Actas Dermosifiliogr. 2020;111:511–512.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 401 "Ancho" => 500 "Tamanyo" => 29375 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Excoriation on an erythematous base in the cervicofacial area.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 725 "Ancho" => 905 "Tamanyo" => 201727 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin (A, ×10; B and <span class="elsevierStyleSmallCaps">C,</span> ×20; D, ×40).</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 334 "Ancho" => 500 "Tamanyo" => 47778 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">×10 magnification.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Occupational dermatoses among fibreglass-reinforced plastics factory workers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K. Minamoto" 1 => "M. Nagano" 2 => "T. Inaoka" 3 => "M. Futatsuka" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1034/j.1600-0536.2002.460604.x" "Revista" => array:6 [ "tituloSerie" => "Contact Dermatitis." "fecha" => "2002" "volumen" => "46" "paginaInicial" => "339" "paginaFinal" => "347" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12190622" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effects of fiber glass on animal and human skin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.B. Sulzberger" 1 => "R.L. Baer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ind Med Surg." 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"fecha" => "2008" "volumen" => "59" "paginaInicial" => "120" "paginaFinal" => "122" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18759883" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Itching in office workers from glass fibers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.J. Verbeck" 1 => "E.M. Bruise-van Unnik" 2 => "K.E. Malten" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1600-0536.1981.tb04116.x" "Revista" => array:5 [ "tituloSerie" => "Contact Dermatitis." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 0 | 2 |
| 2024 October | 71 | 38 | 109 |
| 2024 September | 61 | 32 | 93 |
| 2024 August | 100 | 60 | 160 |
| 2024 July | 77 | 44 | 121 |
| 2024 June | 60 | 47 | 107 |
| 2024 May | 64 | 40 | 104 |
| 2024 April | 68 | 32 | 100 |
| 2024 March | 67 | 40 | 107 |
| 2024 February | 68 | 50 | 118 |
| 2024 January | 67 | 35 | 102 |
| 2023 December | 65 | 31 | 96 |
| 2023 November | 72 | 33 | 105 |
| 2023 October | 60 | 25 | 85 |
| 2023 September | 60 | 35 | 95 |
| 2023 August | 41 | 33 | 74 |
| 2023 July | 38 | 40 | 78 |
| 2023 June | 44 | 28 | 72 |
| 2023 May | 44 | 30 | 74 |
| 2023 April | 34 | 21 | 55 |
| 2023 March | 52 | 34 | 86 |
| 2023 February | 46 | 26 | 72 |
| 2023 January | 36 | 34 | 70 |
| 2022 December | 55 | 42 | 97 |
| 2022 November | 36 | 27 | 63 |
| 2022 October | 33 | 30 | 63 |
| 2022 September | 23 | 42 | 65 |
| 2022 August | 35 | 43 | 78 |
| 2022 July | 45 | 39 | 84 |
| 2022 June | 27 | 35 | 62 |
| 2022 May | 60 | 41 | 101 |
| 2022 April | 64 | 26 | 90 |
| 2022 March | 58 | 58 | 116 |
| 2022 February | 49 | 32 | 81 |
| 2022 January | 67 | 42 | 109 |
| 2021 December | 62 | 30 | 92 |
| 2021 November | 54 | 40 | 94 |
| 2021 October | 60 | 48 | 108 |
| 2021 September | 56 | 30 | 86 |
| 2021 August | 40 | 27 | 67 |
| 2021 July | 33 | 15 | 48 |
| 2021 June | 32 | 17 | 49 |
| 2021 May | 37 | 40 | 77 |
| 2021 April | 77 | 53 | 130 |
| 2021 March | 59 | 26 | 85 |
| 2021 February | 49 | 29 | 78 |
| 2021 January | 33 | 19 | 52 |
| 2020 December | 25 | 22 | 47 |
| 2020 November | 21 | 16 | 37 |
| 2020 October | 35 | 15 | 50 |
| 2020 September | 56 | 30 | 86 |
| 2020 August | 53 | 29 | 82 |
| 2020 July | 36 | 18 | 54 |
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