Case for Diagnosis
Pearly White Papules on the Antihelix
Pápulas perladas en el antihélix
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Oro-Ayude, R.M. Hernández Cancela, A. Flórez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Oro-Ayude" "email" => array:1 [ 0 => "marcosoroayude@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" => "R.M." "apellidos" => "Hernández Cancela" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Flórez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología del Complejo Hospitalario Universitario de Pontevedra, Gerencia de Gestión Integrada Pontevedra y O Salnés, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica del Complejo Hospitalario Universitario de Pontevedra, Gerencia de Gestión Integrada Pontevedra y O Salnés, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pápulas perladas en el antihélix" ] ] "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" => 1200 "Ancho" => 1000 "Tamanyo" => 415227 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Alcian blue ×10.</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 41-year-old man with no medical or surgical past history of interest was referred to the dermatology service due to skin lesions that had appeared 2 months earlier on both pinnae. The lesions were asymptomatic, and the patient reported no potential triggering event.</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 4 pearly papules distributed in a line on the antihelix of the left pinna (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) and 2 lesions of similar characteristics on the right pinna.</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">The histopathology study showed a lymphohistiocytic infiltrate with palisading histiocytes surrounding a central area with necrobiosis and mucin deposit (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">[[?]]What is your Diagnosis?</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Diagnosis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Granuloma annulare on the antihelix.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Clinical Course and Treatment</span><p id="par0030" class="elsevierStylePara elsevierViewall">In this case, the lesions resolved after the biopsy and no treatment was required.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Comment</span><p id="par0035" class="elsevierStylePara elsevierViewall">Granuloma annulare (GA) is a noninfectious granulomatous skin disease. It is a benign entity of unknown etiology and is common in clinical practice; it especially affects children and young adults and is more frequent in females. It generally presents on the wrists, ankles, hands, and feet in the form of annular erythematous papules with central lightening.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">There are 4 main types of GA. In the local variety, between 80% and 90% of all cases, the lesions appear at the aforementioned sites and with the typical morphology. The generalized form, which represents fewer than 15% of cases, affects the torso and extremities in the form of numerous erythematous or yellowish papules, which may coalesce to form annular or circinate plaques. The subcutaneous variety is rare. It typically affects children and manifests as fast-growing painless subcutaneous nodules, with overlying skin of normal appearance, located on the scalp, pretibial region, buttocks, and palmar and plantar regions. The perforating variety is also rare and manifests as erythematous papules that develop into umbilicated lesions with a squamous or scabbed center. Other less common types of GA have been described and the different types also tend to coincide.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Very few cases of GA involving the outer ear have been published in the literature.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–6</span></a> Although GA is more common in women, most published cases involving the outer ear have been reported in boys or young men,<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–6</span></a> and a large percentage of these are bilateral.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a> Moreover, the lesions usually appear on the most exposed areas and it has therefore been suggested that small, repeated traumas may be implicated as a trigger, even when patients do not always identify them.</p><p id="par0050" class="elsevierStylePara elsevierViewall">We report an atypical GA in terms of site of the lesions and in terms of morphology. This presentation is rare in the literature and a correct diagnosis, which is essential to avoid unnecessary interventions or treatments, with their potential complications, may pose a challenge.</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:9 [ 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" => "Comment" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 7 => array:2 [ "identificador" => "xack482683" "titulo" => "Acknowledgments" ] 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: Oro-Ayude M, Hernández Cancela RM, Flórez A. Pápulas perladas en el antihélix. Actas Dermosifiliogr. 2020;111:603–604.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1250 "Ancho" => 840 "Tamanyo" => 137744 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1200 "Ancho" => 1000 "Tamanyo" => 415227 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Alcian blue ×10.</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" => "Granuloma Annulare" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.J. 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Correia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1684/ejd.2010.0926" "Revista" => array:6 [ "tituloSerie" => "Eur J Dermatol" "fecha" => "2010" "volumen" => "20" "paginaInicial" => "409" "paginaFinal" => "410" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20146967" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of atypical granuloma annulare involving both ears" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.G. Kim" 1 => "S.H. Lee" 2 => "T.-J. Yoon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5021/ad.2009.21.4.413" "Revista" => array:7 [ "tituloSerie" => "Ann Dermatol" "fecha" => "2009" "volumen" => "21" "paginaInicial" => "413" "paginaFinal" => "415" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20523836" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1888989115000233" "estado" => "S300" "issn" => "18889891" ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Granuloma annulare presenting as multiple nodules on the pinna" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "N. Raghava" 1 => "J.R. Mitchard" 2 => "R.P. Youngs" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1258/0022215041917916" "Revista" => array:6 [ "tituloSerie" => "J Laryngol Otol" "fecha" => "2004" "volumen" => "118" "paginaInicial" => "640" "paginaFinal" => "642" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15453942" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack482683" "titulo" => "Acknowledgments" "texto" => "<p id="par0060" class="elsevierStylePara elsevierViewall">The authors would like to thank the Dermatology department of Complejo Hospitalario Universitario de Pontevedra, Spain, for their cooperation.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000011100000007/v1_202009190930/S1578219020302146/v1_202009190930/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/15782190/0000011100000007/v1_202009190930/S1578219020302146/v1_202009190930/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219020302146?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 9 | 11 | 20 |
| 2024 October | 93 | 45 | 138 |
| 2024 September | 103 | 20 | 123 |
| 2024 August | 122 | 57 | 179 |
| 2024 July | 116 | 36 | 152 |
| 2024 June | 120 | 36 | 156 |
| 2024 May | 97 | 38 | 135 |
| 2024 April | 95 | 31 | 126 |
| 2024 March | 118 | 37 | 155 |
| 2024 February | 87 | 34 | 121 |
| 2024 January | 120 | 43 | 163 |
| 2023 December | 200 | 14 | 214 |
| 2023 November | 220 | 32 | 252 |
| 2023 October | 179 | 35 | 214 |
| 2023 September | 180 | 32 | 212 |
| 2023 August | 94 | 14 | 108 |
| 2023 July | 137 | 30 | 167 |
| 2023 June | 103 | 20 | 123 |
| 2023 May | 126 | 25 | 151 |
| 2023 April | 106 | 28 | 134 |
| 2023 March | 129 | 29 | 158 |
| 2023 February | 101 | 23 | 124 |
| 2023 January | 102 | 29 | 131 |
| 2022 December | 83 | 39 | 122 |
| 2022 November | 48 | 25 | 73 |
| 2022 October | 47 | 21 | 68 |
| 2022 September | 41 | 37 | 78 |
| 2022 August | 45 | 36 | 81 |
| 2022 July | 22 | 32 | 54 |
| 2022 June | 29 | 25 | 54 |
| 2022 May | 94 | 46 | 140 |
| 2022 April | 98 | 20 | 118 |
| 2022 March | 117 | 39 | 156 |
| 2022 February | 80 | 19 | 99 |
| 2022 January | 149 | 34 | 183 |
| 2021 December | 75 | 37 | 112 |
| 2021 November | 87 | 39 | 126 |
| 2021 October | 91 | 58 | 149 |
| 2021 September | 72 | 36 | 108 |
| 2021 August | 51 | 25 | 76 |
| 2021 July | 41 | 31 | 72 |
| 2021 June | 30 | 21 | 51 |
| 2021 May | 57 | 45 | 102 |
| 2021 April | 122 | 59 | 181 |
| 2021 March | 49 | 29 | 78 |
| 2021 February | 39 | 27 | 66 |
| 2021 January | 38 | 21 | 59 |
| 2020 December | 26 | 21 | 47 |
| 2020 November | 33 | 11 | 44 |
| 2020 October | 48 | 19 | 67 |
| 2020 September | 58 | 34 | 92 |
| 2020 August | 9 | 13 | 22 |
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