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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Membranous aplasia cutis congenita&#46; Erythematous alopecic plaque with a diameter of 8&#8239;mm on the vertex of the scalp&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Aplasia cutis congenita &#40;ACC&#41; is a rare congenital malformation&#46; Membranous ACC is the most common of the 9 subtypes described&#46; Its clinical presentation is highly variable&#44; with appearances ranging from eroded&#44; ulcerated&#44; or scar-like lesions to a glistening surface&#46; The differential diagnosis is broad&#44; and clinical diagnosis can be challenging&#46; Dermoscopy may be a useful tool for the differential diagnosis&#44; but few studies have analyzed its use in this setting&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> We describe the dermoscopic findings of membranous ACC in an infant&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The infant was a 2-month-old boy with no remarkable personal or family history who was seen for a painful alopecic plaque on the vertex of his scalp&#46; His parents reported that the plaque had appeared 3 weeks earlier following the use of a very rigid baby chair&#46; They had applied disinfectants and healing creams&#44; but there had been no clinical response&#46; Physical examination showed a nonscaling erythematous alopecic plaque with a diameter of 8&#8239;mm that did not change on palpation &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Dermoscopy showed a shiny surface with thin telangiectatic vessels and bluish globules &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; A diagnosis of membranous ACC was established&#46; Transfontanellar ultrasound showed no underlying bone or brain defects&#46; The parents were informed of the benign nature of the lesion&#46; No specific treatment was prescribed&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">ACC is a congenital condition characterized by absence of the epidermis&#44; dermis&#44; and&#44; occasionally&#44; bone or dura mater&#46; It is mostly observed on the scalp&#44; especially on the vertex or parietal scalp&#46; The defects are usually small &#40;typically 1&#8722;2&#8239;cm&#41;&#44; although large lesions have been described&#46; ACC has been linked to a number of causes&#44; including use of certain medications or drugs during pregnancy and embryologic malformations&#46; The hair collar sign&#44; a potential marker of neural tube defects&#44; may be observed&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Transfontanellar ultrasound is recommended to rule out underlying bone or brain defects&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Because the lesions are so small&#44; as occurred in our case&#44; they can go unnoticed during the neonatal period&#44; making clinical diagnosis even more challenging&#46; Dermoscopy can be very useful for ruling out trauma or infectious &#40;herpes virus&#44; mycosis&#44; impetigo&#41;&#44; inflammatory &#40;alopecia areata&#41;&#44; or tumoral &#40;sebaceous nevus&#41; causes&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The translucency sign is a characteristic dermoscopic feature of membranous ACC&#46; It consists of the presence of a shiny surface&#44; thin arborizing vessels&#44; and blue globules corresponding to hair bulbs&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;5&#44;6</span></a> Other possible features are an absence of follicular openings on the alopecic plaque and the hair collar sign &#40;hair follicles distributed around the edge of the plaque&#41;&#46; These features are quite specific to ACC and help establish a clinical diagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Findings for sebaceous nevi include yellow lobules or dots not related to hair follicles&#46; In tinea capitis&#44; findings include corkscrew hairs&#44; comma hairs&#44; zigzag hairs&#44; pigtail hairs&#44; and Morse code&#8211;like hairs&#46; Features of alopecia areata&#44; which is very uncommon in neonates and infants&#44; are yellow and black dots&#44; exclamation mark hairs&#44; and vellus hair&#46; Triangular alopecia&#44; in turn&#44; is characterized by short&#44; upright regrowing hairs&#44; vellus hairs&#44; and pigtail hairs&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The dermoscopic features of diseases with focal alopecia in neonates and infants are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">High-frequency ultrasound can also be useful in membranous ACC&#44; as it shows a thin or concave hyperechogenic line corresponding to the epidermis and absence of the dermis or subcutaneous tissue&#59; it can also be used to assess bone status&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Dermoscopy may be a useful diagnostic tool for membranous ACC as it helps rule out trauma&#44; infections&#44; inflammatory disorders&#44; and tumors and may avoid the need for invasive diagnostic tests&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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                  \t\t\t\t">Aplasia cutis congenita&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Translucency sign&#58; shiny appearance&#44; thin vessels&#44; absence of follicular openings&#44; visualization of hair bulbs &#40;blue globules&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Hair around the edge of the plaque &#40;hair collar sign&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Sebaceous nevus&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Yellow lobules or dots &#40;not associated with hair follicles&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Triangular alopecia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Black dots&#44; yellow dots&#44; exclamation hairs&#44; circular hairs&nbsp;\t\t\t\t\t\t\n
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Case and Research Letters
Dermoscopic Findings in Membranous Aplasia Cutis: Differential Diagnosis to Exclude Other Forms of Focal Alopecia in Infants
Hallazgos dermatoscópicos en la aplasia cutis membranosa. Diagnóstico diferencial con otras formas de alopecia focal en lactantes
D. Morgado-Carrascoa,
Corresponding author
morgado@clinic.cat

Corresponding author.
, X. Fustà-Novellb
a Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
b Servicio de Dermatología, Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Barcelona, Spain
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Membranous aplasia cutis congenita&#46; Erythematous alopecic plaque with a diameter of 8&#8239;mm on the vertex of the scalp&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Aplasia cutis congenita &#40;ACC&#41; is a rare congenital malformation&#46; Membranous ACC is the most common of the 9 subtypes described&#46; Its clinical presentation is highly variable&#44; with appearances ranging from eroded&#44; ulcerated&#44; or scar-like lesions to a glistening surface&#46; The differential diagnosis is broad&#44; and clinical diagnosis can be challenging&#46; Dermoscopy may be a useful tool for the differential diagnosis&#44; but few studies have analyzed its use in this setting&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> We describe the dermoscopic findings of membranous ACC in an infant&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The infant was a 2-month-old boy with no remarkable personal or family history who was seen for a painful alopecic plaque on the vertex of his scalp&#46; His parents reported that the plaque had appeared 3 weeks earlier following the use of a very rigid baby chair&#46; They had applied disinfectants and healing creams&#44; but there had been no clinical response&#46; Physical examination showed a nonscaling erythematous alopecic plaque with a diameter of 8&#8239;mm that did not change on palpation &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Dermoscopy showed a shiny surface with thin telangiectatic vessels and bluish globules &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; A diagnosis of membranous ACC was established&#46; Transfontanellar ultrasound showed no underlying bone or brain defects&#46; The parents were informed of the benign nature of the lesion&#46; No specific treatment was prescribed&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">ACC is a congenital condition characterized by absence of the epidermis&#44; dermis&#44; and&#44; occasionally&#44; bone or dura mater&#46; It is mostly observed on the scalp&#44; especially on the vertex or parietal scalp&#46; The defects are usually small &#40;typically 1&#8722;2&#8239;cm&#41;&#44; although large lesions have been described&#46; ACC has been linked to a number of causes&#44; including use of certain medications or drugs during pregnancy and embryologic malformations&#46; The hair collar sign&#44; a potential marker of neural tube defects&#44; may be observed&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Transfontanellar ultrasound is recommended to rule out underlying bone or brain defects&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Because the lesions are so small&#44; as occurred in our case&#44; they can go unnoticed during the neonatal period&#44; making clinical diagnosis even more challenging&#46; Dermoscopy can be very useful for ruling out trauma or infectious &#40;herpes virus&#44; mycosis&#44; impetigo&#41;&#44; inflammatory &#40;alopecia areata&#41;&#44; or tumoral &#40;sebaceous nevus&#41; causes&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The translucency sign is a characteristic dermoscopic feature of membranous ACC&#46; It consists of the presence of a shiny surface&#44; thin arborizing vessels&#44; and blue globules corresponding to hair bulbs&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;5&#44;6</span></a> Other possible features are an absence of follicular openings on the alopecic plaque and the hair collar sign &#40;hair follicles distributed around the edge of the plaque&#41;&#46; These features are quite specific to ACC and help establish a clinical diagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Findings for sebaceous nevi include yellow lobules or dots not related to hair follicles&#46; In tinea capitis&#44; findings include corkscrew hairs&#44; comma hairs&#44; zigzag hairs&#44; pigtail hairs&#44; and Morse code&#8211;like hairs&#46; Features of alopecia areata&#44; which is very uncommon in neonates and infants&#44; are yellow and black dots&#44; exclamation mark hairs&#44; and vellus hair&#46; Triangular alopecia&#44; in turn&#44; is characterized by short&#44; upright regrowing hairs&#44; vellus hairs&#44; and pigtail hairs&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The dermoscopic features of diseases with focal alopecia in neonates and infants are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">High-frequency ultrasound can also be useful in membranous ACC&#44; as it shows a thin or concave hyperechogenic line corresponding to the epidermis and absence of the dermis or subcutaneous tissue&#59; it can also be used to assess bone status&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Dermoscopy may be a useful diagnostic tool for membranous ACC as it helps rule out trauma&#44; infections&#44; inflammatory disorders&#44; and tumors and may avoid the need for invasive diagnostic tests&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Morgado-Carrasco D&#44; Fust&#224;-Novell X&#46; Hallazgos dermatosc&#243;picos en la aplasia cutis membranosa&#46; Diagn&#243;stico diferencial con otras formas de alopecia focal en lactantes&#46; Actas Dermosifiliogr&#46; 2021&#59;112&#58;275&#8211;277&#46;</p>"
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Comma&#44; corkscrew&#44; pigtail&#44; zigzag&#44; or Morse code&#8211;like hairs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Triangular alopecia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Regrowing hairs&#58; short and upright&#44; vellus&#44; and pigtail hairs&#59; terminal hairs at the edge of the lesion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alopecia areata&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Black dots&#44; yellow dots&#44; exclamation hairs&#44; circular hairs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Impetigo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Scaling border&#44; yellowish crusts&#44; irregularly distributed dotted vessels&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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Article information
ISSN: 15782190
Original language: English
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