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with some open comedones and milium cysts on the surface &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; An incisional biopsy of the lesion was performed&#44; and histology revealed a flattened epidermis with foci of vacuolization in the basement layer and thickening of the basement membrane&#44; follicular dilations with keratotic plugs&#44; and comedones&#46; A perivascular and periadnexal inflammatory infiltrate was visible in the dermis &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Given these findings and the patient&#8217;s history&#44; the lesion was diagnosed as comedonic lupus&#46; The patient initially underwent treatment with hydrocortisone&#44; 0&#46;1&#37;&#44; with little response&#44; followed by minocycline &#40;100&#8239;mg&#47;d for 3 months&#41; in association with tretinoin cream&#44; 0&#46;005&#37;&#44; with good results&#44; showing clear improvement of the lesion and residual scarring&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Comedonic or comedonal lupus is a rare entity and a rare variant of chronic cutaneous lupus erythematosus&#46; It is similar to other clinical entities such as acne&#44; which can sometimes make diagnosis difficult&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Very few cases have been reported in the medical literature and this disease is therefore thought to be underdiagnosed&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3</span></a> Clinically&#44; it is characterized by comedones on an erythematous plaque&#44; mainly on seborrheic regions&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The etiology is unknown&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> It has been suggested that exposure to sunlight may be involved in the formation of comedones&#46; The solar damage may produce changes in the collagen of the normal skin&#44; altering its structure and promoting retention of sebum&#44; concluding in the formation of comedones&#44; as occurs in Favre-Racouchot syndrome&#46; The other theory put forward is that follicular plugs act as a factor that promotes the formation of comedones&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Presentation typically occurs between the ages of 25 and 35 years&#44; or even younger&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a> The differential diagnosis should include inflammatory acne&#44; Favre-Racouchot syndrome&#44; milium cysts&#44; inflammatory tinea&#44; and nevus comedonicus&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">When comedones are absent&#44; this disease may be called lupus with an acneiform scarring pattern&#46; In this entity&#44; the lesions are characterized by pitting&#44; resulting from the destruction of the hair follicle and the sebaceous glands due to the inflammatory infiltrate&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;5&#8211;7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The diagnosis is confirmed by means of the histopathology study&#44; which shows a predominant interphase pattern with hydropic degeneration of the basement layer and thickening of the basement membrane&#44; accompanied by keratotic plugs and comedones&#44; as reported in our patient&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a> When histology findings are not conclusive&#44; immunofluorescence may contribute to the diagnosis&#44; revealing a deposit of IgM&#44; IgG&#44; and C3 at the dermal-epidermal junction&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Several therapeutic options exist&#44; 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Early diagnosis and long-term follow-up are very important due to the risk of systemic progression of the disease&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors state that they have received no external funding for this study&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of Interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declares that they have no conflicts of interest&#46;</p></span></span>"
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Case and Research Letters
Comedonic Lupus: An Unusual Presentation of Cutaneous Lupus
Lupus comedónico: presentación inusual de lupus cutáneo
C. Chesséa,b,
Corresponding author
carlachesse@gmail.com

Corresponding author.
, M.J. Fernández-Tapiab, F. Borzottab
a Servicio de dermatología, Hospital Luis C Lagomaggiore, Ciudad de Mendoza, Argentina
b Consultorio particular Mendoza, Argentina
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Infiltrated erythematous plaque with edematous edges&#44; and open comedones and milium cysts&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Skin manifestations of lupus erythematosus are varied&#46; Some of them are atypical and may imitate benign skin diseases&#46; Acneiform lesions are a rare&#44; atypical form of presentation&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 48-year-old woman visited our department with a lesion on the chin that had appeared 2 months earlier&#46; The patient had initially been diagnosed with lupus erythematosus discoides and a subacute cutaneous lupus erythematosus that had appeared 16 years earlier and had been treated with hydroxychloroquine&#46; Treatment was suspended due to maculopathy&#46; Four years after diagnosis of the cutaneous lupus&#44; the patient was finally diagnosed with systemic lupus erythematosus &#40;SLE&#41;&#44; as she met clinical and laboratory criteria &#40;lupus discoides&#44; synovitis&#44; lupus nephritis&#44; positive antinuclear antibody titer&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The physical examination revealed an infiltrated erythematous plaque with edematous edges&#44; with some open comedones and milium cysts on the surface &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; An incisional biopsy of the lesion was performed&#44; and histology revealed a flattened epidermis with foci of vacuolization in the basement layer and thickening of the basement membrane&#44; follicular dilations with keratotic plugs&#44; and comedones&#46; A perivascular and periadnexal inflammatory infiltrate was visible in the dermis &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Given these findings and the patient&#8217;s history&#44; the lesion was diagnosed as comedonic lupus&#46; The patient initially underwent treatment with hydrocortisone&#44; 0&#46;1&#37;&#44; with little response&#44; followed by minocycline &#40;100&#8239;mg&#47;d for 3 months&#41; in association with tretinoin cream&#44; 0&#46;005&#37;&#44; with good results&#44; showing clear improvement of the lesion and residual scarring&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Comedonic or comedonal lupus is a rare entity and a rare variant of chronic cutaneous lupus erythematosus&#46; It is similar to other clinical entities such as acne&#44; which can sometimes make diagnosis difficult&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Very few cases have been reported in the medical literature and this disease is therefore thought to be underdiagnosed&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3</span></a> Clinically&#44; it is characterized by comedones on an erythematous plaque&#44; mainly on seborrheic regions&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The etiology is unknown&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> It has been suggested that exposure to sunlight may be involved in the formation of comedones&#46; The solar damage may produce changes in the collagen of the normal skin&#44; altering its structure and promoting retention of sebum&#44; concluding in the formation of comedones&#44; as occurs in Favre-Racouchot syndrome&#46; The other theory put forward is that follicular plugs act as a factor that promotes the formation of comedones&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Presentation typically occurs between the ages of 25 and 35 years&#44; or even younger&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a> The differential diagnosis should include inflammatory acne&#44; Favre-Racouchot syndrome&#44; milium cysts&#44; inflammatory tinea&#44; and nevus comedonicus&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">When comedones are absent&#44; this disease may be called lupus with an acneiform scarring pattern&#46; In this entity&#44; the lesions are characterized by pitting&#44; resulting from the destruction of the hair follicle and the sebaceous glands due to the inflammatory infiltrate&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;5&#8211;7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The diagnosis is confirmed by means of the histopathology study&#44; which shows a predominant interphase pattern with hydropic degeneration of the basement layer and thickening of the basement membrane&#44; accompanied by keratotic plugs and comedones&#44; as reported in our patient&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a> When histology findings are not conclusive&#44; immunofluorescence may contribute to the diagnosis&#44; revealing a deposit of IgM&#44; IgG&#44; and C3 at the dermal-epidermal junction&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Several therapeutic options exist&#44; although the treatment of choice is oral hydroxychloroquine &#40;200&#8239;mg&#47;12&#8239;h&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;7</span></a> In our case&#44; hydroxychloroquine could not be administered due to the patient&#8217;s ophthalmologic history&#46; Oral and topical retinoids may be used as an alternative and may be supplemented with topical or intralesional corticosteroids&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It should be noted that these treatments presented little therapeutic efficacy in our patient and minocycline &#40;100&#8239;mg&#47;d for 3 months&#41; and topical tretinoin&#44; together with strict photoprotection&#44; was indicated&#44; with good results&#59; we therefore propose this regimen as another alternative treatment&#46; The outcome of comedonic lupus is uncertain and&#44; while few patients have been described in the literature&#44; a risk of progression to SLE has been observed in half of cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a> It should be noted that our patient already presented systemic lupus when the comedonic lupus lesion appeared&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Comedonic lupus thus represents a rare presentation of chronic cutaneous lupus erythematous&#46; Early diagnosis and long-term follow-up are very important due to the risk of systemic progression of the disease&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors state that they have received no external funding for this study&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of Interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declares 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; Chess&#233; C&#44; Fern&#225;ndez-Tapia MJ&#44; Borzotta F&#46; Lupus comed&#243;nico&#58; presentaci&#243;n inusual de lupus cut&#225;neo&#46; Actas Dermosifiliogr&#46; 2021&#59;112&#58;370&#8211;371&#46;</p>"
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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?