Practical Dermoscopy
Violaceous Papule on the Trunk
Pápula violácea en tronco
F.J. Navarro-Triviño
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Unidad de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario San Cecilio, Granada, Spain
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Left, negative staining for immunoglobulin (Ig) G κ light chain. Right, positive staining for IgG λ light chain.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Ruiz-Villaverde, B. Rueda-Villafranca, M. Galvez-Moreno" "autores" => array:3 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Ruiz-Villaverde" ] 1 => array:2 [ "nombre" => "B." "apellidos" => "Rueda-Villafranca" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Galvez-Moreno" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219021001621?idApp=UINPBA000044" "url" => "/15782190/0000011200000007/v1_202107020822/S1578219021001621/v1_202107020822/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Practical Dermoscopy</span>" "titulo" => "Violaceous Papule on the Trunk" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "647" "paginaFinal" => "648" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "F.J. Navarro-Triviño" "autores" => array:1 [ 0 => array:4 [ "nombre" => "F.J." "apellidos" => "Navarro-Triviño" "email" => array:1 [ 0 => "fntmed@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario San Cecilio, Granada, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pápula violácea en tronco" ] ] "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" => 455 "Ancho" => 805 "Tamanyo" => 56941 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermoscopic image of the lesion (DermLite 4). The reddish-violaceous homogeneous lesion is surrounded by a biphasic halo. The first halo has a yellowish-orange tinge (*) and the second halo on the periphery is reddish. The hair follicles remain intact.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case Presentation</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 43-year-old woman with no relevant personal or family history of illness was referred by her primary care physician for evaluation of a pruriginous, violaceous lesion on the back of her trunk. The lesion had appeared 2 weeks earlier, and melanoma was suspected. She reported having noticed spontaneous bleeding from the lesion.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed a violaceous papule surrounded by a purpuric halo (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Dermoscopy showed a structure with a reddish-purple center with lighter-appearing areas; the center was surrounded by a yellowish orange halo and another homogenous reddish halo at the periphery. Hair follicles were intact (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Diagnosis</span><p id="par0015" class="elsevierStylePara elsevierViewall">Targetoid hemosiderotic hemangioma (THH).</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Comment</span><p id="par0020" class="elsevierStylePara elsevierViewall">Santa Cruz and Aronberg first described a THH lesion in 1988, according to Sahim et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> THHs are described as benign vascular lesions that develop on the trunk and legs in middle age (around 30–40 years of age). Although the cause is still unknown, it has been suggested that a THH might be induced by trauma, specifically injury to a preexisting hemangioma.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The presence of estrogen hormone receptors demonstrated by immunohistochemistry suggests that this hormone may accelerate endothelial proliferation and dilation, explaining the clinical behavior of THHs.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> D2-40 positivity and negative immunostaining for CD34 in endothelial cells, along with an absence of actin-positive pericytes, suggest that these lesions may have a lymphatic origin.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">A THH presents clinically as a reddish-violaceous papule surrounded by a violaceous, ecchymotic halo. The lesion may or may not be itchy or painful and is usually solitary. However, patients with multiple lesions have also been described.</p><p id="par0035" class="elsevierStylePara elsevierViewall">THHs have a highly characteristic dermoscopic pattern, as shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>. In a study of 35 cases, the largest series published to date, the most common dermoscopic finding was of a dark reddish lacuna at the center and a reddish-violaceous homogeneous area around the periphery; that pattern was seen in 71.4% of the lesions.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Our patient’s THH had a clearly biphasic halo around its center, a finding that defines the targetoid aspect of this lesion. The differential diagnosis includes consideration of malignant pigmented lesions such as melanoma,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> dermatofibromas, Kaposi sarcoma, insect bites, and basal cell carcinoma.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">THHs are benign vascular lesions that can be distinguished from others by their characteristic dermoscopic pattern. If the diagnosis is in doubt, in the absence of an ecchymotic halo, surgical removal and histopathologic study of the lesion would be the most prudent course of action.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicts of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case Presentation" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Diagnosis" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Comment" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of Interest" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-07-22" "fechaAceptado" => "2019-09-15" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Navarro-Triviño FJ. Pápula violácea en tronco. Actas Dermosifiliogr. 2021;112:647–648.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1011 "Ancho" => 800 "Tamanyo" => 98237 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A violaceous papule surrounded by a homogeneous purpuric halo on the back of a 43-year-old woman.</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" => 455 "Ancho" => 805 "Tamanyo" => 56941 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermoscopic image of the lesion (DermLite 4). The reddish-violaceous homogeneous lesion is surrounded by a biphasic halo. The first halo has a yellowish-orange tinge (*) and the second halo on the periphery is reddish. The hair follicles remain intact.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Targetoid haemosiderotic haemangioma: dermoscopic monitoring of three cases and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.T. Sahim" 1 => "M.A. Demir" 2 => "K. Gunduz" 3 => "S. Ozturkcan" 4 => "A. 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| 2024 November | 25 | 9 | 34 |
| 2024 October | 235 | 48 | 283 |
| 2024 September | 171 | 33 | 204 |
| 2024 August | 172 | 76 | 248 |
| 2024 July | 148 | 34 | 182 |
| 2024 June | 136 | 46 | 182 |
| 2024 May | 114 | 37 | 151 |
| 2024 April | 119 | 33 | 152 |
| 2024 March | 119 | 32 | 151 |
| 2024 February | 102 | 35 | 137 |
| 2024 January | 108 | 37 | 145 |
| 2023 December | 83 | 25 | 108 |
| 2023 November | 115 | 48 | 163 |
| 2023 October | 118 | 41 | 159 |
| 2023 September | 96 | 47 | 143 |
| 2023 August | 84 | 34 | 118 |
| 2023 July | 94 | 51 | 145 |
| 2023 June | 107 | 37 | 144 |
| 2023 May | 100 | 39 | 139 |
| 2023 April | 76 | 32 | 108 |
| 2023 March | 81 | 45 | 126 |
| 2023 February | 87 | 40 | 127 |
| 2023 January | 92 | 72 | 164 |
| 2022 December | 75 | 72 | 147 |
| 2022 November | 42 | 85 | 127 |
| 2022 October | 41 | 35 | 76 |
| 2022 September | 41 | 62 | 103 |
| 2022 August | 32 | 62 | 94 |
| 2022 July | 47 | 50 | 97 |
| 2022 June | 51 | 44 | 95 |
| 2022 May | 110 | 57 | 167 |
| 2022 April | 62 | 66 | 128 |
| 2022 March | 94 | 69 | 163 |
| 2022 February | 91 | 44 | 135 |
| 2022 January | 78 | 60 | 138 |
| 2021 December | 67 | 57 | 124 |
| 2021 November | 57 | 65 | 122 |
| 2021 October | 69 | 86 | 155 |
| 2021 September | 56 | 50 | 106 |
| 2021 August | 87 | 45 | 132 |
| 2021 July | 120 | 37 | 157 |
| 2021 June | 45 | 42 | 87 |
| 2021 May | 71 | 87 | 158 |
| 2021 April | 110 | 39 | 149 |
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