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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Erythromelanosis follicularis faciei et colli &#40;EFFC&#41; is a rare pigmentary disease of unknown etiopathogenesis typically affecting the face&#47;neck of children or young adults&#44; which is clinically characterized by the combination of bilateral&#47;symmetrical brownish pigmentation and erythema&#44; associated with more or less evident follicular plugging&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Of note&#44; such a condition is often associated with keratosis pilaris on the arms and shoulders&#44; thereby letting some authors speculate that EFFC could be a variant of this latter dermatosis&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Not uncommonly&#44; EFFC is mistaken for other similar pigmentary&#47;erythematous dermatoses involving the aforementioned districts&#44; with consequent diagnostic errors&#47;delays and prescription of inappropriate therapies&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Over the last few years&#44; several studies have shown that dermoscopic examination may be useful to assist the diagnosis of general skin diseases&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#8211;5</span></a> We here describe for the first time the use of dermoscopy as a noninvasive diagnostic aid in a case of EFFC&#44; comparing its dermoscopic findings with those detectable in other conditions which classically enter into the differential diagnosis&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 33-year-old man presented with a 6-year history of progressively worsening&#44; asymptomatic&#44; reddish-brown pigmentation associated with slight roughness on the cheeks&#44; temples&#44; lateral aspects of the nose&#44; and frontal area &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Polarized light dermoscopic examination &#40;carried out with DermLite DL3&#215;10&#59; 3Gen&#44; San Juan Capistrano&#44; CA&#44; USA&#41; revealed whitish scales and numerous whitish follicular keratotic plugs over a reddish-brown background&#59; moreover&#44; several gray-blue granules &#40;peppering&#41; were also evident in the perifollicular and interfollicular areas &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Histological examination showed slight orthokeratosis&#44; follicular hyperkeratosis&#44; increased basal layer pigmentation&#44; perivascular and periadnexal lymphocytic infiltrate&#44; and pigmentary incontinence with dermal melanophages &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>b&#41;&#44; thus leading to the diagnosis of EFFC&#46; Topical tacalcitol was prescribed and the use of sunscreen was recommended&#44; with significant improvement of the clinical picture after eight weeks&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Dermoscopic findings seen in our instance of EFFC are related to the peculiar histological features which characterize this condition&#44;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;6</span></a> with follicular plugging&#44; scaling&#44; peppering&#44; and reddish-brown background respectively corresponding to hyperkeratotic hair follicles&#44; orthokeratosis&#44; pigmentary incontinence&#47;dermal melanophages&#44; and dermal vasodilation&#47;hyperpigmentation of the basal layer&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;6</span></a> Such a dermoscopic picture is similar to that reported in a recent case of erythrosis pigmentosa peribuccalis&#44; a pigmentary dermatosis presenting as brownish-red pigmentation and small papules around the mouth and nose&#44; which displayed erythema&#44; scaling&#44; yellowish follicular keratotic plugs&#44; and perifollicular grayish globules&#47;dots&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> These similarities are easily explained by the fact that both such disorders may share several histological features&#44; so much so that they are considered to be part of the same condition spectrum by some authors&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> Interestingly&#44; the detection of the above-mentioned dermocopic features might come in handy in the noninvasive distinction of EFFC from its main differential diagnoses as the latter typically show different features&#46; In particular&#58; lichen planus pigmentosus usually displays diffuse&#44; structureless&#44; brownish pigmentation and&#47;or fine&#47;coarse&#44; gray-blue&#47;brown dots&#47;globules<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a>&#59; Riehl&#39;s melanosis constantly features brownish pseudonetwork&#44; gray dots&#47;granules and telangiectatic vessels<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a>&#59; poikiloderma of Civatte commonly shows structureless brownish pigmentation and telangiectatic vessels&#44; with or without whitish areas &#40;personal observations&#41;&#59; melasma typically presents light yellow-brown uniform patches&#44; with or without dark brown patches and capillary network<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a>&#59; keratosis pilaris rubra atrophicans faciei frequently displays whitish follicular plugs over a reddish background with or without telangiectatic vessels &#40;personal observations&#41;&#59; demodicidosis mainly shows the so-called &#8220;Demodex tails&#8221; &#40;creamy&#47;whitish gelatinous threads representing the presence of the mite itself under magnification&#41; protruding out of follicular openings&#44; &#8220;Demodex follicular openings&#8221; &#40;round and coarse follicular openings containing light brown&#47;grayish plugs surrounded by an erythematous halo&#41;&#44; erythema and whitish scaling<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a>&#59; keratosis pilaris often features coiled&#47;twisted hair embedded in the horny layer&#44; sometimes associated with perifollicular erythema and vascular ectasia &#40;keratosis pilaris rubra&#41;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a>&#59; and follicular lichen planus reported to show follicular keratotic plugs without broken or twisted hairs&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In conclusion&#44; this paper emphasizes that dermoscopy might be used as an auxiliary tool in the noninvasive differential diagnosis of EFFC&#46; Further studies are obviously needed to confirm our preliminar observations&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Case and Research Letter
Dermoscopy of Erythromelanosis Follicularis Faciei et Colli
Dermatoscopia de erythromelanosis folicular faciei et colli
E. Errichettia,
Autor para correspondencia
enzoerri@yahoo.it

Corresponding author.
, S. Pizzolittob, G. Stincoa
a Department of Experimental and Clinical Medicine, Institute of Dermatology, University of Udine, Italy
b Department of Pathology, Santa Maria della Misericordia Hospital, Udine, Italy
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Erythromelanosis follicularis faciei et colli &#40;EFFC&#41; is a rare pigmentary disease of unknown etiopathogenesis typically affecting the face&#47;neck of children or young adults&#44; which is clinically characterized by the combination of bilateral&#47;symmetrical brownish pigmentation and erythema&#44; associated with more or less evident follicular plugging&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Of note&#44; such a condition is often associated with keratosis pilaris on the arms and shoulders&#44; thereby letting some authors speculate that EFFC could be a variant of this latter dermatosis&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Not uncommonly&#44; EFFC is mistaken for other similar pigmentary&#47;erythematous dermatoses involving the aforementioned districts&#44; with consequent diagnostic errors&#47;delays and prescription of inappropriate therapies&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Over the last few years&#44; several studies have shown that dermoscopic examination may be useful to assist the diagnosis of general skin diseases&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#8211;5</span></a> We here describe for the first time the use of dermoscopy as a noninvasive diagnostic aid in a case of EFFC&#44; comparing its dermoscopic findings with those detectable in other conditions which classically enter into the differential diagnosis&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 33-year-old man presented with a 6-year history of progressively worsening&#44; asymptomatic&#44; reddish-brown pigmentation associated with slight roughness on the cheeks&#44; temples&#44; lateral aspects of the nose&#44; and frontal area &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Polarized light dermoscopic examination &#40;carried out with DermLite DL3&#215;10&#59; 3Gen&#44; San Juan Capistrano&#44; CA&#44; USA&#41; revealed whitish scales and numerous whitish follicular keratotic plugs over a reddish-brown background&#59; moreover&#44; several gray-blue granules &#40;peppering&#41; were also evident in the perifollicular and interfollicular areas &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Histological examination showed slight orthokeratosis&#44; follicular hyperkeratosis&#44; increased basal layer pigmentation&#44; perivascular and periadnexal lymphocytic infiltrate&#44; and pigmentary incontinence with dermal melanophages &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>b&#41;&#44; thus leading to the diagnosis of EFFC&#46; Topical tacalcitol was prescribed and the use of sunscreen was recommended&#44; with significant improvement of the clinical picture after eight weeks&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Dermoscopic findings seen in our instance of EFFC are related to the peculiar histological features which characterize this condition&#44;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;6</span></a> with follicular plugging&#44; scaling&#44; peppering&#44; and reddish-brown background respectively corresponding to hyperkeratotic hair follicles&#44; orthokeratosis&#44; pigmentary incontinence&#47;dermal melanophages&#44; and dermal vasodilation&#47;hyperpigmentation of the basal layer&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;6</span></a> Such a dermoscopic picture is similar to that reported in a recent case of erythrosis pigmentosa peribuccalis&#44; a pigmentary dermatosis presenting as brownish-red pigmentation and small papules around the mouth and nose&#44; which displayed erythema&#44; scaling&#44; yellowish follicular keratotic plugs&#44; and perifollicular grayish globules&#47;dots&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> These similarities are easily explained by the fact that both such disorders may share several histological features&#44; so much so that they are considered to be part of the same condition spectrum by some authors&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> Interestingly&#44; the detection of the above-mentioned dermocopic features might come in handy in the noninvasive distinction of EFFC from its main differential diagnoses as the latter typically show different features&#46; In particular&#58; lichen planus pigmentosus usually displays diffuse&#44; structureless&#44; brownish pigmentation and&#47;or fine&#47;coarse&#44; gray-blue&#47;brown dots&#47;globules<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a>&#59; Riehl&#39;s melanosis constantly features brownish pseudonetwork&#44; gray dots&#47;granules and telangiectatic vessels<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a>&#59; poikiloderma of Civatte commonly shows structureless brownish pigmentation and telangiectatic vessels&#44; with or without whitish areas &#40;personal observations&#41;&#59; melasma typically presents light yellow-brown uniform patches&#44; with or without dark brown patches and capillary network<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a>&#59; keratosis pilaris rubra atrophicans faciei frequently displays whitish follicular plugs over a reddish background with or without telangiectatic vessels &#40;personal observations&#41;&#59; demodicidosis mainly shows the so-called &#8220;Demodex tails&#8221; &#40;creamy&#47;whitish gelatinous threads representing the presence of the mite itself under magnification&#41; protruding out of follicular openings&#44; &#8220;Demodex follicular openings&#8221; &#40;round and coarse follicular openings containing light brown&#47;grayish plugs surrounded by an erythematous halo&#41;&#44; erythema and whitish scaling<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a>&#59; keratosis pilaris often features coiled&#47;twisted hair embedded in the horny layer&#44; sometimes associated with perifollicular erythema and vascular ectasia &#40;keratosis pilaris rubra&#41;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a>&#59; and follicular lichen planus reported to show follicular keratotic plugs without broken or twisted hairs&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In conclusion&#44; this paper emphasizes that dermoscopy might be used as an auxiliary tool in the noninvasive differential diagnosis of EFFC&#46; Further studies are obviously needed to confirm our preliminar observations&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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