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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case Description</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 48-year-old woman with no past history of interest consulted for scattered pruritic skin lesions that had appeared 1 week earlier&#46; The patient was in good general condition and had no associated systemic symptoms&#46; Physical examination revealed nummular crusted erosive plaques of varying sizes &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; and tense blisters&#44; some with clear and others with purulent content&#44; located generally on the upper limbs&#44; the hypogastric region&#44; and extensively on the lower limbs&#44; covering the thighs and the pretibial region&#46; Bullous lesions were more numerous on the right hand &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; No mucosal lesions were observed&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Additional Tests</span><p id="par0010" class="elsevierStylePara elsevierViewall">Purulent content from a blister was sampled for bacterial culture&#44; and a skin biopsy of one of the lesions was performed for histology and direct immunofluorescence&#46; Histology &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>A&#41; showed an acute spongiotic reaction pattern&#44; with the presence of a subcorneal blister containing neutrophils and periodic acid-Schiff &#40;PAS&#41;-positive filamentous structures in the stratum corneum &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>B&#41;&#46; Both bacterial culture and direct immunofluorescence were negative&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">What is your diagnosis&#63;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Diagnosis</span><p id="par0020" class="elsevierStylePara elsevierViewall">Bullous tinea&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Clinical Course and Treatment</span><p id="par0025" class="elsevierStylePara elsevierViewall">Based on the histological findings&#44; a complete medical history was performed&#44; revealing previous contact with stray cats&#46; Scales were collected for mycological culture&#44; in which <span class="elsevierStyleItalic">Microsporum canis</span> was isolated&#46; The lesions resolved after treatment with oral terbinafine &#40;250<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#41; for 4 weeks and topical imidazole&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Comment</span><p id="par0030" class="elsevierStylePara elsevierViewall">Bullous tinea&#44; described by Costello in 1952&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> is a clinical variant of dermatophytosis&#44; of which less than 70 cases are described in the literature&#46; A characteristic feature is the appearance of blisters in the context of intense inflammation&#44; usually caused by a zoophilic dermatophyte&#58; <span class="elsevierStyleItalic">Tricophyton mentagrophytes</span> and <span class="elsevierStyleItalic">M&#46; canis</span> are the most frequently isolated&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> The foot is the most commonly affected location&#46; Bullous lesions are usually restricted to the edges of the plaques&#44; and extensive lesions such as those of our patient are exceptional&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> The differential diagnosis of disseminated bullous lesions in adults is broad and includes infections&#44; contact dermatitis&#44; insect bites&#44; and autoimmune blistering diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> The asymmetric location of bullous lesions in tinea can help distinguish it from autoimmune blistering diseases&#44; although differentiation is not possible in extensive cases such that described here&#46; The secondary presentation of nonbullous tinea in the context of an autoimmune bullous disease treated with corticosteroids can also mimic bullous tinea&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> Dermatophytosis can be distinguished from bullous tinea because the former consists of a hypersensitivity reaction to a distant dermatophyte&#44; and direct examination and culture are negative&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Bullous tinea responds to the usual treatment regimen for dermatophytosis&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> However&#44; due to the higher rate of terbinafine resistance of <span class="elsevierStyleItalic">M&#46; canis</span>&#44; prolonged treatment with higher than recommended doses should be considered in these cases&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The present case illustrates an unusual manifestation of a common dermatosis that should be included in the differential diagnosis of bullous lesions in the relevant epidemiological context&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conflicts of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Cases for Diagnosis
Recent-Onset Bullous Lesions
Lesiones ampollosas de reciente aparición
L. Rodríguez-Lago
Autor para correspondencia
lauramatri@gmail.com

Corresponding author.
, P. Almeida-Martín, L. Borrego-Hernando
Servicio de Dermatología, Complejo Hospitalario Universitario Insular - Materno Infantil, Las Palmas de Gran Canaria, Spain
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No mucosal lesions were observed&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Additional Tests</span><p id="par0010" class="elsevierStylePara elsevierViewall">Purulent content from a blister was sampled for bacterial culture&#44; and a skin biopsy of one of the lesions was performed for histology and direct immunofluorescence&#46; Histology &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>A&#41; showed an acute spongiotic reaction pattern&#44; with the presence of a subcorneal blister containing neutrophils and periodic acid-Schiff &#40;PAS&#41;-positive filamentous structures in the stratum corneum &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>B&#41;&#46; Both bacterial culture and direct immunofluorescence were negative&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">What is your diagnosis&#63;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Diagnosis</span><p id="par0020" class="elsevierStylePara elsevierViewall">Bullous tinea&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Clinical Course and Treatment</span><p id="par0025" class="elsevierStylePara elsevierViewall">Based on the histological findings&#44; a complete medical history was performed&#44; revealing previous contact with stray cats&#46; Scales were collected for mycological culture&#44; in which <span class="elsevierStyleItalic">Microsporum canis</span> was isolated&#46; The lesions resolved after treatment with oral terbinafine &#40;250<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#41; for 4 weeks and topical imidazole&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Comment</span><p id="par0030" class="elsevierStylePara elsevierViewall">Bullous tinea&#44; described by Costello in 1952&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> is a clinical variant of dermatophytosis&#44; of which less than 70 cases are described in the literature&#46; A characteristic feature is the appearance of blisters in the context of intense inflammation&#44; usually caused by a zoophilic dermatophyte&#58; <span class="elsevierStyleItalic">Tricophyton mentagrophytes</span> and <span class="elsevierStyleItalic">M&#46; canis</span> are the most frequently isolated&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> The foot is the most commonly affected location&#46; Bullous lesions are usually restricted to the edges of the plaques&#44; and extensive lesions such as those of our patient are exceptional&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> The differential diagnosis of disseminated bullous lesions in adults is broad and includes infections&#44; contact dermatitis&#44; insect bites&#44; and autoimmune blistering diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> The asymmetric location of bullous lesions in tinea can help distinguish it from autoimmune blistering diseases&#44; although differentiation is not possible in extensive cases such that described here&#46; The secondary presentation of nonbullous tinea in the context of an autoimmune bullous disease treated with corticosteroids can also mimic bullous tinea&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> Dermatophytosis can be distinguished from bullous tinea because the former consists of a hypersensitivity reaction to a distant dermatophyte&#44; and direct examination and culture are negative&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Bullous tinea responds to the usual treatment regimen for dermatophytosis&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> However&#44; due to the higher rate of terbinafine resistance of <span class="elsevierStyleItalic">M&#46; canis</span>&#44; prolonged treatment with higher than recommended doses should be considered in these cases&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The present case illustrates an unusual manifestation of a common dermatosis that should be included in the differential diagnosis of bullous lesions in the relevant epidemiological context&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conflicts of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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