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differentiating this diagnosis from actinic porokeratosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A 65-year-old woman with no prior medical history of interest consulted us for an asymptomatic lesion on the hypothenar eminence of her left hand&#46; She reported that it was unrelated to friction or injury&#46; Physical examination revealed a solitary pinkish plaque 14<span class="elsevierStyleHsp" style=""></span>mm along the longest axis&#46; The plaque had clearly defined borders&#44; was slightly depressed&#44; not infiltrated&#44; and not scaling &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">High-frequency ultrasound imaging was performed in B and Doppler color modes with a 10-22<span class="elsevierStyleHsp" style=""></span>MHz linear probe &#40;Esaote MyLab Class C&#44; Genoa&#44; Italy&#41;&#46; The B-mode image revealed abrupt epidermal thinning&#44; with structural loss in a double hyperechogenic layer that sloped to form a single hyperechogenic layer under which a subepidermal low-echogenic band &#40;SLEB&#41; could be seen&#46; The Doppler color image ruled out abnormal vascularization&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The case is noteworthy for good correlation between the ultrasound images and histologic features in biopsied tissue &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">CPH is a benign condition&#44; but it should be conclusively diagnosed to rule out Bowen disease&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Approximately 50 to 70 case reports of CPH have been published to date and all describe histologic findings consistent with a depression corresponding to stair-like epidermal thinning&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4&#44;5</span></a> Few diagnostic images can be found in the literature&#44; however&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Images recently obtained by optimal coherence tomography in 4 patients with CPH<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> showed a nearly abolished stratum corneum&#44; although the lucidum and granulosum strata were preserved&#46; In 1 patient in that series&#44; high-frequency ultrasound showed the stair-like sign with good histologic correlation&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Characteristic CPH findings were also described by a group using the DermaScan high-frequency ultrasound device&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Loss of structure could be seen in acral skin&#44; where there was thinning of the double echogenic layer&#44; which abruptly dropped to form a single echogenic layer with the decreasing echogenicity of SLEB&#44; findings that correspond to the stair-like sign&#46; The images obtained with the DermaScan device were difficult to interpret&#44; however&#44; and this device is little used in our practice setting&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">This report of a case of CPH with histopathologic confirmation also describes high-frequency B-mode ultrasound findings&#44; a diagnostic technique available to dermatologists in our current practice settings in Spain&#46; With this use of ultrasound imaging&#44; a confirmed diagnosis can be reached without resorting to invasive techniques&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0050" class="elsevierStylePara elsevierViewall">The present study received no specific funding from agencies in the public&#44; private&#44; or nonprofit sectors&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of Interest</span><p id="par0055" 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
Ultrasound Image of a Stair-Like Border in Circumscribed Palmar Hypokeratosis
Hipoqueratosis palmar circunscrita: signo de la escalera ecográfico
L. Luna-Bastantea,
Autor para correspondencia
loretoluna.abm@hotmail.com

Corresponding author.
, M. Sigüenzab, L. Nájerob, F. Alfagemeb,c
a Servicio de Dermatología, Complejo Hospitalario de Toledo, Hospital Virgen del Valle, Toledo, Spain
b Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
c Universidad Autónoma de Madrid, Ciudad Universitaria de Cantoblanco, Madrid, Spain
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Photograph of the patient&#39;s left palm&#44; showing an erythematous&#44; pinkish&#44; slightly depressed plaque on the hypothenar eminence&#46; The lesion has well-circumscribed borders and measures 14<span class="elsevierStyleHsp" style=""></span>mm along the longest axis&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Circumscribed palmar hypokeratosis &#40;CPH&#41;&#44; described for the first time in 2002 by P&#233;rez et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> is characterized by a solitary reddish scaly lesion with well-defined borders&#46; Otherwise asymptomatic&#44; CPH lesions are typically located on the thenar or hypothenar eminences of the hand or in the midplantar region of the foot and progress for years before a physician is consulted&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#8211;5</span></a> CPH resembles Bowen disease and actinic porokeratosis&#44; conditions that must be ruled out&#46; Histologic features are a steep stair-like depression in the epidermis&#44; with thinning of the stratum corneum and a granular appearance that contrasts with adjacent skin&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2&#44;4</span></a> In CPH no cornoid lamella can be observed in serial sections of biopsied tissue&#44; differentiating this diagnosis from actinic porokeratosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A 65-year-old woman with no prior medical history of interest consulted us for an asymptomatic lesion on the hypothenar eminence of her left hand&#46; She reported that it was unrelated to friction or injury&#46; Physical examination revealed a solitary pinkish plaque 14<span class="elsevierStyleHsp" style=""></span>mm along the longest axis&#46; The plaque had clearly defined borders&#44; was slightly depressed&#44; not infiltrated&#44; and not scaling &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">High-frequency ultrasound imaging was performed in B and Doppler color modes with a 10-22<span class="elsevierStyleHsp" style=""></span>MHz linear probe &#40;Esaote MyLab Class C&#44; Genoa&#44; Italy&#41;&#46; The B-mode image revealed abrupt epidermal thinning&#44; with structural loss in a double hyperechogenic layer that sloped to form a single hyperechogenic layer under which a subepidermal low-echogenic band &#40;SLEB&#41; could be seen&#46; The Doppler color image ruled out abnormal vascularization&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The case is noteworthy for good correlation between the ultrasound images and histologic features in biopsied tissue &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">CPH is a benign condition&#44; but it should be conclusively diagnosed to rule out Bowen disease&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Approximately 50 to 70 case reports of CPH have been published to date and all describe histologic findings consistent with a depression corresponding to stair-like epidermal thinning&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4&#44;5</span></a> Few diagnostic images can be found in the literature&#44; however&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Images recently obtained by optimal coherence tomography in 4 patients with CPH<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> showed a nearly abolished stratum corneum&#44; although the lucidum and granulosum strata were preserved&#46; In 1 patient in that series&#44; high-frequency ultrasound showed the stair-like sign with good histologic correlation&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Characteristic CPH findings were also described by a group using the DermaScan high-frequency ultrasound device&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Loss of structure could be seen in acral skin&#44; where there was thinning of the double echogenic layer&#44; which abruptly dropped to form a single echogenic layer with the decreasing echogenicity of SLEB&#44; findings that correspond to the stair-like sign&#46; The images obtained with the DermaScan device were difficult to interpret&#44; however&#44; and this device is little used in our practice setting&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">This report of a case of CPH with histopathologic confirmation also describes high-frequency B-mode ultrasound findings&#44; a diagnostic technique available to dermatologists in our current practice settings in Spain&#46; With this use of ultrasound imaging&#44; a confirmed diagnosis can be reached without resorting to invasive techniques&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0050" class="elsevierStylePara elsevierViewall">The present study received no specific funding from agencies in the public&#44; private&#44; or nonprofit sectors&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of Interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Correlation between ultrasound and histologic findings&#46; A&#44; B-mode ultrasound image&#44; 22<span class="elsevierStyleHsp" style=""></span>mHz&#46; Area of abrupt epidermal thinning&#44; sloping downward&#44; with structural loss in a double hyperechogenic layer of acral skin&#46; The image is similar to the stair-like sign&#46; SLEB &#40;a subepidermal low-echogenic band&#41; can be observed under the affected epidermis&#46; B&#44; Histopathology shows an abrupt depression in the epidermis due to corneal layer thinning and shedding&#46; The high correlation between ultrasonography and histology is evident&#46;</p>"
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