Estadísticas

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 55-year-old man&#44; with no relevant medical history&#44; presented with skin lesions on both legs that had appeared 5 months earlier and had become more evident and itchier in the preceding days&#46; He had no associated general symptoms&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed multiple brownish-red nummular purpuric plaques with superficial scaling on the lower limbs &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The lesions did not disappear under pressure&#46; Dermoscopy revealed punctate hemorrhagic stippling and hemosiderin deposits&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Dermal histopathology showed a psoriasiform spongiotic dermatitis with irregular parakeratosis&#44; superficial perivascular infiltrate&#44; and red blood cell extravasation &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Direct immunofluorescence and T-cell receptor clonality analysis of a skin biopsy specimen were both negative&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Additional Tests</span><p id="par0020" class="elsevierStylePara elsevierViewall">Initial laboratory analyses&#44; including a complete blood count&#44; biochemistry and coagulation parameters&#44; and urinalysis&#44; revealed no abnormalities&#46; An autoimmunity study was negative for antinuclear antibodies&#44; antineutrophil cytoplasmic antibodies&#44; and cryoglobulins&#46; Patch test results were negative&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">What is your Diagnosis&#63;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Diagnosis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Based on the clinical and histological findings&#44; the patient was diagnosed with Doucas and Kapetanakis eczematoid purpura&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical Course and Treatment</span><p id="par0035" class="elsevierStylePara elsevierViewall">The lesions resolved after 6 months of treatment with topical corticosteroids&#44; oral colchicine&#44; and oral nicotinamide&#44; leaving residual hyperpigmentation &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Comment</span><p id="par0040" class="elsevierStylePara elsevierViewall">Pigmented purpuric dermatoses &#40;PPD&#41; is a heterogeneous group of benign and chronic dermatoses&#46; They are characterized clinically by the appearance of reddish purple macules and petechiae secondary to capillaritis&#44; and can evolve to hyperpigmented macules as a consequence of hemosiderin reabsorption&#46; They fundamentally affect the lower limbs and are often asymptomatic&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Doucas and Kapetanakis eczematoid purpura is a rare subtype of PPD characterized by itching and scaling on the petechial and hyperpigmented lesion&#46; It was first described in 1949 by Doucas and Kapetanakis&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> It manifests clinically as a symmetrical skin eruption that mainly affects the lower extremities&#46; The primary lesion is a group of red-violaceous punctate macules that do not disappear under pressure&#46; It is therefore essential to include cutaneous vasculitis in the differential diagnosis&#46; This condition can necessitate emergency consultation&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> The lesions can be isolated or can coalesce to cover larger areas&#44; and very frequently show superficial desquamation and lichenification&#46; They usually evolve to develop a brownish or golden coloration and can either disappear or leave a yellowish discoloration that persists for some time&#46; Macules may be accompanied by itching and burning sensations during the period of greatest activity&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Common histological findings in PPD include a superficial perivascular lymphocytic infiltrate in the dermis&#44; red blood cell extravasation&#44; and hemosiderin deposits&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Treatment of PPD can be challenging&#46; However&#44; there is no consensus on treatment and recommendations are based on small series or case studies&#46; Our patient responded well to treatment with topical corticosteroids&#44; colchicine&#44; and nicotinamide&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of Interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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