Case for Diagnosis
Hyperpigmented Verrucous Plaques in a Healthy Young Woman
Placas verrugosas hiperpigmentadas en uma joven sana
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Denied any local symptoms. Lesions had started five years ago and increased in extent over the years. She also complained of facial comedones and visible pores, without any previous treatment. There was a family history of similar lesions – father and paternal grandmother. She denied any systemic symptoms.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">On physical examination, there were reticulated brown patches in the presternal area (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), and similar small plaques in the inguinal region and the armpits bilaterally. Small slightly atrophic macules were visible on the dorsum of the hands. On the face, comedo-like lesions, dilated pores, and diffuse hyperpigmented plaques all over the face, especially on the forehead (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), bilateral malar, perioral and supramandibular regions. She also presents pitted scars on the perioral region.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Histopathology evaluation of lesions in the presternal area presented digitiform epithelial proliferation and corneal pseudocysts (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Additional tests</span><p id="par0020" class="elsevierStylePara elsevierViewall">Laboratory tests showed no changes.</p><p id="par0025" class="elsevierStylePara elsevierViewall">What is your diagnosis?</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Diagnosis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Dowling-Degos disease.</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 patient was counseled about the genetic nature of the disease; daily use of a topical retinoid was prescribed initially.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Comment</span><p id="par0040" class="elsevierStylePara elsevierViewall">Dowling-Degos disease (DDD) is a rare autosomal dominant genodermatosis, with variable penetrance, that presents a mutation in the KTR5 gene.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> The first signs of the disease usually occur in the third or fourth decades of life.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> It is clinically characterized by follicular hyperpigmentation in flexor areas, such as the neck armpit, antecubital fossa, submammary region, and groin. Pigmentation of the dorsum of the hands may be present when there is an overlap of clinical features of Kitamura's reticulate acropigmentation.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> Additional findings include pitted perioral scars in patients with no prior history of acne, and hyperkeratotic comedo-like papules in the neck and armpits.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Some patients may report related pruritus.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The disease is often associated with other dermatoses such as epidermal cysts, keratoacanthomas, hidradenitis suppurativa, seborrheic keratoses, which can be the main complaint in dermatological consultations.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Histopathology shows moderate hyperkeratosis or orthokeratosis, thinned suprapapillary epithelium, elongation of the papillae with hyperpigmentation of the basal layer. Filiform proliferations of the epidermis usually involve the follicle with a follicular plug. A perivascular lymphohistiocytic infiltrate in the papillary dermis and corneal pseudocysts can also be observed.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Dermatoscopy of the hyperpigmented macules usually reveal a regular arrangement of brownish spots of variable size, characterized by a coarse grid of brown lines on a diffuse, light brown background. Therefore, these findings are not specific and are seen in many other conditions.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">DDD must be differentiated from acanthosis nigricans and Kitamura's reticulate acropigmentation. In acanthosis nigricans, the plaques have a velvet like rather than flattened or minimally lichenified texture, and there are no pitted perioral scars or comedo-like lesions. In Kitamura's reticulate acropigmentation there are reticulate, slightly depressed, pigmented acropigmentation macules on acral areas, especially on the dorsum of the hands and feet; palmar pits or breaks in epidermal ridge pattern.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Treatment has unsatisfactory results in most cases. Topical therapeutic options include retinoids, hydroquinone, corticosteroids and azelaic acid. Treatment with Er:YAG laser or isotretinoin is also described.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflict of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical history" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Histopathology" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Additional tests" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Diagnosis" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Clinical course and treatment" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Comment" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflict of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 505 "Ancho" => 755 "Tamanyo" => 56024 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 505 "Ancho" => 755 "Tamanyo" => 60837 ] ] ] 2 => array:6 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 566 "Ancho" => 755 "Tamanyo" => 86109 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case for diagnosis: Dowling-Degos disease and keratoacanthoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.B. Hohmann" 1 => "B. Köche" 2 => "R.R. Bonamigo" 3 => "S.T. Dornelles" 4 => "C.A.S. Cattani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/s0365-05962010000200020" "Revista" => array:6 [ "tituloSerie" => "An Bras Dermatol" "fecha" => "2010" "volumen" => "85" "paginaInicial" => "241" "paginaFinal" => "243" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20520945" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Doença de Dowling-Degos: apresentação clínica e histopatológica clássica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C.C. Zimmermann" 1 => "D. Sforza" 2 => "P.M. Macedo" 3 => "L. Azulay-Abulafia" 4 => "M.F.G.S. Alves" 5 => "S.C.S. Carneiro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/s0365-05962011000500016" "Revista" => array:6 [ "tituloSerie" => "An Bras Dermatol" "fecha" => "2011" "volumen" => "86" "paginaInicial" => "979" "paginaFinal" => "982" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22147038" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0045" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Generalized Dowling-Degos disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Y.H. Wu" 1 => "Y.C. Lin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2006.12.023" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2007" "volumen" => "57" "paginaInicial" => "327" "paginaFinal" => "334" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17637446" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dowling-Degos disease, hidradenitis suppurativa, and multiple keratoacanthomas. A disorder that may be caused by a single underlying defect in pilosebaceous epithelial proliferation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N.A. Fenske" 1 => "C.E. Groover" 2 => "C.W. Lober" 3 => "C.G. Espinoza" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1991" "volumen" => "24" "paginaInicial" => "888" "paginaFinal" => "892" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2050858" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermoscopy of follicular Dowling-Degos disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Dabas" 1 => "R. Mahajan" 2 => "T.P. Afra" 3 => "D. De" 4 => "S. Handa" 5 => "D. Aggarwal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/ijd.IJD_260_18" "Revista" => array:6 [ "tituloSerie" => "Indian J Dermatol" "fecha" => "2020" "volumen" => "65" "paginaInicial" => "290" "paginaFinal" => "294" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32831370" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dowling-Degos disease (reticulate pigmented anomaly of the flexures): a clinical and histopathologic study of 6 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K. You Chan" 1 => "M.D.P. Davis" 2 => "C.F. Schanbacher" 3 => "D.W.P. 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| 2024 Noviembre | 10 | 7 | 17 |
| 2024 Octubre | 96 | 61 | 157 |
| 2024 Septiembre | 94 | 46 | 140 |
| 2024 Agosto | 118 | 86 | 204 |
| 2024 Julio | 115 | 48 | 163 |
| 2024 Junio | 126 | 47 | 173 |
| 2024 Mayo | 104 | 45 | 149 |
| 2024 Abril | 98 | 34 | 132 |
| 2024 Marzo | 128 | 40 | 168 |
| 2024 Febrero | 108 | 49 | 157 |
| 2024 Enero | 176 | 45 | 221 |
| 2023 Diciembre | 143 | 25 | 168 |
| 2023 Noviembre | 218 | 49 | 267 |
| 2023 Octubre | 237 | 66 | 303 |
| 2023 Septiembre | 101 | 54 | 155 |
| 2023 Agosto | 76 | 44 | 120 |
| 2023 Julio | 90 | 97 | 187 |
| 2023 Junio | 87 | 81 | 168 |
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