Carta científico-clínica[Case and Research Letters]
Reticular Erythematous Mucinosis as Differential Diagnosis of the Apple-Jelly Pattern on Dermoscopy: A Case Report
Mucinosis eritematosa reticular como diagnóstico diferencial del patrón de jalea de manzana en la dermatoscopia: a propósito de un caso
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Note the improvement of the lesions after 6 months of treatment with apremilast 30<span class="elsevierStyleHsp" style=""></span>mg twice a day (C and D).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Mansilla-Polo, C. Abril-Pérez, M.Á. Navarro-Mira, R. Botella-Estrada" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Mansilla-Polo" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Abril-Pérez" ] 2 => array:2 [ "nombre" => "M.Á." "apellidos" => "Navarro-Mira" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Botella-Estrada" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731023004908?idApp=UINPBA000044" "url" => "/00017310/unassign/S0001731023004908/v1_202307180913/en/main.assets" ] "asociados" => array:1 [ 0 => array:17 [ "pii" => "S0001731024000528" "issn" => "00017310" "doi" => "10.1016/j.ad.2023.08.013" "estado" => "S200" "fechaPublicacion" => "2024-03-23" "aid" => "3818" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científico-clínica</span>" "titulo" => "Mucinosis eritematosa reticular como diagnóstico diferencial del patrón de jalea de manzana en la dermatoscopia: a propósito de un caso" "tienePdf" => "es" "tieneTextoCompleto" => "es" "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Reticular Erythematous Mucinosis as Differential Diagnosis of the Apple-Jelly Pattern on Dermoscopy: A Case Report" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 509 "Ancho" => 755 "Tamanyo" => 105465 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histología: tinción de azul alcián que muestra el exceso de mucina en la dermis superior (x100).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.G. Maya Betancourth, M.M. Rojas Cuervo, H. Castellanos Lorduy, F. Gonzalez Gonzalez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "J.G." "apellidos" => "Maya Betancourth" ] 1 => array:2 [ "nombre" => "M.M." "apellidos" => "Rojas Cuervo" ] 2 => array:2 [ "nombre" => "H." "apellidos" => "Castellanos Lorduy" ] 3 => array:2 [ "nombre" => "F." 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"apellidos" => "Maya Betancourth" "email" => array:1 [ 0 => "jumayab@unal.edu.co" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "fn0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M.M." "apellidos" => "Rojas Cuervo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "fn0005" ] ] ] 2 => array:3 [ "nombre" => "H." "apellidos" => "Castellanos Lorduy" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "fn0005" ] ] ] 3 => array:3 [ "nombre" => "F." "apellidos" => "Gonzalez Gonzalez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "fn0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Dermatología, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Mucinosis eritematosa reticular como diagnóstico diferencial del patrón de jalea de manzana en la dermatoscopia: a propósito de un caso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 771 "Ancho" => 755 "Tamanyo" => 58433 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermoscopic findings: lesions with an apple jelly pattern, without a scaling collar.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Reticular erythematous mucinosis (REM) is a rare dermatosis characterized by mucin accumulation in the dermis and is a challenging clinicopathological diagnosis.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Dermoscopy is a non-invasive diagnostic tool that has gained importance in recent years to differentiate dermatoses that may be clinically indistinguishable.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> After an exhaustive search of the current literature, no descriptions of dermoscopic findings or patterns in REM were found.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 58-year-old man, with no relevant past medical history, consulted with a 6-month history of progressively appearing asymptomatic lesions on his chest and upper limbs, with no facial or palmoplantar involvement. He reported having used a high-potency topical corticosteroid for 2 months without improvement. The physical examination revealed multiple indurated, non-follicular erythemato-xanthochromic papules 2-3<span class="elsevierStyleHsp" style=""></span>mm in diameter, which were confluent in annular, arciform, and polycyclic plaques, non-scaling and with an eucrhomic center, and without atrophy, distributed over the trunk, shoulders, arms, and forearms (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Dermoscopy revealed linear blood vessels over translucent globular yellowish areas, with no defined structure or scaling collar consistent with an apple jelly pattern (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">A biopsy was obtained, and histological examination showed a sparse perivascular lymphocytic infiltrate and subtle separation of collagen fibers in the papillary dermis. Alcian blue staining demonstrated excess mucin in the upper dermis (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Clinicopathological findings established the diagnosis of REM. Secondary causes were ruled out, and oral hydroxychloroquine treatment at a dose of 400<span class="elsevierStyleHsp" style=""></span>mg per day was initiated, resulting in lesion resolution after 8 weeks without recurrence.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">REM usually affects older women, with a female-to-male ratio of 2:1.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> REM has been associated with various systemic pathological processes, such as thyroid diseases, lupus, breast, lung, and colon neoplasms, monoclonal gammopathy, and infections such as HIV. Its etiology is not clearly defined.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a> Clinically, it is characterized by the appearance of erythematous macules with a reticular pattern, usually located on the trunk, less frequently on the face or upper and lower limbs. Most patients are asymptomatic.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,5</span></a> Histopathology shows mucin deposits and perivascular and periadnexal lymphocytic infiltrates on the superficial dermis, along with pigment incontinence. Alcian blue staining allows for more accurate identification of mucin deposits in the dermis.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Differential diagnosis of REM includes dermatoses presenting with reticulated papules predominantly on the trunk, such as lupus tumidus, confluent and reticulated papillomatosis of Gougerot-Carteaud, prurigo pigmentosa, disseminated granuloma annulare, papular sarcoidosis, papular mucinosis, and dermatomyositis, among others.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">On dermoscopy, the apple jelly pattern can be seen in various dermatological conditions, including lupus vulgaris, sarcoidosis, and leishmaniasis. This pattern is characterized by a yellowish, granulomatous appearance, reminiscent of apple jelly.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Differentiating REM from lupus tumidus can be challenging both clinically and histologically. In lupus tumidus, dermoscopy shows polymorphic vessels, predominantly linear, on a pink erythematous background, with keratin follicular plugs and yellow-white or orange-red globules.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> Unlike REM, confluent and reticulated papillomatosis of Gougerot-Carteaud shows evident epidermal changes due to the presence of scales.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Dermoscopically, it may show fine whitish scaling and flat, polygonal brown globules separated by whitish streaks, described as a cobblestone pattern.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Prurigo pigmentosa is a rare, chronic, and recurrent condition in which initial dermoscopic lesions show pink ovoid structures with superficial linear and dotted vessels and a yellow ring, which may resemble REM findings. However, as papules evolve, brown pigment granules appear at their center.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> In papular sarcoidosis, translucent orange focal areas with no defined structure and surface blood vessels, representing granulomas, can be seen on dermoscopy. Less frequent findings include follicular plugs, scaling, milia cysts, and hyperpigmentation. Disseminated granuloma annulare shows heterogeneous dermoscopic findings, the most common being polymorphic vessels on a pink or erythematous background, associated with white or yellowish globular areas without structure.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">REM is a rare condition with a challenging diagnosis. Its dermoscopic findings—apple jelly pattern—may aid in the differential diagnosis with other entities that present similarly.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:3 [ "etiqueta" => "1" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">All authors contributed equally to the manuscript.</p>" "identificador" => "fn0005" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 715 "Ancho" => 905 "Tamanyo" => 70530 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical image: erythemato-xanthochromic papules on torso and upper limbs.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 771 "Ancho" => 755 "Tamanyo" => 58433 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermoscopic findings: lesions with an apple jelly pattern, without a scaling collar.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 509 "Ancho" => 755 "Tamanyo" => 105465 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histology: Alcian blue staining showing excess mucin in the upper dermis (x100).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reticular erythematous mucinosis (REM): Case report and review of literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R. 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| año/Mes | Html | Total | |
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| 2024 Noviembre | 20 | 8 | 28 |
| 2024 Octubre | 13 | 26 | 39 |
