Case for Diagnosis
Asymptomatic Lesion on the Forehead
Lesión asintomática en la región frontal
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He reported no local trauma or use of topical treatments.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">An irregular plaque of normal skin color, measuring 1 x 0.8<span class="elsevierStyleHsp" style=""></span>cm and with a slightly depressed centre was observed; it was formed of small papules following a serpiginous path in the periphery of the lesion. No other lesions of interest were observed on other areas of the body (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">A biopsy taken from the border of the lesion revealed an accumulation of acellular eosinophilic material associated with thick hypereosinophilic elastic fibers in the superficial papillary dermis. There was a moderate inflammatory infiltrate of lymphocytes and plasma cells in the adjacent dermis, with frequent multinucleated giant cells. One area of the overlying epidermis presented a perforation and there was transepidermal elimination of the acellular eosinophilic material associated with small clusters of neutrophils (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Orcein stain was positive only in the areas with abnormal elastic fibers, including some within the stratum corneum. Orcein stain also revealed altered elastic fibers (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">What Is Your Diagnosis?</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagnosis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Elastosis perforans serpiginosa.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical Course and Treatment</span><p id="par0035" class="elsevierStylePara elsevierViewall">Two sessions of cryotherapy were administered at an interval of 6 weeks. Three months after the second session, the skin on the treated area was slightly atrophied and hypopigmented. At 9 months of follow-up there was no recurrence and no new lesions had appeared.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Comment</span><p id="par0040" class="elsevierStylePara elsevierViewall">Elastosis perforans serpiginosa is a rare dermatosis caused by the transepidermal elimination of thickened elastic fibers. It has traditionally been classified into 3 types: idiopathic; secondary to treatment with D-penicillamine; and associated with other disorders such as Down syndrome, Marfan syndrome, osteogenesis imperfecta, Ehlers-Danlos syndrome, acrogeria, morphea, Rothmund-Thomson syndrome, and pseudoxanthoma elasticum.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Some familial cases have also been described, with variable inheritance patterns.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The lesions typically appear in early adulthood, with a male to female ratio of 4 to 1.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Clinically, elastosis perforans serpiginosa consists of the appearance of asymptomatic or slightly pruritic, skin colored or erythematous papules with a central keratin plug; bleeding occurs if the plug is removed. The papules tend to occur in a curvilinear or serpiginous distribution, preferentially on the face, neck, or extremities. The lesions sometimes resolve spontaneously after months or even years, leaving hypopigmented atrophic scars.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Histological features include the presence of abnormal, thickened elastic fibers that are eliminated via transepidermal channels that form grooves in an acanthotic epidermis. A keratin plug can sometimes be observed on the surface, and there many be multinucleated giant cells and a pericanalicular inflammatory infiltrate.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Specific stains for elastic fibers (Verhoeff-Van Gieson or orcein) show the abnormal morphology of these elastic fibers. In penicillamine-induced cases, slight differences can be seen on optical and electron microscopy.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The etiology and pathogenesis of EPS are unknown. It is thought that the abnormal fibers may be identified as foreign bodies, provoking a granulomatous reaction that results in their elimination. The granulomatous reaction around the elastic fibers may play an important role in the pathophysiology of elastosis perforans serpiginosa, as may the keratinocytes that surround the elastotic material and express the elastin receptor (67-kDa). This receptor could be implicated in the interaction of the keratinocytes with the elastin and its subsequent elimination.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The clinical differential diagnosis principally includes granuloma annulare, prurigo nodularis, tinea, annular sarcoidosis, cutaneous calcinosis, and porokeratosis of Mibelli. Histopathologically, EPS must be distinguished from congenital reactive perforating collagenosis—a rare genodermatosis usually of autosomal dominant inheritance that typically occurs in association with renal dysfunction or diabetes mellitus—and the acquired forms (Kyrle disease and perforating folliculitis).</p><p id="par0065" class="elsevierStylePara elsevierViewall">Most forms of treatment are unsatisfactory although good cosmetic results have been achieved with cryotherapy,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> electrocoagulation, tazarotene, imiquimod, subcutaneous hydrocortisone, cellophane tape stripping, bichloroacetic acid, carbon-dioxide laser, and oral isotretinoin.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The interesting feature in this case of elastosis perforans serpiginosa is the unusually late onset and presentation in the form of a single lesion. We believe that further lesions may appear in the future despite the good initial response to cryotherapy.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 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" => "Diagnosis" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Clinical Course and Treatment" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Comment" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Fuentelsaz-del Barrio V, et al. Lesión asintomática en la región frontal. Actas Dermosifiliogr.2011;102:733-734.</p>" ] ] "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" => 601 "Ancho" => 802 "Tamanyo" => 87428 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Asymptomatic lesion on the right frontal region.</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" => 643 "Ancho" => 856 "Tamanyo" => 155165 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification x200.</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" => 889 "Ancho" => 667 "Tamanyo" => 159565 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Orcein, original magnification x200.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Elastosis perforans serpiginosa en una enferma afecta de pseudoxantoma elástico" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.A. Barnadas" 1 => "R. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 14 | 7 | 21 |
| 2024 Octubre | 118 | 52 | 170 |
| 2024 Septiembre | 89 | 28 | 117 |
| 2024 Agosto | 122 | 50 | 172 |
| 2024 Julio | 112 | 36 | 148 |
| 2024 Junio | 95 | 32 | 127 |
| 2024 Mayo | 92 | 33 | 125 |
| 2024 Abril | 74 | 27 | 101 |
| 2024 Marzo | 111 | 30 | 141 |
| 2024 Febrero | 117 | 35 | 152 |
| 2024 Enero | 71 | 33 | 104 |
| 2023 Diciembre | 76 | 14 | 90 |
| 2023 Noviembre | 79 | 28 | 107 |
| 2023 Octubre | 79 | 22 | 101 |
| 2023 Septiembre | 92 | 31 | 123 |
| 2023 Agosto | 65 | 19 | 84 |
| 2023 Julio | 61 | 35 | 96 |
| 2023 Junio | 47 | 31 | 78 |
| 2023 Mayo | 58 | 27 | 85 |
| 2023 Abril | 64 | 24 | 88 |
| 2023 Marzo | 54 | 18 | 72 |
| 2023 Febrero | 58 | 20 | 78 |
| 2023 Enero | 45 | 38 | 83 |
| 2022 Diciembre | 38 | 39 | 77 |
| 2022 Noviembre | 28 | 22 | 50 |
| 2022 Octubre | 29 | 31 | 60 |
| 2022 Septiembre | 27 | 46 | 73 |
| 2022 Agosto | 26 | 34 | 60 |
| 2022 Julio | 31 | 40 | 71 |
| 2022 Junio | 36 | 27 | 63 |
| 2022 Mayo | 43 | 36 | 79 |
| 2022 Abril | 58 | 51 | 109 |
| 2022 Marzo | 52 | 63 | 115 |
| 2022 Febrero | 32 | 34 | 66 |
| 2022 Enero | 35 | 36 | 71 |
| 2021 Diciembre | 30 | 47 | 77 |
| 2021 Noviembre | 38 | 35 | 73 |
| 2021 Octubre | 35 | 48 | 83 |
| 2021 Septiembre | 35 | 36 | 71 |
| 2021 Agosto | 30 | 29 | 59 |
| 2021 Julio | 38 | 27 | 65 |
| 2021 Junio | 39 | 34 | 73 |
| 2021 Mayo | 34 | 41 | 75 |
| 2021 Abril | 58 | 44 | 102 |
| 2021 Marzo | 77 | 32 | 109 |
| 2021 Febrero | 53 | 30 | 83 |
| 2021 Enero | 45 | 21 | 66 |
| 2020 Diciembre | 39 | 18 | 57 |
| 2020 Noviembre | 24 | 15 | 39 |
| 2020 Octubre | 21 | 17 | 38 |
| 2020 Septiembre | 36 | 11 | 47 |
| 2020 Agosto | 39 | 21 | 60 |
| 2020 Julio | 25 | 17 | 42 |
| 2020 Junio | 32 | 23 | 55 |
| 2020 Mayo | 32 | 18 | 50 |
| 2020 Abril | 26 | 19 | 45 |
| 2020 Marzo | 36 | 20 | 56 |
| 2020 Febrero | 6 | 0 | 6 |
| 2020 Enero | 0 | 2 | 2 |
| 2019 Diciembre | 4 | 0 | 4 |
| 2019 Septiembre | 6 | 0 | 6 |
| 2019 Julio | 0 | 1 | 1 |
| 2019 Mayo | 2 | 6 | 8 |
| 2019 Abril | 0 | 4 | 4 |
| 2019 Marzo | 0 | 7 | 7 |
| 2019 Febrero | 2 | 0 | 2 |
| 2018 Diciembre | 1 | 0 | 1 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Octubre | 2 | 0 | 2 |
| 2018 Septiembre | 1 | 0 | 1 |
| 2018 Marzo | 1 | 0 | 1 |
| 2018 Febrero | 63 | 3 | 66 |
| 2018 Enero | 91 | 7 | 98 |
| 2017 Diciembre | 74 | 7 | 81 |
| 2017 Noviembre | 70 | 4 | 74 |
| 2017 Octubre | 48 | 4 | 52 |
| 2017 Septiembre | 85 | 5 | 90 |
| 2017 Agosto | 89 | 10 | 99 |
| 2017 Julio | 72 | 3 | 75 |
| 2017 Junio | 97 | 9 | 106 |
| 2017 Mayo | 106 | 7 | 113 |
| 2017 Abril | 88 | 8 | 96 |
| 2017 Marzo | 92 | 7 | 99 |
| 2017 Febrero | 54 | 6 | 60 |
| 2017 Enero | 37 | 9 | 46 |
| 2016 Diciembre | 67 | 10 | 77 |
| 2016 Noviembre | 79 | 15 | 94 |
| 2016 Octubre | 115 | 11 | 126 |
| 2016 Septiembre | 174 | 9 | 183 |
| 2016 Agosto | 84 | 13 | 97 |
| 2016 Julio | 62 | 8 | 70 |
| 2016 Junio | 15 | 14 | 29 |
| 2016 Mayo | 8 | 11 | 19 |
| 2016 Abril | 4 | 17 | 21 |
| 2016 Marzo | 9 | 14 | 23 |
| 2016 Febrero | 9 | 15 | 24 |
| 2016 Enero | 5 | 16 | 21 |
| 2015 Diciembre | 8 | 2 | 10 |
| 2015 Noviembre | 16 | 1 | 17 |
| 2015 Octubre | 22 | 8 | 30 |
| 2015 Septiembre | 10 | 8 | 18 |
| 2015 Agosto | 10 | 3 | 13 |
| 2015 Julio | 83 | 4 | 87 |
| 2015 Junio | 54 | 6 | 60 |
| 2015 Mayo | 60 | 14 | 74 |
| 2015 Abril | 66 | 23 | 89 |
| 2015 Marzo | 39 | 10 | 49 |
| 2015 Febrero | 31 | 6 | 37 |
| 2015 Enero | 35 | 13 | 48 |
| 2014 Diciembre | 42 | 19 | 61 |
| 2014 Noviembre | 30 | 18 | 48 |
| 2014 Octubre | 40 | 19 | 59 |
| 2014 Septiembre | 36 | 13 | 49 |
| 2014 Agosto | 41 | 16 | 57 |
| 2014 Julio | 55 | 18 | 73 |
| 2014 Junio | 59 | 16 | 75 |
| 2014 Mayo | 74 | 19 | 93 |
| 2014 Abril | 56 | 10 | 66 |
| 2014 Marzo | 75 | 11 | 86 |
| 2014 Febrero | 60 | 12 | 72 |
| 2014 Enero | 61 | 13 | 74 |
| 2013 Diciembre | 47 | 10 | 57 |
| 2013 Noviembre | 35 | 15 | 50 |
| 2013 Octubre | 13 | 4 | 17 |
| 2013 Septiembre | 14 | 6 | 20 |
| 2013 Agosto | 8 | 7 | 15 |
| 2013 Julio | 7 | 9 | 16 |
| 2013 Junio | 15 | 2 | 17 |
| 2013 Mayo | 15 | 3 | 18 |
| 2013 Abril | 15 | 6 | 21 |
| 2013 Marzo | 23 | 6 | 29 |
| 2013 Febrero | 27 | 7 | 34 |
| 2013 Enero | 35 | 5 | 40 |
| 2012 Diciembre | 14 | 4 | 18 |
| 2012 Agosto | 1 | 0 | 1 |
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