Cases for Diagnosis
Generalized Eruption in a Child
Erupción generalizada en una niña
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Martí, C. Monteagudo, V. Alonso" "autores" => array:3 [ 0 => array:4 [ "nombre" => "N." "apellidos" => "Martí" "email" => array:1 [ 0 => "nuriamarfa@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "C." "apellidos" => "Monteagudo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "V." "apellidos" => "Alonso" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Nisa 9 de Octubre, Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario Clínico de Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Erupción generalizada en una niña" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1175 "Ancho" => 1192 "Tamanyo" => 62377 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 9-year-old girl with a history of obesity came to our clinic for evaluation of pruritic skin lesions that had appeared over 3 months earlier on the trunk and limbs. She had not received any pharmacological treatments or vaccinations and no infections or family history of skin diseases were reported.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">We observed flat, pink polygonal papules and plaques with fine superficial scaling in the form of whitish lines. These lesions affected the ankles, upper limbs, trunk (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), and palms and soles (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). In addition, the fingernails showed longitudinal ridges and some of them showed fraying of the distal edges. There was no involvement of the scalp or mucous membranes. A Koebner phenomenon was observed on scratched skin.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Histology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Histology revealed acanthosis, hypergranulosis, and lichenoid infiltrate with marked damage to basal keratinocytes (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Additional Tests</span><p id="par0020" class="elsevierStylePara elsevierViewall">Laboratory tests (routine blood and urine tests, biochemistry, and hepatitis serology) revealed no pathological findings.</p><p id="par0025" class="elsevierStylePara elsevierViewall">What is your diagnosis?</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagnosis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Childhood lichen planus.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical Course and Treatment</span><p id="par0035" class="elsevierStylePara elsevierViewall">The patient was treated with oral antihistamines and medium-potency topical corticosteroids for 2 weeks and subsequently with a 0.1% tacrolimus ointment. In 2 months she achieved complete remission.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Comment</span><p id="par0040" class="elsevierStylePara elsevierViewall">Lichen planus, first described by Wilson in 1869,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> is a chronic inflammatory dermatosis that affects the skin, mucous membranes, and skin appendages and is more common in adults. Cases of this disease in children account for 1–4% of the total, although the incidence appears to be higher in darkly pigmented races. Lichen planus affects men and women equally and is extremely rare in children under 4 years of age. In the literature there are very few reports of childhood lichen planus with involvement of palms and soles.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The typical presentation of lichen planus is as small, flat, violaceous polygonal papules that cause severe itching. The lesions appear as a symmetrical eruption that may be generalized or affect a few areas. They are located mainly on the anterior face of the wrists, the backs of the hands, the lumbar region, and the pretibial area, with exceptional involvement of the face, scalp, and palms and soles. In children the lesions are frequently eruptive and involvement of the trunk is more frequent than in adults.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Cases of lichen planus occurring after hepatitis B vaccination have been reported. In these cases the lesions usually appear a median of 40 days after vaccination. They tend to start on the limbs and cases with a bullous component are not infrequent.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The duration of the disease varies from a few weeks to several years. Although lichen planus is usually a skin disease without other systemic involvement, it can sometimes be associated with autoimmune diseases and chronic hepatitis, especially hepatitis C virus in some areas where it has a high prevalence, such as Spain, Italy, and France.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Involvement of palms and soles, which is uncommon in adults,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> is even more uncommon in children.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–6</span></a> Recently, Handa and Sahoo<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> found 2 cases (2.3%) of lichen planus with involvement of palms and soles in their study of 87 children with lichen planus. On the palms and soles the lesions do not have the typical clinical presentation of lichen planus, so diagnosis is difficult. Furthermore, Wickham striae are not observed, probably because of the greater thickness of the stratum corneum. However, the histopathologic characteristics are similar to those of other locations.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of Interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts 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" => "Histology" ] 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" => "Conflicts of Interest" ] 8 => 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: Martí N, et al. Erupción generalizada en una niña. Actas Dermosifiliogr. 2012;103:153–6.</p>" ] ] "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" => 1175 "Ancho" => 1192 "Tamanyo" => 62377 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 903 "Ancho" => 1337 "Tamanyo" => 90899 ] ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1188 "Ancho" => 1582 "Tamanyo" => 323593 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×20.</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" => "On lichen planus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "E. 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Alsaleh" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Pediatr Dermatol" "fecha" => "2001" "volumen" => "18" "paginaInicial" => "1" "paginaFinal" => "4" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11583021" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Childhood lichen planus: a study of 87 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Handa" 1 => "B. Sahoo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Int J Dermatol" "fecha" => "2002" "volumen" => "41" "paginaInicial" => "423" "paginaFinal" => "427" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12121559" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0016510708028435" "estado" => "S300" "issn" => "00165107" ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lichen planus in 24 children with review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P. Luis-Montoya" 1 => "L. Dominguez-Soto" 2 => "E. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 1 | 3 | 4 |
| 2024 Octubre | 90 | 34 | 124 |
| 2024 Septiembre | 78 | 18 | 96 |
| 2024 Agosto | 119 | 65 | 184 |
| 2024 Julio | 98 | 38 | 136 |
| 2024 Junio | 85 | 38 | 123 |
| 2024 Mayo | 61 | 33 | 94 |
| 2024 Abril | 88 | 29 | 117 |
| 2024 Marzo | 79 | 22 | 101 |
| 2024 Febrero | 57 | 29 | 86 |
| 2024 Enero | 53 | 38 | 91 |
| 2023 Diciembre | 62 | 17 | 79 |
| 2023 Noviembre | 65 | 31 | 96 |
| 2023 Octubre | 47 | 20 | 67 |
| 2023 Septiembre | 54 | 35 | 89 |
| 2023 Agosto | 25 | 25 | 50 |
| 2023 Julio | 32 | 43 | 75 |
| 2023 Junio | 46 | 18 | 64 |
| 2023 Mayo | 36 | 31 | 67 |
| 2023 Abril | 36 | 13 | 49 |
| 2023 Marzo | 38 | 27 | 65 |
| 2023 Febrero | 40 | 22 | 62 |
| 2023 Enero | 27 | 23 | 50 |
| 2022 Diciembre | 51 | 47 | 98 |
| 2022 Noviembre | 55 | 39 | 94 |
| 2022 Octubre | 25 | 18 | 43 |
| 2022 Septiembre | 19 | 28 | 47 |
| 2022 Agosto | 22 | 21 | 43 |
| 2022 Julio | 23 | 30 | 53 |
| 2022 Junio | 20 | 26 | 46 |
| 2022 Mayo | 46 | 29 | 75 |
| 2022 Abril | 46 | 31 | 77 |
| 2022 Marzo | 57 | 53 | 110 |
| 2022 Febrero | 57 | 30 | 87 |
| 2022 Enero | 34 | 34 | 68 |
| 2021 Diciembre | 29 | 40 | 69 |
| 2021 Noviembre | 33 | 45 | 78 |
| 2021 Octubre | 29 | 53 | 82 |
| 2021 Septiembre | 25 | 42 | 67 |
| 2021 Agosto | 22 | 40 | 62 |
| 2021 Julio | 27 | 25 | 52 |
| 2021 Junio | 33 | 23 | 56 |
| 2021 Mayo | 31 | 47 | 78 |
| 2021 Abril | 69 | 71 | 140 |
| 2021 Marzo | 55 | 23 | 78 |
| 2021 Febrero | 55 | 13 | 68 |
| 2021 Enero | 28 | 13 | 41 |
| 2020 Diciembre | 10 | 17 | 27 |
| 2020 Noviembre | 22 | 15 | 37 |
| 2020 Octubre | 24 | 8 | 32 |
| 2020 Septiembre | 29 | 11 | 40 |
| 2020 Agosto | 21 | 16 | 37 |
| 2020 Julio | 14 | 20 | 34 |
| 2020 Junio | 30 | 24 | 54 |
| 2020 Mayo | 24 | 21 | 45 |
| 2020 Abril | 18 | 18 | 36 |
| 2020 Marzo | 25 | 16 | 41 |
| 2020 Febrero | 8 | 0 | 8 |
| 2019 Diciembre | 0 | 2 | 2 |
| 2019 Noviembre | 0 | 2 | 2 |
| 2019 Septiembre | 2 | 0 | 2 |
| 2019 Julio | 0 | 1 | 1 |
| 2019 Junio | 0 | 15 | 15 |
| 2019 Mayo | 1 | 32 | 33 |
| 2019 Abril | 1 | 9 | 10 |
| 2019 Marzo | 0 | 7 | 7 |
| 2019 Enero | 0 | 4 | 4 |
| 2018 Diciembre | 1 | 0 | 1 |
| 2018 Octubre | 2 | 0 | 2 |
| 2018 Septiembre | 2 | 0 | 2 |
| 2018 Febrero | 25 | 3 | 28 |
| 2018 Enero | 42 | 6 | 48 |
| 2017 Diciembre | 43 | 9 | 52 |
| 2017 Noviembre | 25 | 4 | 29 |
| 2017 Octubre | 31 | 7 | 38 |
| 2017 Septiembre | 21 | 4 | 25 |
| 2017 Agosto | 30 | 14 | 44 |
| 2017 Julio | 37 | 15 | 52 |
| 2017 Junio | 36 | 11 | 47 |
| 2017 Mayo | 27 | 9 | 36 |
| 2017 Abril | 31 | 11 | 42 |
| 2017 Marzo | 33 | 7 | 40 |
| 2017 Febrero | 25 | 8 | 33 |
| 2017 Enero | 22 | 6 | 28 |
| 2016 Diciembre | 47 | 4 | 51 |
| 2016 Noviembre | 45 | 14 | 59 |
| 2016 Octubre | 64 | 25 | 89 |
| 2016 Septiembre | 53 | 4 | 57 |
| 2016 Agosto | 39 | 5 | 44 |
| 2016 Julio | 29 | 10 | 39 |
| 2016 Junio | 11 | 12 | 23 |
| 2016 Mayo | 6 | 8 | 14 |
| 2016 Abril | 5 | 32 | 37 |
| 2016 Marzo | 6 | 7 | 13 |
| 2016 Febrero | 8 | 8 | 16 |
| 2016 Enero | 11 | 10 | 21 |
| 2015 Diciembre | 8 | 7 | 15 |
| 2015 Noviembre | 16 | 10 | 26 |
| 2015 Octubre | 14 | 11 | 25 |
| 2015 Septiembre | 10 | 9 | 19 |
| 2015 Agosto | 12 | 5 | 17 |
| 2015 Julio | 40 | 5 | 45 |
| 2015 Junio | 35 | 12 | 47 |
| 2015 Mayo | 62 | 11 | 73 |
| 2015 Abril | 48 | 10 | 58 |
| 2015 Marzo | 55 | 8 | 63 |
| 2015 Febrero | 40 | 5 | 45 |
| 2015 Enero | 31 | 8 | 39 |
| 2014 Diciembre | 42 | 12 | 54 |
| 2014 Noviembre | 30 | 7 | 37 |
| 2014 Octubre | 50 | 13 | 63 |
| 2014 Septiembre | 27 | 8 | 35 |
| 2014 Agosto | 52 | 10 | 62 |
| 2014 Julio | 54 | 14 | 68 |
| 2014 Junio | 83 | 9 | 92 |
| 2014 Mayo | 91 | 12 | 103 |
| 2014 Abril | 50 | 8 | 58 |
| 2014 Marzo | 74 | 14 | 88 |
| 2014 Febrero | 26 | 5 | 31 |
| 2014 Enero | 33 | 1 | 34 |
| 2013 Diciembre | 39 | 4 | 43 |
| 2013 Noviembre | 22 | 4 | 26 |
| 2013 Octubre | 13 | 5 | 18 |
| 2013 Septiembre | 15 | 5 | 20 |
| 2013 Agosto | 10 | 5 | 15 |
| 2013 Julio | 13 | 9 | 22 |
| 2013 Junio | 15 | 2 | 17 |
| 2013 Mayo | 11 | 5 | 16 |
| 2013 Abril | 16 | 8 | 24 |
| 2013 Marzo | 16 | 4 | 20 |
| 2013 Febrero | 40 | 9 | 49 |
| 2013 Enero | 16 | 3 | 19 |
| 2012 Diciembre | 9 | 5 | 14 |
| 2012 Noviembre | 1 | 1 | 2 |
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