Cases for Diagnosis
Multiple Asymptomatic Congenital Plaques on the Back
Múltiples placas asintomáticas congénitas en la espalda
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Rodríguez-Vázquez, M.L. Martínez-Martínez, G. Fernández-Aragón, M. García-Arpa" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Rodríguez-Vázquez" "email" => array:1 [ 0 => "mrodvaz@yahoo.es" ] "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" => "M.L." "apellidos" => "Martínez-Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "G." "apellidos" => "Fernández-Aragón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "M." 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She presented with a raised lesion on her back that caused discomfort when it came into contact with her clothing. This lesion had appeared on 1 of several asymptomatic plaques that had been present on her back since birth and had grown along with the patient.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">The patient's presenting complaint was a brown verrucous lesion clinically suggestive of intradermal melanocytic nevus without atypia. Of greater interest, however, was the presence of multiple well-defined, slightly raised, smooth brown plaques of different sizes that showed no scaling. The plaques were located close together, but without coalescing, on the lower back region and on the right side of the back, stretching as far as the ipsilateral shoulder (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). The patient had no hypopigmented, periungual, or facial skin lesions.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Biopsy of the congenital lesions showed thickened dermal collagen bundles and no epidermal abnormalities. Verhoeff-van Gieson staining revealed elastic fibers that were thinner than those found in normal skin (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The sebaceous glands exhibited no changes.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">What Is Your Diagnosis?</span></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagnosis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Multiple grouped congenital collagenomas on the back.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical Course and Treatment</span><p id="par0030" class="elsevierStylePara elsevierViewall">The patient had no hereditary diseases, no family history of similar lesions, no history of neurocutaneous syndromes, and no skin lesions characteristic of tuberous sclerosis. Because the lesions were asymptomatic, benign, and extensive, no treatment was given.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Comment</span><p id="par0035" class="elsevierStylePara elsevierViewall">Reticular connective tissue nevi are classified according to the component present in unusually large amounts; they are known as collagenomas when there are elevated levels of collagen fiber and as elastomas when there are elevated levels of stromal proteoglycans.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Collagenomas, or collagenous connective tissue nevi, are hamartomatous lesions of the dermis with increased collagen levels. They can be either hereditary or sporadic, and are usually present at birth or appear in early childhood, although acquired forms also exist. They present as firm skin-colored or lightly pigmented papules, nodules, or plaques, and can be solitary, multiple, or even segmental; they can occur on any part of the body.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Several types of collagenoma have been described, including familial cutaneous collagenoma, which follows an autosomal dominant pattern of inheritance, presents as multiple lesions, usually on the trunk during adolescence, and is associated with cardiovascular and systemic disorders.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Eruptive collagenomas are clinically indistinguishable from familial cutaneous collagenomas, except for the fact that family history is negative and onset is abrupt. Plantar cerebriform collagenoma can occur in isolation but is usually associated with Proteus syndrome.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The shagreen patch is a form of collagenoma that usually occurs on the lower back of patients with tuberous sclerosis. Other types of connective tissue nevi include knuckle pads, collagenomas associated with Down syndrome, ichthyosis, multiple fibrofolliculomas, cardiomyopathy, and hypogonadism; there have also been reports of collagenomas in Cowden syndrome<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> (storiform collagenomas), multiple endocrine neoplasia type 1, and Ehlers-Danlos syndrome.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Collagenomas are histologically characterized by the proliferation of connective tissue due to an increase in collagen fibers—especially type I collagen, the most abundant form of collagen in the dermis—and a resulting proportional decrease in elastic fibers.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Although the etiology and pathogenesis of connective tissue nevi are unknown, sporadic collagenomas may be related to trauma, since they appear most frequently in areas subject to friction.</p><p id="par0060" class="elsevierStylePara elsevierViewall">We found no signs or symptoms of neurocutaneous disease in our patient and were thus able to rule out the presence of shagreen patches, which are a manifestation of tuberous sclerosis and a key consideration in the differential diagnosis.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Collagenomas can be treated, purely for cosmetic reasons, with surgery, although some cases have been treated successfully with intralesional corticosteroids.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The literature contains few cases of congenital giant or multiple grouped collagenomas occurring in isolation, rather than in association with another disease.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The clinical cases that have been reported describe a large plaque formed by the coalescence of multiple lesions. Our case is the first reported instance of multiple independent, yet closely grouped, collagenomas covering such a large area of the body.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of Interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 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:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of Interest" ] 7 => 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: Rodríguez-Vázquez M, et al. Múltiples placas asintomáticas congénitas en la espalda. Actas Dermosifiliogr. 2012;103:241–242.</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" => 713 "Ancho" => 475 "Tamanyo" => 45060 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 317 "Ancho" => 476 "Tamanyo" => 36138 ] ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 819 "Ancho" => 700 "Tamanyo" => 151271 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Hematoxylin–eosin, original magnification ×100. B, Verhoeff-van Gieson, original magnification ×100. C, Verhoeff-van Gieson, original magnification ×400.</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" => "Connective tissue nevi of the skin. Clinical, genetic and histopathologic classification of hamartomas of the collagen, elastin and proteoglycan type" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Uitto" 1 => "D.J. Santa-Cruz" 2 => "A.Z. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 12 | 10 | 22 |
| 2024 Octubre | 70 | 40 | 110 |
| 2024 Septiembre | 96 | 35 | 131 |
| 2024 Agosto | 125 | 52 | 177 |
| 2024 Julio | 84 | 26 | 110 |
| 2024 Junio | 106 | 37 | 143 |
| 2024 Mayo | 68 | 34 | 102 |
| 2024 Abril | 82 | 33 | 115 |
| 2024 Marzo | 77 | 29 | 106 |
| 2024 Febrero | 78 | 34 | 112 |
| 2024 Enero | 79 | 27 | 106 |
| 2023 Diciembre | 87 | 18 | 105 |
| 2023 Noviembre | 112 | 26 | 138 |
| 2023 Octubre | 82 | 24 | 106 |
| 2023 Septiembre | 88 | 36 | 124 |
| 2023 Agosto | 76 | 16 | 92 |
| 2023 Julio | 91 | 30 | 121 |
| 2023 Junio | 92 | 26 | 118 |
| 2023 Mayo | 71 | 29 | 100 |
| 2023 Abril | 67 | 16 | 83 |
| 2023 Marzo | 81 | 24 | 105 |
| 2023 Febrero | 52 | 26 | 78 |
| 2023 Enero | 39 | 26 | 65 |
| 2022 Diciembre | 55 | 34 | 89 |
| 2022 Noviembre | 32 | 28 | 60 |
| 2022 Octubre | 29 | 26 | 55 |
| 2022 Septiembre | 42 | 31 | 73 |
| 2022 Agosto | 63 | 30 | 93 |
| 2022 Julio | 24 | 48 | 72 |
| 2022 Junio | 26 | 21 | 47 |
| 2022 Mayo | 56 | 36 | 92 |
| 2022 Abril | 79 | 39 | 118 |
| 2022 Marzo | 47 | 39 | 86 |
| 2022 Febrero | 36 | 27 | 63 |
| 2022 Enero | 60 | 41 | 101 |
| 2021 Diciembre | 30 | 36 | 66 |
| 2021 Noviembre | 53 | 43 | 96 |
| 2021 Octubre | 125 | 48 | 173 |
| 2021 Septiembre | 57 | 35 | 92 |
| 2021 Agosto | 52 | 34 | 86 |
| 2021 Julio | 41 | 33 | 74 |
| 2021 Junio | 22 | 25 | 47 |
| 2021 Mayo | 31 | 45 | 76 |
| 2021 Abril | 61 | 40 | 101 |
| 2021 Marzo | 54 | 32 | 86 |
| 2021 Febrero | 49 | 45 | 94 |
| 2021 Enero | 23 | 20 | 43 |
| 2020 Diciembre | 17 | 19 | 36 |
| 2020 Noviembre | 33 | 19 | 52 |
| 2020 Octubre | 22 | 10 | 32 |
| 2020 Septiembre | 37 | 18 | 55 |
| 2020 Agosto | 27 | 17 | 44 |
| 2020 Julio | 25 | 18 | 43 |
| 2020 Junio | 25 | 26 | 51 |
| 2020 Mayo | 21 | 13 | 34 |
| 2020 Abril | 30 | 21 | 51 |
| 2020 Marzo | 27 | 12 | 39 |
| 2020 Febrero | 3 | 1 | 4 |
| 2020 Enero | 4 | 1 | 5 |
| 2019 Diciembre | 4 | 4 | 8 |
| 2019 Noviembre | 4 | 5 | 9 |
| 2019 Octubre | 0 | 8 | 8 |
| 2019 Septiembre | 0 | 6 | 6 |
| 2019 Agosto | 4 | 7 | 11 |
| 2019 Julio | 4 | 18 | 22 |
| 2019 Junio | 4 | 10 | 14 |
| 2019 Mayo | 5 | 15 | 20 |
| 2019 Abril | 2 | 25 | 27 |
| 2019 Marzo | 2 | 7 | 9 |
| 2019 Febrero | 0 | 10 | 10 |
| 2019 Enero | 2 | 0 | 2 |
| 2018 Diciembre | 2 | 5 | 7 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 2 | 0 | 2 |
| 2018 Marzo | 2 | 0 | 2 |
| 2018 Febrero | 35 | 1 | 36 |
| 2018 Enero | 55 | 7 | 62 |
| 2017 Diciembre | 58 | 7 | 65 |
| 2017 Noviembre | 44 | 6 | 50 |
| 2017 Octubre | 35 | 12 | 47 |
| 2017 Septiembre | 38 | 7 | 45 |
| 2017 Agosto | 48 | 15 | 63 |
| 2017 Julio | 23 | 5 | 28 |
| 2017 Junio | 51 | 28 | 79 |
| 2017 Mayo | 49 | 11 | 60 |
| 2017 Abril | 53 | 11 | 64 |
| 2017 Marzo | 45 | 43 | 88 |
| 2017 Febrero | 125 | 4 | 129 |
| 2017 Enero | 46 | 13 | 59 |
| 2016 Diciembre | 53 | 9 | 62 |
| 2016 Noviembre | 92 | 8 | 100 |
| 2016 Octubre | 107 | 18 | 125 |
| 2016 Septiembre | 199 | 12 | 211 |
| 2016 Agosto | 170 | 7 | 177 |
| 2016 Julio | 48 | 12 | 60 |
| 2016 Junio | 12 | 7 | 19 |
| 2016 Mayo | 7 | 20 | 27 |
| 2016 Abril | 6 | 6 | 12 |
| 2016 Marzo | 5 | 4 | 9 |
| 2016 Febrero | 9 | 3 | 12 |
| 2016 Enero | 10 | 1 | 11 |
| 2015 Diciembre | 15 | 0 | 15 |
| 2015 Noviembre | 35 | 3 | 38 |
| 2015 Octubre | 29 | 0 | 29 |
| 2015 Septiembre | 10 | 2 | 12 |
| 2015 Agosto | 10 | 1 | 11 |
| 2015 Julio | 145 | 6 | 151 |
| 2015 Junio | 72 | 4 | 76 |
| 2015 Mayo | 89 | 12 | 101 |
| 2015 Abril | 68 | 3 | 71 |
| 2015 Marzo | 98 | 9 | 107 |
| 2015 Febrero | 94 | 9 | 103 |
| 2015 Enero | 66 | 8 | 74 |
| 2014 Diciembre | 80 | 9 | 89 |
| 2014 Noviembre | 48 | 7 | 55 |
| 2014 Octubre | 76 | 12 | 88 |
| 2014 Septiembre | 66 | 12 | 78 |
| 2014 Agosto | 99 | 12 | 111 |
| 2014 Julio | 104 | 24 | 128 |
| 2014 Junio | 111 | 12 | 123 |
| 2014 Mayo | 103 | 12 | 115 |
| 2014 Abril | 81 | 15 | 96 |
| 2014 Marzo | 49 | 6 | 55 |
| 2014 Febrero | 43 | 6 | 49 |
| 2014 Enero | 31 | 8 | 39 |
| 2013 Diciembre | 31 | 8 | 39 |
| 2013 Noviembre | 38 | 10 | 48 |
| 2013 Octubre | 29 | 4 | 33 |
| 2013 Septiembre | 33 | 3 | 36 |
| 2013 Agosto | 33 | 10 | 43 |
| 2013 Julio | 33 | 22 | 55 |
| 2013 Junio | 24 | 13 | 37 |
| 2013 Mayo | 15 | 8 | 23 |
| 2013 Abril | 10 | 6 | 16 |
| 2013 Marzo | 21 | 7 | 28 |
| 2013 Febrero | 44 | 5 | 49 |
| 2013 Enero | 41 | 4 | 45 |
| 2012 Diciembre | 25 | 3 | 28 |
| 2012 Agosto | 2 | 0 | 2 |
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