Case for Diagnosis
Umbilicated Papules on the Dorsum of Hands
Pápulas umbilicadas en dorso de manos
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Sánchez-Moya, R. Juarez-Tosina, D. García Almagro" "autores" => array:3 [ 0 => array:4 [ "nombre" => "A.I." "apellidos" => "Sánchez-Moya" "email" => array:1 [ 0 => "anai.sanchezmoya@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" => "R." "apellidos" => "Juarez-Tosina" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "D." "apellidos" => "García Almagro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Complejo Hospitalario, Toledo, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Complejo Hospitalario, Toledo, 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" => "Pápulas umbilicadas en dorso de manos" ] ] "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" => 528 "Ancho" => 666 "Tamanyo" => 75376 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of a 35-year-old woman who presented with pruritic lesions on the dorsum of the hands that had appeared 6 months earlier. After she started working as a baker and received small burns, the patient experienced more intense symptoms and the lesions worsened. She reported a lifelong history of anomalous scarring from minor injuries, taking the form of papular and erosive lesions that regressed after 6 weeks. The patient has 2 brothers who have similar symptoms.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Lesions at various stages of development were observed on the dorsum of the hands and the arms (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). These round, skin-colored, and in some cases umbilicated papules measured from 2 to 5 <span class="elsevierStyleHsp" style=""></span>mm in diameter and contained a small central keratotic plug (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The older lesions were macular, light brown, and infiltrated.</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">Thickened collagen bundles were observed in the superficial dermis. These bundles were surrounded by areas of epidermal proliferation where transepidermal elimination of collagen took place through a small central crater containing keratotic material, mixed inflammatory infiltrate, and cellular detritus (<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">The results of a complete blood biochemistry ruled out abnormalities in glucose metabolism and renal insufficiency.</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">Familial reactive perforating collagenosis.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical Course and Treatment</span><p id="par0035" class="elsevierStylePara elsevierViewall">Topical treatment was started with tretinoin 0.1%, in combination with emollients, on the more recent lesions. The patient was strongly advised to avoid injury and scratching. Improvement was seen in 4 weeks, with a reduction in the number of lesions and symptom intensity.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Comment</span><p id="par0040" class="elsevierStylePara elsevierViewall">Familial reactive perforating collagenosis is one of the primary perforating diseases, a group of disorders characterized by keratotic plugs through which dermal connective tissue is eliminated through the epidermis.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">These diseases fall into 3 main categories: elastosis perforans serpiginosa involving the elimination of elastic fibers, acquired perforating dermatosis with adult onset often related to diabetes, renal insufficiency, or toxicoderma,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and, least frequently, familial reactive perforating collagenosis.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Mehregan, Schwartz, and Livingood first described this hereditary disorder in 1967; the etiology is still poorly understood and the pattern of transmission varies.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The condition is rare and only 50 cases have been described.</p><p id="par0055" class="elsevierStylePara elsevierViewall">From infancy, these patients develop skin-colored papules measuring less than 10<span class="elsevierStyleHsp" style=""></span>mm in diameter in response to superficial trauma. These lesions become umbilicated and eventually form a crater with a small central keratotic plug. They are typically found on the extensor aspects of the arms, the dorsum of the hands, and, less frequently, the elbows, knees, and feet. The palms of the hands and the soles of the feet are not affected. The lesions disappear within 2 months, leaving atrophy and hypopigmentation. The isomorphic response is more typical in this disease than in other perforating disorders.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The basic defect is thought to be due to a genetic abnormality that affects the collagen, leading to greater lability after injury. The same abnormality is also associated with an increase in serum and tissue concentrations of fibronectin and favors epithelial migration and proliferation, resulting in the transepidermal elimination of damaged collagen.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Histologic examination reveals deposits of basophilic dermal collagen surrounded by inflammatory cells and areas of epidermal proliferation that eventually give rise to transepidermal elimination through a small central crater containing keratotic material and inflammatory cells. Elastic fibres are not affected.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The differential diagnosis must include inflammatory pathologies (folliculitis, prurigo nodularis, arthropod bites), mucoid material deposits (acral persistent papular mucinosis), and tumors (multiple keratoacanthomas, syringomas, and benign fibrous histiocytomas), in addition to all other perforating diseases.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Several treatments have been described, including emollients, topical corticosteroids, topical retinoic acid, oral isotretinoin, and vitamin A supplements, but the results are varied.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The hereditary forms of reactive perforating collagenosis are usually mild and localized, with no alarming symptoms except in rare circumstances.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of Interest</span><p id="par0080" 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" => "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 "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Sánchez-Moya AI, et al. Pápulas umbilicadas en dorso de manos. Actas Dermosifiliogr.2012;103:435-6.</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" => 528 "Ancho" => 666 "Tamanyo" => 75376 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 563 "Ancho" => 750 "Tamanyo" => 118727 ] ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 470 "Ancho" => 630 "Tamanyo" => 124338 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×40.</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" => "The perforating disoders" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.W. 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Pitha" 5 => "M.A. Everett" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am Jm Dermatopathol" "fecha" => "1998" "volumen" => "20" "paginaInicial" => "147" "paginaFinal" => "154" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Familial reactive perforating collagenosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Y.J. Bhat" 1 => "S. Manzoor" 2 => "S. Qayoom" 3 => "R. Wani" 4 => "A.N. Baba" 5 => "A.H. Bhat" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/0019-5154.57608" "Revista" => array:6 [ "tituloSerie" => "Indian J Dermatol" "fecha" => "2009" "volumen" => "54" "paginaInicial" => "334" "paginaFinal" => "337" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20101333" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010300000005/v1_201304241308/S1578219012001758/v1_201304241308/en/main.assets" "Apartado" => array:4 [ "identificador" => "6171" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Cases for Diagnosis" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010300000005/v1_201304241308/S1578219012001758/v1_201304241308/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012001758?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 24 | 16 | 40 |
| 2024 Octubre | 204 | 50 | 254 |
| 2024 Septiembre | 244 | 29 | 273 |
| 2024 Agosto | 319 | 74 | 393 |
| 2024 Julio | 335 | 43 | 378 |
| 2024 Junio | 293 | 46 | 339 |
| 2024 Mayo | 233 | 58 | 291 |
| 2024 Abril | 173 | 36 | 209 |
| 2024 Marzo | 190 | 31 | 221 |
| 2024 Febrero | 240 | 27 | 267 |
| 2024 Enero | 253 | 33 | 286 |
| 2023 Diciembre | 283 | 32 | 315 |
| 2023 Noviembre | 284 | 32 | 316 |
| 2023 Octubre | 230 | 19 | 249 |
| 2023 Septiembre | 234 | 35 | 269 |
| 2023 Agosto | 182 | 22 | 204 |
| 2023 Julio | 167 | 50 | 217 |
| 2023 Junio | 139 | 27 | 166 |
| 2023 Mayo | 259 | 27 | 286 |
| 2023 Abril | 212 | 21 | 233 |
| 2023 Marzo | 199 | 21 | 220 |
| 2023 Febrero | 173 | 24 | 197 |
| 2023 Enero | 129 | 38 | 167 |
| 2022 Diciembre | 107 | 47 | 154 |
| 2022 Noviembre | 67 | 33 | 100 |
| 2022 Octubre | 87 | 23 | 110 |
| 2022 Septiembre | 83 | 31 | 114 |
| 2022 Agosto | 73 | 40 | 113 |
| 2022 Julio | 82 | 42 | 124 |
| 2022 Junio | 42 | 37 | 79 |
| 2022 Mayo | 142 | 39 | 181 |
| 2022 Abril | 195 | 53 | 248 |
| 2022 Marzo | 188 | 60 | 248 |
| 2022 Febrero | 153 | 40 | 193 |
| 2022 Enero | 260 | 42 | 302 |
| 2021 Diciembre | 161 | 29 | 190 |
| 2021 Noviembre | 147 | 49 | 196 |
| 2021 Octubre | 179 | 54 | 233 |
| 2021 Septiembre | 129 | 54 | 183 |
| 2021 Agosto | 158 | 73 | 231 |
| 2021 Julio | 112 | 49 | 161 |
| 2021 Junio | 93 | 51 | 144 |
| 2021 Mayo | 68 | 41 | 109 |
| 2021 Abril | 255 | 63 | 318 |
| 2021 Marzo | 128 | 36 | 164 |
| 2021 Febrero | 98 | 46 | 144 |
| 2021 Enero | 79 | 40 | 119 |
| 2020 Diciembre | 61 | 23 | 84 |
| 2020 Noviembre | 41 | 28 | 69 |
| 2020 Octubre | 55 | 29 | 84 |
| 2020 Septiembre | 33 | 23 | 56 |
| 2020 Agosto | 37 | 33 | 70 |
| 2020 Julio | 42 | 21 | 63 |
| 2020 Junio | 69 | 34 | 103 |
| 2020 Mayo | 36 | 34 | 70 |
| 2020 Abril | 30 | 35 | 65 |
| 2020 Marzo | 40 | 30 | 70 |
| 2020 Febrero | 3 | 8 | 11 |
| 2020 Enero | 4 | 14 | 18 |
| 2019 Diciembre | 8 | 12 | 20 |
| 2019 Noviembre | 4 | 5 | 9 |
| 2019 Octubre | 0 | 5 | 5 |
| 2019 Septiembre | 10 | 10 | 20 |
| 2019 Agosto | 4 | 13 | 17 |
| 2019 Julio | 4 | 14 | 18 |
| 2019 Junio | 5 | 42 | 47 |
| 2019 Mayo | 4 | 98 | 102 |
| 2019 Abril | 2 | 64 | 66 |
| 2019 Marzo | 2 | 16 | 18 |
| 2019 Febrero | 2 | 17 | 19 |
| 2019 Enero | 2 | 9 | 11 |
| 2018 Diciembre | 2 | 0 | 2 |
| 2018 Noviembre | 3 | 0 | 3 |
| 2018 Octubre | 6 | 0 | 6 |
| 2018 Septiembre | 4 | 12 | 16 |
| 2018 Agosto | 0 | 41 | 41 |
| 2018 Julio | 0 | 22 | 22 |
| 2018 Junio | 0 | 18 | 18 |
| 2018 Mayo | 0 | 29 | 29 |
| 2018 Abril | 0 | 15 | 15 |
| 2018 Marzo | 14 | 30 | 44 |
| 2018 Febrero | 100 | 29 | 129 |
| 2018 Enero | 194 | 29 | 223 |
| 2017 Diciembre | 179 | 31 | 210 |
| 2017 Noviembre | 108 | 28 | 136 |
| 2017 Octubre | 111 | 25 | 136 |
| 2017 Septiembre | 90 | 47 | 137 |
| 2017 Agosto | 126 | 57 | 183 |
| 2017 Julio | 96 | 46 | 142 |
| 2017 Junio | 115 | 51 | 166 |
| 2017 Mayo | 107 | 26 | 133 |
| 2017 Abril | 94 | 51 | 145 |
| 2017 Marzo | 104 | 52 | 156 |
| 2017 Febrero | 79 | 43 | 122 |
| 2017 Enero | 64 | 21 | 85 |
| 2016 Diciembre | 104 | 31 | 135 |
| 2016 Noviembre | 144 | 57 | 201 |
| 2016 Octubre | 150 | 40 | 190 |
| 2016 Septiembre | 216 | 48 | 264 |
| 2016 Agosto | 135 | 30 | 165 |
| 2016 Julio | 101 | 26 | 127 |
| 2016 Junio | 17 | 15 | 32 |
| 2016 Mayo | 9 | 12 | 21 |
| 2016 Abril | 4 | 1 | 5 |
| 2016 Marzo | 7 | 28 | 35 |
| 2016 Febrero | 10 | 31 | 41 |
| 2016 Enero | 6 | 42 | 48 |
| 2015 Diciembre | 10 | 24 | 34 |
| 2015 Noviembre | 35 | 25 | 60 |
| 2015 Octubre | 26 | 28 | 54 |
| 2015 Septiembre | 18 | 10 | 28 |
| 2015 Agosto | 11 | 10 | 21 |
| 2015 Julio | 142 | 16 | 158 |
| 2015 Junio | 102 | 9 | 111 |
| 2015 Mayo | 125 | 17 | 142 |
| 2015 Abril | 117 | 21 | 138 |
| 2015 Marzo | 89 | 15 | 104 |
| 2015 Febrero | 88 | 17 | 105 |
| 2015 Enero | 104 | 18 | 122 |
| 2014 Diciembre | 85 | 10 | 95 |
| 2014 Noviembre | 94 | 11 | 105 |
| 2014 Octubre | 145 | 24 | 169 |
| 2014 Septiembre | 103 | 15 | 118 |
| 2014 Agosto | 133 | 18 | 151 |
| 2014 Julio | 130 | 19 | 149 |
| 2014 Junio | 138 | 20 | 158 |
| 2014 Mayo | 81 | 9 | 90 |
| 2014 Abril | 48 | 4 | 52 |
| 2014 Marzo | 47 | 9 | 56 |
| 2014 Febrero | 60 | 3 | 63 |
| 2014 Enero | 47 | 7 | 54 |
| 2013 Diciembre | 46 | 8 | 54 |
| 2013 Noviembre | 39 | 7 | 46 |
| 2013 Octubre | 39 | 8 | 47 |
| 2013 Septiembre | 33 | 7 | 40 |
| 2013 Agosto | 31 | 14 | 45 |
| 2013 Julio | 27 | 15 | 42 |
| 2013 Junio | 10 | 8 | 18 |
| 2013 Mayo | 14 | 13 | 27 |
| 2013 Abril | 17 | 10 | 27 |
| 2013 Marzo | 17 | 5 | 22 |
| 2013 Febrero | 36 | 9 | 45 |
| 2013 Enero | 61 | 4 | 65 |
| 2012 Diciembre | 16 | 4 | 20 |
| 2012 Noviembre | 1 | 1 | 2 |
| 2012 Octubre | 0 | 1 | 1 |
| 2012 Agosto | 3 | 2 | 5 |
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