Case for Diagnosis
Vesicular and Erosive Lesions on the Scalp
Lesiones vesiculosas y erosivas en el cuero cabelludo
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"apellidos" => "Vivanco-Allende" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario Central de Asturias, Oviedo, Asturias, 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" => "Lesiones vesiculosas y erosivas en el cuero cabelludo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 442 "Ancho" => 666 "Tamanyo" => 57448 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Blistering, erosive lesions on the scalp.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 43-year-old man with androgenetic alopecia consulted for blistering lesions and erosions of 6 months’ duration on the scalp. The lesions were asymptomatic or slightly pruritic and tended to recur, although they never disappeared completely. The only trauma to the area reported by the patient was the use of a safety helmet at work for the previous 5 years.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed vesiculobullous lesions, erosions, and crusting, located mainly in the parietal areas of the scalp. Some of the lesions had left shiny atrophic skin with a scar-like appearance (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). No other skin or mucosal lesions were observed.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">An incisional biopsy was performed on the edge of a blistering lesion. Histopathology showed dermal-epidermal separation and subepidermal blisters containing fibrinoid material, lymphocytes, and eosinophils. In the dermis, there was an area with a scar-like appearance, together with an interstitial inflammatory infiltrate consisting of lymphocytes and a marked presence of eosinophils (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Additional Tests</span><p id="par0020" class="elsevierStylePara elsevierViewall">Direct immunofluorescence of a perilesional biopsy specimen showed strong linear deposition of immunoglobulin (Ig) G, IgA, and C3 and weaker deposition of IgM (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Bacterial and viral cultures of exudate were negative.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><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">Localized cicatricial pemphigoid (Brunsting–Perry variety)</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical Course and Treatment</span><p id="par0035" class="elsevierStylePara elsevierViewall">A complete blood count with erythrocyte sedimentation rate, a full biochemical workup, thyroid stimulating hormone levels, and a protein profile was requested, with normal results in all cases. Antinuclear antibodies, anti-basement membrane autoantibodies, and intercellular substance antibodies were negative.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Topical treatment was initiated with once-daily clobetasol propionate 0.05% and resulted in a clear improvement in the lesions within 2 weeks; satisfactory control was subsequently achieved with the application of clobetasol propionate 0.05% once or twice a week. In a year of follow-up, the patient has not developed any mucosal lesions or skin lesions at other sites.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Comment</span><p id="par0045" class="elsevierStylePara elsevierViewall">Cicatricial pemphigoid, which has also recently been named mucous membrane pemphigoid, constitutes a diverse group of blistering diseases that mainly affect the mucous membranes, although, they can occasionally affect the skin.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The condition is mediated by autoantibodies directed against proteins at the dermal-epidermal junction, resulting in the formation of subepidermal blisters. Localized cicatricial pemphigoid tends to be confined to the head and neck, and skin lesions can precede mucosal lesions by months or even years.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Brunsting–Perry pemphigoid, a variant of this condition described by Brunsting and Perry<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> in 1957, tends to affect men between 40 and 70 years of age and is characterized by blistering lesions and recurrent erosions on the head and neck that leave scars when they clear. Unlike other variants of localized cicatricial pemphigoid, Brunsting–Perry pemphigoid does not tend to affect the mucous membranes. It has been reported to occur following trauma to the affected area.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In our patient, the continued trauma to the scalp caused by the use of a safety helmet for 5 years might have triggered the lesions. Histologically, Brunsting–Perry pemphigoid is characterized by subepidermal blistering and a chronic inflammatory infiltrate rich in eosinophils. In most cases, direct immunofluorescence shows linear IgG and complement deposition, occasionally in association with IgA or IgM deposits. Indirect immunofluorescence tests, on the other hand, tend to be negative, as was the case with our patient.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The differential diagnosis should include erosive pustular dermatosis of the scalp, giant cell arteritis, epidermolysis bullosa acquisita, dermatitis artefacta, and infections.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The treatments of choice for Brunsting-Perry cicatricial pemphigus are intralesional or topical corticosteroids, although dapsone, sulfapyridine, and minocycline have also proven effective. Finally, refractory or extensive disease can be treated with oral corticosteroids or other immunosuppressants.</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" => "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:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">B. García-García, S. Mallo-García, B. Vivanco-Allende. Lesiones vesiculosas y erosivas en el cuero cabelludo. Actas Dermosifiliogr. 2012;103:541-2.</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" => 442 "Ancho" => 666 "Tamanyo" => 57448 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Blistering, erosive lesions on the scalp.</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" => 501 "Ancho" => 665 "Tamanyo" => 167718 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin staining, original magnification ×10.</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" => 756 "Ancho" => 570 "Tamanyo" => 147073 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Immunoglobulin (Ig) A (A) and IgG (B) immunofluorescence.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The first international consensus on mucous membrane pemphigoid: definition, diagnostic criteria, pathogenic factors, medical treatment and prognostic indicators" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.S. Chan" 1 => "A.R. Ahmed" 2 => "G.J. Anhalt" 3 => "W. Bernauer" 4 => "K.D. Cooper" 5 => "M.J. Elder" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2002" "volumen" => "138" "paginaInicial" => "370" "paginaFinal" => "379" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11902988" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Localized cicatricial pemphigoid (Brunsting-Perry): electron microscopic study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "V. Leenutaphong" 1 => "R. Von Kries" 2 => "G. 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Perry" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arch Dermatol" "fecha" => "1957" "volumen" => "75" "paginaInicial" => "489" "paginaFinal" => "501" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Brunsting-Perry cicatricial pemphigoid precipitated by trauma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H. Baldwin" 1 => "Y. Lynfield" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "1991" "volumen" => "127" "paginaInicial" => "911" "paginaFinal" => "912" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2036045" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermatosis pustulosa y erosiva del cuero cabelludo" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Redondo-Mateo" 1 => "M.P. Ortega-Serrano" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2002" "volumen" => "93" "paginaInicial" => "51" "paginaFinal" => "53" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010300000006/v1_201304241313/S1578219012002077/v1_201304241313/en/main.assets" "Apartado" => array:4 [ "identificador" => "6154" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case for Diagnosis" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010300000006/v1_201304241313/S1578219012002077/v1_201304241313/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012002077?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 24 | 9 | 33 |
| 2024 Octubre | 167 | 44 | 211 |
| 2024 Septiembre | 195 | 32 | 227 |
| 2024 Agosto | 213 | 61 | 274 |
| 2024 Julio | 213 | 41 | 254 |
| 2024 Junio | 206 | 31 | 237 |
| 2024 Mayo | 170 | 29 | 199 |
| 2024 Abril | 193 | 30 | 223 |
| 2024 Marzo | 148 | 40 | 188 |
| 2024 Febrero | 138 | 25 | 163 |
| 2024 Enero | 128 | 32 | 160 |
| 2023 Diciembre | 117 | 17 | 134 |
| 2023 Noviembre | 137 | 28 | 165 |
| 2023 Octubre | 130 | 34 | 164 |
| 2023 Septiembre | 103 | 32 | 135 |
| 2023 Agosto | 98 | 24 | 122 |
| 2023 Julio | 145 | 40 | 185 |
| 2023 Junio | 98 | 25 | 123 |
| 2023 Mayo | 101 | 31 | 132 |
| 2023 Abril | 95 | 31 | 126 |
| 2023 Marzo | 73 | 25 | 98 |
| 2023 Febrero | 82 | 26 | 108 |
| 2023 Enero | 71 | 49 | 120 |
| 2022 Diciembre | 68 | 58 | 126 |
| 2022 Noviembre | 33 | 37 | 70 |
| 2022 Octubre | 53 | 42 | 95 |
| 2022 Septiembre | 21 | 38 | 59 |
| 2022 Agosto | 27 | 37 | 64 |
| 2022 Julio | 25 | 38 | 63 |
| 2022 Junio | 22 | 44 | 66 |
| 2022 Mayo | 107 | 49 | 156 |
| 2022 Abril | 103 | 49 | 152 |
| 2022 Marzo | 91 | 43 | 134 |
| 2022 Febrero | 92 | 41 | 133 |
| 2022 Enero | 122 | 41 | 163 |
| 2021 Diciembre | 87 | 59 | 146 |
| 2021 Noviembre | 107 | 51 | 158 |
| 2021 Octubre | 101 | 58 | 159 |
| 2021 Septiembre | 92 | 35 | 127 |
| 2021 Agosto | 103 | 35 | 138 |
| 2021 Julio | 72 | 27 | 99 |
| 2021 Junio | 76 | 34 | 110 |
| 2021 Mayo | 42 | 37 | 79 |
| 2021 Abril | 128 | 73 | 201 |
| 2021 Marzo | 111 | 30 | 141 |
| 2021 Febrero | 75 | 24 | 99 |
| 2021 Enero | 80 | 18 | 98 |
| 2020 Diciembre | 84 | 15 | 99 |
| 2020 Noviembre | 54 | 19 | 73 |
| 2020 Octubre | 57 | 10 | 67 |
| 2020 Septiembre | 58 | 17 | 75 |
| 2020 Agosto | 56 | 17 | 73 |
| 2020 Julio | 54 | 13 | 67 |
| 2020 Junio | 69 | 32 | 101 |
| 2020 Mayo | 46 | 13 | 59 |
| 2020 Abril | 69 | 23 | 92 |
| 2020 Marzo | 55 | 16 | 71 |
| 2020 Febrero | 3 | 1 | 4 |
| 2020 Enero | 8 | 1 | 9 |
| 2019 Diciembre | 10 | 3 | 13 |
| 2019 Noviembre | 8 | 0 | 8 |
| 2019 Octubre | 0 | 1 | 1 |
| 2019 Septiembre | 14 | 1 | 15 |
| 2019 Agosto | 9 | 1 | 10 |
| 2019 Julio | 8 | 12 | 20 |
| 2019 Junio | 8 | 16 | 24 |
| 2019 Mayo | 7 | 2 | 9 |
| 2019 Abril | 4 | 8 | 12 |
| 2019 Marzo | 0 | 14 | 14 |
| 2019 Febrero | 6 | 4 | 10 |
| 2019 Enero | 0 | 1 | 1 |
| 2018 Diciembre | 1 | 4 | 5 |
| 2018 Noviembre | 8 | 2 | 10 |
| 2018 Octubre | 2 | 0 | 2 |
| 2018 Septiembre | 5 | 0 | 5 |
| 2018 Marzo | 4 | 0 | 4 |
| 2018 Febrero | 137 | 10 | 147 |
| 2018 Enero | 82 | 7 | 89 |
| 2017 Diciembre | 152 | 8 | 160 |
| 2017 Noviembre | 67 | 8 | 75 |
| 2017 Octubre | 52 | 3 | 55 |
| 2017 Septiembre | 60 | 11 | 71 |
| 2017 Agosto | 43 | 12 | 55 |
| 2017 Julio | 68 | 10 | 78 |
| 2017 Junio | 70 | 25 | 95 |
| 2017 Mayo | 70 | 6 | 76 |
| 2017 Abril | 66 | 6 | 72 |
| 2017 Marzo | 68 | 29 | 97 |
| 2017 Febrero | 123 | 5 | 128 |
| 2017 Enero | 69 | 6 | 75 |
| 2016 Diciembre | 83 | 5 | 88 |
| 2016 Noviembre | 115 | 10 | 125 |
| 2016 Octubre | 147 | 9 | 156 |
| 2016 Septiembre | 193 | 12 | 205 |
| 2016 Agosto | 89 | 7 | 96 |
| 2016 Julio | 59 | 16 | 75 |
| 2016 Junio | 13 | 11 | 24 |
| 2016 Mayo | 7 | 15 | 22 |
| 2016 Abril | 1 | 10 | 11 |
| 2016 Marzo | 9 | 3 | 12 |
| 2016 Febrero | 8 | 1 | 9 |
| 2016 Enero | 7 | 2 | 9 |
| 2015 Diciembre | 11 | 3 | 14 |
| 2015 Noviembre | 19 | 4 | 23 |
| 2015 Octubre | 19 | 4 | 23 |
| 2015 Septiembre | 3 | 2 | 5 |
| 2015 Agosto | 8 | 4 | 12 |
| 2015 Julio | 134 | 11 | 145 |
| 2015 Junio | 90 | 7 | 97 |
| 2015 Mayo | 136 | 5 | 141 |
| 2015 Abril | 109 | 4 | 113 |
| 2015 Marzo | 106 | 10 | 116 |
| 2015 Febrero | 87 | 7 | 94 |
| 2015 Enero | 114 | 13 | 127 |
| 2014 Diciembre | 100 | 9 | 109 |
| 2014 Noviembre | 76 | 9 | 85 |
| 2014 Octubre | 131 | 16 | 147 |
| 2014 Septiembre | 88 | 10 | 98 |
| 2014 Agosto | 96 | 14 | 110 |
| 2014 Julio | 115 | 21 | 136 |
| 2014 Junio | 41 | 4 | 45 |
| 2014 Mayo | 44 | 7 | 51 |
| 2014 Abril | 43 | 3 | 46 |
| 2014 Marzo | 36 | 9 | 45 |
| 2014 Febrero | 41 | 6 | 47 |
| 2014 Enero | 37 | 11 | 48 |
| 2013 Diciembre | 43 | 8 | 51 |
| 2013 Noviembre | 30 | 11 | 41 |
| 2013 Octubre | 26 | 9 | 35 |
| 2013 Septiembre | 23 | 7 | 30 |
| 2013 Agosto | 26 | 14 | 40 |
| 2013 Julio | 11 | 18 | 29 |
| 2013 Junio | 10 | 26 | 36 |
| 2013 Mayo | 9 | 23 | 32 |
| 2013 Abril | 9 | 8 | 17 |
| 2013 Marzo | 16 | 10 | 26 |
| 2013 Febrero | 36 | 6 | 42 |
| 2013 Enero | 32 | 6 | 38 |
| 2012 Diciembre | 29 | 4 | 33 |
| 2012 Noviembre | 1 | 0 | 1 |
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