Case for Diagnosis
Violaceous Papules on the Dorsum of the Hand
Pápulas violáceas en el dorso de la mano
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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, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario Central de Asturias, Oviedo, 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 violáceas en el dorso de la mano" ] ] "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" => 706 "Ancho" => 951 "Tamanyo" => 124618 ] ] ] ] "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 70-year-old woman with no relevant past history who presented 2 lesions on the dorsum of the right hand that had appeared 6 months earlier. The lesions were asymptomatic and had developed gradually.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed 2 violaceous papules located close together on the dorsum of the right hand and that measured 1<span class="elsevierStyleHsp" style=""></span>cm and 0.5<span class="elsevierStyleHsp" style=""></span>cm in diameter (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The lesions had a smooth surface and firm consistency and were not tender to palpation.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">A punch biopsy was taken from 1 of the lesions. Histology showed a normal epidermis, but in the middle and deep dermis there was a disorganized proliferation of mature eccrine glands and ducts with interspersed mature adipocytes (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). In addition, there were numerous vascular structures with walls of varying thickness that were positive for CD31 on immunohistochemistry (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><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">Eccrine angiomatous hamartoma</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical Course and Treatment</span><p id="par0030" class="elsevierStylePara elsevierViewall">As the lesions showed persistent growth, they were excised.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Comment</span><p id="par0035" class="elsevierStylePara elsevierViewall">Eccrine angiomatous hamartoma (EAH) is a rare benign skin tumor combining eccrine and vascular elements. The first case was described by Lotzbeck in 1859, but the term EAH was later proposed by Hyman in 1968.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">EAH typically appears in early childhood, often in congenital form, and during later stages of childhood or even puberty. While infrequent, there have been reports of onset in adults, as in our patient.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Clinically the lesions are usually single, though multiple lesions are observed, and they typically arise on the limbs (80%), although they have been described on other areas of the body. Morphologically, the lesions may consist of papules, nodules, or plaques that can be erythematous, violaceous, bluish, yellowish, or even skin colored. Although EAH is normally asymptomatic, the 2 most common symptoms are pain (42%) and hyperhidrosis (34%).<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Histopathology of EAH reveals a proliferation of mature eccrine glands in the middle and deep dermis in close association with dilated or collapsed angiomatous channels with thin, clearly differentiated walls. Some histopathologic variants also include pilar structures, apocrine glands, lipomatous foci, lymph vessels, and, rarely, bone.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The clinical differential diagnosis must include vascular malformations, smooth muscle hamartoma, juvenile xanthogranuloma, glomus tumor, tufted angioma, blue rubber bleb nevus syndrome, and macular telangiectatic mastocytosis.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The most relevant disorders in the histologic differential diagnosis are sudoriparous angioma, which involves dilation rather than proliferation of the eccrine glands, and eccrine nevus, in which angiomatous proliferation is absent.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">As EAH is benign and occasionally presents spontaneous involution, it does not require aggressive measures. However, in patients with painful lesions or cosmetic concerns, surgical excision is the only definitive treatment.</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: García-García B, et al. Pápulas violáceas en el dorso de la mano. Actas Dermosifiliogr. 2012;103:825-6.</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" => 706 "Ancho" => 951 "Tamanyo" => 124618 ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 714 "Ancho" => 952 "Tamanyo" => 247411 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×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" => 713 "Ancho" => 952 "Tamanyo" => 175678 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">CD31 immunohistochemical staining, original magnification<span class="elsevierStyleHsp" style=""></span>×10.</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" => "Eccrine angiomatous hamartoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.B. 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Troncoso" 4 => "C. de la Torre" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2010.08.006" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2011" "volumen" => "102" "paginaInicial" => "289" "paginaFinal" => "292" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21453905" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eccrine angiomatous hamartoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.T. Pelle" 1 => "H.B. Pride" 2 => "W.B. Tyler" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2002" "volumen" => "47" "paginaInicial" => "429" "paginaFinal" => "435" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12196755" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eccrine angiomatous hamartoma (nevus): immunohistochemical findings and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R.L. Sulica" 1 => "G.F. Kao" 2 => "V.I. Sulica" 3 => "N.S. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 10 | 9 | 19 |
| 2024 Octubre | 63 | 44 | 107 |
| 2024 Septiembre | 83 | 28 | 111 |
| 2024 Agosto | 85 | 49 | 134 |
| 2024 Julio | 69 | 34 | 103 |
| 2024 Junio | 81 | 36 | 117 |
| 2024 Mayo | 81 | 35 | 116 |
| 2024 Abril | 58 | 21 | 79 |
| 2024 Marzo | 75 | 34 | 109 |
| 2024 Febrero | 52 | 34 | 86 |
| 2024 Enero | 55 | 32 | 87 |
| 2023 Diciembre | 54 | 20 | 74 |
| 2023 Noviembre | 73 | 30 | 103 |
| 2023 Octubre | 63 | 25 | 88 |
| 2023 Septiembre | 61 | 36 | 97 |
| 2023 Agosto | 41 | 18 | 59 |
| 2023 Julio | 41 | 35 | 76 |
| 2023 Junio | 38 | 37 | 75 |
| 2023 Mayo | 61 | 30 | 91 |
| 2023 Abril | 42 | 40 | 82 |
| 2023 Marzo | 48 | 48 | 96 |
| 2023 Febrero | 43 | 28 | 71 |
| 2023 Enero | 53 | 42 | 95 |
| 2022 Diciembre | 45 | 53 | 98 |
| 2022 Noviembre | 25 | 20 | 45 |
| 2022 Octubre | 21 | 29 | 50 |
| 2022 Septiembre | 23 | 30 | 53 |
| 2022 Agosto | 25 | 30 | 55 |
| 2022 Julio | 19 | 31 | 50 |
| 2022 Junio | 16 | 28 | 44 |
| 2022 Mayo | 72 | 38 | 110 |
| 2022 Abril | 48 | 37 | 85 |
| 2022 Marzo | 52 | 50 | 102 |
| 2022 Febrero | 26 | 24 | 50 |
| 2022 Enero | 39 | 41 | 80 |
| 2021 Diciembre | 35 | 49 | 84 |
| 2021 Noviembre | 45 | 43 | 88 |
| 2021 Octubre | 49 | 40 | 89 |
| 2021 Septiembre | 28 | 42 | 70 |
| 2021 Agosto | 32 | 28 | 60 |
| 2021 Julio | 33 | 33 | 66 |
| 2021 Junio | 32 | 27 | 59 |
| 2021 Mayo | 42 | 25 | 67 |
| 2021 Abril | 61 | 53 | 114 |
| 2021 Marzo | 66 | 27 | 93 |
| 2021 Febrero | 49 | 25 | 74 |
| 2021 Enero | 26 | 19 | 45 |
| 2020 Diciembre | 29 | 15 | 44 |
| 2020 Noviembre | 17 | 18 | 35 |
| 2020 Octubre | 25 | 6 | 31 |
| 2020 Septiembre | 21 | 12 | 33 |
| 2020 Agosto | 23 | 17 | 40 |
| 2020 Julio | 34 | 16 | 50 |
| 2020 Junio | 28 | 25 | 53 |
| 2020 Mayo | 22 | 17 | 39 |
| 2020 Abril | 35 | 16 | 51 |
| 2020 Marzo | 26 | 12 | 38 |
| 2020 Febrero | 2 | 1 | 3 |
| 2020 Enero | 4 | 0 | 4 |
| 2019 Diciembre | 8 | 1 | 9 |
| 2019 Noviembre | 4 | 1 | 5 |
| 2019 Octubre | 0 | 1 | 1 |
| 2019 Septiembre | 8 | 6 | 14 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 4 | 6 | 10 |
| 2019 Junio | 5 | 44 | 49 |
| 2019 Mayo | 4 | 20 | 24 |
| 2019 Abril | 2 | 12 | 14 |
| 2019 Marzo | 2 | 7 | 9 |
| 2019 Febrero | 2 | 5 | 7 |
| 2019 Enero | 2 | 1 | 3 |
| 2018 Diciembre | 7 | 3 | 10 |
| 2018 Noviembre | 1 | 2 | 3 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 6 | 0 | 6 |
| 2018 Mayo | 0 | 1 | 1 |
| 2018 Marzo | 14 | 4 | 18 |
| 2018 Febrero | 76 | 4 | 80 |
| 2018 Enero | 56 | 12 | 68 |
| 2017 Diciembre | 69 | 8 | 77 |
| 2017 Noviembre | 44 | 6 | 50 |
| 2017 Octubre | 55 | 6 | 61 |
| 2017 Septiembre | 44 | 12 | 56 |
| 2017 Agosto | 46 | 20 | 66 |
| 2017 Julio | 48 | 10 | 58 |
| 2017 Junio | 53 | 18 | 71 |
| 2017 Mayo | 51 | 12 | 63 |
| 2017 Abril | 55 | 9 | 64 |
| 2017 Marzo | 56 | 43 | 99 |
| 2017 Febrero | 40 | 12 | 52 |
| 2017 Enero | 38 | 11 | 49 |
| 2016 Diciembre | 49 | 8 | 57 |
| 2016 Noviembre | 68 | 9 | 77 |
| 2016 Octubre | 85 | 10 | 95 |
| 2016 Septiembre | 80 | 13 | 93 |
| 2016 Agosto | 74 | 10 | 84 |
| 2016 Julio | 52 | 10 | 62 |
| 2016 Junio | 12 | 16 | 28 |
| 2016 Mayo | 6 | 9 | 15 |
| 2016 Abril | 4 | 1 | 5 |
| 2016 Marzo | 11 | 2 | 13 |
| 2016 Febrero | 10 | 10 | 20 |
| 2016 Enero | 5 | 1 | 6 |
| 2015 Diciembre | 6 | 3 | 9 |
| 2015 Noviembre | 15 | 8 | 23 |
| 2015 Octubre | 11 | 11 | 22 |
| 2015 Septiembre | 7 | 6 | 13 |
| 2015 Agosto | 12 | 1 | 13 |
| 2015 Julio | 77 | 13 | 90 |
| 2015 Junio | 58 | 7 | 65 |
| 2015 Mayo | 88 | 9 | 97 |
| 2015 Abril | 83 | 20 | 103 |
| 2015 Marzo | 65 | 7 | 72 |
| 2015 Febrero | 67 | 11 | 78 |
| 2015 Enero | 58 | 11 | 69 |
| 2014 Diciembre | 55 | 9 | 64 |
| 2014 Noviembre | 51 | 7 | 58 |
| 2014 Octubre | 32 | 4 | 36 |
| 2014 Septiembre | 22 | 2 | 24 |
| 2014 Agosto | 26 | 0 | 26 |
| 2014 Julio | 26 | 1 | 27 |
| 2014 Junio | 32 | 5 | 37 |
| 2014 Mayo | 49 | 2 | 51 |
| 2014 Abril | 24 | 2 | 26 |
| 2014 Marzo | 28 | 10 | 38 |
| 2014 Febrero | 39 | 9 | 48 |
| 2014 Enero | 32 | 6 | 38 |
| 2013 Diciembre | 32 | 7 | 39 |
| 2013 Noviembre | 31 | 8 | 39 |
| 2013 Octubre | 21 | 7 | 28 |
| 2013 Septiembre | 23 | 3 | 26 |
| 2013 Agosto | 21 | 12 | 33 |
| 2013 Julio | 10 | 16 | 26 |
| 2013 Junio | 4 | 8 | 12 |
| 2013 Mayo | 10 | 8 | 18 |
| 2013 Abril | 12 | 8 | 20 |
| 2013 Marzo | 18 | 7 | 25 |
| 2013 Febrero | 25 | 8 | 33 |
| 2013 Enero | 18 | 4 | 22 |
| 2012 Diciembre | 20 | 5 | 25 |
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