Case for Diagnosis
Cobblestone Papules on the Neck
Pápulas en empedrado en el cuello
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The lesions had gradually appeared on the back of the neck and were asymptomatic.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed multiple whitish papules measuring 3 mm in diameter and with a rubbery consistency; the follicular openings were spared and showed no mucinous material when pressed. The papules appeared in clusters on the back of the neck (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), with occasional papules in the right axilla.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">No other areas of the body were affected.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Additional Tests</span><p id="par0020" class="elsevierStylePara elsevierViewall">Dermoscopy revealed well-delimited, homogenous, whitish papules with some dotted vessels at the periphery.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A 4-mm punch biopsy taken from a lesion on the neck showed slightly thickened collagen fibers in the mid dermis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). No calcium deposits were observed and staining of the elastic fibers revealed no abnormality.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">What Is Your Diagnosis?</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagnosis</span><p id="par0035" class="elsevierStylePara elsevierViewall">Fibroelastolytic papulosis of the neck.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Treatment</span><p id="par0040" class="elsevierStylePara elsevierViewall">Given the benign nature of the lesions and the fact that they were asymptomatic, it was decided to adopt a conservative approach and no treatment was given.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Comment</span><p id="par0045" class="elsevierStylePara elsevierViewall">In 1989 Shimizu et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> described white fibrous papulosis of the neck. Clinically this entity was characterized by isolated, asymptomatic whitish papules, mainly located on the back and side of the neck, although they were occasionally found on the shoulders and axillae. Histologically, white fibrous papulosis was classified under collagen disorders, given that the lesions were composed of circumscribed collagen bundles in the papillary and upper reticular dermis.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Rongioletti and Rebora<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> later reported another very similar entity, which they named pseudoxanthoma elasticum-like papillary dermal elastolysis, in which they observed yellowish papules resembling those of white fibrous papulosis. In this case, however, the papules showed a tendency to coalesce, giving rise to cobblestone-like plaques suggestive of pseudoxanthoma elasticum (PXE). Histologically the lesions were mainly characterized by elastolysis, with no calcium deposits or fibrosis, and were categorized as elastic fiber abnormalities.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Balus et al.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> subsequently discovered common clinical and histologic findings when reviewing cases reported for both entities alongside 20 of their own. They concluded that there were 2 variants of a single condition that they named fibroelastolytic papulosis of the neck.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The exact cause of fibroelastolytic papulosis of the neck is unknown, although most authors have related it to the skin aging process. Recently cases have also been reported in younger patients with a history of inflammatory diseases in the same area. This suggests that factors other than aging, such as the inflammation of skin adnexa,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> can exert an influence on the subsequent appearance of fibrosis and elastolysis.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Diagnosis is based on clinical presentation, histologic findings, and, more recently, dermoscopy, which shows well-delimited, whitish papules with some dotted vessels at the periphery, as well as pigment that fails to form a true reticulated area.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The case reported here is more compatible with what was originally known as white fibrous papulosis of the neck. This definitive diagnosis was established from the clinical presentation and dermoscopy, but particularly after the exclusion of other entities, such as PXE, on pathology study of the biopsy.</p><p id="par0075" class="elsevierStylePara elsevierViewall">In conclusion, knowledge of fibroelastolytic papulosis of the neck is important as it bears a strong clinical resemblance to PXE. Unlike PXE, however, prognosis is good and not associated with heart or ophthalmological disease.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:3 [ "identificador" => "sec0015" "titulo" => "Additional Tests" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Diagnosis" ] ] ] 3 => array:2 [ "identificador" => "sec0025" "titulo" => "Treatment" ] 4 => array:2 [ "identificador" => "sec0030" "titulo" => "Comment" ] 5 => 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: Echeverría-García B, et al. Pápulas en empedrado en el cuello. Actas Dermosifiliogr. 2013;104:247–8.</p>" ] ] "multimedia" => array:2 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 595 "Ancho" => 900 "Tamanyo" => 87545 ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1198 "Ancho" => 900 "Tamanyo" => 264899 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×10.</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" => "White fibrous papulosis of the neck: a new clinicopathologic entity?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H. Shimizu" 1 => "S. Kimura" 2 => "T. Harada" 3 => "T. Nishikawa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1989" "volumen" => "20" "paginaInicial" => "1073" "paginaFinal" => "1077" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2666457" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pseudoxanthoma elasticum-like papillary dermal elastolysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F. Rongioletti" 1 => "A. Rebora" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1992" "volumen" => "26" "paginaInicial" => "648" "paginaFinal" => "650" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1597557" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fibroelastolytic papulosis of the neck: a report of 20 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L. Balus" 1 => "A. Amantea" 2 => "P. Donati" 3 => "M. Fazio" 4 => "M.C. Giuliano" 5 => "M. Bellocci" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Br J Dermatol" "fecha" => "1997" "volumen" => "137" "paginaInicial" => "461" "paginaFinal" => "466" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9349351" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0002939410009487" "estado" => "S300" "issn" => "00029394" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of fibroelastolytic papulosis on the neck of a young man" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y.C. Song" 1 => "B.H. Oh" 2 => "J.H. Ko" 3 => "J.Y. Kim" 4 => "Y.J. Hwang" 5 => "Y.W. 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Saida" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archdermatol.2009.368" "Revista" => array:5 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2010" "volumen" => "146" "paginaInicial" => "220" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20157048" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010400000003/v1_201304241622/S1578219013000401/v1_201304241622/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/15782190/0000010400000003/v1_201304241622/S1578219013000401/v1_201304241622/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013000401?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 14 | 14 | 28 |
| 2024 Octubre | 93 | 42 | 135 |
| 2024 Septiembre | 94 | 32 | 126 |
| 2024 Agosto | 131 | 57 | 188 |
| 2024 Julio | 118 | 39 | 157 |
| 2024 Junio | 104 | 36 | 140 |
| 2024 Mayo | 84 | 29 | 113 |
| 2024 Abril | 80 | 25 | 105 |
| 2024 Marzo | 99 | 38 | 137 |
| 2024 Febrero | 80 | 29 | 109 |
| 2024 Enero | 78 | 37 | 115 |
| 2023 Diciembre | 73 | 25 | 98 |
| 2023 Noviembre | 71 | 24 | 95 |
| 2023 Octubre | 79 | 35 | 114 |
| 2023 Septiembre | 98 | 37 | 135 |
| 2023 Agosto | 65 | 13 | 78 |
| 2023 Julio | 89 | 35 | 124 |
| 2023 Junio | 102 | 30 | 132 |
| 2023 Mayo | 136 | 28 | 164 |
| 2023 Abril | 95 | 26 | 121 |
| 2023 Marzo | 69 | 27 | 96 |
| 2023 Febrero | 63 | 31 | 94 |
| 2023 Enero | 50 | 41 | 91 |
| 2022 Diciembre | 55 | 52 | 107 |
| 2022 Noviembre | 24 | 35 | 59 |
| 2022 Octubre | 41 | 29 | 70 |
| 2022 Septiembre | 34 | 41 | 75 |
| 2022 Agosto | 29 | 32 | 61 |
| 2022 Julio | 28 | 31 | 59 |
| 2022 Junio | 30 | 25 | 55 |
| 2022 Mayo | 46 | 45 | 91 |
| 2022 Abril | 63 | 40 | 103 |
| 2022 Marzo | 65 | 58 | 123 |
| 2022 Febrero | 48 | 28 | 76 |
| 2022 Enero | 62 | 42 | 104 |
| 2021 Diciembre | 38 | 42 | 80 |
| 2021 Noviembre | 53 | 34 | 87 |
| 2021 Octubre | 60 | 55 | 115 |
| 2021 Septiembre | 47 | 50 | 97 |
| 2021 Agosto | 46 | 30 | 76 |
| 2021 Julio | 60 | 37 | 97 |
| 2021 Junio | 77 | 33 | 110 |
| 2021 Mayo | 64 | 43 | 107 |
| 2021 Abril | 98 | 77 | 175 |
| 2021 Marzo | 73 | 44 | 117 |
| 2021 Febrero | 76 | 32 | 108 |
| 2021 Enero | 58 | 31 | 89 |
| 2020 Diciembre | 54 | 14 | 68 |
| 2020 Noviembre | 32 | 16 | 48 |
| 2020 Octubre | 33 | 9 | 42 |
| 2020 Septiembre | 38 | 16 | 54 |
| 2020 Agosto | 33 | 17 | 50 |
| 2020 Julio | 33 | 11 | 44 |
| 2020 Junio | 38 | 17 | 55 |
| 2020 Mayo | 28 | 17 | 45 |
| 2020 Abril | 31 | 13 | 44 |
| 2020 Marzo | 48 | 20 | 68 |
| 2020 Febrero | 2 | 0 | 2 |
| 2020 Enero | 6 | 1 | 7 |
| 2019 Diciembre | 8 | 5 | 13 |
| 2019 Noviembre | 8 | 0 | 8 |
| 2019 Septiembre | 6 | 2 | 8 |
| 2019 Agosto | 8 | 0 | 8 |
| 2019 Julio | 8 | 2 | 10 |
| 2019 Junio | 8 | 5 | 13 |
| 2019 Mayo | 10 | 21 | 31 |
| 2019 Abril | 5 | 4 | 9 |
| 2019 Marzo | 5 | 6 | 11 |
| 2019 Febrero | 0 | 1 | 1 |
| 2019 Enero | 3 | 0 | 3 |
| 2018 Diciembre | 4 | 0 | 4 |
| 2018 Noviembre | 3 | 0 | 3 |
| 2018 Octubre | 4 | 0 | 4 |
| 2018 Septiembre | 6 | 1 | 7 |
| 2018 Julio | 0 | 9 | 9 |
| 2018 Junio | 0 | 4 | 4 |
| 2018 Mayo | 0 | 9 | 9 |
| 2018 Abril | 0 | 3 | 3 |
| 2018 Marzo | 4 | 4 | 8 |
| 2018 Febrero | 79 | 6 | 85 |
| 2018 Enero | 85 | 6 | 91 |
| 2017 Diciembre | 63 | 8 | 71 |
| 2017 Noviembre | 73 | 9 | 82 |
| 2017 Octubre | 95 | 2 | 97 |
| 2017 Septiembre | 65 | 22 | 87 |
| 2017 Agosto | 84 | 16 | 100 |
| 2017 Julio | 70 | 16 | 86 |
| 2017 Junio | 98 | 18 | 116 |
| 2017 Mayo | 92 | 14 | 106 |
| 2017 Abril | 71 | 8 | 79 |
| 2017 Marzo | 61 | 40 | 101 |
| 2017 Febrero | 127 | 8 | 135 |
| 2017 Enero | 68 | 5 | 73 |
| 2016 Diciembre | 103 | 6 | 109 |
| 2016 Noviembre | 94 | 17 | 111 |
| 2016 Octubre | 148 | 28 | 176 |
| 2016 Septiembre | 194 | 7 | 201 |
| 2016 Agosto | 154 | 7 | 161 |
| 2016 Julio | 67 | 10 | 77 |
| 2016 Junio | 11 | 10 | 21 |
| 2016 Mayo | 5 | 10 | 15 |
| 2016 Abril | 4 | 7 | 11 |
| 2016 Marzo | 2 | 2 | 4 |
| 2016 Febrero | 3 | 2 | 5 |
| 2016 Enero | 10 | 2 | 12 |
| 2015 Diciembre | 11 | 0 | 11 |
| 2015 Noviembre | 13 | 4 | 17 |
| 2015 Octubre | 9 | 3 | 12 |
| 2015 Septiembre | 6 | 1 | 7 |
| 2015 Agosto | 12 | 4 | 16 |
| 2015 Julio | 161 | 114 | 275 |
| 2015 Junio | 99 | 13 | 112 |
| 2015 Mayo | 103 | 11 | 114 |
| 2015 Abril | 101 | 6 | 107 |
| 2015 Marzo | 44 | 2 | 46 |
| 2015 Febrero | 37 | 3 | 40 |
| 2015 Enero | 41 | 3 | 44 |
| 2014 Diciembre | 44 | 4 | 48 |
| 2014 Noviembre | 38 | 4 | 42 |
| 2014 Octubre | 34 | 3 | 37 |
| 2014 Septiembre | 31 | 0 | 31 |
| 2014 Agosto | 32 | 6 | 38 |
| 2014 Julio | 31 | 3 | 34 |
| 2014 Junio | 62 | 11 | 73 |
| 2014 Mayo | 51 | 7 | 58 |
| 2014 Abril | 43 | 2 | 45 |
| 2014 Marzo | 51 | 6 | 57 |
| 2014 Febrero | 33 | 8 | 41 |
| 2014 Enero | 24 | 6 | 30 |
| 2013 Diciembre | 29 | 8 | 37 |
| 2013 Noviembre | 34 | 2 | 36 |
| 2013 Octubre | 34 | 5 | 39 |
| 2013 Septiembre | 16 | 1 | 17 |
| 2013 Agosto | 11 | 8 | 19 |
| 2013 Julio | 3 | 2 | 5 |
| 2013 Junio | 3 | 5 | 8 |
| 2013 Mayo | 1 | 1 | 2 |
| 2013 Abril | 3 | 1 | 4 |
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