Case and Research Letters
Radiodermatitis with Signs of Eccrine Squamous Syringometaplasia Following a Diagnostic Procedure
Radiodermitis secundaria a procedimiento diagnóstico con signos de siringometaplasia escamosa ecrina
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Signos de dismaduración epidérmica: células disqueratósicas, con alteración del tamaño y la polaridad de los queratinocitos, algunos de ellos binucleados (HE<span class="elsevierStyleHsp" style=""></span>×10). B) Conductos ecrinos en los que se observan zonas de metaplasia escamosa junto con infiltrado neutrofílico en el interior de los ovillos, así como un moderado infiltrado inflamatorio periecrino (HE<span class="elsevierStyleHsp" style=""></span>×40).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.J. Concha Garzón, M. Llamas-Velasco, J. Sánchez-Pérez, J. Fraga" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M.J." "apellidos" => "Concha Garzón" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Llamas-Velasco" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Sánchez-Pérez" ] 3 => array:2 [ "nombre" => "J." 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Concha Garzón, M. Llamas-Velasco, J. Sánchez-Pérez, J. Fraga" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M.J." "apellidos" => "Concha Garzón" "email" => array:1 [ 0 => "mjconchg@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Llamas-Velasco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "Sánchez-Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Fraga" "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 La Princesa, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario La Princesa, Madrid, 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" => "Radiodermitis secundaria a procedimiento diagnóstico con signos de siringometaplasia escamosa ecrina" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2812 "Ancho" => 1667 "Tamanyo" => 543800 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Hyperkeratosis and irregular acanthosis. Signs of epidermal dysmaturation: dyskeratotic cells, with keratinocytes of altered size and polarity, some of which are binucleated (hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10). B, Eccrine duct in which areas of squamous metaplasia and a neutrophilic infiltrate can be observed inside the coil, as well as a moderate perieccrine inflammatory infiltrate (hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>40).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Eccrine squamous syringometaplasia (ESS) is a squamous metaplasia of the cuboidal cells of the of the eccrine sweat ducts. ESS is considered a nonspecific reactive response to exposure to toxic agents and drugs but has also been described following cutaneous processes, such as tumors, infections and inflammatory conditions, such as pyoderma gangrenosum, phytophotodermatitis, and chronic ulcers.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report a peculiar case of radiodermatitis with the unusual histopathologic finding of ESS.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The patient was a 62-year-old man who reported the appearance of an itchy erythematous plaque on the right side of his back. The plaque had developed 15 days earlier. His medical history included metabolic syndrome, hyperuricemia, and chronic ischemic heart disease. The patient was receiving regular treatment with atorvastatin, allopurinol, enalapril, isosorbide, carvedilol, ticlopidine, sitagliptin, and metformin. In the previous 2 months, he had undergone a diagnostic coronary angiography and 2 angioplasties.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Physical examination revealed a square-shaped erythematous plaque (9<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>12<span class="elsevierStyleHsp" style=""></span>cm) with well-defined borders and an eroded center (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The location coincided with one of the sites irradiated when the patient received a total dose of 7.8<span class="elsevierStyleHsp" style=""></span>Gy in 3 separate procedures. Histopathology demonstrated hyperkeratosis, irregular acanthosis and dysmaturation of the epidermis, a moderate predominantly neutrophilic perieccrine inflammatory infiltrate in the dermis, and squamous metaplasia of both eccrine coil and duct (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). These findings were compatible with ESS.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The radiodermatitis plaque responded favorably to local treatments and topical corticosteroids. At the time of writing, only slight residual hyperpigmentation persisted.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The frequency of radiodermatitis caused by coronary procedures is not known but is thought to be increasing due to the growing use and complexity of these interventions. The most commonly affected locations are the right axillary region, the middle third of the back, the right anterolateral region of the chest, and the scapular area, as in the present case.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Depending on the time of onset of skin lesions after exposure, radiodermatitis is classically described as either acute or chronic. In recent years, a subacute category has also been added; this form usually occurs weeks to months after the initial exposure.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The radiation dose required to cause erythema is estimated at 3<span class="elsevierStyleHsp" style=""></span>Gy, and doses of over 12<span class="elsevierStyleHsp" style=""></span>Gy can cause peeling as well as secondary necrosis and ulceration. However, the dose threshold varies widely depending on the area exposed and an individual's susceptibility.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> Thus, the radiation dose of more than 7.8<span class="elsevierStyleHsp" style=""></span>Gy received by our patient in the lesion area was sufficient to initiate a cutaneous inflammatory response which may have induced both the radiodermatitis and the ESS.</p><p id="par0045" class="elsevierStylePara elsevierViewall">We have found no similar cases in the literature describing an association between these two conditions.</p><p id="par0050" class="elsevierStylePara elsevierViewall">This patient had not been exposed to any new substances, except for Visipaque (iodixanol), an iodinated contrast agent used during fluoroscopic procedures. However, no association between this substance and ESS has been described.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The differential diagnosis should include dermatitis due to radiation recall, which can present with ESS.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> However, radiation recall dermatitis most commonly affects areas of radiotherapy-exposed skin that are subsequently reactivated by a second substance, often a chemotherapeutic agent. In our case, given the short clinical course of the condition and the lack of exposure to precipitating agents, we can reasonably rule out this diagnosis.</p><p id="par0060" class="elsevierStylePara elsevierViewall">In summary, we have presented an unusual case of ESS in a patient with radiodermatitis, which we believe should be added to the list of dermatological conditions in which signs of ESS may be observed.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Concha Garzón MJ, et al. Radiodermitis secundaria a procedimiento diagnóstico con signos de siringometaplasia escamosa ecrina. Actas Dermosifiliogr. 2013;104:255–7.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 953 "Ancho" => 1332 "Tamanyo" => 106182 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous plaque with an ulcerated center on the right side of the back.</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" => 2812 "Ancho" => 1667 "Tamanyo" => 543800 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Hyperkeratosis and irregular acanthosis. Signs of epidermal dysmaturation: dyskeratotic cells, with keratinocytes of altered size and polarity, some of which are binucleated (hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10). B, Eccrine duct in which areas of squamous metaplasia and a neutrophilic infiltrate can be observed inside the coil, as well as a moderate perieccrine inflammatory infiltrate (hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>40).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chemotherapy-related bilateral dermatitis associated with eccrine squamous syringometaplasia: reappraisal of epidemiological, clinical, and pathological features" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Martorell-Calatayud" 1 => "O. Sanmartín" 2 => "R. Botella-Estrada" 3 => "N.N. Balmer" 4 => "C. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 8 | 12 | 20 |
| 2024 Octubre | 70 | 50 | 120 |
| 2024 Septiembre | 67 | 37 | 104 |
| 2024 Agosto | 109 | 71 | 180 |
| 2024 Julio | 78 | 55 | 133 |
| 2024 Junio | 92 | 49 | 141 |
| 2024 Mayo | 82 | 50 | 132 |
| 2024 Abril | 83 | 33 | 116 |
| 2024 Marzo | 79 | 27 | 106 |
| 2024 Febrero | 67 | 36 | 103 |
| 2024 Enero | 68 | 31 | 99 |
| 2023 Diciembre | 57 | 18 | 75 |
| 2023 Noviembre | 77 | 31 | 108 |
| 2023 Octubre | 64 | 20 | 84 |
| 2023 Septiembre | 64 | 28 | 92 |
| 2023 Agosto | 53 | 15 | 68 |
| 2023 Julio | 66 | 31 | 97 |
| 2023 Junio | 71 | 24 | 95 |
| 2023 Mayo | 51 | 27 | 78 |
| 2023 Abril | 72 | 22 | 94 |
| 2023 Marzo | 46 | 25 | 71 |
| 2023 Febrero | 48 | 26 | 74 |
| 2023 Enero | 30 | 25 | 55 |
| 2022 Diciembre | 47 | 31 | 78 |
| 2022 Noviembre | 25 | 18 | 43 |
| 2022 Octubre | 24 | 22 | 46 |
| 2022 Septiembre | 26 | 29 | 55 |
| 2022 Agosto | 23 | 35 | 58 |
| 2022 Julio | 27 | 33 | 60 |
| 2022 Junio | 25 | 28 | 53 |
| 2022 Mayo | 26 | 32 | 58 |
| 2022 Abril | 44 | 46 | 90 |
| 2022 Marzo | 38 | 47 | 85 |
| 2022 Febrero | 38 | 26 | 64 |
| 2022 Enero | 33 | 36 | 69 |
| 2021 Diciembre | 40 | 39 | 79 |
| 2021 Noviembre | 44 | 36 | 80 |
| 2021 Octubre | 45 | 55 | 100 |
| 2021 Septiembre | 47 | 38 | 85 |
| 2021 Agosto | 55 | 26 | 81 |
| 2021 Julio | 38 | 35 | 73 |
| 2021 Junio | 39 | 32 | 71 |
| 2021 Mayo | 31 | 31 | 62 |
| 2021 Abril | 80 | 65 | 145 |
| 2021 Marzo | 65 | 26 | 91 |
| 2021 Febrero | 63 | 25 | 88 |
| 2021 Enero | 37 | 20 | 57 |
| 2020 Diciembre | 30 | 14 | 44 |
| 2020 Noviembre | 19 | 11 | 30 |
| 2020 Octubre | 25 | 11 | 36 |
| 2020 Septiembre | 31 | 11 | 42 |
| 2020 Agosto | 25 | 17 | 42 |
| 2020 Julio | 30 | 23 | 53 |
| 2020 Junio | 35 | 24 | 59 |
| 2020 Mayo | 19 | 11 | 30 |
| 2020 Abril | 17 | 18 | 35 |
| 2020 Marzo | 29 | 16 | 45 |
| 2020 Febrero | 4 | 1 | 5 |
| 2020 Enero | 0 | 2 | 2 |
| 2019 Diciembre | 2 | 3 | 5 |
| 2019 Noviembre | 0 | 1 | 1 |
| 2019 Octubre | 0 | 3 | 3 |
| 2019 Septiembre | 4 | 1 | 5 |
| 2019 Junio | 2 | 21 | 23 |
| 2019 Mayo | 1 | 28 | 29 |
| 2019 Abril | 0 | 18 | 18 |
| 2019 Marzo | 2 | 10 | 12 |
| 2019 Enero | 2 | 0 | 2 |
| 2018 Noviembre | 0 | 1 | 1 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 2 | 0 | 2 |
| 2018 Mayo | 0 | 1 | 1 |
| 2018 Abril | 0 | 1 | 1 |
| 2018 Marzo | 0 | 1 | 1 |
| 2018 Febrero | 38 | 7 | 45 |
| 2018 Enero | 112 | 6 | 118 |
| 2017 Diciembre | 125 | 8 | 133 |
| 2017 Noviembre | 34 | 4 | 38 |
| 2017 Octubre | 42 | 8 | 50 |
| 2017 Septiembre | 28 | 9 | 37 |
| 2017 Agosto | 29 | 10 | 39 |
| 2017 Julio | 34 | 5 | 39 |
| 2017 Junio | 36 | 6 | 42 |
| 2017 Mayo | 34 | 6 | 40 |
| 2017 Abril | 34 | 9 | 43 |
| 2017 Marzo | 17 | 14 | 31 |
| 2017 Febrero | 24 | 10 | 34 |
| 2017 Enero | 30 | 10 | 40 |
| 2016 Diciembre | 47 | 6 | 53 |
| 2016 Noviembre | 67 | 10 | 77 |
| 2016 Octubre | 93 | 10 | 103 |
| 2016 Septiembre | 76 | 12 | 88 |
| 2016 Agosto | 51 | 5 | 56 |
| 2016 Julio | 42 | 5 | 47 |
| 2016 Junio | 10 | 11 | 21 |
| 2016 Mayo | 8 | 6 | 14 |
| 2016 Abril | 3 | 14 | 17 |
| 2016 Marzo | 5 | 1 | 6 |
| 2016 Febrero | 5 | 2 | 7 |
| 2016 Enero | 6 | 2 | 8 |
| 2015 Diciembre | 6 | 5 | 11 |
| 2015 Noviembre | 14 | 4 | 18 |
| 2015 Octubre | 17 | 3 | 20 |
| 2015 Septiembre | 10 | 2 | 12 |
| 2015 Agosto | 6 | 3 | 9 |
| 2015 Julio | 85 | 115 | 200 |
| 2015 Junio | 70 | 7 | 77 |
| 2015 Mayo | 94 | 20 | 114 |
| 2015 Abril | 68 | 7 | 75 |
| 2015 Marzo | 47 | 2 | 49 |
| 2015 Febrero | 55 | 6 | 61 |
| 2015 Enero | 23 | 2 | 25 |
| 2014 Diciembre | 41 | 4 | 45 |
| 2014 Noviembre | 24 | 4 | 28 |
| 2014 Octubre | 46 | 14 | 60 |
| 2014 Septiembre | 23 | 5 | 28 |
| 2014 Agosto | 27 | 5 | 32 |
| 2014 Julio | 21 | 7 | 28 |
| 2014 Junio | 43 | 11 | 54 |
| 2014 Mayo | 45 | 7 | 52 |
| 2014 Abril | 37 | 2 | 39 |
| 2014 Marzo | 37 | 8 | 45 |
| 2014 Febrero | 37 | 7 | 44 |
| 2014 Enero | 26 | 6 | 32 |
| 2013 Diciembre | 34 | 9 | 43 |
| 2013 Noviembre | 34 | 8 | 42 |
| 2013 Octubre | 24 | 3 | 27 |
| 2013 Septiembre | 20 | 4 | 24 |
| 2013 Agosto | 14 | 3 | 17 |
| 2013 Julio | 8 | 5 | 13 |
| 2013 Junio | 2 | 1 | 3 |
| 2013 Mayo | 1 | 2 | 3 |
| 2013 Abril | 1 | 0 | 1 |
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