Case for Diagnosis
Keratotic Lesions on the Palms and Nail Abnormalities
Lesiones queratósicas en las palmas de las manos y alteraciones ungueales
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Córdoba, J.C. Tardío, J.M. Borbujo" "autores" => array:3 [ 0 => array:4 [ "nombre" => "S." "apellidos" => "Córdoba" "email" => array:1 [ 0 => "scordoba.hflr@salud.madrid.org" ] "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" => "J.C." "apellidos" => "Tardío" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "J.M." "apellidos" => "Borbujo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario de Fuenlabrada, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lesiones queratósicas en las palmas de las manos y alteraciones ungueales" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 500 "Ancho" => 494 "Tamanyo" => 44576 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">The patient was a 53-year-old male with a history of hypertension, for which he was being treated with enalapril. He attended our clinic because of multiple, scaly, slightly itchy papules on the palmar surfaces and sides of the hands and fingers. These lesions had appeared 2 to 3 years earlier and had remained stable without treatment. During this period the patient's fingernails, particularly that of the left thumb, became fragile and striated.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">On the sides of the fingers and the thenar eminences of both hands the patient had multiple skin-colored papules of 1-2<span class="elsevierStyleHsp" style=""></span>mm in size with slightly scaly, keratotic surfaces (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Longitudinal striations were observed on the fingernails of both hands, and pterygium of the nail on the left thumb (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). No lesions were detected in the mucosa or in any other locations.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Biopsy showed a well-circumscribed, dense, subepidermal lymphohistiocytic infiltrate occupying 4 dermal papillae. The infiltrate extended to the epidermal basement membrane, which showed vacuolar degeneration with some apoptotic keratinocytes. The epidermis was thinned and showed parakeratosis (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Additional Tests</span><p id="par0020" class="elsevierStylePara elsevierViewall">Fungal culture of nail scrapings was negative.</p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">What Is Your Diagnosis?</span></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Diagnosis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Palmar lichen nitidus with nail involvement.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical Course and Treatment</span><p id="par0035" class="elsevierStylePara elsevierViewall">The patient was treated with topical clobetasol for 2 months with no improvement of the lesions.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">Lichen nitidus (LN) is a chronic inflammatory disease of unknown etiology that predominantly affects children and young adults. It is characterized by the presence of numerous skin-colored papules of a few millimeters in size. These are widely distributed but predominantly present on the genitals, abdomen, chest, and the flexor surfaces of the extremities. Most cases involve few symptoms and resolve spontaneously.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> LN with involvement of the palms, soles of the feet, nails, and mucous membranes is uncommon.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> There are several clinical variants of LN, including keratotic, vesicular, purpuric, perforating, and generalized forms.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,3</span></a> LN can be associated with lichen planus in up to 30% of cases, suggesting that these 2 conditions may be different manifestations of the same process, rather than independent entities. Histologically, LN is characterized by the presence of clusters of lymphocytes and epithelioid histiocytes, sometimes accompanied by multinucleated giant cells, occupying between 1 and 5 dermal papillae and making close contact with the epidermal basal layer, which shows vacuolar degeneration and colloid bodies. The epidermis is thinned and exhibits parakeratosis. The inflammatory infiltrate is surrounded by elongated epidermal ridges.</p><p id="par0045" class="elsevierStylePara elsevierViewall">LN localized exclusively on the palmar surfaces is relatively uncommon, and affects comparatively older patients (age range, 37-52 years) than other forms of LN. It can present as punctate papules, keratotic spicules, or diffuse palmar hyperkeratosis with flaking and fissuring.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,4,5</span></a> The differential diagnosis of palmar LN should include psoriasis, chronic eczema, and dyshidrotic eczema. Microscopy of palmar LN generally reveals typical LN features, although in some cases the inflammatory infiltrate forms a more diffuse band in the superficial dermis. Palmar LN tends to show a chronic course and can be refractory to treatment.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Nail involvement is observed in less than 10% of LN cases and is often associated with palmar involvement.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> The associated lesions (onychorrhexis, splitting of the distal nail plate, and irregular depressions) are similar to those caused by lichen planus.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">We have presented a case of LN with exclusive palmar involvement. The nail alterations of our patient could be secondary to LN or to the expression of lichen planus which had so far failed to develop in other locations.</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" => "Histology" ] 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" => "Discussion" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Córdoba S, Tardío J, Borbujo J. Lesiones queratósicas en las palmas de las manos y alteraciones ungueales. Actas Dermosifiliogr. 2015;106:133–134.</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" => 533 "Ancho" => 800 "Tamanyo" => 90741 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 500 "Ancho" => 494 "Tamanyo" => 44576 ] ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 500 "Ancho" => 625 "Tamanyo" => 206746 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×100.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Liquen nitidus. Presentación de dos casos, uno de ellos generalizado" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Celasco" 1 => "M. Lequio" 2 => "M. Santamarina" 3 => "M. Hernández" 4 => "A. Soliani" 5 => "A. Abeldaño" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arch Argent Pediatr" "fecha" => "2012" "volumen" => "110" "paginaInicial" => "13" "paginaFinal" => "16" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of palmar lichen nitidus presenting as a clinical feature of pompholyx" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.H. Park" 1 => "S.W. Kim" 2 => "T.W. Noh" 3 => "K.C. Hong" 4 => "Y.S. Kang" 5 => "U.H. 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Novo Lens" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Dermatopathol" "fecha" => "1999" "volumen" => "21" "paginaInicial" => "161" "paginaFinal" => "164" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10218677" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lichen nitidus presenting as palmoplantar hyperkeratosis and nail dystrophy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.S. Munro" 1 => "N.H. Cox" 2 => "J.M. Marks" 3 => "S. Natarajan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Exp Dermatol" "fecha" => "1993" "volumen" => "18" "paginaInicial" => "381" "paginaFinal" => "383" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8403484" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010600000002/v2_201502240233/S1578219014003370/v2_201502240233/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/15782190/0000010600000002/v2_201502240233/S1578219014003370/v2_201502240233/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014003370?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 13 | 11 | 24 |
| 2024 Octubre | 97 | 48 | 145 |
| 2024 Septiembre | 83 | 17 | 100 |
| 2024 Agosto | 115 | 68 | 183 |
| 2024 Julio | 101 | 22 | 123 |
| 2024 Junio | 106 | 29 | 135 |
| 2024 Mayo | 81 | 21 | 102 |
| 2024 Abril | 75 | 22 | 97 |
| 2024 Marzo | 67 | 31 | 98 |
| 2024 Febrero | 82 | 37 | 119 |
| 2024 Enero | 78 | 32 | 110 |
| 2023 Diciembre | 94 | 26 | 120 |
| 2023 Noviembre | 107 | 21 | 128 |
| 2023 Octubre | 99 | 20 | 119 |
| 2023 Septiembre | 90 | 26 | 116 |
| 2023 Agosto | 63 | 13 | 76 |
| 2023 Julio | 93 | 35 | 128 |
| 2023 Junio | 92 | 20 | 112 |
| 2023 Mayo | 78 | 24 | 102 |
| 2023 Abril | 97 | 13 | 110 |
| 2023 Marzo | 67 | 17 | 84 |
| 2023 Febrero | 58 | 24 | 82 |
| 2023 Enero | 63 | 18 | 81 |
| 2022 Diciembre | 51 | 30 | 81 |
| 2022 Noviembre | 36 | 22 | 58 |
| 2022 Octubre | 40 | 21 | 61 |
| 2022 Septiembre | 31 | 33 | 64 |
| 2022 Agosto | 16 | 30 | 46 |
| 2022 Julio | 42 | 29 | 71 |
| 2022 Junio | 60 | 21 | 81 |
| 2022 Mayo | 82 | 44 | 126 |
| 2022 Abril | 52 | 27 | 79 |
| 2022 Marzo | 76 | 43 | 119 |
| 2022 Febrero | 86 | 36 | 122 |
| 2022 Enero | 65 | 33 | 98 |
| 2021 Diciembre | 49 | 30 | 79 |
| 2021 Noviembre | 61 | 40 | 101 |
| 2021 Octubre | 50 | 35 | 85 |
| 2021 Septiembre | 38 | 28 | 66 |
| 2021 Agosto | 42 | 19 | 61 |
| 2021 Julio | 36 | 22 | 58 |
| 2021 Junio | 47 | 34 | 81 |
| 2021 Mayo | 25 | 25 | 50 |
| 2021 Abril | 78 | 27 | 105 |
| 2021 Marzo | 66 | 13 | 79 |
| 2021 Febrero | 48 | 20 | 68 |
| 2021 Enero | 28 | 15 | 43 |
| 2020 Diciembre | 38 | 12 | 50 |
| 2020 Noviembre | 27 | 16 | 43 |
| 2020 Octubre | 19 | 10 | 29 |
| 2020 Septiembre | 29 | 11 | 40 |
| 2020 Agosto | 32 | 21 | 53 |
| 2020 Julio | 19 | 7 | 26 |
| 2020 Junio | 33 | 19 | 52 |
| 2020 Mayo | 22 | 21 | 43 |
| 2020 Abril | 29 | 19 | 48 |
| 2020 Marzo | 26 | 17 | 43 |
| 2020 Febrero | 5 | 9 | 14 |
| 2020 Enero | 4 | 5 | 9 |
| 2019 Diciembre | 8 | 5 | 13 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Octubre | 0 | 1 | 1 |
| 2019 Septiembre | 4 | 2 | 6 |
| 2019 Agosto | 4 | 6 | 10 |
| 2019 Julio | 8 | 4 | 12 |
| 2019 Junio | 4 | 18 | 22 |
| 2019 Mayo | 7 | 29 | 36 |
| 2019 Abril | 2 | 17 | 19 |
| 2019 Marzo | 0 | 6 | 6 |
| 2019 Febrero | 4 | 4 | 8 |
| 2019 Enero | 2 | 1 | 3 |
| 2018 Diciembre | 1 | 0 | 1 |
| 2018 Noviembre | 4 | 5 | 9 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 6 | 0 | 6 |
| 2018 Febrero | 17 | 3 | 20 |
| 2018 Enero | 21 | 4 | 25 |
| 2017 Diciembre | 30 | 7 | 37 |
| 2017 Noviembre | 21 | 4 | 25 |
| 2017 Octubre | 26 | 5 | 31 |
| 2017 Septiembre | 13 | 6 | 19 |
| 2017 Agosto | 14 | 4 | 18 |
| 2017 Julio | 16 | 6 | 22 |
| 2017 Junio | 25 | 6 | 31 |
| 2017 Mayo | 19 | 3 | 22 |
| 2017 Abril | 27 | 7 | 34 |
| 2017 Marzo | 19 | 6 | 25 |
| 2017 Febrero | 16 | 9 | 25 |
| 2017 Enero | 13 | 5 | 18 |
| 2016 Diciembre | 24 | 18 | 42 |
| 2016 Noviembre | 37 | 10 | 47 |
| 2016 Octubre | 33 | 10 | 43 |
| 2016 Septiembre | 0 | 5 | 5 |
| 2016 Julio | 6 | 1 | 7 |
| 2016 Junio | 21 | 2 | 23 |
| 2016 Mayo | 15 | 1 | 16 |
| 2016 Abril | 7 | 6 | 13 |
| 2016 Marzo | 13 | 7 | 20 |
| 2016 Febrero | 4 | 10 | 14 |
| 2016 Enero | 9 | 8 | 17 |
| 2015 Diciembre | 13 | 7 | 20 |
| 2015 Noviembre | 11 | 1 | 12 |
| 2015 Octubre | 8 | 3 | 11 |
| 2015 Septiembre | 6 | 2 | 8 |
| 2015 Agosto | 0 | 1 | 1 |
| 2015 Julio | 3 | 3 | 6 |
| 2015 Junio | 16 | 5 | 21 |
| 2015 Mayo | 10 | 5 | 15 |
| 2015 Abril | 2 | 3 | 5 |
| 2015 Marzo | 1 | 0 | 1 |
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