Case for Diagnosis
Pink Papules Arranged Linearly
Pápulas rosadas de distribución lineal
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Campos-Muñoz, R. Ramírez-Mora, E. López-Bran" "autores" => array:3 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Campos-Muñoz" "email" => array:1 [ 0 => "luciacampos78@hotmail.com" ] "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" => "R." "apellidos" => "Ramírez-Mora" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "E." 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The patient was asymptomatic.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed several pink and brown papules arranged linearly on the floor of the right axilla (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Histopathologic findings showed a dense dermal infiltrate composed of eosinophils, lymphocytes, and cells with abundant cytoplasm and reniform nuclei (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), which were positive for S-100 and CD1a (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><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">The following tests were carried out: complete blood count, biochemistry profile, skeletal survey, chest radiograph, abdominal ultrasound, and full physical examination. All results were normal.</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">Unifocal Langerhans cell histiocytosis (LCH) of the skin (cutaneous eosinophilic granuloma).</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 lesion was surgically excised and the patient has been followed up for 18 months with no local or systemic recurrence.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">LCH is characterized by an infiltrate of cells with Langerhans cell phenotype and can affect various organs, including the skin, mucosas, lymph nodes, liver, spleen, bone, digestive tract, thymus, and pituitary gland.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> According to some studies, skin lesions are present in up to 50% of patients in the initial stages of LCH and can therefore be decisive in establishing a diagnosis; however, because clinical presentation varies so widely, LCH is often not suspected.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">LCH has traditionally been classified as follows: eosinophilic granuloma (single-site disease), Hand-Schüller-Christian disease (chronic, progressive, multifocal disease), and Letterer-Siwe disease (acute, diffuse disease with a poor prognosis). In recent years, however, the Histiocyte Society has recommended classifying LCH by site and extent, as follows: type 1, unifocal; type 2, multifocal without involvement of the liver, spleen, lungs, or bone marrow; type 3, multifocal with involvement of the liver, spleen, lungs, and/or bone marrow, or age less than 2 years.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The typical, classical LCH skin lesions are described as small, purpuric, infiltrated papules with a crusted or scaly surface on the scalp, face, flexures, genital region, and trunk. However, it should be noted that a wide variety of skin lesions of various morphologies can be found in LCH,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> including the following: blisters; vesicles; pustules; single or multiple papules that can be skin-colored, pink, xanthomatous, or purpuric; tumors; nail dystrophy;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> and mucosal ulcerations.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> As a result, the differential diagnosis is very extensive and includes Darier disease, cutaneous candidiasis, non-Langerhans cell histiocytosis, intertrigo, vasculitis, urticaria pigmentosa, sarcoidosis, mycosis fungoides, impetigo, folliculitis, herpes simplex, and chickenpox.</p><p id="par0055" class="elsevierStylePara elsevierViewall">LCH is diagnosed histologically. Skin lesions, because of their accessibility, are often the key to diagnosis. Histologic examination reveals an infiltrate of histiocytoid cells with reniform nuclei that express CD1a and S-100. Intracytoplasmic Birbeck granules are visible with electron microscopy. In the case of our patient, the late presentation of a supposed epidermal nevus at age 8 years prompted us to order the histologic study, which led us to the correct diagnosis.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Unifocal forms of LCH are usually found on bone, most frequently the cranium and long bones. Unifocal manifestation on the skin—as in the reported case—is rare. These localized cases can be treated with nitrogen mustard, psoralen–UV-A therapy, surgery, intralesional corticosteroids, radiation therapy, or thalidomide.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Prognosis is determined by the number of organs involved and will be worse if the liver, lungs, or bone marrow are affected. Localized cutaneous forms of LCH have a good prognosis and rarely progress to multisystem disease.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></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" => "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: Campos-Muñoz L, Ramírez-Mora R, López-Bran E. Pápulas rosadas de distribución lineal. Actas Dermosifiliogr. 2015;106:755–756.</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" => 676 "Ancho" => 500 "Tamanyo" => 89192 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Papules arranged linearly in the right axilla.</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" => 763 "Ancho" => 500 "Tamanyo" => 199564 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Hematoxylin-eosin, original magnification × 40. B, Hematoxylin-eosin, original magnification × 200.</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" => 376 "Ancho" => 500 "Tamanyo" => 88862 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">CD1a, original magnification × 100.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Langerhans cell histiocytosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Valdivielso" 1 => "C. 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Kelly" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MPH.0000000000000248" "Revista" => array:6 [ "tituloSerie" => "J Pediatr Hematol Oncol" "fecha" => "2014" "volumen" => "36" "paginaInicial" => "613" "paginaFinal" => "616" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25171449" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010600000009/v1_201511040157/S1578219015002553/v1_201511040157/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/15782190/0000010600000009/v1_201511040157/S1578219015002553/v1_201511040157/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015002553?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 6 | 10 | 16 |
| 2024 Octubre | 70 | 31 | 101 |
| 2024 Septiembre | 98 | 26 | 124 |
| 2024 Agosto | 102 | 76 | 178 |
| 2024 Julio | 82 | 37 | 119 |
| 2024 Junio | 94 | 32 | 126 |
| 2024 Mayo | 72 | 29 | 101 |
| 2024 Abril | 74 | 22 | 96 |
| 2024 Marzo | 81 | 27 | 108 |
| 2024 Febrero | 70 | 34 | 104 |
| 2024 Enero | 71 | 35 | 106 |
| 2023 Diciembre | 74 | 18 | 92 |
| 2023 Noviembre | 66 | 27 | 93 |
| 2023 Octubre | 79 | 29 | 108 |
| 2023 Septiembre | 78 | 29 | 107 |
| 2023 Agosto | 54 | 13 | 67 |
| 2023 Julio | 53 | 31 | 84 |
| 2023 Junio | 53 | 26 | 79 |
| 2023 Mayo | 52 | 18 | 70 |
| 2023 Abril | 49 | 14 | 63 |
| 2023 Marzo | 68 | 28 | 96 |
| 2023 Febrero | 61 | 21 | 82 |
| 2023 Enero | 32 | 36 | 68 |
| 2022 Diciembre | 52 | 44 | 96 |
| 2022 Noviembre | 37 | 26 | 63 |
| 2022 Octubre | 31 | 27 | 58 |
| 2022 Septiembre | 28 | 36 | 64 |
| 2022 Agosto | 30 | 33 | 63 |
| 2022 Julio | 30 | 39 | 69 |
| 2022 Junio | 34 | 35 | 69 |
| 2022 Mayo | 34 | 35 | 69 |
| 2022 Abril | 31 | 25 | 56 |
| 2022 Marzo | 41 | 39 | 80 |
| 2022 Febrero | 27 | 22 | 49 |
| 2022 Enero | 30 | 28 | 58 |
| 2021 Diciembre | 25 | 30 | 55 |
| 2021 Noviembre | 30 | 45 | 75 |
| 2021 Octubre | 29 | 40 | 69 |
| 2021 Septiembre | 21 | 36 | 57 |
| 2021 Agosto | 18 | 18 | 36 |
| 2021 Julio | 24 | 22 | 46 |
| 2021 Junio | 19 | 25 | 44 |
| 2021 Mayo | 25 | 14 | 39 |
| 2021 Abril | 45 | 54 | 99 |
| 2021 Marzo | 51 | 21 | 72 |
| 2021 Febrero | 73 | 26 | 99 |
| 2021 Enero | 31 | 15 | 46 |
| 2020 Diciembre | 23 | 12 | 35 |
| 2020 Noviembre | 29 | 20 | 49 |
| 2020 Octubre | 21 | 18 | 39 |
| 2020 Septiembre | 30 | 17 | 47 |
| 2020 Agosto | 30 | 11 | 41 |
| 2020 Julio | 30 | 12 | 42 |
| 2020 Junio | 27 | 18 | 45 |
| 2020 Mayo | 17 | 12 | 29 |
| 2020 Abril | 30 | 18 | 48 |
| 2020 Marzo | 32 | 14 | 46 |
| 2020 Febrero | 7 | 0 | 7 |
| 2020 Enero | 4 | 2 | 6 |
| 2019 Diciembre | 9 | 3 | 12 |
| 2019 Noviembre | 4 | 10 | 14 |
| 2019 Octubre | 0 | 5 | 5 |
| 2019 Septiembre | 8 | 10 | 18 |
| 2019 Agosto | 1 | 8 | 9 |
| 2019 Julio | 5 | 13 | 18 |
| 2019 Junio | 6 | 20 | 26 |
| 2019 Mayo | 5 | 21 | 26 |
| 2019 Abril | 2 | 22 | 24 |
| 2019 Marzo | 2 | 12 | 14 |
| 2019 Febrero | 3 | 4 | 7 |
| 2019 Enero | 3 | 4 | 7 |
| 2018 Diciembre | 4 | 5 | 9 |
| 2018 Noviembre | 1 | 8 | 9 |
| 2018 Octubre | 5 | 0 | 5 |
| 2018 Septiembre | 6 | 0 | 6 |
| 2018 Abril | 0 | 2 | 2 |
| 2018 Febrero | 21 | 2 | 23 |
| 2018 Enero | 19 | 7 | 26 |
| 2017 Diciembre | 35 | 13 | 48 |
| 2017 Noviembre | 18 | 6 | 24 |
| 2017 Octubre | 30 | 4 | 34 |
| 2017 Septiembre | 16 | 3 | 19 |
| 2017 Agosto | 39 | 13 | 52 |
| 2017 Julio | 29 | 10 | 39 |
| 2017 Junio | 37 | 7 | 44 |
| 2017 Mayo | 31 | 7 | 38 |
| 2017 Abril | 26 | 7 | 33 |
| 2017 Marzo | 21 | 62 | 83 |
| 2017 Febrero | 19 | 4 | 23 |
| 2017 Enero | 19 | 4 | 23 |
| 2016 Diciembre | 23 | 17 | 40 |
| 2016 Noviembre | 23 | 21 | 44 |
| 2016 Octubre | 27 | 11 | 38 |
| 2016 Septiembre | 0 | 1 | 1 |
| 2016 Julio | 0 | 1 | 1 |
| 2016 Junio | 1 | 1 | 2 |
| 2016 Mayo | 4 | 1 | 5 |
| 2016 Abril | 0 | 1 | 1 |
| 2016 Febrero | 0 | 1 | 1 |
| 2016 Enero | 0 | 2 | 2 |
| 2015 Noviembre | 0 | 4 | 4 |
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