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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 39-year-old Bolivian woman with no relevant past medical history presented with multiple asymptomatic lesions on both hands that had first appeared 5 years earlier&#46; No treatment had been applied&#46; The patient reported that a maternal aunt had similar lesions at the same site&#46;</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 numerous yellowish papules from 2 to 4<span class="elsevierStyleHsp" style=""></span>mm in diameter on the palms of both hands &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figs&#46; 1</a>A and 1B&#41;&#44; occasionally grouped together forming plaques&#44; as well as isolated lesions on the lateral and dorsal aspects of the fingers&#46;</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">A biopsy specimen was taken from one of the lesions and histologic examination revealed orthokeratotic hyperkeratosis &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#44; with a minimal superficial lymphocytic component in the dermis&#46; The Verhoeff histochemical technique revealed reduction and fragmentation of the reticular fibers &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">What Is Your Diagnosis&#63;</span></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Diagnosis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Acrokeratoelastoidosis&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Clinical Course and Treatment</span><p id="par0030" class="elsevierStylePara elsevierViewall">No treatment was prescribed because the lesions were asymptomatic and the patient was not concerned&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">Acrokeratoelastoidosis is an idiopathic genodermatosis&#44; first described by Costa<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> in 1953&#44; that affects the palms and soles&#46; It is included in the group of marginal acrokeratodermas&#44; which are characterized by papules and plaques in the lateral margins of the hands and feet&#59; acrokeratoelastoidosis is a hereditary subtype of this group of dermatoses&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Both dominant and recessive patterns of autosomal inheritance have been described&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;3</span></a> Acrokeratoelastoidosis is characterized by well-defined skin-colored or yellowish polygonal papules&#44; some umbilicated&#44; from 2 to 5<span class="elsevierStyleHsp" style=""></span>mm in diameter&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> The lesions are located on the transitional margin between the dorsal and palmar skin of the hands or between the dorsal and plantar skin of the feet and are usually asymptomatic&#44; although they can be pruritic or be associated with hyperhidrosis&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> The distribution is variable and the lesions can be found either in isolation or grouped together forming plaques&#46; Onset frequently occurs in young adulthood&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The etiology and pathogenesis of acrokeratoelastoidosis are unknown&#46; The causal mechanism is suspected to be the anomalous production of bundles of elastic fibers by the fibroblasts&#44; leading to the fragmentation and reduction in quantity of these fibers in the reticular dermis &#40;elastorrhexis&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> Microscopy reveals a decrease in the number of fibroblasts&#44; which contain dense cytoplasmic granules that could be precursors of reticulin&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> In patients affected by this dermatosis&#44; elastorrhexis without epidermal skin changes at sites not clinically affected has also been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The differential diagnosis should include other marginal acrokeratodermas&#44; especially focal acral hyperkeratosis&#44; degenerative collagenous plaques of the hands&#44; and keratoelastoidosis marginalis&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;2&#44;5</span></a> Acrokeratoelastoidosis and focal acral hyperkeratosis both belong to the subgroup of hereditary acrokeratodermas and can be differentiated by their histologic features&#58; acrokeratoelastoidosis is characterized by elastorrhexis&#44; whereas in focal acral hyperkeratosis the elastic fibers are present in normal amounts and with a normal distribution&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> Acquired forms of degenerative collagenous plaques of the hands and keratoelastoidosis marginalis appear in manual laborers with intense actinic damage&#44; a history of chronic sun exposure&#44; and repeated trauma injuries of the hands<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2&#44;5</span></a>&#59; these conditions usually affect the medial aspect of the thumb and the lateral aspect of the index finger&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The various treatments used to date&#8212;such as cryotherapy&#44; salicylic acid&#44; methotrexate&#44; dapsone&#44; and oral corticosteroids&#8212;have been unsatisfactory&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2&#44;5</span></a> Only acitretin at a dose of 0&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d has shown some usefulness&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of Interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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