Case and Research Letter
Dermoscopy of Erythromelanosis Follicularis Faciei et Colli
Dermatoscopia de erythromelanosis folicular faciei et colli
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Histology reveals findings consistent with a diagnosis of erythromelanosis follicularis faciei et colli, i.e. slight orthokeratosis, follicular hyperkeratosis, increased basal layer pigmentation, perivascular and periadnexal lymphocytic infiltrate, and pigmentary incontinence with dermal melanophages (hematoxylin and eosin stain 200×) (b).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E. Errichetti, S. Pizzolitto, G. Stinco" "autores" => array:3 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "Errichetti" ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Pizzolitto" ] 2 => array:2 [ "nombre" => "G." 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Orthokeratotic papillomatosis with focal lymphoid infiltrate in papillary dermis and church spire pattern.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.M. Sánchez Sánchez, J. Molinero Caturla, J.R. Ferreres Riera, R.M. Penín Mosquera" "autores" => array:4 [ 0 => array:2 [ "nombre" => "J.M." "apellidos" => "Sánchez Sánchez" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Molinero Caturla" ] 2 => array:2 [ "nombre" => "J.R." "apellidos" => "Ferreres Riera" ] 3 => array:2 [ "nombre" => "R.M." 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Errichetti, S. Pizzolitto, G. Stinco" "autores" => array:3 [ 0 => array:4 [ "nombre" => "E." "apellidos" => "Errichetti" "email" => array:1 [ 0 => "enzoerri@yahoo.it" ] "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" => "S." "apellidos" => "Pizzolitto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "G." "apellidos" => "Stinco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Experimental and Clinical Medicine, Institute of Dermatology, University of Udine, Italy" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Pathology, Santa Maria della Misericordia Hospital, Udine, Italy" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dermatoscopia de erythromelanosis folicular faciei et colli" ] ] "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" => 649 "Ancho" => 1753 "Tamanyo" => 390564 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Polarized light dermoscopic examination displays whitish scales and numerous follicular keratotic plugs over a reddish-brown background; moreover, several perifollicular and interfollicular gray-blue granules (peppering) are also evident in the box (a). Histology reveals findings consistent with a diagnosis of erythromelanosis follicularis faciei et colli, i.e. slight orthokeratosis, follicular hyperkeratosis, increased basal layer pigmentation, perivascular and periadnexal lymphocytic infiltrate, and pigmentary incontinence with dermal melanophages (hematoxylin and eosin stain 200×) (b).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Erythromelanosis follicularis faciei et colli (EFFC) is a rare pigmentary disease of unknown etiopathogenesis typically affecting the face/neck of children or young adults, which is clinically characterized by the combination of bilateral/symmetrical brownish pigmentation and erythema, associated with more or less evident follicular plugging.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Of note, such a condition is often associated with keratosis pilaris on the arms and shoulders, thereby letting some authors speculate that EFFC could be a variant of this latter dermatosis.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Not uncommonly, EFFC is mistaken for other similar pigmentary/erythematous dermatoses involving the aforementioned districts, with consequent diagnostic errors/delays and prescription of inappropriate therapies.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Over the last few years, several studies have shown that dermoscopic examination may be useful to assist the diagnosis of general skin diseases.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2–5</span></a> We here describe for the first time the use of dermoscopy as a noninvasive diagnostic aid in a case of EFFC, comparing its dermoscopic findings with those detectable in other conditions which classically enter into the differential diagnosis.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 33-year-old man presented with a 6-year history of progressively worsening, asymptomatic, reddish-brown pigmentation associated with slight roughness on the cheeks, temples, lateral aspects of the nose, and frontal area (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Polarized light dermoscopic examination (carried out with DermLite DL3×10; 3Gen, San Juan Capistrano, CA, USA) revealed whitish scales and numerous whitish follicular keratotic plugs over a reddish-brown background; moreover, several gray-blue granules (peppering) were also evident in the perifollicular and interfollicular areas (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Histological examination showed slight orthokeratosis, follicular hyperkeratosis, increased basal layer pigmentation, perivascular and periadnexal lymphocytic infiltrate, and pigmentary incontinence with dermal melanophages (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>b), thus leading to the diagnosis of EFFC. Topical tacalcitol was prescribed and the use of sunscreen was recommended, with significant improvement of the clinical picture after eight weeks.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Dermoscopic findings seen in our instance of EFFC are related to the peculiar histological features which characterize this condition,<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,6</span></a> with follicular plugging, scaling, peppering, and reddish-brown background respectively corresponding to hyperkeratotic hair follicles, orthokeratosis, pigmentary incontinence/dermal melanophages, and dermal vasodilation/hyperpigmentation of the basal layer.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,6</span></a> Such a dermoscopic picture is similar to that reported in a recent case of erythrosis pigmentosa peribuccalis, a pigmentary dermatosis presenting as brownish-red pigmentation and small papules around the mouth and nose, which displayed erythema, scaling, yellowish follicular keratotic plugs, and perifollicular grayish globules/dots.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> These similarities are easily explained by the fact that both such disorders may share several histological features, so much so that they are considered to be part of the same condition spectrum by some authors.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> Interestingly, the detection of the above-mentioned dermocopic features might come in handy in the noninvasive distinction of EFFC from its main differential diagnoses as the latter typically show different features. In particular: lichen planus pigmentosus usually displays diffuse, structureless, brownish pigmentation and/or fine/coarse, gray-blue/brown dots/globules<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a>; Riehl's melanosis constantly features brownish pseudonetwork, gray dots/granules and telangiectatic vessels<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a>; poikiloderma of Civatte commonly shows structureless brownish pigmentation and telangiectatic vessels, with or without whitish areas (personal observations); melasma typically presents light yellow-brown uniform patches, with or without dark brown patches and capillary network<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a>; keratosis pilaris rubra atrophicans faciei frequently displays whitish follicular plugs over a reddish background with or without telangiectatic vessels (personal observations); demodicidosis mainly shows the so-called “Demodex tails” (creamy/whitish gelatinous threads representing the presence of the mite itself under magnification) protruding out of follicular openings, “Demodex follicular openings” (round and coarse follicular openings containing light brown/grayish plugs surrounded by an erythematous halo), erythema and whitish scaling<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a>; keratosis pilaris often features coiled/twisted hair embedded in the horny layer, sometimes associated with perifollicular erythema and vascular ectasia (keratosis pilaris rubra)<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a>; and follicular lichen planus reported to show follicular keratotic plugs without broken or twisted hairs.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In conclusion, this paper emphasizes that dermoscopy might be used as an auxiliary tool in the noninvasive differential diagnosis of EFFC. Further studies are obviously needed to confirm our preliminar observations.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "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" => 668 "Ancho" => 1752 "Tamanyo" => 183656 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical examination shows irregular areas of reddish-brown pigmentation of the cheeks, temples, lateral aspects of the nose, and frontal area (a and b).</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" => 649 "Ancho" => 1753 "Tamanyo" => 390564 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Polarized light dermoscopic examination displays whitish scales and numerous follicular keratotic plugs over a reddish-brown background; moreover, several perifollicular and interfollicular gray-blue granules (peppering) are also evident in the box (a). Histology reveals findings consistent with a diagnosis of erythromelanosis follicularis faciei et colli, i.e. slight orthokeratosis, follicular hyperkeratosis, increased basal layer pigmentation, perivascular and periadnexal lymphocytic infiltrate, and pigmentary incontinence with dermal melanophages (hematoxylin and eosin stain 200×) (b).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Case for diagnosis erythromelanosis follicularis faciei et colli" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.S. Silva" 1 => "J.C. Fonseca" 2 => "D. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 27 | 8 | 35 |
| 2024 Octubre | 187 | 50 | 237 |
| 2024 Septiembre | 207 | 49 | 256 |
| 2024 Agosto | 266 | 99 | 365 |
| 2024 Julio | 309 | 73 | 382 |
| 2024 Junio | 198 | 44 | 242 |
| 2024 Mayo | 263 | 45 | 308 |
| 2024 Abril | 172 | 27 | 199 |
| 2024 Marzo | 202 | 36 | 238 |
| 2024 Febrero | 289 | 39 | 328 |
| 2024 Enero | 347 | 45 | 392 |
| 2023 Diciembre | 253 | 35 | 288 |
| 2023 Noviembre | 263 | 34 | 297 |
| 2023 Octubre | 227 | 39 | 266 |
| 2023 Septiembre | 201 | 45 | 246 |
| 2023 Agosto | 239 | 29 | 268 |
| 2023 Julio | 141 | 53 | 194 |
| 2023 Junio | 142 | 36 | 178 |
| 2023 Mayo | 199 | 30 | 229 |
| 2023 Abril | 139 | 33 | 172 |
| 2023 Marzo | 134 | 36 | 170 |
| 2023 Febrero | 112 | 43 | 155 |
| 2023 Enero | 111 | 48 | 159 |
| 2022 Diciembre | 70 | 46 | 116 |
| 2022 Noviembre | 52 | 36 | 88 |
| 2022 Octubre | 57 | 29 | 86 |
| 2022 Septiembre | 49 | 45 | 94 |
| 2022 Agosto | 59 | 42 | 101 |
| 2022 Julio | 45 | 47 | 92 |
| 2022 Junio | 50 | 28 | 78 |
| 2022 Mayo | 107 | 56 | 163 |
| 2022 Abril | 101 | 49 | 150 |
| 2022 Marzo | 121 | 54 | 175 |
| 2022 Febrero | 113 | 31 | 144 |
| 2022 Enero | 164 | 50 | 214 |
| 2021 Diciembre | 124 | 42 | 166 |
| 2021 Noviembre | 100 | 58 | 158 |
| 2021 Octubre | 171 | 52 | 223 |
| 2021 Septiembre | 102 | 60 | 162 |
| 2021 Agosto | 134 | 48 | 182 |
| 2021 Julio | 126 | 39 | 165 |
| 2021 Junio | 100 | 31 | 131 |
| 2021 Mayo | 99 | 39 | 138 |
| 2021 Abril | 162 | 63 | 225 |
| 2021 Marzo | 96 | 35 | 131 |
| 2021 Febrero | 83 | 35 | 118 |
| 2021 Enero | 54 | 23 | 77 |
| 2020 Diciembre | 43 | 32 | 75 |
| 2020 Noviembre | 48 | 25 | 73 |
| 2020 Octubre | 43 | 28 | 71 |
| 2020 Septiembre | 42 | 15 | 57 |
| 2020 Agosto | 28 | 25 | 53 |
| 2020 Julio | 52 | 17 | 69 |
| 2020 Junio | 44 | 29 | 73 |
| 2020 Mayo | 42 | 26 | 68 |
| 2020 Abril | 71 | 28 | 99 |
| 2020 Marzo | 16 | 17 | 33 |
| 2020 Febrero | 6 | 0 | 6 |
| 2019 Diciembre | 6 | 0 | 6 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Septiembre | 10 | 0 | 10 |
| 2019 Agosto | 2 | 0 | 2 |
| 2019 Julio | 6 | 0 | 6 |
| 2019 Junio | 4 | 0 | 4 |
| 2019 Mayo | 9 | 0 | 9 |
| 2019 Abril | 2 | 0 | 2 |
| 2019 Marzo | 2 | 0 | 2 |
| 2019 Febrero | 2 | 0 | 2 |
| 2018 Diciembre | 3 | 0 | 3 |
| 2018 Noviembre | 3 | 0 | 3 |
| 2018 Octubre | 4 | 0 | 4 |
| 2018 Septiembre | 4 | 0 | 4 |
| 2018 Febrero | 33 | 4 | 37 |
| 2018 Enero | 73 | 5 | 78 |
| 2017 Diciembre | 50 | 13 | 63 |
| 2017 Noviembre | 35 | 9 | 44 |
| 2017 Octubre | 104 | 47 | 151 |
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