Case and Research Letter
Hyperkeratotic lesions on legs
Lesiones hiperqueratósicas en piernas
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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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The lesions are limited to the areas affected by varicella-zoster virus reactivation 2 years earlier (left scapular region).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. Martín-Carrasco, C. Pérez-Ruiz, T. de Zulueta-Dorado, J. Conejo-Mir" "autores" => array:4 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Martín-Carrasco" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Pérez-Ruiz" ] 2 => array:2 [ "nombre" => "T." "apellidos" => "de Zulueta-Dorado" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Conejo-Mir" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731017301813" "doi" => "10.1016/j.ad.2017.02.016" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731017301813?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219017302457?idApp=UINPBA000044" "url" => "/15782190/0000010800000008/v1_201710010015/S1578219017302457/v1_201710010015/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219017303001" "issn" => "15782190" "doi" => "10.1016/j.adengl.2017.04.010" "estado" => "S300" "fechaPublicacion" => "2017-10-01" "aid" => "1691" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2017;108:779-81" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 458 "formatos" => array:3 [ "EPUB" => 19 "HTML" => 361 "PDF" => 78 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Dermoscopy of Erythromelanosis Follicularis Faciei et Colli" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "779" "paginaFinal" => "781" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dermatoscopia de erythromelanosis folicular faciei et colli" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "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>" ] ] ] "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." "apellidos" => "Stinco" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0001731017302442" "doi" => "10.1016/j.ad.2017.04.016" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731017302442?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219017303001?idApp=UINPBA000044" "url" => "/15782190/0000010800000008/v1_201710010015/S1578219017303001/v1_201710010015/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Hyperkeratotic lesions on legs" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "781" "paginaFinal" => "782" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J.M. Sánchez Sánchez, J. Molinero Caturla, J.R. Ferreres Riera, R.M. Penín Mosquera" "autores" => array:4 [ 0 => array:4 [ "nombre" => "J.M." "apellidos" => "Sánchez Sánchez" "email" => array:1 [ 0 => "joaquinazul2@yahoo.es" ] "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." "apellidos" => "Molinero Caturla" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "J.R." "apellidos" => "Ferreres Riera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "R.M." "apellidos" => "Penín Mosquera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Anatomía Patológica, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, 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 hiperqueratósicas en piernas" ] ] "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" => 745 "Ancho" => 951 "Tamanyo" => 222696 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hemanotoxylin-eosin (×100). Orthokeratotic papillomatosis with focal lymphoid infiltrate in papillary dermis and church spire pattern.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Skin hyperkeratosis is a common pathology in dermatological consultation. From localized pathology, such as corns or common warts, to diseases with a more diffuse effect such as psoriasis and ichthyosis, diagnosis is usually easy, in response to the history and location of lesions. But sometimes histological or analytical study is essential.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report a 71-year-old male with multimorbidity (hypertension, diabetes mellitus, ischemic heart disease, mitral regurgitation, left bundle branch block, hepatic steatosis, fibrosing alveolitis, COPD, hypercholesterolemia, hyperuricemia and glaucoma) who presented hyperkeratotic lesions on the legs (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The patient had worked ten years in a photografic laboratory and twenty as carpenter. The lesions were asymptomatic and he had them for more than twenty years. They were located only on the front side of the legs and other skin was respected. Lesions were 2–6<span class="elsevierStyleHsp" style=""></span>mm in diameter and were very adherent. Some had peripheral reinforcement. The patient showed no other symptoms and denied use of cosmetics or chemicals in the area. He had not suffered weight loss or anorexia. He had no history of contact dermatitis, burns or trauma. There was low actinic exposure in the area. No family member had similar injuries. The patient had a history of working in a carpentry workshop for more than twenty years.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">With suspicion of perforating skin disease, actinic keratosis, or porokeratosis, we carried out a 4<span class="elsevierStyleHsp" style=""></span>mm punch of one of the lesions. Histology showed orthokeratotic papillomatosis with focal lymphoid infiltrate in papillary dermis. The sample showed no atypia. The pathology guided us to keratotic lesions with a ‘church spire’ pattern (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). This pattern suggests multiple diagnostic possibilities: arsenic poisoning or tars, nutritional deficits (phrynoderma), digitata keratosis, Hopf verruciformis acrokeratosis, or stucco keratosis. Chest radiography was normal but analytical research showed urinary arsenic levels of 317<span class="elsevierStyleHsp" style=""></span>μg/g creatinine (normal levels in occupationally exposed people <100<span class="elsevierStyleHsp" style=""></span>μg/g creatinine). The patient was diagnosed with chronic arsenic poisoning.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Arsenic poisoning has, as its main cause, ingestion of contaminated water.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> This is a significant public health problem in areas of South and Southeast Asia (India, China, Taiwan, Philippines, Thailand, Bangladesh) and the Americas (Argentina, Chile, Mexico, and the USA) where arsenical products are detected either naturally or occasionally by industrial waste. As a second etiologic factor there is workplace exposure. Health damage results from inorganic arsenic (the toxic form) in pesticides, herbicides, mining and galvanized microchips. Occasionally wood preservatives contain arsenic derivatives.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> This could explain our case. Our patient had long worked with wood in a carpentry workshop that, he admitted, was not ventilated. As a final cause we have to consider poisoning or drugs (in traditional Chinese medicine,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> certain antileukemia drugs,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> and, until 1960, Fowler's solution as an antiasthmatic).</p><p id="par0025" class="elsevierStylePara elsevierViewall">Chronic arsenic poisoning has a latency period of years<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> before showing clinical signs, but when it does, it may affect multiple systems: cardiovascular (increased QT, T-wave alteration, ST segment alteration), renal and hepatic dysfunction, peripheral neuropathy, blindness, alterations of blood count, electrolytes and acid-base balance, and neoplasms of the lung, bladder, and kidney.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,7</span></a> In skin it usually manifests as dotted, symmetrical palmoplantar keratosic lesions of 2–10<span class="elsevierStyleHsp" style=""></span>mm, which may coalesce into plaques. Outside the palms and soles it is characteristic to find mottled pigmentation with hypopigmented areas. It should be noted that there is also increased risk of non-melanoma skin cancer, especially Bowen's disease, in these patients.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Arsenical dermatosis usually shows a pathology with marked hyperkeratosis, scattered parakeratosis, and mild keratinocyte atipia. Adnexal structures are spared while vacuolation of keratinocytes may be noted.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Chelators (dimercaprol and dimercaptosuccinic acid) are used mainly in the treatment of acute poisoning<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> but these treatments have proven ineffective in chronic forms.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">9,10</span></a> The use of retinoids has been suggested to prevent the formation of epidermoid carcinomas and Bowen's disease in patients with multiple keratoses. But in chronic forms, the most important action is to avoid toxic exposure, ensuring arsenic-free sources of water and limiting occupational exposure.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Hyperkeratotic lesions, so common in the dermatology consultation, tend to be easily diagnosed. The pattern of injury (location, number of lesions, and form) usually gives us an accurate and rapid diagnosis but occasionally we may have difficulties. In these cases we must take into account less common causes such as congenital forms of hyperkeratosis, perforating diseases, paraneoplastic syndrome, or poisoning. We present this case as a reminder and to illustrate one of those rare cases of pathology that we may see in our medical consultation.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0045" 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" => "Conflict 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" => 714 "Ancho" => 951 "Tamanyo" => 123784 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hyperkeratotic lesion on the legs.</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" => 745 "Ancho" => 951 "Tamanyo" => 222696 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hemanotoxylin-eosin (×100). Orthokeratotic papillomatosis with focal lymphoid infiltrate in papillary dermis and church spire pattern.</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" => "Effect of safe water on arsenicosis: a follow-up study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "K.K. Majumdar" 1 => "A. Ghose" 2 => "N. Ghose" 3 => "A. Biswas" 4 => "D.N. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 12 | 14 | 26 |
| 2024 Octubre | 122 | 49 | 171 |
| 2024 Septiembre | 133 | 57 | 190 |
| 2024 Agosto | 151 | 69 | 220 |
| 2024 Julio | 141 | 68 | 209 |
| 2024 Junio | 113 | 50 | 163 |
| 2024 Mayo | 94 | 45 | 139 |
| 2024 Abril | 116 | 18 | 134 |
| 2024 Marzo | 121 | 41 | 162 |
| 2024 Febrero | 103 | 39 | 142 |
| 2024 Enero | 126 | 36 | 162 |
| 2023 Diciembre | 126 | 22 | 148 |
| 2023 Noviembre | 142 | 26 | 168 |
| 2023 Octubre | 100 | 23 | 123 |
| 2023 Septiembre | 120 | 32 | 152 |
| 2023 Agosto | 109 | 20 | 129 |
| 2023 Julio | 103 | 33 | 136 |
| 2023 Junio | 91 | 25 | 116 |
| 2023 Mayo | 129 | 21 | 150 |
| 2023 Abril | 77 | 24 | 101 |
| 2023 Marzo | 72 | 18 | 90 |
| 2023 Febrero | 62 | 24 | 86 |
| 2023 Enero | 63 | 26 | 89 |
| 2022 Diciembre | 59 | 32 | 91 |
| 2022 Noviembre | 21 | 22 | 43 |
| 2022 Octubre | 26 | 18 | 44 |
| 2022 Septiembre | 26 | 30 | 56 |
| 2022 Agosto | 40 | 28 | 68 |
| 2022 Julio | 30 | 34 | 64 |
| 2022 Junio | 29 | 23 | 52 |
| 2022 Mayo | 128 | 30 | 158 |
| 2022 Abril | 137 | 23 | 160 |
| 2022 Marzo | 135 | 45 | 180 |
| 2022 Febrero | 142 | 23 | 165 |
| 2022 Enero | 168 | 31 | 199 |
| 2021 Diciembre | 117 | 30 | 147 |
| 2021 Noviembre | 123 | 50 | 173 |
| 2021 Octubre | 135 | 44 | 179 |
| 2021 Septiembre | 126 | 35 | 161 |
| 2021 Agosto | 157 | 37 | 194 |
| 2021 Julio | 122 | 52 | 174 |
| 2021 Junio | 106 | 27 | 133 |
| 2021 Mayo | 69 | 55 | 124 |
| 2021 Abril | 151 | 50 | 201 |
| 2021 Marzo | 109 | 29 | 138 |
| 2021 Febrero | 102 | 32 | 134 |
| 2021 Enero | 36 | 16 | 52 |
| 2020 Diciembre | 42 | 16 | 58 |
| 2020 Noviembre | 30 | 27 | 57 |
| 2020 Octubre | 33 | 20 | 53 |
| 2020 Septiembre | 18 | 14 | 32 |
| 2020 Agosto | 29 | 20 | 49 |
| 2020 Julio | 16 | 16 | 32 |
| 2020 Junio | 23 | 34 | 57 |
| 2020 Mayo | 14 | 18 | 32 |
| 2020 Abril | 19 | 17 | 36 |
| 2020 Marzo | 17 | 14 | 31 |
| 2020 Febrero | 6 | 0 | 6 |
| 2020 Enero | 2 | 0 | 2 |
| 2019 Diciembre | 4 | 0 | 4 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Septiembre | 4 | 0 | 4 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 4 | 0 | 4 |
| 2019 Junio | 4 | 0 | 4 |
| 2019 Mayo | 7 | 0 | 7 |
| 2019 Abril | 4 | 0 | 4 |
| 2019 Marzo | 2 | 0 | 2 |
| 2018 Diciembre | 4 | 0 | 4 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Septiembre | 4 | 0 | 4 |
| 2018 Marzo | 1 | 0 | 1 |
| 2018 Febrero | 43 | 1 | 44 |
| 2018 Enero | 64 | 5 | 69 |
| 2017 Diciembre | 34 | 8 | 42 |
| 2017 Noviembre | 33 | 9 | 42 |
| 2017 Octubre | 101 | 34 | 135 |
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