Practical Dermoscopy
Unilateral Digital Hyperpigmentation in a Teenager
Hiperpigmentación digital unilateral en adolescente
L. Campos Muñoz
, A. Fueyo Casado, E. López Bran
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Servicio de Dermatología, Hospital Clínico San Carlos, Madrid, Spain
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Campos Muñoz, A. Fueyo Casado, E. López Bran" "autores" => array:3 [ 0 => array:4 [ "nombre" => "L. Campos" "apellidos" => "Muñoz" "email" => array:1 [ 0 => "luciacampos78@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A. Fueyo" "apellidos" => "Casado" ] 2 => array:2 [ "nombre" => "E. López" "apellidos" => "Bran" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Clínico San Carlos, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hiperpigmentación digital unilateral en adolescente" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1380 "Ancho" => 1980 "Tamanyo" => 151828 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Brown macule on the third finger of the left hand.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case Presentation</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 14-year-old boy presented with brown pigmentation on the tip of the third finger of the left hand that had first appeared 4 months earlier. The lesion was asymptomatic and had remained stable over time (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">What Is Your Diagnosis?</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Comment</span><p id="par0010" class="elsevierStylePara elsevierViewall">Polarized light dermoscopy of the brown macule revealed multiple irregular light brown-reddish spots (“pebbles”) located mainly on the ridges of the skin markings. The lesions were highly suggestive of subcorneal hemorrhage (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). On further interrogation regarding possible recurrent trauma in the area of the lesion, the patient reported that he spent 2<span class="elsevierStyleHsp" style=""></span>hours a day playing video games on a PlayStation. The patient repeatedly used the affected finger to operate a lever on the video game controller. PlayStation use was discontinued and the skin lesion disappeared completely.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Although the parallel ridge pattern (PRP) in acral skin has a specificity of 99% for melanoma,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> other benign lesions can also have this pattern. Pigmentation caused by dye, macules typical of certain racial groups with dark skin phototypes, pigmented viral warts, macules associated with Peutz-Jeghers syndrome, chemotherapy-induced acral pigmentation, and acral subcorneal hemorrhage may also show PRP.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Acral subcorneal hemorrhage appears following repeated minor trauma at the same site, normally in association with work or sports. The heel is the area most often affected by acral subcorneal hemorrhage (usually caused by physical exercise), which clinically manifests as a black macule that may be well or poorly defined. Dermoscopy of subcorneal hematomas can reveal various patterns: homogeneous reddish-blackish pigmentation, PRP with pigment occupying the entire ridge, and, less frequently, a parallel-furrow or fibrillar pattern. Another possible pattern is that seen in our patient: multiple rounded and irregular reddish-black or brown “pebbles” along the ridge.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> The globular pattern may also be present as peripheral satellite globules isolated from the main lesion. In conclusion, subcorneal hematomas can show a great variety of patterns and can mimic multiple lesions, but the presence of blackish-reddish or brown coloring can provide a clue regarding the correct diagnosis.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> Another finding suggestive of subcorneal hematoma is the disappearance of the lesion with superficial scraping.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Excessive video game use has been associated with the appearance of blisters, onycholysis, and acral subcorneal hemorrhage on the tips of fingers that repeatedly operate the video game controller.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> Such lesions were first described in the thumb but have since been reported in other fingers, as in our patient. Similar lesions caused by intensive mobile telephone use have been reported in teenagers.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">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:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case Presentation" ] 1 => array:3 [ "identificador" => "sec0010" "titulo" => "What Is Your Diagnosis?" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Comment" ] ] ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of Interest" ] 3 => 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: Muñoz LC, Casado AF, Bran EL. Hiperpigmentación digital unilateral en adolescente. Actas Dermosifiliogr. 2017;108:943–944.</p>" ] ] "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" => 1380 "Ancho" => 1980 "Tamanyo" => 151828 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Brown macule on the third finger of the left hand.</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" => 1268 "Ancho" => 1815 "Tamanyo" => 153433 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Multiple irregular reddish-brown spots (“pebbles”). The spots were mainly distributed on the ridges of the skin markings.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Significance of dermoscopic patterns in detecting malignant melanoma on acral volar skin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T. Saida" 1 => "A. Miyazaki" 2 => "S. 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Conejo-Mir" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2009.12.043" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2011" "volumen" => "65" "paginaInicial" => "238" "paginaFinal" => "239" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21679837" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "From PlayStation™ thumb to cellphone thumb: The new epidemic in teenagers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S.A. Karin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "S Afr Med J" "fecha" => "2009" "volumen" => "99" "paginaInicial" => "161" "paginaFinal" => "162" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19563092" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010800000010/v1_201711300824/S1578219017303116/v1_201711300824/en/main.assets" "Apartado" => array:4 [ "identificador" => "19289" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Practical Dermoscopy" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010800000010/v1_201711300824/S1578219017303116/v1_201711300824/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219017303116?idApp=UINPBA000044" ]
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| 2022 Octubre | 56 | 25 | 81 |
| 2022 Septiembre | 43 | 38 | 81 |
| 2022 Agosto | 28 | 49 | 77 |
| 2022 Julio | 23 | 43 | 66 |
| 2022 Junio | 28 | 38 | 66 |
| 2022 Mayo | 106 | 59 | 165 |
| 2022 Abril | 126 | 43 | 169 |
| 2022 Marzo | 78 | 47 | 125 |
| 2022 Febrero | 71 | 32 | 103 |
| 2022 Enero | 81 | 34 | 115 |
| 2021 Diciembre | 64 | 45 | 109 |
| 2021 Noviembre | 90 | 54 | 144 |
| 2021 Octubre | 109 | 58 | 167 |
| 2021 Septiembre | 141 | 46 | 187 |
| 2021 Agosto | 45 | 31 | 76 |
| 2021 Julio | 30 | 22 | 52 |
| 2021 Junio | 45 | 25 | 70 |
| 2021 Mayo | 51 | 43 | 94 |
| 2021 Abril | 95 | 34 | 129 |
| 2021 Marzo | 58 | 42 | 100 |
| 2021 Febrero | 41 | 24 | 65 |
| 2021 Enero | 39 | 23 | 62 |
| 2020 Diciembre | 30 | 24 | 54 |
| 2020 Noviembre | 36 | 26 | 62 |
| 2020 Octubre | 29 | 14 | 43 |
| 2020 Septiembre | 31 | 21 | 52 |
| 2020 Agosto | 23 | 14 | 37 |
| 2020 Julio | 21 | 21 | 42 |
| 2020 Junio | 35 | 28 | 63 |
| 2020 Mayo | 20 | 14 | 34 |
| 2020 Abril | 13 | 17 | 30 |
| 2020 Marzo | 27 | 17 | 44 |
| 2020 Febrero | 2 | 0 | 2 |
| 2019 Diciembre | 4 | 0 | 4 |
| 2019 Septiembre | 6 | 0 | 6 |
| 2019 Mayo | 2 | 1 | 3 |
| 2019 Febrero | 2 | 0 | 2 |
| 2019 Enero | 1 | 0 | 1 |
| 2018 Diciembre | 2 | 0 | 2 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Octubre | 1 | 0 | 1 |
| 2018 Septiembre | 2 | 0 | 2 |
| 2018 Abril | 1 | 0 | 1 |
| 2018 Febrero | 24 | 6 | 30 |
| 2018 Enero | 45 | 13 | 58 |
| 2017 Diciembre | 72 | 41 | 113 |
| 2017 Noviembre | 10 | 8 | 18 |
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