Case and Research Letters
Lichen Aureus: A Congenital Case?
Liquen aureus: ¿un caso congénito?
O. Corral-Magaña
, J. Escalas Taberner, A. Bauzá Alonso, A. Martin-Santiago
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Servicio de Dermatología, Hospital Universitario Son Espases, Palma de Mallorca, Baleares, España
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"tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "965" "paginaFinal" => "966" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Lichen <span class="elsevierStyleItalic">Aureus:</span> A Congenital Case?" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1496 "Ancho" => 1980 "Tamanyo" => 609398 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histología de la lesión. A) Infiltrado inflamatorio liquenoide en banda en dermis papilar respetando estructuras anexiales (H&E ×10). 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"tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "965" "paginaFinal" => "966" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "O. Corral-Magaña, J. Escalas Taberner, A. Bauzá Alonso, A. Martin-Santiago" "autores" => array:4 [ 0 => array:4 [ "nombre" => "O." "apellidos" => "Corral-Magaña" "email" => array:1 [ 0 => "oricmag@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Escalas Taberner" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Bauzá Alonso" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Martin-Santiago" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Son Espases, Palma de Mallorca, Baleares, España" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Liquen <span class="elsevierStyleItalic">aureus:</span> ¿un caso congénito?" ] ] "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" => 1645 "Ancho" => 1980 "Tamanyo" => 290524 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical and dermoscopic images of the patient. A, Grouped, shiny erythematous-purpuric plaques with fine superficial desquamation on the left knee. B, Dermoscopy showing red dots on a brownish-gray background with a fine network. C, Clinical course of the lesion after several attempted treatments. Note persistence of the plaques but with a slight reduction in color.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 9-year-old boy, with Fitzpatrick skin phototype <span class="elsevierStyleSmallCaps">V</span>, was seen for an asymptomatic lesion on his left knee, diagnosed at birth by the neonatologist as a café au lait spot. The lesion was described in the neonatal discharge report as a brownish macule measuring 1.5<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>1.5<span class="elsevierStyleHsp" style=""></span>cm, on the left knee, observed during the first examination of the newborn infant. However, there had been no subsequent follow-up and the child had not been seen in dermatology before his visit to our outpatient clinic. On examination of the child's left knee, a number of shiny erythematous-purpuric plaques were observed in a linear distribution, with a slightly pigmented halo and fine superficial desquamation. Dermoscopy revealed lobules and pink dots on a diffuse coppery-brown background, and a fine brown network (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). With a diagnostic suspicion of a lichenoid rash, lichen aureus (LA), or nevus flammeus—because of its congenital nature—one of the plaques was biopsied.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Minimal hyperkeratosis, mild acanthosis, and mild epidermal spongiosis were observed on histology, together with a dense, band-like lichenoid inflammatory infiltrate in the papillary dermis, with occasional apoptotic keratinocytes and extensive red cell extravasation (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The patient was diagnosed with LA and treatment was started with 0.1% methylprednisolone aceponate for a month. No improvement was observed at the follow-up visit at 4 months, although his parents considered the lesion to be less infiltrated. He was then prescribed a 1-month course of treatment with 0.25% prednicarbate cream. Four months later the lesion remained unchanged. Given the benign and asymptomatic nature of the lesion and the lack of improvement, it was decided to abstain from further therapy and to keep the patient on follow-up. At the time of writing, the lesion continues unchanged.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">LA is a rare entity in children, with a higher incidence in young adults.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> It was first described in 1959 by Martin, though it was not until 1960 that Calman coined the current name based on its characteristic golden halo.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> It is included in the group of pigmented purpuric dermatoses.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The etiology of LA is unknown, although several etiological factors and triggers have been proposed, such as infection, trauma, toxins, venous insufficiency, contact allergy, and underlying autoimmune diseases.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,3</span></a> LA usually presents as brownish, violaceous, or copper-colored macules and papules or plaques, with a peripheral golden-yellow halo, fine superficial desquamation, and shiny surface.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,3,4</span></a> Lesions are typically unilateral on the limbs or trunk, although they can be bilateral in around 10% of cases.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Up to now, LA has most often been described as a lesion affecting the lower limbs, but a recent series of 25 patients found the same prevalence on arms and legs.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Dermoscopy is a useful diagnostic tool in this entity. The reported findings are summarized in 4 points: a diffuse brownish or copper-red background, red lobules or dots, grayish dots, and a pigmented network or pseudonetwork.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Histologically, there is a characteristic band-like lymphocytic infiltrate and red-cell extravasation with hemosiderin deposits.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Hemosiderin may not be seen in the early stages on staining with hematoxylin and eosin; Perls stain is useful in these cases.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,7</span></a> The presence of a periadnexal and perineural infiltrate is a histological finding disputed in the literature and is more characteristic of lichen striatus. In their series of 25 patients, Zeng YP et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> found a periadnexal infiltrate in 12 patients and a perineural infiltrate in 5, more common than previously reported in LA.</p><p id="par0035" class="elsevierStylePara elsevierViewall">It should be noted that LA can occasionally be confused with mycosis fungoides (MF), and some authors even defend a relationship between the 2 diseases, suggesting that LA may have the capacity to progress to MF.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The diagnosis is clinical and pathological and the differential diagnosis should include other pigmented purpuric dermatoses, mycosis fungoides, lichen striatus, blaschkitis, traumatic contusions, contact dermatitis, and Langerhans histiocytosis.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,8</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The prognosis of the disease is variable and unpredictable; most commonly there is spontaneous resolution with subsequent recurrences.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4,9</span></a> A number of therapeutic alternatives have been proposed, including topical corticosteroids, phototherapy, and calcineurin inhibitors, although there is still no truly effective option.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">We have presented a case of segmental LA in a patient with a high skin phototype, a factor that altered the color of the lesion, giving it a more pigmented appearance than usual and masking the characteristic golden-yellow halo. Dermoscopy and histology enabled us to reach a correct diagnosis. Neonatal LA has been reported in the literature,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> but we have found no other cases of congenital LA. In our patient, the lesion observed when he was 9 years old was at the same site as the lesion described in the first neonatal examination. In addition, the patient's parents described it as the same lesion. This would all support its congenital nature, though this cannot be confirmed, as no dermatologic follow-up was performed on this patient after birth.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0055" 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" => "Références" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Corral-Magaña O, Escalas J, Bauzá A, Martin-Santiago A. Liquen <span class="elsevierStyleItalic">aureus:</span> ¿un caso congénito?. Actas Dermosifiliogr. 2017;108:965–966.</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" => 1645 "Ancho" => 1980 "Tamanyo" => 290524 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical and dermoscopic images of the patient. A, Grouped, shiny erythematous-purpuric plaques with fine superficial desquamation on the left knee. B, Dermoscopy showing red dots on a brownish-gray background with a fine network. C, Clinical course of the lesion after several attempted treatments. Note persistence of the plaques but with a slight reduction in color.</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" => 1496 "Ancho" => 1980 "Tamanyo" => 610867 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histology of the lesion. A, A band-like lichenoid inflammatory infiltrate in the papillary dermis, not affecting the skin appendages. Hematoxylin and eosin (H&E), original magnification<span class="elsevierStyleHsp" style=""></span>×10. B, Widespread red cell extravasation. H&E, original magnification<span class="elsevierStyleHsp" style=""></span>×40.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Références" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lichen aureus: Clinicopathological features in a Chinese series" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Y.P. Zeng" 1 => "K. Fang" 2 => "D.L. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 10 | 10 | 20 |
| 2024 Octubre | 85 | 46 | 131 |
| 2024 Septiembre | 96 | 40 | 136 |
| 2024 Agosto | 132 | 70 | 202 |
| 2024 Julio | 100 | 39 | 139 |
| 2024 Junio | 120 | 60 | 180 |
| 2024 Mayo | 89 | 47 | 136 |
| 2024 Abril | 108 | 23 | 131 |
| 2024 Marzo | 110 | 26 | 136 |
| 2024 Febrero | 101 | 35 | 136 |
| 2024 Enero | 86 | 27 | 113 |
| 2023 Diciembre | 125 | 17 | 142 |
| 2023 Noviembre | 161 | 28 | 189 |
| 2023 Octubre | 151 | 30 | 181 |
| 2023 Septiembre | 128 | 39 | 167 |
| 2023 Agosto | 124 | 21 | 145 |
| 2023 Julio | 125 | 30 | 155 |
| 2023 Junio | 85 | 25 | 110 |
| 2023 Mayo | 83 | 31 | 114 |
| 2023 Abril | 96 | 23 | 119 |
| 2023 Marzo | 86 | 27 | 113 |
| 2023 Febrero | 70 | 29 | 99 |
| 2023 Enero | 46 | 39 | 85 |
| 2022 Diciembre | 69 | 38 | 107 |
| 2022 Noviembre | 71 | 22 | 93 |
| 2022 Octubre | 88 | 17 | 105 |
| 2022 Septiembre | 121 | 38 | 159 |
| 2022 Agosto | 64 | 34 | 98 |
| 2022 Julio | 47 | 38 | 85 |
| 2022 Junio | 45 | 24 | 69 |
| 2022 Mayo | 151 | 35 | 186 |
| 2022 Abril | 109 | 40 | 149 |
| 2022 Marzo | 112 | 37 | 149 |
| 2022 Febrero | 86 | 25 | 111 |
| 2022 Enero | 150 | 47 | 197 |
| 2021 Diciembre | 69 | 46 | 115 |
| 2021 Noviembre | 86 | 48 | 134 |
| 2021 Octubre | 109 | 67 | 176 |
| 2021 Septiembre | 83 | 50 | 133 |
| 2021 Agosto | 116 | 34 | 150 |
| 2021 Julio | 95 | 24 | 119 |
| 2021 Junio | 80 | 31 | 111 |
| 2021 Mayo | 82 | 39 | 121 |
| 2021 Abril | 252 | 58 | 310 |
| 2021 Marzo | 146 | 31 | 177 |
| 2021 Febrero | 109 | 33 | 142 |
| 2021 Enero | 71 | 19 | 90 |
| 2020 Diciembre | 64 | 16 | 80 |
| 2020 Noviembre | 72 | 25 | 97 |
| 2020 Octubre | 67 | 12 | 79 |
| 2020 Septiembre | 63 | 16 | 79 |
| 2020 Agosto | 62 | 19 | 81 |
| 2020 Julio | 49 | 11 | 60 |
| 2020 Junio | 49 | 26 | 75 |
| 2020 Mayo | 43 | 7 | 50 |
| 2020 Abril | 34 | 22 | 56 |
| 2020 Marzo | 24 | 11 | 35 |
| 2020 Febrero | 4 | 0 | 4 |
| 2020 Enero | 4 | 0 | 4 |
| 2019 Diciembre | 8 | 0 | 8 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Septiembre | 8 | 0 | 8 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 4 | 0 | 4 |
| 2019 Junio | 6 | 0 | 6 |
| 2019 Mayo | 4 | 0 | 4 |
| 2019 Abril | 2 | 0 | 2 |
| 2019 Marzo | 6 | 0 | 6 |
| 2019 Enero | 4 | 0 | 4 |
| 2018 Diciembre | 3 | 0 | 3 |
| 2018 Noviembre | 1 | 0 | 1 |
| 2018 Octubre | 5 | 0 | 5 |
| 2018 Septiembre | 2 | 0 | 2 |
| 2018 Marzo | 0 | 1 | 1 |
| 2018 Febrero | 30 | 5 | 35 |
| 2018 Enero | 35 | 9 | 44 |
| 2017 Diciembre | 156 | 33 | 189 |
| 2017 Noviembre | 13 | 9 | 22 |
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