Case and Research Letters
Multiple Epidermolytic Acanthomas on the Scrotum: What Genital Pruritus Can Reveal
Acantomas epidermolíticos múltiples del escroto: Lo que el prurito genital puede esconder
P. García-Martínez
, L. Curto-Barredo, R. Rovira-López, R.M. Pujol
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Servicio Dermatología, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
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Eritema escrotal difuso. Pápulas aisladas de pequeño tamaño. (b). Detalle de las lesiones: múltiples pápulas hiperqueratósicas escrotales. (c). Acantoma epidermolítico: acantosis irregular con hiperqueratosis ortoqueratósica y papilomatosis (hematoxilina-eosina ×<span class="elsevierStyleHsp" style=""></span>40). (d). Detalle del aumento del número de gránulos de queratohialina en el estrato granuloso y acantólisis focal (hematoxilina-eosina ×<span class="elsevierStyleHsp" style=""></span>400).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. García-Martínez, L. Curto-Barredo, R. Rovira-López, R.M. Pujol" "autores" => array:4 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "García-Martínez" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Curto-Barredo" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Rovira-López" ] 3 => array:2 [ "nombre" => "R.M." 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García-Martínez, L. Curto-Barredo, R. Rovira-López, R.M. Pujol" "autores" => array:4 [ 0 => array:4 [ "nombre" => "P." "apellidos" => "García-Martínez" "email" => array:1 [ 0 => "pablogmh@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Curto-Barredo" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Rovira-López" ] 3 => array:2 [ "nombre" => "R.M." "apellidos" => "Pujol" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio Dermatología, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Acantomas epidermolíticos múltiples del escroto: Lo que el prurito genital puede esconder" ] ] "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" => 1712 "Ancho" => 2336 "Tamanyo" => 845494 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Diffuse scrotal erythema and small, isolated papules. B, Detail of the lesions: multiple hyperkeratotic scrotal papules. C, Epidermolytic acanthoma: irregular acanthosis with orthokeratotic hyperkeratosis and papillomatosis. Hematoxylin and eosin (H&E), original magnification<span class="elsevierStyleHsp" style=""></span>×40. D, Detail of the increased number of keratohyalin granules in the stratum granulosum and focal acantholysis. H&E, original magnification<span class="elsevierStyleHsp" style=""></span>×400.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Epidermolytic acanthoma (EA) is a rare benign lesion described by Shapiro and Baraf<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> in 1970. It typically presents clinically as a solitary, asymptomatic verrucous papule. Histologically, there is an epidermal proliferation (acanthoma) with epidermolytic hyperkeratosis, without the concomitant presence of signs suggestive of other cutaneous tumors. The presence of multiple EAs in the genital and perigenital region is an individualized variant with well-defined clinical and pathologic characteristics.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 49-year-old man with no past medical history of interest, reported the progressive appearance over the previous 18 months of multiple pruritic papules on his scrotum.</p><p id="par0015" class="elsevierStylePara elsevierViewall">He denied any triggering factors such as trauma or high-risk sexual behavior. Physical examination revealed the presence of numerous, small (2-4<span class="elsevierStyleHsp" style=""></span>mm), well-defined papules of whitish color and with a verrucous surface lying on a background of mild erythema (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>, A and B). Histology of one of the lesions showed an acanthotic epidermis with intense orthokeratotic hyperkeratosis with hypergranulosis and papillomatosis. Abundant large keratohyalin granules were observed in the stratum granulosum, associated with vacuolar cell degeneration and edema, giving rise to focal separation in the upper third of the epidermis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>, C and D). No histopathological changes suggestive of human papillomavirus (HPV) infection were present, and immunohistochemistry with anti-HPV antibodies was negative.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Treatment with 0.1% pimecrolimus cream was prescribed for the pruritus, and the lesions were then treated using cryotherapy, causing increased discomfort. A slight improvement was observed at the following visit, with reduced erythema and pruritus, and the lesions treated with cryotherapy had resolved.</p><p id="par0025" class="elsevierStylePara elsevierViewall">EA is a benign and usually asymptomatic tumor that typically presents in adult individuals. It has been described as a solitary lesion, though occasionally it can present with multiple lesions that may be localized or widespread. The solitary forms can arise at any site, whereas multiple or widespread lesions appear to preferentially affect the genitocrural region.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Clinically, multiple genital EA lesions present as numerous, flat or verrucous, skin-colored or whitish papules on the scrotum, vulva, perineum, or occasionally perianal region. The lesions can be asymptomatic or produce a variable degree of pruritus, causing scratching and persistence of the condition. The differential diagnosis includes other diseases more prevalent in the genital region, such as condyloma acuminatum, bowenoid papulosis, and molluscum contagiosum.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Histologically there is a compact hyperkeratosis. Vacuolar degeneration of keratinocytes is observed in the granular layer and stratum spinosum of the epidermis, together with the presence of cytoplasmic amphophilic material and numerous basophilic bodies similar to keratohyalin and amorphous eosinophilic bodies of the trichohyalin type.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The etiopathogenesis of EA is unknown. Some potential triggers have been identified, including viral infections, UV exposure, immunosuppression, and recurrent trauma (scratching).<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5–7</span></a> Mutations in the keratin K1 and K10 genes have been reported in isolated cases, and there has been no evidence of the presence or participation of HPV in the majority of cases studied.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8,9</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Multiple asymptomatic EA does not require treatment. However, certain topical keratolytic treatments (lactic, salicylic, or glycolic acid) have been found to be effective in some cases, as have more aggressive treatments, such as curettage, cryotherapy, and carbon dioxide laser. Low-potency topical corticosteroids can be useful in cases with pruritus, and the use of calcineurin inhibitors has also recently been described.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Multiple anogenital EA is a clinical variant of EA that can present with persistent genital pruritus and must be included in the differential diagnosis of multiple papular genital lesions. The characteristic histological findings of EA make skin biopsy useful to confirm the diagnosis.</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" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García-Martínez P, Curto-Barredo L, Rovira-López R, Pujol RM. Acantomas epidermolíticos múltiples del escroto: lo que el prurito genital puede esconder. Actas Dermosifiliogr. 2018;109:81–82.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1712 "Ancho" => 2336 "Tamanyo" => 845494 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Diffuse scrotal erythema and small, isolated papules. B, Detail of the lesions: multiple hyperkeratotic scrotal papules. C, Epidermolytic acanthoma: irregular acanthosis with orthokeratotic hyperkeratosis and papillomatosis. Hematoxylin and eosin (H&E), original magnification<span class="elsevierStyleHsp" style=""></span>×40. D, Detail of the increased number of keratohyalin granules in the stratum granulosum and focal acantholysis. H&E, original magnification<span class="elsevierStyleHsp" style=""></span>×400.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "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" => "Isolated epidermolytic acanthoma. A solitary tumor showing granular degeneration" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Shapiro" 1 => "C.S. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 21 | 19 | 40 |
| 2024 Octubre | 189 | 89 | 278 |
| 2024 Septiembre | 276 | 58 | 334 |
| 2024 Agosto | 333 | 91 | 424 |
| 2024 Julio | 246 | 85 | 331 |
| 2024 Junio | 233 | 71 | 304 |
| 2024 Mayo | 186 | 47 | 233 |
| 2024 Abril | 161 | 30 | 191 |
| 2024 Marzo | 213 | 41 | 254 |
| 2024 Febrero | 316 | 76 | 392 |
| 2024 Enero | 246 | 41 | 287 |
| 2023 Diciembre | 327 | 19 | 346 |
| 2023 Noviembre | 300 | 34 | 334 |
| 2023 Octubre | 273 | 45 | 318 |
| 2023 Septiembre | 268 | 44 | 312 |
| 2023 Agosto | 157 | 29 | 186 |
| 2023 Julio | 165 | 53 | 218 |
| 2023 Junio | 135 | 31 | 166 |
| 2023 Mayo | 117 | 52 | 169 |
| 2023 Abril | 141 | 36 | 177 |
| 2023 Marzo | 156 | 38 | 194 |
| 2023 Febrero | 128 | 43 | 171 |
| 2023 Enero | 145 | 54 | 199 |
| 2022 Diciembre | 149 | 51 | 200 |
| 2022 Noviembre | 92 | 46 | 138 |
| 2022 Octubre | 96 | 51 | 147 |
| 2022 Septiembre | 102 | 68 | 170 |
| 2022 Agosto | 88 | 44 | 132 |
| 2022 Julio | 104 | 42 | 146 |
| 2022 Junio | 86 | 41 | 127 |
| 2022 Mayo | 162 | 52 | 214 |
| 2022 Abril | 203 | 68 | 271 |
| 2022 Marzo | 196 | 61 | 257 |
| 2022 Febrero | 200 | 53 | 253 |
| 2022 Enero | 290 | 69 | 359 |
| 2021 Diciembre | 149 | 54 | 203 |
| 2021 Noviembre | 155 | 47 | 202 |
| 2021 Octubre | 214 | 72 | 286 |
| 2021 Septiembre | 157 | 55 | 212 |
| 2021 Agosto | 185 | 81 | 266 |
| 2021 Julio | 160 | 46 | 206 |
| 2021 Junio | 242 | 38 | 280 |
| 2021 Mayo | 183 | 59 | 242 |
| 2021 Abril | 431 | 109 | 540 |
| 2021 Marzo | 244 | 44 | 288 |
| 2021 Febrero | 198 | 34 | 232 |
| 2021 Enero | 151 | 28 | 179 |
| 2020 Diciembre | 126 | 28 | 154 |
| 2020 Noviembre | 166 | 25 | 191 |
| 2020 Octubre | 98 | 29 | 127 |
| 2020 Septiembre | 105 | 21 | 126 |
| 2020 Agosto | 130 | 25 | 155 |
| 2020 Julio | 104 | 26 | 130 |
| 2020 Junio | 100 | 44 | 144 |
| 2020 Mayo | 87 | 19 | 106 |
| 2020 Abril | 27 | 15 | 42 |
| 2020 Marzo | 26 | 21 | 47 |
| 2020 Febrero | 3 | 0 | 3 |
| 2020 Enero | 4 | 0 | 4 |
| 2019 Diciembre | 4 | 0 | 4 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Septiembre | 4 | 0 | 4 |
| 2019 Agosto | 2 | 0 | 2 |
| 2019 Julio | 6 | 0 | 6 |
| 2019 Junio | 4 | 0 | 4 |
| 2019 Mayo | 6 | 0 | 6 |
| 2019 Abril | 2 | 0 | 2 |
| 2019 Marzo | 2 | 0 | 2 |
| 2018 Diciembre | 4 | 0 | 4 |
| 2018 Noviembre | 1 | 0 | 1 |
| 2018 Septiembre | 5 | 0 | 5 |
| 2018 Febrero | 86 | 25 | 111 |
| 2018 Enero | 264 | 34 | 298 |
| 2017 Diciembre | 10 | 19 | 29 |
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