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"tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "361" "paginaFinal" => "363" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Bueno-Rodriguez, R. Ruiz-Villaverde, M. Caba-Molina, J. Tercedor-Sánchez" "autores" => array:4 [ 0 => array:3 [ "nombre" => "A." "apellidos" => "Bueno-Rodriguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "R." "apellidos" => "Ruiz-Villaverde" "email" => array:1 [ 0 => "ismenios@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Caba-Molina" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Tercedor-Sánchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Dermatología, Complejo Hospitalario de Granada, Granada, España" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Anatomía Patológica, Complejo Hospitalario de Granada, Granada, España" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Linfadenopatía dermopática: ¿realizamos una correcta aproximación diagnóstica?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 653 "Ancho" => 1200 "Tamanyo" => 377085 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Patient 4 (CD1A<span class="elsevierStyleHsp" style=""></span>×10), original magnification. Note the paracortical hyperplasia composed of Langerhans cells.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Dermatopathic lymphadenopathy is a well-defined histopathologic entity with an underestimated prevalence in the general population. It is characterized by lymph node enlargement secondary to a typically pruritic skin disorder.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> It is a form of paracortical hyperplasia that usually occurs in chronic skin diseases, but it can also be found in disorders in which the skin is not involved.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> In most cases, dermatopathic lymphadenopathy clinically manifests as enlargement of the peripheral lymph nodes, although normal-sized nodes may also be seen. It should be contemplated alongside malignant, infectious, and other diseases in the differential diagnosis of peripheral lymphadenopathy. It is widely known that a palpable lymph node is a clinical sign and risk marker of a solid or lymphoproliferative tumor,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> and it is therefore essential to establish a diagnosis and monitor patients with this finding. When attending a patient with a chronic skin disorder who presents with enlarged lymph nodes, it is important to consider a broad differential diagnosis that includes autoimmune diseases,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> infections, and tumors.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We performed a retrospective analysis of clinically diagnosed and histologically confirmed cases of dermatopathic lymphadenopathy cases at our unit between January 2011 and December 2016. We included 4 patients, whose characteristics are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The main diagnosis for which they were under follow-up was atopic dermatitis and there was also an isolated case of lepromatous leprosy. The atopic patients had a Scoring Atopic Dermatitis (SCORAD) index score of over 40 at the time of diagnostic confirmation. They also all had active skin lesions. Palpable lymph nodes had been identified in different locations during the physical examination. They were mostly located in the axillary, groin, and neck regions, which were investigated by ultrasound and/or computed tomography (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Depending on their accessibility, the nodes were sampled by biopsy or fine-needle aspiration (FNA) (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2 and 3</a>). Follow-up duration ranged from 6 months to 5 years. The lymph nodes disappeared in 3 of the 4 patients and reduced considerably in size in the fourth, whose atopic dermatitis is currently being treated with combined oral corticosteroid and intravenous immunoglobulin therapy. None of the patients have presented any signs of malignancy.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Dermatopathic lymphadenopathy is a benign entity with characteristic histologic features that is frequently seen in patients with inflammatory skin disease. It was first described by Pautrier and Woringer in 1937, but the term <span class="elsevierStyleItalic">dermatopathic lymphadenopathy</span> did not appear until 1942, when it was coined by Hurwitt.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> Dermatopathic lymphadenopathy should always be contemplated in patients with persistent lymph node enlargement. It can accompany different types of chronic skin disorders and is more common in patients with extensive skin involvement. Lymph node enlargement tends to be asymptomatic and mainly affects inguinal, axillary, and cervical nodes. The lymph nodes tend to be mobile and not attached to underlying structures.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The characteristic histologic findings include slightly expanded germinal centers surrounded by lymphocytes and a widened paracortical area. The follicular pattern is retained. The most characteristic finding is an expanded paracortical area and pale staining due to the presence of Langerhans cells and in particular interdigitating dendritic cells. Macrophages are a minor component, but they are characteristic because they contain cytoplasmic pigment; most of the cells contain melanin but a small proportion contain hemosiderin. Pigment deposits may also be observed in tattoos, nodal nevus cell inclusions, and melanoma metatasases.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">A broad differential diagnosis must be considered in the case of persistent lymph node enlargement. Dermatopathic lymphadenopathy occurs in association with a variety of skin disorders ranging from infections, such as tuberculosis or fungal infections, to erythrodermas, such as psoriatic or atopic erythrodermas (like the cases in our series). Other disorders include sarcoidosis, lymphoproliferative disorders, tumor metastases,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> and infections (e.g., human immunodeficiency virus infection, tuberculosis, and toxoplasmosis). Dermatopathic lymphadenopathy may also been seen in exfoliative or eczematous diseases, such as toxic shock syndrome, pemphigus, neurodermatitis, and atrophia cutis senilis.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> Prognosis is worse when there is associated mycosis fungoides.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The first step in the diagnostic workup is nodal sampling by FNA and/or biopsy. Prior imaging can help identify the extent of disease and select the most appropriate node for biopsy. Considering its increasing use as a diagnostic tool in dermatology, cutaneous ultrasound should also be considered. Inflammatory lymph nodes tend to have an ellipsoid shape with a length to width ratio of over 2, and unlike nodes that are suggestive of tumor infiltration, they tend to have intact corticohilar differentiation. Considering the risk of lymphoproliferative disease, particularly in patients with atopic dermatitis, close follow-up is recommended in the absence of an objective clinical diagnosis. Histologically, dermatopathic lymphadenopathy should be differentiated from Hodgkin lymphoma and enlarged lymph nodes associated with T-cell lymphoma.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Follow-up is essential. Dermatopathic lymphadenopathy is not only more common in patients with atopic dermatitis, but is also a risk factor for subsequent lymphomas.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0040" 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: Bueno-Rodriguez A, Ruiz-Villaverde R, Caba-Molina M, Tercedor-Sánchez J. Linfadenopatía dermopática: ¿realizamos una correcta aproximación diagnóstica? Actas Dermosifiliogr. 2018;109:361–363.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 503 "Ancho" => 900 "Tamanyo" => 50257 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Patient 4. Computed tomography scan of chest and abdomen: enlarged bilateral axillary lymph nodes with a diameter of up to 13.7<span class="elsevierStyleHsp" style=""></span>mm at the narrowest point on both sides.</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" => 653 "Ancho" => 1200 "Tamanyo" => 436808 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Patient 4 (hematoxylin-eosin original, original magnification ×5): lymph node with preserved architecture presenting hyperplasia of lymphoid follicles in the cortex with pale staining in paracortical area.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 653 "Ancho" => 1200 "Tamanyo" => 377085 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Patient 4 (CD1A<span class="elsevierStyleHsp" style=""></span>×10), original magnification. Note the paracortical hyperplasia composed of Langerhans cells.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Abbreviations: CT, computed tomography; FNA, fine-needle aspiration.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patient 1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patient 2 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patient 3 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patient 4 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diagnosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Atopic dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Atopic dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Atopic dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Atopic dermatitis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Location \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Inguinal/axillary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cervical \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cervical \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axillary \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age, y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Imaging study \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ultrasound \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ultrasound \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CT \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Histopathologic study \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">FNA/biopsy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">FNA/biopsy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">FNA/biopsy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Biopsy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Surgical \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Time to resolution \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 mo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 mo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 mo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Persistence (> 12 mo) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1737266.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Clinical, Imaging, and Histologic Characteristics of 4 Patients With Dermatopathic lymphadenopathy.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Références" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical implication of dermatopathic lymphadenopathy among Japanese: A report of 19 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. 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año/Mes | Html | Total | |
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2024 Noviembre | 49 | 10 | 59 |
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2024 Abril | 302 | 53 | 355 |
2024 Marzo | 347 | 53 | 400 |
2024 Febrero | 429 | 88 | 517 |
2024 Enero | 561 | 86 | 647 |
2023 Diciembre | 601 | 53 | 654 |
2023 Noviembre | 557 | 46 | 603 |
2023 Octubre | 508 | 72 | 580 |
2023 Septiembre | 326 | 63 | 389 |
2023 Agosto | 252 | 54 | 306 |
2023 Julio | 224 | 64 | 288 |
2023 Junio | 191 | 69 | 260 |
2023 Mayo | 267 | 84 | 351 |
2023 Abril | 312 | 82 | 394 |
2023 Marzo | 318 | 82 | 400 |
2023 Febrero | 291 | 80 | 371 |
2023 Enero | 227 | 100 | 327 |
2022 Diciembre | 191 | 99 | 290 |
2022 Noviembre | 153 | 80 | 233 |
2022 Octubre | 118 | 66 | 184 |
2022 Septiembre | 133 | 91 | 224 |
2022 Agosto | 93 | 118 | 211 |
2022 Julio | 75 | 107 | 182 |
2022 Junio | 69 | 106 | 175 |
2022 Mayo | 289 | 122 | 411 |
2022 Abril | 436 | 89 | 525 |
2022 Marzo | 441 | 118 | 559 |
2022 Febrero | 393 | 61 | 454 |
2022 Enero | 409 | 70 | 479 |
2021 Diciembre | 412 | 82 | 494 |
2021 Noviembre | 383 | 70 | 453 |
2021 Octubre | 305 | 92 | 397 |
2021 Septiembre | 382 | 73 | 455 |
2021 Agosto | 364 | 65 | 429 |
2021 Julio | 250 | 60 | 310 |
2021 Junio | 334 | 64 | 398 |
2021 Mayo | 327 | 55 | 382 |
2021 Abril | 686 | 133 | 819 |
2021 Marzo | 400 | 54 | 454 |
2021 Febrero | 347 | 70 | 417 |
2021 Enero | 240 | 51 | 291 |
2020 Diciembre | 240 | 57 | 297 |
2020 Noviembre | 179 | 59 | 238 |
2020 Octubre | 142 | 31 | 173 |
2020 Septiembre | 115 | 35 | 150 |
2020 Agosto | 102 | 38 | 140 |
2020 Julio | 67 | 34 | 101 |
2020 Junio | 65 | 42 | 107 |
2020 Mayo | 24 | 13 | 37 |
2020 Abril | 23 | 19 | 42 |
2020 Marzo | 41 | 14 | 55 |
2020 Enero | 4 | 0 | 4 |
2019 Diciembre | 8 | 0 | 8 |
2019 Noviembre | 4 | 0 | 4 |
2019 Septiembre | 9 | 0 | 9 |
2019 Agosto | 4 | 0 | 4 |
2019 Julio | 4 | 0 | 4 |
2019 Junio | 4 | 0 | 4 |
2019 Mayo | 8 | 6 | 14 |
2019 Abril | 2 | 1 | 3 |
2019 Marzo | 2 | 0 | 2 |
2019 Febrero | 4 | 0 | 4 |
2018 Diciembre | 4 | 0 | 4 |
2018 Noviembre | 2 | 0 | 2 |
2018 Octubre | 2 | 0 | 2 |
2018 Septiembre | 2 | 0 | 2 |