Letter to the Editor
Acquired Port-Wine Stain: Not a simple stain!
Mancha de vino de Oporto adquirida: ¡no es una simple mancha!
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"apellidos" => "Valencia Ramírez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731017306737" "doi" => "10.1016/j.ad.2017.10.016" "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/S0001731017306737?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018301380?idApp=UINPBA000044" "url" => "/15782190/0000010900000005/v1_201806040407/S1578219018301380/v1_201806040407/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Acquired Port-Wine Stain: Not a simple stain!" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">Dear editor</span>," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "462" "paginaFinal" => "463" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Abdelmaksoud, M. Vestita" "autores" => array:2 [ 0 => array:3 [ "nombre" => "A." "apellidos" => "Abdelmaksoud" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "M." "apellidos" => "Vestita" "email" => array:1 [ 0 => "michelangelovestita@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Dermatología, Venereología y Leprología, Hospital Universitario de Mansoura, Mansoura, Egipto" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Cirugía Plástica y Reconstructiva, Departamento de Urgencias y Trasplantes, Universidad de Bari, Bari, Italia" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Mancha de vino de Oporto adquirida: ¡no es una simple mancha!" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">we read with interest a case series of acquired port wine stain (PWS) in 3 otherwise healthy children (2 females and 1 male) by Millán-Cayetano et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> published in Actas Dermo-Sifiliográficas journal. The authors stated “acquired capillary malformation may be considered simply to be a late-onset capillary malformation with a variable latency period”. Actually, acquired PWS is not as “simple” as considered by the authors. The authors underestimated skin diseases masquerading as PWS.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Linear morphea is a form of morphea that can affect an entire extremity and follow the lines of Blaschko. Children are more likely than adults to have linear morphea on the face.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> In many cases, the affected skin is initially erythematous and may resemble a PWS. Vascular damage, such as microvascular injury, and T-cell activation, with subsequent abnormal collagen production by fibroblasts, is thought to be involved in its pathomechanism.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> Nihjawan et al.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> reported four cases that had presented with erythematous vascular-appearing patches resembling PWS. Three lesions were located on the face and one was on the leg. The initial biopsies of two patients revealed telangiectatic dermal vessels, consistent with PWS. However, further biopsies revealed dermal fibrosis with patchy lymphocytic infiltrate, consistent with morphea. Diagnosis of morphea was made approximately 6 months to 3 years after the onset of the acquired PWS. On the other hand, perineural inflammation has rarely been reported to be an early histopathological feature of morphea.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> Singh et al.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> reported 2 cases of morphea with subtle sclerotic changes initially, presented with perineural and intraneural lymphoplasmacytic infiltration. According to Nihjawan et al.,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> there was prominent perineural inflammation which prompted the diagnosis of early morphea. In other words, early inflammatory morphea can present initially with a vascular, nonindurated patch.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> Biopsies of these lesions may not reveal the characteristic features of established morphea and the diagnosis has to be considered if perineural inflammation is seen.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> Nihjawan et al.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> recommended, in patients with acquired PWS, delaying PDL treatment until a diagnosis of early morphea can be excluded.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> However, it is difficult to ascertain whether laser therapy to the initial lesions triggered the increase in fibrosis as some of the reported cases did not receive laser treatment.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> Treatment of PWS using the PDL may reduce the skin erythema, but did not prevent subsequent sclerosis.</p><p id="par0015" class="elsevierStylePara elsevierViewall">To sum up, acquired PWS is not a simple stain. Inflammatory morphea should be considered in the differential diagnosis whenever an acquired PWS has been identified, especially on the face.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> Early stages of morphea are sometimes difficult to recognize, and histology may not helpful in early cases because there is overlap, leading to misdiagnosis. Clinicopathological correlation is of paramount importance in such cases. Morphea should be considered if perineural inflammation is seen in histopathology. Dermoscopy can assist in the early diagnosis of localized scleroderma (LS), with no need for invasive examinations.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> Noteworthy, ultrasound used for LS has demonstrated clear differences from healthy skin and improvement after initiation of treatment.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Abdelmaksoud A, Vestita M. Mancha de vino de Oporto adquirida: ¡no es una simple mancha!. Actas Dermosifiliogr. 2018;109:462–463.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[Article in English, Spanish]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acquired Port-Wine Stain (Fegeler Syndrome): A Report of 3 Cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.F. Millán-Cayetano" 1 => "J. del Boz" 2 => "P. 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|---|---|---|---|
| 2024 Noviembre | 9 | 9 | 18 |
| 2024 Octubre | 75 | 36 | 111 |
| 2024 Septiembre | 100 | 22 | 122 |
| 2024 Agosto | 114 | 49 | 163 |
| 2024 Julio | 89 | 27 | 116 |
| 2024 Junio | 69 | 22 | 91 |
| 2024 Mayo | 56 | 31 | 87 |
| 2024 Abril | 72 | 30 | 102 |
| 2024 Marzo | 76 | 23 | 99 |
| 2024 Febrero | 56 | 30 | 86 |
| 2024 Enero | 50 | 27 | 77 |
| 2023 Diciembre | 57 | 17 | 74 |
| 2023 Noviembre | 68 | 26 | 94 |
| 2023 Octubre | 75 | 17 | 92 |
| 2023 Septiembre | 52 | 28 | 80 |
| 2023 Agosto | 39 | 17 | 56 |
| 2023 Julio | 44 | 25 | 69 |
| 2023 Junio | 46 | 19 | 65 |
| 2023 Mayo | 57 | 24 | 81 |
| 2023 Abril | 54 | 25 | 79 |
| 2023 Marzo | 43 | 24 | 67 |
| 2023 Febrero | 57 | 23 | 80 |
| 2023 Enero | 40 | 27 | 67 |
| 2022 Diciembre | 70 | 39 | 109 |
| 2022 Noviembre | 27 | 33 | 60 |
| 2022 Octubre | 19 | 21 | 40 |
| 2022 Septiembre | 53 | 43 | 96 |
| 2022 Agosto | 22 | 33 | 55 |
| 2022 Julio | 21 | 35 | 56 |
| 2022 Junio | 21 | 26 | 47 |
| 2022 Mayo | 26 | 37 | 63 |
| 2022 Abril | 51 | 23 | 74 |
| 2022 Marzo | 48 | 45 | 93 |
| 2022 Febrero | 58 | 28 | 86 |
| 2022 Enero | 37 | 41 | 78 |
| 2021 Diciembre | 25 | 38 | 63 |
| 2021 Noviembre | 58 | 38 | 96 |
| 2021 Octubre | 43 | 55 | 98 |
| 2021 Septiembre | 27 | 33 | 60 |
| 2021 Agosto | 28 | 26 | 54 |
| 2021 Julio | 26 | 25 | 51 |
| 2021 Junio | 23 | 27 | 50 |
| 2021 Mayo | 23 | 38 | 61 |
| 2021 Abril | 81 | 53 | 134 |
| 2021 Marzo | 69 | 33 | 102 |
| 2021 Febrero | 46 | 24 | 70 |
| 2021 Enero | 24 | 13 | 37 |
| 2020 Diciembre | 58 | 17 | 75 |
| 2020 Noviembre | 45 | 30 | 75 |
| 2020 Octubre | 16 | 13 | 29 |
| 2020 Septiembre | 41 | 19 | 60 |
| 2020 Agosto | 45 | 16 | 61 |
| 2020 Julio | 32 | 15 | 47 |
| 2020 Junio | 40 | 30 | 70 |
| 2020 Mayo | 25 | 22 | 47 |
| 2020 Abril | 30 | 13 | 43 |
| 2020 Marzo | 41 | 20 | 61 |
| 2020 Febrero | 7 | 1 | 8 |
| 2020 Enero | 2 | 0 | 2 |
| 2019 Diciembre | 4 | 0 | 4 |
| 2019 Noviembre | 2 | 0 | 2 |
| 2019 Septiembre | 4 | 0 | 4 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 4 | 0 | 4 |
| 2019 Junio | 4 | 0 | 4 |
| 2019 Mayo | 4 | 0 | 4 |
| 2019 Abril | 4 | 0 | 4 |
| 2019 Marzo | 2 | 0 | 2 |
| 2018 Diciembre | 2 | 0 | 2 |
| 2018 Noviembre | 4 | 0 | 4 |
| 2018 Octubre | 2 | 0 | 2 |
| 2018 Septiembre | 2 | 0 | 2 |
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