Case and Research Letters
Atrophying Pityriasis Versicolor
Pitiriasis versicolor atrófica
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B, Expansive growth pattern of squamous cell carcinoma in greater detail. C, Areas with a koilocytic appearance. D, Extensive nuclear and cytoplasmic positivity to p16.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.M. Segura Palacios, P. García Montero, R. Fúnez Liébana, J.B. Repiso Jiménez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "J.M." "apellidos" => "Segura Palacios" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "García Montero" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Fúnez Liébana" ] 3 => array:2 [ "nombre" => "J.B." "apellidos" => "Repiso Jiménez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731017305495" "doi" => "10.1016/j.ad.2017.06.019" "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/S0001731017305495?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018301318?idApp=UINPBA000044" "url" => "/15782190/0000010900000005/v1_201806040407/S1578219018301318/v1_201806040407/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S157821901830129X" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.04.010" "estado" => "S300" "fechaPublicacion" => "2018-06-01" "aid" => "1811" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2018;109:453-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 47 "HTML" => 47 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Ultrasound Diagnosis of Nodular Hidradenoma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "453" "paginaFinal" => "455" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Diagnóstico ecográfico del hidradenoma nodular" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "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" => 938 "Ancho" => 1250 "Tamanyo" => 304226 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histopathology. A,<span class="elsevierStyleHsp" style=""></span>Well-defined, nonencapsulated dermal-hypodermal lesion with solid cystic areas (hematoxylin-eosin, original magnification ×10). B and C,<span class="elsevierStyleHsp" style=""></span>Two types of cell can be distinguished in the solid portion of the tumor. Polyhedral cells, with a long vesicular nucleus and eosinophilic cytoplasm (B), and large cells with an eccentric nucleus and abundant clear cytoplasm (C) (hematoxylin-eosin, original magnification, ×20 and ×40). D)<span class="elsevierStyleHsp" style=""></span>Positive immunohistochemistry result for CK-7 (CK-7, ×40).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I. Vázquez-Osorio, P. Gonzalvo-Rodríguez, E. Rodríguez-Díaz" "autores" => array:3 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "Vázquez-Osorio" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Gonzalvo-Rodríguez" ] 2 => array:2 [ "nombre" => "E." 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Allegue, C. Fachal, D. González-Vilas, A. Zulaica" "autores" => array:4 [ 0 => array:4 [ "nombre" => "F." "apellidos" => "Allegue" "email" => array:1 [ 0 => "fallegue@mundo-r.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" ] ] ] 1 => array:3 [ "nombre" => "C." "apellidos" => "Fachal" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "D." "apellidos" => "González-Vilas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "A." "apellidos" => "Zulaica" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital do Meixoeiro, Vigo, Pontevedra, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica. Hospital Álvaro Cunqueiro, EOXI, Vigo, Pontevedra, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pitiriasis versicolor atrófica" ] ] "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" => 1350 "Ancho" => 900 "Tamanyo" => 127228 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Slightly depressed hypopigmented and pink plaques of various sizes on the patient's back. Mild desquamation can be observed on some.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Pityriasis versicolor (PV) is a common superficial fungal infection caused by yeasts of the genus <span class="elsevierStyleItalic">Malassezia</span>. In clinical terms, it generally presents on the trunk as round or oval macules that vary in color from hypopigmentation to blackish.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> Its symptoms are easily recognizable, with several atypical forms reported, including the variant with atrophic lesions.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A 28-year-old man with plaque psoriasis treated with topical corticosteroids consulted for the appearance of cutaneous abnormalities that he perceived as being different from his psoriasis lesions. The physical examination revealed several circular areas on the back and the extensor surface of the upper right limb. The areas measured 0.5<span class="elsevierStyleHsp" style=""></span>cm to 4<span class="elsevierStyleHsp" style=""></span>cm and were depressed and atrophic in appearance (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Some were hypopigmented, whereas others were slightly pink; some had mild desquamation, whereas others were similar to typical psoriasis lesions (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The Wood lamp examination did not reveal fluorescence. The skin biopsy revealed laminated hyperkeratosis in the epidermis, with flattening of the rete ridges and an edematous appearance with vascular dilations in the dermis that was more evident in the papillary dermis. The vessels were surrounded by a discreet lymphocytic infiltrate. Periodic acid–Schiff staining revealed abundant short, septate hyphae and spores between the layers of keratin. Orcein staining revealed diminished elastic fibers in the papillary dermis and fragmentation thereof in the superficial reticular dermis (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Direct examination of the lesions revealed the presence of yeasts and pseudomycelium.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The patient was prescribed itraconazole 200<span class="elsevierStyleHsp" style=""></span>mg/d for 7 days combined with topical flutrimazole at night for 1 month. The topical corticosteroid was replaced by calcitriol ointment for treatment of his psoriasis. Although improvement was slow, the patient had fully recovered at 6 months, with no new lesions after 1 year of follow-up.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Atrophying or atrophic PV is an uncommon presentation of this condition.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">2–10</span></a> It manifests clinically as depressed erythematous or hypopigmented areas with discreet desquamation located mainly on the trunk, generally the back and shoulders. The lesions are usually numerous, tend to group together, and measure a few millimeters to several centimeters, although they are generally uniform on the same patient. The diagnostic suspicion can be confirmed by direct examination, which reveals accumulations of yeasts and short hyphae; if these occur together, they have the typical “spaghetti and meatballs” appearance. Skin biopsy may help in atypical cases such as the present one. The most characteristic and differentiating histopathological findings of the atrophic variant include an epidermis with flattened rete ridges and, especially, reduction and fragmentation of the dermal elastic fibers.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">5,9</span></a> The differential diagnosis includes processes that induce skin atrophy, that is, anetoderma, morphea/atrophoderma, mycosis fungoides, sarcoidosis, and corticosteroid-induced atrophy.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">6,9,10</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The mechanism by which species of <span class="elsevierStyleItalic">Malasezzia</span> can induce atrophy in the skin remains unclear. Since many of the patients reported were being treated with topical corticosteroids<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">2–7</span></a> or systemic corticosteroids,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a> atrophy was associated with the atrophogenic effect of the drugs.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">3–7</span></a> The fungal infection is thought to alter the epidermal barrier, thus increasing absorption of corticosteroids in the PV lesions and inducing local cutaneous atrophy. However, in corticosteroid-induced atrophy, in addition to epidermal atrophy and vasodilation, we can see atrophy of skin adnexa and reduction and fragmentation of dermal collagen, whereas in atrophic PV, we do not see alteration of collagen but alteration of the elastic fibers.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">5,6,9,10</span></a> We did not find collagen abnormalities in the case we report, suggesting the possibility of another pathogenic mechanism, given that cases not associated with corticosteroids have been reported.<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">9,10</span></a> Crowson and Magro<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> proposed that this form of PV appeared through a type 1 helper T-cell immune response to <span class="elsevierStyleItalic">Malassezia</span> antigens, in which histocytes recruited and activated by interferon-ϒ would generate the elastases responsible for the dermal elastolysis observed. Flattening of the rete ridges, on the other hand, is mediated by cytokines, such as tumor necrosis factor α and interleukin 1β, which can inhibit the nuclear factor κB pathway of keratinocytes to induce apoptosis and hinder proliferation thereof.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> In parallel, the reduced thickness and loss of hair in areas of PV has also been related to this mechanism.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> Furthermore, a type 2 helper T cell response, which could favor fungal overgrowth, has been implicated, together with the type 1 response, in the pathogenesis of atrophic PV.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Treatment of this variant of PV is standard,<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a> although it has been suggested that longer regimens may be necessary and even that oral and topical approaches should be combined.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a> Obviously, corticosteroids should be withdrawn.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a> As a rule, the atrophy disappears; therefore, compared with other atrophying diseases, atrophying PV has a good prognosis.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0035" 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: Allegue F, Fachal C, González-Vilas D, Zulaica A. Pitiriasis versicolor atrófica. Actas Dermosifiliogr. 2018;109:455–457.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1350 "Ancho" => 900 "Tamanyo" => 127228 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Slightly depressed hypopigmented and pink plaques of various sizes on the patient's back. Mild desquamation can be observed on some.</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" => 600 "Ancho" => 900 "Tamanyo" => 74939 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Psoriatic plaques in the center of depressed areas.</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" => 975 "Ancho" => 1300 "Tamanyo" => 260065 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Epidermis with abundant hyphae and spores in the stratum corneum and flattening of the rete ridges (periodic acid–Schiff, original magnification ×200). The inset shows diminished fine elastic fibers in the papillary dermis (arrow) and fragmented elastic fibers in the superficial reticular dermis, as well as vascular ectasia (orcein stain, original magnification ×100).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0060" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La pitiriasis versicolor y las levaduras del género <span class="elsevierStyleItalic">Malassezia</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "V. Crespo-Erchiga" 1 => "E. Gómez-Moyano" 2 => "M. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 12 | 12 | 24 |
| 2024 Octubre | 107 | 73 | 180 |
| 2024 Septiembre | 120 | 41 | 161 |
| 2024 Agosto | 154 | 61 | 215 |
| 2024 Julio | 116 | 49 | 165 |
| 2024 Junio | 90 | 42 | 132 |
| 2024 Mayo | 81 | 53 | 134 |
| 2024 Abril | 109 | 30 | 139 |
| 2024 Marzo | 119 | 28 | 147 |
| 2024 Febrero | 142 | 49 | 191 |
| 2024 Enero | 107 | 26 | 133 |
| 2023 Diciembre | 123 | 24 | 147 |
| 2023 Noviembre | 104 | 58 | 162 |
| 2023 Octubre | 100 | 36 | 136 |
| 2023 Septiembre | 78 | 38 | 116 |
| 2023 Agosto | 62 | 19 | 81 |
| 2023 Julio | 69 | 37 | 106 |
| 2023 Junio | 66 | 30 | 96 |
| 2023 Mayo | 87 | 32 | 119 |
| 2023 Abril | 66 | 40 | 106 |
| 2023 Marzo | 90 | 34 | 124 |
| 2023 Febrero | 73 | 33 | 106 |
| 2023 Enero | 72 | 37 | 109 |
| 2022 Diciembre | 84 | 50 | 134 |
| 2022 Noviembre | 59 | 35 | 94 |
| 2022 Octubre | 36 | 24 | 60 |
| 2022 Septiembre | 49 | 40 | 89 |
| 2022 Agosto | 48 | 41 | 89 |
| 2022 Julio | 34 | 47 | 81 |
| 2022 Junio | 52 | 58 | 110 |
| 2022 Mayo | 110 | 53 | 163 |
| 2022 Abril | 89 | 32 | 121 |
| 2022 Marzo | 88 | 53 | 141 |
| 2022 Febrero | 109 | 29 | 138 |
| 2022 Enero | 108 | 75 | 183 |
| 2021 Diciembre | 76 | 48 | 124 |
| 2021 Noviembre | 86 | 47 | 133 |
| 2021 Octubre | 83 | 58 | 141 |
| 2021 Septiembre | 78 | 76 | 154 |
| 2021 Agosto | 108 | 37 | 145 |
| 2021 Julio | 112 | 35 | 147 |
| 2021 Junio | 143 | 33 | 176 |
| 2021 Mayo | 158 | 45 | 203 |
| 2021 Abril | 694 | 27 | 721 |
| 2021 Marzo | 217 | 38 | 255 |
| 2021 Febrero | 139 | 27 | 166 |
| 2021 Enero | 101 | 33 | 134 |
| 2020 Diciembre | 74 | 21 | 95 |
| 2020 Noviembre | 88 | 31 | 119 |
| 2020 Octubre | 52 | 13 | 65 |
| 2020 Septiembre | 64 | 27 | 91 |
| 2020 Agosto | 39 | 18 | 57 |
| 2020 Julio | 42 | 27 | 69 |
| 2020 Junio | 50 | 39 | 89 |
| 2020 Mayo | 33 | 21 | 54 |
| 2020 Abril | 42 | 20 | 62 |
| 2020 Marzo | 48 | 22 | 70 |
| 2020 Febrero | 2 | 0 | 2 |
| 2020 Enero | 4 | 0 | 4 |
| 2019 Diciembre | 4 | 0 | 4 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Septiembre | 4 | 0 | 4 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 4 | 0 | 4 |
| 2019 Junio | 4 | 0 | 4 |
| 2019 Mayo | 6 | 1 | 7 |
| 2019 Abril | 2 | 0 | 2 |
| 2019 Marzo | 3 | 2 | 5 |
| 2018 Diciembre | 4 | 0 | 4 |
| 2018 Noviembre | 4 | 0 | 4 |
| 2018 Octubre | 1 | 0 | 1 |
| 2018 Septiembre | 2 | 0 | 2 |
| 2018 Julio | 1 | 1 | 2 |
| 2018 Junio | 1 | 0 | 1 |
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