Practical Dermoscopy
Solitary Lesion on the Lateral Aspect of the Index Finger
Lesión solitaria en el lateral del segundo dedo de la mano
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García-Martínez, I. López-Martín" "autores" => array:2 [ 0 => array:4 [ "nombre" => "F.J." "apellidos" => "García-Martínez" "email" => array:1 [ 0 => "fjgarcia@aedv.es" ] "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" => "I." "apellidos" => "López-Martín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Dermatología, Clínica Universidad de Navarra, Madrid, España" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Centro de Salud Soto del Real, Soto del Real, Madrid, España" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lesión solitaria en el lateral del segundo dedo de la mano" ] ] "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" => 927 "Ancho" => 900 "Tamanyo" => 80460 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Solitary nodule surrounded by an erythematous halo at the lateral base of the left index finger.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case Description</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 35-year-old livestock farmer presented with a 2-week history of a slightly pruritic lesion on the lateral aspect of the proximal phalanx of his left index finger.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The lesion was raised and had a targetoid appearance and elastic consistency. The center was slightly depressed and surrounded by an erythematous halo (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The dermoscopic image (captured using a DermLite II Hybrid M dermatoscope) showed a central homogeneous pink-orange area containing hemorrhagic dots and a peripheral homogeneous pink area containing linear and irregular vessels (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Comment</span><p id="par0020" class="elsevierStylePara elsevierViewall">The patient reported that he only handled cattle and histologic examination of the lesion confirmed the clinical diagnosis of milker's nodule. The lesion resolved without treatment within 3 weeks.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Milker's nodule is an uncommon zoonotic infection caused by the paravaccinia virus, which is a member of the <span class="elsevierStyleItalic">Parapoxvirus</span> genus from the Poxviridae family.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> It is generally transmitted to livestock farmers who have direct contact with the mouth area or udders of an infected animal. It can also be transmitted through contact with fomites used by slaughterhouse workers or veterinarians. Milker's nodule is therefore also considered an occupational dermatosis.</p><p id="par0030" class="elsevierStylePara elsevierViewall">There have been isolated reports of complications such as swollen lymph nodes, fever, and exudative multiforme erythema associated with milker's nodule.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> This viral infection runs a self-limiting course and therefore often goes unnoticed. However, its prevalence has also decreased in our country thanks to improvements in hygiene and health measures at farm holdings.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The main entity that should be considered in the differential diagnosis is Orf nodule, because Orf nodule and milker's nodule have overlapping clinical and histologic findings.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Unlike the paravaccinia virus, the Orf virus can be transmitted through contact with sheep or goats. A thorough history is thus key for differentiating between the 2 entities. In cases where the patient had been in contact with different types of animals, diagnosis must be confirmed through cell cultures.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Dermoscopy is a diagnostic tool typically used to investigate skin cancers, but it is being increasingly used to study inflammatory and infectious skin diseases.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The dermoscopic patterns of several viral infections have been described in recent studies,<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4,5</span></a> one of which included images of milker's nodule and Orf nodule.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> The authors found no specific dermoscopic features to distinguish between the 2 entities.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Of note in the dermoscopic image corresponding to the lesion in our patient is the large number of hemorrhagic dots of varying shapes and sizes arranged in a ring-like distribution in the center of the lesion. Although hemorrhagic dots have been described in other inflammatory diseases, such as psoriasis,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> they could, as occurs with warts, be considered a characteristic finding of viral skin infections. We believe that these dots correspond to dilated blood vessels and to the foci of bleeding seen in histopathologic images.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Dermoscopy may be a very useful tool for establishing a clinical diagnosis of milker's nodule.</p></span></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of Interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Case Description" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Comment" ] ] ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of Interest" ] 2 => 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 F, López-Martín I. Lesión solitaria en el lateral del segundo dedo de la mano. Actas Dermosifiliogr. 2018;109:547–548.</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" => 927 "Ancho" => 900 "Tamanyo" => 80460 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Solitary nodule surrounded by an erythematous halo at the lateral base of the left index finger.</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" => 560 "Ancho" => 900 "Tamanyo" => 49790 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Lateral photograph of the nodule showing the mechanism of infection.</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" => 675 "Ancho" => 900 "Tamanyo" => 53701 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Dermoscopic image showing the numerous hemorrhagic dots against a homogeneous pink area.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Milker's nodule - Case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A.R. 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Aktaş" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Adv Dermatol Allergol" "fecha" => "2017" "volumen" => "34" "paginaInicial" => "357" "paginaFinal" => "362" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Histopatología de las infecciones víricas cutáneas más frecuentes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Requena" 1 => "C. Requena" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2010" "volumen" => "101" "paginaInicial" => "201" "paginaFinal" => "216" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20398595" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010900000006/v1_201808010420/S1578219018301707/v1_201808010420/en/main.assets" "Apartado" => array:4 [ "identificador" => "19289" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Practical Dermoscopy" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010900000006/v1_201808010420/S1578219018301707/v1_201808010420/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018301707?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
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| 2023 Noviembre | 75 | 43 | 118 |
| 2023 Octubre | 95 | 30 | 125 |
| 2023 Septiembre | 93 | 34 | 127 |
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| 2023 Marzo | 71 | 40 | 111 |
| 2023 Febrero | 94 | 42 | 136 |
| 2023 Enero | 71 | 30 | 101 |
| 2022 Diciembre | 76 | 48 | 124 |
| 2022 Noviembre | 45 | 45 | 90 |
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| 2022 Marzo | 101 | 45 | 146 |
| 2022 Febrero | 75 | 39 | 114 |
| 2022 Enero | 119 | 59 | 178 |
| 2021 Diciembre | 79 | 54 | 133 |
| 2021 Noviembre | 84 | 63 | 147 |
| 2021 Octubre | 80 | 63 | 143 |
| 2021 Septiembre | 76 | 48 | 124 |
| 2021 Agosto | 61 | 48 | 109 |
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| 2021 Marzo | 113 | 37 | 150 |
| 2021 Febrero | 96 | 46 | 142 |
| 2021 Enero | 66 | 44 | 110 |
| 2020 Diciembre | 54 | 48 | 102 |
| 2020 Noviembre | 42 | 28 | 70 |
| 2020 Octubre | 35 | 18 | 53 |
| 2020 Septiembre | 34 | 26 | 60 |
| 2020 Agosto | 27 | 27 | 54 |
| 2020 Julio | 24 | 25 | 49 |
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| 2020 Mayo | 18 | 22 | 40 |
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