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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 59-year-old man visited our department with an asymptomatic skin lesion of the glans that had appeared 4 months earlier&#46; He denied having engaged in risky sexual practices&#46; He had no past history of phimosis or prior episodes of trauma or spontaneous bleeding&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed a clearly defined&#44; whiteish keratotic plaque with a diameter of 2<span class="elsevierStyleHsp" style=""></span>cm and a papillomatous surface&#44; close to the urinary meatus &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The patient had no palpable local or regional lymph nodes&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Additional Tests</span><p id="par0015" class="elsevierStylePara elsevierViewall">A complete blood count&#44; biochemical analysis&#44; and serology for virus and syphilis were normal&#46; Polymerase chain reaction for human papilloma virus &#40;HPV&#41; was negative&#46; Histopathology revealed epithelial hyperplasia with hyperkeratosis&#44; parakeratosis&#44; and considerable monocytic&#47;lymphocytic infiltration of the dermis with some eosinophils &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">What Is Your Diagnosis&#63;</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Diagnosis</span><p id="par0020" class="elsevierStylePara elsevierViewall">Lortat-Jacob and Civatte pseudoepitheliomatous keratotic and micaceous balanitis &#40;PKMB&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical Course and Treatment</span><p id="par0025" class="elsevierStylePara elsevierViewall">Topical treatment was instated with a combination of 0&#46;5&#37; 5-fluorouracil and 10&#37; salicylic acid&#44; applied once daily for 12 weeks&#46; The treated area became severely irritated and treatment was suspended for 2 weeks&#46; Subsequent examinations revealed a gradual reduction of the plaque&#46; Persistence of the entity was confirmed in a new biopsy and treatment with ultrapulse CO<span class="elsevierStyleInf">2</span> laser was instated&#44; with a treated area of 34&#37; and energy density of 42&#46;2<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#46; The patient is currently undergoing follow-up at our department and shows no signs of local recurrence&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Comment</span><p id="par0030" class="elsevierStylePara elsevierViewall">PKMB was first described by Lortat-Jacob and Civatte in 1966&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> The disease affects the glans and manifests as keratotic lesions reminiscent of psoriasis plaques&#46; The literature contains few references to this entity and&#44; in epidemiological terms&#44; most published cases are of patients of Indian ethnicity&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Its etiology is currently the subject of debate&#46; The disease has 4 clinical stages&#58; initial or plaque stage&#44; late tumoral stage&#44; warty carcinoma&#44; and transformation into squamous cell carcinoma&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Histopathology typically reveals the following changes&#58; hyperkeratosis&#44; parakeratosis&#44; acanthosis&#44; elongated papillary crests&#44; and mild dysplasia in the basal layers&#46; Nonspecific inflammatory infiltration may be observed in the superficial dermis&#44; with variable numbers of lymphocytes and eosinophils&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Some authors have questioned the potential for this rare form of balanitis to become malignant&#44; but an increase has been reported in the number of recorded cases of warty carcinoma and squamous cell carcinoma arising from PKMB lesions&#44; either at the time of presentation or later&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Careful follow-up of these patients is therefore important&#46; To date&#44; no link has been found between PKMB and HPV&#46; In 1 case of warty carcinoma from PKMB&#44; in situ hybridization and PCR were negative for HPV in the tumor and in the precancerous lesion&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The differential diagnosis should include 3 approaches&#58; infectious causes&#44; with sexually transmitted diseases such as genital herpes simples&#44; soft chancre&#44; and primary syphilis&#59; inflammatory causes&#44; with diseases such as hypertrophic lichen planus and Zoon plasma cell balanitis&#59; and oncologic causes&#44; with penile intraepithelial neoplasia &#40;PeIN&#41;&#44; warty carcinoma&#44; squamous cell carcinoma&#44; keratoacanthoma&#44; giant condylomatosis&#44; and erythroplasia of Queyrat&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> The absence of atypical cells in PKMB histology may be a key finding that makes it possible to differentiate it from oncologic entities&#44; although correlation with the clinical presentation is necessary&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Early clinical diagnosis and biopsy of the lesion are of considerable value&#44; as the disease can be treated topically with 5-fluorouracil&#44;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;5</span></a> which produced a good response in our patient&#46; Other treatment options include cryotherapy&#44; photodynamic therapy&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> and wide resection&#44; 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Case for Diagnosis
Asymptomatic Hyperkeratotic Plaque on the Glans in a Middle-Aged Man
Placa hiperqueratósica asintomática en glande en un varón de mediana edad
P. Aguayo-Carreras
Autor para correspondencia
paula872190@gmail.com

Corresponding author.
, F.J. Navarro-Triviño, R. Ruiz-Villaverde, S. Saenz-Guirado
Servicio de Dermatología, Complejo Hospitalario Universitario de Granada, Granada, Spain
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        "titulo" => "Placa hiperquerat&#243;sica asintom&#225;tica en glande en un var&#243;n de mediana edad"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin&#8211;eosin &#215;10&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 59-year-old man visited our department with an asymptomatic skin lesion of the glans that had appeared 4 months earlier&#46; He denied having engaged in risky sexual practices&#46; He had no past history of phimosis or prior episodes of trauma or spontaneous bleeding&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed a clearly defined&#44; whiteish keratotic plaque with a diameter of 2<span class="elsevierStyleHsp" style=""></span>cm and a papillomatous surface&#44; close to the urinary meatus &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The patient had no palpable local or regional lymph nodes&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Additional Tests</span><p id="par0015" class="elsevierStylePara elsevierViewall">A complete blood count&#44; biochemical analysis&#44; and serology for virus and syphilis were normal&#46; Polymerase chain reaction for human papilloma virus &#40;HPV&#41; was negative&#46; Histopathology revealed epithelial hyperplasia with hyperkeratosis&#44; parakeratosis&#44; and considerable monocytic&#47;lymphocytic infiltration of the dermis with some eosinophils &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">What Is Your Diagnosis&#63;</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Diagnosis</span><p id="par0020" class="elsevierStylePara elsevierViewall">Lortat-Jacob and Civatte pseudoepitheliomatous keratotic and micaceous balanitis &#40;PKMB&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical Course and Treatment</span><p id="par0025" class="elsevierStylePara elsevierViewall">Topical treatment was instated with a combination of 0&#46;5&#37; 5-fluorouracil and 10&#37; salicylic acid&#44; applied once daily for 12 weeks&#46; The treated area became severely irritated and treatment was suspended for 2 weeks&#46; Subsequent examinations revealed a gradual reduction of the plaque&#46; Persistence of the entity was confirmed in a new biopsy and treatment with ultrapulse CO<span class="elsevierStyleInf">2</span> laser was instated&#44; with a treated area of 34&#37; and energy density of 42&#46;2<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#46; The patient is currently undergoing follow-up at our department and shows no signs of local recurrence&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Comment</span><p id="par0030" class="elsevierStylePara elsevierViewall">PKMB was first described by Lortat-Jacob and Civatte in 1966&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> The disease affects the glans and manifests as keratotic lesions reminiscent of psoriasis plaques&#46; The literature contains few references to this entity and&#44; in epidemiological terms&#44; most published cases are of patients of Indian ethnicity&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Its etiology is currently the subject of debate&#46; The disease has 4 clinical stages&#58; initial or plaque stage&#44; late tumoral stage&#44; warty carcinoma&#44; and transformation into squamous cell carcinoma&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Histopathology typically reveals the following changes&#58; hyperkeratosis&#44; parakeratosis&#44; acanthosis&#44; elongated papillary crests&#44; and mild dysplasia in the basal layers&#46; Nonspecific inflammatory infiltration may be observed in the superficial dermis&#44; with variable numbers of lymphocytes and eosinophils&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Some authors have questioned the potential for this rare form of balanitis to become malignant&#44; but an increase has been reported in the number of recorded cases of warty carcinoma and squamous cell carcinoma arising from PKMB lesions&#44; either at the time of presentation or later&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Careful follow-up of these patients is therefore important&#46; To date&#44; no link has been found between PKMB and HPV&#46; In 1 case of warty carcinoma from PKMB&#44; in situ hybridization and PCR were negative for HPV in the tumor and in the precancerous lesion&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The differential diagnosis should include 3 approaches&#58; infectious causes&#44; with sexually transmitted diseases such as genital herpes simples&#44; soft chancre&#44; and primary syphilis&#59; inflammatory causes&#44; with diseases such as hypertrophic lichen planus and Zoon plasma cell balanitis&#59; and oncologic causes&#44; with penile intraepithelial neoplasia &#40;PeIN&#41;&#44; warty carcinoma&#44; squamous cell carcinoma&#44; keratoacanthoma&#44; giant condylomatosis&#44; and erythroplasia of Queyrat&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> The absence of atypical cells in PKMB histology may be a key finding that makes it possible to differentiate it from oncologic entities&#44; although correlation with the clinical presentation is necessary&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Early clinical diagnosis and biopsy of the lesion are of considerable value&#44; as the disease can be treated topically with 5-fluorouracil&#44;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;5</span></a> which produced a good response in our patient&#46; Other treatment options include cryotherapy&#44; photodynamic therapy&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> and wide resection&#44; which should be reserved for cases where histology reveals atypical cells&#46; We report a case of PKMB treated with 5-fluorouracil in combination with salicylic acid&#44; with a good initial response&#46; Treatment was completed with adjuvant CO<span class="elsevierStyleInf">2</span>-laser treatment&#44; which&#44; to date&#44; has not been reported in this disease&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of Interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Aguayo-Carreras P&#44; Navarro-Trivi&#241;o FJ&#44; Ruiz-Villaverde R&#44; Saenz-Guirado S&#46; Placa hiperquerat&#243;sica asintom&#225;tica en glande en un var&#243;n de mediana edad&#46; Actas Dermosifiliogr&#46; 2018&#59;109&#58;913&#8211;914&#46;</p>"
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                      "titulo" => "Pseudoepitheliomatous keratotic and micaceous balanitis&#58; A rare condition successfully treated with topical 5-fluorouracil"
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                            0 => "B&#46; Hanumaiah"
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Treatment of pseudoepitheliomatous&#44; keratotic&#44; and micaceous balanitis with topical photodynamic therapy"
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                          "etal" => false
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        "texto" => "<p id="par0070" class="elsevierStylePara elsevierViewall">We thank Dr&#46; Ainhoa Bueno Rodriguez for her support in resolving this case&#44; and Dr&#46; Naranjo Sintes and Dr&#46; Aneiros Fern&#225;ndez for their help in resolving the histology&#46;</p>"
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