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Visual examination required a digital dermoscopy system&#44; with magnifications of at least &#215;20-30&#46; The structures corresponded to the characteristic urticating hairs of the pine processionary caterpillar &#40;<span class="elsevierStyleItalic">Thaumetopoea pityocampa</span>&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The history of contact with the countryside and the presence of urticating hairs were key to confirming the diagnosis in this case&#46; The lesions resolved without sequelae after several days of treatment with oral antihistamines and topical corticosteroids&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The pine processionary caterpillar is one of the main causes of cutaneous-mucosal reactions to contact with Lepidoptera and is a growing public health problem&#46; In its larval state&#44; the caterpillar is covered with small urticating hairs&#44; which cause lesions on contact with the skin&#46; Owing to their &#8220;harpoon-like&#8221; morphology&#44; with multiple spicules&#44; these structures are able to remain attached to skin&#44; animal hair&#44; and even objects for long periods and can therefore cause symptoms without the need for contact with the pine forests they come from&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The frequency of lesions resulting from this species is usually highest during the first quarter of the year&#44; when mature caterpillars come down from the trees &#8220;in procession&#8221; in order to find a place to bury themselves&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The lesions have many clinical manifestations&#44; including involvement of the skin&#44; eyes&#44; and respiratory tract and anaphylaxis&#46; The skin lesions have a nonspecific morphology in the form of papular dermatitis&#44; urticaria&#44; and even vesicles or blistering&#46; They are more frequently found on exposed areas &#40;neck and limbs&#41;&#44; although they can also be found on covered areas and are usually accompanied by intense pruritus&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Skin lesions have traditionally been treated with oral antihistamines&#44; which are often combined with topical corticosteroids&#46; Furthermore&#44; there are reports of successful therapy with topical dobesilate&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">There are no pathognomonic clinical findings that enable us to diagnose the reaction to this species&#44; except for direct visualization of the urticating hairs on the skin using dermoscopy&#46; Nevertheless&#44; both in the present report and in the literature&#44; these hairs cannot generally be visualized directly using a manual dermatoscope&#44; and a digital device is necessary to enable greater magnification &#40;at least &#215;30&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Therefore&#44; pruriginous lesions on exposed areas should be viewed with a considerable degree of suspicion&#44; and the patient should be asked about possible previous exposure to this caterpillar in order to identify the hairs that will confirm the diagnosis with the help of dermoscopy&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">1&#44;2&#44;4</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Practical Dermoscopy
Telltale Hairs
Pelillos a la mar
S. Sánchez-Péreza,
Autor para correspondencia
ssanchez.derma@gmail.com

Corresponding author.
, C. Torres-Sánchezb, V. Alonso-Useroa
a Instituto Dermatológico Dr. Alonso, Hospital 9 de Octubre, Valencia, España
b Hospital Clínico Universitario de Valencia, Valencia, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case Description</span><p id="par0005" class="elsevierStylePara elsevierViewall">The patient was a 32-year-old woman with a 24-hour history of very pruriginous lesions on the hands&#44; abdomen&#44; neck&#44; and thigh&#46; The lesions were erythematous&#44; and some were more edematous and others more eczematous&#46; The only detail of interest was that she had been to the countryside the previous day &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Comment</span><p id="par0010" class="elsevierStylePara elsevierViewall">Dermoscopy findings were remarkable for the presence of short multiple brownish-orange linear structures&#46; Visual examination required a digital dermoscopy system&#44; with magnifications of at least &#215;20-30&#46; The structures corresponded to the characteristic urticating hairs of the pine processionary caterpillar &#40;<span class="elsevierStyleItalic">Thaumetopoea pityocampa</span>&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The history of contact with the countryside and the presence of urticating hairs were key to confirming the diagnosis in this case&#46; The lesions resolved without sequelae after several days of treatment with oral antihistamines and topical corticosteroids&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The pine processionary caterpillar is one of the main causes of cutaneous-mucosal reactions to contact with Lepidoptera and is a growing public health problem&#46; In its larval state&#44; the caterpillar is covered with small urticating hairs&#44; which cause lesions on contact with the skin&#46; Owing to their &#8220;harpoon-like&#8221; morphology&#44; with multiple spicules&#44; these structures are able to remain attached to skin&#44; animal hair&#44; and even objects for long periods and can therefore cause symptoms without the need for contact with the pine forests they come from&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The frequency of lesions resulting from this species is usually highest during the first quarter of the year&#44; when mature caterpillars come down from the trees &#8220;in procession&#8221; in order to find a place to bury themselves&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The lesions have many clinical manifestations&#44; including involvement of the skin&#44; eyes&#44; and respiratory tract and anaphylaxis&#46; The skin lesions have a nonspecific morphology in the form of papular dermatitis&#44; urticaria&#44; and even vesicles or blistering&#46; They are more frequently found on exposed areas &#40;neck and limbs&#41;&#44; although they can also be found on covered areas and are usually accompanied by intense pruritus&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Skin lesions have traditionally been treated with oral antihistamines&#44; which are often combined with topical corticosteroids&#46; Furthermore&#44; there are reports of successful therapy with topical dobesilate&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">There are no pathognomonic clinical findings that enable us to diagnose the reaction to this species&#44; except for direct visualization of the urticating hairs on the skin using dermoscopy&#46; Nevertheless&#44; both in the present report and in the literature&#44; these hairs cannot generally be visualized directly using a manual dermatoscope&#44; and a digital device is necessary to enable greater magnification &#40;at least &#215;30&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Therefore&#44; pruriginous lesions on exposed areas should be viewed with a considerable degree of suspicion&#44; and the patient should be asked about possible previous exposure to this caterpillar in order to identify the hairs that will confirm the diagnosis with the help of dermoscopy&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">1&#44;2&#44;4</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of Interest</span><p id="par0045" 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; S&#225;nchez-P&#233;rez S&#44; Torres-S&#225;nchez C&#44; Alonso-Usero V&#46; Telltale Hairs&#46; Actas Dermosifiliogr&#46; 2019&#59;110&#58;241&#8211;242&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical images&#46; A&#44; Nonspecific erythematous lesions on the trunk&#46; B&#44; Lesions predominantly affecting the creases of the palm&#46;</p>"
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                      "doi" => "10.1016/j.ad.2011.03.005"
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