Practical dermoscopy
Multiple Acral Papules
Pápulas acrales múltiples
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Calderón-Castrat, I. Kikushima, R. Ballona" "autores" => array:3 [ 0 => array:4 [ "nombre" => "X." "apellidos" => "Calderón-Castrat" "email" => array:1 [ 0 => "xcalderoncastrat@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "I." "apellidos" => "Kikushima" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "R." "apellidos" => "Ballona" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología Pediátrica, Instituto Nacional de Salud del Niño San Borja, Lima, Peru" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología Pediátrica, Instituto Nacional de Salud del Niño Breña, Lima, Peru" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pápulas acrales múltiples" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 850 "Ancho" => 1733 "Tamanyo" => 117740 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(a) Dermoscopic assessment of papules on the palms: Yellow structureless pattern and a peripheral hyperkeratotic rim. (b) *Clouds of paler yellow deposits, linear vessels and a peripheral hyperkeratotic rim.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case Presentation</span><p id="par0005" class="elsevierStylePara elsevierViewall">A healthy 3-year-old boy presented with multiple asymptomatic lesions on his face and hands of 1-year evolution, refractory to multiple treatments for viral warts. Physical examination revealed multiple skin-coloured to pink papules measuring less than 3–5<span class="elsevierStyleHsp" style=""></span>mm located on the volar surface of both hands (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Diagnosis</span><p id="par0010" class="elsevierStylePara elsevierViewall">Acral Juvenile Xanthogranuloma Simulating Common Viral Warts.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Commentary</span><p id="par0015" class="elsevierStylePara elsevierViewall">The initial clinical impression established was common warts. However, dermoscopic assessment revealed a yellow structureless pattern with a peripheral hyperkeratotic rim (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>(a)) and some showed clouds of paler yellow deposits and linear vessels (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>(b)). Subsequently, a skin biopsy was performed demonstrating histiocytic intradermal infiltration, composed of xanthomatous cells and Touton type giant cells. In view of the clinical, dermoscopic and histopathologic findings a diagnosis of acral juvenile xanthogranuloma (JXG) was established.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Juvenile xanthogranuloma (JXG) is a benign, self-healing, non-Langerhans cell histiocytosis that predominantly affects children.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> The clinical presentation is characterized by solitary or multiple, yellow papules and nodules.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2</span></a> The most common sites involved are the head and trunk; however, JXG can develop in any part of the body, including mucosa and genitals.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Diagnosis is based fundamentally on clinical observation in most cases, but may pose difficulties in atypical presentations or locations.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,3</span></a> Several dermoscopic features have been described on account of the evolutionary stages of JXG like the orange-yellow structureless pattern with erythematous border (setting sun sign), clouds of paler yellow globules, branched or linear vessels and whitish streaks.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Differential diagnosis for acral JXG, specifically for solitary lesions, includes Spitz nevi, eccrine poroma,<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3,4</span></a> pyogenic granuloma,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> digital fibrokeratoma,<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4,5</span></a> amongst other lesions. Moreover, multiple acral JXG can easily be mistaken for common viral warts. However, dermoscopic analysis reveals lack of multiple punctate haemorrhages and papilliform surface, a characteristic feature of viral infection.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> In atypical cases, histopathologic analysis is required, showing accumulation of classic non-Langerhans cell histiocytes called Touton giant cells, positive for CD68 and negative for S-100 and CD1a.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The present case highlights the great variability in clinical appearance of JXG and the fundamental role of dermoscopy, even for those clinically apparent benign dermatoses such as viral warts. Recognition of the characteristic dermoscopic features for acral JXG avoids unnecessary and painful treatments due to its benign clinical evolution.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3,4</span></a></p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case Presentation" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Diagnosis" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Commentary" ] 3 => 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: Calderón-Castrat X, Kikushima I, Ballona R. Pápulas acrales múltiples. Actas Dermosifiliogr. 2019;110:855–856.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 846 "Ancho" => 1300 "Tamanyo" => 363798 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">multiple skin-coloured and pink wart-like papules located on both palms.</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" => 850 "Ancho" => 1733 "Tamanyo" => 117740 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(a) Dermoscopic assessment of papules on the palms: Yellow structureless pattern and a peripheral hyperkeratotic rim. (b) *Clouds of paler yellow deposits, linear vessels and a peripheral hyperkeratotic rim.</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" => "Structural correlations between dermoscopic and histopathological features of juvenile xanthogranuloma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Song" 1 => "S.H. Kim" 2 => "D.S. Jung" 3 => "H.C. Ko" 4 => "K.S. Kwon" 5 => "M.B. 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| año/Mes | Html | Total | |
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