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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Dermal melanocytosis is a group of congenital or acquired entities&#44; characterized clinically by bluish-gray discoloration of the skin&#44; and histologically by the presence in the dermis of pigmented spindle and dendritic melanocytes&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> The etiology and pathogenesis are unclear&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Facial forms of dermal melanocytosis have been described&#44; including nevus of Hori&#44; nevus of Ota&#44; nevus of Hidano&#44; periorbital melanosis &#40;as proposed by Watanabe&#41;&#44; and nevus of Sun&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Sun et al&#46; reported 110 cases of nevus fusco-caeruleus zygomaticus in Chinese patients&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> This lesion consists of small speckled patches of skin ranging in color from brown to gray to blue&#44; principally affects the zygomatic region&#44; appears gradually between the second and third decades of life&#44; and is 12&#46;8 times more prevalent in women than men&#46; Familial cases with an autosomal dominant inheritance pattern have been described&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;4</span></a> There is no known association with other dermatoses&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> Histology shows dispersed elongated melanocytes in the upper dermis&#44; as visualized with Fontana-Masson and 3&#44;4-dihydroxyphenylalanine &#40;DOPA&#41; staining or by immunohistochemistry for S100 and HMB-45&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Here&#44; we describe a case of acquired dermal melanocytosis corresponding to nevus of Sun&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A 27-year-old woman presented with asymptomatic hyperpigmented patches in the zygomatic region that had appeared 3 years earlier&#46; Since the appearance of the lesions&#44; she had been evaluated by 4 dermatologists&#44; all of whom had established a diagnosis of melasma&#46; The patient had undergone treatment with hydroquinone&#44; high- and medium-potency steroids&#44; kojic acid&#44; intralesional tranexamic acid&#44; and chemical and physical photoprotection&#44; without improvement&#46; Physical examination revealed dermatosis in the bilateral zygomatic region&#44; below the lower palpebral border&#44; consisting of well defined&#44; speckled&#44; grayish-brown macules of less than 4<span class="elsevierStyleHsp" style=""></span>mm diameter that showed a tendency to coalesce &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A and B&#41;&#46; A clinical diagnosis of acquired facial dermal melanocytosis was established&#44; and a biopsy was taken&#46; Histology &#40;hematoxylin-eosin staining&#41; revealed the presence of pigmented spindle cells distributed in the upper&#44; perivascular&#44; and periadnexal dermis&#46; These cells&#44; which were positive for S100 protein&#44; were identified as dermal melanocytes &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Based on these findings&#44; the diagnosis of nevus-of-Sun-type acquired facial dermal melanocytosis was confirmed&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The main differential diagnosis is melasma&#44; owing to its prevalence in the Spanish population&#46; Clinically&#44; melasma manifests as brown or grayish patches on the face that are usually uniform in color&#44; rarely mottled&#44; and never affect the periorbital area&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Histology shows hyperpigmentation of the basal layer&#44; rupture of the basement membrane&#44; melanophages in the dermis&#44; an increase in the number of vessels&#44; mast cells&#44; and solar elastosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7&#44;8</span></a> By contrast&#44; nevus of Sun affects the zygomatic area and is characterized by hyperpigmented&#44; speckled&#44; brown or gray-blue macules&#46; Histology shows elongated&#44; pigmented spindle cells in the upper dermis that correspond to dermal melanocytes positive for S100 protein&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Other conditions that should be ruled out include ephelides&#44; Riehl melanosis&#44; ashy dermatosis&#44; ochronosis&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> agminated dermal melanocytosis&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> and other forms of acquired facial dermal melanocytosis&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> Treatment consists of physical and chemical photoprotection&#44; although some cases have been treated with Q-switched Alexandrite laser&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4&#44;10</span></a> On the American continent&#44; a case of nevus of Hori was described in an Argentine woman of Japanese descent&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Based on a review of the literature and the shared clinical and histopathological similarities&#44; we propose grouping these pigmentary dermatoses within a single category&#59; acquired facial dermal melanocytosis&#46; It is highly likely that this type of facial hyperpigmentation is underdiagnosed due to confusion with other more common dermatoses&#44; as occurred in the present case&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Case and Research Letters
Acquired Facial Dermal Melanocytosis of the Sun's Nevus Type: A Case Report
Melanocitosis dérmica facial adquirida tipo nevo de Sun. Reporte de un caso
E. Marín Hernándeza,
Autor para correspondencia
emarinh1973@yahoo.com.mx

Corresponding author.
, Y. Calderón Ponce de Leónb, V. Bautista Piñac, L. Sánchez Rodríguezd
a Servicio de Dermatología Pediátrica, Centro Médico Nacional Siglo XXI, Ciudad de México, CDMX, Mexico
b Dermatología, Centro Dermatológico Dr. Ladislao de la Pascua, Ciudad de México, CDMX, Mexico
c Anatomía Patológica, Fundación del Cáncer de Mama (FUCAM), Ciudad de México, Mexico
d Neumología, Instituto Nacional de Enfermedades Respiratorias (INER), Ciudad de México, CDMX, Mexico
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Dermal melanocytosis is a group of congenital or acquired entities&#44; characterized clinically by bluish-gray discoloration of the skin&#44; and histologically by the presence in the dermis of pigmented spindle and dendritic melanocytes&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> The etiology and pathogenesis are unclear&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Facial forms of dermal melanocytosis have been described&#44; including nevus of Hori&#44; nevus of Ota&#44; nevus of Hidano&#44; periorbital melanosis &#40;as proposed by Watanabe&#41;&#44; and nevus of Sun&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Sun et al&#46; reported 110 cases of nevus fusco-caeruleus zygomaticus in Chinese patients&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> This lesion consists of small speckled patches of skin ranging in color from brown to gray to blue&#44; principally affects the zygomatic region&#44; appears gradually between the second and third decades of life&#44; and is 12&#46;8 times more prevalent in women than men&#46; Familial cases with an autosomal dominant inheritance pattern have been described&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;4</span></a> There is no known association with other dermatoses&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> Histology shows dispersed elongated melanocytes in the upper dermis&#44; as visualized with Fontana-Masson and 3&#44;4-dihydroxyphenylalanine &#40;DOPA&#41; staining or by immunohistochemistry for S100 and HMB-45&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Here&#44; we describe a case of acquired dermal melanocytosis corresponding to nevus of Sun&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A 27-year-old woman presented with asymptomatic hyperpigmented patches in the zygomatic region that had appeared 3 years earlier&#46; Since the appearance of the lesions&#44; she had been evaluated by 4 dermatologists&#44; all of whom had established a diagnosis of melasma&#46; The patient had undergone treatment with hydroquinone&#44; high- and medium-potency steroids&#44; kojic acid&#44; intralesional tranexamic acid&#44; and chemical and physical photoprotection&#44; without improvement&#46; Physical examination revealed dermatosis in the bilateral zygomatic region&#44; below the lower palpebral border&#44; consisting of well defined&#44; speckled&#44; grayish-brown macules of less than 4<span class="elsevierStyleHsp" style=""></span>mm diameter that showed a tendency to coalesce &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A and B&#41;&#46; A clinical diagnosis of acquired facial dermal melanocytosis was established&#44; and a biopsy was taken&#46; Histology &#40;hematoxylin-eosin staining&#41; revealed the presence of pigmented spindle cells distributed in the upper&#44; perivascular&#44; and periadnexal dermis&#46; These cells&#44; which were positive for S100 protein&#44; were identified as dermal melanocytes &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Based on these findings&#44; the diagnosis of nevus-of-Sun-type acquired facial dermal melanocytosis was confirmed&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The main differential diagnosis is melasma&#44; owing to its prevalence in the Spanish population&#46; Clinically&#44; melasma manifests as brown or grayish patches on the face that are usually uniform in color&#44; rarely mottled&#44; and never affect the periorbital area&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Histology shows hyperpigmentation of the basal layer&#44; rupture of the basement membrane&#44; melanophages in the dermis&#44; an increase in the number of vessels&#44; mast cells&#44; and solar elastosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7&#44;8</span></a> By contrast&#44; nevus of Sun affects the zygomatic area and is characterized by hyperpigmented&#44; speckled&#44; brown or gray-blue macules&#46; Histology shows elongated&#44; pigmented spindle cells in the upper dermis that correspond to dermal melanocytes positive for S100 protein&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Other conditions that should be ruled out include ephelides&#44; Riehl melanosis&#44; ashy dermatosis&#44; ochronosis&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> agminated dermal melanocytosis&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> and other forms of acquired facial dermal melanocytosis&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> Treatment consists of physical and chemical photoprotection&#44; although some cases have been treated with Q-switched Alexandrite laser&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4&#44;10</span></a> On the American continent&#44; a case of nevus of Hori was described in an Argentine woman of Japanese descent&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Based on a review of the literature and the shared clinical and histopathological similarities&#44; we propose grouping these pigmentary dermatoses within a single category&#59; acquired facial dermal melanocytosis&#46; It is highly likely that this type of facial hyperpigmentation is underdiagnosed due to confusion with other more common dermatoses&#44; as occurred in the present case&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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ISSN: 15782190
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