Case for Diagnosis
Annular Plaques on the Trunk of a Teenage Boy
Placas anulares en el tronco de un adolescente
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Mir-Bonafé, A. Claret-de Castro, E. Rozas-Muñoz" "autores" => array:3 [ 0 => array:4 [ "nombre" => "J.F." "apellidos" => "Mir-Bonafé" "email" => array:1 [ 0 => "joanmirbonafe@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" => "A." "apellidos" => "Claret-de Castro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "E." 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Examination of the patient's torso revealed several asymptomatic brownish erythematous circular plaques. The patient was unsure of when they first appeared. He denied having taken drugs, recent travel, contact with animals, and flea bites.</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 nonscaling brownish erythematous annular plaque on the skin of the upper abdomen with central hypopigmentation and various isolated smaller circular macules on the abdomen, proximal part of the arms (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), and back. The face, palms, and soles were spared, as were the mucous membranes. The affected skin was neither atrophied nor indurated, and sensitivity was unaltered.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> showed a dense lichenoid infiltrate on the tips of the papillae and numerous necrotic keratinocytes. Also visible was a chronic perivascular infiltrate in the superficial dermis. No granulomas, atypical lymphocytes, dermal fibrosis, or vasculitis were observed. Periodic acid–Schiff staining was negative.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Additional Tests</span><p id="par0020" class="elsevierStylePara elsevierViewall">The results of the complete blood count and biochemical tests were normal, and serology for <span class="elsevierStyleItalic">Borrelia</span> species was negative.</p><p id="par0025" class="elsevierStylePara elsevierViewall">What is your diagnosis?</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Diagnosis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Annular lichenoid dermatitis of youth (ALDY).</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Treatment and Clinical Course</span><p id="par0035" class="elsevierStylePara elsevierViewall">Given the diagnosis of ALDY, we prescribed clobetasol propionate 0.1% cream for 4 weeks. This led to complete resolution of the lesions. The patient remained free of lesions until the last check-up, which was 6 months after the lesions had resolved.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">ALDY is an uncommon condition whose etiology and pathogenesis are unknown. It forms part of the broad group known as lichenoid dermatitis, and diagnosis is necessarily based on the correlation between clinical and histopathologic findings. The condition is probably underdiagnosed, with only 46 cases reported in the literature since it was first described in 2003. ALDY generally affects children and adolescents—it is rare in adults—most frequently from the Mediterranean area, with a slight predominance in males.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> Clinically, it presents as annular erythematous plaques or macules with a whitish center mainly affecting the trunk. It is usually asymptomatic. The clinical differential diagnosis is broad and is mainly with morphea, deep erythema annulare centrifugum, mycosis fungoides, tinea corporis, chronic migratory erythema, scleroatrophic lichen, granuloma annulare, and even sarcoidosis.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The correlation between clinical and histopathological data is essential. Histologically, ALDY presents as lichenoid dermatitis affecting mainly the dermal papillae and associated with a mild chronic perivascular inflammatory infiltrate in the superficial dermis. The infiltrate is predominantly CD3<span class="elsevierStyleSup">+</span> and CD4<span class="elsevierStyleSup">+</span>, and in some cases, exocytosis of lymphocytes may be observed. When the condition could be confused with mycosis fungoides, it is necessary to perform a clonal rearrangement study, which should yield a negative result.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> Also useful is the frequent finding of CD20 positivity in the ALDY infiltrate; this is usually negative in mycosis fungoides.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">While benign and usually self-limiting, it can be treated successfully with both topical and oral corticosteroids.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> Phototherapy, topical calcineurin inhibitors, and oral antibiotics can be used in the most refractory cases.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">A recent study of 14 patients in western Austria pointed to a possible association between ALDY and <span class="elsevierStyleItalic">Borrelia burgdorferi</span>.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> The authors detected spirochetes in 11 of the 14 samples and a positive result in 9 of the 12 serology tests performed. In fact, 1 patient diagnosed with ALDY eventually had plaque morphea. Therefore, the authors suggested that <span class="elsevierStyleItalic">B burgdorferi</span> could play a role in the etiology or even that ALDY could be an incipient phase of morphea. In the case we present, the association with <span class="elsevierStyleItalic">B burgdorferi</span> was ruled out by serology testing.</p><p id="par0060" class="elsevierStylePara elsevierViewall">We report a typical case of ALDY, with classic clinical and histopathological characteristics that enable us to present an uncommon condition about which we still have much to learn.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of Interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case Description" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Histopathology" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Additional Tests" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Diagnosis" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Treatment and Clinical Course" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of Interest" ] 8 => 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: Mir-Bonafé JF, Claret-de Castro A, Rozas-Muñoz E. Placas anulares en el tronco de un adolescente. Actas Dermosifiliogr. 2020;111:319–320.</p>" ] ] "multimedia" => array:2 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 513 "Ancho" => 951 "Tamanyo" => 66130 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 714 "Ancho" => 951 "Tamanyo" => 242404 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Annular lichenoid dermatitis of youth: a report of 2 cases and a review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "I. 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Girolomoni" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000381705" "Revista" => array:6 [ "tituloSerie" => "Dermatology" "fecha" => "2015" "volumen" => "231" "paginaInicial" => "195" "paginaFinal" => "200" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26160268" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Annular lichenoid dermatitis (of youth) immunohistochemical and serological evidence for another clinical presentation of borrelia infection in patients of western Austria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Wilk" 1 => "B.G. Zelger" 2 => "M. Emberger" 3 => "B. Zelger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/DAD.0000000000000621" "Revista" => array:7 [ "tituloSerie" => "Am J Dermatopathol" "fecha" => "2017" "volumen" => "39" "paginaInicial" => "177" "paginaFinal" => "180" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27391456" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1098301513000223" "estado" => "S300" "issn" => "10983015" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "[Annular lichenoid dermatitis of youth: a case report and literature review]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D. Debois" 1 => "J.L. Dargent" 2 => "P. Ngendahayo" 3 => "P.P. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 12 | 9 | 21 |
| 2024 Octubre | 75 | 67 | 142 |
| 2024 Septiembre | 82 | 35 | 117 |
| 2024 Agosto | 102 | 72 | 174 |
| 2024 Julio | 91 | 41 | 132 |
| 2024 Junio | 69 | 49 | 118 |
| 2024 Mayo | 75 | 55 | 130 |
| 2024 Abril | 84 | 32 | 116 |
| 2024 Marzo | 85 | 41 | 126 |
| 2024 Febrero | 70 | 48 | 118 |
| 2024 Enero | 73 | 41 | 114 |
| 2023 Diciembre | 51 | 22 | 73 |
| 2023 Noviembre | 97 | 49 | 146 |
| 2023 Octubre | 84 | 35 | 119 |
| 2023 Septiembre | 63 | 46 | 109 |
| 2023 Agosto | 52 | 24 | 76 |
| 2023 Julio | 75 | 50 | 125 |
| 2023 Junio | 80 | 41 | 121 |
| 2023 Mayo | 101 | 57 | 158 |
| 2023 Abril | 73 | 46 | 119 |
| 2023 Marzo | 92 | 46 | 138 |
| 2023 Febrero | 103 | 42 | 145 |
| 2023 Enero | 80 | 35 | 115 |
| 2022 Diciembre | 94 | 45 | 139 |
| 2022 Noviembre | 79 | 44 | 123 |
| 2022 Octubre | 56 | 27 | 83 |
| 2022 Septiembre | 52 | 40 | 92 |
| 2022 Agosto | 32 | 48 | 80 |
| 2022 Julio | 42 | 38 | 80 |
| 2022 Junio | 35 | 44 | 79 |
| 2022 Mayo | 113 | 53 | 166 |
| 2022 Abril | 69 | 41 | 110 |
| 2022 Marzo | 83 | 59 | 142 |
| 2022 Febrero | 74 | 36 | 110 |
| 2022 Enero | 75 | 47 | 122 |
| 2021 Diciembre | 69 | 51 | 120 |
| 2021 Noviembre | 74 | 50 | 124 |
| 2021 Octubre | 75 | 61 | 136 |
| 2021 Septiembre | 57 | 53 | 110 |
| 2021 Agosto | 42 | 70 | 112 |
| 2021 Julio | 40 | 37 | 77 |
| 2021 Junio | 41 | 39 | 80 |
| 2021 Mayo | 40 | 48 | 88 |
| 2021 Abril | 78 | 73 | 151 |
| 2021 Marzo | 57 | 45 | 102 |
| 2021 Febrero | 57 | 41 | 98 |
| 2021 Enero | 40 | 26 | 66 |
| 2020 Diciembre | 35 | 28 | 63 |
| 2020 Noviembre | 25 | 18 | 43 |
| 2020 Octubre | 31 | 33 | 64 |
| 2020 Septiembre | 38 | 24 | 62 |
| 2020 Agosto | 42 | 19 | 61 |
| 2020 Julio | 56 | 27 | 83 |
| 2020 Junio | 73 | 40 | 113 |
| 2020 Mayo | 54 | 27 | 81 |
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