Case for Diagnosis
Chronic Generalized Excoriation
Excoriaciones diseminadas de larga evolución
J. Company-Quiroga
, S. Córdoba, J. Borbujo
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Servicio de Dermatología del Hospital Universitario de Fuenlabrada, Madrid, Spain
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Company-Quiroga, S. Córdoba, J. Borbujo" "autores" => array:3 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Company-Quiroga" "email" => array:1 [ 0 => "j.companyquiroga@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Córdoba" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Borbujo" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología del Hospital Universitario de Fuenlabrada, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Excoriaciones diseminadas de larga evolución" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 725 "Ancho" => 905 "Tamanyo" => 201727 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin (A, ×10; B and <span class="elsevierStyleSmallCaps">C,</span> ×20; D, ×40).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Clinical Characteristics</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 52-year-old man with hypertension managed by dietary intervention, reported having itchy papular and vesicular lesions for 3 years. The intensity of these lesions varied but they had always been present on the forearms, and to a lesser extent on the cervicofacial region, abdomen, and legs. He received antihistamine treatment and prednisone (15 mg/d) without any improvement. He did not have any personal or family history of atopy. He worked in a factory handling car chassis parts with no clear improvement during vacations.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Skin examination showed the presence of extensive excoriation on an erythematous base. The lesions formed extensive chaffed plaques of eczematous appearance on the forearms, cervicofacial region, abdomen, and legs (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Skin biopsy samples from the lesions were taken. Adhesive tape stripping was performed, and the sample subsequently placed on a microscope slide for viewing under an optical microscope.</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">The blood tests, which included IgE, did not show any significant abnormalities. Skin patch tests were performed with the standard battery of the Spanish Contact Dermatitis and Skin Allergy Research Group, with negative results. Biopsy showed the presence of a subepidermal hemorrhagic blister and hyperkeratosis with acanthosis, consistent with a lesion caused by scratching (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). In the sample obtained by adhesive tape stripping, several linear fragments could be seen with a variable diameter under the microscope with polarized light, consistent with glass fibers (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).<span class="elsevierStyleDisplayedQuote" id="dsq0005"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">[[?]]What was the diagnosis?</p></span></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Diagnosis</span><p id="par0020" class="elsevierStylePara elsevierViewall">Fiberglass dermatitis (FGD)</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Course and Treatment</span><p id="par0025" class="elsevierStylePara elsevierViewall">The patient confirmed close contact with fiberglass materials when handling chassis parts. He was recommended to use protective clothing when at work and was prescribed topical treatment with betamethasone and gentamycin, along with oral antihistamine agents. Given a suboptimal control of the clinical symptoms, the patient took several months sick leave, with substantial and sustained improvement in his condition. He finally obtained occupational disability, and remained completely asymptomatic.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Comment</span><p id="par0030" class="elsevierStylePara elsevierViewall">Fiberglass is a widely used material in construction, although given its thermal, acoustic, and electrical insultation properties, it is also used outside that sector. Fiberglass is a clinically inert material that in itself does not lead to sensitization but this may sometimes occur because of resins and other additives used in the final fiberglass product, giving rise to cases of contact allergic eczema.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Nevertheless, fiberglass dermatitis, first described in 1942 by Sulzberger and Baer,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> is an irritative contact dermatitis considered a frequent cause of occupational dermatitis. The pathogenic mechanism consists of penetration of glass fragments into the stratum corneum, leading to mechanical irritation.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Although less frequently described, an airborne transportation mechanism is also possible.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> From the clinical point of view, presentation is in the form of chaffing caused by uncontrolled itching, which may ultimately resemble prurigo, within a broad spectrum of eczematous lesions. Of note is that the intensity of irritation is proportional to the diameter of the fragments, and inversely proportional to their length. Medical history is essential to identify exposure to glass fiber, and so it is important that dermatologists are aware of the existence of this disease. A further barrier to recognition of the condition is that prolonged exposure generates tolerance to the fiber, whereas patients with shorter durations of exposure are those who develop lesions.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Contact tests are not useful for diagnosis, for the reasons highlighted above, although they may be of relevance for identifying concomitant sensitization to additives. Although histopathological study is of little use, as illustrated by our case, it could eventually identify birefringent fiberglass fragments embedded in the stratum corneum.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> A simple and noninvasive test is to obtain a skin sample from the area of the lesion using an adhesive strip. Fiberglass fragments can be observed among corneal remnants under an electron microscope,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> thus providing a definitive diagnosis.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Clinical Characteristics" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Additional Tests" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Diagnosis" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Course and Treatment" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Comment" ] 6 => 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: Company-Quiroga J, Córdoba A, Borbujo J. Excoriaciones diseminadas de larga evolución. Actas Dermosifiliogr. 2020;111:511–512.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 401 "Ancho" => 500 "Tamanyo" => 29375 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Excoriation on an erythematous base in the cervicofacial area.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 725 "Ancho" => 905 "Tamanyo" => 201727 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin (A, ×10; B and <span class="elsevierStyleSmallCaps">C,</span> ×20; D, ×40).</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 334 "Ancho" => 500 "Tamanyo" => 47778 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">×10 magnification.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Occupational dermatoses among fibreglass-reinforced plastics factory workers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K. Minamoto" 1 => "M. Nagano" 2 => "T. Inaoka" 3 => "M. Futatsuka" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1034/j.1600-0536.2002.460604.x" "Revista" => array:6 [ "tituloSerie" => "Contact Dermatitis." "fecha" => "2002" "volumen" => "46" "paginaInicial" => "339" "paginaFinal" => "347" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12190622" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effects of fiber glass on animal and human skin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.B. Sulzberger" 1 => "R.L. Baer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ind Med Surg." 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 1 | 0 | 1 |
| 2024 Octubre | 71 | 38 | 109 |
| 2024 Septiembre | 61 | 32 | 93 |
| 2024 Agosto | 100 | 60 | 160 |
| 2024 Julio | 77 | 44 | 121 |
| 2024 Junio | 60 | 47 | 107 |
| 2024 Mayo | 64 | 40 | 104 |
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| 2024 Marzo | 67 | 40 | 107 |
| 2024 Febrero | 68 | 50 | 118 |
| 2024 Enero | 67 | 35 | 102 |
| 2023 Diciembre | 65 | 31 | 96 |
| 2023 Noviembre | 72 | 33 | 105 |
| 2023 Octubre | 60 | 25 | 85 |
| 2023 Septiembre | 60 | 35 | 95 |
| 2023 Agosto | 41 | 33 | 74 |
| 2023 Julio | 38 | 40 | 78 |
| 2023 Junio | 44 | 28 | 72 |
| 2023 Mayo | 44 | 30 | 74 |
| 2023 Abril | 34 | 21 | 55 |
| 2023 Marzo | 52 | 34 | 86 |
| 2023 Febrero | 46 | 26 | 72 |
| 2023 Enero | 36 | 34 | 70 |
| 2022 Diciembre | 55 | 42 | 97 |
| 2022 Noviembre | 36 | 27 | 63 |
| 2022 Octubre | 33 | 30 | 63 |
| 2022 Septiembre | 23 | 42 | 65 |
| 2022 Agosto | 35 | 43 | 78 |
| 2022 Julio | 45 | 39 | 84 |
| 2022 Junio | 27 | 35 | 62 |
| 2022 Mayo | 60 | 41 | 101 |
| 2022 Abril | 64 | 26 | 90 |
| 2022 Marzo | 58 | 58 | 116 |
| 2022 Febrero | 49 | 32 | 81 |
| 2022 Enero | 67 | 42 | 109 |
| 2021 Diciembre | 62 | 30 | 92 |
| 2021 Noviembre | 54 | 40 | 94 |
| 2021 Octubre | 60 | 48 | 108 |
| 2021 Septiembre | 56 | 30 | 86 |
| 2021 Agosto | 40 | 27 | 67 |
| 2021 Julio | 33 | 15 | 48 |
| 2021 Junio | 32 | 17 | 49 |
| 2021 Mayo | 37 | 40 | 77 |
| 2021 Abril | 77 | 53 | 130 |
| 2021 Marzo | 59 | 26 | 85 |
| 2021 Febrero | 49 | 29 | 78 |
| 2021 Enero | 33 | 19 | 52 |
| 2020 Diciembre | 25 | 22 | 47 |
| 2020 Noviembre | 21 | 16 | 37 |
| 2020 Octubre | 35 | 15 | 50 |
| 2020 Septiembre | 56 | 30 | 86 |
| 2020 Agosto | 53 | 29 | 82 |
| 2020 Julio | 36 | 18 | 54 |
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