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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 41-year-old man with no medical or surgical past history of interest was referred to the dermatology service due to skin lesions that had appeared 2 months earlier on both pinnae&#46; The lesions were asymptomatic&#44; and the patient reported no potential triggering event&#46;</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 4 pearly papules distributed in a line on the antihelix of the left pinna &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; and 2 lesions of similar characteristics on the right pinna&#46;</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">The histopathology study showed a lymphohistiocytic infiltrate with palisading histiocytes surrounding a central area with necrobiosis and mucin deposit &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">&#91;&#91;&#63;&#93;&#93;What is your Diagnosis&#63;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Diagnosis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Granuloma annulare on the antihelix&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Clinical Course and Treatment</span><p id="par0030" class="elsevierStylePara elsevierViewall">In this case&#44; the lesions resolved after the biopsy and no treatment was required&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Comment</span><p id="par0035" class="elsevierStylePara elsevierViewall">Granuloma annulare &#40;GA&#41; is a noninfectious granulomatous skin disease&#46; 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with overlying skin of normal appearance&#44; located on the scalp&#44; pretibial region&#44; buttocks&#44; and palmar and plantar regions&#46; The perforating variety is also rare and manifests as erythematous papules that develop into umbilicated lesions with a squamous or scabbed center&#46; Other less common types of GA have been described and the different types also tend to coincide&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Very few cases of GA involving the outer ear have been published in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;6</span></a> Although GA is more common in women&#44; most published cases involving the outer ear have been reported in boys or young men&#44;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;6</span></a> and a large percentage of these are bilateral&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a> Moreover&#44; 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Case for Diagnosis
Pearly White Papules on the Antihelix
Pápulas perladas en el antihélix
M. Oro-Ayudea,
Autor para correspondencia
marcosoroayude@gmail.com

Corresponding author.
, R.M. Hernández Cancelab, A. Flóreza
a Servicio de Dermatología del Complejo Hospitalario Universitario de Pontevedra, Gerencia de Gestión Integrada Pontevedra y O Salnés, Spain
b Servicio de Anatomía Patológica del Complejo Hospitalario Universitario de Pontevedra, Gerencia de Gestión Integrada Pontevedra y O Salnés, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 41-year-old man with no medical or surgical past history of interest was referred to the dermatology service due to skin lesions that had appeared 2 months earlier on both pinnae&#46; The lesions were asymptomatic&#44; and the patient reported no potential triggering event&#46;</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 4 pearly papules distributed in a line on the antihelix of the left pinna &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; and 2 lesions of similar characteristics on the right pinna&#46;</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">The histopathology study showed a lymphohistiocytic infiltrate with palisading histiocytes surrounding a central area with necrobiosis and mucin deposit &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">&#91;&#91;&#63;&#93;&#93;What is your Diagnosis&#63;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Diagnosis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Granuloma annulare on the antihelix&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Clinical Course and Treatment</span><p id="par0030" class="elsevierStylePara elsevierViewall">In this case&#44; the lesions resolved after the biopsy and no treatment was required&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Comment</span><p id="par0035" class="elsevierStylePara elsevierViewall">Granuloma annulare &#40;GA&#41; is a noninfectious granulomatous skin disease&#46; It is a benign entity of unknown etiology and is common in clinical practice&#59; it especially affects children and young adults and is more frequent in females&#46; It generally presents on the wrists&#44; ankles&#44; hands&#44; and feet in the form of annular erythematous papules with central lightening&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">There are 4 main types of GA&#46; In the local variety&#44; between 80&#37; and 90&#37; of all cases&#44; the lesions appear at the aforementioned sites and with the typical morphology&#46; The generalized form&#44; which represents fewer than 15&#37; of cases&#44; affects the torso and extremities in the form of numerous erythematous or yellowish papules&#44; which may coalesce to form annular or circinate plaques&#46; The subcutaneous variety is rare&#46; It typically affects children and manifests as fast-growing painless subcutaneous nodules&#44; with overlying skin of normal appearance&#44; located on the scalp&#44; pretibial region&#44; buttocks&#44; and palmar and plantar regions&#46; The perforating variety is also rare and manifests as erythematous papules that develop into umbilicated lesions with a squamous or scabbed center&#46; Other less common types of GA have been described and the different types also tend to coincide&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Very few cases of GA involving the outer ear have been published in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;6</span></a> Although GA is more common in women&#44; most published cases involving the outer ear have been reported in boys or young men&#44;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;6</span></a> and a large percentage of these are bilateral&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a> Moreover&#44; the lesions usually appear on the most exposed areas and it has therefore been suggested that small&#44; repeated traumas may be implicated as a trigger&#44; even when patients do not always identify them&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">We report an atypical GA in terms of site of the lesions and in terms of morphology&#46; This presentation is rare in the literature and a correct diagnosis&#44; which is essential to avoid unnecessary interventions or treatments&#44; with their potential complications&#44; may pose a challenge&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "texto" => "<p id="par0060" class="elsevierStylePara elsevierViewall">The authors would like to thank the Dermatology department of Complejo Hospitalario Universitario de Pontevedra&#44; Spain&#44; for their cooperation&#46;</p>"
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