Practical Dermoscopy
Grouped Red Vesicles in the Axilla
Vesículas rojas agrupadas en la axila
M. Mathur, P. Acharya
, A. Karki
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Departamento de Dermatología, Facultad de Ciencias Médicas, Bharatpur, Nepal
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Mathur, P. Acharya, A. Karki" "autores" => array:3 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Mathur" ] 1 => array:4 [ "nombre" => "P." "apellidos" => "Acharya" "email" => array:1 [ 0 => "prakashacharya888@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Karki" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Dermatología, Facultad de Ciencias Médicas, Bharatpur, Nepal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Vesículas rojas agrupadas en la axila" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 807 "Ancho" => 1074 "Tamanyo" => 163291 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous grouped vesicles over left axilla.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case Report</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 15-year-old male presented with asymptomatic, erythematous, grouped vesicles over left axilla noticed since five years of age which did not respond to any topical treatments (<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">What is your diagnosis?</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Diagnosis</span><p id="par0010" class="elsevierStylePara elsevierViewall">Lymphangioma Circumscriptum.</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Commentary</span><p id="par0015" class="elsevierStylePara elsevierViewall">Polarized light dermoscopy revealed multiple erythematous lacunae separated by white septa and linear vascular structures (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). “Hypopyon sign” which refers to the two-tone lacunae due to the settling of blood in the lowest part of the lacunae was observed (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). With the provisional diagnosis of lymphangioma circumscriptum (LS), we performed a biopsy which confirmed the diagnosis.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Cutaneous lymphangiomas are rare vascular tumors divided into two major groups: superficial and deep.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Lymphangioma circumscriptum, also known as superficial lymphatic malformation is the most common type among these tumors. LS is clinically characterized by clusters of translucent vesicles usually presenting soon after birth. The differential diagnoses include hemangiomas, angiokeratomas, angiosarcomas, lymphangiectasia, hemangiomas, cutaneous metastases, warts and molluscum contagiosum.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> Histologically, LS displays many dilated lymphatic channels located in the superficial dermis which may extend to the reticular dermis or subcutaneous tissue.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Presence of lacunae is the most commonly described histological feature of LS which correspond to the dilated, thin-walled lymphatic vessels in the papillary dermis.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> These lacunae are either filled with lymphatic fluid or red blood cells which gives their characteristic whitish or reddish color.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Gencoglan et al.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> described “hypopyon sign” occurring due to the precipitation of red blood cells as the differentiating feature between LS and hemangioma. The presence of white lines separating the lacunae has been attributed to the presence of fibroplasia which is seen in many cases of LS.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Zaballos et al.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> correlated the presence of vascular structures to the micro-shunts between small blood vessels and lymphatic channels.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The presence of lacunae and vascular structures has been described as the most common dermoscopic feature of LS while the “hypopyon sign” has been proposed as the most distinguishing feature of LS.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> These dermoscopic features in combination help to distinguish LS from the other conditions included in the differential diagnoses. We present this case for its educational value as all of the previously described dermoscopic patterns of LS can be clearly appreciated.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflict of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case Report" ] 1 => array:3 [ "identificador" => "sec0010" "titulo" => "What is your diagnosis?" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Diagnosis" ] ] ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Commentary" ] 3 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interest" ] 4 => array:2 [ "identificador" => "xack489888" "titulo" => "Acknowledgements" ] 5 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-12-10" "fechaAceptado" => "2019-01-03" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Mathur M, Acharya P, Karki A. Vesículas rojas agrupadas en la axila. Actas Dermosifiliogr. 2020. <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.ad.2019.01.024">https://doi.org/10.1016/j.ad.2019.01.024</span></p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 807 "Ancho" => 1074 "Tamanyo" => 163291 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous grouped vesicles over left axilla.</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" => 807 "Ancho" => 1074 "Tamanyo" => 226635 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Polarized light dermoscopy (20x) showing erythematous lacunae (white arrowhead), white septa (black arrowhead), linear vascular structures (blue arrowhead) and “hypopyon sign” (red arrowhead).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "[1]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous lymphangioma circumscriptum: frog spawn on the skin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G.A. 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"fecha" => "2012" "volumen" => "26" "paginaInicial" => "1023" "paginaFinal" => "1025" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack489888" "titulo" => "Acknowledgements" "texto" => "<p id="par0040" class="elsevierStylePara elsevierViewall">We would like to thank Professor Dr. T.S. Rao and Dr. Subechhya Jaiswal for their support during the interpretation of histopathological slides.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000011100000008/v1_202011031011/S1578219020302341/v1_202011031011/en/main.assets" "Apartado" => array:4 [ "identificador" => "19289" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Practical Dermoscopy" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000011100000008/v1_202011031011/S1578219020302341/v1_202011031011/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219020302341?idApp=UINPBA000044" ]
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| 2023 Septiembre | 83 | 48 | 131 |
| 2023 Agosto | 52 | 27 | 79 |
| 2023 Julio | 63 | 76 | 139 |
| 2023 Junio | 68 | 36 | 104 |
| 2023 Mayo | 88 | 36 | 124 |
| 2023 Abril | 67 | 23 | 90 |
| 2023 Marzo | 57 | 39 | 96 |
| 2023 Febrero | 58 | 29 | 87 |
| 2023 Enero | 64 | 43 | 107 |
| 2022 Diciembre | 76 | 56 | 132 |
| 2022 Noviembre | 26 | 34 | 60 |
| 2022 Octubre | 34 | 20 | 54 |
| 2022 Septiembre | 29 | 41 | 70 |
| 2022 Agosto | 27 | 31 | 58 |
| 2022 Julio | 25 | 28 | 53 |
| 2022 Junio | 32 | 33 | 65 |
| 2022 Mayo | 48 | 35 | 83 |
| 2022 Abril | 53 | 25 | 78 |
| 2022 Marzo | 42 | 41 | 83 |
| 2022 Febrero | 43 | 15 | 58 |
| 2022 Enero | 52 | 31 | 83 |
| 2021 Diciembre | 43 | 30 | 73 |
| 2021 Noviembre | 54 | 35 | 89 |
| 2021 Octubre | 54 | 48 | 102 |
| 2021 Septiembre | 41 | 39 | 80 |
| 2021 Agosto | 32 | 33 | 65 |
| 2021 Julio | 29 | 26 | 55 |
| 2021 Junio | 33 | 25 | 58 |
| 2021 Mayo | 42 | 41 | 83 |
| 2021 Abril | 91 | 49 | 140 |
| 2021 Marzo | 68 | 32 | 100 |
| 2021 Febrero | 46 | 42 | 88 |
| 2021 Enero | 42 | 26 | 68 |
| 2020 Diciembre | 38 | 19 | 57 |
| 2020 Noviembre | 66 | 19 | 85 |
| 2020 Octubre | 19 | 13 | 32 |
| 2020 Septiembre | 38 | 27 | 65 |
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