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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">An 8-year-old girl was referred by endocrinology to the dermatology department for assessment of mildly pruritic lesions in both axillae&#46; The lesions had developed over a long period of time and were more severe in the left armpit&#46; The patient&#44; whose parents were natives of Romania&#44; was in follow-up by pediatric endocrinology due to precocious puberty&#44; with slightly elevated testosterone levels &#40;normal Synacthen test&#41;&#46; She had also presented with an episode of acute gastroenteritis with liver failure&#44; which required follow-up for 3 years&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed yellowish elastic papules measuring between 1 and 2&#8239;mm&#44; with a perifollicular distribution&#44; grouped in localized plaques in both axillae&#44; with more patchy grouping on the left side &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Histology of a punch biopsy of one of the lesions revealed dilation of the follicular infundibulum and a perifollicular aggregation of foam cells &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; These results were compatible with a diagnosis of Fox-Fordyce disease &#40;FFD&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The clinical course was favorable&#44; with spontaneous improvement of the lesions&#46; The only relevant family history was that her mother reported hyperhidrosis and axillary bromhidrosis&#44; and she was therefore discharged with local antiperspirant on demand &#40;aluminum chlorohydrate&#44; 15&#37;&#41;&#46; It was not possible to establish a temporal relationship between the patient&#8217;s underlying endocrinologic disease and the appearance or improvement of the lesions&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">FFD&#44; also known as apocrine miliaria&#44; was first described in 1902 by George Henry Fox and John Addison Fordyce&#46; It is a rare chronic disease that typically appears in postpubescent women &#40;15&#8211;35 years of age&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Presentation in childhood is exceptional&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The etiology is unknown and the cause is probably multifactorial&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Its association with hormonal factors has been postulated&#44; given the age range in which it appears and the frequent remission of the disease during pregnancy and menopause&#44; although it has not been possible to show any hormone abnormality in patients&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> We do not therefore know whether an association exists with the precocious puberty in our patient&#46; We have found no previous association with liver failure in the literature&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Appearance of the disease as an adverse effect of laser or intense pulsed light &#40;IPL&#41; depilation techniques has been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In this case&#44; the clinical and histologic findings are very similar to primary FFD&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">It presents clinically as small dome-shaped pruritic perifollicular papules the color of yellowish-healthy skin&#46; The most common location is the axillae but the lesions may also present in the periareolar or anogenital region&#44; and&#44; more rarely&#44; on the thighs&#44; the periumbilical region&#44; and sternum&#46; The disease may be associated with hair loss in the affected areas and hypohidrosis&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The lesions improve with pregnancy and the use of hormonal contraceptives&#44; and worsen with heat&#44; hot water&#44; stress&#44; and the menstrual cycle&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The clinical presentation of the disease is constant and similar&#46; Histological findings&#44; however&#44; vary widely&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Formation of a keratin plug in the follicular infundibulum&#44; which also obstructs the apocrine duct may be the trigger&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The most consistent feature is dilation of the infundibulum and hyperkeratosis of the infundibular epithelium&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The most specific finding is perifollicular xanthomatosis&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">It was traditionally believed that this disease involved only the apocrine glands&#46; Recent histological findings&#44; however&#44; suggest that eccrine and nonfollicular variants &#40;involving the apocrine glands&#41; may exist&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The clinical differential diagnosis of this entity should basically include eruptive syringoma&#44; lichen nitidus&#44; trichostasis spinulosa&#44; Graham-Little-Piccardi-Lasseur syndrome&#44; and Darier disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;7&#44;8</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Because it is a rare disease&#44; comparative studies are not available&#44; and treatment remains unclear&#46; Multiple treatments have been described&#44; all of them with variable results&#46; Topical or intralesional corticosteroids are considered to be the treatment of choice&#46; Topical and systemic retinoids&#44; topical antibiotics such as clindamycin&#44; antiperspirants&#44; oral contraceptives&#44; and topical calcineurin inhibitors have also been used&#46; Curettage and electrocoagulation&#44; modified liposuction techniques&#44; and&#44; more recently&#44; fractional CO<span class="elsevierStyleInf">2</span> laser&#44; microwaves&#44; and botulinum toxin A have been used in refractory cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#8211;11</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Spontaneous remission&#44; as in the case of our patient&#44; is anecdotal&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In summary&#44; we report a case of FFD that is exceptional due to onset in prepubertal age and its atypical course&#44; with spontaneous resolution of the lesions&#46; We cannot state the causal relationship with the patient&#8217;s endocrinologic abnormalities&#44; although they probably play a major role in the development of the disease&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0075" 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
Fox-Fordyce Disease in a Pediatric Patient
Enfermedad de Fox-Fordyce en edad infantil
A. Huerta-Venaa,
Autor para correspondencia
andrea.huerta@salud.madrid.org

Corresponding author.
, J.C. Tardíob, A. Hernández-Núñeza, J. Borbujoa
a Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Madrid, Spain
b Servicio de Anatomía Patológica, Hospital Universitario de Fuenlabrada, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">An 8-year-old girl was referred by endocrinology to the dermatology department for assessment of mildly pruritic lesions in both axillae&#46; The lesions had developed over a long period of time and were more severe in the left armpit&#46; The patient&#44; whose parents were natives of Romania&#44; was in follow-up by pediatric endocrinology due to precocious puberty&#44; with slightly elevated testosterone levels &#40;normal Synacthen test&#41;&#46; She had also presented with an episode of acute gastroenteritis with liver failure&#44; which required follow-up for 3 years&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed yellowish elastic papules measuring between 1 and 2&#8239;mm&#44; with a perifollicular distribution&#44; grouped in localized plaques in both axillae&#44; with more patchy grouping on the left side &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Histology of a punch biopsy of one of the lesions revealed dilation of the follicular infundibulum and a perifollicular aggregation of foam cells &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; These results were compatible with a diagnosis of Fox-Fordyce disease &#40;FFD&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The clinical course was favorable&#44; with spontaneous improvement of the lesions&#46; The only relevant family history was that her mother reported hyperhidrosis and axillary bromhidrosis&#44; and she was therefore discharged with local antiperspirant on demand &#40;aluminum chlorohydrate&#44; 15&#37;&#41;&#46; It was not possible to establish a temporal relationship between the patient&#8217;s underlying endocrinologic disease and the appearance or improvement of the lesions&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">FFD&#44; also known as apocrine miliaria&#44; was first described in 1902 by George Henry Fox and John Addison Fordyce&#46; It is a rare chronic disease that typically appears in postpubescent women &#40;15&#8211;35 years of age&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Presentation in childhood is exceptional&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The etiology is unknown and the cause is probably multifactorial&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Its association with hormonal factors has been postulated&#44; given the age range in which it appears and the frequent remission of the disease during pregnancy and menopause&#44; although it has not been possible to show any hormone abnormality in patients&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> We do not therefore know whether an association exists with the precocious puberty in our patient&#46; We have found no previous association with liver failure in the literature&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Appearance of the disease as an adverse effect of laser or intense pulsed light &#40;IPL&#41; depilation techniques has been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In this case&#44; the clinical and histologic findings are very similar to primary FFD&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">It presents clinically as small dome-shaped pruritic perifollicular papules the color of yellowish-healthy skin&#46; The most common location is the axillae but the lesions may also present in the periareolar or anogenital region&#44; and&#44; more rarely&#44; on the thighs&#44; the periumbilical region&#44; and sternum&#46; The disease may be associated with hair loss in the affected areas and hypohidrosis&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The lesions improve with pregnancy and the use of hormonal contraceptives&#44; and worsen with heat&#44; hot water&#44; stress&#44; and the menstrual cycle&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The clinical presentation of the disease is constant and similar&#46; Histological findings&#44; however&#44; vary widely&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Formation of a keratin plug in the follicular infundibulum&#44; which also obstructs the apocrine duct may be the trigger&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The most consistent feature is dilation of the infundibulum and hyperkeratosis of the infundibular epithelium&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The most specific finding is perifollicular xanthomatosis&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">It was traditionally believed that this disease involved only the apocrine glands&#46; Recent histological findings&#44; however&#44; suggest that eccrine and nonfollicular variants &#40;involving the apocrine glands&#41; may exist&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The clinical differential diagnosis of this entity should basically include eruptive syringoma&#44; lichen nitidus&#44; trichostasis spinulosa&#44; Graham-Little-Piccardi-Lasseur syndrome&#44; and Darier disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;7&#44;8</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Because it is a rare disease&#44; comparative studies are not available&#44; and treatment remains unclear&#46; Multiple treatments have been described&#44; all of them with variable results&#46; Topical or intralesional corticosteroids are considered to be the treatment of choice&#46; Topical and systemic retinoids&#44; topical antibiotics such as clindamycin&#44; antiperspirants&#44; oral contraceptives&#44; and topical calcineurin inhibitors have also been used&#46; Curettage and electrocoagulation&#44; modified liposuction techniques&#44; and&#44; more recently&#44; fractional CO<span class="elsevierStyleInf">2</span> laser&#44; microwaves&#44; and botulinum toxin A have been used in refractory cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#8211;11</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Spontaneous remission&#44; as in the case of our patient&#44; is anecdotal&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In summary&#44; we report a case of FFD that is exceptional due to onset in prepubertal age and its atypical course&#44; with spontaneous resolution of the lesions&#46; We cannot state the causal relationship with the patient&#8217;s endocrinologic abnormalities&#44; although they probably play a major role in the development of the disease&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Huerta-Vena A&#44; Tard&#237;o JC&#44; Hern&#225;ndez-N&#250;&#241;ez A&#44; Borbujo J&#46; Enfermedad de Fox-Fordyce en edad infantil&#46; Actas Dermosifiliogr&#46; 2020&#46; <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.ad.2019.03.016">https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1016&#47;j&#46;ad&#46;2019&#46;03&#46;016</span></p>"
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Información del artículo
ISSN: 15782190
Idioma original: Inglés
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