Case and Research Letters
Atypical Palmoplantar Pityriasis Rosea
Pitiriasis rosada atípica palmoplantar
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Martín-Alcalde, M. Elosua-González, F.J. Pinedo-Moraleda, J.L. López-Estebaranz" "autores" => array:4 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Martín-Alcalde" "email" => array:1 [ 0 => "jmartina@fhalcorcon.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Elosua-González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "F.J." "apellidos" => "Pinedo-Moraleda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "J.L." "apellidos" => "López-Estebaranz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología y de Anatomía Patológica, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pitiriasis rosada atípica palmoplantar" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 977 "Ancho" => 1300 "Tamanyo" => 347911 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histological section in which spongiosis (black box) is evident.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 26-year-old man with no relevant history was seen at the emergency department for asymptomatic palmoplantar lesions that had appeared 3 weeks earlier and had not responded to topical prednicarbate treatment (twice daily for 20 days). The patient reported no fever or systemic symptoms. He had no history of oral or genital ulcers in the preceding weeks or months, and reported no risky sexual relations. Physical examination revealed erythematous oval plaques, some of which showed fine collarette scaling, located on the palms (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), soles, and lateral aspects of the feet (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Histology showed superficial lymphocytic perivascular dermatitis with minimal epidermal exocytosis associated with mild spongiosis (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Immunohistochemistry for <span class="elsevierStyleItalic">Treponema pallidum</span> was negative. Serological screening using chemiluminescence immunoassay to detect total antibodies against <span class="elsevierStyleItalic">T pallidum</span> was initially negative. Screening was repeated 1 month later, together with visually interpreted treponemal and non-treponemal tests (<span class="elsevierStyleItalic">T pallidum</span> hemagglutination assay [TPHA] and rapid plasma reagin [RPR] tests), all of which were negative. The lesions resolved without treatment after 4 weeks, and the patient remained free of lesions during follow-up, which ended when he again tested negative in a <span class="elsevierStyleItalic">T pallidum</span> screening test 3 months after lesion resolution. Based on the clinical course and the clinical, histological, and laboratory data, a diagnosis of atypical palmoplantar pityriasis rosea (PR) was established.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">PR is a common entity that mainly affects adolescents and young adults: 75% of cases are diagnosed between the ages of 10 and 35.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Clinically, it presents as a papulosquamous eruption with a self-limiting course, distributed mainly on the trunk and the proximal aspect of the extremities, following the Langer lines. These lesions are usually preceded by a larger scaly lesion called a herald patch, and some patients may report prior flu-like symptoms.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The literature includes infrequent reports of atypical forms, characterized by lesions that are morphologically distinct or appear in other locations. These atypical forms include vesicular, purpuric, inverse, unilateral, and palmoplantar PR. Palmoplantar involvement in PR is very rare, and very few cases are described in the literature. In some such cases the palms and soles are affected in the context of a more typical eruption on the trunk.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> Others consist of palmoplantar involvement in the form of vesicular lesions,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> or of more typical, exclusively palmoplantar lesions.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> We consider our case to correspond to the latter group, diagnosis of which can be difficult to establish. In all cases of PR with palmoplantar involvement the main differential diagnosis is secondary syphilis. For this reason, serological and histological approaches were used to rule out secondary syphilis in our patient and help establish diagnosis. Histology of PR is nonspecific. In our patient biopsy revealed findings that could be considered compatible with an eczematous process. However, given the clinical appearance of the lesions, the absence of pruritus, and the resolution without treatment, this entity was excluded from the differential diagnosis.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Treatment of PR is controversial. Some data support treatment with erythromycin.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> However, given the natural course of the disease alternative options include symptomatic treatment of pruritus with topical corticosteroids or oral antihistamines and therapeutic abstention, which was selected in the present case.</p><p id="par0020" class="elsevierStylePara elsevierViewall">We present a case compatible with palmoplantar PR, a rare variant of PR of which very few cases are described in the literature. Despite their infrequent nature, atypical variants of PR can simulate other conditions, and therefore knowledge of these entities is of the utmost importance.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-08-23" "fechaAceptado" => "2020-03-26" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martín-Alcalde J, Elosua-González M, Pinedo-Moraleda FJ, López-Estebaranz JL. Pitiriasis rosada atípica palmoplantar. Actas Dermosifiliogr. 2021;112:372–374.</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" => 708 "Ancho" => 1255 "Tamanyo" => 157838 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Palmar lesions.</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" => 511 "Ancho" => 905 "Tamanyo" => 71125 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Plantar lesions.</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" => 977 "Ancho" => 1300 "Tamanyo" => 347911 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histological section in which spongiosis (black box) is evident.</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" => "Pityriasis rosea in Rochester, Minnesota, 1969 to 1978" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T.Y. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 15 | 2 | 17 |
| 2024 Octubre | 125 | 51 | 176 |
| 2024 Septiembre | 114 | 26 | 140 |
| 2024 Agosto | 138 | 64 | 202 |
| 2024 Julio | 123 | 26 | 149 |
| 2024 Junio | 122 | 36 | 158 |
| 2024 Mayo | 132 | 26 | 158 |
| 2024 Abril | 127 | 20 | 147 |
| 2024 Marzo | 99 | 34 | 133 |
| 2024 Febrero | 134 | 34 | 168 |
| 2024 Enero | 104 | 38 | 142 |
| 2023 Diciembre | 122 | 23 | 145 |
| 2023 Noviembre | 141 | 52 | 193 |
| 2023 Octubre | 117 | 48 | 165 |
| 2023 Septiembre | 110 | 46 | 156 |
| 2023 Agosto | 82 | 36 | 118 |
| 2023 Julio | 109 | 45 | 154 |
| 2023 Junio | 102 | 41 | 143 |
| 2023 Mayo | 114 | 51 | 165 |
| 2023 Abril | 58 | 49 | 107 |
| 2023 Marzo | 130 | 41 | 171 |
| 2023 Febrero | 120 | 34 | 154 |
| 2023 Enero | 91 | 64 | 155 |
| 2022 Diciembre | 93 | 54 | 147 |
| 2022 Noviembre | 67 | 73 | 140 |
| 2022 Octubre | 76 | 53 | 129 |
| 2022 Septiembre | 102 | 59 | 161 |
| 2022 Agosto | 78 | 47 | 125 |
| 2022 Julio | 61 | 42 | 103 |
| 2022 Junio | 51 | 47 | 98 |
| 2022 Mayo | 86 | 50 | 136 |
| 2022 Abril | 132 | 40 | 172 |
| 2022 Marzo | 131 | 77 | 208 |
| 2022 Febrero | 124 | 38 | 162 |
| 2022 Enero | 143 | 53 | 196 |
| 2021 Diciembre | 115 | 43 | 158 |
| 2021 Noviembre | 73 | 51 | 124 |
| 2021 Octubre | 113 | 82 | 195 |
| 2021 Septiembre | 125 | 54 | 179 |
| 2021 Agosto | 123 | 51 | 174 |
| 2021 Julio | 94 | 40 | 134 |
| 2021 Junio | 67 | 37 | 104 |
| 2021 Mayo | 70 | 72 | 142 |
| 2021 Abril | 113 | 131 | 244 |
| 2021 Marzo | 55 | 39 | 94 |
| 2021 Febrero | 90 | 48 | 138 |
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