Practical Dermoscopy
Violaceous Papule on the Trunk
Pápula violácea en tronco
F.J. Navarro-Triviño
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Unidad de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario San Cecilio, Granada, Spain
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Left, negative staining for immunoglobulin (Ig) G κ light chain. Right, positive staining for IgG λ light chain.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Ruiz-Villaverde, B. Rueda-Villafranca, M. Galvez-Moreno" "autores" => array:3 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Ruiz-Villaverde" ] 1 => array:2 [ "nombre" => "B." "apellidos" => "Rueda-Villafranca" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Galvez-Moreno" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219021001621?idApp=UINPBA000044" "url" => "/15782190/0000011200000007/v1_202107020822/S1578219021001621/v1_202107020822/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Practical Dermoscopy</span>" "titulo" => "Violaceous Papule on the Trunk" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "647" "paginaFinal" => "648" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "F.J. Navarro-Triviño" "autores" => array:1 [ 0 => array:4 [ "nombre" => "F.J." "apellidos" => "Navarro-Triviño" "email" => array:1 [ 0 => "fntmed@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario San Cecilio, Granada, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pápula violácea en tronco" ] ] "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" => 455 "Ancho" => 805 "Tamanyo" => 56941 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermoscopic image of the lesion (DermLite 4). The reddish-violaceous homogeneous lesion is surrounded by a biphasic halo. The first halo has a yellowish-orange tinge (*) and the second halo on the periphery is reddish. The hair follicles remain intact.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case Presentation</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 43-year-old woman with no relevant personal or family history of illness was referred by her primary care physician for evaluation of a pruriginous, violaceous lesion on the back of her trunk. The lesion had appeared 2 weeks earlier, and melanoma was suspected. She reported having noticed spontaneous bleeding from the lesion.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed a violaceous papule surrounded by a purpuric halo (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Dermoscopy showed a structure with a reddish-purple center with lighter-appearing areas; the center was surrounded by a yellowish orange halo and another homogenous reddish halo at the periphery. Hair follicles were intact (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Diagnosis</span><p id="par0015" class="elsevierStylePara elsevierViewall">Targetoid hemosiderotic hemangioma (THH).</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Comment</span><p id="par0020" class="elsevierStylePara elsevierViewall">Santa Cruz and Aronberg first described a THH lesion in 1988, according to Sahim et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> THHs are described as benign vascular lesions that develop on the trunk and legs in middle age (around 30–40 years of age). Although the cause is still unknown, it has been suggested that a THH might be induced by trauma, specifically injury to a preexisting hemangioma.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The presence of estrogen hormone receptors demonstrated by immunohistochemistry suggests that this hormone may accelerate endothelial proliferation and dilation, explaining the clinical behavior of THHs.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> D2-40 positivity and negative immunostaining for CD34 in endothelial cells, along with an absence of actin-positive pericytes, suggest that these lesions may have a lymphatic origin.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">A THH presents clinically as a reddish-violaceous papule surrounded by a violaceous, ecchymotic halo. The lesion may or may not be itchy or painful and is usually solitary. However, patients with multiple lesions have also been described.</p><p id="par0035" class="elsevierStylePara elsevierViewall">THHs have a highly characteristic dermoscopic pattern, as shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>. In a study of 35 cases, the largest series published to date, the most common dermoscopic finding was of a dark reddish lacuna at the center and a reddish-violaceous homogeneous area around the periphery; that pattern was seen in 71.4% of the lesions.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Our patient’s THH had a clearly biphasic halo around its center, a finding that defines the targetoid aspect of this lesion. The differential diagnosis includes consideration of malignant pigmented lesions such as melanoma,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> dermatofibromas, Kaposi sarcoma, insect bites, and basal cell carcinoma.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">THHs are benign vascular lesions that can be distinguished from others by their characteristic dermoscopic pattern. If the diagnosis is in doubt, in the absence of an ecchymotic halo, surgical removal and histopathologic study of the lesion would be the most prudent course of action.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicts of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case Presentation" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Diagnosis" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Comment" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of Interest" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-07-22" "fechaAceptado" => "2019-09-15" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Navarro-Triviño FJ. Pápula violácea en tronco. Actas Dermosifiliogr. 2021;112:647–648.</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" => 1011 "Ancho" => 800 "Tamanyo" => 98237 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A violaceous papule surrounded by a homogeneous purpuric halo on the back of a 43-year-old woman.</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" => 455 "Ancho" => 805 "Tamanyo" => 56941 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermoscopic image of the lesion (DermLite 4). The reddish-violaceous homogeneous lesion is surrounded by a biphasic halo. The first halo has a yellowish-orange tinge (*) and the second halo on the periphery is reddish. The hair follicles remain intact.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Targetoid haemosiderotic haemangioma: dermoscopic monitoring of three cases and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.T. Sahim" 1 => "M.A. Demir" 2 => "K. Gunduz" 3 => "S. Ozturkcan" 4 => "A. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 24 | 9 | 33 |
| 2024 Octubre | 235 | 48 | 283 |
| 2024 Septiembre | 171 | 33 | 204 |
| 2024 Agosto | 172 | 76 | 248 |
| 2024 Julio | 148 | 34 | 182 |
| 2024 Junio | 136 | 46 | 182 |
| 2024 Mayo | 114 | 37 | 151 |
| 2024 Abril | 119 | 33 | 152 |
| 2024 Marzo | 119 | 32 | 151 |
| 2024 Febrero | 102 | 35 | 137 |
| 2024 Enero | 108 | 37 | 145 |
| 2023 Diciembre | 83 | 25 | 108 |
| 2023 Noviembre | 115 | 48 | 163 |
| 2023 Octubre | 118 | 41 | 159 |
| 2023 Septiembre | 96 | 47 | 143 |
| 2023 Agosto | 84 | 34 | 118 |
| 2023 Julio | 94 | 51 | 145 |
| 2023 Junio | 107 | 37 | 144 |
| 2023 Mayo | 100 | 39 | 139 |
| 2023 Abril | 76 | 32 | 108 |
| 2023 Marzo | 81 | 45 | 126 |
| 2023 Febrero | 87 | 40 | 127 |
| 2023 Enero | 92 | 72 | 164 |
| 2022 Diciembre | 75 | 72 | 147 |
| 2022 Noviembre | 42 | 85 | 127 |
| 2022 Octubre | 41 | 35 | 76 |
| 2022 Septiembre | 41 | 62 | 103 |
| 2022 Agosto | 32 | 62 | 94 |
| 2022 Julio | 47 | 50 | 97 |
| 2022 Junio | 51 | 44 | 95 |
| 2022 Mayo | 110 | 57 | 167 |
| 2022 Abril | 62 | 66 | 128 |
| 2022 Marzo | 94 | 69 | 163 |
| 2022 Febrero | 91 | 44 | 135 |
| 2022 Enero | 78 | 60 | 138 |
| 2021 Diciembre | 67 | 57 | 124 |
| 2021 Noviembre | 57 | 65 | 122 |
| 2021 Octubre | 69 | 86 | 155 |
| 2021 Septiembre | 56 | 50 | 106 |
| 2021 Agosto | 87 | 45 | 132 |
| 2021 Julio | 120 | 37 | 157 |
| 2021 Junio | 45 | 42 | 87 |
| 2021 Mayo | 71 | 87 | 158 |
| 2021 Abril | 110 | 39 | 149 |
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