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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#44; Poorly delimited&#44; fleshy erythematous plaques in the inguinal fold&#46; B&#44; Lesions on all fingernails&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case Description</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 29-year-old man was seen for lesions in the inguinal&#44; intergluteal folds that had appeared 2 months earlier&#44; without other associated lesions of the skin or mucosa-f&#46; In addition &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#44; he presented lesions of the nails that he said had been present since the age of 15 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; Interestingly&#44; he reported that his mother also had similar skin and nail lesions that had appeared during adolescence&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">What Is Your Diagnosis&#63;</span><p id="par0010" class="elsevierStylePara elsevierViewall">Darier disease with exclusively flexural involvement&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Comment</span><p id="par0015" class="elsevierStylePara elsevierViewall">Polarized light dermoscopy revealed alternating longitudinal bands of leukonychia and erythronychia associated with subungual hyperkeratosis&#44; splinter hemorrhage&#44; and a V-shaped notch at the distal edge of the nail plate &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Cutaneous histology revealed the presence of dyskeratosis and suprabasal acantholysis&#46; A genetic study of the patient and his mother detected a mutation in the <span class="elsevierStyleItalic">ATP2A2</span> gene&#44; confirming the suspected diagnosis of Darier disease&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Darier disease is a rare genodermatosis that is inherited in an autosomal dominant pattern and is caused by mutations in <span class="elsevierStyleItalic">ATP2A2</span>&#44; which encodes a protein involved in the regulation of calcium channels&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Characteristic findings include the presence of hyperkeratotic papules&#44; which have a seborrheic distribution and are often macerated and foul smelling when located in intertriginous areas&#44; as well as palmar pitting&#44; white papules in the oral mucosa&#44; and dystrophic nails&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Onset usually occurs at puberty and the disease follows a chronic course&#44; with exacerbations induced by infections&#44; sun or heat exposure&#44; and friction&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Fingernail involvement is described in 92&#8211;95&#37; of patients&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> in which the presence of alternating longitudinal white &#40;linear leukonychia&#41; and red &#40;linear erythronychia&#41; bands &#40;candy-cane pattern&#41; is pathognomonic&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3</span></a> Longitudinal striae&#44; subungual hyperkeratosis&#44; splinter hemorrhages&#44; and V-shaped notches in the distal free edge of the nail have also been described&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3&#44;4</span></a> Generally&#44; involvement is polydactylous&#58; the number of affected fingernails ranges from 2 to 5&#44; while toenails tend to be less frequently affected&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">These nail alterations can be key in establishing the differential diagnosis with other dermatoses with similar cutaneous manifestations&#44; including seborrheic dermatitis and Grover disease&#44; in which nail involvement is absent&#44; and Hailey&#8211;Hailey disease&#44; in which Burge described characteristic multiple longitudinal bands of leukonychia&#44; predominantly affecting the thumbs&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">This dermoscopic pattern should not be confused with other types of leukonychia or erythronychia that occur in other diseases&#46; For example&#44; onychopapilloma can present as a single longitudinal band of leukonychia or erythronychia and some glomus tumors present as a single longitudinal band of erythronychia that does not reach the distal border&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4&#44;6</span></a> Darier disease should also be distinguished from transverse leukonychia&#44; whether true &#40;trauma-associated&#41; or apparent &#40;generally associated with systemic diseases&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> and&#44; above all&#44; from other causes of polydactylous longitudinal erythronychia such as lichen planus&#44; primary amyloidosis&#44; graft-versus-host disease&#44; and acantholytic epidermolysis bullosa&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Given that the majority of patients with Darier disease present nail alterations&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> onychoscopy may be useful to facilitate diagnosis in doubtful cases such as that described here&#44; in which flexural involvement and the absence of other skin lesions would suggest a diagnosis of Hailey&#8211;Hailey disease&#44; and in patients with no relevant family history&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicts of Interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Practical Dermoscopy
Candy-Cane Nails
Uñas «en bastón de caramelo»
J. Sánchez-Bernal
Autor para correspondencia
jsanchezbe@salud.aragon.es

Corresponding author.
, M. Álvarez-Salafranca, M. Ara-Martín
Servicio de Dermatología del Hospital Clínico Universitario Lozano Blesa, Zaragoza
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#44; Poorly delimited&#44; fleshy erythematous plaques in the inguinal fold&#46; B&#44; Lesions on all fingernails&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case Description</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 29-year-old man was seen for lesions in the inguinal&#44; intergluteal folds that had appeared 2 months earlier&#44; without other associated lesions of the skin or mucosa-f&#46; In addition &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#44; he presented lesions of the nails that he said had been present since the age of 15 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; Interestingly&#44; he reported that his mother also had similar skin and nail lesions that had appeared during adolescence&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">What Is Your Diagnosis&#63;</span><p id="par0010" class="elsevierStylePara elsevierViewall">Darier disease with exclusively flexural involvement&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Comment</span><p id="par0015" class="elsevierStylePara elsevierViewall">Polarized light dermoscopy revealed alternating longitudinal bands of leukonychia and erythronychia associated with subungual hyperkeratosis&#44; splinter hemorrhage&#44; and a V-shaped notch at the distal edge of the nail plate &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Cutaneous histology revealed the presence of dyskeratosis and suprabasal acantholysis&#46; A genetic study of the patient and his mother detected a mutation in the <span class="elsevierStyleItalic">ATP2A2</span> gene&#44; confirming the suspected diagnosis of Darier disease&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Darier disease is a rare genodermatosis that is inherited in an autosomal dominant pattern and is caused by mutations in <span class="elsevierStyleItalic">ATP2A2</span>&#44; which encodes a protein involved in the regulation of calcium channels&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Characteristic findings include the presence of hyperkeratotic papules&#44; which have a seborrheic distribution and are often macerated and foul smelling when located in intertriginous areas&#44; as well as palmar pitting&#44; white papules in the oral mucosa&#44; and dystrophic nails&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Onset usually occurs at puberty and the disease follows a chronic course&#44; with exacerbations induced by infections&#44; sun or heat exposure&#44; and friction&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Fingernail involvement is described in 92&#8211;95&#37; of patients&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> in which the presence of alternating longitudinal white &#40;linear leukonychia&#41; and red &#40;linear erythronychia&#41; bands &#40;candy-cane pattern&#41; is pathognomonic&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3</span></a> Longitudinal striae&#44; subungual hyperkeratosis&#44; splinter hemorrhages&#44; and V-shaped notches in the distal free edge of the nail have also been described&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3&#44;4</span></a> Generally&#44; involvement is polydactylous&#58; the number of affected fingernails ranges from 2 to 5&#44; while toenails tend to be less frequently affected&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">These nail alterations can be key in establishing the differential diagnosis with other dermatoses with similar cutaneous manifestations&#44; including seborrheic dermatitis and Grover disease&#44; in which nail involvement is absent&#44; and Hailey&#8211;Hailey disease&#44; in which Burge described characteristic multiple longitudinal bands of leukonychia&#44; predominantly affecting the thumbs&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">This dermoscopic pattern should not be confused with other types of leukonychia or erythronychia that occur in other diseases&#46; For example&#44; onychopapilloma can present as a single longitudinal band of leukonychia or erythronychia and some glomus tumors present as a single longitudinal band of erythronychia that does not reach the distal border&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4&#44;6</span></a> Darier disease should also be distinguished from transverse leukonychia&#44; whether true &#40;trauma-associated&#41; or apparent &#40;generally associated with systemic diseases&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> and&#44; above all&#44; from other causes of polydactylous longitudinal erythronychia such as lichen planus&#44; primary amyloidosis&#44; graft-versus-host disease&#44; and acantholytic epidermolysis bullosa&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Given that the majority of patients with Darier disease present nail alterations&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> onychoscopy may be useful to facilitate diagnosis in doubtful cases such as that described here&#44; in which flexural involvement and the absence of other skin lesions would suggest a diagnosis of Hailey&#8211;Hailey disease&#44; and in patients with no relevant family history&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicts of Interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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