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    "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 57-year-old obese woman with a history of disseminated superficial actinic porokeratosis &#40;DSAP&#41; involving the arms and legs&#44; venous insufficiency&#44; and secondary lymphedema presented with morphological changes in the DSAP lesions on the anterior aspect of both legs&#46; She reported that the lesions had become increasingly palpable&#46; Physical examination showed nonpitting edema in both lower limbs and well-defined flat erythematous-pink plaques with a scaling border alternating with other&#44; more raised&#44; plaques &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A and B&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The furrow ink test highlighted the characteristic outlines of DSAP lesions &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A and B&#41;&#46; Dermoscopy of the lesions showed structureless white-pink areas with scales and dotted and glomerular vessels &#40;red dots and globules&#41; against a homogeneous background&#44; visible inside and outside the raised lesions &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Comment</span><p id="par0015" class="elsevierStylePara elsevierViewall">Porokeratosis is a disorder of keratinization of unknown etiology&#46; Seven clinical variants have been described&#58; porokeratosis of Mibelli&#44; DSAP&#44; linear porokeratosis&#44; punctate porokeratosis&#44; porokeratosis palmaris et plantaris disseminata&#44; porokeratosis ptychotropica&#44; and eruptive disseminated porokeratosis&#46; DSAP is characterized by flat papules and erythematous-brownish plaques with a well-defined hyperkeratotic border &#40;the cornoid lamella on histology&#41; and a slightly atrophic central area<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; The clinical diagnosis is supported by observation of a peripheral white border&#44; brown dots&#44; a white central scar-like area&#44; and dotted vessels on dermoscopy<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; The furrow ink test is a useful adjunct for highlighting the cornoid lamella<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Squamous cell carcinoma arising in porokeratosis lesions has been described in all clinical forms of this disorder except punctate porokeratosis<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; The coexistence of porokeratosis and lymphedema&#44; previously described in the literature&#44; poses both a diagnostic and therapeutic challenge&#44; as porokeratosis lesions&#44; which are usually flat or mildly atrophic&#44; can appear as raised plaques in patients with lymphedema&#44; leading to possible confusion with neoplastic lesions<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;6</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In the current case&#44; in addition to characteristic clinical and dermoscopic features of porokeratosis&#44; we observed multiple red globules&#44; which at higher magnification appeared as glomerular vessels&#46; Glomerular vessels in dermoscopy have been typically described in squamous carcinoma in situ&#44; psoriasis&#44; eczema&#44; eccrine poroma&#44; Merkel cell carcinoma&#44; melanoma&#44; Spitz nevus&#44; actinic keratosis&#44; and stasis dermatitis<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The red globules inside and outside the DSAP lesions in our patient corresponded to dilated vessels in the papillary dermis &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41;&#46; This dermoscopic and histologic pattern is consistent with stasis dermatitis&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Note should be taken of the increased risk of squamous cell carcinoma in this setting &#40;due to the presence of both porokeratosis and chronic lymphedema&#41;&#44; lymphangiosarcoma&#44; Kaposi sarcoma&#44; lymphoma&#44; and melanoma arising from chronic lymphedema&#46; It is important to biopsy fast-growing lesions&#44; asymmetric hyperkeratotic lesions&#44; and lesions with an atypical vascular pattern on dermoscopy&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion&#44; dermoscopy is a useful tool for diagnosing stasis dermatitis and monitoring vascular patterns in lesions highly suspicious for malignancy&#44; such as porokeratosis lesions in patients with venous insufficiency and lymphedema&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Practical Dermoscopy
Dermoscopic vascular pattern in porokeratosis coexistent with venous insufficiency and lymphedema
Patrón vascular dermatoscópico en la poroqueratosis que coexiste con una insuficiencia venosa y linfedema
D. Ramos-Rodríguez
Autor para correspondencia
negrinmelian@gmail.com

Corresponding author.
, L.J. Del Pozo-Hernando, F. Mestre-Bauzá
Servicio Dermatología Hospital Son Espases, Palma, Illes Balears, Spain
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        "titulo" => "Patr&#243;n vascular dermatosc&#243;pico en la poroqueratosis que coexiste con una insuficiencia venosa y linfedema"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#44; Raised&#44; flat erythematous-pink pretibial plaques&#46; B&#44; Higher-magnification view&#46; Note the dotted red lesions inside and outside the lesions with a fine collarette&#46;</p>"
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    "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 57-year-old obese woman with a history of disseminated superficial actinic porokeratosis &#40;DSAP&#41; involving the arms and legs&#44; venous insufficiency&#44; and secondary lymphedema presented with morphological changes in the DSAP lesions on the anterior aspect of both legs&#46; She reported that the lesions had become increasingly palpable&#46; Physical examination showed nonpitting edema in both lower limbs and well-defined flat erythematous-pink plaques with a scaling border alternating with other&#44; more raised&#44; plaques &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A and B&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The furrow ink test highlighted the characteristic outlines of DSAP lesions &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A and B&#41;&#46; Dermoscopy of the lesions showed structureless white-pink areas with scales and dotted and glomerular vessels &#40;red dots and globules&#41; against a homogeneous background&#44; visible inside and outside the raised lesions &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Comment</span><p id="par0015" class="elsevierStylePara elsevierViewall">Porokeratosis is a disorder of keratinization of unknown etiology&#46; Seven clinical variants have been described&#58; porokeratosis of Mibelli&#44; DSAP&#44; linear porokeratosis&#44; punctate porokeratosis&#44; porokeratosis palmaris et plantaris disseminata&#44; porokeratosis ptychotropica&#44; and eruptive disseminated porokeratosis&#46; DSAP is characterized by flat papules and erythematous-brownish plaques with a well-defined hyperkeratotic border &#40;the cornoid lamella on histology&#41; and a slightly atrophic central area<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; The clinical diagnosis is supported by observation of a peripheral white border&#44; brown dots&#44; a white central scar-like area&#44; and dotted vessels on dermoscopy<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; The furrow ink test is a useful adjunct for highlighting the cornoid lamella<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Squamous cell carcinoma arising in porokeratosis lesions has been described in all clinical forms of this disorder except punctate porokeratosis<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; The coexistence of porokeratosis and lymphedema&#44; previously described in the literature&#44; poses both a diagnostic and therapeutic challenge&#44; as porokeratosis lesions&#44; which are usually flat or mildly atrophic&#44; can appear as raised plaques in patients with lymphedema&#44; leading to possible confusion with neoplastic lesions<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;6</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In the current case&#44; in addition to characteristic clinical and dermoscopic features of porokeratosis&#44; we observed multiple red globules&#44; which at higher magnification appeared as glomerular vessels&#46; Glomerular vessels in dermoscopy have been typically described in squamous carcinoma in situ&#44; psoriasis&#44; eczema&#44; eccrine poroma&#44; Merkel cell carcinoma&#44; melanoma&#44; Spitz nevus&#44; actinic keratosis&#44; and stasis dermatitis<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The red globules inside and outside the DSAP lesions in our patient corresponded to dilated vessels in the papillary dermis &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41;&#46; This dermoscopic and histologic pattern is consistent with stasis dermatitis&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Note should be taken of the increased risk of squamous cell carcinoma in this setting &#40;due to the presence of both porokeratosis and chronic lymphedema&#41;&#44; lymphangiosarcoma&#44; Kaposi sarcoma&#44; lymphoma&#44; and melanoma arising from chronic lymphedema&#46; It is important to biopsy fast-growing lesions&#44; asymmetric hyperkeratotic lesions&#44; and lesions with an atypical vascular pattern on dermoscopy&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion&#44; dermoscopy is a useful tool for diagnosing stasis dermatitis and monitoring vascular patterns in lesions highly suspicious for malignancy&#44; such as porokeratosis lesions in patients with venous insufficiency and lymphedema&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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