Images in Dermatology
Pseudoxanthoma elasticum-like papillary dermal elastolysis in non-exposed skin
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Erythematous and pruritic papules on forearms" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "250" "paginaFinal" => "251" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 767 "Ancho" => 1207 "Tamanyo" => 87324 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Remission of lesions in right arm (A) and forearm (B).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Aline Palitot Santana, Alberto Eduardo Cox Cardoso, Rafaela Tenório Passos, Íris Sampaio Costa Ferreira" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Aline Palitot" "apellidos" => "Santana" ] 1 => array:2 [ "nombre" => "Alberto Eduardo Cox" "apellidos" => "Cardoso" ] 2 => array:2 [ "nombre" => "Rafaela Tenório" "apellidos" => "Passos" ] 3 => array:2 [ "nombre" => "Íris Sampaio Costa" "apellidos" => "Ferreira" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275220300837" "doi" => "10.1016/j.abdp.2019.06.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275220300837?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620300325?idApp=UINPBA00008Z" "url" => "/03650596/0000009500000002/v1_202004180640/S0365059620300325/v1_202004180640/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0365059620300398" "issn" => "03650596" "doi" => "10.1016/j.abd.2019.07.007" "estado" => "S300" "fechaPublicacion" => "2020-03-01" "aid" => "146" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by/4.0/" "subdocumento" => "crp" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Dermatology</span>" "titulo" => "Dermoscopic pattern of Kyrle's disease" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "244" "paginaFinal" => "246" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 691 "Ancho" => 2167 "Tamanyo" => 123180 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">(A) Dermoscopic image of a lesion in Kyrle's disease (non-polarized dermoscopy 40×). 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She denied systemic symptoms and family history of similar findings. Her medical history included mixed anxiety-depressive disorder treated with olanzapine and sertraline. Physical examination revealed white-to-yellowish millimetric non-follicular papules on the lateral aspects of the neck and supraclavicular fossae (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Dermoscopic examination showed multiple white-colored non-follicular papules, coalescing into plaques with arboriform vessels (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The biopsy showed slight sclerosis of the papillary dermis with neovascularization and a mild inflammatory infiltrate including lymphocytes and some melanophages (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). In the same area, van Gieson stain demonstrated a decrease in the number of elastic fibers that were often thin and fragmented (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>) compatible with pseudoxanthoma elasticum-like papillary dermal elastolysis (PXE-PDE). Cardiac and ophthalmological investigations performed were unremarkable.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">PXE-PDE is a rare acquired elastic tissue disorder characterized by non-follicular yellowish papules coalescing into plaques with predilection for neck, supraclavicular fossae and flexural areas.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> The lesions are usually asymptomatic, but mild itch is sometimes reported, as seen in our case. To date, it affects exclusively women mostly in middle age<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> and it is not associated with any systemic involvement. Dermoscopic findings consist of multiple white-colored non-follicular papules, coalescing into plaques with linear vessels.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Histopathologically, hematoxylin eosin staining does not reveal any specific changes. The focal inflammatory changes present in our case have not been described previously; however, it is presumed that elastic fiber loss could be the result of a transient phenomenon of inflammation. Special staining of elastic fibers with van Gieson or orcein stains are required to demonstrate a total or partial band-like loss of elastic fibers in the papillary dermis.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Calcification or fragmentation of the elastic fibers is absent. Immunohistochemical studies using monoclonal antibodies against antibody P component can also demonstrate partial or complete loss of elastic fibers in papillary dermis.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> The presence of melanophages in the papillary dermis constitutes an additional helpful diagnostic feature.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The cause of PXE-PDE remains unclear, and some etiopathogenic theories have been proposed: ultraviolet radiation, intrinsic aging, abnormal elastogenesis, and genetic or inheritable factors.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a> In our case, ultraviolet radiation's etiopathogenic theory is unlikely because the patient wore hijab.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Differential diagnosis of PXE-PDE includes white fibrous papulosis of the neck, mid-dermal elastolysis, and papillary dermal elastosis. Nevertheless, the main differential diagnosis must be established with pseudoxanthoma elasticum (PXE), a hereditary disorder caused by mutation on ABCC6 gene. Clinically, PXE resembles PXE-PDE, but it appears at a younger age, and it is usually associated with ocular and cardiovascular complications. Histopathologically, PXE presents fragmentation and calcification of elastic fibers demonstrated with von Kossa stain.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Treatments for PXE-PDE, including topical retinoids, have shown poor results<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a>; however, non-ablative fractional resurfacing laser has demonstrated to be effective in some cases.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Herein we present a case of PXE-PDE in a patient who did not receive UV radiation because she wore hijab. In our opinion, more studies are needed in order to better understand the etiopathogenesis of PXE-PDE. It is important that dermatologists recognize this entity and differentiate it from PXE to avoid unnecessary investigation. Clinicopathologic correlation is important and elastic tissue stains are required to correctly diagnose PXE-PDE.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Financial support</span><p id="par0040" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Authors’ contributions</span><p id="par0045" class="elsevierStylePara elsevierViewall">Nuria Setó Torrent: Approval of the final version of the manuscript; elaboration and writing of the manuscript; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Maribel Iglesias Sancho: Approval of the final version of the manuscript; critical review of the manuscript.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Jorge Arandes Marcocci: Approval of the final version of the manuscript; critical review of the manuscript.</p><p id="par0060" class="elsevierStylePara elsevierViewall">María Teresa Fernández Figueras: Approval of the final version of the manuscript; critical review of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:3 [ "identificador" => "xres1327256" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1223485" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors’ contributions" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 5 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-04-14" "fechaAceptado" => "2019-08-11" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1223485" "palabras" => array:4 [ 0 => "Dermis" 1 => "Elastic tissue" 2 => "Female" 3 => "Pseudoxanthoma elasticum" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pseudoxanthoma elasticum-like papillary dermal elastolysis is an acquired elastic tissue disorder clinically similar to pseudoxanthoma elasticum in the absence of systemic involvement. Histopathologically, special staining of elastic fibers demonstrates a total or partial band-like loss of elastic fibers in the papillary dermis. Although ultraviolet radiation seems to be one of the main etiological factors in this entity, we report a case of pseudoxanthoma elasticum-like papillary dermal elastolysis on the neck of a woman who wore hijab.</p></span>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Setó-Torrent N, Iglesias-Sancho M, Arandes-Marcocci J, Fernández-Figueras MT. Pseudoxanthoma elasticum-like papillary dermal elastolysis in non-exposed skin. An Bras Dermatol. 2020;95:247–9.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Hospital Universitari Sagrat Cor-Grupo Quirón Salud, Barcelona, Spain.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 680 "Ancho" => 905 "Tamanyo" => 63628 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Whitish papules on the neck and supraclavicular fossae.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1205 "Ancho" => 905 "Tamanyo" => 102337 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Multiple whitish non-follicular papules, coalescing into plaques with linear vessels, on dermoscopy.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 707 "Ancho" => 905 "Tamanyo" => 230217 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Slight sclerosis of the papillary dermis, neovascularization and a mild inflammatory infiltrate (Hematoxylin & eosin, x100).</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 686 "Ancho" => 905 "Tamanyo" => 274674 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Reduction of elastic fibers in the papillary dermis (van Gieson, x200).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pseudoxanthoma elasticum-like papillary dermal elastolysis: immunohistochemical study using elastic fiber cross-reactivity with an antibody against amyloid P component" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.M. Revelles" 1 => "S. Machan" 2 => "Ú. Pielasinski" 3 => "D. Camacho" 4 => "L. Vallés" 5 => "C. Santonja" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/DAD.0b013e318257be63" "Revista" => array:6 [ "tituloSerie" => "Am J Dermatopathol" "fecha" => "2012" "volumen" => "34" "paginaInicial" => "637" "paginaFinal" => "643" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22722462" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pseudoxanthoma elasticum-like papillary dermal elastolysis: a case report and review of literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Panagou" 1 => "M. Ratynska" 2 => "K. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 22 | 10 | 32 |
| 2024 October | 103 | 79 | 182 |
| 2024 September | 170 | 78 | 248 |
| 2024 August | 176 | 88 | 264 |
| 2024 July | 135 | 118 | 253 |
| 2024 June | 101 | 71 | 172 |
| 2024 May | 92 | 65 | 157 |
| 2024 April | 92 | 80 | 172 |
| 2024 March | 84 | 68 | 152 |
| 2024 February | 77 | 78 | 155 |
| 2024 January | 56 | 45 | 101 |
| 2023 December | 66 | 65 | 131 |
| 2023 November | 80 | 95 | 175 |
| 2023 October | 60 | 71 | 131 |
| 2023 September | 66 | 65 | 131 |
| 2023 August | 58 | 39 | 97 |
| 2023 July | 88 | 36 | 124 |
| 2023 June | 70 | 37 | 107 |
| 2023 May | 62 | 26 | 88 |
| 2023 April | 53 | 22 | 75 |
| 2023 March | 78 | 56 | 134 |
| 2023 February | 61 | 34 | 95 |
| 2023 January | 44 | 38 | 82 |
| 2022 December | 65 | 38 | 103 |
| 2022 November | 94 | 58 | 152 |
| 2022 October | 100 | 59 | 159 |
| 2022 September | 100 | 68 | 168 |
| 2022 August | 57 | 52 | 109 |
| 2022 July | 49 | 54 | 103 |
| 2022 June | 60 | 59 | 119 |
| 2022 May | 46 | 52 | 98 |
| 2022 April | 49 | 46 | 95 |
| 2022 March | 51 | 68 | 119 |
| 2022 February | 24 | 50 | 74 |
| 2022 January | 61 | 77 | 138 |
| 2021 December | 40 | 40 | 80 |
| 2021 November | 71 | 59 | 130 |
| 2021 October | 74 | 91 | 165 |
| 2021 September | 53 | 57 | 110 |
| 2021 August | 37 | 56 | 93 |
| 2021 July | 36 | 46 | 82 |
| 2021 June | 34 | 57 | 91 |
| 2021 May | 51 | 86 | 137 |
| 2021 April | 111 | 313 | 424 |
| 2021 March | 47 | 51 | 98 |
| 2021 February | 24 | 15 | 39 |
| 2021 January | 25 | 11 | 36 |
| 2020 December | 33 | 23 | 56 |
| 2020 November | 36 | 10 | 46 |
| 2020 October | 22 | 7 | 29 |
| 2020 September | 17 | 9 | 26 |
| 2020 August | 22 | 5 | 27 |
| 2020 July | 10 | 9 | 19 |
| 2020 June | 12 | 15 | 27 |
| 2020 May | 13 | 15 | 28 |
| 2020 April | 2 | 8 | 10 |
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