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Purpura annularis telangiectodes of Majocchi
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A new diagnostic clue for this paraneoplastic syndrome?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "666" "paginaFinal" => "668" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "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" => 1465 "Ancho" => 2167 "Tamanyo" => 830573 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histology of the lesions. Atrophic epidermis can be seen with moderate spongiosis and a central area with marked pallor due to the presence of apoptotic keratinocytes of vacuolated appearance below a more superficial layer of extensive hyperkeratosis and parakeratosis, producing a “tricolor flag” appearance (Hematoxylin & eosin, ×20).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Inés Gracia-Darder, Daniel Ramos, Julián Boix-Vilanova, Ana Francisca Bauzá-Alonso" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Inés" "apellidos" => "Gracia-Darder" ] 1 => array:2 [ "nombre" => "Daniel" "apellidos" => "Ramos" ] 2 => array:2 [ "nombre" => "Julián" "apellidos" => "Boix-Vilanova" ] 3 => array:2 [ "nombre" => "Ana Francisca" "apellidos" => "Bauzá-Alonso" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275220302575" "doi" => "10.1016/j.abdp.2020.02.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => 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true "cabecera" => "<span class="elsevierStyleTextfn">Case Letter</span>" "titulo" => "Purpura annularis telangiectodes of Majocchi" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "664" "paginaFinal" => "666" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Aline Soares Garcez, Vitória Regina Pedreira de Almeida Rego, Thadeu Santos Silva" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Aline Soares" "apellidos" => "Garcez" "email" => array:1 [ 0 => "line_garcez@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Vitória Regina Pedreira de Almeida" "apellidos" => "Rego" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Thadeu Santos" "apellidos" => "Silva" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Dermatology Service, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, BA, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Dermatology Service, Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "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" => 679 "Ancho" => 905 "Tamanyo" => 164760 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Lymphohistiocytic infiltrate in the upper dermis, as well as extravasation of red blood cells. It is possible to see some lymphocyte exocytosis (Hematoxylin & eosin, ×400).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Purpura annularis telangiectodes of Majocchi is a rare subtype of pigmented purpuric dermatosis. It is more common in children and young females and predominantly affects the lower limbs, with symmetrical annular reddish-brown macules.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Little is known of its etiology, which may be associated with viral infections, chronic comorbidities, and use of medications. The diagnosis is clinical and histopathological. There is no consensus regarding treatment. Management is based on reports and case series, with variable response to the proposed treatments.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A 6-year-old female patient, daughter of consanguineous parents, presented lesions since 2 years old. The patient had no history of systemic symptoms, allergies, or continued use of medications, except sporadic use of paracetamol. In the beginning, the lesions were erythematous, and subsequently evolved to annular and/or irregular hyperchromic macules, symmetrical in the legs, as well as in the right upper limb, and with an isolated lesion in the anterior cervical region (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). A skin biopsy of the right thigh was performed, demonstrating a lichenoid lymphohistiocytic infiltrate in the upper dermis and red blood cell extravasation, as well as foci of lymphocyte exocytosis and perivascular mononuclear infiltrate, without pigmentary incontinence or vasculitis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Perls' Prussian blue staining indicated the presence of hemosiderin deposition in the papillary dermis (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The patient was screened for hematological, infectious, and rheumatological diseases, all negative. The authors opted for treatment with colchicine orally, with no response after five months of medication use.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Purpura annularis telangiectodes of Majocchi is part of the pigmented purpuric dermatoses, which manifests as annular macules that are symmetrical, reddish-brown, and generally asymptomatic. It preferably affects children and young women, and there is no predominant ethnicity.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a> Commonly, it appears in the lower limbs; there appears to be an orthostatic component in the pathophysiology of the disease, as described in the present case. The etiology of pigmented purpuric dermatoses is not yet fully elucidated, and its triggers are not always detected; therefore, the etiology is idiopathic in most cases. An association with comorbidities such as diabetes mellitus, viral hepatitis, peripheral venous insufficiency, and use of certain medications has been reported, including the following: paracetamol, aspirin, carbamazepine, antihypertensives, infliximab, alpha-interferon, pseudoephedrine, raloxifene, and thiamine.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4</span></a> The present patient did not have any of the aforementioned comorbidities; the sporadic use of paracetamol was the only possible trigger identified in the clinical history. It is worth mentioning that most cases are idiopathic. The administration of paracetamol, even if occasional, may have been a trigger for the clinical picture as described by Kwon et al.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The diagnosis of purpura annularis telangiectodes of Majocchi is clinical and histopathological. The clinical characteristics are closely related to the anatomopathological findings. Lesion pigmentation is due to the extravasation of red blood cells and deposition of hemosiderin seen in the papillary dermis. It is also possible to observe perivascular inflammatory infiltrate composed of lymphocytes, histiocytes, and Langerhans cells. These findings corroborate the possible association of pigmented purpuric dermatoses with cellular immunity, contributing to capillary fragility. Humoral immunity also appears to play a role, which can be evidenced by direct immunofluorescence, which can detect perivascular deposits of immunoglobulins and complement. Foci of lymphocyte exocytosis may occur, as observed in this case. Leukocytoclastic vasculitis or epidermotropism are not observed.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> The knowledge of this entity and its early diagnosis can allow the assessment of the presence of triggers and guide its management.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0020" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors’ contributions</span><p id="par0025" class="elsevierStylePara elsevierViewall">Aline Soares Garcez:; elaboration and writing of the manuscript; critical review of the literature.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Vitória Regina Pedreira de Almeida Rego: Approval of the final version of the manuscript; critical review of the literature.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Thadeu Santos Silva: Approval of the final version of the manuscript; elaboration and writing of the manuscript; intellectual participation in propaedeutic and/or therapeutic conduct of studied cases; critical review of the literature, critical review of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors’ contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-11-05" "fechaAceptado" => "2020-02-17" "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Garcez AS, Rego VRPA, Silva TS. Purpura annularis telangiectodes of Majocchi. An Bras Dermatol. 2020. <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.abd.2020.02.007">https://doi.org/10.1016/j.abd.2020.02.007</span>.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Universidade Federal da Bahia, Salvador, BA, Brazil.</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" => 1541 "Ancho" => 905 "Tamanyo" => 162296 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Multiple brownish macules on the legs and thighs.</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" => 679 "Ancho" => 905 "Tamanyo" => 164760 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Lymphohistiocytic infiltrate in the upper dermis, as well as extravasation of red blood cells. It is possible to see some lymphocyte exocytosis (Hematoxylin & eosin, ×400).</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" => 862 "Ancho" => 905 "Tamanyo" => 119220 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Presence of hemosiderin deposition in the papillary dermis (Perls' Prussian blue, ×200).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Purpura annularis telangiectodes of Majocchi: case report and review of literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F.J. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 30 | 17 | 47 |
| 2024 October | 130 | 98 | 228 |
| 2024 September | 216 | 90 | 306 |
| 2024 August | 177 | 109 | 286 |
| 2024 July | 163 | 116 | 279 |
| 2024 June | 100 | 78 | 178 |
| 2024 May | 89 | 69 | 158 |
| 2024 April | 120 | 78 | 198 |
| 2024 March | 100 | 64 | 164 |
| 2024 February | 90 | 75 | 165 |
| 2024 January | 124 | 45 | 169 |
| 2023 December | 75 | 60 | 135 |
| 2023 November | 98 | 67 | 165 |
| 2023 October | 105 | 94 | 199 |
| 2023 September | 109 | 70 | 179 |
| 2023 August | 83 | 63 | 146 |
| 2023 July | 79 | 37 | 116 |
| 2023 June | 79 | 44 | 123 |
| 2023 May | 101 | 26 | 127 |
| 2023 April | 61 | 21 | 82 |
| 2023 March | 72 | 43 | 115 |
| 2023 February | 56 | 35 | 91 |
| 2023 January | 71 | 32 | 103 |
| 2022 December | 72 | 16 | 88 |
| 2022 November | 73 | 42 | 115 |
| 2022 October | 77 | 41 | 118 |
| 2022 September | 46 | 65 | 111 |
| 2022 August | 43 | 37 | 80 |
| 2022 July | 44 | 50 | 94 |
| 2022 June | 47 | 69 | 116 |
| 2022 May | 36 | 45 | 81 |
| 2022 April | 32 | 70 | 102 |
| 2022 March | 34 | 61 | 95 |
| 2022 February | 27 | 43 | 70 |
| 2022 January | 46 | 75 | 121 |
| 2021 December | 33 | 54 | 87 |
| 2021 November | 45 | 63 | 108 |
| 2021 October | 44 | 78 | 122 |
| 2021 September | 38 | 50 | 88 |
| 2021 August | 48 | 58 | 106 |
| 2021 July | 32 | 34 | 66 |
| 2021 June | 37 | 44 | 81 |
| 2021 May | 86 | 92 | 178 |
| 2021 April | 228 | 254 | 482 |
| 2021 March | 86 | 71 | 157 |
| 2021 February | 32 | 14 | 46 |
| 2021 January | 347 | 20 | 367 |
| 2020 December | 32 | 32 | 64 |
| 2020 November | 34 | 19 | 53 |
| 2020 October | 32 | 14 | 46 |
| 2020 September | 27 | 12 | 39 |
| 2020 August | 22 | 11 | 33 |
| 2020 July | 12 | 10 | 22 |
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