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2</a>&#41;&#46; A 3&#8239;mm punch biopsy was performed&#46; The histopathology revealed a few parakeratotic foci and hyperkeratosis in other surfaces&#46; There were well-circumscribed lymphohistiocytic infiltrate in the papillary dermis expanding a small number of dermal papillae&#46; Epidermal collarettes&#44; elongated claw-like rete ridges wrapped around the subepidermal infiltrates &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>a&#41;&#46; There were occasional multinucleated giant cells within the lymphohistiocytic infiltrates&#46; The parakeratotic foci were located right above the &#8220;ball-and-claw&#8221; areas &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>b&#41;&#46; There were minimal perivascular lymphocytes around the superficial dermal vascular plexus&#46; The diagnosis of palmar LN was established with current clinical&#44; dermoscopic&#44; and histopathologic findings&#46; The patient was given topical keratolytic&#44; corticosteroid&#44; and emollient treatment and followed up&#46; The lesions have improved after treatment based on his teledermatological assessment performed two months later&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was evaluated in the dermatology clinic of Afyonkarahisar Health Sciences University Medical Faculty&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">LN is an uncommon lichenoid dermatosis that could be defined as multiple&#44; separated&#44; shiny&#44; pinpoint&#44; pale to skin-colored papules&#44; 1 to 2&#8239;mm in diameter&#46; LN usually affects children and young adults without any sex predilection&#46; The etiology of the disease is uncertain&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The most commonly involved sites are flexor areas of upper extremities&#44; hand dorsums&#44; trunk&#44; and genitalia&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> LN located solely at palms presenting as hyperkeratotic pitted papules and plaques have been rarely reported&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> It is hard to make a diagnosis of palmar LN when there are no lesions elsewhere on the body&#46; There are some dermoscopic features defined for both palmoplantar and non-palmoplantar LN that might be useful to facilitate the diagnosis before histopathological examination&#46; Herein&#44; we report a case of a 24-year-old man with isolated palmar LN to contribute to the literature and emphasize the diagnostic importance of the dermoscopic description for such a very rare disease&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Isolated palmar LN is a quite rare disease that presents with asymptomatic or occasionally pruritic hyperkeratotic pitted papules&#46; Park et al&#46; reported that palmar involvement usually seemed to accompany LN lesions of typical sites and claimed that there have been only 4 cases of LN confined to the palm including their case&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Similarly&#44; Podder et al reported a case of isolated palmar LN and claimed that this was the first case from Eastern India&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">There are a few dermoscopic findings defined for LN in the literature&#46; These definitions are quite different between the palmoplantar variant and classical LN&#46; The absence of dermatoglyphics&#44; radial ridges&#44; central depression areas with non-polarised mode&#59; ill-defined hypopigmentation with diffuse erythema&#44; and linear vessels with polarised mode were observed in classical LN&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Malakar et al&#46; indicated that dermoscopy of forearm demonstrates multiple&#44; white&#44; well-circumscribed&#44; circular areas and an indistinct brown shadow reflected through these white circles&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In the palmoplantar variant specifically&#59; linear parallel scales discontinued by oval&#44; well-defined depressions and surrounded by ring-shaped&#44; silvery-white scales were described&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> In the case here reported ovoid&#44; comedo-like central depressions surrounded by white halo-like scales and communicating white linear thicker scales parallel to the long axis of ovoid structures were observed&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The histopathological main features of LN are well-circumscribed infiltration of lymphocytes&#44; macrophages&#44; Langerhans giant cells&#44; and multinucleated epithelioid histiocytes in the papillary dermis surrounded by the elongated epidermal rete ridges&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> This subepidermally located lymphohistiocytic infiltrate surrounded by acanthosis&#44; the parakeratotic epidermis is the so-called &#8220;ball-in-clutch&#8221; or &#8220;ball-in-claw&#8221; appearance&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> There were similar histopathological findings in the case here reported&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The presence of white halo-like&#44; well-demarcated structures probably correspond to epidermal acanthosis on histopathology while the brown shadow-like central depressions are considered a reflection of the underlying dense inflammatory infiltrate composed of lymphocytes and epitheloid cells&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Many treatment modalities have been tried including topical and systemic corticosteroids&#44; antihistamines&#44; acitretin&#44; UVA&#44; narrowband UVB&#44; and cyclosporin for LN&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Most lesions were asymptomatic and limited to a small part of the body not requiring intensive treatment with serious side effects on the other hand&#46; We have observed some improvement of the lesions under treatment with topical corticosteroids and keratolytic agents&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Isolated palmar LN is a very rare disease most commonly affecting young patients&#46; Dermoscopy is a noninvasive&#44; cheap&#44; and fast method to diagnose the disease and might be used to make the diagnosis and reduce the need for biopsy&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">This case report was presented as an oral presentation in the International Dermatology&#44; Dermatopathology and Esthetics Academy 2020 Congress&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Financial support</span><p id="par0055" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Authors&#39; contributions</span><p id="par0060" class="elsevierStylePara elsevierViewall">&#304;rem Nur Durusu&#58; Approval of the final version of the manuscript&#59; critical literature review&#59; data collection&#44; analysis&#44; and interpretation&#59; effective participation in research orientation&#59; &#305;ntellectual participation in propaedeutic and&#47;or therapeutic&#59; management of studied cases&#59; preparation and writing of the manuscript&#59; study conception and planning&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Dilara G&#252;ler&#58; Approval of the final version of the manuscript&#59; critical literature review&#59; data collection&#44; analysis&#44; and interpretation&#59; effective participation in research orientation&#59; &#305;ntellectual participation in propaedeutic and&#47;or therapeutic&#59; management of studied cases&#44; study conception&#44; and planning&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">G&#252;lhan G&#252;rel&#58; Approval of the final version of the manuscript&#59; critical literature review&#59; effective participation in research orientation&#59; &#305;ntellectual participation in propaedeutic and&#47;or therapeutic&#59; management of studied cases&#59; manuscript critical review&#59; study conception and planning</p><p id="par0075" class="elsevierStylePara elsevierViewall">G&#252;ls&#252;m &#350;eyma Yal&#231;&#305;n&#58; Approval of the final version of the manuscript&#59; critical literature review&#59; effective participation in research orientation&#59; &#305;ntellectual participation in propaedeutic and&#47;or therapeutic&#59; management of studied cases&#59; study conception and planning&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Images in Dermatology
A very rare localization of a rare disease: palmar lichen nitidus
İrem Nur Durusua,
Corresponding author
nur.durusu@afsu.edu.tr

Corresponding author.
, Dilara Gülera, Gülhan Gürela, Gülsüm Şeyma Yalçınb
a Department of Dermatology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
b Department of Pathology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
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2</a>&#41;&#46; A 3&#8239;mm punch biopsy was performed&#46; The histopathology revealed a few parakeratotic foci and hyperkeratosis in other surfaces&#46; There were well-circumscribed lymphohistiocytic infiltrate in the papillary dermis expanding a small number of dermal papillae&#46; Epidermal collarettes&#44; elongated claw-like rete ridges wrapped around the subepidermal infiltrates &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>a&#41;&#46; There were occasional multinucleated giant cells within the lymphohistiocytic infiltrates&#46; The parakeratotic foci were located right above the &#8220;ball-and-claw&#8221; areas &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>b&#41;&#46; There were minimal perivascular lymphocytes around the superficial dermal vascular plexus&#46; The diagnosis of palmar LN was established with current clinical&#44; dermoscopic&#44; and histopathologic findings&#46; The patient was given topical keratolytic&#44; corticosteroid&#44; and emollient treatment and followed up&#46; The lesions have improved after treatment based on his teledermatological assessment performed two months later&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was evaluated in the dermatology clinic of Afyonkarahisar Health Sciences University Medical Faculty&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">LN is an uncommon lichenoid dermatosis that could be defined as multiple&#44; separated&#44; shiny&#44; pinpoint&#44; pale to skin-colored papules&#44; 1 to 2&#8239;mm in diameter&#46; LN usually affects children and young adults without any sex predilection&#46; The etiology of the disease is uncertain&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The most commonly involved sites are flexor areas of upper extremities&#44; hand dorsums&#44; trunk&#44; and genitalia&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> LN located solely at palms presenting as hyperkeratotic pitted papules and plaques have been rarely reported&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> It is hard to make a diagnosis of palmar LN when there are no lesions elsewhere on the body&#46; There are some dermoscopic features defined for both palmoplantar and non-palmoplantar LN that might be useful to facilitate the diagnosis before histopathological examination&#46; Herein&#44; we report a case of a 24-year-old man with isolated palmar LN to contribute to the literature and emphasize the diagnostic importance of the dermoscopic description for such a very rare disease&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Isolated palmar LN is a quite rare disease that presents with asymptomatic or occasionally pruritic hyperkeratotic pitted papules&#46; Park et al&#46; reported that palmar involvement usually seemed to accompany LN lesions of typical sites and claimed that there have been only 4 cases of LN confined to the palm including their case&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Similarly&#44; Podder et al reported a case of isolated palmar LN and claimed that this was the first case from Eastern India&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">There are a few dermoscopic findings defined for LN in the literature&#46; These definitions are quite different between the palmoplantar variant and classical LN&#46; The absence of dermatoglyphics&#44; radial ridges&#44; central depression areas with non-polarised mode&#59; ill-defined hypopigmentation with diffuse erythema&#44; and linear vessels with polarised mode were observed in classical LN&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Malakar et al&#46; indicated that dermoscopy of forearm demonstrates multiple&#44; white&#44; well-circumscribed&#44; circular areas and an indistinct brown shadow reflected through these white circles&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In the palmoplantar variant specifically&#59; linear parallel scales discontinued by oval&#44; well-defined depressions and surrounded by ring-shaped&#44; silvery-white scales were described&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> In the case here reported ovoid&#44; comedo-like central depressions surrounded by white halo-like scales and communicating white linear thicker scales parallel to the long axis of ovoid structures were observed&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The histopathological main features of LN are well-circumscribed infiltration of lymphocytes&#44; macrophages&#44; Langerhans giant cells&#44; and multinucleated epithelioid histiocytes in the papillary dermis surrounded by the elongated epidermal rete ridges&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> This subepidermally located lymphohistiocytic infiltrate surrounded by acanthosis&#44; the parakeratotic epidermis is the so-called &#8220;ball-in-clutch&#8221; or &#8220;ball-in-claw&#8221; appearance&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> There were similar histopathological findings in the case here reported&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The presence of white halo-like&#44; well-demarcated structures probably correspond to epidermal acanthosis on histopathology while the brown shadow-like central depressions are considered a reflection of the underlying dense inflammatory infiltrate composed of lymphocytes and epitheloid cells&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Many treatment modalities have been tried including topical and systemic corticosteroids&#44; antihistamines&#44; acitretin&#44; UVA&#44; narrowband UVB&#44; and cyclosporin for LN&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Most lesions were asymptomatic and limited to a small part of the body not requiring intensive treatment with serious side effects on the other hand&#46; We have observed some improvement of the lesions under treatment with topical corticosteroids and keratolytic agents&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Isolated palmar LN is a very rare disease most commonly affecting young patients&#46; Dermoscopy is a noninvasive&#44; cheap&#44; and fast method to diagnose the disease and might be used to make the diagnosis and reduce the need for biopsy&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">This case report was presented as an oral presentation in the International Dermatology&#44; Dermatopathology and Esthetics Academy 2020 Congress&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Financial support</span><p id="par0055" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Authors&#39; contributions</span><p id="par0060" class="elsevierStylePara elsevierViewall">&#304;rem Nur Durusu&#58; Approval of the final version of the manuscript&#59; critical literature review&#59; data collection&#44; analysis&#44; and interpretation&#59; effective participation in research orientation&#59; &#305;ntellectual participation in propaedeutic and&#47;or therapeutic&#59; management of studied cases&#59; preparation and writing of the manuscript&#59; study conception and planning&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Dilara G&#252;ler&#58; Approval of the final version of the manuscript&#59; critical literature review&#59; data collection&#44; analysis&#44; and interpretation&#59; effective participation in research orientation&#59; &#305;ntellectual participation in propaedeutic and&#47;or therapeutic&#59; management of studied cases&#44; study conception&#44; and planning&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">G&#252;lhan G&#252;rel&#58; Approval of the final version of the manuscript&#59; critical literature review&#59; effective participation in research orientation&#59; &#305;ntellectual participation in propaedeutic and&#47;or therapeutic&#59; management of studied cases&#59; manuscript critical review&#59; study conception and planning</p><p id="par0075" class="elsevierStylePara elsevierViewall">G&#252;ls&#252;m &#350;eyma Yal&#231;&#305;n&#58; Approval of the final version of the manuscript&#59; critical literature review&#59; effective participation in research orientation&#59; &#305;ntellectual participation in propaedeutic and&#47;or therapeutic&#59; management of studied cases&#59; study conception and planning&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Lichen nitidus is an uncommon lichenoid dermatosis that could be defined as multiple&#44; separated&#44; shiny&#44; pinpoint&#44; pale to skin-colored papules&#46; Palmoplantar lichen nitidus is a quite rare variant of lichen nitidus&#46; It is hard to make a diagnosis of palmar lichen nitidus when there are no lesions elsewhere on the body&#46; There are some dermoscopic features defined for both palmoplantar and non-palmoplantar lichen nitidus that might be useful to facilitate the diagnosis before histopathological examination&#46; Herein&#44; we report a case of a 24-year-old man diagnosed with isolated palmar lichen nitidus with dermoscopic features and histopathological confirmation&#46;</p></span>"
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Idiomas
Anais Brasileiros de Dermatologia
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