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He had been under treatment with topical corticosteroid ointment and etretinate &#40;Tigason<span class="elsevierStyleSup">R</span>&#41; &#40;10&#8210;20&#160;mg&#47;day&#41; for 5 years&#44; but without any significant sufficient improvement&#46; During the course&#44; he complained of a slightly tender nodule on his palm which had appeared 2 months previously&#46; Physical examination revealed a 5-mm sized&#44; brownish firm nodule on the right palm &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Histopathological examination revealed fibrous proliferation in the dermis with the mild acanthosis of the overlying epidermis &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Storiform patterns were not found&#44; and the proliferated fibroblasts were positive for factor XIIIa and CD68&#44; but negative for CD34&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">DF often develops due to fibroblastic cell proliferation as a reactive process in response to some stimuli&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> and cases of digital DFs have been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> By contrast&#44; there have only been a few reported cases of fibrous histiocytoma occurring on the palms&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> Although the patient denied precedent trauma&#44; his hobby is wood carving&#44; for which he frequently uses chisels with his dominant hand&#44; namely the right hand&#46; Therefore&#44; it is possible that DF was triggered by repetitive mechanical stimuli&#46; The patient had multiple porokeratotic plaques on the buttock&#44; Achilles tendon&#44; as well as trunk&#44; which showed well-circumscribed brownish plaques with slightly elevated borders&#44; but they were not either verrucous or hyperkeratotic&#46; The porokeratosis lesions were treated with oral etretinate and topical corticosteroid for 5 years&#46; The profibrotic effects of etretinate such as increasing collagen accumulation and reducing matrix metalloproteinase 1 have been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> However&#44; in the present case&#44; DF occurred solitarily&#44; and there have been no reports on multiple DFs in patients undergoing etretinate therapy&#46; Therefore&#44; the authors believe that DF occurred independently of etretinate intake&#46; Finally&#44; there are no reports of the coexistence of porokeratosis and dermatofibroma&#44; and the coexistence of both disorders in the current case may be coincidental&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Financial support</span><p id="par0020" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Author&#8217; contributions</span><p id="par0025" class="elsevierStylePara elsevierViewall">Toshiyuki Yamamoto&#58; Approval of the final version of the manuscript&#59; Critical literature review&#59; Data collection&#44; analysis and interpretation&#59; Effective participation in research orientation&#59; Intellectual participation in propaedeutic and&#47;or therapeutic&#59; management of studied cases&#59; Manuscript critical review&#59; Preparation and writing of the manuscript&#59; Study conception and planning&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflict of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Images in Dermatology
Palmar dermatofibroma in a patient with multiple porokeratosis
Toshiyuki Yamamoto
Department of Dermatology, Fukushima Medical University, Fukushima, Japan
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Dermatofibromas &#40;DFs&#41; are common&#44; benign dermal nodules that frequently occur on the extremities&#44; shoulders&#44; and buttocks of middle-aged women&#46; DFs rarely occur on the digits<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#59; palmar involvement is extremely rare&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 69-year-old male visited our clinic&#44; complaining of multiple brownish plaques on the trunk&#44; heel&#44; and buttocks &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; He had Diabetes <span class="elsevierStyleItalic">Mellitus</span>&#44; angina&#44; and hypertension&#46; Biopsy taken from the edge of the plaque revealed mild hyperkeratosis and a narrow stack of parakeratotic corneocytes &#40;cornoid lamella&#41;&#44; corresponding with the features of porokeratosis&#46; He had been under treatment with topical corticosteroid ointment and etretinate &#40;Tigason<span class="elsevierStyleSup">R</span>&#41; &#40;10&#8210;20&#160;mg&#47;day&#41; for 5 years&#44; but without any significant sufficient improvement&#46; During the course&#44; he complained of a slightly tender nodule on his palm which had appeared 2 months previously&#46; Physical examination revealed a 5-mm sized&#44; brownish firm nodule on the right palm &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Histopathological examination revealed fibrous proliferation in the dermis with the mild acanthosis of the overlying epidermis &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Storiform patterns were not found&#44; and the proliferated fibroblasts were positive for factor XIIIa and CD68&#44; but negative for CD34&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">DF often develops due to fibroblastic cell proliferation as a reactive process in response to some stimuli&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> and cases of digital DFs have been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> By contrast&#44; there have only been a few reported cases of fibrous histiocytoma occurring on the palms&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> Although the patient denied precedent trauma&#44; his hobby is wood carving&#44; for which he frequently uses chisels with his dominant hand&#44; namely the right hand&#46; Therefore&#44; it is possible that DF was triggered by repetitive mechanical stimuli&#46; The patient had multiple porokeratotic plaques on the buttock&#44; Achilles tendon&#44; as well as trunk&#44; which showed well-circumscribed brownish plaques with slightly elevated borders&#44; but they were not either verrucous or hyperkeratotic&#46; The porokeratosis lesions were treated with oral etretinate and topical corticosteroid for 5 years&#46; The profibrotic effects of etretinate such as increasing collagen accumulation and reducing matrix metalloproteinase 1 have been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> However&#44; in the present case&#44; DF occurred solitarily&#44; and there have been no reports on multiple DFs in patients undergoing etretinate therapy&#46; Therefore&#44; the authors believe that DF occurred independently of etretinate intake&#46; Finally&#44; there are no reports of the coexistence of porokeratosis and dermatofibroma&#44; and the coexistence of both disorders in the current case may be coincidental&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Financial support</span><p id="par0020" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Author&#8217; contributions</span><p id="par0025" class="elsevierStylePara elsevierViewall">Toshiyuki Yamamoto&#58; Approval of the final version of the manuscript&#59; Critical literature review&#59; Data collection&#44; analysis and interpretation&#59; Effective participation in research orientation&#59; Intellectual participation in propaedeutic and&#47;or therapeutic&#59; management of studied cases&#59; Manuscript critical review&#59; Preparation and writing of the manuscript&#59; Study conception and planning&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflict of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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