Case Letter
Dermoscopic findings in a case of plasma cell cheilitis
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(B) Clinical improvement after 7-days of treatment with oral prednisone.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Plasma Cell Cheilitis (PCC) is a rare inflammatory disorder of unknown origin within the spectrum of plasma cell mucositis. Clinically, it manifests as a circumscribed, flat to slightly raised, eroded erythematous plaque or patch involving the lower lip of elderly male patients.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Histopathologically, dense band-like plasma cell infiltration in the upper dermis is seen.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Dermoscopic features of this entity have been described in only one report.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Here we report a case of refractory PCC and its dermoscopic features.</p><p id="par0010" class="elsevierStylePara elsevierViewall">An otherwise healthy 52-year-old man, an agricultural worker, was referred to our hospital with a ten-year history of painful erythematous erosion on the lower lip. Physical examination revealed an erythematous plaque with diffuse desquamation along with erosions and crusts (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Dermoscopy showed a well-defined lesion with the milky-red structureless area, small erosions, and multiple enlarged linear vessels on the periphery with a radial distribution. Scales although present on a small focus of the lesion was not a predominant feature (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Laboratory tests, including complete blood counts and tests for liver and renal function, showed normal findings, and hepatitis B and C and HIV infection was negative; PPD; chest X-Ray; thyroid tests and protein electrophoresis were in normal ranges. Histopathology showed a partially ulcerated pluriestratified epithelium with parakeratosis, without atypia, with pseudoepitheliomatous hyperplasia (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A). The dermis showed foci of chronic inflammatory infiltrate with abundant plasma cells (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B), macrophages, and areas of granulation tissue. The immuno-histochemical study revealed CK AE1/AE3 (-), CD68 (+) in membrane and macrophage cytoplasm, staining positive Kappa (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>C) and Lambda chains (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>D). The patient began treatment with high potency topical and intralesional corticosteroids, with little response. After the use of oral prednisone at a dose of 1 mg/kg/day, he presented total remission of the lesion on the seventh day (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). However, the lesion constantly recurs during tapering. Treatment with topical calcineurin inhibitors was not possible due to economic concerns.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">One of the main differential diagnoses in the context of our patient was Actinic Cheilitis (AC) or even progression to Squamous Cell Carcinoma (SCC). Dermoscopy could be a useful tool to help differentiate these entities. We found some similarities between our case and the previously reported regarding border regularity and vascular enlargement and proliferation.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Other important characteristics found in this case were the milky-red background in the entire lesion with some focal erosions, the absence of stellate border and scales (features suggestive of AC), and radial distribution of the enlarged lineal vessels on the periphery. More reports are needed to establish clear-cut criteria to aid in the clinical differentiation of these entities.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Although PCC is considered a benign disorder is usually refractory to various topical treatments, including topical and intralesional corticosteroids, topical calcineurin inhibitors, antibiotics, and antifungal agents.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> It is unclear whether PCC may represent a precursor lesion of malignancies such as SCC.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Therefore, careful follow-up is recommended.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0025" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors’ contributions</span><p id="par0030" class="elsevierStylePara elsevierViewall">Daniella Truffello: Approval of the final version of the manuscript; critical literature review; data collection, analysis, and interpretation; intellectual participation in propaedeutic and/or therapeutic management of studied cases; study conception and planning.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Carolina Cevallos: Approval of the final version of the manuscript; critical literature review; effective participation in research orientation; manuscript critical review; preparation and writing of the manuscript; study conception and planning.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Claudio Escanilla: Approval of the final version of the manuscript; critical literature review; effective participation in research orientation; intellectual participation in propaedeutic and/or therapeutic management of studied cases; manuscript critical review; study conception and planning.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Pauline Morgan: Approval of the final version of the manuscript; data collection, analysis and interpretation; intellectual participation in propaedeutic and/or therapeutic management of studied cases.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0050" 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" => "2020-10-21" "fechaAceptado" => "2020-12-26" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Hospital Regional Libertador Bernardo O’Higgins, Rancagua, Chile.</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" => 1027 "Ancho" => 2925 "Tamanyo" => 379677 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) The lower lip shows a diffuse xerotic erythematous plaque with erosions and hemorrhagic crusts. (B) Clinical improvement after 7-days of treatment with oral prednisone.</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" => 1259 "Ancho" => 1675 "Tamanyo" => 172184 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermoscopy of PCC shows a sharply demarcated borders with milky-red structureless area (asterisk), small erosions (white arrow), and multiple enlarged linear vessels on the periphery with a radial distribution (black arrow); a small focus of white scale on the inferior aspect of the lesion is also seen.</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" => 1022 "Ancho" => 3341 "Tamanyo" => 812781 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) A biopsy specimen shows a flattened squamous epithelium with parakeratosis without atypia, with pseudoepitheliomatous hyperplasia (Hematoxylin & eosin, ×100). (B) A high-power view shows a dermal chronic inflammatory infiltrate with abundant plasma cells (Hematoxylin & eosin, ×400). (C) A diffuse strong positivity for kappa light chain is noted in the plasma cell infiltrates (Immunohistochemistry, ×400). (D) Plasma cells are also positive for lambda light chain (Immunohistochemistry, ×400).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Plasma cell cheilitis successfully treated with topical calcineurin inhibitors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Y. Yamaguchi" 1 => "W. Nishie" 2 => "T. Ito" 3 => "H. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 17 | 6 | 23 |
| 2024 October | 123 | 66 | 189 |
| 2024 September | 150 | 91 | 241 |
| 2024 August | 149 | 121 | 270 |
| 2024 July | 124 | 109 | 233 |
| 2024 June | 130 | 86 | 216 |
| 2024 May | 116 | 60 | 176 |
| 2024 April | 111 | 107 | 218 |
| 2024 March | 100 | 69 | 169 |
| 2024 February | 128 | 78 | 206 |
| 2024 January | 96 | 50 | 146 |
| 2023 December | 61 | 58 | 119 |
| 2023 November | 81 | 85 | 166 |
| 2023 October | 70 | 66 | 136 |
| 2023 September | 81 | 67 | 148 |
| 2023 August | 73 | 38 | 111 |
| 2023 July | 75 | 42 | 117 |
| 2023 June | 85 | 47 | 132 |
| 2023 May | 59 | 31 | 90 |
| 2023 April | 41 | 13 | 54 |
| 2023 March | 47 | 43 | 90 |
| 2023 February | 49 | 39 | 88 |
| 2023 January | 59 | 39 | 98 |
| 2022 December | 88 | 40 | 128 |
| 2022 November | 98 | 66 | 164 |
| 2022 October | 114 | 71 | 185 |
| 2022 September | 43 | 56 | 99 |
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