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with fine unfocused linear branching vessels&#46; It was also evident multiple yellowish to orange follicular dots in the center of the alopecic patch&#44; with some pigmented thin hairs &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; When applying more pressure on the dermoscope&#44; the erythematous background became more whitish&#44; and the orange dots were more evident&#46; No scale or hair shaft abnormalities were observed&#46; Although the dermoscopy of the unaffected skin at the frontotemporal hair implantation line also revealed some pigmented thin hairs and linear branching vessels&#44; no yellow dots or anysotrichosis were evident &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; An incisional biopsy was performed&#46; Histopathological examination revealed epithelial atrophy&#46; In the mid and upper dermis&#44; there was a granulomatous infiltrate with multinucleated giant cells&#44; some of them with intracytoplasmic asteroid bodies&#44; and there was also a sparse lymphoplasmacytic infiltrate &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; No necrosis was evident&#46; Verhoeff-Van Gieson stain showed elastic fibers in the cytoplasm of multinucleated giant cells &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Clinical and histopathological findings were consistent with annular elastolytic giant cell granuloma&#46; The patient was initially treated with a medium potency topical corticosteroid in combination with tacrolimus 0&#46;1&#37; ointment&#44; with mild benefit&#46; At 6-month follow-up&#44; the authors performed one treatment of intralesional steroids at the border of the lesions&#44; with some improvement in the erythema and stability of the size of the lesions&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Discussion</span><p id="par0020" class="elsevierStylePara elsevierViewall">Annular elastolytic giant cell granuloma &#40;AEGCG&#41; is an uncommon granulomatous cutaneous disease that usually affects sun-exposed skin but may also occur in sun-protected areas&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It is associated with an alteration of elastic fibers and elastophagocytosis&#44; resulting in variable clinical presentations&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Both genders are affected but there is a slight female preponderance&#46; It typically manifests as annular plaques with raised erythematous borders and a slight atrophic and hypopigmented center&#46; Non-scarring alopecia has been reported as a possible presentation of AEGCG&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Diagnosis may be difficult due to the similar clinical features to other granulomatous dermatoses&#44; such as sarcoidosis&#44; classic granuloma annulare and necrobiosis lipoidica&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Histopathology is the gold standard for diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Diagnosis is based on the histological presence of granulomatous inflammation&#44; absence of necrobiosis&#44; and presence of multinucleated giant cells with more than one area of elastophagocytosis &#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Besides the annular form&#44; giant cell elastolytic granuloma can also be classified in papular&#44; reticular or mixed forms&#44; according to the clinical presentation <a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Dermoscopy of the lesions may help to narrow down the clinical differential diagnosis&#46; The dermoscopic hallmark of granulomatous skin diseases consists of a structureless yellowish-orange area&#44; distributed in a focal or diffuse pattern&#44; due to the presence of a granulomatous infiltrate in the dermis&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> However&#44; dermoscopy findings of this particular disorder are scarce in the literature&#46; In the studied patient&#44; the authors observed an erythematous background with multiple empty follicular ostia with follicular yellowish to orange dots&#44; among the central portion of the patch&#46; No scale was observed&#46; Yellowish&#47;orange dots were previously reported in trichoscopy of scalp sarcoidosis&#44; and the authors associated them with the presence of granulomas in the superficial dermis&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Female pattern hair loss &#40;FPHL&#41; may present with yellow dots but the lack of these findings on the unaffected scalp of the patient&#44; along with the absence of anysotrichosis&#44; make the diagnosis of FPHL unlikely&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">This dermoscopy report of AEGCG involving the implantation hair line widens the differential diagnosis of scalp dermatosis with yellowish-orangish dots&#46; The authors believe that it may present a clue to the diagnosis of this entity&#46; More observational reports are needed to confirm the present observations&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Financial support</span><p id="par0040" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Authors&#8217; contributions</span><p id="par0045" class="elsevierStylePara elsevierViewall">Tiago Fernandes Gomes&#58; Data collection&#44; analysis&#44; and interpretation&#59; critical literature review&#59; preparation and writing of the manuscript</p><p id="par0050" class="elsevierStylePara elsevierViewall">Jos&#233; Carlos Cardoso&#58; Approval of the final version of the manuscript&#59; data collection&#44; analysis&#44; and interpretation&#59; Manuscript critical review&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Victoria Guiote&#58; Approval of the final version of the manuscript&#59; data collection&#44; analysis&#44; and interpretation&#59; intellectual participation in propaedeutic and&#47;or therapeutic management of studied cases&#59; manuscript critical review&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Images in Dermatology
Dermoscopy of annular elastolytic giant cell granuloma
Tiago Fernandes Gomesa,
Corresponding author
tiagofgomesd@gmail.com

Corresponding author.
, José Carlos Cardosob, Victoria Guiotea
a Dermatology Department, Centro Hospitalar de Leiria, Portugal
b Dermatology Department, Centro Hospitalar e Universitário de Coimbra, Portugal
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Case report</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 46-year-old female patient presented with a 2-month history of an enlarging frontal alopecic plaque&#46; She denied any pain or pruritus&#46; During the physical examination there were two confluent non-scaly pink alopecic plaques with an erythematous border&#44; at the frontal implantation hair line&#44; with 35 &#215; 70 mm and 40 &#215; 60 mm &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The overlying central skin was slightly atrophic&#46; The remaining scalp had no decrease in hair density&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Dermoscopy revealed empty follicular ostia&#44; with a diffuse erythemato-whitish background&#44; with fine unfocused linear branching vessels&#46; It was also evident multiple yellowish to orange follicular dots in the center of the alopecic patch&#44; with some pigmented thin hairs &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; When applying more pressure on the dermoscope&#44; the erythematous background became more whitish&#44; and the orange dots were more evident&#46; No scale or hair shaft abnormalities were observed&#46; Although the dermoscopy of the unaffected skin at the frontotemporal hair implantation line also revealed some pigmented thin hairs and linear branching vessels&#44; no yellow dots or anysotrichosis were evident &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; An incisional biopsy was performed&#46; Histopathological examination revealed epithelial atrophy&#46; In the mid and upper dermis&#44; there was a granulomatous infiltrate with multinucleated giant cells&#44; some of them with intracytoplasmic asteroid bodies&#44; and there was also a sparse lymphoplasmacytic infiltrate &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; No necrosis was evident&#46; Verhoeff-Van Gieson stain showed elastic fibers in the cytoplasm of multinucleated giant cells &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Clinical and histopathological findings were consistent with annular elastolytic giant cell granuloma&#46; The patient was initially treated with a medium potency topical corticosteroid in combination with tacrolimus 0&#46;1&#37; ointment&#44; with mild benefit&#46; At 6-month follow-up&#44; the authors performed one treatment of intralesional steroids at the border of the lesions&#44; with some improvement in the erythema and stability of the size of the lesions&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Discussion</span><p id="par0020" class="elsevierStylePara elsevierViewall">Annular elastolytic giant cell granuloma &#40;AEGCG&#41; is an uncommon granulomatous cutaneous disease that usually affects sun-exposed skin but may also occur in sun-protected areas&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It is associated with an alteration of elastic fibers and elastophagocytosis&#44; resulting in variable clinical presentations&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Both genders are affected but there is a slight female preponderance&#46; It typically manifests as annular plaques with raised erythematous borders and a slight atrophic and hypopigmented center&#46; Non-scarring alopecia has been reported as a possible presentation of AEGCG&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Diagnosis may be difficult due to the similar clinical features to other granulomatous dermatoses&#44; such as sarcoidosis&#44; classic granuloma annulare and necrobiosis lipoidica&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Histopathology is the gold standard for diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Diagnosis is based on the histological presence of granulomatous inflammation&#44; absence of necrobiosis&#44; and presence of multinucleated giant cells with more than one area of elastophagocytosis &#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Besides the annular form&#44; giant cell elastolytic granuloma can also be classified in papular&#44; reticular or mixed forms&#44; according to the clinical presentation <a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Dermoscopy of the lesions may help to narrow down the clinical differential diagnosis&#46; The dermoscopic hallmark of granulomatous skin diseases consists of a structureless yellowish-orange area&#44; distributed in a focal or diffuse pattern&#44; due to the presence of a granulomatous infiltrate in the dermis&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> However&#44; dermoscopy findings of this particular disorder are scarce in the literature&#46; In the studied patient&#44; the authors observed an erythematous background with multiple empty follicular ostia with follicular yellowish to orange dots&#44; among the central portion of the patch&#46; No scale was observed&#46; Yellowish&#47;orange dots were previously reported in trichoscopy of scalp sarcoidosis&#44; and the authors associated them with the presence of granulomas in the superficial dermis&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Female pattern hair loss &#40;FPHL&#41; may present with yellow dots but the lack of these findings on the unaffected scalp of the patient&#44; along with the absence of anysotrichosis&#44; make the diagnosis of FPHL unlikely&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">This dermoscopy report of AEGCG involving the implantation hair line widens the differential diagnosis of scalp dermatosis with yellowish-orangish dots&#46; The authors believe that it may present a clue to the diagnosis of this entity&#46; More observational reports are needed to confirm the present observations&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Financial support</span><p id="par0040" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Authors&#8217; contributions</span><p id="par0045" class="elsevierStylePara elsevierViewall">Tiago Fernandes Gomes&#58; Data collection&#44; analysis&#44; and interpretation&#59; critical literature review&#59; preparation and writing of the manuscript</p><p id="par0050" class="elsevierStylePara elsevierViewall">Jos&#233; Carlos Cardoso&#58; Approval of the final version of the manuscript&#59; data collection&#44; analysis&#44; and interpretation&#59; Manuscript critical review&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Victoria Guiote&#58; Approval of the final version of the manuscript&#59; data collection&#44; analysis&#44; and interpretation&#59; intellectual participation in propaedeutic and&#47;or therapeutic management of studied cases&#59; manuscript critical review&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Article information
ISSN: 03650596
Original language: English
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