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Placas eritêmato‐descamativas e hiperceratóticas disseminadas" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "691" "paginaFinal" => "694" ] ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1128 "Ancho" => 3008 "Tamanyo" => 938573 ] ] "descripcion" => array:1 [ "pt" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) Observa‐se acantose irregular, espongiose e ceratocrosta, além de edema dérmico com áreas de borramento da junção dermo‐epidérmica (Hematoxilina & eosina, 100<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>). 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Unusual involvement of asymptomatic facial papular eruption: eruptive vellus hair cysts" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "694" "paginaFinal" => "696" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1252 "Ancho" => 3258 "Tamanyo" => 742352 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A‒C) Numerous distinct (1‒3<span class="elsevierStyleHsp" style=""></span>mm) smooth skin-colored papules concentrated on the cheeks and the ears</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Denys Elizabeth Peñaloza Daguer, Alicia Kowalczuk, Mariana Paula Caviedes, Luis Daniel Mazzuoccolo" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Denys Elizabeth" "apellidos" => "Peñaloza Daguer" ] 1 => array:2 [ "nombre" => "Alicia" "apellidos" => "Kowalczuk" ] 2 => array:2 [ "nombre" => "Mariana Paula" "apellidos" => "Caviedes" ] 3 => array:2 [ "nombre" => "Luis Daniel" "apellidos" => "Mazzuoccolo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275223001248" "doi" => "10.1016/j.abdp.2023.05.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275223001248?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623000983?idApp=UINPBA00008Z" "url" => "/03650596/0000009800000005/v1_202307281023/S0365059623000983/v1_202307281023/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0365059623001046" "issn" => "03650596" "doi" => "10.1016/j.abd.2022.11.003" "estado" => "S300" "fechaPublicacion" => "2023-09-01" "aid" => "773" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "article" "crossmark" => 1 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter - Clinical</span>" "titulo" => "Bullous pemphigoid developed after dramatic improvement of severe prurigo nodularis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "689" "paginaFinal" => "691" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1027 "Ancho" => 1250 "Tamanyo" => 89200 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0090" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Nodular lesions are dramatically improved after 2 years.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Tomoko Hiraiwa, Natsuko Matsumura, Tatsuhiko Mori, Nobuyuki Kikuchi, Toshiyuki Yamamoto" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Tomoko" "apellidos" => "Hiraiwa" ] 1 => array:2 [ "nombre" => "Natsuko" "apellidos" => "Matsumura" ] 2 => array:2 [ "nombre" => "Tatsuhiko" "apellidos" => "Mori" ] 3 => array:2 [ "nombre" => "Nobuyuki" "apellidos" => "Kikuchi" ] 4 => array:2 [ "nombre" => "Toshiyuki" "apellidos" => "Yamamoto" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275223001364" "doi" => "10.1016/j.abdp.2023.05.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275223001364?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623001046?idApp=UINPBA00008Z" "url" => "/03650596/0000009800000005/v1_202307281023/S0365059623001046/v1_202307281023/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter - Clinical</span>" "titulo" => "Case for diagnosis. Disseminated erythematous and scaly plaques: chronic mucocutaneous candidiasis" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "691" "paginaFinal" => "694" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Nathalia Chebli de Abreu, Samuel Duarte Timponi França, Hyllo Baeta Marcelo Júnior, Amanda Neto Ladeira" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Nathalia Chebli de" "apellidos" => "Abreu" "email" => array:1 [ 0 => "nathaliachebli@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Samuel Duarte Timponi" "apellidos" => "França" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Hyllo Baeta" "apellidos" => "Marcelo Júnior" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Amanda Neto" "apellidos" => "Ladeira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Dermatology, Hospital Infantil João Paulo II, Fundação Hospitalar do Estado de Minas Gerais, Belo Horizonte, MG, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Dermatology, Hospital Eduardo de Menezes, Fundação Hospitalar do Estado de Minas Gerais, Belo Horizonte, MG, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Mycology, Fundação Ezequiel Dias, Belo Horizonte, MG, Brazil" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1563 "Ancho" => 2508 "Tamanyo" => 480354 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous scaling plaques with well-defined edges and thick adhered crusts on the face (A) and trunk (B)</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A four-year-old male patient from a rural area had disseminated erythematous scaling plaques, some with thick adhered vegetative crusts since he was three years old (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>‒<a class="elsevierStyleCrossRef" href="#fig0010">2</a>). There was no deterioration in the general health status or relevant family history. The mother reported multiple previous hospitalizations due to pericarditis, pneumonia, and skin infections, in addition to episodes of oral and genital candidiasis.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Direct mycological examinations of the skin lesions on the trunk and scalp disclosed the presence of hyphae, pseudohyphae, and yeasts – later identified as <span class="elsevierStyleItalic">Microsporum gypseum</span> and <span class="elsevierStyleItalic">Candida albicans</span> by MALDI-TOF (Matrix-assisted laser desorption ionization time-of-flight) mass spectrometry. Histopathology revealed irregular acanthosis, spongiosis, keratotic crust, and dermal edema, in addition to numerous hyphae and spores restricted to the stratum corneum (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The genome analysis identified a rare heterozygous mutation in exon 7 of the signal transducer and activator of transcription 1 (<span class="elsevierStyleItalic">STAT1</span>) gene; variant c.501A→C; p.Gln167His.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">What's your diagnosis?</span><p id="par0015" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">a)</span><p id="par0020" class="elsevierStylePara elsevierViewall">Acquired Immunodeficiency Syndrome (AIDS)</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">b)</span><p id="par0025" class="elsevierStylePara elsevierViewall">Severe Combined Immunodeficiency (SCID)</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">c)</span><p id="par0030" class="elsevierStylePara elsevierViewall">Chronic Mucocutaneous Candidiasis (CMCC)</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">d)</span><p id="par0035" class="elsevierStylePara elsevierViewall">Hyper-IgE Syndrome (HIES)</p></li></ul></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">Based on the clinical-laboratory correlation, the diagnosis of chronic mucocutaneous candidiasis (CMCC) was established due to the <span class="elsevierStyleItalic">STAT1</span> gene mutation, in addition to extensive dermatophytosis. Complementary exams, including indirect Coombs, thyroid function, anti-HIV I and II serology, autoantibodies, immunoglobulin measurement and lymphocyte immunophenotyping were normal. Oral fluconazole was started with partial regression of the lesions (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">CMCC is a heterogeneous group of rare syndromes characterized by persistent, non-invasive <span class="elsevierStyleItalic">Candida spp</span> infections of the skin, nails, and mucous membranes caused by primary immunological defects.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleItalic">STAT1</span> gain-of-function mutations underlie the autosomal dominant form of the disease and result in defective Th1 and Th17 cell responses, characterized by reduced production of interferon-γ, interleukin-17, and interleukin-22 cytokines, crucial for antifungal defense of the skin and mucous membranes.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a> To the best of our knowledge, this is the first report in which the detected <span class="elsevierStyleItalic">STAT1</span> variant was documented in association with CMCC.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Typically, this form of the disease manifests as erythematous scaling crusted, hyperkeratotic generalized plaques before the age of five, sometimes accompanied by paronychia, hyperkeratosis and nail dystrophy. The oral mucosa is the most frequently affected, although the esophageal, genital and laryngeal mucosa can be affected as well. In addition to chronic <span class="elsevierStyleItalic">Candida</span> infection, there is also increased susceptibility to dermatophyte and bacterial infections, and up to 50% of the patients have associated hypothyroidism, inflammatory bowel disease, or associated autoimmune cytopenias.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The analysis of relevant genes, such as <span class="elsevierStyleItalic">STAT1</span>, <span class="elsevierStyleItalic">AIRE</span> and <span class="elsevierStyleItalic">CARD9</span>, is the only definitive laboratory test for the diagnosis of CMCC. Other immunodeficiencies, including SCID, HIES, and AIDS, can result in chronic candidiasis, but almost invariably course with invasive <span class="elsevierStyleItalic">Candida</span> infections and additional clinical-laboratory characteristics. In SCID, severe disturbances in T-, B-, and sometimes natural killer-cell development and function result in failure to thrive, chronic diarrhea, and recurrent severe infections with common viral pathogens (such as respiratory syncytial virus, adenovirus, and cytomegalovirus), and opportunistic microorganisms – which, in general, lead to death in the first year of life. HIES, in turn, is characterized by persistent generalized eczema, deep staphylococcal abscesses, <span class="elsevierStyleItalic">Aspergillus</span> infections, dimorphic features and recurrent fractures, in addition to increased levels of IgE, eosinophilia and mutation in the <span class="elsevierStyleItalic">STAT3</span> gene. Finally, AIDS is differentiated from CMCC by positive HIV serology, reduced CD4+ T-cell count, and occurrence of opportunistic infections.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Treatment of CMCC involves infection control and management of associated endocrine and autoimmune disorders. <span class="elsevierStyleItalic">Candida</span> infections can be controlled with prolonged use of azole antifungals, preferably fluconazole 100‒200 mg/day. Other therapies have been described in isolated reports to control the immune disorder, such as thymus and hematopoietic cell transplantation.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Recently, some studies have reported good disease control with the use of JAK inhibitors, including ruxolitinib and baricitinib.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Financial support</span><p id="par0065" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Authors' contributions</span><p id="par0070" class="elsevierStylePara elsevierViewall">Nathalia Chebli de Abreu: Design and planning of the study; collection, analysis, and interpretation of data; critical review of the literature; drafting and editing of the manuscript.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Samuel Duarte Timponi France: Critical review of the literature; drafting and editing of the manuscript.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Hyllo Baeta Marcelo Júnior: Collection, analysis and interpretation of data; critical review of the literature; critical review of the manuscript.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Amanda Neto Ladeira: Design and planning of the study; collection, analysis, and interpretation of data; approval of the final version of the manuscript; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied case.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "What's your diagnosis?" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Discussion" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Financial support" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Authors' contributions" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 5 => array:2 [ "identificador" => "xack679987" "titulo" => "Acknowledgments" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-07-05" "fechaAceptado" => "2022-08-10" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Department of Dermatology, Hospital Infantil João Paulo II and Hospital Eduardo de Menezes, Belo Horizonte, MG, Brazil.</p>" ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1563 "Ancho" => 2508 "Tamanyo" => 480354 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous scaling plaques with well-defined edges and thick adhered crusts on the face (A) and trunk (B)</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" => 1405 "Ancho" => 2508 "Tamanyo" => 399553 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Thick vegetative crusts on erythematous plaques affecting the entire right lower limb (A‒B)</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" => 1128 "Ancho" => 3008 "Tamanyo" => 938573 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) Irregular acanthosis, spongiosis and keratotic crust are observed, in addition to dermal edema with areas of blurring of the dermal-epidermal junction (Hematoxylin & eosin, ×100). (B) Presence of numerous hyphae and spores in the stratum corneum (Periodic Acid-Schiff, ×400)</p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1729 "Ancho" => 2175 "Tamanyo" => 341684 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Partial regression of skin lesions. 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