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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Erythematous papules on the malar areas&#44; forehead and chin&#46; Plaques formed by coalescence of papules on both eyelids&#46;</p>"
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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">The authors report the case of a 47-year-old female patient who presented asymptomatic erythematous papules on the central region of the face for eight months&#44; in addition to periocular edema&#46; She initially associated them with the use of a hair dye&#44; but the lesions persisted despite interrupting its use&#46; The lesions did not worsen with sun exposure or any other factor&#46; The patient reported no associated symptoms&#44; comorbidities&#44; or continuous use of medications&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">At dermatological examination&#44; multiple erythematous papules were observed&#44; measuring from 1 to 3<span class="elsevierStyleHsp" style=""></span>mm&#44; distributed over the malar area&#44; forehead and chin&#46; Over the eyelids&#44; these papules coalesced to form plaques&#44; and there was mild bilateral edema &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The skin around the papules presented no changes&#46; No changes were observed in other organs and systems&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The patient had been previously submitted to treatment with prednisone 40<span class="elsevierStyleHsp" style=""></span>mg&#47;day for four months&#44; without response&#46; An extensive laboratory investigation &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41; was performed&#44; as well as biopsy of a lesion &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A and B&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">After histopathological examination of the lesion and other complementary exams&#44; treatment with minocycline and topical betamethasone was then proposed&#46;<span class="elsevierStyleVsp" style="height:1.0px"></span></p></span><span id="sec0011" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0021">What is your diagnosis&#63;</span><p id="par0025" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">a&#41;</span><p id="par0030" class="elsevierStylePara elsevierViewall">Granulomatous rosacea</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">b&#41;</span><p id="par0035" class="elsevierStylePara elsevierViewall">Sarcoidosis</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">c&#41;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Acne agminata</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">d&#41;</span><p id="par0045" class="elsevierStylePara elsevierViewall">Cutaneous tuberculosis</p></li></ul></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">Described by Radcliffe-Crocker in 1903&#44; lupus miliaris disseminatus faciei &#40;LMDF&#41; or acne agminata is a rare chronic granulomatous inflammatory disease of the face&#44; of unknown etiology&#46; It mainly affects adolescents and young adults of both sexes&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">It is characterized by asymptomatic papules and nodules&#44; brownish or yellowish in color&#44; located mainly on the central region of the face&#44; typically on and around the eyelids&#46; Extrafacial involvement can occur&#46; The onset is abrupt&#44; and the condition usually regresses spontaneously in 12&#8211;24 months&#44; leaving punctiform and atrophic scars&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Histologically&#44; it is characterized by epithelioid granulomas similar to tuberculosis&#44; sarcoidosis&#44; granulomatous rosacea&#44; tuberculoid leprosy&#44; or other granulomatous diseases&#46; Its pattern may vary according to the stage of the lesion&#58; early lesions are characterized by nonspecific and non-granulomatous inflammation&#44; whereas well-developed lesions may present epithelioid granulomas with central necrosis&#44; without central necrosis &#40;sarcoid granuloma&#41;&#44; or with abcess formation&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Its etiopathogenesis remains unknown&#46; It was believed to be a manifestation of cutaneous tuberculosis&#59; however&#44; this theory is no longer accepted&#44; as the presence of <span class="elsevierStyleItalic">M&#46; tuberculosis</span> has not been demonstrated&#44; in addition to the fact that the condition does not improve with anti-tuberculosis therapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#44;2&#44;6</span></a> Many authors considered it to be a variant of granulomatous rosacea&#44; a hypothesis that has also been discarded&#44; as in rosacea there is a greater predilection for the malar region&#44; association with diffuse erythema&#44; telangiectasias&#44; exacerbation with corticosteroids&#44; and absence of scarring after resolution&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#44;3</span></a> It can also resemble sarcoidosis&#44; but this usually presents systemic manifestations&#44; as well as laboratory and imaging alterations&#44; not observed in LMDF&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#8211;3&#44;6</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Due to the lack of knowledge of the etiopathogenesis&#44; its treatment is challenging&#59; many drugs have been used as possible treatments&#44; including dapsone&#44; clofazimine&#44; minocycline&#44; doxycycline&#44; tetracycline&#44; prednisone&#44; and isotretinoin&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2&#44;7&#44;8</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Although there are no well-established criteria for the diagnosis of LMDF&#44; the authors reached the diagnosis of acne agminata due to the distribution of the lesions and clinical characteristics suggestive of granulomatous disease of the face&#44; and by excluding other differential diagnoses after biopsy and complementary exams&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Financial support</span><p id="par0080" 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="par0085" class="elsevierStylePara elsevierViewall">Ana Cristina M Garcia&#58; Approval of the final version of the manuscript&#59; elaboration and writing of the manuscript&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">&#194;ngela Marques Barbosa&#58; Approval of the final version of the manuscript&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Marilda Aparecida Milanez Morgado de Abreu&#58; Intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#59; critical review of the manuscript&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Carlos Zelandi Filho&#58; Intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Lupus miliaris disseminatus faciei or acne agminata is a chronic inflammatory disorder of the skin&#44; considered an intriguing entity due to its pathogenesis&#44; which is still largely speculative&#46; It has been linked to tuberculosis&#44; sarcoidosis&#44; rosacea&#44; and other granulomatous diseases&#44; but it is considered an independent entity&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article&#58; Garcia ACM&#44; Barbosa AM&#44; Abreu MAMM&#44; Zelandi Filho C&#46; Case for diagnosis&#46; Eyelid edema and erythematous papules disseminated on the face&#46; An Bras Dermatol&#46; 2020&#46; <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.abd.2019.11.016">https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1016&#47;j&#46;abd&#46;2019&#46;11&#46;016</span></p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Hospital Regional de Presidente Prudente&#44; Universidade do Oeste Paulista&#44; Presidente Prudente&#44; SP&#44; Brazil&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Erythematous papules on the malar areas&#44; forehead and chin&#46; Plaques formed by coalescence of papules on both eyelids&#46;</p>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; No major changes in the epidermis&#46; Granulomatous inflammation in the middle and deep dermis&#46; Caseous necrosis in the center of the granulomatous process &#40;Hematoxylin &#38; eosin&#44; &#215;40&#41;&#46; &#40;B&#41; Focal necrosis and granulomatous inflammation with giant cells &#40;Hematoxylin &#38; eosin&#44; &#215;100&#41;&#46; Special stains were negative for acid-fast bacilli and fungi&#46;</p>"
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                  \t\t\t\t">Protein electrophoresis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Stool parasitology &#40;3 samples&#41;&nbsp;\t\t\t\t\t\t\n
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What is your diagnosis?
Case for diagnosis. Eyelid edema and erythematous papules disseminated on the face
Ana Cristina M. Garciaa,
Autor para correspondência
ana.mendoncagarcia@gmail.com

Corresponding author.
, Ângela Marques Barbosaa, Marilda Aparecida Milanez Morgado de Abreub, Carlos Zelandi Filhoc
a Dermatology Service, Hospital Regional de Presidente Prudente, Universidade do Oeste Paulista, Presidente Prudente, SP, Brazil
b Department of Health Postgraduate Programs, Instituto de Assistência Médica ao Servidor Público Estadual, São Paulo, SP, Brazil
c Private Laboratory, Presidente Prudente, SP, Brazil
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treatment with minocycline and topical betamethasone was then proposed&#46;<span class="elsevierStyleVsp" style="height:1.0px"></span></p></span><span id="sec0011" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0021">What is your diagnosis&#63;</span><p id="par0025" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">a&#41;</span><p id="par0030" class="elsevierStylePara elsevierViewall">Granulomatous rosacea</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">b&#41;</span><p id="par0035" class="elsevierStylePara elsevierViewall">Sarcoidosis</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">c&#41;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Acne agminata</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">d&#41;</span><p id="par0045" class="elsevierStylePara elsevierViewall">Cutaneous tuberculosis</p></li></ul></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">Described by Radcliffe-Crocker in 1903&#44; lupus miliaris disseminatus faciei &#40;LMDF&#41; or acne agminata is a rare chronic granulomatous inflammatory disease of the face&#44; of unknown etiology&#46; It mainly affects adolescents and young adults of both sexes&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">It is characterized by asymptomatic papules and nodules&#44; brownish or yellowish in color&#44; located mainly on the central region of the face&#44; typically on and around the eyelids&#46; Extrafacial involvement can occur&#46; The onset is abrupt&#44; and the condition usually regresses spontaneously in 12&#8211;24 months&#44; leaving punctiform and atrophic scars&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Histologically&#44; it is characterized by epithelioid granulomas similar to tuberculosis&#44; sarcoidosis&#44; granulomatous rosacea&#44; tuberculoid leprosy&#44; or other granulomatous diseases&#46; Its pattern may vary according to the stage of the lesion&#58; early lesions are characterized by nonspecific and non-granulomatous inflammation&#44; whereas well-developed lesions may present epithelioid granulomas with central necrosis&#44; without central necrosis &#40;sarcoid granuloma&#41;&#44; or with abcess formation&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Its etiopathogenesis remains unknown&#46; It was believed to be a manifestation of cutaneous tuberculosis&#59; however&#44; this theory is no longer accepted&#44; as the presence of <span class="elsevierStyleItalic">M&#46; tuberculosis</span> has not been demonstrated&#44; in addition to the fact that the condition does not improve with anti-tuberculosis therapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#44;2&#44;6</span></a> Many authors considered it to be a variant of granulomatous rosacea&#44; a hypothesis that has also been discarded&#44; as in rosacea there is a greater predilection for the malar region&#44; association with diffuse erythema&#44; telangiectasias&#44; exacerbation with corticosteroids&#44; and absence of scarring after resolution&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#44;3</span></a> It can also resemble sarcoidosis&#44; but this usually presents systemic manifestations&#44; as well as laboratory and imaging alterations&#44; not observed in LMDF&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#8211;3&#44;6</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Due to the lack of knowledge of the etiopathogenesis&#44; its treatment is challenging&#59; many drugs have been used as possible treatments&#44; including dapsone&#44; clofazimine&#44; minocycline&#44; doxycycline&#44; tetracycline&#44; prednisone&#44; and isotretinoin&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2&#44;7&#44;8</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Although there are no well-established criteria for the diagnosis of LMDF&#44; the authors reached the diagnosis of acne agminata due to the distribution of the lesions and clinical characteristics suggestive of granulomatous disease of the face&#44; and by excluding other differential diagnoses after biopsy and complementary exams&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Financial support</span><p id="par0080" 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="par0085" class="elsevierStylePara elsevierViewall">Ana Cristina M Garcia&#58; Approval of the final version of the manuscript&#59; elaboration and writing of the manuscript&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">&#194;ngela Marques Barbosa&#58; Approval of the final version of the manuscript&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Marilda Aparecida Milanez Morgado de Abreu&#58; Intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#59; critical review of the manuscript&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Carlos Zelandi Filho&#58; Intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Lupus miliaris disseminatus faciei or acne agminata is a chronic inflammatory disorder of the skin&#44; considered an intriguing entity due to its pathogenesis&#44; which is still largely speculative&#46; It has been linked to tuberculosis&#44; sarcoidosis&#44; rosacea&#44; and other granulomatous diseases&#44; but it is considered an independent entity&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article&#58; Garcia ACM&#44; Barbosa AM&#44; Abreu MAMM&#44; Zelandi Filho C&#46; Case for diagnosis&#46; Eyelid edema and erythematous papules disseminated on the face&#46; An Bras Dermatol&#46; 2020&#46; <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.abd.2019.11.016">https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1016&#47;j&#46;abd&#46;2019&#46;11&#46;016</span></p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Hospital Regional de Presidente Prudente&#44; Universidade do Oeste Paulista&#44; Presidente Prudente&#44; SP&#44; Brazil&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Erythematous papules on the malar areas&#44; forehead and chin&#46; Plaques formed by coalescence of papules on both eyelids&#46;</p>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; No major changes in the epidermis&#46; Granulomatous inflammation in the middle and deep dermis&#46; Caseous necrosis in the center of the granulomatous process &#40;Hematoxylin &#38; eosin&#44; &#215;40&#41;&#46; &#40;B&#41; Focal necrosis and granulomatous inflammation with giant cells &#40;Hematoxylin &#38; eosin&#44; &#215;100&#41;&#46; Special stains were negative for acid-fast bacilli and fungi&#46;</p>"
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                  \t\t\t\t">Protein electrophoresis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Stool parasitology &#40;3 samples&#41;&nbsp;\t\t\t\t\t\t\n
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Informação do artigo
ISSN: 03650596
Idioma original: Inglês
DOI:10.1016/j.abd.2019.11.016
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Prêmio Bernardo Gontijo
Prêmio Bernardo Gontijo
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