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ombros&#44; parte posterior da regi&#227;o cervical e parte superior do t&#243;rax que haviam aparecido no m&#234;s anterior &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1A</a>&#41;&#46; O diagn&#243;stico diferencial inicial incluiu l&#250;pus eritematoso cut&#226;neo subagudo&#44; granuloma anular generalizado e psor&#237;ase anular&#46; Biopsia por <span class="elsevierStyleItalic">punch</span> obtida de borda eritematosa mostrou na histopatologia a presen&#231;a de infiltrado granulomatoso d&#233;rmico disperso com c&#233;lulas gigantes multinucleadas e elastofagocitose compat&#237;vel com o diagn&#243;stico de GAE &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; Exames laboratoriais incluindo hemograma completo&#44; glicemia&#44; fun&#231;&#227;o hep&#225;tica e renal e anticorpos antinucleares foram normais&#46; Considerando que as les&#245;es n&#227;o estavam localizadas em &#225;reas fotoexpostas&#44; a pouca exposi&#231;&#227;o solar do paciente e os casos previamente relatados de GAE tratados com tetraciclinas&#44; foi iniciada doxiciclina 100<span class="elsevierStyleHsp" style=""></span>mg&#47;dia&#46; Ap&#243;s cinco meses&#44; observou&#8208;se resolu&#231;&#227;o completa das les&#245;es e do prurido &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1B</a>&#41;&#46; Entretanto&#44; as les&#245;es recidivaram rapidamente quando a doxiciclina foi suspensa&#44; mas ap&#243;s sua reintrodu&#231;&#227;o&#44; o paciente apresentou melhora acentuada durante os 12 meses seguintes&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">O GAE foi descrito pela primeira vez como granuloma act&#237;nico por O&#8217;Brien&#44; em 1975&#44; para indicar o papel causal do dano solar desencadeando elast&#243;lise e elastofagocitose&#46; Entretanto&#44; a pele fotoenvelhecida apresentando altera&#231;&#245;es degenerativas da elastina raramente est&#225; associada &#224; elastofagocitose&#46; 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Os efeitos anti&#8208;inflamat&#243;rios e antigranulomatosos das tetraciclinas s&#227;o bem conhecidos&#44; mas essa medica&#231;&#227;o n&#227;o &#233; considerada tratamento conveniente em virtude de sua fototoxicidade e do risco raramente relatado de desencadear GAE<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a>&#46; Entretanto&#44; as tetraciclinas mostraram excelentes resultados&#44; com resposta completa nas formas limitadas<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3&#44;4</span></a> e generalizadas<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> envolvendo a pele exposta e n&#227;o exposta ao sol&#44; sem efeitos colaterais&#46; A <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a> resume as principais caracter&#237;sticas do presente paciente e dos tr&#234;s casos publicados anteriormente de GAE tratados com tetraciclinas&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3&#8211;5</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Em conclus&#227;o&#44; as tetraciclinas devem ser consideradas tratamento seguro de primeira linha para pacientes com GAE extenso ou generalizado ou op&#231;&#227;o de segunda linha para formas localizadas que n&#227;o respondem aos tratamentos t&#243;picos convencionais&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Suporte financeiro</span><p id="par0025" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Contribui&#231;&#227;o dos autores</span><p id="par0030" class="elsevierStylePara elsevierViewall">Mar&#237;n&#8208;Pi&#241;ero D&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Sola&#8208;Casas MA&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Perez&#8208;Mu&#241;oz N&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflito de interesses</span><p id="par0045" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Artigo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Casos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Idade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sexo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Comorbidades&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Padr&#227;o e localiza&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tratamentos anteriores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tetraciclina e dose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Desfecho&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nanbu et al&#46; &#40;2015&#41;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nenhuma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Placa anular solit&#225;ria na t&#234;mpora&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Corticosteroide t&#243;pico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Minociclina 200 mg&#47;dia e 100 mg&#47;dia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resolu&#231;&#227;o ap&#243;s 11 semanas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Kabuto et al&#46; &#40;2017&#41;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diabetes <span class="elsevierStyleItalic">mellitus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Placas anulares na parte posterior do pesco&#231;o&#44; regi&#227;o dorsal&#44; t&#243;rax&#44; parte superior dos bra&#231;os&#44; pulsos&#44; dorso das m&#227;os e coxas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tacrolimus t&#243;pico&#44; corticosteroide t&#243;pico e tranilast oral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Minociclina 200 mg&#47;dia e 100 mg&#47;dia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resolu&#231;&#227;o ap&#243;s seis meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Jeha et al&#46; &#40;2020&#41;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Doen&#231;a renal cr&#244;nica&#44; diabetes <span class="elsevierStyleItalic">mellitus</span> e doen&#231;a arterial coronariana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Placas anulares na regi&#227;o ventral dos antebra&#231;os e proximal das coxas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Corticosteroides t&#243;picos e intralesionais&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Doxiciclina 200 mg&#47;dia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resolu&#231;&#227;o ap&#243;s seis meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Presente caso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hipertens&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Placas anulares em toda a regi&#227;o dorsal&#44; ombros&#44; regi&#227;o cervical posterior e parte superior do t&#243;rax&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nenhum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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Cartas ‐ Terapia
Resolução completa de granuloma anular elastolítico de células gigantes generalizado com doxiciclina
Dídac Marín‐Piñeroa,
Autor para correspondência
marindidac@gmail.com

Autor para correspondencia.
, M. Ángeles Sola‐Casasa, Noelia Perez‐Muñozb
a Departamento de Dermatologia, Hospital Universitari Sagrat Cor, Grupo Quirónsalud, Barcelona, Espanha
b Departamento de Patologia, Hospital Universitari General de Catalunya, Grupo Quirónsalud, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Espanha
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          "pt" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; M&#250;ltiplas placas anulares eritematosas nas regi&#245;es dorsal e cervical posterior na consulta inicial&#46; &#40;B&#41; Resolu&#231;&#227;o completa das les&#245;es ap&#243;s cinco meses em tratamento com doxiciclina 100<span class="elsevierStyleHsp" style=""></span>mg&#47;dia&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">O granuloma anular elastol&#237;tico &#40;GAE&#41; &#233; dermatose granulomatosa rara com etiologia e fisiopatologia incertas&#46; As caracter&#237;sticas histopatol&#243;gicas s&#227;o elast&#243;lise e elastofagocitose&#46; O mecanismo definitivo que leva ao dano das fibras el&#225;sticas ainda n&#227;o foi elucidado&#59; o tratamento &#233; desafiador e o uso de tetraciclinas &#233; controverso em virtude de sua potencial fototoxicidade&#46; Aqui&#44; os autores apresentam um caso de GAE generalizado com resolu&#231;&#227;o completa ap&#243;s doxiciclina di&#225;ria&#46; Foram revisados os casos anteriores tratados com tetraciclinas&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Paciente do sexo masculino&#44; de 88 anos&#44; com hipertens&#227;o leve em tratamento com lisinopril&#44; procurou o Departamento de Dermatologia apresentando m&#250;ltiplas placas anulares eritematosas e levemente pruriginosas com centro atr&#243;fico localizadas na regi&#227;o dorsal&#44; ombros&#44; parte posterior da regi&#227;o cervical e parte superior do t&#243;rax que haviam aparecido no m&#234;s anterior &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1A</a>&#41;&#46; O diagn&#243;stico diferencial inicial incluiu l&#250;pus eritematoso cut&#226;neo subagudo&#44; granuloma anular generalizado e psor&#237;ase anular&#46; Biopsia por <span class="elsevierStyleItalic">punch</span> obtida de borda eritematosa mostrou na histopatologia a presen&#231;a de infiltrado granulomatoso d&#233;rmico disperso com c&#233;lulas gigantes multinucleadas e elastofagocitose compat&#237;vel com o diagn&#243;stico de GAE &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; Exames laboratoriais incluindo hemograma completo&#44; glicemia&#44; fun&#231;&#227;o hep&#225;tica e renal e anticorpos antinucleares foram normais&#46; Considerando que as les&#245;es n&#227;o estavam localizadas em &#225;reas fotoexpostas&#44; a pouca exposi&#231;&#227;o solar do paciente e os casos previamente relatados de GAE tratados com tetraciclinas&#44; foi iniciada doxiciclina 100<span class="elsevierStyleHsp" style=""></span>mg&#47;dia&#46; Ap&#243;s cinco meses&#44; observou&#8208;se resolu&#231;&#227;o completa das les&#245;es e do prurido &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1B</a>&#41;&#46; Entretanto&#44; as les&#245;es recidivaram rapidamente quando a doxiciclina foi suspensa&#44; mas ap&#243;s sua reintrodu&#231;&#227;o&#44; o paciente apresentou melhora acentuada durante os 12 meses seguintes&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">O GAE foi descrito pela primeira vez como granuloma act&#237;nico por O&#8217;Brien&#44; em 1975&#44; para indicar o papel causal do dano solar desencadeando elast&#243;lise e elastofagocitose&#46; Entretanto&#44; a pele fotoenvelhecida apresentando altera&#231;&#245;es degenerativas da elastina raramente est&#225; associada &#224; elastofagocitose&#46; As les&#245;es de GAE geralmente est&#227;o localizadas na pele n&#227;o exposta&#59; portanto&#44; outros fatores al&#233;m do calor e da radia&#231;&#227;o ultravioleta devem ser considerados&#46; V&#225;rios eventos podem lesar as fibras el&#225;sticas e desencadear a resposta inflamat&#243;ria que leva &#224; sua fagocitose&#46; Um desses gatilhos pode ser a hiperglicemia no diabetes <span class="elsevierStyleItalic">mellitus</span>&#44; j&#225; que tem sido frequentemente relatada como doen&#231;a concomitante&#46; Muitas outras associa&#231;&#245;es&#44; como neoplasias malignas e doen&#231;as inflamat&#243;rias&#44; j&#225; foram descritas&#44; mas provavelmente a apresenta&#231;&#227;o mais comum &#233; a forma idiop&#225;tica<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a>&#46; Apesar de seu curso benigno&#44; o GAE pode levar v&#225;rios anos para apresentar resolu&#231;&#227;o&#44; porque as les&#245;es geralmente s&#227;o extensas e podem exigir diferentes modalidades de tratamento para prevenir sua progress&#227;o&#46; Os efeitos anti&#8208;inflamat&#243;rios e antigranulomatosos das tetraciclinas s&#227;o bem conhecidos&#44; mas essa medica&#231;&#227;o n&#227;o &#233; considerada tratamento conveniente em virtude de sua fototoxicidade e do risco raramente relatado de desencadear GAE<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a>&#46; Entretanto&#44; as tetraciclinas mostraram excelentes resultados&#44; com resposta completa nas formas limitadas<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3&#44;4</span></a> e generalizadas<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> envolvendo a pele exposta e n&#227;o exposta ao sol&#44; sem efeitos colaterais&#46; A <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a> resume as principais caracter&#237;sticas do presente paciente e dos tr&#234;s casos publicados anteriormente de GAE tratados com tetraciclinas&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3&#8211;5</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Em conclus&#227;o&#44; as tetraciclinas devem ser consideradas tratamento seguro de primeira linha para pacientes com GAE extenso ou generalizado ou op&#231;&#227;o de segunda linha para formas localizadas que n&#227;o respondem aos tratamentos t&#243;picos convencionais&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Suporte financeiro</span><p id="par0025" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Contribui&#231;&#227;o dos autores</span><p id="par0030" class="elsevierStylePara elsevierViewall">Mar&#237;n&#8208;Pi&#241;ero D&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Sola&#8208;Casas MA&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Perez&#8208;Mu&#241;oz N&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflito de interesses</span><p id="par0045" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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                  \t\t\t\t">Masculino&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Placa anular solit&#225;ria na t&#234;mpora&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Corticosteroide t&#243;pico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Minociclina 200 mg&#47;dia e 100 mg&#47;dia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Resolu&#231;&#227;o ap&#243;s 11 semanas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Kabuto et al&#46; &#40;2017&#41;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Diabetes <span class="elsevierStyleItalic">mellitus</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Placas anulares na parte posterior do pesco&#231;o&#44; regi&#227;o dorsal&#44; t&#243;rax&#44; parte superior dos bra&#231;os&#44; pulsos&#44; dorso das m&#227;os e coxas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tacrolimus t&#243;pico&#44; corticosteroide t&#243;pico e tranilast oral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Minociclina 200 mg&#47;dia e 100 mg&#47;dia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resolu&#231;&#227;o ap&#243;s seis meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Jeha et al&#46; &#40;2020&#41;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Doen&#231;a renal cr&#244;nica&#44; diabetes <span class="elsevierStyleItalic">mellitus</span> e doen&#231;a arterial coronariana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Placas anulares na regi&#227;o ventral dos antebra&#231;os e proximal das coxas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Corticosteroides t&#243;picos e intralesionais&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Doxiciclina 200 mg&#47;dia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resolu&#231;&#227;o ap&#243;s seis meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Presente caso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hipertens&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Placas anulares em toda a regi&#227;o dorsal&#44; ombros&#44; regi&#227;o cervical posterior e parte superior do t&#243;rax&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nenhum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Doxiciclina 100 mg&#47;dia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resolu&#231;&#227;o ap&#243;s cinco meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                            2 => "M&#46; Kono"
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                      "doi" => "10.2340/00015555-2056"
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ISSN: 26662752
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