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1 A&#8208;B</a>&#41;&#46; Al&#233;m disso&#44; p&#225;pulas avermelhadas tamb&#233;m foram vistas nos grandes l&#225;bios &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; Foi realizada biopsia de pele das erup&#231;&#245;es papulares regi&#227;o da mand&#237;bula direita&#46; O exame histopatol&#243;gico revelou granulomas de c&#233;lulas epitelioides na derme sem necrose caseosa &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3A</a>&#41;&#46; Em grande aumento observou&#8208;se que os granulomas d&#233;rmicos continham c&#233;lulas epitelioides e c&#233;lulas gigantes multinucleadas &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3B</a>&#41;&#44; e eram circundados por infiltrado inflamat&#243;rio linfo&#8208;histioc&#237;tico&#44; que tamb&#233;m envolvia os fol&#237;culos pilosos&#46; Observou&#8208;se ainda imunomarca&#231;&#227;o com os ant&#237;genos CD68 e CD163 &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3C e D</a>&#41;&#46; O teste tubercul&#237;nico resultou negativo&#46; O tratamento com administra&#231;&#227;o oral de claritromicina mostrou efeitos favor&#225;veis nas les&#245;es vulvares ap&#243;s cinco meses e nas les&#245;es faciais ap&#243;s nove meses&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">O presente caso desenvolveu m&#250;ltiplas les&#245;es papulonodulares infraorbitais e periorais&#44; que s&#227;o os locais frequentemente afetados no LMDF&#46; Al&#233;m disso&#44; foi observado envolvimento vulvar&#46; A paciente n&#227;o apresentava sintomas sist&#234;micos sugestivos de sarcoidose de in&#237;cio juvenil&#46; Ros&#225;cea granulomatosa foi exclu&#237;da porque n&#227;o foi observado eritema facial nem telangiectasia e a paciente negou rubor&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">As caracter&#237;sticas cl&#237;nicas e histopatol&#243;gicas do LMDF pedi&#225;trico s&#227;o ligeiramente diferentes das caracter&#237;sticas do LMDF no adulto&#44; como p&#225;pulas concentradas ao redor da boca&#44; no sulco nasolabial e nas p&#225;lpebras inferiores&#44; tamanho pequeno da p&#225;pula&#44; poucas p&#250;stulas e cicatrizes&#44; vermelhid&#227;o ao redor da boca&#44; pouca necrose caseosa nos granulomas epitelioides e curso cl&#237;nico curto&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Por outro lado&#44; a dermatite periorificial granulomatosa infantil &#40;DPGI&#41; foi relatada como doen&#231;a na qual erup&#231;&#245;es papulares marrom&#8208;amareladas limitadas &#224;s regi&#245;es perioral&#44; perinasal e periocular mostram histopatologicamente granulomas de c&#233;lulas epitelioides ao redor dos fol&#237;culos pilosos&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> As caracter&#237;sticas do LMDF na inf&#226;ncia s&#227;o muito semelhantes &#224;s da DPGI&#59; a diferencia&#231;&#227;o dessas doen&#231;as &#233; desafiadora e podem representar o mesmo processo&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Existem v&#225;rios casos de LMDF com envolvimento extrafacial em locais como pesco&#231;o&#44; regi&#227;o axilar&#44; regi&#227;o inguinal e extremidades&#46; As regi&#245;es genitais tamb&#233;m s&#227;o afetadas e&#44; que seja de conhecimento dos autores&#44; h&#225; apenas quatro casos relatados desse envolvimento no LMDF pedi&#225;trico &#40;um caso&#41; e DPGI &#40;tr&#234;s casos&#41; &#8211; <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3&#44;4</span></a> A idade de in&#237;cio foi de 6 a 9 anos&#44; e todos os casos ocorreram no g&#234;nero feminino&#46; Essas pacientes foram tratadas com sucesso com minociclina oral&#44; anti&#8208;inflamat&#243;rio n&#227;o esteroide t&#243;pico&#44; eritromicina oral e t&#243;pica&#44; metronidazol t&#243;pico&#44; tacrolimus t&#243;pico e metronidazol t&#243;pico&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4&#44;5</span></a> A resposta ao tratamento &#233; melhor no LMDF pedi&#225;trico do que em adultos&#46; Nos casos LMDF pedi&#225;trico&#44; as &#225;reas genitais devem ser examinadas detalhadamente&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Suporte financeiro</span><p id="par0030" 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="par0035" class="elsevierStylePara elsevierViewall">Misaki Kusano&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; concep&#231;&#227;o e planejamento do estudo&#59; manejo de casos estudados&#59; revis&#227;o cr&#237;tica do manuscrito&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Maki Takada&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Natsuko Matsumura&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Toshiyuki Yamamoto&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; concep&#231;&#227;o e planejamento do estudo&#59; revis&#227;o cr&#237;tica do manuscrito&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflito de interesses</span><p id="par0055" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Como citar este artigo&#58; Kusano M&#44; Takada M&#44; Matsumura N&#44; Yamamoto T&#46; Lupus miliaris disseminatus faciei with extra&#8208;facial involvement in a 6&#8208;year&#8208;old Japanese girl&#46; An Bras Dermatol&#46; 2024&#59;99&#58;624&#8211;7&#46;</p>"
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          "pt" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Numerosas pequenas p&#225;pulas eritematosas localizadas nas p&#225;lpebras inferiores &#40;A&#41; e ao redor da boca &#40;B&#41;&#46;</p>"
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          "pt" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">P&#225;pulas avermelhadas nos grandes l&#225;bios&#46;</p>"
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          "pt" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Caracter&#237;sticas histopatol&#243;gicas mostrando granulomas de c&#233;lulas epitelioides na derme&#46; &#40;B&#41; Em grande aumento obervam&#8208;se granulomas d&#233;rmicos compostos por c&#233;lulas epiteloides e c&#233;lulas gigantes multinucleadas&#46; An&#225;lise imuno&#8208;histoqu&#237;mica revelou positividade para CD68 &#40;C&#41; e CD163 &#40;D&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">LMDF&#44; <span class="elsevierStyleItalic">lupus miliaris disseminatus faciei&#59;</span> DPGI&#44; dermatite periorificial granulomatosa infantil&#46;</p>"
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                  <table border="0" frame="\n
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                  \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">Autor e ano de publica&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Doen&#231;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Idade em anos&nbsp;\t\t\t\t\t\t\n
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                  \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">G&#234;nero&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">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">Tratamento&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">Dura&#231;&#227;o do tratamento&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">Wataeda et al&#46; &#40;1990&#41;&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">LMDF infantil&nbsp;\t\t\t\t\t\t\n
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                  \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">9&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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                  \t\t\t\t">Feminino&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">Face&#44; grandes l&#225;bios&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 oral&#44; medicamento anti&#8208;inflamat&#243;rio n&#227;o esteroide 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">3&#44;5 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">Andry et al&#46; &#40;1995&#41;&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">DPGI&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">Desconhecida&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">Feminino&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">Face&#44; perivulvar&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">Desconhecido&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">Desconhecido&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">Amy et al&#46; &#40;2002&#41;&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">DPGI&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">6&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">Feminino&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">Face&#44; grandes l&#225;bios&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">Eritromicina oral e t&#243;pica&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">2 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">Amy et al&#46; &#40;2002&#41;&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">DPGI&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">8&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">Feminino&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">Face&#44; bra&#231;os&#44; abdome&#44; grandes l&#225;bios&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">Eritromicina oral&#44; metronidazol 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">Desconhecido&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "pt" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Casos de envolvimento vulvar no&#160;<span class="elsevierStyleItalic">lupus miliaris disseminatus faciei</span> em crian&#231;as e dermatite periorificial granulomatosa infantil</p>"
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                    0 => array:2 [
                      "titulo" => "Childhood granulomatous periorificial dermatitis&#58; lupus miliaris disseminatus faciei in children&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "N&#46; Misago"
                            1 => "J&#46; Nakafusa"
                            2 => "Y&#46; Narisawa"
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                    0 => array:2 [
                      "doi" => "10.1111/j.1468-3083.2004.01178.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Eur Acad Dermatol Venereol&#46;"
                        "fecha" => "2005"
                        "volumen" => "19"
                        "paginaInicial" => "470"
                        "paginaFinal" => "473"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15987296"
                            "web" => "Medline"
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Cartas ‐ Caso clínico
Lupus miliaris disseminatus faciei com envolvimento extrafacial em menina japonesa de 6 anos
Misaki Kusano
Autor para correspondência
k963@fmu.ac.jp

Autor para correspondência.
, Maki Takada, Natsuko Matsumura, Toshiyuki Yamamoto
Departamento de Dermatologia, Fukushima Medical University, Fukushima, Japão
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Lupus miliaris disseminatus faciei</span> &#40;LMDF&#41;&#44; ou acne agminata&#44; ocorre predominantemente entre os 20 e 30 anos e raramente &#233; observado em crian&#231;as&#46; Os autores relatam um caso pedi&#225;trico de LMDF afetando a face e os grandes l&#225;bios&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Uma paciente feminina japonesa de 6 anos foi encaminhada ao Departamento de Dermatologia com hist&#243;ria de cinco meses de erup&#231;&#245;es papulares pruriginosas na face&#46; A paciente havia sido tratada com antial&#233;rgicos orais e corticosteroides t&#243;picos&#44; sem melhora&#46; O exame f&#237;sico revelou v&#225;rios papulon&#243;dulos avermelhados em forma de c&#250;pula de 1 a 2<span class="elsevierStyleHsp" style=""></span>mm ao redor da boca e das p&#225;lpebras inferiores &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1 A&#8208;B</a>&#41;&#46; Al&#233;m disso&#44; p&#225;pulas avermelhadas tamb&#233;m foram vistas nos grandes l&#225;bios &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; Foi realizada biopsia de pele das erup&#231;&#245;es papulares regi&#227;o da mand&#237;bula direita&#46; O exame histopatol&#243;gico revelou granulomas de c&#233;lulas epitelioides na derme sem necrose caseosa &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3A</a>&#41;&#46; Em grande aumento observou&#8208;se que os granulomas d&#233;rmicos continham c&#233;lulas epitelioides e c&#233;lulas gigantes multinucleadas &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3B</a>&#41;&#44; e eram circundados por infiltrado inflamat&#243;rio linfo&#8208;histioc&#237;tico&#44; que tamb&#233;m envolvia os fol&#237;culos pilosos&#46; Observou&#8208;se ainda imunomarca&#231;&#227;o com os ant&#237;genos CD68 e CD163 &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3C e D</a>&#41;&#46; O teste tubercul&#237;nico resultou negativo&#46; O tratamento com administra&#231;&#227;o oral de claritromicina mostrou efeitos favor&#225;veis nas les&#245;es vulvares ap&#243;s cinco meses e nas les&#245;es faciais ap&#243;s nove meses&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">O presente caso desenvolveu m&#250;ltiplas les&#245;es papulonodulares infraorbitais e periorais&#44; que s&#227;o os locais frequentemente afetados no LMDF&#46; Al&#233;m disso&#44; foi observado envolvimento vulvar&#46; A paciente n&#227;o apresentava sintomas sist&#234;micos sugestivos de sarcoidose de in&#237;cio juvenil&#46; Ros&#225;cea granulomatosa foi exclu&#237;da porque n&#227;o foi observado eritema facial nem telangiectasia e a paciente negou rubor&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">As caracter&#237;sticas cl&#237;nicas e histopatol&#243;gicas do LMDF pedi&#225;trico s&#227;o ligeiramente diferentes das caracter&#237;sticas do LMDF no adulto&#44; como p&#225;pulas concentradas ao redor da boca&#44; no sulco nasolabial e nas p&#225;lpebras inferiores&#44; tamanho pequeno da p&#225;pula&#44; poucas p&#250;stulas e cicatrizes&#44; vermelhid&#227;o ao redor da boca&#44; pouca necrose caseosa nos granulomas epitelioides e curso cl&#237;nico curto&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Por outro lado&#44; a dermatite periorificial granulomatosa infantil &#40;DPGI&#41; foi relatada como doen&#231;a na qual erup&#231;&#245;es papulares marrom&#8208;amareladas limitadas &#224;s regi&#245;es perioral&#44; perinasal e periocular mostram histopatologicamente granulomas de c&#233;lulas epitelioides ao redor dos fol&#237;culos pilosos&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> As caracter&#237;sticas do LMDF na inf&#226;ncia s&#227;o muito semelhantes &#224;s da DPGI&#59; a diferencia&#231;&#227;o dessas doen&#231;as &#233; desafiadora e podem representar o mesmo processo&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Existem v&#225;rios casos de LMDF com envolvimento extrafacial em locais como pesco&#231;o&#44; regi&#227;o axilar&#44; regi&#227;o inguinal e extremidades&#46; As regi&#245;es genitais tamb&#233;m s&#227;o afetadas e&#44; que seja de conhecimento dos autores&#44; h&#225; apenas quatro casos relatados desse envolvimento no LMDF pedi&#225;trico &#40;um caso&#41; e DPGI &#40;tr&#234;s casos&#41; &#8211; <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3&#44;4</span></a> A idade de in&#237;cio foi de 6 a 9 anos&#44; e todos os casos ocorreram no g&#234;nero feminino&#46; Essas pacientes foram tratadas com sucesso com minociclina oral&#44; anti&#8208;inflamat&#243;rio n&#227;o esteroide t&#243;pico&#44; eritromicina oral e t&#243;pica&#44; metronidazol t&#243;pico&#44; tacrolimus t&#243;pico e metronidazol t&#243;pico&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4&#44;5</span></a> A resposta ao tratamento &#233; melhor no LMDF pedi&#225;trico do que em adultos&#46; Nos casos LMDF pedi&#225;trico&#44; as &#225;reas genitais devem ser examinadas detalhadamente&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Suporte financeiro</span><p id="par0030" 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="par0035" class="elsevierStylePara elsevierViewall">Misaki Kusano&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; concep&#231;&#227;o e planejamento do estudo&#59; manejo de casos estudados&#59; revis&#227;o cr&#237;tica do manuscrito&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Maki Takada&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Natsuko Matsumura&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Toshiyuki Yamamoto&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; concep&#231;&#227;o e planejamento do estudo&#59; revis&#227;o cr&#237;tica do manuscrito&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflito de interesses</span><p id="par0055" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Como citar este artigo&#58; Kusano M&#44; Takada M&#44; Matsumura N&#44; Yamamoto T&#46; Lupus miliaris disseminatus faciei with extra&#8208;facial involvement in a 6&#8208;year&#8208;old Japanese girl&#46; An Bras Dermatol&#46; 2024&#59;99&#58;624&#8211;7&#46;</p>"
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          "pt" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Caracter&#237;sticas histopatol&#243;gicas mostrando granulomas de c&#233;lulas epitelioides na derme&#46; &#40;B&#41; Em grande aumento obervam&#8208;se granulomas d&#233;rmicos compostos por c&#233;lulas epiteloides e c&#233;lulas gigantes multinucleadas&#46; An&#225;lise imuno&#8208;histoqu&#237;mica revelou positividade para CD68 &#40;C&#41; e CD163 &#40;D&#41;&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Autor e ano de publica&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Doen&#231;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Idade em anos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">G&#234;nero&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Localiza&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \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">Tratamento&nbsp;\t\t\t\t\t\t\n
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                  \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">Dura&#231;&#227;o do tratamento&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Wataeda et al&#46; &#40;1990&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">LMDF infantil&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Feminino&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Face&#44; grandes l&#225;bios&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Minociclina oral&#44; medicamento anti&#8208;inflamat&#243;rio n&#227;o esteroide 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">3&#44;5 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
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                  \t\t\t\t">Andry et al&#46; &#40;1995&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">DPGI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Desconhecida&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">Feminino&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">Face&#44; perivulvar&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">Desconhecido&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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                  \t\t\t\t">Desconhecido&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
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                  \t\t\t\t">Amy et al&#46; &#40;2002&#41;&nbsp;\t\t\t\t\t\t\n
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                  \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">DPGI&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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                  \t\t\t\t">6&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">Feminino&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">Face&#44; grandes l&#225;bios&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">Eritromicina oral e t&#243;pica&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">2 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">Amy et al&#46; &#40;2002&#41;&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">DPGI&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">8&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">Feminino&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">Face&#44; bra&#231;os&#44; abdome&#44; grandes l&#225;bios&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">Eritromicina oral&#44; metronidazol 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">Desconhecido&nbsp;\t\t\t\t\t\t\n
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Informação do artigo
ISSN: 26662752
Idioma original: Português
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