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Almazán-Fernández, A. Clemente-Ruiz de Almirón, A. Sanz-Trelles, J.C. Ruiz-Carrascosa, R. Naranjo-Sintes" "autores" => array:5 [ 0 => array:4 [ "nombre" => "F.M." "apellidos" => "Almazán-Fernández" "email" => array:1 [ 0 => "almazanweb@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Clemente-Ruiz de Almirón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Sanz-Trelles" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "J.C." "apellidos" => "Ruiz-Carrascosa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "R." "apellidos" => "Naranjo-Sintes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Clínico San Cecilio, Granada, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Carlos Haya, Málaga, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Elastorrexis papulosa. Presentación de un caso y claves para el diagnóstico diferencial" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 718 "Ancho" => 950 "Tamanyo" => 58555 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Multiple whitish papules in a V-shaped area on the upper chest.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Elastic tissue disorders include a heterogeneous group of diseases characterized by a reduction of elastic fibers in the dermis. These rare conditions occasionally have overlapping clinical and histological findings that make diagnosis a challenge for dermatologists and dermatopathologists. We report a case of one of these entities, papular elastorrhexis, and discuss the clinical and histologic differential diagnosis with other disorders characterized by alterations of the elastic tissue.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was a 21-year-old woman, with no relevant medical history, who consulted for the progressive appearance since adolescence of multiple asymptomatic, raised whitish lesions on the upper chest, shoulders, and upper back. She reported no acne on these sites or on the face. Physical examination revealed multiple, slightly raised nonfollicular papules that were whitish in color and measured 1 to 4<span class="elsevierStyleHsp" style=""></span>mm in diameter (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). On histology, orcein stain showed a marked reduction, thinning, and fragmentation of the elastic fibers in the dermis (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The remaining laboratory tests and imaging studies were normal. No similar lesions were detected in other members of the patient's family. A diagnosis of papular elastorrhexis was made on the basis of the clinical and histopathological findings.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The first case of papular elastorrhexis was described by Bordas et al<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> in 1987 and was considered a variant of nevus anelasticus. Although familial cases have been reported,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> the condition is usually acquired after adolescence and the second decade of life, and is more common in women. It presents clinically as multiple nonfollicular, nonconfluent whitish papules, measuring 5<span class="elsevierStyleHsp" style=""></span>mm or less, distributed mainly over the upper part of the trunk (shoulders and proximal upper arms). However, recent reports have described more atypical sites on the head and neck.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Most cases are isolated, with no concomitant disease.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Histologically, there is a reduction and fragmentation of elastic fibers, mainly in the upper dermis.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The clinical characteristics of papular elastorrhexis resemble incomplete forms of the Buschke-Ollendorff syndrome, in which nonconfluent skin lesions called dermatofibrosis lenticularis disseminata appear. The histology of Buschke-Ollendorff syndrome, however, is usually different, as there is an increase in the number of elastic fibers rather than a decrease.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Even so, some authors argue that papular elastorrhexis is one of these incomplete forms with no bone involvement (osteopoikilosis) or other findings. For this reason, dermatofibrosis lenticularis disseminata, together with nevus anelasticus, is the main differential diagnosis of papular elastorrhexis. Nevus anelasticus is characterized by multiple reddish perifollicular papules that appear asymmetrically on the trunk and arms and may become confluent, forming plaques.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> As occurs in papular elastorrhexis, the main histologic finding is a reduction and degeneration of elastic fibers. However, some authors state that there is a greater loss of fibers than in papular elastorrhexis but with less fragmentation.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The differential diagnoses that must be borne in mind, and their clinical and pathological signs, include the following<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7–9</span></a>:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0030" class="elsevierStylePara elsevierViewall">Eruptive collagenoma. This presents as multiple whitish papules measuring 2 to 5<span class="elsevierStyleHsp" style=""></span>mm that appear on the trunk during adolescence. There is a reduction of elastic fibers and homogenization and thickening of collagen.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0035" class="elsevierStylePara elsevierViewall">Perifollicular elastolysis. This occurs in elderly women, with the appearance of whitish-gray perifollicular papules measuring 1 to 4<span class="elsevierStyleHsp" style=""></span>mm in diameter on the neck, ear lobes, arms, and trunk. The etiology appears to be due to the epidermolytic toxin of <span class="elsevierStyleItalic">Staphylococcus epidermidis</span>.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0040" class="elsevierStylePara elsevierViewall">Papular scarring of acne. In this condition, hypopigmented follicular papules develop on the upper trunk in patients with a history of acne. There is a loss of elastic fibers around the follicles.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0045" class="elsevierStylePara elsevierViewall">Secondary anetoderma. This is formed of atrophic plaques or macules measuring 5 to 25<span class="elsevierStyleHsp" style=""></span>mm in diameter, with fine wrinkles and baglike herniation of the underlying tissue. There is a loss of elastic fibers, and elastorrhexis may occasionally affect the entire dermis.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5.</span><p id="par0050" class="elsevierStylePara elsevierViewall">Mid dermal elastolysis. This disorder, most common in women aged 30 to 50 years, presents as erythematous plaques, telangiectasias, and perifollicular papules on the neck and trunk. The lesions resolve leaving an asymptomatic area with fine wrinkles. There is a bandlike loss of elastic fibers in the mid dermis.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6.</span><p id="par0055" class="elsevierStylePara elsevierViewall">Pseudoxanthoma elasticum. Yellow macules and papules coalesce to form plaques, giving rise to a characteristic cobblestone pattern, associated with flaccidity and laxity. There is fragmentation of thickened elastic fibers and basophils with calcium deposits.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7.</span><p id="par0060" class="elsevierStylePara elsevierViewall">Fibroelastolytic papulosis of the neck. A condition that is related to photoaging and that appears in the elderly. Clinical features are similar to pseudoxanthoma elasticum with phenomena of elastolysis, disappearance of elastic fibers, and increased collagen fibers, with reduced melanin content in the epidermis.</p></li></ul></p><p id="par0065" class="elsevierStylePara elsevierViewall">Several of these disorders have been reported recently and are relatively unknown due to the limited number of cases published. Moreover, almost all share similar nonspecific clinical and histological features. A series of data such as age, sex, clinical presentation (nonfollicular papules, no previous history of acne, nonconfluent lesions), and the histology are key to the diagnosis of papular elastorrhexis. The case we report reflects the difficulty of diagnosing this group of diseases, and our aim has been to provide a series of fundamental data to help differentiate each entity, thereby aiding diagnosis.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Almazán-Fernández FM, et al. Elastorrexis papulosa. Presentación de un caso y claves para el diagnóstico diferencial. Actas Dermosifiliogr. 2011;102:549-50.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 718 "Ancho" => 950 "Tamanyo" => 58555 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Multiple whitish papules in a V-shaped area on the upper chest.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 714 "Ancho" => 950 "Tamanyo" => 58339 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Nonconfluent whitish papules on the shoulders.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 710 "Ancho" => 950 "Tamanyo" => 133832 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Marked reduction, thinning, and fragmentation of the elastic fibers in the upper dermis (orcein stain).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Papular elastorrexis: A variety of nevus anelasticus?" 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Year/Month | Html | Total | |
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2024 October | 158 | 73 | 231 |
2024 September | 152 | 36 | 188 |
2024 August | 217 | 58 | 275 |
2024 July | 161 | 51 | 212 |
2024 June | 184 | 62 | 246 |
2024 May | 140 | 55 | 195 |
2024 April | 136 | 44 | 180 |
2024 March | 146 | 46 | 192 |
2024 February | 155 | 51 | 206 |
2024 January | 97 | 54 | 151 |
2023 December | 173 | 30 | 203 |
2023 November | 139 | 41 | 180 |
2023 October | 119 | 62 | 181 |
2023 September | 132 | 42 | 174 |
2023 August | 108 | 24 | 132 |
2023 July | 112 | 48 | 160 |
2023 June | 112 | 36 | 148 |
2023 May | 115 | 38 | 153 |
2023 April | 90 | 25 | 115 |
2023 March | 97 | 31 | 128 |
2023 February | 87 | 18 | 105 |
2023 January | 85 | 24 | 109 |
2022 December | 75 | 45 | 120 |
2022 November | 54 | 24 | 78 |
2022 October | 67 | 26 | 93 |
2022 September | 78 | 38 | 116 |
2022 August | 71 | 45 | 116 |
2022 July | 64 | 40 | 104 |
2022 June | 75 | 27 | 102 |
2022 May | 126 | 35 | 161 |
2022 April | 87 | 38 | 125 |
2022 March | 92 | 68 | 160 |
2022 February | 56 | 36 | 92 |
2022 January | 92 | 49 | 141 |
2021 December | 69 | 64 | 133 |
2021 November | 82 | 61 | 143 |
2021 October | 117 | 60 | 177 |
2021 September | 95 | 41 | 136 |
2021 August | 115 | 59 | 174 |
2021 July | 85 | 49 | 134 |
2021 June | 71 | 57 | 128 |
2021 May | 93 | 51 | 144 |
2021 April | 150 | 59 | 209 |
2021 March | 120 | 42 | 162 |
2021 February | 97 | 39 | 136 |
2021 January | 76 | 24 | 100 |
2020 December | 55 | 32 | 87 |
2020 November | 48 | 35 | 83 |
2020 October | 38 | 20 | 58 |
2020 September | 42 | 15 | 57 |
2020 August | 36 | 38 | 74 |
2020 July | 45 | 15 | 60 |
2020 June | 27 | 36 | 63 |
2020 May | 27 | 36 | 63 |
2020 April | 31 | 27 | 58 |
2020 March | 26 | 38 | 64 |
2020 February | 5 | 6 | 11 |
2020 January | 0 | 9 | 9 |
2019 December | 4 | 15 | 19 |
2019 November | 0 | 9 | 9 |
2019 October | 0 | 11 | 11 |
2019 September | 4 | 17 | 21 |
2019 August | 0 | 16 | 16 |
2019 July | 0 | 16 | 16 |
2019 June | 2 | 18 | 20 |
2019 May | 1 | 37 | 38 |
2019 April | 0 | 44 | 44 |
2019 March | 2 | 23 | 25 |
2019 February | 0 | 11 | 11 |
2019 January | 2 | 8 | 10 |
2018 December | 2 | 3 | 5 |
2018 November | 0 | 3 | 3 |
2018 October | 2 | 0 | 2 |
2018 September | 3 | 3 | 6 |
2018 August | 0 | 3 | 3 |
2018 July | 0 | 4 | 4 |
2018 June | 0 | 6 | 6 |
2018 May | 0 | 5 | 5 |
2018 April | 0 | 7 | 7 |
2018 March | 0 | 9 | 9 |
2018 February | 60 | 7 | 67 |
2018 January | 93 | 26 | 119 |
2017 December | 83 | 11 | 94 |
2017 November | 83 | 13 | 96 |
2017 October | 41 | 21 | 62 |
2017 September | 99 | 25 | 124 |
2017 August | 102 | 22 | 124 |
2017 July | 88 | 21 | 109 |
2017 June | 97 | 25 | 122 |
2017 May | 88 | 22 | 110 |
2017 April | 93 | 23 | 116 |
2017 March | 71 | 40 | 111 |
2017 February | 73 | 10 | 83 |
2017 January | 55 | 19 | 74 |
2016 December | 70 | 16 | 86 |
2016 November | 85 | 17 | 102 |
2016 October | 150 | 31 | 181 |
2016 September | 201 | 32 | 233 |
2016 August | 147 | 29 | 176 |
2016 July | 67 | 17 | 84 |
2016 June | 10 | 16 | 26 |
2016 May | 10 | 8 | 18 |
2016 April | 6 | 2 | 8 |
2016 March | 5 | 1 | 6 |
2016 February | 8 | 21 | 29 |
2016 January | 10 | 14 | 24 |
2015 December | 4 | 3 | 7 |
2015 November | 9 | 1 | 10 |
2015 October | 10 | 4 | 14 |
2015 September | 6 | 9 | 15 |
2015 August | 8 | 5 | 13 |
2015 July | 126 | 18 | 144 |
2015 June | 65 | 18 | 83 |
2015 May | 120 | 24 | 144 |
2015 April | 120 | 21 | 141 |
2015 March | 82 | 10 | 92 |
2015 February | 78 | 9 | 87 |
2015 January | 74 | 19 | 93 |
2014 December | 81 | 25 | 106 |
2014 November | 57 | 18 | 75 |
2014 October | 84 | 25 | 109 |
2014 September | 67 | 17 | 84 |
2014 August | 76 | 12 | 88 |
2014 July | 93 | 23 | 116 |
2014 June | 82 | 9 | 91 |
2014 May | 74 | 16 | 90 |
2014 April | 53 | 11 | 64 |
2014 March | 73 | 23 | 96 |
2014 February | 48 | 23 | 71 |
2014 January | 49 | 22 | 71 |
2013 December | 70 | 19 | 89 |
2013 November | 44 | 25 | 69 |
2013 October | 52 | 23 | 75 |
2013 September | 53 | 16 | 69 |
2013 August | 10 | 18 | 28 |
2013 July | 7 | 21 | 28 |
2013 June | 10 | 28 | 38 |
2013 May | 11 | 13 | 24 |
2013 April | 9 | 16 | 25 |
2013 March | 10 | 6 | 16 |
2013 February | 18 | 9 | 27 |
2013 January | 19 | 8 | 27 |
2012 December | 16 | 5 | 21 |
2012 November | 0 | 2 | 2 |
2012 October | 2 | 2 | 4 |
2012 September | 3 | 1 | 4 |