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array:22 [ "pii" => "S0213925121002379" "issn" => "02139251" "doi" => "10.1016/j.piel.2021.05.020" "estado" => "S300" "fechaPublicacion" => "2022-06-01" "aid" => "2324" "copyright" => "Elsevier España, S.L.U.. Todos los derechos reservados" "copyrightAnyo" => "2021" "documento" => "article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Piel. 2022;37:386-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemAnterior" => array:18 [ "pii" => "S0213925121001532" "issn" => "02139251" "doi" => "10.1016/j.piel.2021.05.001" "estado" => "S300" "fechaPublicacion" => "2022-06-01" "aid" => "2265" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Piel. 2022;37:384-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta clínica</span>" "titulo" => "Exacerbación de psoriasis secundaria a infección por SARS-CoV-2" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "384" "paginaFinal" => "386" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Worsening of psoriasis secondary to SARS-CoV-2 infection" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "f0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 546 "Ancho" => 951 "Tamanyo" => 69735 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "al0005" "detalle" => "Figura " "rol" => "short" ] ] "descripcion" => array:1 [ "es" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Paciente 1. Psoriasis en placas grave (PASI 19) y extenso compromiso de la superficie corporal (BSA 15%).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Fabio Ernesto González González, Natalia Muñoz Angulo, Carolina Ivette Cortés Correa, Elkin Omar Peñaranda Contreras" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Fabio Ernesto" "apellidos" => "González González" ] 1 => array:2 [ "nombre" => "Natalia" "apellidos" => "Muñoz Angulo" ] 2 => array:2 [ "nombre" => "Carolina Ivette" "apellidos" => "Cortés Correa" ] 3 => array:2 [ "nombre" => "Elkin Omar" "apellidos" => "Peñaranda Contreras" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213925121001532?idApp=UINPBA00004N" "url" => "/02139251/0000003700000006/v1_202205280550/S0213925121001532/v1_202205280550/es/main.assets" ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta clínica</span>" "titulo" => "Adult-onset multiple eccrine angiomatous hamartoma" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "386" "paginaFinal" => "388" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Andrea Rodríguez-Tejero, David López-Delgado, María Narváez-Simón, Salvador Arias-Santiago" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Andrea" "apellidos" => "Rodríguez-Tejero" "email" => array:1 [ 0 => "andrea.13.3217@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "af0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cr0005" ] ] ] 1 => array:3 [ "nombre" => "David" "apellidos" => "López-Delgado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "af0005" ] ] ] 2 => array:3 [ "nombre" => "María" "apellidos" => "Narváez-Simón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "af0010" ] ] ] 3 => array:3 [ "nombre" => "Salvador" "apellidos" => "Arias-Santiago" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "af0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Hospital Universitario Virgen de las Nieves, Servicio de Dermatología y Venereología, Granada, Spain" "etiqueta" => "a" "identificador" => "af0005" ] 1 => array:3 [ "entidad" => "Hospital Universitario San Cecilio, Servicio de Anatomía Patológica, Granada, Spain" "etiqueta" => "b" "identificador" => "af0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cr0005" "etiqueta" => "⁎" "correspondencia" => "Autor de correspondencia." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hamartoma angiomatoso ecrino múltiple con inicio en edad adulta" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "f0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1098 "Ancho" => 1660 "Tamanyo" => 521810 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "al0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "es" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Histopathology from one nodule. A. Panoramic vision. Note the lobular architecture of the lesion, with proliferation of eccrine glands and hamartomatous vascular structures, in a stroma with abundant mucin. B. Eccrine component composed of mature eccrine structures (secret and excretory portions) closely associated with numerous small-calibre vessels and mucin deposition (<span class="elsevierStyleItalic">haematoxylin–eosin, original magnification × 10</span>) C. Vascular component consisting of thin-walled blood vessels, with dilated lumens and peripheral moderate lymphocytic infiltrate (<span class="elsevierStyleItalic">haematoxylin–eosin, original magnification × 10</span>).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="p0005" class="elsevierStylePara elsevierViewall">Editor(s):</p><p id="p0010" class="elsevierStylePara elsevierViewall">Eccrine angiomatous hamartoma (EAH) is an uncommon benign cutaneous malformation characterised by the proliferation of hamartomatous eccrine and vascular structures in the dermis. EAH typically manifests as a solitary slowly-growing, angiomatous-appearing nodule or plaque, on the distal extremities of children (often newborns), and may be associated with pain, focal hyperhidrosis and/or hypertrichosis. Adult-onset lesions are very rare<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a>.</p><p id="p0015" class="elsevierStylePara elsevierViewall">We present the case of a 24-year-old man with a bruise-like lesion on the back of the left ankle. It appeared four years ago, as a small, asymptomatic nodule. Gradually, new similar nodular lesions appeared on the same area which slowly increased in size. The patient reported no previous trauma or infection in the area. Our examination revealed several bluish-brown nodules, pulseless and painless on palpation, with notorious hyperhidrosis. The nodules were separated by unharmed skin on distal left calf area (<a class="elsevierStyleCrossRef" href="#f0005">Fig. 1</a>). Histopathological examination of a punch biopsy showed orthokeratotic hyperkeratosis and papillomatous epidermal hyperplasia. In the reticular dermis, there was proliferation of eccrine glands, intimately admixed with numerous small vessels and mucin deposition. Additionally, larger hamartomatous vascular structures with thin walls and moderate peripheral lymphocytic infiltrate in the mid-dermis, were noted (<a class="elsevierStyleCrossRef" href="#f0010">Fig. 2</a>). The diagnóstico of EAH was established and the patient deferred excision due to lack of significant symptoms.</p><elsevierMultimedia ident="f0005"></elsevierMultimedia><elsevierMultimedia ident="f0010"></elsevierMultimedia><p id="p0020" class="elsevierStylePara elsevierViewall">Clinical presentation of EAH can be variable. It typically presents during childhood, as patches, plaques, or nodules ranging in size from 3 mm to 15 cm in diameter and occurring in various shades of bluish-brown, violaceous, red or flesh coloured<a class="elsevierStyleCrossRefs" href="#bb0005"><span class="elsevierStyleSup">1,2</span></a>.</p><p id="p0025" class="elsevierStylePara elsevierViewall">The largest reported case series including 37 patients, 50% of lesions were congenital, with an age of onset ranging from 2 months to 73 years. Median age was 10 years, which highlights its usual paediatric onset<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a>. A recent study including 18 cases identified a higher frequency of adult EAH<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">2</span></a>. The majority of lesions occurred on the extremities, while 20% and 10% appeared on the head/neck and trunk, respectively<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">2</span></a>.</p><p id="p0030" class="elsevierStylePara elsevierViewall">The differential diagnóstico for EAH includes different vascular, neoplastic, and other hamartomatous conditions, and distinction can be difficult even on biopsy. Histological identification of both proliferation of eccrine glands and closely associated hamartomatous vascular structures must be present<a class="elsevierStyleCrossRefs" href="#bb0010"><span class="elsevierStyleSup">2,3</span></a>.</p><p id="p0035" class="elsevierStylePara elsevierViewall">Several variants of EAH have also been reported to contain elements of lipomatous, mucinous, pilar and lymphatic structures<a class="elsevierStyleCrossRef" href="#bb0020"><span class="elsevierStyleSup">4</span></a>. The epidermis is generally unaffected, but it has been reported to show hyperkeratosis, papillomatosis, or hyperplasia.</p><p id="p0040" class="elsevierStylePara elsevierViewall">The firs-line treatment for EAH is surgical excision (curative), and can be indicated in the presence of pain, significant hyperhidrosis or progressive growth. Clinical follow-up is reasonable for asymptomatic lesions<a class="elsevierStyleCrossRefs" href="#bb0005"><span class="elsevierStyleSup">1–4</span></a>. Malignant transformation has not been reported.</p><p id="p0045" class="elsevierStylePara elsevierViewall">To date, only about 20 cases of adult-onset EAH have been described. The presented case is relevant for two main reasons: the age of onset and presence of multiples lesions. Although initially thought to occur as an angiomatous-appearing malformation with solitary presentation on the extremities of children, EAH may develop in adults, and may manifest in a multifocal lineal distribution<a class="elsevierStyleCrossRefs" href="#bb0010"><span class="elsevierStyleSup">2,5</span></a>.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "f0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1979 "Ancho" => 1486 "Tamanyo" => 429646 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "al0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "es" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Multiple bluish nodules on the left ankle. Focal hyperhidrosis.</p>" ] ] 1 => array:8 [ "identificador" => "f0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1098 "Ancho" => 1660 "Tamanyo" => 521810 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "al0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "es" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Histopathology from one nodule. A. Panoramic vision. Note the lobular architecture of the lesion, with proliferation of eccrine glands and hamartomatous vascular structures, in a stroma with abundant mucin. B. Eccrine component composed of mature eccrine structures (secret and excretory portions) closely associated with numerous small-calibre vessels and mucin deposition (<span class="elsevierStyleItalic">haematoxylin–eosin, original magnification × 10</span>) C. Vascular component consisting of thin-walled blood vessels, with dilated lumens and peripheral moderate lymphocytic infiltrate (<span class="elsevierStyleItalic">haematoxylin–eosin, original magnification × 10</span>).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bb0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eccrine angiomatous hamartoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.T. Pelle" 1 => "H.B. Pride" 2 => "W.B. 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Dyduch" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Dermatol" "fecha" => "2012" "volumen" => "51" "numero" => "7" "paginaInicial" => "840" "paginaFinal" => "841" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bb0025" "etiqueta" => "5." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eccrine angiomatous hamartoma: Multiple, symmetrical swellings on forearms of a 10-year-old girl" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Verma" 1 => "B.K. Thakur" 2 => "J. Mishra" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2015" "volumen" => "29" "numero" => "9" "paginaInicial" => "1847" "paginaFinal" => "1848" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "es" "url" => "/02139251/0000003700000006/v1_202205280550/S0213925121002379/v1_202205280550/es/main.assets" "Apartado" => array:4 [ "identificador" => "8183" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Cartas clínicas" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/02139251/0000003700000006/v1_202205280550/S0213925121002379/v1_202205280550/es/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213925121002379?idApp=UINPBA00004N" ]
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