10.5826/dpc.1301a34
text/xml
2160-9381
2518
en
Renan Rangel Bonamigo
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
comedones
Dermoscopic features of an Actinic Comedonal Plaque – a Rare Ectopic Form of Favre-Racouchot Syndrome
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2023-01-31
2022-04-06
2023-01-31
2023-02-27
e2023034
Dermatol Pract Concept
Renan Rangel Bonamigo
2023/01/31
10.5826/dpc.1301a34
e2023034
Department of Dermatology, Hospital de Clínicas de Porto Alegre, Brazil
2160-9381
comedones
en
e2023034
Cardoso F, Nakandakari S, Zattar GA, Soares CT. Actinic comedonal plaque-variant of Favre-Racouchot syndrome: report of two cases. An Bras Dermatol. 2015;90(3 Supl 1):S185-S187. DOI: 10.1590/abd1806-4841.20153543. PMID: 26312711. PMCID: PMC4540545.
Dermoscopic features of an Actinic Comedonal Plaque – a Rare Ectopic Form of Favre-Racouchot Syndrome
https://dpcj.org/index.php/dpc/article/download/2518/1974
             Dermoscopic Features of an Actinic
          Comedonal Plaque – a Rare Ectopic Form of
                Favre-Racouchot Syndrome
        Philippe Visintainer Melo1, Bruna Ossanai Schoenardie1, Gabriela Fortes Escobar1,
                                     Renan Rangel Bonamigo1


1 Department of Dermatology, Hospital de Clínicas de Porto Alegre, Brazil



Key words: Favre-Racouchot, actinic comedonal plaque, dermoscopy, cribriform, chrysalides, comedones
Citation: Visintainer Melo P, Ossanai Schoenardie B, Fortes Escobar G, Ranger Bonamigo R. Dermoscopic features of an actinic comedonal
plaque – a rare ectopic form of Favre-Racouchot syndrome. Dermatol Pract Concept. 2023;13(1):e2023034. DOI: https://doi.org/10.5826/
dpc.1301a34
Accepted: June 7, 2022; Published: January 2023
Copyright: ©2023 Visintainer Melo et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Philippe Visintainer Melo, Ramiro Barcelos street, number 2350, 1st floor, Dermatology Department – Porto
Alegre (city), Rio Grande do Sul (state), Brazil - Postal code 90035-903. Email: phvisintainer@gmail.com




Introduction                                                             a central atrophic area, with comedones and small cysts
                                                                         (Figure 1A). The second lesion, on the right forearm, con-
Cumulative solar exposure has been studied for years. In                 sisted in an area of few grouped erythematous papules, with
1951, nodular cutaneous elastosis with cysts and comedo-                 comedones (Figure 1B). Dermoscopy (DermLite Cam®,
nes on sun damaged skin was described as Favre-Racouchot                 magnification 10×, polarized capture with immersion fluid)
syndrome [1]. It usually manifests as symmetrical lesions on             showed an erythematous background, scar-like depigmen-
the periorbital or temporal areas and mostly affects older               tation areas, chrysalides and fine linear irregular vessels.
men [2]. The ectopic form of this syndrome, called actinic               In the central area, small islands of normal skin could be
comedonal plaque, has rarely been reported and presents                  visualized, while at the periphery of the plaques there were
with lesions mainly on the upper extremities. However, there             milia cysts and comedones on (Figure 2, A and B). Possible
is a lack of dermoscopic descriptions of this entity.                    dermoscopic differential diagnosis included colloid milium,
                                                                         milia, syringoma, discoid lupus and trichoepithelioma. His-
Case Presentation                                                        topathology revealed accentuated infundibular dilatation
                                                                         with follicular plugging (seen clinically and dermoscopi-
A 59-year-old female smoker, phototype IV, presented with                cally as milia cysts and comedones) and circumjacent fibro-
two plaques on her arms that had been growing for the last               sis with loss of elastic fibers (Figure 3), which corresponded
two years. The first lesion, on the lateral aspect of the left           to areas of the scar-like depigmentation and chrysalides
arm, was an erythematous cribriform plaque, surrounding                  on dermoscopy. Based on the clinical and histopathologic



Research Letter | Dermatol Pract Concept. 2023;13(1):e2023034                                                                              1
Figure 1. Clinical findings of actinic comedonal plaque. (A) Erythematous cicatricial cribriform plaque, with comedones and small cysts on
the left arm. (B) Grouped erythematous papules with comedones on the right forearm.




Figure 2. Dermoscopic findings of actinic comedonal plaque. (A,B) Clinical cribriform borders (asterisk) surrounding a dermoscopic ery-
thematous background, scar-like depigmentation areas (plus sign), chrysalides (black arrow) and fine linear irregular vessels (black circle). In
the central area, small islands of normal skin can be visualized (blue circle), as well as milia cysts (blue arrow) and comedones (red arrow)
on the periphery of the plaques.


findings, the diagnosis of ­actinic comedonal plaque was                  of age [3]. The pathogenesis is uncertain, but excessive chronic
established.                                                              UV exposure, cigarette smoking and radiation therapy seem
    The    actinic   comedonal      plaque     is   a   variant    of     to be risk factors [4]. The disease can be associated with ac-
­Favre-Racouchot syndrome, which can be found on sun dam-                 tinic keratosis, cutis rhomboidalis nuchae and even squamous
aged skin, such as the forearms. It was first described by East-          cell carcinoma [5]. Histology reveals marked solar elastosis,
ern et al in 1980 in five fair-skinned men older than 50 years            epidermal and sebaceous gland atrophy, and enlarged dilated


2                                                                             Research Letter | Dermatol Pract Concept. 2023;13(1):e2023034
        Figure 3. Histopathology showing infundibular dilatation surrounded by fibrosis and elastosis (H&E, x40).



pilosebaceous infundibulum with regularly stratified epithe-         References
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actinic comedonal plaque. We observed a clinical cribriform
                                                                      5. Cardoso F, Nakandakari S, Zattar GA, Soares CT. Actinic com-
border, along with a dermoscopic central area with an ery-
                                                                         edonal plaque-variant of Favre-Racouchot syndrome: report of
thematous background, chrysalides and fine linear irregular              two cases. An Bras Dermatol. 2015;90(3 Supl 1):S185-S187.
vessels. In addition, milia cysts and comedones were also vi-            DOI: 10.1590/abd1806-4841.20153543. PMID: 26312711.
sualized. Therefore, dermoscopy may be an additional tool                PMCID: PMC4540545.
for the assessment of this condition, improving the ability to
identify structures in order to establish the correct diagnosis.




Research Letter | Dermatol Pract Concept. 2023;13(1):e2023034                                                                        3
